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Komatsu S, Sumiyoshi M, Miura S, et al. A proposal of clinical ECG index "vagal score" for determining the mechanism of paroxysmal atrioventricular block. J Arrhythm. 2016;33(3):208-213doi: 10.1016/j.joa.2016.10.004.
Komatsu, S., Sumiyoshi, M., Miura, S., Kimura, Y., Shiozawa, T., Hirano, K., Odagiri, F., Tabuchi, H., Hayashi, H., Sekita, G., Tokano, T., Nakazato, Y., & Daida, H. (2017). A proposal of clinical ECG index "vagal score" for determining the mechanism of paroxysmal atrioventricular block. Journal of arrhythmia, 33(3), 208-213. https://doi.org/10.1016/j.joa.2016.10.004
Komatsu, Sayaka, et al. "A proposal of clinical ECG index "vagal score" for determining the mechanism of paroxysmal atrioventricular block." Journal of arrhythmia vol. 33,3 (2017): 208-213. doi: https://doi.org/10.1016/j.joa.2016.10.004
Komatsu S, Sumiyoshi M, Miura S, Kimura Y, Shiozawa T, Hirano K, Odagiri F, Tabuchi H, Hayashi H, Sekita G, Tokano T, Nakazato Y, Daida H. A proposal of clinical ECG index "vagal score" for determining the mechanism of paroxysmal atrioventricular block. J Arrhythm. 2017 Jun;33(3):208-213. doi: 10.1016/j.joa.2016.10.004. Epub 2016 Nov 09. PMID: 28607616; PMCID: PMC5459424.
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J Arrhythm. 2017 Jun;33(3):208-213. doi: 10.1016/j.joa.2016.10.004. Epub 2016 Nov 09.

A proposal of clinical ECG index "vagal score" for determining the mechanism of paroxysmal atrioventricular block.

Journal of arrhythmia

Sayaka Komatsu, Masataka Sumiyoshi, Seiji Miura, Yuki Kimura, Tomoyuki Shiozawa, Keiko Hirano, Fuminori Odagiri, Haruna Tabuchi, Hidemori Hayashi, Gaku Sekita, Takashi Tokano, Yuji Nakazato, Hiroyuki Daida

Affiliations

  1. Department of Cardiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan.
  2. Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan.
  3. Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan.

PMID: 28607616 PMCID: PMC5459424 DOI: 10.1016/j.joa.2016.10.004

Abstract

BACKGROUND: Paroxysmal atrioventricular block (P-AVB) is a well-known cause of syncope; however, its underlying mechanism is difficult to determine. This study aimed to evaluate a new ECG index, the "vagal score (VS)," to determine the mechanism of P-AVB.

METHODS: We evaluated the VS in 20 patients with P-AVB (13 men, 7 women; aged 25-78 years [mean, 59.3 years]). The VS was developed by assigning 1 point each for the following: (1) no AVB or intraventricular conduction disturbance on the baseline ECG, (2) PR prolongation immediately before P-AVB, (3) sinus slowing immediately before P-AVB, (4) initiation of P-AVB by PP prolongation, (5) sinus slowing during ventricular asystole, and (6) resumption of AV conduction with PP shortening, and by assigning -1 point each for (7) the initiation of P-AVB by a premature beat, and (8) resumption of AV conduction by an escape beat. Based on the clinical situations and electrophysiologic findings, we considered the mechanism of P-AVB as vagally mediated or intrinsic conduction disease (ICD).

RESULTS: The VS ranged from 5 to -2 points for each patient. Five patients with a definite vagally mediated P-AVB had high VSs (3-5 points). We observed characteristic ECG findings of ICD consisting of changes in AV conduction by an extrasystole and/or escape beat in only 5 of the 6 patients (83%) with a low VS (1 to -2).

CONCLUSIONS: The VS is simple and potentially useful for determining the mechanism of P-AVB. P-AVB with a VS ≥3 strongly suggested a vagally mediated mechanism.

Keywords: Electrocardiogram (ECG); Intrinsic conduction disease; Mechanism; Paroxysmal atrioventricular block; Vagally mediated

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