Drug-related Atrioventricular Block: Is It a Benign Condition?

Abstract

Introduction: Prognosis of the patients with beta blocker or calcium channel blocker induced AV block is not well known to date. Methods: All patients with symptomatic second-degree or third-degree atrioventricular block (AV) referred to our institution during one year were recuited prospectively and classified in two groups based on drug consumption (beta blocker/calcium channel blocker versus none). They were followed for six months and then collected data was analyzed. Results:The study included 49 patients, 28 patients (age 60.1 ± 20, 19 male) did not use any beta blocker or calcium channel blocker (No-DU group) and other 21 patients (age 73.5 ± 10.4, 7 male) receivd beta blocker, calcium channel blocker or both at the time of AV block (DU group). No-DU group was significantly younger than DU group. The most common atrial rhythm in both groups was sinus. There was no significant difference in QRS wideness or ventricular rate. AV block regressed in 43% of the DU group after discontinuation of drug for five half-life, but, Mobitz type 2 or complete AV block occurred again during six months in 50% of them without consumption of the culprit drug. Conclusions: More than two third of the patients who developed AV block on beta blocker and/or calcium channel blocker needed permanent pacemaker in six months of follow-up, so we concluded that the development of AV block was not as benign as it seems in these patients.

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

“…In our study, the main cause of reversible high‐degree SND/AVB was bradycardic drugs, mainly beta‐blockers. These results are in agreement with those of previous studies highlighting the incidence of conduction disorders with beta‐blockers 7–9,14,15 …”

“…According to current guidelines, permanent pacemaker (PPM) implantation is not indicated in patients with reversible high‐degree AVB or sinus node dysfunction (SND) 6 However, recurrence of high‐degree SND/AVB may occur despite treatment of the cause, leading to PPM at follow‐up 7–9 Indeed, reversible high‐degree SND/AVB may reveal a frailty of the conduction system or automaticity that is likely to reoccur even in the absence of reversible cause 10 …”

Drug Induced Bradycardia

“…In a study by Zeltser D et al 5 bradycardia persisted in 56% of the patients while it resolved in 41% patients after discontinuation of betablockers and non-DHP CCB. In study done by Sima Sayahet al 19 , AV block persisted in 57% of patients while it resolved in 43% of patients after discontinuation of beta blockers and non-DHP CCBs.…”

“…5,18,20 A study by Ovysyshcher IE and Barold SS 4 reported an incidence of 1-15% persistent bradycardia after anti-arrythmic drugs discontinuation, requiring permanent pace maker (PPM) implantation. A study by SimaSayah et al 19 reported recurrence rate for 2 nd and 3 rd degree AV block of 50% after discontinuation of beta and non-DHP CCBs that required permanent pace maker implantation during follow up. A similar study by Osmanov D te al reported recurrence rate of 27% for AV block requiring PPM implantation in nearly half of patients who were on treatment with beta and calcium channel antagonists and digoxin.…”

Drug Induced Bradycardia

“…5,18,20 A study by Ovysyshcher IE and Barold SS 4 reported an incidence of 1-15% persistent bradycardia after anti-arrythmic drugs discontinuation, requiring permanent pace maker (PPM) implantation. A study by SimaSayah et al 19 reported recurrence rate for 2 nd and 3 rd degree AV block of 50% after discontinuation of beta and non-DHP CCBs that required permanent pace maker implantation during follow up. A similar study by Osmanov D te al reported recurrence rate of 27% for AV block requiring PPM implantation in nearly half of patients who were on treatment with beta and calcium channel antagonists and digoxin.…”