Canadian Journal of Cardiology
Clinical Research| Volume 37, ISSUE 10, P1562-1568, October 2021

Heart Failure Due to High-Degree Atrioventricular Block: How Frequent Is It and What Is the Cause?



      The causes of heart failure (HF) during high-grade atrioventricular block (AVB) are poorly understood. This study assessed the mechanisms of HF in patients with AVB.


      We studied patients presenting (between 2012 and 2016) with high-grade AVB not related to acute myocardial infarction. Patients with preexisting significant valvular heart disease were excluded. All patients underwent comprehensive echocardiographic evaluation during AVB, before pacemaker implantation. The diagnosis of HF was based on the Framingham criteria.


      A total of 122 patients were included in the study, 50% male, average age 76 ± 13 years. Twenty-eight patients (23%) with AVB presented with HF. Univariate correlates associated with HF were decrease in cardiac output (CO) (odds ratio [OR] 0.68 [95% confidence interval 0.49-0.9] per L/min; P = 0.007), measures of impaired left ventricular (LV) compliance, and increase in diastolic mitral regurgitation (MR) volume (OR 1.04 [1.01-1.07] per cc; P = 0.0016). Ventricular rate during AVB and LV ejection fraction were not significantly associated with the presence of HF. By multivariate nominal logistic analysis, the best model associated with HF included diastolic MR volume (OR 1.04 [1.001-1.09]; P = 0.02), A-wave deceleration time (OR 0.96 [0.94-0.9]; P = 0.001), and CO (OR 0.92 [0.4-1.00]; P = 0.005) (χ2 = 30.6; area under the receiver operating characteristic curve = 0.84; P < 0.0001 for the entire model).


      In the setting of high-degree AVB, clinical HF occurrence correlates with impaired LV compliance and diastolic MR volume, but not with heart rate or LV ejection fraction. The cardiac performance of patients with poor LV compliance and high-volume diastolic MR may show maladjustment to slow heart rates, manifesting as low CO and HF.



      Les causes de l'insuffisance cardiaque (IC) lors d'un bloc auriculo-ventriculaire (BAV) de haut grade sont mal comprises. Cette étude a évalué les mécanismes de l'IC chez les patients atteints de BAV.


      Nous avons étudié des patients présentant (entre 2012 et 2016) un BAV de haut grade non lié à un infarctus aigu du myocarde. Les patients présentant une cardiopathie valvulaire significative préexistante ont été exclus. Tous les patients ont subi une évaluation échocardiographique complète pendant le BAV, avant l'implantation d'un stimulateur cardiaque. Le diagnostic d'IC était basé sur les critères de Framingham.


      Un total de 122 patients ont été inclus dans l'étude, 50 % d'hommes, âge moyen 76 ± 13 ans. Vingt-huit patients (23 %) atteints de BAV présentaient une IC. Les corrélats univariés associés à l'IC étaient la diminution du débit cardiaque (DC) (rapport de cotes [RC] 0,68 l/min [intervalle de confiance à 95 % 0,49-0,9]; P = 0,007), les mesures de la compliance du ventricule gauche (VG) altérée, et l'augmentation du volume de régurgitation mitrale (RM) diastolique (RC 1,04 par cc [1,01-1,07]; P = 0,0016). La fréquence ventriculaire pendant le BAV et la fraction d'éjection du ventricule gauche n'étaient pas significativement associées à la présence d'une IC. Par analyse logistique nominale multivariée, le modèle optimal associé à l'IC comprenait le volume diastolique de la RM (RC 1,04 [1,001-1,09]; P = 0,02), le temps de décélération de l'onde A (RC 0,96 [0,94-0,9]; P = 0,001) et le DC (RC 0,92 [0,4-1,00]; P = 0,005) (χ2 = 30,6; aire sous la courbe de la fonction d'efficacité du récepteur = 0,84; P < 0,0001 pour le modèle complet).


      Dans le cadre d'un BAV de haut degré, la survenue d'une IC clinique est corrélée à une compliance du VG et un volume RM diastolique altérés, mais pas à la fréquence cardiaque ou à la fraction d'éjection VG. La performance cardiaque des patients présentant une faible compliance du VG et un volume élevé de RM diastolique peut présenter une inadaptation aux fréquences cardiaques lentes, se manifestant par un faible DC et une IC.
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