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Atrioventricular block in aortic insufficiency. Mechanism, ECG features and clinical consequences.

A review of 250 patients with pure aortic insufficiency (AI) and 400 with second or third degree atrioventricular block (AV block) revealed eight patients, seven male and one female, who had both these conditions. The mean age of the eight patients was 51 years (range 39–60). The duration of cardiac symptoms varied from 0 to 30 years. The aetiology of the heart disease was rheumatic fever in four patients, luetic carditis in one, and unknown in three patients. Seven patients had second and third degree AV block and one patient had paroxysmal ventricular standstill. The escape rhythm in the seven patients was nodal, so it seems likely that the occurrence of AV block in patients with AI may be due to mechanical strain on the upper parts of the conduction system, secondary to left ventricular hypertrophy and dilatation. In five patients the onset of AV block was accompanied by severe left heart failure, including pulmonary oedema. The material illustrates that occurrence of AV block may be a contributory cause of sudden deterioration in otherwise well compensated patients with aortic insufficiency.