CLINICAL RESEARCH: ELECTROPHYSIOLOGY
Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug
David Zeltser, MD*,
Dan Justo, MD*,
Amir Halkin, MD ,
Raphael Rosso, MD,
Maya Ish-Shalom, MD,
Mordechai Hochenberg, MD and
Sami Viskin, MD,*
* Internal Medicine D, Tel Aviv–Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Cardiology, Tel Aviv–Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Manuscript received January 14, 2004;
revised manuscript received March 5, 2004,
accepted March 22, 2004.
* Reprint requests and correspondence: Dr. Sami Viskin, Department of Cardiology, Tel Aviv Medical Center, Weizman 6, Tel Aviv 64239, Israel.
saviskin{at}tasmc.health.gov.il
OBJECTIVES: The goal of this study was to determine how often atrioventricular (AV) block is really caused by medications.
BACKGROUND: Beta-blockers, verapamil, and diltiazem are considered a cause of AV block for which pacemaker implantation is not indicated. However, it is not known if such patients can expect a benign course after discontinuation of the culprit medication.
METHODS: Consecutive patients with II or III degree AV block not related to acute myocardial infarction, digitalis toxicity, or vasovagal syncope were studied. The level of AV block (AV-nodal or infranodal) was defined by electrocardiographic criteria. The cause and effect relation between AV block and drugs was defined according to the response to drug discontinuation.
RESULTS: Of 169 patients with AV block, 92 (54%) were receiving beta-blockers and/or verapamil or diltiazem. Patients receiving medications had similar clinical and electrocardiographic characteristics with patients who had AV block in the absence of drugs. Drug discontinuation was followed by resolution of AV block in 41% of cases, whereas spontaneous improvement of AV conduction occurred in 23% of patients who had AV block in the absence of drugs. However, 56% of the patients for whom drug discontinuation led to resolution of AV block had recurrence of AV block in the absence of therapy. Atrioventricular block that was "truly caused by drugs" was found in only 15% of patients who had II or III degree AV block during therapy with beta-blockers, verapamil, or diltiazem.
CONCLUSIONS: Atrioventricular block is commonly "related to drugs" but is rarely "caused by drugs."
|
Abbreviations and Acronyms
| | AV | = atrioventricular | | DR-AVB | = drug-related atrioventricular block |
|
This article has been cited by other articles:
|
|
|
|
 
M.S. Cunnington, C.J. Plummer, and J.M. McComb
Delays and adverse clinical outcomes associated with unrecognized pacing indications
QJM,
July 1, 2009;
102(7):
485 - 490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M.S. Cunnington, C.J. Plummer, A.K. McDiarmid, and J.M. McComb
The patient journey from symptom onset to pacemaker implantation
QJM,
December 1, 2008;
101(12):
955 - 960.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. Mark Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
2085 - 2105.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
2820 - 2840.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Cohen, M. S. Matharu, and P. J. Goadsby
Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy
Neurology,
August 14, 2007;
69(7):
668 - 675.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
