Cases reported "Sick Sinus Syndrome"

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1/37. Spontaneous regression over a 16-year period of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block in a young patient with Ebstein's anomaly.

    A 25-year-old man with Ebstein's anomaly showed spontaneous regression of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block over a 16-year period. This is the first clinical report supporting the hypothesis that abnormal cell death might contribute to the disturbance of the heart conduction system in Ebstein's anomaly.
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2/37. Bundle branch block on alternate beats: by what mechanism?

    In a patient with right bundle branch block occurring on alternate beats during regular sinus rhythm, the conduction disturbance disappeared during hyperventilation induced increase in heart rate, and reappeared with slight slowing of the sinus rate due to carotid sinus massage. The following mechanisms are potentially involved in the electrogenesis of bundle branch block alternans with regular RR intervals: a) phase-3 2:1 bidirectional block; b) phase-3 antegrade block with retrograde concealed activation of the involved bundle branch and subsequent "supernormal" conduction; and c) phase-4 antegrade block with transseptal retrograde concealed invasion of the affected bundle branch by impulses traversing the unimpaired bundle branch. Analysis of the tracing excluded both mechanisms a and b and favored bradycardia-dependent right bundle branch block as a key to explain the alternate pattern of intraventricular conduction.
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3/37. Cardiac pacing as emergency care for serious bradyarrhythmia with circulatory shock.

    Three cases of bradyarrhythmia with serious illness of extracardiac organs are reported. Case 1 had sick sinus syndrome. He was admitted to our hospital complaining of syncope and developed apnea. Case 2 had complete atrioventricular block and serious hepatic failure in the hospital. Case 3 had paroxysmal atrioventricular block. He complained of syncope which followed convulsions. Their symptoms might be due to circulatory shock caused by a lazy lower pacemaker from the ventricle. Emergent temporary pacing successfully improved the extracardiac organ dysfunction. Although their bradyarrhythmias were transient, permanent pacemakers were implanted to inhibit the recurrence. A quick temporary pacing should be indicated in patients with critical bradyarrhythmia like our cases for survival.
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4/37. Acquired atrioventricular block in a patient with sinus node disease on single-chamber atrial pacing.

    Single-chamber atrial pacing is the most physiological and yet economical modality of treatment in patients with symptomatic sinus node disease with normal atrioventricular conduction. However, because of the possibility of future development of a high-degree atrioventricular block and atrial fibrillation, most patients are implanted either dual- or single-chamber right ventricular pacemakers. We report a patient with symptomatic sinus node disease on single-chamber atrial pacing for the past 7 years who developed a progressive increase in the PR interval and ultimately presented with symptomatic high-degree atrioventricular block requiring pacemaker upgradation. The pacemaker was upgraded to the single-chamber ventricular mode with one additional ventricular lead introduced from the same side percutaneously.
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5/37. Atrial escape-capture bigeminy in dominant atrial rhythm with 2:1 exit block.

    A 27-year-old woman with atrial bigeminy is reported in whom long PP intervals alternate with short PP intervals. All P waves are negative in lead II and all PR intervals measure 0.12 s. In the 12-lead electrocardiogram, however, these P waves were definitely different in configuration from each other, and were divided into two groups. Namely, these negative P waves are divided into those of dominant atrial rhythm J1 with 2:1 exit block, and those of atrial escape J2. Long J1-J2 intervals alternate with short J2-J1 intervals. These electrocardiographic findings show the presence of atrial escape-capture bigeminy. Such atrial escape-capture bigeminy in dominant atrial rhythm with 2:1 exit block has never been reported before.
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6/37. hyperkalemia induced failure of atrial and ventricular pacemaker capture.

    hyperkalemia is a life threatening metabolic condition. The common risk factors for hyperkalemia include renal insufficiency, use of angiotensin converting enzyme inhibitors, potassium supplementation and excessive consumption of potassium containing diet. A mild to moderate increase in serum potassium causes an increase in myocardial excitability, but further increase leads to impaired myocardial responsiveness, including that to pacing stimulation. hyperkalemia has been reported to cause failure of atrial capture due to pacemaker exit block. We report a case where hyperkalemia resulted in failure of both the atrial and the ventricular pacemaker capture.
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7/37. Sinus parasystole.

    Sinus parasystole is the expression of a protected nondominant sinus pacemaker, which is totally independent of the dominant rhythm. Two forms of sinus parasystole are described: (1) an active form, where both the dominant and the parasystolic pacemakers are located within the sinus node and (2) a passive form, where the basic rhythm is ectopic and the sinus pacemaker is protected as a result of complete retrograde SA block. Three cases of sinus parasystole are analyzed. In the active form of the arrhythmia the parasystolic sinus P waves are identical to those of the basic sinus rhythm. The diagnosis is suggested by variably coupled premature sinus P waves occurring with mathematically related intervals. This relationship between the parasystolic intervals can not be precise whenever complicating factors such as modulation occur. The recognition of active sinus parasystole is difficult, since the parasystolic P waves do not differ from basic P waves, so that the pattern resembles that of sinus arrhythmia or sinus extrasystoles. The passive form of sinus parasystole is more easily recognized due to the clear-cut difference between the dominant ectopic atrial waves and the "parasystolic" sinus P waves, which manifest with variable coupling intervals and reflect mathematically related intervals in between.
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8/37. sick sinus syndrome and diffuse impairment of the conduction system in a child: successful pacing with a steroid eluting endocardial pacing lead.

    A 9-year-old patient who had had a syncope was found to have atrial flutter in a resting electrocardiogram (ECG). Brief phases of sinus arrest had previously occurred after drug conversion to sinus rhythm. Structural heart disease was excluded by cardiac catheterization and angiography. Electrophysiologic study revealed a sick sinus syndrome, associated with diffuse impairment of the conduction system (supra-, infra-, and intrahisian block). Epimyocardial and an endocardial pacemaker implantation failed because of high stimulation threshold, after 3 years and 2 weeks, respectively. At the third implantation a steroid-eluting endocardial pacing lead was used and satisfactory pacing was still present 2 years later.
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9/37. Lone atrial fibrillation with complete heart block in a child.

    An asymptomatic 9-year-old boy presented with a slow heart rate and a structurally normal heart. He was detected to have complete atrioventricular block and fine atrial fibrillation that was not evident on the surface electrocardiogram. This case appears to be an unusual example of a disease of the cardiac conduction system presenting in childhood.
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10/37. Surgical resection of cor triatriatum in a 74-year-old man. review of echocardiographic findings with emphasis on Doppler and transesophageal echocardiography.

    A 74-year-old man was admitted to the hospital with congestive heart failure secondary to cor triatriatum. He also had sick sinus syndrome with complete heart block and syncope that had been treated with a permanent pacemaker 20 years earlier. The patient underwent successful surgical resection of the atrial membrane with closure of an atrial septal defect. M-mode, two-dimensional, Doppler, and transesophageal echocardiographic findings are reviewed. A unique "spike and dome" pattern on continuous-wave Doppler echocardiography is described that may suggest diagnosis of cor triatriatum.
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