RECURRENT SINUS ARREST DURING LAPAROSCOPIC SACRAL COLPOPEXY IN PATIENTS WITH SICK SINUS SYNDROME : A CASE REPORT

Sick sinus syndrome (SSS) is a disease in which the SA node fails to perform the function of pacemaking. ECG shows various rhythms including sinus arrest. We report recurrent sinus arrest during laparoscopic sacral colpopexy in a 77-year-old female patient with SSS. The patient was diagnosed with SSS, but as there were no symptoms, the operation was performed without pacemaker implantation. After induction of anesthesia, vital signs were stable, but sinus arrest repeatedly appeared due to elevated vagal tone during uterine traction. After operation, the patient underwent pacemaker implantation, and to this day, she is doing well without any symptoms. The anesthesiologist should pay close attention to the progress of the operation through much communication with operator during the surgery. Also, we recommend to considering temporary pacemaker implantation for patients with SSS who undergo surgery that can increase vagal tone.

Asystole in an older patient with recurrent falls. case report

ABSTRACT Introduction: Recurrent falls are a usual problem in older patients. It is therefore important to learn how to differentiate a pathological or syncopal episode from a simple stumbling fall, especially in patients who have limitations for communicating clearly and are poorly understood, in general terms, during the medical consultation. Implantable loop recorders (ILR) have been used as an investigation tool in selected cases of recurrent falls in older patients. Consequently, this case report aims to describe its usefulness in this type of patients. Case presentation: An 87-year-old female patient, hypertensive, with a history of recent stroke and frequent falls -referred to as stumbling-, received an implantable loop recorder due to atrial fibrillation. During one follow-up appointment, a 36-second pause related to a fall was documented, so a bicameral pacemaker was implanted. Conclusions: Evaluating repeated falls in older patients is complex; it must be done in detail to rule out syncopal episodes. Implantable devices to diagnose arrhythmic causes are useful and allow achieving accurate diagnoses and establish specific behaviors aimed at improving the quality of life of patients.

RESUMEN Introducción. Las caídas frecuentes son un problema común en pacientes de la tercera y la cuarta edad, por tanto es importante saber diferenciar cuando se trata de un evento patológico o sincopal, y cuando es un simple tropiezo, sobre todo en pacientes que tienen limitaciones para comunicarse de forma clara y son poco entendidos en términos generales durante la consulta médica. Los monitores de eventos cardiacos pueden ser usados en casos seleccionados de caídas frecuentes en adultos mayores para determinar las posibles causas de estos eventos, por lo que el presente reporte de caso pretende mostrar cuál es su utilidad en un paciente con caídas no sincopales a repetición. Presentación del caso. Paciente femenina de 87 años, hipertensa, con evento cerebrovascular reciente e historia de caídas a repetición referidas como tropiezos, a quien se le implantó un dispositivo diagnóstico de fibrilación auricular. En uno de los controles se observó pausa de 36 segundos relacionada con episodio de caída, por lo que se implantó un marcapasos bicameral. Conclusiones. La evaluación de caídas a repetición en pacientes mayores es compleja y debe realizarse de forma detallada para descartar síncope. El uso de monitores de eventos cardiacos para la identificación de causas arrítmicas de estos eventos permite diagnósticos certeros, con lo que a su vez es posible establecer tratamientos específicos que mejoren la calidad de vida de los pacientes.

Clinical analysis of right coronary artery anomalies in 8 children / 中华实用儿科临床杂志

Objective To observe the clinical characteristics and improve the diagnosis and treatment of right coronary artery anomalies in children.Methods The clinical characteristics,laboratory examination,treatment and prognosis were retrospectively analyzed in children with right coronary artery anomalies (complex cardiac anomalies was excluded),who were admitted into Beijing Children's Hospital Affiliated to Capital Medical University from January 2009 to December 2014.Results A total of 8 medical records of children with right coronary artery anomalies,among whom 5 cases were male and 3 cases were female,with a mean age of (7.06 ± 1.37) years old.In these 8 patients,there were 5 patients with right coronary artery originating from left coronary sinus,1 patient with right coronary artery originating from left wall of aorta,1 patient with single left coronary artery type Lipton L Ⅱ,and 1 patient with right coronary artery absence.The main symptoms included chest distress,chest pain and palpitation in elder children,but in infants,the primary symptom was poor feeding.One case of these patients represented syncope.Electrocardiogram of these patients showed ST-T wave changes,sinoatrial block,and sinus arrest.Ultrasonic cardiogram failed to discover the coronary artery anomalies.Four cases showed enlarged left ventricular end-diastolic diameter,and 1 case showed slight decrease of left ventricular ejection function.All 8 patients were given myocardial tonic with limitation in doing exercise,and clinical follow-up studies were conducted for 6 months.Four patients with enlarged left ventricular were treated with Captopril,and 3 patients of them recovered after 3 to 6 months.Two patients with sinus node malfunction were treated with permanent pacemaker implantation in other hospitals.Conclusions Right coronary artery anomaly in children is rare.Patients with cardiac ischemia and sinus node malfunction should be aware of right coronary malformation.64-section multidetector computerized tomography angiography can diagnose right coronary artery anomalies.To patients with right coronary artery anomalies,vigorous exercises should be avoided to decrease adverse cardiac events.

Permanent Pacemaker Implantation in a Patient with MELAS Syndrome / 대한내과학회지

A 35-year-old male patient with heart and renal failure and pneumonia was transferred to our department due to recurrent cardiac standstill with syncope. He had been diagnosed as and treated for MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) syndrome for the past 3 years. Electrocardiography (ECG) showed the Wolff-Parkinson-White pattern, and an echocardiogram showed hypertrophic cardiomyopathy. He developed syncopal attacks intermittently, and ECG monitoring showed intermittent bradycardia. His Holter monitoring showed several episodes of 5-16 seconds of sinus arrest. We conducted an electrophysiological study to evaluate the arrhythmia. During atrial and ventricular extra-stimuli, cardiac standstill developed several times, and the duration of pauses varied from 2.5 to 5.5 seconds. Abrupt asystolic events also developed accompanying syncopal attacks that were not related to the extra-stimuli. We decided to implant a permanent pacemaker. The patient's syncopal episodes disappeared after implantation of a DDD type pacemaker.

Permanent Pacemaker for Syncope after Heart Transplantation with Bicaval Technique

Sinus node dysfunction occurs occasionally after heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy, and increasing donor age. However, the timing and indication of permanent pacemaker insertion due to sinus node dysfunction following heart transplantation is contentious. Here, we report a case of a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with a bicaval technique, which has been known to associate with few incidences of sinus node dysfunction.