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32. Cardiovascular Nursing
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Searching for predictors of permanent cardiac pacemaker implantation in patients with potential reversible causes for bradycardia
Session:
Posters 2 - Écran 04 - Arritmologia - Dispositivos
Speaker:
Leonor Marques
Congress:
CPC 2018
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.3 Syncope and Bradycardia - Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Leonor Marques; Alexandra Castro; Daniel Seabra; Henrique Guedes; Ana Neto; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Introduction</strong>: Slow heart rate is a common cause for hospital referral. In many patients (pts), a reversible cause for bradycardia can easily be identified, and permanent pacing should be delayed until the correction of these conditions. Medications and electrolyte disturbances are among the major reversible causes for conduction system disturbances. Still, many of these pts may have underlying conduction system disease, with a potential need to a permanent cardiac pacemaker (PM) implantation at a long-term. The identification of this subgroup of pts remains a challenge.</p> <p><strong>Purpose:</strong> To characterize a cohort of pts admitted to a cardiology ward with a diagnosis of bradycardia in the context of negative chronotropic medication intake and/or electrolyte disturbances, and to identify prognostic features that may be associated with permanent PM implantation.</p> <p><strong>Methods: </strong>We retrospectively analyzed a cohort of pts admitted to a cardiology department with a diagnosis of iatrogenic bradycardia between 1/2012 and 9/2016. Clinical characteristics, conduction disorder on admission [sinus node disfunction (SND), atrioventricular block (AVB), atrial fibrillation/flutter with low ventricular rate (AF/AFL with LVR)] and QRS parameters on surface electrocardiogram [duration, morphology, axis], outpatient medication, serum analytical data [electrolytes, digoxin and creatinine] and evidence of structural heart disease were analyzed. The primary endpoint was PPM implantation; the secondary was to identify features that may be associated with PPM implantation.</p> <p><strong>Results:</strong> 121 pts were included (41.3% male; mean age 79.9±8.3 years). SND was diagnosed in 8 (6.6%), AF/AFL with LVR in 34 (28.1%) and AVB in 79 (65.4%) pts. Drug intake was identified in 113 (93.4%) and hyperkalemia in 8 (6.6%) pts as triggers. Drug discontinuation or potassium correction reversed the rhythm disturbance in 16 (13.2%) pts; PPM was needed in 105 (86.8%), with implantation occurring during hospital admission in 98 (93.3%) and after discharge in 7 (6.7%), after a mean follow-up of 9.7 months. When comparing these subgroups, the pts who needed and who needed not PPM, the latter were more frequently woman (p=0.012) and had higher prevalence of AF/AFL (p=0.005); although no differences where found between the triggers for bradycardia, a lower dosage of oral digoxin intake (p=0.029) and a lower serum level of digoxin (p=0.015) on admission predicted the need for PPM.</p> <p><strong>Conclusion:</strong> AVB was the most frequent disturbance identified and drugs were the most common trigger for bradycardia. Even with the identification and correction of a reversible cause, many pts kept indication for PPM, which globally defines these pts as a group of risk who deserve further follow-up. Female sex and the presence of AF/AFL predicted a lower need for PPM, as well as the intake of higher dosages of oral digoxin and higher serum digoxin levels as precipitating factor.</p>
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