Exercise-provoked distal atrioventricular block

Chokshi, Saurabh K.; Sarmiento, Joseph J.; Nazari, Jose; Mattioni, Thomas A.; Zheutlin, Terry; Kehoe, Richard F.

doi:10.1016/0002-9149(90)90749-q

Cited by 37 publications

(8 citation statements)

References 9 publications

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“…If not secondary to myocardial ischemia, AV block in this circumstance usually is due to disease in the His-Purkinje system and is associated with a poor prognosis; thus, pacing is indicated. 81,82 Long sinus pauses and AV block can also occur during sleep apnea. In the absence of symptoms, these abnormalities are reversible and do not require pacing.…”

Section: Acquired Atrioventricular Block In Adultsmentioning

confidence: 99%

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Epstein¹,

DiMarco²,

Ellenbogen³

et al. 2008

Circulation

1,243

488

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Section: Acquired Atrioventricular Block In Adultsmentioning

confidence: 99%

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Epstein¹,

DiMarco²,

Ellenbogen³

et al. 2008

Circulation

1,243

488

View full text Add to dashboard Cite

“…If not secondary to myocardial ischemia, AV block in this circumstance usually is due to disease in the His-Purkinje system and is associated with a poor prognosis; thus, pacing is indicated (81,82). Long sinus pauses and AV block can also occur during sleep apnea.…”

Section: Acquired Atrioventricular Block In Adultsmentioning

confidence: 99%

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Epstein

DiMarco²,

Ellenbogen³

et al. 2008

Journal of the American College of Cardiology

1,808

389

View full text Add to dashboard Cite

“…The authors speculated the role of Bezold-Jarisch reflex in this mechanism and stated that the prevalence of deceleration during exercise appears to be very low, which is in agreement with our experiences in the exercise laboratory. Sinus deceleration during exercise may be an extreme example caused by an ischemia-mediated reflex (4,6).…”

Section: Discussionmentioning

confidence: 99%

Pronounced HR variability after exercise in inferior ischemia: evidence that the cardioinhibitory vagal reflex is invoked by exercise-induced inferior ischemia

Tahara

Takaki

Taguchi

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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. Pronounced HR variability after exercise in inferior ischemia: evidence that the cardioinhibitory vagal reflex is invoked by exercise-induced inferior ischemia. Am J Physiol Heart Circ Physiol 288: H1179 -H1185, 2005. First published October 21, 2004; doi:10.1152/ajpheart.00045.2004.-Potent cardioinhibitory vagal reflex resulting in bradycardia and hypotension has been observed under particular conditions of transmural inferior ischemia and its reperfusion, such as those observed with acute infarction. However, whether exercise-induced ischemia with ST depressions that is subendocardial and that might be recurrently experienced in daily activities can evoke this reflex remains unknown. In patients with exercise-induced ST depressions due to either inferior [right coronary artery stenosis (RCA), n ϭ 52] or anterior ischemia [left anterior descending artery stenosis (LAD), n ϭ 51], we evaluated postexercise vagal activity (from 0 to 6 min) by the time constant of heart rate (HR) decay and HR variability by 30-s averages of the absolute values of successive RR interval differences (⌬RR). Exercise parameters were similar between groups. The time constant was slightly but significantly shorter in RCA than LAD patients (79 Ϯ 24 vs. 93 Ϯ 29 s, P Ͻ 0.01). More significantly, ⌬RR early after exercise (0.5-2.5 min) was approximately twofold greater in RCA than LAD patients (from ϩ76 to ϩ118%, P Ͻ 0.001), indicating pronounced vagal activity stimulated by inferior ischemia. Revascularization prolonged the time constant (P Ͻ 0.05) and attenuated recovery ⌬RR in RCA patients (P Ͻ 0.05, n ϭ 10) but did not change both parameters in LAD patients (n ϭ 12). As well as acute inferior infarction, exercise-induced inferior subendocardial ischemia, which might recurrently occur in daily activities, activates the cardioinhibitory reflex. These new findings must be taken into account in interpreting vagal activity in patients with coronary artery disease.heart rate variability; vagus nerve; coronary artery disease EXPERIMENTAL STUDIES in animals have demonstrated that excitation of vagal sensory nerve endings from myocardial ischemia involving the inferoposterior wall of the left ventricle activates potent cardioinhibitory reflex resulting in bradycardia and hypotension (7,24). In humans, similar observations have been made under particular conditions of severe transmural inferior ischemia and its reperfusion, such as those that occur with myocardial infarction, vasospastic angina, or angioplasty of the right coronary artery (12,15,21,22,28). For example, in the first hour of the onset of acute myocardial infarction, patients with inferior infarction often (ϳ75%) show sinus bradycardia and/or hypotension, which generally responds to intravenous administration of atropine. This observation contrasts with that in patients with anterior infarction, about 50% of whom show sinus tachycardia and/or hypertension (15).Despite these well-recognized clinical observations, little attention has been paid to the question as to whether this refle...

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Exercise-provoked distal atrioventricular block

Cited by 37 publications

References 9 publications

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Pronounced HR variability after exercise in inferior ischemia: evidence that the cardioinhibitory vagal reflex is invoked by exercise-induced inferior ischemia

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