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Cardiology Journal 2024Since the arrival of leadless pacemakers (LPs), they have become a cornerstone in remedial treatment of bradycardia and atrioventricular (AV) conduction disorders, as an... (Review)
Review
Since the arrival of leadless pacemakers (LPs), they have become a cornerstone in remedial treatment of bradycardia and atrioventricular (AV) conduction disorders, as an alternative to transvenous pacemakers. Even though clinical trials and case reports show indisputable benefits of LP therapy, they also bring some doubts. Together with the positive results of the MARVEL trials, AV synchronization has become widely available in LPs, presenting a significant development in leadless technology. This review presents the Micra AV (MAV), describes major clinical trials, and introduces the basics of AV synchronicity obtained with the MAV and its unique programming options.
Topics: Humans; Lipopolysaccharides; Equipment Design; Pacemaker, Artificial; Bradycardia; Cardiac Pacing, Artificial
PubMed: 37246458
DOI: 10.5603/CJ.a2023.0035 -
British Journal of Anaesthesia Jun 1997As part of the development of a model for the study of adverse events, we have investigated the risk of bradycardia with propofol. A systematic search for any type of... (Review)
Review
As part of the development of a model for the study of adverse events, we have investigated the risk of bradycardia with propofol. A systematic search for any type of report, published and unpublished, was made to review the evidence that propofol increases the risk of bradycardia, asystole and death from bradycardic events. Quantitative and qualitative analyses of data with different strengths of evidence were performed. Sixty-five published and 187 spontaneous reports to drug monitoring centres described with different strength of evidence a biological basis for propofol-induced bradycardia, 1444 bradycardias, 86 asystoles and 24 deaths. In controlled clinical trials, propofol significantly increased the risk of bradycardia compared with other anaesthetics (number-needed-to-harm 11.3 (95% confidence interval 7.7-21)). In paediatric strabismus surgery the number-needed-to-harm was 4.1 (3-6.7). One of 660 patients undergoing propofol anaesthesia had an asystole. The risk of bradycardia-related death during propofol anaesthesia was estimated to be 1.4 in 100,000. Data from the phase IV study of propofol did not agree with data from controlled studies. Propofol carries a finite risk for brady-cardia with potential for major harm. Study of adverse events should be made with systematically searched data and, in contrast with study of efficacy, not restricted to randomized, controlled trials.
Topics: Adverse Drug Reaction Reporting Systems; Anesthetics, Intravenous; Bradycardia; Controlled Clinical Trials as Topic; Heart Arrest; Humans; Medical Records; Propofol; Risk Factors
PubMed: 9215013
DOI: 10.1093/bja/78.6.642 -
Respiratory Research Jul 2018Adenosine 5'-triphiosphate (ATP) is released from cells under physiologic and pathophysiologic conditions. Extracellular ATP acts as an autocrine and paracrine agent... (Review)
Review
Adenosine 5'-triphiosphate (ATP) is released from cells under physiologic and pathophysiologic conditions. Extracellular ATP acts as an autocrine and paracrine agent affecting various cell types by activating cell surface P2 receptors (P2R), which include trans-cell membrane cationic channels, P2XR, and G protein coupled receptors, P2YR. We have previously shown that ATP stimulates vagal afferent nerve terminals in the lungs by activating P2X2/3R. This action could lead to bronchoconstriction, cough and the local release of pro-inflammatory neuropeptides. In addition, ATP markedly enhances the IgE-dependent histamine release from human lung mast cells. Thus, we have proposed for the first time that extracellular ATP plays a mechanistic role in pulmonary pathophysiology in general and chronic obstructive pulmonary disease (COPD), and acute bronchoconstriction in asthma in particular. The present review examines whether ATP could also play a role in bradycardia and syncope in a subset of patients with pulmonary embolism.
Topics: Adenosine Triphosphate; Animals; Bradycardia; Humans; Platelet Activation; Pulmonary Embolism; Syncope
PubMed: 30055609
DOI: 10.1186/s12931-018-0848-2 -
Critical Care Medicine Jun 2020The objective of this study was to compare survival outcomes and intra-arrest arterial blood pressures between children receiving cardiopulmonary resuscitation for... (Observational Study)
Observational Study
OBJECTIVES
The objective of this study was to compare survival outcomes and intra-arrest arterial blood pressures between children receiving cardiopulmonary resuscitation for bradycardia and poor perfusion and those with pulseless cardiac arrests.
DESIGN
Prospective, multicenter observational study.
SETTING
PICUs and cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.
PATIENTS
Children (< 19 yr old) who received greater than or equal to 1 minute of cardiopulmonary resuscitation with invasive arterial blood pressure monitoring in place.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Of 164 patients, 96 (59%) had bradycardia and poor perfusion as the initial cardiopulmonary resuscitation rhythm. Compared to those with initial pulseless rhythms, these children were younger (0.4 vs 1.4 yr; p = 0.005) and more likely to have a respiratory etiology of arrest (p < 0.001). Children with bradycardia and poor perfusion were more likely to survive to hospital discharge (adjusted odds ratio, 2.31; 95% CI, 1.10-4.83; p = 0.025) and survive with favorable neurologic outcome (adjusted odds ratio, 2.21; 95% CI, 1.04-4.67; p = 0.036). There were no differences in diastolic or systolic blood pressures or event survival (return of spontaneous circulation or return of circulation via extracorporeal cardiopulmonary resuscitation). Among patients with bradycardia and poor perfusion, 49 of 96 (51%) had subsequent pulselessness during the cardiopulmonary resuscitation event. During cardiopulmonary resuscitation, these patients had lower diastolic blood pressure (point estimate, -6.68 mm Hg [-10.92 to -2.44 mm Hg]; p = 0.003) and systolic blood pressure (point estimate, -12.36 mm Hg [-23.52 to -1.21 mm Hg]; p = 0.032) and lower rates of return of spontaneous circulation (26/49 vs 42/47; p < 0.001) than those who were never pulseless.
CONCLUSIONS
Most children receiving cardiopulmonary resuscitation in ICUs had an initial rhythm of bradycardia and poor perfusion. They were more likely to survive to hospital discharge and survive with favorable neurologic outcomes than patients with pulseless arrests, although there were no differences in immediate event outcomes or intra-arrest hemodynamics. Patients who progressed to pulselessness after cardiopulmonary resuscitation initiation had lower intra-arrest hemodynamics and worse event outcomes than those who were never pulseless.
Topics: Adolescent; Blood Pressure; Bradycardia; Cardiopulmonary Resuscitation; Child; Child, Preschool; Female; Heart Arrest; Hemodynamics; Hospital Mortality; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Male; Prospective Studies; Reperfusion
PubMed: 32301844
DOI: 10.1097/CCM.0000000000004308 -
Ultrasound in Obstetrics & Gynecology :... Jun 2006
Review
Topics: Arrhythmias, Cardiac; Bradycardia; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia; Ultrasonography, Prenatal
PubMed: 16715465
DOI: 10.1002/uog.2819 -
Aging Apr 2019
Topics: Bradycardia; Cardiac Resynchronization Therapy; Heart; Humans
PubMed: 31029058
DOI: 10.18632/aging.101928 -
Journal of Applied Physiology... Aug 2017Diving bradycardia is a primordial oxygen-conserving reflex by which the heart rate of air-breathing vertebrates, including humans, slows down in response to water... (Review)
Review
Diving bradycardia is a primordial oxygen-conserving reflex by which the heart rate of air-breathing vertebrates, including humans, slows down in response to water immersion. Its discovery is attributed to Paul Bert, whose seminal observation was published in 1870 as part of a series of experiments that examined physiological adaptations to asphyxia in ducks and other animals. However, Edmund Goodwyn, a British physician who studied medicine at the University of Edinburgh, had already described this reflex in his doctoral thesis, which was originally published in Latin in 1786 and again in English in 1788. Ironically, even though Goodwyn's work has yet to be recognized in the diving physiology literature, it was referenced in the very publication that contains Bert's original observation. Thus this article brings Goodwyn's work and its historical context to light and argues that he should be credited with the first description of diving bradycardia.
Topics: Animals; Bradycardia; Diving; Heart Rate; Humans; Oxygen; Reflex; Respiration
PubMed: 28495845
DOI: 10.1152/japplphysiol.00221.2017 -
Journal of Cardiothoracic Surgery Sep 2021To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation.
OBJECTIVE
To evaluate the occurrence and risk factors of bradycardia after the Maze procedure in patients with atrial fibrillation and tricuspid regurgitation.
METHODS
All patients underwent mitral valve (MV) replacement and concomitant bi-atrial cut-and-sew Maze procedure along with other cardiac surgical procedures were recruited from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University. According to the severity of tricuspid regurgitation, all patients were divided into mild tricuspid regurgitation group and moderate-to-severe tricuspid regurgitation group. The general clinical data, biochemical indexes, intraoperative and postoperative data were collected. The relationship between tricuspid regurgitation and sinus bradycardia after the Maze procedure was analyzed by multivariate logistic regression model.
RESULTS
We enrolled 82 patients, including 24 males and 58 females. The patients had an average age of 56 ± 10 years old. There were 50 cases in mild tricuspid regurgitation group and 32 cases in moderate-to-severe tricuspid regurgitation group. Compared with the mild tricuspid regurgitation group, postoperative bradyarrhythmia (41% vs. 14%), pre-discharge bradyarrhythmia (63% vs. 14%), postoperative sinus bradycardia (34% vs. 10%) and pre-discharge sinus bradycardia (63% vs. 10%) in moderate-to-severe tricuspid regurgitation group were significantly increased (P < 0.01). In moderate-to-severe tricuspid regurgitation, the risk of sinus bradycardia increased after the Maze procedure (OR = 1.453, 95% CI 1.127-1.874), area under ROC curve was 0.81, the Jordan index was 0.665.
CONCLUSION
The severity of tricuspid regurgitation may be an important factor affecting sinus bradycardia after the Maze procedure. It can be considered as a factor to predict sinus bradycardia after the Maze procedure.
Topics: Atrial Fibrillation; Bradycardia; Female; Humans; Infant, Newborn; Male; Maze Procedure; Mitral Valve Insufficiency; Retrospective Studies; Risk Factors; Treatment Outcome; Tricuspid Valve Insufficiency
PubMed: 34565413
DOI: 10.1186/s13019-021-01653-1 -
Clinical Drug Investigation Sep 2022Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac effect profile. Previous studies have reported...
BACKGROUND AND OBJECTIVES
Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac effect profile. Previous studies have reported bradycardia associated with remdesivir, but few have examined its clinical characteristics. The objective of this study was to investigate remdesivir associated bradycardia and its associated clinical characteristics and outcomes.
METHODS
This is a single-institution retrospective study that investigated bradycardia in 600 patients who received remdesivir for treatment of COVID-19. A total of 375 patients were included in the study after screening for other known causes of bradycardia (atrioventricular [AV] nodal blockers). All patients were analyzed for episodes of bradycardia from when remdesivir was initiated up to 5 days after completion, a time frame based on the drug's putative elimination half-life. Univariate and multivariate statistical tests were conducted to analyze the data.
RESULTS
The mean age of the sample was 56.63 ± 13.23 years. Of patients who met inclusion criteria, 49% were found to have bradycardia within 5 days of remdesivir administration. Compared to the cohort without a documented bradycardic episode, patients with bradycardia were significantly more likely to experience inpatient mortality (22% vs 12%, p = 0.01). The patients with bradycardia were found to have marginally higher serum D-dimer levels (5.2 vs 3.4 µg/mL, p = 0.05) and were more likely to undergo endotracheal intubation (28% vs 14%, p = 0.008). Male sex, hyperlipidemia, and bradycardia within 5 days of completing remdesivir were significant predictors of inpatient mortality. No significant differences in length of stay were found.
CONCLUSIONS
Bradycardia that occurs during or shortly after remdesivir treatment in COVID-19 patients may be associated with an increased rate of in-hospital mortality. However, COVID-19 and its cardiac complications cannot be excluded as potential contributors of bradycardia in the present study. Future studies are needed to further delineate the cardiac characteristics of COVID-19 and remdesivir.
Topics: Adenosine Monophosphate; Adult; Aged; Alanine; Antiviral Agents; Bradycardia; Humans; Male; Middle Aged; Retrospective Studies; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 35978159
DOI: 10.1007/s40261-022-01187-x -
Clinical Cardiology Sep 2021
Topics: Bradycardia; COVID-19; Humans; SARS-CoV-2
PubMed: 34331324
DOI: 10.1002/clc.23701