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Europace Advance Access originally published online on January 25, 2007
Europace 2007 9(3):186-191; doi:10.1093/europace/eul185
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

AV BLOCK

High-degree atrioventricular block during anti-arrhythmic drug treatment: use of a pacemaker with a bradycardia-detection algorithm to study the time course after drug withdrawal

Göran Kennebäck1,*, Fariborz Tabrizi1,2, Peter Lindell1 and Rolf Nordlander2

1 Department of Cardiology, Karolinska University Hospital, Huddinge 14186 Stockholm, Sweden; 2 South Hospital, Stockholm, Sweden

Aim This study examines the recurrence of high-degree atrioventricular block (AVB) during a follow-up period of 2 years in patients with restored AV node function after antiarrhythmic drug withdrawal at implantation of a pacemaker.

Methods Nine men and eight women (77 ± 7 years) taking antiarrhythmic drugs (beta-receptor blockers in 15) and presenting with high-degree AVB were followed for 2 years after being taken off drugs upon receiving a permanent pacemaker with special bradycardia detection software.

Results At inclusion, surface ECG identified two subsets of patients: a QRS duration < 120 ms (n = 5) and those with a QRS duration ≥120 ms (n = 12). During the 2-year follow-up, progression to high-degree AVB occurred in these groups: 1/5 (20%) and 9/12 (75%) P < 0.05. Six patients had to be restarted on drugs, mostly beta-receptor blockers, due to atrial tachyarrhythmias: 3/5 and 3/12. In total, 16 patients (94%) either developed high-degree AVB needing pacing or atrial tachyarrhythmias requiring drug treatment.

Conclusion Patients on beta-receptor blocking drugs and QRS width ≥120 ms developing high-degree AVB should be recommended a pacemaker without further investigation or observation.

Key Words: Atrioventricular block, Drugs, Pacemaker, Pacemaker algorithm

* Corresponding author. Tel: +46 8 58580000; fax: +46 8 58586710. E-mail address: goran.kenneback{at}karolinska.se

Manuscript submitted 24 May 2006. Accepted after revision 4 November 2006.


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