Background: Partial conduction block has been suggested a predictor of recurrence of atrial flutter (AFL).
Aim: The aim of this study was to assess transverse conduction by the crista terminalis (CT) as a problem in evaluating isthmus block and the usefulness of differential pacing for distinguishing slow conduction (SC) and complete conduction block (CB) across the ablation line.
Methods: We assessed 14 patients who underwent radiofrequency catheter ablation of the eustachian valve/ridge-tricuspid valve isthmus for typical AFL. Activation patterns along the tricuspid annulus (TA) suggested incomplete CB across the isthmus. In these patients, atrial pacing was performed from the low posteroseptal (PS) and anteroseptal (AS) right atrium (RA) while the ablation catheter was placed at the ablation line where double potentials (DPs) could be recorded. The pattern of activation of the RA free wall was assessed by a 20-pole catheter positioned along the CT during pacing from the coronary sinus (CS) ostium (CSos) and low lateral RA (LLRA).
Results: Faster transverse conduction across the CT resulted in simultaneous or earlier activation of the distal halo electrodes than of the more proximal electrodes, suggesting incomplete conduction block across the isthmus. CB (13) and SC (1) were detected as changes in the activation times of the first and second components of DPs (DP1, DP2) during PS RA pacing and AS RA. Similar changes in the activation times DP1 and DP2 during AS RA pacing as compared to PS RA reflected SC through the isthmus, whereas increased DP1 activation time and decreased of DP2 activation time reflected complete conduction block across the isthmus.
Conclusions: Transverse conduction across the CT influences the sequence of activation along the TA after isthmus ablation. Differential pacing can distinguish SC from complete conduction block across the ablation line in the isthmus.
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http://dx.doi.org/10.1007/s10840-005-0265-6 | DOI Listing |
BMJ Case Rep
January 2025
Cardiology, AIIMS, New Delhi, India
A young man in his 30s presented to us with multiple episodes of syncope and exertional dyspnoea for the last 2 weeks. He was diagnosed with squamous cell carcinoma of the lower one-third of the oesophagus in 2021 for which he was treated with neoadjuvant chemoradiotherapy, followed by McKeown oesophagectomy. At 2-year follow-up, he had developed a soft tissue swelling in the scalp, which was diagnosed as a tumour recurrence and radiotherapy was initiated.
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January 2025
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Purpose Of Review: This review aims to explore how a diagnosis of LMNA-related cardiomyopathy (LMNA-CM) informs clinical management, focusing on the prevention and management of its complications, through practical clinical strategies.
Recent Findings: Longitudinal studies have enhanced our understanding of the natural history of LMNA-CM including its arrhythmic and non-arrhythmic complications. A LMNA specific ventricular arrhythmia risk prediction strategy has been integrated into clinical practice guidelines.
Pak J Med Sci
January 2025
Qing Wang Orthopedics Department 2, First people's Hospital of Yong Kang, Yongkang, Zhejiang Province 321300, P.R. China.
Objective: To evaluate the efficacy of supra-inguinal fascia iliaca compartment block (S-FICB) in patients undergoing proximal femoral nail antirotation (PFNA) internal fixation surgery for intertrochanteric fracture (ITF).
Methods: Retrospective analysis of 95 patients with ITF undergoing PFNA internal fixation surgery in the First People's Hospital of Yong Kang from March 2021 to August 2023 was performed. Among them, 49 patients received general anesthesia (GA; GA group) and 46 patients received S-FICB combined with general anesthesia (S-FICB group).
Rev Cardiovasc Med
January 2025
Department of Cardiovascular Medicine, Wonkwang University Medical School, 54536 Iksan, Republic of Korea.
Background: Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the relationship between RV pacing, global longitudinal strain (GLS), and EF in patients with preserved EF.
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December 2024
Internal Medicine, Cooper University Hospital, Camden, USA.
This case report presents a complex and challenging scenario of recurrent () bacteremia and tricuspid valve endocarditis in a 77-year-old male patient with multiple comorbidities and indwelling medical devices. The patient's medical history was significant for T4 paraplegia, neurogenic bladder requiring a chronic indwelling suprapubic catheter, heart block status post-permanent pacemaker placement, type 2 diabetes mellitus, chronic kidney disease, and chronic sacral wounds. The case highlights the difficulties in managing antibiotic-resistant infections, particularly in patients with implantable devices and chronic wounds.
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