Rescue axillary artery covered stent during transvenous cardiac device implantation.

Injury to axillary and subclavian arteries during cardiac rhythm device implantation might lead to significant mortality and morbidity especially in those with a low body mass index (BMI). We report the case of 65-year-old underweight male patient with BMI of 15.1 (height 166 cm, weight 41.

Assessment of the quality of anticoagulation management with warfarin in a tertiary care center.

Objectives: To evaluate the quality of an anticoagulation clinic in a tertiary hospital and identified factors affecting the time in the therapeutic range (TTR) and its relation to different complications. Methods: This single-center retrospective study conducted between March 2015 and June 2016 included 1914 patients receiving warfarin therapy. They were divided into 4 warfarin indication groups: non-valvular atrial fibrillation (AF) (n=403), valvular AF (n=227), prosthetic valves (n=700), and venous or pulmonary embolism (n=584).

Remotely monitored inactivity due to COVID-19 lockdowns. Potential hazard for heart failure patients.

Objectives: To study the impact of curfews during the COVID-19 pandemic, on the physical activity in patients of heart failure implanted withcardiac implantable electronic devices (CIEDs).

Methods: This was a retrospective single-center study of heart failure patients inserted with remote monitoring (RM)-capable CIED. We analyzed the transmitted data of physical activity and fluid volume status of all patients, before, and during the lockdown periods between February and April 2020.

A de novo splicing variant supports the candidacy of TLL1 in ASD pathogenesis.

Congenital heart disease (CHD) is the most common type of birth defects with family- and population-based studies supporting a strong hereditary component. Multifactorial inheritance is the rule although a growing number of Mendelian forms have been described including candidates that have yet to be confirmed independently. TLL1 is one such candidate that was proposed in the etiology of atrial septal defect (ASD).

Autosomal recessive long QT syndrome, type 1 in eight families from Saudi Arabia.

Background: One of the most common primary cardiac arrhythmia syndromes is autosomal dominant long QT syndrome, type 1 (LQT1), chiefly caused by mono-allelic mutations in the gene. Bi-allelic mutations in the gene are causal to Jervell and Lange-Nielsen syndrome (JLNS), characterized by severe and early-onset arrhythmias with prolonged QTc interval on surface ECG and sensorineural deafness. Occasionally, bi-allelic mutations in are also found in patients without any deafness, referred to as autosomal recessive long QT syndrome, type 1 (AR LQT1).

The Gulf Implantable Cardioverter-defibrillator Registry: Rationale, Methodology, and Implementation.

Background: The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region.

A Zebrafish Loss-of-Function Model for Human CFAP53 Mutations Reveals Its Specific Role in Laterality Organ Function.

Establishing correct left-right asymmetry during embryonic development is crucial for proper asymmetric positioning of the organs. Congenital heart defects, such as dextrocardia, transposition of the arteries, and inflow or outflow tract malformations, comprise some of the most common birth defects and may be attributed to incorrect establishment of body laterality. Here, we identify new patients with dextrocardia who have mutations in CFAP53, a coiled-coil domain containing protein.

A delayed spontaneous expulsion of a three teeth bridge after 6 months period of aspiration in the right lung following cardiac surgery.

Aspiration of loose teeth is a well-known complication of endo-tracheal intubation hence the importance of oral check by anesthetist prior to ventilation. Artificaial teeth crown (single) or bridges (multiple) can be fixed or removable by the patient. The presence of a foreign body in the lung tissue or airways is a clinical situation that needs aggressive management as it can lead to refractory infections and possible death.

An Initiative Technique to Facilitate Axillary Vein Puncture During CRT Implantation.

Objectives: The aim of the study was to describe a new technique to minimize requirement of contrast and the time to puncture the axillary vein during implantation of cardiac resynchronization therapy (CRT) devices.

Background: One of the challenges to the wide applications of CRT has been the technical difficulty encountered while obtaining venous access utilizing axillary venous puncture. This is mainly due to vague anatomical land marks.

Positional mapping of PRKD1, NRP1 and PRDM1 as novel candidate disease genes in truncus arteriosus.

Background: Truncus arteriosus (TA) is characterised by failure of septation of the outflow tract into aortic and pulmonary trunks and is associated with high morbidity and mortality. Although ranked among the least common congenital heart defects, TA provides an excellent model for the role of individual genes in cardiac morphogenesis as exemplified by TBX1 deficiency caused by point mutations or, more commonly, hemizygosity as part of the 22q11.2 deletion syndrome.

Simultaneous antegrade dual AV node conduction initiates AV nodal re-entrant tachycardia (a rare initiation mechanism).

Typical atrioventricular nodal reentrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia among adults. The concept of dual pathway physiology remains widely accepted, although this physiology likely results from the functional properties of anisotropic tissue within the triangle of Koch, rather than anatomically distinct tracts of conduction. AVNRT is typically induced with anterograde block over the fast pathway and conduction over the slow pathway, with subsequent retrograde conduction over the fast pathway.

The ECG role in identifying the etiology of tachycardia-induced cardiomyopathy (TIC).

Tachycardia-induced cardiomyopathy (TIC) is a well recognized entity of heart failure (HF) and various mechanisms due to tachyarrhythmias have been postulated to be responsible for impaired cardiac contractility. Previously reported cases showed reversibility of such disorders whenever stable cardiac rhythm is maintained adequately and we report on a 16-year-old boy who has been diagnosed to have TIC, which was misinterpreted initially as sinus tachycardia secondary to dilated cardiomyopathy and heart failure. A complete recovery of his left ventricular function was achieved by radiofrequency catheter ablation and highlights the importance of a 12-lead electrocardiogram (ECG) assessment in such patients.

The importance of utilizing 24-h Holter monitoring as a non-invasive method of predicting the mechanism of supraventricular tachycardia.

Despite the emergence of advanced invasive technology in identifying the various types of arrhythmia mechanisms, 24-h ambulatory electrocardiogram monitoring as a non-invasive method remains an invaluable informative tool in delineating such mechanisms. Furthermore, one observational study has supported the utilization of 24-h Holter monitoring in exploring AV Node (AVN) characteristics sufficiently in correlation with invasive studies when limited to patients without Wolf Parkinson White syndrome showing a positive predictive value of 98% in their supraventricular tachycardia (SVT) assessment (Fukuda et al., 2005).

Coronary sinus diverticulum as a cause of resistant posteroseptal pathway ablation.

Coronary sinus (CS) anomalies such as diverticulum, persistent left superior vena cava or CS ostium dilatation are predominantly found in patients with accessory pathway-related tachycardias. Diverticulum of the proximal CS found in 7-11% of patients with postero-septal or left posterior manifests accessory pathways. We reported a 28 year old gentleman with manifested postero-septal accessory pathway, who underwent repeat electrophysiological study (EPS) and radiofrequency ablation for previously failed ablation.

Safe and effective use of conscious sedation for defibrillation threshold testing during ICD implantation.

Background: Over a period of years general anesthesia has been a standard anesthetic technique for defibrillation threshold (DFT) testing at the time of implant. DFT testing without general anesthesia cover has gained limited acceptance. Use of local anesthesia combined with deep sedation for DFT testing might facilitate and simplify these procedures by reducing the procedural time, staff time, avoiding inefficient service in organizing anesthetic cover; thereby improving patient compliance.

An initiative to minimize amount of contrast media utilizing a novel rotational coronary sinus occlusive venography technique with ordinary cath-lab X-ray machine during CRT implantation.

Background: Rotational angiography is one of the latest angiographic modalities to map the coronary venous tree anatomy. It provides a significant reduction in both contrast agent usage and radiation dose (up to 30%), without compromising the clinical utility of images. Hence, the present study was conducted to describe a new technique to minimize the amount of contrast media used during cardiac resynchronization therapy (CRT) implantation.

Controlling rate and rhythm increases feasibility of CT angiography in atrial fibrillation.

A woman, aged 48 years, with severe rheumatic mitral stenosis and uncontrolled permanent atrial fibrillation (AF) underwent preoperative assessment of coronary arteries. Invasive coronary angiography was not possible because of occluded common iliac artery and bilateral radial spasm. Transesophageal echocardiogram showed a very large mobile left atrial appendage clot, precluding cardioversion.

Transient sinus node dysfunction with acute hepatitis of unknown etiology.

We reported a case of a 72-year-old male, known diabetic on insulin, referred because of complete atrioventricular block. He was found to have acute hepatitis during which he developed transient atrial arrhythmia, and sinus node dysfunction. His cardiac symptoms disappeared completely after hepatitis improvement.

Feasibility of cardiac resynchronization therapy in a patient with complex congenital heart disease and dextrocardia, facilitated by cardiac computed tomography and coronary sinus venography.

We describe a case with pacemaker implantation for cardiac resynchronization therapy (CRT) in a patient with complex congenital heart disease, facilitated by cardiac computed tomography (CT) and coronary sinus (CS) venography. A 37-year-old male presented with congenitally corrected transposition of the great arteries and mesocardia, along with a history of two open heart surgeries (closure of atrial septal defects and a ventricular septal defect, and pulmonary valvectomy at age 7; mechanical tricuspid valve replacement at age 13). He showed symptoms of progressive heart failure (NYHA class III) with significant impairment of the systemic right ventricular function.

Maneuvering balloon occlusion technique to deflect LV lead into a target branch during CRT implantation.

Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy (DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of a 45-year-old woman with DCM requiring lead placement is presented here.

Neonatal meningitis.

Objective: To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998.

Methods: Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied.

Results: There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates.

Neonatal meningitis.

Objective: To determine the prevalent bacterial agents of neonatal meningitis and their antibiotic susceptibility in a referral intensive care unit in Assir Central Hospital, Saudi Arabia, during the years 1993-1998.

Methods: Records of newborn infants with positive cerebrospinal fluid culture during the period were retrospectively studied.

Results: There were 1473 nursery admissions, of which 32 episodes of meningitis occurred amongst 31 neonates.