Complete heart block treatment
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Complete Heart Block Treatment
Overview of Complete Heart Block
Complete heart block (CHB), also known as third-degree atrioventricular (AV) block, is a severe cardiac condition where the electrical signals between the atria and ventricles are completely interrupted. This condition can arise from various etiologies, including coronary artery disease, myocardial infarction, hypertensive heart disease, and congenital heart defects .
Pacemaker Therapy for Complete Heart Block
Permanent Pacemaker Implantation
The primary treatment for CHB is the implantation of a permanent pacemaker (PPM). Studies have shown that patients with CHB who receive a PPM have significantly improved survival rates compared to those managed with medical therapy alone. For instance, a review of cases at the University of California Medical Center indicated that patients with implanted pacemakers had markedly better outcomes, with only one death among fourteen patients compared to an average survival time of nineteen months for those without pacemakers. Additionally, patients who develop CHB after nonsurgical septal reduction therapy (NSRT) for hypertrophic obstructive cardiomyopathy also benefit from PPM placement, showing similar improvements in clinical and hemodynamic parameters as those who did not require pacing.
Indications for Pacemaker Use
Pacemaker implantation is particularly recommended in cases of CHB associated with Stokes-Adams attacks, persistent bradycardia with reduced cardiac output, and repeated ventricular tachycardia during medication. Prophylactic pacemaker implantation is also advised for patients with anterior wall infarction and a widened QRS complex, as these patients are at higher risk of developing CHB.
Drug Therapy for Complete Heart Block
Sympathomimetics and Other Medications
Drug therapy can be used to manage CHB, especially in acute settings or when pacemaker implantation is not immediately available. Medications such as atropine, isoprenaline, and corticosteroids have been employed to increase the ventricular rate and improve cardiac function . In cases of CHB associated with acute myocardial infarction (AMI), these drugs can help achieve sinus rhythm and stabilize the patient, although pacemaker therapy may still be necessary in severe cases.
Fetal Heart Block Management
In fetal cases of CHB, sympathomimetic agents like salbutamol have shown promise. Studies have demonstrated that salbutamol can increase fetal heart rate and improve ventricular function, potentially preventing intrauterine cardiac failure and improving outcomes at birth. Additionally, transplacental glucocorticoid therapy with dexamethasone has been effective in some cases, reducing the degree of heart block and resolving hydrops in fetuses with maternal autoantibodies.
Emerging Therapies
Myocyte Transplantation
An innovative approach under investigation is the transplantation of right atrial myocytes into the ventricular wall. This method aims to establish a new pacemaker within the heart, potentially offering a biological alternative to electronic pacemakers. While the concept is promising, further research is needed to address critical biological questions before it can be widely adopted.
Conclusion
Complete heart block is a serious condition that requires prompt and effective treatment. The mainstay of therapy is the implantation of a permanent pacemaker, which significantly improves survival and quality of life. Drug therapy can provide temporary relief and is particularly useful in acute settings or specific patient populations, such as fetuses. Emerging therapies like myocyte transplantation hold potential for the future but require further investigation. Overall, a combination of established and innovative treatments offers hope for better management of CHB.
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