Paroxysmal atrioventricular block: clinical experience with 20 patients

Shohat‐Zabarski, Ronit; Iakobishvili, Zaza; Kusniec, Jairo; Mazur, Alexander; Strasberg, Boris

doi:10.1016/j.ijcard.2003.10.023

Cited by 41 publications

(31 citation statements)

References 34 publications

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“…When symptomatic bradycardia is related to extrinsic causes, removal of potentially reversible causes of the bradycardia is always the first approach to management 2-4). Severe symptomatic bradycardia has been observed during therapy with beta-blockers and non-DHP calcium channels antagonists 3-5).…”

Section: Discussionmentioning

confidence: 99%

Prognosis and Natural History of Drug-Related Bradycardia

et al. 2009

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Background and ObjectivesThe prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known.Subjects and MethodsWe retrospectively analyzed 38 consecutive patients (age 69±11, 21 women) with drug-related bradycardia (DRB) between March 2005 and September 2007. A drug-associated etiology for the bradycardia was established based on the medical history and patient response to drug discontinuation. The mean follow-up duration was 18±8 months.ResultsThe initial electrocardiogram (ECG) showed sinus bradycardia (heart rate ≤40/min) in 13 patients, sinus bradycardia with junctional escape beats in 18 patients, and third-degree atrioventricular (AV) block in seven patients. Drug discontinuation was followed by resolution of bradycardia in 60% of patients (n=23). Among them, five (17.8%) patients resumed taking the culprit medication after discharge and none developed bradycardia again. Bradycardia persisted in 10 (26.3%) patients despite drug withdrawal, and a permanent pacemaker was implanted in seven of them. Third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with the bradycardia caused by drugs.ConclusionBeta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered.

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Section: Discussionmentioning

confidence: 99%

Prognosis and Natural History of Drug-Related Bradycardia

et al. 2009

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“…In case of bradycardia with extrinsic cause, the removal of offending agent is the first approach to management. 15,16 Management depends upon symptoms, temporary pacemaker is required in symptomatic bradycardia. If bradycardia is not resolved, PPM may be needed.…”

Section: Discussionmentioning

confidence: 99%

Persistent Bradycardia; The Outcome in Patients With Bradycardia After Discontinuation of Rate Slowing Drugs in Terms of Frequency

Abbas

Fatima

Hameed

et al. 2017

TPMJ

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ABSTRACT… Objectives: To determine the outcome in patients with bradycardia after discontinuation of rate slowing drugs in terms of frequency of persistent bradycardia. Study Design: Descriptive study. Setting: Faisalabad Institute of Cardiology, Cardiology Department. Period: 2013-2014. Materials and Methods: Pulse and ECG were used to identify the patients and after obtaining informed consent, total 95 patients of bradycardia were included from emergency. Patients with persistent bradycardia were noted after 5 days of discontinuation of culprit drug. Results: Among total 95 patients, 46(48.4%) were male and 49(51.6%) were female. Patients with rate limiting drugs include β blockers 79(75.8%), CCBs 19(20%) and digoxin 4(4.2%). Patients presented to hospital have sinus bradycardia 3(3.2%), 2 nd degree AV block 19(20%) and 3 rd degree AV block 73(76.8%). After 5 days of discontinuation of culprit drug, bradycardia persisted in 32(69.6%) male, 37(75.5%) female patients with sinus bradycardia persisted in 1(33.3%), 2 nd degree AV block in 7(36.8%) and 3 rd degree AV block in 61(83.6%). Conclusion: In majority of patient on rate slowing drug, bradycardia persisted after discontinuation of these drugs. Bradycardia was not truly drug induced, but it was due to underlying conducting system disease which was unmasked by rate slowing drugs. Key words:Bradycardia, Persistent Bradycardia, Rate Slowing Drugs, β-Blocker, Digoxin, Non Dihydropyridine Calcium Channel Blocker, Underlying Conducting System Disease. Article Citation: Abbas S, Fatima S, Hameed N, Qasim M. Persistent bradycardia; The outcome in patients with bradycardia after discontinuation of rate slowing drugs in terms of frequency.

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“…The reason of these changes is thought to be a vagally mediated cardio-biliary reflex [2]. Recently, AV nodal block due to vagotonic reflexes was described in five patients in a case series of twenty patients with paroxysmal AV block [3]. According to this, vagally mediated AV blocks were observed in different circumstances: during left vagus nerve stimulation for epilepsy, or induced by carotid sinus pressure, by gastric dilatation, and by deep inspiration.…”

Section: Discussionmentioning

confidence: 99%