Wenckebach: Insights on Second-Degree AV Block and Symptoms

Atrioventricular block

Hello Doctor: For the past month, I have been feeling a lot of stress and discomfort in my heart.
Occasionally, it feels like my heart skips a beat.
I went to the hospital for an echocardiogram, and the results showed no issues with my heart, except for a very mild tricuspid valve regurgitation.
The doctor said it was nothing to worry about.
I had a 24-hour Holter monitor, and during the day, I didn't experience any skipped beats, but at night, there were two instances where my heart paused for two seconds.
The doctor reviewed the ECG and measured the relevant intervals, telling me that my symptoms are consistent with Wenckebach phenomenon, which may be age-related and indicative of second-degree type I AV block.
He reassured me that it is not serious, that I do not need medication, and that it will not progress to second-degree type II AV block.
If it were type II, it would be dangerous and require a pacemaker.
Sometimes, I may go several days without any episodes, and other times, I might have three skipped beats within a minute.

I would like to ask the doctor if this second-degree type I AV block requires continuous monitoring, as I read online that "for first-degree AV block and second-degree AV block type I, patients without poor perfusion symptoms do not require special treatment." Additionally, I have been experiencing tingling in the fingertips of my left hand and my left foot for the past two weeks, but it seems to be improving (though I suspect the foot issue may be related to sciatica).
Initially, it was just the last two fingers, but now it has shifted to the first three fingers.
I was planning to see a neurologist, but I first visited a traditional Chinese medicine practitioner yesterday.
He was aware of the Wenckebach phenomenon but didn't specify which type it was.
He mentioned that it could also cause hand and foot numbness.
After cupping therapy and acupuncture, I felt much better, but he cautioned me to be careful, as there is a possibility of sudden cardiac death.
This made me feel quite anxious, as my cardiologist did not express such concerns.

I would like to ask the doctor if second-degree type I AV block truly does not require medication, if it can worsen over time, if there is a risk of sudden cardiac death, and if it could be causing my hand and foot numbness.
Thank you for taking the time to read my questions.
Thank you.

40-sui nan, 40~49 year old female. Ask Date: 2016/11/16

Dr. He Dongjin reply Cardiology

Hello, don't be nervous, everything is fine.
Especially at night, the heart is resting and there is no risk of sudden death.
Type 2, level 1 really does not require medication and will not worsen.
Numbness in the hands and feet is unrelated, so don't worry.
Changhua Hospital cares about you.

Reply Date: 2016/11/16

More Info

Wenckebach, also known as Mobitz type I second-degree atrioventricular (AV) block, is a condition characterized by a progressive lengthening of the PR interval on an electrocardiogram (ECG) until a beat is dropped. This phenomenon is often benign and can occur in healthy individuals, particularly in younger populations or athletes. It is essential to understand the implications of this condition, especially in the context of your symptoms and overall health.

From your description, it seems that you have been experiencing occasional heart palpitations or missed beats, which were confirmed by a 24-hour Holter monitor. The fact that your echocardiogram showed no significant structural heart disease and that your doctor has classified your condition as Wenckebach suggests that your heart's electrical conduction system is functioning, albeit with some irregularities.
1. Observation and Management: In cases of Mobitz type I, especially when there are no symptoms of poor perfusion (such as dizziness, fainting, or significant fatigue), the standard approach is indeed to monitor the condition rather than initiate treatment. Your doctor’s recommendation to avoid medication is consistent with guidelines for asymptomatic patients with this type of block. Regular follow-up appointments may be necessary to ensure that the condition does not progress.

2. Symptoms and Concerns: You mentioned experiencing numbness in your left hand and foot. While it is understandable to be concerned about these symptoms, they are not typically associated with Wenckebach. Numbness can arise from various causes, including nerve compression, such as in the case of sciatica affecting the lower extremities or carpal tunnel syndrome affecting the hand. It is wise to consult a neurologist if these symptoms persist, as they may require a different line of investigation.

3. Risk of Progression: The risk of Wenckebach progressing to a more severe form of AV block (such as Mobitz type II or complete heart block) is relatively low, especially in the absence of structural heart disease or other risk factors. However, it is essential to remain vigilant and report any new or worsening symptoms to your healthcare provider.

4. Sudden Cardiac Death: The concern about sudden cardiac death in the context of Wenckebach is generally overstated, particularly in asymptomatic individuals. While it is true that any form of heart block can potentially lead to serious complications, the likelihood of this occurring in a healthy individual with Mobitz type I is minimal. Your heart specialist would have assessed your overall risk based on your medical history, physical examination, and diagnostic tests.

5. Lifestyle and Stress Management: Given that you mentioned increased stress levels, it may be beneficial to incorporate stress management techniques into your routine. Practices such as mindfulness, yoga, or regular physical activity can help alleviate stress and may improve your overall cardiovascular health.

In summary, your diagnosis of Wenckebach type I is typically benign, especially in the absence of concerning symptoms. Continuous monitoring and maintaining open communication with your healthcare providers are crucial. If you experience any new symptoms or if your current symptoms worsen, do not hesitate to seek medical advice. It is always better to err on the side of caution when it comes to your health.

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