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[Organization and management of acute complete atrioventricular block: Results from a Multicenter National Survey]
S-S Bun1, J Taïeb2, D Scarlatti1
1Department of Cardiology, Pasteur University Hospital, 30, avenue de la voie Romaine, Nice, France.
Insights
Complete atrioventricular block (AVB3) management varies significantly between centers, with nearly half of operators unable to implant pacemakers overnight. Disparities exist in emergency AVB3 care, highlighting a need for standardized protocols.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Management
Background:
- Complete atrioventricular block (AVB3) is a critical condition requiring prompt management.
- Organizational aspects of AVB3 care are crucial for patient outcomes.
Purpose of the Study:
- To describe the routine management of AVB3.
- To emphasize the organizational aspects of AVB3 care.
Main Methods:
- A prospective national survey was conducted.
- 28 questions were electronically sent to 100 physicians.
- Data were collected from 93 physicians (93% response rate).
Main Results:
- Permanent pacemaker implantation during nights/weekends is limited for 36% of operators.
- Management strategies for nocturnal AVB3 unresponsive to isoproterenol are not standardized.
- Externalized active fixation leads (AFL) are used by 50% of operators, with noted complications like lead dislocation (86%) and perforation (61%).
Conclusions:
- Significant disparities exist in AVB3 management across different centers.
- Half of the centers utilize externalized AFL with reusable generators.
- Standardization of AVB3 management protocols is warranted.
Background:
Complete atrioventricular block (AVB3) may be an urgent potentially lifethreatening situation. Our objective was to describe the routine management of AVB 3, with emphasis on the organizational aspects.
Methods:
From September 2019 to November 2019, a prospective national survey including 28 questions was electronically sent to 100 physicians (Google Form).
Results:
The answers were collected from 93 physicians (response rate 93%). Permanent pacemaker implantation during weekends and nights (after 8PM) is possible for 49% of the operators (<5 times a year), for 15% (>5 times a year), impossible for 36% of the operators. For AVB3 nonresponsive to isoproterenol occurring during the night, a temporary pacing lead (TPL) is implanted by: the on-site medical staff on-duty (27%), the on-call interventional cardiologist (21%), the on-call electrophysiologist (19%), a permanent pacemaker is implanted by the electrophysiologist (12%), the strategy is not standardized (15%). An externalized active fixation lead (AFL) for AVB3 has already been implanted by 50% of the operators. 80 (86%) have already observed a dislocation of the TPL, a cardiac perforation already occurred in 57 (61%), a groin hematoma in 35 (38%), and this technique was proscribed for 4% of the operators.
Conclusion:
Our survey shows important disparities in terms of management of AVB3 among the different centers. An externalized AFL with a reusable generator was used by half of the centers.
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