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Ventriculo-atrial gradient due to first degree atrio-ventricular block: a case report
Giuseppe Ando'1, Francesco Versaci
1Department of Cardiac Surgery, Tor Vergata University of Rome, Italy. giuseppe.ando@tiscali.it
BMC Cardiovascular Disorders
|August 11, 2005
Summary
A marked first-degree AV block can cause heart failure symptoms by disrupting atrioventricular synchrony. Pacemaker implantation can restore synchrony and improve patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- First-degree AV block typically lacks prognostic significance in asymptomatic patients.
- However, marked PR interval prolongation can impair atrioventricular synchrony, leading to hemodynamic compromise and heart failure symptoms, especially with reduced ventricular compliance.
Observation:
- A 72-year-old woman with a marked first-degree AV block, moderate aortic stenosis, and NYHA class III heart failure presented with hemodynamic alterations.
- Trans-septal catheterization revealed an end-diastolic ventriculo-atrial gradient, ruling out mitral stenosis as the cause.
Findings:
- Permanent pacemaker implantation with physiological AV delay resulted in significant improvement in echocardiographic parameters.
- The patient experienced substantial relief from heart failure symptoms post-pacemaker implantation.
Implications:
- Dual-chamber pacing to restore optimal atrioventricular synchrony is a viable therapeutic strategy.
- This approach can lead to significant clinical improvement in patients with marked first-degree AV block and heart failure symptoms.