Recurrent pacemaker-mediated arrhythmia with a right bundle branch block pattern in a patient with a cardiac
Yubin Zhang1, Yiru Han2, Liangrong Zheng3
1Department of Electrocardiogram, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Summary
Pacemaker-mediated arrhythmias (PMA) are rare in biventricular systems but can worsen heart failure. This case highlights how loss of ventricular capture can trigger these arrhythmias, even without prolonged delays.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiovascular implantable electronic devices can cause pacemaker-mediated arrhythmias (PMA).
- Repetitive reentrant ventriculoatrial synchrony (RRVAS) is a common type of PMA, often due to AV dissociation and VA conduction.
- RRVAS is rare in biventricular systems but poses risks to cardiac resynchronization therapy (CRT) and heart failure.
Observation:
- A rare case of recurrent PMA with a right bundle branch block pattern in a CRT patient is presented.
- Most PMA episodes were triggered by premature atrial contractions with VA conduction, not AV delay prolongation.
- The study observed VA conduction resulting from right ventricular lead loss of capture.
Findings:
- Loss of right ventricular lead capture can induce VA conduction.
- This VA conduction can trigger RRVAS in patients with CRT devices.
- Recurrent PMA can manifest with a right bundle branch block pattern.
Implications:
- Understanding lead integrity is crucial for preventing PMA in CRT patients.
- Identifying triggers like premature atrial contractions and VA conduction is key.
- This case underscores the need for vigilance regarding adverse events in CRT therapy.
Related Concept Videos
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
19
Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
19
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
17
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
17
01:29Disturbances in Heart Rhythm
1.1K
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
1.1K
01:28Mechanism of Cardiac Arrhythmias
1.0K
Arrhythmias are irregular heart rhythms occurring when the heart's electrical impulses become abnormal. These disturbances can lead to various symptoms, depending on their severity and the underlying cause. Some common factors contributing to arrhythmias include hypoxia, ischemia, electrolyte imbalances, excessive catecholamine exposure, drug toxicity, and muscle overstretching. Arrhythmias can be classified into two main types based on the rate and site of origin of abnormal heart rhythms.
1.0K
01:25Dysrhythmias VI: Management of Dysrhythmias
28
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...
28
01:21Cardiac Catheterization II: Right Heart Catheterization
77
Right Heart Catheterization: An OverviewRight heart catheterization is an invasive diagnostic procedure that measures right-sided cardiac and pulmonary artery pressures, calculates cardiac output, and identifies intracardiac shunts. It provides detailed hemodynamic data essential for diagnosing and managing various cardiovascular conditions, such as pulmonary hypertension.Access SitesCommon access sites for right heart catheterization include the internal jugular vein in the neck region, the...
77