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Exercise-induced Atrioventricular Block Progressing to Complete Atrioventricular Block 4 Years after the Initial
Tomo Komaki1,2,3, Yusuke Ajimu1,2, Toyonori Arinaga1,2
1The Cardiac Arrhythmia Center and EP Laboratory, Fukuoka University Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|May 17, 2026
Summary
Exercise-induced atrioventricular (AV) block can progress to complete heart block over time. This case demonstrates that what initially appears benign may require long-term pacemaker support due to deteriorating AV conduction.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Exercise-induced atrioventricular (AV) block is a rare condition that can cause symptoms like dyspnea during physical activity.
- The natural history and long-term implications of exercise-induced AV block are not well-established.
Purpose of the Study:
- To report a case of exercise-induced atrioventricular (AV) block.
- To highlight the potential for progression of AV conduction abnormalities over time.
- To emphasize the importance of long-term monitoring in patients diagnosed with exercise-induced AV block.
Main Methods:
- A 66-year-old male patient presented with exertional dyspnea.
- Diagnostic workup included a normal resting electrocardiogram and an exercise treadmill test.
- The patient was treated with a dual-chamber pacemaker following diagnosis of exercise-induced AV block.
Main Results:
- The treadmill test revealed a 2:1 atrioventricular (AV) block at a heart rate of 142 beats per minute.
- Initially, ventricular pacing was primarily required during exercise.
- Four years post-implantation, the patient developed dependence on ventricular pacing at rest, indicating progression to complete AV block.
Conclusions:
- Exercise-induced atrioventricular (AV) block may not be a benign condition.
- There is a potential for deterioration of AV conduction over time, leading to complete heart block.
- Patients with exercise-induced AV block require careful long-term follow-up and monitoring.
Keywords:
His-Purkinje systemcomplete atrioventricular blockexercise-induced atrioventricular blockpacemaker implantationtreadmill testMore Related Videos
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