His bundle pacing in a patient with atrioventricular conduction abnormalities, persistent atrial flutter at high thromboembolic and bleeding risk after hybrid coronary revascularization and left atrial appendage closure - case report
We present a case of a 78-year-old patient with persistent atrial fl utter, history of atrial fi brillation and atrioventricular conduction disturbances, including fi rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial fl utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and effi cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach..
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
|---|---|
| Enthalten in: |
Българска кардиология - 29(2023), 4, Seite 82-88 |
| Sprache: |
Bulgarisch ; Englisch |
|---|
| Beteiligte Personen: |
M Szotek [VerfasserIn] |
|---|
| Links: |
doi.org [kostenfrei] |
|---|
| Themen: |
Diseases of the circulatory (Cardiovascular) system |
|---|
| doi: |
10.3897/bgcardio.29.e116198 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
DOAJ097822671 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | DOAJ097822671 | ||
| 003 | DE-627 | ||
| 005 | 20240413195013.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240413s2023 xx |||||o 00| ||bul c | ||
| 024 | 7 | |a 10.3897/bgcardio.29.e116198 |2 doi | |
| 035 | |a (DE-627)DOAJ097822671 | ||
| 035 | |a (DE-599)DOAJfaac09d07b804b48a1fafb036e9bf8ca | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a bul |a eng | ||
| 050 | 0 | |a RC666-701 | |
| 100 | 0 | |a M Szotek |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a His bundle pacing in a patient with atrioventricular conduction abnormalities, persistent atrial flutter at high thromboembolic and bleeding risk after hybrid coronary revascularization and left atrial appendage closure - case report |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a We present a case of a 78-year-old patient with persistent atrial fl utter, history of atrial fi brillation and atrioventricular conduction disturbances, including fi rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial fl utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and effi cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach. | ||
| 653 | 0 | |a Medicine | |
| 653 | 0 | |a R | |
| 653 | 0 | |a Diseases of the circulatory (Cardiovascular) system | |
| 700 | 0 | |a W. Kula |e verfasserin |4 aut | |
| 700 | 0 | |a A. Malik |e verfasserin |4 aut | |
| 700 | 0 | |a A. Czunko |e verfasserin |4 aut | |
| 700 | 0 | |a J. Lelakowski |e verfasserin |4 aut | |
| 700 | 0 | |a V. Traykov |e verfasserin |4 aut | |
| 700 | 0 | |a P. Matusik |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i In |t Българска кардиология |d Pensoft Publishers, 2020 |g 29(2023), 4, Seite 82-88 |w (DE-627)DOAJ000148261 |x 26831015 |7 nnns |
| 773 | 1 | 8 | |g volume:29 |g year:2023 |g number:4 |g pages:82-88 |
| 856 | 4 | 0 | |u https://doi.org/10.3897/bgcardio.29.e116198 |z kostenfrei |
| 856 | 4 | 0 | |u https://doaj.org/article/faac09d07b804b48a1fafb036e9bf8ca |z kostenfrei |
| 856 | 4 | 0 | |u https://journal.bgcardio.org/article/116198/download/pdf/ |z kostenfrei |
| 856 | 4 | 0 | |u https://journal.bgcardio.org/article/116198/download/xml/ |z kostenfrei |
| 856 | 4 | 0 | |u https://journal.bgcardio.org/article/116198/ |z kostenfrei |
| 856 | 4 | 2 | |u https://doaj.org/toc/2683-1015 |y Journal toc |z kostenfrei |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_DOAJ | ||
| 951 | |a AR | ||
| 952 | |d 29 |j 2023 |e 4 |h 82-88 | ||