Management and outcome of topical beta-blocker-induced atrioventricular block

• Published in: Cardiovascular journal of South Africa Vol. 26; no. 6; p. 210
• Main Authors: Özcan, Kazim Serhan, Güngör, Bariş, Osmonov, Damirbek, Tekkeşin, Ahmet Ilker, Altay, Servet, Ekmekçi, Ahmet, Toprak, Ercan, Yildirim, Ersin, Çalik, Nazmi, Alper, Ahmet Taha, Gürkan, Kadir, Erdinler, Izzet
• Format: Journal Article
• Language: English
• Published: South Africa 01.11.2015
• Subjects: Administration, Ophthalmic; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Aged; Aged, 80 and over; Atrioventricular Block - chemically induced; Atrioventricular Block - diagnosis; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Cardiac Pacing, Artificial; Electrocardiography; Female; Glaucoma - drug therapy; Heart Conduction System - drug effects; Heart Conduction System - physiopathology; Heart Rate - drug effects; Hospitals, Teaching; Humans; Male; Middle Aged; Pacemaker, Artificial; Recurrence; Risk Factors; Time Factors; Treatment Outcome; Turkey; Turkey
• DOI: 10.5830/CVJA-2015-030

Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers. All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period. A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation. Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.