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PubMed2005

[Adams-Stokes attack due to complete atrioventricular block in a patient with acute promyelocytic leukemia during remission induction therapy using all-trans retinoic acid].

We describe a case of Adams-Stokes syncope due to complete atrioventricular block which occurred in a leukemic patient receiving all-trans retinoic acid (ATRA). Remission induction therapy was performed for a 46-year-old Japanese man with acute promyelocytic leukemia using ATRA (45 mg/m2), enocitabine (170 mg/m2, 5 days), and mitoxantrone (4 mg/m2, 3 days). On the 25th day of chemotherapy, syncope suddenly occurred. Electrocardiography revealed a complete atrioventricular block, and a temporary pacemaker was inserted on the following day. The block was persistent and the cardiac rhythm was dependent on the pacemaker. ATRA was discontinued on the 29th day because the arrhythmia was believed to be an adverse reaction to the ATRA regimen. The normal sinus rhythm was restored 15 days thereafter, and the patient eventually reached remission. He subsequently received 4 courses of consolidation therapy without any cardiovascular complications. Although ATRA sometimes induces arrhythmias, to the best of our knowledge this is the first report in the literature of such a critical ATRA-related arrhythmia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

A histological study of the cardiac conduction system in a heifer with complete atrioventricular block.

A case of complete atrioventricular (AV) block of congenital origin in a 16-month-old Holstein heifer was studied histologically with serial sectioning of the cardiac conduction system. The heart was enlarged and showed moderate dilatation of the left and right ventricles. Histologically, the abnormally placed and poorly formed AV bundle was observed in association with abnormality in the tricuspid extension of the central fibrous body, suggesting that the pathological state of the AV bundle had been responsible for the complete AV block. This type of anatomical fault in the AV bundle is considered to be part of an embryological, developmental malformation of the central fibrous body.

Animals↗
PubMed1986

Atrioventricular block complicating amiodarone-induced hypothyroidism in a patient with pre-excitation and rate-dependent bilateral bundle branch block.

As a clinical entity atrioventricular (AV) block due to hypothyroidism is rare. Such a case induced by hypothyroidism complicating long-term therapy with amiodarone in a 45 year old woman with pre-excitation is presented. Electrophysiologic data obtained before and during thyroxine replacement therapy showed that hypothyroidism lengthens the effective refractory period of the atria, AV node, bypass tract and His-Purkinje system (that in the ventricle not being measured); this lengthening resembles the effects of long-term administration of amiodarone. These observations suggest that depressed thyroid function may be protective against arrhythmias but a patient with preexisting conduction system disease may develop AV block. The tendency to develop AV block in a patient who is euthyroid was reduced by bypass tract conduction. These findings are significant not only in monitoring amiodarone effects during chronic prophylactic drug therapy but also in providing further insight into the complex interrelation between the action of the drug and the thyroid hormones on cardiac muscle.

Amiodarone↗
PubMed1975

The relative risk of spontaneous complete atrioventricular block in elderly patients with impaired intra-ventricular conduction.

We reviewed 144 consecutive patients with symptomatic high grade atrioventricular block. Cases due to congenital heart disease, acute myocardial infarction, cardiac surgery or digitalis toxicity were excluded. Of the remaining, we chose 71 patients in whom atrioventricular conduction was observed either intermittently during complete heart block (CHB) or in electrocardiograms taken within two years prior to documentation of CHB. The mean age was 69 years, with the peak incidence in the seventh decade in 43 men and eight decade in 28 women. Bundle branch block (BBB) was present in 76% of patients as follows: 47% had right BBB (20% with normal QRS axis, 20% with left axis deviation and 7% with right axis deviation), 17% had left BBB (11% with normal QRS axis and 6% with left axis deviation) and 12% had either alternating BBB, right BBB with alternating axis deviation or atypical BBB. "Trifascicular block" patterns accounted for 21% of the total group of CHB. We also studied the prevalence of various patterns of BBB in a group of 2000 random hospital patients of comparable age and sex exclusive of those with acute myocardial infarction and heart surgery. The risk of CHB for the various patterns of BBB was calculated relative to normal intraventricular conduction. All patterns of BBB carried a considerably increased relative risk of CHB, (P smaller than .01). The relative risk was highest for RBBB with left axis deviation and lowest for LBBB with normal or left axis deviation. In the men, 74% had QRS patterns of "bifascicular" or "trifascicular" block during atrioventricular conduction. By contrast, 71% women had atrioventricular beats showing either no BBB or right BBB with normal QRS axis. QRS pattern during CHB was unchanged from that during atrioventricular conduction in 52% if cases (rabge 38%-76% with different QRS patterns) suggesting idiojunctional pacemaker. CHB in these cases was thought to be due probably to coexistent disease in the AV node or His bundle. Although the concept of uni-, bi- and trifascicular block patterns has been useful in identifying patients at greater risk of CHB, the predictability of the electrocardiogram has obvious limitations, particularly in women.

Aged↗
PubMed2000

[Prognostic significance of advanced atrioventricular block in patients with acute myocardial infarction].

BACKGROUND: Advanced atrioventricular block (AB) during acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. Our aim was to determine the prognostic significance of AB and its possible peculiarities in relation to infarction localization and/or the thrombolytic therapy. PATIENTS AND METHODS: The prospective study involved 1,239 patients with AMI. We studied clinical characteristics, as well as indexes of infarct size, short and long-term complications. RESULTS: AB was present in 85 (6.8%) patients and was more often associated with: previous treatment with diuretics, diabetes, inferior localisation, higher number of ECG leads with elevated ST segment, and higher peak of CK. The AB was associated with a higher mortality: in-hospital (27% vs 10.6%; p < 0.01)) and after one-year (31.7% vs 19.4%; p < 0.05). Patients with AB had a different in-hospital mortality depending on anterior or inferior infarct localization (66% vs 18.5%; p < 0.001, respectively). In patients receiving thrombolytic treatment (n = 681), the duration of AB was shorter and in-hospital mortality was lower (13.7% vs 47%, p < 0.11) than that occurred in patients without this treatment (n = 558). AB had independent value for predicting in-hospital mortality (OR: 3.56; 95% CI: 1.84-6.90) and one-year mortality (OR: 2.77; 95% CI: 1.52-5.04). CONCLUSIONS: AB is associated with larger infarcts and higher incidence of complications. The prognosis is especially poor when it is presented associated with anterior infarction and/or in patients without thrombolytic treatment. AB is a variable with independent prognostic value on the mortality.

Disease Progression↗
PubMed1995

Early clinical results with VDD pacing in patients with atrioventricular block.

In patients with intact sinus node function and atrioventricular block III(o) VDD pacing with a single pass lead may have advantages compared to conventional DDD systems. The purpose of this study was to evaluate the reliability of a new VDD pacemaker with regard to problems encountered with the implantation and the stability of the atrial sensing potential in the postoperative course. 24 patients (10 male, 14 female; age 61 +/- 17 years) underwent implantation of the Intermedics UNITY 292+07 VDD pacemaker. Patients were analyzed postoperatively with respect to stimulation parameters applied. The mean follow-up was 10+/- 3 months. While early on 23 of 24 patients were paced in a VDD mode, one patient was programmed to the vvi mode due to atrial flutter. One patient died early after aortic valve replacement, while another lost his atrial sensing one month postoperatively. Two patients were reprogrammed to the vvi mode because of atrial arrhythmias. The other 20 patients demonstrated stable atrial sensing potential aside from unchanged ventricular stimulation parameters. No infectious or unchanged ventricular stimulation parameters. No infectious or technical problems were observed. From these results it is concluded that VDD pacing may represent an excellent alternative in patients with intact sinus node function and AV block III(o). The atrial sensing was found to be reliable with the additional technical advantage that the single pass lead is less prone to dislocation than the atrial leads in DDD pacing.

Adolescent↗
PubMed1978

Value of pacing in cardiac failure associated with chronic atrioventricular block.

The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed. Only 1 of 6 patients studied haemodynamically improved and 1 died in cardiac failure. Of 21 patients assessed clinically, 10 had improved and 8 had died after a mean follow-up of 53 months. In the absence of syncope, pacing was of little symptomatic benefit but still may be justified to prolong survival. Both studies indicated a particularly poor prognosis for patients known to have coronary artery disease. No reliable means were found of determining the prognosis in the individual patient with cardiac failure before pacing.

Adult↗
PubMed2002

[Congenital complete atrioventricular block in children: pathogenesis and clinical outcomes].

Congenital complete atrioventricular block (CCAVB) is induced by the placental transmission of maternal anti-SS-A/Ro and anti-SS-B/La antibodies during the second trimester of pregnancy where they cause inflammatory injury to the foetal heart. Anti-SS-A/Ro and anti-SS-B/La antibodies can be detected in most mothers of children with CCAVB. However, the chance of an antibody-positive woman giving birth to a child with CCAVB is 1-5% and the chance of this recurring is 16%. In addition to the maternal antibodies, foetal and environmental factors may also play a role in the pathogenesis. CCAVB is associated with high morbidity and mortality during the foetal and neonatal period. Pacemaker implantation is indicated in approximately 60% of these children, after the development of symptoms related to bradycardia, although the timing of this is controversial. The effectiveness of therapeutic intervention in the uterus has yet to be determined. A conservative approach is advisable with respect to the use of corticosteroids.

Antibodies, Antinuclear↗
PubMed1991

[A case report of aortic stenosis complicated with complete atrioventricular block].

A case of aortic stenosis complicated with complete atrioventricular block preoperatively was reported. The patient was a 73-year-old woman who had been suffering from dyspnea and fatigability. Preoperative echocardiography revealed severe left ventricular hypertrophy, marked left ventricular-aortic pressure gradient (144 mmHg), and the impairment of left ventricular distensibility. Therefore, DDD pacemaker was implanted in addition to aortic valve replacement. Postoperative cardiac catheterization revealed that cardiac output was increased about 25% by DDD pacing compared with VVI pacing. It is more reasonable to employ DDD pacemaker to the case of which distensibility is impaired.

Aged↗
PubMed1982

Atrioventricular block, including Mobitz type II-like pattern, during ambulatory ECG recording in young athletes aged 14 to 16 years.

Twenty young male athletes, aged 14 to 16 years, and 20 nonathletic male controls of the same ages were studied with regard to atrioventricular block using ambulatory ECG recording. Among the athletic youngsters, the mean hourly heart rates were significantly (p less than 0.01) lower during most of the night hours and during school hours when activities in both groups were uniform. First degree block was found in the athletes in 3 cases, second degree Wenckebach-type block in 3 cases and second degree block with Mobitz type II-like pattern in 2 cases. Among the nonathletes, first degree block was found in one case and second degree Wenckebach-type block in another. The results indicate that after approximately 3 years of physical training, on average 5 times a week, various forms of atrioventricular block, apparently vagally mediated, are observable in young athletes more often than in nonathlete controls.

Adolescent↗
PubMedDate not supplied

Trypanosoma cruzi myocardial infection reactivation presenting as complete atrioventricular block in a Chagas' heart transplant recipient.

A 56-year-old man underwent orthotopic heart transplantation because of end-stage Chagas' cardiomyopathy. One hundred and ten days following heart transplantation, an electrocardiogram tracing showed complete atrioventricular block, which was treated with temporary transvenous pacemaker insertion. An underlying endomyocardial biopsy was graded 3A. The patient was treated with pulse steroid therapy. One week later, the patient died of multiorgan failure secondary to septicemia. A careful review of the endomyocardial biopsy showed nests of parasites in the myocardial tissue accompanied by mononuclear cell infiltrate similar to that found in acute graft rejection. Thus, complete atrioventricular block may be another clinical manifestation of Trypanosoma cruzi infection reactivation in Chagas' heart transplant recipients.

Animals↗
PubMedDate not supplied

Acquired atrioventricular block in a patient with sinus node disease on single-chamber atrial pacing.

Single-chamber atrial pacing is the most physiological and yet economical modality of treatment in patients with symptomatic sinus node disease with normal atrioventricular conduction. However, because of the possibility of future development of a high-degree atrioventricular block and atrial fibrillation, most patients are implanted either dual- or single-chamber right ventricular pacemakers. We report a patient with symptomatic sinus node disease on single-chamber atrial pacing for the past 7 years who developed a progressive increase in the PR interval and ultimately presented with symptomatic high-degree atrioventricular block requiring pacemaker upgradation. The pacemaker was upgraded to the single-chamber ventricular mode with one additional ventricular lead introduced from the same side percutaneously.

Atrial Fibrillation↗
PubMed2000

Successfully treated complete atrioventricular block with corticosteroid in a patient with cardiac sarcoidosis: usefulness of gallium-67 and thallium-201 scintigraphy.

A 71-year-old male with sarcoidosis was followed for 6 years without steroid therapy. He was admitted because of complete atrioventricular block. Chest X-ray showed hilar lymphadenopathy. Echocardiogram showed mild left ventricular hypertrophy without local wall thinning. Cardiac sarcoidosis was diagnosed by a defect of Thallium-201 (Tl-201) imaging and abnormal uptake of Gallium-67 (Ga-67). After the start of corticosteroid therapy, complete atrioventricular block was recovered. Abnormal uptake of Ga-67 was improved. Tl-201 and Ga-67 are useful to diagnose cardiac sarcoidosis, to evaluate the lesion of cardiac involvement and to estimate the efficacy of corticosteroid therapy.

Aged↗