ABSTRACT
BACKGROUND: Sinus node dysfunction because of abnormal impulse generation or sinoatrial conduction block causes bradycardia that can be difficult to differentiate from high parasympathetic/low sympathetic modulation (HP/LSM). HYPOTHESIS: Beat-to-beat relationships of sinus node dysfunction are quantifiably distinguishable by Poincaré plots, machine learning, and 3-dimensional density grid analysis. Moreover, computer modeling establishes sinoatrial conduction block as a mechanism. ANIMALS: Three groups of dogs were studied with a diagnosis of: (1) balanced autonomic modulation (n = 26), (2) HP/LSM (n = 26), and (3) sinus node dysfunction (n = 21). METHODS: Heart rate parameters and Poincaré plot data were determined [median (25%-75%)]. Recordings were randomly assigned to training or testing. Supervised machine learning of the training data was evaluated with the testing data. The computer model included impulse rate, exit block probability, and HP/LSM. RESULTS: Confusion matrices illustrated the effectiveness in diagnosing by both machine learning and Poincaré density grid. Sinus pauses >2 s differentiated (P < .0001) HP/LSM (2340; 583-3947 s) from sinus node dysfunction (8503; 7078-10 050 s), but average heart rate did not. The shortest linear intervals were longer with sinus node dysfunction (315; 278-323 ms) vs HP/LSM (260; 251-292 ms; P = .008), but the longest linear intervals were shorter with sinus node dysfunction (620; 565-698 ms) vs HP/LSM (843; 799-888 ms; P < .0001). CONCLUSIONS: Number and duration of pauses, not heart rate, differentiated sinus node dysfunction from HP/LSM. Machine learning and Poincaré density grid can accurately identify sinus node dysfunction. Computer modeling supports sinoatrial conduction block as a mechanism of sinus node dysfunction.
Subject(s)
Dog Diseases , Heart Rate , Machine Learning , Animals , Dogs , Dog Diseases/diagnosis , Dog Diseases/physiopathology , Heart Rate/physiology , Sinoatrial Block/veterinary , Sinoatrial Block/diagnosis , Sinoatrial Block/physiopathology , Male , Female , Sinoatrial Node/physiopathology , Sick Sinus Syndrome/veterinary , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/physiopathology , Electrocardiography/veterinaryABSTRACT
BACKGROUND: Psychological adaptation after cardiac pacemaker implantation is a challenge for patients with mental illness. CASE PRESENTATION: Here we report a self-harming patient with a psychiatric disorder. A 73-year-old female patient with 16-year coronary heart disease and a 4-year depression was admitted to our hospital for a coma. Two months earlier, the local hospital confirmed that the patient had a second-degree sinoatrial (SA) block (type 2) as well as basal septal hypertrophy with the left ventricular outflow obstruction. Therefore, metoprolol sustained-release tablets 95 mg QD and diltiazem sustained-release tablets 90 mg QD was given as treatment after a pacemaker was implanted. However, the patient had continued complaining about discomfort due to the pacemaker implanted after being discharged from the hospital. Two months later, she attempted to commit suicide by removing her pacemaker and taking 80 sleeping pills. After a series of treatments, the patient improved and was discharged without a pacemaker re-implantation. With continued anti-depression treatment and strengthen family supervision, the patient's condition is stable now. CONCLUSIONS: A suicide attempt by intentionally removing the permanent pacemaker system was rarely reported. In bradycardia patients with a history of psychological or psychiatric disease, careful evaluation should be done before and after implantation of the pacemaker.
Subject(s)
Cardiac Pacing, Artificial/psychology , Depressive Disorder, Major/psychology , Device Removal/psychology , Drug Overdose/psychology , Sinoatrial Block/therapy , Suicide, Attempted/psychology , Aged , Antidepressive Agents/therapeutic use , Cardiac Pacing, Artificial/adverse effects , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , Device Removal/adverse effects , Female , Humans , Mental Health , Sinoatrial Block/diagnosis , Sinoatrial Block/psychology , Treatment OutcomeABSTRACT
BACKGROUND: Atrial fibrillation with symptomatic bradycardia, higher grade atrioventricular block, and sinus node disease are all common indications for permanent pacemaker implantation. The most frequent causes of sinus node disease treated with pacemaker implantation involve degenerative structural changes of the sinus node; less often, extrinsic causes (such as damage due to myocardial infarction or heightened parasympathetic nervous system activity) lead to pacemaker implantation. CASE PRESENTATION: A 50-year-old patient with syncope and documented sinoatrial arrest was referred. Neurologic exams (including CT and EEG) revealed no pathologies, so a pacemaker was implanted. Postoperatively, syncope occurred again due to a focal seizure during which sinus rhythm transitioned to atrial pacing by the device. Further neurologic testing revealed focal epilepsy. Six months later, stage IV glioblastoma was diagnosed and the patient was treated surgically. CONCLUSION: Intracerebral tumors should be considered in the differential diagnosis for patients with unexplained sinoatrial block, as well as in patients with repeat syncope after pacemaker implantation. Cranial MRI could aid the diagnostic workup of such cases.
Subject(s)
Brain Neoplasms/complications , Epilepsy, Temporal Lobe/etiology , Glioblastoma/complications , Heart Atria/physiopathology , Heart Rate , Sinoatrial Block/etiology , Sinoatrial Node/physiopathology , Action Potentials , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Cardiac Pacing, Artificial , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/physiopathology , Glioblastoma/diagnostic imaging , Glioblastoma/pathology , Glioblastoma/surgery , Humans , Male , Middle Aged , Neoplasm Staging , Neurosurgical Procedures , Pacemaker, Artificial , Sinoatrial Block/diagnosis , Sinoatrial Block/physiopathology , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Sinoatrial Block/diagnosis , Arrhythmia, Sinus/diagnosis , Electrocardiography/methods , Diagnosis, DifferentialABSTRACT
Narrow complex bigeminy is a common electrocardraphic finding that can be caused by second degree sinoatrial exit block or ectopic atrial bigeminy. These rhythms can be very challenging to distinguish on a 12-lead electrocardiogram. In this case of an elderly woman who presented with narrow complex bigeminy, we review the differentiating features of second degree sinoatrial exit block and ectopic atrial bigeminy.
Subject(s)
Electrocardiography/methods , Sinoatrial Block/diagnosis , Sinoatrial Block/physiopathology , Aged , Diagnosis, Differential , Female , Humans , Sinoatrial Node/physiopathologyABSTRACT
No disponible
Subject(s)
Humans , Electrocardiography , Atrial Fibrillation/diagnosis , Sinoatrial Block/diagnosis , Atrioventricular Block/diagnosis , Diagnosis, DifferentialABSTRACT
We report a case of a 58 year old gentleman with prior history of catheter ablation for persistent atrial fibrillation (AF). His baseline ECG showed sinus rhythm with a broad and notched P-wave in lead II and biphasic P-wave (positive/negative) in leads III and aVF previously described as advanced interatrial block. A redo ablation procedure was performed due to AF recurrence. An iatrogenic isolation of the coronary sinus (CS) was observed during ablation with marked narrowing and loss of the terminal negative component of the P-wave on the surface ECG.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Coronary Sinus/surgery , Electrocardiography/methods , Sinoatrial Block/diagnosis , Sinoatrial Block/etiology , Atrial Fibrillation/complications , Heart Conduction System , Humans , Iatrogenic Disease , Male , Middle Aged , Treatment OutcomeABSTRACT
AIMS: To determine the clinical significance of the sinoatrial block II° of the Wenckebach type (block W) identified during Holter monitoring. METHODS AND RESULTS: The study included 300 patients (mean age 54 ± 17 years; 130 women) with symptoms suggestive of arrhythmia who underwent Holter monitoring. Block W was identified by a dedicated computer program and subsequently confirmed by a cardiologist. Block W was diagnosed in 88 patients (29%). It occurred only during sleep in 37 (12%) patients and during both daytime activity and sleep in 51 (17%) patients. Block W only during sleep happened predominately in young patients aged between 20 and 30 years, whereas episodes that occurred during both daytime and sleep were found mainly in patients between 60 and 70 years of age. Prospective observation time averaged 41 ± 11 months, and the time to the diagnosis of sinus node disease was 26 ± 10 months. Cox multivariate analyses showed that block W during both daytime and sleep is an independent predictor for the future diagnosis of sinus node disease [hazard ratio-13.6 (5.2-35.5); P < 0.0001]. Age-specific analyses confined this effect to the patients ≥50 years of age. The results also suggest that in patients ≥50 years of age block W during both daytime and sleep may be related to a significant improvement in survival [hazard ratio-0.03 (0.007-0.16); P < 0.0001]. CONCLUSION: Block W during daytime activity in patients with symptoms suggestive of arrhythmia indicates an increased likelihood of the future diagnosis of sinus node disease.
Subject(s)
Electrocardiography, Ambulatory/statistics & numerical data , Sinoatrial Block/diagnosis , Sinoatrial Block/mortality , Syncope/diagnosis , Syncope/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Causality , Comorbidity , Electrocardiography, Ambulatory/methods , Female , Humans , Longitudinal Studies , Male , Middle Aged , Poland/epidemiology , Prevalence , Reproducibility of Results , Sensitivity and Specificity , Sex Distribution , Sinoatrial Block/classification , Survival Rate , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , Syncope/classification , Young AdultSubject(s)
Preoperative Period , Sinoatrial Block/diagnosis , Aged, 80 and over , Electrocardiography , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Sinoatrial Block/diagnosis , Sinoatrial Block/drug therapy , Postoperative Complications/drug therapy , Cataract Extraction/methods , Hypokinesia , Phacoemulsification/methods , Phacoemulsification/trends , Sinoatrial Block/physiopathology , Sinoatrial Block/surgery , Sinoatrial Block , Postoperative Period , Hypokinesia/drug therapy , Phacoemulsification/standards , Phacoemulsification , Electrocardiography/methods , Electrocardiography/trendsABSTRACT
A 22-year-old athlete with nocturnal asymptomatic episodes of transient sinus arrest/sinoatrial block up to 7.3 s and recurrent inappropriate sinus tachycardias which had been incidentally found during Holter electrocardiography diagnostics is presented. In spite of extensive diagnostic work-up including invasive procedures like coronary angiography and electrophysiological study, no causal etiology was found. Based on the normal findings and the lack of symptoms, we decided not to implant a permanent pacemaker. After 14 months, the patient is still asymptomatic. Howerver, the 24-h Holter electrocardiography shows unchanged frequency of nocturnal transient sinus arrest episodes.
Subject(s)
Electrocardiography, Ambulatory/methods , Sinoatrial Block/classification , Sinoatrial Block/diagnosis , Adult , Diagnosis, Differential , Humans , MaleSubject(s)
Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Hyperkalemia/diagnosis , Hyperkalemia/etiology , Pacemaker, Artificial/adverse effects , Sinoatrial Block/complications , Sinoatrial Block/diagnosis , Aged , Diagnosis, Differential , Electrocardiography/methods , Female , Humans , Sinoatrial Block/prevention & control , Unconsciousness/diagnosis , Unconsciousness/etiologySubject(s)
Atrial Fibrillation/epidemiology , Atrial Flutter/epidemiology , Bradycardia/epidemiology , Sick Sinus Syndrome/epidemiology , Sick Sinus Syndrome/genetics , Sinoatrial Block/epidemiology , Adult , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Atrial Flutter/diagnosis , Atrial Flutter/physiopathology , Bradycardia/diagnosis , Bradycardia/physiopathology , Comorbidity , Coronary Sinus/physiopathology , Echocardiography , Electrocardiography , Heart Atria/physiopathology , Humans , Male , Sick Sinus Syndrome/physiopathology , Sinoatrial Block/diagnosis , Sinoatrial Block/physiopathologyABSTRACT
BACKGROUND: Although the most frequent extra-pulmonary manifestations of respiratory syncytial virus (RSV) infection involve the cardiovascular system, no data regarding heart function in infants with bronchiolitis associated with RSV infection have yet been systematically collected. The aim of this study was to verify the real frequency of heart involvement in patients with bronchiolitis associated with RSV infection, and whether infants with mild or moderate disease also risk heart malfunction. METHODS: A total of 69 otherwise healthy infants aged 1-12 months with bronchiolitis hospitalised in standard wards were enrolled. Pernasal flocked swabs were performed to collect specimens for the detection of RSV by real-time polymerase chain reaction, and a blood sample was drawn to assess troponin I concentrations. On the day of admission, all of the infants underwent 24-hour Holter ECG monitoring and a complete heart evaluation with echocardiography. Patients were re-evaluated by investigators blinded to the etiological and cardiac findings four weeks after enrollment. RESULTS: Regardless of their clinical presentation, sinoatrial blocks were identified in 26/34 RSV-positive patients (76.5%) and 1/35 RSV-negative patients (2.9%) (p < 0.0001). The blocks recurred more than three times over 24 hours in 25/26 RSV-positive patients (96.2%) and none of the RSV-negative infants. Mean and maximum heart rates were significantly higher in the RSV-positive infants (p < 0.05), as was low-frequency power and the low and high-frequency power ratio (p < 0.05). The blocks were significantly more frequent in the children with an RSV load of ≥100,000 copies/mL than in those with a lower viral load (p < 0.0001). Holter ECG after 28 ± 3 days showed the complete regression of the heart abnormalities. CONCLUSIONS: RSV seems associated with sinoatrial blocks and transient rhythm alterations even when the related respiratory problems are mild or moderate. Further studies are needed to clarify the mechanisms of these rhythm problems and whether they remain asymptomatic and transient even in presence of severe respiratory involvement or chronic underlying disease.