In a patient with symptomatic third-degree AV block and syncope, what is the definitive treatment?

• A. No treatment
• B. Permanent pacemaker
• C. Digitalis therapy
• D. Ablation therapy

Answer: (B)

Symptomatic complete heart block means the ventricles aren’t receiving impulses from the atria, so the heartbeat relies on a slow escape rhythm that can cause syncope and hemodynamic instability. The definitive treatment is a permanent pacemaker, which provides reliable pacing of the ventricles (and often both chambers) independent of atrial activity. This prevents bradycardia-induced syncope and improves long-term outcomes.

No treatment would leave the bradyarrhythmia unchecked and risky. Digitalis would worsen conduction in complete AV block, potentially making the block worse. Ablation targets other rhythm problems and would not restore reliable conduction in a complete block; it could remove conduction tissue and not solve the need for ongoing pacing.