Azygos vein lead implantation: a therapeutic option for elevated defibrillation threshold.

The evaluation of the defibrillation threshold (DFT) during the implantation of a cardioverter-defibrillator (ICD) is an important stage of the procedure, as a high DFT can be found in up to 16% of patients. We report a patient with idiopathic dilated cardiomyopathy (DCM) submitted to a biventricular ICD implantation. During the procedure, the patient showed a high DFT and showed to be resistant to usual therapeutic modalities.

Summary of the II Brazilian Guideline update on Acute Heart Failure 2009/2011.

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room.

Safety of ablation for atrial fibrillation with therapeutic INR: comparison with transition to low-molecular-weight heparin.

Background: The ideal management of oral anticoagulation (OAC) before and after catheter ablation for atrial fibrillation (AF) is still controversial.

Objective: To compare two anticoagulation strategies for catheter ablation for AF: warfarin withholding and use of low-molecular-weight heparin (LMWH); and maintenance of warfarin and therapeutic INR (between 2.0 and 3.

Use of intracardiac echocardiography in the electrophysiology laboratory.

The intracardiac echocardiography (ICE) offers a detailed visualization of the cardiac structures, in association with hemodynamic information, allowing the precise and real-time positioning of the catheters, decreasing the time of exposure to fluoroscopy and the monitoring of acute complications during the electrophysiological procedure (i.e., formation of thrombi, pericardial effusion, cardiac tamponade), Consequently, its use has progressively increased, mainly in the ablation of atrial fibrillation and ventricular arrhythmias.

Postpartum torsades de pointes and long QT syndrome.

This article reports the case of a puerperal patient admitted with diagnosis of urinary tract infection and heart failure. This condition evolved with torsades de pointes ventricular arrhythmias, then, hypokalemia, and use of Ciprofloxacin. Ventricular arrhythmias did not present any improvement after potassium and magnesium replacement, but after implantation of temporary pacemaker, this condition showed signs of improvement.

Intra-His bundle block. Clinical, electrocardiographic, and electrophysiologic characteristics.

Objective: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS).

Methods: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS.

Results: Intra-His bundle block was documented in 16 pt during an EPS.