Case of successful treatment of second-degree AV block in patient with gastroesophageal reflux disease associated with hiatal hernia

Abstract

Clinical observation of a young patient without an organic pathology of the heart, who repeatedly sought medical help in connection with complaints of episodes of dizziness, lability of blood pressure and pulse numbers, is presented. The medical survey revealed a link between clinical symptoms and progressive retardation of AV conduction (from first-degree AV block to second-degree Mobitz II), and therefore the patient was recommended to be implanted with permanent artificial cardiac pacemaker. To clarify the nature of the conduction disorders, an invasive electrophysiology study was performed, which revealed a proximal AV block due to vagal influences. As the most likely cause of stimulation n. vagus was considered identified in a patient gastroesophageal reflux disease associated with hiatal hernia. Surgical treatment (laparoscopic fundoplication) led to a regression of the clinical and electrocardiographic picture, avoiding the implantation of permanent artificial cardiac pacemaker. The tactic chosen is consistent with the algorithm for managing patients with AV conduction abnormalities (2018 ACC / AHA / HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay), which involves eliminating potentially reversible causes of bradyarrhythmia before deciding whether to install permanent artificial cardiac pacemaker.