Permanent cardiac pacing for patients with iatrogenic or potentially reversible bradyarrhythmia

Duarte, Tatiana; Gonçalves, Sara; Sá, Catarina; Marinheiro, Rita; Fonseca, Marta; Farinha, J; Rodrigues, Rita; Seixo, Filipe; Parreira, Leonor; Caria, Rui

doi:10.1016/j.repce.2018.05.015

Cited by 6 publications

(20 citation statements)

References 8 publications

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“…4 However, some studies have reported that around half of patients with drug-induced AVB do not reverse after the related drug has been discontinued. [7][8][9] Furthermore, some studies similar to this study have reported a majority of patients where AVB has continued after cessation of the inducing agent or has reversed only to repeat and lead to requirement of PPM. 5,6,10 The most plausible explanation is that patients with irreversible AVB have an underlying AV node conduction disorder.…”

Section: Discussionmentioning

confidence: 78%

Systemic immune‐inflammation index as a tool for predicting the need for a permanent pacemaker in patients with drug‐induced atrioventricular block

Şenöz¹,

Erseçgin²

2021

Pacing Clinical Electrophis

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Background: Drug-induced atrioventricular block (AVB) is generally considered reversible and does not require a permanent pacemaker implantation (PPM). However, some studies have demonstrated a failure of AVB cessation even when the inducing agent has been discontinued. This study has investigated the use of systemic immuneinflammation index (SII) to predict irreversible drug-induced AVB after drug discontinuation.Method: Files of patients with high-degree AVB that required a temporary pacemaker (TPM) were retrospectively analyzed. Sixty-three patients in which AVB was druginduced were included in the study. The patients were divided into the following two groups: (1) those whose AVB reversed after discontinuation of the related drug, and(2) those in which AVB did not reverse.Results: AVB reversed in 24 patients (38%) after the inducing agent was discontinued while in the remaining 39 patients (62%) PPM was required. The most common drugs to induce AVB were beta-blockers (n = 46, 73%). Follow-up time with TPM was significantly longer in the irreversible group (2.91 ± 1.05 days vs. 4.94 ± 2.15 days, p < .001).Multivariate logistic regression analysis showed that SII (odds ratio [OR] = 1.002; 95% confidence interval [CI] = 1.000-1.003; p = .01) was an independent predictor of the requirement for a PPM. An SII > 752.05 was found to be a predictor of irreversible AVB requiring PPM with a sensitivity of 64% and specificity of 75% (receiving-operating characteristics [ROC] area under the ROC curve [AUC]: 0.704, 95% CI = 0.570-0.838, p = .007). Conclusion:Approximately 2/3 of drug-induced high-degree AVBs are irreversible. SII is an easily available and cheap inflammatory biomarker that can be used to predict irreversible AVB.

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Section: Discussionmentioning

confidence: 78%

Systemic immune‐inflammation index as a tool for predicting the need for a permanent pacemaker in patients with drug‐induced atrioventricular block

Şenöz¹,

Erseçgin²

2021

Pacing Clinical Electrophis

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“…These results are consistent with those of Duarte et al., who studied 153 patients admitted with iatrogenic or potentially reversible bradyarrhythmia. The diagnoses were as follows: SND 16%, complete AVB 63%, second‐degree AVB 12%, and atrial fibrillation with slow ventricular rate in 10% 14 …”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of pacemaker implantation at follow‐up after reversible high‐degree sinus node dysfunction or atrioventricular block

Habbout

Sagnard

Pommier

et al. 2023

Pacing Clinical Electrophis

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BackgroundA pacemaker implantation is not indicated in cases of reversible high‐degree symptomatic sinus node dysfunction (SND) and atrioventricular block (AVB). However, it remains uncertain whether these reversible automaticity/conduction disorders may recur in some patients at follow‐up, in the absence of reversible cause. This retrospective study aimed to determine the incidence and predictive factors of permanent pacemaker (PPM) implantation at follow‐up and after reversible high‐degree SND/AVB.MethodsBased on medical electronic files codes, we identified patients who were hospitalized in our cardiac intensive care unit between January 2003 and December 2020 due to reversible high‐degree SND/AVB and who were discharged from the hospital alive and without PPM implantation. Acute myocardial infarction and post‐cardiac surgery patients were excluded. We categorized the patients according to the need for PPM at follow‐up due to non‐reversible high‐degree SND/AVB.ResultsOf the 93 patients included, 26 patients (28%) were readmitted for PPM implantation at follow‐up after hospital discharge. Among baseline characteristics, compared with patients who did not have high‐degree SND/AVB recurrence, those who had subsequent PPM implantation had less frequent previous hypertension (70% vs. 46%, p = .031). Regarding the initial causes of reversible SND/AVB, isolated hyperkalemia was found more often in the patients readmitted for PPM (19% vs. 3% vs. p = .017). Moreover, recurrence of high‐degree SND/AVB was significantly associated with the presence of intraventricular conduction disorders (either bundle branch block or left bundle branch hemiblock) on ECG at discharge (36% in patients without PPM vs. 68% in PPM patients, p = .012).ConclusionAlmost one third of the patients discharged alive from the hospital after a reversible high‐degree SND/AVB needed a pacemaker implantation at follow‐up. Complete bundle branch block or left bundle branch hemiblock on discharge ECG after recovery of atrioventricular conduction and/or sinus automaticity was associated with a greater risk of recurrence leading to pacemaker implantation.

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“…The current guidelines are that DR-AVB is reversible, and there is no need for a permanent pacemaker 4 . However, recent studies have shown that the block continues or recurs in almost half of the patients despite cessation of the inducing drug 26,27 . In line with these studies, the block persisted in more than half of the patients in the presented study despite discontinuation of the inducing agent.…”

Section: Discussionmentioning

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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Permanent cardiac pacing for patients with iatrogenic or potentially reversible bradyarrhythmia

Cited by 6 publications

References 8 publications

Systemic immune‐inflammation index as a tool for predicting the need for a permanent pacemaker in patients with drug‐induced atrioventricular block

Systemic immune‐inflammation index as a tool for predicting the need for a permanent pacemaker in patients with drug‐induced atrioventricular block

Incidence and predictors of pacemaker implantation at follow‐up after reversible high‐degree sinus node dysfunction or atrioventricular block

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

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