Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA; Current affiliation: MercyOne Waterloo Heart Care, Waterloo, Iowa, USA
Providence Spokane Cardiology, Spokane, Washington, USA.
Clin Med Res. 2020 Aug;18(2-3):75-81. doi: 10.3121/cmr.2019.1507. Epub 2020 Feb 14.
To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting.
Retrospective observational study.
Emergency room and inpatient.
Patients presenting to the emergency department with symptomatic bradycardia.
We retrospectively reviewed electronic health records of 518 patients from two Mayo Clinic campuses (Rochester and Phoenix) who presented to the emergency department with symptomatic bradycardia (heart rate ≤50 beats/minute) from January 1, 2010 through December 31, 2015. Sinus bradycardia was excluded. The following management strategies were compared: observation, non-invasive management (medications with/without transcutaneous pacing), early permanent pacemaker (PPM) implantation (≤2 days), and delayed PPM implantation (≥3 days). Study endpoints included length of stay and adverse events related to bradycardia (syncope, central line-associated bloodstream infections, cardiac arrest, and in-hospital mortality). Patients who received a PPM were further stratified by weekend hospital admission.
Heart block occurred in 200 (38.6%) patients, and atrial arrhythmias with slow ventricular response occurred in 239 (46.1%) patients. Reversible causes of bradycardia included medication toxicity in 22 (4.2%) patients and hyperkalemia in 44 (8.5%) patients. Adverse events were similar in patients who underwent early compared to delayed PPM implantation (6.6% vs 12.5%, P=.20), whereas adverse events were higher in patients who received temporary transvenous pacing (19.1% vs 3.4%, P<.001). Weekend admissions were associated with increased temporary transvenous pacing, prolonged median time to PPM implantation by 1 day, and prolonged median length of stay by 2 days.
Delayed PPM implantation was not associated with an increase in adverse events. Weekend PPM implantation should be considered to reduce temporary transvenous pacing and shorten length of stay.
确定门诊中因可逆和不可逆病因导致有症状心动过缓的各种治疗策略的临床结局。
回顾性观察性研究。
急诊室和住院部。
因有症状心动过缓（心率≤50 次/分钟）就诊于急诊的患者。
我们回顾性分析了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间，梅奥诊所（罗切斯特和凤凰城）两个院区因有症状心动过缓（心率≤50 次/分钟）就诊于急诊的 518 例患者的电子健康记录。排除窦性心动过缓。比较以下治疗策略：观察、非侵入性治疗（药物治疗加/不加经皮起搏）、早期（≤2 天）永久性起搏器（PPM）植入和晚期（≥3 天）PPM 植入。研究终点包括住院时间和与心动过缓相关的不良事件（晕厥、中心静脉相关血流感染、心脏骤停和院内死亡率）。接受 PPM 的患者根据周末住院情况进一步分层。
200 例（38.6%）患者出现心脏阻滞，239 例（46.1%）患者出现房性心律失常伴缓慢心室反应。心动过缓的可逆病因包括 22 例（4.2%）患者药物毒性和 44 例（8.5%）患者高钾血症。早期与晚期 PPM 植入患者的不良事件发生率相似（6.6%比 12.5%，P=.20），而临时经静脉起搏患者的不良事件发生率较高（19.1%比 3.4%，P<.001）。周末入院与临时经静脉起搏增加、PPM 植入中位时间延长 1 天和中位住院时间延长 2 天有关。
晚期 PPM 植入不会增加不良事件。应考虑周末行 PPM 植入以减少临时经静脉起搏并缩短住院时间。
