cardiovascular-agents and Atrioventricular-Block

Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues in the field including patient selection, safety and efficacy, and procedural end-points.. In this review, the current role of cardioneuroablation is summarized, and controversial issues related to the modality are discussed.. According to small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after cardioneuroablation in patients with vasovagal syncope (VVS). Use of the electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except in procedures limited to the right atrium. Based on a recently published randomized controlled trial and metanalysis, it may be possible now to make a strong recommendation for cardioneuroablation in patients <40 years of age, and those with the cardioinhibitory or mixed type of VVS who continue to experience frequent and/or burdensome syncope recurrences. Considering patients with VVS are prone to significant placebo/expectation effect, sham-controlled trials may help to quantify the placebo effect. In well-selected patients with functional atrioventricular block and sinus bradycardia, may result in encouraging medium-term outcomes. However, functional bradycardia is identified in a minority of patients presenting with high-grade atrioventricular block or sinus node dysfunction.

Topics: Atrioventricular Block; Bradycardia; Cardiovascular Agents; Catheter Ablation; Humans; Sick Sinus Syndrome; Syncope, Vasovagal

Topics: Aortic Valve Stenosis; Atrioventricular Block; Cardiac Surgical Procedures; Cardiovascular Agents; Diagnostic Imaging; Electrocardiography; Endocardial Fibroelastosis; Endocardium; Heart Failure; Humans; Infant; Infant, Newborn; Mumps; Myocarditis; Prognosis

Torsadogenic effects of ivabradine, an inhibitor of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, were assessed in an in vivo proarrhythmia model of acute atrioventricular block rabbit. Ivabradine at 0.01, 0.1, and 1 mg/kg was intravenously administered to isoflurane-anesthetized rabbits (n = 5) in the stable idioventricular rhythm. Ivabradine at 0.01 and 0.1 mg/kg hardly affected the atrial and ventricular automaticity, QT interval, or the monophasic action potential duration of the ventricle. Additionally administred ivabradine at 1 mg/kg decreased the atrial and ventricular rate significantly but increased the QT interval and duration of the monophasic action potential. Meanwhile, torsade de pointes arrhythmias were detected in 1 out of 5 animals and in 2 out of 5 animals after the administration of 0.1 and 1 mg/kg, respectively. Importantly, torsade de pointes arrhythmias could be observed only in 2 rabbits showing more potent suppressive effects on ventricular automaticity. These results suggest that the torsadogenic potential of ivabradine may become evident when its expected bradycardic action appears more excessively.

Topics: Animals; Atrioventricular Block; Cardiovascular Agents; Disease Models, Animal; Electrocardiography; Heart Rate; Hemodynamics; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; Ivabradine; Male; Rabbits; Torsades de Pointes

Calcium channel blockers have been used in the treatment of coronary artery spasm for many years. However, there is insufficient knowledge about their application to treat atrioventricular block caused by coronary spasm. Clinical data of five patients who were diagnosed with coronary spasm caused by atrioventricular block and treated with calcium channel blockers were retrospectively assessed. The patients had varying degrees of atrioventricular block (confirmed by Holter ECG) and myocardial ischemia-like ST-T changes. Two patients were II type I AVB, two patients II type II AVB, and the remaining one patient was III AVB. All patients were all diagnosed with right coronary artery spasm by coronary angiography. The patients were treated with calcium channel blockers. No patient reported recurrence of chest pain or chest discomfort. On Holter ECG monitoring, no significant myocardial ischemia or atrioventricular block was seen. In conclusion, calcium channel blockers are effective and safe in the treatment of atrioventricular block caused by coronary spasm.

Topics: Atrioventricular Block; Calcium Channel Blockers; Cardiovascular Agents; Coronary Angiography; Coronary Vasospasm; Diltiazem; Female; Humans; Male; Middle Aged

Topics: Aged; Atrioventricular Block; Cardiac Pacing, Artificial; Cardiovascular Agents; Chest Pain; Coronary Angiography; Drug Therapy, Combination; Electrocardiography; Female; Humans; Middle Aged; Pacemaker, Artificial; Sick Sinus Syndrome; Takotsubo Cardiomyopathy; Treatment Outcome

Takayasu arteritis is an inflammatory condition that involves the large cardiac vessels, predominantly the aorta and its main branches. It typically affects young women (age, ≤40 yr), most often Asians and Latin Americans. Herein, we describe a rare manifestation of Takayasu arteritis in a 19-year-old black Tunisian man who presented with acute inferior myocardial infarction and complete atrioventricular block after occlusion from a giant aneurysm in the right coronary artery. The coronary artery disease was associated with aneurysmal dilations in the carotid, vertebral, and right renal arteries. Medical therapy improved Thrombolysis in Myocardial Infarction flow in the area of the giant aneurysm from grade 1 to grade 3. Upon the diagnosis of Takayasu arteritis, intravenous methylprednisolone and oral prednisone therapy was started. After 10 days of hospitalization, the patient was discharged on a medical regimen. Renovascular hypertension due to renal artery stenosis was suspected, so he underwent successful percutaneous transluminal angioplasty of the inferior segmental artery of the right renal artery. During 12 months of close postprocedural monitoring, he experienced lower blood pressure, no chest pain, and no cardiovascular complications.This association of conditions has not been previously reported. Besides presenting this very rare combination of findings, we discuss the differential diagnosis of Takayasu arteritis in our patient.

Topics: Angioplasty, Balloon; Atrioventricular Block; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Diagnosis, Differential; Electrocardiography; Glucocorticoids; Humans; Male; Myocardial Infarction; Predictive Value of Tests; Renal Artery Obstruction; Stents; Takayasu Arteritis; Treatment Outcome; Young Adult

Topics: Adenosine; Atrioventricular Block; Atrioventricular Node; Bundle of His; Cardiovascular Agents; Child; Electrocardiography; Female; Humans; Pacemaker, Artificial; Syncope

The therapy of cardiovascular diseases has improved rapidly over the past 20 years. The most commonly used medications in cardiac patients are drugs affecting potassium homeostasis in the kidneys or the gastrointestinal tract, particularly inhibitors of renin-angiotensin-aldosterone (RAA) axis. They all can lead to hyperkalemia. This disorder may cause severe damage to the muscles and both the nervous and cardiovascular systems.. The aim of this study was to evaluate the incidence and clinical course of moderate and severe iatrogenic hiperkalemia in patients hospitalized for cardiovascular disease.. The present study analyzed a history of 26 patients with severe or moderate iatrogenic hyperkalemia, selected from among 5553 patients hospitalized in the years 2005-2006 in the Department of Clinical Cardiology of the Swietokrzyskie Cardiology Center, Kielce. They accounted for 0.46% of all patients treated at that time at the Ward.. The concentration of potassium on admission to hospital was > 6.0 mmol/l. Before admission all patients were treated in out-patient clinics with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, amiloride, triam-terene, beta-blockers, or potassium supplements administered in monotherapy or in combination. A mean age of patients was 79 years, most of them (80%) were women. The average blood potassium level was 7.3 mmol/l on admision and 5.1 mmol/l at discharge. Severe bradyarrhythmia and complete atrioventricular block requiring temporary pacing (n = 13) were observed in 21 patients (81%). Twenty-four patients (85%) had elevated levels of renal function parameters on admission. The average creatinine level on admission was 2.64 mg/dl, and 2.06 mg/dl on discharge. Ten (38%) out of 26 patients suffered from diabetes and 21 patients (81%) had arterial hypertension. Three out of 26 patients died in the hospital despite intensive therapy.. Polypharmacy should be used with particular caution in subjects treated on the ambulatory basis. During administration of inhibitors of RAA system, particularly in elderly out patients, renal function and serum electrolytes should be appropriately monitored both prior to and during the treatment.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Atrioventricular Block; Bradycardia; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Diuretics; Fatal Outcome; Female; Humans; Hyperkalemia; Iatrogenic Disease; Incidence; Male; Polypharmacy; Potassium

Topics: Atrioventricular Block; Cardiovascular Agents; Digitalis; Drug-Related Side Effects and Adverse Reactions; Optic Neuritis