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bradyarrhythmias guidelines

Ravi B Patel, Sara Tannenbaum, Ana Viana-Tejedor, Jianping Guo, KyungAh Im, David A Morrow, Benjamin M Scirica
BACKGROUND: In acute coronary syndrome (ACS), potassium levels <3.5 mEq/L are associated with ventricular arrhythmias. Current guidelines therefore recommend a potassium target >4.0 mEq/L in ACS. Our study evaluated the association between potassium levels, cardiac arrhythmias, and cardiovascular death in patients with non-ST-segment elevation myocardial infarction or unstable angina. METHODS: Potassium levels were measured in 6515 patients prior to randomization to receive either ranolazine or a placebo in the MERLIN-TIMI 36 trial...
December 29, 2015: European Heart Journal. Acute Cardiovascular Care
Alper Kepez, Okan Erdogan
There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guideline-directed therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials...
October 16, 2015: World Journal of Clinical Cases
Andrzej Kutarski, Anna Polewczyk
Sinus node disease and atrioventricularis disorders are very rarely observed in women during pregnancy. Bradyarrhythmia in pregnant women is divided into mild bradycardia connected with pressure on venous cava inferior by growing fetus, new detected AV disorders and existing before pregnancy: AV Ill degree block congenital or after surgery, sinus node disease and channelopathies. Management in bradyarrhythmia in pregnancy is very difficult, despite guidelines. Whenever possible problem should be resolved before pregnancy...
2015: Przegla̧d Lekarski
Derick Todd, Antonio Hernandez-Madrid, Alessandro Proclemer, Maria Grazia Bongiorni, Heidi Estner, Carina Blomström-Lundqvist
The management of arrhythmias detected by implantable cardiac devices can be challenging. There are no formal international guidelines to inform decision-making. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the management of various clinical scenarios among members of the EHRA electrophysiology research network. There were 49 responses to the questionnaire. The survey responses were mainly (81%) from medium-high volume device implanting centres, performing more than 200 total device implants per year...
September 2015: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Giuseppe Boriani, Luigi Padeletti
Sinus node disease (SND), a common indication to implant a pacemaker, is frequently associated with atrial fibrillation (AF), either at implantation (paroxysmal AF) or during follow-up, which often evolves to persistent or permanent AF. Pacemakers with an atrial lead allow continuous monitoring of the atrial rhythm and enable detection of the burden of AF. Asymptomatic atrial tachyarrhythmias, being associated with increased risk of stroke, have important prognostic implications, and their detection could guide decision-making about antithrombotic prophylaxis...
June 2015: Nature Reviews. Cardiology
Antonis S Manolis
Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI...
December 2014: Expert Review of Cardiovascular Therapy
Cynthia Tracy, Ali Boushahri
Patients admitted to the intensive care unit (ICU) are at increased risk for cardiac arrhythmias, the most common of which can be subdivided into tachyarrhythmias and bradyarrhythmias. These arrhythmias may be the primary reason for ICU admission or may occur in the critically ill patient. This article addresses the occurrence of arrhythmias in the critically ill patient, and discusses their pathophysiology, implications, recognition, and management.
July 2014: Critical Care Clinics
Keri L Denay, Michael Johansen
Pacemakers are indicated in patients with certain symptomatic bradyarrhythmias caused by sinus node dysfunction, and in those with frequent, prolonged sinus pauses. Patients with third-degree or complete atrioventricular (AV) block benefit from pacemaker placement, as do those with type II second-degree AV block because of the risk of progression to complete AV block. The use of pacemakers in patients with type I second-degree AV block is controversial. Patients with first-degree AV block generally should not receive a pacemaker except when the PR interval is significantly prolonged and the patient is symptomatic...
February 15, 2014: American Family Physician
Simon Pecha, Timm Schäfer, Yalin Yildirim, Teymour Ahmadzade, Stephan Willems, Hermann Reichenspurner, Florian Mathias Wagner
OBJECTIVES: Concomitant surgical atrial fibrillation (AF) ablation is a safe and feasible procedure, recommended in guidelines. Pacemaker dependency is a known complication of AF ablation. We sought to determine independent predictors for pacemaker implantation after surgical AF ablation. METHODS: Between January 2003 and November 2012, 594 patients underwent concomitant surgical AF ablation. Various energy sources, including cryoablation (n = 139), unipolar radiofrequency (n = 278), and bipolar radiofrequency (n = 177), were used...
March 2014: Journal of Thoracic and Cardiovascular Surgery
Takuhisa Tamura
Sudden death is a serious problem in patients with myotonic dystrophy. Atrioventricular blocks (AVBs) and tachyarrhythmias are regarded as a cause of the cardiac sudden death. The increase of QRS width and the deviation of electrical axis are rather important because the main lesion of AVB is located in His-Purkinje system, while the prolongation of PR interval attracts our attention for AVB. The measurement of His-ventricle (HV) interval is indispensable to cardiac electrophysiological testing for the detection of His-Purkinje abnormalities...
2012: Rinshō Shinkeigaku, Clinical Neurology
Judy W M Cheng
BACKGROUND: The clinical benefits of dual antiplatelet treatment (aspirin + clopidogrel) in the management of acute coronary syndromes (ACS) are well established. However, clopidogrel is a prodrug that requires hepatic activation. Concerns regarding its delayed onset of action, variability in antiplatelet effects, and prolonged recovery of platelet function after discontinuation have prompted the development of P2Y(12) receptor antagonists. Ticagrelor is the most recently developed P2Y(12) receptor antagonist available in the United States...
June 2012: Clinical Therapeutics
Marco De Carlo, Cristina Giannini, Francesco Bedogni, Silvio Klugmann, Nedy Brambilla, Federico De Marco, Giulio Zucchelli, Luca Testa, Jacopo Oreglia, Anna Sonia Petronio
BACKGROUND: Conduction abnormalities are frequent after transcatheter aortic valve implantation with the CoreValve (Medtronic, Minneapolis, MN) and are often treated with liberal permanent pacemaker (PPM) implantation. Our aim was to assess the 1-year outcome of a conservative approach to pacing and to identify its predictors. METHODS: We analyzed 275 consecutive patients without a PPM before transcatheter aortic valve implantation who underwent successful CoreValve implantation at our 3 centers, sharing a conservative approach to pacing...
March 2012: American Heart Journal
Carl Christian Lagethon Bjørnstad, Erik Gjertsen, Frode Thorup, Torstein Gundersen, Kristian Tobiasson, Jan Erik Otterstad
OBJECTIVES: Over the last few decades the number of temporary pacemaker placements has declined, while the number of operators has increased. The present study was undertaken in order to assess the quality of present day temporary pacing in Norwegian general hospitals. DESIGN: Prospective, multi-center study from five general hospitals in Norway with a catchment area of 998,000 inhabitants. All temporary pacing procedures performed at these hospitals during a 1-year period should be registered...
June 2012: Scandinavian Cardiovascular Journal: SCJ
Alexies Ramirez, T Scott Wall, Martin Schmidt, Kimberly Selzman, Marcos Daccarett
Cardiac rhythm devices are increasingly being utilized as the population ages and the incidence of chronic heart failure, bradyarrhythmias and the indications for pacing and prevention of sudden cardiac arrest expand. The number of patients receiving oral anticoagulants and dual antiplatelet therapy is similarly increasing. Implantation of cardiac rhythm devices during concomitant use of oral anticoagulants or antiplatelet regimens poses an increased risk of perioperative bleeding complications. Traditionally, heparin-based bridging protocols have been recommended for such patients to mitigate the bleeding risk while reducing the risk of thrombotic complications...
May 2011: Expert Review of Cardiovascular Therapy
Jean Paul Bounhoure, Michel Galinier, Serge Boveda, Jean-Paul Albenque
Despite therapeutic advances, the mortality rate associated with congestive heart failure remains as high as 20% per year. Among patients with severe left ventricular dysfunction, more than 60% of deaths result from ventricular tachycardia or fibrillation, 20% from bradyarrhythmias (including advanced atrio-ventricular block or asystole), and 20% from terminal ventricular pump failure. Ventricular arrhythmias and sudden death result from an interaction between a trigger and a substrate with neurohumoral factors (enhanced activity of the adrenergic and renin-angiotensin systems, electrolyte disturbances, etc...
June 2010: Bulletin de L'Académie Nationale de Médecine
Peter Mitro, Peter Kirsch, Gabriel Valočik, Pavol Murín
AIMS: To evaluate the aetiology and the diagnostic yield of the standardized diagnostic work-up based on European Society of Cardiology guidelines in the syncope unit. METHODS AND RESULTS: A total of 501 patients (191 men and 310 women), mean age 65 years (44-75 years), were prospectively evaluated. They underwent initial evaluation (history, physical evaluation, and a 12-lead electrocardiogram) and subsequently targeted tests that differed according to suspected aetiology...
April 2011: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Madan Mohan Maddali
The primary concern in patients with bifascicular block is the increased risk of progression to complete heart block. Further, an additional first-degree A-V block in patients with bifascicular block or LBBB might increase the risk of block progression. Anesthesia, monitoring and surgical techniques can induce conduction defects and bradyarrhythmias in patients with pre-existing bundle branch block. In the setting of an acute MI, several different types of conduction disturbance may become manifest and complete heart block occurs usually in patients with acute myocardial infarction more commonly if there is pre-existing or new bundle branch block...
January 2010: Annals of Cardiac Anaesthesia
Ulrich Lotze, Brigitte Rothhagen, Katharina Neubauer, Irmhild Mäder
BACKGROUND: The symptomatic sick sinus syndrome presents a classic indication for the implantation of a dual-chamber pacemaker according to the current national and international guidelines. However, in cases where dizziness and near syncope due to a sinus node dysfunction are found together with clinical characteristics of a sleep apnea-hypopnea syndrome (SAHS), screening for sleep apnea would be prudent before deciding for a pacemaker. CASE STUDY: The case report presented herein describes a patient with symptomatic sinus bradycardia and second-degree SA block with a Wenckebach periodicity, in whom the primary decision to implant a pacemaker was altered in favor of treatment with nCPAP (nasal continuous positive airway pressure) because after a careful and thorough evaluation of the patient's history and symptoms, a severe mixed SAHS was diagnosed...
September 2008: Herz
Ferlitsch Arnulf, Schmid Monika, Schmidinger Herwig, Homoncik Monika, Pleiner-Duxneuner Johannes, Ulbrich Gregor, Gangl Alfred, Peck-Radosavljevic Markus
INTRODUCTION: Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC). During this procedure, severe cardiac bradyarrhythmias can occur. A preemptive injection of atropine is recommended by professional guidelines to prevent these dysrhythmias. METHODS: Patients scheduled for PEI were randomized 1:1 to receive 0.5 mg atropinehydrochloride or placebo in a double-blind randomized placebo-controlled trial. Patients were electrocardiogram monitored, which were then analysed by an experienced rhythmologist blinded to the treatment arm...
May 2009: Liver International: Official Journal of the International Association for the Study of the Liver
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