COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with significant cardiovascular dysfunction in patients with, and without, pre-existing cardiovascular disease [ 1 ]. There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome [ 2 ]. There is growing evidence showing that arrhythmias are also one of the major complications of COVID-19. We report a patient with no known cardiac conduction disease who presented with syncope, positive SARS-CoV-2 PCR, who was persistently bradycardic and subsequently developed sinus node dysfunction (SND). To date, there are a limited number of reports of sinus node dysfunction (SND) associated with COVID-19. We describe the clinical characteristics, potential pathophysiologic mechanisms and management of COVID-19 patients who experienced de novo SND.
Various electrocardiographic (EKG) manifestations have been reported in patients with coronavirus disease 2019 (COVID-19). There is growing evidence showing that new onset QT-prolongation is a common EKG finding in COVID-19 patients. In this report, we present a case of a 71-year-old man who was found to have a new onset, irreversible, prolonged QT-interval requiring permanent biventricular pacemaker despite testing negative twice for RT-PCR COVID-19 and correction of all known reversible causes. To date, there are a limited number of reports of irreversible QT-prolongation associated with COVID-19. This case report emphasizes the importance of a physician’s clinical judgment in the setting of negative RT-PCR COVID-19 testing. A robust systemic inflammatory state seen in active COVID-19 infection is possibly the key mechanism precipitating the new EKG findings.
Introduction Although ablation of typical atrial flutter (AFL) can be easily achieved with radiofrequency energy (RF), there are no studies that compare effectiveness of different ablation catheters. Our study aimed to compare the effectiveness of various types of ablation catheters in the treatment of AFL. Methods We analysed patients with AFL who underwent RF ablation by a single operator at our institution. Successful ablation was evidenced by presence of bidirectional conduction block (trans-isthmus conduction time ≥130 ms, or doubling of baseline conduction time, or presence of double potentials ≥90ms). Logistic regression was used to compare success rate and linear regression to compare lesion time. Results Out of the 222 patients, only 6 patients did not meet success criteria (2.7%). Catheters used were 8 mm tip in 16 patients, internally irrigated (Chili II Boston Scientific) in 47 patients, externally irrigated (non-force sensing) catheters (CoolPath, Abbott) in 40 patients. Externally irrigated force sensing catheter (Tacticath, Abbott) was used with >10 gm of force and (LPLD) setting (30W-45°C-60 sec) in 50 patients, and high-power short duration (HPSD) setting (50W-43°C −12 sec,) in 70 patients. No complications were encountered. Catheter type had no statistically significant association with ablation success. In terms of lesion time, HPSD catheter statistically significantly shortened lesion time by 758.3s, [CI −1128.29, −388.35s] followed by LPLD by 419.0s [CI −808.49, −29.47s]. Table 1 shows the lesion time difference for the catheters used as compared with 8 mm tip. Conclusions Typical atrial flutter radiofrequency ablation procedure had a high success rate, not influenced by type of ablation catheter. Contact force ablation catheter on HPSD is associated with shorter total lesion time. Funding Acknowledgement Type of funding sources: None.
The study aims to shed light on the relations between enablers of The European Foundation for Quality Management (EFQM) and its results at Palestinian Central Bureau of Statistics (PCBS). The study adopts the analytical descriptive approach that is applied at PCBS according to a regular random sample of 100 employees to whom the questionnaire is distributed, and the data is analyzed according to the statistical analysis program (SPSS). The study found out that there is a relation between EFQM's enablers combined with its results at PCBS where the strength of the relation is 86%; moreover, it also shows that there is a statistical relation between leadership, partnerships, resources, processes, products, and services with EFQM's model results and that there is no relation between strategy and staff with EFQM's model results where each enabler is associated with the results with a percentage of (78%) to enable operations, products, services, partnerships, and resources of (75%), (64%) for leadership, (61%) for staff, and (56%) for strategy. The results highlight a number of points of strength; most importantly, that PCBS is keeping pace with the rapid development of technology in data collection to support the credibility of its statistical outputs; in addition to this, PCBS is known for its high levels of planning and review of its work results and that PCBS administrations supports the areas of excellence, creativity, and opportunities for improvement of its staff as well as supporting PCBS's strategy through a set of performance indicators related to society's needs and measurement of impressions. The study came out with recommendations, the most important of which is PCBS' efforts towards achieving the second level of the European institutions "recognized for excellence" and updating the European quality excellence model in light of the rapid technological developments and the modern management information systems.
The first cases of COVID-19 infection were reported as pneumonia of unknown cause in China in December 2019. While respiratory complications remain the hallmark of the disease, multisystem involvement has been well documented. Cardiovascular involvement with potentially lethal myocarditis has been extensively reported in the literature. Reports of conduction system disturbances are much rarer, especially in patients without other signs of cardiac involvement. We present a case of an 88-year-old male with no prior cardiac history who presented to the hospital with obstipation. He was diagnosed with a small bowel obstruction and underwent a lysis of adhesions. During the hospitalization, he developed intermittent bradycardia with a high-degree atrioventricular (AV) block. A decision was made to implant a permanent pacemaker. During a pre-procedure COVID-19 screen, he was found to be positive for the presence of SARS-CoV-2 RNA. He had no signs of myocardial injury, a transthoracic echocardiogram showed no abnormalities, and he remained free of any respiratory symptoms. While the involvement of the cardiac conduction system has been documented in patients with symptomatic COVID-19 infection, our patient only exhibited conduction abnormalities and remained free of other COVID-19 symptoms. The sole involvement of the conduction system by COVID-19 is rare, especially in patients with otherwise asymptomatic infections. There is no long-term data to suggest whether such conduction abnormalities are temporary or permanent. As such, patients might benefit from the implantation of a permanent pacemaker.
Syncope is usually caused by cerebral hypoperfusion. Differentials to consider during the workup of syncope includes vasovagal, orthostatic, drug-induced, arrhythmia, structural heart disease, and ischemic cardiomyopathy. An 81-year-old African American man with recurrent witnessed syncopal events and newly diagnosed heart failure underwent extensive cardiac workup including electrocardiograms (EKG), echocardiogram, Holter monitor, electrophysiology (EP) study, and coronary angiogram. The workup revealed ischemic ventricular tachycardia in the setting of significant coronary artery disease including 80% distal left main disease. The patient underwent a coronary artery bypass graft (CABG) with subsequent resolution of further syncopal events. The patient was successfully discharged with guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) and coronary artery disease (CAD). It is very rare for ischemic cardiomyopathy to present as syncope; however, it is not unheard of. Extensive transmural ischemia could lead to ventricular arrhythmias, a known cause of syncope. This rare presentation serves as a reminder to consider ischemic heart disease in the evaluation of syncope.
Background51‐year‐old female with extensive prior atrial surgery involving myxoma resection and patch septum repair and prior typical atrial flutter as well as peripatch reentry underwent redo radiofrequency ablation of typical atrial flutter.MethodsAfter high density mapping was performed, and gap in the prior typical flutter line was ablated.ResultDuring the ablation transient atrioventricular (AV) block was noted. Subsequent remapping of the right atrium revealed that there was a narrow strip of tissue between the cavo‐tricuspid isthmus (CTI) and the coronary sinus (CS) os on which activation of the AV node was now depending. From all other directions, the AV node was surrounded by scar tissue.ConclusionsThe most likely explanation for the transient AV block during the ablation procedure is that there was reversible injury to the tissue strip between the CTI and the CS os, which is critical for the activation of the AV node.
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