Cardiac Monitoring and Demand Pacemaker in Guillain-Barre Syndrome

Abstract

Life-threatening alterations of respiratory and cardiovascular functions may complicate the course of severe Guillain-Barre syndrome. Cardiac arrest, fore-warned by episodes of bradycardia or other arrhythmia, may occur despite adequately assisted respirations. A patient with Guillain-Barre syndrome required tracheostomy and ventilatory assistance. Continuous cardiac monitoring revealed that tracheal aspiration provoked an idioventricular rhythm of 40 beats per minute, which reverted to sinus rhythm after the procedure. To prevent cardiac arrest during the transition from idioventricular to sinus rhythm, a demand pacemaker was inserted into the right ventricle. Set to activate if the rate fell below 65 beats per minute, the pacemaker functioned both during and between tracheal aspiration procedures. Cardiac monitoring in severe cases of Guillain-Barre syndrome may detect potentially lethal arrhythmias that may then be avoided by a demand pacemaker.

Treatment guidelines for Guillain-Barré Syndrome

“…However, the presence of tachycardia, increased daily variation in systolic blood pressure, reduced normal respiratory-induced heart rate variation, and first episode of severe bradyarrhythmia reduce the threshold for insertion of pacemaker. [7071] Endotrachial suction may provoke bradycardia or systole, and this can be reduced by hyperoxygenation. Hypertension is seen in one third of patients with GBS and can be labile or be followed by hypotension.…”

Guillain-Barré Syndrome with asystole requiring permanent pacemaker: a case report

“…The treatment approach has ranged from the use of isoproterenol and atropine, to insertion of a temporary or permanent pacemaker [14,15]. …”

Long-term transvenous temporary pacing with active fixation bipolar lead in the management of severe autonomic dysfunction in Miller-Fisher syndrome: A case report

“…Bradycardia and asystole requiring permanent pacemaker use in GBS has been reported [16][17][18][19][20][21][22]. Placement of permanent pacemaker has been advocated as the treatment of choice by some, in patients with severe autonomic dysfunction and rhythms originating from sites other than sinus node [19,20].…”

“…Placement of permanent pacemaker has been advocated as the treatment of choice by some, in patients with severe autonomic dysfunction and rhythms originating from sites other than sinus node [19,20]. A hesitation in pursuing early pacemaker implantation in patients with unprovoked serious bradycardia and sinus pauses may occur in the clinical decisionmaking, possibly due to lack of information on the natural history of cardiac dysautonomia.…”