Variations of Left Atrial Activation Patterns in Congestive Heart Failure

We report about a case of a patient admitted to the Intensive Cardiac Care Unit for severe congestive heart failure which showed modification of P‐wave morphology and duration, correlated with the clinical evolution. In the case here described, we show that ECG analysis, specifically P wave, allow us to assess the hemodynamic evolution of the acute decompensated heart failure patient. Electrocardiographic examination is the first and the most simple and available diagnostic tool in the evaluation of patients with cardiac diseases. Usually, P‐wave evaluation is not carefully assessed, in spite of very useful informations we can draw from its interpretation. We report about a patient admitted to our Intensive Cardiac Care Unit (ICCU) for severe congestive heart failure which showed peculiar modification of P‐wave morphology and duration, well correlated with the clinical course.     

Complete atrioventricular block in Shone's syndrome

A rare case of an adult patient with Shone's syndrome is presented in whom Lev's disease seems to be the major pathology underlying the development of complete A-V block.     

Progression of partial to advanced interatrial block

Interatrial block (IAB), prolonged conduction between the atria, is denoted by P waves of 110 milliseconds or more and may manifest as partial or advanced. Theoretically, partial IAB may progress to its advanced counterpart if conduction delay increases to complete block. However, there have been no reports of such progression, and electrophysiologic studies have not shown this phenomenon. We briefly review the interatrial conducting pathways of IAB and present the first documentation of possible progression of partial to advanced IAB.     

Mesothelioma of the atrioventricular node and congenital complete heart block

Congenital complete heart block (CCHB) has heterogeneous etiologies. It may occur as an isolated entity with no associated congenital cardiac malformations and is difficult to diagnose even with modern technology. Mesothelioma of the atrioventricular (AV) node is a benign tumor that causes CCHB. The occurrence of this tumor is rare, and a definitive diagnosis of the entity is made only at autopsy. The conduction disturbance caused by the mesothelioma is potentially treatable and should be considered in the differential diagnosis of CCHB. We present a case report of a 38-year-old female with CCHB caused by such a tumor. Clinical diagnosis and treatment of CCHB are reviewed.     

Resumption of interatrial conduction after atrial premature beat in baseline interatrial aberrancy

Interatrial block (IAB) is a delay or blockage of interatrial conduction from the right atrium to the left atrium, causing prolongation of the P-wave duration on the electrocardiogram. This condition is unfortunately not uncommon in clinical practice, especially among the elderly. It is often overlooked because the P wave is small and abnormalities can be difficult to detect. An isolated IAB does not usually cause any abnormal symptoms and may not require any specific treatment. Nevertheless, a relationship between an IAB and other cardiovascular conditions including left atrial electromechanical dysfunction, atrial remodeling, atrial fibrosis, atrial fibrillation, and stroke has been reported. Early diagnosis of this condition is critical. This case report presents a functional interatrial block or interatrial aberrancy that returned to normal after an atrial premature complex where the interatrial conduction remained normal in subsequent beats.     

Exceptional prevalence of interatrial block in a general hospital population

BACKGROUND: Interatrial block (IAB: P wave > or = 110 ms) is a strong correlate of left atrial (LA) enlargement and an important predictor of supraventricular tachyarrhythmias, notably atrial fibrillation and flutter. It is surprising that, despite its association with arrhythmias and its effects on the electromechanical properties of the left atrium, there is widespread neglect of this common abnormality. HYPOTHESIS: The study was undertaken to investigate the prevalence of IAB in a general hospital population. METHODS: We prospectively evaluated the electrocardiograms of 1,000 consecutive adult patients. analyzed for P-wave duration. RESULTS: Our results showed a very high prevalence of IAB (41.1% of patients in sinus rhythm and 32.8% of all patients). As expected, it was more common in patients aged > 60 years. CONCLUSIONS: Given this unusually high prevalence of IAB in hospital patients and its ominous portents (LA enlargement. thrombosis and embolism, arrhythmias), physicians should be aware of its frequency and computer software should be programmed to recognize it.     

Progressive interatrial block associated with atrial fibrillation in a patient with hypertrophic cardiomyopathy

Progressive interatrial block is a clinically significant condition that has previously been reported in various patient populations. It is a manifestation of progressive fibrosis affecting the Bachmann region. This report presents a case of progressive interatrial block associated with atrial fibrillation in the context of hypertrophic cardiomyopathy.     

Complete atrioventricular block during cardiac catheterization: Two case reports in patients without pre-existing conduction abnormalities

Third-degree atrioventricular block has been well documented during ventricular catheterization of patients with underlying conduction abnormalities. Two cases reported here describe patients with normal conduction at baseline who sustained complete heart block during ventricular catheterization. Catheterizing physicians should be aware of this risk, which has not been previously reported.     

The morphology of the atrioventricular node in scleroderma -- a three-dimensional reconstruction

A new technique for looking at the atrioventricular node andbundle is described and applied to the conducting system insix patients with scleroderma. The conducting system blockswere removed, sectioned, appropriately stained and photographed.Outlines of the atrioventricular node and bundle were generatedand digitized. From the digital information three-dimensionalimages were generated and the atrioventricular node and bundlewere rotated so that the shape could be studied from any view.In striking contrast to normal atrioventricular nodal reconstructions,those from the patients who had scleroderma showed a narrowand flattened proximal atrioventricular node. The nodal microscopy,on the other hand, did not differ significantly in architecture.It is postulated that the alterations by fibrous replacementof the proximal node could account for the relatively high frequencyof atrioventricular conduction Scleroderma, problems in patientswith scleroderma and could paradoxically account for the relativelyfrequent occurrence of supraventricular tachycardias that arealso found in this disease.     

Hyperkalemia-induced bundle branch block and complete heart block

Hyperkalemia was associated with complete heart block in one patient that resolved by first showing right bundle branch block and marked left axis deviation (left anterior hemiblock). Then the right bundle branch block resolved, leaving the marked left axis deviation that was present before the hyperkalemic episode. Another patient with hyperkalemia had right bundle branch block with marked left axis deviation, both of which disappeared with correction of the hyperkalemia. These findings suggest that hyperkalemia can depress conduction in the His-Purkinje system and raise the possibility that hyperkalemia may induce complete heart block distal to the atrioventricular junction.     

Complete atrioventricular block due to large cell lymphoma: Resolution with chemotherapy

Malignant lymphoma commonly involves the heart. Previous studies have found cardiac metastases in up to 20% of patients dying with lymphoma. Cardiac signs and symptoms of lymphoma are relatively rare, however, and in most cases, the diagnosis is made either postmortem or too late to affect the clinical course. This report presents the first case of complete heart block due to lymphoma that responded to surgery and chemotherapy with return of normal atrial ventricular conduction.     

Lyme Carditis Presenting With Complete Heart Block and Wide Complex Escape Rhythm

A 19-year-old woman with newly diagnosed Lyme disease presented with complete heart block and an accompanying escape rhythm with a right bundle branch block morphology. With antibiotics, her dysrhythmia resolved completely within 24 hours of presentation. This case highlights an unusual electrocardiographic manifestation of Lyme carditis.     

完全性左束支阻滞81例临床分析

目的分析完全性左束支阻滞(CLBBB)病例的临床特点。方法回顾性分析81例完全性左束支阻滞患者的病因、动态心电图、超声心动图、冠状动脉造影结果。结果60岁以上男性43例,占53%。病因以冠心病、高血压、心功能不全多见。本组冠脉造影的28例完全性左束支阻滞患者中确诊为冠心病者16例,占57.14%。超声心动图结果:55%患者心房、心室增大或心房心室同时增大。左室射血分数(LVEF)<50%者22例,占33.8%。动态心电图检查可见左束支阻滞常合并各种类型心律失常。结论完全性左束支阻滞常发生在老年男性患者,常见于器质性心脏病,尤其是冠心病、高血压、扩张型心肌病。完全性左束支阻滞可导致不良的心脏血流动力学效应,导致左心室功能受损。     

Occurrence of complete heart block associated with acute renal infarction

Complete heart block (CHB) and acute renal infarction (ARI) are both uncommon diseases and seldom encountered in the clinical practice. We describe a rare case of pre‐existing left bundle branch block, presenting simultaneously with CHB and ARI. The possible mechanism depends on prior presence of either CHB or ARI. If ARI occurs first, severe pain and embolism may enhance the vagal tone resulting in decrease in the heart rate and transient intraventricular conduction interruption, which subsequently causes CHB. The opposite scenario, CHB preceding ARI, is also possible. CHB can be physiologic and transient, with higher risk of development in the circumstance of pre‐existing conduction system disturbances. Patients with CHB are predisposed to formation of thrombi and thromboemboli, giving rise to ARI. In conclusion, awareness and timely identification of the clinical manifestations of these two diseases may facilitate early diagnosis and prompt management.