scholarly journals Rare Case of Rapidly Worsening REM Sleep Induced Bradycardia

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ayyappa S. Duba ◽  
Suneetha Jasty ◽  
Ankit Mahajan ◽  
Vijay Kodadhala ◽  
Raza Khan ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Rare Case ◽  
Sinoatrial Node ◽  
Past Medical History ◽  
Sinus Arrest ◽  
Dual Chamber ◽  
Significant Past Medical History ◽  
Sleep Study ◽  
Dual Chamber Pacemaker ◽  
Over Time

Sinoatrial arrest also known as sinus pause occurs when sinoatrial node of the heart transiently ceases to generate the electrical impulse necessary for the myocardium to contract. It may last from 2.0 seconds to several minutes. Etiologies of sinoatrial arrest can be complex and heterogeneous. During rapid eye movement (REM) sleep, sinus arrests unrelated to apnea or hypopnea are very rare and only a few cases have been reported. Here we report a case of 36-year-old male with no significant past medical history who presented to our hospital after a syncopal episode at night. Physical examination showed no cardiac or neurological abnormalities and initial EKG and neuroimaging were normal. Overnight telemonitor recorded several episodes of bradyarrhythmia with sinus arrest that progressively lengthened over time. Sleep study was done which confirmed that sinus arrests occurred more during REM sleep and are unrelated to apnea or hypopnea. Electrophysiology studies showed sinus nodal dysfunction with no junctional escape, subsequently a dual chamber pacemaker placed for rapidly worsening case of REM sleep induced bradycardia.

Twiddler’s syndrome with occult lead insulation damage in a child with epicardial pacemaker leads

2020 ◽  
Vol 30 (6) ◽  
pp. 890-891
Author(s):  
Peter Kramer ◽  
Felix Berger ◽  
Björn Peters
Keyword(s):  
Rare Case ◽  
Pacemaker Lead ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Ventricular Lead ◽  
Insulation Defect ◽  
Pacemaker Leads ◽  
Twiddler’S Syndrome ◽  
Lead Testing

AbstractWe present a rare case of incidentally diagnosed Twiddler’s syndrome in a child 7 years after implantation of a dual-chamber pacemaker system with epicardial leads. During revision, an insulation defect of the ventricular lead was evident, despite unremarkable prior pacemaker lead testing. The lead was repaired and a new generator was suture-fixated to prevent re-occurrence of generator manipulation.

scholarly journals Giant haemorrhagic retroperitoneal mesothelial cyst: a rare case report

2017 ◽  
Vol 5 (10) ◽  
pp. 4626
Author(s):  
Sandesh Deolekar ◽  
Bibekananda Mahapatra ◽  
Sridevi Murali ◽  
Karna Chheda ◽  
Naseem Khan ◽  
...  
Keyword(s):  
Rare Case ◽  
Unusual Case ◽  
Abdominal Discomfort ◽  
Mesenteric Cyst ◽  
Past Medical History ◽  
Significant Past Medical History ◽  
Mesothelial Cyst ◽  
Rare Case Report ◽  
Specific Symptoms ◽  
Cystic Mesothelioma

A peritoneal cystic mesothelioma is a very rare mesenteric cyst of mesothelial origin. The size of this lesion usually ranges between a few centimetres and 10 cm. It is usually asymptomatic, but occasionally presents with various, non-specific symptoms. We present a 24-years-old woman with vague abdominal discomfort and associated distension for 6 months, with generalized weakness with no significant past medical history. This is an unusual case of a giant peritoneal mesothelioma which is hemorrhagic nature which could be the first such case reported. 

scholarly journals Seizure Triggered by Sick Sinus Syndrome

2017 ◽  
pp. bcr-2017-222011 ◽  
Author(s):  
Nilesh Patel ◽  
Faisal Majeed ◽  
Anupam Ashutosh Sule
Keyword(s):  
Sinoatrial Node ◽  
Sick Sinus Syndrome ◽  
Cerebral Hypoperfusion ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Definitive Therapy ◽  
Clonic Seizures ◽  
Symptomatic Bradycardia ◽  
Sinus Dysfunction ◽  
Convulsive Syncope

Sick sinus syndrome (SSS) is a dysfunction of sinoatrial node resulting in symptomatic bradycardia or sinus pauses causing decreased cardiac output with cerebral hypoperfusion and usually presents as syncope, presyncope or fatigue. The occurrence of a seizure is very rare. A 69-year-old man suffered two episodes of generalised tonic–clonic seizures. MRI and electroencephalogram failed to reveal the cause of seizures. In the emergency room, he experienced presyncope simultaneous to bradycardia and sinus pauses. He was stabilised with atropine and dopamine infusion and underwent definitive therapy with a permanent dual-chamber pacemaker with complete symptom resolution. Diagnostic confounders include convulsive syncope and ictal bradycardia. Syncope may be accompanied by myoclonic jerks (convulsive syncope), but postictal confusion is absent. Bradycardia may be seen during the postictal period (ictal bradycardia syndrome), but protracted sinus dysfunction is not present. Hypoperfusion due to significant SSS triggered seizures in this patient who may have an underlying predisposition.

scholarly journals Tracheal Diverticulum: A Unique Case with Intraoperative Morphologic Assessment

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Rohini Chennuri ◽  
Pavithra Dissanayake ◽  
Urjeet A. Patel ◽  
Gabor Tarjan
Keyword(s):  
Rare Case ◽  
Case Reports ◽  
Past Medical History ◽  
Minor Salivary Glands ◽  
Imaging Studies ◽  
Significant Past Medical History ◽  
Unique Case ◽  
Radiologic Findings ◽  
Tracheal Diverticulum ◽  
Cystic Cavity

There are rare case reports of tracheal diverticula or paratracheal air cysts. These cases, however, were reported mostly as incidental sonographic or radiologic findings without histologic confirmation. Furthermore, the handful of studies that describe this entity histopathologically report only cases in patients with prior respiratory symptoms. Here, we report a rare case of an asymptomatic 60-year-old female with no significant past medical history who presented with primary hyperparathyroidism. She was found to have an incidental right paraesophageal air-filled diverticulum with multiple thin septations on her imaging studies. She was taken to surgery and the histologic examination of the specimen revealed multiloculated cystic cavity lined by respiratory-type columnar epithelium with lymphocytic infiltrate and minor salivary glands within the surrounding stroma, rendering the diagnosis of tracheal diverticula.

scholarly journals A case report of inappropriate inhibition of ventricular pacing due to a unique pacemaker electrogram storage feature

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Habib R Khan ◽  
William K Chan ◽  
Juliana Kanawati ◽  
Raymond Yee
Keyword(s):  
Rare Case ◽  
Storage Capacitor ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Holter Monitor ◽  
Case Summary ◽  
Ventricular Lead ◽  
Internal Function ◽  
Third Degree Atrioventricular Block

Abstract Background Modern permanent pacemakers (PPMs) have individual features designed to identify cardiac rhythm abnormalities and improve their performance. Inappropriate pacing inhibition may be an undesired outcome from these features and cause symptoms in patients who require frequent pacing, leading to dizziness, and syncope. Inappropriate inhibition can be difficult to identify in circumstances that are intermittent and difficult to reproduce. Case summary A 57-year-old female underwent a mitral valve replacement (MVR) for severe mitral stenosis. One month following MVR, she presented with symptomatic third-degree atrioventricular block, and a dual-chamber PPM (Advisa™, Medtronic, Minneapolis, USA) was implanted and programmed DDD 50–130 b.p.m. At the 3-month follow-up, she reported frequent episodes of lightheadedness. She was found to have intermittent ventricular pacing inhibition on a 48-h Holter monitor due to an internal function of the Advisa™ series of PPMs that attempts to store an electrogram (EGM) every 1 h and 30 s. During the EGM storage, an amplified signal from the storage capacitor can result in oversensing by the ventricular channel and inappropriate pacing inhibition. Discussion To rectify the issue, the ventricular lead sensitivity value was increased from 0.9 mV to 1.2 mV. No instances of inappropriate ventricular pacing inhibition were noted on follow-up. To our knowledge, this is a rare case of inappropriate ventricular pacing inhibition caused by a combination of PPM self-adjusting sensitivity algorithm and oversensing every 1 h and 30 s from an amplified storage capacitor. Physicians should be aware of this possible complication and differentiate it from device or lead malfunction.

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