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Objectives: The purpose of this study was to prospectively evaluate the feasibility and diagnostic value of right ventricular overdrive pacing (RVOP) during supraventricular tachycardia (SVT) using a 2-catheter approach with automatic pacing from the right ventricular inflow (RVIT) and outflow tract (RVOT)., Methods: One hundred and thirty-six consecutive patients (with 138 arrhythmias, mean age 36 ± 20 years, range 4-95) were enrolled in this study. Only coronary sinus and ablation catheters were used. RVOP was delivered from RVIT and then from RVOT. Each attempt consisted of 10 synchronized beats delivered at a cycle length of 10-40 ms longer than the tachycardia cycle length., Results: RVOP was sufficient to confirm the transition zone within the first 9 beats in the majority of SVTs. Atrial perturbation (acceleration, delayed) in the transition zone was detected in all patients with orthodromic atrioventricular (AV) reentry. Patients with typical AV nodal reentry, atypical AV nodal reentry and atrial tachycardia did not show atrial timing perturbation during fusion complexes of RVOP., Conclusions: Synchronized RVOP from RVIT or RVOT is an easy and accurate method for the quick and reliable differential diagnosis of SVT in various clinical settings, particularly when only a limited number of catheters are used.

We describe a case of severe left ventricular (LV) heart failure caused by tachycardiomyopathy with concomitant presence of unsolved thrombus in left atrial appendage despite effective oral anticoagulant treatment. Successful ablation of atrial flutter and atrioventricular nodal reentry tachycardia entailed resolution of heart failure symptoms and normalisation of LV function.

We describe a case of a 35 year-old woman with AVNRT and AVB successfully treated with radiofrequency ablation. Prior to the procedure, PR interval was very prolonged (420 ms) and second degree Wenckebach AV block during sinus rythm with heart rate below 80/min was seen. After the successful RF ablation an improvement in atrio-ventricular conduction with disappearance of Wenckebach periodicity was achieved. This case shows that there is a possibility of successful elimination of slow pathway with improvement in AV conduction.

We present a case of 75-year-old man with numerous inappropriate interventions of an implanted cardioverter-defibrillator (ICD). In this patient with ischaemic cardiomyopathy, ICD was implanted for primary prevention of sudden cardiac death following recurrent syncope. ICD interrogation and non-invasive electrophysiologic study (NIPS) confirmed a risk of reentry-mediated tachycardia and excluded the presence of a manifest or concealed accessory pathway. Invasive electrophysiologic study revealed a wide zone that triggered atrioventricular nodal reentrant tachycardia, and ablation of the slow pathway resulted in complete remission of the arrhythmia. NIPS performed using atrial and ventricular ICD leads and subsequent ICD interrogation confirmed long-term effectiveness of the procedure. At the same time, clinical improvement of heart failure was seen, leading to a suspicion of tachycardia-induced cardiomyopathy coexisting with ischaemic cardiomyopathy.

We present a case of a 61-year-old man with a history of syncope and sudden cardiac arrest due to ventricular fibrillation, with the symptoms of spontaneous electrocardiographic changes characteristic for the Brugada syndrome. The patient received an implantable cardioverter-defibrillator. This patient was previously hospitalised in 2003, when the diagnosis of atrio-ventricular block has been established and in 2006, when he had chest pain and was operated because of the right coronary artery ostium haematoma. However, the diagnosis of Brugada syndrome was not established.

We present a case of a 53-year-old smoking patient with myocardial infarction, in whom coronary angiography revealed many coronary arteries aneurysms, without substantial epicardial vessel narrowings. Patient was medically treated with a good outcome.

Background: A critical stenosis of the left main coronary artery (LMCA) needs immediate diagnosis and therapy because of poor prognosis due to significant decrease of myocardial perfusion., Aim: To identify patients with a critical stenosis of LMCA using clinical, biochemical electrocardiographic and echocardiographic data., Methods: Consecutive 75 subjects with angiographic result of culprit lesion in LMCA were selected. Coronary artery disease risk factors, resting and exercise ECG changes, regional contractility defects in echocardiography and applied therapy were analysed., Results: A coexistence of critical LMCA narrowing and sclerotic changes in remaining coronary arteries were present in 93.3% of patients with predilection to the left anterior descending artery (65.3%). An ST segment elevation in aVR lead in resting ECG was correlated with LMCA stenosis in 54.7% of patients. Coronary artery by-pass grafting and resulted in good 1.5-years clinical outcome., Conclusions: 1. Patients with LMCA stenosis usually have disseminated sclerotic changes in coronary arteries. 2. Evaluation of resting ECG with emphasis on ST elevation in aVR lead may be useful to predict LMCA stenosis. 3. Further studies are required to define factors identifying patients with LMCA disease.