Heart block disrupts the heart’s electrical signals, causing a slow or irregular heartbeat. It can be congenital or develop after heart surgery, and there are three types with varying severity. Type I may not require treatment, while Type II and III may need a pacemaker to regulate the heart’s rhythm.
Heart block causes problems with the way the heart transmits electrical signals and, depending on the type, can stop or slow the heart rhythm and pose serious risks. Although the name seems to involve blocked arteries or blood flow to the heart, this condition really refers to how the atria send electrical signals to the ventricles to keep them in a steady rhythm. When this conduction pathway is slowed down or completely disrupted, the heart may beat more slowly or beat so inefficiently that it cannot circulate blood adequately. The severity of this condition and its need for treatment depends on the type and generally three types are discussed (types I, II and III).
There are several circumstances in which any form of heart block can occur. Sometimes it is a congenital condition, appearing in some babies before they are even born. It can result after heart surgery to treat congenital heart defects or adult heart disease. Some athletes develop it at any point in life. Older adults with or without various types of heart disease can also have heart block, and the latter group tends to be the largest.
The types of heart block indicate its symptoms and the need for treatment. Type I refers to a situation in which small delays in signaling from the atria to the ventricles and have no symptoms or require medical intervention. An electrocardiogram (ECG) shows delays, but many don’t know they have type I because ECGs aren’t routine tests. This form of signal dysfunction is benign, may never progress to another type, and poses no risk of problems. The heart can work very well with very little signal delay.
Type II can be more severe, and there are at least two subtypes of this form of heart block. In one subtype, some electrical signals don’t get to the ventricles and this can cause “skipped” beats, which also cause symptoms such as dizziness. A more serious form is called Mobitz type II and many signals are missing from the ventricles creating a heart rhythm that is too slow. This second type requires treatment: Often a pacemaker is needed to regulate the rhythm.
Type III or complete heart block also requires implantation of a pacemaker because no signals from the atria reach the ventricles. The heart rate is significantly slowed because the ventricles rely on their own conduction system, which is inadequate. Without treatment with a pacemaker, heart attack or heart failure can occur, and death is possible.
If this condition occurs in any of its forms, patients will be referred to a cardiologist or electrophysiologist to diagnose the type and look for any other diseases that may be contributing factors. As stated, some forms of Type I and Type II may not need treatment, but Mobitz Type II and complete heart block benefit from rhythm regulation to keep the heart functioning. Pacemaker implantation is a common surgery, and many patients who undergo it leave the hospital within a day or two of the surgery.
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