A boy with fatigue and heart block: what's the mechanism?

When the atrioventricular node is damaged, accessory pathways can perform primary atrioventricular conduction but may spontaneously degrade during childhood. After surgical atrial septal defect repair during infancy, an adolescent male presented with fatigue due to iatrogenic complete atrioventricular node block with a degrading antegrade accessory pathway resulting in symptomatic bradyarrhythmia.

Late recovery of sinus rhythm following perioperative complete atrioventricular block in a child with congenitally corrected transposition.

We report a patient with l-transposition of the great arteries who developed perioperative complete atrioventricular block at 5 years of age in conjunction with a modified double-switch operation, but had unexpected late recovery of normal sinus rhythm months later. This case highlights that even for patients with l-transposition, which is particularly vulnerable to developing both spontaneous and perioperative complete atrioventricular block, late recovery of atrioventricular node conduction may still be possible after surgery.

Preoperative right ventricle voltage mapping in Ebstein's anomaly: can we make the late arrhythmogenic mortality following the cone procedure zero?

A young woman with Epstein's anomaly had a large endocardial scar in the atrialised ventricular myocardium. In patients with significant preoperative ventricular scarring, more information is needed to help appropriately manage the risk of ventricular arrhythmias and sudden death.

High prevalence of catecholamine-facilitated focal ventricular tachycardia in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Background: Exercise-related ventricular tachycardia (VT) and high burden of premature ventricular contractions (PVCs) are common in arrhythmogenic right ventricular dysplasia/cardiomyopathy. We hypothesized that VT in arrhythmogenic right ventricular dysplasia/cardiomyopathy shows a high degree of association with the PVC at baseline.

Methods And Results: The study population included 16 consecutive arrhythmogenic right ventricular dysplasia/cardiomyopathy patients with recurrent VT who underwent catheter ablation.

Initial experience with magnetic resonance imaging of atrial scar and co-registration with electroanatomic voltage mapping during atrial fibrillation: success and limitations.

Background: Ablation for atrial fibrillation (AF) frequently requires multiple procedures to achieve durable restoration of sinus rhythm. Early studies have suggested that delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium (LA) can assist in performing repeat ablation procedures.

Objective: The purpose of this study was to investigate the utility of DE-MRI in delineating regions of LA low voltage and PV reconnection sites in patients undergoing repeat PV isolation for recurrent AF.

A proposal for new clinical concepts in the management of atrial fibrillation.

Atrial fibrillation (AF) represents a growing public health burden. It is a complex condition, involving a number of etiologic factors and arrhythmia mechanisms associated with atrial remodeling. Greater understanding of these mechanisms may improve therapy.

Atrial Fibrillation Ablation in Obese Patients.

Despite the increased burden of atrial fibrillation (AF), obese patients have similar, if not slightly improved, mortality, described as the "obesity paradox." Catheter ablation for AF in obese patients is a reasonable option, but patients should be screened for sleep apnea and counseled about the possibility of longer procedure times and repeat procedures to achieve similar success rates. Quality of life will likely improve after successful ablation.

Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.

Background: The reported complication rate of catheter ablation of atrial fibrillation (AF) varies.

Objective: Our goal was to assess temporal trends and the effect of both institutional and individual operators' experience on the incidence of complications.

Methods: All patients undergoing AF ablation at Johns Hopkins Hospital between February 2001 and December 2010 were prospectively enrolled in a database.

Demographic profile of patients undergoing catheter ablation of atrial fibrillation.

Background: Catheter ablation is a widely accepted treatment for drug refractory atrial fibrillation (AF). The purpose of our study was to examine secular trends in the demographic profile of patients undergoing AF ablation.

Methods And Results: Data for 792 patients who underwent catheter ablation for AF at Johns Hopkins Hospital between years 2001 and 2009 were systematically reviewed.

The role of obesity and sleep apnea in atrial fibrillation.

Purpose Of Review: To discuss the relationship between obesity and obstructive sleep apnea as they relate to the growing atrial fibrillation epidemic, and to discuss possible mechanistic links and implications for treatment of atrial fibrillation.

Recent Findings: Increasing BMI plays an important role in development of atrial fibrillation in both men and women. Sleep-disordered breathing contributes to cardiac chamber enlargement, which may be responsible for increasing atrial fibrillation in this population.

A history of prior bare metal stent restenosis is associated with major adverse cardiac events in subsequent bare metal stenting of de novo coronary lesions.

Objective: To investigate the risk of major adverse cardiac events (MACE) in patients with a history of bare metal stent (BMS) restenosis who undergo subsequent bare metal stenting of a geographically distinct, de novo coronary lesion.

Methods: We conducted a retrospective review of 72 BMS procedures performed in geographically distinct, de novo coronary lesions in patients with a history of previous BMS placement at least 3 months prior to the second, index stent procedure. Patients with a history of in-stent restenosis (ISR) were compared with those who had no ISR in their initial stent.

Qualitative methods for intervention research.

Intervention research takes place in field settings and requires understanding of social meanings and social processes. These are tasks for which qualitative research methods are well suited. The purpose of this paper is to provide a starting point for those who would like to learn more about the qualitative research methods used in disciplines where the study of social phenomena in naturalistic settings is common-particularly sociology, cultural anthropology, and human services program evaluation.

Childhood leukemia mimicking arthritis.

Physicians who take care of children must consider the differential diagnosis of acute leukemia with any unexplained musculoskeletal symptom. A mild leukopenia could de the first laboratory abnormality associated with early symptoms.

Radiolabeled, nonspecific, polyclonal human immunoglobulin in the detection of focal inflammation by scintigraphy: comparison with gallium-67 citrate and technetium-99m-labeled albumin.

The accumulation of nonspecific polyclonal human immunoglobulin (IgG) radiolabeled with 125I or 111In was compared to that of [67Ga]citrate and [99mTc]albumin in rats with deep thigh inflammation due to Escherichia coli infection. Serial scintigrams were acquired at 1, 3, 24, and in some cases, 48 hr after injection. As early as 3 hr postinjection, [111In]IgG showed greater accumulation at the lesion than [99mTc]HSA (p less than 0.

Drug interactions: a study and evaluation of their incidence in Victoria.

This study attempted to quantify the incidence of drug interactions in general practice prescribing in Victoria. We used a computer program to search 428 prescriptions and associated medication records for possible interactions. We made 2445 drug/drug comparisons; the computer program generated 37 possible interaction alerts, none of which warranted a change in therapy.