Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9192-9197
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9192
Temporary pacemaker protected transjugular intrahepatic portosystemic shunt in a patient with acute variceal bleeding and bradyarrhythmia: A case report
Xin Yao, Shi-Hui Li, Li-Rong Fu, Shan-Hong Tang, Jian-Ping Qin
Xin Yao, Shi-Hui Li, Li-Rong Fu, Shan-Hong Tang, Jian-Ping Qin, Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Author contributions: Yao X performed the operation and wrote the paper; Li SH and Fu LR collected the data; Tang SH collected the data; Qin JP participated in and guided the operation, conceptualized the idea, and finalized the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interests to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Ping Qin, MD, Chief Doctor, Doctor, Department of Gastroenterology, General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. jpqqing@163.com
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: July 15, 2021
Revised: July 15, 2021
Accepted: September 6, 2021
Article in press: September 6, 2021
Published online: October 26, 2021
Abstract
BACKGROUND

Esophagogastric varices are a common complication of cirrhosis with portal hypertension and endoscopic treatment has been recognized as a primary preventive and therapeutic option for such patients; however, it should be noted that bradyarrhythmia is regarded as one of the contraindications to endoscopic examination. Meanwhile, acute variceal bleeding may result in a high mortality rate in cirrhotic patients with portal hypertension accompanied by bradyarrhythmia. At present, there is an absence of reports concerning the treatment of such group of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS). The present report details the case of a cirrhotic patient with acute variceal bleeding accompanied by bradyarrhythmia who underwent TIPS under temporary pacemaker protection.

CASE SUMMARY

We report the case of a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation. The patient was successfully treated by TIPS under temporary pacemaker protection.

CONCLUSION

In terms of cirrhotic patients with abnormal cardiac electrophysiological conduction, TIPS may be effective in reducing the complications of portal hypertension following the exclusion of severe pulmonary hypertension and heart failure, showing moderate feasibility in clinical applications.

Keywords: Transjugular intrahepatic portosystemic shunt, Hypertension, Cirrhotic, Temporary pacemaker, Bradyarrhythmia

Core Tip: Transjugular intrahepatic portosystemic shunt (TIPS) has been applied extensively in the treatment of cirrhotic patients presenting with portal hypertension; however, treating cirrhotic patients with bradyarrhythmia presents a great challenge due to the possibility of serious cardiac complications. In our case report, a 64-year-old male patient who was confirmed with bradyarrhythmia by ambulatory electrocardiogram 24 h before the operation was successfully treated by TIPS under temporary pacemaker protection.