Prognostic value of junctional recovery times and long-time follow-up of complete atrioventricular nodal block at a young age

Abstract The main purpose of clinical and electrophysiologic investigation in patients having complete atrioventricular (AV) nodal block is to differentiate between 2 different heterogeneous groups 1 : one presenting with syncope or other bradycardia/tachycardia-related symptoms 2 and the asymptomatic group. The data available at the present time do not allow us to conclude which criteria is the best to distinguish the patient at risk for syncope in the latter group. Even when the site of block is in the proximal part of the His bundle 1 with a good response to parasympathetic blockade 3 or to exercise, 4 the junctional rhythm may not be stable enough, and Adam-Stokes attacks may occur. 5 Some investigators believe that life-expectancy in symptomatic patients can be good. 6 However, others have recognized that life-threatening arrhythmias may develop, 7 and a prophylactic pacemaker should be implanted. 8