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Long-term follow-up of older patients with Mobitz type I second degree atrioventricular block
  1. Ann G Coumbe1,2,
  2. Niyada Naksuk1,2,
  3. Marc C Newell3,
  4. Porur E Somasundaram4,
  5. David G Benditt2,
  6. Selcuk Adabag1
  1. 1Division of Cardiology, Veterans Administration Medical Center, Minneapolis, Minnesota, USA
  2. 2Cardiac Arrhythmia and Syncope Center, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
  3. 3Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
  4. 4St. Luke's Hospital, Duluth, Minnesota, USA
  1. Correspondence to Dr Selcuk Adabag, Division of Cardiology, Veterans Administration Medical Center, Section of Cardiology (111 C), One Veterans Drive, Minneapolis, MN 55417, USA; adaba001{at}umn.edu

Abstract

Objective To examine the long-term survival of older patients with Mobitz I second degree atrioventricular (AV) block.

Design Retrospective cohort study. Propensity score adjustment for requiring a cardiac implantable electronic device (CIED) was performed. Multivariable Cox regression analysis was used.

Setting Tertiary care referral centre.

Patients We examined 299 older patients (age >45 years) with Mobitz I second degree AV block on ECG at the Minneapolis Veterans Affairs Medical Center from 1992 to 2010.

Main outcome measure Survival.

Results The average age of patients was 75±9 years; 99% were male; 59% had coronary heart disease; 44% had heart failure. 141 (47%) patients required CIED, of which 17 were implantable cardioverter-defibrillators (ICDs). CIEDs were implanted a median of 110 days after the ECG for symptomatic bradycardia, high-degree AV block or prevention of sudden cardiac death. Patients with CIED had greater cardiac co-morbidity than those without CIED. After a median 3.3 years of follow-up (range 3 days to 19 years), 190 (64%) patients died. Patients with CIED had longer survival than those without CIED (p=0.001). In propensity-adjusted multivariable Cox regression analysis, CIED implantation was associated with a 46% reduction in mortality (HR 0.54, 95% CI 0.35 to 0.82; p=0.004). Excluding 17 patients with ICDs did not alter the results.

Conclusions In this retrospective cohort study of older male patients with Mobitz I AV block on ECG, CIED implantation was associated with longer survival.

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