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Marcu DTM, Adam CA, Dorobanțu DM, Șalaru DL, Sascău RA, Balasanian MO, Macovei L, Arsenescu-Georgescu C, Stătescu C. Beta-Blocker-Related Atrioventricular Conduction Disorders—A Single Tertiary Referral Center Experience. Medicina (B Aires) 2022; 58:medicina58020320. [PMID: 35208643 PMCID: PMC8877089 DOI: 10.3390/medicina58020320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Drug-related bradyarrhythmia is a well-documented major adverse event among beta-blocker users and a potential cause for hospitalization or additional interventions. Whether beta-blocker use is associated with specific bradyarrhythmia presentations, and how this relates to other predisposing factors, is not well known. We aim to evaluate the association between beta-blocker use and the type of atrioventricular (AV) conduction disorder in patients with symptomatic bradycardia. Materials and Methods: We conducted a retrospective cohort study on 596 patients with a primary diagnosis of symptomatic bradyarrhythmia admitted to a single tertiary referral center. Of the cases analyzed, 253 patients were on beta-blocker treatment at presentation and 343 had no bradycardic treatment. We analyzed demographics, clinical and paraclinical parameters in relation to the identified AV conduction disorder. A multivariate regression analysis was performed to explore factors associated with beta-blocker use. Results: Of the 596 patients (mean age 73.9 ± 8.8 years, 49.2% male), 261 (43.8%) had a third-degree AV block, 92 (15.4%) had a second-degree AV block, 128 (21.5%) had slow atrial fibrillation, 93 (15.6%) had sick sinus syndrome and 21 (3.5%) had sinus bradycardia/sinus pauses. Beta-blocker use was associated with the female gender (p < 0.001), emergency admission (p < 0.001), dilated cardiomyopathy (p = 0.003), the lower left ventricular ejection fraction (p = 0.02), mitral stenosis (p = 0.009), chronic kidney disease (p = 0.02), higher potassium levels (p = 0.04) and QRS duration > 120 ms (p = 0.02). Slow atrial fibrillation (OR = 4.2, p < 0.001), sick sinus syndrome (OR = 2.8, p = 0.001) and sinus bradycardia/pauses (OR = 32.9, p < 0.001) were more likely to be associated with beta-blocker use compared to the most common presentation (third-degree AV block), after adjusting for other patient characteristics. Conclusions: Beta-blocker use is more likely to be associated with slow atrial fibrillation, sick sinus syndrome and sinus bradycardia/pauses, compared to a second- or third-degree AV block, after adjusting for other patient factors such as gender, admission type, ECG, comorbidities, cardiac function and lab testing.
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Affiliation(s)
- Dragoș Traian Marius Marcu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
| | - Cristina Andreea Adam
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
- Correspondence:
| | - Dan-Mihai Dorobanțu
- Children’s Health and Exercise Research Centre (CHERC), University of Exeter, Exeter EX1 2LU, UK;
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol BS2 8BJ, UK
| | - Delia Lidia Șalaru
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
| | - Radu Andy Sascău
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
| | - Mircea Ovanez Balasanian
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
| | - Liviu Macovei
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
| | - Cătălina Arsenescu-Georgescu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
| | - Cristian Stătescu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (D.T.M.M.); (D.L.Ș.); (R.A.S.); (M.O.B.); (L.M.); (C.A.-G.); (C.S.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I. M. Georgescu” Iași, 700115 Iasi, Romania
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Dalgaard F, Pallisgaard JL, Lindhardt TB, Gislason G, Blanche P, Torp-Pedersen C, Ruwald MH. Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillations. Open Heart 2020; 7:e001125. [PMID: 32257243 PMCID: PMC7103856 DOI: 10.1136/openhrt-2019-001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives To identify risk factors and to develop a predictive risk score for pacemaker implantation in patients with atrial fibrillation (AF). Methods Using Danish nationwide registries, patients with newly diagnosed AF from 2000 to 2014 were identified. Cox proportional-hazards regression computed HRs for risk factors of pacemaker implantation. A logistic regression was used to fit a prediction model for 3-month risk of pacemaker implantation and derived a risk score using 80% of the data and its predictive accuracy estimated using the remaining 20%. Results Among 155 934 AF patients included, the median age (IQR) was 75 (65–83) and 51.3% were men. During a median follow-up time of 3.4 (1.2–5.0) years, 8348 (5.4%) patients received a pacemaker implantation. Risk factors of pacemaker implantation were (in order of highest risk first) age above 60 years, congenital heart disease, heart failure at age under 60 years, prior syncope, valvular AF, hypertension, ischaemic heart disease, male sex and diabetes mellitus. The derived risk score assigns points ranging from 1 to 14 to each of these risk factors. The 3-month risk of pacemaker implantation increased from 0.4% (95% CI: 0.2 to 0.8) at 1 point to 2.6% (95% CI: 1.9 to 3.6) at 18 points. Area under the receiver operator characteristics curve was 62.9 (95% CI: 60.3 to 65.5). Conclusion We highlighted risk factors of pacemaker implantation in newly diagnosed AF patients and created a risk score. The clinical utility of the risk score needs further investigation.
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Affiliation(s)
| | | | | | | | - Paul Blanche
- Cardiology, Gentofte Hospital, Hellerup, Denmark
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