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Drugs that slow the conduction of the electrical signal through AV node, such as beta-blockers, digoxin, calcium channel blockers, and amiodarone, can cause heart block if they are taken in excessive amounts, or the levels in the blood get too high.
The medications that most commonly cause first-degree heart block are those that increase the refractory time of the AV node, thereby slowing AV conduction. These include calcium channel blockers, beta-blockers, cardiac glycosides, and anything that increases cholinergic activity such as cholinesterase inhibitors. [2]
Via indirect action, it leads to an increase in acetylcholine production, stimulating M2 receptors on AV node leading to an overall decrease in speed of conduction. Magnesium sulfate is an antiarrhythmic drug, but only used against very specific arrhythmias [ 14 ] such as torsades de pointes .
Unless a pacemaker is present, beta blockers can severely depress conduction in the AV node, resulting in a reduction of heart rate and cardiac output. One should be very cautious with the use of beta blockers in tachycardia patients with Wolff-Parkinson-White Syndrome, as it can result in life-threatening arrhythmia in certain patients.
Atropine is also useful in treating second-degree heart block Mobitz type 1 (Wenckebach block), and also third-degree heart block with a high Purkinje or AV-nodal escape rhythm. It is usually not effective in second-degree heart block Mobitz type 2, and in third-degree heart block with a low Purkinje or ventricular escape rhythm. [citation needed]
A dromotropic agent is one which affects the conduction speed (in fact the magnitude of delay [1]) in the AV node, and subsequently the rate of electrical impulses in the heart. [2] [3] Positive dromotropy increases conduction velocity (e.g. epinephrine stimulation), negative dromotropy decreases velocity (e.g. vagal stimulation). [4]
Third-degree atrioventricular block (AV block) is a medical condition in which the electrical impulse generated in the sinoatrial node (SA node) in the atrium of the heart can not propagate to the ventricles. [1] Because the impulse is blocked, an accessory pacemaker in the lower chambers will typically activate the ventricles.
Flecainide is a medication used to prevent and treat abnormally fast heart rates. [1] This includes ventricular and supraventricular tachycardias. [1] Its use is only recommended in those with dangerous arrhythmias or when significant symptoms cannot be managed with other treatments. [1]
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