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

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Gino Lee ◽  
Patrick Badertscher ◽  
Christian Sticherling ◽  
Stefan Osswald
Keyword(s):  
Atrioventricular Block ◽  
Structural Heart Disease ◽  
Av Block ◽  
Lyme Carditis ◽  
Escape Rhythm ◽  
Av Conduction ◽  
Complete Av Block ◽  
Third Degree Atrioventricular Block ◽  
Rule Out ◽  
New Onset

Abstract 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.

Electrophysiological and mathematical characteristics of the escape rhythm during complete AV block

1974 ◽  
Vol 8 (2) ◽  
pp. 173-186 ◽  
Author(s):  
F. URTHALER ◽  
C. R. KATHOLI ◽  
J. MACY ◽  
T. N. JAMES
Keyword(s):  
Av Block ◽  
Escape Rhythm ◽  
Complete Av Block ◽  
Mathematical Characteristics

scholarly journals Successful transcutaneous pacing following ventricular standstill during anaesthetic induction in a dog with third-degree atrioventricular block

2020 ◽  
Vol 8 (3) ◽  
pp. e001146
Author(s):  
Lucy Miller ◽  
Miguel Gozalo-Marcilla ◽  
Geoff Culshaw ◽  
Ambra Panti
Keyword(s):  
General Anaesthesia ◽  
Atrioventricular Block ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Anaesthetic Induction ◽  
Temporary Pacing ◽  
Escape Rhythm ◽  
Transcutaneous Pacing ◽  
Peripheral Pulse ◽  
Third Degree Atrioventricular Block

Third-degree atrioventricular block is a haemodynamically unstable bradycardia frequently resulting in signs of lethargy, weakness and collapse. In this reported case, a four year-four month-old male neutered Cavalier King Charles spaniel diagnosed with third-degree atrioventricular block was referred for transvenous permanent pacemaker implantation. During induction of general anaesthesia, the dog suffered cardiac arrest consistent with ventricular standstill, as indicated by cessation of ventricular electrical activity on the ECG monitor and the absence of a peripheral pulse. The prior placement of transthoracic pacing pads under sedation allowed for rapid commencement of temporary transcutaneous pacing and proved effective in achieving ventricular capture with re-establishment of cardiac output. The subsequent general anaesthesia for implantation of a permanent pacemaker was uneventful. This report considers the possible causes of ventricular escape rhythm suppression and highlights the importance of ensuring availability of a temporary pacing method from the outset when anaesthetising animals with unstable and symptomatic bradycardias.

scholarly journals Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

Healthcare ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 119 ◽  
Author(s):  
Cynthia Yeung ◽  
Adrian Baranchuk
Keyword(s):  
Lyme Disease ◽  
Risk Stratification ◽  
Atrioventricular Block ◽  
Systematic Approach ◽  
Av Block ◽  
Diagnosis And Management ◽  
Favorable Prognosis ◽  
Lyme Carditis ◽  
High Degree ◽  
Risk Stratification Score

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with a highly favorable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

Infra-Hissian complete AV block

2017 ◽  
Author(s):  
Hein Heidbuchel ◽  
Mattias Duytschaever ◽  
Haran Burri
Keyword(s):  
Atrioventricular Block ◽  
Av Block ◽  
Complete Atrioventricular Block ◽  
Complete Atrioventricular ◽  
Complete Av Block

This case examines infra-Hisian complete atrioventricular block with ventriculoatrial conduction

scholarly journals Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

2018 ◽  
Author(s):  
Cynthia Yeung ◽  
Adrian Baranchuk
Keyword(s):  
Lyme Disease ◽  
Risk Stratification ◽  
Atrioventricular Block ◽  
Systematic Approach ◽  
Diagnosis And Treatment ◽  
Av Block ◽  
Diagnosis And Management ◽  
Lyme Carditis ◽  
High Degree ◽  
Risk Stratification Score

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with highly favourable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

P2275Left-sided deviation and fibrous-fatty infiltration of the right bundle branch in the elderly: implication for transcatheter aortic valve implantation (TAVI) procedure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J A Cabrera ◽  
A Porta-Sanchez ◽  
D Nunez Pernas ◽  
J M Rubio ◽  
F Navarro ◽  
...  
Keyword(s):  
Fatty Infiltration ◽  
Ventricular Septum ◽  
Detailed Knowledge ◽  
Fatty Tissue ◽  
Av Block ◽  
Av Conduction ◽  
The Right ◽  
Complete Av Block ◽  
Membranous Septum ◽  
Av Bundle

Abstract Introduction Permanent and irreversible damage to the conduction tissue is one of the most common complications of TAVI. Detailed knowledge of the anatomy of the atrioventricular (AV) bundle is crucial to minimize the potential for injury to the His bundle branch block or complete AV block. Purpose Preexisting anatomic location and damage of the right bundle branch (RBB) may have important unrecognized clinical implications. Methods The myocardial arrangement and the presence of fibrous and fatty tissue infiltration of the AV conduction axis and right bundle branch were examined by dissection techniques and histological sections in 57 structurally normal human heart specimens (48 males, 77±7 years). Results The AV conduction axis enters the AV component of the membranous septum and is encircled by the fibrous tissue of the central fibrous body. The AV bundle is divided in a non-branching portion and a branching portion. After a short distance of the non-branching component along the septal crest, the RBB arises at the end of the branching portion of the conduction axis and is located superficially in the muscular ventricular septum. The RBB takes off from the bundle at the level of origin of the superior fascicle of the left bundle, passing then through the thickness of the ventricular septum to emerge beneath the medial papillary muscle of the tricuspid valve. In 22 hearts (49%) in which we found to have a relatively left-sided deviation of the AV bundle in relation to the interventricular membranous septum the RBB runs intramyocardial along the muscular interventricular septum. In the remaining 51% of the hearts the RBB runs subendocardially in the crest of the interventricular muscular septum. We found connective tissue and fatty infiltration along the right bundle branch in 23 hearts (40%) from its origin to its distal part. A significant correlation was found between age and the presence of RBB fibrosis (85% of hearts from individuals with age >80 years). These 2 conditions may make the RBB very vulnerable to self-expanding aortic valves during or after TAVI (figure). RBB and its critical region Conclusions The presence of an intramyocardial location of the RBB with a lef-sided deviation and the fibro-fatty infiltration found in the mayority of senescent hearts are relevant anatomic determinants that may increase the risk of complete AV block following a TAVI procedure.

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