Primo-implantation of a dual-chamber pacemaker in a patient with symptomatic first-degree AV block with proven AV dyssynchrony at an abnormally long PQ interval (pseudopacemaker syndrome)

Abstract

Atrioventrikulární blokáda prvního stupně (AV blokáda I. st.) je defi nována jako prodloužení PR intervalu nad 200 ms [1]. Při extrémně dlouhém PR intervalu může vzniknout situace obdobná pacemakerovému syndromu, tedy kolize systoly síní a komor, provázená podobnými příznaky včetně symptomů srdečního selhání i při normální systolické funkci levé komory [2]. Označuje se jako pseudopacemakerový syndrom [3][4][5][6][7][8][9][10]. Uvádíme případ pacientky s výrazně dlouhým PR intervalem po náhradě mitrální chlopně s příznaky pseudopacemakerového syndromu. Jde o relativně vzácnou klinickou diagnózu a při jejím výskytu je doporučena implantace kardiostimulátoru ve třídě IIa [11].

Cardiac implantable devices and takotsubo syndrome. A rare but potential eventuality

“…A permanent dual-chamber pacemaker implantation was performed. The procedure was accomplished without any complications [11][12][13]. 24 h later she complained of retrosternal pain, sweating and dyspnea.…”

Pseudo‐pacemaker syndrome with prolonged PR interval: A narrative review

“…None of the patients developed chest pain or ECG changes suggestive of coronary artery disease during the stress test. Chronotropic insufficiency was witnessed in two patients, 2,20 compared to three patients which were able to achieve at least 79% of their maximal predicted heart rate 2,14,17 . None of the patients developed high‐degree AV block, and only one patient developed blocked premature atrial contractions 19 .…”

“…The retrieved 17 cases of PPMS—including our case report—are outlined in Table 1 2,6,10,12–21 . Most (88.2%) were adults with an average age of 47 years ranging from 13 to 86 years old.…”

“…Apart from our case and the one published by Ogunlade et al 6 . where no clear association between the patient’s past medical history and the presence of PPMS could be found, four etiologies of PPMS were identified in the remaining cases (n. 15), as follows: (1) Idiopathic PPMS related to poor AV nodal conduction (20% of cases); 2,14,16 (2) reversible inflammatory causes (13%) such as acute myocarditis 15 or acute rheumatic fever; 13 (3) cardiac surgery, 20 interventional procedures 11 or chest radiation 17 leading to the permanent damage of the normal AV conduction system (20%), and, finally, (4) PPMS due to manifest dual AV nodal physiology (DAVNP) occurring as a primary finding (27%) 10,12,16,19 or post slow pathway ablation for treatment of AVNRT (20%) 10,18,21 . In fact, in this latter group, two patients (66%) had residual DAVNP due to damage to the fast pathway, either as a complication of slow pathway ablation 21 or deliberate ablation as a treatment option for AVNRT 10 .…”

“…The retrieved 17 cases of PPMS-including our case report-are outlined in Table 1. 2,6,10,[12][13][14][15][16][17][18][19][20][21] Most (88.2%) were adults with an average age of 47 years ranging from 13 to 86 years old. Our 82-year-old patient was the second oldest patient ever described.…”