Approach to the Diagnosis and Management of Complex Fascicular Ventricular Tachycardias.

Complex ventricular tachycardias involving the fascicular system (fascicular ventricular tachycardias [FVTs]) can be challenging. In this review, we describe our approach to the diagnosis and ablation of these arrhythmias with 10 illustrative cases that involve (1) differentiation from supraventricular tachycardia; (2) assessment for atypical bundle branch reentry and other interfascicular FVTs; (3) examination of P1/P2 activation sequences in sinus rhythm, pacing, and tachycardia; and (4) entrainment techniques to establish the tachycardia mechanism and aid circuit localization. To summarize, 5 cases had prior ablation with 2 previously misdiagnosed as supraventricular tachycardia.

High-density electroanatomic mapping of atriofascicular pathways using multipolar mapping catheters can identify oblique pathways and avoid mechanical bump termination.

Background: Atriofascicular fibers (AFFs) are rare accessory pathways that have higher rates of recurrence after ablation because of either failure to identify AFF (M) potentials or mechanical termination with contact.

Objective: We aimed to evaluate whether electroanatomic mapping (EAM) using multielectrode, high-density nonlinear catheters can reliably localize AFF potentials and determine a site for ablation without causing mechanical termination.

Methods: Seven patients underwent electrophysiology studies (EPS) and EAM using high-density, multielectrode catheters for antidromic tachycardia using AFFs.

QRS prolongation is associated with associated with adverse cardiac remodeling in hypertrophic cardiomyopathy.

Background: Signal-averaged electrocardiogram (SAECG) records myocardial depolarization, and can detect inhomogeneous/slow conduction in fibrotic myocardium, which promotes reentrant ventricular arrhythmias (VAs). Hypertrophic cardiomyopathy (HCM) is associated with a high prevalence of cardiac fibrosis and VAs, but abnormal SAECG has low predictive power for VAs. We hypothesized that HCM-specific structural/electrical remodeling underlies this result.

Sabbath Observance and Delayed Primary Repair of Lacerations: Experience from a Plastic Surgery Practice.

Background: Despite public and medical professionals' misconceptions about the timing of laceration repair and its consequences, it has been shown that the concept of the "golden period" has not been established, and in many uncomplicated wounds, may extend beyond 24 hours. This author presents his experience with delaying primary repairs, which may represent one of the largest published casuistries.

Methods: A retrospective review of cases over a 14-year practice and review of the literature on the topic of the golden period and delayed primary repair of lacerations were performed.