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1.
Herzschrittmacherther Elektrophysiol ; 32(2): 221-226, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33956224

RESUMO

We report the case of a pregnant woman with complete heart block during her first trimester who presented with dyspnea at the East African Heart Rhythm Project in Nairobi. There was no evidence of an acute cause (e.g., myocarditis, cardiomyopathy, autoimmune or neuromuscular disease). No ECG had been previously documented; therefore, congenital complete heart block was likely. We implanted a dual-chamber pacemaker using conventional fluoroscopy. Several measures at implantation allowed us to limit fluoroscopy to 30 s and radiation to < 100 µGym2. The implantation was uneventful, dyspnea improved instantaneously and further pregnancy, labor and birth were uncomplicated. Bradycardia requiring pacemaker implantation is rare during pregnancy and usually consists of symptomatic complete heart block. Beyond undiagnosed or untreated pre-existing atrioventricular block, drug therapy for fetal tachycardia, myocarditis (including Lyme borreliosis and Chagas disease), inflammatory infiltrative diseases (e.g., sarcoidosis), cardiomyopathies and neuromuscular disease may have caused bradycardia. In the absence of treatable causes, pacemaker implantation becomes necessary if bradycardia brings about risks for the mother or the fetus. Using transesophageal or intracardiac echocardiography, radiation can be avoided completely or, by taking some simple measures, may be kept to a minimum so that there is no risk for the fetus.


Assuntos
Bloqueio Atrioventricular , Marca-Passo Artificial , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/terapia , Bradicardia/diagnóstico , Bradicardia/terapia , Feminino , Humanos , Quênia , Gravidez , Taquicardia
2.
BMJ Case Rep ; 14(3)2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687942

RESUMO

A 53-year-old man was admitted for recurrent syncope and found to have complete heart block (CHB). Cardiac magnetic resonance imaging MRI) showed extensive patchy late gadolinium enhancement in the apical and lateral walls, consistent with cardiac sarcoidosis (CS) but no scar in the septum. A fluorodeoxyglucose (FDG)-positron emission tomography showed FDG uptake in the septum and basal lateral walls. Imaging suggested active inflammation in the septum affecting atrioventricular (AV) conduction but no irreversible fibrosis. Diagnosis of isolated CS requires a high level of suspicion and multidisciplinary teamwork involving heart failure specialists, electrophysiologists and rheumatologists. After specialist and patient discussion, treatment of the disease was initiated with prednisone 40 mg daily, 11 months after presenting with CHB. Three weeks later, ECG with pacing inhibited showed second-degree AV block Mobitz type II and 4 weeks later, AV conduction recovery. This highlights the importance of immediate therapy in reversing AV conduction abnormalities in CS.


Assuntos
Bloqueio Atrioventricular , Cardiomiopatias , Sarcoidose , Corticosteroides , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/tratamento farmacológico , Cardiomiopatias/diagnóstico , Cardiomiopatias/tratamento farmacológico , Meios de Contraste , Gadolínio , Humanos , Masculino , Pessoa de Meia-Idade , Sarcoidose/complicações , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico
3.
Europace ; 23(3): 451-455, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33432349

RESUMO

AIMS: The novel coronavirus SARS-CoV-2 has shown the potential to significantly affect the cardiovascular system. Cardiac arrhythmias are commonly reported complications in COVID-19 hospitalized patients. METHODS AND RESULTS: While tachyarrhythmias seem most common, we describe four cases of COVID-19 patients who developed a transient high-degree atrioventricular (AV) block during the course of their hospitalization. All four patients who developed a high-degree AV block during their hospitalization with COVID-19 did not require permanent pacing. CONCLUSION: Similarly to most AV blocks associated with infectious organisms and given its transient nature, this case series suggests that conservative management strategies should be preferred in COVID-19 patients who develop complete heart block.


Assuntos
Bloqueio Atrioventricular/etiologia , Nó Atrioventricular/fisiopatologia , Frequência Cardíaca , Hospitalização , Potenciais de Ação , Adulto , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , /terapia , Tratamento Conservador , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
4.
Gen Thorac Cardiovasc Surg ; 69(5): 882-884, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33400204

RESUMO

The Impella device can effectively unload the left ventricle in patients undergoing high-risk percutaneous coronary intervention (PCI) and in cases of cardiogenic shock. Herein, we report a rare case of a 59-year-old man who was treated using PCI and the Impella CP for acute coronary syndrome. The patient suffered from severe acute aortic regurgitation and complete atrioventricular block (CAVB) with hemodynamic instability soon after the Impella removal. The non-coronary cusp (NCC) tear occurred from the NCC and right coronary cusp commissure to the middle of the NCC. The patient successfully underwent aortic valve replacement with no CAVB postoperatively.


Assuntos
Bloqueio Atrioventricular , Coração Auxiliar , Intervenção Coronária Percutânea , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia
5.
Int Heart J ; 62(1): 201-206, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455993

RESUMO

The definite diagnosis of cardiac sarcoidosis (CS) can be difficult because it mimics other cardiomyopathies and morphological abnormalities during its time course. Distinguishing CS isolated cardiac sarcoidosis from other cardiomyopathies is very important for the introduction of immunosuppressive therapy.In this study, we report a patient who had initially been diagnosed with hypertrophic obstructive cardiomyopathy (HOCM). The patient developed complete atrioventricular block (CAVB) and morphological abnormalities, which led to his primary diagnosis being re-conducted. Moreover, we made a definite diagnose of isolated CS (ICS) based on the guideline for the diagnosis and treatment using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT)1) and performed tailor-made treatment including immunosuppressive therapy.


Assuntos
Bloqueio Atrioventricular/etiologia , Cardiomiopatia Hipertrófica/diagnóstico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Assistência ao Convalescente , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/diagnóstico , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ablação por Cateter/métodos , Ecocardiografia/métodos , Fluordesoxiglucose F18/farmacocinética , Humanos , Imunossupressores/uso terapêutico , Masculino , Miocárdio/patologia , Tomografia por Emissão de Pósitrons/métodos , Prednisolona/uso terapêutico , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370998

RESUMO

Coronary artery fistulas are abnormal vascular conduits, rarely related to atrioventricular conduction abnormalities. We report the case of a 52-year-old woman who presented with dyspnoea on exertion. Her ECG revealed advanced atrioventricular block and left bundle branch block. CT scans confirmed two fistulas, from the conus branch of right coronary artery and from the left anterior descending coronary artery, into the pulmonary artery. The patient underwent pacemaker implantation. To date, only nine patients with different degrees of heart blocks associated with coronary artery fistulas have been reported. Herein, we review and summarise previously reported cases of different degrees of heart blocks associated with coronary artery fistulas.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Anomalias dos Vasos Coronários/complicações , Fístula/complicações , Marca-Passo Artificial , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/terapia , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Teste de Esforço/métodos , Feminino , Fístula/diagnóstico , Humanos , Pessoa de Meia-Idade , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
8.
Rev. clín. med. fam ; 13(3): 223-225, oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-ET1-7138

RESUMO

El bloqueo auriculoventricular de tercer grado o completo se puede manifestar clínicamente de múltiples formas, como mareo, disnea o angina. Es una emergencia médica que el médico de familia debe ser capaz de identificar precozmente y tratar urgentemente. Presentamos el caso clínico de un paciente con bloqueo auriculoventricular completo y nuestro manejo en un Punto de Atención Continuada


Third-degree or complete atrioventricular block may manifest clinically in multiple ways, such as dizziness, dyspnea, or angina. It is a medical emergency that the family doctor should be able to identify early and treat urgently. We present the clinical case of a patient with complete atrioventricular block and its management in an emergency Primary Care unit


Assuntos
Humanos , Masculino , Idoso , Bloqueio Atrioventricular/diagnóstico , Bradicardia/diagnóstico , Hiperidrose/etiologia , Tontura/etiologia , Diagnóstico Diferencial , Atenção Primária à Saúde , Bloqueio Atrioventricular/classificação , Fatores de Risco
10.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32855347

RESUMO

BACKGROUND: Children are at risk for multisystem inflammatory syndrome in children (MIS-C) after infection with severe acute respiratory syndrome coronavirus 2. Cardiovascular complications, including ventricular dysfunction and coronary dilation, are frequent, but there are limited data on arrhythmic complications. METHODS: Retrospective cohort study of children and young adults aged ≤21 years admitted with MIS-C. Demographic characteristics, electrocardiogram (ECG) and echocardiogram findings, and hospital course were described. RESULTS: Among 25 patients admitted with MIS-C (60% male; median age 9.7 [interquartile range 2.7-15.0] years), ECG anomalies were found in 14 (56%). First-degree atrioventricular block (AVB) was seen in 5 (20%) patients a median of 6 (interquartile range 5-8) days after onset of fever and progressed to second- or third-degree AVB in 4 patients. No patient required intervention for AVB. All patients with AVB were admitted to the ICU (before onset of AVB) and had ventricular dysfunction on echocardiograms. All patients with second- or third-degree AVB had elevated brain natriuretic peptide levels, whereas the patient with first-degree AVB had a normal brain natriuretic peptide level. No patient with AVB had an elevated troponin level. QTc prolongation was seen in 7 patients (28%), and nonspecific ST segment changes were seen in 14 patients (56%). Ectopic atrial tachycardia was observed in 1 patient, and none developed ventricular arrhythmias. CONCLUSIONS: Children with MIS-C are at risk for atrioventricular conduction disease, especially those who require ICU admission and have ventricular dysfunction. ECGs should be monitored for evidence of PR prolongation. Continuous telemetry may be required in patients with evidence of first-degree AVB because of risk of progression to high-grade AVB.


Assuntos
Bloqueio Atrioventricular/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Adolescente , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
JACC Cardiovasc Interv ; 13(9): 1046-1054, 2020 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-32305392

RESUMO

OBJECTIVES: The aim of this study was to determine the utility of rapid atrial pacing immediately after transcatheter aortic valve replacement (TAVR) to predict the need for permanent pacemaker implantation (PPI). BACKGROUND: Risk stratification for patients without high-grade atrioventricular block (AVB) after TAVR is imprecise and based on anatomic considerations, electrocardiographic characteristics, and clinical suspicion. A more reliable assessment is necessary to minimize inpatient rhythm monitoring and/or reduce unnecessary PPI. METHODS: Consecutive patients undergoing TAVR at 2 centers were included. After valve implantation in patients without pacemakers who did not have complete heart block or atrial fibrillation, the temporary pacemaker was withdrawn from the right ventricle and placed in the right atrium. Rapid atrial pacing was performed from 70 to 120 beats/min, and patients were assessed for the development of Wenckebach AVB. Patients were then followed for clinical outcomes, including PPI. RESULTS: A total of 284 patients were included. Of these, 130 (45.8%) developed Wenckebach AVB. There was a higher rate of PPI within 30 days of TAVR among the patients who developed Wenckebach AVB (13.1% vs. 1.3%; p < 0.001), with a negative predictive value for PPI in the group without Wenckebach AVB of 98.7%. A greater percentage of patients receiving self-expanding valves required PPI than those receiving a balloon-expandable valves (15.9% vs. 3.7%; p = 0.001), though these rates were still relatively low among patients who did not develop Wenckebach AVB (2.9% and 0.8%). CONCLUSIONS: Atrial pacing post-TAVR is easily performed and can help identify patients who may benefit from extended rhythm monitoring. Patients who did not develop pacing-induced Wenckebach AVB demonstrated an extremely low likelihood of PPI.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/diagnóstico , Técnicas Eletrofisiológicas Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Tomada de Decisão Clínica , Feminino , Humanos , Itália , Masculino , Ohio , Marca-Passo Artificial , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Desnecessários
15.
Intern Med ; 59(12): 1531-1533, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32188809

RESUMO

We encountered a 42-year-old woman with a history of diabetes mellitus and cataracts presenting with repeated syncope whose electrocardiogram showed advanced atrioventricular block. On admission, we excluded major potential differential diagnoses as causes of an atrioventricular block but did not suspect myotonic dystrophy, which was eventually diagnosed by chance based on a suspected weakness of the respiratory muscles followed by a detailed neurological physical examination. Myotonic dystrophy should be suspected as a differential diagnosis when relatively young patients present with conductance disorder.


Assuntos
Distrofia Miotônica/diagnóstico , Adulto , Bloqueio Atrioventricular/diagnóstico , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Distrofia Miotônica/fisiopatologia , Síncope
17.
BMC Cardiovasc Disord ; 20(1): 69, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32039709

RESUMO

BACKGROUND: Complete heart blocks underwent to permanent pacemaker placement are a common complication of tricuspid valve replacement (TVR). If indicated, endocardial placement of a right ventricular (RV) lead is precluded in the presence of mechanical TVR. CASE PRESENTATION: A 20-year-old female patient firstly underwent metallic prosthetic valve operation with tricuspid valve endocarditis in 2014. Three years after the operation, echocardiography revealed dysfunction of the prosthetic valve thus reoperation was decided. In the second operation, the patient underwent a bioprosthesis valve and AV complete block developed in the postoperative period. Left ventricular ejection fraction (EF) was 45% was found on echocardiography. Pacemaker dependence of the patient, it was aimed to place two electrodes into the left ventricle. Electrodes were placed the target two branches in coronary sinus (CS) and right atrium. Univentricular bifocal pacing was enabled to work. CONCLUSION: Electrode placement in the CS is a very good alternative to epicardial surgical lead placement in cases where endocardial lead placement from the right atrium to the RV is contraindicated. In patients with lower left ventricular EF who will be pacemaker dependent, the insertion of two electrodes into the CS to prevent pacemaker is a safe and effective treatment.


Assuntos
Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Seio Coronário/fisiopatologia , Frequência Cardíaca , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Tricúspide/cirurgia , Potenciais de Ação , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/fisiopatologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Volume Sistólico , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Função Ventricular Esquerda , Adulto Jovem
18.
PLoS One ; 15(2): e0229092, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040499

RESUMO

INTRODUCTION: Sheep have been adopted as a pre-clinical large animal for scientific research as they are good models of cardiac anatomy and physiology, and allow for investigation of pathophysiological processes which occur in the large mammalian heart. There is, however, no defined model of atrioventricular block in sheep to allow for pre-clinical assessment of new cardiac treatment options. We therefore aimed to develop an adult sheep model of atrioventricular block with the focus on future novel applications. METHODS AND RESULTS: We utilized six sheep to undergo two procedures each. The first procedure involved implantation of a single chamber pacemaker into the right ventricular apex, for baseline assessment over four weeks. The second procedure involved creating atrioventricular block by radiofrequency ablation of the His bundle, before holding for a further four weeks. Interrogation of pacemakers and electrocardiograms determined the persistence of atrioventricular block during the follow up period. Pacemakers were inserted, and atrioventricular block created in 6 animals using a conventional approach. One animal died following ablation of the His bundle, due to procedural complications. Four unablated sheep were assessed for baseline data over four weeks and showed 5.53 ± 1.28% pacing reliance. Five sheep were assessed over four weeks following His bundle ablation and showed continuous (98.89 ± 0.81%) ventricular pacing attributable to persistent atrioventricular block, with no major complications. CONCLUSION: We have successfully developed, characterized and validated a large animal model of atrioventricular block that is stable and technically feasible in adult sheep. This model will allow for the advancement of novel therapies, including the development of cell and gene-based therapies.


Assuntos
Bloqueio Atrioventricular/etiologia , Fascículo Atrioventricular/efeitos da radiação , Modelos Animais de Doenças , Animais , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Fascículo Atrioventricular/fisiologia , Ablação por Cateter , Eletrocardiografia , Humanos , Masculino , Marca-Passo Artificial , Ovinos
19.
BMC Cardiovasc Disord ; 20(1): 89, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093607

RESUMO

BACKGROUND: Acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) still has a poor mortality risk, even in the current percutaneous coronary intervention (PCI) era. However, early PCI for ACS with HAVB is associated with improved in-hospital survival and a 6-month survival similar to that of ACS without HAVB. CASE PRESENTATION: A 70-year-old man was admitted to our hospital for ACS with HAVB. ECG showed complete AV block, complete right bundle branch block (CRBBB), and left axis deviation. Cardiac enzymes were elevated. He underwent temporary pacemaker insertion and coronary angiography, which showed severe stenosis of the proximal right coronary artery (RCA), 99% stenosis of the distal RCA with Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow, and total occlusion of the proximal left anterior descending artery (LAD). We performed primary PCI in both the RCA and LAD, which resulted in TIMI grade 3 flow in both. After PCI, the HAVB recovered to normal sinus rhythm with CRBBB; a normal QRS interval returned within three days. The patient was discharged from the hospital without complications. CONCLUSION: In this case of ACS with HAVB, early intensive coronary artery reperfusion resulted in long-term patient survival. The blood supply to the AV node and bilateral bundle branches is complex. Multivessel ischemia may compromise both primary and collateral blood flows to the AV node and septum, resulting in severe conduction impairment. Clinicians performing PCI should be aware of this anatomy and physiology.


Assuntos
Síndrome Coronariana Aguda/terapia , Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Intervenção Coronária Percutânea , Potenciais de Ação , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/fisiopatologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Circulação Colateral , Angiografia Coronária , Circulação Coronária , Stents Farmacológicos , Humanos , Masculino , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento
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