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

Abstract

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.

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

“…For this reason, a recent study using a method similar to that of our study reported that the systemic immune-inflammation index (SII), which is a readily available and inexpensive inflammatory biomarker, can be used to predict irreversible high-grade DR-AVB (ref. 8 ).…”

“…6,7 ). It is not clear whether DR-AVB reversal will be achieved in a given patient and how long to wait before deciding permanent pacemaker implanta-tion 8 . These uncertainties may result in prolonged patient standby with a temporary pacemaker or unneeded permanent pacemaker implantation.…”