Materiały źródłowe

• #1 Bradycardia: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17841-bradycardia

  For many people, bradycardia doesn’t cause symptoms and isn’t a problem, especially when it happens because you’re in very good physical shape. When it happens with symptoms, it’s usually a treatable condition with a positive outlook. […] For people who do have symptoms or problems because of bradycardia, you’re more likely to have a good outcome with early diagnosis and treatment. Delays in treatment, especially when bradycardia happens because of certain conditions, usually increase your risk of complications or death. […] Overall, your healthcare provider is the best person to tell you whether or not this condition will be a short-term concern or if you’ll have it for the rest of your life. In most cases where you have symptoms and you’ll have it for the rest of your life, you’ll need to take medication daily or have surgery to implant a pacemaker.

• #2 Bradycardia | Diagnosis & Disease Information – The Cardiology Advisor

  https://www.thecardiologyadvisor.com/ddi/bradycardia/

  The prognosis for bradycardia varies based on the underlying cause and individual patient characteristics. In general, when sinus bradycardia is diagnosed early, the prognosis is good. However, the prognosis tends to be poor for patients with sick sinus syndrome and bradycardia, with a 5-year survival rate of 45% to 70%. Many patients with bradycardia are asymptomatic and never experience complications, particularly those with a high physical fitness level. Early diagnosis of symptomatic bradycardia and prompt initiation of treatment are critical to prevent serious complications and death, especially in patients with severe medical comorbidities. […] Conditions that increase the risk of heart damage and bradycardia include the following: Hypertension; Smoking; Heavy alcohol use; Recreational drug use; Stress; Anxiety; and Older age.

• #3 Sinus Bradycardia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493201/

  Prognosis is good when the rhythm is promptly identified by a healthcare provider. However, patients with sick sinus syndrome who have bradycardia tend to have a poor prognosis with 5-year survival rates between 45 to 70%. […] With the number of bariatric procedures increasing each year, it has been observed that many of these patients also develop sinus bradycardia. Whether this is linked to the sudden loss of weight is not yet known.

• #4 Relative Bradycardia in Patients with Septic Shock Requiring Vasopressor Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5512273/

  Relative bradycardia in patients with septic shock is associated with lower mortality, even after adjustment for confounding. […] Our data support expanded investigation into whether inducing relative bradycardia will benefit patients with septic shock. […] Mortality was significantly lower in the bradycardic group than in the never-bradycardic group (21% vs. 34%, p0.001). […] Bradycardia was associated with significantly lower mortality (OR=0.55, adjusted p0.001). […] The extent of bradycardia (normalized AUC of HR 80 beats/min) was also associated with significantly lower mortality, as depicted in Figure 2 (OR 0.92 per beats/min, adjusted p0.001). […] Our results provide further support for clinical equipoise in investigations of induced relative bradycardia for patients with septic shock.

• #5 Meta-analysis and systematic literature review of COVID-19 associated bradycardia as a predictor of mortality | The Egyptian Heart Journal | Full Text

  https://tehj.springeropen.com/articles/10.1186/s43044-022-00284-8

  Cardiac arrhythmias have been identified as independent predictors of mortality in Coronavirus disease 2019 (COVID-19) patients. While some studies have reported poor prognosis with bradycardia in COVID-19 patients, others have not found any association between bradycardia and mortality in COVID-19 patients. […] A pooled estimate, with a sample size of 1320 patients, comparing the effect of patients that were bradycardic during their admission with those that were not on mortality showed that bradycardia did not lead to increased mortality in COVID-19 patients (OR 1.25, 95% CI 0.413.84, p=0.7). […] This meta-analysis showed that bradycardia was not significantly associated with mortality in COVID-19 patients. […] Our study found that bradycardia was not associated with mortality in COVID-19 patients. […] The implication for practice is that there might be no mortality benefit in aggressively treating asymptomatic sinus bradycardia in COVID-19 patients. […] The result of this meta-analysis showed that bradycardia was not significantly associated with mortality in COVID-19 patients.

• #6 Asymptomatic Bradycardia Does Not Predict Mortality in Older Adultslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/jc201110260000002/2011/10/26/asymptomatic-bradycardia-does-not-predict

  In a single-center cohort, untreated bradycardia in adults older than 60 was associated with eventual pacemaker placement but did not increase mortality risk. […] The prognostic implications of asymptomatic bradycardia in older patients are unclear. […] Patients older than 60 with asymptomatic bradycardia can be reassured that their long-term prognosis is no different from that of patients without asymptomatic bradycardia.

• #7 Prognosis of the Bradycardia Pacemaker Recipient Assessed at First Implantation: A Nationwide Cohort Study

  https://www.acc.org/latest-in-cardiology/journal-scans/2013/08/29/20/33/prognosis-of-the-bradycardia-pacemaker-recipient

  Prognosis of the Bradycardia Pacemaker Recipient Assessed at First Implantation: A Nationwide Cohort Study […] What are the long-term prognosis and pre-implantation determinants of prognosis of bradycardia pacemaker (PM) recipients? […] At the end of a mean follow-up of 5.8 (standard deviation 1.1) years, 512 patients (33%) died, mostly of noncardiac cause (67%). There were two PM-related deaths. Survival rates were 93%, 81%, 69%, and 61% after 1, 3, 5, and 7 years, respectively. PM recipients without concomitant cardiovascular disease at implantation showed survival rates comparable to age- and sex-matched controls. Predictors at time of implantation associated with cardiac mortality were: age, coronary artery disease (CAD), diabetes, heart failure, valve disease, and the indication for PM implantation. Predictors for all-cause mortality were: male gender, age, body mass index, CAD, cardiac surgery, diabetes, heart failure, and maintained atrioventricular synchrony.

• #8 Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillation | Open Heart

  https://openheart.bmj.com/content/7/1/e001125

  In patients with atrial fibrillation, bradycardia may lead to excess associated morbidity and subsequently pacemaker implantation. […] We highlighted risk factors of pacemaker implantation in newly diagnosed AF patients and created a risk score. The clinical utility of the risk score needs further investigation. […] To our knowledge, this is the largest cohort study to determine important risk factors for PPM and the first study to produce a 3-month risk score predicting PPM risk in patients with newly diagnosed AF. Significant covariates were identified as risk factors of PPM: age 60 years, CHD, age 60 years and HF, prior syncope, valvular AF, hypertension, IHD, male sex and DM. A risk score was produced and internally validated to predict PPM implantation in a 3-months follow-up. […] Overall, the 5-year risk for PPM in newly diagnosed AF patients was 5%. We identified nine risk factors of PPM: age above 60 years, CHD, age 60 years with HF, prior syncope, valvular AF, hypertension, IHD, male sex and DM. A risk score was produced to predict the absolute risk of PPM during a 3-months follow-up after discharge or outpatient visit for AF diagnosis. The clinical utility of the novel risk score needs further investigation.

• #9 Prognosis of the Bradycardia Pacemaker Recipient Assessed at First Implantation: A Nationwide Cohort Study

  https://www.acc.org/latest-in-cardiology/journal-scans/2013/08/29/20/33/prognosis-of-the-bradycardia-pacemaker-recipient

  The authors concluded that a pre-implantation history of heart failure, CAD, and diabetes are the most important predictors for worse prognosis in PM recipients. […] This prospective multicenter study of unselected bradycardia PM recipients reported that PM recipients without underlying heart disease have a prognosis similar to that of the general population. The study identified several predictors at the time of implantation to be independently associated with a worse prognosis, the most important being a history of heart failure, CAD, and diabetes. These observations suggest that the prognosis of contemporary PM recipients is mainly determined by cardiovascular comorbidity, and a pure bradycardia indication for pacing does not appear to influence survival.

• #10 :: KCJ :: Korean Circulation Journal

  https://e-kcj.org/DOIx.php?id=10.4070/kcj.2009.39.9.367

  The prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known. […] Beta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered. […] When symptomatic bradycardia is related to extrinsic causes, removal of potentially reversible causes of the bradycardia is always the first approach to management. […] In patients with clinically significant bradycardia secondary to drug treatment, one must decide whether to discontinue, reduce the dosage, or continue medication use if there is no acceptable alternative; in the latter case pacing therapy should be considered.

• #11 :: KCJ :: Korean Circulation Journal

  https://e-kcj.org/DOIx.php?id=10.4070/kcj.2009.39.9.367

  A recent study reported that drug-induced AV block, in patients treated with beta-blockers and non-DHP calcium channels antagonists, the AV block 'truly caused by drugs’ was found in only 15% of the patients, and in the majority of cases, the 'culprit’ drugs were found to be 'innocent bystanders’. […] It is possible that clinically significant and symptomatic 'drug-induced’ bradycardia in other patients might also be primarily due to underlying sinus and/or AV node disease. […] Combined drug therapy, advanced age, a history of prior myocardial infarction, decreased systolic performance, and ventricular arrhythmia increase the risk of bradyarrhythmic complications associated with drug therapy. […] In this study, third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with bradycardia in cases truly associated with drugs.

• #12 :: KCJ :: Korean Circulation Journal

  https://e-kcj.org/DOIx.php?id=10.4070/kcj.2009.39.9.367

  Although these patients could be discharged without permanent pacing, according to current guidelines, it was suggested that pacemaker implantation should be considered in such patients. […] In conclusion, beta-blockers were the most common drugs associated with the development of bradycardia. About one quarter of the cases with DRB were not caused by drugs, but were revealed by drugs. Close follow-up of these patients is needed because implantation of a permanent pacemaker may be required in some of them.

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