Dataset Information

Iatrogenic pacemaker-induced ventricular arrhythmia: a case report.

ABSTRACT:

Background

Minimizing right ventricular (RV) pacing to reduce the progression of heart failure is an established practice. Proprietary algorithms to reduce unnecessary RV pacing have been incorporated into both simple and complex cardiac pacemaker devices, for reducing the possibility of heart failure and arrhythmias.

Case summary

We present a case of a 43-year-old male implanted with a dual-chamber primary prevention implantable cardioverter-defibrillator (AUTOGEN EL, Boston Scientific) for sudden cardiac death. At the time of implant, the patient had hypertrophic cardiomyopathy with mild left ventricular (LV) systolic impairment, and sinus rhythm with intact atrioventricular (AV) conduction. The patient developed progression of his disease with symptoms (dyspnoea) and LV impairment. This led to a decision to activate the minimal RV pacing algorithm (RYTHMIQ™). A deterioration in AV conduction caused intrinsic ventricular beats to fall in the atrial blanking period, and subsequent VVI backup pacing resulted in R on T pacing. This induced ventricular arrhythmia. RYTHMIQ™ was subsequently deactivated, and the patient has had no further device-induced arrhythmias.

Discussion

Numerous studies have demonstrated the adverse effect of RV pacing on LV function. Minimizing RV pacing is, therefore, encouraged in individuals with intact AV conduction. However, underlying conduction abnormalities must be assessed prior to activating algorithms designed to minimize RV pacing. This case demonstrates the importance of careful intracardiac electrogram interpretation and individual case-based device programming, to avoid device-induced complications.

SUBMITTER: Pooranachandran V

PROVIDER: S-EPMC9113372 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Iatrogenic pacemaker-induced ventricular arrhythmia: a case report.

Pooranachandran Vivetha V Hodson Tim T Nicolson Will W Ng Ghulam Andre GA

European heart journal. Case reports 20220503 5

<h4>Background</h4>Minimizing right ventricular (RV) pacing to reduce the progression of heart failure is an established practice. Proprietary algorithms to reduce unnecessary RV pacing have been incorporated into both simple and complex cardiac pacemaker devices, for reducing the possibility of heart failure and arrhythmias.<h4>Case summary</h4>We present a case of a 43-year-old male implanted with a dual-chamber primary prevention implantable cardioverter-defibrillator (AUTOGEN EL, Boston Scie ...[more]

PMID: 35592746

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Project description:BackgroundAnti-mitochondrial antibody (AMA)-positive myositis is an atypical inflammatory myopathy characterized by chronic progression of muscle atrophy and cardiac involvement. Few detailed reports have shown the clinical course of the cardiac complications of AMA-positive myositis.Case summaryA 47-year-old man presented with shortness of breath on exertion. Cardiac dilatation was visible on chest X-ray, and echocardiography demonstrated diffuse hypokinesis with a reduced left ventricular (LV) ejection fraction of 30%. He had mild muscle weakness in the bilateral iliopsoas muscles, and his creatine kinase (CK) and anti-mitochondrial M2 antibody levels were elevated. A liver biopsy showed no findings of primary biliary cholangitis. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsy showed interstitial fibrosis and marked degeneration of the mitochondria. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed circumferential abnormal accumulation in the LV myocardium, and he was diagnosed with cardiomyopathy associated with AMA-positive myositis. Optimal drug therapy for heart failure was started, and a cardiac resynchronization therapy-defibrillator was implanted. However, his cardiac function did not improve, and he was hospitalized due to ventricular tachycardia storm 5 years after the diagnosis. Ventricular tachycardia was terminated by radiofrequency catheter ablation on the LV-anterior papillary muscle. Steroid therapy was initiated and resulted in a decreased uptake of FDG and a normalized CK level at 3 months after his second discharge; however, LV systolic dysfunction remained 1 year later.DiscussionAnti-mitochondrial antibody-positive myositis can affect the myocardium and cause severe LV dysfunction and life-threatening ventricular arrhythmia over time.KeywordsAnti-mitochondrial antibody-positive myositis • Endomyocardial biopsy • Ventricular tachycardia • Left ventricular dysfunction • Case report • Magnetic resonance imaging • Near-infrared spectroscopy-intravascular ultrasound.

Project description:BackgroundRadiofrequency ablation (RFA) is the most effective non-pharmacological approach in the reduction of ventricular tachycardia (VT) recurrence. However, it is crucial to thoroughly screen every patient for contraindications for RFA and provide appropriate pharmacological prophylaxis, if needed, since adverse effects may be fatal.Case summaryA 77-year-old male with multi-vessel coronary artery disease, heart failure with reduced ejection fraction (New York Heart Association (NYHA) Class III), with implantable cardioverter-defibrillator was admitted to our clinic due to recurrent life-threatening VT. The patient presented several concomitant diseases: dyslipidaemia, hypertension, and chronic kidney disease in Stage IIIB. He had a history of two myocardial infarctions and coronary artery bypass grafts complicated by mediastinitis and dehiscence of a sternotomy scar (2013). Radiofrequency ablation and pace mapping of VT were performed in sterile conditions, but no pre-operative antibiotic prophylaxis was administered. There were no local or general complications in the post-operative period. The patient was discharged from the clinic in good condition. A week later, the patient suffered from septic shock and infective endocarditis of mitral valve complicated with infiltration of the ventricular septum, wall dissection of the left ventricle (LV), pseudoaneurysm, and abscess of the LV. At the time of the second hospitalization extensive dental carries were found and oral cavity sanitation was performed. Due to the severity of the condition, patient did not survive.ConclusionOral cavity infections are common but often overlooked, mainly when the RFA procedure is urgent. A thorough physical examination, including a dental check-up, is crucial to minimize the risk of potential infection of the endocardial tissue and maximize the benefits of the therapy. Still, it is possible that the myocardial infection was not a result of oral cavity infection but a result of other undiagnosed and untreated infection. Contamination of the procedure site with patients' own microbiota or foreign microorganisms by the medical personnel is also a likely and unfortunate scenario. The presented case highlights the significance of not only prophylaxis, screening, and treatment of possible inflammation sites before RFA but also the need for sustaining sanitary standards and sterile conditions.

Dataset Information

Iatrogenic pacemaker-induced ventricular arrhythmia: a case report.

Background

Case summary

Discussion

Publications

Iatrogenic pacemaker-induced ventricular arrhythmia: a case report.

Similar Datasets

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