Total atrioventricular block in patient with late onset acute inferior myocardial infarction

TAVB is common complication of acute inferior myocardial infarction (AMI). Total atrioventricular block (TAVB) occurs when none of the impulses are conducted from atrium to ventricles and move independently without coordination. In our case, A 61-year-old woman came to the emergency room (ER) with chief complaint of general weakness and nausea without any other complaints since 4 days before going to ER. She had TAVB which is a complication of undiagnosed AMI due to silent ischemia. She didn't get reperfusion therapy because of patient delay and limited resources. Pharmacological therapy had been given while awaiting implantation of temporary pacemaker (TPM). Two days after insertion, the heart rhythm returned to sinus rhythm, therefore permanent pacemaker implantation was not required. TAVB in AMI usually resolves spontaneously. Therefore, it is important to identify TAVB in AMI, so we can quickly diagnose and promptly treat the patient. Thus, it can reduce mortality and increase the probability of spontaneous resolution of TAVB, so physician practice management (PPM) insertion can be avoided.

Persistence of Left Superior Vena Cava in Nonagenarian Undergoing Pacemaker Implant: Case Report

Introduction: The persistence of the left superior vena cava (PLSVC) is a congenital malformation of the veins that drain blood from the upper body, causing the flow to the right atrium to be processed through the coronary sinus. Case report: We describe the case of a nonagenarian woman, previously asymptomatic until she developed total atrioventricular block when she was referred for implantation of a double chamber pacemaker. Persistence of the left superior vena cava was detected during the procedure and confirmed by venography. The implantation of the electrodes was performed safely and without complications. Conclusion: Despite not usually causing symptoms, the presence of PLSVC can make invasive procedures a challenging task. Knowledge of anatomy and the use of simple techniques can facilitate interventions in this scenario.

Degree of coronary occlusions links to the patient clinical outcome: four cases of double culprits acute ST-segment elevation myocardial infarction

Background: Double coronary culprit lesions in ST-segment elevation myocardial infarction (STEMI) is uncommon. Despite successful primary percutaneous coronary intervention (PPCI) in all culprit lesions, the clinical outcome remains unfavorable and the possible factors for the outcome are not fully understood.Cases Presentation: We reported four cases of double culprit lesions STEMI underwent PPCI. Patient A, a 62 y.o. male with extensive anterior-inferior STEMI, had total occlusion (TO) at both proximal left anterior descending (LAD) and mid right coronary artery (RCA). Patient B, a 42 y.o. male with extensive anterior-inferior STEMI, had subtotal occlusion (STO) at proximal RCA and TO at proximal LAD. Both of them had RBBB ECG pattern. Patient C, a 67 y.o. male with inferior STEMI had 90% thrombus occlusion at proximal–mid LAD and TO at proximal RCA. Patient D, a 65 y.o. male with anteroseptal STEMI, had STO at proximal LAD and 80% thrombus occlusion at mid left circumflex. The cardiomyocyte infarction biomarkers increased in all patients. Although all of them underwent successful PPCI in all of culprit lesions, they suffered from acute heart failure and two of them experienced recurrent ventricular arrhythmia episodes. One of them (patient A) died two days post PPCI. He was only patient who suffering from total occlusion in LAD and RCA with TIMI thrombus 5 and experienced a total atrioventricular block post-PPCI.Conclusion: STEMI with coronary double culprits have severe clinical outcome, regardless of the successful PCI. The degree of coronary occlusions might be linked to the patient clinical outcome.

Case Report: Successful primary percutaneous coronary intervention in octogenarian with acute-on-chronic kidney disease and total atrioventricular block after acute myocardial infarction

Myocardial infarction (MI) is frequently complicated by the worsening of renal function. Undergoing primary percutaneous coronary intervention (PCI) becomes crucial to a patient with ST-segment elevation myocardial infarction (STEMI). With appropriate management of MI, acute-on-chronic kidney disease (ACKD) requiring dialysis post-MI remains an important clinical predictor of elevated in-hospital mortality among patients with MI. In this study, we reported an octogenarian patient suffering from STEMI with ACKD and total atrioventricular block (TAVB). She underwent insertion of a temporary pacemaker and primary PCI. Renal function was improved after dialysis by decreasing the amount of serum creatinine from 8.1 mg/dL at admission to 1.05 mg/dL after primary PCI and dialysis. Primary PCI should still be considered for patients with acute MI, even though these patients have kidney disease, to save the heart muscle and even indirectly improve the kidney function itself.

Difference in Cardiac Electrical Vulnerability Between Passive Silicone Steroid Eluting Lead vs. Active Screw-in Lead

Patients with total atrioventricular block are of particular interest and prone to severe prognosis unless treated with emergency cardiac pacing. We evaluated different types of leads and their impact on the myocardium, according to the fixation type and pacing method.. A pacemaker patient has a different depolarization pattern and a single chamber pacemaker, has by definition, an intracardiac desynchronization and a different electro-mechanical coupling activity. The presence of late potentials is an independent prognosis factor for cardiac death and electrical vulnerability, especially after myocardial infarction(MI). Late potentials recorded as magnitude vector are the expresion of late depolarization of the surrounding tissue and represent the morfological substrate for reentry. Thus, the incidence of late potentials after pacemaker implant, represents the expresion of electrical vulnerability of the stimulated right ventricular myocardium. In order to deeply study the parameters of magnitude vectors, we noticed the appearance of late potentials during the transitory stimulation in acute atrioventricular block and a restoration of vector normal parameters, after conduction recovery and sinus rhythm conversion.