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“First-degree AV block—a benign entity?” Insertable cardiac monitor in patients with 1st-degree AV block reveals presence or progression to higher grade block or bradycardia requiring pacemaker implant

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Abstract

Background

First-degree AV block has in the past generally been considered a benign condition. A few recent studies have shown that 1st-degree AV block is associated with an increased risk for heart failure, pacemaker (IPG) implantation, and death. We investigated the outcomes of patients who received an insertable cardiac monitor (ICM) (Medtronic Reveal XT®) within the scope of the INSIGHT XT study and had 1st-degree AV block at baseline.

Methods

The observational, international, multi-center INSIGHT (R)XT study prospectively enrolled 1003 patients implanted with an ICM for arrhythmia diagnosis, irrespective of the clinical indication. This analysis includes 37 patients who had documented 1st-degree AV block at enrolment. Patients with known concurrent higher grade block at enrolment were excluded.

Results

The indications for rhythm monitoring and ICM implantation were syncope/pre-syncope in 54.1%, cryptogenic stroke in 18.9%, AF with rhythm control intervention in 21.6%, and unexplained palpitations in 5.4%. Mean age was 68 ± 14 years, 75.7% were male, and concurrent bundle branch block was present in 8.1%. The median follow-up time was 12.2 months (IQR3.9–15.9). Fifteen patients (40.5%) received an IPG during the follow-up, and in 93.3% of the cases, the implant was needed to treat a now detected more severe bradycardia or progression of the conduction disease.

Conclusions

ICM either revealed progression of 1st-degree AV block to a higher grade block (53%) or detected an already existing more severe bradycardia warranting an IPG in 40.5% patients. This finding supports the conclusion that 1st-degree AV block might be a risk marker for more severe intermittent conduction disease and is not benign in all patients. Further studies may reveal patient subgroups which are at risk for demonstrating or developing higher grade AV block and may warrant a future IPG implantation.

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Funding

This study was supported by Medtronic.

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Authors and Affiliations

  1. Peter Osypka Heart Center Munich, Hospital Munich-Thalkirchen, Am Isarkanal, 36 81379, Munich, Germany

    Thorsten Lewalter

  2. Department of Cardiology, Krankenhaus der Elisabethinen-Academic Teaching Hospital, Linz, Austria

    Helmut Pürerfellner

  3. Department of Cardiology, Careggi University Hospital, Florence, Italy

    Andrea Ungar

  4. Medtronic BRC, Maastricht, The Netherlands

    Guido Rieger

  5. Medtronic EMEA Regional Clinical Center, Rome, Italy

    Lorenza Mangoni

  6. Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland

    Firat Duru

Authors
  1. Thorsten Lewalter
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  2. Helmut Pürerfellner
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  3. Andrea Ungar
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  4. Guido Rieger
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  5. Lorenza Mangoni
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  6. Firat Duru
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Consortia

on behalf of the INSIGHT XT study investigators

Corresponding author

Correspondence to Thorsten Lewalter.

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Conflict of interest

Thorsten Lewalter has received speaker honorarium from Medtronic.

Helmut Pürerfellner has received speaker honorarium from Medtronic.

Andrea Ungar has received speaker honorarium from Medtronic.

Guido Rieger is an employee of Medtronic.

Lorenza Mangoni is an employee of Medtronic.

Firat Duru has received speaker honorarium from Medtronic.

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Lewalter, T., Pürerfellner, H., Ungar, A. et al. “First-degree AV block—a benign entity?” Insertable cardiac monitor in patients with 1st-degree AV block reveals presence or progression to higher grade block or bradycardia requiring pacemaker implant. J Interv Card Electrophysiol 52, 303–306 (2018). https://doi.org/10.1007/s10840-018-0439-7

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  • DOI: https://doi.org/10.1007/s10840-018-0439-7

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