Is proximal coronary sinus involved in the circuit in some cases of ECG "typical" atrial flutter?

Aim: It is commonly conceived that coronary sinus (CS) participates in atrial flutter (AFL) circuit but limited to the fibers surrounding its ostium. We evaluated the involvement of proximal CS in typical AFL.

Methods: Twenty AFL patients underwent entrainment mapping using postpacing interval minus AFL cycle length (PPI-AFL CL) including CS where a decapolar catheter was positioned with proximal bipole 1 cm from the ostium.

Evaluation of time course and predicting factors of progression of paroxysmal or persistent atrial fibrillation to permanent atrial fibrillation.

Background: To evaluate time course and predictors of progression of paroxysmal or persistent atrial fibrillation (AF) to permanent AF.

Methods And Results: We included 460 patients referred for paroxysmal (n = 337) or persistent (n = 123) AF between 1994 and 2012. Mean follow-up was 13.

Reentry mechanisms and ablation of ECG-typical atrial flutters involving the cavo-tricuspid isthmus and the proximal coronary sinus.

Aim: Reentry circuits of a rare typical atrial flutter (AFL) involving the cavo-tricuspid isthmus (CTI) and proximal coronary sinus (CS) are described based on electrophysiological data and effects of radiofrequency (RF).

Methods And Results: Twelve patients with ECG-typical AFL in whom entrainment demonstrated that CTI and proximal CS were both part of the circuit were included. Initial RF target was CTI in 8 patients and proximal CS in 4.

Low doses of intravenous epinephrine for refractory sustained monomorphic ventricular tachycardia.

We report three cases of sustained monomorphic ventricular tachycardia (VT) in the setting of coronary artery disease, resistant to beta-blockers in two patients and to amiodarone in all, successfully terminated by low doses of intravenous (IV) epinephrine. VT was the first manifestation of coronary artery disease in one patient, whereas the other two patients had a previous history of myocardial infarction and were recipients of an implantable cardioverter-defibrillator (ICD). One of these two patients experienced an arrhythmic storm.

Long-term efficacy of low doses of quinidine on malignant arrhythmias in Brugada syndrome with an implantable cardioverter-defibrillator: a case series and literature review.

Background: To prevent the recurrence of ventricular arrhythmias (VA) in Brugada syndrome (BrS), only quinidine has been consistently reported to have a beneficial effect. Recommended doses are ≥ 1 g/d. The efficacy of lower doses of quinidine has been suggested on the basis of a few isolated experiences.

Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump.

Purpose: A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump.

Methods: We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter.

Adverse effects of long-term right ventricular apical pacing and identification of patients at risk of atrial fibrillation and heart failure.

In patients needing a pacemaker (PM) for bradycardia indications, the amount of right ventricular (RV) apical pacing has been correlated with atrial fibrillation (AFib) and heart failure (HF) in both DDD and VVI mode. RV pacing was linked with left ventricular (LV) dyssynchrony in almost 50% of patients with PM implantation and atrioventricular (AV) node ablation for AFib. In patients with normal systolic function needing a PM, apical RV pacing resulted in LV ejection fraction (LVEF) reduction.

C-reactive protein levels in the brugada syndrome.

Background. Inflammation in the Brugada syndrome (BrS) and its clinical implication have been little studied. Aims.

Cryoablation of atrioventricular nodal reentrant tachycardia: a clinical review.

Slow-pathway ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT). Cryoablation is effective and safe, but its widespread use seems to be limited by a slightly lower long-term clinical efficacy when compared to radiofrequency (RF) ablation. However, the occurrence of atrioventricular block requiring permanent pacing with RF remains clinically relevant (about 1%).

Correlations between long-term results after cryoablation for atrioventricular nodal reentry tachycardia and a residual jump associated or not with a single echo.

Aims: While in radiofrequency ablation for atrioventricular nodal reentry tachycardia (AVNRT) a residual jump and a single echo do not seem to substantially modify long-term results, in cryoablation procedures their effects are still under evaluation. The purpose of this study was to evaluate if a residual jump associated or not with an isolated echo is correlated with outcome.

Inclusion Criteria: acute successful slow pathway cryoablation for slow-fast AVNRT.

Catheter cryoablation of atrio-ventricular nodal reentrant tachycardia. A clinical review.

Cryoablation is a new method in interventional cardiac electrophysiology for percutaneous catheter ablation of cardiac arrhythmias. Cryothermal mapping enables the functional assessment of a particular site before permanent ablation. In this way, the targeted tissue may be confirmed as safe for ablation.

Radiofrequency ablation of coronary sinus-dependent atrial flutter guided by fractionated mid-diastolic coronary sinus potentials.

Background: The efficacy of radiofrequency (RF) ablation of an uncommon coronary sinus (CS)-dependent atrial flutter (AFL) was evaluated using conventional electrophysiological criteria in a highly selected subset of patients with typical and atypical AFL.

Methods: Fourteen patients with atrial flutter (11 males, mean age 69 ± 9 years) without previous right or left atrial RF ablation were included. Heart disease was present in eight patients.

A case of inappropriate sinus tachycardia after atrio-ventricular nodal reentrant tachycardia cryoablation successfully treated by ivabradine.

We illustrate a case of persistent inappropriate sinus tachycardia after slow pathway atrio-ventricular (AV) nodal reentrant tachycardia cryoablation, and inadvertent fast pathway lesion with residual first-degree AV block in a 72-year-old man with a small Koch's triangle. At the end of the cryoprocedure, the patient presented with sinus tachycardia 100 b.p.

Effective cryoablation of a lateral accessory pathway within the distal coronary sinus.

Limited information is available on the efficacy of cryoablation in the coronary venous system in humans. A patient with a lateral accessory pathway was referred to our center after several unsuccessful endocardial and epicardial (within the coronary sinus) attempts using standard radiofrequency energy. Ablation was subsequently performed successfully by applying cryoenergy distally into the coronary sinus, using a temperature of -50 degrees C and a freezing application time of 45 s.

Determinants of mortality in patients undergoing cardiac resynchronization therapy: baseline clinical, echocardiographic, and angioscintigraphic evaluation prior to resynchronization.

Background: In dilated cardiomyopathy (DCM) patients (pts) with cardiac resynchronization therapy (CRT) for ventricular dyssynchrony, long-term predictors of mortality and morbidity remain poorly investigated.

Method And Results: We reviewed data of 102 pts, 68 +/- 10 years, NYHA Class II-IV (14 Class II, 67 Class III, 21 Class IV), who benefited from CRT (69 CRT, 33 CRT-ICD). Fifty-two patients had an ischemic DCM, 36 a previously implanted conventional PM/ICD, 29 a permanent atrial fibrillation, and 19 needed dobutamine in the month preceding implant.

P wave duration and morphology predict atrial fibrillation recurrence in patients with sinus node dysfunction and atrial-based pacemaker.

P wave duration and morphology have never been systematically evaluated as markers of AF in patients with a conventional indication to pacing. This study correlated sinus P wave duration and morphology and the incidence of AF in patients with sinus node dysfunction (SND), previous history of AF before implant, and atrial-based pacemaker. Included were 140 patients (86 men, 54 women; mean age 71.