Drug Discontinuation and Temporary Pacemaker for AV Block

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Drug Discontinuation and Temporary Pacemaker for AV Block

Results


Baseline characteristics are presented in Table 1.

Forty-seven patients ended with an indication for a PPM at the initial hospital admission, despite drug discontinuation (Fig. 1). Two of these patients had spontaneous resolution after drug discontinuation, but had to be restarted on drugs and were treated with a PPM before discharge. Eight patients were discharged without a PPM due to initial resolution of the AV block. Of these, 3 subsequently had an event: 2 patients were readmitted with relapse of AV block requiring a PPM, and 1 patient had a witnessed syncope. The last mentioned patient died after 8 years of a noncardiac cause. In total, 49 (89%) patients had an indication for a PPM.



(Enlarge Image)



Figure 1.



Follow-up of 55 patients with atrioventricular block after implantation of temporary pacemaker.





The mean follow-up time for patients not requiring a PPM (n = 6) was 1497 ± 1538 (mean ± SD) days. Three of these patients died of noncardiac causes, and 3 did not experience any events. Of these, 1 patient was successfully ablated for atrial flutter, and after conversion to normal sinus rhythm, PPM was not required.

Accordingly, 5 of 55 patients benefited from discontinuation of the AV blocking drug.

Twenty-six out of 27 patients (96%) receiving beta-blocker monotherapy subsequently had an indication for a PPM after cessation of drug treatment. The 1 remaining patient without indication for permanent pacing after beta-blocker withdrawal died after a short follow-up time of 28 days due to renal failure. Of 15 patients treated with a combination of beta-blocker and digoxin, only 1 patient had resolution of the AV block due to drug withdrawal. One out of 4 patients treated with a combination of either verapamil and digoxin or verapamil, beta-blocker, and digoxin (2 patients in each group) had an indication for a PPM.

Insertion of the temporary electrode was followed by complications (infection or displacement) in 11% of cases. Implantation of PPM was on average postponed 7 ± 8 days to observe the effects of drug discontinuation on conduction restoration.

According to analysis by logistic regression, neither the degree of AV block, QRS width or any other tested variable (age, leading symptom, heart demographics, cardiac rhythm or drugs) were significant predictors of the outcome of an indication for a PPM (Table 1, Table 2).

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