From the Guidelines
Treatment options for heart blocks depend on the type and severity of the block, with permanent pacemaker being the definitive treatment for symptomatic or higher-grade blocks. For asymptomatic first-degree and Mobitz type I second-degree heart blocks, often no treatment is needed beyond regular monitoring 1. However, for symptomatic or higher-grade blocks (Mobitz type II second-degree, third-degree/complete heart block), a permanent pacemaker is the recommended treatment, as it can significantly improve survival and quality of life 1.
In emergency situations with symptomatic bradycardia, temporary measures include atropine (0.5-1 mg IV every 3-5 minutes, maximum 3 mg), dopamine (5-20 mcg/kg/min IV), or epinephrine (2-10 mcg/min IV) 1. Isoproterenol (2-10 mcg/min IV) may be used in specific cases while awaiting pacemaker placement. Temporary pacing via transcutaneous or transvenous methods can stabilize patients until permanent pacing is available.
Underlying causes should be addressed, including discontinuing medications that slow heart rate (beta-blockers, calcium channel blockers, digoxin), treating electrolyte abnormalities, managing thyroid disorders, or addressing ischemia. Heart blocks caused by Lyme disease may respond to appropriate antibiotic therapy, with hospitalization and continuous monitoring recommended for symptomatic patients 1. Regular follow-up is essential for all patients with heart blocks, even those not requiring immediate intervention, as the condition may progress over time.
Some key considerations in the management of heart blocks include:
- Identifying and addressing underlying causes
- Monitoring for progression of the block
- Considering temporary or permanent pacing as needed
- Managing symptoms and preventing complications
- Regular follow-up to adjust treatment as necessary
Overall, the goal of treatment is to improve symptoms, prevent complications, and improve quality of life for patients with heart blocks. The most recent and highest quality study 1 supports the use of permanent pacemaker implantation for symptomatic or higher-grade heart blocks, and this should be considered the definitive treatment for these patients.
From the FDA Drug Label
Atropine also may lessen the degree of partial heart block when vagal activity is an etiologic factor In some patients with complete heart block, the idioventricular rate may be accelerated by atropine; in others, the rate is stabilized.
The treatment options for patients with heart blocks include atropine. Atropine may lessen the degree of partial heart block when vagal activity is an etiologic factor. In some patients with complete heart block, atropine may accelerate the idioventricular rate or stabilize the rate 2.
From the Research
Treatment Options for Heart Blocks
The treatment options for patients with heart blocks depend on the severity and type of block.
- For third-degree atrioventricular block (complete heart block), treatment may include:
- In some cases, dopamine and epinephrine may be used as a bridge therapy while waiting for transfer to a higher level of care 5
- For first-degree AV block, insertable cardiac monitors may be used to detect progression to higher grade block or bradycardia requiring pacemaker implantation 6
- Atropine may be used to treat sinus bradycardia and conduction disturbances in patients with acute myocardial infarction, but should be used with caution due to potential adverse effects 7
Pharmacologic Interventions
Pharmacologic interventions, such as atropine, dopamine, and epinephrine, may be used to manage heart blocks.
- Atropine is effective in treating ventricular arrhythmias and conduction disturbances in patients with inferior myocardial infarction 7
- Dopamine and epinephrine may be considered for complete atrioventricular block if transfer to a higher level of care is not feasible 5
Procedural Interventions
Procedural interventions, such as pacemaker implantation, may be necessary for patients with heart blocks.