Organisation and management of acute complete atrioventricular block in France: Results from a French multicentre national survey

Abstract

Active fixation leads for acute complete atrioventricular block (AVB 3) have recently been introduced in the last international guidelines for cardiac pacing. To describe the routine management of acute AVB 3 in France, with emphasis on the organisational aspects. From September 2019 to November 2019, a prospective national survey including 29 questions was electronically sent to 100 physicians (Google Form). The answers were collected from 93 physicians (response rate 93%). A temporary active fixation lead for AVB 3 has already been implanted by 50.5% of the operators. Eighty (86%) have already observed a dislocation of the temporary pacing lead (TPL), a cardiac perforation already occurred in 57 (61.3%), a groin hematoma in 35 (37.6%), and this technique was proscribed for 4.3% of the operators. Definitive pacemaker implantation during weekends and nights (after 8PM) is possible for 48.9% of the operators (< 5 times a year), for 15.2% (> 5 times a year), impossible for 35.9% of the operators. For AVB3 non-responsive to isoproterenol occurring during the night ( Fig. 1 ), a TPL is implanted by: the on-site medical staff on-duty (27.2%), the on-call interventional cardiologist (20.7%), the on-call electrophysiologist (18.5%), a permanent pacemaker is implanted by the electrophysiologist (12%), the strategy is not standardised (15.2%). Our survey shows important disparities in terms of management of acute AVB3 among the different centres, and a high incidence of complications with temporary passive pacing leads. An active fixation lead with an external pacemaker was used by half of the centres.