RESUMEN
Seldom are reports of phase 4 block or bradycardia-dependent conduction block in atrial tissue found in the literature. Here, we describe the case of a patient with sick sinus syndrome with Torsade de Pointes who, following the implantation of a double-chamber implantable cardioverter defibrillator, developed intra-atrial bradycardia-dependent conduction block. The patient's optimal pacing parameters were achieved by raising the rate.
Asunto(s)
Bradicardia , Desfibriladores Implantables , Electrocardiografía , Humanos , Desfibriladores Implantables/efectos adversos , Bradicardia/terapia , Bradicardia/etiología , Masculino , Síndrome del Seno Enfermo/terapia , Persona de Mediana Edad , Anciano , Bloqueo Interauricular , Torsades de Pointes/etiologíaRESUMEN
Medical advances prolonging life have led to more permanent pacemaker implants. When pacemaker implantation (PMI) is commonly caused by sick sinus syndrome or conduction disorders, predicting PMI is challenging, as patients often experience related symptoms. This study was designed to create a deep learning model (DLM) for predicting future PMI from ECG data and assess its ability to predict future cardiovascular events. In this study, a DLM was trained on a dataset of 158,471 ECGs from 42,903 academic medical center patients, with additional validation involving 25,640 medical center patients and 26,538 community hospital patients. Primary analysis focused on predicting PMI within 90 days, while all-cause mortality, cardiovascular disease (CVD) mortality, and the development of various cardiovascular conditions were addressed with secondary analysis. The study's raw ECG DLM achieved area under the curve (AUC) values of 0.870, 0.878, and 0.883 for PMI prediction within 30, 60, and 90 days, respectively, along with sensitivities exceeding 82.0% and specificities over 81.9% in the internal validation. Significant ECG features included the PR interval, corrected QT interval, heart rate, QRS duration, P-wave axis, T-wave axis, and QRS complex axis. The AI-predicted PMI group had higher risks of PMI after 90 days (hazard ratio [HR]: 7.49, 95% CI: 5.40-10.39), all-cause mortality (HR: 1.91, 95% CI: 1.74-2.10), CVD mortality (HR: 3.53, 95% CI: 2.73-4.57), and new-onset adverse cardiovascular events. External validation confirmed the model's accuracy. Through ECG analyses, our AI DLM can alert clinicians and patients to the possibility of future PMI and related mortality and cardiovascular risks, aiding in timely patient intervention.
Asunto(s)
Enfermedades Cardiovasculares , Aprendizaje Profundo , Electrocardiografía , Marcapaso Artificial , Humanos , Electrocardiografía/métodos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Inteligencia Artificial , Síndrome del Seno EnfermoRESUMEN
Empty sella syndrome (ESS) is characterized by the herniation of cerebrospinal fluid into the sella, which results in the enlargement of the sella and compression of the pituitary gland. ESS commonly accompanies pituitary dysfunction and abnormal secretion of one or more hormones, which manifests as symptoms like cold intolerance, fatigue, and memory impairment. However, the occurrence of sick sinus syndrome (SSS) in ESS has not been reported. A 66-year-old female patient was admitted to the hospital with complaints of dizziness and fatigue. Electrocardiogram (ECG) revealed sinus arrest, junctional escape rhythm, and a heart rate of 40 bpm. Then, the patient was diagnosed with SSS. Thyroid function test indicated decreased thyroxine levels and slightly elevated thyroid-stimulating hormone levels. Additionally, hyposecretion of cortisol and insulin-like growth factors was observed. Magnetic resonance imaging of the pituitary gland confirmed the diagnosis of ESS. The patient was treated with hydrocortisone and euthyrox, relieving the symptoms of dizziness and fatigue. Thyroid function tests during the follow-up period showed normal hormone levels, and ECG examination revealed no abnormalities.
Asunto(s)
Electrocardiografía , Síndrome de Silla Turca Vacía , Síndrome del Seno Enfermo , Humanos , Síndrome de Silla Turca Vacía/complicaciones , Síndrome de Silla Turca Vacía/diagnóstico , Femenino , Anciano , Síndrome del Seno Enfermo/diagnóstico , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/complicaciones , Imagen por Resonancia Magnética , Hidrocortisona/uso terapéuticoRESUMEN
Left bundle branch pacing (LBBP) has been subject to increasing interest over the last few years due to its capacity for physiological conduction and its advantages compared to His bundle pacing. His bundle pacing has certain limitations, such as a small pacing area for the His bundle, a high threshold that leads to battery depletion, a low R-wave amplitude that may result in atrial or His oversensing, and ventricular signal undersensing. In this case series, four patients (two female and two male) aged 62.2 ± 8.4 years old with symptomatic sick sinus disease and no scar tissue in the interventricular septum underwent LBBP. All LBBPs were done with standard LBBP using a lumenless SelectSecure 3830 lead (Medtronic®, Minneapolis, USA) with a fixed helix. The lead parameters showed a good R-wave amplitudes (13 ± 7.4 mV) and a low threshold (0.77 ± 0.17 V @ 0.4 ms). All patients were discharged on the next day. During follow-up period of 13.3 ± 12.9 months, all patients were well and no complications were noted. In conclusion, LBBP may be as an alternative of novel conduction pacing techniques and can be done relatively easy and safe, even with limited experience center.
Asunto(s)
Fascículo Atrioventricular , Estimulación Cardíaca Artificial , Electrocardiografía , Humanos , Femenino , Persona de Mediana Edad , Masculino , Fascículo Atrioventricular/fisiopatología , Estimulación Cardíaca Artificial/métodos , Anciano , Síndrome del Seno Enfermo/terapia , Resultado del Tratamiento , Marcapaso Artificial , Bloqueo de Rama/terapia , Bloqueo de Rama/fisiopatologíaRESUMEN
AIMS: Subclinical atrial fibrillation (AF) is associated with increased risk of progression to clinical AF, stroke, and cardiovascular death. We hypothesized that in pacemaker patients requiring dual-chamber rate-adaptive (DDDR) pacing, closed loop stimulation (CLS) integrated into the circulatory control system through intra-cardiac impedance monitoring would reduce the occurrence of atrial high-rate episodes (AHREs) compared with conventional DDDR pacing. METHODS AND RESULTS: Patients with sinus node dysfunctions (SNDs) and an implanted pacemaker or defibrillator were randomly allocated to dual-chamber CLS (n = 612) or accelerometer-based DDDR pacing (n = 598) and followed for 3 years. The primary endpoint was time to the composite endpoint of the first AHRE lasting ≥6 min, stroke, or transient ischaemic attack (TIA). All AHREs were independently adjudicated using intra-cardiac electrograms. The incidence of the primary endpoint was lower in the CLS arm (50.6%) than in the DDDR arm (55.7%), primarily due to the reduction in AHREs lasting between 6 h and 7 days. Unadjusted site-stratified hazard ratio (HR) for CLS vs. DDDR was 0.84 [95% confidence interval (CI), 0.72-0.99; P = 0.035]. After adjusting for CHA2DS2-VASc score, the HR remained 0.84 (95% CI, 0.71-0.99; P = 0.033). In subgroup analyses of AHRE incidence, the incremental benefit of CLS was greatest in patients without atrioventricular block (HR, 0.77; P = 0.008) and in patients without AF history (HR, 0.73; P = 0.009). The contribution of stroke/TIA to the primary endpoint (1.3%) was low and not statistically different between study arms. CONCLUSION: Dual-chamber CLS in patients with SND is associated with a significantly lower AHRE incidence than conventional DDDR pacing.
Asunto(s)
Fibrilación Atrial , Estimulación Cardíaca Artificial , Frecuencia Cardíaca , Ataque Isquémico Transitorio , Marcapaso Artificial , Síndrome del Seno Enfermo , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/epidemiología , Anciano , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/fisiopatología , Estimulación Cardíaca Artificial/métodos , Ataque Isquémico Transitorio/prevención & control , Ataque Isquémico Transitorio/epidemiología , Persona de Mediana Edad , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/epidemiología , Incidencia , Resultado del Tratamiento , Factores de Tiempo , Factores de Riesgo , Desfibriladores Implantables , Técnicas Electrofisiológicas Cardíacas , Acelerometría , Anciano de 80 o más AñosRESUMEN
BACKGROUND Compression of the vagus nerve by a pharyngeal mass is a well-documented condition that can result in sinus node dysfunction (SND). However, there is scarce literature on extrinsic vagal nerve compression from a tonsillar abscess. CASE REPORT A 59-year-old woman with a history of asthma and chronic throat discomfort presented to the Emergency Department with bradycardia, palpitations, and voice changes. Following a shellfish allergy hospitalization, an otolaryngology evaluation revealed an enlarged right tonsil, recommending tonsillectomy, but scheduling challenges persisted. The patient reported mild throat pain, dysphagia, hoarseness, rhinorrhea, and exertional dyspnea and was admitted for the evaluation of peritonsillar mass. She was found to be bradycardic with a heart rate of 47, with an electrocardiogram revealing SND. Albuterol and ipratropium nebulizers, as well as dexamethasone and pantoprazole, were initiated. With this treatment, the patient symptomatically improved with a new heart rate of 68. She was discharged with outpatient appointments, but was unfortunately lost to follow-up. CONCLUSIONS This case reveals sinus node dysfunction resulting from extrinsic vagal nerve compression by a tonsillar abscess. Pressure on the vagus nerve can trigger bradycardia and low blood pressure, possibly due to compensatory overfiring of afferent vagal nerve signals from local mass effect. Early recognition and antibiotic treatment are essential to prevent cardiac complications. Clinicians must remain vigilant for such extrinsic causes, particularly in patients with chronic sore throat and cardiac symptoms. Further research and case reports are needed to deepen our understanding of this rare yet significant association.
Asunto(s)
Síndrome del Seno Enfermo , Humanos , Femenino , Persona de Mediana Edad , Síndrome del Seno Enfermo/terapia , Absceso Peritonsilar/complicaciones , Síndromes de Compresión Nerviosa/etiología , Nervio VagoRESUMEN
BACKGROUND: New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino-atrial nodal artery (SANA) may still be occluded after a percutaneous coronary intervention (PCI), causing sinus node dysfunction (SND). Ischemic sinus nodes are usually asymptomatic but can cause sinus arrest sometimes requiring pacemaker placement. In rare cases, junctional escape rhythms, a manifestation of sinus exit blocks after PCI, can predict cardiogenic shock. METHODS: We present a case study of a patient who underwent bifurcation PCI to the LMCA to the LCX but subsequently developed cardiogenic shock as a result of SND, a junctional escape rhythm required substantial inotropic support. This case offers an exemplification of a sparsely documented, yet infrequent manifestation of iatrogenic ischemic SND at an unorthodox site, the confluence of the LMCA-LCX. In addition, we conducted a comprehensive analysis of 22 scholarly works pertaining to the subject of sinus node dysfunction (SND) subsequent to PCI resulting from ischemia caused by stenosis or occlusion of the SANA. RESULTS: RCA was responsible for 96.1% of SND cases, whereas LCX was responsible for 3.9%. SND was asymptomatic in 49.3% of cases and junctional escape rhythm in 37.6% of symptomatic cases. 28% needed a temporary transvenous pacemaker, while 7.8% needed a permanent one. Interventional management recanalized the SANA in 5.2% of patients, restoring flow. CONCLUSION: Transient sino-atrial node ischemia after PCI can cause acute SND. Before stent implantation, doctors should consider SND. Complete plaque evaluation around the SANA is needed before choosing the best PCI procedure.
Asunto(s)
Intervención Coronaria Percutánea , Humanos , Masculino , Síndrome del Seno Enfermo/terapia , AncianoRESUMEN
This case report discusses a 42-year-old male with dextro-transposition of the great arteries (D-TGA) status post Mustard repair and sick sinus syndrome status post dual-chamber pacemaker implant, who developed symptomatic superior vena cava (SVC) baffle stenosis. He was treated with a combined pacemaker extraction and subsequent SVC baffle stenting. The case highlights the complexities of treating SVC baffle stenosis in the presence of cardiac implantable devices and demonstrates the efficacy of this combined approach. Furthermore, the authors delve into the intricacies of D-TGA, its surgical history, and the long-term complications associated with atrial switch procedures.
Asunto(s)
Remoción de Dispositivos , Marcapaso Artificial , Stents , Transposición de los Grandes Vasos , Humanos , Transposición de los Grandes Vasos/cirugía , Masculino , Adulto , Marcapaso Artificial/efectos adversos , Síndrome de la Vena Cava Superior/cirugía , Síndrome de la Vena Cava Superior/etiología , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/cirugíaRESUMEN
The heterozygous mutation c.155G > T in GNB2 clinically leads to sinus bradycardia and sinus node dysfunction. Here, patient-specific skin fibroblasts of the mutation carrier were used for Sendai virus reprogramming into human induced-pluripotent stem cells (hiPSC). For generating the isogenic control cell line, a CRISPR/Cas9-mediated HDR-repair of the hiPSCs was carried out. Both generated cell lines (GNB2 SV5528, GNB2 K26) maintained a normal karyotype, cell morphology, pluripotency in immunofluoresence and RT-qPCR analysis. Both hiPSC-lines showed differentiation potential into all three germ layers. Differentiated cardiomyocytes of this isogenic set may pave the way for investigating pharmacological rescue strategies for sinus node dysfunction.
Asunto(s)
Sistemas CRISPR-Cas , Células Madre Pluripotentes Inducidas , Mutación , Humanos , Células Madre Pluripotentes Inducidas/metabolismo , Sistemas CRISPR-Cas/genética , Heterocigoto , Línea Celular , Diferenciación Celular , Síndrome del Seno Enfermo/genética , Subunidades beta de la Proteína de Unión al GTP/genética , Subunidades beta de la Proteína de Unión al GTP/metabolismoRESUMEN
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.
Asunto(s)
Enfermedades de los Perros , Frecuencia Cardíaca , Aprendizaje Automático , Animales , Perros , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/fisiopatología , Frecuencia Cardíaca/fisiología , Bloqueo Sinoatrial/veterinaria , Bloqueo Sinoatrial/diagnóstico , Bloqueo Sinoatrial/fisiopatología , Masculino , Femenino , Nodo Sinoatrial/fisiopatología , Síndrome del Seno Enfermo/veterinaria , Síndrome del Seno Enfermo/diagnóstico , Síndrome del Seno Enfermo/fisiopatología , Electrocardiografía/veterinariaRESUMEN
AIMS: In patients with heart failure (HF), concomitant sinus node dysfunction (SND) is an important predictor of mortality, yet its molecular underpinnings are poorly understood. Using proteomics, this study aimed to dissect the protein and phosphorylation remodelling within the sinus node in an animal model of HF with concurrent SND. METHODS AND RESULTS: We acquired deep sinus node proteomes and phosphoproteomes in mice with heart failure and SND and report extensive remodelling. Intersecting the measured (phospho)proteome changes with human genomics pharmacovigilance data, highlighted downregulated proteins involved in electrical activity such as the pacemaker ion channel, Hcn4. We confirmed the importance of ion channel downregulation for sinus node physiology using computer modelling. Guided by the proteomics data, we hypothesized that an inflammatory response may drive the electrophysiological remodeling underlying SND in heart failure. In support of this, experimentally induced inflammation downregulated Hcn4 and slowed pacemaking in the isolated sinus node. From the proteomics data we identified proinflammatory cytokine-like protein galectin-3 as a potential target to mitigate the effect. Indeed, in vivo suppression of galectin-3 in the animal model of heart failure prevented SND. CONCLUSION: Collectively, we outline the protein and phosphorylation remodeling of SND in heart failure, we highlight a role for inflammation in electrophysiological remodelling of the sinus node, and we present galectin-3 signalling as a target to ameliorate SND in heart failure.
Asunto(s)
Modelos Animales de Enfermedad , Insuficiencia Cardíaca , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización , Ratones Endogámicos C57BL , Proteómica , Síndrome del Seno Enfermo , Nodo Sinoatrial , Animales , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/genética , Insuficiencia Cardíaca/patología , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización/metabolismo , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización/genética , Nodo Sinoatrial/metabolismo , Nodo Sinoatrial/fisiopatología , Fosforilación , Síndrome del Seno Enfermo/metabolismo , Síndrome del Seno Enfermo/fisiopatología , Síndrome del Seno Enfermo/genética , Masculino , Mediadores de Inflamación/metabolismo , Inflamación/metabolismo , Inflamación/fisiopatología , Inflamación/patología , Frecuencia Cardíaca , Canales de Potasio/metabolismo , Canales de Potasio/genética , Simulación por Computador , Modelos Cardiovasculares , Humanos , Transducción de Señal , Potenciales de AcciónRESUMEN
BACKGROUND: Tachycardia-bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS. METHODS: We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy. RESULTS: Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR]â =â 0.62 and 95% confidence interval [CI]: 0.14-2.65), procedural complications (ORâ =â 1.53 and 95% CI: 0.67-3.48), and cardiovascular rehospitalization (ORâ =â 0.57 and 95% CI: 0.26-1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (ORâ =â 0.37 and 95% CI: 0.17-0.82), thromboembolism (ORâ =â 0.25 and 95% CI: 0.12-0.49), stroke (ORâ =â 0.28 and 95% CI: 0.13-0.57), heart failure (ORâ =â 0.27 and 95% CI: 0.13-0.56), freedom from AF (ORâ =â 23.32 and 95% CI: 7.46-72.92), and prevention of progression to persistent AF (ORâ =â 0.12 and 95% CI: 0.06-0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (ORâ =â 0.21 and 95% CI: 0.08-0.59). CONCLUSION: AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Marcapaso Artificial , Humanos , Fibrilación Atrial/terapia , Ablación por Catéter/métodos , Bradicardia/terapia , Taquicardia/terapia , Síndrome del Seno Enfermo/terapiaRESUMEN
INTRODUCTION: Pacemaker implantation can be challenging in patients with congenital heart disease. METHODS AND RESULTS: In a patient with Ebstein disease and symptomatic sinus node dysfunction, despite multiple attempts, the Micra® pacemaker could not be implanted in the severely dilated right ventricle. In that context, and after iodine injection to confirm the appropriate location, the Micra® pacemaker was successfully implanted in the right appendage at the first attempt. CONCLUSION: Despite the recent development of dedicated dual-chamber leadless pacemaker, to the best of our knowledge, this case is the first off-label Micra® implantation in a right appendage.
Asunto(s)
Apéndice Atrial , Estimulación Cardíaca Artificial , Marcapaso Artificial , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/cirugía , Apéndice Atrial/diagnóstico por imagen , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/fisiopatología , Síndrome del Seno Enfermo/diagnóstico , Anomalía de Ebstein/cirugía , Anomalía de Ebstein/fisiopatología , Resultado del Tratamiento , Masculino , Diseño de EquipoRESUMEN
BACKGROUND: Transvenous pacemaker placement is an integral component of therapy for severe dysrhythmias and a core skill in emergency medicine. OBJECTIVE: This narrative review provides a focused evaluation of transvenous pacemaker placement in the emergency department setting. DISCUSSION: Temporary cardiac pacing can be a life-saving procedure. Indications for pacemaker placement include hemodynamic instability with symptomatic bradycardia secondary to atrioventricular block and sinus node dysfunction; overdrive pacing in unstable tachydysrhythmias, such as torsades de pointes; and failure of transcutaneous pacing. Optimal placement sites include the right internal jugular vein and left subclavian vein. Insertion first includes placement of a central venous catheter. The pacing wire with balloon is then advanced until electromechanical capture is obtained with the pacer in the right ventricle. Ultrasound can be used to guide and confirm lead placement using the subxiphoid or modified subxiphoid approach. The QRS segment will demonstrate ST segment elevation once the pacing wire tip contacts the endocardial wall. If mechanical capture is not achieved with initial placement of the transvenous pacer, the clinician must consider several potential issues and use an approach to evaluating the equipment and correcting any malfunction. Although life-saving in the appropriate patient, complications may occur from central venous access, right heart catheterization, and the pacing wire. CONCLUSIONS: An understanding of transvenous pacemaker placement is essential for emergency clinicians.
Asunto(s)
Marcapaso Artificial , Humanos , Marcapaso Artificial/efectos adversos , Estimulación Cardíaca Artificial/métodos , Bradicardia/etiología , Arritmias Cardíacas/terapia , Arritmias Cardíacas/complicaciones , Síndrome del Seno Enfermo/terapiaRESUMEN
Background and Objectives: Atrioventricular (AV) dyssynchrony as well as atrial and ventricular pacing affect left atrial (LA) function. We conducted a study evaluating the effect of atrial and ventricular pacing on LA morphological and functional changes after dual-chamber pacemaker implantation. Materials and Methods: The study prospectively enrolled 121 subjects who had a dual-chamber pacemaker implanted due to sinus node disease (SND) or atrioventricular block (AVB). Subjects were divided into three groups based on indication and pacemaker programming: (1) SND DDDR 60; (2) AVB DDD 60 and (3) AVB DDD 40. Subjects were invited to one- and three-month follow-up visits. Three subsets based on pacing burden were analyzed: (1) high atrial (A) low ventricular (V); (2) high A, high V and (3) low A, high V. LA function was assessed from volumetric parameters and measured strains from echocardiography. Results: The high A, low V group consisted of 38 subjects; while high A, high V had 26 and low A, high V had 23. A significant decrease in reservoir and contractile LA strain parameters were only observed in the high A, low V pacing group after three months (reservoir 25.9 ± 10.3% vs. 21.1 ± 9.9%, p = 0.003, contractile -14.0 ± 9.0% vs. -11.1 ± 7.8, p = 0.018). While the re-established atrioventricular synchrony in the low A, high V group maintained reservoir LA strain at the baseline level after three months (21.4 ± 10.4% vs. 22.5 ± 10.4%, p = 0.975); in the high A, high V group, a further trend to decrease was noted (20.3 ± 8.9% vs. 18.7 ± 8.3%, p = 0.231). Conclusions: High atrial pacing burden independently of atrioventricular dyssynchrony and ventricular pacing impairs LA functional and morphological parameters. Changes appear soon after pacemaker implantation and are maintained.
Asunto(s)
Bloqueo Atrioventricular , Marcapaso Artificial , Humanos , Estimulación Cardíaca Artificial/efectos adversos , Atrios Cardíacos , Síndrome del Seno Enfermo/terapia , Bloqueo Atrioventricular/terapiaRESUMEN
BACKGROUND: The stretching of the lead caused by somatic growth may lead to complications (dislodgement, fracture, failure) of transvenous leads implanted in pediatric patients. Atrial loop and absorbable ligatures may prevent it. Periodical lead advancement with lead pushing from the pocket may be an option to growth-induced stretching. Our aim was to analyze retrospectively the outcome of periodical transvenous lead advancement in children with pacemaker (PM). METHODS: A procedure of lead advancement was performed in patients with a single-chamber PM implanted for isolated congenital complete atrioventricular block or sinus node dysfunction with growth-induced lead straightening/stretching. The PM pocket was opened, the lead was released from subcutaneous adherences and was gently advanced to shape again a loop/semi-loop in the atrium without dislodging the tip. Lead data (threshold, sensing, impedance) were compared before and after the procedure. Data are described as median (25th-75th centiles). RESULTS: 14 patients with 13 VVIR and 1 AAIR PM implanted at 6.8 (5.9-8.0) years of age, 23 (19-26) kg, 118 (108-124) cm, underwent 30 advancement procedures, 1.5 (1.0-2.3) per patient, during follow-up [45 (35-63) months]. Delta between procedures was: 18 (14-25) months, 11 (7-13) cm, 6 (4-9) kg; 90% of leads were successfully advanced without complications. Three unsuccessful procedures occurred with longer times [30 (14-37) months]. Electrical lead parameters did not show significant differences pre-/post-procedures. CONCLUSION: the advancement of transvenous leads in children seems safe and effective. This procedure may be another possible choice to preserve transvenous lead position and function until growth has completed.
Asunto(s)
Marcapaso Artificial , Humanos , Masculino , Femenino , Estudios Retrospectivos , Niño , Preescolar , Electrodos Implantados , Bloqueo Atrioventricular/terapia , Síndrome del Seno Enfermo/terapiaAsunto(s)
Fibrilación Atrial , Dextrocardia , Síndrome del Seno Enfermo , Situs Inversus , Humanos , Dextrocardia/complicaciones , Dextrocardia/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Situs Inversus/complicaciones , Situs Inversus/diagnóstico por imagen , Síndrome del Seno Enfermo/complicaciones , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/diagnósticoAsunto(s)
Fibrilación Atrial , Dextrocardia , Síndrome del Seno Enfermo , Situs Inversus , Humanos , Dextrocardia/complicaciones , Dextrocardia/diagnóstico por imagen , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Situs Inversus/complicaciones , Situs Inversus/diagnóstico por imagen , Síndrome del Seno Enfermo/complicaciones , Síndrome del Seno Enfermo/terapia , Síndrome del Seno Enfermo/diagnóstico , Masculino , Femenino , Anciano , Persona de Mediana EdadRESUMEN
The development of the cardiogenetics field in Germany has been increasing since the mid-1990s with many national contributions, some of them were really important and groundbreaking. The starting point was and still is the patient and his family, e.g. with a familial form of arrhythmia or cardiomyopathy, the clarification of the genetic cause and the personalized treatment of those being affected. The scientific, always translationally oriented interest in identifying a causative gene and uncovering the underlying pathomechanisms has led to notable contributions for Brugada syndrome, short QT syndrome and cardiac conduction disorders or sinus node dysfunction, but also in DCM or ARVC. What is important, however, is always the way back (bench > bed side): implementation of national and international recommendations for cardiogenetic diagnostics in daily cardiological routine and the personalized care and therapy of those being affected.
Asunto(s)
Síndrome de Brugada , Cardiomiopatías , Humanos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/genética , Arritmias Cardíacas/terapia , Síndrome del Seno Enfermo/genética , AlemaniaRESUMEN
BACKGROUND: Screening for atrial fibrillation (AF) may reveal incidental arrhythmias of relevance. The aim of this study was to describe incidental arrhythmias detected during screening for AF in the STAR-FIB (Predicting SilenT AtRial FIBrillation in Patients at High Thrombembolic Risk) cohort study. METHODS AND RESULTS: In the STAR-FIB cohort study, we screened hospitalized patients for AF with 3 repeat 7-day Holter ECGs. We analyzed all Holter ECGs for the presence of the following incidental arrhythmias: (1) sinus node dysfunction, defined as sinus pause of ≥3 seconds' duration; (2) second-degree (including Wenckebach) or higher-degree atrioventricular block (AVB); (3) sustained supraventricular tachycardia of ≥30 seconds' duration; and (4) sustained ventricular tachycardia of ≥30 seconds' duration. We furthermore report treatment decisions because of incidental arrhythmias. A total of 2077 Holter ECGs were performed in 794 patients (mean age, 74.7 years; 49% women), resulting in a mean cumulative duration of analyzable ECG signal of 414±136 hours/patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were sinus node dysfunction in 14 patients (1.8%), AVB in 41 (5.2%), supraventricular tachycardia in 42 (5.3%), and ventricular tachycardia in 2 (0.3%). Second-degree AVB was found in 23 patients (2.9%), 2:1 AVB in 10 (1.3%), and complete AVB in 8 (1%). Subsequently, 8 patients underwent pacemaker implantation, 1 for sinus node dysfunction (post-AF conversion pause of 9 seconds) and 7 for advanced AVB. One patient had an implantable cardioverter-defibrillator implanted for syncopal ventricular tachycardia. CONCLUSIONS: Incidental arrhythmias were frequently detected during screening for AF in the STAR-FIB study and resulted in device therapy in 1.1% of our cohort patients.