Third-degree atrioventricular block caused by intoxication with rhododendron leaves.

We report the case of a 41-year-old human with third-degree atrioventricular block caused due to intoxication with water concoction prepared from Rhododendron leaves. Such poisoning is rare. It is prone to arrhythmia with hemodynamic instability and is confused with various diseases. For these reasons, the correct diagnosis and treatment of this poisoning are particularly important. We confirmed it by analyzing the remaining liquid carried by the family members. After symptomatic and supportive treatment, the patient was discharged uneventfully.

Permanent left bundle branch area pacing in a child with a third-degree atrioventricular block: A case report.

Permanent left bundle branch area pacing (LBBP) is a promising physiological pacing technique that has emerged in recent years. However, LBBP is almost exclusively clinically applied in adult patients. The feasibility and safety of the use of LBBP in children have not been well-assessed. Here, we report the case of a 6-year-old child with a third-degree atrioventricular block after surgical aortic valve replacement who successfully received a permanent LBBP.

A case report of one vasovagal syncope patient with third-degree atrioventricular block caused by SCN5A gene mutation and literature review.

BACKGROUND: Vasovagal syncope (VVS) is common in children and significantly affects their quality of life. To our knowledge, this the first case report of SCN5A gene mutation associated with VVS and third-degree atrioventricular block (atrioventricular block, AVB), which could help pediatricians aware that VVS is not always a benign condition and help to identify VVS children at the risk of sudden death. CASE PRESENTATION: A twelve-year-old male child was admitted to Beijing Children's Hospital of Capital Medical University for chest tightness for 9 days and syncope in July 2018. The child was diagnosed as VVS with third-degree AVB after complete investagations. A heterozygous mutation in the exon coding region of the SCN5A gene, C. 5851G > T (coding region 5551 nucleotide changed from G to T), was detected in the peripheral blood of the child. Electrophysiological examination and modified vagal ganglion radiofrequency ablation were performed in the child. The ECG playback was normal on the second day after operation. Holter showed no abnormality and no chest tightness or syncope occurred after 3 months and 1 year follow-up. CONCLUSIONS: Our case report firstly reported that SCN5A mutation contributed to the pathogenesis of VVS with third-degree AVB. Vagal ganglion modified ablation have obtained good therapeutic effect. Gene analysis was of great value to the accurate diagnosis and treatment of VVS children.

Inadvertent pacemaker lead dislodgement.

Transcatheter aortic valve implantation (TAVI) has become an established treatment option for aortic valve stenosis in patients with a high risk for conventional surgical valve replacement. A well-known complication is the development of conduction abnormalities. In the case of a new third-degree atrioventricular block, the complication can be life-threatening and permanent pacing is needed. Often these patients have a venous sheath placed in the jugular vein for the perioperative period. We report a case of inadvertent dislodgement of a permanent pacemaker lead after removal of a preoperatively placed venous sheath in a TAVI patient.

A rare cardiac tumor: Bronchogenic cyst of interatrial septum.

Intracardiac bronchogenic cysts are uncommon congenital tumors, which rarely become symptomatic. We describe a rare case of bronchogenic cyst in the atrioventricular node. A 36-year-old man with third-degree atrioventricular block was referred to our hospital. Transthoracic echocardiography revealed a cystic mass at the right atrial aspect of the low interatrial septum. He underwent surgical resection of the mass, and a permanent epicardium pacemaker was implanted. His postoperative course was uneventful. Microscopic examination showed a cyst surrounded by ciliated columnar epithelium and partially smooth muscle, and the histopathological diagnosis was bronchogenic cyst.

A case report of cardiac neuromodulation in a young patient with a third-degree atrioventricular block.

Background: There are some functional bradyarrhythmias that are caused by a dysregulation of the autonomic nervous system, for which a therapeutic strategy of cardioneuroablation (CNA) is conceivable. Case summary: In this study, we report the case of a 19-year-old woman with a non-congenital third-degree atrioventricular block (AVB), symptomatic for lipothymia and dyspnea caused by mild exertion. She had a structurally normal heart and no other comorbidities. The atropine test and the exercise stress test documented a sinus tachycardia at 190 bpm with a 2:1 AVB, a narrow QRS, and an atrioventricular conduction of 1:1 until reaching a sinus rhythm rate of 90 bpm. She underwent the CNA procedure, which targeted the inferior paraseptal ganglion plexus, with a gradual change in the ECG levels recorded during the radiofrequency delivery from a third-degree AVB to a first-degree AVB. After the procedure, we observed a complete regression of the third-degree AVB, with evidence of only a first-degree AVB and a complete regression of symptoms until the 6-month follow-up. Conclusions: Although not yet included in current guidelines, the CNA procedure could be used to treat AV node dysfunction in young subjects, as it could represent an alternative to pacemaker implantation. However, more randomized studies are needed to assess the long-term efficacy of this promising technique.

The anatomical basis of third-degree atrioventricular block in dogs with atrioventricular valve endocardiosis.

The cardiac conduction system was examined histologically in 13 canine cases of atrioventricular (AV) valve endocardiosis with third-degree AV block. In all cases, gross examination revealed marked thickening and distortion of the base of the central fibrous body (CFB) and varying degrees of endocardial thickening of the upper portion of the ventricular septum (VS) as well as marked thickening of the mitral and tricuspid valve leaflets due to myxomatous degeneration. Microscopically, the thickened and distorted CFB had encased or trapped, either partly or totally, the underlying penetrating and branching portions of the AV bundle. The myxomatous and/or fibrofatty tissue, which had proliferated at the base of the extensive CFB, protruded into or encroached on the AV bundle, causing severe (51-75%) to very severe (76% or more) reduction of the conduction fibres. The upper portions of the left and right bundle branches were involved in the endocardial thickening due to degenerative and fibrotic changes at the uppermost VS; however, both bundle branches were much less severely affected than the AV bundle, the degree of reduction of the conduction fibres ranging from mild (25% or less) to moderate (26-50%). These observations suggest that the sites most vulnerable to lesions in the AV conduction system are the penetrating and branching portions of the AV bundle, which would represent the anatomical basis for third-degree AV block in canine cases of AV valve endocardiosis.

Case report: The presence of third-degree atrioventricular block caused by pulmonary embolism masquerading as acute ST-segment elevation myocardial infarction.

Background: Pulmonary embolism (PE) typically presents with chest pain, tachypnea, hemoptysis, syncope, and increased markers of myocardial injury. On an electrocardiogram (ECG), sinus tachycardia, right bundle branch block (RBBB), S1Q3T3 pattern, and/or precordial T-wave inversion may be observed. Despite being one of the common causes of chest pain, a third-degree atrioventricular block (III° AVB) is rare in cases of PE, which can lead to difficulties in diagnosis or even overlooking this condition. Case summary: In this case report, we present a patient who was transferred to our hospital with suspected acute myocardial infarction (AMI). The patient's ECG showed ST-segment elevation in the inferior wall and a III° AVB, combined with significantly increased markers of myocardial injury. Interestingly, the patient also had a history of cerebral hemorrhage (ICH) for 7 days prior to being transferred to our hospital. After undergoing a systematic examination and evaluation, the final diagnosis for the patient was PE. Conclusions: In addition to considering common symptoms, it is important not to overlook rare symptoms when diagnosing a disease. This case serves as an example of how the misdiagnosis rate for PE can be reduced by conducting a comprehensive clinical evaluation and paying attention to all clinical clues and examination results.

Crochetage, the Forgotten Electrocardiographic Sign.

Acquired complete heart block is a rare but severe arrhythmia caused by various factors such as infections, medications, and autoimmune conditions. Atrial septal defect (ASD) is a common congenital heart defect, with larger ASDs possibly causing symptoms such as fatigue, shortness of breath, and frequent respiratory infections. In some cases, high-grade atrioventricular block with ASD can occur; however, the exact incidence is not well established. We report a rare case of a 15-year-old male presenting with acute dizziness. Initial electrocardiogram (EKG) showed a complete heart block with a Crochetage sign. Patent foramen ovale (PFO) was confirmed by transthoracic and transesophageal echocardiograms. Closure of PFO and permanent pacemaker resulted in complete resolutions of symptoms and disappearance of Crochetage sign.

Sudden cardiac death caused by a right coronary artery aneurysm complicated with acute myocardial infarction: a case report.

Coronary aneurysms are defined as coronary artery ectasia (CAE) more than 1.5 times the normal adjacent segment diameter or the maximum coronary artery diameter. Although most CAE patients are asymptomatic, some patients present with acute coronary syndrome (ACS), such as angina pectoris, myocardial infarction (MI), and even sudden cardiac death. Sudden death due to coronary artery dilatation is very rare. However, we report a case of a patient with aneurysm-like dilatation of both the left and right coronary arteries, with acute inferior ST segment elevation myocardial infarction and sudden death due to third-degree atrioventricular block. After cardiopulmonary resuscitation, the patient underwent emergency coronary intervention. After thrombus aspiration and intracoronary thrombolysis in the right coronary artery, the atrioventricular block returned to normal on the fifth day of hospitalization. Following anticoagulant therapy, coronary angiography was repeated and showed that the thrombus had disappeared. The patient is recovering well after active rescue at the time of writing.

Electrocardiography of Atrioventricular Block.

Delayed atrioventricular (AV) conduction most commonly occurs in the AV node, resulting from AH prolongation on an intracardiac electrocardiogram and PR prolongation on a surface electrocardiogram. AV conduction may be blocked in a 2:1 manner, with a normal PR interval and wide QRS suggesting infranodal disease, whereas a prolonged PR interval and narrow QRS are more suggestive of AV nodal disease. Block within the His is suspected when there is 2:1 AV block with normal PR and QRS intervals. Complete heart block occurs when the atrial rhythm is totally independent of a junctional or lower escape rhythm.

Case Report: Oxaliplatin-Induced Third-Degree Atrioventricular Block: First Discovery of an Important Side-Effect.

Background: The adverse effects of anticancer therapy in patients with malignancies and cardiovascular diseases are complicated. Oxaliplatin is one of the most commonly used chemotherapy drugs for gastric and colorectal cancers, and oxaliplatin-induced cardiotoxicity has rarely been reported. Case Summary: We report a 76-year-old man with adenocarcinoma of the esophagogastric junction and a 40-day history of non-ST-elevation myocardial infarction who exhibited a new third-degree atrioventricular block after oxaliplatin administration. We immediately withdrew oxaliplatin treatment and, to avoid future episodes, we implanted a permanent pacemaker for safety and added diltiazem hydrochloride. The third-degree atrioventricular block disappeared after oxaliplatin withdrawal. We detected no recurrence of the third-degree atrioventricular block in future chemotherapies. Conclusions: This is the first reported oxaliplatin-induced third-degree atrioventricular block, likely mediated by coronary artery spasm. Cancer patients with acute coronary syndrome are a unique and vulnerable population, whom physicians should carefully evaluate and monitor during anticancer treatment. Remarkably, even the most common chemotherapy drugs can cause life-threatening cardiac adverse events.

Rupture of the right sinus of Valsalva aneurysm and formation of ventricular septal dissection and third-degree atrioventricular block: A case report.

Sinus of Valsalva aneurysm is a rare congenital or acquired cardiac structural abnormality. The sinus of Valsalva aneurysm refers to the local development defect of the aortic sinus wall. Under aortic hypertension, the sinus wall becomes thinner and expands outward. Its clinical manifestations range from asymptomatic to severe life-threatening complications caused by compression or rupture of important surrounding structures. A few cases of aortic aneurysm sinus with arrhythmias have been reported, including complete heart block. Here, we present the case of a 50-year-old male patient with recurrent syncope due to a third-degree atrioventricular block. We found a right sinus of Valsalva aneurysm that ruptured into the basal segment of the interventricular septum and formed a basal septal dissection on echocardiography, which could have caused a third-degree atrioventricular block. This case report highlights the importance of finding secondary etiologies in the sudden or transient onset of third-degree atrioventricular block and using echocardiography to evaluate patients with heart block.

Combined Tricuspid Valve Repair and Orthotopic Liver Transplantation in a Patient With Severe Tricuspid Regurgitation and Pulmonary Hypertension.

Severe pulmonary hypertension and severe tricuspid regurgitation are often considered strict contraindications for orthotopic liver transplantation. A combined approach of tricuspid repair and subsequent liver transplantation could provide a novel approach for patients with severe pulmonary hypertension and tricuspid regurgitation to undergo orthotopic liver transplantation. A 62-year-old male with a history of end-stage renal disease on hemodialysis, cirrhosis, and third-degree atrioventricular heart block status post single lead pacemaker insertion presented for an orthotopic liver transplant. However, after placement of a Swan-Ganz catheter by the anesthesia team, the patient's central venous pressure was found to be high, and his mean pulmonary artery pressure was 40 mmHg. His case was canceled due to concern for poor postoperative outcomes after a subsequent transesophageal echocardiogram revealed a severely dilated right heart and 4+ tricuspid regurgitation with flow reversal into the hepatic veins. After discussion among the hospital's transplant committee, the patient was planned to have a tricuspid valve repair, liver transplant, and kidney transplant surgery several months later. The patient successfully underwent tricuspid valve repair and orthotopic liver transplant and then kidney transplant the following day.

Transient third-degree atrioventricular block during anesthesia in a cat.

BACKGROUND: Third-degree atrioventricular block (AVB) is usually permanent, with transient cases being rare. Cats with transient third-degree AVB. It had been not reported in detail. CASE DESCRIPTION: A 9.3-year-old, male shorthair cat was evaluated for possible nervous disease resulting from otitis interna. Under propofol and isoflurane anesthesia, this cat developed a third-degree AVB. Isoproterenol was administered by continuous infusion to increase its heart rate. During recovery, heart rate returned to sinus bradycardia together with first-degree AVB without medical treatment. The cause of transient AVB was not observed at the examination. CONCLUSION: The case of this cat suggests that anesthesia can result in a transient third-degree AVB.

Third-degree atrioventricular block and pacemaker implantation in a man with severe hemophilia A: A case report.

Hemophilia A (HA) is a rare bleeding disorder characterized by reduced factor VIII (FVIII) activity and consequently spontaneous bleeding. Since the introduction of prophylaxis with safer FVIII concentrates, people with HA are ageing. Interestingly, they are developing cardiovascular diseases as their non-hemophilia counterparts. We describe a 48-year-old patient with severe HA who presented a third-degree atrioventricular block. A DDDR pacemaker was implanted under supervision of the Hematology Clinics. There were no adverse events during the procedure. The procedure was safe, and it should be performed under the supervision of a hemophilia expert.

A rare and reversible cause of third-degree atrioventricular block: a case report.

BACKGROUND: Cardiac involvement of Lyme disease (LD) typically results in atrioventricular (AV) conduction disturbance, mainly third-degree AV block. CASE SUMMARY: A 54-year-old patient presented to our emergency department due to recurrent syncope. Third-degree AV block with a ventricular escape rhythm (33 b.p.m.) was identified as the underlying rhythm. Transthoracic echocardiography (TTE) was normal. To rule out common reversible causes of complete AV block, a screening test for Lyme borreliosis was carried out. Elevated levels for borrelia IgG/IgM were found and confirmed by western blot analysis. Lyme carditis (LC) was postulated as the most likely cause of the third-degree AV block given the young age of the patient. Initiation of antibiotic therapy with ceftriaxone resulted in a gradual normalization of the AV conduction with stable first-degree AV block on Day 6 of therapy. The patient was changed on oral antibiotics (doxycycline) and discharged without a pacemaker. After 3 months, the AV conduction recovered to normal. DISCUSSION: Lyme carditis should always be considered, particularly in younger patients with new-onset AV block and without evidence of structural heart disease. Atrioventricular block recovers in the majority of cases after appropriate antibiotic treatment.

A retrospective evaluation of the indications, complications, and outcomes associated with epicardial pacemakers in 20 cats from a single institution.

INTRODUCTION: The objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system. ANIMALS: Twenty client-owned cats. MATERIALS AND METHODS: Medical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time. RESULTS: The majority of cats were presented for syncope (n = 11), and the most common ECG diagnosis was advanced second-degree atrioventricular block (n = 9). Fifteen cats (15/20, 75%) had one or more major or minor complications. One cat died in the perioperative period as a result of a major complication. None of the variables evaluated were associated with a statistically significant increase in the occurrence of major or minor complications. The most common major complication was loss of ventricular capture (seven instances in six cats), which was successfully treated in all cases by increasing pacemaker output or replacing both the lead and the pulse generator. The most common minor complications were arrhythmias (n = 7) and sensing issues (n = 8). The overall median survival time (MST) was 948 days. No statistical difference in survival time was identified between cats that experienced a major complication and those that did not. CONCLUSIONS: Although complications were common in this feline population after EP, major and minor complications were successfully treated.

Successful application of closed loop stimulation pacemakers with remote monitoring in 3 miniature donkeys with syncope.

Rate-adaptive single chamber pacemakers with accelerometer, closed loop stimulation (CLS), and remote monitoring functionality (Eluna 8 SR-T, Biotronik, SE & Co, Germany) were implanted in 3 miniature donkeys with third-degree atrioventricular block and syncope. After recovery, different pacemaker programming modes were tested at rest, during stress without physical exercise and during physical exercise. Pacing rates were compared to actual atrial rates and showed that CLS functionality allowed physiological heart rate adaptation. A transmitter installed in the stable provided wireless connection of the pacemaker to the internet. Home monitoring was activated which performed daily wireless transmission of pacemaker functional measurements to an online server allowing diagnosis of pathological arrhythmias and pacemaker malfunction from a distance. Closed loop stimulation and remote monitoring functionality resulted in nearly physiological rate adaptation and allowed remote "from-the-stable" patient follow-up.

Third-Degree Heart Block Associated With Saddle Pulmonary Embolism: A Rare Sequelae of COVID-19-Induced Hypercoagulable State.

The pathophysiology of coronavirus disease 2019 (COVID-19) involves multi-organ dysfunction, particularly involving the respiratory, cardiovascular and hematological systems. This dysfunction is partly due to systemic inflammation causing a wide array of pathological sequelae thus posing a significant challenge to management despite the advances in treatment made thus far. In this report, we present a COVID-19 patient who developed a transient complete heart block and was temporarily paced as a complication of a saddle pulmonary embolus (PE). The mechanism of complete heart block is unclear, may be related to strain, ischemia, or vagal response. We believe that this is a unique sequence of events in a COVID-19 patient and, to our knowledge, is the first of its kind to be reported.