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Hayashi H, Abe A, Oguma T, Ito Y, Nakayama A. Sick sinus syndrome diagnosed after a sinus arrest during treatment for zygomatic fracture: a case report. BMC Oral Health 2023; 23:676. [PMID: 37726766 PMCID: PMC10507857 DOI: 10.1186/s12903-023-03413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Intraoperative sinus arrest is rarely seen during zygomatic fracture treatment. The patient was diagnosed with sick sinus syndrome based on repeated postoperative sinus arrest, which could have resulted in death if diagnosed late, making this case very significant to report. CASE PRESENTATION Sick sinus syndrome is an arrhythmia associated with reduced automaticity of the sinoatrial node or impaired sinoatrial node conduction. We report the case of a 67-year-old man diagnosed with the syndrome after a sinus arrest that occurred during a zygomatic fracture treatment. The patient had cheek pain and mouth opening disorder, dizziness after fainting and sustaining a facial injury. Preoperative examination determined that the syncope was due to drug-induced arrhythmia, and surgery was authorized after drug withdrawal. During the operation, sinus arrest was observed due to trigeminal vagal reflex, and heart rate was restarted by stopping the operation and chest compressions. After the surgery, the patient showed symptoms of dizziness and palpitations, and sinus arrest following atrial fibrillation and supraventricular tachycardia, which was diagnosed as sick sinus syndrome, and a pacemaker was implanted. Currently, 8 years have passed since the surgery, and there are no symptoms of mouth opening disorder, dizziness, or palpitations. CONCLUSIONS In the case of maxillofacial injuries due to syncope, cardiogenic syncope is a possibility, and repeated syncope is a risk for death due to delayed diagnosis. There are no reports of maxillofacial trauma leading to a diagnosis of sick sinus syndrome. The purpose of this case report is to disseminate the importance of diagnosing the cause of syncope as well as injury treatment.
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Affiliation(s)
- Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
| | - Tetsushi Oguma
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yu Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Atsushi Nakayama
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Shiraishi K, Goto T, Oya S, Hayashi S, Sakurai S. Lidocaine Tape Application for 3 Hours Prevents Vasovagal Syncope During Venipuncture: A Case Series. Anesth Prog 2023; 70:34-36. [PMID: 36995954 PMCID: PMC10069530 DOI: 10.2344/anpr-70-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/21/2022] [Indexed: 03/31/2023] Open
Abstract
Vasovagal syncope (VVS) or reflex is usually caused by physical and mental stress-related factors, like pain, anxiety, and fear, and it is one of the most frequent complications during dental treatment. Two patients, both with histories of dental phobia and of VVS during vaccination, venipuncture, and dental treatment with local anesthetics, were scheduled for dental treatment under intravenous (IV) sedation. However, both experienced episodes of VVS that occurred during venipuncture using a 24-gauge indwelling needle. We determined that pain was the main trigger of VVS for these patients and attempted to reduce venipuncture-associated pain using 60% lidocaine tape applied 3 hours before venipuncture at their next dental visits, respectively. Use of the lidocaine tape was successful and permitted comfortable placement of the IV catheter without any onset of VVS.
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Affiliation(s)
- Kaho Shiraishi
- Department of Dental Anesthesiology, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Takashi Goto
- Department of Dental Anesthesiology, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Shoko Oya
- Department of Dental Anesthesiology, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Shintaro Hayashi
- Department of Dental Anesthesiology, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
| | - Satoru Sakurai
- Department of Dental Anesthesiology, Division of Oral Pathogenesis and Disease Control, Asahi University School of Dentistry, Gifu, Japan
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3
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Al-Bayati A, Wiseman K, Udongwo N, Ajam F, Hansalia R, Apolito R. Heart Block Caused by Ticagrelor Use in a Patient Who Underwent Adenosine Diastolic Fractional Reserve Assessment: A Case Report. J Med Cases 2022; 12:499-502. [PMID: 34970374 PMCID: PMC8683107 DOI: 10.14740/jmc3815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/18/2021] [Indexed: 11/30/2022] Open
Abstract
Ticagrelor is a direct and rapid-acting antagonist of the P2Y12-adenosine diphosphate receptor found on platelets. The drug is recommended as a first-line antiplatelet agent in patients with acute coronary syndromes, as evidenced in its superiority compared to clopidogrel according to the Platelet Inhibition and Patient Outcomes study. Specifically, the mechanism of action has been proven to show higher inhibition and less variability in its action on P2Y12 receptors compared to clopidogrel. Additionally, ticagrelor inhibits the equilibrative nucleoside transporter 1 adenosine transporter protein leading to an increased concentration of adenosine in the blood, particularly at sites of ischemia. This effect increases the biological efficacy of ticagrelor in terms of cardioprotection, anticoagulation effects, and anti-inflammatory effects. However, the effects are also thought to be responsible for some of the adverse pharmacological effects reported with ticagrelor, such as bradycardia and ventricular pauses > 3 seconds. Herein, we report a case of recurrent sinus arrest and ventricular asystole in a patient pre-treated with ticagrelor and subsequent physiological assessment of a coronary lesion with fractional flow reserve using intravenous adenosine infusion.
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Affiliation(s)
- Asseel Al-Bayati
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Kyle Wiseman
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Ndausung Udongwo
- Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Firas Ajam
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Riple Hansalia
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Renato Apolito
- Department of Cardiology, Jersey Shore University Medical Center, Neptune, NJ, USA
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Teo YH, Han R, Leong S, Teo YN, Syn NL, Wee CF, Tan BKJ, Wong RC, Chai P, Kojodjojo P, Kong WK, Lee CH, Sia CH, Yeo TC. Prevalence, types and treatment of bradycardia in obstructive sleep apnea - A systematic review and meta-analysis. Sleep Med 2021; 89:104-113. [PMID: 34971926 DOI: 10.1016/j.sleep.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We sought to clarify the prevalence of comorbid OSA and bradycardia, and the effect of continuous positive airway pressure (CPAP) therapy on bradycardia outcomes. METHODS We systematically searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) for randomized or observational studies reporting the co-prevalence of sleep apnea and bradycardia or evaluated the use of CPAP on the incidence of bradycardias. We used random-effects models in all meta-analyses and evaluated heterogeneity using I2. RESULTS We included 34 articles from 7204 records, comprising 4852 patients. Among patients with OSA, the pooled prevalence of daytime and nocturnal bradycardia were 25% (95% CI: 18.6 to 32.7) and 69.8% (95% CI: 41.7 to 88.2) respectively. Among patients with bradycardia, the pooled prevalence of OSA was 56.8% (95% CI: 21.5 to 86.3). CPAP treatment, compared to those without, did not significantly reduce the risk of daytime (two randomized trials; RR: 0.50; 95% CI: 0.11 to 2.21) or nocturnal bradycardia (one randomized-controlled trial and one cohort study; RR: 0.76; 95% CI: 0.48 to 1.20). CONCLUSIONS This meta-analysis demonstrates a high comorbid disease burden between OSA and bradycardia. Future research should explore the treatment effect of CPAP on bradycardia incidence, as compared to placebo.
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Affiliation(s)
- Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Ruobing Han
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Shariel Leong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Nicholas L Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Caitlin Fern Wee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Benjamin Kye Jyn Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Pipin Kojodjojo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228.
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597; Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228
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Braiman D, Konstantino Y, Westreich R. When the brain slows the heart-herpes encephalitis and sinus arrest: a case report. Eur Heart J Case Rep 2021; 5:ytab254. [PMID: 34377921 PMCID: PMC8343447 DOI: 10.1093/ehjcr/ytab254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022]
Abstract
Background Herpes simplex virus (HSV) encephalitis is a known cause of cognitive deterioration, neurological disturbances, and seizures though are rarely associated with sinus node dysfunction. Case summary We present a 54-year-old man admitted to the hospital with a 10-day history of fever, confusion, and fatigue, 1 week following a transient loss of consciousness. An initial workup suggested HSV encephalitis and the patient was started on intravenous Acyclovir. Due to his episode of syncope, a 24 h Holter electrocardiogram monitoring was performed. The Holter documented multiple episodes of sinus arrest, with a second episode of syncope noticed by the hospital staff concurrent with the last documented sinus arrest. Following antiviral treatment and resolution of the encephalitis we noticed complete resolution of sinus node dysfunction. We subsequently avoided permanent pacemaker implantation. Discussion Our case of proven HSV encephalitis complicated by sinus node arrest and syncope with complete resolution following antiviral treatment suggests no indication for permanent pacemaker implantation. This approach is consistent with data from previously reported cases.
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Affiliation(s)
- Dana Braiman
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Yuval Konstantino
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
| | - Roi Westreich
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel.,Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center, 84101, Be'er Sheva, Israel
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Anno T, Tsujimoto K, Shigemoto R, Kojima S, Kaneto H. Diabetic ketoacidosis and sinus arrest conditions in a patient with an inserted cardiac pacemaker. Acta Diabetol 2021; 58:657-660. [PMID: 33392711 PMCID: PMC8076143 DOI: 10.1007/s00592-020-01615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan.
| | - Kotone Tsujimoto
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Ryo Shigemoto
- Department of General Internal Medicine 1, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama, 700-8505, Japan
| | - Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, 700-8505, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, 701-0192, Japan
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Lampropoulos CE, Mavrogeni S, Dervas A, Manios E, Chatzidou S, Kontogiannis C, Spiliopoulou S, Melliou S, Kalogianni E, Papaioannou I. Myocardial fibrosis after COVID-19 infection and severe sinus arrest episodes in an asymptomatic patient with mild sleep apnea syndrome: A case report and review of the literature. Respir Med Case Rep 2021; 32:101366. [PMID: 33619450 DOI: 10.1016/j.rmcr.2021.101366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
COVID-19 infection is a new disease mainly affecting the respiratory system but is also accompanied by many extra-pulmonary manifestations. A case of a 47-year old male with unique myocardial fibrosis after COVID-19 infection involving the left ventricular wall, intraventricular septum and almost complete damage of interatrial septum, in combination with asymptomatic severe sinus arrest episodes related to mild obstructive sleep apnea syndrome is described here. Myocardial fibrosis may be a consequence of COVID-19 infection. Almost complete fibrosis of interatrial septum is a unique complication of COVID-19. Cardiac MRI is very useful in detecting myocardial complications. Severe sinus arrest episodes are very unusual in patients with mild OSA syndrome.
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Kojima H, Tanaka R, Iwamoto Y, Ishido H, Sakurai Y, Masutani S. Markedly long pause due to sinus arrest during dexmedetomidine use and nasal continuous positive airway pressure in two infants with respiratory syncytial virus infection. J Cardiol Cases 2021; 23:10-2. [PMID: 33437332 DOI: 10.1016/j.jccase.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/25/2020] [Accepted: 08/12/2020] [Indexed: 11/21/2022] Open
Abstract
Nasal respiratory support for infants with respiratory distress caused by respiratory syncytial (RS) virus infection sometimes requires appropriate sedation. Dexmedetomidine can be an alternative sedative because of its advantage of less frequent respiratory suppression. We report the cases of twin infants with RS virus infection who showed unreported long pauses (4 and 10 s) due to sinus arrest while receiving dexmedetomidine. After termination of dexmedetomidine administration, the long pause of >2 s was no longer observed in both cases. RS virus infection may inhibit the conduction system and sometimes induce bradyarrhythmia. Cardiac and sinus arrests are reported as complications of dexmedetomidine administration. Thus, because dexmedetomidine administration and RS virus infection may additively or synergistically inhibit the conduction system, the use of dexmedetomidine in infantile RS infection should be carefully considered. If sedation is unavoidable, other drugs should be used first. An evidence-based safe regimen for sedation in infants with RS infection should be established in the near future. <Learning objective: Dexmedetomidine use as a sedative should be carefully considered in infants with respiratory syncytial (RS) infection because dexmedetomidine administration and RS virus infection may additively or synergistically inhibit the conduction system. If sedation is unavoidable, other drugs should be used first.>.
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Perego M, Porteiro Vàzquez DM, Ramera L, Lombardo SF, Pane C, Bontempi LV, Santilli RA. Heart rhythm characterisation during unexplained transient loss of consciousness in dogs. Vet J 2020; 263:105523. [PMID: 32928492 DOI: 10.1016/j.tvjl.2020.105523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
The identification of the heart rhythm during an episode of transient loss of consciousness (TLOC) is considered the reference standard method to elucidate the underlying aetiology. This study aimed to characterise heart rhythm in dogs during TLOC using Holter and external loop recorder monitoring. We retrospectively reviewed 24-h Holter monitoring and external loop recorder tracings from 8084 dogs. Heart rhythms from dogs that experienced TLOC during the recording was analysed to identify rhythm disturbances that occurred during episodes of TLOC. Electrocardiograms (ECGs) were subsequently categorised into Type 1 (ventricular arrest), Type 2 (sinus bradycardia), Type 3 (no/slight rhythm variations), and Type 4 (tachycardia). Transient LOC was documented in 92 dogs over 230 episodes of TLOC. Percentage of cases with ECGs compatible with each classification were as follows: 72.1%, Type 1; 6.1%, Type 2; 20.9%, Type 3; and 0.9%, Type 4. Cardiac rhythm during the TLOC could have been a consequence of a neurocardiogenic mechanism in 46.7% cases, while intrinsic rhythm disturbances of the sinus node or of the atrioventricular node were diagnosed in 31.5% cases. In two cases, tachycardia was the possible cause of the TLOC. ECG patterns in dogs presenting with multiple TLOC episodes were completely reproducible during each episode. TLOC in dogs was primarily caused by ventricular arrest. Most dogs with TLOC had electrocardiographic finding suggestive of a reflex or neurally-mediated syncope, but one third had an ECG more suggestive of a conduction disorder. Distinguishing these two entities could help inform diagnostic, therapeutic, and prognostic plans.
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Affiliation(s)
- M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Ospedale Veterinario I Portoni Rossi, Via Roma 57, 40069, Zola Predosa, Bologna, Italy
| | | | - L Ramera
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - S F Lombardo
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Ospedale Veterinario I Portoni Rossi, Via Roma 57, 40069, Zola Predosa, Bologna, Italy
| | - C Pane
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - L V Bontempi
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA.
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Wakuta N, Yamamoto S. Risk of fatal sinus arrest induced by low-grade subarachnoid hemorrhage: A case of a young patient with obstructive sleep apnea. Surg Neurol Int 2020; 11:156. [PMID: 32637209 PMCID: PMC7332489 DOI: 10.25259/sni_66_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background Sleep apnea syndrome (SAS) and subarachnoid hemorrhage (SAH) are both considered possible causes of secondary arrhythmias. However, there are limited reports on the increased risk of bradyarrhythmia for arrhythmia-free SAS patients with SAH. Case Description A 31-year-old woman with SAS developed low-grade SAH and underwent coil embolization on postbleed day 1. Following a coiling procedure, she experienced worsening episodes of sinus arrest lasting up to 12 s and required a temporary pacemaker. Frequent episodes of sinus arrest were detected for the next 4 days. Thereafter, all types of arrhythmias gradually decreased, and she eventually recovered to be arrhythmia free. Conclusion Acceleration of sympathetic nervous activity caused by acute SAH may predispose patients to bradyarrhythmia with SAS and elicit asystole. The coexistence of SAS and SAH should be recognized as a cause of life-threatening sinus arrest, even if the severity of SAH is low grade.
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Affiliation(s)
- Naoki Wakuta
- Department of Neurosurgery, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Satoshi Yamamoto
- Department of Neurosurgery, Okinawa Miyako Hospital, Okinawa, Japan
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11
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Wang LYT, Ng GYP. COVID-19 treatment with lopinavir-ritonavir resulting in sick sinus syndrome: a case report. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33089048 PMCID: PMC7337728 DOI: 10.1093/ehjcr/ytaa171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023]
Abstract
Background COVID-19 infection is the most serious global public health crisis of the century. With no approved treatments against it, investigational treatments are being used despite limited safety data. Besides being at higher risk of complications of COVID-19 infection, patients with underlying cardiovascular disease are more likely to develop cardiac-related side effects of treatment. We present a case of sinus arrest with junctional escape related to lopinavir–ritonavir. Case summary A 67-year-old man, with underlying stable ischaemic heart disease, acquired COVID-19 infection. He had a prolonged duration of fever and cough. He subsequently developed acute respiratory distress and required intensive care unit (ICU) care. Given his severe infection, he was started on lopinavir–ritonavir. Hydroxychloroquine was not used as he had a prolonged QTc interval. During observation in the ICU, the patient developed recurrent episodes of sinus arrest with junctional escape. Initial concerns were of myocarditis, but he had no ST-segment changes on ECG, with mild elevations of highly sensitive troponin I and a normal transthoracic echocardiogram. A multidisciplinary team discussion involving the intensivist, infectious disease physicians, and cardiologist; the decision was made to stop treatment with lopinavir–ritonavir. Within 48 h, the bradyarrhythmia resolved. The patient did not require transvenous and permanent pacemaker insertion. Conclusion Current efficacy and safety evidence of lopinavir–ritonavir as a treatment in COVID-19 patients is limited. Although uncommonly reported, those with underlying cardiovascular disease are at increased risk of bradyarrhythmia-related adverse effects of lopinavir–ritonavir. When initiating investigational therapies, especially in patients with cardiovascular conditions, adequate counselling and close monitoring are required.
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Affiliation(s)
- Laureen Yi-Ting Wang
- National University Heart Centre, National University Hospital Singapore, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Gavin Yeow Ping Ng
- National University Heart Centre, National University Hospital Singapore, 5 Lower Kent Ridge Rd, Singapore 119074
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Ma LL, Liu Y, Jia SX, Lv HC, Fang MY, Xia YL. A case report: high dose melphalan as a conditioning regimen for multiple myeloma induces sinus arrest. Cardiooncology 2020; 6:4. [PMID: 32190351 PMCID: PMC7069049 DOI: 10.1186/s40959-020-0059-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022]
Abstract
High dose melphalan is commonly used as a conditioning regimen for autologous stem cell transplantation in multiple myeloma. There are reports of adverse cardiac events with melphalan manifested by supraventricular tachycardia and atrial fibrillation. Here, we report a rare case of a 58 year old female with multiple myeloma, who developed sinus arrest after autologous stem cell transplantation using high dose melphalan as a conditioning regimen. It was severe and rare, therefore, monitoring for cardiac toxicity in patients receiving high-dose melphalan is mandatory.
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Affiliation(s)
- Liang-Liang Ma
- 1Department of Hematology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Liu
- 2Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116021 Liaoning China
| | - Si-Xun Jia
- 3Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Road, Dalian, 116001 Liaoning China
| | - Hai-Chen Lv
- 2Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116021 Liaoning China
| | - Mei-Yun Fang
- 3Department of Hematology, Affiliated Zhongshan Hospital of Dalian University, 6 Jiefang Road, Dalian, 116001 Liaoning China
| | - Yun-Long Xia
- 2Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, 116021 Liaoning China
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Brignole M, Iori M, Solari D, Bottoni N, Rivasi G, Ungar A, Deharo JC, Guieu R. Efficacy of theophylline in patients with syncope without prodromes with normal heart and normal ECG. Int J Cardiol 2019; 289:70-73. [PMID: 30928258 DOI: 10.1016/j.ijcard.2019.03.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/26/2019] [Accepted: 03/21/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients affected by syncope without or with very short (≤5 s) prodrome with normal heart and normal ECG have been seen to present low plasma adenosine levels. We investigated whether chronic treatment of these patients with theophylline, a non-selective adenosine receptor antagonist, results in clinical benefit. METHODS In a consecutive case-series of 16 patients (mean age 47 ± 25 years, 9 females) who had ECG documentation of asystolic syncope, we compared the incidence of syncopal recurrence during a period without and a period with tailored theophylline therapy. RESULTS During a median of 60 months before ECG documentation of the index episode, the patients had a median of 2 syncopes per year. During the 6 months of the study phase without therapy, the patients had a median of 2.6 syncopes per year, p = 0.63. During the 23 months of the study phase with theophylline, the patients had a median of 0.4 syncopes per year, p = 0.005 vs history and p = 0.005 vs no therapy. In the 13 patients who had an implantable loop recorder during both study phases, the incidence of asystolic episodes > 3 s decreased from 9.6 per year to 1.1 per year, p = 0.0007. During theophylline treatment, syncope recurred in 1/5 (20%) patients who had an idiopathic atrioventricular block as the index event versus 9/11 (81%) patients who had a sinus arrest, p = 0.005. CONCLUSION Theophylline is effective in reducing syncopal burden in patients with syncope without prodromes with normal heart and normal ECG. Its efficacy is greater in those with idiopathic atrioventricular block.
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Affiliation(s)
- Michele Brignole
- Department of Cardiology, Ospedali del Tigullio, Lavagna, GE, Italy.
| | - Matteo Iori
- Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Diana Solari
- Department of Cardiology, Ospedali del Tigullio, Lavagna, GE, Italy
| | - Nicola Bottoni
- Department of Cardiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Giulia Rivasi
- Department of Geriatrics and Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Ungar
- Department of Geriatrics and Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Regis Guieu
- Department of Cardiology, Hopital La Timone Adultes, Marseille, France; UMR MD2, Aix Marseille University, Institute of Biological research of the French Army (IRBA), Marseille, France
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Abstract
The sick sinus syndrome includes symptoms and signs related to sinus node dysfunction. This can be caused by intrinsic abnormal impulse formation and/or propagation from the sinus node or, in some cases, by extrinsic reversible causes. Careful evaluation of symptoms and of the electrocardiogram is of crucial importance, because diagnosis is mainly based on these 2 elements. In some cases, the pathophysiologic mechanism that induces sinus node dysfunction also favors the onset of atrial arrhythmias, which results in a more complex clinical condition, known as "bradycardia-tachycardia syndrome."
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Affiliation(s)
- Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia, Perugia 06129, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence, Florence 50134, Italy; Cardiology Department, IRCCS Multimedica, Via Milanese, 300, Sesto San Giovanni, Milan 20099, Italy
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15
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Semmler V, von Krogh F, Haller B, Reents T, Bourier F, Telishevska M, Kottmaier M, Kornmayer M, Brooks S, Koch-Büttner K, Lennerz C, Brkic A, Grebmer C, Blazek P, Weigand S, Hessling G, Kolb C, Deisenhofer I. The incidence, indications and predictors of acute pacemaker implantation after ablation of persistent atrial fibrillation. Clin Res Cardiol 2019; 108:651-9. [PMID: 30460479 DOI: 10.1007/s00392-018-1393-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with persistent atrial fibrillation (AF) may additionally suffer from a concealed sinus node disease. We sought to determine the incidence, indications and predictors of acute pacemaker [PM] implantation within 1 week after the ablation of persistent AF. METHODS AND RESULTS We performed a retrospective analysis of patients, who had had an ablation of persistent AF at our center. Between 01/2011 and 08/2016, 1234 patients (mean age 65 ± 10 years, 66.7% male) without prior PM implantation underwent an ablation of persistent AF. Pulmonary vein isolation (PVI) was performed in 1158 (93.8%), the additional ablation of complex fractionated atrial electrograms (CFAE) in 1109 (89.9%) and linear ablation in 524 (42.5%) patients. Temporary cardiac pacing was necessary in 27 (2.2%) patients. The temporary PM was removed in 15 patients (1.2%) because sinus node recovered after a median of 1.0 (minimum 0.1-maximum 2.0) day. The remaining 12 (1.0%) patients required the implantation of a permanent PM. Another 13 (1.1%) patients required permanent PM implantation without prior temporary pacing. In a multivariable regression model, age [OR 1.07 (1.02-1.12), p = 0.006], sinus pauses prior to ablation [OR 7.97 (2.36-26.88), p = 0.001] and atria with low voltage [OR 2.83 (1.31-6.11), p = 0.008] were identified as significant predictors for acute cardiac pacing. CONCLUSION Acute cardiac pacing within 1 week after the ablation of persistent AF was necessary in 40 (3.2%) patients. Age, sinus pauses in history prior to ablation and the existence of low-voltage areas in the atria were identified as relevant risk factors.
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16
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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17
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Bhaskaran A, Kumar S, Kizana E, Thomas SP, Chik WWB. Multimodality imaging, electrophysiologic, electroanatomic, and histopathologic characterization of atrial sarcoidosis presenting with sinus arrest and reentrant right atrial flutter. HeartRhythm Case Rep 2018; 4:469-74. [PMID: 30364526 DOI: 10.1016/j.hrcr.2018.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Kolarich AR, Mubarak M, Wells S, Campbell CT, Samraj RS. A case of sinus pause induced by swallowing in the setting of olanzapine and guanfacine overdose. J Intensive Care Soc 2018; 20:277-280. [PMID: 31447925 DOI: 10.1177/1751143718786109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Olanzapine, a second-generation antipsychotic, is used in both adult and pediatric populations for schizophrenia, bipolar disorder, and depression and has been associated with autonomic dysregulation in the setting of overdose. Guanfacine is a sympatholytic drug used in the treatment of attention deficit hyperactivity disorder and has also been associated with autonomic dysfunction. We present a unique case of a 17-year-old male who overdosed on 340 mg of olanzapine and 189 mg of extended-release guanfacine with a previously unreported adverse event. Specifically, five days after ingestion, he developed a 5-8 s sinus pause every time he forcefully swallowed any beverage, suggestive of a vagal hypersensitivity reaction. The report will review the autonomic dysfunction of olanzapine and guanfacine and management of asymptomatic sinus pause in the critical care setting.
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Affiliation(s)
| | - Matthew Mubarak
- Pediatric Critical Care Medicine, University of Florida, UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Shannon Wells
- Pediatric Critical Care Medicine, University of Florida, UF Health Shands Children's Hospital, Gainesville, FL, USA
| | | | - Ravi S Samraj
- Pediatric Critical Care Medicine, University of Florida, UF Health Shands Children's Hospital, Gainesville, FL, USA
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19
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Shiraiwa N, Umesawa M, Hoshino S, Enomoto T, Kusunoki S, Tamaoka A, Ohkoshi N. Miller Fisher syndrome with sinus arrest. Neurol Int 2017; 9:7312. [PMID: 29109855 PMCID: PMC5651449 DOI: 10.4081/ni.2017.7312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nobuko Shiraiwa
- Course of Neurology, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology.,Department of Neurology, Tsukuba Memorial Hospital
| | - Mitsumasa Umesawa
- Department of Neurology, Tsukuba Memorial Hospital.,Department of Public Health, School of Medicine, Dokkyo Medical University
| | | | | | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University
| | - Akira Tamaoka
- Department of Neurology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Norio Ohkoshi
- Course of Neurology, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology
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20
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McGuinn EM, Bhatia N, O'Leary JM, Crossley GH, Rottman JN. Emergent use of an MRI-conditional external pacemaker in a patient with sinus arrest facilitating diagnosis of a temporal lobe neoplasm. HeartRhythm Case Rep 2017; 2:296-299. [PMID: 28491694 PMCID: PMC5419830 DOI: 10.1016/j.hrcr.2016.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Nirmanmoh Bhatia
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jared M O'Leary
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George H Crossley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey N Rottman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Nakou ES, Simantirakis EN, Kallergis EM, Skalidis EI, Vardas PE. Long-standing sinus arrest due to the occlusion of sinus node artery during percutaneous coronary intervention: Clinical implications and management. Int J Cardiol 2016; 203:432-3. [PMID: 26547050 DOI: 10.1016/j.ijcard.2015.10.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022]
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22
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Sinha SK, Varm CM, Thakur R, Krishna V, Goel A, Kumar A, Jha MJ, Mishra V, Singh Syal K. An Unconventional Route of Left Ventricular Pacing. Cardiol Res 2015; 6:324-328. [PMID: 28197251 PMCID: PMC5295572 DOI: 10.14740/cr423w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/12/2022] Open
Abstract
We present a case of a rare complication of transvenous right ventricular pacing by temporary pacing wire causing iatrogenic interventricular septal perforation and left ventricular pacing in a 69-year-old man who was referred for recurrent syncope with sinus arrest.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Chandra Mohan Varm
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Ashutosh Kumar
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Vikas Mishra
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
| | - Karandeep Singh Syal
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, 208002, India
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23
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Takigawa M, Kuwahara T, Okubo K, Takahashi A. Sudden manifestation of sinus arrest nine months after catheter ablation treatment for persistent atrial fibrillation. J Arrhythm 2015; 31:238-9. [PMID: 26336567 DOI: 10.1016/j.joa.2014.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/12/2014] [Accepted: 11/26/2014] [Indexed: 10/23/2022] Open
Abstract
A 39-year-old man with a seemingly non-remodeled, small heart suffered persistent atrial fibrillation (AF). Extensive isolation of the pulmonary vein, superior vena cava, and posterior left atrium, in conjunction with right atrium focal ablation, was performed to ablate multiple AF foci during two catheter ablation sessions. Sinus arrest occurred suddenly during follow-up, despite the absence of recurrent AF, ultimately necessitating pacemaker implantation. This case underscores the necessity of careful follow-up after catheter ablation, highlighting the risk of sudden, severe sinus node dysfunction, even in young AF patients with small hearts.
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Affiliation(s)
- Masateru Takigawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan
| | - Taishi Kuwahara
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan
| | - Kenji Okubo
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan
| | - Atsushi Takahashi
- Cardiovascular Center, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka 238-8558, Japan
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24
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Okahara A, Nagamoto Y, Umemoto S, Matsuura T, Ozaki K, Nakano Y, Takegami K, Mine D, Shirahama T, Koga Y, Yoshida K, Sadamatsu K, Hayashida K. Blackout during meals: A case report of swallow syncope due to sinus arrest. J Cardiol Cases 2014; 10:91-93. [PMID: 30546515 DOI: 10.1016/j.jccase.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/10/2014] [Accepted: 05/12/2014] [Indexed: 11/17/2022] Open
Abstract
A 79-year-old male, with a history of percutaneous coronary intervention (PCI), was referred to our cardiovascular department for a detailed examination of blackout caused by sinus arrest only during meals. Ultrasound echocardiography showed normal cardiac contraction with no asynergy, irrespective of the remaining stenotic coronary lesion. An electrophysiological study revealed deteriorated atrioventricular nodal conduction at a Wenckebach point of 70 beats per minute. However, sinus node function was normal as demonstrated by a sinus node recovery time of 1369 ms. Coronary angiography showed triple-vessel disease including the remaining stenotic coronary lesion, and a PCI was performed on the right coronary artery. Nevertheless, sinus arrest during meals was unchanged. Swallow syncope was partially improved by dietary modification; however, pacemaker implantation (PMI) was performed eventually, and the patient became asymptomatic after PMI. <Learning objective: Swallow syncope is a rare cause of syncope that belongs to the neurally mediated reflex syncopal syndromes, which can induce a variety of bradyarrhythmias: sinus bradycardia, sinus arrest, sinoatrial block, atrioventricular block, or atrial and ventricular asystole. In this case, we demonstrated that dietary modification or pacemaker implantation improved swallow syncope due to sinus arrest.>.
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Affiliation(s)
- Arihide Okahara
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | | | - Shintaro Umemoto
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Taku Matsuura
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Koji Ozaki
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Yasuhiro Nakano
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kaoru Takegami
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Daigo Mine
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | | | - Yasuaki Koga
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Keiki Yoshida
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kenji Sadamatsu
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Kiyoshi Hayashida
- Division of Cardiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
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25
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Mastrine L, Chada S, Enakpene E, Hollander G. Combination of asystole and sinus arrest with junctional escape rhythm seen in Takotsubo cardiomyopathy: A case report. J Cardiol Cases 2013; 8:125-128. [PMID: 30546762 DOI: 10.1016/j.jccase.2013.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/01/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by a transient depression of contractile function of mid and/or apical segments of the left ventricle with compensatory hyperkinesis of the basal segment. It leads to ballooning of the apex in systole, resembling an octopus trap, hence the name. There have been many different arrhythmias associated with TCM. These occurrences are not benign, with atrial fibrillation, atrio-ventricular block, and ventricular fibrillation most commonly associated with inpatient mortality in that order. Here we present a unique case of TCM with respect to arrhythmia. After a literature review, this is the only case to our knowledge with the rare combination of asystole and sinus arrest with junctional escape rhythm during the patient's initial presentation. <Learning objective: (i) Observe a case with a unique combination of arrhythmias in Takotsubo cardiomyopathy (TCM) never previously documented in the literature. (ii) Review the incidence of TCM and associated arrhythmia with inpatient mortality. (iii) Review the incidence of junctional escape rhythm associated with TCM.>.
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Affiliation(s)
- Lou Mastrine
- Cardiology, Maimonides Medical Center, 4802 Tenth Ave, Brooklyn, NY 11219, USA
| | - Sameer Chada
- Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Evbu Enakpene
- Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Gerald Hollander
- Clinical Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
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