Abstract 11889: Ischemic Evaluation in Patients Presenting With Advanced Atrioventricular Block - Experience From a Large County Health System

Abstract

Introduction: Coronary artery disease (CAD) is a risk factor for advanced (2 nd degree Mobitz II and 3 rd degree) atrioventricular (AV) block. Research Question: While AV block in the setting of acute myocardial infarction (AMI) is often reversible, data is limited on utility of ischemic evaluation in advanced AV block without AMI. Aim: We assessed whether ischemic evaluation and revascularization was associated with reversibility of advanced AV block not in the setting of AMI. Methods: We queried the electronic medical records of a large county health system that serves the Houston metropolitan area for patients with diagnosis of advanced AV block between 1/1/2018 and 1/1/2022. Demographic, medical history, ischemic evaluation (by coronary catheterization or stress test) data and pacemaker interrogation reports were abstracted from the medical records. Patients with AV block from AMI were excluded. Results: Over a period of 4 years, there were 116 patients who presented with advanced AV block, of which 73 (62.9%) underwent ischemic evaluation either by coronary angiography or non-invasive imaging. Patients who underwent ischemic evaluation were associated with lower pacing burden on device interrogation compared to those with no ischemic evaluation (Table 1). In multivariable regression, ischemic evaluation was associated with lower odds of pacing burden >40% on device interrogation (OR -1.53, 95% CI -3.02, -0.03) but not AV block resolution (OR 0.41, 95% CI -1.76, 2.58). Of those who underwent ischemic evaluation, 26.0% had obstructive CAD, of which 78.9% underwent revascularization. AV block resolved in 13.3% who underwent revascularization. Conclusion: Among patients presenting with advanced AV block not in the setting of AMI, ischemic evaluation was associated with decreased pacing burden but not AV block resolution. In patients found to have obstructive CAD, a minority had resolution of AV block after revascularization.