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Incidence and predictors of pacemaker implantation at follow-up after reversible high-degree sinus node dysfunction
Ahmed Habbout1,2, Audrey Sagnard1, Thibaut Pommier1,2
1Cardiology Department, University Hospital, Dijon, France.
Insights
Nearly one-third of patients with reversible high-degree sinus node dysfunction (SND) or atrioventricular block (AVB) required pacemaker implantation later. Intraventricular conduction disorders on discharge ECG predict recurrence, necessitating permanent pacemaker (PPM) implantation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Pacemaker implantation is not indicated for reversible high-degree sinus node dysfunction (SND) and atrioventricular block (AVB).
- The recurrence of these conduction disorders after resolution of the reversible cause remains uncertain.
- This study investigates the incidence and predictors of permanent pacemaker (PPM) implantation in patients with initially reversible SND/AVB.
Purpose of the Study:
- To determine the incidence of permanent pacemaker (PPM) implantation in patients initially presenting with reversible high-degree sinus node dysfunction (SND) and atrioventricular block (AVB).
- To identify predictive factors for the need for PPM implantation during follow-up in these patients.
Main Methods:
- Retrospective analysis of patients hospitalized for reversible high-degree SND/AVB between 2003 and 2020.
- Exclusion of patients with acute myocardial infarction or post-cardiac surgery.
- Categorization based on the need for PPM implantation at follow-up due to non-reversible SND/AVB.
Main Results:
- 28% of the 93 included patients required PPM implantation at follow-up.
- Less frequent prior hypertension was noted in patients who did not require PPM.
- Isolated hyperkalemia as the initial cause was more frequent in patients readmitted for PPM.
- Intraventricular conduction disorders (bundle branch block or hemiblock) on discharge ECG were significantly associated with subsequent PPM implantation (68% vs. 36%).
Conclusions:
- A significant proportion (almost one-third) of patients with reversible high-degree SND/AVB require pacemaker implantation during follow-up.
- The presence of complete bundle branch block or left bundle branch hemiblock on the discharge ECG is a strong predictor of recurrence and the need for PPM.
Background:
A 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.
Methods:
Based 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.
Results:
Of 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).
Conclusion:
Almost 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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