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Turk Kardiyol Dern Ars. 2020 Mar;48(2):103-108. doi: 10.5543/tkda.2019.96613.

The need for permanent pacemaker after restoration of conduction following atrioventricular block: a retrospective cohort study.

Author information

1
Department of Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
2
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

OBJECTIVE:

A permanent pacemaker (PPM) is necessary for patients with a symptomatic third-degree or advanced second-degree atrioventricular (AV) block. An AV block due to medication use can often be reversed; however, subsequent relapse can occur and necessitate subsequent PPM implantation. The aim of this study was to explore the course and prognosis of patients with an AV block.

METHODS:

This historical cohort study was conducted between January 2013 and June 2018. A total of 1900 patient records were analyzed and 1123 subjects with an AV block on admission were enrolled. The patients were categorized into 2 groups: Group 1 comprised patients with an AV block due to medication use (n=316, 28%) and Group 2 included patients with an AV block caused by other etiologies (n=807, 72%). Data of the cause of AV block, recurrence, and PPM implantation were analyzed. Patients in both groups who did not require a PPM during the index admission were followed up regarding subsequent implantation of a PPM.

RESULTS:

AV conduction was recovered in 38 (12%) patients in Group 1 and 48 (6%) patients in Group 2 during the index hospitalization. However, recurrence of the AV block was observed in 18% of Group 1 patients and 40% of Group 2 patients. Only 25 patients in each group (4.5% of the whole study population) remained PPM-free during a median 3-year follow-up period.

CONCLUSION:

The study findings suggest that drug-induced AV blocks may not be as benign as previously thought. The high relapse rate indicates that watchful follow-up may be required despite discontinuation of the responsible medication and that consideration of earlier PPM implantation in cases of early recurrence may be warranted.

PMID:
32147658
DOI:
10.5543/tkda.2019.96613
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