Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia
| Autor: | Victor A. Abrich, Gregory W. Barsness, Rachel J. Le, Paul A. Friedman, Eric H. Yang, Siva K. Mulpuru, Bradley R. Lewis, Yong Mei Cha, Ryan J. Lennon |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Bradycardia Pacemaker Artificial 030213 general clinical medicine Time Factors Heart block Transcutaneous pacing Sinus bradycardia 03 medical and health sciences 0302 clinical medicine Risk Factors Heart rate medicine Humans Hospital Mortality Adverse effect Aged Original Research Aged 80 and over Community and Home Care business.industry General Medicine Emergency department Middle Aged medicine.disease Transvenous pacing Anesthesia Female medicine.symptom business |
| Zdroj: | Clin Med Res |
| ISSN: | 1554-6179 1539-4182 |
| DOI: | 10.3121/cmr.2019.1507 |
| Popis: | OBJECTIVE: To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting. DESIGN: Retrospective observational study. SETTING: Emergency room and inpatient. PARTICIPANTS: Patients presenting to the emergency department with symptomatic bradycardia. METHODS: 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. RESULTS: 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 |
| Databáze: | OpenAIRE |
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