Bidirectional ventricular tachycardia in cardiac sarcoidosis.

A 73-year-old man with history of pulmonary sarcoidosis was found to have runs of non-sustained bidirectional ventricular tachycardia (BVT) with two different QRS morphologies on a Holter monitor. Cardiac magnetic resonance delayed gadolinium imaging revealed a region of patchy mid-myocardial enhancement within the left ventricular basal inferolateral myocardium. An 18-fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased uptake in the same area, consistent with active sarcoid, with no septal involvement. Follow-up FDG-PET one year later showed disease progression with new septal involvement. Cardiac sarcoidosis, characterized by myocardial inflammation and interstitial fibrosis that can lead to conduction system disturbance and macro re-entrant arrhythmias, should be considered in differential diagnosis of BVT. BVT may indicate septal involvement with sarcoidosis before the lesions are large enough to be detected radiologically

Electrocardiographic Patterns of Ventricular Arrhythmias in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

Ventricular arrhythmias in patients with ARVD/C are common. Differentiation between idiopathic ventricular tachycardia and arrhythmogenic right ventricular dysplasia is of utmost importance. Baseline sinus rhythm electrocardiography as well as electrocardiographic differences during ventricular arrhythmias (VT or PVCs) can be helpful in differentiating the two disease states. The pathological fibrofatty myocyte replacement in ARVD/C as well as ventricular arrhythmia origin are likely responsible for these differences

Transient complete heart block following catheter ablation of a left lateral accessory pathway.

A 16-year-old female with symptomatic Wolff-Parkinson-White (WPW) syndrome underwent catheter ablation of a left-sided lateral accessory pathway. The accessory pathway was eliminated with the first ablation lesion; however, the patient immediately developed complete heart block (CHB). At first, complete heart block was thought to be due to ablation of left atrial extension of the AV node, and pacemaker therapy was considered. However, careful ECG analysis revealed that the development of CHB was in fact due to bump injury to the AV node during transseptal catheterization. Conservative management allowed resolution of AV nodal conduction without need for a permanent pacemaker

Diel Vertical Movements of a Scalloped Hammerhead, \u3ci\u3eSphyrna lewini\u3c/i\u3e, in the Northern Gulf of Mexico

Despite the circumglobal distribution of scalloped hammerheads, Sphyrna lewini (Griffith and Smith, 1834), little information is available regarding fine-scale movement and habitat use patterns for this species. Over a 27-d period, data were collected on diel habitat use and environmental preferences of a 240 cm (total length) female S. lewini. The shark exhibited a consistent and repeated diel vertical movement pattern, making more than 76 deep nighttime dives; the maximum depth reached was 964 m, where the temperature was 5.8 degrees C. The purpose of the nightly oscillatory deep diving pattern is unknown but could possibly represent feeding behavior. These findings represent the first detailed account of S. lewini diel vertical behavior and habitat utilization in the western North Atlantic Ocean

Observations of a Feeding Aggregation of Whale Sharks, Rhincodon typus, in the North Central Gulf of Mexico

On 26 June 2006 an aggregation of 16 whale sharks was observed for a period of 4 hr in the north central Gulf of Mexico (GOM). The sharks remained within an area about 1.0 km2 in size and continuously ram filter fed at the surface. Visual analysis of a plankton sample collected from the study site revealed the presence of copious amounts of fish eggs in mid-embryonic development and a minor amount of other zooplankton. A second plankton sample (control) collected about 3.5 km from the study site in an area where no whale sharks were present contained few eggs, however other zooplankton were similar to the study site sample in species composition and abundance. Two egg morphs were identified, and samples of one of the morphs, which represented 98% of the eggs at the study site, were verified by genetic analysis as little tunny, Euthynnus alleteratus. The observed feeding behavior and the abundance of fish eggs at the study site indicated the whale sharks were feeding on recently spawned little tunny eggs. This represents the first confirmed observation of a feeding aggregation of whale sharks in the GOM

First Record of a Sleeper Shark in the Western Gulf of Mexico and Comments on Taxonomic Uncertainty Within Somniosus (Somniosus)

A sleeper shark, Somniosus (Somniosus) sp., is reported from Alaminos Canyon in the western Gulf of Mexico at a depth of about 2647 m based on observations made using a remotely operated vehicle. This is the first record of a sleeper shark (Somniosus, Somniosidae) from the western Gulf of Mexico and deepest record of any shark from the Gulf of Mexico. Despite claims to the contrary in the literature, no taxonomic character has been identified to date that can be used to unequivocally identify all representatives of Somniosus (Somniosus), and as a result, some species records must be considered dubious

Randomized trial of conventional transseptal needle versus radiofrequency energy needle puncture for left atrial access (the TRAVERSE-LA study).

BackgroundTransseptal puncture is a critical step in achieving left atrial (LA) access for a variety of cardiac procedures. Although the mechanical Brockenbrough needle has historically been used for this procedure, a needle employing radiofrequency (RF) energy has more recently been approved for clinical use. We sought to investigate the comparative effectiveness of an RF versus conventional needle for transseptal LA access.Methods and resultsIn this prospective, single-blinded, controlled trial, 72 patients were randomized in a 1:1 fashion to an RF versus conventional (BRK-1) transseptal needle. In an intention-to-treat analysis, the primary outcome was time required for transseptal LA access. Secondary outcomes included failure of the assigned needle, visible plastic dilator shavings from needle introduction, and any procedural complication. The median transseptal puncture time was 68% shorter using the RF needle compared with the conventional needle (2.3 minutes [interquartile range {IQR}, 1.7 to 3.8 minutes] versus 7.3 minutes [IQR, 2.7 to 14.1 minutes], P = 0.005). Failure to achieve transseptal LA access with the assigned needle was less common using the RF versus conventional needle (0/36 [0%] versus 10/36 [27.8%], P < 0.001). Plastic shavings were grossly visible after needle advancement through the dilator and sheath in 0 (0%) RF needle cases and 12 (33.3%) conventional needle cases (P < 0.001). There were no differences in procedural complications (1/36 [2.8%] versus 1/36 [2.8%]).ConclusionsUse of an RF needle resulted in shorter time to transseptal LA access, less failure in achieving transseptal LA access, and fewer visible plastic shavings