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Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement.

Abstract

INTRODUCTION AND OBJECTIVES

Atrioventricular block (AVB) in the presence of bradycardic drugs (BD) can be reversible, and pacemaker implantation is controversial. Our objective was to analyze the pacemaker implantation rate in the mid-term, after BD suspension, and to identify predictive factors.

METHODS

We performed a cohort study that included patients attending the emergency department with high-grade AVB in the context of BD. We studied the persistence of AVB after BD discontinuation, recurrence in patients with AVB resolution, and the predictive variables associated with pacemaker requirement at 3 years.

RESULTS

Of 127 patients included (age, 79 [71-83] years), BAV resolved in 60 (47.2%); among these patients, recurrence occurred during the 24-month median follow-up in 40 (66.6%). Pacemaker implantation was required in 107 patients (84.3%), despite BD discontinuation. On multivariable analysis, the variables associated with pacemaker need at 3 years were heart rate <35 bpm (OR, 8.12; 95%CI, 1.82-36.17), symptoms other than syncope (OR, 4.09; 95%CI, 1.18-14.13), and wide QRS (OR, 5.65; 95%CI, 1.77-18.04). Concomitant antiarrhythmic treatment was associated with AVB resolution (OR, 0.12; 95%CI, 0.02-0.66).

CONCLUSIONS

More than 80% of patients with AVB secondary to BD require pacemaker implantation despite drug discontinuation. Predictive variables were wide QRS, heart rate <35 bpm, and clinical presentation other than syncope.

Authors+Show Affiliations

Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain. Electronic address: laura.jordan.1987@gmail.com.Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.UGC Corazón, Hospital Clínico Universitario de Málaga, Málaga, Spain.UGC Corazón, Hospital Clínico Universitario de Málaga, Málaga, Spain.Unidad de Cuidados Intensivos, Complejo Hospitalario de Jaén, Jaén, Spain.UGC Corazón, Hospital Clínico Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), UGC Corazón, Hospital Clínico Universitario de Málaga, CIBERCV, Universidad de Málaga (UMA), Málaga, Spain.Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain.

Pub Type(s)

Journal Article

Language

eng spa

PubMed ID

31964605

Citation

Jordán-Martínez, Laura, et al. "Atrioventricular Block in Patients Undergoing Treatment With Bradycardic Drugs. Predictors of Pacemaker Requirement." Revista Espanola De Cardiologia (English Ed.), 2020.
Jordán-Martínez L, Rivera-López R, Bermúdez-Jiménez F, et al. Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement. Rev Esp Cardiol (Engl Ed). 2020.
Jordán-Martínez, L., Rivera-López, R., Bermúdez-Jiménez, F., Jiménez-Jaimez, J., Alzueta, J., Barrera-Cordero, A., ... Tercedor, L. (2020). Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement. Revista Espanola De Cardiologia (English Ed.), doi:10.1016/j.rec.2019.09.028.
Jordán-Martínez L, et al. Atrioventricular Block in Patients Undergoing Treatment With Bradycardic Drugs. Predictors of Pacemaker Requirement. Rev Esp Cardiol (Engl Ed). 2020 Jan 18; PubMed PMID: 31964605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrioventricular block in patients undergoing treatment with bradycardic drugs. Predictors of pacemaker requirement. AU - Jordán-Martínez,Laura, AU - Rivera-López,Ricardo, AU - Bermúdez-Jiménez,Francisco, AU - Jiménez-Jaimez,Juan, AU - Alzueta,Javier, AU - Barrera-Cordero,Alberto, AU - Rivera-Fernández,Ricardo, AU - Jiménez-Navarro,Manuel, AU - Álvarez,Miguel, AU - Tercedor,Luis, Y1 - 2020/01/18/ PY - 2019/02/04/received PY - 2019/09/10/accepted PY - 2020/1/23/entrez KW - Antiarrhythmic drugs KW - Atrioventricular block KW - Bloqueo auriculoventricular KW - Bradycardic drugs KW - Fármacos antiarrítmicos KW - Fármacos bradicardizantes KW - Marcapasos KW - Pacemaker KW - Syncope KW - Síncope JF - Revista espanola de cardiologia (English ed.) JO - Rev Esp Cardiol (Engl Ed) N2 - INTRODUCTION AND OBJECTIVES: Atrioventricular block (AVB) in the presence of bradycardic drugs (BD) can be reversible, and pacemaker implantation is controversial. Our objective was to analyze the pacemaker implantation rate in the mid-term, after BD suspension, and to identify predictive factors. METHODS: We performed a cohort study that included patients attending the emergency department with high-grade AVB in the context of BD. We studied the persistence of AVB after BD discontinuation, recurrence in patients with AVB resolution, and the predictive variables associated with pacemaker requirement at 3 years. RESULTS: Of 127 patients included (age, 79 [71-83] years), BAV resolved in 60 (47.2%); among these patients, recurrence occurred during the 24-month median follow-up in 40 (66.6%). Pacemaker implantation was required in 107 patients (84.3%), despite BD discontinuation. On multivariable analysis, the variables associated with pacemaker need at 3 years were heart rate <35 bpm (OR, 8.12; 95%CI, 1.82-36.17), symptoms other than syncope (OR, 4.09; 95%CI, 1.18-14.13), and wide QRS (OR, 5.65; 95%CI, 1.77-18.04). Concomitant antiarrhythmic treatment was associated with AVB resolution (OR, 0.12; 95%CI, 0.02-0.66). CONCLUSIONS: More than 80% of patients with AVB secondary to BD require pacemaker implantation despite drug discontinuation. Predictive variables were wide QRS, heart rate <35 bpm, and clinical presentation other than syncope. SN - 1885-5857 UR - https://www.unboundmedicine.com/medline/citation/31964605/Atrioventricular_block_in_patients_undergoing_treatment_with_bradycardic_drugs._Predictors_of_pacemaker_requirement L2 - http://www.revespcardiol.org/en/linksolver/ft/pii/S1885-5857(19)30416-5 DB - PRIME DP - Unbound Medicine ER -