Επιπλεγμένη Αγγειοπλαστική Διάσωσης (Rescue PCI) σε 38χρονο Ασθενή

Περιγράφεται η περίπτωση 38χρονου ασθενούς με θρομβολυμένο οξύ πρόσθιο έμφραγμα που επεπλάκη από μετεφραγματική στηθάγχη, καρδιακή ανεπάρκεια και καρδιογενές shock και οδηγήθηκε σε επείγουσα στεφανιογραφία που κατέδειξε νόσο στελέχους και 3 αγγείων. Ο ασθενής αντιμετωπίστηκε με αγγειοπλασική διασώσεως (rescue) και stenting με λίαν επιπλεγμένη πορεία, οι φάσεις της οποίας αναλύονται λεπτομερώς με τελική ωστόσο ικανοποιητική έκβαση

Electrocardiographic and Electrophysiologic Characteristics of Ventricular Extrasystoles Arising from the Aortomitral Continuity

Left ventricular outflow tract arrhythmias originating from the aortomitral continuity, the left coronary cusp, the superior basal septum, and the epicardial left ventricular summit display common electrocardiographic and electrophysiological features, probably due to the close proximity of those locations. Catheter ablation of these arrhythmias can be challenging. The case of a 68-year-old male with frequent premature ventricular extrasystoles arising from the aortomitral continuity of the basal left ventricle is described. The electrocardiographic and electrophysiologic characteristics of this arrhythmia are discussed

Current Ablation Strategies for Persistent and Long-Standing Persistent Atrial Fibrillation

Atrial fibrillation (AF) is associated with an increased risk of cardiac and overall mortality. Restoration and maintenance of sinus rhythm is of paramount importance if it can be accomplished without the use of antiarrhythmic drugs. Catheter ablation has evolved into a well-established treatment option for patients with symptomatic, drug-refractory AF. Ablation strategies which target the pulmonary veins are the cornerstone of AF ablation procedures, irrespective of the AF type. Ablation strategies in the setting of persistent and long-standing persistent AF are more complex. Many centers follow a stepwise ablation approach including pulmonary vein antral isolation as the initial step, electrogram-based ablation at sites exhibiting complex fractionated atrial electrograms, and linear lesions. Up to now, no single strategy is uniformly effective in patients with persistent and long-standing persistent AF. The present study reviewed the efficacy of the current ablation strategies for persistent and long-standing persistent AF

Catheter Ablation of Incessant Ventricular Tachycardia in a Patient With Coronary Artery Disease

A 67-year-old male with known coronary artery disease was referred to our hospital for catheter ablation of incessant ventricular tachycardia (VT). Transthoracic echocardiography revealed severe wall motion abnormalities of the left ventricle along with an apical aneurysm. Left ventricular voltage mapping showed a region with low voltage (<1.5 mV) at the left ventricular apex. Propagation mapping revealed a macro-reentry circuit around the apical aneurysm. Mid-diastolic potentials were recorded during the VT (Fig. 1, left panel, arrows), while entrainment mapping was excellent. The first radiofrequency energy application terminated the tachycardia. A circumferential lesion around the aneurysm was finally performed (Fig. 1, right panel, red dots). Ventricular tachycardia became non-inducible, and the patient is free from arrhythmic events during the last six months... (excerpt

QT and QU Interval Prolongation, Bidirectional Ventricular Tachycardia and Aborted Sudden Death. An Andersen-Tawil Syndrome

A 42-year-old lady survived an episode of near-drowning and she was subsequently diagnosed with a rare genetic disease, recently classified as long QT 7 syndrome, for which she received an implantable cardioverter defibrillator. The features of this syndrome are herein described

Catheter Ablation of Right Ventricular Outflow Tract Ventricular Tachycardia

Α 57-year-old female with repetitive monomorphic ventricular tachycardia was referred for an electrophysiological study. ECG during sinus rhythm was normal. ECG during tachycardia revealed a left bundle branch block (LBBB) pattern with inferior axis suggestive of an outflow tract tachycardia (Fig. 1). Structural heart disease was excluded. Transthoracic echocardiography and coronary angiography were unremarkable. The tachycardia was easily induced by atrial pacing (Fig. 2). This was suggestive of cyclic adenosine monophosphate (c-AMP) triggered activity as the pathophysiological basis of the arrhythmia. Activation mapping revealed the earliest activity at the posteroseptal region of the right ventricular outflow tract. A systolic pre-potential was recorded in this area, which is rarely seen in these type of arrhythmias (Fig. 3)... (excerpt

Drug-Induced Proarrhythmia: QT Interval Prolongation and Torsades de Pointes

Drug-induced torsades de pointes (TdP), a life-threatening polymorphic ventricular tachycardia associated with prolongation of the QT interval, has been the main safety reason for the withdrawal of non-cardiac agents from clinical use over the last decade. This complication is commonly referred to as drug-induced proarrhythmia. The present review highlights on the mechanisms underlying the drug-induced QT interval prolongation and TdP as well as on the identification of easily recognized risk factors that predispose to this potentially life-threatening condition

Fever-Induced Type 1 ECG Pattern of Brugada Syndrome

A 38-year-old female  presented to the emergency department with symptoms and signs of an upper respiratory infection. ECG on admission performed during febrile state (38.8°C) revealed the diagnostic type 1 ECG pattern of Brugada syndrome. Two hours later, a new ECG performed without fever failed to show any of these abnormalities. Due to the increased risk of ventricular arrhythmias during febrile state, fever should be vigorously treated with antipyretics in these patients

Catheter Ablation of Ventricular Extrasystoles Originating from the Left Coronary Cusp

We describe the case of a 55-year-old man with frequent premature ventricular extrasystoles displaying inferior axis and positive QRS concordance in precordial leads. The arrhythmia was successfully ablated from the left coronary cusp. The electrocardiographic and electrophysiological characteristics of this arrhythmia are discussed

Uncommon Cardiomyopathies

Anderson-Fabry Disease (AFD) is an X-linked recessive lysosomal disorder, leading to multisystemic disease because of abnormal glycosphyngolipids widespread accumulation, the result of α-galactosidaseA deficient activity. Cardiac involvement is common; includes left ventricular hypertrophy and gradually impairing cardiac function. Although the disease is unveiled in childhood and culminates in cardiac, cerebrovascular and end-stage renal disease, diagnosis is often delayed or missed. Recently established enzyme replacement therapy (ERT) may improve most of the disease’s manifestations. Early diagnosis is thus crucial for AFD patient management. Isolated non-compaction of the ventricular myocardium (IVNC) is a rare congenital form of cardiomyopathy. It is characterized by the postnatal persistence of the embryonic pattern of myoarchitecture, consistent of prominent trabeculations and deep intertrabecular recesses, and assumed to occur as a consequence of intrauterine arrest of myocardial compaction. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and magnetic resonance imaging. Management issues revolve around the management of heart failure, arrhythmias and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Significant overlapping with many other forms of cardiomyopathies suggest that non-compaction may be a morphologic trait rather than a distinct cardiomyopathy