AV Block with Increased PR Interval

Dear Dr. Dean,

My physician informed me that I have an AV block with an increased PR interval, and may eventually need a pace maker if the block gets worse.

I’m 77 years old and still exercise moderately on the elliptical and with light weights without any immediate fatigue.

Can you recommend any Life Enhancement products that would be helpful in correcting or slowing down the AV block from getting worse?

Sincerely,
ARTHUR, Novato, CA

Dear Arthur,

Heart block (atrioventricular block, aka AV block) is an abnormal heart rhythm where the heart beats too slowly (bradycardia). In this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers (atria) and the lower chambers (ventricles).

A normal heartbeat is initiated by an electrical signal from the heart’s pacemaker, the sinoatrial (SA) node, located at the top of the right atrium. The electrical signal travels through the atria and reaches the atrioventricular (AV) node. After crossing the AV node, the electrical signal passes through the bundle of His. This bundle then divides into thin, wire-like structures called bundle branches that extend into the right and left ventricles. The electrical signal travels down the bundle branches and eventually reaches the ventricles, causing them to contract. Heart block occurs when this passage of electricity from the top to the bottom of the heart is delayed or interrupted.

There are several degrees of heart block (Fig. 1):

  • First-degree heart block — The electrical impulses are slowed as they pass through the conduction system, but they all successfully reach the ventricles. First-degree heart block rarely causes symptoms or problems. Well-trained athletes may have first-degree heart block. Medications can also cause this condition. No treatment is generally needed for first-degree heart block.

  • Second-degree heart block (Type I) — The electrical impulses are delayed further and further with each heartbeat until a beat fails to reach to the ventricles entirely. It sometimes causes dizziness and/or other symptoms. People with normal conduction systems may sometimes have type 1 second degree heart block when they sleep.

  • Second-degree heart block (Type II) — With this condition, some of the electrical impulses are unable to reach the ventricles. This condition is less common than Type I, and is more serious. A pacemaker may be required to treat type II (second degree heart block), as it frequently progresses to third degree heart block.

  • Third-degree heart block — also called complete heart block—occurs when none of the electrical impulses from the atria reach the ventricles. When the ventricles (lower chambers) do not receive electrical impulses from the atria (upper chambers), they may generate some impulses on their own, called junctional or ventricular escape beats. Ventricular escape beats, the heart’s naturally occurring backups, are usually very slow. Patients frequently feel poorly in complete heart block, with lightheadedness and fatigue.

Figure 1. Four degrees of heart block.

LEM1503DeanFig1_274.jpg

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Depending on the degree of the block, some people with heart block may not experience any symptoms. Others will have symptoms that may include fainting (syncope), dizziness lightheadedness, chest pain, and shortness of breath.

Heart block can thus be considered to be a neurodegenerative disease of aging, as the likelihood of heart block increases as we get older. It is also associated with fibrosis of the heart, and dysregulation of the bio-electric conduction system. As your physician suggested, the only orthodox approach to progressive heart block is the placement of a pacemaker.

I’m not aware of any well-studied natural approaches to this condition, but here are some suggestions, based on a reasonable approach.

First, continue your moderate intensity exercise as you described.

In the 1930s, scientists identified a connection between deficiencies of B vitamins and heart block in rats and pigeons.1,2 The scientists induced heart block and arrhythmias by feeding a diet of polished rice—and reversed the condition by adding wheat germ or brewer’s yeast to the diet (both known to contain high quantities of the known and then-unknown B factors).

Consequently, I recommend that you insure an adequate intake of the entire B complex spectrum, as in Bio­Enhance with DNAble. An additional B factor that I recommend to my patients with any kind of neuropathy is Benfotiamine, a fat-soluble form of vitamin B1. Benfotiamine has been shown to improve vascular endothelial function and to enhance heart cell function in diabetics.3,4

Magnesium and potassium contribute essentially to the electrical stability of the heart. Magnesium-potassium aspartate has been used therapeutically for many years to enhance cardiac function and to protect against arrhythmias.

In 1967, German scientists compared the outcomes in three groups of patients who suffered an acute myocardial infarction:5

Figure 2. Dr. Hans Nieper’s schematic of how mineral aspartates and orotates enhance intracellular mineral transport.

LEM1503DeanFig2_274.jpg

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An American study included 232 patients with frequent ventricular arrhythmias (> 720 ventricular premature beats [VPBs]/24 hours), who were treated for 3 weeks with either oral magnesium-potassium aspartate or placebo.6

In 2007, Chinese scientists studied the protective effects of magnesium-potassium aspartate in 98 patients with angina and arrhythmia due to coronary artery disease.7

Although none of the above three studies examined the effect of magnesium-potassium aspartate on heart block, per se, I think the overall beneficial effects on normalizing cardiac rhythm imply that magnesium-potassium aspartate would also be beneficial for the conduction defects which result in heart block of any degree. LEP’s On Target Magnesium Plus contains magnesium aspartate. Take as directed on the label. LEP’s Potassium Basics contains potassium bicarbonate.

A third mineral salt that may help is lithium orotate. Orotic acid is a mineral transporter that helps transport minerals into the cells. Consequently lithium orotate is 20 times more bio-available than the prescription forms of lithium (citrate and carbonate), where it specifically normalizes the cells of the heart’s pacemaker.8

CoQ10 and Carnitine are both important for congestive heart failure and cardiac bioenergetics,9

Finally, I suggest IV or oral chelation with LEP’s Oral Chelator Complex. This will eliminate toxic heavy metals (which may depress electro-conductivity in the AV node), improve blood flow, and reduce myocardial fibrosis (another contributor to AV block) via its ability to inhibit cross-linkages.

Again, all of the above suggestions are admittedly guesswork—but they are educated guesswork based on the known mechanisms of the above-listed nutrients, and should counter the possible causes of heart block. Let me know how you do.

Ward Dean, MD

References

  1. Carter CW. Heart block in pigeons, curative factor. Biochem J. 1930; 24(6):1811 – 9.
  2. Carter CW. Maintenance nutrition in the pigeon and its relation to heart block. Biochem J. 1934;28(3):933 – 9.
  3. Stirban A, Negrean M, Stratmann B, Gawlowski T, Horstmann T, Gotting C et al. Benfotiamine prevents macro- and microvascular endothelial dysfunction and oxidative stress following a meal rich in advanced glycation end products in individuals with type 2 diabetes. Diabetes Care. 2006; 29(9):2064 – 71.
  4. Asli F, Ceylan-Isik , Shan Wu , et al. High-dose benfotiamine rescues cardiomyocyte contractile dysfunction in streptozotocin-induced diabetes mellitus. J Appl Physiol. 2006;100 (1):150 – 6.
  5. Stepantschitz G, Frohlich E: Vorlaufige Mittellung uber Verwendung sogenannter Elektrolvtschlepper bei Myokardinfarkt. Wein Med Wschr. 1967;117:884 – 9.
  6. Zehender M, Meinertz T, Faber T, et al. Antiarrhythmic effects of increasing the daily intake of magnesium and potassium in patients with frequent ventricular arrhythmias. Magnesium in Cardiac Arrhythmias (MAGICA) Investigators. J Am Coll Cardiol. 1997 Apr;29(5):1028 – 34.
  7. Zhi YF, Huang YS, Xu BS, and Wang SR. [Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Nov;19(11):662 – 6.
  8. Nieper H. Dr. Nieper’s Revolution in Technology, Medicine and Society. Oldenburg: Druckhaus Neue Stalling; 1985.
  9. Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine, Revised 2nd Ed. Rocklin, CA: Prima Publishing; 1997.

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