56-36: Permanent cardiac pacing in iatrogenics bradyarrhythmias or in patients with potential reversibles causes. (10th June 2016)

• Record Type: Journal Article
• Authors: Duarte, Tatiana; Gonçalves, Sara; Sá, Catarina; Marinheiro, Rita; Rodrigues, Rita; Amador, Pedro; Seixo, Filipe; Parreira, Leonor; Caria, Rui
• Is Part Of: Europace. Volume 18(2016)Supplement 1
• Page Start: i40
• Page End: i40
• Publication Date: 2016-06-10
• Subjects: Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/18.suppl_1.i40c
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Introduction: In patients (pts) with iatrogenic or potential reversible bradyarrhythmia, drug discontinuation or correction is recommended before permanent cardiac pacing implantation.However, these pts often have conduction system disease and there are few data on recurrent events in this population and the need for cardiac pacing at long-term. Aim: To evaluated the need of permanent cardiac pacing during hospitalization or after discharge in pts with iatrogenic bradyarrhythmia or associated with other potentially reversible cause. Methods: We evaluated 153 consecutive patients admitted in the emergency during 6 years with the primary diagnosis of bradyarrhythmia (AV nodal disease - Third and Second degree AV block, Sinus bradycardia (SB) and atrial fibrillation with slow heart rate (AF)) in the context of iatrogenic or metabolic abnormalities. The population was characterized according to baseline characteristics, type of bradyarrhythmia, outpatient therapy and ionics changes. We determined the percentage of pts in which permanent pacemaker was impanted during hospitalization or after discharge in the total population and according to each type of bradyarrhythmia. Results: We studied 153 patients (47% male sex, mean age 82 ± 11 years) admitted for iatrogenic or potential reversible bradyarrhythmia. Major diagnoses were SB 16% (n = 24); Thrid degree AV block (TAVB) 63.4% (n = 97); Second degree AV block (SAVB) 12% (n = 18); AF 10% (n = 15). 92% percent of pts was under cronotropic therapy, 3% of pts had hyperkalemia and 12, 4% had a potential combined etiology (metabolic disorder + medication). After therapy suspension and correction of ionic changes, 55% (n = 84) of pts needed of definitive pacemaker implantation during hospitalization or after discharge (after a median time of 18 months)(Table 1). Iatrogenic bradyarrhythmia was more reversible in pts under amiodarone or digoxin than in pts with beta-blockers, howerever without statistically significant. Conclusion: In pts with bradyarrhythmia potencially associated to a reversible cause, a higher percentage of these do not resolve the bradycardia or has recurrence of the event with need of permanent pacemaker implantation. Pts with AV node disease associated to pharmacological iatrogenesis constituted a subgroup with a higher risk of recurrence. These require greater vigilance during follow-up and should be considered the permanent pacemaker after the first episode.