Beta-Blocker Use and Risk of Symptomatic Bradyarrhythmias: A Hospital-Based Case-Control Study

Quek, Chu Zhen; Lu, Hou Tee; Kam, Ji Yen; Leo, B.; Gunasekaran,; Lee, C.Y.

doi:10.1016/j.ijcard.2017.09.070

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Factors associated with bradyarrhythmia and beta-blocker use are not well known, especially with the type of atrioventricular (AV) conduction disorder at presentation. Further research on this topic is necessary to identify potential risk factors that can predict the occurrence and type of symptomatic bradyarrhythmia [9][10][11].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…To prevent tachycardia and AF symptoms, patients are treated with rate and/or rhythm control therapies . Rate‐lowering drugs (RLDs) and anti‐arrhythmic drugs (AADs) are known to be pro‐arrhythmic that can lead to bradycardia, potentially aggravating the risk of falls and syncope . However, whether RLD and AAD use in patients with AF are associated with a higher risk of fall‐related injuries and syncope is unknown.…”

mentioning

confidence: 99%

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope

Dalgaard

Pallisgaard

Numé

et al. 2019

J American Geriatrics Society

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OBJECTIVES Management of atrial fibrillation (AF) with rate and/or rhythm control could lead to fall‐related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall‐related injuries and syncope in a real‐world older AF cohort. DESIGN A retrospective cohort study. SETTING Danish nationwide administrative registries from 2000 to 2015. PARTICIPANTS A total of 100 935 patients with AF aged 65 years or older claiming prescription of rate‐lowering drugs (RLDs) and/or anti‐arrhythmic drugs (AADs) were included. We compared the use of rate‐lowering monotherapy with rate‐lowering dual therapy, AAD monotherapy, and AAD combined with rate‐lowering therapy. MEASUREMENTS Outcomes were fall‐related injuries and syncope as a composite end point (primary) or separate end point (secondary). RESULTS In this population, the median age was 78 years (interquartile range [IQR] = 72‐84 y), and 53 481 (53.0%) were women. During a median follow‐up of 2.1 years (IQR = 1.0‐5.1), 17 132 (17.0%) experienced a fall‐related injury, 5745 (5.7%) had a syncope, and 21 093 (20.9%) experienced either. Compared with rate‐lowering monotherapy, AADs were associated with a higher risk of fall‐related injuries and syncope. The incidence rate ratio (IRR) for the composite end point was 1.29 (95% confidence interval [CI]: 1.17‐1.43) for AAD monotherapy and 1.46 [95% CI = 1.34‐1.58] for AAD combined with rate‐lowering therapy. When stratifying by individual drugs, amiodarone significantly increased the risk of fall‐related injuries and syncope (IRR = 1.40 [1.26‐1.55]). Compared with more than 180 days of rate‐lowering monotherapy, a higher risk of all outcomes was seen in the first 90 days of any treatment; however, the greatest risk was in the first 14 days for those treated with AADs. CONCLUSION In AF patients aged 65 years and older, AAD use was associated with a higher risk of fall‐related injuries and syncope, and the risk was highest within the first 14 days for those treated with AADs. Only amiodarone use was associated with a higher risk. J Am Geriatr Soc 67:2023–2030, 2019

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The endogenous cannabinoid and the adrenergic systems in modulation of stress-response

Suleymanoglu,

Bakalov,

Sabit

et al. 2024

PHAR

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In our modern, fast-paced society, excessive stress (or distress) is a major risk factor for developing a plethora of diseases. There are several neuromediatory systems in the brain that regulate the response to stress, including the adrenergic and endocannabinoid systems. In our experiments, we study the effects of the endocannabinoid system on the restrain stress-induced analgesia (r-SIA). The experiments were done on male Wistar rats. The animals were confined in special restrainers for a period of one hour. The animals were treated with Clonidine (at 4 mg/kg) – a prototypical α2-agonist; Yohimbine – an α2-adrenergic receptor antagonist; Desipramine – a NE reuptake blocker; CB1r agonist anandamide (AEA); CB1r antagonist АМ251 in different combinations. r-SIA was investigated by means of the paw pressure test in order to get a better understanding of the role that the neurotransmitter anandamide plays in the process. The degree to which the levels of r-SIA fluctuated served as an indicator of the degree to which the cannabinoid system and the adrenergic system interacted with one another. Cannabinoids that are administered exogenously were found to reduce levels of r-SIA and modulate the effects of the adrenergic system. These conclusions were reached based on the findings of our research.

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Beta-Blocker Use and Risk of Symptomatic Bradyarrhythmias: A Hospital-Based Case-Control Study

Cited by 3 publications

References 28 publications

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

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

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope

The endogenous cannabinoid and the adrenergic systems in modulation of stress-response

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Beta-Blocker Use and Risk of Symptomatic Bradyarrhythmias: A Hospital-Based Case-Control Study

Cited by 3 publications

References 28 publications

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

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

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall‐Related Injuries and Syncope

﻿The endogenous cannabinoid and the adrenergic systems in modulation of stress-response

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The endogenous cannabinoid and the adrenergic systems in modulation of stress-response