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1.
Postgrad Med ; 131(8): 572-573, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31538832

RESUMO

A 62-year-old man presented to the emergency department with shortness of breath and chest tightness. His initial ECG appeared to have an ectopic P-wave with a lengthening PR interval consistent with second degree AV block - Mobitz Type I. But closer inspection showed a faster, independent atrial rate. The patient was diagnosed with ectopic atrial bradycardia with complete AV block and junctional escape, and was ultimately referred for pacemaker.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/cirurgia , Bloqueio Atrioventricular/complicações , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Taquicardia Atrial Ectópica/complicações
2.
Cardiol Young ; 29(5): 697-698, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31169106

RESUMO

The coexistence of long QT syndrome with 2:1 or complete atrioventricular blocks has been reported in the literature, but, to the best of our knowledge, this is the first pediatric case of long QT syndrome coexisting with first-degree atrioventricular blocks( 1 - 3 ).


Assuntos
Bloqueio Atrioventricular/complicações , Síndrome do QT Longo/complicações , Bloqueio Atrioventricular/diagnóstico , Eletrocardiografia , Humanos , Lactente , Síndrome do QT Longo/diagnóstico , Masculino
3.
Medicine (Baltimore) ; 98(17): e15211, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027067

RESUMO

RATIONALE: Patients with situs inversus totalis (SIT) and complete atrioventricular (AV) block are extremely rare, and only few cases have been reported up to now. Due to the rarity of such condition and its anatomical complexity, we reported this case as a reference for obstetricians, providing valuable insights into potential clinical treatment. PATIENT CONCERNS: We reported a case of 30-year-old patient with complete AV block, and her heart rate was only about 45 beats per minute. DIAGNOSES: The patient was diagnosed with term delivery with SIT and complete AV block. INTERVENTIONS: A temporary pacemaker (TPM) was implanted before cesarean section (CS) because of complete AV block. OUTCOMES: CS was performed successfully after the implantation of a TPM. The heart rate remained stable, and the 24-hour blood loss was limited. LESSONS: This study presents a complex heart disease case which needed more frequent antenatal examination and restriction of physical activity. To reduce the risk of pregnancy, basic disease needed to be cured before pregnancy. Our findings could provide guidance for future clinical studies.


Assuntos
Bloqueio Atrioventricular/terapia , Cesárea , Dextrocardia/terapia , Marca-Passo Artificial , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Bloqueio Atrioventricular/complicações , Dextrocardia/complicações , Feminino , Humanos , Recém-Nascido , Gravidez
4.
Intern Med ; 58(14): 2041-2044, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30918200

RESUMO

An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.


Assuntos
Bloqueio Atrioventricular/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Imagem Cinética por Ressonância Magnética/métodos , Marca-Passo Artificial , Síncope/complicações , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica , Bloqueio Atrioventricular/cirurgia , Meios de Contraste , Eletrocardiografia Ambulatorial/métodos , Fibrose/cirurgia , Gadolínio DTPA , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Miocárdio/patologia , Síncope/cirurgia , Resultado do Tratamento
7.
Clin Cardiol ; 42(4): 452-458, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30801746

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with its incidence making up nearly one-third of all hospital admissions. Atrioventricular block (AVB) is a conduction abnormality along the atrioventricular node or the His-Purkinje system. The relationship between atrioventricular conduction block and AF is controversial. HYPOTHESIS: This study is designed to observe whether there is a correlation between AVB and AF, and which type of AVB has the most obvious correlation with AF. METHODS: This study retrospectively reviewed 1345 patients. We classified the AVB according to the AVB classification criteria. One hundred and two patients were excluded, and the final total sample size was 1243 patients, including 679 patients in the AF group (378, 55.7% males) and 564 patients in the non-AF group (287, 50.8% males). AF group and non-AF group were compared to observe the relationship between AVB and AF. RESULTS: The I AVB have a relative statistical risk of 1.927 (95% confidence interval [CI]: 1.160-3.203, P < 0.05) with the occurrence of AF. II AVB occupied the largest proportion, accounting for 67 cases (9.87%), and the statistical risk of II AVB in AF is 16.845 (95% CI: 6.099-46.524, P < 0.000). III AVB has a comparative statistical risk of 17.599 (95% CI: 4.212-73.541, P < 0.000). CONCLUSIONS: The three types of AVB in the AF group were significantly higher than that in the non-AF group. II AVB has the highest incidence rate compared with other types of AVB in the AF group. AVB can be used as a risk factor for AF occurrence.


Assuntos
Fibrilação Atrial/etiologia , Bloqueio Atrioventricular/complicações , Nó Atrioventricular/fisiopatologia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Bloqueio Atrioventricular/epidemiologia , Bloqueio Atrioventricular/fisiopatologia , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
9.
J Matern Fetal Neonatal Med ; 32(11): 1884-1892, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29251180

RESUMO

INTRODUCTION: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by immune-mediated complete atrio-ventricular block (CAVB) in utero. MATERIAL AND METHODS: Pubmed, Embase, Cinahl, and ClinicalTrials.gov databases were searched. Only studies reporting the outcome of fetuses with immune CAVB diagnosed on prenatal ultrasound without any cardiac malformations and treated with fluorinated steroids compared to those not treated were included. The primary outcome observed was the regression of CAVB; secondary outcomes were need for pacemaker insertion, overall mortality, defined as the occurrence of either intrauterine (IUD) or neonatal (NND) death, IUD, NND, termination of pregnancy (TOP). Furthermore, we assessed the occurrence of all these outcomes in hydropic fetuses compared to those without hydrops at diagnosis. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used to combine data. RESULTS: Eight studies (162 fetuses) were included. The rate of regression was 3.0% (95%CI 0.2-9.1) in fetuses treated and 4.3% (95%CI 0.4-11.8) in those not treated, with no difference between the two groups (odds ratio (OR): 0.9, 95%CI 0.1-15.1). Pacemaker at birth was required in 71.5% (95%CI 56.0-84.7) of fetuses-treated and 57.8% (95%CI 40.3-74.3) of those not treated (OR: 9, 95%CI 0.4-3.4). There was no difference in the overall mortality rate (OR: 0.5, 95%CI 0.9-2.7) between the two groups; in hydropic fetuses, mortality occurred in 76.2% (95%CI 48.0-95.5) of the treated and in 23.8% (95%CI 1.2-62.3) of the untreated group, while in those without hydrops the corresponding figures were 8.9% (95%CI 2.0-20.3) and 12% (95%CI 8.7-42.2), respectively. Improvement or resolution of hydrops during pregnancy occurred in 76.2% (95%CI 48.0-95.5) of cases treated and in 23.3% (95%CI 1.2-62.3) of those nontreated with fluorinated steroids. CONCLUSIONS: The findings from this systematic review do not suggest a potential positive contribution of antenatal steroid therapy in improving the outcome of fetuses with immune CAVB.


Assuntos
Bloqueio Atrioventricular/tratamento farmacológico , Hidropisia Fetal/tratamento farmacológico , Esteroides Fluorados/uso terapêutico , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/imunologia , Bloqueio Atrioventricular/mortalidade , Feminino , Humanos , Hidropisia Fetal/imunologia , Gravidez
12.
Am J Cardiol ; 123(2): 297-305, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30401486

RESUMO

Transcatheter aortic valve implantation (TAVI) often causes intraventricular conduction abnormalities (ICA), particularly left bundle branch block (LBBB) and advanced atrioventricular block, requiring pacemaker implantation (PMI). However, the relation between ICA and clinical outcomes after TAVI with balloon-expandable valves remains unclear, particularly in the Asian population. This retrospective study included all patients who underwent TAVI with balloon-expandable valves from October 2013 to September 2016. We defined ICA as new onset of complete LBBB (CLBBB) or PMI within 2 weeks after TAVI. We divided the patients into 2 groups: those with and without ICA (new-ICA and no-ICA groups) and we assessed 1-year outcome. Two hundred one consecutive patients underwent TAVI using balloon-expandable valves (mean age, 84.8 ± 5.7 years; women, 64%). ICA occurred in 47 patients (23%), 37 patients (18%) developed CLBBB, and 34 patients recovered from CLBBB within 1 year after TAVI. Ten patients (5%) who developed symptomatic bradycardia required PMI within 2 weeks after TAVI. At 30 days after PMI, 7 patients already had a very low ventricular pacing rate, and 6 patients who recovered from bradycardia needed pacing at 1 year. Patients with ICA tended to have high 1-year all-cause mortality, but there was no significant difference between the 2 groups (12% vs 7%, p = 0.15). In conclusion, ICA occurred in 23% of patients after TAVI with balloon-expandable valves, and approximately 90% of them recovered from ICA during the follow-up. There was no significant difference in 1-year all-cause mortality between the new-ICA and no-ICA groups.


Assuntos
Bloqueio Atrioventricular/etiologia , Bloqueio de Ramo/etiologia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/cirurgia , Bradicardia/etiologia , Bradicardia/cirurgia , Eletrocardiografia , Feminino , Humanos , Japão , Masculino , Marca-Passo Artificial , Estudos Retrospectivos
13.
Int Heart J ; 59(6): 1320-1326, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30369567

RESUMO

Cardiac resynchronization therapy (CRT) improves heart function and prognosis in third-degree atrioventricular block (AVB) patients with heart failure (HF). However, it is still unclear how to screen for appropriate patients before implantation. This study aimed to evaluate the value of using QRS duration to predict CRT efficacy.This study enrolled a total of 72 third-degree AVB patients with HF who received CRT implantation. The patients were divided into Groups A (QRS duration < 120 ms, 33 cases), B (120 ms ≤ QRS duration < 150 ms, 22 cases), and C (QRS duration ≥ 150 ms, 17 cases) according to their baseline QRS duration. The effects of different QRS durations on CRT efficacy were analyzed.The CRT response rate were 30.3%, 50.0%, and 76.5% in Groups A, B, and C, respectively (P = 0.008). The patients in the 3 groups showed significant changes in left ventricular (LV) end-diastolic volume, LV end-systolic volume, and LV ejection fraction over the baseline values at 12 months after the implantation (P < 0.05), with the greatest change observed in Group C. Survival analysis indicated statistically significant differences among Groups A, B, and C (P = 0.024). Multivariate logistic regression analysis suggested that QRS duration was an independent prognostic factor for CRT efficacy. Baseline QRS duration was associated with improved myocardial remodeling and reductions in the incidence rates of primary endpoint events.QRS ≥ 150 ms is an effective predictor of postoperative outcome in patients with third-degree AVB and HF treated with CRT.


Assuntos
Bloqueio Atrioventricular/terapia , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/etiologia , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/mortalidade , Bloqueio Atrioventricular/fisiopatologia , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento
14.
Cardiol Young ; 28(12): 1487-1488, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30326976

RESUMO

Cardiac conduction disease affects patients with Kearns-Sayre syndrome. We report a young asymptomatic patient with Kearns-Sayre syndrome with abnormal conduction on electrocardiogram and Holter monitor, although not advanced atrioventricular block. She underwent prophylactic pacemaker placement, and rapidly developed complete atrioventricular block, which resulted in 100% ventricular pacing. It may be reasonable to consider prophylactic pacemaker implantation in patients with Kearns-Sayre syndrome with evidence of cardiac conduction disease even without overt atrioventricular block given its unpredictable progression to complete atrioventricular block.


Assuntos
Bloqueio Atrioventricular , Síndrome de Kearns-Sayre/complicações , Marca-Passo Artificial , Procedimentos Cirúrgicos Profiláticos , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/prevenção & controle , Bloqueio Atrioventricular/cirurgia , Doença do Sistema de Condução Cardíaco/complicações , Doença do Sistema de Condução Cardíaco/cirurgia , Criança , Progressão da Doença , Eletrocardiografia , Feminino , Humanos
16.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(4): 160-166, out.-dez. 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-999212

RESUMO

Objetivos: Descrever as características de pacientes menores de 18 anos com bloqueio atrioventricular total congênito submetidos a implante ou troca de marcapasso definitivo. Métodos: Foram analisados retrospectivamente 34 pacientes que foram submetidos a implante ou troca de marcapasso entre janeiro de 2011 e maio de 2017 em um único centro. Os pacientes foram divididos em 2 grupos (grupo I: implante e grupo II: troca) e avaliados de acordo com o sexo, idade, cardiopatia congênita, indicação do implante, técnica utilizada, complicações e mortalidade. Resultados: 47,1% eram do sexo feminino. A mediana para idade no momento do implante foi de 2 anos e 6 meses e para peso foi de 17,5Kg. Cardiopatia congênita teve prevalência de 52,9% nos pacientes. As indicações para implante de marcapasso definitivo foram: frequência cardíaca menor que 70 bpm com cardiopatia ou disfunção (44,1%), frequência cardíaca menor que 55 bpm sem cardiopatia (26,5%), sinais e sintomas de baixo débito cardíaco (20,6%) e disfunção ventricular (8,8%). A técnica epicárdica foi realizada em 73,5% e a endocárdica em 26,5% dos pacientes. Foi implantado marcapasso bicameral em 53% e monocameral em 47% deles. Complicações foram observadas em 23,5% e a mortalidade foi de 8,8%. Conclusões: A criteriosa avaliação desses pacientes permite uma adequada escolha do sistema e da técnica de implante. Pouco mais da metade dos pacientes tinham cardiopatia congênita, a técnica epicárdica foi a mais realizada, a maioria recebeu marcapasso bicameral, e as complicações e a mortalidade foram semelhantes as encontradas na da literatura


Aims: Describe the characteristics of 34 patients under 18, with congenital complete heart block submitted for definitive pacemaker implant or replacement. Methods: We retrospectively analyzed patients who underwent pacemaker implant or replacement between January 2011 and May 2017 at a single center. The patients were divided into 2 groups (group I: implant and group II: replacement) and evaluated according to gender, age, congenital heart disease, implant indication, technique used, complications and mortality. Results: Thirty-four patients underwent definitive pacemaker implant or replacement, 47.1% of which were female. The median age at the time of implantation was 2 years and 6 months and median weight was 17.5 kg. Congenital heart disease was found in 52.9% of the patients. The indications for definitive pacemaker implant were heart rate lower than 70 bpm with heart disease or dysfunction (44.1%), heart rate less than 55 bpm without heart disease (26.5%), signs and symptoms of low cardiac output (20.6%) and ventricular dysfunction (8.8%). The epicardial technique was performed in 73.5% and the endocardial technique in 26.5% of the patients. A bicameral pacemaker was implanted in 53% and monocameral ventricular pacemaker in 47% of the patients. Complications were observed in 23.5%, with a mortality of 8.8% of the patients. Conclusions: The careful evaluation of the characteristics of these patients allows an adequate choice of the system and the implant technique. Just over half of the patients had congenital heart disease, the epicardial technique was the most performed, most received bicameral pacemaker, and complications and mortality were similar to the literature


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Marca-Passo Artificial , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Cardiopatias Congênitas/terapia , Pericárdio , Arritmias Cardíacas , Próteses e Implantes , Comorbidade , Fatores Sexuais , Estudos Retrospectivos , Fatores Etários , Eletrodos , Frequência Cardíaca
17.
J Electrocardiol ; 51(5): 830-832, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30177322

RESUMO

There is a paucity of research on how the Sgarbossa criteria perform in patients with ventricular pacing. However, the limited research that exists suggests that the criteria are specific, but not sensitive, for myocardial ischemia in this population. We present the case of a 73-year-old man who presented to the ED with acute chest pain. His previous medical history was significant for hypertension and a pacemaker due to type 2 s-degree AV block. His initial ECG fulfilled all three Sgarbossa criteria and subsequent coronary angiography identified a culprit lesion in the posterior descending artery. In this case, awareness of the Sgarbossa criteria's applicability in patients with ventricular paced rhythm facilitated earlier identification of ischemia and subsequent intervention.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Eletrocardiografia , Marca-Passo Artificial , Síndrome Coronariana Aguda/complicações , Idoso , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/terapia , Dor no Peito/etiologia , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Humanos , Masculino
19.
J Pharmacol Sci ; 137(2): 237-240, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29980434

RESUMO

We analyzed torsadogenic and pharmacokinetic profile of E-4031 using chronic atrioventricular block dogs. E-4031 in intravenous doses of 0.03, 0.1 and 0.3 mg/kg over 10 min prolonged QT/QTc, and increased short-term variability of QT in a dose-related manner (n = 4), resulting in onset of torsade de pointes in 1 animal after the middle dose and 4 animals after the high dose, while it attained peak plasma concentrations of 16.5, 60.5 and 182.5 ng/mL at 10 min after their start of administration, respectively (n = 2). These results bridge the gap of information between in vitro proarrhythmia assay and clinical observation in human subjects.


Assuntos
Antiarrítmicos/efeitos adversos , Antiarrítmicos/farmacocinética , Bloqueio Atrioventricular/fisiopatologia , Eletrocardiografia/efeitos dos fármacos , Piperidinas/efeitos adversos , Piperidinas/farmacocinética , Piridinas/efeitos adversos , Piridinas/farmacocinética , Torsades de Pointes/induzido quimicamente , Animais , Antiarrítmicos/administração & dosagem , Bloqueio Atrioventricular/complicações , Doença Crônica , Cães , Relação Dose-Resposta a Droga , Humanos , Infusões Intravenosas , Piperidinas/administração & dosagem , Piridinas/administração & dosagem , Torsades de Pointes/etiologia
20.
Rev Port Cardiol ; 37(11): 947.e1-947.e4, 2018 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30054119

RESUMO

Sudden cardiac arrest survivors continue to be a challenge for cardiologists. An appropriate initial diagnostic approach is crucial for planning a successful therapeutic strategy. We report the case of a 62-year-old woman who suffered an out-of-hospital cardiac arrest due to third-degree atrioventricular (AV) block. Despite suspected acute coronary syndrome, the coronary angiogram proved inconclusive, while cardiac magnetic resonance imaging ruled out other differential diagnoses such as acute myocarditis. The reversible nature of the AV block rendered permanent pacing unnecessary.


Assuntos
Bloqueio Atrioventricular , Morte Súbita Cardíaca/etiologia , Síndrome Coronariana Aguda , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/fisiopatologia , Angiografia Coronária , Diagnóstico Diferencial , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Pessoa de Meia-Idade
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