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Complete Heart Block — EECC MCQ

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EasyArrhythmia & ElectrophysiologyComplete Heart BlockEECC

A 78-year-old woman presents with syncope and bradycardia. ECG shows complete (third-degree) heart block with a ventricular escape rate of 35 bpm and broad QRS morphology. She has no reversible cause identified. What is the most appropriate management?

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Correct answer: B — Permanent dual-chamber (DDD) pacemaker implantation

Complete heart block with syncope and a slow, broad-complex ventricular escape rhythm requires permanent pacing (Class I). A dual-chamber (DDD) pacemaker is preferred over single-chamber VVI pacing to maintain AV synchrony and reduce the risk of pacemaker syndrome (retrograde VA conduction causing symptoms). Temporary pacing is indicated as a bridge only if there is haemodynamic compromise requiring urgent stabilisation before permanent implant. Atropine is unlikely to be effective in infranodal block (broad QRS escape) as the block is below the level of vagal influence. The 2024 ESC Pacing Guidelines recommend DDD as the default pacing mode for AV block.

Reference: ESC (2021): Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy