Abstract
Complete atrioventricular block is defined as interrupted conduction between the atrium and ventricle. When the block is below the atrioventricular node, the wide QRS complex escape rhythm arises at or below the His bundle with a rate slower than 40 beats/min. Patients with it are generally symptomatic and consult a doctor voluntarily. When the block is at the level of the atrioventricular node, the narrow QRS complex escape rhythm arises from a junctional pacemaker with a relatively preserved heart rate and the symptoms of such patients are mild. However, if atrioventricular block is symptomatic and irreversible, pacemaker implantation should be considered to prevent sudden cardiac death or exacerbation of heart failure.
A 33-year-old woman presented with dyspnea on exertion, but did have any sense of unease about this. She was diagnosed with complete atrioventricular block from electrocardiography in a general check-up. The complete atrioventricular block in this case was proved to be idiopathic and induced latent heart failure. A cardiac pacemaker was implanted and the dyspnea improved. Nearly all patients with complete atrioventricular block present with some degree of symptoms and consult a doctor. However, the severity of symptoms can vary and few patients are found in electrocardiography conducted in general health check-ups. Medical staff engaged in general checkups should pay attention to complete atrioventricular block. Asymptomatic or mildly symptomatic cases are more likely to be young, otherwise-healthy patients with a high junctional escape rhythm. However, such patients may not act on referrals to cardiologists, so they should be encouraged appropriately to receive consultation after the general health check-up.
