Atropine for Mobitz II AV blocks

[Jabbed]

ACLS guidelines suggest atropine as an initial intervention for unstable Mobitz II, but this doesn't make sense to me physiologically. Given that the parasympathetic innervation of the heart is sparse below the AV node, wouldn't atropine instigate a higher degree AV block given that the lesion is infranodal?

@Instatewaiter

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[Levo]

Deleted

 

[pericardium]

ACLS guidelines have changed over the years, and what may make sense physiologically may not be used as a guideline in real life for the sake of simplicity

 

[TooMuchResearch]

It's easy to have someone give atropine while you decide on your next intervention. Maybe you read the ECG wrong, maybe the atropine will help.

 

[Instatewaiter]

ACLS guidelines suggest atropine as an initial intervention for unstable Mobitz II, but this doesn't make sense to me physiologically. Given that the parasympathetic innervation of the heart is sparse below the AV node, wouldn't atropine instigate a higher degree AV block given that the lesion is infranodal?

@Instatewaiter

So I agree, that Atropine is largely worthless. But not all Mobitz two is infranodal as theclassic teaching is (although the lions share is infranodal/infrahissian). In my experience, usually atropine just does nothing.

The Real treatment is placement of a temporary pacemaker wire if unstable. However, not everyone is able to do that and ACLS is meant for the noncardiologists. It is meant to be mindless. So AC LS does not allow for thought or intricacy becase that will confuse people. If I have a guy who I know was ischemic and is having VT, I'm not going to choose amiodarone. I'm choosing Lidocaine. But acls does allow for that. Forget the data about amio and procainamide for VT, they have you choose amiodarone because it will also treat supraventricular arrhythmias and not everyone doing ACLS will be able to figure out what is VT and what is SVT