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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
Open accessAbstract
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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“Current evidence suggests that drug‐related AVB is a common clinical problem in the elderly [1, 5, 7, 8, 9, 10, 11, 12, 13, 14].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [7]
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“Only a limited number of studies have examined and identified predictive factors for the overall need for permanent pacing, initial recovery from drug‐related and/or hyperkalemia‐related AVB, and recurrence following drug discontinuation and/or correction of hyperkalemia, often with conflicting findings [1, 5, 7, 9, 10, 12].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [7]
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“Despite the initial resolution of AVB following drug discontinuation, it is convincingly reported that the rates of recurrence and the necessity for permanent pacing are remarkably high [1, 5, 7, 8, 9, 10, 11, 12, 13, 14].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [7]
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“with a significantly higher recurrence rate in those with increased QRS duration (≥ 120 ms) (75%) compared to those with normal QRS duration (< 120 ms) (20%) (p < 0.05) [7].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [7]
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“Over a 2‐year period, high‐grade AVB recurred in 59% of patients, with a significantly higher recurrence rate in those with increased QRS duration (≥ 120 ms) (75%) compared to those with normal QRS duration (< 120 ms) (20%) (p < 0.05) [7].”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [7]
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Cited by
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
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Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.043 · Cited by 337
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000627 · Cited by 162
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.036 · Cited by 140
Metadata
- Authors
- Kennebäck, G., Tabrizi, F., Lindell, P., & Nordlander, R.
- Affiliations
- Karolinska University Hospital (SE)
- Stockholm South General Hospital (SE)
- Corresponding author
- Kennebäck, Göran
- ORCID
- Tabrizi, Fariborz
- Venue
- EP Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-01-25
- Volume
- 9
- Issue
- 3
- Pages
- 186-191
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2137288652
- Cited by
- 19
- References
- 16
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 4 · 2018: 4 · 2013: 1
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- high-grade atrioventricular block, antiarrhythmic drug withdrawal, beta-blockers, permanent pacemaker, QRS duration, atrial tachyarrhythmia, drug-induced bradycardia
- MeSH terms
- Aged, Aged, 80 and over, Algorithms, Anti-Arrhythmia Agents, Bradycardia, Female, Follow-Up Studies, Heart Block, Humans, Male, Middle Aged, Pacemaker, Artificial, Recurrence, Withholding Treatment
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- The paper
- Kennebäck, G., Tabrizi, F., Lindell, P., & Nordlander, R. (2007). 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. EP Europace. https://doi.org/10.1093/europace/eul185
