Third-degree atrioventricular block in an adolescent following acute alcohol intoxication

Alcohol abuse is a major problem among adolescents, and has both acute, potentially lethal, and long-term harmful effects. The authors describe an adolescent who was in a subcomatose condition after binge drinking. His serum alcohol concentration was 3.7 g/l. The next morning, before transfer to the paediatric ward, he developed a third-degree atrioventricular (AV) block without cardiac output while his infusion needle was removed. This recovered spontaneously after a precordial thump. Retrospectively, electrocardiography showed an increasing PR prolongation (200-300 ms) before the removal of the infusion needle. ECG recordings several hours later showed a first-degree AV block, which was no longer seen during follow-up, 1 month later. The authors conclude that acute alcohol poisoning has the potential to prolong the PR interval in young, healthy adolescents without pre-existing first-degree AV block and provoke a third-degree AV block after vagal stimulation. It is yet another potential danger of acute alcohol intoxication in this age group.