Permanent Pacing in a Patient With Fontan Circulation: Use All You Have at Your Discretion.

Patients with Fontan circulation post significant technical challenges at the time of permanent pacemaker implantation, as majority of them are treated with surgically implanted epicardial pacemakers. However, transvenous pacemaker implantation is technically feasible, and the treating physician should be aware of each individual's anatomy and available treatment options.

Successful ablation of idiopathic left ventricular tachycardia in an adult patient during extracorporeal membrane oxygenation treatment.

Idiopathic ventricular tachycardia (VT) is usually a benign arrhythmia with good prognosis that can be managed with antiarrhythmic agents and is often cured using ablation. There is, however, a malignant potential in a subset of patients with idiopathic VT as was the case for our patient whom we discuss in this case report. After a review of the medical literature, and to our knowledge, this is the first case of a successful idiopathic VT ablation in an adult while extracorporeal membrane oxygenation was being used.

Cardiac Outcomes Through Digital Evaluation (CODE) STEMI project: prehospital digitally-assisted reperfusion strategies.

Background: Guidelines for reperfusion in ST-elevation myocardial infarction (STEMI) were recently adopted by the Canadian Cardiovascular Society. We have developed a blended model of prehospital thrombolytic (PHL) therapy or primary percutaneous coronary intervention (PPCI) activation, in order to achieve guideline times.

Methods: In our urban centre of 658,700 people, emergency medical services (EMS) were trained to perform and screen electrocardiograms (ECGs) for suspected STEMI.

Dilated cardiomyopathy: an unexpected complication of rapidly conducted atrial flutter in the Wolff-Parkinson-White syndrome.

This report describes a 34-year-old male with the Wolff-Parkinson-White syndrome who presented with the unusual finding of a tachyarrhythmia-induced cardiomyopathy secondary to atrial flutter with 1:1 conduction through a left-lateral accessory pathway. Catheter ablation of the accessory connection resulted in complete normalization of cardiac function.

Idiopathic ventricular fibrillation controlled successfully with phenytoin.

We describe a case of an individual with idiopathic ventricular fibrillation whose arrhythmias were successfully controlled with phenytoin therapy.

Differential entrainment distinguishes atrioventricular nodal reentry tachycardia from atrioventricular reentrant tachycardia.

Background: Entrainment from the right ventricular (RV) apex and the base has been used to distinguish atrioventricular reentrant tachycardia (AVRT) from atrioventricular nodal reentry tachycardia (AVNRT). The difference in the entrainment response from the RV apex in comparison with the RV base has not been tested.

Methods: Fifty-nine consecutive patients referred for ablation of supraventricular tachycardia (SVT) were included.

Is there a role for statins in atrial fibrillation?

3-Hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statins) are some of the most commonly prescribed drugs in the world. While lipid modification remains the primary function of statins, there has been increasing interest in its potential pleiotropic effects, particularly as an anti-inflammatory agent in its role as an antiarrhythmic. Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and carries with it a significant burden in both morbidity and mortality.

The association of atrial tachyarrhythmias with isolated atrial amyloid disease: preliminary observations in autopsied heart specimens.

Objective: Isolated atrial amyloidosis (IAA) is associated with atrial tachyarrhythmias. However, only a few studies have appraised atrial tachyarrhythmias and atrial depolarization abnormalities in connection with high-grade IAA. We conducted a collaborative retrospective study to assess this association.

Can U waves be "notched"?

Abnormal U waves (unduly larger or misshapen) are associated with several conditions such as hypokalemia, arrhythmias, cardiac ischemia, ventricular hypertrophy, and hypertension. Abnormal U waves have also been linked to certain cardiac medications, predominantly antiarrhythmics. However, mechanisms of U-wave-abnormality remains debated and perhaps elusive with the true U-wave relationship to T waves still being investigated.

Differences in treadmill exercise tolerance parameters between patients with partial and advanced interatrial depolarization abnormality.

Advanced interatrial block (aIAB) is considerably much less common than partial interatrial block (pIAB), occuring in <2% of the elderly hospitalized population. Less is, therefore, known of the true clinical burden of aIAB, particularly in relation to graded exercise. Therefore, 12 patients with aIAB and 30 patients with pIAB who performed a baseline exercise tolerance test and had a repeat test performed > or = 2 years later were included in the study.

Spontaneous alternans in Brugada ST-segment morphology within minutes.

Brugada syndrome is an inherited, life-threatening, cardiac channelopathy where the electrocardiogram (ECG) characteristically depicts a classic pattern of complete or incomplete right bundle-branch block with ST-segment elevation in the right precordial leads V(1) to V(3). These, almost inalienable, ECG patterns may be dynamic, where changes may resolve to baseline or one particular type may evolve into another. Such alternans has been described with fever, electrolyte imbalances, atrial pacing, glucose and/or insulin administration, psychotropic drugs, beta-adrenergic blocker use, class IA and IC antiarrhythmic provocation testing, such as with ajmaline, procainamide, or flecainide, and even large meals, that is, "full stomach sign.

Relation of recurrence of atrial fibrillation after non-ST-elevation acute myocardial infarction to left atrial abnormality.

Atrial fibrillation (AF) is common during the course of acute myocardial infarction and is associated with left atrial (LA) dilatation. However, the role of LA depolarization abnormality on the electrocardiogram (ECG) in the setting of LA dilatation was not studied in this context. Patients admitted with non-ST-segment elevation myocardial infarction (NSTEMI) who developed new-onset AF (International Classification of Diseases, Ninth Revision code 427.