From the Guidelines
No permanent pacing is recommended for patients with vagally mediated heart block, especially if they are asymptomatic.
Treatment Approach
- The treatment approach for vagally mediated heart block is focused on managing the underlying cause, rather than immediately resorting to permanent pacing 1.
- According to the 2018 ACC/AHA/HRS guideline, permanent pacing is not recommended for patients with asymptomatic vagally mediated atrioventricular block [III: Harm, C-LD] 1.
- The guidelines suggest that treatment of the underlying cause should be the primary approach, and permanent pacing should only be considered if the atrioventricular block does not resolve despite treatment of the underlying cause [I, C-LD] 1.
Key Considerations
- Symptomatic vs. asymptomatic: The guidelines differentiate between symptomatic and asymptomatic patients, with permanent pacing being recommended for symptomatic patients with reversible causes of atrioventricular block, but not for asymptomatic patients 1.
- Reversible causes: The guidelines emphasize the importance of identifying and treating reversible causes of atrioventricular block, rather than resorting to permanent pacing 1.
From the Research
Treatment for Vagally Mediated Heart Block
The treatment for vagally mediated heart block, also known as vagally mediated functional atrioventricular block, may involve various approaches. Some of the key treatment options include:
- Cardioneuroablation, a relatively new strategy for managing patients with excessive vagal activation, which involves radiofrequency catheter ablation of main ganglionated plexi around the heart 2, 3, 4, 5
- Electroanatomical-guided cardioneuroablation (EACNA) has shown promising results in patients with vagally induced atrioventricular blocks (VAVBs), with acute procedural success achieved in 96.2% of cases 3
- Selective and/or stepwise radiofrequency catheter ablation (RFCA) of the areas related to the three main autonomic ganglia around the heart may also be effective in treating functional bradyarrhythmias, neurally mediated reflex syncope, and symptomatic atrioventricular block 5
- Atropine infusion may be used to reverse vagally mediated AV block, as seen in some cases 6
- Pacemaker placement may be required in some patients who do not respond to other treatments or experience recurrence of AV block 3
Key Considerations
When considering treatment for vagally mediated heart block, it is essential to:
- Identify the underlying cause of the condition and determine the best course of treatment
- Evaluate the patient's symptoms and medical history to determine the most appropriate treatment approach
- Consider the potential risks and benefits of each treatment option, including cardioneuroablation and pacemaker placement 3, 4, 5
- Monitor patients closely after treatment to assess the effectiveness of the treatment and potential recurrence of symptoms 3, 4, 5