A cardiac implantable device infection by in an immunocompromized patient.

Infection of cardiac implantable electronic devices is a severe condition associated with high mortality, particularly in patients who are dependent upon heart-pacing devices. are found in 70 % of reported cases. We report the case of a cardiac-pacemaker infection in a 79-year-old man, cumulating a history of rheumatoid arthritis treated by corticosteroids and methotrexate by a recently identified micro-organism: .

Resynchronization with left ventricle lead placement through the foramen ovale.

Left ventricle (LV) lead placement in a coronary sinus branch for cardiac resynchronization therapy may fail because of anatomical variants, phrenic nerve stimulation, and/or lead instability. We report a case of successful resynchronization from a lead inserted from the left subclavian vein and positioned through a patent foramen ovale (PFO). In conclusion, endocardial LV lead insertion through a PFO enables effective resynchronization delivery without the risks associated with a thoracotomy or atrial transseptal puncture.

Resynchronization: what if the left ventricular lead cannot reach the lateral or posterolateral wall?

Background: The recommended left ventricular (LV) lead position for cardiac resynchronization therapy (CRT) is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at this site. The objective of our study was to compare the clinical response to CRT when the LV lead could be implanted or not at the lateral or posterolateral wall.

Where are the left ventricular leads really implanted? A study of 90 consecutive patients.

Background: Cardiac resynchronization therapy (CRT) is a recognized treatment for severe heart failure. The recommended left ventricular (LV) lead position is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at the expected site.

Reverse remodeling with resynchronization in an asymptomatic patient with dilated hypokinetic cardiomyopathy.

Cardiac resynchronization therapy (CRT) is a validated treatment for selected heart failure patients who remain highly symptomatic despite optimal drug treatment. Yet there is currently no indication for CRT in patients with few or no symptoms. We report a spectacular "reverse remodeling" effect after CRT in an asymptomatic patient with hypokinetic dilated myocardiopathy who needed pacing for atrio-ventricular conduction disorder.

Preclavicular route following cephalic venous cutdown for pacemaker or defibrillator lead implantation.

Following cephalic venous cutdown, an unexpected preclavicular course was used in two cases for a pacemaker and a defibrillator lead implantation. This very rare anomaly was documented by cephalic venogram but did not cause any significant intraoperative difficulty during single lead implantation.

Atrioventricular nodal reentrant tachycardia diagnosed by pacemaker electrograms.

Electrograms stored by pacemakers or implantable defibrillators enable the diagnosis of numerous atrial or ventricular arrhythmia episodes. We present the case of a patient implanted with a DDD pacemaker for sinus node dysfunction who experienced episodes of tachycardia. Atrioventricular nodal reentrant tachycardia was diagnosed by real-time analysis of electrograms during and at the onset of the tachycardia episodes.

Cardiac resynchronization therapy using a VDD lead.

In heart failure patients with normal sinus node function, cardiac resynchronization therapy can be achieved with only two leads, one VDD type, and one left ventricular. This reduces the number of venous punctures, implanted leads, and possibly operation and fluoroscopic times and complication rates. We present two cases and discuss the advantages and limits of such a procedure.

Life-threatening pulmonary embolism with right-sided heart thrombus. Rapid recovery with recombinant tissue plasminogen activator.

We report the case of a woman treated with urokinase for acute pulmonary embolism with a right-sided heart thrombus. She developed life-threatening acute cor pulmonale which dramatically improved within 4 h with recombinant tissue plasminogen activator (rtPA). We emphasize the clinical interest of rtPA for the treatment of life-threatening pulmonary embolism.

Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy.

Background: Ablation of the slow pathway has been performed to eliminate atrioventricular (AV) nodal reentrant tachycardia (AVNRT) either by a surgical approach or by using radiofrequency catheter technique guided by retrograde slow pathway activation mapping. From previous experience of midseptal and posteroseptal mapping, we were aware of the existence of peculiar slow potentials in most humans. Postulating their role in AVNRT, we studied these potentials and the effects of radiofrequency energy.

[Potential value of omega-3 polyunsaturated fatty acids in the prevention of atherosclerosis and cardiovascular diseases].

Several epidemiological studies have shown decreased cardiovascular mortality and a lower incidence of coronary artery disease in subjects with high dietary intakes of Omega-3 polyunsaturated fatty acids. It has since been shown that Omega-3 fatty acids have a number of beneficial effects in the prevention of atherosclerosis in man: reduction of blood pressure, modifications of lipoprotein metabolism, modifications of haemostasis (increased bleeding time and reduced platelet aggregation), decreased plasma fibrinogen, modifications of the metabolism of arachidonic acid and its derivatives (decreased thromboxane and leukotriene synthesis, increased prostacyclin synthesis). Therefore, Omega-3 polyunsaturated fatty acids have several beneficial effects on the presumed mechanisms of atherogenesis and/or its complications: they could represent an original and seductive solution to the problem of prevention of cardiovascular disease.

Scrub typhus: an imported Rickettsial disease.

A case of scrub typhus due to Rickettsia tsutsugamushi is reported. This imported rickettsial disease was contracted by a 30-year-old woman while traveling in Thailand, and was transmitted by an infected mite's bite. Diagnosis was confirmed by specific serology and resolution was obtained by tetracycline therapy.

Frequency of recurrent atrial fibrillation after catheter ablation of overt accessory pathways.

The effect of successful catheter ablation of overt accessory pathways on the incidence of atrial fibrillation (AF) was studied in 129 symptomatic patients with (n = 75) or without (n = 54) previous documented AF. Fourteen had had ventricular fibrillation. Factors predictive of recurrence were examined, including electrophysiologic parameters.

Decreased incidence of infection after renal transplantation with the use of cyclosporine.

The incidence of infection within six months of cadaveric kidney transplantation was reviewed in 183 consecutive patients. Prior to June, 1985, 91 patients received azathioprine 2 mg/kg/day and prednisone 0.5 mg/kg/day; 63 patients (group A1) also received antilymphocyte globulin 15 mg/kg/day for the first ten days, whereas for the 28 other patients (group A2) antilymphocyte globulin had to be withdrawn before 72 hours because of general intolerance.

[Cardiac lesions in AIDS].

The frequency of cardiac lesions in AIDS patients is diversely evaluated. At post-mortem examination macroscopic lesions are said to have been found in 20 percent of the patients, and microscopic lesions in 50 percent. In some clinical studies, up to 55 percent of the patients had echocardiographic abnormalities.

Distinctive response of arrhythmogenic right ventricular disease to high dose isoproterenol.

Arrhythmogenic right ventricular disease is a potential cause of ventricular arrhythmias. Diagnosis is important due to the risk of sudden death, particularly as first symptom. Diagnosis is based on the angiographic demonstration of abnormal right ventricular morphology and function, while the sensitivity of noninvasive tests is relatively low.

Fulguration for AV nodal tachycardia: results in 42 patients with a mean follow-up of 23 months.

This report describes a catheter ablation technique to treat atrioventricular nodal reentrant tachycardia while preserving anterograde conduction, and its application in 42 patients with drug-refractory repetitive episodes of tachycardia. One of these patients had common and reverse forms of tachycardia. Using atrial activation in the His-bundle lead as a reference, the optimal ablation site was selected by positioning an electrode catheter to obtain a synchronous or earlier atrial activation than the reference during tachycardia.

Catheter ablation of accessory pathways: technique and results in 248 patients.

Two hundred and forty-eight patients with refractory arrhythmias related to an accessory pathway underwent catheter ablation. Cathodal shocks (160 to 240 joules) were delivered through the distal electrode of a standard catheter (usually a quadripolar electrode catheter with 5-mm interelectrode distances). A paddle electrode positioned opposite to the catheter served as the anode.

[Interventional rhythmology].

Interventional cardiorhythmology was born with the invention of electrical catheter ablation of the common atrioventricular bundle of His as a palliative treatment of supraventricular arrhythmias refractory to medicinal treatment. This method is now used as a curative treatment. In Wolff-Parkinson-White syndrome, all accessory pathways, whatever their location, can be destroyed with a very high success rate (96 p.

[Malaria and retinal hemorrhages].

A 24-year-old woman presented with retinal hemorrhages, back from a travel in Cameroon. She took a chloroquine chemoprophylaxis. We diagnosed a malaria due to Plasmodium falciparum with anemia, splenomegaly and low parasitemia.