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

Abstract

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.