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Bradycardia and Pacemakers/CRT

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MGH Cardiology Board Review

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Abstract

Bradyarrhythmias are a heterogeneous group of cardiac rhythm disturbances which are implicated in over 40 % of sudden cardiac deaths in the hospital. Broadly classified, they are manifestations of either a failure of cardiac impulse generation or impulse propagation. They may be physiologic and benign, as in sinus bradycardia and sinus arrhythmia in athletes, or pathologic and warranting intervention, as in compromising bradycardia from sinus node dysfunction or ventricular asystole from high-grade atrioventricular (AV) block after an anterior myocardial infarction (MI).

The purpose of this chapter is to review the pathophysiology of various bradyarrhythmias and to review treatment options available. In addition, a brief overview of pacemakers and cardiac resynchronization therapy (CRT) will be provided.

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Abbreviations

ACC:

American College of Cardiology

AF:

Atrial fibrillation

AHA:

American Heart Association

AV:

Atrioventricular

BPEG:

British Pacing Electrophysiology Group

bpm:

Beats per minute

CHB:

Complete heart block

CL:

Cycle length

CRT:

Cardiac resynchronization therapy

cSNRT:

Corrected sinoatrial node recovery time

ECG:

Electrocardiogram

EP:

Electrophysiologic

FDA:

Food and Drug Administration

HCM:

Hypertrophic cardiomyopathy

HF:

Heart failure

HR:

Heart rate

HRS:

Heart Rhythm Society

ICD:

Implantable cardioverter defibrillator

LAFB:

Left anterior fascicular block

LBBB:

Left bundle branch block

LPFB:

Left posterior fascicular block

LQT1:

Long QT syndrome type 1

LV:

Left ventricular

LVEF:

Left ventricular Ejection fraction

MI:

Myocardial infarction

NASPE:

North American Society for Pacing and Electro­physiology

NYHA:

New York Heart Association

PPM:

Permanent pacemakers

RA:

Right atrium

RBBB:

Right bundle branch block

RV:

Right ventricle

SA:

Sinoatrial

SACT:

Sinoatrial conduction time

SND:

Sinus node dysfunction

SNRT:

Sinoatrial node recovery time

VT:

Ventricular tachycardia

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Author information

Authors and Affiliations

  1. Harvard Medical School Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Gaurav A. Upadhyay MD (Clinical and Research Fellow)

  2. Harvard Medical School Cardiac Arrhythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jagmeet P. Singh MD, DPHIL (Associate Professor)

Authors
  1. Gaurav A. Upadhyay MD
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  2. Jagmeet P. Singh MD, DPHIL
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Editor information

Editors and Affiliations

  1. Cardiology Division Yawkey Building 5B, Room 5850, Massachusetts General Hospital, Boston, Massachusetts, USA

    Hanna K. Gaggin

  2. Cardiology Division Yawkey Building, Suite 5984, Massachusetts General Hospital, Boston, Massachusetts, USA

    James L. Januzzi, Jr.

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Upadhyay, G.A., Singh, J.P. (2014). Bradycardia and Pacemakers/CRT. In: Gaggin, H., Januzzi, Jr., J. (eds) MGH Cardiology Board Review. Springer, London. https://doi.org/10.1007/978-1-4471-4483-0_25

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  • DOI: https://doi.org/10.1007/978-1-4471-4483-0_25

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  • Online ISBN: 978-1-4471-4483-0

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