[Effort-induced atrioventricular block. Apropos of 62 cases]

Abstract

Based on a retrospective study, we report the clinical and electrophysiological characteristics of 62 cases of effort-induced atrio-ventricular block (AVB). The diagnosis of effort-induced AVB was established by stress test and/or Holter ECG. This series consisted of 18 women and 44 men with a mean age of 64 +/- 13 years. AVB presented in the form of poor adaptation to effort in 41 patients (66%), fainting and/or presyncope suggestive of Stokes-Adams attacks in 20 patients (32%), associated with poor adaptation to effort, except in 5 patients. 48 patients (77%) did not have any underlying heart disease. The ECG was normal in 25 patients (40%) or abnormal, demonstrating a 1st degree AVB and/or an intraventricular conduction disorder. On electrophysiological investigation, the AVB was type II (Mobitz II) in 48 patients (77%), generally 2/1. The block was infranodal, either in or below the His bundle, in 56 patients (90%). When it was situated above the His bundle, it was organic and degenerative, situated at the AV node, at the node-His junction, or even proximally in the His bundle. Effort-induced AVB implies DDD atrioventricular stimulation. The presence of this anomaly should be investigated in patients with poor adaptation to effort, but also when the clinical picture is dominated by Stokes-Adam attacks.