Database : MEDLINE
Search on : Atrioventricular and Block [Words]
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[PMID]: 29523425
[Au] Autor:Velibey Y; Yaylak B; Guvenc TS; Cinier G; Kalenderoglu K; Guzelburc O; Yildirimturk O
[Ad] Address:Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
[Ti] Title:Inadvertent Left Ventricle Endocardial or Uncomplicated Right Ventricular Pacing: How to Differentiate in the Emergency Department.
[So] Source:J Emerg Med;, 2018 Mar 06.
[Is] ISSN:0736-4679
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Temporary transvenous pacemaker implantation is an important and critical procedure for emergency physicians. Traditionally, temporary pacemakers are inserted by electrocardiography (ECG) guidance in the emergency department because fluoroscopy at the bedside in an unstable patient can be limited by time and equipment availability. However, in the presence of atrial septal defect, ventricular septal defect, and patent foramen ovale, the pacemaker lead can be implanted inadvertently into the left ventricle or directly into the coronary sinus instead of right ventricle. Regular pacemaker rhythm can be achieved despite inadvertent implantation of the pacemaker lead into the left ventricle, leading to ignorance of the possibility of lead malposition. CASE REPORT: A 65-year-old female patient with hemodynamic instability and complete atrioventricular block underwent temporary pacemaker implantation via right jugular vein with ECG guidance at the emergency department. Approximately 12 h after implantation, it was noticed that the ECG revealed right bundle branch block (RBBB)-type paced QRS complexes. Diagnostic workup revealed that the lead was inadvertently located in the left ventricular apex. This case illustrates the importance of careful scrutiny of the 12-lead ECG and imaging clues in identifying lead malposition in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Because inadvertent left ventricle endocardial pacing carries a high risk for systemic embolization, it is important to determine whether an RBBB pattern induced by ventricular pacing is the result of a malpositioned lead or uncomplicated transvenous right ventricular pacing.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

  2 / 25544 MEDLINE  
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[PMID]: 29223306
[Au] Autor:Nigolian A; Dayal N; Nigolian H; Stettler C; Burri H
[Ad] Address:Cardiology Department, Geneva University Hospital, Geneva, Switzerland.
[Ti] Title:Diagnostic accuracy of multi-lead ECGs obtained using a pocket-sized bipolar handheld event recorder.
[So] Source:J Electrocardiol;51(2):278-281, 2018 Mar - Apr.
[Is] ISSN:1532-8430
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Handheld ECG event recorders are useful for rhythm monitoring but only record a single lead, which may limit interpretation. We sought to investigate if a multi-lead ECG may be reconstituted using this device, and aimed to evaluate diagnostic accuracy. METHODS: A commercially-available handheld bipolar ECG event recorder was used to reconstruct a 9-lead ECG (leads I, II and III, V1-6). Tracings were analyzed independently by a cardiologist and a fellow. RESULTS: A total of 52 patients were evaluated. Accuracy was excellent (85-98%) for identifying atrial fibrillation, atrioventricular block, bundle branch block and left ventricular hypertrophy, but lower (77-88%) for ST-segment changes and prolonged QTc. CONCLUSIONS: A 9-lead ECG can be reconstituted using a handheld single-lead ECG event recorder, and provides good diagnostic accuracy for common findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review

  3 / 25544 MEDLINE  
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[PMID]: 29514866
[Au] Autor:Li G; Saguner AM; Akdis D; Fontaine GH
[Ad] Address:Unité de Rythmologie, Institut de Cardiologie, Hôpital de la Salpetrière, Paris, France.
[Ti] Title:Intramyocardial block in patients with atrioventricular block.
[So] Source:J Investig Med;, 2018 Mar 07.
[Is] ISSN:1708-8267
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Atrioventricular (AV) block has been extensively studied. However, conduction inside the myocardium in patients with AV block has not been reported. In this study, we aimed to demonstrate the presence of intramyocardial block in patients with AV block. Five consecutive patients with spontaneous high-grade AV block and Torsades de pointes (TdP) were prospectively studied with standard United States Catheter Instruments (USCI) endocardial temporary catheter located at the right ventricle (RV) apex. The morphology of endocardial potentials observed in the basic QRS complexes as well as during episodes of TdP was studied. The electrogram (EGM) of the basic rhythm showed a sharp deflection of high amplitude preceded and/or followed by a smooth potential of low amplitude interpreted as far-field potentials in all patients. The sharp potential can be observed at the beginning, in the middle or at the end of the smooth potential. All these potentials were reproduced from beat to beat and were falling inside the QRS complex of the surface ECG. Therefore, these aspects are zones of electrically depressed or silent myocardium larger than the interelectrode distance of 12 mm. This situation is in agreement with recent genetic factors. In this study, we demonstrated for the first time that patients with spontaneous AV block also have trouble in ventricular activation located on the AV conduction system and inside the myocardium. It is then possible to speculate that the presence of diffuse non-conducting myocardium explains why most TdPs do not degenerate into ventricular fibrillation (VF) and generally stop spontaneously.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

  4 / 25544 MEDLINE  
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[PMID]: 29293974
[Au] Autor:Collis R; Tsang V; Pantazis A; Tome-Esteban M; Elliott PM; McGregor CGA
[Ad] Address:Institute of Cardiovascular Science, University College London, London, UK.
[Ti] Title:Individualized surgical strategies for left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.
[So] Source:Eur J Cardiothorac Surg;, 2017 Dec 26.
[Is] ISSN:1873-734X
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Surgical strategies to treat drug refractory left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy include septal myectomy (SM) and, less frequently, mitral valve (MV) repair or replacement. The primary aim of this study was to report the surgical technique and management outcomes in a consecutive group of patients with variable phenotypes of hypertrophic cardiomyopathy in a broad national specialist practice. METHODS: A total of 203 consecutive patients, 132 men (mean age 48.6 ± 14.6 years) underwent surgery for the management of LVOTO. Surgical approaches included SM (n = 159), SM with MV repair (n = 25), SM with MV replacement (n = 9) and MV replacement alone (n = 10). Specific surgical approaches were performed based on the underlying mechanism of obstruction. Eleven (5.4%) patients had previous alcohol septal ablation for the management of LVOTO. Concomitant non-mitral cardiac procedures were carried out in 22 (10.8%) patients. RESULTS: Operative survival rate was 99.0% with 2 deaths within 30 days. The mean bypass time was 92.9 ± 47.8 min, with a mean length of hospital stay of 10.5 ± 7.8 days. Surgical complications included 3 ventricular septal defects requiring repair (1.5%), 1 Gerbode defect surgically repaired, 2 aortic valve repairs (1.0%), 2 transient ischaemic attacks (1.0%) and 4 strokes (2.0%). Thirty-nine (19.2%) patients had perioperative new-onset atrial fibrillation and 8 (3.9%) patients had unexpected atrioventricular block requiring a permanent pacemaker. Mean resting left ventricular outflow tract gradient improved from 70.6 ± 40.3 mmHg preoperatively to 11.0 ± 10.5 mmHg at 1 year postoperatively (P < 0.001). Mean New York Heart Association class improved from 2.6 ± 0.5 preoperatively to 1.6 ± 0.6 at 1 year after the procedure. CONCLUSIONS: In variable phenotypes of LVOTO in hypertrophic cardiomyopathy, an individualized surgical approach provided effective reductions in left ventricular outflow tract gradients and good symptomatic relief with acceptable mortality and morbidity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/ejcts/ezx458

  5 / 25544 MEDLINE  
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[PMID]: 29267867
[Au] Autor:Brignole M; Deharo JC; Menozzi C; Moya A; Sutton R; Tomaino M; Ungar A
[Ad] Address:Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Via Don Bobbio 25, 16033 Lavagna, Italy.
[Ti] Title:The benefit of pacemaker therapy in patients with neurally mediated syncope and documented asystole: a meta-analysis of implantable loop recorder studies.
[So] Source:Europace;, 2017 Dec 15.
[Is] ISSN:1532-2092
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Aim: Although the efficacy of cardiac pacing in patients with neurally mediated syncope (NMS) and documented asystole is established, a more robust point estimate of the benefit, which is not possible with any individual study, is lacking. Methods and results: We undertook a meta-analysis of individual participant data from four studies that reported follow-up data on syncope recurrence with cardiac pacing in patients with NMS who had had an electrocardiographic (ECG) documentation of an asystolic event by means of implantable loop recorder (ILR). Of a total of 1046 patients, who had ILR implanted, 383 (36.6%) patients had an ECG documentation of a diagnostic event during mean follow-up of 13 ± 10 months. Of these, 201 (52%) patients, corresponding to 19.2% of the total ILRs, had an asystolic event of 12.8 ± 11.0 s duration documented and met the criteria for pacemaker therapy. Follow-up was available in 121 (60%) of those patients with asystolic events. Syncope recurred after pacing in 18 (14.9%) patients with an actuarial rate of 13% [95% confidence interval (CI) ±6] at 1 year, 21% (95%CI ±10) at 2 years, and 24% (95%CI ±11) at 3 years. On multivariable Cox regression analysis, positive tilt test response was the only significant predictor of syncope recurrence with a hazard ratio (95% CI) of 4.3 (1.4-13). On the contrary, type of asystolic event (sinus arrest or atrioventricular block), prodrome, cardiac abnormalities, number and duration of history of syncope, age, and gender were not predictors of recurrence of syncope. Conclusion: A long asystolic pause, suitable for pacemaker therapy, was found in one of five patients with ILR. After pacemaker implantation, most of these patients remained free of syncope recurrence for up to 3 years. The benefit of pacemaker was greater in patients with negative tilt test.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/europace/eux321

  6 / 25544 MEDLINE  
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[PMID]: 29512819
[Au] Autor:Ciardulli A; D'Antonio F; Magro-Malosso ER; Manzoli L; Anisman P; Saccone G; Berghella V
[Ad] Address:Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
[Ti] Title:Maternal steroid therapy for fetuses with second degree immune-mediated congenital atrioventricular block: a systematic review and meta-analysis.
[So] Source:Acta Obstet Gynecol Scand;, 2018 Mar 07.
[Is] ISSN:1600-0412
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:INTRODUCTION: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by second degree immune-mediated atrioventricular block (AVB). MATERIAL AND METHODS: Studies reporting the outcome of fetuses with immune-mediated second degree AVB diagnosed on prenatal ultrasound and treated with fluorinated steroids compared to those not treated were included. The primary outcome was the overall progression of AVB to either continuous or intermittent third degree AVB at birth. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used. RESULTS: 5 studies (71 fetuses) were included. The progression rate to AVB at birth in fetuses treated with steroids was 52% (95% CI 23-79) while in fetuses not receiving steroid therapy was 73% (95% CI 39-94). The overall rate of regression to either first degree, intermittent first/second degree or sinus rhythm in fetuses treated with steroids was 25% (95% CI 12-41) compared to 23% (95% CI 8-44) of those not treated. Stable (constant) second degree AVB at birth was present in 11% (95% CI 2-27) of cases in the treated group and in none of the new-borns in the untreated group, while complete regression to sinus rhythm occurred in 21% (95% CI 6-42) of fetuses receiving steroids versus 9% (95% CI 0-41) of those untreated. CONCLUSIONS: There is still limited evidence as to the benefit of administered fluorinated steroids in terms of affecting outcome of fetuses with second degree immune-mediated AVB. This article is protected by copyright. All rights reserved.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher
[do] DOI:10.1111/aogs.13338

  7 / 25544 MEDLINE  
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[PMID]: 29477480
[Au] Autor:Baburin I; Varkevisser R; Schramm A; Saxena P; Beyl S; Szkokan P; Linder T; Stary-Weinzinger A; van der Heyden MAG; Houtman M; Takanari H; Jonsson M; Beekman JHD; Hamburger M; Vos MA; Hering S
[Ad] Address:Department of Pharmacology and Toxicology, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria. Electronic address: igor.baburin@univie.ac.at.
[Ti] Title:Dehydroevodiamine and hortiamine, alkaloids from the traditional Chinese herbal drug Evodia rutaecarpa, are I blockers with proarrhythmic effects in vitro and in vivo.
[So] Source:Pharmacol Res;, 2018 Mar 03.
[Is] ISSN:1096-1186
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Evodiae fructus is a widely used herbal drug in traditional Chinese medicine. Evodia extract was found to inhibit hERG channels. The aim of the current study was to identify hERG inhibitors in Evodia extract and to investigate their potential proarrhythmic effects. Dehydroevodiamine (DHE) and hortiamine were identified as I (rapid delayed rectifier current) inhibitors in Evodia extract by HPLC-microfractionation and subsequent patch clamp studies on human embryonic kidney cells. DHE and hortiamine inhibited I with IC s of 253.2 ±â€¯26.3 nM and 144.8 ±â€¯35.1 nM, respectively. In dog ventricular cardiomyocytes, DHE dose-dependently prolonged the action potential duration (APD). Early afterdepolarizations (EADs) were seen in 14, 67, 100, and 67% of cells after 0.01, 0.1, 1 and 10 µM DHE, respectively. The proarrhythmic potential of DHE was evaluated in 8 anesthetized rabbits and in 8 chronic atrioventricular block (cAVB) dogs. In rabbits, DHE increased the QT interval significantly by 12 ±â€¯10% (0.05 mg/kg/5 min) and 60 ±â€¯26% (0.5 mg/kg/5 min), and induced Torsade de Pointes arrhythmias (TdP, 0.5 mg/kg/5 min) in 2 rabbits. In cAVB dogs, 0.33 mg/kg/5 min DHE increased QT duration by 48 ±â€¯10% (P < 0.05*) and induced TdP in 2/4 dogs. A higher dose did not induce TdP. In human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs), methanolic extracts of Evodia, DHE and hortiamine dose-dependently prolonged APD. At 3 µM DHE and hortiamine induced EADs. hERG inhibition at submicromolar concentrations, APD prolongation and EADs in hiPSC-CMs and dose-dependent proarrhythmic effects of DHE at micromolar plasma concentrations in cAVB dogs should increase awareness regarding proarrhythmic effects of widely used Evodia extracts.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:Publisher

  8 / 25544 MEDLINE  
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[PMID]: 29508515
[Au] Autor:Sorini Dini C; Landi D; Meucci F; Di Mario C
[Ad] Address:Careggi University Hospital, Florence, Italy.
[Ti] Title:Unexpected delayed complete atrioventricular block after Cardioband implantation.
[So] Source:Catheter Cardiovasc Interv;, 2018 Mar 06.
[Is] ISSN:1522-726X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The Cardioband system is a transcatheter direct annuloplasty device that is implanted in patients with severe symptomatic functional mitral regurgitation (MR) due to annulus dilatation and high surgical risk. This device covers the posterior two-thirds of the annulus, from the anterolateral to the posteromedial commissure, implanted in close proximity of the left circumflex artery, atrioventricular (AV) conduction system, and coronary sinus. We present the case of an 80-year-old-gentleman with prohibitive surgical risk, treated with Cardioband implantation for functional MR with an evident P1-P2 cleft and P2-P3 indentation, a relative contraindication to MitraClip implantation. We achieved procedural success with significative mitral annulus reduction (30% anteroposterior reduction from 37 to 26 mm) and MR reduction (from grade 4 to grade 1-2). A late onset Mobitz 2 AV block developed after 26 hr and evolved to complete AV block in the following day, requiring definitive biventricular pacemaker (PM). Less than 200 Cardioband implantations have been performed but, to our knowledge, this is the first reported AV block, possibly facilitated by the pre-existing bifascicular block, suggesting the opportunity of prolonged ECG monitoring after Cardioband like any other mechanical transcatheter structural intervention possibly affecting the AV conduction system.
[Pt] Publication type:CASE REPORTS
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1002/ccd.27519

  9 / 25544 MEDLINE  
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[PMID]: 29506582
[Au] Autor:Chlebowski MM; Heese BA; Malloy-Walton LE
[Ad] Address:1Department of Pediatric Cardiology,Children's Mercy,Kansas City,MO,USA.
[Ti] Title:Early childhood onset of high-grade atrioventricular block in Hunter syndrome.
[So] Source:Cardiol Young;:1-2, 2018 Mar 06.
[Is] ISSN:1467-1107
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Cardiac involvement has been reported in various mucopolysaccharidoses syndromes. Cardiac valve pathology is the most prominent cardiac manifestation of patients with these syndromes. To date, there have been no reports of early childhood onset of high-grade atrioventricular block in patients with Hunter syndrome. We present a case of a 3-year-old boy with Hunter syndrome who was found to have various degrees of atrioventricular block. This case highlights the importance of early routine cardiac screening for conduction abnormalities and close follow-up in patients with mucopolysaccharidoses syndromes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1017/S1047951118000215

  10 / 25544 MEDLINE  
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[PMID]: 29435607
[Au] Autor:Follansbee CW; Beerman L; Arora G
[Ad] Address:Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA. Christopher.Follansbee@chp.edu.
[Ti] Title:Marked First-Degree Atrioventricular Block and Pseudo-Pacemaker Syndrome in a Pediatric Patient.
[So] Source:Pediatr Cardiol;39(3):637-639, 2018 Mar.
[Is] ISSN:1432-1971
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:We describe a 17-year-old female who presented with 3 weeks of abdominal pain, exercise intolerance, and an episode of altered mental status found to have marked first-degree atrioventricular block. Exercise stress test and cardiac catheterization demonstrated pseudo-pacemaker syndrome, and a permanent pacemaker was placed. Following placement, she has resolution of symptoms and markedly improved exercise tolerance.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Process
[do] DOI:10.1007/s00246-018-1829-4


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