Journal
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
Volume -, Issue -, Pages -Publisher
WILEY
DOI: 10.1111/pace.14755
Keywords
atrioventricular block; intraventricular conduction; pacemaker; recurrence; sinus node dysfunction
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This retrospective study analyzed patients with reversible high-degree symptomatic sinus node dysfunction (SND) and atrioventricular block (AVB), excluding acute myocardial infarction and post-cardiac surgery patients. The results showed that nearly one third of the patients required pacemaker implantation at follow-up. Patients with complete bundle branch block or left bundle branch hemiblock on discharge ECG were more likely to experience recurrence leading to pacemaker implantation.
BackgroundA pacemaker implantation is not indicated in cases of reversible high-degree symptomatic sinus node dysfunction (SND) and atrioventricular block (AVB). However, it remains uncertain whether these reversible automaticity/conduction disorders may recur in some patients at follow-up, in the absence of reversible cause. This retrospective study aimed to determine the incidence and predictive factors of permanent pacemaker (PPM) implantation at follow-up and after reversible high-degree SND/AVB. MethodsBased on medical electronic files codes, we identified patients who were hospitalized in our cardiac intensive care unit between January 2003 and December 2020 due to reversible high-degree SND/AVB and who were discharged from the hospital alive and without PPM implantation. Acute myocardial infarction and post-cardiac surgery patients were excluded. We categorized the patients according to the need for PPM at follow-up due to non-reversible high-degree SND/AVB. ResultsOf the 93 patients included, 26 patients (28%) were readmitted for PPM implantation at follow-up after hospital discharge. Among baseline characteristics, compared with patients who did not have high-degree SND/AVB recurrence, those who had subsequent PPM implantation had less frequent previous hypertension (70% vs. 46%, p = .031). Regarding the initial causes of reversible SND/AVB, isolated hyperkalemia was found more often in the patients readmitted for PPM (19% vs. 3% vs. p = .017). Moreover, recurrence of high-degree SND/AVB was significantly associated with the presence of intraventricular conduction disorders (either bundle branch block or left bundle branch hemiblock) on ECG at discharge (36% in patients without PPM vs. 68% in PPM patients, p = .012). ConclusionAlmost one third of the patients discharged alive from the hospital after a reversible high-degree SND/AVB needed a pacemaker implantation at follow-up. Complete bundle branch block or left bundle branch hemiblock on discharge ECG after recovery of atrioventricular conduction and/or sinus automaticity was associated with a greater risk of recurrence leading to pacemaker implantation.
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