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Vagally mediated atrioventricular block: pathophysiology and diagnosis
  1. Paolo Alboni1,
  2. Anna Holz1,
  3. Michele Brignole2
  1. 1Department of Medicine, Section of Cardiology, Ospedale Privato Quisisana, Ferrara, Italy
  2. 2Department of Cardiology, Arrhythmologic Center, Ospedali del Tigullio, Lavagna, Italy
  1. Correspondence to Dr Paolo Alboni, Department of Medicine, Section of Cardiology, Ospedale Privato Quisisana, Viale Cavour 128, 44121 Ferrara, Italy; alboni.cardiologia{at}gmail.com

Abstract

Vagally mediated atrioventricular (AV) block is defined as a paroxysmal AV block, localised within the AV node, associated with slowing of the sinus rate. All types of second-degree AV block, including pseudo-Mobitz II block, and complete AV block, may be present. Most of the patients have normal AV conduction. Differential diagnosis with intrinsic AV block is based on the behaviour of the sinus rate. Vagally mediated AV block is benign; it can be recorded as an asymptomatic or symptomatic event (syncope/presyncope). Syncope due to this form of AV block should be diagnosed and managed as neurally mediated syncope. When this block is fortuitously recorded in asymptomatic patients, pacemaker implantation is not indicated.

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