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Background: Cardiac electrophysiologic study and radiofrequency ablation have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India. Objective: The purpose of this study was to evaluate our experience with cardiac electrophysiologic studies (EPS) and radiofrequency catheter ablations (RFA) of ectopic atrial tachycardias (AT). Materials and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department, of the Institute of Cardiovascular diseases, Madras Medical Mission, India. All cases diagnosed to have ectopic AT following cardiac EPS between January 2010 and April 2014 were selected for study. The records, which were obtained from the cardiac electrophysiology clinical research office of Madras Medical Mission, were reviewed. 73 cases were chosen for analysis, using SPSS statistical software version 15. Results: There were 73 patients, comprised 31 males and 42 females. The mean age was 47.38 years. Commonly associated diseases were diabetes mellitus 16 (21.9%), hypertension 14 (19.1%), coronary heart disease 12 (16.5%) and congenital heart disease 8 (11%). The most common locations of AT were coronary sinus Ostial region 7 (14.0%), parahisian region 6 (12.0%) and crista terminaris region 4 (8.0%). Ablation was successful in 43 (84.3%). Complication rate was 4.11%. Conclusions: Treatment of ectopic AT by RFA is highly effective and safe.

Background: Cardiac electrophysiologic study (EPS) and radiofrequency (RF) ablation have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India. Objective: The purpose of this study was to evaluate our experience with cardiac EPSs and Radiofrequency ablations (RFAs) of ventricular tachycardia (VT). Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. All cases diagnosed to have VT following cardiac EPS between January 2010 and April 2014 were selected for the study. The records which were obtained from the Cardiac Electrophysiology Clinical Research Office of Madras Medical Mission were reviewed. One hundred and thirteen cases were chosen for the analysis, using SPSS statistical software version 15. Results: There were 113 patients, comprised 78 males and 35 females. The mean age was 48.79 years. Common etiologic classes of VT were idiopathic outflow tract VT - 50.4%, ischemic heart disease - 20.4%, arrhythmogenic right ventricular cardiomyopathy (ACMP) - 11.5%, and idiopathic dilated cardiomyopathy (IDCM) - 12.4%. Ablation was attempted in 92 (82.1%). The initial outcome was highest in IDCM, 87.5%, and least in ACMP, 50.0%. Conclusions: Treatment of VT by RFA is comparatively effective and safe.

Context: Accessory pathways (APs) are one of the common supraventricular arrhythmias encountered regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aims: The purpose of this study was to evaluate the initial outcome following radiofrequency catheter ablations of accessory pathways. Settings and Design: This retrospective study was carried out in the Cardiac Electrophysiology Department, of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. Methods and Materials: Records of consecutive cases of accessory pathways following cardiac electrophysiologic studies and radiofrequency ablation carried out between January 2013 and March 2014 were reviewed. Seventy-seven cases were chosen for analysis. Statistical Analysis Used: The data were analyzed using SPSS statistical software version 15. Results: The 77 patients comprised 49 males and 28 females There was a very high success rate (96.1%). Early complications were observed in only 2 (2.6%) patients, comprising cardiac tamponade, and pericardial effusion without tamponade. There was no mortality from the procedure. 10.4% were cares of recurrence following previous RFA. Conclusions: RFA of APs was associated with a high success rate and very low incidence of complication.

Context: Diagnoses of supraventricular arrhythmias often depend on combination of varied features of baseline electrophysiology, tachycardia and responses to pacing manoeuvres. These investigations are carried out regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aims: The purpose of this study was to describe the initial outcome following cardiac electrophysiologic studies and radiofrequency ablation of typical atrio-ventricular nodal re-entrant tachycardia (AVNRT). Settings and Design: This retrospective study was carried out in the Cardiac Electrophysiology Department, of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. Subjects and Methods: Records of consecutive cases of typical AVNRT following cardiac electrophysiologic studies and radiofrequency ablation carried out between May 2013 to April 2014 were reviewed. Eighty-two cases were chosen for analysis. Statistical analysis used: The data obtained were analysed using SPSS statistical software version 15. Results: The 82 patients comprised 24 males and 58 females. Dual nodal physiology was documented in 79 (96.3%), A simultaneous V and A (VA interval Conclusions: Treatment of typical AVNRT by radiofrequency cardiac catheter ablation at the Madras Medical Mission is highly effective and safe.

Background: Cardiac resynchronization therapy (CRT) is a relatively new therapy for patients with symptomatic heart failure resulting from systolic dysfunction. The procedure is carried out regularly in the Cardiac Catheterization laboratory of Madras Medical Mission, India. Objective: We sought to determine the benefit of cardiac resynchronization therapy in patients followed up at the centre. Methods: We retrospectively studied cases of cardiac resynchronization therapy carried out at the Madras Medical Mission over the past five years with respect to clinical as well as echocardiographic changes from the time of implantation to follow-up. Results: After a mean interval of 11.32 ± 9.25 months the improvements were observed as follows: Mean heart rate 77.94 ± 16.58/min to 69.13 ± 8.37/min (P = 0.066), mean systolic blood pressure 121.13 ± 16.33 mmHg to 131.73 ± 16.85 mmHg (P = 0.022), mean NYHA class, 3.27 ± 0.57 to 1.69 ± 0.67 (P = 0.000), QRS duration 169.39 ± 0.17 ms to 125.40 ± 24.40 ms (P = 0.000), mean ejection fraction 27.56 ± 5.47 to 38.62 ± 8.91 (P = 0.000), mean septal to posterior wall delay 164.30 ± 106.03 ms to 78.13 ± 38.04 ms (P = 0.001), mean interventricular delay 44.47 ± 23.47 ms to 26.72 ± 16.87 ms (P = 0.006), mean mitral regurgitation grade 2.50 ± 0.98 to 1.88 ± 0.90 (P = 0.026) and mean systolic dysfunction grade 3.96 ± 0.20 to 3.31 ± 0.97 (P = 0.001). Conclusion: The improvements in mean NYHA class, ejection fraction and synchrony, at follow-up, were highly significant.

Context: Radiofrequency ablation (RFA) is a recognised mode of therapy for cardiac arrhythmias. The procedure is carried our regularly at the Cardiac Catheterization Laboratory of Madras Medical Mission, India. Aim: To evaluate the intermediate term follow-up results of radiofrequency catheter ablations. Subjects and Methods: This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission (MMM), India. Records of consecutive cardiac electrophysiologic studies carried out between January and October 2009, together with records of follow-up to March 2014 for those that underwent RFAs were reviewed. In total, the records of 139 cases that had RFAs were analysed. Results: The 139 patients comprised of 65 males and 74 females. The indication for RFA was drug refractory arrhythmias in the vast majority (137 patients). There was a very high success rate (97.1%), following cardiac ablations. Early complications were observed in only 3 (2.2%) patients. Recurrence rate of the indication for RFA was very low (1.43%), and there was no mortality associated with the procedure. Conclusions: The treatment of patients with cardiac arrhythmias using RFA, was associated with a high rate of success, and low rate of complications.

Context: Hemophagocytic lymphohistiocytosis (HLH), due to the excessive activity of histiocytes and lymphocytes, is a rare but aggressive disease that typically occurs in infancy but can be seen in all ages. If left untreated, patients with HLH may live for only a few months and die from multi-organ failure. Case Report: We present two cases of HLH diagnosis. Fever, spleen, and hepatic abnormalities were noted in both cases. Conclusion: Early diagnosis is the key and these two cases of similar etiology highlight how fever of unknown origin should force us to broaden our differential.