scholarly journals Permanent Pacemaker Implantation in a Patient with Takotsubo Cardiomyopathy and Complete Atrioventricular Block

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Toshihiro Terui ◽  
Masumi Iwai-Takano ◽  
Tomoyuki Watanabe
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Wall Motion ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Permanent Pacemaker ◽  
Av Block ◽  
Permanent Pacemaker Implantation ◽  
History Of ◽  
Complete Atrioventricular ◽  
Complete Av Block

This case report presents a patient with Takotsubo cardiomyopathy (TCM) and complete atrioventricular (AV) block who was treated with permanent pacemaker implantation. A 78-year-old woman with a history of hypertension presented with a 6-month history of palpitations. On initial evaluation, her heart rate was 40 beats/minute. Electrocardiography revealed a complete AV block and T-wave inversion in these leads: I, II, aVL, aVF, and V3–6. Echocardiography showed akinesis from the midventricle to the apex and hyperkinesis on the basal segments. The patient was diagnosed with TCM and complete AV block. Because improvement of TCM may subsequently improve the AV node dysfunction associated with TCM, the patient was admitted for treatment of heart failure without pacemaker implantation. The left ventricular (LV) abnormal wall motion improved gradually; however, the AV block persisted intermittently. On hospital day 14, a pause of 5–6 seconds without LV contraction was observed, and permanent pacemaker implantation was performed. On day 92, echocardiography revealed normal LV wall motion. However, electrocardiography revealed that the pacemaker rhythm with atrial sensing and ventricular pacing remained. Although specific degree of damage that may result from AV block associated with TCM is unknown, some of these patients require pacemaker implantation, despite improvement of abnormality in LV wall motion.

scholarly journals Complete heart block associated with Remdesivir in COVID-19: a case report

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Vijairam Selvaraj ◽  
Chirag Bavishi ◽  
Simaben Patel ◽  
Kwame Dapaah-Afriyie
Keyword(s):  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Av Block ◽  
Bundle Branch Block ◽  
Chronotropic Response ◽  
Case Summary ◽  
History Of ◽  
Electrocardiogram Ecg ◽  
Complete Atrioventricular ◽  
Complete Av Block

Abstract Background Since the pandemic began in 2020, Remdesivir has been widely used for the treatment of coronavirus disease-2019 (COVID-19). Here, we describe a case of a patient with COVID-19 who developed transient complete atrioventricular (AV) block and bradycardia after initiating treatment with Remdesivir. Case summary A 72-year-old male with a history of atrial fibrillation and lung cancer was hospitalized for COVID-19. Electrocardiogram (ECG) on admission demonstrated atrial fibrillation and right bundle branch block. He was started on a course of Dexamethasone and Remdesivir. Within 24 h of starting Remdesivir, he was noted to be in atrial fibrillation with ventricular rates between 30 and 40 b.p.m. On Day 5 of Remdesivir therapy, ECG demonstrated complete AV block. Having completed the Remdesivir regimen, during the next 48 h, he was closely monitored, and the AV block resolved spontaneously. As he remained asymptomatic and had an adequate chronotropic response with activity, pacemaker implantation was not recommended. Discussion Despite the widespread use of Remdesivir, there is little known information about its cardiac toxicity. Daily ECGs and close cardiac surveillance of patients who develop severe bradycardia or AV block are essential. Discontinuation of the medication usually results in the resolution of these cardiac disturbances.

scholarly journals An unyielding valve leading to venous spasm during pacemaker implantation: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-4
Author(s):  
Darshan Krishnappa ◽  
Scott Sakaguchi ◽  
Ganesh Kasinadhuni ◽  
Venkatakrishna N Tholakanahalli
Keyword(s):  
Pacemaker Implantation ◽  
Distal Portion ◽  
Permanent Pacemaker ◽  
Permanent Pacemaker Implantation ◽  
Case Summary ◽  
Venous Puncture ◽  
History Of ◽  
Chemical Irritation ◽  
Mechanical Irritation ◽  
Uncommon Complication

Abstract Background Subclavian venous spasm is an uncommon complication during permanent pacemaker implantation. The exact aetiology of subclavian venous spasm is not clear but has been suggested to be due to either mechanical irritation of the vein during needle puncture or due to chemical irritation from contrast injection. Here, we report a case of an unyielding subclavian vein valve that impeded guidewire advancement and the repeated guidewire manipulation led to venous spasm. Case summary A 45-year-old woman with a history of surgical repair of Tetrology of Fallot in childhood presented with symptomatic bifascicular block and underwent a permanent pacemaker implantation. A subclavian venogram done prior to the procedure showed a prominent valve in the distal portion of the vein. Following venous puncture, guidewire advancement was impeded by the prominent valve. The resulting guidewire manipulation led to subclavian venous spasm necessitating a medial subclavian venous puncture and access. Discussion Prolonged mechanical irritation of the vein during pacemaker implantation may lead to venous spasm impeding pacemaker implantation. Early identification of an impeding valve and obtaining access medial to the valve may help prevent this uncommon complication.

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