Underutilization of implantable cardioverter defibrillators post coronary artery bypass grafting in patients with systolic dysfunction.

Background: Evaluation of the need for prophylactic internal cardiac defibrillators among patients with ischemic cardiomyopathies should be deferred until at least 3 months after revascularization procedures to allow adequate time for recovery of ventricular function.

Methods: Among patients with left ventricular systolic dysfunction (LVSD) who undergo coronary artery bypass grafting (CABG), the proportion of patients who are risk stratified postoperatively with reassessment of left ventricular ejection fraction (LVEF) is unknown.

Results: One hundred and six patients with LVSD (LVEF < 40%) who underwent CABG during 2004-2006 and survived 3 months post CABG were evaluated.

Stress cardiomyopathy (takotsubo cardiomyopathy).

Background: Due to the rise in the number of reports of stress cardiomyopathy in the literature, awareness of this condition is increasing. Although different names have been used to describe this condition, the similarities in clinical, electrocardiographic, echocardiographic, and angiographic features suggest that they represent the same spectrum of diseases with different underlying causes. The pathophysiology of stress cardiomyopathy remains controversial.

Dual chamber pacing in a patient of hypertrophic cardiomyopathy with failure to wean from mechanical ventilator.

We discuss the case of a 63 years old female who required repeated intubation due to recurrent pulmonary edema. She was found to have hypertrophic cardiomyopathy with a gradient of 82 mmHg across the left ventricular outflow tract. Initially adequate rate control and treatment with negative inotropes did not help her condition.

Troponin elevation in patients with various tachycardias and normal epicardial coronaries.

Troponin elevation is usually synonymous with acute coronary syndrome (ACS). Although sensitive for ACS, the elevation of serum troponin, in the absence of clinical evidence of ischemia, should prompt a search for other etiologies of myocardial necrosis. In fact, elevated values of troponin are correlated with myocardial necrosis even though it does not discriminate the mechanism involved.

Persistent left superior vena cava: a blessing in disguise.

Persistent left superior vena cava (SVC) is an uncommon condition, usually encountered during cannulation of the left subclavian vein. We describe a patient who required a cardiac device upgrade to cardiac resynchronization implantable cardioverter defibrillator for biventricular failure. The presence of a persistent left SVC proved to be a blessing in disguise in this patient as he had since developed total occlusion of the left subclavian-innominate system.

Atrial fibrillation: current concepts.

Atrial fibrillation (AF) is the most common arrhythmia which is a focus of newer modalities of treatment, especially ablation techniques using innovative mapping techniques. Its incidence and prevalence increases with aging and presence of structural heart disease, the latter being less than 1% prior to age 40, rising to 8% at age 80. Concomittant morbidity and excessive mortality is related to the increased incidence of stroke and congestive heart failure.

Deglutition induced atrial tachycardia and atrial fibrillation.

Deglutition induced supraventricular tachycardia is an uncommon condition postulated to be a vagally mediated phenomenon due to mechanical stimulation. Patients usually present with mild symptoms or may have severe debilitating symptoms. Treatment with Class I agents, beta blockers, calcium channel blockers, amiodarone and radiofrquency catheter ablation has shown to be successful in the majority of reported cases.

Piggy-back pacing: implantation of pacemaker and defibrillator on top of each other.

Following the publication of several landmark trials, there has been a significant increase in the cardiac device implantation. Within this population there are a number of patients who have pre-existing cardiac devices that have been placed for a number of different conditions. While the usual approach is to remove the existing unit and replace it with a new device with the removal or capping of existing lead systems, this practice often sacrifices an existing unit that still possesses good battery longevity.