ABSTRACT
BACKGROUND: Leadless pacemaker has been acknowledged as a promising pacing strategy to prevent pocket and lead-related complications. Although rare, cardiac perforation remains a major safety concern for implantation of Micra transcatheter pacing system (TPS). CASE PRESENTATION: A 83-year-old female with low body mass index (18.9 kg m-2) on dual anti-platelet therapy, was indicated for Micra TPS implantation due to sinus arrest and paroxysmal atrial flutter. The patient developed mild pericardial effusion during the procedure since the delivery catheter was accidentally placed into the coronary sinus for several times. Cardiac perforation with moderate pericardial effusion and pericardial tamponade was detected 2 h post-procedure. The patient was treated with immediately pericardiocentesis and recovered without further invasive therapy. CONCLUSION: Pericardial effusion caused by accidently placing a delivery catheter into the coronary sinus is rare but should be carefully considered in Micra TPS implantation, especially for those with periprocedural anti-platelet therapy.
Subject(s)
Atrial Flutter/therapy , Cardiac Catheterization/adverse effects , Cardiac Pacing, Artificial/adverse effects , Heart Injuries/etiology , Medical Errors , Pacemaker, Artificial/adverse effects , Pericardial Effusion/etiology , Sinus Arrest, Cardiac/therapy , Aged, 80 and over , Atrial Flutter/diagnosis , Atrial Flutter/physiopathology , Cardiac Catheterization/instrumentation , Cardiac Tamponade/etiology , Equipment Design , Female , Heart Injuries/diagnostic imaging , Humans , Pericardial Effusion/diagnostic imaging , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/physiopathology , Treatment OutcomeSubject(s)
Atrioventricular Block/therapy , Cardiac Pacing, Artificial/methods , Electrocardiography/methods , Heart Transplantation , Sinus Arrest, Cardiac/therapy , Aged , Atrioventricular Block/diagnosis , Atrioventricular Block/physiopathology , Humans , Male , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/physiopathologyABSTRACT
We present a case of sinus arrest and junctional escape rhythm from sinus node artery (SNA) thrombus in a 55-year-old man after revascularisation of right coronary and proximal circumflex arteries for infero-posterior wall ST-segement elevation myocardial infarction (STEMI). Sinus arrest from occlusion of the SNA is uncommon. The ensuing bradycardia may have haemodynamic consequences requiring temporary pacing but is almost always self-limited.
Subject(s)
Chest Pain/diagnostic imaging , Coronary Sinus/diagnostic imaging , Coronary Thrombosis/diagnosis , Myocardial Revascularization/methods , Sinus Arrest, Cardiac/diagnosis , Aspirin/therapeutic use , Chest Pain/etiology , Coronary Angiography , Coronary Sinus/physiopathology , Coronary Thrombosis/physiopathology , Coronary Thrombosis/therapy , Defibrillators, Implantable , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Purinergic P2Y Receptor Antagonists/therapeutic use , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapy , Smokers , Treatment OutcomeABSTRACT
Obstructive sleep apnea (OSA) is associated with the occurrence of various kinds of bradyarrhythmia and tachyarrhythmia. The activation of the autonomic nerve system is an important causative factor of the pathogenesis of the arrhythmia in OSA patients. Previous studies have shown that the R-R interval is an effective parameter for evaluating autonomic nerve activities. However, whether or not OSA can induce variations in the R-R interval and whether or not continuous positive airway pressure (CPAP) therapy can improve these variations in OSA patients are unclear. The present study explored whether or not CPAP therapy could improve the regularity of the R-R interval.
Subject(s)
Atrioventricular Block/therapy , Continuous Positive Airway Pressure , Sleep Apnea, Obstructive/therapy , Aortic Aneurysm, Thoracic/surgery , Atrioventricular Block/etiology , Autonomic Nervous System Diseases , Bradycardia/etiology , Bradycardia/therapy , Electrocardiography , Humans , Male , Middle Aged , Polysomnography , Postoperative Complications/etiology , Postoperative Complications/therapy , Sinus Arrest, Cardiac/etiology , Sinus Arrest, Cardiac/therapyABSTRACT
Vagoglossopharyngeal neuralgia (VGPN) is a very rare condition. VGPN with convulsive like attack is even rarer All of the cases had their head turned to the opposite side of facial pain. Hemifacial spasm occurring concurrently with VGPN has never been reported. Herein, we present the first case of VGPN that had ipsilateral hemifacial spasm and versive seizure-like movement to the same side of facial pain. We reported a 71-year-old man presenting with multiple episodes of intermittent sharp shooting pain arising on the right middle neck, followed by hemifacial spasm on right face. Then the patient became syncope while his head and gaze turned to the same side of the painful neck. Electrocardiography showed sinus arrest. Interictal Electroencephalography was normal. This patient initially responded to pregabalin for two weeks, then the symptoms became worse. Microvascular decompression and carbamazepine resulted in the complete remission of all symptoms after six months of follow-up. We could not explain the pathophysiology of unilateral versive seizure like movement.
Subject(s)
Epilepsy, Partial, Motor/complications , Glossopharyngeal Nerve Diseases/complications , Hemifacial Spasm/complications , Neuralgia/complications , Sinus Arrest, Cardiac/complications , Syncope/complications , Vagus Nerve Diseases/complications , Aged , Carbamazepine/therapeutic use , Electrocardiography , Electroencephalography , Epilepsy, Partial, Motor/diagnosis , Epilepsy, Partial, Motor/therapy , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/therapy , Hemifacial Spasm/diagnosis , Hemifacial Spasm/therapy , Humans , Magnetic Resonance Imaging , Male , Microvascular Decompression Surgery/methods , Neuralgia/diagnosis , Neuralgia/therapy , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/therapy , Syncope/diagnosis , Syncope/therapy , Vagus Nerve Diseases/diagnosis , Vagus Nerve Diseases/therapyABSTRACT
Syncope is defined as a transient, self-limiting loss of consciousness and postural tone due to transient global cerebral hypoperfusion. After syncope the following questions have to be answered: was it a syncopal episode, has the etiological diagnosis been determined, are there data suggestive of a high risk of cardiovascular events or death and what are the therapeutic options? Therefore, a standardized diagnostic work-up is necessary. This diagnostic work-up with differential diagnostic considerations is given for three clinical cases: a 52-year-old man experienced syncope while driving a car and on the morning of the same day syncope had previously occurred while in a standing position. The initial cardiological and neurological evaluation revealed no pathological findings but after implantation of a loop recorder a further syncope with a sinus arrest of 17 s occurred 1 year later. The patient received a single chamber pacemaker. The second case is a 79-year-old female with Parkinson's disease for many years and a primary autonomic dysfunction leading to dizziness and syncope due to pronounced blood pressure fluctuations with hypertensive and hypotensive phases. The last patient is a 22-year-old female with postural orthostatic tachycardia syndrome and recurrent syncope. The diagnostic evaluation and treatment proved to be difficult.
Subject(s)
Parkinson Disease/diagnosis , Parkinson Disease/therapy , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/therapy , Syncope/diagnosis , Syncope/therapy , Adult , Aged , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Parkinson Disease/complications , Sinus Arrest, Cardiac/complications , Syncope/etiology , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: Concomitant surgical atrial fibrillation (AF) ablation is a safe and feasible procedure, recommended in guidelines. Pacemaker dependency is a known complication of AF ablation. We sought to determine independent predictors for pacemaker implantation after surgical AF ablation. METHODS: Between January 2003 and November 2012, 594 patients underwent concomitant surgical AF ablation. Various energy sources, including cryoablation (n = 139), unipolar radiofrequency (n = 278), and bipolar radiofrequency (n = 177), were used. Left atrial (n = 463, 77.9%) and biatrial (n = 131, 22.1%) ablation was performed. Univariate and multivariate logistic regression analysis was used to identify independent predictors for pacemaker implantation within 30 days after surgical AF ablation. RESULTS: The mean patient's age was 68.6 ± 9.4 years, and 66.8% were male. No major ablation-related complications occurred. A total of 41 (6.9%) of patients received pacemaker implantation during the 30-day follow-up period. Indications for pacemaker implantation were atrioventricular block in 25 (60.9%) of patients, sinus bradycardia or sinus arrest in 9 (22.0%) of patients, and bradyarrhythmia in 7 (17.1%) of patients. Demographic data, type of surgical procedure, and type of energy source did not have a significant impact on pacemaker implantation rate. However, biatrial ablation led to a significant pacemaker implantation rate compared with isolated left-sided ablation (6.3% vs 13.6%; P = .028). CONCLUSIONS: Concomitant surgical AF ablation showed a pacemaker implantation rate of 6.9% after 30-day follow-up. Univariate and multivariate analysis showed biatrial lesion set as the only statistically significant predictor for pacemaker implantation after surgical AF ablation.
Subject(s)
Atrial Fibrillation/surgery , Atrioventricular Block/therapy , Bradycardia/therapy , Cardiac Pacing, Artificial , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Pacemaker, Artificial , Sinus Arrest, Cardiac/therapy , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Atrioventricular Block/diagnosis , Atrioventricular Block/etiology , Atrioventricular Block/physiopathology , Bradycardia/diagnosis , Bradycardia/etiology , Bradycardia/physiopathology , Chi-Square Distribution , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/etiology , Sinus Arrest, Cardiac/physiopathology , Time Factors , Treatment OutcomeABSTRACT
A 67-year-old man who had a history of syncope was admitted because of effort angina. The sinus node (SN) was the single blood supply from the right coronary artery (RCA). After we implanted 2 everolimus-eluting stents for RCA, slow-flow occurred and the SN artery was occluded, and junctional escape rhythm was sustained. After the wiring to the occluded SN artery, junctional escape rhythm immediately recovered to sinus rhythm, and the patient achieved continuous sinus rhythm and stable hemodynamics. Given that acute SN ischemia is a possible cause of sinus dysfunction, careful choice of a percutaneous coronary intervention strategy should be taken into consideration if the SN artery is the single blood supply from the RCA and if syncopal history is present.
Subject(s)
Angina Pectoris/therapy , Angioplasty, Balloon, Coronary/adverse effects , Coronary Artery Disease/therapy , Drug-Eluting Stents/adverse effects , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapy , Aged , Angina Pectoris/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Vessels/physiopathology , Humans , Male , Radiography , Risk Factors , Sinus Arrest, Cardiac/etiologySubject(s)
Bradycardia/diagnosis , Heart Arrest/diagnosis , Heart Arrest/physiopathology , Polysomnography , Sinus Arrest, Cardiac/diagnosis , Sleep Apnea, Obstructive/diagnosis , Autonomic Nervous System/physiopathology , Blood Pressure/physiology , Bradycardia/physiopathology , Bradycardia/therapy , Continuous Positive Airway Pressure , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Female , Heart/innervation , Heart Arrest/therapy , Heart Rate/physiology , Humans , Middle Aged , Signal Processing, Computer-Assisted , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapy , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/therapy , Ventricular Premature Complexes/diagnosis , Ventricular Premature Complexes/physiopathology , Ventricular Premature Complexes/therapySubject(s)
Myocarditis/diagnosis , Sinus Arrest, Cardiac/diagnosis , Action Potentials , Acute Disease , Echocardiography, Doppler, Pulsed , Electrocardiography , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Humans , Male , Middle Aged , Myocarditis/complications , Myocarditis/physiopathology , Myocarditis/therapy , Predictive Value of Tests , Sinus Arrest, Cardiac/etiology , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapy , Voltage-Sensitive Dye ImagingABSTRACT
OBJECTIVES: Important adjustments in the autonomic nervous system occur during sleep. Bradycardia, due to increased vagal tone, and hypotension, caused by reduction of sympathetic activity, may occur during non rapid eye movement (REM) sleep (NREM). Increased sympathetic activity, causing increased heart rate, is conversely a feature of phasic REM sleep. During REM sleep, sinus arrests and atrioventricular (AV) blocks unrelated to apnea or hypopnea have been described. These arrhythmias are very rare and only a few cases have been reported in the literature. PATIENTS/METHODS: Following an ECG performed for other reasons, two patients with no history of sleep complaints nor symptoms of heart failure or heart attack were referred to our center for nocturnal brady-arrhythmias. RESULTS: 24h ECG Holter recorded several episodes of brady-arrhythmia with sinus arrest in the first patients and brady-arrhythmias with complete AV block in the second patient. In both patients, episodes of brady-arrhythmia were prevalent in the second part of the night. Nocturnal polysomnography (PSG) demonstrated that episodes occurred only during REM sleep, particularly during phasic events. Treatment with pacemaker was considered only for the patient with complete AV blocks. CONCLUSIONS: These types of brady-arrhythmias are usually detected accidentally due to their lack of symptoms. It has been suggested that in some patients they may lead to sudden unexpected death. Thus, the identification of predisposing factors is mandatory in order to prevent potentially dangerous arrhythmic events.
Subject(s)
Autonomic Nervous System Diseases/diagnosis , Bradycardia/diagnosis , Bradycardia/therapy , Cardiac Pacing, Artificial , Sleep, REM , Adult , Autonomic Nervous System Diseases/complications , Bradycardia/etiology , Circadian Rhythm , Electrocardiography, Ambulatory , Humans , Male , Polysomnography , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/etiology , Sinus Arrest, Cardiac/therapy , Young AdultABSTRACT
A 5-month-old female infant presented with new-onset acute lymphoblastic leukemia and hyperleukocytosis with white blood cell count of 352 × 10(9) cells/L. She developed sinus pauses and hypoxemic respiratory failure. A manual single volume exchange blood transfusion was done with complete resolution of sinus pauses and hypoxemia.
Subject(s)
Autonomic Nervous System Diseases/complications , Exchange Transfusion, Whole Blood/methods , Hypoxia/complications , Leukocytosis/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Sinus Arrest, Cardiac/etiology , Antineoplastic Agents/therapeutic use , Autonomic Nervous System Diseases/physiopathology , Autonomic Nervous System Diseases/therapy , Electrocardiography , Female , Follow-Up Studies , Humans , Hypoxia/blood , Hypoxia/therapy , Infant , Leukocyte Count , Leukocytosis/blood , Leukocytosis/therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Respiratory Insufficiency , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapyABSTRACT
Familial hypokalemic periodic paralysis is an autosomal dominant muscle disorder characterized by episodic attacks of muscle weakness, accompanied by a decrease in blood potassium levels. It is based on genetic mutations in the genes CACNA1S (most frequent, encoding the skeletal muscle calcium channel) and SCN4A (10% of cases, encoding the sodium channel). Few cases have been reported with cardiac dysrhythmia. We report a rare case of a patient with a novel SCN4A mutation who presented, on ECG, extreme bradycardia and syncopal sinus arrest that required a temporary pacemaker implant
Subject(s)
Bradycardia/genetics , Heart Rate/genetics , Mutation , Paralysis, Hyperkalemic Periodic/genetics , Sinus Arrest, Cardiac/genetics , Sodium Channels/genetics , Adult , Bradycardia/physiopathology , Bradycardia/therapy , Cardiac Pacing, Artificial , DNA Mutational Analysis , Electrocardiography , Humans , Male , NAV1.4 Voltage-Gated Sodium Channel , Pacemaker, Artificial , Paralysis, Hyperkalemic Periodic/complications , Paralysis, Hyperkalemic Periodic/physiopathology , Paralysis, Hyperkalemic Periodic/therapy , Potassium Compounds/administration & dosage , Sinus Arrest, Cardiac/physiopathology , Sinus Arrest, Cardiac/therapy , Syncope/genetics , Treatment OutcomeABSTRACT
A 63-year-old man presented with recurrent syncopal attacks associated with swallowing and right-sided throat pain. Immediately after admission, he presented a 16-s asystolia. The patient's clinical history was unremarkable except for previous postimplant periodontitis. Several episodes of severe bradycardia and sinus pauses, always associated with painful deglutition, were recorded subsequently. X-ray orthopanthomography and magnetic resonance imaging of the neck confirmed several areas of periodontitis around the previous dental implants and right mastoid inflammation. A barium swallow and fibre-optic endoscopy also revealed a small sliding hiatus hernia and distal chronic oesophageal inflammation. Despite complete dental curettage, antibiotics and antigastro-oesophageal reflux therapy, only partial relief of the pain and incomplete resolution of the arrhythmic disorder were obtained after 3 weeks, and the patient underwent pacemaker implantation. At 1-month follow-up, however, he reported the complete relief of the throat pain; subsequent Holter monitoring showed normal sinus rhythm, without pacemaker-induced electrical activity.
Subject(s)
Bradycardia/etiology , Deglutition Disorders/etiology , Mastoiditis/complications , Periodontitis/complications , Pharyngitis/etiology , Sinus Arrest, Cardiac/etiology , Syncope/etiology , Anti-Bacterial Agents/therapeutic use , Bradycardia/pathology , Bradycardia/therapy , Deglutition Disorders/pathology , Deglutition Disorders/therapy , Electrocardiography, Ambulatory , Gastroesophageal Reflux/complications , Gastrointestinal Agents/therapeutic use , Hernia, Hiatal/complications , Humans , Magnetic Resonance Imaging , Male , Mastoiditis/pathology , Mastoiditis/physiopathology , Middle Aged , Pacemaker, Artificial , Periodontitis/pathology , Periodontitis/physiopathology , Pharyngitis/pathology , Pharyngitis/physiopathology , Pharyngitis/therapy , Radiography, Panoramic , Recurrence , Sinus Arrest, Cardiac/pathology , Sinus Arrest, Cardiac/therapy , Subgingival Curettage , Syncope/pathology , Syncope/physiopathology , Syncope/therapy , Treatment OutcomeABSTRACT
We describe the case of a 30-year-old pregnant woman who underwent pacemaker implantation for recurrent syncope caused by sinus arrest. In order to minimize radiation exposure, which may potentially have teratogenic effects, we decided to perform pacemaker implantation by means of a hybrid technique involving the evaluation of electrophysiologic signals and transthoracic echocardiographic imaging to guide lead positioning within the right ventricle. After the procedure, the patient was always asymptomatic and had no recurrences of syncope. Six months later, she experienced uncomplicated natural labor, and the newborn was absolutely healthy. On a 10-month follow-up examination, the lead position was still optimal, and ventricular sensing and pacing thresholds were good. Our case demonstrates that pacemaker implantation under the guidance of electrophysiologic signals and transthoracic echocardiographic imaging, with only a short view by pulsed fluoroscopy in order to verify the correct lead position, is an effective and well-tolerated procedure in pregnant women.
Subject(s)
Cardiac Pacing, Artificial , Electrocardiography , Pacemaker, Artificial , Pregnancy Complications, Cardiovascular/therapy , Sinus Arrest, Cardiac/therapy , Syncope/therapy , Ultrasonography, Interventional , Adult , Female , Fluoroscopy/adverse effects , Humans , Live Birth , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Radiation Dosage , Recurrence , Sinus Arrest, Cardiac/complications , Sinus Arrest, Cardiac/diagnostic imaging , Syncope/diagnostic imaging , Syncope/etiology , Treatment OutcomeABSTRACT
A 64-year-old woman presented with bradycardia from sinus pauses during exacerbations of postherpetic trigeminal distribution neuralgia. She had underlying systemic lupus erythematosus. Sphenopalatine ganglion blockade was employed to treat her pain. The episodes of bradycardia resolved with successful alleviation of pain. This report emphasizes that a sphenopalatine ganglion blockade can be employed in the treatment and prevention of sinus arrest associated with postherpetic trigeminal distribution neuralgia.