Prevalence and Clinical Characteristics of Patients with Pause-Dependent Atrioventricular Block

Bun, Sok‐Sithikun; Asarisi, Florian; Heme, Nathan; Squara, Fabien; Scarlatti, Didier; Taghji, Philippe; Deharo, Jean‐Claude; Moceri, Pamela; Ferrari, Émile

doi:10.3390/jcm11020449

Cited by 4 publications

(13 citation statements)

References 16 publications

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“…11 It is important to consider that although unusual, in some cases a number of different mechanisms of PAVB may coexist. 11,13 Figure 1 shows that in this dog, PAVB was initiated by a sinus rhythm with unchanged PR, that during the asystolic pause, there was sinus rate acceleration and that the episode was terminated by a ventricular ectopic beat. According to the Aste and Brignole classification, this case would be characterised as an I-AVB.…”

Section: Discussionmentioning

confidence: 82%

“…The electrophysiological mechanism of PD-PAVBs is somewhat controversial in medical literature, 14 but Bun et al suggest that it is associated with changes in the depolarisation of diseased His-Purkinje fibres. 12,13 After pauses, spontaneous depolarisations occur in these fibres, leading to inactivation of sodium channels and decrease in membrane resting potential, which leads to an inability to conduct electrical impulses. 5,13 Resetting of the transmembrane potential by an appropriately timed escape beat or premature beat is necessary to restore AV conduction.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 After pauses, spontaneous depolarisations occur in these fibres, leading to inactivation of sodium channels and decrease in membrane resting potential, which leads to an inability to conduct electrical impulses. 5,13 Resetting of the transmembrane potential by an appropriately timed escape beat or premature beat is necessary to restore AV conduction. 5,13 Subclassification of PAVB according to the presence of pause dependency is a recent topic of discussion in human cardiology.…”

Section: Discussionmentioning

confidence: 99%

“…In human medicine, PAVB can be further classified into intrinsic paroxysmal AV block (I-AVB), extrinsic vagal paroxysmal AV block (EV-AVB) and extrinsic idiopathic paroxysmal AV block (EI-AVB). 11,13 There are important differences between these groups regarding epidemiology, prognosis and response to pacemaker or theophylline therapy. 11 There is also a subclassification of PAVB relating to the initiation of the block, characterising it as pause-dependent (PD-PAVB) or tachycardia-dependent AV block (TD-PAVB), although there is controversy regarding nomenclature and the exact electrophysiological mechanisms involved in each type.…”

Section: Introductionmentioning

confidence: 99%

“…11 There is also a subclassification of PAVB relating to the initiation of the block, characterising it as pause-dependent (PD-PAVB) or tachycardia-dependent AV block (TD-PAVB), although there is controversy regarding nomenclature and the exact electrophysiological mechanisms involved in each type. 6,13,14 In veterinary medicine, specific electrocardiographic features of PAVB are only mentioned regarding syncope classification during unexplained transient loss of consciousness (TLOC) episodes, 8 but there have been no detailed descriptions of different classifications of PAVB to date. To the author's knowledge, this is the first case report of PAVB with an apparent response to aminophylline in a dog.…”

Section: Introductionmentioning

confidence: 99%

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Paroxysmal atrioventricular block in a mixed‐breed dog

Pessoa

Goncalves

2023

Vet Record Case Reports

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An 11‐year‐old female mixed‐breed dog was presented with syncopal episodes occurring up to 10 times a day for 3 months. The owner reported events lasting for approximately 15 s, during which the dog would fall into lateral recumbency, have muscle tremors and show intense salivation. After the event, the animal was disorientated for a few seconds before full recovery. A surface electrocardiogram was obtained, during which an episode of syncope occurred, with a paroxysmal atrioventricular block lasting 10.5 s. The event was characterised as an intrinsic pause‐dependent paroxysmal atrioventricular block associated with cardiogenic syncope type 1E. The dog received aminophylline 10 mg/kg every 8 hours and the frequency of syncopal episodes decreased until it died of non‐cardiac causes 3 months later. There is little information on paroxysmal atrioventricular blocks in dogs, and further electrocardiographic event characterisation may the influence choice of therapy in individual cases.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Paroxysmal atrioventricular block in a mixed‐breed dog

Pessoa

Goncalves

2023

Vet Record Case Reports

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Pause-Dependent Paroxysmal Episode of Third-Degree Atrioventricular Block Triggered by Premature Atrial Contraction

Di,

Lin

2024

Am J Case Rep

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Patient: Male, 65-year-old Final Diagnosis: Atrioventricular block Symptoms: Syncope Clinical Procedure: — Specialty: Cardiology Objective: Rare disease Background: Paroxysmal third-degree atrioventricular block (AVB) can exhibit a vast array of symptoms, but commonly, paroxysmal AVB leads to presyncope, syncope, or possibly sudden cardiac death. We present a rare case of pause-dependent paroxysmal AVB that was triggered by a premature atrial contraction. Case Report: A 65-year-old man with frequent episodes of presyncope and syncope for 3 weeks was admitted to our hospital for further diagnosis. A resting 12-lead electrocardiogram showed an incomplete right bundle branch block, and a 24-h Holter recording showed multiple episodes of third-degree AVB. Intracardiac tracing revealed that the block site was distal, at the infra-His-Purkinje system. Conclusions: This case highlights a rare case of pause-dependent paroxysmal AVB that was triggered by a premature atrial contraction. This type of AVB is an abrupt, unexpected, repetitive block of atrial impulses as they propagate to the ventricles. It is relatively rare, and due to its transient nature, it is often under recognized and can lead to sudden cardiac death.

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Prevalence and Clinical Characteristics of Patients with Torsades de Pointes Complicating Acquired Atrioventricular Block

Bun

Heme

Asarisi

et al. 2023

JCM

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Background: Female gender, degree of QT prolongation, and genetic susceptibility are known risk factors for developing torsades de pointes (TdP) during high-grade atrioventricular block (HG-AVB). Our objective was to analyze the prevalence and clinical characteristics of patients presenting with TdP and AVB (TdP [+]) in comparison with non-TdP patients with AVB (TdP [−]). Methods: All the ECGs from patients prospectively admitted for AVB (2 to 1, HG, and complete) at the University Hospital of Nice were analyzed. Automated corrected QT (QTc), manual measurements of QT and JT intervals, and Tpeak-to-end were performed at the time of the most severe bradycardia. Results: From September 2020 to November 2021, 100 patients were admitted for HG-AVB. Among them, 17 patients with TdP were identified (8 men; 81 ± 10 years). No differences could be identified concerning automated QTc, manual QTc (Bazett correction), baseline QRS width, or mean left ventricular ejection fraction between the two groups. Potassium serum level on admission and mean number of QT-prolonging drugs per patient were not significantly different between the two groups, respectively: 4.34 ± 0.5 mmol/L in TdP [+] versus 4.52 ± 0.6 mmol/L (p = 0.33); and 0.6 ± 0.7 in TdP [+] versus 0.3 ± 0.5 (p = 0.15). In contrast, manual QTcFR (Fridericia correction), JT (Fridericia correction), Tpeak-to-end, and Tpe/QT ratio were significantly increased in the TdP [+] group, respectively: 486 ± 70 ms versus 456 ± 53 ms (p = 0.04); 433 ± 98 ms versus 381 ± 80 ms (p = 0.02); 153 ± 57 ms versus 110 ± 40 ms (p < 0.001); and 0.27 ± 0.08 versus 0.22 ± 0.06 (p < 0.001). Conclusions: The incidence of TdP complicating acquired AVB was 17%. Longer QTcFR, JT, and Tpeak-to-end were significantly increased in the case of TdP but also in the presence of permanent AVB during the hospitalization.

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Prevalence and Clinical Characteristics of Patients with Pause-Dependent Atrioventricular Block

Cited by 4 publications

References 16 publications

Paroxysmal atrioventricular block in a mixed‐breed dog

Paroxysmal atrioventricular block in a mixed‐breed dog

Pause-Dependent Paroxysmal Episode of Third-Degree Atrioventricular Block Triggered by Premature Atrial Contraction

Prevalence and Clinical Characteristics of Patients with Torsades de Pointes Complicating Acquired Atrioventricular Block

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