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European Journal of Pediatrics Feb 2016Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for... (Review)
Review
UNLABELLED
Heart rate is commonly used in pediatric early warning scores. Age-related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Bradycardia is defined as a heart rate below the lowest normal value for age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block. As a result of several different etiologies, it may occur in an entirely structurally normal heart or in association with concomitant congenital heart disease. Genetic variants in multiple genes have been described to date in the pathogenesis of inherited sinus node dysfunction or progressive cardiac conduction disorders. Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. The simplest aspect of severe bradycardia management is reflected in the Pediatric and Advanced Life Support (PALS) guidelines.
CONCLUSION
Early diagnosis and appropriate management are critical in many cases in order to prevent sudden death, and this review critically assesses our current practice for evaluation and management of bradycardia in neonates and children.
WHAT IS KNOWN
Bradycardia is defined as a heart rate below the lowest normal value for age. Age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiogram features that differ from adults and vary with age. Pediatric bradycardia most commonly manifests as sinus bradycardia, junctional bradycardia, or atrioventricular block.
WHAT IS NEW
Management and eventual prognosis of bradycardia in the young are entirely dependent upon the underlying cause. Bradycardia may occur in a structurally normal heart or in association with congenital heart disease. Genetic variants in multiple genes have been described. Reasons to intervene for bradycardia are the association of related symptoms and/or the downstream risk of heart failure or pause-dependent tachyarrhythmia. Early diagnosis and appropriate management are critical in order to prevent sudden death.
Topics: Bradycardia; Child; Disease Management; Female; Heart Rate; Humans; Infant, Newborn; Male
PubMed: 26780751
DOI: 10.1007/s00431-015-2689-z -
Herzschrittmachertherapie &... Mar 2020Clinical relevance of acute bradycardia is driven by symptoms and not primarily by the reported decreased heart rate. Bradycardias may remain asymptomatic especially due... (Review)
Review
Clinical relevance of acute bradycardia is driven by symptoms and not primarily by the reported decreased heart rate. Bradycardias may remain asymptomatic especially due to compensatory mechanisms (in particular increase of left ventricular ejection fraction). Nearly half of acute bradycardias have a reversible cause. Detection of potential reversible bradycardia causes is therefore regarded as the cornerstone of bradycardia treatment in the emergency setting. Effective therapies for the treatment of acute bradycardia are available, including intravenous chronotropic drugs and pacemaker implantation.
Topics: Bradycardia; Humans; Pacemaker, Artificial; Stroke Volume; Ventricular Function, Left
PubMed: 32006163
DOI: 10.1007/s00399-020-00665-z -
The Physician and Sportsmedicine Sep 2019It is established that an intensive training results in a lower average resting heart rate. Management of bradycardia in an athlete can be difficult given the underlying... (Review)
Review
It is established that an intensive training results in a lower average resting heart rate. Management of bradycardia in an athlete can be difficult given the underlying mechanisms are not clearly understood. The authors reviewed the different mechanisms described in the literature, including recent advances in physiology regarding remodeling of ion channels, which may partially explain bradycardia in athletes. Sinus bradycardia amongst athletes, especially endurance focused athletes, is common but difficult to apprehend. The underlying mechanisms are observably of multifactorial origin and likely incompletely elucidated by the current body of knowledge.
Topics: Adult; Athletes; Bradycardia; Female; Humans; Male; Physical Endurance; Young Adult
PubMed: 30640577
DOI: 10.1080/00913847.2019.1568769 -
JAMA Internal Medicine Oct 2022
Topics: Bradycardia; Humans
PubMed: 35994283
DOI: 10.1001/jamainternmed.2022.3674 -
WMJ : Official Publication of the State... Jun 2018Relative bradycardia is a poorly understood paradoxical phenomenon that refers to a clinical sign whereby the pulse rate is lower than expected for a given body... (Review)
Review
INTRODUCTION
Relative bradycardia is a poorly understood paradoxical phenomenon that refers to a clinical sign whereby the pulse rate is lower than expected for a given body temperature.
OBJECTIVE
To provide an overview and describe infectious and noninfectious causes of relative bradycardia.
METHODS
PubMed and Medline databases were searched using individual and Medical Subject Headings terms including relative bradycardia, fever, pulse-temperature dissociation and pulsetemperature deficit in human studies published from inception to October 2, 2016. The causes and incidence of relative bradycardia were reviewed.
RESULTS
Relative bradycardia is found in a wide variety of infectious and noninfectious diseases. The pathogenesis remains poorly understood with proposed mechanisms including release of inflammatory cytokines, increased vagal tone, direct pathogenic effect on the myocardium, and electrolyte abnormalities. The incidence of this sign varies widely, which may be attributable to multiple factors, including population size, time course for measuring pulse and temperature, and lack of a consistent definition used. The fact that this sign is not consistently identified in case series suggests that relative bradycardia is caused by mechanisms presumably involving or influenced by pathogen and host factors.
CONCLUSIONS
Relative bradycardia is a sensitive but nonspecific clinical sign that may be an important bedside tool for narrowing the differential diagnosis of potential infectious and noninfectious etiologies. Recognizing this relationship may assist the clinician by providing bedside clinical clues into potential etiologies of disease, particularly in the setting of infectious diseases and in circumstances when other stigma of disease is absent.
Topics: Bradycardia; Diagnosis, Differential; Humans; Incidence; Risk Factors
PubMed: 30048576
DOI: No ID Found -
Heart Rhythm May 2022
Topics: Atrioventricular Block; Bradycardia; Electrocardiography; Humans; Pacemaker, Artificial; Transcatheter Aortic Valve Replacement
PubMed: 35501110
DOI: 10.1016/j.hrthm.2021.09.017 -
Minerva Medica Aug 2023COVID-19 is an infectious disease caused by a Coronavirus in humans, namely SARS-CoV-2, which has quickly become a global pandemic. The infection is responsible for a... (Review)
Review
BACKGROUND
COVID-19 is an infectious disease caused by a Coronavirus in humans, namely SARS-CoV-2, which has quickly become a global pandemic. The infection is responsible for a severe form of pneumonia, which may lead to lung failure and death. Among the therapeutic strategies, the antiviral agent remdesivir has become one of the most used drugs. The current literature reports a causal correlation between remdesivir administration and the incidence of cardiovascular effects. We aimed to further investigate this relationship, by exploring the association between the use of remdesivir and the onset of bradyarrhythmic disorders.
METHODS
We reviewed medical records, blood exams and chest imaging of 85 patients with COVID-19 pneumonia (M/F: 57/28, age: 61±12 years) admitted between September 2020 and May 2021 to the Division of Respiratory Diseases in Palermo, Italy.
RESULTS
We found a significant correlation between treatment with remdesivir and the occurrence of bradycardia, lasting for at least 3 days, which returned to normal values after the discontinuation of the drug. A significant reduction in heart rate (HR) was observed in the days following remdesivir administration (L. ratio 47.4, P<0.0001) in 24 patients (HR on the first day of observation: 75±14 bpm; at discharge: 72±14 bpm). Cardiac events occurred more frequently in subjects with extensive pulmonary involvement (greater than 50% of the total parenchyma, as assessed by chest CT).
CONCLUSIONS
We suggest to carefully monitor the administration of the drug in patients with risk factors for arrhythmic or cardiovascular events.
Topics: Humans; Middle Aged; Aged; COVID-19; SARS-CoV-2; Bradycardia; COVID-19 Drug Treatment; Antiviral Agents
PubMed: 35332758
DOI: 10.23736/S0026-4806.22.08035-1 -
The Israel Medical Association Journal... Apr 2022Heart rate disorders and in particular sinus arrhythmias are known to accompany viral infections. Sinus tachycardia is prevalent in the presence of increased body...
Heart rate disorders and in particular sinus arrhythmias are known to accompany viral infections. Sinus tachycardia is prevalent in the presence of increased body temperature and respiratory rate. However, bradycardia has also been described for centuries to complicate viral illnesses.
Topics: Bradycardia; COVID-19; Electrocardiography; Heart Rate; Humans
PubMed: 35415977
DOI: No ID Found -
Herzschrittmachertherapie &... Jun 2023The cardiac implantable electronic device (CIED) is the therapy of choice for management of symptomatic bradyarrhythmias. However, the indication for CIED implantation... (Review)
Review
The cardiac implantable electronic device (CIED) is the therapy of choice for management of symptomatic bradyarrhythmias. However, the indication for CIED implantation in the cases of asymptomatic bradycardias should be carefully individualized. Incidental electrocardiographic findings in asymptomatic patients (e.g., low baseline heart rates, higher than first-degree atrioventricular block or longer pauses) may complicate the physician's decision regarding the necessity of CIED implantation. The main reason is the inherit risk of short- and long-term complications with every CIED implantation, i.e., peri-operative complications, risk of CIED infection, lead fractures, and the necessity for lead extraction. Therefore, before opting for, or against, CIED implantation, several factors should be considered in the subset of asymptomatic patients.
Topics: Humans; Defibrillators, Implantable; Bradycardia; Treatment Outcome; Pacemaker, Artificial; Heart Diseases; Retrospective Studies
PubMed: 37115247
DOI: 10.1007/s00399-023-00943-6 -
Sleep Medicine Jan 2022The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The association of obstructive sleep apnea (OSA) with bradycardia is not well-characterized, which may confer significant morbidity and mortality if left untreated. We sought to clarify the prevalence of comorbid OSA and bradycardia, and the effect of continuous positive airway pressure (CPAP) therapy on bradycardia outcomes.
METHODS
We systematically searched four electronic databases (PubMed, Embase, Cochrane Library, Scopus) for randomized or observational studies reporting the co-prevalence of sleep apnea and bradycardia or evaluated the use of CPAP on the incidence of bradycardias. We used random-effects models in all meta-analyses and evaluated heterogeneity using I.
RESULTS
We included 34 articles from 7204 records, comprising 4852 patients. Among patients with OSA, the pooled prevalence of daytime and nocturnal bradycardia were 25% (95% CI: 18.6 to 32.7) and 69.8% (95% CI: 41.7 to 88.2) respectively. Among patients with bradycardia, the pooled prevalence of OSA was 56.8% (95% CI: 21.5 to 86.3). CPAP treatment, compared to those without, did not significantly reduce the risk of daytime (two randomized trials; RR: 0.50; 95% CI: 0.11 to 2.21) or nocturnal bradycardia (one randomized-controlled trial and one cohort study; RR: 0.76; 95% CI: 0.48 to 1.20).
CONCLUSIONS
This meta-analysis demonstrates a high comorbid disease burden between OSA and bradycardia. Future research should explore the treatment effect of CPAP on bradycardia incidence, as compared to placebo.
Topics: Bradycardia; Cohort Studies; Continuous Positive Airway Pressure; Humans; Prevalence; Sleep Apnea, Obstructive
PubMed: 34971926
DOI: 10.1016/j.sleep.2021.12.003