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.

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...

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.

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].

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.

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.

Atrioventricular block complicating inferior acute myocardial infarction treated with thrombolytic therapy

Objective To investigate the influence and mechanism of incidence of atrioventricular block (AVB) treated with thrombolytic therapy in acute inferior myocardial infarction (AIMI).Methods A total of 46 patients with AIMI were divided into the thrombolytic group (n = 23) and the nonthrornboytic group (n = 23). Intravenous or intracoronary urokinase was given to the former group. We observed the advancing courses of AVB, and further assessed the relationship between occurrence of AVB and stenosis of infarct-related artery (IRA) with coronary angiography.Results Two cases died of Ⅲ o AVB in the non-thrombolytic group, but none was found in the thrombolytic group. The occurrence rate of AVB was similar in both groups; but that of Ⅲ ° AVB was much lower in the thrombolytic group (4 cases) than that in the non-thrombolytic group (11 cases, P ＜ 0.05), and the duration of AVB decreased from 201 ± 113 hours to 102±60 hours after thrombolytic therapy ( P＜0.01 ),which was mainly due to the decrease of AVB in the vanishing interval, but not in the developing interval.The coronary angiography demonstrated that there were an increasing reperfusion flow and a decreasing coronary stenosis of the infarct-related artery after thrombolytic therapy.Conclusion Thrombolytic therapy can reduce the incidence of severe AVB, shorten its duration and decrease the mortality by increasing the coronary reperfusion flow in the patients with AIMI.

Late recurrent high degree atrioventricular block after percutaneous closure of a perimembranous ventricular septal defect

High degree atrioventricular block （HDAVB） is a serious complication of transcatheter closure of a perimembranous ventricular septal defect （PMVSD）. We report one patient who developed transient HDAVB seven days after transcathter closure of PMVSD and had recurrent HDAVB 42 months after the procedure.

Asymptomatic Paget＇s disease of bone presenting with complete atrioventricular block

Paget＇s disease of bone is a deforming bone disease （osteitis deformans） characterized by increased bone remodeling, bone hypertrophy, and abnormal bone structure, leading to bone expansion, deformities, easy fractures, and occasionally, neoplastic transformation. It is the second most common bone disorder after osteoporosis. The disease is relatively rare in Asia but is common in Europe and North America, affecting approximately 2% of the population over 50 years,

The association between hyperuricemia and atrioventricular blocks:A retrospective study

Background Atrioventricular block(AVB)is associated with adverse events even cardiac death. Serum uric acid(SUA)might lead to cadiovascular disease including arrhythmia and SUA lowering therapy could lower the risk. But the study of the association between AVB and SUA is rare at present. Method Sixty-four patients with AVB from Sep 2017 to Sep 2018 were enrolled as case group and another 64 patients in the same period were enrolled as control group. The levels of serum uric acid(SUA)and related parameters were compared between the two groups. Results The level of SUA was significantly higher in case group than in control group(402.13±140.08 vs. 351.17±87.81,P=0.015). HUA was associated with AVB significantly(OR 2.863,95%CI1.305～6.279,P=0.009),even after adjustment for confounding factors(OR 2.609,95%CI 1.081～6.296,P=0.033). For the comparison among AVB subgroups,only the association between HUA and Ⅲ-degree subtypes was found significantly(OR 3.411,95%CI 1.452～8.016,P=0.005). Conclusion HUA is positively associated with AVB independent of other potential confounding factors. But further analysis of different subtypes indicated that only the association between HUA and Ⅲ-degree AVB was found significant.

无导线起搏器低位间隔植入对心脏电学同步性的影响及安全性初步评价

目的:探讨无导线起搏器低位间隔植入的可行性及其对心脏电学同步性影响及安全性。方法:选择2021年1月至2023年8月于阜外华中心血管病医院植入无导线起搏器的患者36例,根据无导线起搏器植入部位的不同分为中位间隔组(n=16)和低位间隔组(n=20),并比较两组的临床特点及心脏电学同步性及手术安全性。结果:36例患者,男性21例(58.3%),平均年龄(68±13)岁,两组患者合并缓慢性心律失常类型的差异无统计学意义(P=0.73)。36例患者共进行了61次植入尝试,两组在尝试次数、手术时间、起搏器参数方面差异均无统计学意义,低位间隔组平均手术时间略短,但差异亦无统计学意义[(84±37)min vs.(105±35)min,P=0.09]。在电学同步性方面,低位间隔组与中位间隔组起搏状态下体表QRS时限差异无统计学意义[(162.0±21.1)ms vs.(174.0±14.8)ms,P=0.20]。所有患者在术中均未出现血管穿刺并发症、心脏穿孔及心包填塞等情况。术后平均随访(5.6±1.2)个月期间,未出现无导线起搏器相关并发症及再入院。结论:无导线起搏器低位间隔植入对心脏电学同步性影响与中位间隔起搏相似,起搏部位安全有效。

Unusual course of congenital complete heart block in an adult:A case report

BACKGROUND Congenital complete heart block(CCHB)with normal cardiac structure and negativity for anti-Ro/La antibody is rare.Additionally,CCHB is much less frequently diagnosed in adults,and its natural history in adults is less well known.CASE SUMMARY A 23-year-old woman was admitted to our hospital for frequent syncopal episodes.She had bradycardia at the age of 1 year but had never had impaired exercise capacity or a syncopal episode before admission.The possible diagnosis of acquired complete atrioventricular block was carefully ruled out,and then the diagnosis of CCHB was made.According to existing guidelines,permanent pacemaker implantation was recommended,but the patient declined.With regular follow-up for 28 years,the patient had an unusually good outcome without any invasive intervention or medicine.She had an uneventful pregnancy and led a normally active life without any symptoms of low cardiac output or syncopal recurrence.CONCLUSION This case implies that CCHB in adulthood may have good clinical outcomes and does not always require permanent pacemaker implantation.

Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database

BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has resulted in a worldwide health crisis since it first appeared.Numerous studies demonstrated the virus’s predilection to cardiomyocytes;however,the effects that COVID-19 has on the cardiac conduc-tion system still need to be fully understood.AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks(BBB).METHODS The 2020 National Inpatient Sample(NIS)database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioven-tricular blocks(HDAVB)and right or left BBB utilizing ICD-10 codes.The patients with pre-existing pacemakers,suggestive of a prior diagnosis of HDAVB or BBB,were excluded from the study.The primary outcome was inpatient mortality.Secondary outcomes included total hospital charges(THC),the length of hospital stay(LOS),and other major cardiac outcomes detailed in the Results section.Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17.RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database,of which 3210(0.4%)and 17365(1.6%)patients were newly diagnosed with HDAVB and BBB,respectively.We observed a significantly higher odds of in-hospital mortality,cardiac arrest,cardiogenic shock,sepsis,arrythmias,and acute kidney injury in the COVID-19 and HDAVB group.There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism.Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock than those without BBB.However,unlike HDAVB,COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB.CONCLUSION In conclusion,there is a significantly higher odds of inpatient mortality,cardiac arrest,cardiogenic shock,sepsis,acute kidney injury,supraventricular tachycardia,ventricular tachycardia,THC,and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB.Likewise,patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia,atrial fibrillation,atrial flutter,ventricular tachycardia,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock as compared to those without BBB.Therefore,it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.

Pediatric Post-Operative Atrio-Ventricular Block Meets the Affordable Care Act: A New Strategy for Management

Introduction: Post-operative (post-op) complete atrio-ventricular heart block (CAVB) occurs after 1% - 4% of pediatric cardiac operations. Current practice dictates implantation of permanent pacemaker (PPM) when post-op CAVB persists >9 days. We propose that earlier PPM implantation may be the most cost-effective methodology since patient costs increase with extended length of stay (LOS). Methods: Data on the probabilities of persistent post-op CAVB were extracted from published reports. No individual patient data were utilized during this study. This was utilized to create a decision-making model and a total cost analysis on post-op day 0 - 10 to determine the most cost-efficient day to implant a PPM. Cost variables included estimates of daily cardiac ICU care, cost of PPM implantation, LOS, cost related to possible superficial or deep infection based on published prevalence rates (2.3% and 4.9%, respectively) and need for explant due to deep infection or recovery of native conduction. The model assumes 5-day minimum LOS and 1 day increase in LOS with PPM implantation. Cost data were obtained from relevant billing codes and manufacturer list prices for PPM and leads. A secondary analysis evaluated probability of unnecessary PPMs implanted and excess costs. Results: Post-op day (POD) 4 is the lowest total cost of PPM implantation for post-op CAVB, even when accounting for possible risk of either superficial or deep infection. A one-way sensitivity analysis accounting for variability of cardiac ICU care costs between centers ranging from $3000 - $9000 per day consistently replicates POD 4 as the most cost-effective day for PPM implantation. Implant on POD 4 results in a 26% chance of unnecessary implantation. Conclusions: The most cost-efficient day for PPM implantation for post-op CAVB is post-op day 4, which results in a minimum total cost savings of $17,422 per patient. Added costs due to risk of superficial or deep infection are marginal due to low prevalence of post-operative infection in this population.

希氏束起搏与右心室心尖部起搏对房室传导阻滞患者心脏结构学参数与功能学参数影响的临床研究

目的:探究希氏束起搏(HBP)与右心室心尖部起搏(RVAP)对房室传导阻滞(AVB)患者心脏结构学参数与功能学参数的影响。方法:选取收治的104例AVB患者为研究对象,随机分为HBP组和RVAP组各52例,HBP组行HBP治疗,RVAP组行RVAP治疗,比较两组术前、术后心脏结构学参数、心脏起搏参数、心率和血流动力学参数[心率(HR)、每搏输出量(SV)、心脏指数(CI)和左室射血分数(LVEF)]及QRS时限变化情况。结果:两组手术前后心脏结构学参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)比较,差异均无统计学意义(均P>0.05);术中、术后1个月、术后6个月心脏起搏阈值、R波幅度、电极阻抗比较无统计学差异(均P>0.05);术前、术后1个月,两组HR、SV、CI、LVEF、QRS时限比较无统计学差异(均P>0.05);术后6个月,HBP组HR、SV、CI、LVEF显著高于RVAP组(均P<0.05),RVAP组QRS波时限显著低于HBP组(P<0.05);结论:HBP对AVB患者的电-机械同步性优于RVAP,近期心脏血流动力学及心功能稳定性良好。

左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响

目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。

获得性房室传导阻滞的病因学研究进展

房室传导阻滞(AVB)是引起缓慢性心律失常的主要原因。其病因分为遗传性和获得性,其中获得性因素更为常见。近年来,对获得性AVB的病因学进行探讨发现,其病因复杂,主要包括冠心病、退行性疾病、感染性疾病、风湿性或自身免疫性疾病、浸润性疾病、自主神经功能异常、甲状腺功能减退、高钾血症等。因此,早期明确获得性AVB的病因至关重要,可为其治疗提供针对性策略,以改善预后。随着现代诊疗技术的发展,更多获得性AVB病因的发现将会为其治疗提供新思路。

永久起搏器植入术后2年心房电极穿孔一例

1病例资料患者男性,70岁,因“胸痛8 h余”于2023年1月8日入院。患者入院前8 h无诱因出现胸痛,位于胸骨后,呈绞痛,深呼吸时疼痛加重,持续不缓解,伴胸闷、气短、乏力,无恶心、呕吐,无黑矇、晕厥等。既往于2020年7月27日因“二度Ⅱ型房室传导阻滞”于我院植入永久起搏器(Medtronic Advisa A3DR01 DDDR,Medtronic),起搏器电极型号:右心房Medtronic 5076-52,右心室Medtronic 5076-58,起搏器程控参数见表1。2020年冠状动脉CT血管成像(computed tomography angiography,CTA)检查提示,冠状动脉粥样硬化性心脏病,双支血管病变(前降支中段狭窄50%,回旋支远段狭窄75%),纵隔肿物。建议行冠状动脉造影检查及进一步明确纵隔占位病变性质,患者均拒绝。