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The Journal of Thoracic and... Oct 2023
Topics: Humans; Atrioventricular Block; Heart Defects, Congenital; Pacemaker, Artificial; Electrocardiography
PubMed: 36933789
DOI: 10.1016/j.jtcvs.2023.03.012 -
JAMA Internal Medicine Dec 2021
Topics: Atrioventricular Block; Humans; Tachycardia
PubMed: 34661597
DOI: 10.1001/jamainternmed.2021.5962 -
Journal of the American Heart... Mar 2020
Topics: Atrioventricular Block; Cardiomyopathy, Hypertrophic; Humans; Prognosis
PubMed: 32146897
DOI: 10.1161/JAHA.120.015911 -
The American Journal of Medicine Apr 2023
Topics: Humans; Atrioventricular Block; Electrocardiography
PubMed: 36502954
DOI: 10.1016/j.amjmed.2022.10.024 -
Pediatric Cardiology Apr 2024Postoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker...
Postoperative atrioventricular block may occur after pediatric cardiac surgery. A small proportion of those who develop atrioventricular block will require pacemaker placement. The primary aim of this study was to determine factors associated with postoperative atrioventricular block. Secondary aims included determining factors associated with pacemaker placement in those with atrioventricular block. Data from the PHIS data were utilized to identify patients under 18 years of age who underwent cardiac surgery. Those who did and did not develop atrioventricular block. Univariable analyses and regression analyses were conducted to determine factors associated with postoperative atrioventricular block. Similar analyses were conducted to determine factors associated with pacemaker placement in those with atrioventricular block. A total of 43,716 admissions were identified. Of these, 2093 (5%) developed atrioventricular block and 480 (1% of total admissions) underwent pacemaker placement. Approximately 70% of those with atrioventricular block received steroids but this was not associated with a decrease in pacemaker placement. Risk factors (congenital malformations of the heart, comorbidities, medications) associated with increased risk of atrioventricular block and pacemaker placement were identified. Postoperative atrioventricular block occurred in 5% of pediatric admissions for cardiac surgery. Of these admissions with postoperative atrioventricular block, 23% required pacemaker placement. Isoproterenol and steroids were not associated with a reduction in the likelihood of pacemaker placement.
Topics: Child; Humans; Adolescent; Atrioventricular Block; Pacemaker, Artificial; Cardiac Surgical Procedures; Heart Defects, Congenital; Postoperative Complications; Steroids
PubMed: 38427091
DOI: 10.1007/s00246-024-03427-7 -
Journal of Cardiovascular... Mar 2022The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/CAVB) after pacemaker implantation are unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/CAVB) after pacemaker implantation are unclear.
METHODS
We performed a meta-analysis of all the studies of CCAVB. A systematic search of PubMed and CENTRAL databases from January 1, 1967 to January 31, 2020 was performed. The quality of studies included was critically appraised using the Newcastle-Ottawa scale, and outcome data were analyzed using the restricted maximum likelihood function.
RESULTS
Twenty-nine studies were eligible for analysis, with a total of 1553 patients. The all-cause-mortality was 5.7% (95% confidence interval [CI]: 2.5%-9.9%), while pacing-induced cardiomyopathy (PICM) was seen in 3.8% (95% CI: 1.2-7.2). Diagnosis at birth (effect size [ES] [95%CI]: -2.23 [-0.36 to -0.10]; p < .001), presence of congenital heart disease (ES [95%CI]: -0.67 [0.41-0.93]; p < .001), younger age at pacemaker implantation (ES [95%CI]: -0.01 [-0.02 to -0.001]; p = .02), and duration of pacing (ES [95%CI]: -0.03 [-0.05 to -0.003]; p = .03), were associated with an higher mortality on binominal logistic regression. None of the parameters were significant on multivariate analysis.
CONCLUSION
Pooled proportional mortality in patients with CCAVB and CAVB is 5.7% with an infrequent incidence of PICM (3.8%) in the paced patients with AVB suggesting that pacing in these patients is an effective management strategy with a low incidence of long-term side effects. Registry and randomized data can throw additional light regarding the natural history and appropriate management strategy in these patients.
Topics: Atrioventricular Block; Cardiac Pacing, Artificial; Cardiomyopathies; Child; Humans; Incidence; Infant, Newborn; Multivariate Analysis; Pacemaker, Artificial; Retrospective Studies
PubMed: 35018695
DOI: 10.1111/jce.15358 -
Heart (British Cardiac Society) Jul 2022
Topics: Atrioventricular Block; Electrocardiography; Humans; Pacemaker, Artificial
PubMed: 35383105
DOI: 10.1136/heartjnl-2022-320841 -
British Journal of Pharmacology Mar 2022Ventricular cardiac arrhythmia is a life threating condition arising from abnormal functioning of many factors in concert. Animal models mirroring human... (Review)
Review
Ventricular cardiac arrhythmia is a life threating condition arising from abnormal functioning of many factors in concert. Animal models mirroring human electrophysiology are essential to predict and understand the rare pro- and anti-arrhythmic effects of drugs. This is very well accomplished by the canine chronic atrioventricular block (CAVB) model. Here we summarize canine models for cardiovascular research, and describe the development of the CAVB model from its beginning. Understanding of the structural, contractile and electrical remodelling processes following atrioventricular (AV) block provides insight in the many factors contributing to drug-induced arrhythmia. We also review all safety pharmacology studies, efficacy and mechanistic studies on anti-arrhythmic drugs in CAVB dogs. Finally, we compare pros and cons with other in vivo preclinical animal models. In view of the tremendous amount of data obtained over the last 100 years from the CAVB dog model, it can be considered as man's best friend in preclinical drug research. LINKED ARTICLES: This article is part of a themed issue on Preclinical Models for Cardiovascular disease research (BJP 75th Anniversary). To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v179.5/issuetoc.
Topics: Animals; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Atrioventricular Block; Dogs; Heart; Humans
PubMed: 33684961
DOI: 10.1111/bph.15436 -
International Heart Journal Jan 2021Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB)...
Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.
Topics: Adult; Aged; Aged, 80 and over; Atrioventricular Block; Disease-Free Survival; Endocarditis; Female; Follow-Up Studies; Heart Valve Diseases; Humans; Intensive Care Units; Male; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Retrospective Studies; Risk Factors; Tricuspid Valve
PubMed: 33455981
DOI: 10.1536/ihj.20-278 -
Journal of Electrocardiology 2022Paradoxical ventriculophasic response (P-VR), a rare entity, has not been fully investigated. This study sought to compare the electrocardiographic features of P-VR and...
BACKGROUND
Paradoxical ventriculophasic response (P-VR), a rare entity, has not been fully investigated. This study sought to compare the electrocardiographic features of P-VR and typical ventriculophasic response (T-VR).
METHODS
The 12‑lead electrocardiogram (ECG) data recorded before implantation of a cardiac implantable electronic device were analyzed in patients with greater than second-degree atrioventricular block (AVB). P-VR or T-VR was defined as present if the PP interval interposing a QRS complex was prolonged or shortened, respectively, by >3% compared with the preceding PP interval without a QRS complex when a QRS complex occurred within a span of 60% of the preceding PP interval.
RESULTS
Of 95 patients (age 80 ± 9 years; 49 men) with heart block, 1868 instances (an instance was defined as a set of PP intervals without a QRS complex and the subsequent PP interval interposing a QRS complex) from 214 ECGs were analyzed: 894 instances from 122 ECGs in 64 patients with complete AVB (cAVB) and 974 instances from 92 ECGs in 43 patients with 2:1 AVB (12 showed both cAVB and 2:1 AVB). P-VR was observed in 48 patients (51%). The position of the interposed QRS complex relative to the preceding PP interval was earlier in P-VR than in T-VR. The PP interval was shorter in P-VR than in T-VR.
CONCLUSION
P-VR was present in >50% of patients and was affected by the position of the interposed QRS complex and the PP interval.
Topics: Aged; Aged, 80 and over; Atrioventricular Block; Electrocardiography; Female; Humans; Male
PubMed: 35183045
DOI: 10.1016/j.jelectrocard.2022.02.002