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| A PICTURE IS WORTH A THOUSAND WORDS |
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| Year : 2013 | Volume
: 14
| Issue : 4 | Page : 190-191 |
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Exercise-induced complete AV block
Srivats Nadig, Pranjal Agarwal, Sudeep Kumar, Aditya Kapoor
Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 12-Feb-2014 |
Correspondence Address:
Aditya Kapoor
Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1995-705X.126889
How to cite this article:
Nadig S, Agarwal P, Kumar S, Kapoor A. Exercise-induced complete AV block. Heart Views 2013;14:190-1 |
A 8-year-old male presented with exertional shortness of breath since the last 6 months. He denied any history of syncope, presyncope, palpitations or angina. The resting 12 lead ECG revealed complete left bundle branch block (LBBB), with PR interval 160 ms [Figure 1]a. The patient underwent an exercise stress test for evaluation of his symptoms. Intact 1:1 atrioventricular conduction was noted during stage 1 and stage 2 of the stress test, untill a sinus rate of 168 bpm [Figure 1]b. However, during stage 3, a sudden complete AV block was noted with a prolonged asystole [Figure 1]c. The patient complained of dizziness and became hypotensive. The test was immediately terminated and the patient put in a supine position. The episode of complete AV block was then followed by intermittent 2:1 AVB [Figure 2]a and b. Transient 3:1 and 4:1 AV block [Figure 3]a and b were also noted before resumption of normal sinus rhythm occurred after nearly 20 min. Since the patient was hemodynamically stable and symptoms had resolved almost immediately on termination of the exercise test, temporary pacing was not initiated. The patient successfully underwent a dual chamber permanent pacemaker implantation 24 hours later.
Exercise-induced high grade atrioventricular (AV) block in patients with intact 1:1 AV conduction at rest is a rare phenomenon. Complete AV block occurring during exercise is an even more uncommon entity. [1],[2] It is important for clinicians to be aware of this clinical entity since most such patients have conduction block at the infra-nodal intra-Hisian or infra-Hisian level, necessitating a pacemaker implantation. [3]
 References | |  |
| 1. | Byrne JM, Marais HJ, Cheek GA. Exercise-induced complete heart block in a patient with chronic bifascicular block. J Electrocardiol 1994;27:339-42. 
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| 2. | Chokshi SK, Sarmiento J, Nazari J, Mattioni T, Zheutlin T, Kehoe R. Exercise-provoked distal atrioventricular block. Am J Cardiol 1990;66:114-6.
[PUBMED] |
| 3. | Woelfel AK, Simpson RJ Jr, Gettes LS, Foster JR. Exercise-induced distal atrioventricular block. J Am Coll Cardiol 1983;2:578-81.
[PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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