A proposal of clinical ECG index “vagal score” for determining the mechanism of paroxysmal atrioventricular block

Journal of Arrhythmia. 2017;33(3):208-213 DOI 10.1016/j.joa.2016.10.004

 

Journal Homepage

Journal Title: Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)

Publisher: Wiley

Society/Institution: Japanese Heart Rhythm Society

LCC Subject Category: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system

Country of publisher: Australia

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS

Sayaka Komatsu, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Masataka Sumiyoshi, MD (Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan)
Seiji Miura, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Yuki Kimura, MD (Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan)
Tomoyuki Shiozawa, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Keiko Hirano, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Fuminori Odagiri, MD (Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan)
Haruna Tabuchi, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Hidemori Hayashi, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Gaku Sekita, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)
Takashi Tokano, MD (Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan)
Yuji Nakazato, MD (Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan)
Hiroyuki Daida, MD (Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 45 weeks

 

Abstract | Full Text

Background: Paroxysmal atrioventricular block (P-AVB) is a well-known cause of syncope; however, its underlying mechanism is difficult to determine. This study aimed to evaluate a new ECG index, the “vagal score (VS),” to determine the mechanism of P-AVB. Methods: We evaluated the VS in 20 patients with P-AVB (13 men, 7 women; aged 25–78 years [mean, 59.3 years]). The VS was developed by assigning 1 point each for the following: (1) no AVB or intraventricular conduction disturbance on the baseline ECG, (2) PR prolongation immediately before P-AVB, (3) sinus slowing immediately before P-AVB, (4) initiation of P-AVB by PP prolongation, (5) sinus slowing during ventricular asystole, and (6) resumption of AV conduction with PP shortening, and by assigning –1 point each for (7) the initiation of P-AVB by a premature beat, and (8) resumption of AV conduction by an escape beat. Based on the clinical situations and electrophysiologic findings, we considered the mechanism of P-AVB as vagally mediated or intrinsic conduction disease (ICD). Results: The VS ranged from 5 to –2 points for each patient. Five patients with a definite vagally mediated P-AVB had high VSs (3–5 points). We observed characteristic ECG findings of ICD consisting of changes in AV conduction by an extrasystole and/or escape beat in only 5 of the 6 patients (83%) with a low VS (1 to –2). Conclusions: The VS is simple and potentially useful for determining the mechanism of P-AVB. P-AVB with a VS ≥3 strongly suggested a vagally mediated mechanism.