Poor prognosis in young patients with atrioventricular block of unknown aetiology: who is to blame? The physician or the pacemaker?

International audience; The rate of permanent pacemaker (PPM) implantation is still growing in Europe, due in part to population ageing with an increased risk of developing conduction diseases. Although most PPM recipients are elderly patients, some young patients experience atrioventricular block (AVB) requiring PPM. In a recent study by Rudbeck-Resdal et al. evaluating AVB in young patients, the estimated incidence of developing AVB before 50 years of age was 17.7/year/million inhabitants throughout their 20-year nationwide study period.1 The aetiology of AVB was identified in only half of the patients. The most frequent causes were complications to cardiac surgery (15.3%), congenital AVB or congenital heart disease (9.0% and 4.2%, respectively), and cardioinhibitory reflex (5.0%). An underlying cardiomyopathy or sarcoidosis were uncommon causes in this specific population.