Bedside evaluation of atrioventricular block with narrow QRS complexes: Usefulness of carotid sinus massage and atropine administration

Lucia M. Mangiardi, Rodolfo Bonamini, Mariarosa Conte, Fiorenzo Gaita, Fulvio Orzan, Patrizia Presbitero, Antonio Brusca

Research output: Contribution to journalArticle

Abstract

Second-degree intra-His bundle block is frequently of type I (Wenckebach periods) or 2:1. In this situation, the surface electrocardiogram does not permit distinction between intranodal (atrioventricular [A-V]) and subnodal (intra-His) block. This study examined the value of bedside carotid sinus massage and atropine administration in diagnosing the site of block from the standard electrocardiogram in subjects with chronic A-V block and narrow QRS complexes. Fifteen patients had intra-His bundle block and 10 had intranodal block. The combination of two tests correctly located the site of block in 22 subjects, and was noncontributory in 3. Thirteen of the 15 intra-His bundle blocks and 9 of the 10 intranodal blocks were properly identified; in three cases the results were nondiagnostic, but no wrong diagnoses were made. The noninvasive bedside method of carotid sinus massage and the use of atropine permit both the localization and the determination of the type of block in the majority of cases of second degree A-V block and narrow QRS complexes. In a proper clinical context they can obviate the need for invasive electrophysiologic studies.

Original languageEnglish
Pages (from-to)1136-1145
Number of pages10
JournalThe American Journal of Cardiology
Volume49
Issue number5
DOIs
Publication statusPublished - Apr 1 1982

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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