How is AV block treated?

No. Some people have mild AV block and don’t even notice it. For example, athletes and teenagers sometimes have it while resting or sleeping. But this change in signal transmission is not considered to be a medical problem. It goes away as soon as they become active again and their heart rate increases. So no treatment is needed.

A pacemaker is a device that sends out electrical signals. If your heart stops sending its own signals regularly or fast enough, the pacemaker becomes active and makes the heart muscle squeeze regularly – so the pacemaker sets the pace of the heartbeat. The device is implanted in a minor surgical procedure – usually under local anesthesia. The surgeon slides it under the skin or under the large chest muscle below the collarbone. From there, it sends electrical signals to the heart along thin wires (leads).

In some people, a pacemaker can be implanted directly into the heart without leads.

For urgent treatment in emergencies, external pacemakers are normally used. They are larger and heavier than implanted pacemakers, and make it harder to move freely. So they are only a temporary solution. If an external pacemaker is used, the electrode leads are often fed through a vein into the heart. The electrical signals given off in the heart don’t cause any discomfort. Sometimes the electrodes of external pacemakers are placed on the skin instead. Then the electrical signals are unpleasant, so this treatment is done under general anesthesia.

Pacemakers are usually recommended if AV block causes symptoms over a long period of time. They are also recommended if other heart problems cause the heart to beat very slowly and lead to related symptoms – like if the sinus node isn't working properly.

Sometimes a pacemaker is considered even if you don't have any noticeable symptoms. For example, in severe (third-degree) AV block or in a type of second-degree AV block known as “Mobitz type 2.”

If you're deciding whether or not to get a pacemaker, you can use our decision aid to help you weigh the pros and cons.

Pacemakers are generally used in the treatment of heart rhythm disorders that lead to an abnormally slow heartbeat (bradycardia). Some people with heart failure get a pacemaker too. Their pacemaker not only sets the pace of the heartbeat: It also makes sure that the different areas of the heart muscle work together effectively – for example, by making both of the lower heart chambers (ventricles) squeeze at the same time. This treatment is also known as cardiac resynchronization therapy (CRT).

Pacemakers rarely cause complications. Like any kind of surgery, the procedure to implant the device can lead to infections, wound-healing problems or bleeding (if blood vessels, the lungs, or the wall of the heart are injured).

Later, there is a slight risk of the electrode leads moving out of place or being damaged over time. Other rare complications include malfunctions and " pacemaker syndrome" (with a pounding heart, dizziness and shortness of breath). Pacemaker syndrome can develop if the upper and lower heart chambers aren't in sync with one another. But this can be avoided with modern pacemakers.

Medication for AV block is only considered in an emergency. Then the doctor may inject medication like atropine or adrenaline (epinephrine) to quickly increase the heart rate. Certain asthma medications can be used in emergencies too because they can also increase the heart rate. This emergency medication can make sure the heart doesn't stop pumping blood around the body. It is a temporary solution until a permanent pacemaker can be implanted or the cause of the AV block is successfully treated.

The potential side effects of the medication include blood pressure fluctuations, an abnormal heartbeat, skin problems and allergic reactions.