What is the role of atropine in the treatment of third-degree atrioventricular (AV) block?

Updated: Jul 05, 2018
  • Author: Akanksha Agrawal, MBBS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

In addition, care should be taken in administering atropine to a patient with a suspected acute myocardial infarction (MI), in that the resulting vagolysis leads to unopposed sympathetic stimulation, which can cause increased ventricular irritability and potentially dangerous ventricular arrhythmias. Furthermore, atropine is ineffective in patients with a denervated heart (eg, those patients who have undergone a cardiac transplant procedure).

Similarly, use of isoproterenol may be attempted to accelerate a ventricular escape rhythm with a low probability for efficacy and the same concerns in patients with suspected acute MI. Isoproterenol is more likely to facilitate conduction with a distal level of block, but patients with a block at the distal level are more likely to have a contraindication, such as active ischemic heart disease. Isoproterenol should only be used as a temporary measure until more definitive and less risky treatments (eg, transvenous pacing) can be arranged.

Once the patient has been stabilized, a decision must be made regarding permanent pacemaker implantation. [20, 21, 22, 23, 24] The admitting cardiologist will determine the need for and timing of permanent pacemaker implantation.


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