Incidence and predictors of complete atrioventricular conduction recovery among patients with heart block

Aim: In this study, our aim was to determine clinical factors related to the recovery of the conduction system in patients presenting with atrioventricular (AV) block. Materials & methods: A total of 178 patients who were hospitalized at a tertiary center due to second- or third-degree AV block were retrospectively analyzed. Results: During hospital follow-up, 19.1% of patients had fully recovered from AV block. According to a logistic regression analysis; younger age (odds ratio [OR]: 0.950; 95% CI: 0.932–0.967; p < 0.001), presenting with acute coronary syndrome (OR: 18.863; 95% CI: 3.776–94.222; p < 0.001), β-blocker usage (OR: 12.081; 95% CI: 3.498–41.726; p < 0.001), high serum creatinine levels (OR: 4.338; 95% CI: 2.110–8.918; p < 0.001) and no calcification at the aortic valve (OR: 0.189; 95% CI: 0.050–0.679; p = 0.011) were found to be related to resolution of AV block. Conclusion: It is crucial to know the reversible causes of AV block to prevent unnecessary permanent pacemaker implantation.

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Histologically confirmed case of complete atrioventricular block due to hepatocellular carcinoma

BMJ Case Reports ◽

10.1136/bcr-2018-224785 ◽

2018 ◽

pp. bcr-2018-224785

Author(s):

Takuro Nishiwaki ◽

Norihiko Yamamoto ◽

Yoshihumi Hirokawa ◽

Yoshiyuki Takei

Keyword(s):

Heart Failure ◽

Hepatocellular Carcinoma ◽

Rare Complication ◽

Pacemaker Implantation ◽

Cardiac Metastasis ◽

Av Block ◽

Complete Atrioventricular Block ◽

Β Blocker ◽

Complete Atrioventricular ◽

Complete Av Block

A 72-year-old man, who had been diagnosed as having hepatocellular carcinoma (HCC) with multiple extrahepatic metastasis, complained a general fatigue which appeared 2 weeks before admission. Because bradycardia was detected on physical examination, ECG was performed which revealed the complete atrioventricular (AV) block. We stopped Ca-blocker and β-blocker, but the bradycardia persisted. He was admitted to our hospital for an emergent pacemaker implantation. On admission, he complained dyspnoea. After the surgery, he died due to deterioration of heart failure. The autopsy revealed cardiac metastasis of HCC on AV node, so it was suspected that cardiac metastasis caused the AV block. We thought that the cause of his death was the exacerbation of heart failure associated with bradycardia. It was likely that complete AV block as a very rare complication caused by cardiac metastasis of HCC influenced the prognosis of this patient.

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Implantable loop recorder follow-up

European Heart Journal ◽

10.1093/eurheartj/ehab724.0318 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J Pena Mellado ◽

R Macias ◽

L Tercedor ◽

M Alvarez Lopez

Keyword(s):

Head Trauma ◽

Type I ◽

Av Block ◽

Implantable Loop Recorder ◽

Ecg Monitoring ◽

Loop Recorder ◽

Tertiary Center ◽

Unexplained Syncope ◽

Baseline Characteristics

Abstract Introduction Long ambulatory ECG monitoring can be a useful component in the evaluation of the patient with unexplained syncope or syncope with suspected arrhythmic origin, as well as a sensitive tool for detecting asymptomatic spontaneous cardiac arrhythmias or conduction abnormalities in predisposed patients. Purpose To determine the diagnostic cost-effectiveness of the implantable loop recorder (ILR) in the origin of unexplained syncope in our center. Methods A retrospective observational study was carried out in a tertiary center, those patients with an ILR between August 2014 and March 2021 were included. Baseline characteristics of the population and their previous ECG, arrythmias detected during follow-up and pacemaker implant rate were evaluated. Results One hundred twenty-seven patients with a ILR were included (age 67 years, 49.6% males). Most often cause of ILR was unexplained syncope (90.6%) followed by monitoring after TAVI implant (3.9%). Normal LVEF (>50%) was present in 85.6%,and 75.6% had NYHA I functional class. 118 patients (92.9%) presented sinus rhythm at implant time, and 8 (6.3%) presented AF. 12.6% presented first degree atrioventricular (AV) block, 2 patients (1.6%) had presented previously Mobitz Type I AV block and one patient 2:1 block. Left bundle branch block (LBBB) was present in 13.4%,RBBB in 3.1%,LAFB in 9.4%, RBBB+LAFB in 11% and RBBB+LPFB in 2.4%. Median time of follow-up was 21 months. 3rd degree AV block was the most frequent arrhythmia detected (12.1%), followed by >3s pause (8%) and previously unknown AF (2.4%).The patients with syncope who suffered head trauma (33%) presented a higher rate of pacemaker (PCM) implant compared to those without head trauma: 31.6% vs 14.7%. In total,19.8% PCM rate implant during follow-up. No complications ILR related. Conclusion In conclusion, long home ECG monitoring with ILR is a powerful and helpful tool to find out or rule out potentially dangerous arrhythmias as cause of syncope, with no complications in our experience. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics Arrhythmias detected during follow-up

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Conduction disturbances after TAVR: rates of pacemaker implantation, burden of ventricular pacing and prognostic significance

EP Europace ◽

10.1093/europace/euab116.382 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

S Bricoli ◽

G Benatti ◽

L Vignali ◽

I Tadonio ◽

MF Notarangelo ◽

...

Keyword(s):

Prognostic Significance ◽

Pacemaker Implantation ◽

Av Block ◽

Ventricular Pacing ◽

Conduction Disturbances ◽

Long Term Follow Up ◽

Rv Pacing ◽

Complete Av Block

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The occurrence of conduction disturbances remains frequent after TAVR. However, the effect of PM on mortality is controversial and many patients may recover spontaneous AV conduction during follow-up. PURPOSE To evaluate the incidence of PM implantation after TAVR, PM dependency and burden of ventricular pacing during follow-up and their influence on mortality. METHODS AND RESULTS We performed a retrospective analysis of all consecutive 293 patients who underwent TAVR from 2015 to 2019 at our hospital, regional hub for this procedure. Patients were classified into 3 groups: patients without PM (no-PM), patients with a PM implanted prior to TAVR (pre-PM) and patients requiring a PM following TAVR (post-PM) and their clinical and procedural characteristics are listed in Table 1. The rate of PM implantation after TAVR was 20,8%, at a median of 3.6 days after the procedure. The most common indication was complete AV block. A VVIR pacemaker was implanted in 28 patients, a DDD/DDDR PM in 27 patients and 2 patients received a CRT device. Among post-PPM patients, only 16% were PM-dependent at 2-month and 1-year follow-up. All of them received a PM for complete AV block (AVB). At 1-year follow-up, RV pacing burden was 60% among AVB patients and 23% in patients with a PM implanted for other reasons. PM implantation after TAVR was not associated with a mortality difference at 30-day, 1-year and long-term follow-up. Pre-PPM patients showed a higher mortality rate at long-term follow-up although not statistically significant. CONCLUSIONS Our data suggest that a single chamber device should be preferred in patients implanted for reasons other than complete AVB; in patients with AVB, the use of dual chamber device with an algorithm to minimize RV pacing should be the most suitable choice. Overall (293)No PPM (216)Pre-PPM (19)Post-PPM (57)p-valueAge, median(IQR)82(80-86)82(80-86)82(79-87)82(80-86)0,53Female, n(%)160(55)129(59)6(32)25(44)0,40NYHA III-IV, n(%)191(65)147(68)15(79)29(51)0,06Logistic Euroscore, mean (IQR)7,53(3,5-8,3)7(3,5-8)9,83(3,6-12)6(3,5-7,4)0,51Right bundle-branch block, n(%)21(7)13(6)na8(14)0,04AVA, mean ± SD0,69 ± 0,190,7 ± 0,190,7 ± 0,160,66 ± 0,180,23Self-expandable valve, n(%)181(62)123(57)12(63)46(81)0,001Balloon-expandable valve, n(%)102(35)86(40)7(37)8(14)0,0003Implant depth, mean ± SD6,87 ± 2,96,32 ± 2,65,71 ± 39,12 ± 30,0001Abstract Figure. Kaplan-Meier survival curve

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

Case Reports in Cardiology ◽

10.1155/2021/6637720 ◽

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.

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A case report of unusually long episodes of asystole in a severe COVID-19 patient treated with a leadless pacemaker

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa238 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6

Author(s):

Ivan Cakulev ◽

Jayakumar Sahadevan ◽

Mohammed Najeeb Osman

Keyword(s):

Atrial Fibrillation ◽

Case Report ◽

Pacemaker Implantation ◽

Av Block ◽

Leadless Pacemaker ◽

Case Summary ◽

Cardiac Manifestations

Abstract Background Experience has been emerging about cardiac manifestations of COVID-19-positive patients. The full cardiac spectrum is still unknown, and management of these patients is challenging. Case summary We report a COVID-19 patient who developed unusually long asystolic pauses associated with atriventricular block (AV) block and atrial fibrillation who underwent leadless pacemaker implantation. Discussion Asystole may be a manifestation of COVID-19 infection. A leadless pacemaker is a secure remedy, with limited requirements for follow-up, close interactions, and number of procedures in a COVID-19 patient.

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A case of cardiac strangulation following epicardial pacemaker implantation

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-020-01337-y ◽

2020 ◽

Vol 68 (12) ◽

pp. 1499-1502

Author(s):

Chihiro Miyagi ◽

Yoshie Ochiai ◽

Yusuke Ando ◽

Manabu Hisahara ◽

Hironori Baba ◽

...

Keyword(s):

Pulmonary Stenosis ◽

Pacemaker Implantation ◽

Complete Atrioventricular Block ◽

Dual Chamber ◽

Congenital Complete Atrioventricular Block ◽

Ventricular Lead ◽

Cardiac Silhouette ◽

The Right ◽

Complete Atrioventricular

AbstractAn 8-year-old boy had undergone permanent epicardial pacemaker implantation with a Y-shaped bipolar ventricular lead on day 6 after birth for treatment of congenital complete atrioventricular block. He was found to have pulmonary stenosis and mitral stenosis by follow-up echocardiography. Further studies including computed tomography and cardiac catheterization revealed that the pacemaker lead had completely encircled the cardiac silhouette and was in a state of “cardiac strangulation”. We removed the previous pacing leads and generator and implanted a new epicardial dual-chamber pacing system in the right atrium and right ventricle. Additionally, an expanded polytetrafluoroethylene sheet was placed between the new leads and the heart to prevent recurrence of cardiac strangulation.

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

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab200 ◽

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.

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Abstract 14856: Leadless Pacemaker Implantation in Patients With Paroxysmal Complete Atrioventricular Block

Circulation ◽

10.1161/circ.142.suppl_3.14856 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ivan mendoza ◽

Jorge Penalver ◽

Ninoska N Aranguibel ◽

Chamorro Jose ◽

Juan P zambrano ◽

...

Keyword(s):

Pacemaker Implantation ◽

Complication Rates ◽

Av Block ◽

Test Analysis ◽

Leadless Pacemaker ◽

Pacemaker Syndrome ◽

Ventricular Response ◽

Feasible Alternative ◽

Complete Av Block

Introduction: Transcatheter pacing systems have recently emerged as a safe and effective alternative in treating patients who require right ventricular pacing therapy. Traditionally, patients with atrial fibrillation with slow ventricular response had been benefit from this therapy. More recent, patients with symptomatic paroxysmal complete AV block had been receiving these devices. At this moment there is no data available about the feasibility , safety or outcomes of leadless pacemaker in this subgroup of patients Objective: The aim of this study was to assess the feasibility safety and 1 year follow up of the transcatheter leadless pacemaker device in patients with paroxysmal complete AV block . Methods: One hundred and ten (110 ) consecutive patients who underwent implantation of a Micra transcatheter leadless pacemaker (LPM)and have been follow up for at least a year were evaluated . Forty one (41) of these patients had the device implanted after experiencing symptomatic paroxysmal complete AV block. A t-test analysis was used to compare patient demographics, total procedure times, complication rates and recaptures necessary during the procedure. Results: All the patients with symptomatic paroxysmal complete AV block were implanted successfully with the leadless pacemaker system ( LPN ) . None of the patients suffered complications during the procedures. Fifty three percent ( 53%) were female , mean age of 77 , mean procedure time was 21.1 min. The mean number of recaptures required were 0.48 . None of the patient experienced pacemaker syndrome or progress to complete AV block after 1 year of follow up Conclusion: Leadless pacemaker implantation appears to be a safe and feasible alternative for subjects with symptomatic paroxysmal complete AV block . Further studies are required in these subgroup of patients

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β-blocker dialyzability and the risk of mortality and cardiovascular events in patients undergoing hemodialysis

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa058 ◽

2020 ◽

Vol 35 (11) ◽

pp. 1959-1965 ◽

Cited By ~ 2

Author(s):

Ping-Hsun Wu ◽

Yi-Ting Lin ◽

Mei-Chuan Kuo ◽

Jia-Sin Liu ◽

Yi-Chun Tsai ◽

...

Keyword(s):

Cardiovascular Events ◽

Hemodialysis Patients ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Mortality Hazard ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Β Blocker ◽

Mortality Hazard Ratio

Abstract Background β-blocker (BB) dialyzability has been proposed to limit their efficacy among hemodialysis (HD) patients. We attempted to confirm this hypothesis by comparing health outcomes associated with the initiation of dialyzable or nondialyzable BBs in a nationwide cohort of HD patients. Methods We created a prospective cohort study of 15 699 HD patients who initiated dialyzable BBs (atenolol, acebutolol, metoprolol and bisoprolol) and 20 904 hemodialysis patients who initiated nondialyzable BBs (betaxolol, carvedilol and propranolol) between 2004 and 2011 in Taiwan healthcare. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs, a composite of the acute coronary syndrome, ischemic stroke and heart failure) between users of dialyzable versus nondialyzable BBs during a 2-year follow-up. Results New users of dialyzable BBs were younger, more often men, with diabetes mellitus, hypertension and hyperlipidemia compared with users of nondialyzable BBs. Compared with nondialyzable BBs, initiation of dialyzable BBs was associated with lower all-cause mortality {hazard ratio [HR] 0.82 [95% confidence interval (CI) 0.75–0.88]} and lower risk of MACEs [HR 0.89 (95% CI 0.84–0.93)]. Results were confirmed in subgroup analyses, censoring at BB discontinuation or switch, after 1:1 propensity score matching, reclassifying bisoprolol or excluding bisoprolol/carvedilol users. Conclusions This study does not offer support for the hypothesis that the dialyzability of BBs reduces their efficacy in HD patients.

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Timing of pacemaker and ICD implantation in LMNA mutation carriers

Open Heart ◽

10.1136/openhrt-2021-001622 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001622

Author(s):

Laura Helena Ollila ◽

Kjell Nikus ◽

Hannu Parikka ◽

Sini Weckström ◽

Heliö Tiina

Keyword(s):

Pacemaker Implantation ◽

Conduction System ◽

Cardiac Conduction ◽

Icd Implantation ◽

Device Implantation ◽

Lmna Mutation ◽

Mutation Carriers ◽

Younger Age ◽

Male Patients

AimsLMNA-cardiomyopathy is often associated with pathology in the cardiac conduction system necessitating device implantations. The aim was to study the timing and types of device implantations and need for re-implantations in LMNA mutation carriers.MethodsWe studied the hospital records of 60 LMNA mutation carriers concerning device implantations and re-implantations and their indications. Data were collected until April 2019.ResultsThe median follow-up time from the first ECG recording to the last clinical follow-up, transplantation, or death was 7.7 (IQR=9.1) years. Altogether 61.7% (n=37) of the LMNA mutation carriers received a pacemaker or an implantable cardioverter defibrillator (ICD), and of them 27.0% (n=10) needed a device upgrade. Notably, in some patients the upgrade took place very soon after the first implantation. The first device was implanted at an average age of 47.9 years (SD=9.5), whereas the upgrade took place at an average age of 50.3 years (SD=8.1). Most upgrades were ICD implantations. Male patients underwent device upgrade more often and at a younger age than women. By the end of follow-up, 35.0% (n=21) of the patients fulfilled echocardiographic criteria for dilated cardiomyopathy, and 90.5% of them (n=19) needed pacemaker implantation.ConclusionMost LMNA mutation carriers underwent pacemaker implantation in this study. Due to the progressive nature of LMNA-cardiomyopathy, device upgrades are quite common. An ICD should be considered when the initial device implantation is planned in an LMNA mutation carrier.

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