Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone

Kim, JoonHyuk; Goldbarg, Seth; Leung, Steven; Yang, Hua; Slotwiner, David J.

doi:10.1016/j.hrcr.2018.11.007

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…With increased implementation, recent concerns have emerged whereby (1) HBP implantation is technically more challenging with a long learning curve 2 ; and (2) thresholds for His capture may unpredictably rise after device placement. 3 In response to these issues (given current technology), left bundle branch area pacing (LBBAP) as pioneered by Huang et al 4 has been introduced as a novel form of physiological pacing, potentially overcoming many of the limitations of HBP while maintaining all of the advantages. 4 , 5 Although LBBAP may yield pacing thresholds more similar to myocardial pacing, whether this form of permanent pacing can be successfully targeted in all patients is unclear.…”

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confidence: 99%

His-bundle pacing is the best approach to physiological pacing

2020

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confidence: 99%

His-bundle pacing is the best approach to physiological pacing

2020

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“…However, PHBP is a newer modality and the effects of various drugs on the His‐bundle capture threshold are not yet well described. Amiodarone was recently reported to raise the capture threshold in a case of nonselective PHBP 13 . The exact mechanism by which flecainide might exert such an effect requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Increased capture threshold in permanent His‐bundle pacing associated with flecainide

Jiang

Wasserlauf

Knight

et al. 2020

Pacing Clinical Electrophis

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A 64-year-old man underwent implantation of a permanent His-bundle pacemaker. A marked rise in the selective His-bundle capture threshold was noted 1 month after the patient started flecainide acetate for rhythm control of recurrent, symptomatic atrial flutter and atrial fibrillation. The capture threshold subsequently normalized 4 days after discontinuing flecainide and switching to dofetilide. To our knowledge, this is the first documented case of a rise in selective His-bundle capture threshold associated with flecainide acetate. Further studies are needed to characterize this association which could result in higher capture thresholds, decreased battery longevity, and mimic His-bundle lead failure. K E Y W O R D Sflecainide acetate, pacemaker, pacing, permanent His-bundle pacing

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“…Amiodarone, a class III antiarrhythmic, is one of the antiarrhythmic drugs described in situations of increased stimulation threshold, [18] unlike the rest of the class III antiarrhythmics, this can probably be explained by the class I effect that amiodarone possesses [19].…”

Section: Discussionmentioning

confidence: 99%

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2024

IJCMCR

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Rheumatoid Arthritis (RA) is a chronic autoimmune joint disease characterized by persistent systemic inflammation.In rheumatoid arthritis, cardiac involvement is not uncommon and may involve all three tunics of the heart. We report an exceptional case of RA associated with complete Atrioventricular Block (AVB) and intracardiac mobile mass. This is a patient with RA initially put on chloroquine, complicated by a complete BAV implanted with a double chamber pace, then put on corticosteroid therapy and methotrexate for four years. Faced with the worsening of his osteoporosis and the probable increase in the threshold of pacemaker stimulation, it was decided to replace methotrexate with leflunomide. As part of the patient's cardiac evaluation, an ETT was performed, inadvertently objectifying a mass in the right atrium attached to the atrial tube and the tricuspid valve without obstruction.Full BAV is very rare. It can be seen especially in old polyarthritis. Several mechanisms can explain this, including rheumatoid nodules; Chloroquine poisoning; amyloid infiltration and rheumatoid vasculitis.The association of RA and intracardiac mass is rare. By analyzing the few cases described in the literature, five main causes are summarized: rheumatoid nodules, cancers, granulomatosis of valves, intracavitary thrombus and infective endocarditis.We discuss through our case, the epidemiological and etiological particularity of the association of RA with a major conductive disorder, as well as the difficulty of the etiological diagnosis of an intracardiac mass in the context of RA.

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Increased threshold in nonselective His-bundle pacing suspected to be caused by amiodarone

Cited by 6 publications

References 8 publications

His-bundle pacing is the best approach to physiological pacing

His-bundle pacing is the best approach to physiological pacing

Increased capture threshold in permanent His‐bundle pacing associated with flecainide

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