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Complete Atrioventricular Block Following Mediastinal Irradiation: A Report of Six Cases
Author(s) -
SLAMA MICHEL S.,
GULUDEC DOMINIQUE,
SEBAG CLAUDE,
LEENHARDT ANTOINE R.,
DAVY JEANMARC,
PELLERIN DENIS E.,
DRIEU LUC H.,
VICTOR JACQUES,
BRECHENMACHER CLAUDE,
MOTTÉ GILBERT
Publication year - 1991
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1991.tb02842.x
Subject(s) - medicine , atrioventricular block , cardiology , right bundle branch block , bundle branch block , heart block , radiation therapy , electrocardiography , radiology , surgery
Complete atrioventricular block (AVB) following radiotherapy has been reported rarely, usually after high dose mediastinal irradiation for Hodgkin's disease or Jung or breast carcinoma. We report six new cases of episodic complete infranodal AVB, requiring permanent pacemaker implantation. The mean age was 48‐years old (ranging from 25–60) at the first Adams Stokes attack, mean delay was 12 years after irradiation (10–18), and mean radiation dose was 5.200 rads (4,000–6,500). All patients had abnormal interval electrocardiograms (right bundle branch block in two, left bundle branch block in three, alternating left and right bundle branch block in one). Electrocardiograms during the episode of AVB or Holter recordings were consistent with infranodal block in all patients; eleclrophysiological study performed in five patients confirmed infranodal AVB in four, and one was normal. Pericardial disease was constant, which included pericardial constriction in four patients. Two patients died after failure of pericardiectomy to improve congestive heart failure, due to epicardial, myocardial, and endocardial involvement. Noncardiac mediastinal lesions were present in four cases. Since this delayed complication may occur in patients of such age that the relation between the AVB and the chest irradiation is questionable, we propose the following etiologic criteria: high radiation dose (over 4,000 rads); delay of 10 years or more; abnormal interval tracings: pericardial involveinent; and associated cardiac or mediastinal radiation‐induced lesions.