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Left ventricular lead misplacement discovered a decade after cardiac resynchronization therapy-defibrillator implantation: a case report.
Introduction: Satisfactory left ventricular (LV) lead placement into the coronary sinus (CS) can be achieved in the majority of patients but there are still instances of acute failure most often due to anatomical differences, for example due to tortuous CS anatomy. Chronic LV lead misplacement and its delayed discovery is not a common scenario. It is unclear if chronic dual right ventricular pacing can hasten the progression of heart failure. Case presentation: A 73-year-old lady presented to our cardiac centre with severe heart failure. She had non-ischaemic dilated cardiomyopathy with underlying left bundle branch block and a cardiac resynchronization therapy-defibrillator device in situ for the past decade. She also had a chronic pericardial effusion of unknown aetiology. Whilst the patient was being treated for acute heart failure, it was noted on patient telemetry that the QRS morphology for supposed bi-ventricular pacing was unusual. This led to a lateral chest radiograph and a CS venogram to be performed, both of which confirmed that the LV lead was in fact not in the CS. Plans were made to place a new LV lead but unfortunately the patient continued to clinically deteriorate despite maximal treatment and died before this could be performed. Discussion: It is only with thorough review of the electrocardiographic data and chest radiography that led to the discovery of chronic LV lead misplacement. This case illustrates the importance of expert review of radiographic imaging and electrocardiographic data in patients with implanted cardiac devices
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Finding the heart of the problem: A letter to the editor on 'Detection of oesophageal course during left atrial ablation' by Santoro et al.
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Letter to the editor: oesophageal cooling for protection during left atrial ablations.
Detection of Massive Forming Galaxies at Redshifts Greater than One
The complex problem of when and how galaxies formed has not until recently
been susceptible of direct attack. It has been known for some time that the
excessive number of blue galaxies counted at faint magnitudes implies that a
considerable fraction of the massive star formation in the universe occurred at
z < 3, but, surprisingly, spectroscopic studies of galaxies down to a B
magnitude of 24 found little sign of the expected high-z progenitors of current
massive galaxies, but rather, in large part, small blue galaxies at modest
redshifts z \sim 0.3. This unexpected population has diverted attention from
the possibility that early massive star-forming galaxies might also be found in
the faint blue excess. From KECK spectroscopic observations deep enough to
encompass a large population of z > 1 field galaxies, we can now show directly
that in fact these forming galaxies are present in substantial numbers at B
\sim 24, and that the era from redshifts 1 to 2 was clearly a major period of
galaxy formation. These z > 1 galaxies have very unusual morphologies as seen
in deep HST WFPC2 images.Comment: 10 pages LaTeX + 5 PostScript figures in uuencoded gzipped tar file;
aasms4.sty, flushrt.sty, overcite.sty (the two aastex4.0 and overcite.sty
macros are available from xxx.lanl.gov) Also available (along with style
files) via anonymous ftp to ftp://hubble.ifa.hawaii.edu/pub/preprints .
E-print version of paper adds citation cross-references to other archived
e-prints, where available. To appear in Nature October 19, 199
High Prevalence of False Chordae Tendinae in Patients Without Left Ventricular Tachycardia
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74774/1/j.1540-8159.2007.00628.x.pd
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Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation.
Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console
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