Elsevier

Journal of Electrocardiology

Volume 51, Issue 1, January–February 2018, Pages 153-155
Journal of Electrocardiology

Exercise induced complete atrioventricular block: Utility of exercise stress test,☆☆

https://doi.org/10.1016/j.jelectrocard.2017.09.001Get rights and content

Highlights

  • EIAVB is rare in patients with normal atrioventricular conduction at rest.

  • Many reports suggest that EIAVB is due to a diseased infranodal His-Purkinje system.

  • Simple, noninvasive exercise testing can readily diagnose EIAVB.

  • In the absence of myocardial ischemia, pacing is indicated to treat EIAVB.

Abstract

Exercise induced complete atrioventricular block (EIAVB) is a relatively uncommon condition. This phenomenon is clinically important because it can mimic symptoms of other cardiovascular conditions and may be associated with exercise intolerance and subsequent syncope. A 76 year old man with long-standing hypertension and diabetes mellitus presented with recurrent episodes of lightheadedness and syncope with physical activity. ECG showed sinus rhythm with first degree atrioventricular block. Echocardiography did not show any valvular disease causing his symptoms. Coronoary angiographic evaluation revealed non-obstructive coronary artery disease. Because of the exertional nature of his symptoms, a symptom-limited treadmill exercise test was performed which revealed EIAVB. A permanent dual chamber pacemaker was implanted and his symptoms resolved completely.

Section snippets

Case

A 76 year old man with long-standing hypertension (on losartan) and diabetes mellitus presented with recurrent episodes of lightheadedness and syncope with physical activity. The patient was asymptomatic at presentation and denied chest pain. He was hemodynamically stable with a heart rate of 67 beats per minute (bpm) and blood pressure of 143/77 mm Hg. Physical exam was unremarkable. ECG showed sinus rhythm with a heart rate of 58 bpm, first degree atrioventricular (AV) block (PR interval 284 ms)

Discussion

Exercise induced complete atrioventricular block (EIAVB) is a relatively uncommon condition and is rarely reported in patients with normal AV conduction at rest [1]. EIAVB may be associated with exercise intolerance and syncope, mimicking the symptoms of other important cardiovascular conditions like arrhythmias, dynamic LV outflow obstruction, aortic stenosis, and CAD. Several mechanisms have been proposed to explain this phenomenon. Many reports suggest that EIAVB is due to a diseased

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There are more references available in the full text version of this article.

Cited by (0)

Funding sources: None.

☆☆

Conflict of interest statement: None of the authors have any conflicts of interest.

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