298Atrioventricular synchronous pacing in leadless ventricular pacemaker is safe and effective in patients with paroxysmal AV block and atrial arrhythmias

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Garweg ◽  
S K Khelae ◽  
J Y S Chan ◽  
L Chinitz ◽  
P Ritter ◽  
...  
Keyword(s):  
Normal Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Mode Switching ◽  
Ventricular Rate ◽  
Low Grade ◽  
Atrial Arrhythmias ◽  
Av Block ◽  
Mode Switch ◽  
Switching Algorithm ◽  
Normal Sinus

Abstract Funding Acknowledgements Medtronic, Inc. Background/Introduction Accelerometer (ACC)-based AV synchronous pacing by tracking atrial activity is feasible using a leadless ventricular pacemaker. Patients may experience variable AV conduction (AVC) and/or atrial arrhythmias during the lifetime of their device. ACC-based AV synchronous pacing should facilitate AVC and pace appropriately in those two common rhythms. Purpose To characterize the behavior of ACC-based AV synchronous pacing algorithms during paroxysmal AV block (AVB) and atrial arrhythmias. Methods The MARVEL2 (Micra Atrial tRacking using a Ventricular accELerometer) was a 5-hour acute study to assess the efficacy of atrial tracking with a temporarily downloaded algorithm into a Micra leadless pacemaker. Patients with a history of AVB were eligible for inclusion. The MARVEL2 algorithm included a mode-switching algorithm that switched between VDD and VVI-40 depending upon AVC status. The AVC algorithm requires 2 ventricular paces (VP) at 40 bpm out of 4 pacing cycles to switch to VDD. Results Overall, 75 patients (age 77.5 ± 11.8 years, 40% female, median time from Micra implant 9.7 months) from 12 centers worldwide were enrolled. During study procedures, 40 patients (53%) had normal sinus rhythm with complete AVB, 18 (24%) had 1:1 AVC, 5 (7%) had varying AVC status, 8 (11%) had atrial arrhythmias, and 2 other rhythms.  Two patients with complete AVB had the AVC mode switch feature disabled due to an idioventricular rate >40 bpm.  Among the 40 subjects with a predominant 3rd degree AVB and normal sinus function the median %VP was 99.9% compared to 0.2% among those with 1:1 AVC (Figure). In the patients with 1:1 AVC, there were 64 opportunities to AVC mode switch with 48 switching to VDI-40. In the other 16 cases (2 patients) the mode remained VDD due to sinus bradycardia varying between 40-45 bpm. High %VP was observed in 2 patients with 1:1 AVC and sinus bradycardia <40 bpm. The AVC mode switch minimized %VP (<1%) in patients with PR intervals > 300 ms (N = 2). Among patients with varying AVC, the algorithm appropriately switched to VDD when the ventricular rate was paced at 40 bpm. During infrequent AVB or AF with ventricular response >40 bpm, VVI-40 mode was maintained. In patients with AF, the ACC signal was of low amplitude and there was infrequent sensing, resulting in VP at the lower rate (50 bpm). In the one patient with atrial flutter, the ACC was intermittently detected, resulting in VP at 67 bpm (IQR 66-67 bpm). Conclusion(s) The mode switching algorithm in the MARVEL2 reduced %VP in patients with 1:1 AVC and appropriately switched to VDD during complete AVB.  If greater AV synchrony or rate support is required, disabling the AVC algorithm may be appropriate for low grade AVB or idioventricular rhythms. In the presence of atrial arrhythmias, the algorithm paced near the lower rate. Abstract Figure. Distribution of VP% by heart rhythm

Some effects of breath holding and apneic underwater diving on cardiac rhythm in man

1962 ◽  
Vol 17 (3) ◽  
pp. 461-466 ◽  
Author(s):  
C. Robert Olsen ◽  
Darrell D. Fanestil ◽  
Per F. Scholander
Keyword(s):  
Cardiac Arrhythmias ◽  
Cardiac Rhythm ◽  
Sinus Tachycardia ◽  
Normal Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Breath Holding ◽  
Sinus Arrest ◽  
Sinus Arrhythmia ◽  
Normal Sinus ◽  
Idioventricular Rhythm

Man's bradycardic response to simple breath holding was augmented by submersion in water of 27 C and was not prevented by muscular exercise. Cardiac arrhythmias occurred with 45 of 64 periods of apnea in 16 subjects and were more frequent during the dives than during breath holding. These arrhythmias, with the exception of atrial, nodal, and ventricular premature contractions, were inhibitory in type and included sinus bradycardia and arrhythmia, sinus arrest followed by either nodal escape or ventricular escape, A-V block, A-V nodal rhythm, and idioventricular rhythm. T waves frequently became tall and peaked during both breath holding and dives. Prompt return to normal sinus rhythm was the rule with the first breath after surfacing. Sinus tachycardia, sinus arrhythmia, and atrial, nodal, or ventricular premature contractions were seen during recovery. Submitted on October 9, 1961

Relation of initial resting ventricular rate to the ability to achieve and maintain normal sinus rhythm in patients with atrial fibrillation

2005 ◽  
Vol 95 (5) ◽  
pp. 597-602 ◽  
Author(s):  
Howard A. Cooper ◽  
Joseph Sacco ◽  
Allen J. Solomon ◽  
Gregory K. Feld ◽  
Robert Leman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Ventricular Rate ◽  
Normal Sinus

Perioperative Outcomes and Safety of Atrial Fibrillation Catheter Ablation in Octogenarians: A Retrospective Study and Review of the Benefits of Rhythm Control

Cardiology ◽  
2017 ◽  
Vol 137 (3) ◽  
pp. 173-178
Author(s):  
Stephanie Hakimian ◽  
Juan C. Camacho ◽  
Edwin Grajeda Silvestri ◽  
Farid AbdelMalak ◽  
Elie Donath ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Normal Sinus Rhythm ◽  
Therapeutic Option ◽  
Sinus Bradycardia ◽  
Age Groups ◽  
Coronary Intervention ◽  
Rhythm Control ◽  
Perioperative Outcomes ◽  
Normal Sinus

Objectives: Catheter ablation for rhythm control has emerged as a successful therapeutic option for the treatment of atrial fibrillation (AF), though it has not been well studied in octogenarians. This study evaluates its safety in octogenarians in a community hospital and reviews the benefits of rhythm control. Methods: Among 1,592 patients undergoing AF ablation, 84 octogenarian were identified. The primary outcome was normal sinus rhythm (NSR) on electrocardiogram at discharge. Secondary outcomes were periprocedural complications and markers and risks of reablation compared to younger cohorts. Results: An NSR on discharge occurred in 83 patients. Three patients required pacing for symptomatic sinus bradycardia, complete heart block, and symptomatic junctional bradycardia, respectively. Reablation for recurrent AF occurred in 23 octogenarians. Using the octogenarians as reference, the relative risk (RR) of 1 reablation was not significantly different among the age groups 70-79, 60-69, and <60 years. The RR of 2 reablations was greater in the octogenarian group (RR 0.26 [95% CI 0.09-0.71, p = 0.008], 0.42 [95% CI 0.17-1.04, p = 0.06], and 0.27 [95% CI 0.1-0.75, p = 0.01], respectively). Coronary artery disease (OR 0.14, 95% CI 0.02-0.68, p = 0.026) and percutaneous coronary intervention (OR 0.13, 95% CI 0.02-0.63, p = 0.021) were markers for reablation. Conclusion: AF catheter ablation achieved an NSR with minimal periprocedural complications. The benefits of rhythm control should be considered in treatment.

Normal Sinus Rhythm–Sinus Bradycardia is Common in Young Children Post-extracardiac Fontan

2016 ◽  
Vol 37 (7) ◽  
pp. 1377-1379
Author(s):  
William N. Evans ◽  
Ruben J. Acherman ◽  
Humberto Restrepo
Keyword(s):  
Young Children ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Normal Sinus ◽  
Extracardiac Fontan

scholarly journals Classification of Atrial Arrhythmias using Neural Networks

2018 ◽  
Vol 7 (2) ◽  
pp. 90 ◽  
Author(s):  
Jai Utkarsh ◽  
Raju Kumar Pandey ◽  
Shrey Kumar Dubey ◽  
Shubham Sinha ◽  
S. S. Sahu
Keyword(s):  
Normal Sinus Rhythm ◽  
High Accuracy ◽  
Ecg Signal ◽  
Atrial Arrhythmias ◽  
Autoregressive Modelling ◽  
Test Set ◽  
Normal Sinus ◽  
The Neural Network ◽  
Electrocardiogram Ecg

Electrocardiogram (ECG) is an important tool used by clinicians for successful diagnosis and detection of Arrhythmias, like Atrial Fibrillation (AF) and Atrial Flutter (AFL). In this manuscript, an efficient technique of classifying atrial arrhythmias from Normal Sinus Rhythm (NSR) has been presented. Autoregressive Modelling has been used to capture the features of the ECG signal, which are then fed as inputs to the neural network for classification. The standard database available at Physionet Bank repository has been used for training, validation and testing of the model. Exhaustive experimental study has been carried out by extracting ECG samples of duration of 5 seconds, 10 seconds and 20 seconds. It provides an accuracy of 99% and 94.3% on training and test set respectively for 5 sec recordings. In 10 sec and 20 sec samples it shows 100% accuracy. Thus, the proposed method can be used to detect the arrhythmias in a small duration recordings with a fairly high accuracy.

scholarly journals Do all patients with atrial fibrillation need long-term anticoagulation?

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Munish Sharma ◽  
Rohit Masih ◽  
Daniel A.N. Mascarenhas
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Oral Anticoagulants ◽  
Heart Association ◽  
The United States ◽  
Ventricular Rate ◽  
Normal Sinus ◽  
Systemic Embolization

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this. Many times, a patient may not be in AF chronically, nor is the AF burden (the amount of time patient is in AF out of the total monitored time) calculated. We present three cases of new onset transient AF triggered by temporary stressors. We were able to restore normal sinus rhythm (NSR) with chemical cardioversion. As per 2014 American College of Cardiology (ACC)/American Heart Association (AHA) recommendations, we started all three patients on OACs based on CHA<sub>2</sub>DS<sub>2</sub>VASc score <span style="text-decoration: underline;">&gt;</span>2. However, the patients refused long term OACs after restoration of NSR and correction of the temporary enticing stressors. In any case, the decision to start OACs would have had its own risks. Here we describe how antiarrhythmic drugs were used to maintain NSR, all while they were continuously monitored to determine the need to continue OACs.

scholarly journals Hyperthyroidism With Atrial Fibrillation in Children: A Case Report and Review of the Literature

2021 ◽  
Vol 12 ◽  
Author(s):  
Deepa Subramonian ◽  
Yuwei Juliana Wu ◽  
Shazhan Amed ◽  
Shubhayan Sanatani
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Thyroid Hormone ◽  
Mitral Regurgitation ◽  
Normal Sinus Rhythm ◽  
Ventricular Rate ◽  
Review Of The Literature ◽  
Free T4 ◽  
Normal Sinus ◽  
Current Guidelines

Atrial fibrillation is exceedingly rare in children with structurally and functionally normal hearts. We present a novel case of a 15-year-old female with known hyperthyroidism who subsequently developed atrial fibrillation. She had been suffering from fatigue, heat intolerance and myalgias for 6 months. Her initial TSH was 0.01mU/L, and free T4 was 75.4 pmol/L, with a free T3 of &gt;30.8 pmol/L. An electrocardiogram showed atrial fibrillation with a ventricular rate of 141 beats per minute. An echocardiogram demonstrated an enlarged left atrium and ventricle, with mild mitral regurgitation. She was treated with methimazole and underwent synchronized cardioversion. She subsequently returned to a euthyroid state and remained in normal sinus rhythm. In this case, we discuss the physiologic and arrhythmogenic properties of thyroid hormone, with a summary of the existing literature on atrial fibrillation in hyperthyroidism in children. Current guidelines for treatment of atrial fibrillation are also outlined.

Bradyarrhythmias

2018 ◽  
Author(s):  
Kim Rajappan
Keyword(s):  
Heart Rate ◽  
Sick Sinus Syndrome ◽  
Sinus Bradycardia ◽  
Sinus Node ◽  
Ventricular Rate ◽  
Type I ◽  
Av Block ◽  
Node Disease ◽  
Wenckebach Phenomenon ◽  
Mobitz Type

A bradyarrhythmia is defined as a rhythm disturbance that results in a heart rate of less than 60 bpm. It is important to note that many healthy people have a resting heart rate that is less than 60 bpm, most commonly due to sinus bradycardia (i.e. a rhythm arising from the sinus node but with a ventricular rate less than 60 bpm). Other forms of bradyarrhythmia are sinus node disease, sick sinus syndrome, first-degree atrioventricular (AV) block, second-degree AV block (which can be characterized as Möbitz type I (Wenckebach phenomenon) or Möbitz type II), and third-degree AV block (also known as complete heart block). This chapter discusses the bradyarrhythmias, focusing on their etiology, symptoms, demographics, diagnosis, prognosis, and treatment.

scholarly journals Lyme Carditis Buried Beneath ST-Segment Elevations

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Basia Michalski ◽  
Adrian Umpierrez De Reguero
Keyword(s):  
Lyme Disease ◽  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Young Patients ◽  
Acute Myocardial Ischemia ◽  
Av Block ◽  
Normal Sinus ◽  
Lyme Carditis ◽  
St Segment ◽  
Common Manifestation

Lyme disease is caused by the spirochete Borrelia burgdorferi and is carried to human hosts by infected ticks. There are nearly 30,000 cases of Lyme disease reported to the CDC each year, with 3-4% of those cases reporting Lyme carditis. The most common manifestation of Lyme carditis is partial heart block following bacterial-induced inflammation of the conducting nodes. Here we report a 45-year-old gentleman that presented to the hospital with intense nonradiating chest pressure and tightness. Lab studies were remarkable for elevated troponins. EKG demonstrated normal sinus rhythm with mild ST elevations. Three weeks prior to hospital presentation, patient had gone hunting near Madison. One week prior to admission, he noticed an erythematous lesion on his right shoulder. Because of his constellation of history, arthralgias, and carditis, he was started on ceftriaxone to treat probable Lyme disease. This case illustrates the importance of thorough history taking and extensive physical examination when assessing a case of possible acute myocardial infarction. Because Lyme carditis is reversible, recognition of this syndrome in young patients, whether in the form of AV block, myocarditis, or acute myocardial ischemia, is critical to the initiation of appropriate antibiotics in order to prevent permanent heart block, or even death.

Sign in / Sign up

Export Citation Format

Share Document