Challenging wide QRS tachycardia diagnosis: One trigger two mechanisms.

The coexistence of different types of wide QRS complex tachycardias induced by the same trigger has rarely been observed. The electrical instability and incessant nature of tachycardias can cause tachycardiomyopathy and will not allow accurate diagnosis during an electrophysiological study (EPS). In case of an electrical storm, elimination of the trigger may be the first approach to provide patient stability.

Combining conventional technique with fluoroscopy integration module in accessory pathway ablation.

Introduction: Accessory pathway (AP) ablation is a straightforward approach with high success rates, but the fluoroscopy time (FT) is significantly longer in conventional technique. Electroanatomical mapping systems (EMS), reduce the FT, but anatomical and activation mapping may prolong the procedure time (PT). The fluoroscopy integration module (FIM) uses prerecorded fluoroscopy images and allows ablation similar to conventional technique without creating an anatomical map.

Comparison of electrophysiological characteristics of right- and left-sided Mahaim-type accessory pathways.

Aims: Mahaim-type accessory pathways (MAPs) are generally right-sided due to the embryological differentiation, but left-sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right- and left-sided MAPs.

Methods: Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4).

Inappropriate tachycardia at rest as a consequence of atrial preference pacing algorithm.

A 34-year-old female with a past medical history of sick sinus syndrome which requiring placement of single chamber (atrial) permanent pacemaker (Medtronic, Minneapolis, MN, USA). One year after pacemaker implantation, the patient reported exercise intolerance and palpitation at rest. Device interrogation during clinic visit revealed 99% atrial pacing and high atrial rate episodes.

Nonsustained ventricular tachycardia in heart failure with preserved ejection fraction.

Background: Ventricular tachycardia (VT) is a common arrhythmia in heart failure with reduced ejection fraction but its incidence, predictors, and significance have not been determined in heart failure with preserved ejection fraction (HFpEF).

Methods: We performed a retrospective review of arrhythmias in two cohorts of patients with an HFpEF diagnosis. Patients in cohort 1 (n = 40) underwent routine arrhythmia surveillance with a 14-day ambulatory electrocardiogram (ECG) monitor.

QTc dispersion as a novel marker in identifying patients requiring an epicardial approach for ablation of scar mediated ventricular tachycardia.

Introduction: Epicardial exit sites of ventricular tachycardia (VT) are frequently encountered during VT ablation requiring an epicardial ablation approach for successful elimination of VT. We sought to assess the utility of repolarization markers in identifying individuals requiring an epicardial ablation approach in addition to an endocardial approach.

Methods: 32 patients who underwent successful ablation for scar mediated VT were included in the study.

A single-centre cohort and short-term follow-up of patients who developed persistent new onset left bundle branch block after transcatheter aortic valve replacement.

The most common conduction abnormality after transcatheter aortic valve replacement (TAVR) is new-onset left bundle branch block (LBBB) with an exact frequency that varies based on the valve system used for TAVR. PPM implantation in patients with persistent new onset LBBB post TAVR is controversial. The primary objective of this study is to report PPM utilisation and mortality in this patient population.

Co-occurrence of late potential and discrete prepotential on ablation site in a case of cardiac crux located premature ventricular complexes successfully ablated within the middle cardiac vein.

Some premature ventricular complexes (PVCs) originate from the coronary venous system. The great cardiac vein and the anterior cardiac vein are the most frequent localizations. The middle cardiac vein is an unusual anatomy for a point of origin for PVC.

Impact of defibrillation threshold testing on burden of heart failure hospitalizations.

Defibrillation threshold testing (DT) following implantable cardioverter defibrillator (ICD) implantation has not shown to improve mortality. However, the impact of DT on burden of heart failure (HF) hospitalisations has not been well defined. We studied retrospectively consecutive patients who underwent ICD implantation or generator change between 2008 and 2014.

Multiple Non-Essential Transition Metals Are Accumulated in Carotid Atherosclerotic Plaques: Missing Link in Atherosclerosis?

Population studies revealed that metal exposure through food, environment, and smoking was related with increased risk of cardiovascular disease. In this study, we determined complex chemical elements in surgical carotid endarterectomy specimens and carotid tissues from autopsies without atherosclerosis. Atherosclerotic plaques from 41 endarterectomies and normal carotid tissue from 30 autopsies were collected and elemental composition was determined by inductively coupled plasma optical emission spectrometry (ICP-OES) method.

Blunted Chronotropic Response to Hypotension in Cough Syncope.

Objectives: This study compared hemodynamic and chronotropic responses to cough in cough syncope (CS) patients to those in control subjects.

Background: Cough syncope is an uncommon form of situational fainting variously attributed to both reflex and mechanical causes. We hypothesized that if baroreflex responses contribute to CS, post-cough hypotension should be associated with cardioinhibition comparable to that observed in other reflex faints.

Vagus nerve stimulation: An evolving adjunctive treatment for cardiac disease.

The vagus nerve is a major component of the autonomic nervous system and plays a critical role in many body functions including for example, speech, swallowing, heart rate and respiratory control, gastric secretion, and intestinal motility. Vagus nerve stimulation (VNS) refers to any technique that stimulates the vagus nerve, with electrical stimulation being the most important. Implantable devices for VNS are approved therapy for refractory epilepsy and for treatment-resistant depression.

Premature ventricular contractions: Reassure or refer?

When patients present with palpitations, the primary care physician can perform the initial evaluation and treatment for premature ventricular contractions (PVCs). Many patients need only reassurance and do not need to see a cardiologist.

Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic.

Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation.

[Relation between mean platelet volume and subclinical atherosclerosis in patients with metabolic syndrome].

Objectives: Metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. There is evidence of platelet activation in MetS. Mean platelet volume (MPV), a determinant of platelet activation, is a newly emerging risk factor for atherothrombosis.

Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-segment elevated myocardial infarction.

In this study, we aimed to investigate the association of the neutrophil-to-lymphocyte ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) risk score in patients with ST-segment elevated myocardial infarction (STEMI). We analyzed 101 consecutive patients with STEMI. Patients were divided into 3 groups by use of GRACE risk score.

The significance of the left atrial volume index in cardioversion success and its relationship with recurrence in patients with non-valvular atrial fibrillation subjected to electrical cardioversion: a study on diagnostic accuracy.

Objective: The aim of this study was to assess the predictive value of the left atrial volume index (LAVI) in electrical cardioversion (ECV) and observe the recurrence rate of atrial fibrillation (AF) after a successful ECV in patients with non-valvular atrial fibrillation.

Method: This study was designed as a diagnostic accuracy and prospective cohort study. Eighty patients (mean age 62±12 years; 52.

Catheter ablation for long-standing persistent atrial fibrillation in patients who have failed electrical cardioversion.

Ablation outcomes in 22 consecutive long-standing persistent atrial fibrillation (LPAF) patients with failed direct current cardioversion (DCCV; group 1) were compared with findings in 22 consecutive LPAF patients who had successful DCCV (control 1) and 22 consecutive patients with paroxysmal atrial fibrillation (AF; control 2). All patients underwent a stepwise progressive ablation protocol (pulmonary vein isolation, ablation of complex fractionated atrial electrogram, and repeat ablation of any induced atrial tachycardias). Over 18-month follow-up, 59 % of group 1 patients remained in sinus rhythm without recurrent AF, compared to 64 % and 77 % in controls 1 and 2, respectively.

Aortic valve endocarditis and cerebral mycotic aneurysm due to brucellosis.

Brucellosis is an infectious disease caused by Gram-negative coccobacilli. Direct contact with the infected tissue or blood, consumption of infected dairy products, and inhalation of infectious aeresol particles can transmit the disease. Brucella endocarditis is rare but the most fatal complication of brucellosis.