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

Abstract

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.

Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process

“…Over the past decades, researchers in the field have been constantly concerned with identifying new molecules to explain the pathophysiological mechanisms underlying the connection between ON and MS [ 176 ]. In the era of polymedicine, the identification of effective therapeutic molecules with a reduced degree of interaction with the medication of other pathologies (especially those with cardiological target) [ 177 , 178 , 179 ]. CSF analysis revealed the presence of central nervous system autoimmune markers such as glial fibrillary acidic protein-IgG, with diagnostic, therapeutic, and prognostic roles alike [ 180 ].…”

The Evolution of Pulmonary Hypertension and Its Prognostic Implications Post-TAVI—Single Center Experience

“…Periprocedural risks have also been reported among men, who have a higher risk of acute kidney injury and need of pacemaker implantation. TAVI is predominantly performed in elderly patients who have an increased risk of adverse effects both associated with the previously administered bradycardia medication and the periprocedural risk of atrioventricular conduction disorders, which requires special consideration [29][30][31].…”

Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects

“…Although bradycardia is thought to be a cardinal symptom of beta-blockers, it was only demonstrated in 3 out of 13 patients’ initial ECG. 65 , 66 However, QTc prolongation is a well-known ECG parameter which correlates with mortality in a wide range of acute poisoning episodes. 67 …”