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Exercise-induced second-degree atrioventricular block

Y Yuzuki1, M Horie, T Makita

  • 1Third Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.

Japanese Circulation Journal
|March 1, 1997
PubMed
Summary
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This report details two cases of exercise-induced second-degree atrioventricular (AV) block, highlighting varied presentations and diagnostic challenges in patients with exertional symptoms. The findings underscore the importance of electrophysiologic studies in diagnosing these rare conditions.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Atrioventricular (AV) block can manifest in various forms, with exercise-induced types posing diagnostic challenges.
  • Understanding the mechanisms of exercise-induced AV block is crucial for appropriate patient management.

Observation:

  • Two patients presented with exertional dyspnea and distinct forms of exercise-induced second-degree AV block.
  • Case 1: A 49-year-old male developed 2:1 AV block during treadmill testing, with electrophysiologic study suggesting rate-dependent intrahissian block.
  • Case 2: A 31-year-old female with a history of atrial septal defect repair experienced syncope and dyspnea, exhibiting type II second-degree AV block during exercise, unmasked by disopyramide provocation.

Findings:

  • Exercise can unmask or induce significant atrioventricular conduction abnormalities.

Related Experiment Videos

  • Electrophysiologic studies, including provocative maneuvers, are essential for characterizing exercise-induced AV block.
  • Rate-dependent and drug-induced AV block mechanisms were implicated in the presented cases.

    • Implications:

    • These cases expand the understanding of exercise-induced atrioventricular conduction disturbances.
    • Clinicians should consider exercise-induced AV block in patients with unexplained exertional symptoms and conduction abnormalities.
    • Further research into the pathophysiology and management of exercise-induced AV block is warranted.