ABSTRACT
Resumen Presentamos un caso de síndrome de marcapasos asociado a la ausencia de sincronía aurículo-ventricular, debido a la colocación invertida e inadvertida de los electrodos, en una paciente portadora de bloqueo aurículo-ventricular completo; para su diagnóstico, es fundamental un cuidadoso análisis del electrocardiograma, las imágenes con rayos X y los electrogramas intracavitarios.
Abstract Pacemaker syndrome: what is the mechanism? We present the case of pacemaker syndrome related to the absence of atrioventricular synchrony, due to inverted and inadvertent placement of the electrodes, in a patient with complete atrioventricular block. A careful analysis of the electrocardiogram, X-ray images and intracavitary electrograms are essential for its diagnosis.
Subject(s)
Humans , Female , Aged , Pacemaker, Artificial , Heart Block/surgery , Costa Rica , Cardiac Resynchronization Therapy Devices/adverse effectsABSTRACT
RESUMEN Hombre de 80 años de edad, con antecedentes de miocardiopatía dilatada de origen isquémico, con disfunción sisto-diastólica del ventrículo izquierdo, que inicialmente presentó flutter auricular con inestabilidad hemodinámica y se realizó cardioversión eléctrica, luego de la cual se obtuvo un ritmo no precedido de onda P a 40 latidos por minuto, que fue interpretado como fibrilación auricular bloqueada; razón por la que se le colocó un marcapasos externo. Durante su evolución se realizó electrocardiograma de 12 derivaciones, donde se evidenció estimulación ventricular permanente con conducción retrógrada (ventrículo-auricular). Se disminuyó la frecuencia de estimulación para priorizar el ritmo espontáneo del paciente y se obtuvo marcada mejoría de la curva de presión arterial.
ABSTRACT An 80-year-old male patient is presented, with previous dilated cardiomyopathy of ischemic etiology, with systo-diastolic left ventricular dysfunction, who initially presented atrial flutter and hemodynamic instability, thus, an electrical cardioversion was performed. After this procedure, a blocked atrial fibrillation was observed. Thus, an external pacemaker was placed. During the evolution, a 12 lead electrocardiogram was performed, showing permanent ventricular stimulation with retrograde conduction (ventriculo-atrial). The pacing rate was diminished for prioritizing the patient's spontaneous rhythm resulting in an improvement of the blood pressure curve.
Subject(s)
Heart Conduction System , Cardiac Pacing, Artificial , Atrial FunctionABSTRACT
Se presenta el caso clínico de un paciente de 52 años de edad que, a causa de una disfunción sintomática del nódulo sinusal, portaba un marcapasos permanente unicameral ventricular desde hacía 9 años, al cual se le había sustituido el generador por agotamiento de la batería. Un mes después del cambio el paciente acudió a la consulta especializada de Arritmias y Marcapasos en el Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, por presentar síntomas de cansancio fácil, disnea, mareos y síncopes; se le indicaron electrocardiogramas de superficie que mostraron una conducción retrógrada ventriculoauricular y pseudofusiones. Teniendo en cuenta las manifestaciones clínicas y los hallazgos electrocardiográficos, se diagnosticó un síndrome de marcapasos y se decidió implantar un electrodo auricular y variar la modalidad de estimulación a la de doble cámara, como terapéutica efectiva para ello. Los síntomas desaparecieron y el paciente evolucionó favorablemente hasta su egreso de la institución hospitalaria.
The case report of a 52 years patient is presented that had a ventricular unicameral permanent pacemaker for 9 years, due to a symptomatic dysfunction of the synusal nodule. The pacemaker had dead battery and the generator was substituted. A month after the change the patient went to the Arrhytmias and Pacemaker specialized service at "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, due to symptoms of easy tireness, dyspnea, dizziness and fainting fits; surface electrocardiograms were indicated that showed a ventriculoauricular retrograde conduction and pseudofusions. Taking into account the clinical features and the electrocardiographic findings, a pacemaker syndrome was diagnosed and it was decided to implant an auricular electrode and vary the stimulation modality to that of double camera, as effective therapy for it. The symptoms disappeared and the patient had a favorable clinical course when he was discharged from the hospital institution.
Subject(s)
Pacemaker, Artificial , Pacemaker, Artificial/adverse effectsABSTRACT
Objective To investigate the efficacy of permanent left ventricular epicardial pacing through left lateral thoracotomy in children with complete atrioventricular block (CAVB)or complete left bundle branch block (CLBBB)as well as its effects on heart synchronization.Methods Permanent left ventricular epicardial pacemakers were implanted through left lateral thoracotomy in 26 children with CAVB or CLBBB in Heart Center,the First Affiliated Hospital of Tsinghua University.These children aged (2.3 ±2.1 )years old (1 month -9 years old),weight (1 1 .2 ± 5.8)kg (5 -32 kg),among them 1 5 cases were male and 1 1 cases were female.Among the 26 patients,24 patients had CAVB and 2 patients had dilated cardiomyopathy secondary to CLBBB.Fifteen children who visited the Pediatrics Department for acute upper respiratory tract infection were chosen as control group.The efficacy of left ventricular epi-cardial pacemakers was analyzed and its effects on heart synchronization were observed by using tissue Doppler imaging (TDI).Results Implantations of pacemakers were successfully conducted in all the 26 patients with no complications associated with operations.Left atrial and ventricular dual chamber epicardial pacemakers were implanted in 21 patients and left ventricular single chamber epicardial pacemakers were implanted in 5 patients.Within the follow -up period of (28.2 ±1 5.1 )months (1 month -51 months),atrial and ventricular leads were 1 00% effective.No significant diffe-rence was found in atrial electrode sensing,ventricular electrode threshold and ventricular electrode impedance com-pared with those during implantation(P >0.05).For the 6 patients with preoperative cardiac insufficiency,their left ventricular diastolic diameters decreased from (48.50 ±1 1 .1 0)mm to (40.67 ±6.40)mm after operation,and the difference was significant (t =2.96,P =0.030);but left ventricular ejection fraction increased from 0.27 ±0.08 to 0.53 ±0.08 after operation,and the difference was significant (t =-5.02,P =0.004).Two patients with right ven-tricular pacing developed pacemaker syndrome and were switched to left ventricular epicardial pacing.Their cardiac function returned to normal 1 .5 and 2.0 years later,respectively.Fifteen patients received evaluation of heart synchroni-zation by TDI.No significant difference was found in LVEF,septal -to -lateral wall motion delay,septal -to -posterior wall motion delay and standard deviation of Standard deviation of the peak tissue velocity between these 2 groups(all P >0.05).Conclusions For children requiring epicardial pacing,left ventricular epicardial pacing is safe and effec-tive,which can protect left ventricular systolic synchronization,prevent or reverse the pacemaker syndrome.
ABSTRACT
Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.