Explore chapters and articles related to this topic
Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
Despite the fact that sinus bradycardia and Wenckebach atrioventricular (AV) block (type I second-degree AV block) have been observed during pregnancy, labor, and delivery (109), conduction blocks are not a normal finding in pregnancy. Type II second-degree AV block and third-degree AV block are associated with an increased incidence of sudden death, and permanent pacemaker should be considered. The exception to this is congenital complete heart block, which is generally well tolerated and, because it carries a good prognosis, usually does not need to be treated with a pacemaker, unless it is symptomatic.
Bradycardia
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Second-degree AV block is characterized by a failure of one or more atrial impulses to reach the ventricles and is further sub-classified as type I and type II which define the electrocardiographic pattern rather than the anatomical site of block. Type I second-degree AV block or Wenkebach pattern is defined as the occurrence of a single non-conducted sinus P wave associated with inconstant PR intervals before and after the blocked impulse provided there are at least two consecutive conducted P waves (i.e., 3:2 AV block) to determine behavior of the PR interval.7 The term inconstant PR interval is important because the majority of type I sequences are atypical and do not conform to the traditional teaching about the mathematical behavior of the PR intervals.7 The PR intervals may shorten or stabilize and show no discernible or measurable change anywhere in a type I sequence. The description of “progressive” prolongation of the PR interval is misleading because PR intervals may shorten or stabilize and show no discernible or measurable change anywhere in a type I sequence. Indeed, atypical type I patterns in their terminal portion can exhibit a number of consecutive PR intervals showing no discernible change before the single blocked beat. However, even in such cases the post-block PR interval is always shorter. Slowing or an increase of the sinus rate does not interfere with the diagnosis of type I block.
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
Second degree AV block commonly occurs in a 2:1 pattern with every second atrial impulse failing to conduct to the ventricles. Without at least two consequently conducted beats occurring prior to block, it is not possible to classify this pattern as Wenckebach or Mobitz II block, because there is no opportunity to observe the PR prolongation that occurs in Wenckebach pattern. Additional ECG and clinical criteria are needed to make the distinction between an AV nodal and infranodal mechanism of 2:1 block. ECG evidence favouring an infranodal mechanism may include the presence of another defect of distal conduction, for example bundle branch block or intraventricular conduction delay. Observing Wenckebach or Mobitz II block at other times in the same patient may also help to determine the level of block. Occasionally, in 2:1 AV block the PP intervals containing QRS completes are shorter than the PP intervals not containing QRS complexes. This is called ventriculophasic sinus arrhythmia. High-grade AV block refers to failure of two or more consecutive atrial beats to conduct to the ventricles.
Clinical Features, Autoantibodies, and Outcome of Neonatal Lupus Erythematosus
Published in Fetal and Pediatric Pathology, 2022
It is suggested that the management of NLE depends on the type and the severity of clinical features. IVIG and systemic corticosteroids were used in the management of hepatic and hematological manifestations in previous studies [4,7,15]. In these studies, the efficacy of IVIG and systemic corticosteroids in hepatic and hematological involvements was confirmed. IVIG and systemic corticosteroids were administered to NLE patients with hepatic and hematological manifestations in our study. All hepatic and hematological abnormalities resolved with IVIG and/or systemic corticosteroids therapy within 12 months in all. As a permanent and serious manifestation of patients with NLE, the presence of CHB should require a pacemaker to be implanted [1]. However, none of the four patients with CHB in our study had pacemakers. One patient with a third-degree AV block was auto-discharged against medical advice. At time of auto-discharge, this patient had 50 heart beats per minute and a pacemaker should have been inserted, according to the guidelines [16]. He died at home. The patient with a second-degree AV block and one patient with a third-degree AV block in our study got well, however, a third-degree AV block persists in another child without a pacemaker, now aged 4 years. Long-term follow-up may be needed for children with CCHB.
Monocentric experience of leadless pacing with focus on challenging cases for conventional pacemaker
Published in Acta Cardiologica, 2018
Christophe Garweg, Joris Ector, Gabor Voros, Adèle Greyling, Bert Vandenberk, Stefaan Foulon, Rik Willems
Patients were predominantly male (n = 46, 69.7%) with a mean age of 79.1 ± 9.7-year-old. Indications for pacing were complete third degree atrioventricular (AV) block in 20 patients (30.3%), second degree AV block in 2 patients (3.0%), symptomatic sinus node dysfunction in 14 patients (21.2%), and permanent atrial fibrillation with bradycardia in 30 patients (45.5%). Among this population, 22 patients were considered as potentially challenging cases for conventional pacing due to the presence of at least one of the following conditions: acquired or congenital cardiovascular abnormalities (n = 15), previous tricuspid valve surgery (n = 4), cardiac transplantation (n = 2), after pacemaker extraction (n = 7) and cardiac amyloidosis (n = 1). Thirteen of them (19.6% of the entire population) had no option for implantation of a conventional pacing system. Details of these patients are given in Table 2.
Prognostic impact of bundle branch blocks in patients with ST-segment elevation myocardial infarction
Published in Acta Cardiologica, 2021
Flora Ozkalayci, Erdem Turkyilmaz, Bernas Altıntaş, Ozgur Yasar Akbal, Ali Karagoz, Can Yucel Karabay, İbrahim Halil Tanboga, Vecih Oduncu
Three thousand fifty-seven STEMI patients underwent pPCI were retrospectively analysed (mean age was 58.7 ± 11.9, male gender was 77.75%). Those patients with BBB in their ECG on admission were re-evaluated for their prior ECG. Among these patients 134 (4.4%) had LBBB, and 67 (2.2%) had RBBB, in whom BBB onset was classified into three subgroups. Patients with left anterior fascicular hemi block patients and posterior fascicular hemi block were enrolled to no-BBB group. Patients with trifascicular block, second degree AV block and third degree AV block were excluded. Those patients with cardiopulmonary arrest in admission were excluded.