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Iatrogenic Atrioventricular Block: myth or reality?
Session:
Sessão de Comunicações Orais 15 – Instabilidade eléctrica e terapêuticas do sistema de condução: do pacing à tempestade arrítmica
Speaker:
João Mirinha Luz
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Mirinha Luz; João Grade Santos; Luís Brandão; Rita Miranda; Alexandra Briosa; Diogo Santos da Cunha; Carlos Alvarenga; João Simões; Andreia Eusébio; Hélder Pereira; Sofia Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Introduction and aim:</u> Atrioventricular block (AVB) can be associated with secondary causes, some of them potentially reversible. Permanent Pacemaker (PPM) implantation aims at ameliorating symptoms and prevent sudden cardiac death but is not recommended in transient causes that can be corrected or prevented. Previous work from our group demonstrated high rate of recurrences of initially though iatrogenic AVB (iAVB) and raised the hypothesis that pure iAVB is a rare entity. Our aim was to further characterize the population which had recurrence of symptomatic AVB after having recovered from an index event and having corrected secondary causes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods:</u> Data were collected from patients (pts) admitted with second- or third-degree AVB (ICD-10 codes I44.2, I44.3 and I44.5) in a district hospital between January 2011 and December 2024, associated with bradycardic drugs and/or drug-induced hyperkalemia (hyperK). Data were analyzed using SPSS software version 28.0 (IBM).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results:</u> 218 pts were admitted during the study period. Mean age was 77.7 years, mostly male (56%). Most pts (73%) presented with complete AVB (cAVB). HyperK was found in 22% of pts on admission, although most of them (62%) had potassium levels below 6.5 mmol/L. Overall, 88% of pts were receiving bradycardic drugs, predominantly beta-blockers (75%). 168 pts (77%) did not recover intrinsic rhythm and implanted PPM on initial admission (PMfirst). Fifty pts (23%) recovered intrinsic rhythm after withdrawal of the triggering agent. Of these, 76% (38 pts) re-presented and required PPM implantation (PMsecond), mainly due to recurrent cAVB (53%), with a median recurrence time of 9 months. Only 12 pts (5.5%) were free of AVB during follow-up. Among PMfirst pts, median ventricular pacing at 1 month (1m), 1 year (1y) and 3 years (3y) after implantation was 99%. In PMsecond pts, median pacing was significantly lower at 1m (60%, p<0.001) and 1y (73%, p=0.035), but not at 3y (92%, p=0.388), and the majority of them had high (over 20%) percentages of ventricular pacing right after PPM implantation (1m: 59%; 1y: 67%; 3y: 93%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion:</u> AVB secondary to transient causes have a low rate of remission with its correction with a high rate of recurrence in follow-up. Those patients had high pacing rates upfront which increased over time but were, nonetheless, significantly lower than those that initially implanted a PPM. That further reinforces the possibility that pure iAVB is a rare entity but rather an earlier manifestation of latent advanced conduction disease.</span></span></p>
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