Key result
Easily missed paroxysmal AV block requires continuous monitoring and prompt pacing to prevent SCD.
Why the study?
Paroxysmal atrioventricular block involves an abrupt shift to complete heart block, but because episodes are transient and ECGs may appear normal between events, the condition is frequently overlooked.
Highlights the critical need for continuous monitoring to identify transient paroxysmal AV block and the efficacy of prompt pacing to prevent prolonged asystole and sudden cardiac death.
Supports continuous monitoring to detect paroxysmal AV block; hypothesis-generating for prompt pacing to prevent SCD.
Paroxysmal atrioventricular block (PAVB) is an abrupt shift from normal conduction to complete heart block. Because episodes are transient and ECGs may appear normal between events, the condition is frequently overlooked. A 73-year-old male presented with recurrent near-syncope and intermittent bradycardia. In the ED, a premature atrial complex triggered sudden complete heart block without preceding PR or sinus slowing, consistent with intrinsic PAVB. He required transcutaneous and then transvenous pacing, and ultimately received a leadless ventricular pacemaker. Coronary angiography showed chronic disease unlikely to explain his conduction abnormality, and he remained asymptomatic at one year. PAVB is life-threatening and easily missed without continuous monitoring. Early identification and prompt pacing are critical to prevent prolonged asystole and sudden cardiac death.
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Patel et al. (2026) studied this question. Paroxysmal atrioventricular block is a life-threatening, easily missed condition that requires continuous monitoring for detection and prompt pacing to prevent sudden cardiac death.
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