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Indications for Permanent Pacing and Cardiac Resynchronization Therapy
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Shiv Bagga, J. David Burkhardt, Mandeep Bhargava
Although, the incidence of progression of bifascicular block to third-degree AV block is low, ranging from 2% to 6% per year, observational studies in these patients with syncope, have shown a higher mortality rate, with SCD being mainly responsible for this mortality.11–13 Based on these data, guidelines recommend a Class IIa indication for permanent cardiac pacing in patients with bifascicular block and syncope, even if the cause of syncope cannot be determined. It must also be emphasized that though the most common cause of syncope in patients with bifascicular block is atrioventricular block, other mechanisms like reflex syncope or tachyarrhythmias (with underlying structural heart disease) may be invoked.13,14
Recognition of common arrhythmias
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Nicholas P. Kerr, Rajesh N. Subbiah
The combination of left anterior or posterior fascicular block with right bundle branch block is called bifascicular block. While isolated hemiblock is of little clinical significance, in bifascicular block all AV conduction is dependent on the single remaining fascicle, indicating a severe degree of intraventricular conduction disease and a high risk of progression to complete heart block. When bifascicular block is associated with PR prolongation (first degree AV block), the conduction disturbance is even more severe. This pattern is sometimes called ‘trifascicular’ block. That term should be avoided because one of the fascicles is not entirely blocked, but conducting with delay. Similarly, it is confusing to refer to isolated left bundle branch block as ‘bifascicular’ block, or the combination of left bundle branch block and first-degree AV block as ‘trifascicular’ block.
Bradyarrhythmias
Published in Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins, The Junior Doctor’s Guide to Cardiology, 2017
Ian Mann, Christopher Critoph, Caroline Coats, Peter Collins
This is defined as the combination of RBBB, left axis deviation or LBBB and right axis deviation. If there is also first-degree heart block in the context of bifascicular block, it is termed trifascicular block.
Effectiveness and safety of implantable loop recorder and clinical utility of remote monitoring in patients with unexplained, recurrent, traumatic syncope
Published in Expert Review of Medical Devices, 2023
Pietro Palmisano, Federico Guerra, Vittorio Aspromonte, Gabriele Dell’Era, Pier Luigi Pellegrino, Mattia Laffi, Carlo Uran, Silvana De Bonis, Michele Accogli, Antonio Dello Russo, Giuseppe Patti, Francesco Santoro, Antonella Torriglia, Gerardo Nigro, Antonio Bisignani, Giovanni Coluccia, Giulia Stronati, Vincenzo Russo, Ernesto Ammendola
Baseline characteristics of the study population, and the additional diagnostic tests performed before ILR implantation are shown in Table 1, left column. Their mean age was 68.1 ± 13.6 years, and 59.4% were male. An NYHA class >II was recorded in 5% of patients, and 6% had a left ventricular ejection fraction <50%. Fifty-three patients (11%) had an HFRS score of ≥5 points and were identified as frail. All enrolled patients reported at least one episode of traumatic syncope before ILR insertion, and about a third reported severe trauma secondary to syncope. Another third of patients reported aura or prodromes preceding spontaneous syncopal episodes. About half of the patients had basal ECG abnormalities that were not considered sufficient to explain the etiology of syncopal episodes; the most frequent abnormality was first-degree atrioventricular (AV) block (22%), followed by chronic bifascicular block (13%).
The clinical approach to diagnosing peri-procedural myocardial infarction after percutaneous coronary interventions according to the fourth universal definition of myocardial infarction – from the study group on biomarkers of the European Society of Cardiology (ESC) Association for Acute CardioVascular Care (ACVC)
Published in Biomarkers, 2022
Johannes Mair, Allan Jaffe, Bertil Lindahl, Nicholas Mills, Martin Möckel, Louise Cullen, Evangelos Giannitsis, Ola Hammarsten, Kurt Huber, Konstantin Krychtiuk, Christian Mueller, Kristian Thygesen
This patient with CCS presented acutely to a local hospital with symptoms and signs of acute heart failure. The ECG showed persistent atrial fibrillation with a bifascicular block (complete right bundle branch block with left anterior hemiblock) with non-specific ST-segment and T wave changes. Initially the left ventricular function was severely depressed with severe mitral valve regurgitation. The patient had a prior history of inferior type 1 MI with reopening of the circumflex artery and stent implantation 10years before. The admission hs-cTnT concentration was 20ng/L [99th percentile URL ≤14ng/L] but without significant change >20% on serial testing (22ng/L). After acute heart failure management, the patient was admitted to a tertiary care centre for elective coronary angiography to exclude progression of coronary artery disease. The admission hs-cTnT value at this hospital was 19ng/L, and the N-terminal pro B-type natriuretic peptide concentrations was markedly increased at 3169ng/L. Left ventricular systolic function was then moderately impaired, and there was also some improvement in the severity of mitral valve regurgitation to moderate degree. The angiogram revealed a subtotal occlusion of the previously implanted stent (Figure 5(A)), which could be reopened, and two drug-eluting stents were implanted (Figure 5(B)). The hs-cTnT concentration on the day after the PCI was 22ng/l. There were no coronary events during a 12-months follow-up period.
Life-Threatening Cyanide Intoxication after Ingestion of Amygdalin in Prehospital Care
Published in Prehospital Emergency Care, 2022
Patrik Cmorej, Petr Bruthans, Jaroslav Halamka, Irena Voriskova, David Peran
EMS crews (paramedic and physician in the rendezvous system) responded and upon the arrival, the patient was found unconscious, spontaneously ventilating with limb convulsions. The physician assessed the patient using the ABCDE algorithm. The airways were clear, with the smell of bitter almonds present. Insufficient spontaneous ventilation was noted with an oxygen saturation of 85%. The patient was given oxygen via a non-rebreather mask at a high flow (15 l per minute). Good air movement and symmetrical chest rise and fall was present. Initial blood pressure was 73/44 mmHg with a regular heart rate of 69 beats per minute. Intravenous access was obtained, and 500 ml infusion bolus of Hartmann’s solution was begun. When the patient’s blood pressure did not respond to fluid bolus, norepinephrine 2 mg in 20 ml of 5% glucose was initiated (100 mcg/ml with initial speed of 20 ml/hour) resulting in blood pressure increase to 80/50 mmHg. A sinus rhythm at 59 beats/min with a single ventricular extrasystole was present on the 12 -leads ECG. In addition, bifascicular block and ST segment depression up to 1 mm on the lateral wall were present. Unconsciousness persisted with a GCS of 1 − 1 − 1.