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PubMed1990

Atrioventricular block in the atypical form of junctional reciprocating tachycardia: evidence supporting the atrioventricular node as the site of reentry.

Serial electrophysiologic studies were performed in 19 patients with the atypical form of supraventricular tachycardia having a long RP and short PR interval. In all 19 patients, supraventricular tachycardia was found to have a 1:1 P-QRS relation during initial control electrophysiologic studies, and in all 19 patients, electrophysiologic studies suggested that junctional reentry was the mechanism of supraventricular tachycardia. Seven of the 19 patients developed atrioventricular (AV) block during initiation of supraventricular tachycardia or after induction of supraventricular tachycardia following various drug administrations in subsequent studies. In three patients, second degree block within the His bundle or block distal to the His bundle recording site occurred after administration of quinidine. In one patient it occurred after procainamide, and in another patient it occurred after atropine. In one patient, 2:1 block proximal to the His deflection occurred after verapamil. In the remaining patient, a transient Wenckebach block proximal to the His deflection was noted after adenosine triphosphate. In this latter patient, 2:1 AV block was also noted after propranolol and digoxin. The site of reentry in these seven patients with AV block during supraventricular tachycardia was confined to the AV node area. Their supraventricular tachycardia did not involve a slowly conducting paraseptal accessory pathway because the distal AV node, His bundle and ventricle were not found to be necessary links in the tachycardia circuit.

Adolescent↗
PubMed1975

Acute inferior wall myocardial infarction associated with complete atrioventricular block and left posterior hemiblock.

Three cases of acute inferior wall myocardial infarction associated with complete atrioventricular block and junctional escape rhythm showing left posterior hemiblock are presented. The triad appears to consitiute a distinct syndrome. It is postuated that the subsidiary pacemaker is situated either in the bundle of His or the proximal part of the anterior division of the left bundle-branch.

Aged↗
PubMed2000

[Paroxysmal atrioventricular block during coronary revascularization with ultrasound. A case report].

The authors report the case of advanced atrioventricular block during a procedure of right coronary revascularisation with ultrasound. The different possible physiopathological mechanisms are discussed. Although no formal conclusions can be drawn, certain features suggest a paroxysmal nodal conduction defect secondary to transient parasympathetic stimulation by the ultrasound, a stimulation triggered by a Bezold-Jarish type of cardiac reflex or by direct local excitation of vagal fibres of the atrioventricular node.

Coronary Disease↗
PubMed1993

Complete atrioventricular block complicating inferior acute wall myocardial infarction: short- and long-term prognosis.

The incidence of complete atrioventricular block (AVB) in a large group of patients with Q-wave inferior acute myocardial infarction (AMI) was 251 (11%) of 2273 patients. This incidence was significantly higher in women (14%) and patients > 70 years old (15%) than in men and patients < 70 years old (10% and 9%, respectively). Patients with complete AVB exhibited more serious arrhythmic and mechanical complications during hospitalization and included more patients with very high enzyme levels than their counterparts without AVB. The in-hospital mortality rate was 92 (37%) of 251 patients with complete AVB versus 200 (11%) of 1890 in those without AVB (p < 0.0001). After adjustment for age, gender, and important anamnestic, medical, and enzymatic findings, complete AVB emerged as an independent predictor of in-hospital mortality, yielding an odds ratio of 2.0 (90% confidence interval 1.12 to 3.57). The long-term (5-year) mortality rate in hospital survivors was slightly but not significantly higher in patients with complete AVB (28%) during hospitalization than in their counterparts with no AVB (23%). In view of these data, patients with inferior AMI in whom complete AVB develops are at increased risk and may benefit from urgent revascularization; the postdischarge management of survivors with complete AVB should be no different from that of patients without AVB.

Aged↗
PubMed1981

Sinoatrial conduction time in patients with atrioventricular block.

In 20 patients with atrioventricular (A-V) block, sinoatrial conduction time (SACT) was measured in order to established to incidence of sinoatrial conduction defects. 10 patients had complete A-V block, 5 patients second-degree A-V block type 1, 2 patients second-degree A-V block type II, nd 3 patients first-degree A-V block. Prolonged bidirectional SACT was found in 8 cases (40%). The mean value (+/- SD) of SACT was 206 +/- 69 ms. In comparison with SACT in a group of 11 patients without symptoms and signs of sinus node disorder (mean value 156 +/- 25 ms) the difference was significant (p less than 0.05). On the other side, the values of SACT were shorter in patients with A-V block than in 13 patients with sick sinus syndrome (mean value 311 +/- 82 ms); the difference was statistically significant (p less than 0.001). The study shows that impairment of sinoatrial conduction frequently coexists with A-V conduction defects.

Adult↗
PubMed1989

[Artificial cardiac stimulation in the newborn infant with complete congenital atrioventricular block. Study of 16 cases].

This is a retrospective study of 16 children with congenital complete atrioventricular block (CAVB) who were fitted with a pacemaker in infancy. All were neonates admitted at the age of 1 to 9 days for bradycardia; 3 had a cardiopathy. In 8 children a permanent pacemaker was implanted in the first two days of life on account of a heart rate slower than 50 beats/min, accompanied with threatening symptoms (heart failure or syncopes) in 4 cases. In 6 children the pacemaker was implanted at the age of 2 to 3 months; in spite of reassuring electrocardiograms, 5 of them were readmitted in an emergency for heart failure or syncope with slow heart rate; the 6th patient had disorders of ventricular excitability. Finally, 2 asymptomatic infants underwent pacing: one at 20 days for bundle branch block, the other at 6 months for slow phase abnormalities. Pacing was epicardial in all patients, the chamber being positioned in the space that separates the kidney from the parietal peritoneum. Ventricular synchronous pacing (VVI) was applied in 14 cases and atrioventricular pacing (DDD) in the two most recent cases. Two children died post-operatively, due to inadequate attachment of the electrode resulting in loss of ventricular capture in one case, and to extensive left atrial thrombosis in the other case. Two children died at a later stage of severe respiratory pathology. The 12 survivors were followed up for a mean period of 3.7 +/- 3.1 years. Three pacemakers were replaced: one at 28 months for infection, the others at 3 and 6 years respectively for running down of the batteries.2 +

Cardiac Pacing, Artificial↗
PubMed1989

Mechanisms of chronotropic cardiac effects of alinidine and plasma concentration-response relationships in the conscious dog with chronic atrioventricular block.

The chronotropic cardiac effects of alinidine were studied in the conscious dog with chronic atrioventricular block. Alinidine at 0.5 - 4 mg/kg, i.e., at plasma concentrations between 42 +/- 2 and 1625 +/- 371 ng/ml, initially increased atrial rate dose-dependently. This effect fell off rapidly, but atrial bradycardia was never observed. After atropine and pindolol, which raised basal atrial rate, alinidine (2 mg/kg) decreased atrial rate, whereas after phenoxy-benzamine, yohimbine or phentolamine, it produced atrial effects identical to those observed under basal conditions, i.e., initial tachycardia and no bradycardia. Alinidine dose-relatedly decreased ventricular rate. None of the pretreatments modified the maximal ventricular bradycardia, but interestingly after pindolol or yohimbine this effect developed more rapidly (maximal bradycardia between 3 and 5 against 30 min) and then declined progressively. Alinidine did not modify mean blood pressure at any dose. After atropine, phenoxybenzamine or phentolamine, alinidine remained without effect on mean blood pressure, but after pindolol or yohimbine, a hypotensive effect appeared concomitantly with the reduction of the ventricular bradycardia. These results show that the initial atrial cardioacceleration due to alinidine results from a direct vagolytic action of this drug and that the absence of atrial bradycardia results from buffering by the vagolytic effect and/or a relatively low basal atrial rate. They also suggest that the ventricular bradycardia does not involve either the muscarinic cholinoceptors or the alpha- or beta-adrenoceptors, though the results obtained after pindolol or yohimbine suggest possible involvement of a fall in sympathetic tone by stimulation of presynaptic or central alpha2-adrenoceptors, particularly in the persistence of the bradycardic effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed2005

Relationship between basal thinning of the interventricular septum and atrioventricular block in patients with cardiac sarcoidosis.

BACKGROUND: Basal thinning of the interventricular septum (IVS) and atrioventricular block (AVB) are characteristic features of cardiac sarcoidosis. Since the conduction system passes along IVS, it has been considered that a close connection exists between basal thinning of IVS and AVB. However, neither the incidence of cases showing basal thinning of IVS nor the relation between it and AVB has been clarified. We thus investigated to elucidate these two issues. METHODS: Thirty-five patients with cardiac sarcoidosis were selected for this study and underwent echocardiographic examination. The wall thickness of IVS was measured at a site 1 cm below the aortic valve inserted point of IVS. Thickness of this site < or = 5 mm was defined as thinning. Twelve-lead and Holter electrocardiograms were obtained to determine the presence/absence and degree of AVB. RESULTS: Basal thinning of IVS was noted in 7 of the 35 patients (20%). AVB was present in 4 of these 7 (57%), and was first degree in 3 (43%) and third degree in one (14%). AVB was not present in 3 patients. Basal thinning of IVS was not apparent in 28 of the 35 patients (80%). AVB was observed in 14 of the 28 patients, 3 had first degree block, 2 had second degree block, and 9 had third degree block. AVB was not observed in 14 of the 28 patients. CONCLUSIONS: These results clarified that basal thinning of IVS is not as common as previously thought in cardiac sarcoidosis, basal thinning of IVS and the presence/absence and degree of AVB are not necessarily correlated.

Adult↗
PubMed2002

Frequency, predictors, and consequences of atrioventricular block after mitral valve repair.

This study examines the incidence, predictors, and evolution of postoperative atrioventricular block (AVB) after mitral valve repair (MVR) in 115 consecutive patients using Carpentier's technique (between November 1996 and April 1997). Postoperative AVB occurred in 27 patients (23%). Third-degree AVB was found in 7 patients (6%) in the immediate postoperative period, but in 4 it was transient, resolving partially or completely before the seventh postoperative day. Second-degree AVB (Mobitz type I) occurred in 4 patients (3%) immediately after operation and resolved in all before hospital discharge. Isolated first-degree AVB occurred in 16 patients (14%) and was permanent in 12. Neither the preoperative variables nor the mitral procedures including anterior versus posterior leaflet repair were related to postoperative AVB. A lesser systemic hypothermia during surgery was the only, modestly independent predictor of postoperative AVB (odds ratio 1.53; 95% confidence interval 1.04 to 2.25; p = 0.031). Three patients (2.6%) had permanent pacemaker implantation, on average 18 days after operation, and all had persistent third-degree AVB. With a mean follow-up of 3 years, no recurrence or worsening of conduction disturbances, no further pacemaker implantation, and no late deaths were observed.

Adolescent↗
PubMed1989

Survival rates after pacemaker implantation: a study of patients paced for sick sinus syndrome and atrioventricular block.

It is still a matter of controversy as to whether the patients paced for atrioventricular block (AVB) have different prognosis and survival rates than those paced for Sick Sinus Syndrome (SSS). We have compared the survival rates of 962 AVB patients (group A) with that of 283 SSS patients (group B) who underwent pacemaker implantation during the period January 1968 to December 1986. The survival rate graphs of the examined groups were calculated using the actuarial method and the differences in the survival rates between the groups were evaluated using the Logrank test. Our results show that SSS patients have a higher survival rate than AV block with a difference on the rate of survival between the two groups reaching the borderline of statistical significance. Multivariate discriminant analysis was then used to assess that of the parameters (i.e., age at the time of implantation, sex, electrophysiological indication to pacing, etiology or pacing mode) could have had the main influence upon mortality and the different pattern of the survival rate graph within the two groups of patients. Our data show that survival is mostly related to age, pacing mode and, although more slightly, to underlying heart disease; the electrophysiological indication to pacing, instead, does not significantly influence it.

Age Factors↗
PubMed2005

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block.

This study describes a case of exercise-induced myocardial ischaemia accompanied by complete atrioventricular block (CAVB). A 59-year-old man with major depression, treated with regular imipramine and lithium for 20 years, experienced syncope episodes during exercise. Exercise, testing initially, identified ST depression in the inferior leads, and later found CAVB resulting in syncope and seizure. The patient recovered completely after resuscitation. Myocardial ischaemic markers were negative, but 35% stenosis was detected in the distal left main coronary artery by angiography. The combined use of verapamil, nitrate and aspirin was treated as the possible coronary spasm. Repeat treadmill caused negative ischaemic study or exercise-induced arrhythmia, 7 days later. The pathophysiology of the very rare exercise-induced paroxysmal CAVB has been reviewed.

Antidepressive Agents↗
PubMed1992

[Long-term prognosis of congenital atrioventricular block].

The aim of this study was to assess the long term prognosis of congenital atrioventricular block (AVB). From 1965 to 1990, 42 cases of congenital AVB (22 antenatal or natal diagnoses and 20 presumed congenital AVB according to Yater's criteria). The AVB was isolated in 28 cases and associated with cardiac disease in 14 cases (8 of which were corrected transposition of the great arteries). The average age of the patients was 14 years (range 32 years to 18 months) at the time of the study. There was a clear female predominance (64%). Maternal connective tissue disease was present in 18% of cases (in the group of children born after 1977 when maternal connective tissue diseases was systematically looked for). Cardiac failure was present in 10 cases (8 with associated AVB); syncope and sudden death were observed in 11 cases. The indication for pacemaker therapy was the presence of poor prognostic factors: syncope, poorly controlled cardiac failure, low heart rate, increased QRS duration, prolonged QTc, infrahisian AVB, long pauses or arrhythmias on Holter monitoring. The only significant prognostic factors in this series were a previous history of syncope, increased QRS duration and a QTc of over 0.45 seconds. Fourteen patients were paced (endocavitary pacing only from 1981), usually in the DDD mode: 8 for syncope, 2 for cardiac failure, 4 for a poor prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Bundle branch and atrioventricular block as complications of acute myocardial infarction in the thrombolytic era.

OBJECTIVE: To analyze the incidence of intraventricular and atrioventricular conduction defects associated with acute myocardial infarction and the degree of in hospital mortality resulting from this condition during the era of thrombolytic therapy. METHODS: Observational study of a cohort of 929 consecutive patients with acute myocardial infarction. Multivariate analysis by logistic regression. Was used. RESULTS: Logistic regression showed a greater incidence of bundle branch block in male sex (odds ratio = 1.87, 95% CI = 1.02-3.42), age over 70 years (odds ratio = 2.31, 95% CI = 1.68-5.00), anterior localization of the infarction (odds ratio = 1.93, 95% CI = 1.03-3.65). There was a greater incidence of complete atrioventricular block in inferior infarcts (odds ratio = 2.59, 95% CI 1.30-5.18) and the presence of cardiogenic shock (odds ratio = 3.90, 95% CI = 1.43-10.65). Use of a thrombolytic agent was associated with a tendency toward a lower occurrence of bundle branch block (odds ratio = 0.68) and a greater occurrence of complete atrioventricular block (odds ratio = 1.44). The presence of bundle branch block (odds ratio = 2.45 95%, CI = 1.14-5.28) and of complete atrioventricular block (odds ratio = 13.59, 95% CI = 5.43-33.98) was associated with a high and independent probability of inhospital death. CONCLUSION: During the current era of thrombolytic therapy and in this population, intraventricular disturbances of electrical conduction and complete atrioventricular block were associated with a high and independent risk of inhospital death during acute myocardial infarction.

Aged↗
PubMed1992

[Fetal atrioventricular block].

PURPOSE: To study the pathogenesis, evolution and prognosis of the complete heart block of the fetus. METHODS: Bidimensional echocardiography associated to M-mode and doppler was performed in 600 patients. All cases of congenital heart block were referred because the fetuses presented hydrops, bradycardia and/or cardiac malformation suspected by routine ultrasound. RESULTS: Isolated heart block was found in 6 fetuses (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with complex cardiac disease and left atrial isomerism was found in 6 fetuses with no survivors (5 cases of complete type and 1 case of 2nd degree type 2:1). Heart block associated with atrioventricular discordante was found in 1 case. CONCLUSION: The findings of this study agree the literature about the relation between maternal anti-RO antibodies and isolated complete heart block. We also found a poor prognosis in the group with heart block and complex cardiac malformations.

Brazil↗
PubMed1990

[Atrioventricular block at the nodal level and block of an accessory pathway during percutaneous mitral valvuloplasty].

We describe the simultaneous occurrence of a temporal complete atrioventricular block and a persistent disappearance of preexcitation, in a patient with rheumatic mitral stenosis and a ventricular preexcitation, after an effective percutaneous mitral valvuloplasty. These conduction disturbances were attributed to atrioventricular node and paraseptal atrioventricular pathway trauma, due to transseptal manipulation during the mitral valvuloplasty.

Adult↗
PubMed2006

[Atrioventricular block in unstable angina. Results of the ARIAM registry].

OBJECTIVE: Describe the frequency of high degree atrioventricular block (HDAVB) in patients with unstable angina (UA), analyze the variables associated with their appearance and evaluate whether HDAVB is independently associated with increased mortality or increased length of ICU stay. DESIGN: Retrospective descriptive study of patients with UA included in the ARIAM registry. SETTING: ICUs from 129 hospitals in Spain. PATIENTS: From June 1996 to December 2003 a total of 14,096 patients were included in the ARIAM registry with a diagnosis of UA. MAIN VARIABLES OF INTEREST: Variables associated with the development of HDAVB, variables associated with the mortality of patients with UA, variables associated with the length of ICU stay of patients with UA. RESULTS: HDAVB frequency was 1%. Development of HDAVB was independently associated with the Killip classification and the presence of sustained ventricular tachycardia or ventricular fibrillation. Crude mortality of patients was significantly increased when HDAVB was present (9% versus 1%, p < 0,001). When adjusted for other variables, HDAVB was not associated with increased mortality. Development of HDAVB in patients with UA was independently associated with an increase in the length of ICU stay (adjusted odds ratio 1.89: 95% confidence interval: 1.33-5.69). CONCLUSIONS: Patients with UA complicated with HDAVB represent a high-risk population with an increased ICU stay.

Aged↗