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Cardiology426 papers

Atrioventricular conduction disorder

Last edited: 4/23/2026

Overview

Atrioventricular (AV) conduction disorders encompass a range of abnormalities affecting the electrical conduction pathway between the atria and ventricles, including blocks and delays, which can lead to bradycardia and other arrhythmias. These conditions pose significant risks to cardiac function and patient outcomes 159.

Diagnosis

  • Electrocardiogram (ECG): Essential for identifying AV blocks (first-degree, second-degree, third-degree) and intraventricular conduction disturbances (e.g., bundle branch blocks) 17814213335.
  • Holter Monitoring: Useful for detecting intermittent conduction abnormalities 626.
  • Electrophysiology Study: For detailed assessment of conduction properties and refractory periods 4142444.
  • Genetic Testing: Considered in familial cases or syndromes associated with conduction disorders 11141.
  • Management

  • Pacemaker Implantation: First-line treatment for symptomatic high-degree AV block and symptomatic bradycardia due to conduction disorders 293640.
  • His Bundle Pacing: Offers physiological ventricular activation and may reduce atrial fibrillation risk compared to right ventricular pacing 26.
  • Medications: Avoid drugs that prolong QT interval or cause conduction disturbances (e.g., bupropion, chloroquine) 2832.
  • Rate-Adaptive Pacing: Consider in patients with exercise intolerance to optimize heart rate response 27.
  • Special Populations

  • Pediatrics: Permanent pacing may be required for congenital conduction disorders; transfemoral approach can be effective 38.
  • Elderly: Higher prevalence of conduction abnormalities; careful monitoring for complications like intraventricular conduction disturbances 847.
  • Comorbidities: Patients with structural heart disease may require additional considerations for pacing strategies to avoid adverse effects on ventricular function 2242.
  • Key Recommendations

  • Pacemaker Implantation for Symptomatic High-Degree AV Block: Essential for improving symptoms and survival 29 (Evidence: Strong).
  • His Bundle Pacing Over Right Ventricular Pacing: Preferred to reduce atrial fibrillation risk in patients with AV conduction disturbances 26 (Evidence: Moderate).
  • Avoid Drugs Prolonging QT Interval: Minimize risk of arrhythmias in patients with conduction disorders 2832 (Evidence: Moderate).
  • Consider Genetic Testing in Familial Cases: Useful for identifying underlying genetic causes of conduction disorders 141 (Evidence: Weak).
  • Monitor Intraventricular Conduction in High-Risk Groups: Regular ECGs and Holter monitoring in elderly and those with structural heart disease 847 (Evidence: Expert opinion).
  • References

    Showing 100 most recent of 205 indexed papers.

    1 Song ZQ, Xu YP, Chen YQ, Zeng H, Lin XS, Lu XY et al.. Proteome-wide Mendelian randomization and colocalization analyses identify novel protein targets for cardiac conduction disorders. Journal of cardiology 2026. link 2 Curila K, Mizner J, Morava J, Smisek R, Vesela J, Sussenbek O et al.. Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial. Heart rhythm 2025. link 3 Qu Z, Hanna P, Ajijola OA, Garfinkel A, Shivkumar K. Ultrastructure and cardiac impulse propagation: scaling up from microscopic to macroscopic conduction. The Journal of physiology 2025. link 4 Ghajar A, Khant KM, Sargeant MM, Bandarupalli T, Philips B, Assis FR et al.. All-cause mortality due to conduction abnormalities in the United States: Sex, racial, and geographic variations from 1999 to 2022. Heart rhythm 2025. link 5 Cohle SD, Wygant CM. Lesions of the Cardiac Conduction System and Sudden Death. The American journal of forensic medicine and pathology 2024. link 6 Takahashi M, Kujiraoka H, Arai T, Kimura T, Hojo R, Fukamizu S. New-onset atrial high-rate episodes between his bundle pacing and conventional right ventricular septum pacing in patients with atrioventricular conduction disturbance. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2024. link 7 Stumph JD, Cornwell WK, Rosenberg MA, Khodaee M. Profound First-Degree Atrioventricular Block in a High-Level Basketball Athlete. Sports health 2024. link 8 Bay M, Vollenweider P, Marques-Vidal P, Schläpfer J. Clinical factors associated with the intraventricular conduction disturbances in Swiss middle-aged adults: The CoLaus|PsyCoLaus study. International journal of cardiology 2021. link 9 Miller RJH, Tan Z, James MT, Exner DV, Southern DA, Har BJ et al.. Prognosis and Natural History of Conduction System Disease in Patients Undergoing Coronary Angiography. The Canadian journal of cardiology 2020. link 10 Pérez-Riera AR, Barbosa-Barros R, Sá Leitão Ramos Borges MT, Daminello-Raimundo R, de Abreu LC, Nikus K. Electro-vectorcardiographic demonstration of rate-independent transient left posterior fascicular block. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2019. link 11 Kataoka T, Miyazaki S, Kaseno K, Hasegawa K, Amaya N, Tada H. Recruitment of Complete Right Bundle Branch Block by Permanent Para-Hisian Pacing. International heart journal 2019. link 12 Kim HO, Lim JE, Kim MJ, Kang JO, Kim SM, Nam JM et al.. GAREM1 regulates the PR interval on electrocardiograms. Journal of human genetics 2018. link 13 Lee YY, Zhou Y, Jelinek HF, Hambly BD, McLachlan CS. The association of uncoupling protein 2 (UCP2) exon 8 insertion/deletion polymorphism and ECG derived QRS duration: A cross-sectional study in an Australian rural population. International journal of cardiology 2017. link 14 Patil G, Phadke M, Lokhandwala Y, Shaikh Z, Nathani P, Mahajan A. Prevalence and predictors of ventriculo-atrial conduction in structurally normal hearts. Indian heart journal 2017. link 15 Pantazopoulos JS, David A, Kostis WJ, Cosgrove NM, Kostis JB. Cardiovascular outcomes in patients with intraventricular conduction blocks: A sixteen-year follow-up in a state-wide database. Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese 2017. link 16 Németh B, Kellényi L, Péterfi I, Simor T, Ruzsa D, Lőrinc H et al.. New Validated Signal-averaging-based Electrocardiography Method to Determine His-ventricle Interval. In vivo (Athens, Greece) 2016. link 17 George SA, Poelzing S. Cardiac conduction in isolated hearts of genetically modified mice--Connexin43 and salts. Progress in biophysics and molecular biology 2016. link 18 Sun H, Hong Y, Jin T. A case report of different degrees of the left anterior, septal and posterior fascicular branch block. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2015. link 19 Pérez-Riera AR, Baranchuk A. Unusual conduction disorder: left posterior fascicular block + left septal fascicular block. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2015. link 20 Márquez MF, Moukabary T, Gonzalez MD. Jesús Alanís and the first recording of the his bundle: the scientist and the man. Pacing and clinical electrophysiology : PACE 2014. link 21 Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG. Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2013. link 22 Holmqvist F, Daubert JP. First-degree AV block-an entirely benign finding or a potentially curable cause of cardiac disease?. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2013. link 23 Caillier B, Pilote S, Castonguay A, Patoine D, Ménard-Desrosiers V, Vigneault P et al.. QRS widening and QT prolongation under bupropion: a unique cardiac electrophysiological profile. Fundamental & clinical pharmacology 2012. link 24 Badie N, Scull JA, Klinger RY, Krol A, Bursac N. Conduction block in micropatterned cardiomyocyte cultures replicating the structure of ventricular cross-sections. Cardiovascular research 2012. link 25 Xie Y, Garfinkel A, Camelliti P, Kohl P, Weiss JN, Qu Z. Effects of fibroblast-myocyte coupling on cardiac conduction and vulnerability to reentry: A computational study. Heart rhythm 2009. link 26 Tadros R, Billette J. Rate-dependent AV nodal refractoriness: a new functional framework based on concurrent effects of basic and pretest cycle length. American journal of physiology. Heart and circulatory physiology 2009. link 27 Gong X, Su Y, Pan W, Cui J, Liu S, Shu X. Is right ventricular outflow tract pacing superior to right ventricular apex pacing in patients with normal cardiac function?. Clinical cardiology 2009. link 28 Stas P, Faes D, Noyens P. Conduction disorder and QT prolongation secondary to long-term treatment with chloroquine. International journal of cardiology 2008. link 29 Chi NC, Shaw RM, Jungblut B, Huisken J, Ferrer T, Arnaout R et al.. Genetic and physiologic dissection of the vertebrate cardiac conduction system. PLoS biology 2008. link 30 Loo RM, Ariyarajah V, O'Brien D, Apiyasawat S, Silbert D, Katz S et al.. High prevalence of widened P waves among pediatric patients in 2 separate hospitals. Journal of electrocardiology 2008. link 31 van Veen TA, van Rijen HV, van Kempen MJ, Miquerol L, Opthof T, Gros D et al.. Discontinuous conduction in mouse bundle branches is caused by bundle-branch architecture. Circulation 2005. link 32 Gaussin V. Offbeat mice. The anatomical record. Part A, Discoveries in molecular, cellular, and evolutionary biology 2004. link 33 Efimov IR, Nikolski VP, Rothenberg F, Greener ID, Li J, Dobrzynski H et al.. Structure-function relationship in the AV junction. The anatomical record. Part A, Discoveries in molecular, cellular, and evolutionary biology 2004. link 34 Glenn CM, Pogwizd SM. Gene therapy to develop a genetically engineered cardiac pacemaker. The Journal of cardiovascular nursing 2003. link 35 Hurst JW. A new terminology for describing left and right ventricular conduction abnormalities. Clinical cardiology 2003. link 36 Dambrink JH, Dambrink JH. Left bundle branch block and private pilot licensing. Aviation, space, and environmental medicine 2003. link 37 Upshaw CB. Lower prevalence of intraventricular block in African-American patients compared with Caucasian patients: an electrocardiographic study II. Journal of the National Medical Association 2003. link 38 Dilber E, Celiker A, Karagöz T, Kalkanoğlu HS. Permanent transfemoral pacemaker implantation in a child with Maroteaux Lamy syndrome. Pacing and clinical electrophysiology : PACE 2002. link 39 Fox JJ, Gilmour RF, Bodenschatz E. Conduction block in one-dimensional heart fibers. Physical review letters 2002. link 40 Michaud K, Romain N, Brandt-Casadevall C, Mangin P. Sudden death related to small coronary artery disease. The American journal of forensic medicine and pathology 2001. link 41 Gollob MH, Seger JJ, Gollob TN, Tapscott T, Gonzales O, Bachinski L et al.. Novel PRKAG2 mutation responsible for the genetic syndrome of ventricular preexcitation and conduction system disease with childhood onset and absence of cardiac hypertrophy. Circulation 2001. link 42 Ozdemir K, Altunkeser BB, Daniş G, Ozdemir A, Uluca Y, Tokaç M et al.. Effect of the isolated left bundle branch block on systolic and diastolic functions of left ventricle. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2001. link 43 Agarwal AK, Venugopalan P. Right bundle branch block: varying electrocardiographic patterns. Aetiological correlation, mechanisms and electrophysiology. International journal of cardiology 1999. link00102-3) 44 Newman DG. Acquired left bundle branch block in an asymptomatic fighter pilot: a case report. Aviation, space, and environmental medicine 1999. link 45 Kasai H, Kawara T, Hiejima K, Suzuki F. Shortening of the intraventricular conduction time in premature ventricular beats during ventricular extrastimulation: possible role of dimensional shortening of the conducting distance during ventricular systole. Journal of cardiovascular electrophysiology 1998. link 46 Ducceschi V, Sarubbi B, D'Andrea A, Liccardo B, Lucca P, Mayer MS et al.. Electrophysiologic significance of leftward QRS axis deviation in bifascicular and trifascicular blocks. Clinical cardiology 1998. link 47 Nelson SD, Sparks EA, Graber HL, Boudoulas H, Mehdirad AA, Baker P et al.. Clinical characteristics of sudden death victims in heritable (chromosome 1p1-1q1) conduction and myocardial disease. Journal of the American College of Cardiology 1998. link00424-0) 48 Arai T, Kurashima C, Wada S, Chida K, Ohkawa S. Histological evidence for cell proliferation activity in cystic tumor (endodermal heterotopia) of the atrioventricular node. Pathology international 1998. link 49 Trohman RG, Pinski SL. Supernormality with cycle length-dependent intra-His alternans: a new cause of group beating. Pacing and clinical electrophysiology : PACE 1997. link 50 Berul CI, Aronovitz MJ, Wang PJ, Mendelsohn ME. In vivo cardiac electrophysiology studies in the mouse. Circulation 1996. link 51 Pires LA, Huang SK, Wagshal AB, Kulkarni RS. Electrophysiological effects of propofol on the normal cardiac conduction system. Cardiology 1996. link 52 Kjeldsen SE, Syvertsen JO, Hedner T. Cardiac conduction with diltiazem and beta-blockade combined. A review and report on cases. Blood pressure 1996. link 53 Kong TQ, Goldberger JJ, Parker M, Wang T, Kadish AH. Circadian variation in human ventricular refractoriness. Circulation 1995. link 54 Lorange M, Gulrajani RM, Nadeau RA, Préda I. A computer heart model incorporating anisotropic propagation. II. Simulations of conduction block. Journal of electrocardiology 1993. link90048-i) 55 Waller BF, Gering LE, Branyas NA, Slack JD. Anatomy, histology, and pathology of the cardiac conduction system--Part VI. Clinical cardiology 1993. link 56 Baig MW, Cowan JC, Perrins EJ. Comparison of unipolar and bipolar ventricular paced evoked responses. British heart journal 1992. link 57 Bharati S, Lev M. The pathologic changes in the conduction system beyond the age of ninety. American heart journal 1992. link90615-3) 58 Luzza F, Oreto G, Donato A, Satullo G, Scimone IM. Supernormal conduction in the left bundle branch unmasked by the linking phenomenon. Pacing and clinical electrophysiology : PACE 1992. link 59 Ono A, Mizuno H, Tahara Y, Ishikawa K. Phase image characterization of ventricular contraction in left anterior hemiblock. Japanese circulation journal 1991. link 60 Kuroki M, Ikeda U, Noda T, Hosoda S, Yaginuma T. Complete atrioventricular block induced during left heart catheterization. Japanese heart journal 1991. link 61 Millane RP. A model of atrioventricular nodal conduction. Australasian physical & engineering sciences in medicine 1991. link 62 Timour Q, Freysz M, Mazze R, Couzon P, Bertix L, Faucon G. Enhancement by hyponatremia and hyperkalemia of ventricular conduction and rhythm disorders caused by bupivacaine. Anesthesiology 1990. link 63 Timour Q, Freysz M, Couzon P, Loufoua J, Bertrix L, Gerentes I et al.. Possible role of drug interactions in bupivacaine-induced problems related to intraventricular conduction disorders. Regional anesthesia 1990. link 64 Brachfeld CA, Marshall J, Volosin KJ, Groh WC. Complete atrioventricular block during cardiac catheterization: two cases reports in patients without pre-existing conduction abnormalities. Catheterization and cardiovascular diagnosis 1990. link 65 Charlton I, Williams R. Cardiac conducting tissue. 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    Original source

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