Modifiable predictors of atrioventricular block warranting a pacemaker: A cohort study
6 affiliations
- 1Division of Cardiology, Department of Medicine, University of California, San Francisco, California, United States of America
- 2Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- 3Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 4Department of Cardiology, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark
- 5Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- 6Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
Abstract
Background: Recent studies focused on atrial fibrillation have demonstrated that the etiology of cardiac arrhythmias may be influenced by modifiable risk factors. It remains unknown if similar predictors are relevant to bradyarrhythmias, the most severe form being atrioventricular (AV) block warranting a pacemaker. This study aimed to identify predictors of AV block warranting a pacemaker. Methods: We used the California Health Care Access and Information databases to identify Californians ≥18 years who received care in an emergency department, outpatient surgery facility, or hospital in 2005−2020. We examined demographics, comorbidities, lifestyle factors, and air pollution levels as potential predictors. Outcome and covariates were identified using ICD-9, ICD-10, and CPT codes. We used multivariable adjusted Cox proportional models to identify predictors of pacemaker implantation for AV block. Results: Among 28,640,453 patients, the mean age was 44.2 ± 19.3 years, 54% were female, and 0.3% received a pacemaker for AV block over a mean follow-up of 9.8 ± 4.8 years. In the fully adjusted model, 19 predictors were associated with an increased risk of pacemaker implantation for AV block, including older age, male sex, and cardiovascular comorbidities; modifiable lifestyle factors included heavy alcohol use, use of tobacco, cannabis consumption, and obesity. Asian and Pacific Islanders and Blacks were at lower risk compared to Whites. Conclusions: This large cohort study identified several modifiable risk factors that may be the focus of future strategies to reduce the risk of AV block warranting a pacemaker.
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BibTeX
@article{thein2026modifiable,
title = {{Modifiable predictors of atrioventricular block warranting a pacemaker: A cohort study}},
author = {Anna-Sophie Thein and Janet J. Tang and Jean Jacques Noubiap and Thomas A. Dewland and Tor Biering-Sørensen and Gregory M. Marcus},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0356491},
url = {https://doi.org/10.1371/journal.pone.0356491},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Modifiable predictors of atrioventricular block warranting a pacemaker: A cohort study
AU - Anna-Sophie Thein
AU - Janet J. Tang
AU - Jean Jacques Noubiap
AU - Thomas A. Dewland
AU - Tor Biering-Sørensen
AU - Gregory M. Marcus
PY - 2026
DA - 2026/09/09
JO - PLOS One
DO - 10.1371/journal.pone.0356491
UR - https://doi.org/10.1371/journal.pone.0356491
AB - Background: Recent studies focused on atrial fibrillation have demonstrated that the etiology of cardiac arrhythmias may be influenced by modifiable risk factors. It remains unknown if similar predictors are relevant to bradyarrhythmias, the most severe form being atrioventricular (AV) block warranting a pacemaker. This study aimed to identify predictors of AV block warranting a pacemaker. Methods: We used the California Health Care Access and Information databases to identify Californians ≥18 years who received care in an emergency department, outpatient surgery facility, or hospital in 2005−2020. We examined demographics, comorbidities, lifestyle factors, and air pollution levels as potential predictors. Outcome and covariates were identified using ICD-9, ICD-10, and CPT codes. We used multivariable adjusted Cox proportional models to identify predictors of pacemaker implantation for AV block. Results: Among 28,640,453 patients, the mean age was 44.2 ± 19.3 years, 54% were female, and 0.3% received a pacemaker for AV block over a mean follow-up of 9.8 ± 4.8 years. In the fully adjusted model, 19 predictors were associated with an increased risk of pacemaker implantation for AV block, including older age, male sex, and cardiovascular comorbidities; modifiable lifestyle factors included heavy alcohol use, use of tobacco, cannabis consumption, and obesity. Asian and Pacific Islanders and Blacks were at lower risk compared to Whites. Conclusions: This large cohort study identified several modifiable risk factors that may be the focus of future strategies to reduce the risk of AV block warranting a pacemaker.
SN - 1932-6203
ER -