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Omotayo Alaba Eluwole - One of the best experts on this subject based on the ideXlab platform.
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Marked First Degree Atrioventricular Block: an extremely prolonged PR interval associated with Atrioventricular Dissociation in a young Nigerian man with Pseudo-Pacemaker Syndrome: a case report
BMC Research Notes, 2014Co-Authors: Oluwadare Ogunlade, Anthony O Akintomide, Olufemi E Ajayi, Omotayo Alaba EluwoleAbstract:The diagnosis of Marked First Degree Atrioventricular Block is made with electrocardiogram when PR interval ≥0.30 s. A PR interval of up to 0.48 s had been reported in literature. Data is sparse on an extremely prolonged PR interval associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome. Electrocardiogram with this type of uncommon features poses diagnostic and management challenges in clinical practice. We report a case of a 22 year old Nigerian male from Igbo ethnic group who presented himself for medical screening with a history of exercise intolerance, occasional palpitation and fainting spells. He has no history of cough, orthopnoea, paroxysmal nocturnal dyspnoea nor body swelling. A physical examination revealed that the patient has a pulse rate of 64 beats per minute, blood pressure of 110/70 mmHg and soft heart sounds. Standard 12-lead electrocardiogram showed an uncommon Marked First Degree Atrioventricular Block with an extremely prolonged PR interval of 0.56 s. Long rhythm strips of the electrocardiogram showed extremely prolonged PR interval associated with Atrioventricular Dissociation and variable degrees of Atrioventricular Block (Mobitz type I and II). An extremely prolonged PR interval may occur in First Degree Atrioventricular Block and it may be associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome which may pose diagnostic and management challenges. This suggests that not all cases of First Degree Atrioventricular Block are benign and so should be sub-classified based on degree of PR interval prolongation and associated electrical abnormalities.
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Marked First Degree Atrioventricular Block: an extremely prolonged PR interval associated with Atrioventricular Dissociation in a young Nigerian man with Pseudo-Pacemaker Syndrome: a case report
BMC Research Notes, 2014Co-Authors: Oluwadare Ogunlade, Anthony O Akintomide, Olufemi E Ajayi, Omotayo Alaba EluwoleAbstract:Background The diagnosis of Marked First Degree Atrioventricular Block is made with electrocardiogram when PR interval ≥0.30 s. A PR interval of up to 0.48 s had been reported in literature. Data is sparse on an extremely prolonged PR interval associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome. Electrocardiogram with this type of uncommon features poses diagnostic and management challenges in clinical practice. Case presentation We report a case of a 22 year old Nigerian male from Igbo ethnic group who presented himself for medical screening with a history of exercise intolerance, occasional palpitation and fainting spells. He has no history of cough, orthopnoea, paroxysmal nocturnal dyspnoea nor body swelling. A physical examination revealed that the patient has a pulse rate of 64 beats per minute, blood pressure of 110/70 mmHg and soft heart sounds. Standard 12-lead electrocardiogram showed an uncommon Marked First Degree Atrioventricular Block with an extremely prolonged PR interval of 0.56 s. Long rhythm strips of the electrocardiogram showed extremely prolonged PR interval associated with Atrioventricular Dissociation and variable degrees of Atrioventricular Block (Mobitz type I and II). Conclusions An extremely prolonged PR interval may occur in First Degree Atrioventricular Block and it may be associated with Atrioventricular Dissociation and Pseudo-Pacemaker Syndrome which may pose diagnostic and management challenges. This suggests that not all cases of First Degree Atrioventricular Block are benign and so should be sub-classified based on degree of PR interval prolongation and associated electrical abnormalities.
S. Serge Barold - One of the best experts on this subject based on the ideXlab platform.
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Conventional and biventricular pacing in patients with first-degree atrioventricular block
Europace : European pacing arrhythmias and cardiac electrophysiology : journal of the working groups on cardiac pacing arrhythmias and cardiac cellula, 2012Co-Authors: S. Serge Barold, Bengt HerwegAbstract:Recent reports suggest that first-degree atrioventricular block is not benign. However, there is no evidence that shortening of the PR interval can improve outcome except for symptomatic patients with a very long PR interval ≥0.3 s. Because these patients require continual forced pacing, biventricular pacing should be used according to accepted guidelines for third-degree AV block. Functional atrial undersensing may occur in patients with conventional dual-chamber pacing and first-degree AV block because the sinus P-wave tends to be displaced into the post-ventricular atrial refractory period (PVARP) an arrangement that may cause a Pacemaker Syndrome. Prevention requires programming a shorter AV and PVARP that is feasible because retrograde conduction is rare in first-degree AV block patients. A relatively new pacing mode to minimize right ventricular stimulation has been designed by eliminating the traditional AV interval but with dual-chamber backup. This pacing mode permits the establishment of very long AV intervals that may cause Pacemaker Syndrome. About 50% of patients undergoing cardiac resynchronization therapy (CRT) have a PR interval ≥200 ms. The CRT patients with first-degree AV block are prone to develop electrical desynchronization more easily than those with a normal PR interval. The duration of desynchronization after exceeding the upper rate on exercise is also more pronounced. AV junctional ablation is rarely necessary in patients with first-degree AV block but should be considered for symptomatic functional atrial undersensing or when the disturbances caused by first-degree AV block during CRT cannot be managed by programming.
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A case of Pacemaker and Pacemaker-like Syndrome.
Journal of Interventional Cardiac Electrophysiology, 2003Co-Authors: Amir Kashani, Ali Mehdirad, Carey S. Fredman, Kurt M. Biermann, S. Serge BaroldAbstract:This report describes the occurrence of both Pacemaker Syndrome and a Pacemaker-like Syndrome (so-called “pseudoPacemaker Syndrome”) in a patient who exhibited an atrioventricular junctional rhythm probably on the basis of sick sinus Syndrome. The clinical and hemodynamic manifestations of the two clinical situations were similar and associated with regular retrograde ventriculoatrial conduction. The abnormalities during the junctional rhythm were reproduced during ventricular pacing. Surprisingly, the occurrence of the Pacemaker-like Syndrome during junctional rhythm in patients with normal left ventricular function has rarely been described.
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Pacemaker Repetitive Nonreentrant Ventriculoatrial Synchronous Rhythm. A Review
Journal of Interventional Cardiac Electrophysiology, 2001Co-Authors: S. Serge Barold, Paul A. LevineAbstract:Ventriculoatrial (VA) synchrony during dual chamber pacing can occur in any patient who has the ability to sustain repeated retrograde conduction. If the retrograde P wave is sensed, the result will be an endless loop tachycardia or repetitive reentrant VA synchrony. VA synchrony can also occur when a dual chamber Pacemaker does not sense a retrograde P wave within the postventricular atrial refractory period. In this situation if the normally suprathreshold atrial stimulus at the end of the atrial escape interval is continually delivered when the atrial myocardium is physiologically refractory, the result will be a repetitive nonreentrant VA synchronous rhythm. Repetitive nonreentrant VA synchrony may produce unfavorable hemodynamic consequences and the Pacemaker Syndrome. It represents an example of functional atrial undersensing combined with functional loss of atrial capture. Management requires modification of the programmed settings of the Pacemaker and utilization of certain algorithms designed for other functions but nevertheless effective in this situation.
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The Pacemaker Syndrome — A Matter of Definition
The American journal of cardiology, 1997Co-Authors: Kenneth A Ellenbogen, David M Gilligan, Mark A Wood, Carlos Morillo, S. Serge BaroldAbstract:Pacemaker Syndrome is an iatrogenic disease that is often underdiagnosed. We propose that Pacemaker Syndrome represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode. Clinicians implanting and programming Pacemakers should attempt to optimize AV synchrony to prevent the occurrence of Pacemaker Syndrome.
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Pacemaker Syndrome during atrial-based pacing
Cardiac Pacing and Electrophysiology, 1994Co-Authors: S. Serge BaroldAbstract:Ausubel and Furman defined the Pacemaker Syndrome as a clinical complex of “signs and symptoms related to the adverse hemodynamic and electrophy-siologic consequences of ventricular pacing” [1] in the presence of a normally functioning implanted ventricular Pacemaker. Recent studies have indicated that the incidence of the Pacemaker Syndrome (including subtle manifestations) is considerably higher than previously believed as most patients with dual chamber pulse generators prefer the DDD (VDD) to the VVI mode, with only a small number showing no preference. Schuller and Brand [2] recently suggested that the Pacemaker Syndrome be redefined more broadly as follows: “The Pacemaker Syndrome refers to symptoms and signs present in the Pacemaker patient which are caused by inadequate timing of atrial and ventricular contractions”. This new definition is more appropriate because the introduction of pacing modes more physiologic than the VVI or WIR modes has not entirely eliminated the Pacemaker Syndrome, which can also occur under certain circumstances with atrial-based pacing in the presence of “inadequate timing of atrial and ventricular contractions” (Table 1). During VVI(R) pacing, the Pacemaker Syndrome is more commonly related to retrograde ventriculoatrial (VA) conduction than the random timing of atrial and ventricular activity. Similarly during atrial-based pacing, the continual occurrence of an atrial event after a ventricular event engenders the Pacemaker Syndrome more commonly than AV dissociation.
Kerry L. Lee - One of the best experts on this subject based on the ideXlab platform.
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High incidence of Pacemaker Syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST)
Journal of the American College of Cardiology, 2004Co-Authors: Mark S. Link, Kenneth A Ellenbogen, N.a. Mark Estes, Anne S. Hellkamp, E. John Orav, Bassiema Ibrahim, Arnold J. Greenspon, Carlos Rizo-patron, Lee Goldman, Kerry L. LeeAbstract:Abstract Objectives We evaluated the incidence, predictors, and treatment of Pacemaker Syndrome in patients with sinus node dysfunction treated with ventricular-based (VVIR) pacing in the Mode Selection Trial (MOST). Background Pacemaker Syndrome, or intolerance to VVIR pacing, consists of cardiovascular signs and symptoms induced by VVIR pacing. Methods The definition of Pacemaker Syndrome required that a patient with single-chamber VVIR pacing develop either congestive signs and symptoms associated with retrograde conduction during VVIR pacing or a ≥20 mm Hg reduction of systolic blood pressure during VVIR pacing, associated with reproducible symptoms of weakness, lightheadedness, or syncope. Results Of 996 patients randomized to VVIR pacing, 182 (18.3%) met criteria for Pacemaker Syndrome in follow-up. Pacemaker Syndrome occurred early in most patients (13.8% at 6 months, 16.0% at 1 year, increasing to 19.7% at 4 years). Baseline univariate predictors of Pacemaker Syndrome included a lower sinus rate and higher programmed Pacemaker rate. Previous heart failure, ejection fraction, and drop in systolic blood pressure with VVIR pacing at implantation did not predict the development of Pacemaker Syndrome. Post-implantation predictors of Pacemaker Syndrome were a higher percentage of paced beats, higher programmed low rate, and slower underlying spontaneous sinus rate. Quality of life decreased at the time of diagnosis of Pacemaker Syndrome and improved with reprogramming to atrial-based pacing. Conclusions Severe Pacemaker Syndrome developed in nearly 20% of VVIR-paced patients and improved with reprogramming to the dual-chamber pacing mode. Because prediction of Pacemaker Syndrome is difficult, the only way to prevent Pacemaker Syndrome is to implant atrial-based Pacemakers in all patients.
A. J. Camm - One of the best experts on this subject based on the ideXlab platform.
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The Pacemaker Syndrome: Old and new causes
Clinical cardiology, 1991Co-Authors: H. Schüller, J. Brant, A. J. CammAbstract:The Pacemaker Syndrome refers to symptoms and signs in the Pacemaker patient caused by inadequate timing of atrial and ventricular contractions. The lack of normal atrioventricular synchrony may result in decreased cardiac output and venous "cannon A waves." A sudden increase in atrial pressure at the onset of asynchrony may elicit a systemic hypotensive reflex response. A wide range of symptoms can be observed. The Pacemaker Syndrome is encountered in a significant number of patients with ventricular (VVI) Pacemakers, mostly when 1:1 retrograde ventriculoatrial conduction is present. The risk of occurrence of the Pacemaker Syndrome is minimized if Pacemaker systems are used which restore or maintain the normal atrioventricular contraction sequence. Hence, in sinus node disease, atrial stimulation with or without ventricular stimulation should be employed, while in high-grade atrioventricular block dual-chamber pacing is recommended. The Pacemaker Syndrome is not restricted to the VVI stimulation mode. It can be seen, though rarely, in atrial and dual-chamber pacing, and an awareness of these new causes is necessary. An established Pacemaker Syndrome can often be counteracted by adjusting the pulse generator function.
Kenneth A Ellenbogen - One of the best experts on this subject based on the ideXlab platform.
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High incidence of Pacemaker Syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST)
Journal of the American College of Cardiology, 2004Co-Authors: Mark S. Link, Kenneth A Ellenbogen, N.a. Mark Estes, Anne S. Hellkamp, E. John Orav, Bassiema Ibrahim, Arnold J. Greenspon, Carlos Rizo-patron, Lee Goldman, Kerry L. LeeAbstract:Abstract Objectives We evaluated the incidence, predictors, and treatment of Pacemaker Syndrome in patients with sinus node dysfunction treated with ventricular-based (VVIR) pacing in the Mode Selection Trial (MOST). Background Pacemaker Syndrome, or intolerance to VVIR pacing, consists of cardiovascular signs and symptoms induced by VVIR pacing. Methods The definition of Pacemaker Syndrome required that a patient with single-chamber VVIR pacing develop either congestive signs and symptoms associated with retrograde conduction during VVIR pacing or a ≥20 mm Hg reduction of systolic blood pressure during VVIR pacing, associated with reproducible symptoms of weakness, lightheadedness, or syncope. Results Of 996 patients randomized to VVIR pacing, 182 (18.3%) met criteria for Pacemaker Syndrome in follow-up. Pacemaker Syndrome occurred early in most patients (13.8% at 6 months, 16.0% at 1 year, increasing to 19.7% at 4 years). Baseline univariate predictors of Pacemaker Syndrome included a lower sinus rate and higher programmed Pacemaker rate. Previous heart failure, ejection fraction, and drop in systolic blood pressure with VVIR pacing at implantation did not predict the development of Pacemaker Syndrome. Post-implantation predictors of Pacemaker Syndrome were a higher percentage of paced beats, higher programmed low rate, and slower underlying spontaneous sinus rate. Quality of life decreased at the time of diagnosis of Pacemaker Syndrome and improved with reprogramming to atrial-based pacing. Conclusions Severe Pacemaker Syndrome developed in nearly 20% of VVIR-paced patients and improved with reprogramming to the dual-chamber pacing mode. Because prediction of Pacemaker Syndrome is difficult, the only way to prevent Pacemaker Syndrome is to implant atrial-based Pacemakers in all patients.
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The Pacemaker Syndrome — A Matter of Definition
The American journal of cardiology, 1997Co-Authors: Kenneth A Ellenbogen, David M Gilligan, Mark A Wood, Carlos Morillo, S. Serge BaroldAbstract:Pacemaker Syndrome is an iatrogenic disease that is often underdiagnosed. We propose that Pacemaker Syndrome represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode. Clinicians implanting and programming Pacemakers should attempt to optimize AV synchrony to prevent the occurrence of Pacemaker Syndrome.
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the Pacemaker Syndrome a matter of definition
American Journal of Cardiology, 1997Co-Authors: Kenneth A Ellenbogen, David M Gilligan, Mark A Wood, Carlos Morillo, Serge S BaroldAbstract:Pacemaker Syndrome is an iatrogenic disease that is often underdiagnosed. We propose that Pacemaker Syndrome represents the clinical consequences of suboptimal atrioventricular (AV) synchrony or AV dyssynchrony, regardless of the pacing mode. Clinicians implanting and programming Pacemakers should attempt to optimize AV synchrony to prevent the occurrence of Pacemaker Syndrome.
