THERAPEUTIC MANAGEMENT OF COMPLETE ATRIOVENTRICULAR BLOCK (AVB): ACUTE STABILIZATION AND LIFE SUPPORT

Abstract

Complete atrioventricular block (CAVB) is a potentially serious clinical condition characterized by the complete dissociation between atrial and ventricular activity, which can lead to hemodynamic instability and risk of sudden death. This narrative review aimed to synthesize recent evidence on the etiology, clinical presentation, acute stabilization strategies, and therapeutic management of CAVB, with emphasis on identifying reversible causes and indications for definitive support. Wide etiological heterogeneity was observed, with a predominance of idiopathic cases in young adults, although metabolic disorders, electrolyte imbalances, myocardial ischemia, sarcoidosis, and drug toxicity have also been described. In pediatrics, a significant proportion of patients present with early diagnosis and initial asymptomatic evolution, but with a high rate of pacemaker implantation need during follow-up. The identification of reversible causes, such as pharmacological intoxication or myocardial inflammation, showed a direct impact on management, potentially avoiding the need for definitive device implantation. In the absence of reversibility, permanent pacing is the primary therapeutic strategy, with the choice of implantation route depending on clinical and anatomical factors. Among the late complications, cardiomyopathy induced by chronic right ventricular pacing stands out, potentially indicating cardiac resynchronization therapy. It is concluded that the management of AV block requires a systematic approach, careful etiological investigation, and individualized therapy, especially in young populations, where early identification of the cause can significantly impact long-term prognosis.