Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T. Popa" Iași, 700115 Iași, Romania.
Institute of Cardiovascular Diseases "Prof. Dr. George I. M. Georgescu" Iași, 700115 Iași, Romania.
Medicina (Kaunas). 2022 Feb 20;58(2):320. doi: 10.3390/medicina58020320.
: Drug-related bradyarrhythmia is a well-documented major adverse event among beta-blocker users and a potential cause for hospitalization or additional interventions. Whether beta-blocker use is associated with specific bradyarrhythmia presentations, and how this relates to other predisposing factors, is not well known. We aim to evaluate the association between beta-blocker use and the type of atrioventricular (AV) conduction disorder in patients with symptomatic bradycardia. : We conducted a retrospective cohort study on 596 patients with a primary diagnosis of symptomatic bradyarrhythmia admitted to a single tertiary referral center. Of the cases analyzed, 253 patients were on beta-blocker treatment at presentation and 343 had no bradycardic treatment. We analyzed demographics, clinical and paraclinical parameters in relation to the identified AV conduction disorder. A multivariate regression analysis was performed to explore factors associated with beta-blocker use. : Of the 596 patients (mean age 73.9 ± 8.8 years, 49.2% male), 261 (43.8%) had a third-degree AV block, 92 (15.4%) had a second-degree AV block, 128 (21.5%) had slow atrial fibrillation, 93 (15.6%) had sick sinus syndrome and 21 (3.5%) had sinus bradycardia/sinus pauses. Beta-blocker use was associated with the female gender ( < 0.001), emergency admission ( < 0.001), dilated cardiomyopathy ( = 0.003), the lower left ventricular ejection fraction ( = 0.02), mitral stenosis ( = 0.009), chronic kidney disease ( = 0.02), higher potassium levels ( = 0.04) and QRS duration > 120 ms ( = 0.02). Slow atrial fibrillation (OR = 4.2, < 0.001), sick sinus syndrome (OR = 2.8, = 0.001) and sinus bradycardia/pauses (OR = 32.9, < 0.001) were more likely to be associated with beta-blocker use compared to the most common presentation (third-degree AV block), after adjusting for other patient characteristics. : Beta-blocker use is more likely to be associated with slow atrial fibrillation, sick sinus syndrome and sinus bradycardia/pauses, compared to a second- or third-degree AV block, after adjusting for other patient factors such as gender, admission type, ECG, comorbidities, cardiac function and lab testing.
药物相关性心动过缓是β受体阻滞剂使用者中一种记录完善的主要不良事件，也是导致住院或进一步干预的潜在原因。β受体阻滞剂的使用是否与特定的心动过缓表现相关，以及这与其他易患因素的关系如何，目前尚不清楚。我们旨在评估β受体阻滞剂的使用与有症状心动过缓患者的房室（AV）传导障碍类型之间的关系。
我们对在一家三级转诊中心因有症状的心动过缓入院的 596 例患者进行了回顾性队列研究。在分析的病例中，253 例患者在就诊时接受了β受体阻滞剂治疗，343 例患者未接受心动过缓治疗。我们分析了与确定的 AV 传导障碍相关的人口统计学、临床和实验室参数。进行了多变量回归分析以探讨与β受体阻滞剂使用相关的因素。
在 596 例患者中（平均年龄 73.9 ± 8.8 岁，49.2%为男性），261 例（43.8%）患有三度房室传导阻滞，92 例（15.4%）患有二度房室传导阻滞，128 例（21.5%）患有缓慢型心房颤动，93 例（15.6%）患有病态窦房结综合征，21 例（3.5%）患有窦性心动过缓/窦性停搏。β受体阻滞剂的使用与女性（<0.001）、紧急入院（<0.001）、扩张型心肌病（=0.003）、左心室射血分数较低（=0.02）、二尖瓣狭窄（=0.009）、慢性肾脏病（=0.02）、较高的钾水平（=0.04）和 QRS 持续时间>120 ms（=0.02）相关。与最常见的表现（三度房室传导阻滞）相比，在调整其他患者特征后，缓慢型心房颤动（OR=4.2，<0.001）、病态窦房结综合征（OR=2.8，=0.001）和窦性心动过缓/停搏（OR=32.9，<0.001）更可能与β受体阻滞剂的使用相关。
β受体阻滞剂的使用与三度房室传导阻滞相比，更可能与缓慢型心房颤动、病态窦房结综合征和窦性心动过缓/停搏相关，这与性别、入院类型、心电图、合并症、心功能和实验室检查等其他患者因素有关。
