Biventricular Arrhythmogenic Cardiomyopathy Mimicking Cardiac Sarcoidosis.

Noninvasive imaging is crucial for diagnosing and managing arrhythmogenic cardiomyopathy. Despite advanced multimodality imaging tools, challenges persist in differentiating it from other arrhythmogenic diseases (eg, cardiac sarcoidosis). We present a case of arrhythmogenic cardiomyopathy with an variant of uncertain significance exhibiting a phenocopy of cardiac sarcoidosis.

Seasonal Variation in the Incidence of In-Hospital Cardiac Arrest.

Background: Seasonal variation in cardiovascular outcomes, including out-of-hospital cardiac arrest, has been described.

Objectives: This study aimed to investigate seasonal differences in the incidence of in-hospital cardiac arrest (IHCA) and associated mortality.

Methods: Using National Inpatient Sample data from 2005 to 2019, we determined the incidence of IHCA in 4 seasons.

Risk of Atrial Fibrillation and Stroke After Bariatric Surgery in Patients With Morbid Obesity With or Without Obstructive Sleep Apnea.

Background And Purpose: Weight loss in morbidly obese patients reduces atrial fibrillation (AF); however, it is unknown whether similar benefits are maintained in patients with obstructive sleep apnea (OSA). We sought to determine whether incident AF and stroke rates are affected by OSA after weight loss and to identify predictors of AF and stroke.

Methods: Differences in laparoscopic adjustable gastric banding–induced weight loss on incident AF and stroke events in those with and without OSA in the entire and in propensity-matched cohorts were determined longitudinally, and independent predictors of AF and stroke were identified.

A Tale of Fits and Faint: A Case of Hypervagotonic Nerve Stimulation.

Vagal nerve stimulators are devices used to treat medically refractory epilepsy. Here, we present a rare, unique, and life-threatening side effect of vagal nerve stimulator placement. ().

Preexcitation Syndromes.

The classic electrocardiogram in Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval and prolonged QRS duration in the presence of sinus rhythm with initial slurring. The clinical syndrome associated with above electrocardiogram finding and the history of paroxysmal supraventricular tachycardia is referred to as Wolff-Parkinson-White syndrome. Various eponyms describing accessory or anomalous conduction pathways in addition to the normal pathway are collectively referred to as preexcitation syndromes.

Guiding the management of ventricular arrhythmias in patients with left ventricular noncompaction cardiomyopathy: a knowledge gap.

Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death.

Mutations in SCN10A are responsible for a large fraction of cases of Brugada syndrome.

Background: BrS is an inherited sudden cardiac death syndrome. Less than 35% of BrS probands have genetically identified pathogenic variants. Recent evidence has implicated SCN10A, a neuronal sodium channel gene encoding Nav1.

Repolarization syndromes.

Repolarization syndromes, including early repolarization, Brugada, and short and long QT, have been implicated increasingly as causes of sudden cardiac death (SCD) despite no obvious mechanical cardiac abnormalities. So-called idiopathic ventricular fibrillation is now often reassigned to one of the aforementioned entities. Underlying causes are diverse; genetic mutation has been proven in many but not all cases.

Cardiac Image Registration: Rotational Error Correction and Gated Stabilization for Cardiac Motion.

Dynamic motion of the heart due to cardiac and respiratory cycles, and rotation from varying patient positions between imaging modalities, can cause errors during cardiac image registration. This study used phantom, patient and animal models to assess and correct these errors. Rotational errors were identified and corrected using different phantom orientations.

Periprocedural anticoagulation for atrial fibrillation ablation.

Background: Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined.

Objective: We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation.

Biventricular pacing and QT interval prolongation.

Introduction: The purpose of this study was to examine BiV pacing-dependent changes in QT interval and the related potential for proarrhythmia. Biventricular (BiV) pacing has emerged as a promising therapy for patients with advanced congestive heart failure (CHF) and bundle branch block (BBB).

Methods And Results: One hundred and seventy-six consecutive patients (123 men and 53 women; mean age 67 +/- 16 years) with ischemic (n = 128) or nonischemic (n = 48) cardiomyopathy in New York Heart Association Class II (8%) or III (92%) CHF (ejection fraction 24 +/- 9%) underwent atrial synchronous BiV pacing.

Pulmonary vein isolation and linear lesions in atrial fibrillation ablation.

Background: Various strategies have been used for atrial fibrillation (AF) ablation. It is unclear whether adding linear lesions to pulmonary vein (PV) isolation has significant advantages.

Objectives: We assessed the clinical benefit of adding linear lesions in patients undergoing PV isolation for AF.

Computed tomography-fluoroscopy image integration-guided catheter ablation of atrial fibrillation.

Introduction: This study examines the feasibility of atrial fibrillation (AF) ablation using registered three-dimensional computed tomography (CT) images of the left atrium with fluoroscopy.

Methods And Results: A total of 50 consecutive patients with symptomatic AF refractory to medical therapy (32 paroxysmal, 18 persistent, age 55 +/- 10 years) were randomized to undergo a catheter-based AF ablation procedure with or without the CT-fluoroscopy guidance system. All patients underwent preprocedural contrast-enhanced CT imaging and segmentation of the left atrium.

Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death.

Background: Cardiac ion channelopathies are responsible for an ever-increasing number and diversity of familial cardiac arrhythmia syndromes. We describe a new clinical entity that consists of an ST-segment elevation in the right precordial ECG leads, a shorter-than-normal QT interval, and a history of sudden cardiac death.

Methods And Results: Eighty-two consecutive probands with Brugada syndrome were screened for ion channel gene mutations with direct sequencing.

Posterior left atrial-esophageal relationship throughout the cardiac cycle.

Background: Radiofrequency energy delivered throughout the cardiac cycle has the potential to cause thermal injury to the esophagus if the anatomical relationship between the posterior left atrium and the esophagus changes during cardiac motion.

Objective: To assess the posterior left atrial-esophageal relationship throughout the cardiac cycle.

Methods: In this study, the anatomical relationship between the posterior left atrium and the esophagus was assessed throughout the cardiac cycle in 10 consecutive patients.

The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival.

Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention).

Pharmacotherapy of atrial fibrillation.

Atrial fibrillation is the most common sustained arrhythmia of clinical significance. Its prevalence rises with age. It is a significant cause of thromboembolic phenomena.

Role of Echocardiography in Complications Associated with Partial or Complete Rupture of the Myocardium in Acute Myocardial Infarction.

In this report, we focus on the specific complications of acute myocardial infarction that are associated with rupture of the myocardium and for which two-dimensional and Doppler color flow echocardiography expedites accurate diagnosis for prompt treatment, including surgical repair, which can be crucial to survival in such cases.

Echocardiographic Assessment of Complications Related to Left Ventricular Function in Acute Myocardial Infarction.

Three complications of acute myocardial infarction without myocardial rupture are directly associated to the function of the myocardium: papillary muscle dysfunction, congestive heart failure, and cardiogenic shock. In this article, the pathophysiological mechanism of each complication is discussed, and the contribution of echocardiography to diagnosis and management is reviewed.