title: Management and outcome of topical beta-blocker-induced atrioventricular block.
abstract: BACKGROUND
  Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers.
  
  
  METHODS
  All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period.
  
  
  RESULTS
  A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation.
  
  
  CONCLUSIONS
  Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.
authors.affiliation: Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey. serhandr@gmail.com; serhan_oz@yahoo.com.
authors.forename: Kazim Serhan
authors.initials: KS
authors.lastname: Özcan
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Bariş
authors.initials: B
authors.lastname: Güngör
authors.affiliation: Department of Cardiology, Almaty Sema Hospital, Almaty, Kazakhstan.
authors.forename: Damirbek
authors.initials: D
authors.lastname: Osmonov
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Ahmet Ilker
authors.initials: AI
authors.lastname: Tekkeşin
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Servet
authors.initials: S
authors.lastname: Altay
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ekmekçi
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Toprak
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Ersin
authors.initials: E
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Nazmi
authors.initials: N
authors.lastname: Çalik
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Ahmet Taha
authors.initials: AT
authors.lastname: Alper
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Gürkan
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
authors.forename: Izzet
authors.initials: I
authors.lastname: Erdinler
mesh_terms: D060433:Administration, Ophthalmic; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000319:Adrenergic beta-Antagonists