Human ; Craniocerebral Trauma ; Coronary Artery Disease ; Heart Block ; Heart Failure

The electrocardiographic analysis of heart blocks provides great opportunities for the discussion of mechanisms of electrical cardiac conduction, serving as “teachable moments” in medicine. Recognition of heart blocks can sometimes be a challenge as they can present in many forms, different severities and levels of blocks that present as varied patterns on electrocardiographic tracing. The ultimate key to correct diagnosis rests on adequate understanding of normal electrophysiology of the electrical system of the heart. While it is vital to recognize the pattern, we should always know and understand the physiology behind the pattern. This article presents a detailed analysis of a case of heart block which can easily be misinterpreted on first look. The case is featured not for its rarity but for the interesting concepts in cardiac electrophysiology that are highlighted. Navigation of the different elements of tracing can be an adventure and a great learning experience enjoyed by both students and experts.
Heart Block ; Electrocardiography

OBJECTIVE: To investigate the clinical manifestations and laboratory indicators of anti-Sjögren's-syndrome-related antigen A (SSA) antibody associated fetal cardiac disease. METHODS: Pregnant women hospitalized at Peking University People's Hospital from January 2013 to July 2023 were included. Eleven patients with anti-SSA antibody positive were eventually diagnosed with fetal cardiac di-sease. And patients with anti-SSA antibody positive without fetal cardiac disease were selected as controls. Clinical manifestations, laboratory indications and drug usage were compared between the two groups. RESULTS: Among these 11 patients, congenital heart block was confirmed in seven, which was the most common manifestations of fetal cardiac malformation. The proportion of the patients diagnosed with autoimmune disease before pregnancy in fetal cardiac malformation group was significantly lower than that in the control group (P=0.032), while most of the patients in the fetal cardiac malformation group received immune-related examinations for the first time because of this time's fetal cardiac diagnosis. While most of the patients in the control group received routine examinations because of autoimmune diseases diagnosed before pregnancy. During pregnancy, the white blood cell level [(9.29±2.58)×10⁹/L vs. (7.10±1.90×10⁹/L, t=3.052, P=0.004], erythrocyte sedimentation rate [(49.50 (48.00, 51.00) mm/h vs. 23.00 (15.00, 30.25) mm/h, Z=-2.251, P=0.024], IgA level [3.46 (2.30, 5.06) g/L vs. 2.13 (1.77, 2.77) g/L, Z=-2.181, P=0.029], and antinuclear antibody (ANA) titers [1∶320 (1∶160, 1∶320) vs. 1∶80 (1∶40, 1∶160), Z=-3.022, P=0.003] were significantly higher in fetal cardiac malformation group than in the control group. The proportion of positive anti-SSB antibody during pregnancy did not show a statistically significant difference between the two groups (37.5% vs. 7.7%, P=0.053). There was no significant difference in hydroxychloroquine dosage and initiation time between the two groups. The dosage of prednisone in the second and third trimesters was significantly higher in the cardiac malformation group than that in the control group, but there was no significant difference in the first trimester. CONCLUSION Fetal cardiac disease is rare in pregnant women with anti-SSA antibody. White blood cell, erythrocyte sedimentation rate, IgA, the titer of ANA positivity were higher in the fetal heart disease group during pregnancy. Since congenital heart block is difficult to reverse, its prevention and monitoring are more important than remedial treatment.
Humans ; Female ; Pregnancy ; Sjogren's Syndrome/complications* ; Autoimmune Diseases ; Heart Block/diagnosis* ; Autoantibodies ; Antibodies, Antinuclear ; Immunoglobulin A

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

Autoantibodies ; Heart Block/prevention & control* ; Humans

heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10–70) vs. 19.63 (10–25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.]]>
Airway Extubation ; Anesthesia ; Animals ; Arterial Pressure ; Atrioventricular Block ; Bradycardia ; Brain Neoplasms ; Carbon Dioxide ; Dexmedetomidine ; Dihydroergotamine ; Dogs ; Fever ; Heart Rate ; Hypertension ; Hypotension ; Hypothermia ; Labetalol ; Neurosurgery ; Observational Study ; Odds Ratio ; Retrospective Studies ; Seizures ; Tachycardia

A unicuspid aortic valve is a rare congenital malformation that frequently presents with valvular dysfunction and dilatation or aortic aneurysm, requiring combined aortic valve surgery and aortic repair. Some patients show severe valve calcification extending into the interventricular septum, possibly resulting in damage to the conduction system during debridement for valve replacement. We present a rare case of severe aortic stenosis with a unicommissural unicuspid aortic valve diagnosed by preoperative transesophageal echocardiography in a 36-year-old man. After composite graft replacement of the aortic valve, aortic root, and ascending aorta, a permanent pacemaker was placed because of postoperative complete heart block.
Adult ; Aorta ; Aortic Aneurysm ; Aortic Valve Stenosis ; Aortic Valve ; Debridement ; Dilatation ; Echocardiography, Transesophageal ; Heart Block ; Heart Defects, Congenital ; Humans ; Transplants

BACKGROUND: Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS: Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS: During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.
Bundle-Branch Block ; Cardiac Resynchronization Therapy ; Death ; Electrocardiography ; Follow-Up Studies ; Heart Failure ; Heart Transplantation ; Humans ; Immunodeficiency Virus, Bovine

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The annual incidence of systemic sarcoidosis is estimated at 10–20 per 100,000 individuals. Owing to the recent advances in imaging modalities, cardiac sarcoidosis (CS) is diagnosed more frequently. The triad of CS includes conduction abnormality, ventricular tachycardia, and heart failure. Atrial and ventricular arrhythmias are caused by either inflammation or scar formation. Inflammation should be treated with immunosuppression and antiarrhythmic agents and scar formation should be treated with antiarrhythmics and/or ablation, in addition to implantable cardioverter defibrillator (ICD) implantation, if necessary. Ablation can provide a good outcome, but it might require bipolar ablation if the critical portion is located mid-myocardium. Late recurrence might be caused by reactivation of sarcoidosis, which would need to be evaluated by positron emission tomography-computed tomography imaging. Risk of sudden cardiac death (SCD) in patients with advanced atrioventricular block is not low, and ICD implantation could be considered instead of a pacemaker. For risk stratification for SCD, late gadolinium enhancement by cardiac magnetic resonance imaging or program stimulation is often used.
Arrhythmias, Cardiac ; Atrioventricular Block ; Catheter Ablation ; Cicatrix ; Death, Sudden, Cardiac ; Defibrillators ; Defibrillators, Implantable ; Electrons ; Gadolinium ; Heart Failure ; Humans ; Immunosuppression ; Incidence ; Inflammation ; Magnetic Resonance Imaging ; Recurrence ; Sarcoidosis ; Tachycardia, Ventricular

Central venous catheter (CVC) placement is an operation which can establish a fast, safe, and effective deep venous access to rescue patients under critical conditions, especially for those receiving hemodialysis. It is a simple operation with almost no complications, but different complications have been still reported, such as bleeding, infection, embolism, low blood flow, and cardiac arrhythmias. In this case, the patient with preexisting left bundle branch block suffered right bundle branch block, leading to complete heart block during CVC placement. When the patient developed complete heart block, we immediately treated him with isoproterenol, and the surgery was terminated as soon as possible. The patient gradually recovered the sinus rhythm after the treatment. This complication is rare but severe, and clinicians should recognize the risks and take strategies as early as possible. We think the cause of complete heart block in this patient may be related to mechanical trauma to the right ventricle by the guide wire or catheter insertion. Therefore, CVC placement should be performed with more caution, and the guide wire and catheter tip should be inserted less than 18 cm deep.
Arrhythmias, Cardiac ; Catheterization, Central Venous ; Central Venous Catheters ; Heart Block ; Humans ; Male ; Renal Dialysis