Atrioventricular block secondary to transient causes and long‐term recurrence after an index event
Open accessAbstract
Background: Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long‐term recurrence are lacking. Methods: Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. Results: In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2–47.5 (p = .03)); greater serum potassium levels (OR 2.3; CI 95% 1.28–4.0 (p < .01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13–4.4 (p = .02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02–40.3 (p < .01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8–15.1 (p < .01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19–1.5 (p = .23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow‐up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. Conclusions: Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow‐up warrants a close follow‐up or PPM implantation at index admission.
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True drug-induced AVB is rare.
“Notably, an accumulating body of evidence indicates that true drug‐induced AVB is rare, while recurrence rates are high.”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
The Discussion describes pure iatrogenic AVB as rare, but explicitly frames this as a hypothesis rather than an established finding. It also excludes acute myocardial infarction cases, so the unqualified claim is stronger than the source's conclusion. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn patients with drug-related AVB, 97% required permanent pacemaker implantation.
“Overall, 97% of the patients required permanent pacemaker implantation, while only 3% had sustained AVB recovery during the follow‐up period.”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
Sections 3.2 and 3.3 report that 133 of 162 patients received a pacemaker at admission and another 24 received one after recurrence, totaling 157 of 162 (97%). The Abstract reports five patients (3%) with sustained recovery. However, the cohort had AV block associated with various transient causes, including electrolyte imbalance; the 97% figure is not reported specifically for patients with drug-related AV block. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe high recurrence and pacing trend is evident even in patients receiving high doses of bradycardic or antiarrhythmic medications, those on drug combinations, and those with additional reversible factors such as hyperkalemia.
“This trend appears to be evident even in patients receiving high doses of bradycardic or antiarrhythmic medications, those on drug combinations, and those with additional reversible factors such as hyperkalemia [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 [12]
The Discussion reports that most patients had recurrence even after high-dose or combined AV-nodal-blocking drugs were stopped, and that patients whose hyperkalemia was corrected recurred and eventually required pacing. Results §3.3 reports pacemaker implantation after recurrence in 24 of 29 patients initially discharged without one. However, Variables §2.2 and Limitations §4.1 say dose was assessed only for beta-blockers, so the claim about high-dose antiarrhythmic medications is not supported. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDrug-related AVB is a common clinical problem in the elderly.
“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 [12]
Baseline Characteristics reports that the 162 patients had a mean age of 78 and that 88.9% had bradycardic drug therapy as an iatrogenic factor. This supports an association between drugs and AVB in this elderly cohort, but the study selected patients already admitted with AVB and does not establish how common drug-related AVB is among elderly people generally. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn patients with drug-related AVB, only 3% had sustained AVB recovery during follow-up.
“Overall, 97% of the patients required permanent pacemaker implantation, while only 3% had sustained AVB recovery during the follow‐up period.”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
Section 3.3 reports sustained AVB recovery in five of 162 patients (3%) in the overall cohort. Section 3.1 says most patients received bradycardic drugs, but the cohort also included other reversible causes; the paper does not establish 3% as the rate specifically among patients with drug-related AVB. Page numbers are not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured
After initial resolution of AVB following drug discontinuation, the rates of recurrence and the necessity for permanent pacing are remarkably high.
“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 [12]
Section 3.3 (page unavailable) reports that 24 of 29 patients whose AV block initially resolved later had a recurrence requiring a permanent pacemaker. Section 2.3 (page unavailable) defines the study population as patients treated by drug discontinuation or correction of an electrolyte imbalance; the reported recurrence rate is for that combined group, not specifically for patients whose AV block resolved after drug discontinuation. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOnly 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.
“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 [12]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn patients with drug-related AVB, initial AVB recovery was associated with higher doses of bradycardic/antiarrhythmic medications (OR = 2.2; 95% CI = 1.13-4.4; p = 0.02).
“higher doses of bradycardic/antiarrhythmic medications (OR = 2.2; 95% CI = 1.13–4.4; p = 0.02)”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
Section 3.2 and Table 2 report that higher bradycardic-drug dose was associated with initial rhythm recovery (OR 2.2; 95% CI 1.13–4.4; p = .02). However, Section 2.2 says only beta-blockers were categorized by dose; antiarrhythmic doses were not analyzed. The reported association therefore does not establish the claim for higher doses of antiarrhythmic medications. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAVB recurrence rates were exceedingly high in all patient subsets, even in those receiving the highest dosage or combinations of multiple AV nodal blocking agents.
“However, AVB recurrence rates were exceedingly high in all these patient subsets, even in those receiving the highest dosage or combinations of multiple AV nodal blocking agents [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 [12]
Section 3.3 (Sustained recovery; page not available) reports recurrence requiring a pacemaker in 24 of 29 patients (82.8%) who initially recovered, supporting a very high overall recurrence rate. The copy does not establish that recurrence was exceedingly high in every drug-dose and drug-combination subset; the dose and combination comparisons concern initial recovery, not subgroup recurrence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn patients with drug-related AVB, initial AVB recovery was associated with the presence of chronic kidney disease requiring dialysis (OR = 7.6; 95% CI = 1.2-47.5; p = 0.03).
“Factors associated with an initial AVB recovery included the presence of chronic kidney disease requiring dialysis (OR = 7.6; 95% CI = 1.2–47.5; p = 0.03)”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
Section 3.2 reports that CKD requiring dialysis was associated with initial rhythm recovery, with the stated OR, confidence interval, and p value. The estimate is for the study’s overall cohort with AVB attributed to reversible causes, not a separately reported drug-related AVB subgroup; Table 1 lists both drug therapy and electrolyte imbalance among the cohort’s characteristics. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHigher doses of bradycardic/antiarrhythmic drugs are associated with higher rates of initial AVB resolution after drug discontinuation and/or hyperkalemia correction.
“Santos et al. demonstrated that, although higher doses are associated with higher rates of initial AVB resolution after drug discontinuation and/or hyperkalemia correction, the recurrence rates of AVB and the need for permanent pacing remain very high in these patients [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 [12]
The Abstract and Table 2 report that higher bradycardic-drug doses were associated with initial AVB recovery, and the Abstract reports that 24 of 29 patients with initial recovery later had recurrence requiring permanent pacing. However, the Variables section says that only beta-blockers were categorized by dose; it does not establish a dose association for antiarrhythmic drugs generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn Santos et al.'s study, 88.9% of patients had drug-related AVB, 21% had hyperkalemia-related AVB, and 10.5% presented with both conditions.
“Of these, 88.9% had drug‐related AVB, 21% had hyperkalemia‐related AVB, and 10.5% presented with both conditions [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 [12]
In Santos et al.'s study, overall 97% of patients required permanent pacemaker implantation.
“Overall, 97% of the patients required permanent pacemaker implantation,”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
In Santos et al.'s study, following drug discontinuation and correction of hyperkalemia, 82.1% of patients had persistent AVB requiring permanent pacemaker implantation during their initial admission.
“Following drug discontinuation and correction of hyperkalemia, 82.1% of patients had persistent AVB requiring permanent pacemaker implantation during their initial admission, while the remainder (17.9%) recovered from AVB and were discharged without a permanent pacemaker [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 [12]
In Santos et al.'s study, among patients with initial AVB recovery, 82.8% experienced an AVB relapse during a maximum follow-up of 130 months.
“Remarkably, among patients with initial AVB recovery, 82.8% experienced an AVB relapse during a maximum follow‐up of 130 months (median follow‐up: 10 months; interquartile range: 17 months).”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
The absence of conduction abnormalities in the baseline ECG was not associated with AVB recovery following drug discontinuation or hyperkalemia correction, nor with sustained long-term rhythm recovery.
“Finally, it was demonstrated that the absence of conduction abnormalities in the baseline ECG (retrieved from electronic health records before the index admission) was not associated with AVB recovery following drug discontinuation or hyperkalemia correction, nor with sustained long‐term rhythm recovery [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 [12]
Combinations of multiple bradycardic or antiarrhythmic drugs increased the likelihood of initial AVB resolution in patients with drug-related and/or hyperkalemia-related AVB.
“Santos et al. demonstrated that, although combinations of multiple bradycardic or antiarrhythmic drugs increased the likelihood of initial AVB resolution in patients with drug‐related and/or hyperkalemia‐related AVB, the recurrence rates of AVB were exceedingly high [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 [12]
In patients with drug-related AVB, initial AVB recovery was associated with the concurrent presence of both drug therapy and hyperkalemia (OR = 5.2; 95% CI = 1.8-15.1; p < 0.01).
“the concurrent presence of both drug therapy and hyperkalemia (OR = 5.2; 95% CI = 1.8–15.1; p < 0.01) [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 [12]
In patients with drug-related AVB, initial AVB recovery was associated with greater potassium levels (OR = 2.3; 95% CI = 1.28-4.0; p < 0.01).
“greater potassium levels (OR = 2.3; 95% CI = 1.28–4.0; p < 0.01)”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
In patients with drug-related AVB, initial AVB recovery was associated with the use of multiple bradycardic/antiarrhythmic drugs in combination (OR = 9.0; 95% CI = 2.02-40.3; p < 0.01).
“the use of multiple bradycardic/antiarrhythmic drugs in combination (OR = 9.0; 95% CI = 2.02–40.3; p < 0.01)”
From Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? (2025) · cites this paper as [12]
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“4,6,8 There is a general perception of frequent recurrences in this population though the actual rate of patients that require a PPM and their prognosis is largely unknown as studies with long-term follow-up are scarce.”
BackgroundResultInfluential
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Research works printed but not linked: 1
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Sfairopoulos, D., Bazoukis, G., Sideris, S., Fragakis, N., Letsas, K., Zekios, K., Liu, T., & Korantzopoulos, P. (2025) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16697 · Cited by 3 · see citing works
- Authors
- Santos, J. G., Martinho, M., Ferreira, B., Cunha, D., Briosa, A., Miranda, R., Almeida, S., Pereira, H., & Brandão, L.
- Affiliations
- Hospital Garcia de Orta (PT)
- Corresponding author
- Santos, João Grade
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2024-02-26
- Volume
- 47
- Issue
- 4
- Pages
- 483-489
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W4392169223
- Cited by
- 1
- References
- 14
- Citations by year
- 2025: 1
- FWCI
- 0.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrioventricular block, complete heart block, long-term recurrence, permanent pacemaker implantation, hyperkalemia, serum potassium, chronic kidney disease, dialysis, conduction abnormalities
- MeSH terms
- Cardiac Conduction System Disease, Humans, Pacemaker, Artificial, Potassium, Retrospective Studies, Risk Factors, Causality, Atrioventricular Block
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