Torsade de pointes in a patient with complete atrioventricular block and pacemaker failure, misdiagnosed with epilepsy

Cai, Si-yu; Ye, Shenfeng; Xiang, Wu; Xiang, Meixiang; Wang, Jianan

doi:10.1016/j.jelectrocard.2015.03.007

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Unresolved, severe ventricular bradycardia is known to trigger compensatory ventricular remodeling and increased arrhythmogenicity 6,8,9,23 . We performed echocardiographic examinations over a 4-week follow-up period in CAVB animals and compared the data with sham-operated animals which underwent the same surgical procedures as the CAVB animals, including thoracotomy and advancement of the ablation needle but without delivering the ablative energy.…”

Section: Resultsmentioning

confidence: 99%

A rat model of complete atrioventricular block recapitulates clinical indices of bradycardia and provides a platform to test disease-modifying therapies

Kim

Wolfson

Fernandez

et al. 2019

Sci Rep

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Complete atrioventricular block (CAVB) is a life-threatening arrhythmia. A small animal model of chronic CAVB that properly reflects clinical indices of bradycardia would accelerate the understanding of disease progression and pathophysiology, and the development of therapeutic strategies. We sought to develop a surgical model of CAVB in adult rats, which could recapitulate structural remodeling and arrhythmogenicity expected in chronic CAVB. Upon right thoracotomy, we delivered electrosurgical energy subepicardially via a thin needle into the atrioventricular node (AVN) region of adult rats to create complete AV block. The chronic CAVB animals developed dilated and hypertrophied ventricles with preserved systolic functions due to compensatory hemodynamic remodeling. Ventricular tachyarrhythmias, which are difficult to induce in the healthy rodent heart, could be induced upon programmed electrical stimulation in chronic CAVB rats and worsened when combined with β-adrenergic stimulation. Focal somatic gene transfer of TBX18 to the left ventricular apex in the CAVB rats resulted in ectopic ventricular beats within days, achieving a de novo ventricular rate faster than the slow atrioventricular (AV) junctional escape rhythm observed in control CAVB animals. The model offers new opportunities to test therapeutic approaches to treat chronic and severe CAVB which have previously only been testable in large animal models.

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Section: Resultsmentioning

confidence: 99%

A rat model of complete atrioventricular block recapitulates clinical indices of bradycardia and provides a platform to test disease-modifying therapies

Kim

Wolfson

Fernandez

et al. 2019

Sci Rep

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“…La fisiopatología ha sido explicada por la presencia de bloqueo en fase 4 del sistema de conducción infraHisiano (11) . Es importante anotar que esta enfermedad es frecuentemente diagnosticada de forma errónea como un trastorno convulsivo o epilepsia y los pacientes llegan a ser tratados con medicamentos antiepilépticos (ver diagnósticos diferenciales mas importantes en la figura 1) (13) .…”

Section: Discussionunclassified

Síncope como manifestación clínica del bloqueo aurículo-ventricular paroxístico y respuesta al implante de marcapasos bicameral

Patiño¹,

Posada²,

González³

et al. 2021

CES Med

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El síncope es el principal síntoma que presentan los pacientes con bloqueo aurículo-ventricular completo paroxístico, y puede obedecer a una serie de etiologías intrínsecas o extrínsecas. Los bloqueos son causa de disfunción importante, con alta carga de morbilidad, incluso en pacientes sin cardiopatía isquémica o anomalía estructural de base. Se presenta el caso de una paciente con corazón estructuralmente normal, quien ingresó para estudio de síncope y durante el monitoreo Holter de 24 horas se documentó bloqueo aurículo-ventricular completo paroxístico, por lo cual se procedió al implante de un marcapasos bicameral, con muy buena respuesta a la intervención. Los bloqueos aurículo-ventricular completos pueden ser paroxísticos o permanentes y la única forma de diferenciarlos son los hallazgos electrocardiográficos. Es muy importante realizar el diagnóstico de bloqueo aurículo-ventricular completo, bien sea paroxístico o definitivo, porque el único tratamiento es el implante de un dispositivo de estimulación eléctrica cardíaca.

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“…Bradycardia, particularly, is historically known to be correlated with vasovagal syncope but neurological deterioration may also occur without severe hypotension and collapse; a small cohort of severely bradycardic elderly patients showed that pacemaker implantation improved their mental deterioration [16]. Finally, complete AV block has also been associated with drug-resistant epilepsy [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Case report: severe bradycardia, a reversible cause of “Cardio-Renal-Cerebral Syndrome”

Aoun

Tabbah

2016

BMC Nephrol

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BackgroundCardio-Renal Syndromes were first classified in 2008 and divided into five subtypes. The type 1 Cardio-Renal Syndrome (CRS) is characterized by acute decompensation of heart failure leading to acute kidney injury (AKI). Bradyarrhythmia was not mentioned in the classification as a cause for low cardiac output (CO) in type 1 CRS. Besides, CRS was not previously associated with central nervous system (CNS) injury despite the fact that cardiac, renal and neurological diseases can coexist.Case presentationWe report the case of a 93-year old diabetic man who presented for obnubilation. He had a slow atrial fibrillation, was not hypotensive and was not taking any beta-blocker. He developed, simultaneously, during his hospitalization, severe bradycardia (<35 beats per minute), oligoanuria and further neurological deterioration without profound hypotension. An ECG revealed a complete atrioventricular (AV) block and all his symptoms were completely reversed after pacemaker insertion. His creatinine decreased progressively afterwards and at discharge, he was conscious, alert and well oriented.ConclusionOur case highlights the importance of an early recognition of low cardiac output secondary to severe bradyarrhythmia and its concurrent repercussion on the kidney and the brain. This association of the CRS with CNS injury-that we called “Cardio-Renal-Cerebral Syndrome”–was successfully treated with permanent pacemaker implantation.

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Torsade de pointes in a patient with complete atrioventricular block and pacemaker failure, misdiagnosed with epilepsy

Cited by 4 publications

References 7 publications

A rat model of complete atrioventricular block recapitulates clinical indices of bradycardia and provides a platform to test disease-modifying therapies

A rat model of complete atrioventricular block recapitulates clinical indices of bradycardia and provides a platform to test disease-modifying therapies

Síncope como manifestación clínica del bloqueo aurículo-ventricular paroxístico y respuesta al implante de marcapasos bicameral

Case report: severe bradycardia, a reversible cause of “Cardio-Renal-Cerebral Syndrome”

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