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Complete Heart Block Pacing — RACP Adult Medicine MCQ

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EasyCardiologyComplete Heart Block PacingRACP Adult Medicine

A 65-year-old man presents with complete heart block (CHB) and a ventricular rate of 32 bpm. He is haemodynamically stable but symptomatic with dizziness. His CHB is not due to a reversible cause. What is the definitive treatment?

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Correct answer: B — Permanent pacemaker implantation

Symptomatic complete heart block (third-degree AV block) without a reversible cause (e.g., drug effect, acute MI, myocarditis) is a Class I indication for permanent pacemaker implantation. While temporary measures (atropine, isoprenaline, transcutaneous pacing) may be needed acutely for haemodynamic support, they are bridges to definitive therapy. The pacing mode depends on the presence/absence of AF and sinus node function (DDD for CHB with sinus rhythm; VVI for CHB with permanent AF).

Reference: eTG – 2025 – Cardiovascular; ESC – 2021 – Cardiac Pacing Guidelines