Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing Olubunmi.

Slides:

Advertisements

Similar presentations

Marc H. Bivins, MD, Mark J. Callahan, MD Mayo Clinic Proceedings

Advertisements

Gopi Dandamudi, MD, FHRS, Pugazhendhi Vijayaraman, MD, FHRS

Charles D. Burger, MD, Roger K. Resar, MD Mayo Clinic Proceedings

Managing Cancer Pain: Basic Principles and Invasive Treatments

Pursuing the Perfect Pacemaker

Left Ventricular and Biventricular Pacing in Congestive Heart Failure

Clinical Intracardiac Electrophysiologic Testing: Technique, Diagnostic Indications, and Therapeutic Uses STEPHEN C. HAMMILL, M.D. Mayo Clinic Proceedings

Volume 92, Issue 3, Pages (September 1987)

William L. Lanier, MD Mayo Clinic Proceedings

KRISHNA A. RAO, M. D. , ARUN ADLAKHA, M. D. , BIKRAM VERMA-ANSIL, M. D

Charles D. Burger, MD, Roger K. Resar, MD Mayo Clinic Proceedings

Differential Clubbing and Cyanosis: Classic Signs of Patent Ductus Arteriosus With Eisenmenger Syndrome Sunil Kumar Srinivas, MD, Cholenahally Nanjappa.

Urinothorax: Unexpected Cause of a Pleural Effusion

Jeffrey P. Moak, MD, Marco A. Mercader, MD, Dingchao He, MD, TK

Atrial Flutter Simulated by a Portable Compact Disk Player

Second-Degree Atrioventricular Block: A Reappraisal

Pugazhendhi Vijayaraman et al. JACEP 2015;1:

Acute Myocardial Infarction Associated With Amphetamine Use

Topical Analgesics in the Management of Acute and Chronic Pain

Carotid Sinus Syndrome and Wrestling

Differential Clubbing and Cyanosis: Classic Signs of Patent Ductus Arteriosus With Eisenmenger Syndrome Sunil Kumar Srinivas, MD, Cholenahally Nanjappa.

Electrical resynchronization induced by direct His-bundle pacing

Marc H. Bivins, MD, Mark J. Callahan, MD Mayo Clinic Proceedings

A case of paroxysmal atrioventricular block–induced cardiac arrest

Mary Jane Rasmussen, RN, Paul A. Friedman, MD, Stephen C

Prakash G. Suryanarayana, MD, David S. Frankel, MD, FHRS, Francis E

Challenges in the diagnosis and management of idiopathic ventricular fibrillation Jonathan Lipton, MD, PhD, George J. Klein, MD, Raymond W. Sy, MBBS,

A case of scar-related ventricular tachycardia demonstrating termination with nonglobal capture at the site of concealed entrainment with dual slow conduction.

KRISHNA A. RAO, M. D. , ARUN ADLAKHA, M. D. , BIKRAM VERMA-ANSIL, M. D

Ruchit Shah, MD, Vineet Kumar, MD, FHRS HeartRhythm Case Reports

Peripartum Cardiomyopathy Presenting as an Acute Myocardial Infarction

Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia Keiko Takahashi, MD, PhD,

Limitations of 12-lead electrocardiogram wide complex tachycardia algorithms in a patient with left atrial flutter and large myocardial infarction Carlos.

Chronic Dermatomyositis with Intermittent Trifascicular Block

Bradley D. Brochu, MD, Ahmed Abdi-Ali, MD, Jeffrey Shaw, MD, F

Complete congenital heart block: A case of multilevel block

Volume 92, Issue 3, Pages (September 1987)

Dual intraventricular response after cardiac resynchronization

Pugazhendhi Vijayaraman et al. JACEP 2015;1:

QRS normalization during atrial pacing in a patient with complete left bundle branch block: What is your diagnosis? Oholi Tovia-Brodie, MD, Yoav Michowitz,

Polymorphic ventricular arrhythmia triggered by temporary epicardial right ventricular stimulation after cardiac surgery Carlos Lopez, MD, Teresa Oloriz,

Overcoming left bundle branch block by permanent His bundle pacing: Evidence of longitudinal dissociation in the His via recordings from a permanent pacing.

Bundle branch reentry: A novel mechanism for sustained ventricular tachycardia in Chagas heart disease Alvaro V. Sarabanda, MD, PhD, Wagner L. Gali,

Electrical resynchronization induced by direct His-bundle pacing

Hiroko Asakai, MD, Laura Fenwick, BSc, Robert M. Hamilton, MD, FRCP(C)

Successful treatment of tachycardia-induced cardiomyopathy secondary to dual atrioventricular nodal nonreentrant tachycardia using cryoablation Harold.

An unusual cause of HV prolongation

Incremental value of electroanatomical mapping for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in a patient with sustained ventricular.

Slow pathway modification for treatment of pseudo-pacemaker syndrome due to first- degree atrioventricular block with dual atrioventricular nodal physiology

Colin Yeo, MBBS, Martin Green, MD, Robert Lemery, MD, FHRS

Radiofrequency catheter ablation for treatment of premature ventricular contractions triggering ventricular fibrillation from the right ventricular outflow.

Unappreciated Prevalence of Interatrial Block and Associated Consequences: A Poorly Perceived Pandemic David H. Spodick, MD, DSc Mayo Clinic Proceedings

Medical Treatment of Overactive Bladder: In Response

Transcranial Magnetic Stimulation as an Antidepressant Alternative in a Patient With Brugada Syndrome and Recurrent Syncope Miguel M. Alampay, MD, Mark.

HeartRhythm Case Reports

Successful catheter ablation of focal ventricular tachycardia originating from right bundle branch without making right bundle branch block, using pharmacologic.

Atrioventricular block at the distal His bundle: Electrophysiological insights from left bundle branch pacing Pugazhendhi Vijayaraman, MD, FHRS, Weijian.

Preoperative Smoking Cessation: The Role of the Primary Care Provider

Ablation of a symptomatic spontaneous automatic focus arising from an atriofascicular fiber Sandrine Venier, MD, Paul Khairy, MD, PhD, Bernard Thibault,

Clomiphene-Induced Severe Hypertriglyceridemia and Pancreatitis

Idiopathic ventricular fibrillation with repetitive activity inducible within the distal Purkinje system Michel Haissaguerre, MD, Ghassen Cheniti, MD,

Managing Cancer Pain: Basic Principles and Invasive Treatments

HeartRhythm Case Reports

Joao Pimenta, M.D., Manoel Miranda, M.D., Lélio A. Silva, M.D. CHEST

Resolution of new left bundle branch block and ventricular tachycardia with immunosuppressive therapy in a patient with cardiac sarcoidosis Aatish Garg,

Volume 12, Issue 2, Pages (February 2015)

Prolonged QT Syndrome: Perioperative Management

Brugada-type Electrocardiographic Pattern Unmasked by Fever

Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD

A wide QRS complex tachycardia utilizing an atypical accessory pathway in latent Wolff- Parkinson-White syndrome: Manifestation of anterograde conduction.

Presentation transcript:

Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing Olubunmi O. Oladunjoye, MD, Adeolu O. Oladunjoye, MD, Oreoluwa Oladiran, MD, David J. Callans, MD, Robert D. Schaller, DO, Anthony Licata, MD Mayo Clinic Proceedings: Innovations, Quality & Outcomes Volume 3, Issue 2, Pages 226-230 (June 2019) DOI: 10.1016/j.mayocpiqo.2019.03.008 Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Baseline 12-lead electrocardiogram showing normal sinus rhythm at 63 beats/min without pain, followed by atrial pacing at 150 beats/min with left bundle branch block and immediate chest discomfort. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2019 3, 226-230DOI: (10.1016/j.mayocpiqo.2019.03.008) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Pacing at 2.5 V @ 1 ms results in 1 beat of nonselective His-bundle pacing (HBP) with left bundle branch block (LBBB) correction, as evidenced by a pseudo delta wave and lack of a discreet potential on the HBP electrogram (red arrows). Pacing at 2.0 V @ 1 ms results in selective HBP with LBBB correction, as evidenced by an initial isoelectric interval and a similar QRS morphology (blue arrows). Note that there is now a discreet potential on the HBP electrogram. Pacing at 0.25 V @ 1 ms also results in selective HBP, but now fails to correct LBBB (black arrows). Identical responses were seen during both dual-chamber and ventricular-only pacing configurations. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2019 3, 226-230DOI: (10.1016/j.mayocpiqo.2019.03.008) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Anterior-posterior chest radiograph showing a dual-chamber His-bundle pacemaker (HBP). RA = right atrial. Mayo Clinic Proceedings: Innovations, Quality & Outcomes 2019 3, 226-230DOI: (10.1016/j.mayocpiqo.2019.03.008) Copyright © 2019 Mayo Foundation for Medical Education and Research Terms and Conditions