Life-threatening alterations of respiratory and cardiovascular functions may complicate the course of severe Guillain-Barré syndrome. Cardiac arrest, forewarned by episodes of bradycardia or other arrhythmia, may occur despite adequately assisted respirations.
A patient with Guillain-Barré syndrome required tracheostomy and ventilatory assistance. Continuous cardiac monitoring revealed that tracheal aspiration provoked an idioventricular rhythm of 40 beats per minute, which reverted to sinus rhythm after the procedure. To prevent cardiac arrest during the transition from idioventricular to sinus rhythm, a demand pacemaker was inserted into the right ventricle. Set to activate if the rate fell below 65 beats per minute, the pacemaker functioned both during and between tracheal aspiration procedures. Cardiac monitoring in severe cases of Guillain-Barré syndrome may detect potentially lethal arrhythmias that may then be avoided by a demand pacemaker.
Emmons PR, Blume WT, DuShane JW. Cardiac Monitoring and Demand Pacemaker in Guillain-Barré Syndrome. Arch Neurol. 1975;32(1):59–61. doi:10.1001/archneur.1975.00490430081017
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