In Mobitz type II second-degree atrioventricular block, what is the typical sequence of management?

In Mobitz type II second-degree atrioventricular block, what is the typical sequence of management?

• A. Transcutaneous pacing initially
• B. Permanent pacemaker
• C. Transcutaneous pacing initially followed by permanent pacemaker
• D. Observation

Answer: (C)

Mobitz type II blocks carry a real danger of sudden progression to complete heart block, so management aims to stabilize the patient first and then provide definitive pacing. If the patient is unstable or symptomatic, immediate temporary pacing is needed to maintain heart rate and cardiac output. Transcutaneous pacing can bridge the patient through the acute phase while you arrange definitive therapy. Once stabilization is achieved, a permanent pacemaker is placed because the underlying conduction disturbance is usually fixed in the His-Purkinje system and unlikely to improve. Observation alone is inappropriate due to the risk of sudden deterioration, and starting with a permanent pacemaker without bridging support would leave an unstable patient unmanaged in the short term.

Mobitz type II blocks carry a real danger of sudden progression to complete heart block, so management aims to stabilize the patient first and then provide definitive pacing. If the patient is unstable or symptomatic, immediate temporary pacing is needed to maintain heart rate and cardiac output. Transcutaneous pacing can bridge the patient through the acute phase while you arrange definitive therapy. Once stabilization is achieved, a permanent pacemaker is placed because the underlying conduction disturbance is usually fixed in the His-Purkinje system and unlikely to improve. Observation alone is inappropriate due to the risk of sudden deterioration, and starting with a permanent pacemaker without bridging support would leave an unstable patient unmanaged in the short term.