Key result
Among patients with high-degree AVB on antiarrhythmic drugs, progression to AVB after drug withdrawal occurred in 75% of those with QRS ≥120 ms versus 20% of those with QRS <120 ms.
Why the study?
Does antiarrhythmic drug withdrawal prevent recurrence of high-degree AVB in patients presenting with AVB while on these drugs?
Cohort (n=17)
Does antiarrhythmic drug withdrawal prevent recurrence of high-degree AVB in patients presenting with AVB while on these drugs?
Patients developing high-degree AVB while on beta-blockers who have a QRS duration >= 120 ms have a high rate of AVB recurrence despite drug withdrawal and should receive a permanent pacemaker.
Answers are grounded in this paper and cite their sources.
QRS ≥120 ms was associated with high AVB recurrence after drug withdrawal; leaves open whether pacing decisions should change without randomized data.
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 > or =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 > or =120 ms developing high-degree AVB should be recommended a pacemaker without further investigation or observation.
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Kennebäck et al. (2007) conducted a cohort in High-degree atrioventricular block during anti-arrhythmic drug treatment (n=17). QRS duration ≥ 120 ms vs. QRS duration < 120 ms was evaluated on Progression to high-degree AVB (p=<0.05). Among patients with high-degree AVB on antiarrhythmic drugs, progression to AVB after drug withdrawal occurred in 75% of those with QRS ≥120 ms versus 20% of those with QRS <120 ms.
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