No abstract available.
Seizures* ; Sick Sinus Syndrome* ; Syncope

A 70-year-old woman developed sick sinus syndrome associated with thyrotoxicosis. Initial T3 was above 800ng/dl and TSH was below 0.05IU/ml. But sinus node dysfunction was resolved upon achieving a euthyroid state. This clinical course suggest that transient reversible sinus node dysfunction could be developed due to thyrotoxicosis.
Aged ; Female ; Humans ; Sick Sinus Syndrome* ; Thyrotoxicosis*

Pacemaker-mediated tachycardia(PMT) is a circus movement tachycardia that can occur in patients with dual chamber pacemaker with atrial sensing(VDD or DDD), when a ventricular depolarization, either spontaneous or paced, causes retrograde activation of the atrium. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventriculoatrial conduction. We report one case of PMT in a 78-year-old male who received DDD type pacemaker due to sick sinus syndrome. In this case, PMT was disappeared after reprogramming parameters of pacemaker and the application of PMT protection algorithm.
Aged ; Dichlorodiphenyldichloroethane ; Humans ; Male ; Sick Sinus Syndrome ; Tachycardia*

Symptomatic sinus bradycardia in adults with systemic lupus erythematosus (SLE) is rare. Here, we report a case of severe sinus bradycardia requiring temporary cardiac pacing in a SLE patient successfully treated using methylprednisolone pulse therapy.
Adult ; Bradycardia ; Humans ; Lupus Erythematosus, Systemic ; Methylprednisolone ; Sick Sinus Syndrome

Persistent left superior vena cava is a rare congenital anomaly resulting from the failure of the left cardinal vein to degenerate in utero. This anomaly was discovered in 0.3% of large autopsy examinations. Its most relevant clinical implication is the association with cardiac impulse formation and conduction problems. In the case of DDD pacemaker implantation for this anomaly, skillful manual stylet shaping is required or an active fixation device, for example a screw device for stable positioning of pacemaker leads, is needed. We experienced a case of sick sinus syndrome in a patient with persistent left superior and absent right superior vena cava in 72-year-old man. We successfully implanted a DDD type pacemaker through the left superior vena cava via coronary sinus. This is the first Korean report of a successfully implanted permanent pacemaker in a patient with persistent left superior and absent right superior vena cava.
Aged ; Autopsy ; Coronary Sinus ; Dichlorodiphenyldichloroethane* ; Humans ; Sick Sinus Syndrome ; Veins ; Vena Cava, Superior*

Electrical injury is a serious public health problem. Heart is one of the most frequently affected organs. Electrical injury can cause life-threatening cardiac complications such as asystole, ventricular fibrillation, and myocardial rupture. In this case report, we present a 20-yr-old male patient with sick sinus syndrome that developed years after electrical injury.
Adult ; Atropine/diagnostic use ; Electric Injuries/complications* ; Electrocardiography ; Exercise Tolerance ; Human ; Male ; Pacemaker, Artificial ; Sick Sinus Syndrome/etiology* ; Sick Sinus Syndrome/physiopathology ; Sick Sinus Syndrome/therapy ; Sinoatrial Node/physiopathology ; Time Factors

Sick sinus syndrome(SSS) is an important condition for anesthesiologists to recognize. The clinical manifestations of the SSS may be quite difficult to recognize as they may be intermittent, protracted, and multifared. SSS is defined by severe bradycardia and by sinus pause of arrest with escape. An imp-ulse originating in the sinus sode that is blocked before it can depolarize the atrium is referred to as sinoatrial(SA) lock. Physiologically, most signs and srmptoms result from hrpoperfusion of vital sign. The brain, heart, and kidneys are most prominently affected. While it can be mild, producing syncope, it is a frequent symptom and requires permanent pacemaker implantation. We experienced one case of anesthetic management of SSS using spinal anesthesia.
Anesthesia, Spinal* ; Bradycardia ; Brain ; Heart ; Kidney ; Sick Sinus Syndrome* ; Syncope ; United Nations ; Vital Signs

Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult ; Atrioventricular Block ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Humans ; Sick Sinus Syndrome ; Sinoatrial Node*

Intoxifications caused by toxic honey were occurred recently in Korea. Honey poisoning is known to be induced by grayanotoxins, that appear in flowers of different species of Rhododendron. These toxic compounds cause depolarization of membranes that contain fast Na channel by increasing in Na permeability. After ingestion of toxic honey patients may present with neurological, cardiovascular, gastrointestinal sign and symptoms. Two cases of honey poisoning are described here. Both patients experienced syncope and severe arterial hypotension after ingestion of honey which was brought from Nepal and Brazil. Conservative treatement was fully successful in both patients within 24 hours. We report the first case of honey poisoning in Korea.
Brazil ; Eating ; Flowers ; Honey* ; Humans ; Hypotension ; Korea ; Membranes ; Nepal ; Permeability ; Poisoning* ; Rhododendron ; Sick Sinus Syndrome ; Syncope*