Cardiac sarcoidosis diagnosed after orthotopic heart transplantation and clinically mimicking arrhythmogenic right ventricular cardiomyopathy.

Described herein is a 71-year-old man who underwent orthotopic heart transplant (OHT) for chronic severe heart failure secondary to cardiac sarcoidosis (CS) devoid of non-caseating granulomas but nevertheless characteristic of CS. Clinically, his heart disease had suggested the presence of arrhythmogenic right ventricular cardiomyopathy.

Flecainide toxicity late after liver transplantation.

Flecainide is an antiarrhythmic agent indicated for patients with supraventricular arrhythmias without ischemic or structural heart disease. Flecainide toxicity is a rare condition in which patients may present with bradycardia, widening of QRS, PR prolongation, ventricular tachycardia, syncope, malaise, dizziness, visual disturbance, nausea, vomiting, and/or lethargy. It carries an associated mortality rate of approximately 10%.

Hyfrecation and Interference With Implantable Cardiac Devices.

Background: Mohs micrographic surgery, excisional surgery, and electrodessication and curettage (ED&C) are common dermatologic procedures that often use electrodessication through hyfrecators to achieve hemostasis. According to in vitro studies, electrodessication is considered safe in patients with implanted cardiac devices. To the authors' knowledge, there are no in vivo data to support this claim.

Brugada ST elevation masquerading as ST elevation myocardial infarction.

Brugada syndrome (BS) is a genetic cardiac syndrome first described in 1992 that is characterized by distinct abnormalities noted in leads V1 and V2 on electrocardiogram. It often leads to syncope or even sudden death in affected patients due to its propensity for ventricular tachycardia and fibrillation. The characteristic ST elevation seen in these patients can be confused with ischemic ST elevation.

Takotsubo cardiomyopathy in the setting of complete heart block.

Few cases of coincident takotsubo cardiomyopathy and complete heart block (CHB) have been reported. A 62-year-old woman presented with typical chest pain and was found to have CHB with a left ventricular ejection fraction of 35% and apical ballooning on ventriculogram. The patient was transvenously paced and a permanent biventricular pacemaker was placed when the CHB did not resolve.

Analysis of electrocardiographic intervals before and after transcatheter aortic valve implantation to predict the need for permanent pacing.

Transcatheter aortic valve implantation (TAVI) is growing in utilization in the USA, and atrioventricular heart block is a common complication of the procedure. In patients with conduction system changes following TAVI, there are no clear guidelines for permanent pacing, leading to difficult clinical decisions on how long to leave temporary transvenous pacemakers in place. The aim of our study was to determine whether changes in electrocardiogram characteristics could predict the need for permanent pacing.

Bilateral sympathectomy for treatment of refractory ventricular tachycardia.

Ventricular tachycardia (VT) commonly occurs in patients with ischemic or nonischemic cardiomyopathy and requires antiarrhythmic drugs, ablation, or advanced circulatory support. However, life-threatening VT may be refractory to these therapies, and may cause frequent implantable cardioverter defibrillator (ICD) discharges. Left cardiac sympathetic denervation reduces the occurrence of these fatal arrhythmias by inhibiting the sympathetic outflow to the cardiac tissue.

Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Pro.

Warfarin has had a thin margin of benefit over risk for the prevention of stroke and systemic embolism in patients with ESRD because of higher bleeding risks and complications of therapy. The successful use of warfarin has been dependent on the selection of patients with nonvalvular atrial fibrillation at relatively high risk of stroke and systemic embolism and lower risks of bleeding over the course of therapy. Without such selection strategies, broad use of warfarin has not proven to be beneficial to the broad population of patients with ESRD and nonvalvular atrial fibrillation.

Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF.

Objective: We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM).

Methods: We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models.

Syncope secondary to second-degree atrioventricular block with donepezil use.

Donepezil, an acetylcholinesterase inhibitor, is approved for the treatment of mild to moderate dementia secondary to Alzheimer's disease. Although most prescribers are aware of the common gastrointestinal side effects of donepezil, cardiovascular side effects are rarely observed. Cardiovascular side effects of donepezil have almost always been observed in patients with a history of conduction defects or sick sinus syndrome.

Drug-induced QT interval prolongation: mechanisms and clinical management.

The prolonged QT interval is both widely seen and associated with the potentially deadly rhythm, Torsades de Pointes (TdP). While it can occur spontaneously in the congenital form, there is a wide array of drugs that have been implicated in the prolongation of the QT interval. Some of these drugs have either been restricted or withdrawn from the market due to the increased incidence of fatal polymorphic ventricular tachycardia.

Unusual origin of type 1 atrioventricular block with comments on Wenckebach's contribution.

We present a case that demonstrates the rare occurrence of type 1 second-degree atrioventricular block (Wenckebach or Mobitz type 1 block) as a result of block in the infranodal conduction system. This extremely rare occurrence often predicts progression to complete heart block and necessitates cardiac pacing. It also demonstrates the value of an electrophysiological study and exercise stress testing to identify the level of block, predict prognosis, and plan a management strategy.

Pacemaker laser lead extraction and reimplantation of dual-chamber implantable cardioverter defibrillator via Mustard baffle in complete transposition of great arteries.

We present a case of a complicated lead extraction and reimplantation of an implantable cardioverter defibrillator (ICD) in a young woman with complete transposition of great arteries (CTGA), a cyanotic congenital heart defect in which the aorta and the pulmonary trunk are transposed. The malformation results in two parallel circulations, whereby the left ventricle is attached to the pulmonary trunk and the right ventricle is attached to the aorta. Survival depends on the mixing of these two circulations at the level of the atria or ventricles or great arteries.

Causes and management of drug-induced long QT syndrome.

Long QT syndrome (LQTS) is characterized by inherited or acquired prolonged QT interval on the surface electrocardiogram. This can lead to torsade de pointes ventricular tachycardia (TdP VT) and ventricular fibrillation. In the acquired form of the disease, medications from several classes can cause TdP VT or potentiate the electrocardiographic findings.

Usefulness of percutaneous balloon mitral commissurotomy in preventing the development of atrial fibrillation in patients with mitral stenosis.

A prospective cohort of patients with mitral stenosis and no history of atrial arrhythmias showed no decrease in the incidence of atrial fibrillation (AF) after successful versus unsuccessful Inoue balloon percutaneous balloon mitral valve commissurotomy. Advanced age and left atrial dimension best predicted which patients developed AF during follow-up, whereas percutaneous balloon mitral valve commissurotomy procedural success and left atrial pressure reduction did not have an impact on incidence of AF.

Optimal duration of monitoring in patients with unexplained syncope.

The optimal duration of monitoring of patients with recurrent unexplained syncope who undergo prolonged monitoring with an implantable loop recorder is unknown. We examined the probability of syncope in a group of 167 patients with this condition who underwent prolonged monitoring with an implantable loop recorder. A 12-month monitoring period appears to capture >90% of episodes.