The Impact of Drug Discontinuation in Patients Treated with Temporary Pacemaker Due to Atrioventricular Block

Knudsen, Maria Bisgaard; Thøgersen, Anna Margrethe; Hjortshøj, Søren Pihlkjær; Riahi, Sam

doi:10.1111/jce.12211

Cited by 24 publications

(14 citation statements)

References 10 publications

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“…It was suggested that AVCD usually does not take place without structural heart disease, even if it was triggered by drugs. [ 7 ] This situation suggests the presence of a latent CSD in extrinsic etiology. The advanced age of patients also supports the existence of underlying degenerative CSD in extrinsic etiology.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Restoring the cardiac depolarization and ensuring effective myocardial contraction by inserting a TTPM provide sufficient cardiac output, and thus end-organ perfusion is maintained. [3,4] Heterogeneous conditions can cause unstable bradyarrhythmias requiring TTPM insertion, such as idiopathic and degenerative diseases of the conduction system, [5] drug overuse and adverse effects, [6][7][8][9] electrolyte imbalance, [8,10] and acute myocardial infarction (AMI). [11] The aim of the study was to determine demographic, etiologic, and electrocardiographic (ECG) characteristics of patients who underwent TTPM insertion in the ED and to identify predictors of in-hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

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Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: Single-Center Experience

et al. 2021

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Objectives: Insertion of a temporary transvenous pacemaker (TTPM) is one of the life-saving interventions performed in the emergency department (ED). The aim of the study was to determine demographic, clinical characteristics, and in-hospital outcomes of patients who underwent TTPM insertion due to hemodynamically unstable bradyarrhythmia in the ED. Methods: In our study, 234 consecutive patients who underwent TTPM insertion at the bedside in the ED between January 2014 and October 2019 were included in the study. Etiological characteristics, electrocardiographic (ECG) findings, requirements for permanent pacemaker (PPM), and in-hospital mortality of the patients were analyzed retrospectively. Results: Extrinsic causes were the most common etiology of unstable bradyarrhythmia (57.6%). Most extrinsic causes were drug therapy-related factors (60.7%). Bradyarrhythmia persisted in 60% of patients after extrinsic causes were eliminated. The most common ECG finding was a high-degree atrioventricular block (62%). PPM was implanted in 44% of patients. In-hospital mortality rate was 19.7%. In the multivariate regression analysis, the left ventricular ejection fraction (LVEF) and diastolic blood pressure (DBP) measured at admission (p<0.001 and p<0.001, respectively) were determined to be independent predictors for in-hospital mortality. Conclusion: First diagnosis and intervention in the ED are of great importance for patients with unstable bradyarrhythmia. The fastest possible TTPM insertion in the ED can reduce mortality by reducing the exposure time to hypoperfusion of vital organs, especially in patients with reduced LVEF and low DBP. Furthermore, it should be kept in mind that an underlying latent conduction system disease can also be present in bradyarrhythmias thought to occur potentially due to extrinsic factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: Single-Center Experience

et al. 2021

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“…[7][8][9] Furthermore, some studies similar to this study have reported a majority of patients where AVB has continued after cessation of the inducing agent or has reversed only to repeat and lead to requirement of PPM. 5,6,10 The most plausible explanation is that patients with irreversible AVB have an underlying AV node conduction disorder. This conduction disorder becomes evident with the use of AV blocking agents and does not improve after drug withdrawal.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 However, it is common for AVB to continue after the related drug has been discontinued, requiring permanent pacemaker implantation (PPM). 5 A study indicates that an underlying atrioventricular conduction disorder leads to this situation. 6 Unknown is in which patients AVB will resolve after discontinuation of the related drug.…”

Section: Introductionmentioning

confidence: 99%

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

Şenöz¹,

Erseçgin²

2021

Pacing Clinical Electrophis

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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.

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“…Spells have lots of different origins that can be difficult to sort out but bradycardia is at the top of the list. The context is important, which brings us to the manuscript of Knudsen et al . in this issue of the Journal of Cardiovascular Electrophysiology .…”

Section: Editorial Commentmentioning

confidence: 99%

Not So Temporary Pacing

Sweeney

2013

Cardiovasc electrophysiol

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The Impact of Drug Discontinuation in Patients Treated with Temporary Pacemaker Due to Atrioventricular Block

Abstract: The vast majority of patients treated with a TPM due to AV block and who receive beta-blockers alone or in combination with digoxin have a final indication for a PPM despite cessation of drug treatment. TPM are frequently associated with complications.

Cited by 24 publications

References 10 publications

Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: Single-Center Experience

Bedside Temporary Transvenous Pacemaker Insertion in the Emergency Department: Single-Center Experience

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

Not So Temporary Pacing

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