A Case of 2:1 Atrio-Ventricular Block- Unravelled by Exercise Testing

2020 ◽  
Vol 02 ◽  
Author(s):  
Sharada Sivaram Kalavakolanu ◽  
Madan Mohan Balakrishnan ◽  
Deepesh Venkatarama
Keyword(s):  
Exercise Testing ◽  
Exercise Test ◽  
Heart Block ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Ecg Monitoring ◽  
Permanent Pacing ◽  
Mill Test

: We present a case of 75-year-old lady with effort intolerance and baseline ECG showing 2:1 atrio-ventricular block, in whom it was unclear as to requirement of permanent pacing, even after long term ECG monitoring. She underwent a tread mill test during which her QRS became wide and developed complete heart block within 2 minutes of the test. Thus, a simple exercise test helped in confirming level of block to be infra nodal without need for invasive study. In patients with exertional symptoms, even in elderly, and in those where ECG masquerades as a benign entity, exercise testing is useful to differentiate benign cases of atrio-ventricular block from the more serious cases that mandate a pacemaker implantation.

scholarly journals Mucormycosis: An Uncommon Cutaneous Infection at Permanent Pacemaker-Implanted Site in a Very Low-Birthweight Baby

2022 ◽  
Author(s):  
Minati Choudhury ◽  
Jitin Narula ◽  
Milind P. Hote ◽  
Sarita Mohapatra
Keyword(s):  
Heart Block ◽  
Low Birthweight ◽  
Pulse Generator ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Cutaneous Infection ◽  
Very Low Birthweight ◽  
Congenital Complete Heart Block ◽  
Life Threatening

AbstractPermanent pacemaker implantation in low birthweight (LBW) babies with congenital complete heart block is extremely challenging due to a paucity of appropriate pulse generator placement pocket sites. The development of infection following an implantation procedure can pose a life-threatening risk to the patients. With more patients in the younger group receiving these devices than ever before and the rate of infection increasing rapidly, a closer look at the burden of infection and its impact on outcome of these patients is warranted. We report mucormycosis infection at the abdominal pacemaker pocket site of an infant requiring pacemaker explantation and re-insertion into the intrapleural space.

scholarly journals Complete Heart Block, Severe Right Ventricular Dysfunction in a Child with COVID-19 Infection

2021 ◽  
pp. 1-10
Author(s):  
Sezen Gulumser Sisko ◽  
Sezen Ugan Atik ◽  
Cem Karadeniz ◽  
Alper Guzeltas ◽  
Yakup Ergul
Keyword(s):  
Atrioventricular Block ◽  
Heart Block ◽  
Ventricular Dysfunction ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Complete Atrioventricular Block ◽  
Right Heart ◽  
Complete Atrioventricular

Abstract A young child presented with hepatomegaly, ascites, and bradycardia in the setting of coronavirus disease-2019. Permanent complete atrioventricular block and severe right heart failure were diagnosed. He was treated with surgical epicardial pacemaker implantation. This report is the first description of coronavirus disease-2019–induced permanent complete atrioventricular block in a child.

scholarly journals Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1243
Author(s):  
Andrianto Andrianto ◽  
Eka Prasetya Budi Mulia ◽  
Denny Suwanto ◽  
Dita Aulia Rachmi ◽  
Mohammad Yogiarto
Keyword(s):  
Pericardial Effusion ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tongue Cancer ◽  
Pacemaker Implantation ◽  
Metastatic Tumor ◽  
Variable Number ◽  
Permanent Pacemaker ◽  
Cardiac Metastasis ◽  
Temporary Pacemaker

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

scholarly journals Nearly fatal ventricular arrhythmia following pacemaker implantation in a young female with complete heart block

2019 ◽  
Vol 35 (5) ◽  
pp. 766-769
Author(s):  
Hussam Ali ◽  
Pierpaolo Lupo ◽  
Sara Foresti ◽  
Guido De Ambroggi ◽  
Riccardo Mantovani ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Heart Block ◽  
Complete Heart Block ◽  
Pacemaker Implantation ◽  
Young Female

scholarly journals Safety of Permanent Pacemaker Implantation: A Prospective Study

2019 ◽  
Vol 8 (1) ◽  
pp. 35 ◽  
Author(s):  
Mª Reyes Carrión-Camacho ◽  
Ignacio Marín-León ◽  
José Manuel Molina-Doñoro ◽  
José Rafael González-López
Keyword(s):  
Antithrombotic Therapy ◽  
Pacemaker Implantation ◽  
Complication Rates ◽  
Minor Complication ◽  
Permanent Pacing ◽  
Short And Long Term ◽  
A Prospective Study ◽  
Technical Failures ◽  
Lead Dislodgement

Although pacemaker implantation is considered to be low risk, it is not exempt from complications and technical failures during the procedure, both in the short and long term, and the complications that such patients may present remain unknown. The aim has been to analyze the complication rates associated with permanent pacing and to identify if these differ between patients with or without previous antithrombotic therapy. We used a prospective, single center, observational study of 310 adult patients with indications of permanent pacing. They were hospitalized from 1 January to 31 December 2014 and followed up for 6 months after the pacemaker implant. The participants were distributed into two groups according to the antithrombotic therapy prior to the implant. The most frequent major complications were pneumothorax (3.87%) and lead dislodgement (8.39%), while superficial phlebitis (12.90%) and uncomplicated hematomas (22.58%) were presented as the most recurrent minor complications. Hematomas were the most frequent minor complication in the antithrombotic therapy cohort, and shoulder pain was reported as the most recurrent minor complication in the non-exposed group. Finding out about complications in pacemaker implants enables a complete view of the process, and hence the prioritization of actions aimed at improving safety and reducing associated risks.

scholarly journals Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-4
Author(s):  
Robert Harvey ◽  
Adrian Chong ◽  
John Hill ◽  
Dariusz Korczyk
Keyword(s):  
Right Ventricular ◽  
Heart Block ◽  
Complete Heart Block ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Cardiac Conduction ◽  
Clinical Report ◽  
Presenting Symptoms ◽  
Permanent Pacing ◽  
Acute Elevation

Abstract Background Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction. Case summary In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99 mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently ‘normalized’ after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings. Discussion There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies.

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