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Nightly phenomena, day time work: Difference between revisions
Nightly phenomena, day time work (view source)
Revision as of 16:45, 7 October 2007
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m (New page: R. Tukkie, R. Rienks, A.A.M. Wilde In 2002, an a trial demand inhibited (AAI) pacemaker was implanted in a young male (born 1984) because of a primary arrhythmia disorder. On a routine H...) |
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'''What is the consequence of the observed phenomenon in question 1 in the setting of this patient’s primary electrical disease?''' | '''What is the consequence of the observed phenomenon in question 1 in the setting of this patient’s primary electrical disease?''' | ||
As a result of the pause after the non-conducted atrial paced beat, the QT interval further prolongs significantly to QTc 740 ms, increasing the risk of torsades de pointes. QT prolongation at bradycardia is a feature of | As a result of the pause after the non-conducted atrial paced beat, the QT interval further prolongs significantly to QTc 740 ms, increasing the risk of torsades de pointes. QT prolongation at bradycardia is a feature of type III LQTS. | ||
type III LQTS. | |||
'''What action should be undertaken?''' | '''What action should be undertaken?''' | ||
It is mandatory to prevent relative bradycardia and pauses due to Wenckebach block in this patient. This can be achieved by adding a ventricular lead and programming the new pacemaker to duel-chamber with an AV delay long enough to advocate intrinsic AV conduction to the ventricle. Our patient underwent an uneventful upgrade and a control Holter recording showed excellent prevention of pauses. | It is mandatory to prevent relative bradycardia and pauses due to Wenckebach block in this patient. This can be achieved by adding a ventricular lead and programming the new pacemaker to duel-chamber with an AV delay long enough to advocate intrinsic AV conduction to the ventricle. Our patient underwent an uneventful upgrade and a control Holter recording showed excellent prevention of pauses. | ||