2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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Angiographic patterns of coronary sinus anatomy and its relation to successful ablation sites in accessory pathway patients

Background: The epicardial coronary venous system assumes importance in accessory pathway (AP) ablation especially in case of lengthy or failed attempts of ablation. Epicardial accessory pathways may be related to CS myocardial coat along one of its tributaries or to a CS diverticulum. The purpose of the present study was to use CS angiography to evaluate the relation of different patterns of CS anatomy to successful ablation sites of APs. Methods and results: The CS-angiographic features and incidence of structural anomalies were prospectively studied in 56 patients undergoing AP radiofrequency ablation. Retrograde CS angiography was successfully performed in 46/56 pt (82%), (33 males/13 females). The CS angiographic findings of the 46 patients were compared to the AP localization established by electrophysiological mapping and to the successful ablation sites. CS anomalies were identified in 17 (37%) patients and included the following: CS diverticulum (seven patients), funnel shaped ostium (three patients), CS aneurysm (two patients), subthebasian pouch (one patient), sharp angulation (one patient), and bulbous malformation (one patient). CS diverticuli represented (41%) of the encountered CS anomalies. Seventy-one percent of the CS diverticuli were seen in posteroseptal and left posterior locations of APs. Successful ablation site was related to CS-anomalies in seven (15.2%) patients (five patients with CS diverticulum, one patient with CS aneurysm, and one patient with CS angulation). Successful ablation was achieved from within the CS (coronary sinus – accessory pathway) (CS AP) in 10 patients (21.7%) (in relation to CS tributary in six (13%) and in relation to the neck of a CS diverticulum in four patients). CS AP represented 50% of the encountered posteroseptal and left posterior APs. Conclusion: CS angiography can guide us in reaching successful ablation sites of AP inside or outside the CS. CS diverticulum is the most common CS anomaly in posteroseptal and left posterior APs

Permanent pacing in infants and children: A single center experience in implantation and follow up

Background: Permanent pacing in pediatric population has been growing in Egypt. The aim of this study is to present one center experience in pediatric pacing including implantation procedures and long-term outcome. Methods and results: During the period from 1996 to 2010, we collected the data of 32 children (18 males) with a mean age of 5.7 ± 3.8 years that underwent permanent pacemaker (PPM) implantation. Their mean weight was 21.6 ± 13.8 kg, and median body surface area (BSA) was 0.7 m2. Twenty-five patients (78.1%) had congenital heart disease (CHD). Pacing was done via subclavian vein puncture while epicardial pacing was done via standard surgical techniques. All patients were followed up for 0.25–14 years (median: 2.5 years). Suboptimal pacing parameters were defined by one or more of the following: R/P wave malsensing, pacing threshold >2 V, or battery longevity of  0.05). Conclusion: Permanent pacing in pediatric age group is relatively safe. However, there is substantial higher incidence of suboptimal pacing parameters and pacing system failures especially in younger and smaller children. Epicardial steroid eluting leads are comparable to endocardial steroid eluting leads in performance

Risk factors of sudden cardiac death in Egyptian patients younger than 40 years

Abstract Background Sudden cardiac death in young people is a major problem. The causes are well known; however, they may not be discovered before the episode of sudden death. A challenge for the future is identifying patients at risk before an episode of sudden cardiac death. Development of preventive and educational programs is required to identify sudden cardiac death/sudden cardiac arrest (SCD/SCA) risk factors, causes and characteristics. We aimed to study the characteristics of SCD/SCA in a cohort of young Egyptian population. Our retrospective cohort study included 246 patients of SCD/SCA who were collected from 5000 records of arrhythmia patients from January 2010 till January 2020. The records of the specialized arrhythmia clinic were reviewed to collect the families of SCD/SCA. All patients and/or their first-degree relatives were subjected to thorough history taking and clinical evaluation and investigations. Comparisons were done regarding age group and presence of positive family history of SCD. Results Males constituted 56.9% of the study population. Mean age was 26.6 ± 12.73 years. Positive family history was present in 202 (82.1%) cases. Sixty-one percent of the cases had history of syncopal attacks. SCD/SCA during non-exertion or sleep occurred in 50.4% of cases. Hypertrophic cardiomyopathy was the most common cause of SCD/SCA (20.3%), followed by dilated cardiomyopathy (19.1%), long QT Syndrome (11.4%), complete heart block (8.5%), and Brugada syndrome (6.8%). In the older age group of 18–40 years, hypertrophic cardiomyopathy was responsible for SCD in 44 patients (25.3%) versus 6 patients (8.3%) in younger age group (p-value: 0.003). DCM was also dominant in older age group (42 patients; 24.1%) versus 5 patients (6.9%) in younger age group. Hypertrophic cardiomyopathy was more prevalent in positive family history group (46 patients; 22.8%) versus 4 patients (9.1%) in negative family history group (p-value: 0.041). Conclusion Family history of SCD was the most common risk factor of SCD. The most common cause of SCD in young Egyptian patients below 40 years was hypertrophic cardiomyopathy, followed by dilated cardiomyopathy. Both diseases were more common in the age group between 18 and 40 years. Hypertrophic cardiomyopathy was more common in patients with positive family history of SCD/SCA

Cardiac pacing in sub-Saharan Africa

We read with interest the report by Jouven et al. describing the feasibility and effectiveness of a proctorship-based approach to the development of African cardiac pacing capabilities, arguing that three missions (median seven days) enrolling 10 to 15 patients were able to efficiently train local teams