What is the definitive treatment for Mobitz type II second-degree heart block?

What is the definitive treatment for Mobitz type II second-degree heart block?

• A. Permanent pacemaker
• B. Temporary transcutaneous pacing
• C. Digoxin therapy
• D. Catheter ablation

Answer: (A)

Mobitz type II second-degree AV block is a fixed conduction problem in the His-Purkinje system, where impulses intermittently fail to reach the ventricles and the risk of progressing to complete heart block is high. Because of this unstable conduction and the potential for sudden bradycardia, definitive management requires a permanent pacemaker to provide a reliable ventricular rhythm and maintain adequate heart rate. Temporary transcutaneous pacing can stabilize someone in the acute setting, but it isn’t a lasting solution. Digoxin worsens AV block by slowing conduction through the AV node and is not appropriate here. Catheter ablation targets specific arrhythmias but would not cure this intrinsic conduction disease; in fact, ablating the conduction tissue could worsen block and necessitate a pacemaker anyway. A permanent pacemaker, often dual-chamber to maintain AV synchrony, is the appropriate long-term treatment.

Mobitz type II second-degree AV block is a fixed conduction problem in the His-Purkinje system, where impulses intermittently fail to reach the ventricles and the risk of progressing to complete heart block is high. Because of this unstable conduction and the potential for sudden bradycardia, definitive management requires a permanent pacemaker to provide a reliable ventricular rhythm and maintain adequate heart rate.

Temporary transcutaneous pacing can stabilize someone in the acute setting, but it isn’t a lasting solution. Digoxin worsens AV block by slowing conduction through the AV node and is not appropriate here. Catheter ablation targets specific arrhythmias but would not cure this intrinsic conduction disease; in fact, ablating the conduction tissue could worsen block and necessitate a pacemaker anyway. A permanent pacemaker, often dual-chamber to maintain AV synchrony, is the appropriate long-term treatment.