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Journal of Clinical Medicine Jan 2024Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to...
BACKGROUND
Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors.
METHODS
We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010.
RESULTS
During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2-3.8, = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9-12.4, < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4-10.1, < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8-8.3, < 0.001).
CONCLUSION
Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation.
PubMed: 38256672
DOI: 10.3390/jcm13020538 -
Heart Rhythm Jun 2024
Topics: Humans; Electrocardiography; Heart Conduction System
PubMed: 38431023
DOI: 10.1016/j.hrthm.2024.02.059 -
Cureus Oct 2023Pacemakers and implantable cardioverter defibrillators (ICDs) have revolutionized cardiology by providing life-saving interventions for patients with cardiac rhythm... (Review)
Review
Pacemakers and implantable cardioverter defibrillators (ICDs) have revolutionized cardiology by providing life-saving interventions for patients with cardiac rhythm disturbances. Pacing the heart is an effective treatment for people suffering from bradycardia caused by sinus node dysfunction or atrioventricular (AV) block, and electronic pacing has saved countless lives since its introduction into clinical practice. AV synchronization is the typical cycle of atrial depolarization and contraction followed by ventricular depolarization and contraction. The continuation of this cycle leads to appropriate ventricular filling and cardiac output. By contrast, the failure of the cycle results in AV asynchrony, which may result in heart failure. Cardiac resynchronization treatment (CRT) involves using customized pacemakers with or without implantable cardioverter defibrillators and tries to resynchronize the failing heart by enhancing myocardial contraction without increasing energy consumption. This review delves into the extensive journey of pacemakers and ICDs in the field of cardiology. It highlights the transformative impact of these devices on patient care and quality of life, emphasizing technological advancements, clinical applications, and prospects. This comprehensive review aims to provide insights into the dynamic landscape of cardiac rhythm management.
PubMed: 37927638
DOI: 10.7759/cureus.46389 -
Journal of Clinical Medicine Sep 2023Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating... (Review)
Review
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
PubMed: 37762995
DOI: 10.3390/jcm12186056 -
Cureus Dec 2023Background An electrocardiogram (ECG) is a standard tool used to detect various cardiovascular abnormalities. Detection sensitivity for atrial fibrillation (AF) was...
Background An electrocardiogram (ECG) is a standard tool used to detect various cardiovascular abnormalities. Detection sensitivity for atrial fibrillation (AF) was recently shown to be greatly increased by using short, intermittent ECG recordings.Modern mobile ECG recording devices that can monitor patients' heart activities around the clock have made this a reality. The Apple Watch is one of these portable ECG devices that can detect heart rhythms and is approved by the American FDA for screening and detecting AF. Objectives We compared the results of the Apple Watch I lead ECG with conventional ECG results to assess the sensitivity and specificity of the Apple Watch I lead ECG. We then determined the abnormalities that can be detected by the Apple Watch I lead ECG. Methods This study was conducted on outpatient cardiac clinics at King Abdullah bin Abdulaziz University Hospital (KAAUH), and Prince Sultan Cardiac Center (PSCC), from May to October 2021. A standard 12-lead ECG was recorded and compared with the Apple Watch I lead ECG. A total of 469 ECG comparisons were included in this study and evaluated by two investigators. The data on patient demographics, medical and medication history, and ECG data were reviewed and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results No significant differences were seen between the Apple Watch and the 12-lead ECG in terms of the studied ECG characteristics. A significant and strong positive correlation between the heart rate measurements in the 12-lead ECG and Apple Watch ECG was documented. The most commonly found abnormalities in the Apple Watch ECG were AF in 37 (7.9%), followed by first-degree atrioventricular (AV) block in 32 (6.8%). The sensitivity of Apple Watch's automated interpretation to detect an AF was 99.54%, while the manual interpretation yielded a sensitivity of 100%. Conclusion The results of this study demonstrated a robust relationship between the 12-lead ECG and Apple Watch ECG in the diagnosis of arrhythmias. Consequently, cardiac patients may consider the Apple Watch ECG a trustworthy remote monitoring technique.
PubMed: 38161560
DOI: 10.7759/cureus.49786 -
The Journal of International Medical... Jan 2024Atrioventricular block (AVB) is a rare cardiac manifestation of hyperthyroidism (HTH). The scientific literature contains multiple reports of AVB in patients with HTH,... (Review)
Review
Atrioventricular block (AVB) is a rare cardiac manifestation of hyperthyroidism (HTH). The scientific literature contains multiple reports of AVB in patients with HTH, ranging from subclinical to overt HTH and even thyroid storm. However, much remains unknown about the true prevalence, clinical course, optimal management, and outcomes of AVB in patients with HTH. Such patients are possibly overtreated with pacemakers because of a lack of understanding that AVB might be secondary to the hyperthyroid state and thus reversible. This narrative review discusses the pathophysiology of AVB in patients with HTH in the context of the available evidence.
Topics: Humans; Atrioventricular Block; Hyperthyroidism; Patients; Heart
PubMed: 38206211
DOI: 10.1177/03000605231223040 -
Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications.Journal of Cardiovascular Development... Nov 2023Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its... (Review)
Review
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due to the close proximity of the conduction system to the aortic root. New onset left bundle branch block (LBBB) and high-grade atrioventricular block are the most commonly reported CA post TAVI. The overall rate of PPM implantation post TAVI varies and is related to pre- and intra-procedural factors. Therefore, when screening patients for TAVI, Heart Teams should take under consideration the various anatomical, pathophysiological and procedural conditions that predispose to CA and PPM requirement after the procedure. This is particularly important as TAVI is being offered to younger patients with longer life-expectancy. Herein, we highlight the incidence, predictors, impact and management of CA in patients undergoing TAVI.
PubMed: 37998527
DOI: 10.3390/jcdd10110469 -
Frontiers in Cardiovascular Medicine 2023Acute myocardial infarction (AMI) complicated by tachyarrhythmias or high-grade atrioventricular block (HAVB) may lead to increased mortality.
BACKGROUND
Acute myocardial infarction (AMI) complicated by tachyarrhythmias or high-grade atrioventricular block (HAVB) may lead to increased mortality.
PURPOSE
To evaluate the sex differences in patients with AMI complicated by tachyarrhythmias and HAVB and their associated outcomes.
MATERIALS AND METHODS
We analyzed the incidence rates of arrhythmias following AMI from the Acute Coronary Syndrome Israeli Survey database from 2000 to 2018. We assessed the differences in arrhythmias incidence and the associated mortality risk between men and women.
RESULTS
This cohort of 14,280 consecutive patients included 3,159 (22.1%) women and 11,121 (77.9%) men. Women were less likely to experience early ventricular tachyarrhythmia (VTA), (1.6% vs. 2.3%, = 0.034), but had similar rates of late VTA (2.3% vs. 2.2%, = 0.62). Women were more likely to experience atrial fibrillation (AF) (8.6% vs. 5.0%, < 0.001) and HAVB (3.7% vs. 2.3%, < 0.001). The risk of early VTAs was similar in men and women [adjusted Odds Ratio (aOR) = 0.76, = 0.09], but women had a higher risk of AF (aOR = 1.27, = 0.004) and HAVB (aOR = 1.30, = 0.03). Early [adjusted hazard ratio (aHR) = 2.84, < 0.001] and late VTA (aHR =- 4.59, < 0.001), AF (aHR = 1.52, < 0.001) and HAVB (aHR = 2.83, < 0.001) were associated with increased 30-day mortality. Only late VTA (aHR = 2.14, < 0.001) and AF (aHR = 1.44, = 0.002) remained significant in the post 30 days period.
CONCLUSIONS
During AMI women experienced more AF and HAVB but fewer early VTAs than men. Early and late VTAs, AF, and HAVB were associated with increased 30-day mortality. Only late VTA and AF were associated with increased post-30-day mortality.
PubMed: 37928761
DOI: 10.3389/fcvm.2023.1217525 -
The Journal of Innovations in Cardiac... Dec 2023Although myocardial infarction (MI) is a reversible cause of atrioventricular (AV) block, the association of ischemia other than MI with AV block is unclear. The purpose...
Although myocardial infarction (MI) is a reversible cause of atrioventricular (AV) block, the association of ischemia other than MI with AV block is unclear. The purpose of this study is to investigate this relationship. Among patients nominated for pacemaker implantation due to AV block in two centers from 2017-2020, 120 patients with significant coronary artery disease (CAD) in angiography were included in the study. Patients were divided into two equal groups based on their CAD treatment approach: drug therapy and revascularization. Coronary lesions were divided into three types based on location: left anterior descending artery (type 1), dominant coronary with AV node branch (type 2), and a combination of both (type 3). After coronary disease treatment, all patients were followed up with for 14 months, and AV block reversibility was assessed. There were 7 cases of block reversibility in the revascularization group (11.7%) and 1 case in the medical group (1.7%), which differed significantly ( = .02). A history of acute coronary syndrome, smoking, opium use, chronic kidney disease, hypertension, age, sex, and chronic obstructive pulmonary disease were not significantly associated with reversible block. Also, the type of coronary obstruction had no significant relationship with block reversibility ( = .3, .5, and .8 for type 1, type 2, and type 3, respectively). Hibernation due to ischemia can be a reversible cause of an AV blockage. Therefore, it is recommended that significant coronary artery lesions be revascularized before pacemaker implantation.
PubMed: 38155722
DOI: 10.19102/icrm.2023.14125