Prinzmetal angina in the differential diagnosis of syncope.

Prinzmetal (variant) angina may be associated with cardiac arrhythmias that can deteriorate to fatal ventricular arrhythmias. We present 2 patients with syncope where vasospastic angina and severe ventricular arrhythmias were found to be responsible for the syncopal episodes.

Cardiac defibrillator implantation via persistent left superior vena cava facilitated by a coronary sinus delivery system.

Persistent left superior vena cava (PLSVC) is a benign vascular anomaly that complicates pacemaker or implantable cardioverter defibrillator (ICD) lead implantation. Thus far, right ventricular lead implantation via PLSVC has been mostly accomplished by forming a U-shaped stylet, necessitating considerable manoeuvring depending on the heart size and geometry. In this article we report a technique of ICD lead implantation via PLSVC, using a coronary sinus delivery system as used today in cardiac resynchronization therapy.

Paroxysmal atrioventricular block: clinical experience with 20 patients.

Background: Paroxysmal atrioventricular (AV) block is an ill-defined entity, previously described in sporadic cases in association with vasovagal reaction, coronary angiography and distal conduction disease.

Methods: We describe 20 patients (10 women) aged 26 to 80 years with symptomatic paroxysmal AV block.

Results: Eight patients had ischemic heart disease-three with dilated cardiomyopathy, and two with co-existing carotid sinus hypersensitivity.

Mitral annulus calcification with a mobile component as a possible source of embolism.

Mitral annulus calcification has been associated with embolic events, but the precise pathophysiology has not been elucidated. The authors describe four patients who experienced embolic events whose transesophageal echocardiograms showed a mitral annulus calcification, with a mobile component that exhibited the same echogenicity as the calcification. Three patients had no other conditions known to be associated with embolism.

Perforation of the right ventricular free wall by an active fixation transvenous cardioverter defibrillator lead.

A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.