Electrophysiological characteristics of junctional pacemakers in congenital A‐V block and following his bundle cryoablation

Bexton, R. S.; De, Ward

doi:10.1002/clc.4960051102

Cited by 4 publications

(1 citation statement)

References 18 publications

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“…The escape rhythm depends on the automaticity or intrinsic rate of the tissue distil to the block [6]. The escape rhythms can be divided into narrow complex or wide complex escape rhythm based on the QRS duration (whether the QRS duration is less than or more than 120 milliseconds).…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with Ischemic and Non-Ischemic Complete Heart Block

Sundhu

Yildiz

Syed

et al. 2017

Cureus

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IntroductionThird degree or complete heart block (CHB) is a medical emergency and usually requires permanent pacemaker placement. CHB can be caused by cardiac ischemia or non-ischemic conditions such as infiltrative diseases or fibrosis. The purpose of this study is to identify the baseline clinical characteristics associated with ischemic versus non-ischemic causes of complete heart block and compare their outcomes.Materials and methodsAn institutional review broad approval was granted by the Cleveland Clinic Health System. In our study, 216 patients with CHB presenting to Fairview Hospital between January 2014 and June 2016 were initially identified using the International Classification of Disease (ICD) codes at discharge. Only the patients with a new diagnosis of complete heart block (CHB) were included in the study (total N=62), which led to the exclusion of 154 patients. The patients were characterized into non-ischemic and ischemic groups based on cardiac marker elevation, electrocardiogram changes and/or cardiac catheterization findings. In all the patients, data including the following was collected: demographics such as age, gender, ethnicity and body mass index; pre-existing comorbidities such as hypertension, chronic kidney disease, diabetes mellitus, thyroid disease, previous coronary artery disease, history of cancer; use of nodal blocking agents, electrolyte abnormalities on admission, echocardiographic parameters such as ejection fraction (EF), right ventricular systolic pressure (RVSP), left ventricular end diastolic and systolic volumes (LVEDV and LVESV, respectively). The primary outcome was all-cause mortality and the secondary outcome was pacemaker placement. Categorical variables were analyzed using chi-square and continuous variables using ANOVA.ResultsOut of 62 patients (N=62), 48 had non-ischemic and 14 had ischemic CHB. The mean age was 67 years (95% CI, 60.55-74.73) in the ischemic group and 75 years (95% CI, 71.52-78.80) in the non-ischemic group, p=0.04. Patients with ischemic CHB had a lower mean EF of 49.6% (95% CI, 42.04%-57.23%) compared to 57.42% in non-ischemic CHB patients (95% CI, 53.97%-60.87%), p=0.05. History of coronary artery disease was present in 71.4% (10/14) patients with ischemic CHB compared to 37.5% (18/48) patients with non-ischemic CHB, p=0.02. There was no statistically significant difference between the two groups in terms of gender, diabetes, hypertension, thyroid dysfunction, chronic kidney disease, nodal blocking agents, electrolyte abnormalities or smoking status. For outcomes, 6/48 (12.5%) of patients with non-ischemic CHB had died compared to 3/14 (21.4%) ischemic CHB (p=0.327). Permanent pacemaker was implanted in 45/48 patients (93.75%) of the non-ischemic CHB compared to 6/14 (42.83%) in the ischemic group (p<0.001).ConclusionsPatients with ischemic CHB are younger, and they have a lower ejection fraction but they are less likely to get a pacemaker compared to non-ischemic CHB. Further studies with a bigger sample size are required to understand the lo...

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Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with Ischemic and Non-Ischemic Complete Heart Block

Sundhu

Yildiz

Syed

et al. 2017

Cureus

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Use of Ambulatory Electrocardiographic Monitoring to Identify High-Risk Patients with Congenital Complete Heart Block

1987

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To define the long-term natural history of congenital complete heart block, we followed 27 patients prospectively by means of frequent ambulatory electrocardiographic (ECG) recordings for a mean (+/- SD) of 8 +/- 3 years. During that time, 8 of the 13 patients with a mean daytime heart rate below 50 bpm (Group A) had cardiac complications such as sudden death, syncope, presyncope, or excessive fatigue. Six of the eight patients had additional ECG findings that suggested an instability of the junctional escape mechanism. These findings included nocturnal junctional exit block (three patients), little or no change in the junctional rate with physical activity (three patients), and associated tachyarrhythmias (three patients). None of the 14 patients with a mean daytime heart rate of 50 bpm or more (Group B) had an adverse clinical outcome, and 5 of the 13 patients in Group A also remained well. Among the five patients in stable condition in Group A, three had no evidence of an unstable junctional mechanism. We conclude that patients with a mean daytime junctional rate below 50 bpm and other evidence of an unstable junctional escape mechanism should probably undergo prophylactic pacemaker implantation. Since junctional exit block and tachyarrhythmias sometimes appear first during follow-up, the method of risk stratification employed in this study depends on serial ambulatory ECG recordings.

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Prophylactic Pacing for Prevention of Sudden Death in Congenital Complete Heart Block?

Odemuyiwa

1992

Pacing Clin Electro

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Electrophysiological characteristics of junctional pacemakers in congenital A‐V block and following his bundle cryoablation

Cited by 4 publications

References 18 publications

Clinical Characteristics and Outcomes of Patients with Ischemic and Non-Ischemic Complete Heart Block

Clinical Characteristics and Outcomes of Patients with Ischemic and Non-Ischemic Complete Heart Block

Use of Ambulatory Electrocardiographic Monitoring to Identify High-Risk Patients with Congenital Complete Heart Block

Prophylactic Pacing for Prevention of Sudden Death in Congenital Complete Heart Block?

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