History Of Complete Heart Block Research Articles

Case of a misleading ECG

An elderly man with severe chronic obstructive pulmonary disease and a history of complete heart block with pacemaker placement was found to have pacemaker lead infection and required device extraction. He had a standard dual chamber pacemaker in place, however the ECG obtained showed paced QRS complexes with presence of R wave in lead V1 and QS in lead I suggestive of left ventricular pacing. Additional imaging with CT scan obtained for confirmation revealed that the heart was displaced to the left posterior hemithorax secondary to pulmonary disease. Due to significant posterolateral rotation of the heart, a right ventricular paced rhythm can demonstrate Q/S waves in the lateral leads (I, aVL, V5–6) and R waves in the right precordial leads (V1–3). This can be misdiagnosed as a left ventricular paced rhythm.

Understanding the Breadth and Depth of C-L Psychiatry: Assessing and Managing Delirium

Understanding the Breadth and Depth of C-L Psychiatry: Assessing and Managing Delirium

Factors associated with implantable cardioverter defibrillators appropriate therapy in cardiac sarcoidosis: a meta-analysis.

Background:Patients with cardiac sarcoidosis (CS) are at increased risk of atrioventricular blocks, ventricular arrhythmias, and sudden cardiac death. Objectives We aimed to investigate the characteristics associated with appropriate therapy in implantable cardiac defibrillator (ICD) -implanted CS patients.Methods:We performed a PubMed and Web of Science search for studies reporting patients with CS who underwent an ICD implantation. The primary criterion was an appropriate therapy.Results:We screened 705 studies, of which 5 were included in the final analysis. We conducted a meta-analysis including 464 patients (mean age 55 years, 282 males (60%)). The mean follow-up was 3.5 years. Among the 464 patients, 180 received an appropriate therapy (39%). Patients who received an appropriate therapy were younger (-3.33, 95% confidence interval (CI) -6.42 to -0.23, p=0.004), were more likely to be male (OR 2.06, 95% CI 1.37-3.09, p=0.0005), had a lower left ventricular ejection fraction (LVEF) (-10.5, 95% CI -18.23 to -2.78, p=0.008), had a higher rate of complete heart block (OR 2.19, 95% CI 1.20 to 3.99, p=0.01), and more frequently had ventricular pacing (OR 6.44 95% CI 2.57 to 16.16, p<0.0001).Conclusions:Appropriate ICD therapy during CS is associated with young age, male sex, low LVEF, history of complete heart block, and ventricular pacing. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 17-23)

Isolated Right Ventricular Cardiac Sarcoidosis Presenting as Complete Heart Block

Introduction Sarcoidosis is a multi-organ disease with formation of granulomas. Involvement of the heart causes inflammation, leading to atrioventricular block (AVB) or ventricular arrhythmias, and portends a poor prognosis. Cardiac sarcoidosis is detected in only 2% of patients, and most have left ventricular (LV) involvement. Isolated right ventricular (RV) involvement is rare. High suspicion is necessary to make the diagnosis, and advanced testing is required. Recognizing cardiac sarcoid is imited to the RV and determining presence of pulmonary hypertension (PH), is imperative for management. Case Presentation A 53 yo woman presented with dyspnea and palpitations. She has a history of complete heart block (CHB) requiring permanent pacemaker placement, and atrial arrhythmias. On evaluation, BP 153/81 mmHg and HR 71 bpm. Physical exam was normal. Given clinical history and refractory dyspnea, there was concern for an inflammatory process. Cardiac monitoring revealed frequent premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT). An echocardiogram demonstrated normal valvular and LV function, but the RV was severely dilated with moderate dysfunction. A right -heart catheterization (RHC) demonstrated normal pulmonary artery pressures and pulmonary capillary wedge pressure. A nuclear PET scan showed areas of increased FDG uptake within the RV, distal anteroseptal LV and pericardium, concerning for sarcoidosis. An endomyocardial biopsy (EMB) demonstrated multinucleated giant cells, confirming sarcoidosis. The patient underwent radiofrequency ablation for AFL. Her device was upgraded to a defibrillator. She was initiated on Cellcept. Serial echocardiograms revealed no PH and stable RV size and function. Case Discussion The diagnosis of cardiac sarcoidosis is elusive due to non-specific signs and symptoms. It often presents with CHB, ventricular arrhythmias or sudden death, atrial arrhythmias, or heart failure. Our patient was diagnosed with CHB, then went on to develop atrial and ventricular arrhythmias, and RV failure. The majority of patients with cardiac involvement have LV involvement. There are only a few case reports of isolated RV involvement. Since lone RV cardiac sarcoidosis is uncommon, diagnosis is delayed. Fortunately in our patient, once sarcoidosis was confirmed to be primarily involving the RV, a RHC and serial transthoracic echocardiograms were performed to rule out PH, which would influence treatment. Conclusion Cardiac sarcoidosis is rare, identified in only 25% of patients with systemic sarcoidosis, and has a poor prognosis. A high degree of suspicion is warranted, especially among young patients with arrhythmias of unclear etiology. Further investigation with serologic ACE levels, imaging such as cardiac magnetic resonance imaging (CMR) or nuclear PET scan, and EMB should be done. Finally, periodic echocardiograms and RHCs are necessary to ensure PH does not develop, which has implications for management.

ECG Challenge: August 19, 2014

HomeCirculationVol. 130, No. 8ECG Challenge: August 19, 2014 Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBECG Challenge: August 19, 2014 Originally published19 Aug 2014https://doi.org/10.1161/CIRCULATIONAHA.114.012313Circulation. 2014;130:715IntroductionA 75-year–old man with a previous history of complete heart block for which he received a dual-chamber pacemaker presents to his cardiologist for a routine follow-up and pacemaker check. He denies all symptoms. Physical examination is unremarkable, although an irregular pulse is found. An ECG is obtained.What is the diagnosis?Download figureDownload PowerPointTo submit your diagnosis, go to http://circ.ahajournals.org/letters/submit/circulationaha;130/9/715. The diagnosis will follow in next week’s issue (August 26).Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.FootnotesCorrespondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Parkway, West Roxbury, MA 02132. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails August 19, 2014Vol 130, Issue 8 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.012313 Originally publishedAugust 19, 2014 PDF download Advertisement SubjectsElectrocardiology (ECG)

Right Ventricular Sarcoidosis: Is It Time for Updated Diagnostic Criteria?

A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy.

Case report - lazarus syndrome after prolonged resuscitation

A 62-year-old male with a history of complete heart block with pacemaker pacing was found unresponsive after a fall whilst inpatient. He sustained severe head injury and was transferred to the Intensive Care Unit. Five minutes

Deep vein thrombosis in a patient with congenital heart disease and permanent transfemoral pacing

A 45-year-old woman with previous repair of coarctation of aorta, ventricular septal defect closure, and progressive decline in her exercise capacity was admitted for the treatment of left leg deep venous thrombosis (DVT). She had a history of complete heart block and insertion of a pectoral pacemaker. After numerous problems with pocket infections, multiple box changes and fracture of the atrial lead, the pectoral system was extracted, and a transfemoral permanent pacemaker was implanted. Even though transfemoral pacing is considered a safe alternative to epicardial lead placement, this may not be the case in functionally impaired patients with mobility problems. Physicians caring for such patients should be alert to symptoms of DVT and provide prompt treatment to avoid major complications.

Natural History and Current Therapy for Complete Heart Block in Children and Patients with Congenital Heart Disease

Complete heart block, either congenital or acquired, in children and patients with congenital heart disease is a relatively frequent occurrence requiring therapy. The natural history of this condition has been distorted by the advent of new diagnostic and therapeutic modalities. The therapy of complete heart block is evolving with new data suggesting that traditional treatment strategies utilizing right ventricular apical pacing may have inadvertent deleterious effects on cardiac function. In the following manuscript, the natural history of complete heart block is reviewed and the current therapy examined.

Keeping abreast of advances in fetal cardiology

Advances in genetics and computing have contributed to a better understanding of the mechanisms underlying cardiovascular development, its programming and possible therapeutic manipulation. Pre-conceptual folate can reduce the prevalence of cardiac malformations and improvements in imaging allow us to detect congenital heart disease and assess function at earlier gestations. Three- and four-dimensional imaging may improve the surgeons' understanding of complex vascular malformations as well as permitting remote diagnosis. Treatment of fetal arrhythmias may be rationalised by fetal electrocardiography and magnetocardiography and by further defining the natural history of complete heart block and mechanisms of tachyarrhythmia. Tissue engineering and robotics may improve the surgical outcome for children by creating conduits with growth potential thus reducing the need for multiple surgical procedures. These technologies may permit successful fetal surgical procedures. Cross discipline collaboration has been key in enabling these advances which have changed the face of fetal cardiology.

Cardiovascular Clinics, Pediatric Cardiology.

This volume about cardiovascular clinics is devoted to pediatric cardiology. Mary Allen Engle, MD, guest editor, has selected 27 contributors for this treatise. The book is dedicated to Dr. Helen B. Taussig and late Dr. Alfred E. Blalock, the mother and the father of pediatric cardiology. Taranta and Gordis discuss prevention of first attacks of rheumatic fever and recurrences. Blumenthal and Jesse state that atherosclerosis has a multifactorial causation with beginnings in childhood. Innocent murmurs are differentiated from organic murmurs by Dr. Levy. Cardiac conduction pathways in infant and child are described by Massing, Liebman, and James. Dr. William Friedman presents some neuropharmacological studies of perinatal myocardium. Supraventricular and ventricular dysrhythmias are illustrated and discussed by Dr. Ehlers. An international study of natural history of complete heart block is related by Michaelsson and Engle. The pharmacological aspects of cardioactive agents, primarily antiarrhythmic drugs are elucidated by Dr.

Demonstration of the Supernormal Period in the Intact Human Heart as a Result of Pacemaker Failure

A 47-year-old man with a 23-year history of complete heart block and A-V junctional rhythm was treated with a permanent pacemaker employing a demand type pulse generator and a bipolar endocardial electrode in the right ventricle. Fourteen months later the pulse generator showed evidence of failure and it then became possible to demonstrate that pacemaker stimuli could evoke a response only during a 50 millisecond period toward the end of the T wave, this interval being the supernormal period of the heart in this individual.

Clinical and electrocardiographic studies in complete heart block

IN THE past few years, the treatment of complete heart block has been radically changed by the introduction of artificial pacemakers. Formerly, complete heart block, with or without the Stokes-Adams syndrome, was managed by pharmacological agents to improve atrio-ventricular conduction and to stimulate the idioventricular pacemaker. With the advent of the implantable pacemaker, it was soon apparent that indications for its use would have to be precisely defined. Some investigators Il-31 have advocated the pacemaker in all cases of complete heart block especially with a histo’ry of even a single Stokes-Adams attack. Others 141 adopting a more conservative approach, reserve this instrument for patients with repeated, disabling episodes of syncope or intractable heart failure. In attempting to establish the value of and indications for the pacemaker, a study of the natural history of complete heart block would be invaluable as a basis for comparison. This report is an analysis of 99 cases of complete heart block encountered in clinical practice with particular reference to the clinical and elcctrocardiographic manifestations.