Serie of Vagal-Mediated AV Block About 2 Cases

Vagally mediated atrioventricular (AV) block is defined as a paroxysmal AV block, localized within the AV node, associated with slowing of the sinus rate. All types of second-degree AV block, including pseudo-Mobitz II block, and complete AV block, may be present. In this article, we present a serie of 2 patients with recurrent syncope accompanied by transient second AV block at Ibn Rochd University Hospital in Casablanca – Morocco.

Our patient were a 30-year-old man and a 23 years old woman. They were referred for recurrent syncope which was not associated with any other symptoms nor special medical history. At their admission, the clinical examinations were generally normal, their paraclinical exams too, including ECG; echocardiography and biological data. In both of cases the Holter-ECG revealed transient AV block, and their explorations of autonomic nervous system showed major vagal hyperactivity. Effort test was performed too for searching AV block at effort, but they with no particularity. For treatment, we suggested a therapeutic plan composed of lifestyle modification and other measures. Pacing was not indicated considering the good improvement after two years of treatment and serious follow-up.

Physiological vagally hypertonia is frequent at young and athlets people. Vagally mediated atrioventricular (AV) block is defined as a paroxysmal AV block associated with slowing of the sinus rate secondary to a surge in parasympathetic activity. Syncope is a common symptom and it may be associated with identifiable trigger. It may be asymptomatic as noticed on Holter recordings. Extrinsic vagal AVB also known as vasovagal syncope, which is typically treated with lifestyle modification, isotonic maneuvers, and rarely medication or pacemaker insertion.

Informed consent was obtained from all patients prior to their inclusion in this case report. All patients were informed of the case report’s purpose. Measures were taken to protect the confidentiality and privacy of patients. We disclose no conflicts of interest that may have influenced the publication.