conduction abnormalities
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2021 ◽  
Vol 10 (23) ◽  
pp. 5536
Author(s):  
Lianne N. van Staveren ◽  
Willemijn F. B. van der Does ◽  
Annejet Heida ◽  
Yannick J. H. J. Taverne ◽  
Ad J. J. C. Bogers ◽  
...  

We investigated whether patterns of activation at Bachmann’s bundle are related to AF inducibility. Epicardial mapping of Bachmann’s bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2–164) mm vs. 6(2–28) mm, p = 0.048), prolonged total activation time (55(28–143) ms vs. 46(24–73) ms, p = 0.012), multiple wavefronts entering Bachmann’s bundle more frequently (64% vs. 37%, p = 0.046) and more often areas of simultaneous activation (conduction velocity > 1.7 m/s, 45% vs. 16%, p = 0.038). These observations further support a relation between conduction abnormalities at Bachmann’s bundle and AF inducibility. The next step is to examine whether Bachmann’s bundle activation patterns can also be used to identify patients who will develop AF after cardiac surgery during both short- and long-term follow-up.


2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Preeti Singhal ◽  
Somsupha Kanjanauthai ◽  
Wilson Kwan

Prosthetic valve endocarditis after transcatheter aortic valve replacement (PVE after TAVR) is a feared complication most often observed during the early postprocedural period. We report a case of severe, multivalvular PVE after TAVR with complete heart block caused by an uncommon organism. A 78-year-old female with prior Streptococcus agalactiae mitral valve endocarditis treated with antibiotics presented one year later with severe, symptomatic aortic insufficiency. She subsequently underwent TAVR given high surgical risk. Six weeks post-TAVR, she presented with syncope, fever, and complete heart block. Transthoracic echocardiogram was not demonstrative of vegetation. Blood cultures were positive for Staphylococcus lugdunensis. Transesophageal echocardiogram (TEE) demonstrated vegetations of the aortic, mitral, and tricuspid valves and aorto-mitral continuity. While awaiting surgery, the patient developed cardiac arrest; she was resuscitated and taken to surgery emergently. The patient underwent TAVR explantation, bovine pericardial tissue aortic and porcine bioprosthetic mitral valve replacements, and tricuspid valve repair. Additionally, left main coronary artery endarterectomy was performed due to presence of infectious vegetative material. Staphylococcus lugdunensis is an unusual but virulent organism that may damage both native and prosthetic valves. Early surgery is recommended for PVE after TAVR, especially in cases with perivalvular disease causing conduction abnormalities. Learning Objectives. TAVR has revolutionized the management of severe aortic stenosis and has even been successfully utilized in select cases of aortic regurgitation. Unfortunately, there are a number of associated complications that can be difficult to diagnose, such as prosthetic valve endocarditis (PVE). We emphasize maintaining a high clinical suspicion for PVE after TAVR in patients presenting with conduction abnormalities and highlight the importance of early surgical management in cases complicated by heart block, abscesses, or destructive penetrating lesions.


Author(s):  
Suliman Ahmad ◽  
Peter Kabunga

Abstract Background Exercise stress testing identifies functional abnormalities that may manifest only during physiologic stress to the heart. This may have significant prognostic value in identifying latent conduction abnormalities in asymptomatic patients with Myotonic dystrophy type 1, who may benefit from prophylactic PPM implantation. Case report We report the case of a patient with Myotonic dystrophy type 1 with a 5-month history of atypical left sided chest pain. Her baseline ECG showed sinus rhythm and variable PR interval prolongation (206 to 220 ms) without symptoms of cardiac conduction disease. Routine blood tests and cardiac investigations including a 24-hour ECG monitoring, echocardiogram and a cardiac MRI scan, revealed no abnormalities. To investigate her chest pain and to determine the need for prophylactic permanent pacemaker implantation, exercise stress testing and an electrophysiological study were performed. Exercise testing revealed minimal PR shortening (PR = 200ms) at peak exercise and paradoxical PR prolongation (PR = 280ms) during the early recovery period. A prophylactic DDDR permanent pacemaker was implanted following an electrophysiological study that revealed a prolonged HV interval of 84 ms. Discussion and Conclusion The current use of annual ECG and 24 Holter monitoring may not adequately detect abnormal cardiac conduction in asymptomatic patients with Myotonic dystrophy type 1. The invasive nature of electrophysiology studies limits its use as a screening tool for conduction abnormalities in asymptomatic patients. Thus, exercise stress testing could be used to identify underlying conduction abnormalities in Myotonic dystrophy type 1 patients without any specific symptoms of bradycardia, which warrant further invasive electrophysiological studies.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F De Torres-Alba ◽  
G Kaleschke ◽  
J Vormbrock ◽  
H Deschka ◽  
H Baumgartner

Abstract Introduction The latest generation balloon-expandable transcatheter heart valve SAPIEN 3 Ultra (S3-Ultra) was recently released and has shown promising initial results. So far, the pacemaker (PM) implantation rate after transcatheter aortic valve implantation (TAVI) with the S3-Ultra system compared to the SAPIEN 3 (S3) system has not been widely investigated. Aims To compare the PM implantation rate after TAVI with the latest generation S3-Ultra system with the S3 system in an unselected cohort of patients at risk. Methods We analyzed the development of conduction abnormalities after TAVI in 1780 consecutive patients treated with S3 and S3-Ultra between January 2014 and February 2021. After excluding valve-in-valve procedures (n=31) and patients with previously implanted PM (n=203) 1546 patients were finally analyzed. All patients at risk (i. e. those without previous PM) were monitored with ECG for at least 7 days after TAVI. Results Of 1546 patients, 1382 were treated with S3 (20 mm, 14; 23 mm, 524; 26 mm, 558; 29 mm, 286) and 164 with S3-Ultra (20 mm, 0; 23 mm, 77; 26 mm, 87). There were no significant differences in baseline demographic, ECG and procedural characteristics. There was no significant difference in the rate of new developed conduction abnormalities or PM implantation rate between S3 and S3-Ultra in the overall cohort (37.8% S3 vs 33,7% S3-Ultra, p=0.451 for all new conduction abnormalities, 13.8% S3 vs 14.6% S3-Ultra, p=0.756 for PM implantation). This comparable PM implantation rate between the two systems was consistent when analyzing only the 23 and 26 mm valve sizes of the S3 system (12.1% S3 vs. 14.6% S3-Ultra, p=0.361) and when excluding the first period of S3 implantation at our institution (2014) before a modification of the implantation technique that lead to a drop in the rate of PM implantations (S3 2015–2020 12.9% vs S3-Ultra 14.6%, p=0.534). Conclusions In our cohort, the PM implantation rate after TAVI with the S3-Ultra system was comparable to that of its predecessor. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Carlos A. Carmona ◽  
Fatma Levent ◽  
Kelvin Lee ◽  
Bhavya Trivedi

Cardiac manifestations in multisystem inflammatory syndrome in children (MIS-C) can include coronary artery aneurysms, left ventricular systolic dysfunction, and electrocardiographic disturbances. We report the clinical course of three children with MIS-C while focusing on the unique considerations for managing atrioventricular conduction abnormalities. All initially had normal electrocardiograms but developed bradycardia followed by either PR prolongation or QTc elongation. Two had mild left ventricular ejection fraction dysfunction prior to developing third-degree heart block and/or a junctional escape rhythm; one had moderate left ventricular systolic dysfunction that normalized before developing a prolonged QTc. On average, our patients presented to the hospital 4 days after onset of illness. Common presenting symptoms included fevers, abdominal pain, nausea, and vomiting. Inflammatory and coagulation factors were their highest early on, and troponin peaked the highest within the first two days; meanwhile, peak brain-natriuretic peptide occurred at hospital days 3-4. The patient’s lowest left ventricular ejection fraction occurred at days 5-6 of illness. Initial electrocardiograms were benign with PR intervals below 200 milliseconds (ms); however, collectively the length of time from initial symptom presentation till when electrocardiographic abnormalities began was approximately days 8-9. When comparing the timing of electrocardiogram changes with trends in c-reactive protein and brain-natriuretic peptide, it appeared that the PR and QTc elongation patterns occurred after the initial hyperinflammatory response. This goes in line with the proposed mechanism that such conduction abnormalities occur secondary to inflammation and edema of the conduction tissue as part of a widespread global myocardial injury process. Based on this syndrome being a hyperinflammatory response likely affecting conduction tissue, our group was treated with different regimens of intravenous immunoglobulin, steroids, anakinra, and/or tocilizumab. These medications were successful in treating third-degree heart block, prolonged QTc, and a junctional ectopic rhythm.


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