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Related Experiment Videos

[A complete atrioventricular block during exertion].

A Medeiros1, P Iturralde, F Millán

  • 1Instituto Nacional de Cardiología Ignacio Chávez, INCICH, México, D.F.

Archivos Del Instituto De Cardiologia De Mexico
|October 26, 1999
PubMed
Summary

Exercise-induced atrioventricular (AV) block, though rare in those with normal resting ECGs, can occur. This study highlights two cases, one likely due to conduction system issues and the other to ischemic heart disease.

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Exercise-induced atrioventricular (AV) block is uncommon in individuals with normal resting electrocardiograms (ECGs).
  • Understanding the underlying mechanisms is crucial for appropriate diagnosis and management.

Observation:

  • Two patients presented with AV block during treadmill testing: a 54-year-old woman with complete AV block and a 31-year-old man with third-degree AV block, angina, and ST depression.
  • The woman's condition was linked to distal AV block without ischemic heart disease, while the man's was associated with suspected ischemic heart disease.

Findings:

  • The first patient's AV block was likely due to abnormal refractoriness in the His-Purkinje system responding to autonomic changes during exercise.
  • The second patient's AV block was secondary to ischemic heart disease, resolving with anti-ischemic therapy and normal electrophysiologic studies on follow-up.

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Implications:

  • Third-degree AV block during exercise can occur even without pre-existing conduction system abnormalities.
  • Exercise-induced infra-Hisian AV block warrants pacing until ischemic heart disease is excluded.