scholarly journals Unmasking of infra‐Hisian conduction abnormality by intravenous isoproterenol during electrophysiology study for syncope

2021 ◽  
Author(s):  
Debabrata Bera ◽  
Debdatta Majumdar ◽  
Sanjeev S. Mukherjee ◽  
Suchit Majumder ◽  
Sanjeev Kathuria
Keyword(s):  
Conduction Abnormality ◽  
Electrophysiology Study

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

2020 ◽  
Author(s):  
Firas Ajam ◽  
Arda Akoluk ◽  
Anas Alrefaee ◽  
Natasha Campbell ◽  
Avais Masud ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Conduction ◽  
Future Research ◽  
Dialysis Patients ◽  
Bundle Branch Block ◽  
Conduction Abnormality ◽  
Ckd Stage ◽  
Stage 1 ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

scholarly journals Abolishment of high-risk left lateral accessory pathway by myocardial infarction: a blessing in disguise? A case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Jim O’Brien ◽  
Nikola Kozhuharov ◽  
Shui Hao Chin ◽  
Mark Hall
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Case Report ◽  
High Risk ◽  
Coronary Sinus ◽  
Refractory Period ◽  
Accessory Pathway ◽  
Coronary Syndrome ◽  
Electrophysiology Study ◽  
Anomalous Coronary

Abstract Background Antegradely conducting left lateral accessory pathways are a risk for supraventricular tachycardias and pre-excited atrial fibrillation. Rarely, an anomalous coronary sinus can cause difficulty in locating the pathway. The left circumflex coronary artery and obtuse marginal branches supply the posterolateral left ventricle. We describe a case report of a high-risk accessory pathway associated with an anomalous coronary sinus which, between successive electrophysiology studies, was obliterated by a felicitous acute coronary syndrome in the left circumflex territory. Case summary A 49-year-old male with palpitations and manifest pre-excitation was referred for electrophysiology study. Initial study revealed a high-risk left lateral accessory pathway with antegrade effective refractory period of 240 ms and rapidly conducting pre-excited atrial fibrillation. The coronary sinus could not be cannulated to localize the pathway. Coronary angiography and cardiac computed tomography showed an anomalous coronary sinus emptying into the right atrial free wall and patent coronaries. While awaiting repeat electrophysiology study, the patient suffered an acute coronary syndrome with immediate loss of previously visible pre-excitation on electrocardiogram, and underwent stenting of an occluded marginal branch of the circumflex. Repeat electrophysiology study demonstrated a now low-risk accessory pathway (effective refractory period 390 ms). Since infarction, the patient’s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation. Discussion Left lateral accessory pathways, which can associate with an anomalous coronary sinus, derive from tissue similar to normal ventricular myocardium and are vulnerable to ischaemic insults in the area subtended by the circumflex artery.

Cardiac Electrophysiology Study, Diagnostic Maneuvers and Ablation

2016 ◽  
pp. 39-102
Author(s):  
Benedict M. Glover ◽  
Orla Buckley ◽  
Siew Yen Ho ◽  
Damian Sanchez-Quintana ◽  
Pedro Brugada
Keyword(s):  
Cardiac Electrophysiology ◽  
Electrophysiology Study

A Case of Patient Suspected Familial Dilated Cardiomyopathy with Conduction Abnormality

2013 ◽  
Vol 19 (10) ◽  
pp. S175
Author(s):  
Yasufumi Nagata ◽  
Masaru Araki ◽  
Masaaki Takeuchi ◽  
Hidetoshi Yoshitani ◽  
Kyoko Otani ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Conduction Abnormality ◽  
Familial Dilated Cardiomyopathy

scholarly journals Incidental Findings of Brugada Syndrome Type-1 and Epsilon-Like Pattern in Otherwise Healthy Man: a Case Report

2022 ◽  
Author(s):  
Brian Mendel ◽  
Valerie Dirjayanto ◽  
Radityo Prakoso ◽  
Sisca Siagian
Keyword(s):  
Brugada Syndrome ◽  
Unknown Origin ◽  
Initial Assessment ◽  
Structural Abnormality ◽  
Bundle Branch Block ◽  
Case Presentation ◽  
Electrophysiology Study ◽  
Esc Guidelines

Abstract Background: Brugada Syndrome (BrS) and arrhythmogenic right ventricle dysplasia (ARVD) are rare cardiomyopathies predisposing to sudden cardiac death (SCD). Comprehending the electrocardiographic features of these cardiomyopathies are crucial especially in emergency settings.Case presentation: A 25-year old medical student presented with no complaints, but had episodes of syncope, chest pain, and palpitations of unknown origin 10 years ago. The initial assessment showed stable hemodynamics. During examination, the ECG demonstrated incomplete right bundle branch block, Brugada-type 1 pattern, with signs of Epsilon wave. The following year, assessment of the ECG was repeated and findings were found suggestive of Brugada syndrome, although his echocardiography showed no structural abnormality. According to ESC guidelines, asymptomatic Brugada patients should undergo electrophysiology study.Conclusion: Careful follow-up with electrophysiology study is recommended for this patient in order to identify the likelihood of true Brugada and suitability for radiofrequency ablation or implantation of implantable cardioverter defibrillator (ICD).

scholarly journals Split Accessory Pathway Potentials in a Patient with Antidromic AVRT

2021 ◽  
Author(s):  
Weizhuo Liu ◽  
Wentao Gu ◽  
Xinping Luo ◽  
Jian Li ◽  
Nanqing Xiong
Keyword(s):  
Accessory Pathway ◽  
Conduction Delay ◽  
Tricuspid Annulus ◽  
Reentrant Tachycardia ◽  
Delta Wave ◽  
Electrophysiology Study ◽  
Isoproterenol Infusion

A 27-year-old female presenting palpitation without ECG documentation underwent electrophysiology study. EP study revealed atrioventricular accessory pathway with poor and unidirectional pathway conduction, and a fasciculoventricular pathway. During isoproterenol infusion, delta wave promptly became prominent, after which an antidromic AV reentrant tachycardia was induced. When the pathway was mapped, widely split double pathway potentials were observed at 12 o’clock site of tricuspid annulus during mild preexcitation, demonstrating an example of intra-pathway conduction delay, which can be reversed by isoproterenol. Ablation at the site caused accelerated pathway rhythm and eliminated the pathway, rendering the tachycardia non-inducible.

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