The surface electrocardiogram (ECG) can provide many clues to a patient’s underlying medical condition or tendency for arrhythmogenesis. An 80-year-old man with severe aortic stenosis and an implantable cardioverter-defibrillator (ICD) for advanced heart block presented with burping, chest discomfort and intermittent pounding sensations. His ECG showed atrial fibrillation with intermittent ventricular pacing at 60 bpm characterized by irregularly irregular rhythm, absent P waves, narrow intrinsic QRS complexes alternating with wide-paced beats (left bundle branch block [LBBB] morphology, superior axis) and visible pacing spikes. Device interrogation revealed ventricular tachycardia (VT) storm with multiple appropriate ICD shocks explaining his pounding sensations. This report highlights two key teaching points: recognizing atrial fibrillation during ventricular pacing—a frequently missed diagnosis affecting nearly half of patients with pacemakers—and managing VT storm to reduce shock burden. After device reprogramming and antiarrhythmic adjustment, the patient became asymptomatic.

Human ; Male ; Aged: 65-79 Yrs Old ; Thorax ; Teaching ; Tachycardia, Ventricular ; Electrocardiography ; Atrial Fibrillation ; Bundle-branch Block ; Constriction, Pathologic

A case of an elderly patient with severe aortic insufficiency who carried high risks for surgical valve replacement. After a detailed preoperative evaluation, the patient successfully received transapical transcatheter aortic valve replacement. Postoperatively, complete left bundle branch block developed, resulting in impaired left ventricular function. Despite guideline-directed medical therapy for heart failure, cardiac function showed no significant recovery. At 4.5 months post-surgery, left bundle branch pacing was performed, leading to a marked improvement in cardiac function.
Aged ; Humans ; Male ; Aortic Valve Insufficiency/surgery* ; Bundle-Branch Block/etiology* ; Cardiac Pacing, Artificial ; Postoperative Complications/therapy* ; Transcatheter Aortic Valve Replacement/adverse effects*

Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.
Female ; Humans ; Atrioventricular Block/therapy* ; Feasibility Studies ; Transcatheter Aortic Valve Replacement ; Pacemaker, Artificial ; Bundle-Branch Block

Bundle of His ; Bundle-Branch Block ; Cardiac Pacing, Artificial ; Electrocardiography ; Humans ; Purkinje Fibers

Bundle of His ; Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Electrocardiography ; Heart Conduction System ; Heart Failure/therapy* ; Humans

Humans ; Bundle-Branch Block/diagnosis*

Objective: To explore the feasibility, safety and effectiveness of left bundle branch area pacing (LBBAP) in children aged ≤3 years. Methods: A total of 10 children aged ≤3 years who were diagnosed with brady arrhythmia in the First Hospital of Tsinghua University from September 2020 to September 2021 were retrospectively analyzed. All the children met the indication of permanent pacemaker implantation and underwent LBBAP successfully. The intraoperative data (pacing parameters, electrocardiogram and radiographic imaging), cardiac ultrasound data and clinical data during regular postoperative follow-up were recorded. The preoperative and postoperative data were compared using matched samples t test. Results: Ten children (aged (1.6±0.7) years with weight of (10.3±2.5) kg) underwent LBBAP successfully. The QRS wave duration on the postoperative electrocardiogram was (100±9) ms, and the percentage of ventricular pacing was (97±7)%. The postoperative follow-up period was 6 (6, 12) months. At 1 week after operation, the left ventricular end-diastolic diameter Z scores in these children reduced significantly compared with those before operation (1.3±0.6 vs. 3.6±1.1, t=9.37, P<0.001). During the follow-up period, cardiac function was normal and the last left ventricular ejection fraction was (66±4)% in all children. At the last follow-up, the pacing threshold of the 10 children was smaller than 1.0 V and was acceptable. Compared with the intraoperative baseline values, the pacing threshold was slightly higher ((0.8±0.1) vs. (0.5±0.1) V, t=-5.27, P=0.001). However, no significant difference was found regarding sensing threshold ((16±5) vs. (14±4) mV, t=-0.83, P=0.426) and impedance ((584±88) vs. (652±86) Ω, t=2.26, P=0.050). During follow-up, no electrode related complications were recorded. Conclusions: LBBAP is safe and effective for infants and toddlers. Narrow QRS pacing with stable pacing parameters and normal cardiac function could be achieved postoperatively.
Bundle of His ; Bundle-Branch Block ; Cardiac Pacing, Artificial/methods* ; Child, Preschool ; Electrocardiography/methods* ; Humans ; Retrospective Studies ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left

Bundle-Branch Block/therapy* ; Cardiac Pacing, Artificial ; Cardiac Resynchronization Therapy ; Electrocardiography ; Humans ; Treatment Outcome

block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33–4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09–5.85; P = 0.03) were significantly associated with PM implantation.CONCLUSION: ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.]]>
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bundle-Branch Block ; Catheter Ablation ; Defibrillators ; Follow-Up Studies ; Humans ; Korea ; Male ; Observational Study ; Retrospective Studies ; Sick Sinus Syndrome ; Syncope ; Tachycardia

Anti-Arrhythmia Agents ; Brugada Syndrome/complications* ; Bundle-Branch Block/complications* ; Electrocardiography ; Humans ; Quinidine ; Ventricular Fibrillation