PubMed · 1854305
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C McRae, N Carson. 1991. Sinus rhythm.. https://pubmed.ncbi.nlm.nih.gov/1854305/
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A decrease in sinus node dysfunction and pacemaker requirement after orthotopic heart transplantation was observed over a 6.5-year period, probably indicating the effect of a learning curve. Indirect evidence suggests a traumatic genesis of sinus node dysfunction after cardiac transplantation.
A case of acute promyelocytic leukemia (APL) complicated by sinus bradyarrhythmia during the course of all-trans retinoic acid (ATRA) administration is reported. A 3-year-old boy was admitted for evaluation of petechiae and APL was diagnosed. He was initially treated with 45 mg/m2 of ATRA without success, and a complete remission was achieved when the dose was increased to 135 mg/m2. Sinus bradyarrhythmia was first recognized 3 days after the induction therapy with ATRA. It did not disappear even when the patient stopped taking the medication. However, the arrhythmia tended to be augmented whenever he received ATRA again. Close observation of his cardiac condition was mandatory to continue ATRA as an integral part of the therapy for APL, combined with multidrug chemotherapy including anthracyclines, which themselves are potentially toxic to myocardium. In conclusion, the present case revealed the possibility that ATRA therapy induces sinus node arrhythmia, or that it can potentiate preexisting node dysfunctions.
OBJECTIVE: To assess the relative efficacy of a pacing esophageal stethoscope and intermittent boluses (40 mg) of gallamine in correcting sinus bradycardia (SB) during coronary artery surgery. DESIGN: The study was prospective, randomized, and controlled. SETTING: A community hospital. PARTICIPANTS: Fifty patients scheduled for elective coronary artery surgery. INTERVENTIONS: The patients were randomly allocated to receive treatment for an SB (less than 60 BPM) with either transesophageal atrial pacing (TAP) or gallamine. MEASUREMENTS AND MAIN RESULTS: Heart rate, blood pressure, and systemic hemodynamics were measured. The electrocardiogram was monitored for rate, rhythm, and conduction abnormalities. Twenty-four of the 25 TAP patients could be paced at a rate of 70 BPM after SB. Cardiac index increased from 1.90 to 2.56 L/min/m2. In the gallamine group, heart rate was increased from 50 to 66 BPM, but cardiac index only increased to 2.2 L/min/m2, and 2 patients developed nodal rhythms. Eight of these patients had peak heart rates over 80 BPM, and two were over 90 BPM. CONCLUSIONS: The ability to reliably and precisely control heart rate was superior with TAP compared with intermittent bolus dosing with gallamine.