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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
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Syncope in patients paced for atrioventricular block.

Milena Aste1, Daniele Oddone1, Paolo Donateo1

  • 1Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna 16033, Italy.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 7, 2016
PubMed
Summary

Cardiac pacing effectively prevents syncope in patients with documented atrioventricular block (AVB). However, syncope may recur in some patients with suspected AVB or without structural heart disease, highlighting the importance of accurate AVB diagnosis.

Keywords:
Atrioventricular blockCardiac pacingSyncope

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Syncope is a primary indication for cardiac pacing in approximately 40% of patients with atrioventricular block (AVB).
  • Limited data exist on the efficacy of cardiac pacing in preventing recurrent syncope in this patient population.

Purpose of the Study:

  • To evaluate the effectiveness of cardiac pacing in preventing syncopal recurrences in patients with atrioventricular block (AVB).
  • To assess the impact of documented versus suspected AVB on syncope recurrence after pacemaker implantation.
  • To investigate syncope recurrence in patients with and without structural heart disease (SHD).

Main Methods:

  • Retrospective analysis of 229 patients who received permanent pacemakers for AVB between January 2009 and December 2013.
  • Patients were categorized based on the presence of syncope and documentation of AVB.
  • Follow-up data were analyzed to determine actuarial syncope recurrence rates at 5 years.

Main Results:

  • In patients with documented AVB and syncope, the 5-year syncope recurrence rate was 1%.
  • Patients with suspected but undocumented AVB and syncope experienced a significantly higher recurrence rate of 14% (P = 0.001).
  • Syncope recurrence was also higher in patients without structural heart disease (SHD), with a 5-year estimate of 6%.

Conclusions:

  • Cardiac pacing is highly effective in preventing syncope when atrioventricular block (AVB) is definitively documented.
  • A non-negligible proportion of paced patients may experience recurrent syncope if AVB is only suspected or if they lack structural heart disease (SHD).
  • Accurate diagnosis of AVB is crucial for optimizing syncope management with cardiac pacing.