Failure of Intracardiac Pacing After Fatal Propafenone Overdose: A Case Report

Background

Propafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone.

Temporary Pacing in Complete Heart Block due to Lyme Disease: A Case Report

The authors present the case of a 44-year-old man who was admitted with complete heart block and signs of severe bradycardia. After steroid administration and temporary pacemaker treatment the complete heart block resolved. During this therapy transient ST segment and T wave abnormalities occurred. The positive Borrelia burgdorferi antibody titer arrived only after therapy had been completed. This is regarded as the first case of Lyme carditis with complete heart block diagnosed in eastern Europe. Carditis resolved without antibiotic treatment and has not recurred.     

Hemodynamic Effect of Physiological Dual Chamber Pacing in a Patient with End-Stage Dilated Cardiomyopathy: A Case Report

I report a case of end-stage dilated cardiomyopathy with first-degree atrioventricular (AV) block, which had been resistant to intensive medical therapy and was eventually treated by DDD pacemaker. The optimal AV interval setting was decided using invasive right-heart catheterization and Doppler echocardiography. At a pacing rate of 92/minute, an AV interval setting of between 200 and 100 msec increased left ventricular filling and enhanced myocardial contractility. An AV interval setting of 50 msec increased the left ventricular filling further. However, this resulted in deteriorated left ventricular function. Based on these findings, the pacemaker was programmed at an optimal AV delay of 100 msec, a rate of 82-150 beats/min and a DDD mode, resulting in a good clinical course for 4 months after the therapy. Thus, it is suggested that in patients with end-stage dilated cardiomyopathy and first-degree AV block, an optimal AV delay setting using a DDD pacemaker can improve deteriorated myocardial function probably by increasing the left ventricular filling, and thus promote utility of the Frank-Starling mechanism.     

Pseudo-fracture of Pacemaker Lead Due to Securing Suture: A Case Report

With improved pacemaker lead design and materials, complications caused by lead problems have decreased.^4,5 There have been isolated reports of leads severed by suture material but they have been rare. Presented is a case of suture-induced "pseudo-fracture" in a urethane-insulated ventricular lined endocardial lead (Medtronic Model #6971-58). No loss of capture or sensing function has been encountered eight months following initial implantation. It is felt that the softer, stronger urethane permitted compression and resulted in a radiographic suggestion of a fractured lead, but lead integrity does not seem to have compromised. Although (his may be an inconsequential radiographic finding, it could lead to an inappropriate lead removal unless it is properly interpreted. (PACE, Vol. 4, November-December, 1981)     

Recurrent Pulmonary Emboli Secondary to Right Atrial Thrombus Around a Permanent Pacing Catheter: A Case Report and Review of the Literature

This report describes the management of a woman with multiple pulmonary emboli secondary to a large right atrial clot which had formed around her permanent transvenous pacemaker. She continued to have pulmonary emboli despite adequate anticoagulation. Removal of the catheter and pacing required right atriotomy under cover of cardiopulmonary bypass. Additionally, eight English language case reports of symptomatic pericatheter thromboses are reviewed. In these cases, pericatheter clot resulted either in right-sided inlet obstruction or pulmonary emboli. The mortality rate was 75%. Although the cause for our patent's thromboembolic events is uncertain, congestive heart failure was a predisposing factor in 75% of the other reported cases. We suggest that pacemaker patients in congestive heart failure might benefit greatly from chronic anticoagulation.     

P-Null Phenotype Due to a Rare Frame-Shift Mutation and with Allo-Anti-PP1Pk Causing a Severe Hemolytic Transfusion Reaction: A Case Report with Clinical Management

IntroductionThe identification of alloantibodies to high-frequency antigens (HFA) and subsequent transfusion management can be challenging and often poses a problem in finding the compatible blood for transfusion. The aim of this study was to investigate the specificity of the antibody to the HFA causing a hemolytic transfusion reaction (HTR) and procure the compatible blood unit for future transfusion.Case presentationA 4-year-old female met with a head injury that led to intracranial bleeding and surgical intervention was required to remove blood clots. In the face of anemia, blood transfusion was planned. The pretransfusion tests on her blood sample revealed the presence of a pan-reactive alloantibody with hemolytic properties. She was transfused with 10 mL of the least incompatible red blood cells (RBCs) to which she reacted with signs of clinical hemolysis, i.e., chill, rigor, fever, and hemoglobinuria, on 3 different occasions. Despite her anemia, she was managed by medical intervention only. Her antibody reacted with all RBCs tested, except autologous and P-null (p phenotype) cells. Her RBCs did not react with anti-PP1Pk, which corroborated her phenotype as P-null. The genomic study revealed she was hemi- or homozygous or for a deletion of 26-bp in A4GALTexon 3, previously reported as causing the P-null phenotype and designated A4GALT*01N.019.ConclusionThis report documents a rare case of the P-null phenotype with an alloanti-PP1Pk causing a severe HTR to transfusion of the trial dose of the least incompatible blood. The case is the first example of this specific A4GALTmutation found in India.     

氟达拉宾治疗慢性淋巴细胞白血病诱发嗜酸细胞增多症1例报告并文献复习

目的:探讨氟达拉宾治疗慢性淋巴细胞白血病(CLL)诱发嗜酸细胞增多症的临床特点、诊断及治疗方法,减少误诊误治的发生。方法:总结1例诊断及治疗经过,结合文献对临床特点进行复习。结果:此病多发生在用药后2.4个疗程,大多无症状,少数患者发生皮损,皮损重者可应用激素及抗组胺药治疗。结论:氟达拉宾及2-氯脱氧腺苷(2-CdA)治疗淋巴增殖性疾病可诱发嗜酸细胞增多症,用药期间监测血象有助于早期诊断。