Retrograde Snaring for Left Ventricular Lead Placement in the Presence of a Persistent Left Superior Vena Cava.

Left ventricular lead positioning is technically demanding in cardiac resynchronization therapy (CRT) device implantation, especially in patients with complex cardiac venous anatomies. We report a case in which retrograde snaring was employed to successfully deliver the left ventricular lead through a persistent left superior vena cava for CRT implantation.

Women and Alcohol: Limitations in the Cardiovascular Guidelines.

Patients and physicians rely on evidence-based guidelines to guide alcohol consumption recommendations, but significant discrepancies in alcohol consumption limits are found between different international societies. Current American Heart Association (AHA) preventive management guidelines on hypertension, transient ischemic attack, stroke, and stable ischemic heart disease recommend sex-specific daily alcohol consumption limits which are inconsistent from other international society recommendations. In this focused review of current American Heart Association guidelines and their sources, we evaluate the evidence behind sex-specific alcohol consumption cut-offs.

Fluoroless Catheter Ablation of Atrial Fibrillation: Integration of Intracardiac Echocardiography and Cartosound Module.

Objective: To evaluate the feasibility, safety, and clinical efficacy of non-fluoroscopic radiofrequency catheter ablation of atrial fibrillation (AF) in comparison to traditional fluoroscopy-guided ablation in a local Canadian community cohort.

Methods: We retrospectively studied consecutive patients with paroxysmal and persistent AF undergoing pulmonary vein isolation (PVI) guided by intracardiac echocardiography (ICE) and Carto system (CartoSound module). ICE-guided PVI without fluoroscopy (Zero-fluoro group) was performed in 116 patients, and conventional fluoroscopy-guided PVI (Traditional group) was performed in 131 patients.

Metabolomics Work Flow and Analytics in Systems Biology.

Metabolomics is an omics approach of systems biology that involves the development and assessment of large-scale, comprehensive biochemical analysis tools for metabolites in biological systems. This review describes the metabolomics workflow and provides an overview of current analytic tools used for the quantification of metabolic profiles. We explain analytic tools such as mass spectrometry (MS), nuclear magnetic resonance (NMR) spectroscopy, ionization techniques, and approaches for data extraction and analysis.

Perturbations in cardiac metabolism in a human model of acute myocardial ischaemia.

Introduction: Acute myocardial ischaemia and the transition from reversible to irreversible myocardial injury are associated with abnormal metabolic patterns. Advances in metabolomics have extended our capabilities to define these metabolic perturbations on a metabolome-wide scale.

Objectives: This study was designed to identify cardiac metabolic changes in serum during the first 5 min following early myocardial ischaemia in humans, applying an untargeted metabolomics approach.

Successful implantation of a left ventricular lead in an anomalous coronary sinus.

We describe the case of a 56-year-old man who was referred for CRT implantation and found to have anomalous CS. Catheterization of the CS initially failed due to this anomaly. However, a single large posterior-lateral branch with diminutive CS in the atrioventricular groove allowed for successful implantation of the LV lead.

The Effect of Sex on Door-to-Balloon Time in Patients Presenting With ST-Elevation Myocardial Infarction and Referred for Primary Percutaneous Coronary Intervention: A Systematic Review.

Timely reperfusion using primary percutaneous coronary intervention (pPCI) is the cornerstone of acute ST-elevation myocardial infarction (STEMI) management. We conducted a systematic review to examine the effect of sex on door-to-balloon (D2B) time and symptom-to-balloon (S2B) time. We observed longer D2B times and S2B times in female patients presenting with STEMI and referred for pPCI when compared to male patients.

Importance of Polarity Reversal in Leads I/aVL in the Diagnosis of an Accessory Pathway Originating from the Aortomitral Continuity.

Accessory pathways (APs) are commonly located around the tricuspid and mitral annulus; however, they can be rarely seen in unusual locations like the aortomitral continuity (AMC), the right atrium to the right ventricular outflow region, and the left atrial appendage to left ventricle connection. Although several electrocardiogram algorithms have been proposed to localize the AP, the sensitivity of these algorithms is not high and they may fail to localize the mentioned unusual localizations. In this report, we describe a case of a 37-year-old man presenting with an AP originating from the AMC, which was successfully ablated.

Acute heart failure in pregnancy: importance of a timely multidisciplinary approach to recognition and management.

Increased cardiovascular demands of pregnancy may unmask occult diseases, such as dilated cardiomyopathy or valvular stenosis, or precipitate peripartum cardiomyopathy. We report a case of the emergency management and delivery of a young pregnant woman who presented with acute decompensated heart failure that was not immediately recognized. An emergency transfer to a tertiary care institution was arranged.

Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta-analysis.

Background: Coronavirus disease 2019 (COVID-19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis.

Objectives: We conducted a systematic review and meta-analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID-19.

Methods: PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes.

Diathermy-induced Ventricular Fibrillation.

Diathermy is extensively used in patients for intracardiac device implant and extraction. While diathermy helps with adequate hemostasis, it may rarely be associated with fatal dysrhythmias. We report a case of diathermy-induced ventricular fibrillation during device extraction.

Value of electrocardiography in coronavirus disease 2019 (COVID-19).

In December 2019, reports of an unknown pneumonia not responsive to traditional treatments arose in Wuhan, China. The pathogen was subsequently identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known to be responsible for the coronavirus disease-2019 (COVID-19) illness, and public health emergency of international concern was declared by the World Health Organization. There is increasing awareness of the cardiovascular manifestations of COVID-19 disease, and the adverse impact of cardiovascular involvement on its prognosis.

Rate-dependent aberrancy and cardiac resynchronization therapy.

Left bundle branch block (LBBB) can result in significant dyssynchrony in left ventricular (LV) contraction, ultimately leading to cardiac remodeling. LBBB can be rate dependent and may appear with LV systolic dysfunction. Cardiac resynchronization therapy (CRT) has been demonstrated to improve hemodynamics as well as clinical symptoms in patients with LBBB.

Evaluation and Management of Asymptomatic Bradyarrhythmias.

Asymptomatic bradyarrhythmias involving sinus node dysfunction and atrioventicular blocks are frequently noted in clinical practice. Its prevalence is expected to rise as devices that are developed for monitoring cardiac rhythm for longer duration become more widely available. Episodes of bradyarrhythmia that are asymptomatic are considered to have a benign course compared with those that cause symptoms and do not necessitate further treatment.

Successful leadless pacemaker implantation in a patient with profound bradycardia following transcatheter aortic valve replacement and mitral valve-in-valve procedure.

Leadless pacemakers provide a potential alternative to conventional transvenous pacemakers for patients undergoing high-risk transcatheter valve replacement procedures. This is a description of a successful leadless pacemaker implantation in a 51-year-old woman who developed profound bradycardia following a transcatheter aortic valve replacement and mitral valve-in-valve procedure.

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial.

Objectives: The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).

Design: Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively.

Left Septal Fascicular Block Following Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy.

Left septal fascicular block, or blockage of the middle fibers of the left bundle branch, is known to be suggestive of a critical proximal obstruction of the left anterior descending coronary artery before its first septal perforator branch. We describe the case of a 68-year-old male who exhibited this transient intraventricular dromotropic disturbance following alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm.

Background: The European Society of Cardiology's 0/1-hour algorithm improves the early triage of patients towards "rule-out" or "rule-in" of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department.

New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration).

Background: Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new-onset AF.

Electrocardiographic evidence of abnormal atrial phenotype in Brugada syndrome.

Background: Brugada syndrome (BrS) is an inherited ion channelopathy that may predispose affected individuals to atrial cardiomyopathy. We tested the hypothesis that BrS patients have higher degrees of atrial electrophysiological abnormalities compared to controls, and these can be reflected by changes in P-wave parameters determined on the electrocardiogram (ECG).

Methods: This was a single-center retrospective study comparing BrS patients to age- and gender-matched control subjects.

Cardiac arrhythmias secondary to hormone therapy in trans women.

: With greater social acceptance and the evolution of transgender medicine as a specialty, more trans women are seeking hormone therapy (HT). Several studies have identified an increase in cardiovascular disease in trans women, however no studies have investigated the incidence of arrhythmias. Using two cases from the authors' clinic as examples, we propose that hormone therapy in trans women may increase the risk of cardiac arrhythmias.