Causes of Heart Block in Young and Middle-Aged South Africans.
Curr Probl Cardiol 2022:101247. [PMID:
35568083 DOI:
10.1016/j.cpcardiol.2022.101247]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND
There is a paucity of data regarding the aetiology of atrioventricular heart block (AVB) in young and middle-aged patients, particularly from low- and middle-income countries.
OBJECTIVE
To determine the aetiology of AVB in patients ≤ 55 years treated with transvenous pacemakers in a low- or middle-income country.
METHODS
We performed a retrospective review of all patients who received a transvenous pacemaker for newly diagnosed AVB from 01/01/2013 to 31/12/2020 at Groote Schuur Hospital, Cape Town, South Africa.
RESULTS
One thousand one hundred one (1101) consecutive patients received a permanent transvenous pacemaker for AVB. One hundred thirty-six patients (12.4%) were ≤ 55 years. The study patients' mean (standard deviation) age was 41 (11) years, and 48.5% were female. Third-degree AV block was diagnosed in 73.5%, 2:1 AV block in 8.1%, and Mobitz Ι second degree AV block in 5.9%. The aetiology of AVB could be determined in 97/136 (71.3%) patients. Forty-three of 136 (31.6%) patients were post-surgical, and 16/136 (11.8%) patients had developed AVB from an acute myocardial infarction. Cardiac Magnetic Resonance (CMR) imaging was performed in 26 patients: cardiac sarcoidosis was diagnosed in 7/26 patients. No pathology could be identified in 10/26 patients who had CMR. The aetiology of AVB remained unknown in 39/136 patients (28.7%).
CONCLUSION
Prior valve surgery is the leading cause of AVB treated with a transvenous pacemaker in patients ≤ 55 years in this South African referral unit. Cardiac magnetic resonance imaging identified disease processes that require further management in many cases.
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