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Some premature ventricular complexes (PVCs) originate from the coronary venous system. The great cardiac vein and the anterior cardiac vein are the most frequent localizations. The middle cardiac vein is an unusual anatomy for a point of origin for PVC. We present here a case of frequent PVCs with characteristic electrocardiographic features, which we successfully ablated inside the middle cardiac vein.

Aims Mahaim-type accessory pathways (MAPs) are generally right-sided due to the embryological differentiation, but left-sided localization is also possible. This study aims to compare the clinical and electrophysiological characteristics of right- and left-sided MAPs. Methods Of 251 patients diagnosed with AP by electrophysiological study between November 2015 and February 2020, 12 patients with MAP were included (right sided n = 8, left sided n = 4). MAP was diagnosed if; (1) no retrograde conduction; (2) anterograde decremental conduction; (3) adenosine sensitivity; and (4) Mahaim potential at successful ablation site were present. Results Ten of twelve MAPs were clustered on the lateral walls of the mitral (n = 3, 75%) and tricuspid annuli (n = 7, 87.5%). Right-sided MAPs were mostly long pathways extending toward the conduction system whereas left-sided MAPs were short extending toward the neighboring myocardium. For right- and left-sided APs, the median QRS times were 129 and 156 ms (p = .042), the median VAbl -RVApex intervals were -12 and 64 ms (p = .007), the median QRS-V(His) intervals were 16 and 86 ms (p = .120), and the median VAbl -QRS interval was -8 and 12 ms (p = .017), respectively. Coexistence of dual atrioventricular node physiology was observed only in right-sided APs (n = 3, 37.5%). Conclusion MAPs are more typically located on the right but may rarely be seen on the left. Catheter ablation was associated with high success without complications.

Amaç: Hipertrofik kardiyomiyopati (HKM), ani kardiyak ölümün (AKÖ) nedenlerinden biridir. Bu çalışmada, HKM’de en sık mutasyon bulunan üç sarkomerik gende, AKÖ için yüksek riskli patojenik varyantların belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmaya, AKÖ ve/veya HKM için aile öyküsü olan 12 yetişkin HKM’li indeks vaka ve 31 aile üyesi dahil edildi. Tüm katılımcılar, kardiyolojik olarak değerlendirildi. MYH7, MYBPC3 ve TNNT2 genlerinin ekzonik bölgeleri, CorTAG HCM1 dizileme sistemi kullanılarak analiz edildi. Bulgular: HKM’li indeks vakaların 8’inde, amino asit değişimine neden olan 6 farklı patojenik varyant bulundu. Bunlardan beşinin, MYH7 genindeki Val698Ala, Arg719Trp, Met822Leu ve Arg- 663Cys (üç vakada) ve TNNT2 genindeki Arg102Trp değişimlerinin daha önce tanımlanmış yanlış anlamlı patojenik varyantlar olduğu belirlendi. İleri yaşta AKÖ öyküsü olan bir HKM ailesinde, MYBPC3 geninde Tyr525Asn ve c.*27-21G>A varyantlar bileşik heterozigot olarak ilk defa tanımlandı. Bu varyantlar, Türk popülasyonu kontrol örneklerinde (n=777) saptanmadı. Sonuç: Bu çalışmada, AKÖ öyküsü olan bir HKM ailesinde yeni varyantlar tanımlandı. Ancak, HKM ailelerinde saptanan patojenik varyantlar ile AKÖ riski arasında net bir ilişki bulunamadı., Objective: Hypertrophic cardiomyopathy (HCM) is one of sudden cardiac death (SCD) causes. This study aimed to identify high-risk pathogenic variants for SCD in the three sarcomeric genes with the most frequent mutations in HCM. Material and Method: The study included 12 adult HCM index cases with a family history of SCD and/or HCM, and 31 of their family members. All the participants were evaluated with detailed cardiac examinations. The exonic regions of the MYH7, MYBPC3 and TNNT2 genes were analysed using CorTAG HCM1 resequencing arrays. Results: Six pathogenic variants causing amino acid substitutions were found in 8 of the index cases with HCM. Five of them were identified as previously defined missense variants of Val698Ala, Arg719Trp, Met822Leu and Arg663Cys (in three cases) in the MYH7 gene, and Arg102Trp in the TNNT2 gene. For the first time in an HCM family with a history of late-onset SCD, Tyr525Asn and c.*27-21G> A variants in the MYBPC3 gene were identified as compound heterozygous. These variants were not present in control subjects (n=777) from the Turkish population. Conclusion: In this study, novel variants in the MYBPC3 gene were identified in an HCM family with SCD history. However, there was no clear association between pathogenic variants and the risk of SCD.

Objective The frequency, significance and prognostic value of left ventricle obstruction (LVO) induced with provocation (latent LVO) is controversial for hypertrophic cardiomyopathy (HC) patients. This study was designed to assess the value of latent LVO in predicting the clinical course in 101 patients with HC. Methods and results Patients were followed for a mean of 82 ± 48 months (range 2 to 148 months) for clinical end points defined as a composite of cardiovascular death resuscitated cardiac arrest, appropriate defibrillator shock or hospitalization due to worsening of heart failure symptoms. Presence of LVO (hazard ratio 3.63; 95% confidence interval, 1.85 to 7.12; P = 0.0001) and log NT-proBNP levels (hazard ratio, 1.40; 95% confidence interval, 1.14 to 1.72; P = 0.001) were the independent variables associated with an increased risk of experiencing clinical end points. HC patients with latent LVO have a trend toward decreased survival when compared with HC patients without LVO (log rank P = 0.027), but better survival than patients with resting LVO (log rank P = 0.007). HC patients with NT-proBNP levels

Primary tricuspid valve regurgitation may be encountered in daily practice as a result of multiple etiologies. Described herein are the cases of 2 patients with severe primary tricuspid regurgitation. The underlying mechanism was posterior leaflet prolapse due to spontaneous chordae rupture in 1 case, and iatrogenic posterior leaflet tissue loss during removal of a permanent pacemaker in the other. Transthoracic and transesophageal echocardiography, which permit assessment of the tricuspid valve with multilevel imaging, are the techniques of choice for accurate detection and understanding of the etiology, the severity of valve regurgitation, and the determination of treatment options, in addition to providing assistance with timing and guidance during intervention. Three-dimensional echocardiography offers the ability to visualize the entire tricuspid valve and to identify which leaflets are affected by the pathology.

Objective: Bioactive roles of adipokines in coronary atherosclerosis and acute coronary syndromes have been demonstrated previously. Ho-wever, there is a lack of data regarding the relationship between serum adipokines and periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI). Therefore, we aimed to investigate the association between serum adipokines and PMI related to elective PCI. Methods: In total, 153 consecutive patients (aged 60.6 +/- 8.2 years, 98 men) with stable angina pectoris undergoing elective PCI were enrolled in this observational cross-sectional study. Serum resistin, leptin, adiponectin, and high-sensitive Troponin T (hscTnT) levels were measured immediately before PCI and after 12-h PCI. The no-injury, PMI, and type 4a myocardial infarction (type 4a MI) groups were defined as groups consisting patients with post-procedural hscTnT concentrations < 14 ng/L, between 14-70 ng/L, and > 70 ng/L, respectively. Results: Serum hscTnT, resistin, and leptin concentrations significantly (p

Objective: The observation that Bop null allele mice show underdeveloped right ventricle and excessive development of left ventricle, suggests the possible relationship between human BOP gene and hypertrophic cardiomyopathy (HCMP). In our study, we investigated this possible relationship between BOP gene variations and QT dispersion, a noninvasive arrhythmic risk marker for HCMP. Methods: This cross-sectional study consisted of 50 patients clinically diagnosed with HCMP and 60 healthy subjects. Exonic regions of BOP gene were amplified by polymerase chain reaction and amplified exonic regions were analyzed by Single-Strand Conformation Polymorphisms (SSCP). The samples with different migration patterns were sequenced through an automated sequencing system. Continuous variables were compared by unpaired t-test for independent samples or Mann-Whitney U test. Genotype-disease relationship was tested by Chi-square test. Results: The nucleotide substitutions G275>A and C965>A in exon 2 and 7 were determined only in HCMP group. The G707>C, C710>T, T761>C, T1217>C SNPs in exon 6 and 9 are also found in the control group. Significant differences were found between two groups (p=0.002 and p

Objective: Cigarette smoking is one of the major risk factors for coronary artery disease. However, chronic smoking has additional cardiac adverse effects independent of coronary atherosclerosis. We assessed the possible effects of chronic smoking on left and right ventricular (LV, RV) long-axis function using Doppler myocardial imaging (DMI). Methods: Forty otherwise healthy smokers (mean age = 26 ± 3 years) and 40 age-matched nonsmoking controls enrolled. Standard echocardiography protocol was followed by DMI. Peak systolic (V S), early (VE) and late diastolic (VA) velocities, peak systolic strain (S), and strain rate (SR) were measured from septal, lateral, and RV free walls. Results: The baseline characteristics of two groups were similar. There were significant differences regarding Doppler myocardial velocity, S, and SR indices. Septal VE (P < 0.04), S (P < 0.0001) and SR (P < 0.02) were significantly reduced in smokers. For both lateral and RV free wall, VS (P < 0.003, P < 0.002, respectively), VE (P < 0.0001, P < 0.002, respectively), S (P < 0.0001 for both), and SR (P < 0.0001, P < 0.002, respectively) were significantly reduced in smokers. There were significant correlations between the amount of smoking and septal, lateral, and RV free wall S and SR. Conclusions: Chronic cigarette smoking causes alterations in long-axis systolic and diastolic functions of right and left ventricles in healthy young subjects. These changes can be accurately detected with Doppler myocardial velocity and SR imaging. (ECHOCARDIOGRAPHY, Volume 26, October 2009).

We have evaluated the prevalence of left main coronary artery disease (LMCAD) among patients referred to multislice computed tomography (MSCT) coronary angiography examinations. The study Group comprised of 1,000 consecutive patients (750 male and 250 female; mean age 53±12 years) who underwent successful 64-slice MSCT examinations. Left main coronary artery (LMCA) was classified into three Groups: normal LMCA; nonsignificant LMCAD with coronary plaques resulting in obstructions ≤50%; and significant LMCAD corresponding to obstructions >50%. We have found that 24 patients (2.4%) had significant LMCAD. Additional 200 patients (20%) had nonsignificant LMCAD. Univariate analysis revealed that LMCAD was associated with age, male gender, diabetes, hypertension, hyperlipidemia, typical symptoms, history of previous myocardial infarction and previous percutaneous coronary intervention. Only age and male gender were found as independent predictors for LMCAD in multivariate analysis (P < 0.001 and P = 0.001, respectively,). Angiographic follow-up was avaliable for the 24 patients with significant LMCAD, and conventional coronary angiography confirmed the presence of significant LMCAD in all of these patients. Significant LMCAD was found in 2.4% of the 1,000 patients referred to 64-slice MSCT examinations. Age and male gender were the independent predictors for LMCAD.

Decreased serum levels of high-density lipoprotein (HDL) cholesterol have been shown to be of prognostic significance in patients with severe infectious diseases. Serum HDL cholesterol levels were therefore investigated as a possible parameter for the prediction of clinical outcomes in patients with left-sided infective endocarditis (IE). Fifty-four patients with IE with available admission serum HDL cholesterol levels were included in the study. A clinical outcome was defined as a complicated course during hospitalization. Forty-two patients had complicated courses during their in-hospital stays. The median serum HDL cholesterol level was significantly lower in patients with IE (n = 54) than healthy controls (n = 26) (26 vs 47 mg/dl, p

To assess the value of plasma NT proBNP levels for predicting adverse outcomes in patients with dilated cardiomyopathy (DCM).Seventy-eight patients with DCM (EF40%) with sinus rhythm were enrolled. All patients had undergone echocardiographic examination, coronary angiography, and cardiac catheterisation. Blood samples for plasma NT proBNP levels were taken at rest following echocardiographic examination. Patients were followed up for 660+/-270 days for clinical endpoints defined as; death from worsening heart failure, sudden cardiac death and heart transplantation (Tx).Clinical end points were observed in 19 patients (5 Tx, 4 sudden cardiac death, 10 death from worsening heart failure). Variables associated with an increased hazard of clinical endpoints in univariate analysis were log NT proBNP, age, NYHA functional class, left ventricle ejection fraction, mitral valve effective regurgitation orifice area, and E wave deceleration time. The plasma level of NT proBNP (Hazard ratio=2.5 [95% CI: 1.3-4.7], p=0.0024) and age (hazard ratio=0.94 [95% CI: 0.90-0.98], p=0.0005) were the independent variables associated with an increased risk of clinical endpoints. NT proBNP plasma level4500 pg/ml detected patients with clinical endpoints with a sensitivity, and specificity of 72%, 80%, respectively. The event free survival was found to be significantly lower in patients with NT proBNP levels4500 pg/ml.NT proBNP seems to be a strong predictor of adverse outcomes in patients with DCM with sinus rhythm and may be used as a reliable biological marker in risk stratification.

Background: Mutations in PRKAG2, the gene for the gamma 2 regulatory subunit of AMP-activated protein kinase, cause cardiac hypertrophy and electrophysiological abnormalities. We identified a novel mutation in PRKAG2 causing familial ventricular pre-excitation and severe cardiac hypertrophy. Methods and results: We studied 30 members of one family and 120 healthy controls. Molecular analysis of PRKAG2 gene revealed one missense mutation in exon 14 which was confirmed by restriction enzyme digestion. We identified a G to A transition, resulting in a Glu506Lys substitution in the PRKAG2 gene in 8 of the family members, who all had cardiac hypertrophy and ventricular pre-excitation. High incidence of right ventricular hypertrophy and left ventricular outflow tract obstruction are other prominent features of this novel PRKAG2 mutation. Family members without mutation had no cardiac disease. The 120 unrelated healthy individuals did not show this mutation. Conclusions: Coexistence of unexplained ventricular hypertrophy and pre-excitation should prompt the diagnosis of PRKAG2 mutations and these patients should be referred for genetic analysis. The possible alteration of AMP-activated protein kinase activity due to genetic defects in PRKAG2 may serve as a template for developing more specific therapies in the treatment of patients with this mutation. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Patients with mitral stenosis, especially those with atrial fibrillation, are at increased risk for thromboembolic complications. Size of the left atrium, left atrial appendage dysfunction and severity of mitral stenosis are known risk factors for thromboembolism in patients with mitral stenosis. It has been postulated that F-wave amplitude on surface ECG is correlated with left atrial size, left atrial appendage function, and risk of thromboembolism in patients with nonrheumatic atrial fibrillation. The aims of this study were as follows: (1) to examine the relationship between surface ECG F-wave amplitude and left atrial appendage function, and (2) to assess the clinical significance of F-wave amplitude as it relates to risk of thromboembolism in a group of patients with rheumatic mitral stenosis.One hundred patients with rheumatic mitral stenosis and permanent atrial fibrillation but without moderate to severe mitral insufficiency were investigated by transthoracic and transesophageal echocardiography. Two groups were formed according to the presence of a coarse (Group 1; n=60; F-wave in lead V1or =1 mm) or fine (Group 2; n=40; F-wave in lead V11 mm) F-wave on surface ECG.Comparison showed that Group 1 had significantly smaller mitral valve area (1.44+/-0.6 versus 1.7+/-0.74 cm2, respectively; P0.05), lower peak left atrial appendage flow velocity (18.8+/-2.1 versus 25.6+/-1.9 cm/s, respectively; P0.005), higher-grade spontaneous echo contrast (2.05+/-1.44 versus 0.98+/-1.14, respectively; P0.0001), and higher prevalence of thromboembolism (35% versus 12.5%, respectively; P0.012). Multiple logistic regression analysis revealed that mitral valve area, left atrial appendage peak velocity, and coarse F-wave were independent clinical risk factors for thromboembolism in this patient group.The data suggest that presence of a coarse F-wave on surface ECG is associated with left atrial appendage dysfunction, and indicates higher thromboembolic risk in patients with predominant rheumatic mitral stenosis.

Objective Homeodomain Only Protein X (HOPX) is an unusual homeodomain protein which regulates Serum Response Factor (SRF) dependent gene expression. Due to the regulatory role of HOPX on SRF activity and the regulatory role of SRF on cardiac hypertrophy, we aimed to investigate the relationship between HOPX gene variations and hypertrophic cardiomyopathy (HCM). Methods In this study, designed as a case-control study, we analyzed coding and flanking non-coding regions of the HOPX gene through 67 patients with HCM and 31 healty subjects. Certain regions of the gene were investigated by Single Stranded Conformation Polymorphism (SSCP) and Restriction Fragment Length Polymorphism (RFLP). Statistical analyses of genotypes and their relationship with clinical parameters were performed by chi-square, Kruskal-Wallis and the Fisher's exact test. Results In 5' Untranslated Region (UTR) and intronic region of the HOPX gene, we found a C>T substitution and an 8-bp insertion/deletion (In/Del) polymorphism, respectively. These two polymorphisms seemed to constitute an haplotype. While the frequency of homozygous genotypes of In/Del and C/T polymorphisms were found significantly lower in the patients with syncope (p=0.014 and p=0.017, respectively), frequency of their heterozygous genotypes were found significantly higher in the patients with syncope (p=0.048 and p=0.030, respectively). CONCLUSION: Though there was not found any mutation in coding sequence of HOPX gene, two non-coding polymorphisms were found related to syncope in HCM patients. While homozygous status of these polymorphisms was found to be protective against the syncope, their heterozygous status seemed to be a risk factor for syncope in HCM patients. Our results suggest that HOPX may contribute to pathogenesis or manifestation of HCM as a modifier gene.

Background: Consensus statements were proposed for the diagnosis of Brugada syndrome (BS). The clinical diagnostic criteria were defined as documented ventricular fibrillation or ventricular tachycardia (VT), family history of sudden cardiac death at

Atrial fibrillation (AF) can be the first manifestation of latent Brugada syndrome (BS). The aim of our study was to assess the prevalence of AF as the first clinical diagnosis in patients with BS and their demographic and clinical characteristics and diagnosis management in a large cohort of patients. The patient group consisted of 611 patients with BS. The data from those with a diagnosis of AF previous to the identification of BS were analyzed (n = 35). Eleven cases were unmasked after the initiation of a class I antiarrhythmic drug and one during the establishment of general anesthesia. In the remaining population, BS was diagnosed using an ajmaline test performed mainly because of younger age in patients with lone AF (n = 13), previous syncope or sudden cardiac death (n = 3), or a clinical history of sudden cardiac death in the family (n = 5). The mean patient age was 49 +/- 15 years, 21 were male patients, 14 had a family history of sudden death, 15 had had previous syncope, and 4 had survived cardiac arrest. Concomitant electrical disorder was found in 13 patients. Remarkably, 21 patients had normal findings on the baseline electrocardiogram. In conclusion, AF could be one of the first clinical manifestations of latent BS in a considerable number of patients. This identification is crucial because the treatment of these patients is subject to relevant changes. The ajmaline test plays an essential role, mainly in young patients with a family history of sudden death, despite having normal findings on a baseline electrocardiogram. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:362-367)

We present the case of a 50-year-old patient with several episodes of syncope and documented simultaneous wide and narrow QRS complex tachycardia. We then review this tacharrhythmia, focusing on electrophysiological findings and pathophysiology, diagnosis and treatment., Journal Article, info:eu-repo/semantics/published

A 62-year-old male was admitted to the emergency department of our centre because of recurrent episodes of palpitations and dizziness. The patient had a history of severe blunt chest trauma with multiple rib fractures (5–10th) due to a tractor fall 2 years before. The electrocardiographic tracing at admission showed ( Panel A ) a wide QRS tachycardia with the right …

Item does not contain fulltext AIMS: Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study comparing the latter to verification of electrical isolation with the 'traditional' circular mapping catheter. METHODS AND RESULTS: We assigned 40 consecutive patients matched for age and left atrial diameter suffering of paroxysmal atrial fibrillation to cryoballoon PVI using either the circular mapping catheter or the Achieve as a mapping catheter. Duration of procedure as well as fluoroscopy times were significantly lower in the Achieve group than in the circular mapping catheter group (111 +/- 14 min vs. 126 +/- 13 min, P < 0.005 and 22 +/- 5 min vs. 29 +/- 4 min, P < 0.0001, respectively). There were no significant differences between both groups in terms of mean degree of occlusion, mean minimal temperatures, and PVI. Pulmonary vein isolation could be documented by real-time recordings in 55% of veins in the Achieve group with mean time to isolation of 65 +/- 23 s. CONCLUSION: Cryoballoon ablation in conjunction with the novel Achieve is feasible, safe, and affords PVI in nearly all veins in similar proportions to the approach with the traditional guidewire. Furthermore, if compared to the procedure with the circular mapping catheter, cryoballoon ablation with the Achieve is significantly faster and associated to shorter fluoroscopy times.

Left ventricular hypertrophy is 1 of the most frequent cardiac manifestations associated with an unfavorable prognosis. However, many different causes of left ventricular hypertrophy exist. The aim of the present study was to assess the diagnostic value of common electrocardiographic (ECG) parameters to differentiate Fabry disease (FD), amyloidosis, and nonobstructive hypertrophic cardiomyopathy (HC) from hypertensive heart disease (HHD) and aortic stenosis (AS). In 94 patients with newly diagnosed FD (n = 17), HHD (n = 20), amyloidosis (n = 17), AS (n = 20), and HC (n = 20), common ECG parameters were analyzed and tested for their diagnostic value. A stepwise approach including the Sokolow-Lyon index, corrected QT duration, and PQ interval minus P-wave duration in lead II to overcome P-wave abnormalities was applied. A corrected QT duration < 440 ms in combination with a PQ interval minus P-wave duration in lead II < 40 ms was 100% sensitive and 99% specific for the diagnosis of FD, whereas a corrected QT duration > 440 ms and a Sokolow-Lyon index

Item does not contain fulltext AIMS: Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Nowadays, catheter-based ablative approaches are mainly reserved for drug-refractory patients. However, the value of an ablative therapy as a first-line alternative remains elusive. The aim of our study was to analyse the acute procedural success and clinical outcome of patients with lone paroxysmal AF undergoing cryoballoon ablation (CBA) as first-line treatment. METHODS AND RESULTS: Eighteen individuals (mean age 44 +/- 9 years, range 23-61 years, 15 males) with lone paroxysmal AF preferring a catheter-based treatment to drug treatment as first-line therapy were consecutively enrolled in our study. Mean left atrial size was 39 +/- 4 mm and mean left ventricular ejection fraction 58 +/- 3%. After a mean of 2.4 CBA (range 2-4) applications pulmonary vein (PV) isolation could be demonstrated in 70 (97%) PVs. Additional lesions with a focal ablation catheter were needed to isolate one right inferior pulmonary vein and one left superior pulmonary vein in two different patients. At the end of the procedure, all (100%) PVs were isolated. After a 2-month blanking period, 16 patients (89%) were free of symptomatic AF recurrence at a mean follow-up of 14 +/- 9 months and without antiarrhythmic drugs (AADs). CONCLUSION: Cryoballoon ablation in patients with lone paroxysmal AF yields a high acute efficacy rate with a great chance of being free of symptomatic AF recurrence without antiarrhythmic drugs on a mid-term follow-up period, when offered as a first-line treatment. 01 februari 2012

In this report we present a case of a 28-year-old woman who was admitted to our emergency room complaining of chest pain. Her clinical ECG and biochemical evaluation was consistent with acute nonatherogenic myocardial infarction. Subsequent work is revealed that she was suffering from ulcerative colitis with acute exacerbation since last week. We discussed triggering factors for thrombogenic and inflammatory tendency of patient with comprehensive review of literature to clarify the causal relationship.

Özet – Kalp pili telemetrisi kalp ritmi hakkında, cihazda kullanılan algoritmaya bağımlı yorumları yansıtır. Bu verilerin yararlı olabilmesi için, her bir algoritmaya ait kısıtlılıkların ve bu algoritmanın uyarma ve algılama parametreleriyle ilişkilerinin bilinmesi gerekir. Bu yazıda, kalp pili Holter kayıtlarının sürekli olmayan supraventriküler taşikardi epizotları göstermesine rağmen, kalp pili tarafından durumun yanlışlıkla ventrikül taşikardisi olarak tanımlandığı bir olgu sunuldu. Summary – Pacemaker telemetry reflects algorithmdependent interpretations about the cardiac rhythm. For these data to be useful, it is necessary to recognize the limitations of each algorithm and its interactions with pacing and sensing parameters. We report on a case in which pacemaker Holter recording showed several episodes of nonsustained supraventricular tachycardia which were erroneously classified as ventricular tachycardia.

We report two patients with apical hypertrophic cardiomyopathy who had repolarization changes for a single sinus beat after short periods of right ventricular apical pacing during invasive electrophysiological study.

Objective ― The aim of this study is to report the characteristics of myocardial bridging (MB) using 64-slice computed tomography and to demonstrate the association between atherosclerotic coronary artery disease (CAD) and MB. Methods and results― In 990 consecutive patients who underwent multi-slice computed tomography (MSCT) coronary angiography for suspected or known coronary artery disease, myocardial bridge evaluation was performed with axial, curved multiplanar reconstruction and three-dimensional volume-rendered images. 265 bridged segments were identified in 223 (22.5%) patients. Multiple MBs on left coronary arteries were found in 4I patients. Most of the MBs were in the LAD (62.6%), followed by the obtuse marginal artery (I4.7%) and diagonal artery (I4.3%). The average length of MBs was I4 ± 7 mm, and the average depth was I.6 ± I.I mm. No significant difference was observed between patients with and without MB on the middle LAD in respect of age, gender, prevalence of diabetes, hyperlipidaemia, hypertension, current smoking and prevalence of atherosclerotic plaques at the proximal LAD. On the other hand, prevalence of atherosclerotic plaques at the distal LAD were significantly lower in patients with MB on the middle LAD (3.5% vs. I9.7%, P: 0.0001). Conclusions - The presence and morphological characteristics of MB and its relation with atherosclerotic plaques in the involved coronary artery can be comprehensively analysed with 64-slice computed tomography coronary angiography. Atherosclerosis is a common finding in segments proximal to MB, but the prevalence of plaques in equivalent segments (proximal LAD in our study) is not higher than in patients under similar coronary artery disease risk and without MB. On the other hand, prevalence of atherosclerotic plaques at the distal LAD was significantly lower in our patients with MB on the middle LAD. Finally, we suggest that rather than causing proximal atherosclerosis, MB might have a more important role in the protection of distal segments of the bridged arteries from atherosclerosis.

Sibutramine is an anti-obesity drug, which acts by inhibiting neuronal re-uptake of noradrenaline and serotonin. Although the most frequently seen effect of sibutramine on cardiovascular system is an increase in blood pressure and pulse rate, rare but severe side effects such as sibutramine-induced ventricular arrhythmias, heart failure and cardiovascular disease-related death are also reported. We describe a 24 year-old man with low atherosclerotic risk profile who had acute myocardial infarction possibly associated with sibutramine use. © 2008 Elsevier Ireland Ltd. All rights reserved.

Background: The purpose of this study was to explore the relationship between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and extensive echocardiographic variables in patients with hypertrophic cardiomyopathy (HCM). Methods: We evaluated plasma NT-proBNP levels in 88 patients with HCM and examined the plasma NT-proBNP levels' relationships with echocardiographic indexes. Echocardiographic variables were analysed using univariate and multivariate logistic regression to identify predictors of NT-proBNP elevation. Results: Several echocardiographic variables predicted NT-proBNP elevation, including left atrial dimension index (LADI), left ventricular maximal wall thickness (MWT), left ventricular posterior wall thickness, severe mitral regurgitation, mitral septal and lateral tissue Doppler velocities, and mitral septal E/Ea ratio. Left ventricular ejection fraction, left ventricular dimensions, mitral early flow propagation velocity, isovolumic relaxation time, and left ventricular outflow tract obstruction were not significant predictors of NT-proBNP in this group of patients. With multivariate analysis LADI (HR 5.0; 95% CI 1.5-17.1, p = 0.01) and MWT (HR 4.0; 95% CI 1.2-13.2, p = 0.022) emerged as independent determinants of NT-proBNP elevation. Conclusions: In HCM plasma NT-proBNP is prominently increased. LADI and MWT are independent predictors of elevated levels. These data indicate that NT-proBNP elevations are mainly determined by diastolic load in HCM. © 2008 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.

A 78 year old woman with history of uncontrolled hypertension was admitted complaining of severe dyspnea. Clinical evaluation revealed signs of biventricular heart failure. An ECG showed atrial fibrilation and left bundle branch block. Transthoracic echocardiography (TTE) of the patient revealed left ventricle (LV) enlargement (end systolic diameter 49 mm, end diastolic diameter 60 mm) with severely compromised systolic function, and multiple, mobile left ventricle masses located at apical (45×32 mm), basal inferior (25×22 mm) and mid-septal (11×9 mm) segments with the possible diagnosis of thrombus (Fig. 1. panels A, B, C). Moderate mitral and mild tricuspid regurgitation was noted. Protein S, protein C and antiphospholipid antibody levels of the patient were normal and Factor V Leiden mutation was not present. We elected to treat the patient conservatively, and she was fully anticoagulated with warfarin (target INR 3–4) and commenced on treatment for heart failure (ramipril, spironolactone, and furosemide). Further assessment was performed using cardiac MR imaging and confirmed the diagnosis of multiple thrombi in left ventricle (Fig. 1. panels D, E, F). After two weeks of warfarin treatment no thrombus could be detected in left ventricle with transthorasic echocardiography (Fig. 1. panels G, H, I). The patient was discharged

Aims: Diastolic tissue Doppler (TD) parameters allow prediction of patients with hypertrophic cardiomyopathy (HC) at risk of sudden death, ventricular tachycardia, or cardiac arrest. The aim of this study was to assess the value of TD imaging in predicting the clinical course of patients with HC. Methods and results: Eighty-six HC patients were prospectively included in the study and followed-up for clinical endpoints (cardiovascular death or hospitalization due to worsening of heart failure symptoms). Patients with clinical endpoints (n = 25) had larger left atrium diameters, thicker left ventricle (LV) walls, more often LV outflow obstruction and lower TD velocities of LV. LV outflow tract obstruction (r=0.54, R2=0.29, P 4 cm/s were significantly free of clinical endpoints. Conclusion: In conclusion, LMSa seems to be a reliable parameter that can be used in predicting the HC patients at risk for clinical deterioration or death at long-term follow-up. © The Author 2008.

A 12-year-old female patient, who had emergency left modified Blalock–Taussig shunt operation during neonate and a total cavo-pulmonary shunt operation performed at the age of 5 years following a diagnosis of pulmonary atresia with intact ventricular septum (PAIVS), was under regular follow-up. At her last visit, she was admitted with exercised-induced anginal symptoms. …

Objective: Few data exist regarding the prognostic value of QT dispersion in hypertrophic cardiomyopathy (HCM). In this study, we prospectively investigated the association between baseline QT dispersion and clinical course of HCM. Methods: Overall, 101 patients with asymmetric septal hypertrophy (59 men, mean age 45±16 years, range 13-74 years) were included in the study and were followed up for 595±367 days for clinical endpoints defined as cardiac death and hospitalization due to worsening in heart failure symptoms. QRS duration, QT interval, and JT interval were manually measured on 12-lead electrocardiogram (ECG). QT dispersion and corrected QT dispersion were calculated accordingly. The ECG findings of the patients with and without clinical endpoints were compared. Results: Twenty-nine patients experienced clinical endpoints (3 sudden deaths, 26 hospitalizations due to worsening heart failure). The measurements of QT, JT and QRS intervals were all comparable between the two groups (p>0.05 for all). QT dispersion and corrected QT dispersion were significantly different between patients with and without clinical endpoints (64±30 ms vs. 83±18 ms and 71±33 ms vs. 90±18 ms, respectively, p=0.001 for both). Corrected QT dispersion >80 ms detected patients with clinical endpoints with sensitivity and specificity of 79% and 75%, respectively. Patients with corrected QT dispersion

We describe an unusual case of staphylococcal endocarditis with vegetation attached to the left ventricular outflow endocardium in a patient with chronic severe aortic regurgitation that was diagnosed by transthoracic echocardiography. There was no involvement of aortic valve endocardium confirmed by transthoracic echocardiography, transesophageal echocardiography, and macroscopically in the operation. This report confirms that chronic endocardial trauma may provide a fertile nidus for the development of bacterial vegetation. © 2006 Forum Multimedia Publishing, LLC.

Renal artery aneurysms are uncommon, and the underlying cause ranges from fibromuscular dysplasia to atherosclerosis. Hypertension is the most common presenting symptom. The natural history is unclear, but the likelihood of rupture appears to increase as the diameter of the renal artery aneurysm exceeds 15 mm. A 54-year-old woman with resistant hypertension despite a combination of 3 antihypertensive drugs who …

This study was designed to assess the value of plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels in predicting clinical courses in 80 patients with hypertrophic cardiomyopathy. Patients were followed for a mean of 571 ± 294 days for clinical end points, defined as a composite of cardiovascular death and hospitalization for worsening heart failure symptoms. NT-pro-BNP plasma level (hazard ratio 1.6, 95% confidence interval 1.10 to 2.55, p = 0.015) and New York Heart Association (NYHA) functional class (hazard ratio 3.7, 95% confidence interval 1.17 to 12.09, p = 0.025) were the independent variables associated with increased risk for experiencing clinical end points. NT-pro-BNP plasma level ?1,500 pg/ml detected patients with clinical end points with sensitivity, specificity, and accuracy of 83%, 81%, and 81%, respectively. The hypertrophic cardiomyopathy population was stratified into low-, medium-, and high-risk subgroups using 2 simple variables, NYHA functional class and NT-pro-BNP. Patients in lower NYHA classes and with NT-pro-BNP levels

Pulmonary atresia and ventricular septal defect (PA-VSD) with major aortopulmonary collaterals (MAPCAs) is a complex and extremely heterogeneous anomaly. PA-VSD with both pulmonary arteries originating from systemic arterial circulation without MAPCAs and patent ductus arteriosus (PDA) is a very rare disease and according to our knowledge a case without cyanosis and symptoms of congestive heart failure after the first decade of life has not been reported. The majority of untreated patients die in their first decade of life as a result of intractable congestive heart failure or respiratory distress. This report informs about a 21-year-old PA-VSD patient who presented without cyanosis with both pulmonary arteries arising from aorta associated with right sided endocarditis and a paradoxical embolic event.

A 47-year-old male with intermediate risk of coronary artery disease and atypical chest pain was referred to our hospital for multislice computed tomography (MSCT) coronary angiography. MSCT of the patient revealed apical interruption of myocardium and apical diverticulum (15 × 11 mm) of the left ventricle (Panels A–F). The ECG of …

▸ In this study we propose an innovative treatment strategy in patients with cathecolaminergic polymorphic ventricular tachycardia. ▸ These patients often suffer from inappropriate ICD shocks. ▸ Left cardiac symphatethic denervation could represent a solution in patients in whom arrhythmic episodes are refractory to betablockers or antiarrhythmic drugs.