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S. Serge Barold - One of the best experts on this subject based on the ideXlab platform.
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Second-Degree Atrioventricular Block revisited.
Herzschrittmachertherapie & Elektrophysiologie, 2012Co-Authors: S. Serge Barold, Bengt HerwegAbstract:Type I Second-Degree Atrioventricular (AV) Block describes visible, differing, and generally decremental AV conduction. The literature contains numerous differing definitions of Second-Degree AV Block, especially Mobitz type II Second-Degree AV Block. The widespread use of numerous disparate definitions of type II Block appears primarily responsible for many of the diagnostic problems surrounding Second-Degree AV Block. Adherence to the correct definitions provides a logical and simple framework for clinical evaluation. Type II Second-Degree AV Block describes what appears to be an all-or-none conduction without visible changes in the AV conduction time before and after the Blocked impulse. Although the diagnosis of type II Block requires a stable sinus rate, absence of sinus slowing is an important criterion of type II Block because a vagal surge (generally a benign condition) can cause simultaneous sinus slowing and AV nodal Block, which can superficially resemble type II Block. Furthermore, type II Block has not yet been reported in inferior myocardial infarction (MI) and in young athletes where type I Block may be misinterpreted as type II Block. The diagnosis of type II Block cannot be established if the first postBlock P wave is followed by a shortened PR interval or the P wave is not discernible. A narrow QRS type I Block is almost always AV nodal, whereas a type I Block with bundle branch Block barring acute MI is infranodal in 60–70 % of cases. A 2:1 AV Block cannot be classified in terms of type I or type II Block, but it can be nodal or infranodal. A pattern resembling a narrow QRS type II Block in association with an obvious type I structure in the same recording (e.g., Holter) effectively rules out type II Block because the coexistence of both types of narrow QRS Block is exceedingly rare. Concealed (nonpropagated) His bundle or ventricular extrasystoles may mimic both type I and/or type II Block (pseudo AV Block). All correctly defined type II Blocks are infranodal. Infranodal Block presenting with either type I or II manifestations requires pacing regardless of QRS duration or symptoms.
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Second-Degree Atrioventricular Block revisited
Herzschrittmachertherapie + Elektrophysiologie, 2012Co-Authors: S. Serge Barold, Bengt HerwegAbstract:Type I Second-Degree Atrioventricular (AV) Block describes visible, differing, and generally decremental AV conduction. The literature contains numerous differing definitions of Second-Degree AV Block, especially Mobitz type II Second-Degree AV Block. The widespread use of numerous disparate definitions of type II Block appears primarily responsible for many of the diagnostic problems surrounding Second-Degree AV Block. Adherence to the correct definitions provides a logical and simple framework for clinical evaluation. Type II Second-Degree AV Block describes what appears to be an all-or-none conduction without visible changes in the AV conduction time before and after the Blocked impulse. Although the diagnosis of type II Block requires a stable sinus rate, absence of sinus slowing is an important criterion of type II Block because a vagal surge (generally a benign condition) can cause simultaneous sinus slowing and AV nodal Block, which can superficially resemble type II Block. Furthermore, type II Block has not yet been reported in inferior myocardial infarction (MI) and in young athletes where type I Block may be misinterpreted as type II Block. The diagnosis of type II Block cannot be established if the first postBlock P wave is followed by a shortened PR interval or the P wave is not discernible. A narrow QRS type I Block is almost always AV nodal, whereas a type I Block with bundle branch Block barring acute MI is infranodal in 60–70 % of cases. A 2:1 AV Block cannot be classified in terms of type I or type II Block, but it can be nodal or infranodal. A pattern resembling a narrow QRS type II Block in association with an obvious type I structure in the same recording (e.g., Holter) effectively rules out type II Block because the coexistence of both types of narrow QRS Block is exceedingly rare. Concealed (nonpropagated) His bundle or ventricular extrasystoles may mimic both type I and/or type II Block (pseudo AV Block). All correctly defined type II Blocks are infranodal. Infranodal Block presenting with either type I or II manifestations requires pacing regardless of QRS duration or symptoms. Der atrioventrikuläre (AV) Block zweiten Grades vom Typ I bezeichnet eine sichtbare, abweichende und i. Allg. abnehmende AV-Erregungsleitung. In der Literatur finden sich zahlreiche, sich unterscheidende Definitionen des AV-Blocks zweiten Grades, insbesondere des Mobitz-Blocks Typ II. Die gängige Verwendung zahlreicher differierender Definitionen des Typ-II-Blocks scheint der Hauptgrund für viele der diagnostischen Schwierigkeiten in Zusammenhang mit dem AV-Block zweiten Grades zu sein. Das Festhalten an den korrekten Definitionen schafft einen logischen und einfachen Rahmen für die klinische Beurteilung. Der AV-Block zweiten Grades von Typ II beschreibt eine Art „Alles-oder-nichts-Erregungsleitung“ ohne erkennbare Änderungen der AV-Erregungsleitungszeit vor und nach dem Blockierten Impuls. Obwohl die Diagnose des Typ-II-Blocks eine stabile Sinusfrequenz voraussetzt, ist eine fehlende Verlangsamung der Sinusfrequenz ein wichtiges Kriterium dieses Typs. Denn eine Erhöhung des Vagotonus – in der Regel ein benigner Zustand – kann zugleich eine Verlangsamung der Sinusfrequenz und einen AV-Block hervorrufen, was oberflächlich betrachtet einem Typ-II-Block ähneln kann. Ferner liegen bislang keine Berichte über einen Typ-II-Block bei Patienten mit inferiorem Myokardinfarkt (MI) und bei jungen Sportlern vor, bei denen ein Typ-I- als Typ-II-Block fehlgedeutet werden könnte. Die Diagnose eines Typ-II-Blocks kann nicht gestellt werden, wenn auf die erste P-Welle nach dem Block ein verkürztes PR-Intervall folgt oder wenn die P-Welle nicht erkennbar ist. Ein Typ-I-Block mit schmalem QRS-Komplex ist fast immer AV-nodal, wohingegen ein Typ-I-Block mit SchenkelBlock, aber ohne akuten MI in 60–70 % der Fälle infranodal ist. Ein 2:1-AV-Block lässt sich nicht im Sinne eines Typ-I- oder Typ-II-Blocks klassifizieren, kann aber nodal oder infranodal sein. Ein Muster, das einem Typ-II-Block mit schmalem QRS-Komplex ähnelt, in Verbindung mit einer klaren Typ-I-Struktur in derselben Aufzeichnung (z. B. im Langzeit-EKG nach Holter) schließt einen Typ-II-Block mit hoher Wahrscheinlichkeit aus, da ein Nebeneinander beider Blockformen mit schmalem QRS-Komplex äußerst selten ist. Verborgene (nicht weitergeleitete) His-Bündel- oder ventrikuläre Extrasystolen können den Typ-I- und/oder Typ-II-Block nachahmen (Pseudo-AV-Block). Alle korrekt bestimmten Typ-II-Blocks sind infranodal. Letzteres Erscheinungsbild, entweder mit einer Typ-I- oder einer Typ-II-Manifestation, erfordert ungeachtet der QRS-Dauer und der Symptome eine Schrittmachertherapie.
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Mobitz type II Second-Degree Atrioventricular Block in athletes: true or false?
British journal of sports medicine, 2008Co-Authors: S. Serge Barold, Luigi PadelettiAbstract:The electro cardiographic patterns of type I and type II Second-Degree Atrioventricular ( AV) Block during sinus rhythm describe the behaviour of the PR intervals (in sinus rhythm) in sequences (with at least two consecutive conducted PR intervals) where a single P wave fails to conduct to the ventricles.1 Unfortunately, the diagnosis of Mobitz type II Second-Degree AV Block continues to be an important clinical problem because the standard definitions of Second-Degree AV Block are often misinterpreted.1 The literature is replete with cases of type I Second-Degree AV Block labelled as type II Block, and similar errors have crept into the sports literature with claims that narrow QRS type II AV Block can also occur in otherwise healthy young athletes2,–,7 and less commonly after exercise in the form of vasovagal syncope (table 1).8 These reports of type II Block in athletes provided either no ECG or misdiagnosed ones. Furthermore, when stated, the definitions of type II Block were inappropriate. The occurrence of type II Block in young athletes is counterintuitive because it would imply serious disease of the His–Purkinje system and an absolute indication for a permanent pacemaker regardless of symptoms.1 We were unable to find a single case of precisely documented type II Block in young athletes. Yet, many review articles continue to list type II Block as one of the manifestations of the athlete's heart.9,–,12 Accurate diagnosis of type II Block in athletes is critical and will affect treatment recommendations. Based on these considerations, there is a need for reviewing the pitfalls surrounding the diagnosis of type II Block with emphasis on how errors can be avoided by strict adherence to definitions. View this table: Table 1 Incidence of reported type II Second-Degree Atrioventricular Block (AVB) in athletes Type …
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John Hay and the earliest description of type II Second-Degree Atrioventricular Block.
The American journal of cardiology, 2001Co-Authors: S. Serge Barold, Berndt LüderitzAbstract:I t is universally acknowledged that in 1899, Wenckebach first described type I Second-Degree Atrioventricular (AV) Block in humans.1 The centennial of this clinical landmark was recently publicized.2 Although Wenckebach called this process “Luciani periods” after the Italian physiologist who observed this phenomenon in the frog heart in 1872, this pattern is now widely known as the Wenckebach phenomenon or periodicity.3 A number of workers have attributed the discovery of both types I and II Second-Degree AV Block solely to Wenckebach.4–6 As a result, types I and II Second-Degree AV Block is sometimes incorrectly designated as Wenckebach type I and type II Block.7 Others have claimed that type II Block was described independently by Wenckebach and Hay both in 1906.8–13 There are also rare, unfounded claims by compatriots of John Hay that it was he who discovered both types I and II Second-Degree AV Block.14 It was actually John Hay who discovered the form of Second-Degree AV Block currently known as type II Block15 (Figure 1). Information about John Hay can be found in the recent article by Upshaw and Silverman.16 Hay’s original contribution was cited by Thomas Lewis in his 1925 book17 and by Schamroth in his 1971 book.18 Yet, Burch in his monograph on the history of electrocardiography merely stated that “incomplete heart Block was studied extensively in man by MacKenzie, Wenckebach and Hay, by means of the polygraph.” without citing Hay’s work nor his 1906 article.19 Katz and Pick of the famed Chicago School of Electrocardiography did not mention Hay’s contribution to the understanding of Second-DegreeAV Block in their classic 1956 book.20 In fact, the Chicago electrocardiographers indicated in other publications that Wenckebach and Hay described type II seconddegree AV Block independently.12 In 1906 John Hay from Liverpool, England, published a case report in the Lancet describing a new form of Second-Degree AV Block distinct from that previously reported by Wenckebach.15 Hay documented his findings without the benefit of the electrocardiograph, which was introduced clinically years later. Hay analyzed simultaneous tracings from the radial (arterial) and jugular (venous) pulses in a 65year-old patient with lightheadedness. The recordings in Figures 2 and 3 were described as showing a-c intervals (as a measure of AV conduction corresponding to the PR interval of the electrocardiogram) essentially normal and constant in duration regardless of the number of missing ventricular beats. Figure 2 clearly shows what is now considered type II seconddegree AV Block with constant a-c intervals before and after a single-Blocked atrial impulse (“a” wave not followed by “c” deflection) in a sequence of at least 4:3 AV Block. Hay correctly emphasized that no similar case had been recorded in the literature and dismissed the type of AV Block described by Wenckebach because the a-c interval failed to vary. The purist will argue that Figure 2 cannot be interpreted as type II Second-Degree AV Block because there are no PR intervals and the behavior of the a-c intervals cannot be determined accurately. However, the diagnosis of type II Block can be made with certainty by looking at the heart rate in the arterial recording on top of Figure 2. Note that the duration of the pause between the fourth and fifth arterial beats is exactly double that of the cycle before the Block (between the third and fourth arterial beats). This indicates that AV conduction before and after the Blocked impulse was constant. This constitutes the hallmark of type II Block when there are at least 2 consecutively conducted P waves and only a single nonconducted impulse. A vagal effect on the AV node can be ruled out because the cycle before the Block (between the third and From the Broward General Hospital, Fort Lauderdale, Florida; and the University of Bonn, Bonn, Germany. Dr. Barold’s address is: 6237 NW 21st Court, Boca Raton, Florida 33496. E-mail: ssbarold@aol.com. Manuscript received November 24, 2000; revised manuscript received and accepted January17, 2001. FIGURE 1. John Hay 1873 to 1959. (Courtesy of Arthur Hollman MD., London England).
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Second-Degree Atrioventricular Block: A Reappraisal
Mayo Clinic proceedings, 2001Co-Authors: S. Serge Barold, David L. HayesAbstract:In this review, we discuss the various forms and causes of Second-Degree Atrioventricular (AV) Block and the reasons they remain poorly understood. Both type I and type II Block characterize Block of a single sinus P wave. Type I Block describes visible, differing, and generally decremental AV conduction. Type II Block describes what appears to be an all-or-none conduction without visible changes in the AV conduction time before and after the Blocked impulse. Although the diagnosis of type II Block is possible with an increasing sinus rate, absence of sinus slowing is an important criterion of type II Block because a vagal surge (generally a benign condition) can cause simultaneous sinus slowing and AV nodal Block, which can superficially resemble type II Block. The diagnosis of type II Block cannot be established if the first postBlock P wave is followed by a shortened PR interval or is not discernible. A pattern resembling a narrow QRS type II Block in association with an obvious type I structure in the same recording (eg, Holter) effectively rules out type II Block because the coexistence of both types of narrow QRS Block is exceedingly rare. Concealed His bundle or ventricular extrasystoles confined to the specialized conduction system without myocardial penetration and depolarization can produce electrocardiographic patterns that mimic type I and/or type II Block (pseudo-AV Block). All correctly defined type II Blocks are infranodal. A narrow QRS type I Block is almost always AV nodal, whereas a type I Block with bundle branch Block barring acute myocardial infarction is infranodal in 60% to 70% of cases. A 2:1 AV Block cannot be classified in terms of type I or type II Block, but it can be nodal or infranodal. Infranodal Blocks require pacing regardless of form or symptoms. The widespread use of numerous disparate definitions of type II Block appears primarily responsible for many of the problems surrounding Second-Degree AV Block. Adherence to the correct definitions provides a logical and simple framework for clinical evaluation.
Yungkuei Soong - One of the best experts on this subject based on the ideXlab platform.
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perinatal outcome of fetus with isolated congenital second degree Atrioventricular Block without maternal anti ssa ro ssb la antibodies
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005Co-Authors: Yaolung Chang, Peter C C Hsieh, Shuenndyh Chang, Anshine Chao, Ching Chung Liang, Yungkuei SoongAbstract:Abstract Objective: We determined the perinatal outcomes of fetuses with isolated congenital second degree Atrioventricular Block detected in utero and born to mothers seronegative for anti-SSA/Ro-SSB/La antibodies. Methods: Isolated second degree Atrioventricular Block was defined as second degree Atrioventricular Block detected in utero without the accompanying structural cardiac anomaly, tachyarrhythmia, non-conducted premature atrial beats or long QT syndrome. We review our own cases and search from Medline using keywords such as Atrioventricular Block, arrhythmia, bradycardia and congenital to collect cases of congenital isolated second degree Atrioventricular Block. Results: Two cases were from our institution and five cases from a Medline search; in total seven cases of isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies were analyzed. Six of the seven fetal arrhythmias reverted to sinus rhythm by delivery and did not recur during the follow-up period. The prognosis of the fetus with isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies is better than that of the fetus with maternal anti-SSA/Ro-SSB/La antibodies or the fetus of congenital long QT syndrome with second degree Atrioventricular Block detected in utero. Conclusion: The fetus with isolated congenital second degree Atrioventricular Block carries a good prognosis in the absence of maternal anti-SSA/Ro-SSB/La antibodies.
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Perinatal outcome of fetus with isolated congenital second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies.
European journal of obstetrics gynecology and reproductive biology, 2005Co-Authors: Yaolung Chang, Peter C C Hsieh, Shuenndyh Chang, Anshine Chao, Ching Chung Liang, Yungkuei SoongAbstract:Abstract Objective: We determined the perinatal outcomes of fetuses with isolated congenital second degree Atrioventricular Block detected in utero and born to mothers seronegative for anti-SSA/Ro-SSB/La antibodies. Methods: Isolated second degree Atrioventricular Block was defined as second degree Atrioventricular Block detected in utero without the accompanying structural cardiac anomaly, tachyarrhythmia, non-conducted premature atrial beats or long QT syndrome. We review our own cases and search from Medline using keywords such as Atrioventricular Block, arrhythmia, bradycardia and congenital to collect cases of congenital isolated second degree Atrioventricular Block. Results: Two cases were from our institution and five cases from a Medline search; in total seven cases of isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies were analyzed. Six of the seven fetal arrhythmias reverted to sinus rhythm by delivery and did not recur during the follow-up period. The prognosis of the fetus with isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies is better than that of the fetus with maternal anti-SSA/Ro-SSB/La antibodies or the fetus of congenital long QT syndrome with second degree Atrioventricular Block detected in utero. Conclusion: The fetus with isolated congenital second degree Atrioventricular Block carries a good prognosis in the absence of maternal anti-SSA/Ro-SSB/La antibodies.
David Luke Glancy - One of the best experts on this subject based on the ideXlab platform.
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Type I Second Degree Atrioventricular Block in a Woman With Remote Repair of a Ventricular Septal Defect.
The American journal of cardiology, 2018Co-Authors: Solomon A. Seifu, Jameel Ahmed, Frank E. Wilklow, Neeraj Jain, Royce D. Yount, Pramilla N. Subramaniam, David Luke GlancyAbstract:In a 45-year-old woman with syncope, an electrocardiogram revealed intermittent asymptomatic type I second degree Atrioventricular Block, right bundle branch Block and left anterior fascicular Block. An echocardiogram documented concentric left ventricular hypertrophy and right ventricular dilatation and hypokinesia. Because the patient did not have second degree Atrioventricular Block at the time of an electrophysiological study, the Atrioventricular node, the left posterior fascicle, and the His bundle all remain potential sites for the type I second degree Atrioventricular Block on her initial electrocardiogram.
Yaolung Chang - One of the best experts on this subject based on the ideXlab platform.
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perinatal outcome of fetus with isolated congenital second degree Atrioventricular Block without maternal anti ssa ro ssb la antibodies
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005Co-Authors: Yaolung Chang, Peter C C Hsieh, Shuenndyh Chang, Anshine Chao, Ching Chung Liang, Yungkuei SoongAbstract:Abstract Objective: We determined the perinatal outcomes of fetuses with isolated congenital second degree Atrioventricular Block detected in utero and born to mothers seronegative for anti-SSA/Ro-SSB/La antibodies. Methods: Isolated second degree Atrioventricular Block was defined as second degree Atrioventricular Block detected in utero without the accompanying structural cardiac anomaly, tachyarrhythmia, non-conducted premature atrial beats or long QT syndrome. We review our own cases and search from Medline using keywords such as Atrioventricular Block, arrhythmia, bradycardia and congenital to collect cases of congenital isolated second degree Atrioventricular Block. Results: Two cases were from our institution and five cases from a Medline search; in total seven cases of isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies were analyzed. Six of the seven fetal arrhythmias reverted to sinus rhythm by delivery and did not recur during the follow-up period. The prognosis of the fetus with isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies is better than that of the fetus with maternal anti-SSA/Ro-SSB/La antibodies or the fetus of congenital long QT syndrome with second degree Atrioventricular Block detected in utero. Conclusion: The fetus with isolated congenital second degree Atrioventricular Block carries a good prognosis in the absence of maternal anti-SSA/Ro-SSB/La antibodies.
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Perinatal outcome of fetus with isolated congenital second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies.
European journal of obstetrics gynecology and reproductive biology, 2005Co-Authors: Yaolung Chang, Peter C C Hsieh, Shuenndyh Chang, Anshine Chao, Ching Chung Liang, Yungkuei SoongAbstract:Abstract Objective: We determined the perinatal outcomes of fetuses with isolated congenital second degree Atrioventricular Block detected in utero and born to mothers seronegative for anti-SSA/Ro-SSB/La antibodies. Methods: Isolated second degree Atrioventricular Block was defined as second degree Atrioventricular Block detected in utero without the accompanying structural cardiac anomaly, tachyarrhythmia, non-conducted premature atrial beats or long QT syndrome. We review our own cases and search from Medline using keywords such as Atrioventricular Block, arrhythmia, bradycardia and congenital to collect cases of congenital isolated second degree Atrioventricular Block. Results: Two cases were from our institution and five cases from a Medline search; in total seven cases of isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies were analyzed. Six of the seven fetal arrhythmias reverted to sinus rhythm by delivery and did not recur during the follow-up period. The prognosis of the fetus with isolated second degree Atrioventricular Block without maternal anti-SSA/Ro-SSB/La antibodies is better than that of the fetus with maternal anti-SSA/Ro-SSB/La antibodies or the fetus of congenital long QT syndrome with second degree Atrioventricular Block detected in utero. Conclusion: The fetus with isolated congenital second degree Atrioventricular Block carries a good prognosis in the absence of maternal anti-SSA/Ro-SSB/La antibodies.
Roberto Vettor - One of the best experts on this subject based on the ideXlab platform.
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Aripiprazole Overdose and Transient 2:1 Second Degree Atrioventricular Block: Only A Coincidence?
Current drug safety, 2019Co-Authors: Lucia Russo, Angelo Di Vincenzo, Alessandro Rizzo, Marco Rossato, Roberto VettorAbstract:BACKGROUND Atypical antipsychotics, unlike traditional antipsychotics, are considered to have limited cardiovascular side effects, but recent evidence drew attention to potential cardiac rhythm disturbances during aripiprazole therapy. Prolonged QT-interval and increased heart rate were described during treatment with therapeutic doses of aripiprazole, and some reports have even shown relevant arrhythmias, such as ventricular trigeminy and supraventricular tachycardia, in patients treated with this drug. CASE REPORT Here, we report a case of a young female who attempted suicide with aripiprazole overdose presenting with a concomitant 2:1 second degree Atrioventricular Block. Little is known on the cardiac toxicity of atypical antipsychotics in overdose: reporting this case description, far from establishing direct causality. RESULTS AND CONCLUSION We would promote further efforts to define the possible effects of the drug on the cardiac conduction system, for a safer management of patients in clinical practice.