Interventricular Septal Hematoma Complicating Left Bundle Branch Area Pacing: A Case Report—The Devil Is Not So Black as He Is Painted
Paolo PastoriFabrizio De RosaFrancesco VitaliAndrea FasuloGiovanni TortorellaMonica PastoreMichele MalagùMatteo Bertini
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Abstract:
Background: This case report outlines the presentation of an emerging complication arising from left bundle branch area pacing (LBBAP). Case summary: A 43-year-old male with no history of cardiac problems experienced recurrent episodes of syncope with no prodromal symptoms. During monitoring in the emergency department, the patient underwent an episode of asystole, leading to LBBAP implantation. The procedure encountered technical challenges, resulting in an interventricular septal hematoma and subsequent ventricular arrhythmias. Despite initial concerns, conservative management led to resolution, demonstrated through echocardiographic follow-ups. Discussion: This report underscores the significance of ventricular arrhythmias as indicators of interventricular septal hematoma, providing insights into its diagnosis, management, and implications for LBBAP procedures.Keywords:
Asystole
Interventricular septum
Conservative Management
Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Although the risk of asystole can be reduced with anticholinergic medications, the recent emphasis on new modifications of technique (first, the use of subconvulsive stimuli to titrate the seizure threshold, and second, pretreatment with intravenous beta-blockers) may increase the risk of asystole in ECT patients.I present four new cases of asystole in ECT and outline a scheme for anticipating and preventing asystole.An episode of asystole did not prove to be an obstacle to further uncomplicated ECT.If risk factors contributing to asystole are reduced and adequate doses of intravenous atropine are on hand, a patient's ECT treatments need not be interrupted.
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Abstract Asystole presenting at the start of electrical stimulus application during electroconvulsive therapy (ECT) is a relatively common occurrence. It is most likely caused by vagal nerve stimulation, affecting autonomic cardiac tone. This article reviews the effect of the electrode placement (EP) on the incidence and severity of bradycardia and asystole. A systematic literature review was conducted using the Embase and PubMed databases, up to September 2021, searching for studies evaluating the effect of EP on bradycardia and/or asystole during ECT. Nine case reports describing asystole in patients receiving ECT almost exclusively reported the association with bitemporal (BT) EP. One small descriptive study found no significant effect of EP on cardiac pauses. The results from 4 cohort studies, however, suggest that a right unilateral placement bears a higher risk for developing bradycardia and asystole than BT and bifrontal ECT. The available evidence suggests that right unilateral ECT holds a greater risk for the development of bradycardia and asystole than BT and bifrontal EP.
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Early identification of cardiac asystole as a reason for syncope is of uttermost significance, as insertion of a cardiac pacemaker can save the patient's life and prevent severe injury. The aim of this work was to emphasize the subtle and unusual presentations of asystole in patients evaluated in epilepsy units.We reviewed the clinical presentation, ECG and EEG data of a series of seven patients who were evaluated in four epilepsy units and were diagnosed with asystole.Three patients had unusual clinical manifestations of cardiac asystole, resembling epileptic seizures. Three patients had asystole induced by epileptic seizures and in one patient the diagnosis was not clear. All patients except one were implanted with a pacemaker and improved clinically.Seizure-induced asystole is a rare complication of epilepsy and asystole may clinically mimic epileptic seizures. A high level of suspicion and thorough prolonged cardiac and EEG monitoring are mandatory for reaching the right diagnosis. As the diagnosis is rare and difficult to reach, a flow chart to assist diagnosis is suggested.
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Asystole is an uncommon but potentially fatal complication of electroconvulsive therapy (ECT). Several risks for poststimulus asystole have been described, but risks for asystole at other times have not.Two instances of ECT postictal asystole in healthy adult males are reported. Features in common are identified.features shared differ from risk factors for poststimulus asystole. In common were adult but not geriatric age, male sex, good physical and cardiac health, mesomorphic habitus, anticholinergic pretreatment, vigorous ECT seizure, and low resting heart rate. Both patients showed postictal bradyarrhythmia at the previous ECT.Postictal asystole has apparent similarities to postexertional asystole in athletes. The combination of higher pretreatment doses of an atropinic agent, a sympatholytic agent, and close monitoring of postictal cardiac rhythm should be considered with patients similar to ours, especially after occurrence of postictal bradyarrhythmia.
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AIMTo examine whether wearable cardioverter defibrillator (WCD) alarms for asystole improve patient outcomes and survival.
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