Diagnosis difficulties in elderly patients with atrial fibrillation and complete atrioventricular block
DOI:
https://doi.org/10.14739/2310-1237.2021.3.243299Keywords:
atrial fibrillation, atrioventricular block, pacemaker, Morgagni–Adams–Stokes attacks.Abstract
The association of atrial fibrillation (AF) with complete atrioventricular block (CAVB) is a common clinical feature in elderly patients. It is characterized by the loss of specific symptoms of AF (palpitations, intermissions); in the first place may come CAVB symptoms: dizziness, Morgagni–Adams–Stokes (MAS) attacks.
Aim. The article objective is to illustrate the dynamic changes in the course of AF with the development of CAVB on the example of a clinical case and to discuss the difficulties in timely diagnosis and therapy correction.
Case presentation. A 75-year-old male was diagnosed with a rapid ventricular response form of AF. The onset of CAVB caused the transition from rapid ventricular response form of AF to slow ventricular response form, which was initially accompanied by a subjective improvement in the patient’s condition. As the disease progressed, the patient’s condition worsened due to the development of MAS attacks.
The elderly patients with a permanent form of AF require constant cardiac monitoring by an experienced specialist who has appropriate vigilance in management of patients with arrhythmias, awareness about possible concomitant conduction disorders.
This provides comprehensive cardiac support, including timely pacemaker implantation which gives more options for AF symptoms monitoring and heart rate control, has a positive modifying effect on drug therapy.
Conclusions. Changes in the clinical picture of AF after development of CAVB can lead to late diagnosis of CAVB, inadequate therapy and untimely pacemaker implantation, as a consequence, to progression of concomitant pathology and the development of life-threatening complications, as in our clinical case.
References
Staerk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2017). Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. Circulation research, 120(9), 1501-1517. https://doi.org/10.1161/CIRCRESAHA.117.309732
Mou, L., Norby, F. L., Chen, L. Y., O'Neal, W. T., Lewis, T. T., Loehr, L. R., Soliman, E. Z., & Alonso, A. (2018). Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status: ARIC Study (Atherosclerosis Risk in Communities). Circulation. Arrhythmia and electrophysiology, 11(7), e006350. https://doi.org/10.1161/CIRCEP.118.006350
Chao, T. F., Liu, C. J., Tuan, T. C., Chen, T. J., Hsieh, M. H., Lip, G., & Chen, S. A. (2018). Lifetime Risks, Projected Numbers, and Adverse Outcomes in Asian Patients With Atrial Fibrillation: A Report From the Taiwan Nationwide AF Cohort Study. Chest, 153(2), 453-466. https://doi.org/10.1016/j.chest.2017.10.001
Lee, E., Choi, E. K., Han, K. D., Lee, H., Choe, W. S., Lee, S. R., Cha, M. J., Lim, W. H., Kim, Y. J., & Oh, S. (2018). Mortality and causes of death in patients with atrial fibrillation: A nationwide population-based study. PloS one, 13(12), e0209687. https://doi.org/10.1371/journal.pone.0209687
Dan, G. A., Iliodromitis, K., Scherr, D., Marín, F., Lenarczyk, R., Estner, H. L., Kostkiewicz, M., Dagres, N., & Lip, G. (2018). Translating guidelines into practice for the management of atrial fibrillation: results of an European Heart Rhythm Association Survey. Europace, 20(8), 1382-1387. https://doi.org/10.1093/europace/euy094
Zhang, L., He, J., Lian, M., Zhao, L., & Xie, X. (2018). Dynamic Electrocardiography is Useful in the Diagnosis of Persistent Atrial Fibrillation Accompanied with Second-Degree Atrioventricular Block. Acta Cardiologica Sinica, 34(5), 409-416. https://doi.org/10.6515/ACS.201809_34(5).20180326E
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C., Boriani, G., Castella, M., Dan, G. A., Dilaveris, P. E., Fauchier, L., Filippatos, G., Kalman, J. M., La Meir, M., Lane, D. A., Lebeau, J. P., Lettino, M., Lip, G., Pinto, F. J., Thomas, G. N., … ESC Scientific Document Group (2021). 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European heart journal, 42(5), 373-498. https://doi.org/10.1093/eurheartj/ehaa612
Thind, M., Holmes, D. N., Badri, M., Pieper, K. S., Singh, A., Blanco, R. G., Steinberg, B. A., Fonarow, G. C., Gersh, B. J., Mahaffey, K. W., Peterson, E. D., Reiffel, J. A., Piccini, J. P., Kowey, P. R., & ORBIT-AF Investigators and Patients (2018). Embolic and Other Adverse Outcomes in Symptomatic Versus Asymptomatic Patients With Atrial Fibrillation (from the ORBIT-AF Registry). The American journal of cardiology, 122(10), 1677-1683. https://doi.org/10.1016/j.amjcard.2018.07.045
Lim, Y., Singh, D., & Poh, K. K. (2018). High-grade atrioventricular block. Singapore medical journal, 59(7), 346-350. https://doi.org/10.11622/smedj.2018086
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., Lee, R., Marine, J. E., McLeod, C. J., Oken, K. R., Patton, K. K., Pellegrini, C. N., Selzman, K. A., Thompson, A., & Varosy, P. D. (2019). 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 74(7), e51-e156. https://doi.org/10.1016/j.jacc.2018.10.044
Kirchhof, P., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., van Gelder, I. C., Haase, D., Haegeli, L. M., Hamann, F., Heidbüchel, H., Hindricks, G., Kautzner, J., Kuck, K. H., Mont, L., Ng, G. A., Rekosz, J., Schoen, N., Schotten, U., … EAST-AFNET 4 Trial Investigators (2020). Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. The New England journal of medicine, 383(14), 1305-1316. https://doi.org/10.1056/NEJMoa2019422
January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Jr, Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., Heidenreich, P. A., Murray, K. T., Shea, J. B., Tracy, C. M., & Yancy, C. W. (2019). 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 74(1), 104-132. https://doi.org/10.1016/j.jacc.2019.01.011
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S. E., Kreutz, R., Laurent, S., Lip, G., … ESC Scientific Document Group (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European heart journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., Cleland, J., Coats, A., Crespo-Leiro, M. G., Farmakis, D., Gilard, M., Heymans, S., Hoes, A. W., Jaarsma, T., Jankowska, E. A., Lainscak, M., … ESC Scientific Document Group (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European heart journal, 42(36), 3599-3726. https://doi.org/10.1093/eurheartj/ehab368
Hauptman, P. J., Swindle, J. P., Masoudi, F. A., & Burroughs, T. E. (2010). Underutilization of beta-blockers in patients undergoing implantable cardioverter-defibrillator and cardiac resynchronization procedures. Circulation. Cardiovascular quality and outcomes, 3(2), 204-211. https://doi.org/10.1161/CIRCOUTCOMES.109.880450
Jellinger, P. S., Handelsman, Y., Rosenblit, P. D., Bloomgarden, Z. T., Fonseca, V. A., Garber, A. J., Grunberger, G., Guerin, C. K., Bell, D., Mechanick, J. I., Pessah-Pollack, R., Wyne, K., Smith, D., Brinton, E. A., Fazio, S., & Davidson, M. (2017). American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocrine practice, 23(Suppl 2), 1-87. https://doi.org/10.4158/EP171764.APPGL
Inoue, H., Uchiyama, S., Atarashi, H., Okumura, K., Koretsune, Y., Yasaka, M., Yamashita, T., Taniguchi, A., Fukaya, T., & J-Dabigation Surveillance Investigators (2019). Effectiveness and safety of long-term dabigatran among patients with non-valvular atrial fibrillation in clinical practice: J-dabigatran surveillance. Journal of cardiology, 73(6), 507-514. https://doi.org/10.1016/j.jjcc.2018.12.013
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
