Heart block necessitating pacing at Iraqi center for heart diseases, October 2011 – August 2013

Abstract

A cross– sectional study was conducted at Iraqi Center for Heart Disease– Baghdad /Iraq. A
82 cases of heart block during the period from October 2011- August 2013. 43(52.43%) were
males while female sex was reported in 39 (47.56%), 40(48.78%) had syncope dizziness,
18(21.95%) impaired performance, and 8(9.75%) presyncope. 3rd degree heart block was
reported in 47(57.31%), Sick sinus syndrome in 14(17.07%) mobitz 2 in 11(29.39%),
bifascicular in 5(6.09%) and be fascicular with prolonged PR interval in 2(2.43%). Temporary
pacing was done in 70 (85.36%). Congenital heart block was reported in only one patient
(1.21%), while familial heart block had not been reported. Critical IHD had been seen in
20(24.39%). Acute MI was founded in one case (1.21%) only. Permanent pacemaker had
been implanted in 74 (90.24%) of patients. The highest rates of heart block had been shown
in elderly patients and mostly of the white race. Sex has no an impact on the incidence of
heart block. Dizziness was a common presenting symptom. Most of events were insidious.
The majority of our cases of heart block 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 heart block. Drugs although rarely encountered as a cause of
heart block in our series but should be taken into consideration. Congenital heart block 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
Sick sinus syndrome in those cases studied by this test. No need to perform treadmill test in
most of our cases. Coronary angiography is required to be performed according to the
recommended guidelines and IHD was reported in a quarter of our cases. Acute myocardial
infarction was rare as a cause of heart block necessitating a permanent pacing.