Atrioventricular block pacemaker implantation

Atrioventricular block in general is treated by implantation of an electrical pacemaker. A pharmacological alternative (although no longer used today) was atropine. However, atropine can be used for bridging the time between the onset of symptoms and the definitive implantation of a pacemaker. 

A decision to refer for permanent pacemaker implantation for loss of atrioventricular synchrony due to first degree AV nodal block is challenging. In the setting of normal conduction in the ventricles, the improvement that may be gained by improving atrioventricular synchrony must be weighed against... 

An 86-year-old Japanese man received a pacemaker for atrioventricular block, and 2 months later developed a scaly erythema over the implantation site and later widespread nummular eczema. Histologically, the lesions showed slight spongiosis, intracellular edema, moderate acanthosis in the epidermis, and perivascular infiltration with thickened capillary walls in the dermis. The pacemaker contained titanium and a variety of other metals, but patch tests were all negative. However, titanium sensitivity was demonstrated by intracutaneous and lymphocyte stimulation tests. 

It is unclear whether topiramate played any role in rare cardiovascular events. These included symptoms of Raynaud s phenomenon in three patients, and third-degree atrioventricular block requiring emergency cardiac pacemaker implantation in one patient with preexisting right bundle branch block (SEDA-21, 76). 

Fig. 10.12 (A) Same patient as Fig. 10.11. Pulmonary capillary wedge pressure shows large cannon waves. Scale 0-40mmHg. (B) Same patient after testing with a temporary dual chamber pacemaker with a physiologic AV delay. Note the normal pulmonary capillary wedge pressure. The patient was markedly improved after the implantation of a dual chamber pacemaker with AV delay optimization. (Barold SS. Acquired Atrioventricular Block. In Kusumoto F, Goldschlager N (Eds), Cardiac Pacing for the Clinician, Philadelphia, PA Lippincott, Williams Wilkins, 2001 with permission).

Barold SS. American College of Cardiology/American Heart Association guidelines for pacemaker implantation after acute myocardial infarction. What is persistent advanced block at the atrioventricular node Am J Cardiol 1997 80 770-774. 

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