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Key Clinical Message Congenitally corrected transposition of the great arteries (CCTGA) should not be missed in patients with dextrocardia and situs solitus. We report a case of a 56‐year‐old man with late diagnosis of CCTGA after ventricular lead replacement. Free LV wall pacing may be favorable in these patients so to prevent deterioration of the systemic RV function.

Introduction Radiofrequency isolation of pulmonary vein can be accompanied by transient sinus bradycardia or atrioventricular nodal (AVN) block, suggesting an influence on vagal cardiac innervation. However, the importance of the atrial fat pads in relation with the vagal innervation of AVN in humans remains largely unknown. The aim of this study was to evaluate the role of ganglionated plexi (GP) in the innervation of the AVN by the right vagus nerve. Methods and results Direct epicardial high-frequency stimulation (HFS) of the GP (20 patients) and the right vagus nerve (10 patients) was performed before and after fat pad exclusion or destruction in 20 patients undergoing thoracoscopic epicardial ablation for the treatment of persistent AF. Asystole longer than 3 seconds or acute R-R prolongation over 25% was considered as a positive response to HFS. Prior to the ablation, positive responses to HFS were detected in 3 GPs in 7 patients (35%), 2 GPs in 5 patients (25%), and one GP in 8 patients (40%). After exclusion of the fat pads, all patients had a negative response to HFS. All the patients who exhibited a positive response to right vagus nerve stimulation (n = 10) demonstrated negative responses after the ablation. Conclusion The integrity of the GP is essential for the right vagus nerve to exert physiological effects of on AVN in humans.

Background Supraventricular tachycardias (SVT) are a common arrhythmia therefore an accurate diagnosis is of clinical importance. Although an ECG performed during tachycardia greatly aids diagnosis, patient history and predisposing factors also improve diagnostic accuracy. Methods This prospective study included 100 consecutive patients undergoing electrophysiological study for SVT with the aim to reassess their clinical characteristics and describe frequent predisposing factors, such as the “sign of lace-tying” that to our knowledge has not previously been reported. Each patient completed an extensive questionnaire (70 questions) during their hospital stay. Results Our series comprised: 67% of patients with atrioventricular nodal reentrant tachycardia (AVNRT); 24% with an accessory pathway; and 9% presented atrial tachycardia. Half of the population were male and 29% of the cohort presented hypertension. Syncope during tachycardia appeared in 15% of patients, dizziness in 52% and thoracic pain in 59%. We encountered a predisposing risk factor for SVT in 53% of cases; with 32% exhibiting an anteflexion of the trunk termed the “sign of lace-tying.” Data also showed that younger patients tended to present AVRT and regular pounding in the neck appeared only in patients with AVNRT. Conclusions Overall, our study has highlighted the importance of considering clinical signs and patient characteristics both before and during SVT for the precise diagnosis of paroxysmal SVT. Furthermore, 32% of patients presented the “sign of lace-tying” or body position change before SVT, implying a diagnosis of SVT.

A 62-year-old man with cured lymphoma as only significant medical history experienced a first reflex syncope after prolonged orthostatic posture, with cardiac arrest. Prolonged asystole was followed by ventricular fibrillation needing external defibrillation. The defibrillator provided complete recordings. Thorough investigation revealed no cardiac abnormalities apart from a few right ventricular outflow tract premature complexes. This patient benefitted from implantation of an ICD for ventricular fibrillation secondary to reflex syncope, usually considered benign.

Since the first publication of the Brugada syndrome in 1992 several variants of this ECG pattern have been described. We report a very unusual case of preexcitation with changing electrocardiographic morphologies which appeared to be an association of a variable Brugada pattern with a persistent antegrade preexcitation.

Assessment of volume in relation with left atrial (LA) shape alteration before and after PV isolation. We compared trapezoidal modification of LA using echocardiography with the ellipsoid formula (Eel) and CT, with both ellipsoid (CTel) and truncated cone formulas (CTtr), in 40 patients, before and ±3 months after AF ablation. A trapezoidal shape was present in 76.3% of patients. The different volume measurements were statistically correlated (r = 0.603–0.837, p