Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement

Jordán-Martínez, Laura; Bermúdez-Jiménez, Francisco; Jiménez‐Jáimez, Juan; Alzueta, Javier; Barrera-Cordero, Alberto; Rivera-Fernández, Ricardo; Álvarez, Miguel; Tercedor, Luís

doi:10.1016/j.rec.2019.09.028

Cited by 4 publications

(13 citation statements)

References 25 publications

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“…Although common clinical practice supports such an observation this is the first time such data is presented, as former studies lacked dosage characterization. [4][5][6][7][8][9] Nonetheless, even in the cohort with the highest dosage and Interestingly, we were able to obtain prior ECG data for most of the population, which was not available in previous reports. It demonstrated an overall very high burden of conduction abnormalities, and this was consistent even for the cohort with initial recovery of rhythm and late recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 However, such bradyarrhythmia can be associated with extrinsic causes, most notably myocardial infarction (MI), AV nodal blocking drugs (such as beta-blockers and some calcium channel blockers) and metabolic disorders such as hyperkaliemia, some of which are potentially reversible. 3 In about 20%−50% of "iatrogenic" AVB there is recovery of rhythm with suspension and correction of secondary causes [4][5][6][7] and, in such cases, a permanent pacemaker (PPM) implantation is not recommended. 1,2 Nevertheless, in short follow-up studies only about 10%−15% of patients are able to maintain a sustained recovery.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Nevertheless, in short follow-up studies only about 10%−15% of patients are able to maintain a sustained recovery. 4,6,8 There is a general perception of frequent recurrences in this population though the actual rate of patients that require a PPM and their prognosis is largely unknown as studies with long-term follow-up are scarce. 5,8,9 Our goal was to characterize the population of patients with an index event of atrioventricular block secondary to transient causes, assessing predictors of recovery, and to follow those which resolved after its correction in a long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Santos,

Martinho,

Ferreira

et al. 2024

Pacing Clinical Electrophis

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BackgroundAtrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long‐term recurrence are lacking.MethodsPatients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis.ResultsIn a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2–47.5 (p = .03)); greater serum potassium levels (OR 2.3; CI 95% 1.28–4.0 (p < .01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13–4.4 (p = .02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02–40.3 (p < .01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8–15.1 (p < .01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19–1.5 (p = .23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow‐up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm.ConclusionsRecovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow‐up warrants a close follow‐up or PPM implantation at index admission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Santos,

Martinho,

Ferreira

et al. 2024

Pacing Clinical Electrophis

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“…This conclusion follows the observation that most AV blocks cannot be attributed to medication alone, with drugs being a mere trigger of an underlying condition. In addition, delay in PM implantation may result in adverse effects on both the patient's quality of life and long-term prognosis as well as the financial burden on the healthcare system resulting from repeated and prolonged hospitalizations [1,18]. Considering these effects, a paradigm shift appears to be necessary, and there are already recommendations for the implantation of a PM despite bradycardic treatment, under certain conditions [19].…”

Section: Discussionmentioning

confidence: 99%

Beta-Blocker-Related Atrioventricular Conduction Disorders—A Single Tertiary Referral Center Experience

Marcu

Adam²,

Dorobantu

et al. 2022

Medicina

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Background and Objectives: Drug-related bradyarrhythmia is a well-documented major adverse event among beta-blocker users and a potential cause for hospitalization or additional interventions. Whether beta-blocker use is associated with specific bradyarrhythmia presentations, and how this relates to other predisposing factors, is not well known. We aim to evaluate the association between beta-blocker use and the type of atrioventricular (AV) conduction disorder in patients with symptomatic bradycardia. Materials and Methods: We conducted a retrospective cohort study on 596 patients with a primary diagnosis of symptomatic bradyarrhythmia admitted to a single tertiary referral center. Of the cases analyzed, 253 patients were on beta-blocker treatment at presentation and 343 had no bradycardic treatment. We analyzed demographics, clinical and paraclinical parameters in relation to the identified AV conduction disorder. A multivariate regression analysis was performed to explore factors associated with beta-blocker use. Results: Of the 596 patients (mean age 73.9 ± 8.8 years, 49.2% male), 261 (43.8%) had a third-degree AV block, 92 (15.4%) had a second-degree AV block, 128 (21.5%) had slow atrial fibrillation, 93 (15.6%) had sick sinus syndrome and 21 (3.5%) had sinus bradycardia/sinus pauses. Beta-blocker use was associated with the female gender (p < 0.001), emergency admission (p < 0.001), dilated cardiomyopathy (p = 0.003), the lower left ventricular ejection fraction (p = 0.02), mitral stenosis (p = 0.009), chronic kidney disease (p = 0.02), higher potassium levels (p = 0.04) and QRS duration > 120 ms (p = 0.02). Slow atrial fibrillation (OR = 4.2, p < 0.001), sick sinus syndrome (OR = 2.8, p = 0.001) and sinus bradycardia/pauses (OR = 32.9, p < 0.001) were more likely to be associated with beta-blocker use compared to the most common presentation (third-degree AV block), after adjusting for other patient characteristics. Conclusions: Beta-blocker use is more likely to be associated with slow atrial fibrillation, sick sinus syndrome and sinus bradycardia/pauses, compared to a second- or third-degree AV block, after adjusting for other patient factors such as gender, admission type, ECG, comorbidities, cardiac function and lab testing.

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“…Although the inducing agent is appropriately discontinued, this is not the case for almost half of the patients due to the persistence or recurrence of high-grade AVB (ref. 6,7 ). It is not clear whether DR-AVB reversal will be achieved in a given patient and how long to wait before deciding permanent pacemaker implanta-tion 8 .…”

Section: Introductionmentioning

confidence: 99%

Myringosclerosis as a predictor of the requirement for a permanent pacemaker in patients with drug-related atrioventricular block

Coşgun¹,

Hamur²,

Değirmenci³

et al. 2022

BIOMED PAP

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Aims. Drug-related atrioventricular block (DR-AVB) may develop in patients with underlying latent degenerative conduction disorders, especially with antiarrhythmics and antihypertensives. Although, according to the current guidelines, reversal is achieved with cessation of the inducing agent, this is not the case for nearly half of the patients. The pathophysiological processes of DR-AVB and myringosclerosis include systemic inflammation and degeneration. This study investigated the role of myringosclerosis in predicting irreversible high-grade DR-AVB despite drug cessation. Methods. This observational, non-randomized, prospective study involved 152 patients with high-grade DR-AVB, 72 of whom had reversible DR-AVB and 80 had irreversible DR-AVB and required permanent pacemakers. The patients' demographic, clinical, echocardiographic, and laboratory characteristics were recorded. Otoscopic tympanic membrane examinations for myringosclerosis were performed. Results. There were no major differences in demographic, echocardiographic or laboratory characteristics between the two groups or previous medications. The median monitoring time with a temporary pacemaker was significantly longer in the irreversible than in the reversible group (5 [4−7] days vs. 2 [1−5] days; P<0.001). The incidence of myringosclerosis was significantly higher in the irreversible than in the reversible group (61.3% vs. 22.2%; P=0.001). Multivariate logistic regression analysis showed that myringosclerosis was an independent predictor of irreversible DR-AVB (odds ratio: 1.703, 95% confidence interval: 1.194-3.058; P=0.01). Conclusion.Myringosclerosis is a readily available, inexpensive, and non-invasive assessment and is a marker of inflammation and degeneration that can predict irreversible DR-AVB.

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Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement

Cited by 4 publications

References 25 publications

Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Atrioventricular block secondary to transient causes and long‐term recurrence after an index event

Beta-Blocker-Related Atrioventricular Conduction Disorders—A Single Tertiary Referral Center Experience

Myringosclerosis as a predictor of the requirement for a permanent pacemaker in patients with drug-related atrioventricular block

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