scholarly journals Management of pacemaker patients after myocardial infarction

2021 ◽  
pp. 61-67
Author(s):  
I. A. Bryuhanova ◽  
E. V. Gorbunova ◽  
K. V. Bakovsky ◽  
S. E. Mamchur
Keyword(s):  
Myocardial Infarction ◽  
Pacemaker Implantation ◽  
Coronary Intervention ◽  
Cardiac Conduction ◽  
Dynamic Monitoring ◽  
Pacing Threshold ◽  
Efficient Operation ◽  
Conduction Disorders ◽  
Equipment Safety ◽  
Implantable Pacemaker

Myocardial infarction (MI) is the leading cause of death and disability in the population. Effective restoration of coronary blood flow in the infarction-dependent artery during percutaneous coronary intervention contributes to the regression of structural and functional remodeling of the left ventricle. Meanwhile, in 18% of cases, patients with myocardial infarction require implantation of a pacemaker because of the cardiac conduction disorders, among which atrioventricular blockade is the leading one. The need for pacemaker implantation is determined by the clinical features and the type of bradycardia complicating myocardial infarction. The scope of preventive measures at the stage of outpatient specialized cardiac care for patients with myocardial infarction and pacemaker includes medical, physical, and psychological rehabilitation. In addition, the presence of an implantable pacemaker necessitates specialized dynamic monitoring by an arrhythmologist, including programming the pacemaker. Performing a magnetic test allows to assess the efficiency of the pacemaker, the level of its charge and promptly determine the need to its replacement. Determination of the pacing threshold ensures efficient operation of the implantable device. After discharge from the hospital, a schedule for checking the pacemaker is determined, namely, 3 months after the date of implantation of the pacemaker, then 1-2 times a year. In the event of complaints of dizziness, fainting or damage of the pacemaker implantation site, the pacemaker check is carried out unscheduled. Patients with a history of myocardial infarction and an implantable pacemaker should be informed about the limitations that may be associated with the presence of a pacemaker. It is recommended to exclude contact with possible sources of electrical interference as much as possible, to avoid medical physiotherapy using galvanic currents. When using industrial or household equipment, safety precautions must be followed.

Cardiogenic shock in myocardial infarction-results of in-hospital follow-up

Open Medicine ◽  
2011 ◽  
Vol 6 (2) ◽  
pp. 213-219
Author(s):  
Damian Kawecki ◽  
Beata Morawiec ◽  
Renata Rybczyk ◽  
Zofia Trzepaczyńska ◽  
Brygida Przywara-Chowaniec ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Coronary Intervention ◽  
Short Term ◽  
Invasive Treatment ◽  
Conduction Disorders ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

AbstractThe purpose of this study was to present the outcomes of treatment of cardiogenic shock (CS) complicating acute myocardial infarction (AMI) among patients hospitalized from 1999 through 2006. The study enrolled 1003 patients. Group 1 comprised 87 patients presenting with AMI complicated with CS, whereas Group 2 comprised 916 patients presenting with AMI without CS symptoms. Determination of invasive treatment was according to standard guidelines. The endpoint comprised death, stroke, and reocclusion/reinfarction. Follow-up was confined to the intra-hospital period. CS was observed more frequently in cases of ST-elevation MI (STEMI) and right ventricular MI. The transportation and door-to-needle time were shorter in Group 1. CS patients were characterized by a more severe coronary artery disease, higher maximal creatinine kinase levels, lower global ejection fractions, and increased incidence of atrioventricular conduction disorders. The efficacy of percutaneous coronary intervention (PCI) was 82.26% in Group 1 and 95.03% in Group 2. Death occurred in 33.3% of CS patients and in 3.6% of AMI patients (p<0.0001). Our study proved that in a short-term follow-up, PCI is a procedure of high efficacy in CS patients. The short-term follow-up precluded a conclusion of statistically significant benefits from the shortening of the transportation and door-to-needle time.

Abstract 16603: Appropriate Timing of Pacemaker Implantation in Patients With Wild-Type and Variant Amyloidogenic Transthyretin Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yusei Kawahara ◽  
Miwa Ito ◽  
Tadashi Hoshiyama ◽  
Hisanori Kanazawa ◽  
Kenichi Tsujita
Keyword(s):  
Cardiac Amyloidosis ◽  
Pacemaker Implantation ◽  
The Other ◽  
Cardiac Conduction ◽  
Wild Type ◽  
Conduction Disorders ◽  
Other Hand ◽  
Conduction Disorder ◽  
Second Degree

Background and Objectives: It has been shown that cardiac conduction disorders can be seen in patients with wild-type amyloidogenic transthyretin (ATTRwt) and variant ATTR (ATTRv) cardiac amyloidosis. However, its appropriate timing of pacemaker implantation has not been clarified yet. Methods and Results: The consecutive 100 patients with ATTRwt cardiac amyloidosis who diagnosed by myocardium biopsy and/or technetium-99m-pyrophosphate scintigraphy and 62 patients with ATTRv cardiac amyloidosis who diagnosed by means of genetic screening were included in this study. In patients with ATTRwt cardiac amyloidosis, 21 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in only 5 patient (first degree atrioventricular block (AVB); 4 patients, complete AVB; 1 patients) and only one patient underwent cardiac implantable electric device (CIED) implantation during follow-up period. On the other hand, in patients with ATTRv cardiac amyloidosis, 36 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in 13 patient (first degree AVB; 8 patients, second degree AVB; 3 patients, trifascicular block; 1 patients, complete AVB; 1 patients) (5/21 vs 13/36, p=0.335) and 6 patients underwent CIED implantation during follow-up period (1/21 vs 6/36, p=0.186). Furthermore, in ATTRwt cardiac amyloidosis, 10 patients (first degree AVB; 2 patients, second degree AVB; 1 patient, trifascicular block; 7 patients) had underwent CIED implantation because of cardiac conduction disorders and/or prevention of sudden cardiac death. However, only 4 patients with trifascicular block progressed to complete AVB.On the other hand, In ATTRv cardiac amyloidosis, 14 patients (first degree AVB; 2 patients, second degree AVB; 4 patient, trifascicular block; 8 patients) had underwent CIED implantation for same reason. However, only 3 patients with trifascicular block progressed to complete AVB. Conclusions: Patients with ATTRv cardiac amyloidosis were more likely to progress conduction disorders than those with ATTRwt cardiac amyloidosis. However, prophylactic pacemaker implantation might had not need in both ATTRwt and ATTRv patients with first or second degree AVB.

scholarly journals Pseudopacemaker syndrome and marked first-degree atrioventricular block: Case report

2010 ◽  
Vol 138 (9-10) ◽  
pp. 635-638
Author(s):  
Ivan Stankovic ◽  
Biljana Putnikovic ◽  
Milos Panic ◽  
Alja Vlahovic-Stipac ◽  
Aleksandar Neskovic
Keyword(s):  
Myocardial Infarction ◽  
Pacemaker Implantation ◽  
Coronary Intervention ◽  
Bare Metal Stent ◽  
P Wave ◽  
Av Block ◽  
Inferior Myocardial Infarction ◽  
Temporary Pacing ◽  
Pacemaker Syndrome ◽  
Acute Inferior Myocardial Infarction

Introduction. Pacemaker syndrome consists of the symptoms and signs present in the single chamber (VVI) pacemaker patient with electrode placed in the right ventricular apex. It is caused by inadequate timing of atrial and ventricular contractions. Pacemaker syndrome without a pacemaker (or pseudopacemaker syndrome) refers to occurrence of symptoms in the presence of marked first-degree atrioventricular (AV) block, when P wave is too close to the preceding QRS complex producing the same haemodynamic disturbance as artificial pacemaker cardiac stimulation with retrograde VA conduction. Case Outline. We present the patient with acute inferior myocardial infarction due to late bare metal stent thrombosis, treated with primary pectutaneous coronary intervention. Hospital course was complicated by complete heart block which was treated with temporary pacing. During the stand-by mode of temporary pacing, sinus rhythm with marked first-degree AV block (PQ interval 480 ms) was observed while the patients re-experienced the symptoms that were present prior to pacemaker implantation. Temporary pacing was continued for the next 24 hours when spontaneous shorteninig of PQ interval (250-270 ms) was noticed; since the patient was asymptomatic during the stand-by mode, the pacemaker electrodes were removed and the patient discharged 11 days after admission. Conclusion. Conduction disturbances, such as the varying degrees of AV blocks, are relatively common in acute inferior myocardial infarction. The first degree AV blok is usually asymptomatic and does not require treatment, unless when it is associated with pseudopacemaker syndrome. In that case, temporary pacing provides haemodynamic stability until conduction system recovers.

His bundle pacing in older patient with continuous proximal atrio-ventricular block after myocardial infarction

2018 ◽  
Vol 3 (48) ◽  
pp. 24-27
Author(s):  
Agnieszka Wojdyła-Hordyńska ◽  
Grzegorz Hordyński ◽  
Pavel Dąbrowski ◽  
Tomasz Pawlik ◽  
Agata Kubal-Tkocz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Diastolic Dysfunction ◽  
Conduction Block ◽  
Coronary Intervention ◽  
Atrioventricular Conduction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disorders ◽  
Percutaneous Coronary ◽  
Pr Interval

His bundle pacing (HBP) synchronizes atrio-ventricular and intraventricular delays. We observed the relationship between the level of atrio-ventricular block, ventricles synchrony, diastolic function improvement in a patient with moderate systolic disorders and diastolic dysfunction after myocardial infarction. HBP may be useful to treat conduction disorders and prevent further systolic and diastolic dysfunction. We present the case of a 92-year-old man in a very good general psychophysical status, treated with percutaneous coronary intervention of circumferential branch of left coronary artery angioplasty due to myocardial infarction, regional contractility disorders of left ventricle with ejection fraction (LVEF) 45%, and observed long PR interval with paroxysmal second degree atrioventricular conduction block. A successful implantation of a permanent HBP lead in the postinfarction period was performed. The His bundle capture restored AV synchrony and diminished diastolic disorders. Our case demonstrates that atrioventricular conduction disorders in the course of myocardial infarction may be corrected by HBP.

scholarly journals Comparing outcomes of transcatheter versus surgical aortic valve replacement in patients with atrial arrythmias

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Gill
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Atrial Flutter ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Cardiac Conduction ◽  
Surgical Aortic Valve Replacement ◽  
Conduction Disorders ◽  
Risk Patients

Abstract Introduction In patients with severe aortic valve stenosis, clinical trials have demonstrated a similar mortality risk with transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low to intermediate-risk patients. However, data comparing these procedures in patients with atrial arrhythmias is lacking. Purpose This study aimed to evaluate and compare the in-hospital mortality and outcomes of TAVR and SAVR for severe aortic stenosis in patients with atrial fibrillation or atrial flutter. Methods We performed a retrospective cross-sectional analysis using the 2018 National Inpatient Sample. Patients aged 50 years and older with TAVR or SAVR related hospitalizations were identified. Patients with endocarditis and those undergoing coronary artery bypass grafting or other valvular procedures were excluded. Propensity score matching was utilized to mitigate selection bias. The scoring was based on a multivariate logistic regression model accounting for age, gender, race, hospital type, hospital region, hospital teaching status, median household income, and medical comorbidities. Using 8-to-1-digit match, we paired each admission in TAVR group with one admission in SAVR group. Results In 2018, a total of 3487 TAVRs and 1466 SAVRs were performed in patients who had atrial fibrillation or atrial flutter. TAVR and SAVR had no statistically significant difference in inpatient mortality (0.9% vs 0.8%, p=0.79). However, SAVR was associated with higher odds of cardiogenic shock (OR 1.82; 95% CI 1.41–2.35, p&lt;0.0001), acute kidney injury (OR 2.29; 95% CI 1.77–2.97, p&lt;0.0001), mechanical ventilation (OR 2.06; 95% CI 1.75–2.43, p&lt;0.0001), pneumonia (OR 1.76; 95% CI 1.37–2.28, p&lt;0.0001), pneumothorax (OR 6.38; 95% CI 4.17–9.76, p&lt;0.0001) and postoperative hemorrhage (OR 3.21; 95% CI 2.13–4.85, p&lt;0.0001). On the contrary, SAVR was associated with decreased likelihood of subsequent cardiac conduction disorders (OR 0.63; 95% CI 0.51–0.79, p&lt;0.0001) and pacemaker implantation (OR 0.69; 95% CI 0.49–0.98, p=0.037). SAVR was associated with an increased length of hospitalization (3.9 vs. 8.4 days, p&lt;0.0001), with no difference in medical costs. Conclusion Inpatient mortality for TAVR and SAVR was similar in patients with atrial fibrillation and atrial flutter. TAVR was associated with a lower risk of inpatient complications, indicating greater suitability for high-risk patients. However, clinicians should be cognizant of the increased risk for cardiac conduction disorders after TAVR, necessitating pacemaker implantation. FUNDunding Acknowledgement Type of funding sources: None. Characteristics of the matched cohort Forest plot comparing outcomes

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