Erysipelas and acute myocarditis: an unusual combination.

Myocarditis is a rare disease with variable clinical presentation and diverse electrocardiographic and echocardiographic features. Viral infection is the most common cause, but myocarditis can also be caused by bacterial infection. The most frequently involved bacterial agent is group A Streptococcus, which is also an etiologic agent of erysipelas.

A simple pacing method to diagnose postero-anterior (clockwise) cavo-tricuspid isthmus block after radiofrequency ablation.

Aims: Bidirectional block of the cavo-tricuspid isthmus (CTI) is a widely accepted endpoint for typical atrial flutter ablation, but its evaluation may be difficult, especially in the postero-anterior (clockwise) direction. The main goal was to evaluate pacing at the septal edge of the ablation line as an indicator of clockwise CTI block and as a predictor for flutter recurrence.

Methods And Results: In 94 patients undergoing flutter ablation, CTI block in the antero-posterior (counterclockwise) direction was determined by differential pacing from several levels of the anterior right atrial (RA).

Electroanatomic study of the left atrial insertion of an epicardial accessory pathway integrating the coronary sinus.

Endocardial electro-anatomic reconstruction of the left atrium and activation mapping defined a very large atrial accessory pathway insertion with a previously failed ablation attempt. Radiofrequency application inside the coronary sinus (CS), at a site with a sharp electrogram bridging atrial and ventricular electrograms abolished pathway conduction. The myocardium in the venous branches of the CS appeared to be responsible for this extraordinary atrial insertion area.