From the Guidelines
Mobitz type one heart block (Wenckebach) typically does not require treatment if the patient is asymptomatic, but for symptomatic patients, permanent pacing is reasonable if symptoms are clearly attributable to the atrioventricular block, as stated in the 2018 ACC/AHA/HRS guideline 1, 2, 3.
Key Considerations
- The 2018 ACC/AHA/HRS guideline recommends permanent pacing for symptomatic patients with marked first-degree or second-degree Mobitz type I (Wenckebach) atrioventricular block, with a Class IIa recommendation and Level of Evidence C-LD 1, 3.
- Asymptomatic patients can be monitored without intervention, as Mobitz type one heart block is generally benign and often transient.
- Underlying causes like myocardial ischemia or electrolyte abnormalities should be addressed, and medication side effects should be considered, with discontinuation of the offending drug if necessary.
Treatment Approach
- For symptomatic patients, permanent pacing is a reasonable treatment option, as it can help alleviate symptoms attributable to the atrioventricular block 1, 2, 3.
- Temporary cardiac pacing may be necessary if atropine is ineffective, and discontinuation of the offending drug is recommended if the heart block is caused by medication side effects.
- Regular follow-up with a cardiologist is important to monitor for progression to higher-degree heart blocks.
Guideline Recommendations
- The 2018 ACC/AHA/HRS guideline provides recommendations for permanent pacing in patients with bradycardia and cardiac conduction delay, including those with Mobitz type one heart block 1, 2, 4, 3.
- The guideline emphasizes the importance of shared decision-making and patient-centered care in treatment decisions, and recommends considering the patient's goals of care and preferences when determining the best course of treatment 4.
From the FDA Drug Label
Atropine also may lessen the degree of partial heart block when vagal activity is an etiologic factor The treatment for Mobitz type one heart block may be atropine as it can lessen the degree of partial heart block when vagal activity is an etiologic factor 5.
From the Research
Treatment for Mobitz Type One Heart Block
The treatment for Mobitz type one heart block is as follows:
- Atropine administration: A single dose of atropine 0.5 mg IV push has been used to treat Mobitz type one heart block, as seen in a case report where a patient's condition resolved after treatment 6
- Monitoring: Patients with Mobitz type one heart block should be closely monitored, with repeat electrocardiograms (EKGs) to assess the resolution of the condition, as done in the case report where a repeat EKG before discharge showed resolution of the Mobitz type 1 6 ### Important Considerations
- Identification of the underlying cause: It is essential to identify the underlying cause of Mobitz type one heart block, such as Tejocote root toxicity, to provide appropriate treatment and prevent further complications 6
- Clinical awareness: Healthcare professionals should be aware of the potential cardiovascular repercussions of herbal supplement usage, especially in regions where such supplements are prevalent 6