Synergistic effects of cardiac resynchronization therapy and Bachmann’s bundle pacing on heart failure with atrial tachyarrhythmias

Cardiac resynchronization therapy (CRT) is electrical resynchronization of the ventricles. Bachmann’s bundle (BB) pacing is considered to be electrical resynchronization of the atria. Atrial fibrillation (AF) and congestive heart failure (HF) often coexist in the same patient. A 69 year-old man who underwent CRT combined with BB pacing for HF and atrial tachycardias or atrial fibrillation (AF) improved HF symptoms. The combined therapy reduced the number of admissions and occurrence of atrial tachyarrhythmias. It is possible that CRT combined with BB pacing could provide synergistic, beneficial effects on symptoms in patients with HF and AF and hence break a vicious circle

Does T wave inversion in lead aVL predict mid-segment left anterior descending lesions in acute coronary syndrome? A retrospective study

Objectives: Limited data are available regarding the predictive value of electrocardiographic T wave inversion in lead aVL for mid-segment left anterior descending (MLAD) lesions among patients with acute coronary syndrome (ACS). Setting: Retrospective single-centre study, using a prospectively-collected coronary angiography database from January 2012 to December 2013. Participants: We included consecutive adult patients with ACS who underwent urgent percutaneous coronary intervention (PCI) within 24 h after arriving at the hospital. We excluded patients who did not undergo an ECG before PCI, patients with proximal MLAD occlusion and patients diagnosed with vasospastic angina. Primary and secondary outcome measures: The primary outcome was MLAD lesion >50%. The other outcome of interest was MLAD lesion as a cause of ACS. First, we evaluated the diagnostic values of T wave inversion in lead aVL regardless of other T wave changes for each outcome. Second, we evaluated the diagnostic values of isolated T wave inversion in lead aVL. Results: Overall, 219 patients were eligible for the analysis. T wave inversion in lead aVL regardless of other T wave changes had a sensitivity of 32.9%, specificity of 48.2%, positive predictive value of 27.6% and negative predictive value of 54.5% for predicting MLAD lesions. Isolated T wave inversion in lead aVL had a sensitivity of 9.8%, specificity of 86.9%, positive predictive value of 30.8% and negative predictive value of 61.7% for predicting MLAD lesions. These diagnostic values did not change materially when focusing on patients with MLAD lesion as the cause. Conclusions: While T wave inversion in lead aVL regardless of other T wave changes had low diagnostic values for predicting MLAD lesions, isolated T wave inversion in lead aVL had a high specificity. Our inferences underscore the importance of a cautious interpretation of T wave inversion in lead aVL among patients with ACS

Inappropriate implantable cardioverter defibrillator shocks—incidence, effect, and implications for driver licensing

PurposePatients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions.MethodsInappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold.ResultsOf the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively.ConclusionsWe found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits

A case of ventricular fibrillation not detected by an automated external defibrillator

We report a case of ventricular fibrillation (VF) which an automated external defibrillator (AED) could not detect. A 13-year-old girl collapsed just after playing basketball. Cardio pulmonary resuscitation (CPR) was started immediately and 5 minutes later an AED was applied by a rescue team. The monitor of the AED displayed typical VF, but the AED did not detect it as VF. The VF was not detected during 2 more attempts. Detection occurred on the fourth attempt, and counter-shock was successfully delivered, but the process took an extra 9 minutes. After the event, the girl was diagnosed with a latent type of prolonged QT syndrome. We analyzed the reason why the VF was not detected by the AED and found that the ECG detected by the AED fell outside the device’s parameters for ventricular tachycardia (VT) or VF. We emphasize that the AED is an excellent device, but we should also be aware of its limitations