Misinterpretation of sleep-induced second-degree atrioventricular block

A number of publications have claimed that Mobitz type Ⅱ atrioventricular block(AVB)may occur during sleep.None of the reports defined type Ⅱ AVB and representative electrocardiograms were either misinterpreted or missing.Relatively benign Wenckebach type Ⅰ AVB is often misdiagnosed as Mobitz type Ⅱ which is an indication for a pacemaker.Review of the published reports indicates that Mobitz type II AVB does not occur during sleep when it is absent in the awake state.Conclusion:There is no proof that sleep is associated with Mobitz type Ⅱ AVB.

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy:A case report

BACKGROUND Refractory secondary hyperparathyroidism(SHPT)is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification.Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias,including atrioventricular block.This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block(CAVB),which was eventually reversed to a first-degree atrioventricular block.CASE SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy.She developed SHPT,and an electrocardiogram revealed a first-degree atrioventricular block.Then,she underwent parathyroidectomy(PTX)with autotransplantation.Unfortunately,a few years later,she developed SHPT again,and an electrocardiogram revealed a CAVB.A few years after the second PTX surgery,the calcification of the left atrium and left ventricle improved,and her CAVB was reversed.CONCLUSION This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage.Following parathyroid surgery,calcification of the cardiac conduction system improved,leading to reversal of the atrioventricular block.It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

Ticagrelor therapy and atrioventricular block:Do we need to worry?

Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication.

A rare case of Staphylococcus lugdunensis septicemia associated with myocarditis and atrioventricular block

Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].

Rare narrow QRS tachycardia with atrioventricular dissociation: A case report

BACKGROUND Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction.Concealed Mahaim fiber is not very rare;however,concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular(AV)dissociation.Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported.We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency(RF)ablation of a rare narrow QRS tachycardia with AV dissociation.CASE SUMMARY A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation.Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm.Echocardiography showed no structural heart disease.A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia.His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm.The tachycardia could be initiated and entrained by ventricular pacing.Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential.The earliest atrial activation was mapped near the proximal slow AV nodal pathway.RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential,and tachycardia could no longer be induced.CONCLUSION Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential.

Identification of a New Lamin A/C Mutation in a Chinese Family Affected with Atrioventricular Block as the Prominent Phenotype

Even though mutations in LMNA have been reported in patients with typical dilated cardio-myopathy(DCM)and atrioventricular block(AVB)previously,the purpose of this study was to disclose this novel genetic abnormality in one Chinese family with the atypical phenotype of progressive AVB followed by DCM with normal QRS interval.Genome-wide linkage analysis mapped the AVB gene in this family to a marker at chromosome 1q21.2,where the LMNA gene was located.Direct DNA sequence analysis revealed a heterozygous G t...

A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation

Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called ＂ablate and pace＂ approach offers the potential for more robust control ofven- tricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic fimction. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implanta- tion time, and the proper device selection after atrioventricular junction ablation are also discussed.

Clinical Study on the Treatment of 325 Cases of Atrioventricular Node Reentrant Tachycardia by Radiofrequency Catheter Ablation

In order to improve the efficacy of modified inferior method or middle method of radiofrequency catheter ablation (RFCA) in the treatment of atrioventricular node reentrant tachycardia (AVNRT), the clinical data of 325 cases of AVNRT from March 1992 to Feb. 2000 being subjected to the treatment of RFCA were retrospectively analyzed. The results showed that the successful rate was increased and recurrence was decreased year by year. In the recent 4 years the effective rate was up to 100 %. The complication of three grade of AVB occurred in 3 % and recurrent rate in 9.1 % before March 1996, but both of them were zero in the last 3 years. The time of RFCA procedure and X ray exposure was significantly reduced. It was concluded that ablating more than 3 targets by modified inferior method or middle method with energy titrating and strict endpoint was the crux of obtaining satisfactory therapeutic effects and preventing recurrence.

Reversible cardiogenic shock caused by atrioventricular junctional rhythm after percutaneous coronary intervention

An 82-year-old female patient undergoing cardiogenic shock caused by atrioventficular junctional rhythm immediately after percutaneous coronary intervention （PCI） is described. Pharmacotherapy was invalid, and subsequent application of atrial pacing reversed the cardiogenic shock. PCI-related injury of sinuatrial nodal artery leading to acute atrial contractility loss, accompanied by atrioventricular junctional arrhythmia, was diagnosed. We recommend that preoperative risk evaluation be required for multi-risk patients. Likewise, emergent measures should to be established in advance. This case reminds us that atrial pacing can be an optimal management technique once cardiogenic shock has occurred.

Completed atrioventricular block induced by atrial septal defect occluder unfolding:A case report

BACKGROUND An atrial septal defect is a common condition and accounts for 25%of adult congenital heart diseases.Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects(ASDs).CASE SUMMARY A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography(TTE)1 year ago.The electrocardiogram showed a heart rate of 88 beats per minute,normal sinus rhythm,and no change in the ST-T wave.After admission,TTE showed an atrial septal defect with a left-to-right shunt,aortic root short-axis section with an ASD diameter of 8 mm,a parasternal four-chamber section with an ASD diameter of 9 mm,and subxiphoid biatrial section with a diameter of 13 mm.Percutaneous occlusion was proposed.The intraoperative TTE scan showed that the atrial septal defect was oval in shape,was located near the root of the aorta,and had a maximum diameter of 13 mm.A 10-F sheath was placed in the right femoral vein,and a 0.035°hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava.A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly.TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth.Immediately after the disc was revealed,electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged,the P waves and QRS waves were separated,a junctional escape rhythm maintained the heart rate,and the blood pressure began to decrease.After removing the occluder,the elevation in the ST segment returned to normal immediately,and the sinus rhythm returned to average approximately 10 min later.After consulting the patient’s family,we finally decided to withdraw from the operation.CONCLUSION Compression of the small coronary artery,which provides an alternative blood supply to the atrioventricular nodule during the operation,leads to the emergence of a complete atrioventricular block.

Risk factors of early mortality and major morbidity in adult patients after surgical repair of partial atrioventricular septal defects

Objective To investigate the risk factors for prolonged postoperative mechanical ventilation patients with atrioventricular septal defect(AVSD).Methods We retrospectively analyzed the clinical data of 76 patients with atrioventricular septal defect aged more than 18 years in our hospital from January 1^st 2011 to December 31^st 2017.

Surgical repair of intermediate atrioventricular septal defect in adults

Objective To review the results of surgical correction of intermediate atrioventricular septal defect in adults and associated cardiac comorbidities.Methods Retrospective case analysis of database of department of SICU form FuWai Hospital.Ten consecutive patients operated for intermediate atrioventricular septal defect repair from March 2013 to November 2017 were included.

Determination of the optimal atrioventricular and interventricular delays in cardiac resynchronization therapy

Objective In order to provide the maximum benefit of cardiac resynchronization therapy(CRT),we tried to use an echocardiography method to optimize the atrioventricular and interventricular delay.Methods The study included 6 patients who underwent implantation of biventricular pacemakers for drug-resistant heart failure.Two-dimensional echocardiography and tissue Doppler imaging were carried out before and after the pacemaker implantation.The optimal AV delay was defined as the AV delay resulting in maximum timevelocity integral(TVI)of transmitral filling flow,the longest left ventricular filling time(LVFT)and the minimum mitral regurgitation(MR).The optimal VV delay was defined as the VV delay producing the maximum LV synchrony and the largest aortic TVI.Results CRT was successfully performed in all patients.After pacemaker implantation,an acute improvement in left ventricular ejection fraction(LVEF)was observed from 26.5%to 35%.Meanwhile,the QRS duration decreased from 170ms to 150ms.The optimal AV delay was programmed at 130,120,120,120,150 and 110ms respectively with heart rate corrected,LVFT significantly lengthened and TVI of MR decreased(non-optimal vs optimal AV delay:LVFT:469ms vs 523ms;TVI of MR:16.43cm vs 13.06cm,P<0.05).The optimal VV delay was programmed at 4,4,4,8,12 and 8ms with LV preactivation respectively.Programming the optimal VV delay increased the aortic TVI from 17.33cm up to 21.42cm(P<0.05).In the septal and lateral wall,peak systolic velocities improved from2.70cm/s to 3.02cm/s(P>0.05)and froml.31cm/s to 2.50cm/s(P<0.05)respectively.The septal-to-lateral delay in peak velocity improved from 56.4ms to 13.3ms after CRT(P<0.01).Conclusions Optimization of AV and VV delays may further enhance the efficacy of CRT.However,there was interindividual variability of optimal values,warranting individual patient examination.

Comparison of remote magnetic versus manual catheter navigation for ablation of atrioventricular nodal reentry tachycardia

Objective The purpose of this study was to compare remote magnetic catheter navigation with manual navigation for the ablation of atrioventricular nodal reentry tachycardia （AVNRT）. Methods From November 2007 to November 2009, 30 consecutive patients with AVNRT received radiofrequency ablation in the Institute of Geriatric Cardiology. Of them, 14 were treated with remote magnetic navigation （RMN） and 16 with manual catheter navigation （MCN）. Total fluoroscopic time,procedure time, procedural success rate, and complication rate were compared between the two groups. Results Total fluoroscopy time and precise orientation time were reduced in RMN group compared to MCN group （7.5＋0.3 min vs 13.9~5.3 rain, and 1.0-x-0.3 min vs 3.2：~0.6 min, respectively, both P〈0.05）. Procedural success rates in both groups were 100% and no AVNRT recurred in all patients during 3 months＇ follow-up. The number of lesions delivered was less for RMN group （3.4~1.1 vs 6.3＋2.2, P〈0.05）. Total procedure time （25.6~7.5 rain vs 27.5a：6.2 rain,/〉〉0.05） was similar between the 2 groups. No procedural complications occurred in both groups. Conclusions RMN for mapping and ablation of AVNRT significantly reduce precise orientation time, total fluoroscopy time and number of lesions delivered compared to the conventional technique of manual steering of deflectable catheters. Remote magnetic control mapping and ablation of AVNRT is more safe and feasible （J Geriatr Cardio12010; 7：7-9）.

Partial Ventricular Atrioventricular Canal Aged about a Case

Introduction: The partial ventricular atrioventricular canal is a congenital heart malformation of the ostium primum type of variable surface that can reach the single atrium where the interatrial septum is no more than a cephalic muscular vestige attached to the roof of the atrium. His diagnosis at the age of 73 is not a common situation. The interest of this clinical case that we report lies in the peculiarity of its mode of discovery and its evolution under medical treatment. Observation. He was a 73-year-old patient with no known cardiovascular risk factor and has since been at about 18 years of age with heart failure syndrome with progressive dyspnea, cough and edema of the lower limbs, but never explored for lack of financial means, and the evolution was enamelled by episodes of cardiac decompensation, the last of which dated back to 03/07/2018 justifying a hospitalization in our service. Cardiac ultrasound shows a partial atrioventricular canal. The care was medical. Conclusion: The atrioventricular canal is a congenital heart disease complex of poor prognosis.

Surgical Experience of a Partial Atrioventricular Septal Defect in an Elderly Patient: A Case Report

The following paper describes patch closure (bovine pericardial sheet) of an ostium primum atrial septal defect and mitral valve repair (sutured mitral valve cleft + autologous pericardial annuloplasty + Alfieri’s method) in a 50-year-old man. He had been perfectly well until he was brought to the emergency room because of acute heart failure. Chest radiography revealed right-side heart enlargement. Electrocardiography indicated atrial flutter. Echocardiography revealed a large ostium primum atrial septal defect and moderate mitral regurgitation. The pulmonary-to-systemic blood flow ratio was 3.24. First, cardiologists performed catheter ablation of the cavotricuspid isthmus for atrial flutter. We performed patch closure of an ostium primum atrial septal defect and mitral valve repair after the patient’s heart failure was under control. The patient was discharged 13 days postoperatively in a satisfactory condition without any critical complications.

Tako-tsubo syndrome after administration of intravenous adrenaline during atrioventricular block

We describe the clinical case of a 70-year-old woman with complete atrioventricular block that after administration of intravenous adrenaline, developed electrocardiographic changes suggestive of acute coronary syndrome, together with apical dyskinesia of the left ventricle. After ruling out the existence of coronary lesions, and after total recovery of the echocardiographic alterations in segmental contractility, she was diagnosed as Tako-tsubo syndrome induced by administration of adrenaline. This is the first report of this syndrome in the scenario of atrioventricular block treated with adrenaline infusion.

Using Three-Dimensional Lorenz Scatter Plots to Detect Patients with Atrioventricular Node Double Path Caused by Interpolated Ventricular Premature Systoles: A Case Study

A series of related electrophysiology phenomena can be caused by the occurrence of interpolated ventricular premature contraction.In our recent three-dimensional Lorenz R-R scatter plot research,we found that atrioventricular node double path caused by interpolated ventricular premature contraction imprints a specifi c pattern on three-dimensional Lorenz plots generated from 24-hour Holter recordings.We found two independent subclusters separated from the interpolated premature beat precluster,the interpolated premature beat cluster,and the interpolated premature beat postcluster,respectively.Combined with use of the trajectory tracking function and the leap phenomenon,our results reveal the presence of the atrioventricular node double conduction path.

A Case of Transient Advanced Atrioventricular Block after Aortic Valve Replacement, Report of a Case

Approximately 3%-11.8% of cases require permanent pacemaker implantation due to atrioventricular block (AVB) after aortic valve replacement (AVR), and determination of conduction disturbances such as left or right bundle branch block by preoperative electrocardiography is correlated with high risk postoperative permanent pacemaker implantation. Intraoperative risk factors include severe calcification of the aortic valve, prolonged cardiopulmonary bypass time, aortic clamp time. Recently, there have been reports of high rates of pacemaker implantation (14.2%) after transcatheter aortic valve implantation. The time of permanent pacemaker implantation after AVB is often 4-10 days, and the European Society of Cardiology guidelines recommend a period of seven days of persistent atrioventricular block postsurgery prior to permanent pacemaker implantation. We report a 79-year-old woman in which the patient developed high-degree AVB after AVR was performed for severe aortic stenosis with complete right bundle branch block. However, her pulse returned to sinus rhythm 7 days postsurgery.

Ellis-Van-Creveld Syndrome and Congenital Cardiac Anomaly: Common Atrium with Atrioventricular Canal Septal Defect

Background: Children presenting with physical features of chondro-ectodermal dysplasia (Ellis-Van Creveld syndrome) such as skeletal and joint abnormalities often have concomitant congenital cardiac anomalies. Presence of cardiorespiratory symptoms in children with Ellis-Van Craved syndrome warrants a thorough cardiologic evaluation to recognize and treat underlying congenital heart anomaly. Aim: A child with physical stigmata of Ellis-Van-Creveld syndrome is evaluated to detect an associated congenital cardiac anomaly and accomplish successful repair of the underlying cardiac lesion to reduce the cardiac related morbidity and improve the patient survival. Case Presentation: Ten years old boy with chondroectodermal dysplasia (dental anomalies, genu valgum and other skeletal abnormalities) presented with dyspnea and cyanosis. Cardiac evaluation by 2D echo revealed an atrioventricular (AV) canal septal defect with AV valve regurgitation and a common atrium. Angiocardiography showed a goose neck deformity of the left ventricular outflow tract. The Qp/Qs was 3.4: 1, with systemic arterial oxygen desaturation (SaO2 of 0.7) and O2 saturation in the common atrium was 0.7. The pulmonary venous connections to the common atrium were anomalous. Atriotomy on cardiopulmonary bypass and on a cardioplegic arrest discerned a partial AV canal septal defect with a common bridging leaflet, clefts in septal leaflets of tricuspid and mitral vlalves, an incompletely closed interventricular communication, and a common atrium with highly anomalous pulmonary venous insertions well anterior (8 cm) to vena caval orifices. Intracardiac repair was performed with two patches of Goertex to partition the common atrium into the pulmonary and systemic venous chambers after repair of the partial AV canal septal defect. Patient required only a temporary afterload reduction with enalapril;otherwise patient had an uneventful postoperative course. At a 2-year follow-up, the child was well without AV valve regurgitation and had normal biventricular function. Conclusion: A child with Ellis-Van-Creveld syndrome with skeletal abnormalities and dental anomalies had manifested with cardio-respiratory symptoms. Preoperative cardiac and intraoperative evaluation showed a common atrium with severely anomalous pulmonary venous connection and partial AV canal septal defect. Successful biventricular repair was accomplished by repairing the partial AV canal septal defect and partitioning the common atrium into left and right atrium by a complex atrial routing technique with two patches of Gore-Tex. On a follow-up at 2 years, the patient had adequate biventricular function without AV valve regurgitation. 114264