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Cardiology

Ventricular Arrest With a Duration of 23.8 Seconds

To identify the key insights or developments described in this article

1 Credit CME

JAMA Internal Medicine

Published Online: July 17, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Zhongzheng Zhou, MD¹;

Author Affiliations

¹Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China

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A patient in their late 40s was admitted to the hospital to receive a uterine myomectomy procedure. The patient had no history of structural heart disease, hypertension, myocarditis, or sleep apnea syndrome, and denied a family history of cardiovascular disease and sudden death. The patient had not received any pharmacologic agents that would affect cardiac rhythm. Biochemical evaluation showed normal levels of whole blood cells count, electrolytes, myocardial enzymes, and brain natriuretic peptide. A 12‐lead electrocardiogram (ECG), chest radiographic imaging, and echocardiographic findings showed no abnormalities. To assess the risk of general anesthesia, the patient underwent evaluation with a Holter monitor, which recorded the patient’s cardiac activity during the syncope (Figure, A).

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A patient in their late 40s was admitted to the hospital to receive a uterine myomectomy procedure. The patient had no history of structural heart disease, hypertension, myocarditis, or sleep apnea syndrome, and denied a family history of cardiovascular disease and sudden death. The patient had not received any pharmacologic agents that would affect cardiac rhythm. Biochemical evaluation showed normal levels of whole blood cells count, electrolytes, myocardial enzymes, and brain natriuretic peptide. A 12‐lead electrocardiogram (ECG), chest radiographic imaging, and echocardiographic findings showed no abnormalities. To assess the risk of general anesthesia, the patient underwent evaluation with a Holter monitor, which recorded the patient’s cardiac activity during the syncope (Figure, A).

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Article Information

Corresponding Author: Yi Long, Chongqing Traditional Chinese Medicine Hospital, No. 7 Branch Rd, Panxi, Jiangbei District, Chongqing 400021, China (619036254@qq.com).

Published Online: July 17, 2023. doi:10.1001/jamainternmed.2023.1732

Conflict of Interest Disclosures: None reported.

References

Lee S , Wellens HJ , Josephson ME . Paroxysmal atrioventricular block. Heart Rhythm. 2009;6(8):1229-1234. doi:10.1016/j.hrthm.2009.04.001 PubMed Google Scholar Crossref

Zyśko D , Gajek J , Koźluk E , Mazurek W . Electrocardiographic characteristics of atrioventricular block induced by tilt testing. Europace. 2009;11(2):225-230. doi:10.1093/europace/eun299 PubMed Google Scholar Crossref

Sud S , Klein GJ , Skanes AC , Gula LJ , Yee R , Krahn AD . Implications of mechanism of bradycardia on response to pacing in patients with unexplained syncope. Europace. 2007;9(5):312-318. doi:10.1093/europace/eum020 PubMed Google Scholar Crossref

Hyman MC , Papireddy M , Frankel DS . Paroxysmal atrioventricular block. JAMA Intern Med. 2021;181(8):1108-1109. doi:10.1001/jamainternmed.2021.2526 PubMed Google Scholar Crossref

Komatsu S , Sumiyoshi M , Miura S , et al. A proposal of clinical ECG index “vagal score” for determining the mechanism of paroxysmal atrioventricular block. J Arrhythm. 2017;33(3):208-213. doi:10.1016/j.joa.2016.10.004 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.