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Bradycardia

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1. Leadless cardiac pacemaker implantation for bradyarrhythmias

and procedure The condition, current treatments and procedure The condition 2.1 Bradyarrhythmias are abnormal heart rhythms that can result in a slow heart rate (bradycardia), usually defined as less than 60 beats per minute. There are a range of causes including diseases such as sick sinus syndrome or atrioventricular block. The most common causes are the natural ageing process, ischaemic heart disease, heart valve disorders and heart failure. If untreated, bradycardia may lead to fatigue, fainting (...) , palpitations, dizziness, heart failure and an increased risk of death. Current treatments 2.2 Bradyarrhythmias are managed with pacemakers, as described in NICE technology appraisal guidance. Dual-chamber pacing is recommended for symptomatic bradycardia caused by sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and/or atrioventricular block, and also for sick sinus syndrome in people without atrioventricular block. Single- chamber ventricular pacemakers may be used

2018 National Institute for Health and Clinical Excellence - Interventional Procedures

2. Bradycardia

Bradycardia Bradycardia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Bradycardia Last reviewed: February 2019 Last updated: March 2018 Summary Any heart rhythm slower than 50 bpm, even if transient, owing to sinus node dysfunction and/or atrioventricular (AV) conduction abnormalities. Causes include intrinsic sinus node and AV nodal disease, or extrinsic influences, which may be reversible. Common symptoms include (...) . Potentially life-threatening complications, including cardiovascular collapse and death, may occur. Definition While some consider bradycardia to be a heart rate <60 bpm, this is in dispute and most consider rates of <50 bpm to represent bradycardia. A study of 500 normal people, using ECG recordings, showed the mean afternoon heart rate to be 70 bpm in men and women, with two standard deviations being 46 to 93 bpm in men and 51 to 95 bpm in women. Spodick DH, Raju P, Bishop RL, et al. Operational

2018 BMJ Best Practice

4. What are the treatment options for atropine-resistant unstable bradycardia?

What are the treatment options for atropine-resistant unstable bradycardia? Chiefs’ Inquiry Corner – 8/19/2019 – Clinical Correlations Search Chiefs’ Inquiry Corner – 8/19/2019 August 19, 2019 2 min read Atropine and transcutaneous pacing are first line treatments for unstable bradycardia. In patients who do not respond to three doses of at least 0.5mg of atropine, additional pharmacologic measures can be taken while attempting to electrically pace the heart. Specifically, patients (...) with infranodal block may not respond atropine’s cholinergic blockade, and may respond better to beta adrenergic stimulation. Both dopamine and epinephrine carry class IIb, level of evidence B guideline based recommendations as atropine alternatives in unstable bradyarrhythmias. References: The PIOPED-II study prospectively evaluated 824 patients and calculated the sensitivity and specificity of CT angiography in detecting acute pulmonary embolism to be 83% and 96% respectively. Of note, the study used

2019 Clinical Correlations

5. ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay

ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay Accepted Manuscript 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay Fred M. Kusumoto, MD, FACC, FAHA, FHRS, Chair, Writing Committee, Mark H. Schoenfeld, MD, FACC, FAHA, FHRS, Vice Chair, Writing Committee, Coletta Barrett, RN, FAHA, Writing Committee Member, James R. Edgerton, MD, FACC, FHRS, Writing Committee (...) 25701 To appear in: Journal of the American College of Cardiology Please cite this article as: Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD, 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay, Journal of the American College of Cardiology (2018), doi: https

2018 American College of Cardiology

6. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhyth Full Text available with Trip Pro

Kimberly A KA Thompson Annemarie A Varosy Paul D PD eng Journal Article 2018 11 06 United States J Am Coll Cardiol 8301365 0735-1097 AIM IM J Am Coll Cardiol. 2019 Aug 20;74(7):1016-1018 31416524 ACC/AHA Clinical Practice Guidelines AV block Holter monitoring ablation ambulatory electrocardiography aminophylline atrioventricular block atropine beta-adrenergic agonist bradyarrhythmia bradycardia bundle branch block cardiac pacing cardiac resynchronization therapy cardiac sinus pause cardiac surgery (...) 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhyth 30412709 2019 08 16 1558-3597 74 7 2019 Aug 20 Journal of the American College of Cardiology J. Am. Coll. Cardiol. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report

2019 EvidenceUpdates

7. A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay Full Text available with Trip Pro

A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP).Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent

2019 EvidenceUpdates

8. Dual chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block

occasionally does not generate electrical impulses, from a period lasting a couple of seconds to several minutes sinoatrial exit block, in which the sinus node generates electrical impulses normally, but the signal is blocked before it leaves the sinus node alternating bradyarrhythmias and tachyarrhythmias (a fast heart rate), such as bradycardia-tachycardia syndrome atrioventricular block (a condition in which electrical impulses from the sinus node are slowed or blocked). Atrioventricular block can occur (...) Dual chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block Dual-chamber pacemak Dual-chamber pacemakers for ers for symptomatic br symptomatic brady adycardia due to sick cardia due to sick sinus syndrome without atrio sinus syndrome without atriov ventricular entricular block block T echnology appraisal guidance Published: 26 November 2014 nice.org.uk/guidance/ta324 © NICE 2018. All rights reserved. Subject to Notice of rights (https

2014 National Institute for Health and Clinical Excellence - Technology Appraisals

9. The Effect of Noninvasive High-Frequency Oscillatory Ventilation on Desaturations and Bradycardia in Very Preterm Infants: A Randomized Crossover Trial (Abstract)

The Effect of Noninvasive High-Frequency Oscillatory Ventilation on Desaturations and Bradycardia in Very Preterm Infants: A Randomized Crossover Trial Noninvasive high-frequency oscillatory ventilation compared with nasal continuous positive airway pressure significantly reduced the number of desaturations and bradycardia in preterm infants. However, noninvasive high-frequency oscillatory ventilation was associated with increased oxygen requirements and higher heart rates.Australian and New

2018 EvidenceUpdates

10. Electrophysiological Testing for the Investigation of Bradycardias Full Text available with Trip Pro

Electrophysiological Testing for the Investigation of Bradycardias In this article we review the role of electrophysiological testing in patients presenting with bradycardia due to sinus node or atrioventricular node disease. In sinus bradycardia the role of electrophysiology studies is not established. In AV conduction disturbances, an electrophysiology study may be necessary both for the establishment of atrioventricular block as the main cause of symptoms, and for identification

2017 Arrhythmia & electrophysiology review

11. Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia Full Text available with Trip Pro

Efficacy of isoproterenol for treating amlodipine overdose resulting in bradycardia Amlodipine predominantly affects vascular smooth muscle cells. Amlodipine overdose usually presents with vasodilatory shock, accompanied by reflex tachycardia rather than bradycardia.An 81-year-old woman presented with impaired consciousness 8 h after ingesting 50 5-mg amlodipine tablets with suicidal intent. On admission, her blood pressure was 50/40 mmHg and her heart rate was 45 b.p.m. Serum amlodipine level (...) was extremely high (474.4 ng/mL), causing refractory bradycardia. She remained hypotensive despite fluid resuscitation, and therefore was administered dopamine and norepinephrine. She was also administered glucagon and calcium gluconate, and underwent high-dose insulin euglycemic therapy.Although her blood pressure improved, bradycardia progressively worsened and isoproterenol infusion was initiated, which resulted in an improvement in her heart rate. The patient discharged on day 14 without any

2017 Acute medicine & surgery

12. A 40-Something male with a "Seizure," Hypotension, and Bradycardia

A 40-Something male with a "Seizure," Hypotension, and Bradycardia Dr. Smith's ECG Blog: A 40-Something male with a "Seizure," Hypotension, and Bradycardia Monday, October 7, 2019 This is by one of our , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. Per bystanders, he went down after some intense sporting activity, and had “shaking” type movement. He reports no personal or familial history of seizures. One of our EMS Fellows (...) Wall , not the LV anterior wall. When there is inferior and anterior STE, the differential is: 1. inferior + RV MI due to RCA occlusion vs. 2. LAD occlusion in a "wraparound LAD" (wraps around to the inferior wall). In this case, the inferior STE is the most exaggerated, and the anterior STE is highest in V1 and V2. Both of these features make inferior + RV MI by far the most likely ( ) There is also sinus bradycardia and t he patient is in shock with hypotension. Although the shock is no doubt

2019 Dr Smith's ECG Blog

13. Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone

Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone - GOV.UK GOV.UK uses cookies to make the site simpler. or Search Simeprevir with sofosbuvir: risk of severe bradycardia and heart block when taken with amiodarone Avoid concomitant use of amiodarone with simeprevir (Olysio▼) and sofosbuvir (Sovaldi▼) combination therapy, unless other antiarrhythmics (...) are not tolerated or contraindicated; monitor closely (particularly during the first weeks of treatment) monitor patients at high risk of bradyarrhythmia continuously for 48 hours in an appropriate clinical setting after starting concomitant amiodarone and antiviral treatment monitor patients who have stopped amiodarone within the last few months and need to start taking any of these antiviral combinations—this is due to the long half-life of amiodarone advise patients taking amiodarone with any

2015 MHRA Drug Safety Update

14. Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone

Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone - GOV.UK GOV.UK uses cookies to make the site simpler. or Search Sofosbuvir with daclatasvir; sofosbuvir and ledipasvir: risks of severe bradycardia and heart block when taken with amiodarone Avoid concomitant use of amiodarone with ledipasvir (...) in patients taking either of these antiviral combinations when other anti-arrhythmics are not tolerated or contraindicated; monitor closely (particularly during the first weeks of treatment) monitor patients at high risk of bradyarrhythmia continuously for 48 hours in an appropriate clinical setting after starting concomitant amiodarone and antiviral treatment monitor patients who have stopped amiodarone within the last few months and need to start taking either of these antiviral combinations

2015 MHRA Drug Safety Update

15. Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants: A Single-center, Retrospective Study. Full Text available with Trip Pro

Hypoxemia, Bradycardia, and Multiple Laryngoscopy Attempts during Anesthetic Induction in Infants: A Single-center, Retrospective Study. Successful tracheal intubation of an infant may be a challenging skill to acquire due to differing anatomy and physiology compared to older children and adultsMultiple intubation attempts may be associated with increased complications WHAT THIS ARTICLE TELLS US THAT IS NEW: In a quaternary pediatric academic center, 16% of healthy infants undergoing routine (...) procedures. Our primary outcome was the incidence of hypoxemia or bradycardia during induction of anesthesia. We evaluated the relationship between laryngoscopy attempts and our primary outcome, adjusting for age, weight, American Society of Anesthesiologists status, staffing model, and encounter location.A total of 1,341 patients met our inclusion criteria, and 16% (n = 208) had multiple laryngoscopy attempts. The incidence of hypoxemia was 35% (n = 469) and bradycardia was 8.9% (n = 119). Hypoxemia

2019 Anesthesiology

16. A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block. (Abstract)

A unique case of bradycardia recognized by wearable technology as first presentation of complete heart block. Wearable technology has advanced significantly, and the proposed health benefits have been widely touted. Most of the discussion has been surrounding the identification and diagnosis of asymptomatic atrial fibrillation. However, the heart monitoring functions of the wearable technology can also identify other abnormalities as well. We present the first case of wearable technology (...) identified bradycardia diagnosed as the primary presentation of complete heart block. Wearable technology has advanced significantly, but still poses questions regarding its use in screening for rare conditions. One remaining challenge is balancing the desire to screen for rare asymptomatic conditions without overburdening emergency departments with patients responding to alarms on their devices.Copyright © 2019 Elsevier Inc. All rights reserved.

2019 American Journal of Emergency Medicine

17. Randomized Controlled Trial on the Effects of Morning versus Evening Primary Vaccination on Episodes of Hypoxemia and Bradycardia in Very Preterm Infants. (Abstract)

Randomized Controlled Trial on the Effects of Morning versus Evening Primary Vaccination on Episodes of Hypoxemia and Bradycardia in Very Preterm Infants. Hypoxemia and bradycardia occur frequently in preterm infants, but are incompletely understood. They are more prevalent during infections and following immunization. Data on adults suggested an increased immune response if subjects slept following vaccination, suggesting an interaction between circadian rhythm and the immune system. Whether

2019 Neonatology Controlled trial quality: uncertain

18. Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. Full Text available with Trip Pro

Effect of Intravenous Ondansetron on Spinal Anesthesia-Induced Hypotension and Bradycardia: A Randomized Controlled Double-Blinded Study. Spinal anesthesia is a safe anesthetic technique commonly practiced. However, it is associated with hypotension (33%), bradycardia (13%), and shivering which are induced by hypovolemia, sympathetic blockade, and Bezold-Jarisch reflex through intracardiac serotonin (5HT3) receptors and vagus nerve.To study the effect of intravenous (i.v.) ondansetron (...) on hypotension and bradycardia induced by spinal anesthesia.This was a randomized controlled double-blinded study done in a tertiary care teaching hospital.Of 140 patients, 70 in Group A received 2 mL of i.v. ondansetron 4 mg and 70 in the Group B received 2 mL of i.v. normal saline. 3 mL of 0.5% hyperbaric bupivacaine was injected intrathecally. Measurements of blood pressure and heart rate (HR) were taken every 3 min for 30 min after spinal anesthesia was performed. Mean arterial pressure (MAP) drop more

2019 Anesthesia, essays and researches Controlled trial quality: uncertain

19. Severe bradycardia caused by the deviation of the laryngeal mask airway Supreme: A case report. Full Text available with Trip Pro

Severe bradycardia caused by the deviation of the laryngeal mask airway Supreme: A case report. Classic laryngeal mask airway (LMA) has long been used for airway management. The LMA Supreme is a modified single-use version of the LMA Proseal, but it still remains some deficits such as the instable positioning that lead to easily sliding and the mask bowl full of air might lead to the reduced blood flow of the internal carotid artery. The carotid sinus is a baroreceptor that responds (...) to the stretching of the arterial wall. Manual pressure of the carotid artery at the upper margin of the sternocleidomastoid muscle provoked bradycardia and hypotension.A previously fit and well 42-year-old woman presented with breast fibroma on the left side. No other disease history could be recorded. Her family history was negative for neuromuscular and autoimmune disease.The patient suffered from a severe bradycardia and hypotension when the LMA showed a shift. We presented with a hypothetical

2019 Medicine

20. Chinese Patent medicine to treat a 32-year-old man with sinus bradycardia and cardiac sinus arrests: A case report. Full Text available with Trip Pro

. An ambulatory electrocardiogram showed sinus arrhythmia, sinus bradycardia, and significant sinus arrhythmia. The minimum heart rate was 33 bpm (beats per minute). The number of sinus arrest was 42 and the maximum RR interval was 2216 ms.The patient was diagnosed with bradyarrhythmia in Western medicine and "palpitation" in TCM.The patient was treated with methods of benefiting qi and nourishing yin and activating blood circulation along with warming yan for nearly 5 months. CPM (Chinese patent medicine (...) Chinese Patent medicine to treat a 32-year-old man with sinus bradycardia and cardiac sinus arrests: A case report. Sinus bradycardia refers to a sinus heart rate <60 bpm. Cardiac sinus arrests refer to the omission of atrial activation caused by transient cessation of impulse generation at the sinoatrial node. Normally, drugs such as atropine, isoproterenol, dopamine, dobutamine, or epinephrine can be used for the acute treatment of bradycardia. Temporary pacing is used for treating severe

2019 Medicine

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