ABSTRACT
We report a patient with a systemic vasculitis and heart involvement with complete atrio-ventricular block. After pacemaker implantation, the stimulation threshold significantly increased resulting in exit block. Two adjunctive ventricular leads were implanted with temporary threshold improvement. Oral glucocorticoids decreased the stimulation threshold with a transient, dose-dependent efficacy but with remarkable side effects. Azathioprine, an immunosuppressive agent, obtained a sustained decrease of the stimulation threshold.
Subject(s)
Atrioventricular Block/therapy , Autoimmune Diseases/drug therapy , Azathioprine/therapeutic use , Glucocorticoids/therapeutic use , Immunosuppressive Agents/therapeutic use , Pacemaker, Artificial , Prednisolone/therapeutic use , Administration, Oral , Atrioventricular Block/physiopathology , Azathioprine/administration & dosage , Electric Stimulation Therapy , Female , Glucocorticoids/administration & dosage , Humans , Immunosuppressive Agents/administration & dosage , Middle Aged , Prednisolone/administration & dosageABSTRACT
OBJECTIVES: The purpose of this study was to verify in a long-term follow-up whether frequent monomorphic right ventricle extrasystoles may progress to arrhythmogenic right ventricular dysplasia (ARVD). BACKGROUND: Frequent monomorphic right ventricle extrasystoles are generally considered benign. However, in patients with this pattern, cardiac magnetic resonance (MR) has recently shown anatomical and functional abnormalities of the right ventricle. METHODS: Sixty-one patients who had been classified by noninvasive examinations as having frequent idiopathic right ventricle ectopy were contacted after 15 +/- 2 years (12 to 20) and submitted to clinical examination, electrocardiogram (ECG), Holter monitoring, stress test, signal averaged ECG, echocardiography and, in 11 patients, cardiac MR. The primary end point was to ascertain the presence of cases of sudden death or progression to ARVD. RESULTS: At the end of the follow-up, 55 patients were alive; six died, none of sudden death; eight stated to be well but refused further examinations. The 47 patients examined had normal ECG; in 24 patients (51%), extrasystoles were no longer present at Holter monitoring; late potentials were present in up to 15% of the patients; the right ventricle was normal at echocardiography. In 8 of 11 patients (73%), cardiac MR showed focal fatty replacement and other abnormalities of the right ventricle. CONCLUSIONS: In this long-term follow-up study, no patient died of sudden death nor developed ARVD; two-thirds of the patients were asymptomatic, and, in half of the patients, ectopy had disappeared. Focal fatty replacement in the right ventricle was present in most.
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Ventricular Dysfunction, Right/diagnosis , Adolescent , Adult , Child , Disease Progression , Electrocardiography , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Systole , Ventricular PressureABSTRACT
Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe 1 case of superior vena cava obstruction associated with permanent transvenous DDD pacemaker, following local infection. Thrombolytic therapy was initially effective, resulting in relief of signs of obstruction. However systemic infection occurred 3 months later. The patient was subsequently submitted to surgical removal of the infected pacemaker apparatus. Several therapeutical options described in previous papers are reviewed: anticoagulants, thrombolytics, percutaneous dilatation, surgical removal of the catheter. In conclusion, when a chronic process induced by local infection is present, surgical treatment is the best therapeutical approach.
