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Rani V, Sharma R, Dalal JS, Saxena A, Lohchab SS, Dalal M. Newborns with congenital complete heart block: Advice for perinatal care providers. Trop Doct 2024; 54:167-171. [PMID: 38380895 DOI: 10.1177/00494755241231324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Congenital complete heart block (CCHB) is a rare, but a potentially life-threatening manifestation of autoimmune diseases in neonates. Bradycardia in CCHB can be misdiagnosed as foetal distress in utero and thus precipitating a Caesarean section. We report a case series of three neonates with bradycardia without any electrolyte abnormalities and structurally normal hearts with favourable outcomes.
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Affiliation(s)
- Vijay Rani
- Resident, Department of Pediatrics, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Renu Sharma
- Resident, Department of Pediatrics, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Jagjit Singh Dalal
- Senior Professor and Head, Department of Neonatology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Anita Saxena
- Vice-Chancellor, Pt B D Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Shamsher Singh Lohchab
- Senior Professor, Department of Cardiothoracic and Vascular Surgery, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Monika Dalal
- Professor, Department of Obstetrics and Gynecology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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2
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Huang Y, Deng J, Liu J, Yang F, He Y. Autoimmune congenital heart block: a case report and review of the literature related to pathogenesis and pregnancy management. Arthritis Res Ther 2024; 26:8. [PMID: 38167489 PMCID: PMC10759413 DOI: 10.1186/s13075-023-03246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
Autoimmune congenital heart block (ACHB) is a passively acquired immune-mediated disease characterized by the presence of maternal antibodies against components of the Ro/SSA and La/SSB ribonucleoprotein complex that mainly affects the cardiac conducting system. ACHB occurs in 2% of women with positive anti-Ro/SSA and anti-La/SSB antibodies and causes a high risk of intrauterine fetal death, neonatal mortality, and long-term sequelae. In this review, we first describe a case of ACHB to provide preliminary knowledge. Then, we discuss the possible pathogenic mechanisms of ACHB; summarize the pregnancy management of patients with positive anti-Ro/SSA and anti-La/SSB antibodies and/or rheumatic diseases, the prevention of ACHB, and the treatment of ACHB fetuses; and propose routine screening of these antibodies for the general population. Careful follow-up, which consists of monitoring the fetal heart rate, is feasible and reassuring for pregnant women with positive anti-Ro/SSA and/or anti-La/SSB antibodies to lower the risk of ACHB in fetuses. Moreover, maternal administration of hydroxychloroquine may be useful in preventing ACHB in pregnant women with anti-Ro/SSA and/or anti-La/SSB antibodies.
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Affiliation(s)
- Ying Huang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, No. 183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Jialin Deng
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, No. 183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, China
- Institute of Clinical Immunology, Academy of Orthopedics, Guangdong Province, Guangzhou, China
| | - Jinghua Liu
- Department of Pediatrics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Fangyuan Yang
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, No. 183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, China.
- Institute of Clinical Immunology, Academy of Orthopedics, Guangdong Province, Guangzhou, China.
| | - Yi He
- Department of Rheumatology and Immunology, The Third Affiliated Hospital, Southern Medical University, No. 183, Zhongshan Avenue West, Tianhe District, Guangzhou, 510630, China.
- Institute of Clinical Immunology, Academy of Orthopedics, Guangdong Province, Guangzhou, China.
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3
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Grazina A, Cardoso I, Fiarresga A, Aguiar Rosa S, Garcia Brás P, Ferreira V, Viegas JM, Lacerda Teixeira B, Ramos R, de Sousa L, Martins Oliveira M, Galrinho A, Cacela D, Cruz Ferreira R. Permanent pacemaker implantation after alcoholic septal ablation induced complete heart block: Long-term impact. Rev Port Cardiol 2024; 43:13-19. [PMID: 37423311 DOI: 10.1016/j.repc.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimized medical therapy often undergo alcohol septal ablation (ASA). One of the most frequent complications is complete heart block (CHB), requiring a permanent pacemaker (PPM) in variable rates of up to 20% of patients. The long-term impact of PPM implantation in these patients remains unclear. This study aimed to evaluate the long-term clinical outcomes in patients who implant PPM after ASA. METHODS Patients who underwent ASA at a tertiary center were consecutively and prospectively enrolled. Patients with previous PPM or implantable cardio-defibrillator were excluded from this analysis. Patients with and without PPM implantation after ASA were compared based on their baseline characteristics, procedure data and three-year primary endpoint of composite of all-cause mortality and hospitalization and secondary endpoint of composite of all-cause mortality and cardiac cause hospitalization. RESULTS Between 2009 and 2019, 109 patients underwent ASA, 97 of whom were included in this analysis (68% female, mean age 65.2 years old). 16 patients (16.5%) required PPM implantation for CHB. In these patients, no vascular access, pacemaker pocket or pulmonary parenchyma complications were noted. The baseline characteristics of comorbidities, symptoms, echocardiographic and electrocardiographic findings were identical in the two groups, with higher mean age (70.6±10.0 years vs. 64.1±11.9 years) and lower beta-blocker therapy rate (56% vs. 84%) in the PPM group. Procedure-related data showed higher creatine kinase (CK) peaks in the PPM group (1692 U/L vs. 1243 U/L), with no significant difference in the alcohol dose. At three years after ASA procedure, there were no differences in the primary and secondary endpoints between the two groups. CONCLUSIONS Permanent pacemaker after ASA induced CHB do not affect long term prognosis in hypertrophic obstructive cardiomyopathy patients.
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Affiliation(s)
- André Grazina
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal.
| | - Isabel Cardoso
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
| | | | | | | | - Vera Ferreira
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
| | | | | | - Rúben Ramos
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
| | - Lídia de Sousa
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
| | | | - Ana Galrinho
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
| | - Duarte Cacela
- Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal
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O'Rourke K, Ma T, Bojko K, Chen L. An Unusual Cause of Complete Heart Block. Crit Care Nurs Q 2024; 47:14-18. [PMID: 38031304 DOI: 10.1097/cnq.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Mercury poisoning is most frequently associated with multiorgan toxicity involving the brain, lungs, and kidneys. Cardiotoxic effects of mercury are rare and often overlooked. We demonstrate mercury poisoning-induced cardiotoxicity through a case study and then provide a review of the incidence, pathophysiology, and associated management plans. This case illustrates the importance of thorough history-taking to promote early recognition of toxicity.
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Affiliation(s)
- Kerry O'Rourke
- Columbia University School of Nursing, New York City, New York (Mss O'Rourke and Ma, Mr Bojko, and Dr Chen); and Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York (Dr Chen)
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5
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Liu Y, Li W, Zhou K, Hu Z. Reverse complete heart block using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report. Pediatr Rheumatol Online J 2023; 21:135. [PMID: 37946215 PMCID: PMC10636865 DOI: 10.1186/s12969-023-00920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND It has been reported that the complete heart block (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. CASE PRESENTATION A 35+ 6-week male preterm baby was transferred to the neonatal intensive care unit of the Army Medical Center in May 2020 for slight cyanosis around the lips and nose. Two days after birth, a sudden decrease in heart rate was observed during electrocardiogram (EGG) monitoring. Physical examination revealed a bluish-purple discoloration around the lips and an irregular heartbeat. EGG showed the presence of isolated P (142 bpm) and QRS (78 bpm) waves, ventricular escape beats, and a diagnosis of NL-CHB. To reverse the condition, transcutaneous pacing and five sessions of plasmapheresis were performed. At a 1.5-year follow-up, the baby exhibited well-developed cardiac structure and normal neurodevelopment. CONCLUSIONS Transcutaneous pacing and repeated plasmapheresis might be possible to reverse CHB in NL.
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Affiliation(s)
- Yanfei Liu
- Department of Pediatrics & Neonatology, Army Medical Center, Army Medical University, Chongqing, 400042, China
| | - Wanwei Li
- Department of Pediatrics & Neonatology, Army Medical Center, Army Medical University, Chongqing, 400042, China
| | - Kun Zhou
- Department of Pediatrics & Neonatology, Army Medical Center, Army Medical University, Chongqing, 400042, China
| | - Zhangxue Hu
- Department of Pediatrics & Neonatology, Army Medical Center, Army Medical University, Chongqing, 400042, China.
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6
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Mondal A, Yoo M, Tuttle S, Mah D, Nelson R, Sachse FB, Hitchcock R, Kaza AK. Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery. JAMA Netw Open 2023; 6:e2341174. [PMID: 37921766 PMCID: PMC10625035 DOI: 10.1001/jamanetworkopen.2023.41174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heart block requiring permanent pacemaker (PPM) implantation. Objective To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation. Design, Setting, and Participants In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heart block after CHS between January 1, 1960, and December 31, 2018. Patients younger than 4 years with postoperative PPM implantation were selected, and up to 20-year follow-up data were used for cost analysis based on mean hospital event charges and length of stay (LOS) data. Data were analyzed from January 1, 2020, to November 30, 2022. Exposure Implantation of PPM after CHS in pediatric patients. Main Outcomes and Measures Annual trends in CHS and postoperative PPM implantations were assessed. Direct and indirect costs associated with managing conduction health for the 20 years after PPM implantation were estimated using Markov model simulation and patient follow-up data. Results Of the 28 225 patients who underwent CHS, 968 (437 female [45.1%] and 531 male [54.9%]; 468 patients aged <4 years) received a PPM due to postoperative heart block. The rate of CHS and postoperative PPM implantations increased by 2.2% and 7.2% per year between 1960 and 2018, respectively. In pediatric patients younger than 4 years with PPM implantation, the mean (SD) 20-year estimated direct and indirect costs from Markov model simulations were $180 664 ($32 662) and $15 939 ($1916), respectively. Using follow-up data of selected patients with clinical courses involving 1 or more complication events, the mean (SD) direct and indirect costs were $472 774 ($212 095) and $36 429 ($16 706), respectively. Conclusions and Relevance In this economic evaluation study, the cost of PPM implantation in pediatric patients was found to accumulate over the lifespan. This cost may represent not only a substantial financial burden but also a health care burden to patient families. Reducing the incidence of PPM implantation should be a focused goal of CHS.
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Affiliation(s)
- Abhijit Mondal
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Minkyoung Yoo
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Stephanie Tuttle
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Richard Nelson
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Frank B. Sachse
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Aditya K. Kaza
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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7
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Shahid S, El Assaad I, Patel A, Parikh S, Aziz PF. Conduction defects in pediatric patients with Pearson syndrome: When to pace? Heart Rhythm 2023; 20:1459-1460. [PMID: 37442408 DOI: 10.1016/j.hrthm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Saneeha Shahid
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Iqbal El Assaad
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Akash Patel
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Sumit Parikh
- Department of Pediatric Neurology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio.
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8
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Tang PT, Do DH, Nsair A. Permanent Pacemaker Implantation After Orthotopic Heart Transplantation: Could Less Be More? JACC Clin Electrophysiol 2023; 9:1972-1976. [PMID: 37758371 DOI: 10.1016/j.jacep.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Pok-Tin Tang
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom.
| | - Duc H Do
- University of California-Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ali Nsair
- UCLA Heart Transplant Program, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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9
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Flowers ME, Garber K, Temples HS. Identifying Congenital Heart Block in Primary Care. J Pediatr Health Care 2023; 37:478-483. [PMID: 37031100 DOI: 10.1016/j.pedhc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 04/10/2023]
Abstract
Congenital heart block is a rare disease characterized by electrical conduction abnormalities of the heart in patients with both structural and without structural abnormalities. The most common cause of congenital heart block is autoimmune related, but other potential causes exist. Treatment for congenital heart block is determined by the severity of the disease and presenting symptoms. Primary care providers are in the optimal position to support patients and families. Although common causes and treatments of congenital heart block are known, much research is still to be done on the cause, optimal treatments, and potential long-term side effects.
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Hanumansetty K, Babu S, Koshy T, Dharan BS. The role of cardiac anaesthesiologists in placing a temporary transvenous endocardial lead in the operation room during pulse generator replacement in a child with congenital complete heart block. Ann Card Anaesth 2023; 26:362-363. [PMID: 37470547 PMCID: PMC10451133 DOI: 10.4103/aca.aca_173_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Kartheek Hanumansetty
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Saravana Babu
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Thomas Koshy
- Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Baiju S. Dharan
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Shabbir MA, Saad Shaukat MH, Ehtesham M, Murawski S, Singh S, Alimohammad R. Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC guidelines adherence. PLoS One 2022; 17:e0263727. [PMID: 35226666 PMCID: PMC8884493 DOI: 10.1371/journal.pone.0263727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background The presence of bifascicular block on electrocardiography suggests that otherwise-unexplained syncope may be due to complete heart block. European Society of Cardiology (ESC) recommends investigating it with electrophysiology study (EPS). PPM is indicated if high-degree atrioventricular block is inducible. Long term rhythm monitoring with implantable loop recorder (ILR) is recommended if EPS is negative. We evaluated adherence to these guidelines. Methods This is a single-center retrospective audit of adult patients with bifascicular block hospitalized for unexplained syncope between January 2018 and August 2019 under general medicine service. Patients with an alternative explanation for syncope were excluded. Guideline adherence was assessed by formal cardiology consult and whether EPS followed by ILR and/or PPM were offered. Results 65 out of 580 adult patients (11.2%) admitted to general medicine service for syncope had a bifascicular block; 29 (5%) were identified to have bifascicular block and unexplained syncope. Median age was 77 ±10 years; 9 (31%) were female, and 6 (20.7%) patients had at least one prior hospital visit for syncope at our academic medical center. Cardiology was consulted on 17 (58.6%) patients. Two patients were evaluated by EPS (1 refused) followed by ILR. Overall, 3 out of 29 patients (10.3%) received guideline-directed evaluation during the hospitalization based on ESC guidelines. None of the patients received empiric PPM during the index hospitalization. Conclusion Among patients admitted to the general medicine service with unexplained syncope and bifascicular block, a minority (10.3%) underwent guideline-directed evaluation per ESC recommendations. Cardiology was consulted in 58.6% of cases.
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Affiliation(s)
- Muhammad Asim Shabbir
- Department of Internal Medicine, Albany Medical College, Albany, NY, United States of America
- * E-mail:
| | | | - Moiz Ehtesham
- Department of Internal Medicine, Albany Medical College, Albany, NY, United States of America
| | - Shannon Murawski
- Department of Internal Medicine, Albany Medical College, Albany, NY, United States of America
| | - Sukhraj Singh
- Department of Internal Medicine, Albany Medical College, Albany, NY, United States of America
| | - Rizwan Alimohammad
- Department of Cardiology, Capital Cardiology Associates, Albany Medical College, Albany, NY, United States of America
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Blank E, Shah AD, Rosenblum JM, Lloyd MS. "Valve-sparing" transvenous defibrillator systems after tricuspid valve intervention. Heart Rhythm 2021; 18:2212-2214. [PMID: 34583059 DOI: 10.1016/j.hrthm.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Evan Blank
- Emory University School of Medicine, Atlanta, Georgia
| | - Anand D Shah
- Emory University School of Medicine, Atlanta, Georgia
| | - Joshua M Rosenblum
- Emory University Department of Cardiothoracic Surgery, Atlanta, Georgia; Emory Adult Congenital Heart Center, Atlanta, Georgia
| | - Michael S Lloyd
- Emory University School of Medicine, Atlanta, Georgia; Emory Adult Congenital Heart Center, Atlanta, Georgia.
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Alsamarrai A, Wang TKM. Balloon aortic valvuloplasty for severe aortic stenosis: single-centre contemporary patterns and experience. N Z Med J 2021; 134:123-129. [PMID: 34531603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Ammar Alsamarrai
- Registrar, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Tom Kai Ming Wang
- Staff Cardiologist, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States; (previously) Cardiology Advanced Trainee, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
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14
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Soares C, Arikan P, Gilson M. Infective Endocarditis with Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa Presenting as Complete Heart Block. R I Med J (2013) 2021; 104:13-15. [PMID: 34323872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 79-year-old male with a history of ESRD and treated MRSA endocarditis was found to have a recurrence of MRSA bacteremia. He was treated with antibiotics. During his hospitalization, he suddenly developed complete heart block requiring transcutaneous pacing, and subsequently transvenous pacing wires were placed. Transesophageal echocardiography demonstrated pseudo- aneurysm of the mitral-aortic intervalvular fibrosa as well as aortic valve thickening, and a mitral vegetation. Cardiothoracic surgery was consulted to obtain source control, but the patient was deemed to be a poor surgical candidate. While continuing medical therapy and transvenous pacing, the patient developed refractory hypotension, acidosis, and ultimately expired.
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Affiliation(s)
- Cullen Soares
- House Staff Officer in Medicine, Rhode Island Hospital; Alpert Medical School of Brown University, Providence, RI
| | - Pinar Arikan
- House Staff Officer in Medicine, Rhode Island Hospital; Alpert Medical School of Brown University, Providence, RI
| | - Michael Gilson
- Attending Physician, Rhode Island Hospital; Clinical Associate Professor of Medicine, Alpert Medical School of Brown University, Providence, RI
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Abstract
Glyphosate is a commonly used non-selective herbicide in agriculture and aquafarms. Gastrointestinal, respiratory and cardiovascular symptoms are predominant manifestations of glyphosate poisoning. Cardiac dysfunction should be kept as a possibility in patients presenting with shock, and the treatment is mainly supportive. We present such a case.
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Affiliation(s)
- Soumitra Ghosh
- Senior Resident, Department of Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Tale
- Senior Resident, Department of Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Anil Garbhapu
- Senior Resident, Department of Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Bhalla
- Professor, Department of Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Czosek RJ, Gao Z, Anderson JB, Knilans TK, Ollberding NJ, Spar DS. Progressive QRS Duration and Ventricular Dysfunction in Pediatric Patients with Chronic Ventricular Pacing. Pediatr Cardiol 2021; 42:451-459. [PMID: 33247765 DOI: 10.1007/s00246-020-02504-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
Pacemakers are a mainstay of therapy for patients with congenital and acquired heart block, but ventricular pacing is related to ventricular dysfunction. We sought to evaluate patient and device characteristics associated with ventricular dysfunction in pediatric patients with chronic ventricular pacing. This was a retrospective cohort of pediatric patients with heart block and chronic ventricular pacing. Patient, ECG, and device characteristics were analyzed to determine factors associated with ventricular dysfunction. Longitudinal ECG and echocardiogram parameters were obtained to track changes in QRS and systemic ventricular systolic function over time. In total, 82 patients were included (median age at implant 0.81 years). Over a follow-up time of 6.1 years, 18% developed ventricular dysfunction. Patients with dysfunction had greater current QRS duration (p = 0.002) compared to those with preserved function with a similar time from device implantation. There was no difference between lead location or age at device implantation. QRS duration increased with time from implant and the resultant ΔQRS was associated with ventricular dysfunction (p = 0.01). QRS duration >162 ms was associated with a 5.8 (2-9)-fold increased risk for dysfunction. Transvenous leads were associated with longer QRS duration with no difference compared to epicardial leads in development of ventricular dysfunction. This study demonstrated that the absolute paced QRS duration and Δpaced QRS were association with long-term ventricular dysfunction independent of how long a given patient was paced. Patients in high-risk categories may benefit from close echocardiographic monitoring. Whether permissive junctional rhythm or His bundle/biventricular pacing decreases the rate of dysfunction needs further study.
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Affiliation(s)
- Richard J Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Zhiqian Gao
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
| | - Jeffrey B Anderson
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Timothy K Knilans
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Spar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Sapp JA, Gillis AM, AbdelWahab A, Nault I, Nery PB, Healey JS, Raj SR, Lockwood E, Sterns LD, Sears SF, Wells GA, Yee R, Philippon F, Tang A, Parkash R. Remote-only monitoring for patients with cardiac implantable electronic devices: a before-and-after pilot study. CMAJ Open 2021; 9:E53-E61. [PMID: 33495385 PMCID: PMC7843075 DOI: 10.9778/cmajo.20200041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Outcomes for patients with cardiac implantable electronic devices are better when follow-up incorporates remote monitoring technology in addition to in-clinic visits. For patients with implantable devices, we sought to determine the feasibility, safety and associated health care utilization of remote-only follow-up, along with its effects on patients' quality of life and costs. METHODS This multicentre before-and-after pilot study involved patients with new or existing pacemakers or implantable cardioverter defibrillators. The "before" phase of the study spanned the period October 2015 to February 2017; the "after" phase spanned the period October 2016 to February 2018. The exposure was remote-only follow-up in combination with Remote View, a service that facilitates access to device data, allowing device settings to be viewed remotely to facilitate remote programming. Outcomes at 12 months were feasibility (adherence to remote monitoring), safety (rate of adverse events) and health care utilization (remote and in-clinic appointments). We also assessed quality of life, using 3 validated scales, and costs, taking into account both health care system and patient costs. RESULTS A total of 176 patients were enrolled. Adherence (defined as at least 1 successful remote transmission during follow-up) was 87% over a mean follow-up of 11.7 (standard deviation 2.2) months. There was a reduction in in-clinic visits at specialized sites among patients with both implantable defibrillators (26 v. 5, p < 0.001, n = 48) and pacemakers (42 v. 10, p < 0.001, n = 51). There was no significant change in visits to community sites for patients with defibrillators (13 v. 17, p = 0.3, n = 48). The composite rate of death, stroke, cardiovascular hospitalization and device-related hospitalization was 7% (n = 164). No adverse events were linked to the intervention. There was no change in quality-of-life scales between baseline and 12 months. Health care costs were reduced by 31% for patients with defibrillators and by 44% for those with pacemakers. INTERPRETATION This pilot study showed the feasibility of remote-only follow-up, with no increase in adverse clinical outcomes and no effect on quality of life, but with reductions in costs and health care utilization. These results support progression to a larger-scale study of whether superior effectiveness and reduced cost can be achieved, with preservation of safety, through use of remote-only follow-up. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT02585817.
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Affiliation(s)
- John A Sapp
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anne M Gillis
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Amir AbdelWahab
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Isabelle Nault
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Pablo B Nery
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Jeff S Healey
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Satish R Raj
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Evan Lockwood
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Laurence D Sterns
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Samuel F Sears
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - George A Wells
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Raymond Yee
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - François Philippon
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Anthony Tang
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont
| | - Ratika Parkash
- QEII Health Sciences Centre, Dalhousie University (Sapp, AbdelWahab, Parkash), Halifax, NS; Department of Cardiac Sciences (Gillis, Raj), University of Calgary, Calgary, Alta.; Institut universitaire de cardiologie and pneumologie de Quebec (Nault, Philippon), Université Laval, Québec, Que.; University of Ottawa Heart Institute (Nery, Wells), Ottawa, Ont.; Hamilton Health Sciences (Healey), McMaster University, Hamilton, Ont.; CK Hui Heart Centre (Lockwood), Edmonton, Alta.; Vancouver Island Health Authority (Sterns), Victoria, BC; East Carolina University (Sears), Greenville, NC; London Health Sciences Centre (Yee, Tang), University of Western Ontario, London, Ont.
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18
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Carberry T, Hauck A, Backer C, Webster G. Right ventricular septal pacing via transmural approach for resynchronization in a child with postoperative heart block. Pacing Clin Electrophysiol 2020; 43:1213-1216. [PMID: 32885843 PMCID: PMC7584390 DOI: 10.1111/pace.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
An infant with transposition of the great arteries was paced for postoperative heart block (single-site, right ventricular [RV] epicardial). She developed severe left ventricular (LV) dysfunction and septal dyskinesis. Resynchronization was performed at the age of 4 with an LV epicardial lead and an RV septal endocardial lead. The endocardial lead was affixed to the interventricular septum, then tunneled through the RV free wall and attached to an abdominal pulse generator. QRS duration decreased (176 to 122 ms) and LV ejection fraction improved (26 to 61%) and remained stable for 8 years. We present a case of successful resynchronization in congenital heart disease using a transmural RV septal lead.
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Affiliation(s)
- Thomas Carberry
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda Hauck
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carl Backer
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregory Webster
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Das A, Basnet P, Shrestha R, Hada A, Bhandari B. Pregnancy with Complete Heart Block-An Emergency Cesarean Section with Temporary Pacemaker: A Case Report. JNMA J Nepal Med Assoc 2020; 58:597-599. [PMID: 32968295 PMCID: PMC7580374 DOI: 10.31729/jnma.5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Management of a pregnant woman with complete heart block presenting during pregnancy and without pacing remains debatable. To bear up against any hemodynamic variations in peripartum period, temporary pacemakers have been advocated by some authors. Herein, we report a case of successful management of a 24 year old, pregnant woman with CHB who had an uneventful emergency caesarean delivery under spinal anesthesia after temporary pacing. She was an unbooked patient detected with CHB first time during active stage of labour. She delivered a healthy male baby and was discharged from the hospital in a stable and satisfactory condition on seventh postoperative day.
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Affiliation(s)
- Anamika Das
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Pritha Basnet
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Ramesh Shrestha
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abha Hada
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bidhur Bhandari
- Department of Obstetrics and Gynecology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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20
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Kochav JD, Rosenbaum M, Kochav SM, Slater E, Wassercug-Zemer N, Lewis MJ. Effect of Ventricular Pacing on Morbidity in Adults After Fontan Repair. Am J Cardiol 2020; 125:1263-1269. [PMID: 32081367 DOI: 10.1016/j.amjcard.2020.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
Implantation of a permanent pacemaker is a negative prognostic marker in patients with Fontan palliation; however, data delineating outcomes in adult patients with pacemaker requirements are lacking. We hypothesize that high ventricular pacing burden is associated with adverse outcomes in adult Fontan patients. We performed a retrospective review comprising adult patients with history of Fontan repair. A high burden of ventricular pacing was defined as ≥40% pacing. Major adverse clinical events (MACE) were defined as all-cause mortality or need for advanced cardiac therapies (ventricular assist device or heart transplant). A total of 145 adult patients with Fontan were studied for a median of 3.1 years. Twenty (14%) patients had implanted pacemakers with ≥40% ventricular pacing. Twelve events occurred in those with ≥40% ventricular pacing (incidence 60.0%) versus 11 in those without (incidence 8.8%). In multivariable analysis, ≥40% ventricular-pacing (odds ratio 12.51, confidence interval [CI] 3.56 to 43.83, p <0.001) was associated with MACE independent of initial Fontan type, New York Heart Association functional class at baseline, or history of atrial tachyarrythmia. In survival analysis, patients with ≥40% ventricular pacing had nearly 8 times the risk of MACE compared with those with a lower ventricular pacing burden (hazard ratio 7.79, 95% CI 2.56 to 23.66, p <0.001), whereas patients with atrial-only or <40% ventricular pacing burden had a trend toward higher hazard of MACE compared with those without permanent pacemaker (hazard ratio 3.38, 95% CI 0.92 to 12.47, p = 0.07) that did not meet statistical significance. These findings suggest that high ventricular pacing burden contributes to poor outcomes in the adult Fontan patients and bear consideration when determining optimal treatment of tachyarrhythmias in this population.
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Affiliation(s)
- Jonathan D Kochav
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marlon Rosenbaum
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Stephanie M Kochav
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emily Slater
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Noa Wassercug-Zemer
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Lewis
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York.
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21
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Abstract
Twiddler's syndrome is a rare cause of pacemaker failure, where patient manipulation of the pulse generator results in lead dislodgement or retraction. Variations in manifestation have been identified including reel syndrome, where rotation occurs around the transverse axis resulting in coiling of the leads, and ratchet syndrome where arm movement results in lead displacement. Device manipulation leading to device failure has been documented in up to 1.7% of implants, particularly in patients with large pockets or mental disorders. Such complications have serious consequences, particularly in pacing-dependent patients where loss of capture may result in asystole. This article reviews the case of an 84-year-old patient presenting at 8-month pacemaker follow-up in complete heart block with no evidence of pacemaker function.
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Affiliation(s)
- Bethany Smith
- Cardiac Physiologist, North Cumbria University Hospital
| | - Lisa Ashton
- Lecturer BSc Healthcare Science (Cardiac Physiology), School of Medicine, University of Leeds
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22
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Hamilton RM. Editorial commentary: Live better electrically? Optimizing the timing and application of pacing in congenital heart block. Trends Cardiovasc Med 2019; 30:287-288. [PMID: 31395307 DOI: 10.1016/j.tcm.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Robert M Hamilton
- The Hospital for Sick Children, Pediatrics (Cardiology), 555 University Ave Rm 1725D, Toronto, Ontario M5G1X8, Canada.
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23
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Amanullah M, Razzaq S, Siddiqui AH, Khan FW. Minimally invasive technique of placing a dual chamber permanent pacemaker in children. J PAK MED ASSOC 2019; 69:1119-1123. [PMID: 31431764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To share the experience of a minimally invasive technique in the implantation of a dual chamber permanent pacemaker in paediatric population. METHODS The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients aged up to 16 years who underwent epicardial dual chamber permanent pacemaker insertion via xiphisternal incision between April 2011 and August 2016. Demographic data included age, weight and gender of the patient. Indications for pacemaker insertion, electrocardiography findings, concomitant cardiac procedures and procedural complications were reviewed. Pacemaker thresholds and impedance at the time of implantation and throughout the course of follow-up were extracted from the clinical data. RESULTS Of the 10 patients, 5(50%) were males and 5(50%)were females. The overall mean age was 3.4}3.8 years (range: 1 month - 13 years). The mean weight at the time of operation was 11.4}6.8 kg (range: 4.3-27kg). Indications for permanent pacemaker insertion included postoperative advanced or complete atrioventricular block in 7(70%) and complete congenital heart block in 3(30%). There was no reported morbidity. CONCLUSIONS Dual chamber permanent pacemaker insertion via xiphisternal incision was found to be of benefit to the patients and the surgeons alike.
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Affiliation(s)
| | - Somia Razzaq
- Jinnah Sindh Medical University, Karachi,Pakistan
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24
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Schneider AE, Wackel PL. Unconventional 2:1 Ventricular Pacing in a Neonate with Congenital Heart Block and Biventricular Noncompaction. Tex Heart Inst J 2019; 46:136-138. [PMID: 31236081 DOI: 10.14503/thij-17-6368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital complete heart block with concomitant biventricular noncompaction cardiomyopathy has been reported once previously. Although not universal, when restrictive physiology is present, impaired diastolic filling may pose a distinct challenge to pacing during the neonatal period. We present the case of a neonate with congenital complete heart block and biventricular noncompaction that resulted in severe diastolic dysfunction and atrioventricular dyssynchrony. We intentionally used 2:1 ventricular pacing to provide atrioventricular synchrony with every paced beat, and this resulted in hemodynamic and clinical improvement. This unconventional pacing technique may be beneficial in other neonates who have complete heart block and diastolic dysfunction.
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25
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So CY, Cheung GSH, Lam YY. Percutaneous Closure of an Iatrogenic Perimembranous Ventricular Septal Defect After Mechanical Aortic Valve Replacement Using a Novel Venous-Arteriovenous Loop. J Invasive Cardiol 2019; 31:E64-E65. [PMID: 30927537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This image illustrates the feasibility of percutaneous closure of perimembranous ventricular septal defect occluder in a patient with mechanical aortic valve replacement utilizing a novel venous-arteriovenous loop, and emphasizes the importance of concomitant fluoroscopic and echocardiographic guidance in structural heart interventions.
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Affiliation(s)
- Chak-Yu So
- Department of Medicine and Therapeutics, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong SAR.
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Abstract
BACKGROUND The clinical course of children with advanced heart block secondary to Lyme disease has not been well characterized. OBJECTIVE To review the presentation, management, and time to resolution of heart block due to Lyme disease in previously healthy children. METHODS An IRB approved single-center retrospective study was conducted of all patients < 21 years old with confirmed Lyme disease and advanced second or third degree heart block between 2007 and 2017. RESULTS Twelve patients (100% male) with a mean age of 15.9 years (range 13.2-18.1) were identified. Six patients (50%) had mild to moderate atrioventricular valve regurgitation and all had normal biventricular function. Five patients had advanced second degree heart block and 7 had complete heart block with an escape rate of 20-57 bpm. Isoproterenol was used in 4 patients for 3-4 days and one patient required transvenous pacing for 2 days. Patients were treated with 21 days (n = 6, 50%) or 28 days (n = 6, 50%) of antibiotics. Three patients received steroids for 3-4 days. Advanced heart block resolved in all patients within 2-5 days, and all had a normal PR interval within 3 days to 16 months from hospital discharge. CONCLUSION Symptomatic children who present with new high-grade heart block from an endemic area should be tested for Lyme disease. Antibiotic therapy provides quick and complete resolution of advanced heart block within 5 days, while steroids did not appear to shorten the time course in this case series. Importantly, no patients required a permanent pacemaker.
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Affiliation(s)
- Meena Bolourchi
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA
| | - Eric S Silver
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA
| | - Leonardo Liberman
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, 2-North, New York, NY, USA.
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27
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Abstract
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
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Affiliation(s)
- Julene S Carvalho
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; Fetal Medicine Unit, St George's University Hospital, Blackshaw Road, London, SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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28
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Bansal R, Kumar V, Talwar KK. Traumatic Fracture of Pacemaker Lead by Suture Transfixation to Pectoral Muscle. J Invasive Cardiol 2018; 30:E156. [PMID: 30504521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report acute lead fracture during pacemaker implantation. Suturing the lead without the sleeve might damage the lead. To avoid this result, we suggest tying knots tightly, but not too vigorously.
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Affiliation(s)
- Raghav Bansal
- Max Super Specialty Hospital Saket, Press Enclave Road, Mandir Marg, Saket, New Delhi, Delhi 110017, India.
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Wang TKM, Martin A, Looi KL, Lever N. LV epicardial lead placement at time of cardiac surgery: useful for some-but not all. N Z Med J 2018; 131:45-49. [PMID: 30496167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Tom Kai Ming Wang
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Department of Medicine, University of Auckland, Auckland
| | - Andrew Martin
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
| | - Khang-Li Looi
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Department of Medicine, University of Auckland, Auckland
| | - Nigel Lever
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Department of Medicine, University of Auckland, Auckland
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30
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Hitchcock R, Obr CJ, Subramani S. Cardiac Tamponade and Complete Heart Block During Transcatheter Aortic Valve Implantation: A Simulation Scenario for Anesthesia Providers. MedEdPORTAL 2018; 14:10779. [PMID: 30800979 PMCID: PMC6342360 DOI: 10.15766/mep_2374-8265.10779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
Introduction This simulation on cardiac tamponade and complete heart block in the context of severe aortic stenosis presents the learner with a rare (cardiac tamponade) and a common (complete heart block) complication in the intraoperative setting of transfemoral aortic valve implantation in a high-fidelity, low-risk simulation environment. Based on an amalgam of index cases, the simulation was developed to address a recognized area of need for cardiothoracic anesthesia scenarios in the simulation curriculum of our home institution. Methods The simulation case file covered the case narrative, learning objectives, a summary of critical actions performed, and supplemental figures needed to complete the educational activity. A high-fidelity patient simulator, an anesthesia machine, monitors, and a computer capable of displaying standard computer slide presentation software and movie files provided the optimal environment for simulation. Results Fifteen anesthesia residents experienced the simulation over the 2016-2017 and 2017-2018 academic years. The trainees who experienced this simulation improved their understanding of tamponade hemodynamic pathophysiology and recognition of hemodynamically unstable bradycardia. Discussion This case has been an effective addition to the repertoire of simulation scenarios at the University of Iowa and has been incorporated into the general curriculum of simulation cases for mid-training junior and senior anesthesia residents.
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Affiliation(s)
- Robert Hitchcock
- Clinical Associate Anesthesiologist, Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Clark J. Obr
- Clinical Associate Professor, Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Sudhakar Subramani
- Clinical Assistant Professor, Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine
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31
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Nor Hidayah ZA, Azerin O, Mohd Nazri A. Complete heart block in young adult with acute rheumatic fever. Med J Malaysia 2018; 73:323-325. [PMID: 30350813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.
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Affiliation(s)
- Z A Nor Hidayah
- Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia.
| | - O Azerin
- Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - A Mohd Nazri
- Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
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Tongprasert F, Sittiwangkul R, Lerthiranwong T, Tongsong T. Prenatal sonographic monitoring of progressive cardiac damages caused by anti-Ro antibodies: A case report. J Clin Ultrasound 2018; 46:347-350. [PMID: 29023775 DOI: 10.1002/jcu.22541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
Maternal autoantibodies to Ro/SSA are often linked to congenital heart block and rarely associated with structural defects. We describe the case of a fetus with anti-Ro-mediated second-degree block at 19 weeks, which progressed to a complete block, fibroelastosis, atrioventricular valve insufficiency, and semilunar valve stenosis/insufficiency at 20, 22, 24, and 26 weeks, respectively, although the fetus received transplacental anti-arrhythmic drugs. The 2150-g fetus was vaginally delivered at 35 weeks. An external pacemaker was inserted immediately after birth and replaced with permanent pacemaker at the age of 3 months. The newborn has had a good outcome with well-controlled heart rate.
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Affiliation(s)
- Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand
| | - Thitikarn Lerthiranwong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand
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Leong D, Sovari AA, Ehdaie A, Chakravarty T, Liu Q, Jilaihawi H, Makkar R, Wang X, Cingolani E, Shehata M. Permanent-temporary pacemakers in the management of patients with conduction abnormalities after transcatheter aortic valve replacement. J Interv Card Electrophysiol 2018. [PMID: 29532275 DOI: 10.1007/s10840-018-0345-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Damage to the cardiac conduction system requiring permanent pacemaker (PPM) implantation is a known adverse outcome of transcatheter aortic valve replacement (TAVR). A permanent-temporary pacemaker (PTPM) is a device that involves an active-fixation lead attached to an external pulse generator taped to the skin. We reviewed the utility of PTPMs as a temporary bridge measure after TAVR in patients with conduction abnormalities that do not meet conventional criteria for PPM placement. METHODS Between January 01, 2013 and December 31, 2015, we analyzed 67 patients who received PTPM after TAVR. Baseline demographics, comorbidities, type and size of the valve, pre-TAVR electrocardiograms (ECGs), post-TAVR ECGs at 1 day, 1 month, and 6 months, and pacemaker interrogation results were reviewed for each patient if available. RESULTS The mean age of patients was 80.5 ± 9.1 years. PTPM were placed for 2.3 ± 2.4 days. Among these patients, 44.8% (n = 30) received a PPM prior to discharge. Male gender (OR 2.84, 95% CI 1.05-7.69, p = 0.05) and an increase in QRS duration post-TAVR (p = 0.01) were associated with PPM placement. Pacemaker interrogation data of 11 patients with PPM revealed that 27% (n = 3) had < 1% V-pacing requirements and < 10% A-pacing requirements. CONCLUSIONS In post-TAVR patients who develop conduction abnormalities that do not meet conventional PPM implantation indications, PTPM safely provides a time period for further assessment and may prevent unnecessary PPM implantation. Male gender and an increase in QRS duration post-TAVR are associated with PPM implantation. Additionally, some patients may recover from their conduction disturbances and demonstrate low pacemaker utilization.
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Affiliation(s)
- Derek Leong
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA.
| | - Ali A Sovari
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Ashkan Ehdaie
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Tarun Chakravarty
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Qiang Liu
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Rajendra Makkar
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Xunzhang Wang
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Eugenio Cingolani
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
| | - Michael Shehata
- Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Suite 5512, Los Angeles, CA, 90048, USA
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35
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Charles Blouin M, Bouhout I, Demers P, Carrier M, Perrault L, Lamarche Y, El-Hamamsy I, Bouchard D. Tackling the Issue of High Postoperative Pacemaker Implantation Rates in Sutureless Aortic Valve Replacement: Should Balloon Inflation be Removed from the Implantation Method of the Perceval Prosthesis? J Heart Valve Dis 2017; 26:247-254. [PMID: 29092107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Sutureless aortic valve replacement (AVR) is an emerging alternative to standard AVR in elderly and high-risk patients. This procedure is associated with a high rate of postoperative permanent pacemaker implantation (PPI). The study aim was to assess the impact on the rate of PPI of implanting the Perceval prosthesis without using balloon inflation. METHODS A total of 159 patients who underwent sutureless AVR using the Perceval prosthesis was included. Balloon inflation was used in 132 patients (Balloon group) and not used in the remaining 27 (No-Balloon group). Clinical, echocardiographic and electrocardiographic outcomes were assessed. RESULTS There was no significant difference in PPI rate between the two groups (26% for Balloon group versus 22% in No-Balloon group; p = 0.700). Balloon inflation had no significant impact on the incidence of paravalvular leaks (p = 0.839), or on the need to return to cardiopulmonary bypass (CPB) intraoperatively due to paravalvular leak or unsatisfactory deployment (p >0.999). Mean and peak transaortic pressure gradients were similar between the two groups (p = 0.417 and p = 0.522, respectively). Cross-clamp and CPB times were shorter in the No-Balloon group (49.6 ± 15.9 min versus 61.1 ± 25.6 min and 64.1 ± 26.3 min versus 79.6 ± 35.4 min, respectively; p = 0.027 and p = 0.012, respectively). CONCLUSIONS The two groups had similar postoperative PPI rates. Implanting the Perceval prosthesis without balloon inflation is safe and had no impact on paravalvular leaks, intraoperative complications or hemodynamic results. Reductions in aortic cross-clamp time and CPB time were observed when the balloon was not used.
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Affiliation(s)
| | - Ismail Bouhout
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Louis Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Ismail El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada. Electronic correspondence:
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Abstract
Atrial standstill is a rare disorder of cardiac rhythm that is characterized by total absence of electrical activity in one or both atria. We report herein the case of a patient with atrial fibrillation and symptomatic 4.0 s pauses who received a ventricular demand pacemaker. The patient later underwent mitral valve replacement with a pericardial tissue valve and the Cox-maze III procedure for symptomatic mitral stenosis and atrial fibrillation. Following surgery, he developed atrial standstill and became pacemaker dependent. The pacemaker was later revised to an atrioventricular sequential pacemaker. Twelve hours after revision, atrioventricular sequential pacing was noted and mechanical function of the atria was confirmed by Doppler echocardiography.
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Affiliation(s)
- Harsh Agrawal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Kul Aggarwal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Martin A. Alpert
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
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37
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Moini C, Sidia B, Poindron D, Fiorina L, Farge A, Amara W, El Issa M. [Cardiac permanent pacemaker after transcatheter aortic valve implantation: A predictive and scientific review]. Ann Cardiol Angeiol (Paris) 2016; 65:346-351. [PMID: 27693168 DOI: 10.1016/j.ancard.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i.e when that size is inferior to the valve's one) and the QRS duration after the procedure (the superior threshold has been set at 128ms for the Corevalve). The currently recommendations advice to implant a pacemaker are as followed: high grade AV block (in the main studies, the implantation occurs within the 5 days after the TAVI), complete and transient AV block during the TAVI, second degree AV block and RBBB associated with first degree AV block. Our article aims to review the arrhythmic issues of TAVI.
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Affiliation(s)
- C Moini
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France; Service de cardiologie, centre hospitalier de Melun, 2, rue Fréteau-de-Peny, 77011 Melun cedex, France
| | - B Sidia
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France
| | - D Poindron
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France
| | - L Fiorina
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France; Unité de rythmologie et de stimulation cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, 77000 Melun, France
| | - A Farge
- Unité de chirurgie cardiaque, hôpital Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France
| | - W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - M El Issa
- Unité de rythmologie et de stimulation cardiaque, hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France.
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Mehrotra S, Kumar B, Vijayvergiya R, Mathew S. High traffic congestion in right atrium. Indian Heart J 2016; 68 Suppl 2:S190-S193. [PMID: 27751286 PMCID: PMC5067761 DOI: 10.1016/j.ihj.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 11/17/2022] Open
Abstract
A 62-year lady presented with limb swelling and heart failure due to leads induced venous fibrosis and severe tricuspid stenosis, 33 years after pacemaker implantation. After undergoing surgical removal of all leads and tricuspid valve replacement under cardiopulmonary bypass, she regained a normal functional status and tricuspid and right ventricular functions.
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Affiliation(s)
| | | | | | - S Mathew
- Cardiothoracic Surgery, PGIMER, Chandigarh, India
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Kassotis J, Voigt L, Mongwa M, Reddy CVR. Feasibility of Dual-Chamber (DDD) Pacing via a Single-Pass (VDD) Pacing Lead Employing a Floating Atrial Ring (Dipole): Case Series, Future Considerations, and Refinements. Angiology 2016; 56:323-9. [PMID: 15889201 DOI: 10.1177/000331970505600313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the feasibility of DDD pacing from a standard single-pass VDD pacemaker system. Over the past 2 decades significant advances have been made in the development of single-pass VDD pacing systems. These have been shown in long-term prospective studies to effectively preserve atrioventricular (AV) synchrony in patients with AV block and normal sinus node function. What remains problematic is the development of a single-pass pacing system capable of DDD pacing. Such a lead configuration would be useful in those patients with peripheral venous anomalies and in younger patients with congenital anomalies, which may require lead revisions in the future. In addition, with the increased use of resynchronization (biventricular pacing) therapy, the availability of a reliable single-pass lead will minimize operative time, enhance patient safety, and minimize the amount of hardware within the heart. The feasibility of DDD pacing via a Medtronic Capsure VDD-2 (Model #5038) pacing lead was evaluated. Twenty patients who presented with AV block and normal sinus node function were recruited for this study. Atrial pacing thresholds and sensitivities were assessed intraoperatively in the supine position with various respiratory maneuvers. Five patients who agreed to participate in long-term follow-up received a dual-chamber generator and were evaluated periodically over a 12-month period. Mean atrial sensitivity was 2.35 ±0.83 mV at the time of implantation. Effective atrial stimulation was possible in all patients at the time of implantation (mean stimulation threshold 3.08 ±1.04 V @ 0.5 ms [bipolar], 3.34 ±0.95 V @ 0.5 ms [unipolar]). Five of the 20 patients received a Kappa KDR701 generator, and atrial electrical properties were followed up over a 1-year period. There was no significant change in atrial pacing threshold or incidence of phrenic nerve stimulation over the 1-year follow-up. A standard single-pass VDD pacing lead system was capable of DDD pacing intraoperatively and during long-term follow-up. Despite higher than usual thresholds via the atrial dipole, pacemaker telemetry revealed <10% use of atrial pacing dipole over a 12-month period, which would minimally deplete the pacemaker’s battery. In addition, the telemetry confirmed appropriate sensing and pacing of the atrial dipole throughout the study period. At this time such systems can serve as back-up DDD pacing systems with further refinements required to optimize atrial thresholds in all patients.
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Affiliation(s)
- John Kassotis
- Clinical Electrophysiologic Services, New York Methodist Hospital, Clinical Affiliate of New York Presbyterian Hospital System, Brooklyn, 11215, USA.
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40
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Konno T, Shimizu M, Ino H, Araki T, Yamaguchi M, Inoue M, Tofuku Y, Mabuchi H. A Rare Type of Alternating Bundle Branch Block in a Patient with Cardiac Sarcoidosis. Angiology 2016; 56:115-7. [PMID: 15678266 DOI: 10.1177/000331970505600117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report a rare type of alternating bundle branch block observed in a patient with cardiac sarcoidosis. Not only alternation of complete right and left bundle branch block but also narrow QRS complexes were observed on electrocardiogram. The mechanism of these unusual findings is briefly discussed.
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MESH Headings
- Adult
- Bundle-Branch Block/diagnosis
- Bundle-Branch Block/etiology
- Bundle-Branch Block/therapy
- Cardiomyopathies/complications
- Cardiomyopathies/diagnosis
- Diagnosis, Differential
- Diagnostic Imaging
- Electrocardiography
- Heart Block/diagnosis
- Heart Block/etiology
- Heart Block/therapy
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/therapy
- Male
- Pacemaker, Artificial
- Sarcoidosis/complications
- Sarcoidosis/diagnosis
- Sarcoidosis, Pulmonary/complications
- Sarcoidosis, Pulmonary/diagnosis
- Syncope/etiology
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/therapy
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Affiliation(s)
- Tetsuo Konno
- Molecular Genetics of Cardiovascular Disorders, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Gargouri L, Safi F, Maalej B, Mallek S, Turki F, Majdoub I, Akrout M, Abid D, Kamoun S, Mahfoudh A. Neonatal lupus erythematosus with congenital heart block in twins. Tunis Med 2016; 94:401-404. [PMID: 28051234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background - Neonatal lupus erythematosus is an uncommon acquired autoimmune disease caused by transplacental passage of maternal antibodies SSA/Ro, SSB/La or U1 ribonucleoproteins. The most common clinical manifestations are skin rash, cardiac lesions, thrombocytopenia, anemia and hepatosplenomegaly. Complete congenital heart block is usually irreversible needing a pacemaker implantation in two-thirds of cases. Cases report - We report neonatal lupus erythematosus with complete congenital heart block in twins. Newborns were delivered by caesarean section at week 38 of gestation with a heart rate regular at 70 beats per minute. Both twins and mother were positive for antinuclear, anti-SSA, and anti-SSB antibodies. Twins received single-chamber pacemaker implants at day 12 of life. The evolution was immediately favorable with a heart rate around 110 beats per minute. The follow-up was 2 years. The twins are currently asymptomatic. Conclusion - Complete congenital heart block is the most serious manifestation of the neonatal lupus erythematosus associated with significant morbidity and mortality.
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Ruffatti A, Cerutti A, Favaro M, Del Ross T, Calligaro A, Hoxha A, Marson P, Leoni L, Milanesi O. Plasmapheresis, intravenous immunoglobulins and bethametasone - a combined protocol to treat autoimmune congenital heart block: a prospective cohort study. Clin Exp Rheumatol 2016; 34:706-713. [PMID: 27385463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES At the moment there are no standard guidelines for the treatment of autoimmune congenital heart block (CHB). We set out to carry out a prospective cohort study to evaluate the benefits, limits, and safety of a combined therapy protocol to treat antibody-related CHB. METHODS Twelve consecutive pregnant patients positive to anti-SSA/Ro ± anti-SSB/La antibodies in whom CHB was detected were prospectively evaluated from 2009 to 2014. The treatment protocol consisted of: weekly plasmapheresis, fortnightly intravenous immunoglobulins (IVIG), and daily 4 mg betamethasone from CHB detection until delivery; IVIG was administered to the neonates soon after birth. RESULTS At the time CHB was detected, six of the foetuses presented atrioventricular blocks of 2(nd) degree type and six of 3(rd) degree type. Two of the foetuses with a 2(nd) degree block reverted to a 1st degree block and one to a normal atrioventricular conduction. The condition was stable throughout the pregnancy in the other three cases of 2(nd) degree block. All six 3(rd) degree blocks were stable during pregnancy and confirmed at birth. After a mean of 37.6 months ± 19.6 SD post-birth, the infants with 1st, normal sinus rhythm, and 2(nd) degree blocks at birth were all found to be stable. During the follow-up (29 months ± 19.8 SD), pacemakers were implanted in three of the six infants with 3(rd) degree blocks. CONCLUSIONS This combined therapy seems to be effective and safe in treating 2(nd) degree CHB, while its efficacy in treating 3rd degree CHB remains to be established.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Italy.
| | - Alessia Cerutti
- Paediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - Teresa Del Ross
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - Antonia Calligaro
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - Piero Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Italy
| | - Loira Leoni
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Ornella Milanesi
- Paediatric Cardiology Unit, Department of Women's and Children's Health, University of Padua, Italy
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Abstract
Despite significant advances in the pharmacological treatment of heart failure, rates of mortality and morbidity from the condition remain a concern. The introduction of cardiac resynchronisation therapy (CRT) has been a welcome addition to the treatment strategy of patients who display ventricular dyssynchrony. Several control studies have shown significant benefits from this intervention in particular improved mortality and reduction in symptom burden. In this short review, we focus on several concepts of CRT and discuss the implications of surgical implantation of the left ventricular (LV) lead as compared to the standard transvenous approach.
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Affiliation(s)
- S M Shaw
- North West Regional Cardiac and Transplant Unit, University Hospital of South Manchester, NHS Hospitals Foundation Trust, Manchester, UK
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Thomason JD, Kraus MS, Fallaw TL, Calvert CA. Survival of 4 dogs with persistent atrial standstill treated by pacemaker implantation. Can Vet J 2016; 57:297-298. [PMID: 26933268 PMCID: PMC4751773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pacemakers were implanted in 4 client-owned female dogs which had persistent atrial standstill. Three dogs were alive after 14 to 39 months and 1 dog was euthanized after 10.5 years. This report demonstrates that some dogs with persistent atrial standstill can survive for extended time periods.
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Abstract
Ventricular tachyarrhythmias are common in hypertrophic cardiomyopathy that may lead to syncope and sudden death. Bradyarrhythmia such as atrioventricular conduction disturbance, a relatively rare complication associated with hypertrophic cardiomyopathy, may also cause syncope and sudden death in hypertrophic cardiomyopathy. We report a 28-year old man who was diagnosed as a case of hypertrophic cardiomyopathy presented with syncope and complete heart block. Subsequently, a permanent pacemaker was implanted to the patient.
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Affiliation(s)
- L Dubey
- Department of Cardiology College of Medical Sciences and Teaching Hospital Bharatpur, Nepal
| | - S Guruprasad
- Department of Cardiology College of Medical Sciences and Teaching Hospital Bharatpur, Nepal
| | - R Bhattacharya
- Department of Cardiology College of Medical Sciences and Teaching Hospital Bharatpur, Nepal
| | - G Subramanyam
- Department of Cardiology College of Medical Sciences and Teaching Hospital Bharatpur, Nepal
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Sowton E, Spurrell R, Roy P. Clinical use of pacemakers in the treatment of conduction disturbances. Adv Cardiol 2015; 14:266-75. [PMID: 1136890 DOI: 10.1159/000397657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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50
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Cole TO, Mbanefo CO. Increasing indications for implanted cardiac pacemaker in Nigeria. Adv Cardiol 2015; 21:279-82. [PMID: 619553 DOI: 10.1159/000400464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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