Atrioventricular Conduction System Disease

Vijayaraman, Pugazhendhi; Ellenbogen, Kenneth A.

doi:10.1016/b978-0-323-37804-8.00014-6

Cited by 5 publications

(17 citation statements)

References 229 publications

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“…Patients with any degree of AV block typically complain of dizziness, decreased energy, palpitations, presyncope, or syncope. Those with more advanced disease might present with fatigue, angina, and congestive heart failure, reflecting inadequate cardiac output or tissue perfusion [ 2 ]. The most severe symptom is the Stokes-Adams attack, which is defined as syncopal attacks caused by polymorphic ventricular tachycardia [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Those with more advanced disease might present with fatigue, angina, and congestive heart failure, reflecting inadequate cardiac output or tissue perfusion [ 2 ]. The most severe symptom is the Stokes-Adams attack, which is defined as syncopal attacks caused by polymorphic ventricular tachycardia [ 2 ]. The degree of an AV block can be distinguished based on ECG findings, anatomic site of the block (Figure 3 ), onset, severity, clinical presentation, underlying etiology, or associated conditions [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most severe symptom is the Stokes-Adams attack, which is defined as syncopal attacks caused by polymorphic ventricular tachycardia [ 2 ]. The degree of an AV block can be distinguished based on ECG findings, anatomic site of the block (Figure 3 ), onset, severity, clinical presentation, underlying etiology, or associated conditions [ 2 ]. Of note, the generic term “high-grade AV block” is used to describe any form of AV block that suggests an increased risk for complete heart block (CHB) or symptomatic bradycardia.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, the generic term “high-grade AV block” is used to describe any form of AV block that suggests an increased risk for complete heart block (CHB) or symptomatic bradycardia. It typically includes type II second-degree block, 2:1 AV block, and CHB [ 2 ], and therefore should be avoided due to the various etiologies.…”

Section: Discussionmentioning

confidence: 99%

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Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole

Sullivan

Rogalska

Vargas

2020

Cureus

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Atrioventricular (AV) block in pregnancy is infrequently encountered and there is little management guidance available. We present a case of a 24-year-old G3P1011 at 24 weeks' gestation who presented to the obstetrics and gynecology clinic complaining of palpitations, fatigue, and dyspnea on exertion. Cardiology workup including an electrocardiogram (ECG) and Holter monitor detected second-degree type II (Mobitz) AV block with the longest asystole event lasting 15.8 seconds. A St. Jude's dual-chamber pacemaker (Abbott Laboratories, Abbott Park, IL) was implanted immediately. Standard radiation precautions were taken with additional shielding for the fetus. The patient experienced significant improvement in her symptoms. The patient went into labor at 37 3/7 weeks. Due to non-reassuring fetal heart tones, a cesarean section was performed, and a healthy baby girl was born. The management of heart block in pregnancy can be divided into involving those who are symptomatic and those who are asymptomatic. Symptoms of heart block can include palpitations, fatigue, dyspnea, and/or syncope; the presence of these symptoms warrants the placement of a pacemaker, preferably during pre-pregnancy or during the first two trimesters, as high-grade heart block is associated with significant mortality. Those who are in their last trimester or postpartum should consider the use of a temporary pacemaker as heart block could be due to pregnancy-related cardiovascular changes. For women with heart block, labor and delivery could result in worsening of bradycardia due to uterine contractions displacing blood into the central circulation. Most women with heart block do well in labor and delivery and having a pacemaker is not necessarily an indication for a cesarean section.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole

Sullivan

Rogalska

Vargas

2020

Cureus

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“…Selective HBP (S‐HBP) was defined as ventricular activation occurring solely over the His‐Purkinje system: (1) His‐Purkinje mediated cardiac activation and repolarization as evidenced by electrocardiographic concordance of QRS and T wave complexes; and (2) the paced‐ventricular interval was almost identical to the His‐ventricular interval (Figure ). Nonselective HBP was (NS‐HBP) defined based on capture of basal ventricular septum in addition to His bundle capture as: (1) no isoelectric interval between pacing stimulus and QRS; (2) the electrical axis of the paced QRS must be concordant with the electrical axis of the spontaneous QRS (if known); and (3) narrowing of QRS with higher output or vice versa (Figure ) . The HBP lead was connected to the RV port (no back‐up lead) or the left ventricular port in a patient with cardiac resynchronization therapy (CRT) device (RV lead in RV port).…”

Section: Methodsmentioning

confidence: 99%

Permanent His bundle pacing: Electrophysiological and echocardiographic observations from long‐term follow‐up

Vijayaraman

Dandamudi

Lustgarten

et al. 2017

Pacing Clinical Electrophis

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Pregnancy and complete atrioventricular block: a case report

Batallanos¹,

López²

2023

Annals of Medicine &Amp; Surgery

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Introduction: Bradycardia in pregnancy due to complete atrioventricular block (CAVB) is a rare but serious occurrence that can be life-threatening to the mother and fetus. Patients with CAVB may be asymptomatic, but symptomatic cases require urgent and definitive management. Case presentation: The case of a 20-year-old primigravida with previously undiagnosed CAVB who attended the obstetric emergency service in labor is presented. The route of delivery was vaginal without complications. The decision was made to implant a permanent dual-chamber pacemaker on the third day of the puerperium, and the patient did no present cardiovascular symptoms during outpatient follow-up. Clinical discussion: CAVB is a rare but serious condition in pregnancy that can be congenital or acquired. While some cases are relatively benign, others can lead to decompensation and fetal complications. There is no consensus on the best delivery route, but vaginal delivery is generally safe unless contraindicated for obstetric reasons. Pacemaker implantation may be necessary in some cases and can be performed safely during pregnancy. Conclusion: This case highlights the importance of cardiac evaluation in pregnant patients, especially those with a history of syncope. It also highlights the need for adequate and urgent management in symptomatic cases of CAVB in pregnancy and adequate evaluation to decide when to implant the pacemaker as a definitive measure.

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Atrioventricular Conduction System Disease

Cited by 5 publications

References 229 publications

Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole

Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole

Permanent His bundle pacing: Electrophysiological and echocardiographic observations from long‐term follow‐up

Pregnancy and complete atrioventricular block: a case report

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