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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Reflex sympathetic dystrophy following pacemaker insertion.

Vikram A Londhey¹, Nishant Singh, Seema Kini

¹Medicine Department and Rheumatology Clinic, TNMC and BYL Nair Charitable, Hospital, Mumbai 400008.

The Journal of the Association of Physicians of India

|February 17, 2012

Summary

A pacemaker implantation may trigger reflex sympathetic dystrophy syndrome (RSDS), a rare condition causing hand pain and swelling. Early treatment with amitriptyline and indomethacin led to significant symptom improvement in this case.

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Area of Science:

Cardiology
Neurology
Radiology

Background:

A 55-year-old male with a history of mitral valve prolapse (MVP), mitral regurgitation, and complete heart block, who had a pacemaker implanted a year prior, presented with symptoms.
The patient reported two months of pain, swelling in the right hand's dorsum and small joints, and decreased sweating on the right hand.

Observation:

Bilateral wrist X-rays revealed pronounced demineralization (osteopenia) specifically in the right hand.
These clinical and radiological findings led to a diagnosis of reflex sympathetic dystrophy syndrome (RSDS).

Findings:

The patient was diagnosed with reflex sympathetic dystrophy syndrome (RSDS), suspected to be induced by the pacemaker insertion.
Treatment with amitriptyline and indomethacin resulted in a dramatic improvement of the patient's symptoms.

Implications:

This case highlights a potential, albeit rare, complication of pacemaker implantation: drug-induced reflex sympathetic dystrophy syndrome.
Early diagnosis and pharmacological intervention, including amitriptyline and indomethacin, can effectively manage RSDS symptoms, improving patient outcomes.