The Predictors of the Reversibility Among Patients With a High-Grade Atrioventricular Block

Abstract

Abstract Aim: Reversibility of atrioventricular block (AVB) is evident in clinical practice. Identifying predictors associated with AVB reversibility is important to prevent unnecessary permanent pacemaker (PPM) implantations and related complications. We aimed to identify possible causes of AVB reversibility. Methods: Demographic and clinical data were collected by retrospectively scanning the hospital electronic information system between 2012 and 2020. Patients hospitalized for the first time with high-degree AV block were included. Results: Irreversible AVB was observed in 165 patients while reversible AVB was observed in 78 patients. Patients without AVB recovery was older (77 years vs 74.5 years, p=0.026) and had more frequent previous history of coronary artery disease (CAD) (29.4% vs 13.9%, p=0.004). Presentation with acute coronary syndrome (ACS) was more frequent in patients with reversible block (15.3% vs 2.4%, p<0.001). Beta-blockers use (38.4% vs 15.1%, p<0.001) and non-dihydropyridine calcium channel blockers (NCCB) use (7.7% vs 1.8%, p=0.033) were more common in patients with reversible AVB. The multivariate analysis displayed that ACS on admission (OR 0.103, 95% CI 0.030-0.350, p<0.001), beta-blockers use (OR 0.235, 95% CI 0.116-0.476, p<0.001) and NCCBs use (OR 0.13, 95% CI 0.030-0.563, p=0.006) predicted the reversibility of AVB; however, age and significant chronic CAD history was not a determinant of the reversibility of AVB (p=0.07 and p=0.178, respectively). Conclusion: In patients those admitting with ACS and beta-blockers or NCCBs use, AV block might be reversible that should be carefully questioned and treated before a PPM implantation. Significant CAD history is not an indicator of the reversibility which might not be needed to wait for treatment to avoid PPM implantation.