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Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Serious AEs were rare; 1 patient in the etripamil arm experienced transient severe bradycardia and syncope, assessed as due to hyper-vagotonia.Conclusions:Intranasal etripamil 70 mg reduced VR and improved symptom-relief and treatment-satisfaction.
There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. mEq of K pushed fast and circulated theoretically would raise serum K immediately by 1.0
She has not yet been seen by electrophysiology or had further genetic testing for Brugada syndrome. Circulation, 117, 1890–1893. [3]: As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up. Heart Rhythm, 13(7): 1515-1520. [2]:
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.
He was discharged with an event monitor and electrophysiology follow up. Perhaps because the bradycardia in vasovagal syncope is only one part of the autonomic response. Phase 4 block is also referred to as "bradycardia dependent block." Circulation , 143 (10), 10621065. What do you think? A stunning result.
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