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Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace? Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi; Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol 41 No 1 (2020): Indonesian Journal of Cardiology: Januari - Maret 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.950

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace? Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi; Stephanie Salim; Sunu Budhi Raharjo; Dony Yugo Hermanto; Dicky Armein Hanafy; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol 41 No 1 (2020): Indonesian Journal of Cardiology: Januari - Maret 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.950

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality Sunu Budhi Raharjo; Sarah Humaira; Lies Dina Liastuti
Jurnal Kardiologi Indonesia Vol 42 No 3 (2021): Indonesian Journal of Cardiology: July - September 2021
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1143

The prevalence of stroke in Indonesia increased overtime. CS ranges from 15 to 40% from all ischemic strokes. Finding the etiology of ischemic stroke is important to prevent recurrence. AF is predicted as the etiology behind CS. The current recommendation only supports short period of ECG monitoring. However, studies have shown that a higher detection rate can be achieved with longer duration of monitoring. ICM, a diagnostic tool with the highest detection rate, is still considered cost-effective when the calculation takes into account the QALY gained. Digital health tools such as handheld devices and smartwatch ECG have revolutionized the screening of AF however it is still considered as pre-diagnostic and verification is needed to confirm the rhythm generated.

Pacing Induced Cardiomyopathy: What is The Solution? Butarbutar, Maruli Wisnu Wardhana; Raharjo, Sunu Budhi
Jurnal Kardiologi Indonesia Vol 43 No 1 (2022): Indonesian Journal of Cardiology: January - March 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1123

ABSTRACT Background Right ventricular pacing is associated with adverse outcome including increased risks of cardiovascular morbidity and mortality. RV pacing causes abnormal ventricular activation results in an inefficient contraction pattern with ventricular dyssynchrony and loss of myocardial work that may lead to LV dilation, systolic dysfunction, and clinical HF. Pacing induced cardiomyopathy (PICM) is caused by chronic and high burden RV pacing that may occur several months or years after pacemaker implantation. Objective To present a case of pacing induced cardiomyopathy (PICM) managed by CRT-P implantation. Case Illustration A male, 56 years old, was referred from dr. M. Djamil General Hospital with CHF Fc II-III, s/p PPM DDDR due to high degree AV block (2016) and history of failed CRT-P implantation (2018). He complained DOE (+), PND (+) and OP (+) since April 2017. Physical examination revealed pansystolic murmur grade 2/6 at apex, no rales and no oedema at both legs. ECG showed pacing rhythm and intrinsic rhythm was type 2 second degree AV block and RBBB with QRS duration 150 ms. Echocardiography showed global hypokinetic and dilated LV (LV EDD 71 mm, LV ESD 63 mm) with progressively reduced EF 38% à 33% (Simpson), functional moderate MR and mild TR. CAG showed non-significant coronary artery stenosis with 20% stenosis at distal LAD. Patient was diagnosed as pacing induced cardiomyopathy (PICM). At catheter laboratory, there was stenosis of left subclavian vein. His-Bundle pacing (HBP) was planned at first, however CRT-P with biventricular epicardial pacing was then performed in which LV lead was inserted through right axillary vein. During follow up at general ward, ECG showed biventricular pacing rhythm. There was no signs and symptoms of heart failure. Patient was hospitalized for 3 days and then discharged in a good condition. Summary We reported a case of pacing induced cardiomyopathy in male patient 56 years old. Pacing induced cardiomyopathy is a complication of high burden RV pacing. Options to treat PICM once it has developed, or to prevent it from developing in the first place, may include conduction system pacing (e.g.: HBP) or CRT-P implantation.

Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights Simbolon, Jessica Putri Natalia; Raharjo, Sunu Budhi; Santoso, Anwar; Liastuti, Lies Dina; Hermanto, Dony Yugo; Rossimaria, Vienna; Pritazahra, Armalya; Hanafy, Dicky Armein; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 44 No 3 (2023): Indonesian Journal of Cardiology: July - September 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1562

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population. Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD. Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period. Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%. Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.This article has a related Erratum.

Local anesthetic systemic toxicity (LAST) during pacemaker implantation through persistent left superior vena cava (PLSVC) Sunu Budhi Raharjo; Gadistya Novitri Adinda; Dony Yugo Hermanto; Indira Aura Balqis; Dicky Armein Hanafy
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.18

BACKGROUND: Local anesthesia is considered safe and commonly used in the pacemaker implantation procedure. However, it carries a risk of local anesthetic systemic toxicity (LAST). Although rare, LAST occurrence can be fatal. CASE PRESENTATIONS: We reported a case of a 69-year-old woman with fatigue and dizziness. The patient's ECG indicates atrial fibrillation with total AV block. Pacemaker implantation was performed under local anesthesia. Within minutes of lidocaine injection, the patient developed a seizure followed by cardiac arrest. Immediate administration of intravenous midazolam and cardiopulmonary resuscitation was done, resulting in the patient's stability. A permanent pacemaker was successfully implanted using a modified hand-shaped stylet to accommodate the presence of a persistent left superior vena cava (PLSVC). Brain computed tomography scan showed only mild brain atrophy. No clinical symptoms were documented during the outpatient visit after discharge. CONCLUSIONS: Local anesthetic systemic toxicity during pacemaker implantation is a rare but potentially catastrophic. Prompt recognition of its signs and appropriate management are crucial. In this case, a persistent left superior vena cava posed additional challenges to the pacemaker implantation.

From Benign Origins to Final Moments: Right Ventricular Outflow Tract Premature Ventricular Complexes Culminating in Asystole on Holter Monitoring Raharjo, Sunu Budhi; Raj, Sai Vhimal; Pritazahra, Armalya; Hanafy, Dicky Armein; Hermanto, Dony Yugo; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1586

Background: Premature Ventricular Complexes (PVCs) are a common cardiac arrhythmia typically of benign nature. Their origin, the right ventricular outflow tract (RVOT), is often a point of interest due to its implications in treatment strategies. While the vast majority of PVC RVOT cases remain uneventful, there are isolated incidents that challenge this common perception. Continuous monitoring methods, such as the Holter monitor, have provided invaluable insights into the real-world dynamics of arrhythmias, capturing rare events that can be of paramount clinical significance. Case Illustration: A 60-year-old female, presented to Harapan Kita Hospital Jakarta in May with palpitations. Over several visits, physical examinations consistently indicated a heart within normal parameters, absent of murmurs or gallop. Successive ECGs revealed persistent PVCs of RVOT origin. Despite medical intervention, her arrhythmic pattern persisted. By September, her symptoms had diversified, including occasional chest pain, nausea, and dyspnea. An ECG, yet again, confirmed PVCs with RVOT origin. During a Holter monitoring session on September, a distressing sequence of events was captured. The monitor initially registered a non-sustained Ventricular Tachycardia (VT). which escalated to sustained VT, ventricular fibrillation, and culminating in asystole, marking the patient's final moments. Conclusions: The pathophysiological journey from benign PVCs of RVOT origin to a fatal arrhythmic event underscores the unpredictability and inherent dangers of cardiac arrhythmias. This case is a reminder of the critical importance of persistent monitoring, timely interventions, and the nuanced understanding of conditions conventionally deemed 'benign'.

Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights Simbolon, Jessica Putri Natalia; Raharjo, Sunu Budhi; Santoso, Anwar; Liastuti, Lies Dina; Hermanto, Dony Yugo; Rossimarina, Vienna; Pritazahra, Armalya; Hanafy, Dicky Armein; Yuniadi, Yoga
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2022

In “Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights” (Indonesian Journal of Cardiology, 44(3), 87-94. https://doi.org/10.30701/ijc.1562), there is an error noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1562. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.1562

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