Cardiac Resynchronization Therapy in Heart Failure and Atrioventricular HeartBlock Report available from https://muhc.ca/tau Technology Assessment Unit of the McGill University Health Centre (MUHC) Update of TAU Reports #77 and #78: Cardiac Resynchronization Therapy in Heart Failure and Atrioventricular HeartBlock Report number: 88 Brief Report DATE: December 14, 2021 Report and policy committee declare no conflicts of interest. Suggested Citation Suarthana E, Almeida N. Update of TAU Reports #77 and 78. Cardiac Resynchronization Therapy in Heart Failure and Atrioventricular HeartBlock. Montreal (Canada): Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC); Jan 06, 2022. Report no. 88. 31 pagesCRT i 14 December 2021 Technology Assessment Unit
Incidence and Prognosis of Surgical HeartBlock in Patients with L-transposition of the Great Arteries. L-transposition of the great arteries (L-TGA) represents a spectrum of congenital heart defects (CHD) associated with atrioventricular block (AVB). However, the incidence and prognosis of postoperative AVB among patients with variants of L-TGA is uncertain. Assess the incidence and risk factors
BRASH syndrome with a complete heartblock- a case report. BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia. We present a case of a 68 years old female patient examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13/15. Her laboratory tests showed creatinine of 1.83 mg/dL, blood urea nitrogen of 89 mg/dL and potassium elevated to the level of 6.39 mEq/dL. ECG revealed complete heartblock with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous
Newborns with congenital complete heartblock: Advice for perinatal care providers. Congenital complete heartblock (CCHB) is a rare, but a potentially life-threatening manifestation of autoimmune diseases in neonates. Bradycardia in CCHB can be misdiagnosed as foetal distress in utero and thus precipitating a Caesarean section. We report a case series of three neonates with bradycardia without
Systemic Diseases and HeartBlock. Systemic diseases can cause heartblock owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heartblock should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heartblock. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heartblock in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles
Transient pacing in pigs with complete heartblock via myocardial injection of mRNA coding for the T-box transcription factor 18. The adenovirus-mediated somatic transfer of the embryonic T-box transcription factor 18 (TBX18) gene can convert chamber cardiomyocytes into induced pacemaker cells. However, the translation of therapeutic TBX18-induced cardiac pacing faces safety challenges. Here we of TBX18 mRNA in rats led to de novo automaticity and pacemaker properties and, compared with the injection of adenovirus, to substantial reductions in the expression of inflammatory genes and in activated macrophage populations. In rodent and clinically relevant porcine models of complete heartblock, intramyocardially injected TBX18 mRNA provided rate-adaptive cardiac pacing for one month that strongly
Impact of early detection and steroid treatment on fetal ventricular heart rate and pacemaker implantation in anti-Ro/SSA positive congenital heartblock. We investigated the effects of timing of detection and transplacental fluorinated steroid treatment on ventricular heart rate (HR) and age at pacemaker implantation in fetal third-degree atrioventricular block (AVB). Twenty-five of 31 fetuses
Impact of day of admission on patients admitted with complete heartblock: Analyzing the weekend effect. Complete heartblock (CHB) is a conduction disorder that can be fatal if not treated promptly. Admission on a week or weekend day may influence the outcomes of cardiac emergencies, such as CHB. The purpose of this study was to determine the effects of weekday vs. weekend admissions in terms of CHB outcomes. A retrospective cohort study was conducted using the National Inpatient Sample database to study the outcomes of adult patients admitted with complete heartblock. Outcomes were compared between the patients admitted on weekends (midnight Friday to midnight Sunday) and weekdays. Thirty-four thousand three hundred ninety-five patients were included, of which 7350 (21.37 %) were admitted
A rare case with fetal autoimmune heartblock and KNCH2 variant-induced long QT syndrome: a controversial opinion on prenatal management strategy. Among all fetal heartblock patients, > 50% cases are associated with maternal autoimmune diseases, and such patients should receive treatment. However, nearly half of fetal heartblock cases involve a mother with negative results following autoimmune
Reversal of Fetal HeartBlock in Antibody-Positive Mother After Hydroxychloroquine and Dexamethasone. Maternal autoantibody-related complete heartblock in the fetus is considered irreversible. During prenatal care for a 25-year-old nulliparous Hispanic woman with newly diagnosed nephrotic-range proteinuria and positive anti-nuclear antigen antibody, complete fetal heartblock with a ventricular rate of 60 beats per minute was detected on a fetal echocardiogram at 28-week gestation. A small pericardial effusion and ascites were noted consistent with fetal hydrops. Dexamethasone and hydroxychloroquine were initiated. Fetal rhythm improved to Mobitz type 1 second-degree heartblock, with a ventricular rate of 91 beats per minute. The fetus was born prematurely at 34-week gestation with second
A Case of Neonatal Lupus Presenting with Myocardial Dysfunction in the Absence of Congenital HeartBlock (CHB): Clinical Management and Brief Literature Review of Neonatal Cardiac Lupus. Neonatal lupus (NLE) is a rare acquired autoimmune disorder caused by transplacental passage of maternal autoantibodies to Sjogren's Syndrome A or B (SSA-SSB) autoantigens (Vanoni et al. in Clin Rev Allerg Immunol 53:469-476, 2017) which target fetal and neonatal tissues for immune destruction. The cardiac trademark of NLE is autoimmune heartblock, which accounts for more than 80% of cases of complete atrioventricular heartblock (AVB) in newborns with a structurally normal heart (Martin in Cardiol Young 24: 41-46, 2014). NLE presenting with cardiac alterations not involving rhythm disturbances
Electrocardiographic Predictors of Complete HeartBlock During Right Ventricular Lead Implantation in Patients Who Underwent Cardiac Resynchronization Therapy. Cardiac resynchronization therapy (CRT) device procedures have their own complications in addition to the complications associated with standard pacemaker implantations. This study aimed to analyze the predictors of the right bundle branch injury resulting in complete heartblock (CHB) during right ventricular (RV) lead implantation in patients who underwent CRT with defibrillator. We conducted an observational study of consecutive 790 patients who underwent CRT with defibrillator device implantation at our institution from 2010 to 2022. Relevant clinical information and complete data regarding the echocardiographic data, implantation
Long-Term Follow-Up of Second-Degree HeartBlock in Children. Little is known about the outcomes of children with second-degree heartblock. We aimed to determine whether children with structurally normal hearts and Mobitz 1, 2:1 block or Mobitz 2 are at increased risk for progressing to complete heartblock (CHB) or requiring a pacemaker (PM) at long-term follow-up. We searched our institutional electrophysiology database for children with potentially concerning second-degree block on ambulatory rhythm monitoring between 2009 and 2021, defined as frequent episodes of Mobitz 1 or 2:1 block, episodes of Mobitz 1 or 2:1 block with additional evidence of conduction disease (i.e. first-degree heartblock, bundle branch block), or episodes of Mobitz 2. Ambulatory rhythm monitor, ECG, and demographic data were
Reverse complete heartblock using transcutaneous pacing and repeated plasmapheresis in a neonate with lupus: a case report. It has been reported that the complete heartblock (CHB) in neonatal lupus (NL) cannot be reversed. This study reported a case of NL-CHB that was reversed by transcutaneous pacing and repeated plasmapheresis. A 35-week male preterm baby was transferred to the neonatal
Ventricular Functional Analysis in Congenital Complete HeartBlock Using Speckle Tracking: Left Ventricular Epicardial Compared to Right Ventricular Septal Pacing. Chronic right ventricular (RV) apical pacing in patients with congenital complete atrioventricular block (CCAVB) is associated with left ventricle (LV) dyssynchrony and dysfunction. Hence, alternative pacing sites are advocated
Cost of Pacing in Pediatric Patients With Postoperative HeartBlock After Congenital Heart Surgery. Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heartblock requiring permanent pacemaker (PPM) implantation. To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation. In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heartblock after CHS between
Causes of HeartBlock in Young and Middle-Aged South Africans. There is a paucity of data regarding the aetiology of atrioventricular heartblock (AVB) in young and middle-aged patients, particularly from low- and middle-income countries. To determine the aetiology of AVB in patients ≤ 55 years treated with transvenous pacemakers in a low- or middle-income country. We performed a retrospective
Auxilin is a novel susceptibility gene for congenital heartblock which directly impacts fetal heart function. Neonatal lupus erythematosus (NLE) may develop after transplacental transfer of maternal autoantibodies with cardiac manifestations (congenital heartblock, CHB) including atrioventricular block, atrial and ventricular arrhythmias, and cardiomyopathies. The association with anti-Ro/SSA
Health Outcomes of 215 Mothers of Children With Autoimmune Congenital HeartBlock: Analysis of the French Neonatal Lupus Syndrome Registry. Transplacental passage of maternal anti-SSA and anti-SSB antibodies, potentially associated with maternal autoimmune diseases, can cause neonatal lupus syndrome. Given the paucity of data in this setting, we report short- and long-term outcomes of mothers of offspring with congenital heartblock (CHB). This retrospective study included anti-SSA/SSB antibody-positive mothers of fetuses with high-degree CHB and focused on their health status before pregnancy, at CHB diagnosis, and thereafter. We analyzed 215 women with at least 1 pregnancy with CHB. Prior to this diagnosis, only 52 (24%) mothers had been diagnosed with an autoimmune disease, mainly systemic
Third Trimester Fetal Heart Rates in Antibody-Mediated Complete HeartBlock Predict Need for Neonatal Pacemaker Placement. Congenital complete heartblock (CCHB) affects 1 in 20,000 newborns. This study evaluates fetal and neonatal risk factors predictive of neonatal pacemaker placement in antibody-mediated complete heartblock. The Children's Hospital Los Angeles institutional fetal, pacemaker