Treatment of Heart Block
The treatment of heart block depends on the degree of conduction impairment, the presence of symptoms, and the underlying cause. The main goals of treating heart block are clear. First, doctors want to get the heart beating properly again. Next, they work to ease symptoms like dizziness or weakness. Finally, they try to stop serious problems, such as fainting, heart failure, or sudden cardiac arrest.
In first-degree heart block, the electrical impulse delays but doesn’t get interrupted. Doctors usually don’t need to treat it unless the person shows symptoms. In many cases, doctors regularly monitor first-degree block, especially if medication or other reversible factors cause it. Adjusting or discontinuing medications such as beta-blockers, calcium channel blockers, or digoxin can resolve the issue when appropriate.
Second-degree heart block
Second-degree heart block is more serious and may need treatment, especially in Mobitz Type II. This type has a higher risk of turning into complete heart block. However, if something temporary, like an infection or medication, causes the block, treating the problem or stopping the drug can fix it. However, symptomatic patients or those with evidence of progressive conduction disease usually require a permanent pacemaker.
Third-degree (complete) heart block is a medical emergency when symptomatic and nearly always requires a permanent pacemaker. In the acute setting, temporary pacing may be initiated via an external or transvenous pacemaker until a permanent device can be implanted. Permanent pacemakers regulate the heartbeat by providing electrical impulses that restore proper timing between atrial and ventricular contractions.
For individuals with congenital heart block, treatment decisions depend on the severity of the block, presence of symptoms, and associated structural abnormalities. Asymptomatic children with stable heart rates may be monitored, while those with slow heart rates, signs of heart failure, or poor growth typically need a pacemaker.
Treatment of Heart Block
In cases where heart block is due to infection (such as Lyme disease or rheumatic fever), appropriate antibiotic or anti-inflammatory treatment may resolve the conduction issue. Similarly, correcting electrolyte imbalances or managing infiltrative diseases like sarcoidosis may reverse the conduction abnormality if addressed early.
Pacemaker implantation is generally safe and significantly improves quality of life and prognosis for individuals with symptomatic or high-risk heart block. The device is placed under the skin, usually in the chest, and connected to leads that deliver electrical impulses to maintain a coordinated heart rhythm.
In addition to pacemakers, some patients may benefit from adjunct therapies such as:
Cardiac resynchronisation therapy (CRT): Especially for patients with heart failure and wide QRS complexes.
Implantable cardioverter-defibrillators (ICDs): For those at risk of life-threatening arrhythmias in addition to conduction abnormalities.
Lifestyle modifications, including managing cardiovascular risk factors (blood pressure, cholesterol, diabetes), quitting smoking, and maintaining regular follow-up care, are also essential to support long-term heart health.
Treatment of Heart Block
In summary, the treatment of heart block ranges from observation to pacemaker implantation depending on the degree and cause. Timely intervention, particularly for second- and third-degree blocks, can be lifesaving and significantly improve outcomes.
