title: The impact of drug discontinuation in patients treated with temporary pacemaker due to atrioventricular block.
abstract: BACKGROUND
  Patients treated with a temporary pacemaker (TPM) due to atrioventricular (AV) block are often monitored after discontinuation of AV node blocking drugs to evaluate the indication for permanent pacing. However, the impact of drug discontinuation is sparsely documented. We investigated to what extent drug discontinuation abolished the need for permanent pacemaker (PPM) implantation.
  
  
  RESULTS
  All hospital records of patients who received a TPM at Aalborg Hospital, Denmark, between January 2000 and March 2011 (n = 575) were retrospectively reviewed. Patients with AV block who were treated with a TPM and concomitant cessation of drug therapy were included if there was no other underlying mechanism causing the AV block. AV blocking drugs included antiarrhythmic agents classes II-IV and digoxin. Fifty-five patients fulfilled our inclusion criteria. Forty-seven patients had an indication for a PPM at the initial hospital admission, despite drug discontinuation. Of the remaining 8 patients who were discharged without a PPM, 3 subsequently experienced events: 2 had recurrence of AV block requiring a PPM, and 1 experienced syncope. Thus, in total, 49 (89%) patients had a final indication for a permanent pacemaker (PPM). Of patients receiving beta-blocker monotherapy, 26 (96%) had an indication for a PPM. TPM implantation was complicated by infection or displacement in 11% of cases.
  
  
  CONCLUSIONS
  The vast majority of patients treated with a TPM due to AV block and who receive beta-blockers alone or in combination with digoxin have a final indication for a PPM despite cessation of drug treatment. TPM are frequently associated with complications.
authors.affiliation: Department of Cardiology and Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Maria Bisgaard
authors.initials: MB
authors.lastname: Knudsen
authors.forename: Anna Margrethe
authors.initials: AM
authors.lastname: Thøgersen
authors.forename: Søren Pihlkjaer
authors.initials: SP
authors.lastname: Hjortshøj
authors.forename: Sam
authors.initials: S
authors.lastname: Riahi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D054537:Atrioventricular Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001283:Atrioventricular Node / Q000187:drug effects* / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D003718:Denmark; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010343:Patient Admission; D010351:Patient Discharge; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrioventricular block; beta-adrenergic blockers; pacemakers; pacing indications; slow-channel blockers; temporary pacing