Sensitivity and specificity of sodium channel blocking test in the diagnosis of Brugada syndrome.

The ECG features of Brugada syndrome are dynamic and frequently concealed. Sodium channels blockers are widely used to unmask the Brugada electrocardiographic (ECG) pattern. The sensitivity and specificity of I(Na) channel blocking test varies significantly.

Prevalence of early repolarization pattern in inferolateral leads in patients with Brugada syndrome.

Background: Recent data have shown a high incidence of the early repolarization pattern confined in inferolateral leads in patients with idiopathic ventricular fibrillation.

Objectives: The purpose of the present study was to investigate the prevalence and the prognostic significance of the early repolarization pattern in inferolateral leads in patients with Brugada syndrome.

Methods: Clinical, genetic, and electrophysiologic data from 290 individuals (223 males, mean age 48.

Clinical characteristics of patients with drug-induced QT interval prolongation and torsade de pointes: identification of risk factors.

The present study aimed to investigate the causative medications and underlying risk factors that predispose to drug-induced QT interval prolongation. Twenty-one patients with drug-induced long QT (90% females, mean age 64.3 +/- 14.

Histological recognition and classification of the atrioventricular node artery variants: a new approach.

Background: There is a controversy in the literature concerning the origin, course, and distribution of the atrioventricular (AV) node artery.

Methods: Postmortem coronary angiography, dissection, and microscopic examination were performed in 100 human hearts specimens, providing anatomical, histological, and postmortem angiographic features of the AV node artery.

Results: Two anatomical types of AV node artery, depending on its length (long-short), were found.

Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation.

Aims: An increasing body of evidence has demonstrated the essential role of inflammation in the genesis and maintenance of atrial fibrillation (AF). The aim of the present study was to investigate whether success or failure of electrical pulmonary vein isolation (PVI) in patients with AF is related with the presence of a pre-ablative inflammatory state as determined by known clinical parameters and conventional markers of inflammation including high-sensitivity C-reactive protein, white blood cell (WBC) count, and fibrinogen.

Methods And Results: Seventy-two patients with paroxysmal (64%) or persistent AF (36%) underwent successful electrical PVI.

Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction.

Objectives: The present study aimed to investigate the clinical and echocardiographic determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation (AF) and preserved left ventricular ejection fraction (LVEF).

Methods: NT-pro-BNP levels were measured in 45 patients with paroxysmal AF, 41 patients with permanent AF and 48 controls.

Results: NT-pro-BNP levels were found significantly elevated in patients with paroxysmal (215+/-815 pg/ml) and permanent AF (1,086+/-835 pg/ml) in relation to control population (86.

ECG findings of acute myocardial infarction and atrioventricular block during a transseptal procedure for left atrial ablation.

We report on a patient with transient atrioventricular block and ST-segment elevation mimicking the ECG of myocardial infarction during transseptal puncture for radiofrequency catheter ablation of atrial fibrillation. Symptoms and EGG findings resolved spontaneously. A neurally-mediated mechanism, activated by the mechanical effects of the transseptal puncture on the interatrial septum and leading to coronary artery spasm, may be considered as a possible explanation of this phenomenon.

Catheter ablation of recipient-to-donor atrioatrial conduction with Wenckebach-like phenomenon after orthotopic heart transplantation.

This report describes a case of atrial tachycardia in the recipient atrium manifested electrocardiographically as typical atrial flutter in the donor atrium due to atrioatrial conduction delay with Wenckebach-like phenomenon at the anastomotic line. Radio-frequency energy application resulted in immediate recipient-to-donor conduction block.

Neurally mediated susceptibility in individuals with Brugada-type ECG pattern.

Background: Neurally mediated syncope and Brugada syndrome (BS) share common pathophysiologic mechanisms related to autonomic nervous system modulations, and particularly with increased vagal tone. This study aimed to investigate the incidence of neurally mediated susceptibility in individuals with Brugada-type electrocardiogram (ECG) pattern.

Methods And Results: Eight asymptomatic male individuals (mean age 41.

Ablation of atrial fibrillation in patients with heart failure: reversal of atrial and ventricular remodelling.

Introduction: The management of patients with heart failure and atrial fibrillation (AF) is a medical challenge, especially in the case of patients in whom sinus rhythm or rate control cannot be achieved with optimal pharmaceutical treatment.

Methods: Thirteen consecutive patients (11 men and 2 women, 35-70 years old, median age 55 +/- 23 years) with heart failure (NYHA I-IV, median ejection fraction 35 +/- 5%, range 25-40%) and symptomatic persistent (10 patients, 76.9%) or permanent (3 patients, 23.

Reversal of premature ventricular complex-induced cardiomyopathy following successful radiofrequency catheter ablation.

Premature ventricular complex (PVC)-induced cardiomyopathy is an underappreciated cause of left-ventricular (LV) dysfunction. The present report describes the case of an elderly man with a very high burden of monomorphic PVCs and LV dysfunction. Elimination of the left ventricular focus following radiofrequency catheter ablation resulted in reversal of cardiomyopathy.

Large left atrial myxoma presented as fever of unknown origin: a challenging diagnosis and a review of the literature.

Myxoma is the most common type of primary tumors of the heart in adults. The majority of patients with myxomas may experience symptoms due to central or peripheral embolism or intracardiac obstruction, while in some cases, they may be completely asymptomatic. Rarely, patients develop unusual symptoms that complicate the diagnostic evaluation.

The natural history of arrhythmogenic right ventricular cardiomyopathy.

The authors describe the case of a 66-year-old woman with arrhythmogenic right ventricular dysplasia masqueraded as dilated cardiomyopathy. Her medical history included recurrent episodes of syncope beginning at the age of 28. The natural history of the disease is discussed.

Prevalence of Brugada sign in a Greek tertiary hospital population.

Aims: The purpose of the present study was to determine for the first time the prevalence of Brugada-type electrocardiographic (ECG) pattern (Brugada sign) in unselected individuals served by an urban Greek tertiary hospital during a 4-year time period.

Methods And Results: Among 11,488 individuals (6640 males, 4848 females), 25 (23 males, 2 females, aged 36.8 +/- 19.

Post-mortem angiographic and histologic findings of coronary artery fibromuscular dysplasia.

The present report highlights on exceptional angiographic and histologic features of coronary artery fibromuscular dysplasia in a young man complaining of chest discomfort during strenuous exercise. The striking features of fibromuscular dysplasia were the relative proximal localization of the lesion in left anterior descending coronary artery, the extensive length of the lesion, and the exclusive involvement of the intima producing a diffuse regular narrowing lesion. An eccentric intimal proliferation of the small left anterior descending coronary artery branches along their epicardial and intramural course was additionally demonstrated.

Prevalence of paroxysmal atrial fibrillation in Brugada syndrome: a case series and a review of the literature.

Objective: The present study aimed at investigating the incidence of paroxysmal atrial fibrillation in 10 patients with spontaneous or induced type 1 electrocardiographic pattern of Brugada syndrome (three with syncopal episodes and seven asymptomatic). Both clinical entities are closely associated with changes in autonomic modulation and, particularly, with increased vagal tone.

Methods: Transthoracic echocardiography, exercise treadmill test and 24-h Holter recordings were performed to all patients.

Brugada electrocardiographic pattern induced during febrile state with marked leukocytosis.

Several agents and conditions have been reported to unmask or accentuate the electrocardiographic pattern of Brugada syndrome including fever. At a molecular level, sodium channels have been showed to be temperature dependent. Herein, we describe a case of Brugada electrocardiographic pattern unmasked during febrile state and marked leukocytosis.

Acute myocardial infarction with normal coronary arteries in a patient with Hodgkin's disease: a late complication of irradiation and chemotherapy.

We describe the case of a 31-year-old man who experienced an acute myocardial infarction 16 years after undergoing radiation and vinca alkaloid therapy for Hodgkin's disease. Even though coronary artery disease is a well-established complication after mediastinal radiation therapy, this adult patient had normal coronary angiographic results, with no traditional risk factors for coronary artery disease, and no hematologic or other abnormality associated with hypercoagulability.

Fine-needle aspiration biopsy-RT-PCR expression analysis of prothymosin alpha and parathymosin in thyroid: novel proliferation markers?

Fine-needle aspiration biopsy-based cytology has become an established and reliable diagnostic preoperative test in the evaluation of thyroid nodules. Despite the high specificity and sensitivity of the method, results might be doubtful in a significant number of cases. Genetic analysis of the aspirates by RT-PCR may contribute, in parallel to the cytology report, to a more precise diagnosis.

Pathophysiology and management of syncope in Kearns-Sayre syndrome.

A 20-year-old woman with known Kearns-Sayre syndrome was transferred to the emergency department due to syncopal episodes. The electrocardiogram on admission showed complete atrioventricular block. The diagnosis of mitochondrial encephalomyopathy was made when she was 14 years old.

ST-segment elevation induced during the transseptal procedure for radiofrequency catheter ablation of atrial fibrillation.

We report two cases of transient coronary artery ischemia manifested as chest discomfort with ST-segment elevation in inferior leads during the transseptal procedure for radiofrequency catheter ablation of atrial fibrillation. This unexpected complication was resolved by intravenous administration of nitrates. All patients exhibited normal coronary arteries in angiography.

Secondary prevention of sudden cardiac death in coronary artery spasm: is implantable cardioverter defibrillator always efficient?

Syncope and/or cardiac arrest in the setting of coronary artery spasm have been associated with atrioventricular block and asystole or ventricular tachyarrhythmias. Ventricular arrhythmias have been predominantly reported in cases of multivessel coronary artery spasm. The present report highlights the case of a young woman who suffered repeated episodes of multivessel coronary artery spasm in association with polymorphic ventricular tachycardia and cardiac arrest.