From the Guidelines
Ventricular blockages, or heart blocks, are primarily caused by damage to the heart's electrical conduction system, with common causes including coronary artery disease, heart attacks, aging-related degeneration, heart surgery complications, certain medications, and congenital heart defects, as outlined in the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay 1.
Causes of Ventricular Blockages
- Coronary artery disease
- Heart attacks that damage heart tissue
- Aging-related degeneration of the conduction system
- Heart surgery complications
- Certain medications (particularly beta-blockers and calcium channel blockers)
- Congenital heart defects
- Other causes such as infectious, inflammatory, and metabolic disorders
Treatment of Ventricular Blockages
- First-degree and some second-degree blocks may not require treatment beyond monitoring.
- For severe second-degree or third-degree blocks, a pacemaker is typically the definitive treatment, as recommended by the 2018 ACC/AHA/HRS guideline 1.
- In emergency situations before pacemaker placement, medications like atropine (0.5-1mg IV) or isoproterenol may temporarily increase heart rate.
- Underlying causes should also be addressed, such as discontinuing medications that slow conduction, treating electrolyte imbalances, or managing coronary artery disease.
- Regular cardiac follow-ups are essential for patients with any degree of heart block to monitor for progression and adjust treatment as needed.
Importance of Regular Follow-ups
Regular cardiac follow-ups are crucial to monitor the progression of heart block and adjust treatment as needed, as emphasized in the 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1.
Key Takeaways
- Ventricular blockages are caused by damage to the heart's electrical conduction system.
- Treatment depends on the severity of the blockage.
- A pacemaker is typically the definitive treatment for severe second-degree or third-degree blocks.
- Regular cardiac follow-ups are essential to monitor progression and adjust treatment as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Ventricular Blockages
- Ventricular blockages can be caused by various factors, including structural heart disease, coronary artery disease, and valvular heart disease 2, 3.
- Atherosclerosis is a major underlying cause of cardiovascular diseases, which can lead to ventricular blockages 4.
- Coronary artery disease can also cause ventricular blockages, and its severity can differ between men and women with severe aortic stenosis 5.
- Valvular heart disease can lead to atrial structural and functional remodeling, which can trigger atrial tachyarrhythmia and ventricular blockages 6.
Treatment of Ventricular Blockages
- Treatment strategies for ventricular blockages include less invasive valvular and safer complex coronary interventions, such as transcatheter aortic valve replacement (TAVR) and percutaneous mitral and tricuspid valve therapy 2.
- Early therapeutic intervention in valvular disease can help promote early cardiovascular risk estimation and reduce the risk of ventricular blockages 6.
- The integration of atrial function assessment in clinical practice can help identify patients at risk of ventricular blockages and guide treatment decisions 6.
- Further study is needed to optimize the evaluation and management of women with severe aortic stenosis and ventricular blockages 5.