Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

Sato, Yuichi; Dohi, Kaoru; Kusuki, Hirofumi; Tanimura, Muneyoshi; Watanabe, Kiyotaka; Sugiura, Emiyo; Kumagai, Naoto; Nakamori, Shiro; Nakajima, Hiroshi; Fujii, Eitaro; Nakamura, Mashio; M, Ito

doi:10.2169/internalmedicine.52.0056

Intern. Med.

2013

DOI: 10.2169/internalmedicine.52.0056

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Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

Yuichi Sato

Kaoru Dohi

Hirofumi Kusuki

et al.

Abstract: A 58-year-old woman with chronic heart failure (CHF) received cardiac resynchronization-defibrillator (CRT-D) therapy without atrial lead implantation due to longstanding atrial fibrillation (AF). Three months after oral amiodarone therapy was initiated for the treatment of non-sustained ventricular tachycardia detected by the CRT-D device, the patient's heart failure symptoms worsened and 12-lead electrocardiography showed newly emerged p-waves with atrioventricular (AV) dissociation. Immediately after the de… Show more

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Cited by 2 publications

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Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

Qin

Zhang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter (LVESd), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) (P<0.01), but positively with the LVEF (P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV (P<0.01), but negatively with the LVEF (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group (78% sensitivity, 83% specificity), those in QRS-2 group (83% sensitivity, 77% specificity) and in QRS-3 group (89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

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Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

Qin

Zhang

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Drug-induced atrioventricular blockages

Kulikova

Остроумова

Komarova

2020

Medicinskij alfavit

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Atrio-ventricular (AV) blockages are a serious violation of the heart rhythm. One of the reasons for the development of this pathology may be taking medications. This effect has a significant number of drugs used for the treatment of diseases of the cardiovascular system, central nervous system, general and local anesthetics, antineoplastic drugs, and many others. The main mechanism for the development of drug-induced AV blockades is the inhibition of AV node conduction. The most common risk factors for the development of drug-induced AV blockades are taking two and more drugs that have an inhibitory effect on AV conduction, the initial duration of the PQ interval more than 0.2 second, initial dysfunction of the AV node, increased plasma concentration of a potential inducer drug due to the presence of kidney and/or liver disease, drugdrug interactions, and specific risk factors for individual drugs. Special attention in solving this problem should be paid to both stopping the developed AV conduction disorder – medication or using an electric cardiostimulator, and its prevention. This article systematizes the literature data on drug-induced AV blockades in order to increase the awareness of practitioners and patients about their prevalence, risk factors, approaches to diagnosis, treatment and prevention.

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Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

Cited by 2 publications

References 8 publications

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure

Drug-induced atrioventricular blockages

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