Heart Block and Conduction Disturbances

Heart block and conduction disturbances appear to be relatively common in the general population. Because many individuals with conduction system disease are asymptomatic and never seek medical attention, our knowledge of the natural history of these disorders comes from large population-based studies. Because conduction system disease is a heterogeneous entity of diverse causes, treatment options may vary from individual to individual, depending on the specific cause and the clinical manifestations. Permanent pacing is the cornerstone of treatment for most patients with symptomatic conduction system disease. Recent technologic improvements in permanent pacing systems have made this option more attractive, although there are situations in which other therapeutic options may be considered. Specific therapy is not necessary in all patients with conduction system disease, especially those without symptoms. Of those requiring treatment, medication may be helpful in certain situations, but pacemakers remain the mainstay of therapy in most. Recent advances in the therapy of ischemic heart disease (eg, thrombolytic agents and reperfusion techniques) show some promise in arresting or even reversing some forms of conduction system disease, but these techniques require further study.