Polymorphic ventricular tachycardia in a woman taking cesium chloride.

A 47-year-old patient presented with syncope and recurrent episodes of polymorphic ventricular tachycardia. She had evidence of prolonged QT interval by ECG and had been taking cesium as a dietary supplement. Correction of the hypokalemia and discontinuation of the cesium resulted in normalization of the QT interval during follow-up with no further recurrence of ventricular arrhythmias.

Dofetilide (Tikosyn): a new drug to control atrial fibrillation.

Unlabelled: Dofetilide, a new class III antiarrhythmic agent, selectively blocks a specific cardiac potassium channel, IKr, increasing the effective refractory period of the myocyte and thereby terminating reentrant arrhythmias. Given orally, it appears to effectively convert atrial fibrillation and atrial flutter to sinus rhythm and maintain sinus rhythm after conversion in appropriately selected patients. This paper reviews the pharmacology of dofetilide, the evidence of its effectiveness, and the appropriate precautions in using it.

[Pleomorphic carcinoma of the lung heralded as bilateral leg pain].

This is a case of a 70 year old male patient suffering from bilateral leg pain for 2 months. Physical examination disclosed clubbing. X-rays of the legs showed bilateral periosteal elevation with subperiosteal bone formation.

Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia.

Objectives: To describe a normal heart left bundle branch block, inferior axis ventricular tachycardia (VT), that could not be ablated from the right or left ventricular outflow tracts.

Background: Whether these VTs are epicardial and can be identified by a specific electrocardiographic pattern is unclear.

Methods: Twelve patients with normal heart left bundle branch block, inferior axis VT and previously failed ablation were included in this study.

Ventricular tachycardia syndromes.

Better understanding of the underlying mechanism and substrate of different VTs has made it possible to tailor treatment strategies properly. The advent of sophisticated device-based therapy and of more precise and effective catheter ablation approaches will expand clinicians' ability to gain control of this multifaceted arrhythmia syndrome.

A simple method of mapping atrial premature depolarizations triggering atrial fibrillation.

Atrial premature depolarizations (APDs) originating from focal sites, particularly the pulmonary veins (PV), may become triggers of atrial fibrillation (AF). Accurate mapping of APDs with conventional methods may be time consuming and expose the patient to unnecessary instrumentation of the left atrium. We hypothesized that the atrial activation sequence recorded using a simple system that includes an esophageal catheter and a custom-made 16-electrode catheter with two sets of floating electrodes eight in the coronary sinus and eight in the high right atrium) could be sufficient to localize the APDs.

First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation.

Background: Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. An anatomic approach to complete pulmonary vein isolation could overcome these limitations.

Methods And Results: Fifteen patients with atrial fibrillation refractory to medication underwent circumferential isolation of the pulmonary veins by using a novel catheter, with an ultrasound transducer (8-MHz) mounted near the tip, in a saline-filled balloon.

Rheumatic fever in the Nazareth area during the last decade.

Background: Acute rheumatic fever is considered a relatively uncommon disease in developed countries. Although cases are encountered in the Nazareth area in Israel, no systematic study of this disease has been done in the last 20 years.

Objective: To study the incidence and characteristics of acute rheumatic fever cases in the Nazareth area during the last decade.

Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation.

Objectives: We sought to evaluate the safety and efficacy of higher energy synchronized cardioversion in patients with atrial fibrillation refractory to standard energy direct current (DC) cardioversion.

Background: Standard external electrical cardioversion fails to restore sinus rhythm in 5% to 30% of patients with atrial fibrillation.

Methods: Patients with atrial fibrillation who failed to achieve sinus rhythm after at least two attempts at standard external cardioversion with 360 J were included in the study.

Transiliac permanent pacemaker implantation after extraction of infected pectoral pacemaker systems.

Infected pectoral pacemaker systems were extracted in 5 patients and new pacemakers were reimplanted in a pelvic pocket through the iliac veins. In patients who have infected pectoral pacemaker systems, this easy and safe technique provides an alternate route for reimplantation of permanent pacemakers.

Long-term follow-up of heart transplant recipients requiring permanent pacemakers.

Background: Permanent pacemaker implantation after heart transplantation is contentious. Indications for these devices in this population are uncertain. The goals of this project were to (1) analyze the time course of donor sinus node dysfunction and atrioventricular block after heart transplantation; (2) evaluate which selected parameters (donor age, ischemic time, heart rate before pacer insertion, and number of rejection episodes) might relate to persistent permanent pacing need, and (3) assess pacemaker complications during follow-up.

Radiofrequency catheter ablation for management of symptomatic ventricular ectopic activity.

Objectives: This study assessed the useful role of intracardiac mapping and radiofrequency catheter ablation in eliminating drug-refractory monomorphic ventricular ectopic beats in severely symptomatic patients.

Background: Ventricular ectopic activity is commonly encountered in clinical practice. Usually, it is not associated with life-threatening consequences in the absence of significant structural heart disease.

Comparison of echocardiographic assessment of cardiac hemodynamics in the intensive care unit with right-sided cardiac catheterization.

Estimation of left ventricular filling pressure and cardiac index is important in the management of patients requiring right heart catheterization. Doppler echocardiography can provide a noninvasive measure of these parameters, but its accuracy in individual measurements, predicting hemodynamic subgroups, and in tracking serial changes in critically ill patients remains to be elucidated. Left ventricular filling pressure and cardiac index were assessed in 49 critically ill patients requiring right heart catheterization and Doppler echocardiographic studies.