Remove Academic Remove Bradycardia Remove Heart Failure
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What is the mechanism of LBBB in DCM ? How does left bundle branch pacing correct it ?

Dr. S. Venkatesan MD

Unfortunately ,there appears to be a herd mentality, gradually creeping in to many of us, to jump over from traditional RV /RA pacing to the bundle branch area pacing , as an alternative to CRT or even regular bradycardia pacing. There is less compelling academic reasons for this change, than we think.

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A 20-something woman with cardiac arrest.

Dr. Smith's ECG Blog

During the night, while on telemetry, the patient became bradycardic, with periods of isorhythmic AV dissociation (nodal escape rhythm alternating with sinus bradycardia), and there were sporadic PVCs. NT-pro-BNP peaked at 4831, consistent with heart failure. This is what T-waves look like when there is a long QT."

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. Breath sounds were clear in all lung fields. No appreciable skin pallor. He reported to be a social drinker, but used tobacco products daily.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.