scholarly journals Clinically Significant High-Grade AV Block as a Reversible Cause for Acute Kidney Injury in Hospitalized Patients—A Propensity Score Matched Cohort

2021 ◽  
Vol 10 (11) ◽  
pp. 2424
Author(s):  
Aviram Hochstadt ◽  
Ido Avivi ◽  
Merav Ingbir ◽  
Yacov Shacham ◽  
Ilan Merdler ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Clinical Decision Making ◽  
Pacemaker Implantation ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Adverse Outcomes ◽  
High Grade ◽  
Av Block ◽  
Threatening Condition

Background. High-grade AV block (HGAVB) is a life-threatening condition. Acute kidney injury (AKI) which is usually caused by renal hypo-perfusion is associated with adverse outcomes. We aimed to investigate the association between AKI and HGAVB. Methods. This is a retrospective cohort comparing the incidence of AKI among patients with HGAVB requiring pacemaker implantation compared with propensity score matched controls. Primary outcome was the incidence of AKI at admission. Secondary outcomes were change in creatinine levels, AKI during stay, recovery from AKI, mortality and major adverse kidney events (MAKE). Results. In total, 80 HGAVB patients were compared to 400 controls. HGAVB patients had a higher proportion of admission AKI compared to controls (36.2% versus 21.1%, RR = 1.71 [1.21–2.41], p = 0.004). Creatinine changes from baseline to admission and to maximum during hospitalization, were also higher in HGAVB (p = 0.042 and p = 0.033). Recovery from AKI was more frequent among HGAVB patients (55.2% vs. 25.9%, RR = 2.13 [1.31–3.47], p = 0.004) with hospitalization time, MAKE and crude mortality similar (p > 0.158). Conclusions. AKI occurs in about one third of patients admitted with HGAVB, more frequent compared to controls. Patients with AKI accompanying HGAVB were likelier to recover from AKI. Further studies to explore this relationship could aid in clinical decision making for HGAVB patients.

scholarly journals High-grade Atrioventricular Block in Pilot

2020 ◽  
Author(s):  
Stephanie Salim ◽  
Sunu Budhi Raharjo ◽  
Dony Yugo Hermanto ◽  
Dicky Armein Hanafy ◽  
Yoga Yuniadi
Keyword(s):  
Pacemaker Implantation ◽  
Holter Monitoring ◽  
Coronary Intervention ◽  
Atrial Pacing ◽  
High Grade ◽  
Av Block ◽  
Av Node ◽  
Flight Operations ◽  
Threatening Condition ◽  
History Of

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

scholarly journals High-grade Atrioventricular Block in Pilot

2020 ◽  
Author(s):  
Stephanie Salim ◽  
Sunu Budhi Raharjo ◽  
Dony Yugo Hermanto ◽  
Dicky Armein Hanafy ◽  
Yoga Yuniadi
Keyword(s):  
Pacemaker Implantation ◽  
Holter Monitoring ◽  
Coronary Intervention ◽  
Atrial Pacing ◽  
High Grade ◽  
Av Block ◽  
Av Node ◽  
Flight Operations ◽  
Threatening Condition ◽  
History Of

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

scholarly journals Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Surabhi Ranjan ◽  
Martha Quezado ◽  
Nancy Garren ◽  
Lisa Boris ◽  
Christine Siegel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
High Grade Glioma ◽  
Clinical Decision ◽  
High Grade

Pre-existent 1st degree AV-Block before TAVI with Sapien 3 – is prolonged monitoring required?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F De Torres Alba ◽  
G Kaleschke ◽  
J Vormbrock ◽  
H Reinecke ◽  
H Deschka ◽  
...  
Keyword(s):  
Pacemaker Implantation ◽  
High Grade ◽  
Av Block ◽  
Multivariable Logistic Regression Model ◽  
Consensus Document ◽  
Risk Patients ◽  
Valve In Valve ◽  
Prolonged Monitoring ◽  
Sapien 3 ◽  
Expert Consensus Document

Abstract Introduction Pre-existing right bundle branch block (RBBB) is a well stablished risk factor for the development of high grade conduction abnormalities (CAs) after TAVI. The association of pre-existing 1st degree AV-Block (AVB1) with high grade CAs after TAVI has been inconsistent. A recently published Expert Consensus Document classifies patients with AVB1 in the lowest risk group, allowing for discharge at day 1 post-TAVI. We aimed to study the risk of these patients of developing delayed high grade CAs requiring pacemaker implantation (PM). Methods We studied the development CAs in 1447 consecutive patients treated with Sapien 3 between January 2014 and December 2019. After excluding valve-in-valve procedures (n=30) and pts with previously implanted PM (n=167) 1254 patients remained for analysis. All patients were monitored for at least 7 days, as this was our institutional policy during the study period. We analyzed if pre-existing ECG abnormalities predict early and delayed (>24h) high grade CAs with a multivariable logistic regression model. Results Of 1254 pts, 159 (12.5%) required a permanent PM after TAVI. In 104 (65%) CAs requiring PM occurred intraprocedural or during the first 48h while in the remaining 35% developed with more delay. We analyzed the presence of previous CAs in pts still free from indication for PM after the first 48h after TAVI (n=1150) in order to identify characteristics that may predict delayed PM requirement (Table). In the multivariable model not only RBBB (OR 5.42, CI95% 2.69–10.94, p<0.0001) but also AVB1 was significantly associated to delayed high grade CAs requiring PM implantation (OR 2.25, CI95% 1.24–4.08, p=0.005). Conclusion In this study, in pts requiring PM implantation after TAVI, the high grade CAs occurred after 48h in 35% of patients. Not only RBBB but also AVB1 was an independent predictor of delayed high grade CAs. These results question the safety of considering patients with pre-existing AVB1 as low-risk patients and suggest a more prolonged monitoring also for them. Funding Acknowledgement Type of funding source: None

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