HRS Board Review 2025 New Courses (Reviewers Copy)-Workshop 1_Electrocardio_Miller_2025

Video Transcription

Okay, the answer is a dual chamber pacemaker insertion. The reason for this is that this is a case of paroxysmal AV block indicated by a non-conducted PAC right there.  It's not obvious. In fact, you may just think this is vagal because there's a slowing of the PP interval,  but it actually stays at the baseline rate or even accelerates a little bit here towards the end. This is thus not vagal and it is not benign.  It requires pacing as sudden death from unrecoverable block can occur. Fortunately, hers recovered and so she lived to tell, but it doesn't always end up that way.  EP study would add nothing to her care. In fact, it might give false reassurance and conduction parameters would probably be found to be normal at the time.  Here are the PP intervals and you see it actually does accelerate a little bit, not like what vagal would do. So this is a very clear example.  If you see that PAC there that doesn't conduct and initiates the sequence.

Video Summary

The patient needs a dual chamber pacemaker due to paroxysmal AV block, not vagal stimulation, as indicated by a non-conducted PAC. While sometimes it appears benign, this condition poses a risk of sudden death from unrecoverable block. Insertion of a pacemaker is critical since an EP study might falsely reassure, showing normal conduction at the time. Observing the subtle acceleration in PP intervals confirms the condition is not vagal. The situation is dangerous despite the patient's recovery in this case, highlighting the necessity for pacing intervention.

Keywords

dual chamber pacemaker

paroxysmal AV block

non-conducted PAC

sudden death risk

pacing intervention