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Sinus Bradycardia (sinus + bradycardia)
Selected AbstractsVagal bradycardia at termACTA PAEDIATRICA, Issue 5 2009Cristina Delcò Abstract We discuss the case of a newborn boy presenting well into term with severe bradycardic events and sinus pauses up to 5.4 sec. Sinus bradycardia below 80 bpm and sinus pauses or asystole of more than 2 sec are considered pathologic at term. After exclusion of specific causes, the diagnosis of vagal hyper-reflectivity (VHR) was retained, a state caused by unbalance between sympathetic and parasympathetic activity, the latter overriding the former. It is thought to be a functional and transitional anomaly of the sympathetic and vagal tone during the first months of life and may lead to prolonged monitoring and delayed hospital discharge. This form of rare bradycardia can be treated with atropine and allowed in our case immediate resolution of events and safe discharge from hospital. Conclusion: When VHR is diagnosed, atropine is the treatment permitting resolution of symptomatic episodes of bradycardia and early and safe discharge from hospital. [source] Electrocardiographic Findings, Device Therapies, and Comorbidities in Octogenarian Implantable Defibrillator RecipientsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2010JAMES D. DANIELS M.D. Implantable Defibrillators in Octogenarians.,Background: The use of implantable cardioverter-defibrillators (ICDs) in octogenarians is poorly defined. Objective: To assess baseline electrocardiographic (ECG) findings, arrhythmia episodes, and development of severe nonarrhythmic illness or death in patients aged ,80 years at ICD implantation, and to compare them with younger patients. Methods: Medical records and device interrogations for 199 patients ,70 years old who underwent ICD implantation were reviewed. Patients were divided into 3 groups based on age at the time of implant: age 70,74 (group 1; 88 patients), age 75,79 (group 2; 67 patients), and age ,80 (group 3; 44 patients). Results: ECGs: Octogenarians were more likely to have sinus bradycardia (SB) (P = 0.047) and left bundle branch block (LBBB) (P = 0.043) compared to younger patients. There was no difference among groups in the proportion of patients with atrial fibrillation or any degree of AV block. Therapies: There was no difference between age groups in any therapy (P = 0.78), appropriate therapy (P = 0.54), or inappropriate therapy (P = 0.21) per patient-year. There was no difference between groups in time-to-first therapy of any type (P = 0.71). Nonarrhythmic death/morbidity: There was no difference between groups in time to death or serious illness. Conclusion: Our study is the first to evaluate in detail the therapies received by octogenarians after ICD placement. The higher incidence of SB and LBBB might influence the number of pacing sites in octogenarian patients. Very elderly patients have similar rates of arrhythmic episodes and development of severe comorbidities as septuagenarians, and they should not be denied ICD implantation based solely on age. (J Cardiovasc Electrophysiol, Vol. 21, pp. 236,241, March 2010) [source] How Revealing Are Insertable Loop Recorders in Pediatrics?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008PATRICIA A. FRANGINI M.D. Introduction: An insertable loop recorder (ILR) in patients with infrequent syncope or palpitations may be useful to decide management strategies, including clinical observation, medical therapy, pacemaker, or implantable cardioverter defibrillator (ICD). We sought to determine the diagnostic utility of the Reveal® ILR (Medtronic, Inc., Minneapolis, MN, USA) in pediatric patients. Methods: Retrospective review of clinical data, indications, findings, and therapeutic decision in 27 consecutive patients who underwent ILR implantation from 1998,2007. Results: The median age was 14.8 years (2,25 years). Indications were syncope in 24 patients and recurrent palpitations in three. Overall, eight patients had structural heart disease (six congenital heart disease, one hypertrophic cardiomyopathy, one Kawasaki), five had previous documented ventricular arrhythmias with negative evaluation including electrophysiology study, and three patients had QT prolongation. Tilt testing was performed in 10 patients, of which five had neurocardiogenic syncope but recurrent episodes despite medical therapy. After median three months (1,20 months), 17 patients presented with symptoms and the ILR memory was analyzed in 16 (no episode stored in one due to full device memory), showing asystole or transient atrioventricular (AV) block (2), sinus bradycardia (6), or normal sinus rhythm (8). Among asymptomatic patients, 3/10 had intermittent AV block or long pauses, automatically detected and stored by the ILR. In 19 of 20 patients, ILR was diagnostic (95%) and five subsequently underwent pacemaker implantation, while seven patients remained asymptomatic without ILR events. Notably, no life-threatening events were detected. The ILR was explanted in 22 patients after a median of 22 months, two due to pocket infection, 12 for battery depletion and eight after clear documentation of nonmalignant arrhythmia. Conclusions: The ILR in pediatrics is a useful adjunct to other diagnostic studies. Patient selection is critical as the ILR should not be utilized for malignant arrhythmias. A diagnosis is attained in the majority of symptomatic patients, predominantly bradyarrhythmias including pauses and intermittent AV block. [source] Syncope and sinus bradycardia from combined use of thalidomide and , -blocker,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2008Takashi Yamaguchi MD Abstract We present a case of a 76-year-old Japanese man with hypertension and multiple myeloma (MM) presented with syncope and sinus bradycardia. Thalidomide therapy for MM was added to longstanding atenolol therapy one month prior to presentation. His heart rate (HR) was around 70 beats per minute (bpm) before addition of Thalidomide. His HR on presentation was less than 30,bpm. He was treated with intravenous atropine followed by temporary pacemaker and taken off atenolol. His HR returned to around 70,bpm few days after discontinuation of atenolol, even though he was still taking thalidomide, permitting outpatient management without a pacemaker. Both thalidomide and atenolol have been reported to cause bradycardia. Neither agent caused bradycardia when used alone in this patient, but simultaneous use caused symptomatic bradycardia. As thalidomide is prescribed more frequently, clinicians should be aware of the possibility of drug-induced sinus bradycardia due to the interaction of thalidomide and , -blockers. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||