Electrocardiographic algorithms to guide a management strategy of idiopathic outflow tract ventricular arrhythmias

The current guidelines of the European Society of Cardiology outlined electrocardiographic (ECG) differentiation of the site of origin (SoO) in patients with idiopathic ventricular arrhythmias (IVAs). The aim of this study was to compare 3 ECG algorithms for differentiating the SoO and to determine their diagnostic value for the management of outflow tract IVA. We analyzed 202 patients (mean age [SD]: 45 [16.7] years; 133 women [66%]) with IVAs with the inferior axis (130 premature ventricular contractions or ventricular tachycardias from the right ventricular outflow tract [RVOT]; 72, from the left ventricular outflow tract [LVOT]), who underwent successful radiofrequency catheter ablation (RFCA) using the 3‑dimensional electroanatomical system. The ECGs before ablation were analyzed using custom‑developed software. Automated measurements were performed for the 3 algorithms: 1) novel transitional zone (TZ) index, 2) $V_{2}S/V_{3}R$, and 3) $V_{2}$ transition ratio. The results were compared with the SoO of acutely successful RFCA. The $V_{2}S/V_{3}R$ algorithm predicted the left‑sided SoO with a sensitivity and specificity close to 90%. The TZ index showed higher sensitivity (93%) with lower specificity (85%). In the subgroup with the transition zone in lead V3 (n = 44, 15 from the LVOT) the sensitivity and specificity of the V2– transition‑ratio algorithm were 100% and 45%, respectively. The combined TZ index+$V_{2}S/V_{3}R$ algorithm (LVOT was considered only when both algorithms suggested the LVOT SoO) can increase the specificity of the LVOT SoO prediction to 98% with a sensitivity of 88%. The combined TZ‑index and $V_{2}S/V_{3}R$ algorithm allowed an accurate and simple identification of the SoO of IVA. A prospective study is needed to determine the strategy for skipping the RVOT mapping in patients with LVOT arrhythmias indicated by the 2 combined algorithms

Nieinwazyjne badanie elektrofizjologiczne i ablacja częstoskurczu będącego przyczyną bardzo licznych interwencji ICD-DDD u chorego z pozawałową kardiomiopatią rozstrzeniową

We present a case of 75-year-old man with numerous inappropriate interventions of an implanted cardioverter-defibrillator (ICD). In this patient with ischaemic cardiomyopathy, ICD was implanted for primary prevention of sudden cardiac death following recurrent syncope. ICD interrogation and non-invasive electrophysiologic study (NIPS) confirmed a risk of reentry-mediated tachycardia and excluded the presence of a manifest or concealed accessory pathway. Invasive electrophysiologic study revealed a wide zone that triggered atrioventricular nodal reentrant tachycardia, and ablation of the slow pathway resulted in complete remission of the arrhythmia. NIPS performed using atrial and ventricular ICD leads and subsequent ICD interrogation confirmed long-term effectiveness of the procedure. At the same time, clinical improvement of heart failure was seen, leading to a suspicion of tachycardia-induced cardiomyopathy coexisting with ischaemic cardiomyopathy. Kardiol Pol 2010; 68, 5: 599-60

Infekcyjne zapalenie wsierdzia związane z obecnością elektrody, powikłane zatorami septycznymi

Lead-dependent infective endocarditis (LDIE) has emerged as a serious complication of electrotherapy in the era of advanced medical technology and is a growing problem due to greater patient longevity, limited electrode life-time, an increasing number of abandoned leads, and subclinical symptoms. We present a case of dramatic course of LDIE in a 26 year-old patient in whom standard management had failed to cure endocarditis. This case was complicated by extensive pulmonary septic emboli and required cardio-thoracic intervention. Kardiol Pol 2011; 69, 7: 696–69