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Background: Placing the right ventricular pacing electrode in different places than the apex is less deleterious to the ejection fraction and left ventricular synchrony. Currently it is not defined which non apical site is better alternative. The aim of this paper was to determine if there is a difference in systolic function and left ventricular synchrony with stimulation of medial septum or outflow tract of the right ventricle in patients with atrioventricular block and pacemaker device., Methods: This was an observational analytical cross study. The patients included in this study were the population over 18 years old, diagnosed with atrioventricular block and pacemaker device. Two groups were divided according to the site of electrode placement whether in medial septum region or outflow tract of the right ventricle. The ejection fraction and left ventricular synchrony was determined by echocardiogram., Results: 54 patients were included in each group, with similar demographic characteristics, except for the time of placement of ventricular electrode (p = < 0.001). No significant difference in ejection fraction or left ventricular synchrony was found., Conclusions: There were no differences in ejection fraction or left ventricular synchrony regardless of the ventricular electrode placement.

Three cases of patients with hypertropic cardiomyopathy, apical aneurysm, and mid-ventricular obstruction are presented. Two patients were diagnosed first by two-dimensional and Doppler echocardiography, which showed mid-ventricular obliteration, characteristic hourglass image, and paradoxic jet flow. One patient with suboptimal echocardiogram was necessary to perform contrast echocardiogram. Clinical picture was characterized by angina and dyspnea. Thallium myocardial imaging revealed perfusion abnormalities in apical region, ischemia or necrosis. Cardiac catheterism showed mid-ventricular obliteration and significant intraventricular gradient and coronary arteries angiography without lesions.

Unlabelled: The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA)., Methods: We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1 (3.1%). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinase in 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 +/- 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counter-pulsation., Results: Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16 (50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success postangioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock., Conclusion: RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.