Online ISSN: 2515-8260

Author : AL-Daghir, Dr. Hassan Abdul Amir

Heart Block Necessitating Pacing At Iraqi Center For Heart Diseases. October 2011 – August 2013

Dr. Hassan Abdul Amir AL-Daghir

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 11, Pages 6543-6552

We aimed at assessing the cases of H.B. at Iraqi center for heart diseases regarding their causes, management .
A  cross – sectional study was conducted at Iraqi Center for Heart Disease – Baghdad / Iraq .We had studied 82 cases of H.B during the period from October 2011- August 2013 . We studied our cases according to base line characteristics, so also  according to age groups, presetting features ,types of  H.B, preceding manifestations and the drugs incriminated. Also we evaluated the cardiac biomarkers, the incidence of CHB, the need of performing exercise test ,electrolytes assessment ,renal function indices and type of implanted  permanent pacemakers.
All of our cases were of white race and 43(52.43%) were males while female sex was reported in 39(47.56%) . Of our patients syncope was reported in 40(48.78%),. dizziness in 36(34.9%) .Impaired performance in 18(21.95%) and presyncope in 8(9.75%) of the patients . 3rd degree HB was reported in 47(57.31%) , SSS in 14(17.07%) mobitz 2 in 11(29.39%) , bifascicular in 5(6.09%) and bifascicular with prolonged PR interval in 2(2.43%) . As preceding illnesses hypertension was reported in 47(57.31%) , DM in 27(32.92%) , IHD in 20(24.39%), Rh.H.D in 4(4.87%) and autoimmune diseases in 3(3.65%). Diastolic dysfunction was reported in 27( 32.92%) while systolic dysfunction in 9(10.27%). Temporary pacing was done in 70(85.36%) . CHB was reported in only one patient (1.21%) while familial  HB had not been reported . Critical IHD had been seen in 20(24.39%) . Acute MI in one case (1.21%) only . Permanent pacemaker had been implanted in 74(90.24%) of patients .
The highest rates of HB had been shown in elderly patients and mostly of the white race. Sex has no an impact on the incidence of HB. Dizziness was a common presenting symptom. Most of events were insidious. The majority of our cases of H.B were of 3rd degree type. Ischemic heart diseases precede the event in about  a quarter of our cases, also DM and hypertension are commonly preceding the occurrence of H.B. Drugs although rarely encountered as a cause of H.B in our series but should be taken into consideration. Congenital H.B was extremely rare and so also the familial type which had not be encountered in our cases. Temporary pacing as a bridge for permanent pacing was commonly used. Cardiac biomarkers were nearly normal in all our patients. 
Holter study showed  AV block to be more common than SSS in those cases studied by this test. No need to perform treadmill test in most of our cases. CA is required to be performed according to the recommended guidelines and I.H.D. was reported in  a quarter of our cases. Acute MI was rare as a cause of H.B necessitating a permanent pacing.