A Strategy of Lead Abandonment in a Large Cohort of Patients With Sprint Fidelis Leads.

Objectives: This study sought to examine outcomes of our approach to managing a large cohort of patients with Sprint Fidelis (Medtronic, Minneapolis, Minnesota) leads.

Background: The optimal management approach for patients with leads under advisory is unknown. Concerns regarding the risk of device infection and complications associated with delaying lead extraction have recently been suggested to argue against abandoning leads under advisory.

Double conduction through the atrioventricular node following acute medullary infarction: a case report.

Lateral medullary syndrome (LMS), also known as Wallenberg's syndrome, PICA syndrome, results from occlusion of the posterior inferior cerebellar artery, with associated infarction of parts of medulla oblongata, and cerebellum on the ipsilateral side. It often manifests as various patterns of sensory, motor, and autonomic deficits. While sensorimotor dysfunction presents as a predicted pattern of clinical signs and symptoms, autonomic dysfunction is usually less clinically apparent, and can be easily mistaken as a concomitant pathology in the end organ it affects.

Relation of the Brugada Phenocopy to Hyperkalemia (from the International Registry on Brugada Phenocopy).

Brugada phenocopies (BrPs) are clinical entities that differ in etiology from true congenital Brugada syndrome but have identical electrocardiographic (ECG) patterns. Hyperkalemia is known to be one of the causes of BrP. The aim of this study was to determine the clinical characteristics and evolution of hyperkalemia-induced BrP.

Concealed Accessory Pathways with a Single Ventricular and Two Discrete Atrial Insertion Sites.

Background: Atrioventricular reciprocating tachycardia (AVRT) utilizing a concealed accessory pathway is common. It is well appreciated that some patients may have multiple accessory pathways with separate atrial and ventricular insertion sites.

Methods: We present three cases of AVRT utilizing concealed pathways with evidence that each utilizing a single ventricular insertion and two discrete atrial insertion sites.

Effects of tricuspid valve regurgitation on outcome in patients with cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT.

Myocardial injury secondary to ICD shocks: insights from patients with lead fracture.

Background: Patients who receive appropriate implantable cardioverter defibrillator (ICD) shocks have a subsequent adverse prognosis. Most data suggest that patients with inappropriate ICD shocks also have a subsequent adverse prognosis, although this is more controversial. The shocks may be an epiphenomenon, that is, a marker of underlying disease progression; however, it cannot be excluded that shocks cause direct myocardial damage.

Effects of tricuspid valve regurgitation on clinical and echocardiographic outcome in patients with cardiac resynchronization therapy.

Aims: The severity of tricuspid regurgitation (TR) is a predictor of outcome among heart failure patients. The interaction between cardiac resynchronization therapy (CRT) and TR has not been described. In this study, we examined the effect of pre-implant TR, and worsened TR post-implant, on response to CRT and overall survival.

Beneficial effect of Bradycardia Tachycardia Response (BTR) algorithm on VT detection in the presence of rate smoothing.

Introduction: Rate smoothing algorithms, while known to help prevent ventricular tachyarrhythmias in some patients, have been shown to result in underdetection of ventricular tachycardia (VT) due to interaction between bradycardia pacing and tachycardia detection parameters. A new algorithm named Bradycardia Tachycardia Response (BTR) has been developed in order to prevent rate smoothing-induced underdetection. The efficacy of BTR is not known.

The effects of anodal stimulation on electrocardiogram, left ventricular dyssynchrony, and acute haemodynamics in patients with biventricular pacemakers.

Aims: Anodal stimulation (ANS) is a recognized phenomenon among patients with cardiac resynchronization therapy (CRT); this is noted during left ventricular (LV) pacing by the LV tip to right ventricular (RV) ring configuration. Its incidence varies according to the implanted hardware. We aim at evaluating the incidence of ANS and its acute haemodynamic effects among CRT patients.

Pacemakers and magnetic resonance imaging: no longer an absolute contraindication when scanned correctly.

Background: Until recently, cardiac pacemakers and implantable cardioverter defibrillators were considered an absolute contraindication for magnetic resonance imaging. Given the significant increase in implanting such devices, these contraindications will preclude MRI scanning in a large patient population. Several recent reports have addressed the safety and feasibility of MRI in the presence of cardiac implantable devices.

The incidence and clinical predictors of early stent thrombosis in patients with acute coronary syndrome.

Background: Acute coronary syndrome (ACS) is associated with activation of platelets and the coagulation system which could influence the incidence of early stent thrombosis (EST). We aimed to determine the incidence and predictors of EST in patients undergoing coronary stenting during ACS.

Methods: The study comprised 1202 consecutive patients, drawn from a nationwide ACS survey, who underwent coronary stenting during ACS and were followed up for 30 days.

Apical ballooning syndrome: a complication of dual chamber pacemaker implantation.

Apical ballooning is a cardiac syndrome (Takotsubo Cardiomyopathy) described as a typical form of acute transient left ventricular dysfunction. While its onset has often been associated with emotionally or physically stressful situations, it has an overall favorable prognosis. We describe here a case of transient apical ballooning following permanent pacemaker implantation.

Left internal mammary artery atherosclerosis: twenty-three years after repair of aortic coarctation.

Atherosclerosis of the internal mammary artery is a rare disease. We describe a case in which a 41-year-old man underwent coronary artery bypass surgery 23 years after repair of aortic coarctation. The diseased mammary artery was used to graft the left anterior descending coronary artery after intraoperative confirmation of good patency.

Iatrogenic right coronary artery dissection with retrograde extension to the right coronary sinus.

Iatrogenic coronary artery dissection extending into the aorta is a rare condition. We report a case in a 46-year-old male patient who had dissection of the right coronary artery which occurred during diagnostic coronary catheterization. The dissection extended retrogradely to affect the right coronary sinus.

Surgical intervention to remove an entrapped fractured guidewire during angioplasty.

Intra-coronary entrapment of angioplasty hardware is a rare complication of coronary intervention. Such complication is potentially dangerous. We present two cases of an entrapped fractured guidewire during angioplasty.

Coronary endarterectomy on beating heart: is it worth doing?

Background: Management of patients with severely impaired left ventricular function (LVF) associated with diffusely atheromatous coronary artery disease is a real dilemma. Coronary revascularization can be done only after endarterectomy to facilitate anastomosis. The aim of the present work is to present our experience and see whether performing endarterectomy during off-pump bypass can be of any benefit.

Visceral leishmaniasis complicated by fungal pulmonary valve endocarditis.

We present a rare neglected case of fungal pulmonary valve endocarditis which presented with typical extra cardiac manifestations after repeated injections for treatment of visceral leishmaniasis. Surgical intervention to replace the pulmonary valve was the only option to manage the patient in spite of extensive medical treatment.

Myocardial revascularization in patients with low ejection fraction < or =35%: effect of pump technique on early morbidity and mortality.

Background And Aim: Left ventricular dysfunction is an important predictor of in-hospital mortality. Surgical risk among these patients remains high. The present study is conducted to evaluate the difference in early morbidity and mortality among patients with compromised left ventricular function (LVF) after myocardial revascularization using either off-pump or on-pump coronary artery bypass graft.