Treatment of Second-Degree AV Block

Immediate Assessment and Stabilization

The American Heart Association recommends permanent pacemaker implantation for all patients with Mobitz Type II second-degree AV block, even if asymptomatic, due to the high risk of sudden progression to complete heart block and sudden cardiac death 1, 2
Mobitz Type II block shows constant PR intervals before and after blocked P waves, representing infranodal disease with unpredictable progression 2

The American College of Cardiology recommends permanent pacemaker implantation for symptomatic second-degree AV block of any type with bradycardia symptoms 1, 2
Permanent pacemaker implantation is indicated for Mobitz Type II block, even if asymptomatic, because the block is infranodal with unreliable escape mechanisms and unpredictable progression 2, 3
Asystole ≥3.0 seconds or escape rate <40 bpm in awake patients is an indication for permanent pacemaker implantation 1, 2

Dual-chamber pacing (DDD) is the preferred mode for second-degree AV block Type II to maintain atrioventricular synchrony and prevent pacemaker syndrome 2

Persistent Type II block after acute MI with bilateral bundle branch block requires permanent pacemaker 2
The American Heart Association recommends programing dual-chamber devices to maintain native AV conduction when possible to prevent pacing-induced ventricular dysfunction 3

The American College of Cardiology advises against delaying pacemaker implantation in Type II block waiting for symptoms, as progression can be sudden and life-threatening 2, 3
It is crucial to distinguish between Mobitz Type II and Type I, as Type II requires pacing even when asymptomatic while Type I at the AV node level does not 1, 2