Asymptomatic Complete Heart Block: How Soon Should a Pacemaker be Implanted?
Abstract
Material and Methods: A retrospective analysis of data from the electronic medical records from 2002 to 2020 was conducted at a university hospital in Southern Thailand. The study focused on patients diagnosed with asymptomatic complete heart block using standard 12-lead electrocardiograms. Kaplan-Meier survival analysis was used to examine the time from diagnosis to any adverse events before pacemaker implantation.
Results: Among 95 asymptomatic complete heart block patients with incidental detection of bradycardia (mean age 70.4±15.0 years old) during hospital visits, the mean heart rate was 40.5±7.2 beats per minute and the median QRS duration was 110 milliseconds (ms) (interquartile range (IQR) 92, 145.8 ms). All patients eventually underwent pacemaker implantation. The median waiting time for the implant was 61 days (IQR 14, 223 days). During the waiting period, 34 patients (35.8%) experienced adverse events. Syncope was the first major adverse event that occurred 27 days after the diagnosis. According to survival analysis, the 30-day and 90-day event-free survivals were 94.2% and 83.7%, respectively.
Conclusion: The waiting period for pacemaker implantation in patients with asymptomatic complete heart block poses certain risks. To mitigate the chance of developing major adverse events, it is better to implant a pacemaker sooner rather than later.
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