Case of successful treatment of second-degree AV block in patient with gastroesophageal reflux disease associated with hiatal hernia

Clinical observation of a young patient without an organic pathology of the heart, who repeatedly sought medical help in connection with complaints of episodes of dizziness, lability of blood pressure and pulse numbers, is presented. The medical survey revealed a link between clinical symptoms and progressive retardation of AV conduction (from first-degree AV block to second-degree Mobitz II), and therefore the patient was recommended to be implanted with permanent artificial cardiac pacemaker. To clarify the nature of the conduction disorders, an invasive electrophysiology study was performed, which revealed a proximal AV block due to vagal influences. As the most likely cause of stimulation n. vagus was considered identified in a patient gastroesophageal reflux disease associated with hiatal hernia. Surgical treatment (laparoscopic fundoplication) led to a regression of the clinical and electrocardiographic picture, avoiding the implantation of permanent artificial cardiac pacemaker. The tactic chosen is consistent with the algorithm for managing patients with AV conduction abnormalities (2018 ACC / AHA / HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay), which involves eliminating potentially reversible causes of bradyarrhythmia before deciding whether to install permanent artificial cardiac pacemaker.

Epidemiological Record of Permanent Artificial Cardiac Pacemaker Implant at a Reference Center

Objective: To identify the profile of patients who implanted pacemakers and their complications in a tertiary cardiology center in the state of Santa Catarina. Methods: Unicentric, observational and prospective study with 81 patients submitted to pacemaker implantation by the Cardiovascular Surgery Service. Results: Provisional pacemaker was necessary in 42 cases (51.8%) and the average time of temporary pacemaker insertion was 2.2 days. Death occurred in 3 patients (3.7%), however only 1 case (1.2%) was associated with the implant. Conclusion: The clinical characteristics and indications of the implant in the study population were similar to those found in the literature, however the number of complications was high and the length of stay of the provisional pacemaker is beyond that recommended.

Biomedical Instrumentation

This paper covers the measurement of biopotentials for diagnosis: the electrical voltages that can be measured from electrodes placed on the skin or within the body. Biopotentials include: the electrocardiogram (ECG), electroencephalogram (EEG), electrocortogram (ECoG), electromyogram (EMG), electroneurogram (ENG), electrogastrogram (EGG), action potential (AP), electroretinogram (ERG), electro-oculogram (EOG). This paper also covers skin conductance, pulse oximeters, urology, wearable systems and important therapeutic devices such as: the artificial cardiac pacemaker, defibrillator, cochlear implant, hemodialysis, lithotripsy, ventilator, anesthesia machine, heart-lung machine, infant incubator, infusion pumps, electrosurgery, tissue ablation, and medical imaging. It concludes by covering electrical safety. It provides future subjects for research such as a blood glucose sensor and a permanently implanted intracranial pressure sensor.