Bradycardia

Hy\VES, D.L. AND FURMAN, S.: Atrio-ventricular and ventriculo-atrial conduction times in patients undergoing pacemaker implant. Pacemaker mediated reentrant tachycardias have been seen frequently during use 0/ dual chamber sensing pacemakers and are dependent on the presence of intact retrograde (ventriculo-atrial] conduction. The status of a patient's retrograde (VA) conduction cannot be deferminedfrom fhe surface electrocardiogram. At the time of pacemaker implant the state of antegrade conduction should be determined at incremental atrial pacing rates, the exact timing measured from the intracardiac electrograms, i.e., from the intrinsic deflection of the atrium to the intrinsic deflection of the ventricle. With this information obtained in 53 patients, it was possible to determine which patients could safely receive dual chamber sensing pacemaker devices, the appropriate pacemaker atriai refractory period setting to avoid pacemaker mediated tachycardias in those patients with intuct retrograde conduction, and the optimal timing for programming the pacemaker's AV delay. Patients who have been studied in this manner and who were felt to be suitable for a dual chamber sensing device have not displayed pacemaker mediated reentrant tachycardias. Forty-seven percent of all patients who require pacemaker impiant have VA 1:1 conduction: 67% of those with sinus node dysfunction and lVA. of those with complete antegrade bJock have VA conduction at a mean interval of 235 ± 5d ms (range 110-380

Profound bradycardia during eye surgery is potentially serious event. In clinical practice this Oculocardiac Reflex (OCR) is most often encountered during squint surgery. The objective of this study was to assess the occurrence of OCR and prove the effect of anticholinergic premedication (atropine) to prevent OCR. This study comprises of sixty patients (age 2-30 years) operated for squint surgery under general anaesthesia. Cases were divided into two groups of thirty each. Group 1 was premedicated with intravenous injection of atropine and Group 2 did not receive any premedication. Patients were monitored during operation for any bradycardia or dysrhythmias. The observed data showed occurrence of 70% OCR in Group 2 as compared to only 10% in Group 1. Severe bradycardia in 40% cases of Group 2 needed intervention by IV injection of atropine. Our study showed that atropine premedication in the patients of squint surgery under general anaesthesia definitely obtunds OCR and prevents any...

Our earlier studies demonstrated the ability of L-arginine (L-Arg) to reverse radiation-induced immune dysfunction. The aim of the present study was to investigate cardiac dysfunction up to 24 h after 2 Gy of total-body irradiation (TBI) and its mitigation by L-Arg. The current studies also explore the association of radiation-induced inflammation and electrocardiographic (ECG) abnormalities. TBI-induced cardiac iNOS and kinin B1 R, changes in the ECG profile like bradycardia, increased RR interval, ST elevation and increased QRS duration at 4 h and 24 h after TBI. TBI with 2 Gy induced inflammatory responses in spleen and cardiac tissue. L-Arg administered 2 h after TBI (TBI+L-Arg) mitigated the entire inflammatory response and ECG profile toward normalcy. L-Arg administered just before TBI (L-Arg +TBI) could not reverse the above-mentioned changes. Radiation-induced inflammatory responses at +4 h and +24 h after TBI in spleen and cardiac tissue correlated with the changes in ECG profile at the corresponding time. The results suggest the ability of L-Arg administered at the correct therapeutic window to mitigate radiation-induced cardiac dysfunction at 4 and 24 h after TBI.

Les apnées du prématuré constituent encore actuellement un problème clinique majeur, imposant des choix thérapeutiques parfois difficiles. Des apnées plus ou moins longues surviennent chez presque tous les grands prématurés, témoignant d’une instabilité de la régulation respiratoire en rapport avec l’immaturité. Au rôle causal de celle-ci peut toutefois s’ajouter celui de nombreuses pathologies néonatales, qui peuvent aussi contribuer à la survenue d’apnées et doivent être recherchées et traitées. Les apnées du prématuré de courte durée (moins de dix secondes, sans hypoxémie ou bradycardie associée) peuvent être considérées comme sans risque pour l’enfant. Les apnées plus longues entraînent une hypoxémie et un ralentissement de la fréquence cardiaque et des perturbations de l’hémodynamique et de l’oxygénation cérébrales, susceptibles d’entraîner des effets délétères pour le développement à long terme. L’évaluation de leur degré de gravité immédiate et de leurs risques à long terme demeure imprécise. Les décisions thérapeutiques ne peuvent s’appuyer que sur assez peu de données scientifiques. Le citrate de caféine est un traitement efficace des apnées du prématuré, largement utilisé depuis des décennies. Mais c’est seulement très récemment qu’une évaluation rigoureuse de ses bénéfices et de ses inconvénients a été menée. Elle a mis en évidence la faible toxicité du citrate de caféine, et des bénéfices inattendus chez les enfants traités : diminution de fréquence des dysplasies bronchopulmonaires, de la persistance du canal artériel, et, à 18 mois, diminution du taux d’infirmité motrice cérébrale. La pression expiratoire positive par voie nasale, traitement également efficace des apnées, peut être utilisée en cas d’échec ou d’insuffisance du traitement par caféine et en association avec lui.Prematurity apnea remains a major clinical problem that requires treatment choices which are sometimes difficult. Prematurity apnea occurs in most infants of gestational age at birth less than 33 weeks. It is a developmental disorder which usually reflects a “physiological” immaturity of respiratory control. However, neonatal diseases may be associated and play an additive role, resulting in an increased incidence of apnea. Careful screening should therefore be performed in order to make sure that no other factor than immaturity is involved in the occurrence of apnea. Short apnea (less than 10 s, without hypoxemia and bradycardia), due to immaturity, are not clinically relevant. More prolonged apnea, that last for more than 15 or 20 s, and / or apnea associated with bradycardia or oxygen desaturation, results in short-term disturbances of cerebral haemodynamics and oxygenation, which may negatively impact on neurodevelopmental outcome. Evaluating the immediate severity of apnea and the risks that apnea may affect long-term outcome remains a challenge. The choice of treatments is based on a few evidences. Caffeine citrate, which reduces the incidence of apnea, has been used for decades. However, a thorough evaluation of risks and benefits of this medication has been performed only recently. Caffeine citrate was found to be safe and resulted in unexpected benefits. In treated infants, compared with controls, indeed, a decreased incidence of the following complications was recorded: bronchopulmonary dysplasia at 36 weeks of conceptional age, patent ductus arteriosus, cerebral palsy at 18 months of age. Nasal CPAP can be used in association with caffeine citrate, when the latter is not effective enough.

Interchangeability between fast Fourier transform (FFT) and autoregressive (AR) analysis was assessed on series of 256 R-R intervals recorded in 56 seated subjects and in 15 men performing an orthostatic test. Low-(LF) and high-frequency (HF) components were calculated and expressed both in absolute (square milliseconds) and normalized units (NU). During orthostatic stress, the same upward trend for LF square milliseconds and LF/HF ratio and downward trend for HF square milliseconds and HF NU were observed with FFT and AR analysis. However, the values for HF square milliseconds were significantly greater with FFT, as compared with AR analysis in standing position ( P b .05). Moreover, Bland & Altman method highlighted a large discrepancy between the results of FFT and AR analysis for all heart rate variability indices in the 3 conditions. Therefore, parametric and nonparametric spectral analyses could not be considered as interchangeable at rest in healthy subjects even if they give same qualitative results. D

Interstitial deletions of the proximal short arm of chromosome 3 occurring as constitutional aberrations are rare and a defined clinical phenotype is not established yet. We report on a 30-months-old girl with distinct facial features (square facies, plagiocephaly, broad forehead, broad nasal bridge, long philtrum and low set ears) and psychomotor/speech delay associated with an interstitial deletion of 3p12 chromosomal band, del(3)(p12p12). Clinical manifestations of our child were compared with those of other eight patients with the same deletion previously described to further delineate the proximal 3p deletion syndrome.

developed a sinusal bradycardia after receiving intermediate or high dose cytarabine. Two were men, median age was 27 years (17-68); two had chromosomal abnormalities: t(3;5) and t(8;14) respectively; no data on polymorphisms in cytarabine metabolism are available. VP16, an anthracycline (daunoblastine or mitoxantrone) and fludarabine for acute myelogenous leukaemia patients, and high dose methotrexate for L3, were associated. No cardioactive drug or morphine was used. No electrolyte imbalance, ischemic cardiopathy, hypothermia, typhoid fever, virus infection were recorded before the diagnosis of bradycardia; benzyl alcohol containing diluent was not used and the drug was manufactured and diluted in the same way. One patient had mild allergy to nonsteroidal anti-inflammatory drugs. At diagnosis, alterations on echocardiography were recorded in two patients (mitralic insufficiency and prolapse respectively), and all the patients had a baseline electrocardiogram that heart rate ranged from 60 to 120 bpm with normal morphology.

Part of the Orthopedics Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Orthopaedic Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons.

Until now, there has been neither an agreed-upon experimental model nor descriptors of the clinical symptoms that occur over the course of acute murine infection. The aim of this work is to use non-invasive methods to evaluate clinical signs in Swiss Webster mice that were experimentally infected with the Y strain of Trypanosoma cruzi during acute phase (Inf group). Infected mice showed evident clinical changes beginning in the second week of infection (wpi): (i) animals in hunched postures, closed eyes, lowered ears, peeling skin, increased piloerection, prostration and social isolation; (ii) significant decrease in the body weight (Inf: 26.2±2.6 g vs. non-infected group (NI) 34.2±2.5 g), chow (1.5±0.3 vs. 6.3±0.5 mg) and water (2.4±0.5 vs. 5.8±0.7 ml) intake; (iii) significant decrease of the spontaneous activity as locomotor parameters: distance (0.64±0.06 vs. 1.8±0.13 m), the velocity (1.9±0.3 vs. 6.7±1.5 cm/s) and exploratory behaviour by the frequency (1.0±0.5 vs.5....

Typhoid fever, a systemic infectious disease caused by Salmonella typhi, is classically characterized by fever, paradoxical bradycardia, abdominal pain, and a rose colored rash. This was a retrospective review of 21 confirmed cases over a 5-year period. Mean age was 32.6 years (range 2–60 years), and Mexico (7/21) and El Salvador (3/21) represented the most common countries of origin. Recent travel to an endemic area was noted in 14 patients. The most common complaints were fever (15/21), headache (10/21), abdominal pain (9/21), and diarrhea (6/21). Average duration of symptoms before presentation to the Emergency Department (ED) was 7.9 days. High fever associated with bradycardia was noted in 12 patients. Leukopenia was present in 7 patients. Blood culture was the most sensitive confirmatory test while the Widal test was positive in 7 out of 11 cases. Fever of unknown origin (12/21), followed by presumed typhoid fever (3/21) were the most common ED diagnoses. It is important to re...

Postural sway and heart rate were recorded in young men viewing emotionally engaging pictures. It was hypothesized that they would show a human analog of “freezing” behavior (i.e., immobility and heart rate deceleration) when confronted with a sustained block of unpleasant (mutilation) images, relative to their response to pleasant/arousing (sport action) or neutral (objects) pictures. Volunteers stood on a stabilometric platform during picture viewing. Significantly reduced body sway was recorded during the unpleasant pictures, along with increased mean power frequency (indexing muscle stiffness). Heart rate during unpleasant pictures also showed the expected greater deceleration. This pattern resembles the “freezing” and “fear bradycardia” seen in many species when confronted with threatening stimuli, mediated by neural circuits that promote defensive survival.

To ascertain whether the implementation of a paced feeding protocol in a sample of preterm infants with respiratory diagnoses will result in the development of more efficient sucking patterns, increased weight gain, decreased incidence of bradycardia during feeding, and shorter length of hospital stay.

maker-ICD Interactions. Numerous types of interactions between pacemakers und implantable curdioverter defibrillators (ICDs) have been described. Pacemaker outputs preventing appropriate detection of ventricular tachycardia or ventricular fibrillution by the ICD is one of the more serious. Asvnchronous pacemaker activity during ventricular arrhythmias may be caused by either nonsensing of the arrhvthmia or by noise reversion, which is an algorithm that causes the pacemaker to switch to asynchronous pacing when repetitive sensing at a high rate occurs. We analyzed the mechanisms underlying asynchronous pacemaker activity in ventricular arrhythmias using pacemaker telemetry during the arrhythmia. Thirtynine induced arrhythmias from 26 different procedures in 19 patients with both pacemakers and ICDs were analyzed. Of the 39 arrhythmias, asynchronous pacemaker activity occurred in 16. The underlying mechanism was nonsensing in 4 episodes and noise reversion in 12 episodes. Clinically significant interference with detection arose on three occasions. Conditions favoring the occurrence of noise reversion include specific pacemaker models, arrhythmia cycle lengths in the range causing noise reversion of the individual pacemaker model, long noise sampling periods, and VVI pacing mode. Noise reversion can be diagnosed by telemetering the pacemaker marker channel during ventricular arrhvthmias as a part of routine pacemaker-ICD interaction evaluation. It can be prevented or minimized by programming short ventricular refractory periods or using pacemakers with shoii retriggerable refractory periods.

and Gynecologists, and the Society for Maternal-Fetal Medicine partnered to sponsor a 2-day workshop to revisit nomenclature, interpretation, and research recommendations for intrapartum electronic fetal heart rate monitoring. Participants included obstetric experts and representatives from relevant stakeholder groups and organizations. This article provides a summary of the discussions at the workshop. This includes a discussion of terminology and nomenclature for the description of fetal heart tracings and uterine contractions for use in clinical practice and research. A three-tier system for fetal heart rate tracing interpretation is also described. Lastly, prioritized topics for future research are provided.

Background: Kangaroo care, i.e., skin-to-skin cohabitation (SSC) between an infant and caregiver, is often used in neonatal intensive care units to promote bonding, breastfeeding and infant growth. The direct salutary effects of SSC on cardio-respiratory control in preterm infants remain equivocal; some reports suggest improved breathing stability, others indicate worsening of apnea, bradycardia and hypoxemia. Aim: The purpose of this study was to investigate physiological relationships between the infant and caregiver during SSC. We hypothesized that respiratory stability of the premature infant is influenced by the caregiver's heartbeat. Design: A prospective study was performed in eleven preterm infants (6 female; mean PCA 32 wks). SSC was compared to a preceding incubator-control period (CTL) matched for time from feed and condition duration. Abdominal respiratory movement, electrocardiogram, skin temperature and blood-oxygen levels were recorded from the infant and the caregiver. Results: During CTL, infant interbreath interval variance (IBIv; respiratory instability) was directly related to its own heart rate variance (HRv; rho = 0.770, p = 0.009). During SSC, infant IBIv and apnea incidence were each related to caregiver HRv (rho 0.764, p = 0.006; rho 0.677, p = 0.022, respectively). Infant cardiorespiratory coupling was also enhanced during SSC compared to CTL in the eupneic frequency range (0.7-1.5 Hz, p = 0.018) and reduced for slower frequencies (0.15-0.45 Hz; p = 0.036). Conclusion: These findings suggest that during SSC, respiratory control of the premature infant is influenced by the caregiver's cardiac rhythm. We propose that the caregiver's heartbeat causes sensory perturbations of the infant via somatic or other afferents, revealing a novel cohabitation-induced feed-back mechanism of respiratory control in the neonate.

To make a low cost Heart rate monitor, to measure heart rate of a person using Lab VIEW software tool. The primary focus was on the cost constraint and reducing the hardware complexities. To build this Heart rate monitor, we have used simple component that can be easily available in any Electronics Lab. As we all of us know that heart rate indicate normal health of person, it also indicate a deviation of normal Heart rate, so it is helpful for medical practitioners to diagnose any kind of disease and can give helpful direction to provide effective treatment over the disease .Heart rate monitor is the primary equipment need to monitor the patient condition continuously. Heart rate monitor also indicate whether the person is suffering from Bradycardia or Tachycardia.

The NASPE/BPEG generic pacemaker code for antibradyarrhythmia and adaptive-rate pacing and antitachyarrhythmia devices. A new generic pacemaker code, derived from and compatible with the Revised ICHD Code, was proposed jointly by the North American Society of Pacing and EJectrophysioIogy (NASPE] Mode Code Committee and the British Pacing and ElectrophysioJogy Croup (BPEC], and has been adopted by the NASPE Board of Trustees. It is abbreviated as the NBC {for "NASPE/BPEC Generic"] Code, and was developed to permit extension of the generic-code concept to pacemakers whose escape rate is continuously controlled by monitoring some physiologic variable, rather than determined by jixed escape intervals measured from stimuli or sensed depolarizations, and to antitachyarrhythmia devices including cardioverters and dejibrillators. The NASPE/BPEC Code incorporates an "R" in the fourth position to signify rate modulation (adaptive-rate pacing], and one of four letters in the jifth position to indicate the presence of antitachyarrhythmia-pacing capability or of cardioversion or dejibrillation functions.

An 82-year-old widowed woman with a history of recurrent unipolar major depression is referred to the electroconvulsive therapy (ECT) service of an academic medical center. During her illness, she has had four episodes of major depression consisting of periods of depressed mood, crying spells, loss of interest in usual activities, insomnia, loss of appetite and weight, difficulty with concentration, feelings of helplessness and hopelessness, and thoughts of suicide. During the current episode, which has lasted for 6 months, she has had typical symptoms of melancholic depression, as well as psychotic symptoms (e.g., a somatic delusion that she has terminal cancer), with suicidal ideation and a plan for taking a drug overdose. Previous treatment during this episode has included citalopram (Celexa), duloxetine (Cymbalta), and the combination of olanzepine (Zyprexa) and duloxetine, but the patient did not have a response to any of these agents. She could not tolerate the anticholinergic side effects of tricyclic antidepressants. Her psychiatrist seeks specialty consultation regarding the appropriateness and safety of ECT for this patient.

The cardiovascular activity of the aqueous fraction of the hydroalcoholic extract of Sida cordifolia leaves (AFSC) was evaluated. In normotensive non-anaesthetized rats was observed that AFSC (5, 10, 20, 30 and 40 mg/kg, i.v.) induced hypotension (6 F 2%; 8 F 2%; 11 F 2%; 19 F 3% and 33 F 3%, respectively) and bradycardia (0.3 F 3%; 13 F 4%; 38 F 6%; 64 F 7% and 80 F 5%, respectively). Hypotensive response was completely abolished after atropine (2 mg/kg; i.v.) but potentialized after hexamethonium (20 mg/kg; i.v.) (12 F 2%; 21 F 5%; 28 F 3%; 32 F 2% and 32 F 3%, respectively), while bradycardic response was completely abolished after atropine (2 mg/ kg; i.v.) and attenuated with hexamethonium (20 mg/kg; i.v.) (1 F 0.3%; 5 F 1%; 7 F 1%; 7 F 1% and 10 F 1%, respectively). In hexamethonium treated rats, l-NAME significantly attenuated the hypotensive response (9 F 2%; 14 F 1%; 16 F 1%; 16 F 2% and 22 F 3%, respectively). In normotensive anaesthetized and vagotomized rats, hypotensive and bradycardic responses were significantly attenuated (0.5 F 0.2%; 1 F 0.4%; 3 F 0.6%; 4 F 0.8% and 6 F 1%, respectively, n = 6, and 7 F 2%; 12 F 5%; 15 F 2%, 17 F 2% and 25 F 3%, respectively). The anaesthesia with sodium thiopental did not affect the AFSC-induced responses when compared with those induced in nonanaesthetized rats (data not showed). In conclusion, the results obtained so far show that AFSC produce hypotension and bradycardia, mainly due to a direct stimulation of the endothelial vascular muscarinic receptor and indirect cardiac muscarinic activation, respectively.

AIm: Endoscopic third ventriculostomy (ETV) is currently considered the best alternative to shunt systems in the treatment of triventricular hydrocephalus. However, there has been very few published data about the anaesthetic management and the complications of ETV procedure in infants. In this report, we detail our experience with 57 infants, who underwent ETV as an initial treatment for obstructive triventricular hydrocephalus between 2003 and 2010. mAterIAl and methOds: Anesthesia chart-records were retrospectively investigated and perioperative data were classified according to the stages of the procedure. results: In this series, mean heart rate values showed a statistically significant difference in the period concerning the balloon dilatation of ventriculostomy orifice. An episode of bradycardia occurred in 2 patients during balloon dilatation. After the deflation of the balloon, bradycardia resolved immediately without administration of any medication. Video recordings of those two patients revealed that one of them had a narrow and opaque tuber cinereum, and the other had a shallow interpeduncular cistern.

We have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.

Resting heart rate (RHR) declines with exercise training. Possible mechanisms include: 1) increased parasympathetic tone, 2) decreased responsiveness to beta-adrenergic stimulation, 3) decreased intrinsic heart rate or 4) combination of these factors. To determine whether an increase in resting parasympathetic tone or decrease in response to beta-adrenergic stimulation contributes to the decrease in RHR with training. 51 screened healthy subjects aged 18-32 (n=20, mean age 26, 11 female) or 65-80 (n=31, mean age 69, 16 female) were tested before and after 6months of supervised exercise training. Heart rate response to parasympathetic withdrawal was assessed using atropine and beta-adrenergic responsiveness during parasympathetic withdrawal using isoproterenol. Training increased VO2 max by 17% (28.7±7.7 to 33.6±9.20ml/kg/min, P&lt;0.001). RHR decreased from 62.8±6.6 to 57.6±7.2 beats per minute (P&lt;0.0001). The increase in heart rate in response to parasympathetic withdrawal was u...

Background Endogenous adenosine might cause or perpetuate bradyasystole. Our aim was to determine whether aminophylline, an adenosine antagonist, increases the rate of return of spontaneous circulation (ROSC) after out-ofhospital cardiac arrest.

20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.

Hypotension and bradycardia after conduction of spinal anesthesia are common and may lead to intraoperative cardiac arrest or death. The present study was carried out to investigate the incidence and risk factors of hypotension and/or bradycardia in the patients receiving spinal anesthesia. The authors prospectively studied 1,220 patients to identify the incidence of hypotension (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 30% decreased systolic blood pressure) and bradycardia (heart rate &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 60 beats/min) after spinal anesthesia. Historical, clinical and physiologic data were correlated with the incidences by univariate analysis. Logistic regression with a forward stepwise algorithm was performed to identify independent variables. A p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was considered significant. Incidence of hypotension and bradycardia were 36.8% and 4.9% respectively. The risk factors of hypotension included increasing age (OR = 1.019 ; 95%CI 1.017-1.031); analgesia level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = T4 dermatome (OR = 2.068; 95%CI 1.486-2.879); body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30 (OR = 1.534; 95%CI 1.120-2. 100); cesarean section (OR= 1.723; 95%CI 1.244-2.386 and prehydration fluid &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 500 mL (OR 1.472; 95%CI 1.071-2.023). The risk factors of bradycardia were increasing age (OR = 1.042; 95%CI 1.023-1.061) and analgesic level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = T4 dermatome (OR = 2.246; 95%CI 1.101-4.584). The incidence of hypotension and bradycardia may increase with increasing age and analgesic level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = T4 dermatome. Three other factors related to hypotension after spinal anesthesia were body mass index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 30, cesarean section, and prehydration fluid of less than 500 mL.

Background: Severe bradycardia and asystole after spinal anesthesia was considered a serious side effect. Beta (β)-blockers lower blood pressure with decrease resting heart rate and left ventricular function. In this study, we retrospectively recorded the incidence of severe bradycardia and asystole during spinal anesthesia in patients medicated with β-blockers and investigated risk factors contributing to the incidence of severe bradycardia.
Methods: Anesthesia chart of 693 cases were retrospectively examined. All patients receive elective surgery in our institute
with spinal anesthesia and received β-blockers until the day of operation. Bradycardia was defined as a heart rate <50 beats per minute for at least 1 minute. Ten variables as risk factors contributing to bradycardia were selected: gender, age, body mass index, spinal drug dose, and peak sensory block height, baseline heart rate, baseline systolic blood pressure, baseline
diastolic blood pressure, baseline mean blood pressure, and history of diabetes.
Results: Eighty six of the 693 (13.4%) patients experienced bradycardia. No asystole occurred. On univariate analysis,
male gender, absence of diabetes, low baseline heart rate was associated with statistically higher incidence of bradycardia. In multivariate logistic regression, low baseline heart rate, absence of diabetes elevated the risk of bradycardia (Odds Ratio, 10.44 and 2.6 respectively).
Conclusions: The incidence of severe bradycardia during spinal anesthesia was 13.4% in the patient receiving the
β-blockers. Those with low baseline heart rate and absence of diabetes were more vulnerable to develop severe bradycardia.
Keywords: Bradycardia; Spinal Anesthesia; Beta-Blocker.

Branchio-oto-renal syndrome (BOR, Melnick-Fraser syndrome, MIM#113650) refers to a rare autosomal dominant disorder characterized by branchial cysts or fistulas, hearing loss, external ear malformation, preauricular pits and renal abnormalities. The authors present three episodes of significant bradycardia in two siblings diagnosed with BOR syndrome during the sevoflurane general anesthesia. There is no published experience of anesthesia with this syndrome. Bradycardia occurred variously at induction, maintenance and immediately prior to emergence and required surgical stimulation, atropine, or epinephrine to treat. We seek to raise awareness of the potential for bradycardia during the procedures in patients with this syndrome requiring volatile anesthesia, especially sevoflurane.

Cardiotocography (simultaneous recording of fetal heart rate (FHR) and uterine contractions) is one of the most used diagnostic techniques to evaluate fetal well-being and to investigate the functional state of the fetal autonomic nervous system. Recently, great interest has been paid to the variability of the FHR, and its frequency analysis, as a base for a more objective analysis of the cardiotocographic (CTG) tracings. FHR signals are unevenly sampled series. To obtain evenly sampled series, cardiotocographs often use zero-order interpolation. Such process is simple and fast but results unsuitable for frequency analyses because it introduces alterations in the FHR power spectrum. An algorithm for the recovery of the true FHR series out of the zero-order interpolated CTG data was developed and evaluated. ᭧

Background: Outpatient electrical cardioversion (EC) of atrial fibrillation is currently the standard of care. Shock-related arrhythmias may be particularly deleterious in this setting. Preoperative identification of high-risk patients may be very useful. Methods: A retrospective analysis was made of 543 consecutive elective EC procedures in 457 outpatients over an 8-year period in a university cardiological institute. The protocol included adequate anticoagulation, intravenous anesthesia, direct current shock, and a direct observation after a shock to detect procedure-related complications. No patients were excluded due to severity of pathology or comorbidities. Clinical characteristics, energy delivered, medications, arrhythmic phenomena, and predictors of success and complications were analyzed. Results: Of 543 ECs performed, 88.2% restored sinus rhythm, which persisted at discharge in 83.2%. No anesthesia-related complications were detected. No thromboembolic complications were detected. Use of a biphasic cardioverter was the only predictor of success (P = 0.0001). The bradyarrhythmic complication rate was 1.5%. No ventricular arrhythmic events were detected. Atrial flutter was present in five of eight patients who developed complications versus 44 of 535 patients who had no complications (P < 0.0005), and prosthetic heart valves in four of eight complicated versus 40 of 535 uncomplicated cases (P = 0.0044). The combination of atrial flutter and prosthetic heart valve was found in four of eight complicated versus 11 of 535 uncomplicated cases (P < 0.0005). Conclusion: Shock-related arrhythmias are essentially bradyarrhythmias. Atrial flutter and previous cardiac surgery identify a subgroup of patients at high risk of postshock bradyarrhythmic complications.

KCNE1 encodes an auxiliary subunit of cardiac potassium channels. Loss-of-function variations in this gene have been associated with the LQT5 form of the long QT syndrome (LQTS), secondary to reduction of I Ks current. We present a case in which a D85N rare polymorphism in KCNE1 is associated with an LQT2 phenotype.