Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR.

Background: The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.

Methods: We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB).

An Unusual Cause of Cerebral Embolism: PFO-Straddling, Spontaneously Fractured Pacemaker Lead.

We report an exceptionally rare complication of cardiac pacing: a case of spontaneous fracture of a modern bipolar pacing lead that led to migration across a patent foramen ovale into the left atrium and embolic stroke. ().

ST elevation myocardial infarction, or not - This is the question.

We present an artefactual ECG created by a digital ECG-recording machine, caused by deletion of the first 80 ms of the QRS complex immediately following the pacing spike in a patient with complete atrio-ventricular block, biventricular pacing and chronic atrial fibrillation. The artefact was mistaken for inferior ST elevation myocardial infarction and the patient underwent unnecessary urgent coronary angiogram. We are not aware of this particular artefact pattern being previously reported in the literature.

A regularly irregular tachycardia with variable QRS morphologies - What is the mechanism?

We present a complex ECG displaying a combination of atrial tachycardia with Mobitz type I AV block, and right bundle branch block (RBBB) alternans (RBBB alternating with normal QRS conduction) during Wenckebach cycle. A detailed explanation regarding the mechanism of this complex arrhythmia is provided, and the mechanism of bundle branch alternans is reviewed. A unique feature of our case is the added complexity given by the presence of atrial tachycardia and AV Wenckebach, which departs from the previous description of bundle branch alternans during 1:1 AV conduction.

Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation.

Background: Valve disease is using up an important, growing proportion of the resources allocated for healthcare. Clinical care is often suboptimal and while multidisciplinary clinics are the 'gold standard', their adoption has been patchy and inhomogeneous.

Methods: We hypothesised that adoption of valve clinics can deliver financial savings and set out to estimate differences in cost between a standard model in which the cardiologist sees every case and a multidisciplinary model in which some cases are devolved to sonographer-led or nurse-led clinics, assuming usage of various tests in accordance with practice at our institutions and to published data.

Accessory mitral valve--an unexpected intra-operative TEE finding causing left ventricular outflow tract obstruction in an adult.

There is a long-standing debate between proponents of routine intra-operative echo and those who want it restricted to selected groups of patients (such as those undergoing valve repair or correction of congenital abnormalities). We present a case where routine transesophageal echocardiography (TEE) identified completely unexpected pathology, with implications for the postoperative follow-up and for patient outcomes. A 64-year-old male, with a history of surgical repair of coarctation of the aorta in childhood, was admitted for elective valve replacement for severe aortic stenosis (AS).

Novel use of transesophageal echocardiographic probe for intraoperative epicardial imaging.

We studied 3 patients in whom standard transesophageal echocardiography was either not feasible nor offered suboptimal images. A standard multi-plane transesophageal echocardiography probe was covered in a sterile sheath containing ultrasonic gel, and the tip of the probe was placed on the beating heart by the surgeon. Echocardiographic imaging planes were selected by combining multi-plane imaging with "flexion" and "extension" of the probe by the echocardiographer, with minimal surgical manipulation.

The role of nicorandil in the treatment of myocardial ischaemia.

Nicorandil is an anti-anginal agent that has been used in the United Kingdom for over 6 years and is becoming increasingly popular. It induces coronary and peripheral vasodilatation via a dualistic mode of action, mediated by the opening of potassium-ATP channels (K(ATP)) and its nitrate effect by stimulation of adenyl cyclase, with an increase in cGMP levels. Comparison to nitrates and other anti-anginal agents have shown it to be of equal efficacy in relieving ischaemic symptoms.