PubMed · 6535760
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I Sathyamurthy, S Krishnaswami, I P Sukumar. Pacemaker Twiddler's syndrome.. https://pubmed.ncbi.nlm.nih.gov/6535760/
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The appearance of syncope in a patient with an accessory pathway is often a sign of high conduction capacity along the pathway, and calls for urgent ablation. Serious complications may ensue if it is assumed that these patients have an underlying mechanism of tachyarrhythmia, and ablation of the accessory pathway performed hastily without careful electrophysiological evaluation may lead to serious complications. The case described here, despite the patient's unusual presenting features, illustrates that the causal mechanism of syncope is not always what it appears to be. Although our patient had an obvious accessory pathway that was clearly evident in the electrocardiogram, the actual cause of the problem was complete infrahissian atrioventricular block.
Bradyarrhythmia requiring permanent pacing after heart transplantation remains a common problem. Sinus node dysfunction is the most common indication, and late onset of atrioventricular (AV) block has rarely been reported. We report the case of a patient who developed advanced AV block at 41 months after transplantation. Right bundle branch block with progressive increase of QRS complex duration was noted in serial electrocardiograms. At the time of late AV block development, the patient did not have acute rejection and coronary angiogram was normal. The mechanism of late onset of AV block is unclear, but it may be caused by progressive conduction.
QRS widening has important clinical and prognostic implications in patients with chronic heart failure. Ventricular conduction abnormalities such as a left bundle branch block, cause ventricular dysynchrony and several hemodynamic disadvantages. The presence of ventricular dysynchrony results in abnormal wall motion, impaired ventricular contractility, decreased ventricular filling, and increased mitral regurgitation. Biventricular pacing has been recently proposed as an adjunct therapy for advanced heart failure in patients with ventricular conduction abnormalities. Biventricular pacing acutely increases the + dP/dt of left ventricle, the systolic blood pressure and the pulse pressure, prolongs the diastolic left ventricular filling time, shortens the mitral regurgitation duration, and reduces the pulmonary wedge pressure. The implantation of biventricular pacemaker results in improvements of the functional class, exercise capacity, quality of life, echocardiographic findings, and neurohormonal data. Although the indication for biventricular pacing has not yet established, patients with functional class III or IV and left bundle branch block or left ventricular conduction delay showing QRS duration > or = 150 ms are good candidates.