Drug Discontinuation and Temporary Pacemaker for AV Block
Drug Discontinuation and Temporary Pacemaker for AV Block
Introduction: Patients treated with a temporary pacemaker (TPM) due to atrioventricular (AV) block are often monitored after discontinuation of AV node blocking drugs to evaluate the indication for permanent pacing. However, the impact of drug discontinuation is sparsely documented. We investigated to what extent drug discontinuation abolished the need for permanent pacemaker (PPM) implantation.
Methods and Results: All hospital records of patients who received a TPM at Aalborg Hospital, Denmark, between January 2000 and March 2011 (n = 575) were retrospectively reviewed. Patients with AV block who were treated with a TPM and concomitant cessation of drug therapy were included if there was no other underlying mechanism causing the AV block. AV blocking drugs included antiarrhythmic agents classes II–IV and digoxin. Fifty-five patients fulfilled our inclusion criteria. Forty-seven patients had an indication for a PPM at the initial hospital admission, despite drug discontinuation. Of the remaining 8 patients who were discharged without a PPM, 3 subsequently experienced events: 2 had recurrence of AV block requiring a PPM, and 1 experienced syncope. Thus, in total, 49 (89%) patients had a final indication for a permanent pacemaker (PPM). Of patients receiving beta-blocker monotherapy, 26 (96%) had an indication for a PPM. TPM implantation was complicated by infection or displacement in 11% of cases.
Conclusions: 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.
Patients with symptomatic third-degree or advanced second-degree atrioventricular (AV) block have a class I indication for a permanent pacemaker (PPM). However, during concomitant treatment with AV-blocking drugs, the need for PPM is often evaluated based on their response to drug discontinuation over several days. According to current guidelines, PPM implantation may be considered in the setting of drug use if the block is expected to recur after drug discontinuation (class IIb recommendation). However, the proportion of patients requiring permanent pacing after drug discontinuation is unknown, and the prognosis of patients who are discharged without a PPM is largely unknown.
In a population of patients with AV block and concomitant AV blocking therapy, we investigated the prognosis and to what extent discontinuation of these drugs abolished the need for PPM implantation.
Abstract and Introduction
Abstract
Introduction: Patients treated with a temporary pacemaker (TPM) due to atrioventricular (AV) block are often monitored after discontinuation of AV node blocking drugs to evaluate the indication for permanent pacing. However, the impact of drug discontinuation is sparsely documented. We investigated to what extent drug discontinuation abolished the need for permanent pacemaker (PPM) implantation.
Methods and Results: All hospital records of patients who received a TPM at Aalborg Hospital, Denmark, between January 2000 and March 2011 (n = 575) were retrospectively reviewed. Patients with AV block who were treated with a TPM and concomitant cessation of drug therapy were included if there was no other underlying mechanism causing the AV block. AV blocking drugs included antiarrhythmic agents classes II–IV and digoxin. Fifty-five patients fulfilled our inclusion criteria. Forty-seven patients had an indication for a PPM at the initial hospital admission, despite drug discontinuation. Of the remaining 8 patients who were discharged without a PPM, 3 subsequently experienced events: 2 had recurrence of AV block requiring a PPM, and 1 experienced syncope. Thus, in total, 49 (89%) patients had a final indication for a permanent pacemaker (PPM). Of patients receiving beta-blocker monotherapy, 26 (96%) had an indication for a PPM. TPM implantation was complicated by infection or displacement in 11% of cases.
Conclusions: 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.
Introduction
Patients with symptomatic third-degree or advanced second-degree atrioventricular (AV) block have a class I indication for a permanent pacemaker (PPM). However, during concomitant treatment with AV-blocking drugs, the need for PPM is often evaluated based on their response to drug discontinuation over several days. According to current guidelines, PPM implantation may be considered in the setting of drug use if the block is expected to recur after drug discontinuation (class IIb recommendation). However, the proportion of patients requiring permanent pacing after drug discontinuation is unknown, and the prognosis of patients who are discharged without a PPM is largely unknown.
In a population of patients with AV block and concomitant AV blocking therapy, we investigated the prognosis and to what extent discontinuation of these drugs abolished the need for PPM implantation.
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