起搏器电池耗竭的心电图表现及临床意义

目的探讨起搏器电池耗竭的心电图表现及其临床意义。方法对23例临床证实起搏器电池耗竭患者的临床资料及心电图进行回顾性分析。结果起搏频率减慢或起搏频率不均6例;起搏频率奔放1例;感知功能异常6例;起搏功能异常3例;感知及起搏功能均异常4例;起搏方式改变3例。结论起搏器电池耗竭可以有多种心电图表现,但必须结合临床,要除外起搏器系统的机械故障及起搏器参数设置不当引起类似的心电图改变,对于证实起搏器电池耗竭的患者要及时更换起搏器。     

Interventricular septal mass in a patient with cardiac sarcoidosis

Sarcoidosis is a granulomatous disease that may involve multiple organ systems. The prognosis of sarcoidosis is influenced by the presence and severity of cardiac lesions. Thinning of the wall in the ventricular septum has often been reported, whereas an interventricular septal mass is rare. We describe a case of cardiac sarcoidosis resulting in a myocardial mass in the basal portion of the interventricular septum that was sensitive to corticosteroid treatment.     

Atrial fibrosis quantified using late gadolinium enhancement MRI is associated with sinus node dysfunction requiring pacemaker implant

Atrial Fibrosis and Sinus Node Dysfunction . Introduction: Sinus node dysfunction (SND) commonly manifests with atrial arrhythmias alternating with sinus pauses and sinus bradycardia. The underlying process is thought to be because of atrial fibrosis. We assessed the value of atrial fibrosis, quantified using Late Gadolinium Enhanced‐MRI (LGE‐MRI), in predicting significant SND requiring pacemaker implant. Methods: Three hundred forty‐four patients with atrial fibrillation (AF) presenting for catheter ablation underwent LGE‐MRI. Left atrial (LA) fibrosis was quantified in all patients and right atrial (RA) fibrosis in 134 patients. All patients underwent catheter ablation with pulmonary vein isolation with posterior wall and septal debulking. Patients were followed prospectively for 329 ± 245 days. Ambulatory monitoring was instituted every 3 months. Symptomatic pauses and bradycardia were treated with pacemaker implantation per published guidelines. Results: The average patient age was 65 ± 12 years. The average wall fibrosis was 16.7 ± 11.1% in the LA, and 5.3 ± 6.4% in the RA. RA fibrosis was correlated with LA fibrosis (R²= 0.26; P < 0.01). Patients were divided into 4 stages of LA fibrosis (Utah I: <5%, Utah II: 5–20%, Utah III: 20–35%, Utah IV: >35%). Twenty‐two patients (mean atrial fibrosis, 23.9%) required pacemaker implantation during follow‐up. Univariate and multivariate analysis identified LA fibrosis stage (OR, 2.2) as a significant predictor for pacemaker implantation with an area under the curve of 0.704. Conclusions: In patients with AF presenting for catheter ablation, LGE‐MRI quantification of atrial fibrosis demonstrates preferential LA involvement. Significant atrial fibrosis is associated with clinically significant SND requiring pacemaker implantation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 44‐50, January 2012)     

Vasodepressor cough syncope masked by sleep apnea-induced asystole

Vasodepressor Cough Syncope. Cough syncope is classified among the neural-reflex "situational" faints, but whether the clinical consequences in affected individuals result from reflex triggered bradyarrhythmia or vasodepressor-induced hypotension, or both, is often unknown. In this report we describe findings in a patient with a clinical history consistent with cough syncope, and in whom documented multiple asystolic spells were at first believed to be responsible for symptoms. However, pacemaker therapy initiated at an outside facility failed to suppress symptoms, and subsequent referral for more detailed autonomic study revealed the asystole to be due to sleep apnea, whereas cough-induced vasodepressor hypotension was the basis of syncope in this individual; the latter provided a pathophysiologic target for prevention of recurring symptoms. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1024-1027, September 2012).