Permanent pacing in disorders of sinus node function

Krishnaswami, Venkataraman; Geraci, Anthony R.

doi:10.1016/0002-8703(75)90502-5

Cited by 51 publications

(6 citation statements)

References 15 publications

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“…In the management of this syndrome, electrical pacing seemed to offer logical therapeutic benefits and has produced temporary relief. Unfortunately, the initial benefits have failed to eliminate a formidable mortality: 42% within 25 months in one series and 33% within an average of 17.9 months survival in another series (11,29). Furthermore, electrical pacing has failed to control the syncope resulting from tachydysrhythmias even though it does allow more vigorous application of antiarrhythmic drugs by reducing the risk that occurs without its protection.…”

Section: Discussionmentioning

confidence: 99%

The Unbalanced Heart

Wehrmacher¹,

Talano²,

Kaye³

et al. 1979

Cardiology

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The heart often appears to function independently because it can maintain regular activity even when isolated from the rest of the body. Likewise, it maintains its regularity in the midst of powerful but balanced neural and pressure influences. Experimental situations designed to unbalance these forces produce rhythm disturbances resembling those encountered clinically. Unbalancing of the sympathetic supply with the parasympathetic supply totally obliterated, leads to tachycardias of various origin which are eliminated by adrenergic blockade. Removing the sinoatrial node results in atrial brady-tachyarrhythmia, eliminated by cholinergic blockade. Unbalancing the pressure load results in premature ventricular contractions that are clearly not mediated by external neural controls. Cardiac rhythm disturbances thus result from a variety of forces that may be readily tolerated when balanced by opposing forces but cannot be controlled without that buffer.

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Section: Discussionmentioning

confidence: 99%

The Unbalanced Heart

Wehrmacher¹,

Talano²,

Kaye³

et al. 1979

Cardiology

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“…It has long been recognised that atrial fibrillation carries a high risk of embolism, particularly cerebral. Recently, systemic embolism as a hazard of chronic sinoatrial disorder has been suggested (Rubenstein et al, 1972), denied (Eraut and Shaw, 1973), but increasingly documented (Samarasinghe and Senanayake, 1973;Radford and Julian, 1974; Krishnaswami and Geraci, 1975;Fairfax et al, 1976). In one study it occurred in 16% of patients with chronic sinoatrial disorder against 1.3% of matched patients with complete heart block (Fairfax et al, 1976).…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular incidents after myocardial infarction.

McAllen¹,

Marshall²

1977

Journal of Neurology, Neurosurgery & Psychiatry

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(Young et al., 1960). Correlation between the degree of atheroma of coronary and carotid arteries is likewise high (Young et al., 1960;Mitchell and Schwartz, 1965). When necropsy evidence of myocardial infarction is made the starting point, the prevalence of carotid stenosis is again high, the lumen of the sinus being reduced by half in 59% of men with myocardial infarction against 35% in unselected necropsies (Mitchell and Schwartz, 1965). Conversely, when atheroma of the carotid sinus is the starting point the prevalence of myocardial infarction rises from 8% in cases with mild atheroma to 67% in severe cases (Martin et al., 1960).Embolisation from the heart to the carotid and cerebral circulation is also a common pathological finding. In a series of cases of occlusion of the internal carotid artery 20% were caused by emboli

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“…It is commonly believed that 60% of clinically detected systemic emboli from the atrium are cerebral [6,7]. Neither pacemaker implantation [5,8,9] nor digitalis therapy [4] prevents or delays this consequence of atrial fibrillation in the setting of bradycardia-tachycardia syndrome. EFFICACY OF ANTICOAGULATION.…”

Section: Summary Of Available Datamentioning

confidence: 99%

Anticoagulation and Atrial Fibrillation in the Bradycardia- Tachycardia Syndrome

Pauker¹

1981

Med Decis Making

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Case DescriptionJF, an 80-year-old woman, presented to the New England Medical Center with syncope. She had a ten-year history of edema due to mild congestive heart failure, treated with a thiazide diuretic and digoxin. Extensive evaluation revealed paroxysmal atrial fibrillation and sinus bradycardia; a diagnosis of sick sinus or bradycardia-tachycardia syndrome was made. Syncope did not recur and pacemaker therapy was not considered. Anticoagulation was begun as prophylaxis against systemic embolization.JF returned to the hospital one month later with microscopic hematuria. Her renal function was normal, and intravenous pyelography showed no abnormality. Urinary bleeding subsided spontaneously, but anticoagulants were discontinued. A consultation was requested from the Division of Clinical Decision Making to clarify the risks and benefits of prophylactic anticoagulation in atrial fibrillation associated with the bradycardiatachycardia syndrome. The Problem StatedThe decision facing the clinical staff was whether or not to resume anticoagulation. In patients with atrial fibrillation associated with mitral valve disease, oral anticoagulants are regularly used as prophylaxis against systemic embolization because the risk of embolization in that setting is quite

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Permanent pacing in disorders of sinus node function

Cited by 51 publications

References 15 publications

The Unbalanced Heart

The Unbalanced Heart

Cerebrovascular incidents after myocardial infarction.

Anticoagulation and Atrial Fibrillation in the Bradycardia- Tachycardia Syndrome

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