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We present a case of orthodromic atrioventricular re-entrant tachycardia exhibiting both right and left bundle branch block pattern wide QRS morphologies caused by bilateral bystander nodoventricular (NV) accessory pathways. These wide QRS morphologies came from pre-excitation accompanied by delta waves. In the context of NV accessory pathways, left-sided manifest NV accessory pathways are rare.

A 75-year-old man was admitted for repeat ablation of atrial fibrillation. At 30 min after infusion of 3.5 ml of ethanol into the vein of Marshall, inferior ST-segment elevation with coronary arterial vasospasm was observed. This is the first report of coronary vasospasm after chemical ablation of the vein of Marshall. (Level of Difficulty: Intermediate.)

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Accumulating evidence indicates a link between inflammation and AF, and important advances in understanding mechanisms of AF are arising from studies of the critical components involved in the modulation of the immunoinflammatory balance within the atrium. However, molecular mechanisms remain unclear. Indeed, although preclinical and clinical studies suggest that chronic inflammation may promote development of AF, the roles of inflammation in the process are complex and incompletely understood. The purpose of this review is to briefly highlight current evidence on relationships between inflammation and AF, and to discuss possible mechanisms of development of AF and/or possible therapeutic approaches targeting components of the inflammatory response.