Abstract 14683: Central Nervous System Mediated Cardiac Bradyarrhythmia With Asystole That Required Permanent Pacemaker in a Young Woman With Anti- NMDAR Encephalitis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yogamaya Mantha ◽  
Azeen Anjum ◽  
Anita G Holtz ◽  
Uday Tatiraju ◽  
Macym Rizvi ◽  
...  
Keyword(s):  
Young Woman ◽  
Autonomic Dysfunction ◽  
Early Recognition ◽  
High Titer ◽  
Brain Mri ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Laboratory Evaluation ◽  
Abnormal Movements ◽  
Permanent Cardiac Pacemaker

Background: We report a young woman who presented with acute psychosis and autonomic dysfunction who was diagnosed with Anti-N-Methyl-D-Aspartate Receptor Encephalitis (anti-NMDARE). Her life-threatening autonomic instability was controlled only after the placement of a permanent cardiac pacemaker. Case Presentation: A 29-year-old woman presented with abnormal movements and depersonalization. Vital signs showed BP 132/94 mmHg, HR 110 beats/min, RR 26 cycles/min, temperature of 101 F and spO2 of 80 % on RA. She was emergently intubated. Laboratory evaluation showed elevated CRP 6.98 mg/dL and CK 3329 U/L. Brain MRI revealed an abnormality in the right amygdala and hippocampus. Infectious workup was negative; however, a high titer of CSF NMDAR antibody was present. CT abdomen and pelvis revealed a 1.1 cm cyst within the left ovary. With a diagnosis of anti-NMDARE, she was treated with plasmapheresis, methylprednisolone, and immunoglobulin G therapy and underwent bilateral salpingo-oophorectomy with pathology confirming a teratoma. Despite these treatments, she continued to display autonomic dysfunction. Telemetry showed tachycardia-bradycardia with asystole that remained refractory to treatment and required placement of a permanent pacemaker (PPM). She showed clinical improvement after PPM and treatment ( Figure ). Conclusion: This is a rare case of severe bradyarrhythmia in anti NMDARE that necessitated placement of a permanent cardiac pacemaker. Neural-mapping studies show that the amygdala and hippocampus strongly modulate autonomic control. Disruption of cortical circuitry related to autonomic tone likely lead to arrhythmias in our case. Class I indications for pacemakers in the ICU include asystole, symptomatic bradycardia with hypotension and/or unresponsive to atropine. Early recognition, cardiorespiratory support, multistep pharmacological care and sometimes early electrophysiological support in anti-NMDARE are paramount.

Correlation between Deep Venous Thrombosis and Inflammation in Patients after Implantation of Permanent Pacemaker

2020 ◽  
Author(s):  
Jianxin MA ◽  
Lian CUI ◽  
Wenjin HUO ◽  
Guanghui WANG ◽  
Xin QUAN ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Pacemaker Implantation ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Inflammatory Factors ◽  
Control Group ◽  
Observation Group ◽  
Permanent Cardiac Pacemaker ◽  
Pai 1

Background: The correlation between postoperative deep venous thrombosis (DVT) and inflammation in patients with permanent cardiac pacemaker implantation was analyzed. Methods: A total of 130 cases undergoing permanent pacemaker implantation in the 305 Hospital of Chinese PLA and Fuwai Hospital from May 2014 to February 2017 were selected. Of the 130 cases, 60 patients complicated with DVT were selected as the observation group, and the remaining 70 cases without complications of DVT were selected as the control group. The relationship and influence of various factors were explored. Results: The number of patients smoking and the number of subjects with DVT history in the observation group were higher than those in the control group. In the observation group, plasminogen activator inhibitor (PAI)-1: Ag, PAI-1: Ac, thrombin-activated fibrinolysis inhibitor (TAFI): Ag, and TAFI: Ac levels were higher than those in control group (P<0.05). The levels of inflammatory factors of the peripheral blood of the observation group were significantly higher than those of the control group (P<0.05). In the correlation analysis of serum inflammatory factors and coagulation factors, CRP, IL-6, IL-10 were positively correlated with PAI-1: Ag level. Age, BMI, smoking history, number of implanted electrodes, DVT history, duration of immobilization and inflammatory factor levels had independent predictive value on postoperative complicated DVT. Conclusion: The serum inflammatory factors are closely associated with postoperative DVT in patients implanted with permanent cardiac pacemaker, and the serum inflammatory factors are a good reference for the evaluation of DVT.

scholarly journals Anesthetic Management of an Elderly Patient with Permanent Pacemaker posted for Fixation of Tibial and Radial Fracture

2015 ◽  
Vol 1 (4) ◽  
pp. 77-79
Author(s):  
GS Karthik ◽  
Praveen Halgunaki ◽  
Rangalakshmi LNU
Keyword(s):  
Elderly Patient ◽  
Anesthetic Management ◽  
Cardiac Pacemaker ◽  
The United States ◽  
Permanent Pacemaker ◽  
Radial Fracture ◽  
Intraoperative Care ◽  
Risk Patients ◽  
Permanent Cardiac Pacemaker

ABSTRACT Cardiac patients with pacemaker presenting for noncardiac surgery pose a considerable challenge to the anesthesiologists. In the United States it is said that there are more than 500,000 patients with pacemaker and every year more than 115,000 devices are implanted. Intraoperative care of the pacemaker as well as understanding its anesthetic implication is crucial in the management of these high-risk patients. We hereby present a case of an 85-year-old male posted for plating of tibial fracture with k-wiring of radius fracture who had permanent cardiac pacemaker in situ. How to cite this article Halgunaki P, Karthik GS, Rangalakshmi, Sahajananda H. Anesthetic Management of an Elderly Patient with Permanent Pacemaker posted for Fixation of Tibial and Radial Fracture. J Med Sci 2015;1(4):77-79.

Safety considerations for performing robotic surgery in the presence of a permanent pacemaker

2018 ◽  
Vol 29 (7-8) ◽  
pp. 242-246
Author(s):  
Sarvpreet S Ubee ◽  
Masilamani Selvan ◽  
Rangaswamy Chandrashekar ◽  
Peter Cooke
Keyword(s):  
Robotic Surgery ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Complex Patients ◽  
Published Report ◽  
Intraoperative Management ◽  
Who Checklist ◽  
Permanent Cardiac Pacemaker ◽  
Safety Considerations ◽  
Access Surgery

With increasing experience, more complex patients are undergoing robotic surgery but the patient safety during these procedures remains paramount. Being a relatively recent technique of minimal access surgery, the safety and feasibility of robotic surgery is still under scrutiny. We recently performed two robotic procedures in patients who have permanent cardiac pacemaker. We believe this is the first published report through which it is shared and discussed, the preoperative and intraoperative management for these patients along with the importance of WHO checklist for safely performing robotic procedures. The importance of pre-procedure planning and briefing cannot be emphasised enough as these along with intraoperative management remain the key step in dealing with an adverse cardiac event due to permanent pacemaker malfunction.

scholarly journals CLINICAL PROFILES OF PATIENTS UNDERGOING PACEMAKER IMPLANTATION

2021 ◽  
Vol 9 (12) ◽  
pp. 703-705
Author(s):  
Owais Ahmed Wani ◽  
◽  
Nasir Ali ◽  
Ouber Qayoom ◽  
Rajveer Beniwal ◽  
...  
Keyword(s):  
Heart Block ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Male Gender ◽  
Observational Methods ◽  
Clinical Profiles ◽  
Implantation Rates ◽  
Permanent Cardiac Pacemaker

Background and Objective: The implantation of a permanent cardiac pacemaker for the treatment of bradyarrhythmia is one of the most popular cardiac interventions. The goal of this study is to look at the clinical profiles of individuals who have permanent pacemakers implanted Material and Methods: The study was conducted using observational methods. The study included patients who received a permanent pacemaker for bradyarrhythmias between November 2019 and November 2021. A thorough review of the demographic profile and indications was performed. Results: The vast majority of the 312 patients were older, with the majority being between the ages of 56 and 88 years old (75 % ). Pacemakers were implanted in more men than in women. Complete heart block was the most common ECG finding and the most common presenting symptom was syncope. The most prevalent sign of pacing was acquired A-V block, and the most common pacemaker mode was single chamber (VVI/VVIR). Conclusion: Acquired A-V block and SSS were found to be the most common reasons for pacemaker implantation in our study. Higher implantation rates were linked to advanced age and male gender.

scholarly journals Anxiety in patients with permanent cardiac pacemaker aged > 60 years old

2020 ◽  
Vol 6 (2) ◽  
pp. 66
Author(s):  
Stella Vasileiou ◽  
Moschoula Mina Iordani ◽  
Illias Martinis ◽  
Alexandra Nikitopoulou ◽  
Jona Sakiqi ◽  
...  
Keyword(s):  
Associated Factors ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Systematic Assessment ◽  
Long Term Follow Up ◽  
Low Levels ◽  
Permanent Cardiac Pacemaker ◽  
Implanted Device

Introduction: A cardiac pacemaker is a small implanted device to control abnormal heart rhythms. According to estimates, 3 million individuals worldwide live with an implanted permanent pacemaker (PPM) while about 600 thousand pacemakers are implanted, annually.Purpose: to explore anxiety of pacemaker recipients as well as all the associated demographic and self-reported characteristics.Material and Method: 100 outpatients with PPM were enrolled in the study. Collection of data was performed by the completion of the “Self-rating Anxiety Scale Zung (SAS)” which included patients' characteristics.  Results: From the 100 participants 65% were men, 66% were >70 years old, 60% married, 50,5% of primary education and 90% lived in Attica. In terms of anxiety, 50% of recipients scored less than 48 on SAS scale (wide of range: 20-80) indicating mild to low levels of anxiety. Regarding associated factors, anxiety was found to be statistically significantly associated with gender (p=<0,001), understanding of provided information (p=<0,001), understanding of precautions in electromagnetic fields (p=0,021), desire for more frequent and long term follow-up and devise assessment (p=<0,001 and p=<0,001, respectively).Conclusions: Though pacemaker is an opportunity to prolong survival, however systematic assessment of anxiety and all the associated factors is considered to be of primary importance in clinical pacemaker settings.

Abstract 17303: Permanent Cardiac Pacemaker Implant Improves Sleep Habit

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Sharma Kattel ◽  
Masaru Hiki ◽  
Takatoshi Kasai ◽  
Yuji Saito ◽  
Hiroyuki Daida
Keyword(s):  
Sudden Cardiac Death ◽  
Sleep Duration ◽  
Cardiac Death ◽  
Cardiac Pacemaker ◽  
Permanent Pacemaker ◽  
Quality Of Sleep ◽  
Sleep Habit ◽  
Symptomatic Bradycardia ◽  
Permanent Cardiac Pacemaker

Background: Permanent cardiac pacemaker is indicated in patients with symptomatic bradycardia. Its role in sleep disorder is unknown, however some patient report improvement in their sleep habit after permanent cardiac pacemaker implant. We examined the role of permanent cardiac pacemaker in relation to patients’ sleeping habits. Methods: Total of 174 patients who agreed to participate in the study were included (21 Implantable Cardioverter Defibrillator (ICD) and 153 pacemaker implants). The ICD group was used as the control group. Patients with bi-ventricular pacemaker implants for cardiac re-synchronization therapy were excluded from the study. Questionnaires about the sleep habit were evaluated before and after the device implant and analyzed using paired T test and Chi square test. Results: The indications for permanent pacemaker therapy were high grade AV block (33%), sick sinus syndrome (64%) and syncope (1%). Indications of ICD were primary or secondary sudden cardiac death prevention without history of known symptomatic bradycardia (100%). Mean Ventricular pacing was 40.39% (interquartile range: 97%) of the time in the pacemaker group. There were no baseline differences in sleep duration and quality of sleep in both the ICD and pacemaker group prior to device implant. Improved sleep habit (46% in pacemaker vs 23% in the ICD group, P=0.04) and better quality of sleep (44% in pacemaker vs 19% in ICD, P=0.01) were reported after device implant. The patients in pacemaker group reported much improvement in sleep duration (average by 30 minutes in Pacemaker vs 15 minutes in ICD, P=0.002). Conclusions: Patients who had permanent pacemaker implant for symptomatic bradycardia showed improved sleep quality and duration than the patients with ICD implant for primary or secondary sudden cardiac death prevention. Mechanisms of improved sleep habit in pacemaker group are unclear, but possibly associated with improved cardiac output with consistent heat rate during sleep from the pacemaker. Further large-scale studies are needed to validate this concept.

scholarly journals In utero MRI identifies consequences of early-gestation alcohol drinking on fetal brain development in rhesus macaques

2020 ◽  
Vol 117 (18) ◽  
pp. 10035-10044
Author(s):  
Xiaojie Wang ◽  
Verginia C. Cuzon Carlson ◽  
Colin Studholme ◽  
Natali Newman ◽  
Matthew M. Ford ◽  
...  
Keyword(s):  
White Matter ◽  
Brain Development ◽  
Ex Vivo ◽  
Early Recognition ◽  
Brain Mri ◽  
Fetal Brain ◽  
Fetal Mri ◽  
Diffusion Anisotropy ◽  
Self Administration ◽  
White Matter Tracts

One factor that contributes to the high prevalence of fetal alcohol spectrum disorder (FASD) is binge-like consumption of alcohol before pregnancy awareness. It is known that treatments are more effective with early recognition of FASD. Recent advances in retrospective motion correction for the reconstruction of three-dimensional (3D) fetal brain MRI have led to significant improvements in the quality and resolution of anatomical and diffusion MRI of the fetal brain. Here, a rhesus macaque model of FASD, involving oral self-administration of 1.5 g/kg ethanol per day beginning prior to pregnancy and extending through the first 60 d of a 168-d gestational term, was utilized to determine whether fetal MRI could detect alcohol-induced abnormalities in brain development. This approach revealed differences between ethanol-exposed and control fetuses at gestation day 135 (G135), but not G110 or G85. At G135, ethanol-exposed fetuses had reduced brainstem and cerebellum volume and water diffusion anisotropy in several white matter tracts, compared to controls. Ex vivo electrophysiological recordings performed on fetal brain tissue obtained immediately following MRI demonstrated that the structural abnormalities observed at G135 are of functional significance. Specifically, spontaneous excitatory postsynaptic current amplitudes measured from individual neurons in the primary somatosensory cortex and putamen strongly correlated with diffusion anisotropy in the white matter tracts that connect these structures. These findings demonstrate that exposure to ethanol early in gestation perturbs development of brain regions associated with motor control in a manner that is detectable with fetal MRI.

scholarly journals Quality Of Life In Patients With Permanent Cardiac Pacemaker In The Slovak Republic

2014 ◽  
Vol 17 (7) ◽  
pp. A496 ◽  
Author(s):  
K. Gerlichova ◽  
E. Simkova ◽  
D. Mastiliakova ◽  
I. Matisakova ◽  
J. Bielik
Keyword(s):  
Quality Of Life ◽  
Slovak Republic ◽  
Cardiac Pacemaker ◽  
Permanent Cardiac Pacemaker

Therapeutic Irradiation over a Permanent Cardiac Pacemaker

1991 ◽  
Vol 14 (2) ◽  
pp. 143-145 ◽  
Author(s):  
R.J. TESKEY ◽  
I. WHELAN ◽  
Y. AKYUREKLI ◽  
L. EAPEN ◽  
M.S. GREEN
Keyword(s):  
Cardiac Pacemaker ◽  
Permanent Cardiac Pacemaker ◽  
Therapeutic Irradiation
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