Özcan Kazim Serhan, Güngör Bariş, Osmonov Damirbek, Tekkeşin Ahmet Ilker, Altay Servet, Ekmekçi Ahmet, Toprak Ercan, Yildirim Ersin, Çalik Nazmi, Alper Ahmet Taha, Gürkan Kadir, Erdinler Izzet
Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey.
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Centre, Istanbul, Turkey.
Cardiovasc J Afr. 2015 Nov-Dec;26(6):210-3. doi: 10.5830/CVJA-2015-030.
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.
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.
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.
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.
局部用β受体阻滞剂在青光眼治疗中具有公认的作用。我们旨在调查因局部用β受体阻滞剂诱发有症状的房室传导阻滞患者的结局。
2009年1月至2013年1月期间，所有在我院锡亚米·埃尔塞克培训与研究医院入院或出院且诊断为房室传导阻滞的患者均纳入本研究。招募使用眼科β受体阻滞剂的受试者，并在住院期间及停药后3个月随访其对永久起搏器的需求。对于房室传导阻滞持续超过72小时或在随访期间复发的患者，植入永久起搏器。
共有1122例诊断为房室传导阻滞的患者住院，在研究期间946例（84.3%）植入了永久起搏器。13例使用眼科β受体阻滞剂治疗青光眼且未使用其他心率限制药物的患者纳入研究。心电图检查显示，8例患者为完全性房室传导阻滞，5例为高度房室传导阻滞。使用的眼科β受体阻滞剂中，7例（55%）为噻吗洛尔，4例（30%）为倍他洛尔，2例（15%）为卡替洛尔。眼科β受体阻滞剂治疗的平均持续时间为30.1±15.9个月。停药后，10例患者的传导阻滞持续存在并植入了永久起搏器。随访期间，又有1例患者需要植入起搏器。因此，总共13例患者中有11例（84.6%）植入了起搏器。起搏器植入率根据所用局部β受体阻滞剂的类型无差异（p = 0.37）。心电图显示存在结下阻滞与较高的起搏器植入率相关。
我们的结果表明，用于治疗青光眼的局部用β受体阻滞剂可能会导致严重的传导异常，当发生房室传导阻滞时，高比例患者需要植入起搏器。
