Giant Interventricular Septal Hematoma Complicating Left Bundle Branch Pacing: A Cautionary Tale.

An 88-year-old woman underwent atrioventricular node ablation and left bundle branch pacing for atrial fibrillation. She presented to the emergency room several hours after discharge with dyspnea. An echocardiogram revealed a giant interventricular septal hematoma.

Percutaneous Extraction of an Embolized IVC Filter Strut Embedded in the Right Ventricle.

The incidence of IVC filter fracture is high with risk for embolization and may require open surgery. We present a minimally invasive approach of complex transcatheter extraction of an embolized and embedded IVC filter strut from the right ventricle. ().

Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study.

Objectives: This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging.

Background: HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking.

Aorto-Right Ventricular Fistula and Paravalvular Leak After Transcatheter Aortic Valve Implantation.

Aorto-right ventricular fistula is a potentially fatal complication following transcatheter aortic valve implantation (TAVI). This paper presents a case of successful percutaneous repair of aorto-right ventricular fistula and paravalvular leak after TAVI by using 3D-printed models for pre-procedural planning, and a review of published aorto-right ventricular fistula cases to date. ().

Left bundle branch pacing utilizing three dimensional mapping.

Introduction: Permanent His bundle pacing is feasible and effective in patients with atrioventricular block or left bundle branch block. However, pacing thresholds to capture the distal His bundle is often higher. Recently left bundle branch area pacing (LBBP) has been shown to be feasible by advancing the lead transvenously, deep into the interventricular septum to reach the left ventricular endocardial surface.

Prospective evaluation of feasibility and electrophysiologic and echocardiographic characteristics of left bundle branch area pacing.

Background: His bundle pacing (HBP) is the most physiologic form of pacing but associated with higher thresholds and lower success in patients with His-Purkinje conduction disease. Recent reports have described transvenous left bundle branch area pacing (LBBAP).

Objective: We aimed to prospectively evaluate the feasibility and the electrophysiologic and echocardiographic characteristics of LBBAP.

Gradient variability in hypertrophic cardiomyopathy: New insights from computer-assisted, high fidelity, rest and exercise hemodynamic analysis.

Objectives: This study examines the intrapatient variability in peak instantaneous left ventricular outflow tract (LVOT) gradients and aortic pulse pressures during rest, exercise, and after ventricular ectopy.

Background: Although the variability in LVOT gradients in patients with hypertrophic cardiomyopathy (HCM) is well known, the predictors of such variation are not. We hypothesized that quantitative invasive analysis of gradient variation could identify useful predictors of maximal gradients.

Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block.

Background Cardiac resynchronization therapy utilizing biventricular pacing is an effective therapy for patients with left ventricular (LV) systolic dysfunction, left bundle branch block, and heart failure. Benefits of biventricular pacing may be limited in patients with right bundle branch block (RBBB). Permanent His bundle pacing (HBP) has recently been reported as an option for cardiac resynchronization therapy.

Rest and exercise hemodynamic and metabolic findings in active duty soldiers referred for cardiac catheterization to exclude heart disease: Insights from past invasive cardiopulmonary exercise testing using multisensor high fidelity catheters.

Objective: This study describes results of iCPET from the past, which used submaximal stress and multisensor high-fidelity catheters to exclude heart disease in a unique population of young adults.

Background: There has been resurgence in comprehensive hemodynamic evaluation of complex cardiovascular patients. Although dynamic assessments during cardiac catheterization have become commonplace, there remains limited information regarding left and right heart hemodynamic changes during supine exercise in young adults.

Using multidetector computed tomography in a swine model to assess the effects of sublingual nitroglycerin and intravenous adenosine on epicardial coronary arteries.

This study examines the effects of intravenous infusion of adenosine and sublingual nitroglycerin on coronary angiograms obtained by current-generation multidetector computed tomography. We assessed coronary vasodilation at baseline and after intravenous adenosine (140 microg/kg/min) or sublingual nitroglycerin spray (800 microg) in 7 female swine (weight, 40.9 +/- 1.

Rapid correction of hypokalemia in a patient with an implantable cardioverter-defibrillator and recurrent ventricular tachycardia.

We present the case of a 74-year-old man with non-ischemic dilatated cardiomyopathy and an implantable cardioverter-defibrillator presenting with a serum potassium of 2.6 mmol/L, recurrent unstable ventricular tachycardia, and multiple defibrillations. Administration of a rapid bolus of 20 mEq KCL solution via central venous access, followed by an additional total of 80 mEq (orally and intravenously [i.

Respiratory changes in the pulse-oximetry waveform associated with pericardial tamponade.

Background: Timely identification of hemodynamic compromise in patients with acute pericardial effusion and tamponade is critical in patient management. Respiratory variability in pulse-oximetry waveforms has been correlated with pulsus paradoxus, but has not been reported with cardiac tamponade in adult patients.

Hypothesis: This study describes changes in respiratory variability in pulse-oximetry waveform pre and post pericardiocentesis in patients with hemodynamically significant pericardial effusions.

Fluoroscopic localization of the femoral head as a landmark for common femoral artery cannulation.

We sought to determine the reliability of frequently used landmarks for femoral arterial access in patients undergoing cardiac catheterization. The common femoral artery (CFA) is the most frequently used arterial access in cardiac catheterization. Arterial sheath placement into the CFA has been shown to decrease vascular complications.

Feasibility of remote echocardiography with satellite transmission and real-time interpretation to support medical activities in the austere medical environment.

Echocardiography is an essential tool in the evaluation of patients with cardiac emergencies and chest trauma. The objective of our study was to establish the feasibility and diagnostic accuracy of a portable satellite transmission system in the assessment of cardiac emergencies for the real-time support of mass casualty and humanitarian relief efforts. Twelve patients with various degrees of cardiac structural disease identified by conventional inhospital transthoracic echocardiography were transported to a remote portable field hospital where transthoracic echocardiography was performed with a handheld echocardiographic device.

Satellite and mobile wireless transmission of focused assessment with sonography in trauma.

Objectives: Focused assessment with sonography in trauma (FAST) can define life-threatening injuries in austere settings with remote real-time review by experienced physicians. This study evaluates vest-mounted microwave, satellite, and LifeLink communications technology for image clarity and diagnostic accuracy during remote transmission of FAST examinations.

Methods: Using a SonoSite, FAST was obtained on three patients with pericardial and intraperitoneal effusions and two control subjects in a remotely located U.

Feasibility of real-time echocardiographic evaluation during patient transport.

Echocardiography is a key diagnostic tool in evaluating patients with cardiac emergencies and chest trauma. The lack of qualified real-time interpretation limits its use by emergency first responders. Early diagnosis of cardiac emergencies has the potential to facilitate triage and medical intervention to improve outcomes.