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The Journal of Emergency Medicine Sep 2023Brugada syndrome (BrS) is an inherited disease that can lead to sudden cardiac death. Medications, such as antidysrhythmics, and fevers can unmask or induce the Brugada...
BACKGROUND
Brugada syndrome (BrS) is an inherited disease that can lead to sudden cardiac death. Medications, such as antidysrhythmics, and fevers can unmask or induce the Brugada pattern on an electrocardiogram (ECG). This case report highlights a patient who developed drug-induced Brugada type I pattern after a procainamide infusion for the treatment of new-onset atrial fibrillation (AF) or flutter and discusses the implications for this incidental but potentially lethal finding.
CASE REPORT
We report a case of a young man who presented to the emergency department (ED) with new-onset AF with rapid ventricular response that began within 12 h of presentation. ED treatments included a crystalloid IV fluid bolus, diltiazem pushes, synchronized electrical cardioversion, and a procainamide infusion. After the procainamide infusion, the patient developed ECG findings consistent with Brugada pattern. Both the AF and Brugada pattern resolved spontaneously within 24 h. The patient was discharged without implantable cardioverter defibrillator placement due to presumed isolated procainamide-induced Brugada pattern and lack of concerning features, such as inducible dysrhythmia during electrophysiology study, family history of sudden death, and history of syncope. The patient was counseled to follow-up with genetics and avoid BrS-inducing medications. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: Procainamide, an option for the treatment of AF in the ED, can provoke Brugada pattern. If encountered, it is important to recall that some patients may not be diagnosed with BrS if determined to be low risk according to the Shanghai criteria. All patients should be referred to cardiology for further evaluation.
Topics: Male; Humans; Procainamide; Atrial Fibrillation; China; Brugada Syndrome; Death, Sudden, Cardiac; Electrocardiography
PubMed: 37495422
DOI: 10.1016/j.jemermed.2023.04.020 -
The Journal of Innovations in Cardiac... Jul 2023Pediatric postoperative junctional ectopic tachycardia (JET), although usually self-limited, may lead to significant morbidity and mortality. Anti-arrhythmic medications...
Pediatric postoperative junctional ectopic tachycardia (JET), although usually self-limited, may lead to significant morbidity and mortality. Anti-arrhythmic medications are often necessary to restore atrioventricular synchrony when non-pharmacological measures fail. Multiple drugs have been described for the management of postoperative JET, with enteral ivabradine being the latest addition. While safe administration of ivabradine has been described in combination with other anti-arrhythmics (amiodarone, flecainide), no study has described the use of ivabradine in conjunction with intravenous procainamide for the management of postoperative JET. Our case report describes the safe use of ivabradine and procainamide combination therapy in a young patient.
PubMed: 37492694
DOI: 10.19102/icrm.2023.14075 -
Pacing and Clinical Electrophysiology :... Sep 2023New and persistent left bundle branch block (NP-LBBB) following Transcatheter Aortic Valve Replacement (TAVR) is an ongoing concern with incidence ranging from as low as...
Electrophysiological evaluation following development of new and persistent left bundle branch block after transcatheter aortic valve replacement: A single center pilot study.
INTRODUCTION
New and persistent left bundle branch block (NP-LBBB) following Transcatheter Aortic Valve Replacement (TAVR) is an ongoing concern with incidence ranging from as low as 4% to up to 65% (varying for different types of valves). Such patients are at risk of developing high-grade atrioventricular block (HAVB) warranting permanent pacemaker (PPM) implantation. However, currently, there are no consensus guidelines or large prospective studies to risk stratify these patients for safer discharge after TAVR.
OBJECTIVES
To provide insight from a single center study on using modified electrophysiology (EP) study to risk stratify post-TAVR patients to outpatient monitoring for low-risk versus pacemaker implantation for high-risk patients.
METHODS AND RESULTS
Between June 2020 and March 2023, all patients who underwent a TAVR procedure (324 patients) at our institution were screened for development of NP-LBBB post-operatively. Out of 26 patients who developed NP-LBBB, after a pre-specified period of observation, 18 patients were deemed eligible for a modified EP study to assess His-Ventricular (HV) interval. 11 out of 18 patients (61.1%) had normal HV interval (HV < 55 ms). Three out of 18 patients (16.7%) had HV prolongation (55 ms < HV < 70 ms) without significant HV prolongation (defined as an increase in HV interval > 30%) with intra-procedural procainamide challenge. Four out of 18 patients (22.2%) had significant HV prolongation (HV > 70 ms) warranting PPM implantation based on a multidisciplinary approach and shared decision-making with the patients. Total of 50% of patients discharged with PPM (two out of four patients) were noted to be pacemaker dependent based on serial device interrogations. All patients who did not receive PPM were discharged with ambulatory monitoring with 30-day event monitor and did not develop HAVB on serial follow-up.
CONCLUSION
Normal HV interval up to 55 ms on modified EP study after TAVR and development of NP-LBBB can be utilized as a threshold for risk stratification to facilitate safe discharge. The optimal upper limit of HV interval threshold remains unclear in determining appropriate candidacy for PPM.
Topics: Humans; Bundle-Branch Block; Transcatheter Aortic Valve Replacement; Pilot Projects; Prospective Studies; Treatment Outcome; Risk Factors; Arrhythmias, Cardiac; Atrioventricular Block; Pacemaker, Artificial; Aortic Valve Stenosis; Aortic Valve
PubMed: 37428778
DOI: 10.1111/pace.14784 -
Spectrochimica Acta. Part A, Molecular... Dec 2023Triangle-shaped silver nanoprisms (AgNPMs) were prepared by a photo-induced method through a seed-mediated growth process and were successfully employed as an...
Triangle-shaped silver nanoprisms (AgNPMs) were prepared by a photo-induced method through a seed-mediated growth process and were successfully employed as an ultra-sensitive surface-enhanced Raman scattering (SERS) substrate for the detection of the chemotherapeutic N-acetyl procainamide (NAPA) compound. The transformation of the morphology of the nanoprisms substrate could be noted with a remarkable change in color, possessing an average size of 95 nm. The shape-modified AgNPMs exhibited interesting optical characteristics owing to the truncated dual edges, which led to a pronounced longitudinal localized surface plasmonic resonance (LLSPR) behavior. The nanoprisms-based SERS substrate demonstrated an outstanding sensitivity for NAPA in aqueous solutions with the lowest ever reported detection limit of 0.5 × 10 M corresponding to excellent recovery and stability. A steady linear response with a broad dynamic range (10-10 M) and an R of 0.945 was also achieved. The results proved that the NPMs demonstrated excellent efficiency, reproducibility (97%), and stability (30 days) with a superior Raman signal enhancement reaching an ultralow detection limit of 0.5 × 10 M compared to the nanosphere particles which could show an LOD of 0.5 × 10 M.
Topics: Silver; Procainamide; Spectrum Analysis, Raman; Reproducibility of Results; Metal Nanoparticles
PubMed: 37327727
DOI: 10.1016/j.saa.2023.122996