High-degree atrioventricular block during anti-arrhythmic drug treatment: use of a pacemaker with a bradycardia-detection algorithm to study the time course after drug withdrawal

Kennebäck, Göran; Tabrizi, Fariborz; Lindell, Peter; Nordlander, Rolf

doi:10.1093/europace/eul185

Cited by 19 publications

(8 citation statements)

References 13 publications

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“…In study by Lee JH et al 20 this finding was seen in 26.3% patients that persisted after discontinuation of culprit drug suggesting underlying infra-nodal conduction system disease. Similar to above study Kenneback G et al 23 ms were independent predictors of progression to a complete heart block requiring permanent pace maker implantation following culprit drug discontinuation, thus favoring infra-nodal etiology as this site is mostly associated with such an AV block. However we did not assessed this finding in our study.…”

Section: Discussionsupporting

confidence: 74%

Drug Induced Bradycardia

Ahmad

Yasir

Fatima

2018

TPMJ

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… Background: Bradycardia in patients on rate slowing drugs i.e. beta blockers, digoxin and non dihydropyridine calcium channel blockers is common after discontinuation of rate slowing drugs. Bradycardia persists in majority of patients, so bradycardia is not truly drug induced but due to underlying conduction system disease. 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 cross-sectional. Place and Duration of Study: Cardiology Department, Faisalabad Institute of Cardiology, Faisalabad, from September 2015 to March, 2016. Methodology: After written informed consent 95 patients who fulfilled the inclusion and exclusion criteria were selected for this study. Patients with bradycardia (heart rate less than 60 beats per minute) identified by pulse and electrocardiography (ECG) were admitted and culprit drug was discontinued. All admitted patients were followed everyday by doing ECG and counting pulse twice. Patients, in whom bradycardia resolved, were discharged. Patients were monitored for persistent bradycardia after discontinuation of culprit drug for 5 days. Results: Out of 95 patients 46 (48%) were male and 49 (52%) female, age range was 25-85 years with mean age 61±11 years. Heart rate ranged 25-45 beats per minute with mean value of 31.28± 6.08, 72 (75.8%) patients were on beta blockers, 19 (20%) on calcium channel blockers and 4 (4.2%) patients were on digoxin. 73 (76.80%) patients had 3 0 AV block, 19 (20%) 2 0 AV block while 3 (3.20%) had sinus bradycardia. Bradycardia persisted in 69 (72.60%) patients out of which 32 (69.6%) were male and 37(75.5%) female. Bradycardia resolved in 26 (27.40%) patients in which 14 (30.4%) were male and 12(24.5%) were female. Conclusion: Persistent bradycardia is common in patients with drug induced bradycardia. Such bradycardia is not truly drug induced but is related to unmasking of subclinical conduction system disease by rate lowering drugs like beta blockers, calcium channel blockers and digoxin.

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Section: Discussionsupporting

confidence: 74%

Drug Induced Bradycardia

Ahmad

Yasir

Fatima

2018

TPMJ

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“…In a study of patients with high-degree AV block, a QRS width ≥120 ms was an independent predictor for the progression of a high-degree AV block after drug withdrawal 13). In this study, third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with bradycardia in cases truly associated with drugs.…”

Section: Discussionmentioning

confidence: 46%

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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“…Sixteen out of 17 (94%) patients either redeveloped high‐degree AV block or atrial tachyarrhythmias necessitating the use of AV blocking agents. The mean time from inclusion to documented relapse of AV block was 9 ± 7 months . In this study, 2 out of 8 patients (25%) who were initially discharged without a PPM experienced relapse of the AV block requiring implantation of a PPM.…”

Section: Discussionmentioning

confidence: 65%

“…Further, Kenneback et al . investigated the risk of relapse among 17 patients with symptomatic high‐degree AV block that had initially disappeared after drug discontinuation . Sixteen out of 17 (94%) patients either redeveloped high‐degree AV block or atrial tachyarrhythmias necessitating the use of AV blocking agents.…”

Section: Discussionmentioning

confidence: 99%