Functional uni-ventricular heart due to post-myocardial infarction ventricular septum rupture

Ventricular septum defect (VSD) is an often lethal complication caused by myocardial infarction. We report a rare case of post-myocardial infarction ventricular septum rupture in a patient after extracorporeal cardiopulmonary resuscitation (eCPR). In the bedside echocardiography after VA ECMO cannulation, we noticed the circular, hypertrophied left ventricle with the disintegrated inter-ventricular septum (maximum dehiscence 3.3 cm), accompanied by decreased left-ventricular ejection fraction and the right ventricle being compressed by the left ventricle's free septal wall. There was no pressure-relevant inter-ventricular separation resulting in left-to-right-shunting and therefore resulting in a fully functional uni-ventricular heart

The discovery of slowness: Time to deconstruct Gretzky's and Messi's predictive brains

Jafari and Smith hypothesized that time during games may pass slower for the world's best football player, Lionel Messi, from Argentina. This hypothesis leads to two questions: How can we explain such temporal paradox and how could this explain his dominant performances? Remarkably, the Argentinian's case was preceded by the equally astonishing case of Wayne Gretzky: The Canadian considered ice hockey as a rather slow game and was the best player in the sport's history. Whether Messi's and Gretzky's motor neurons fire faster, (inter)act differently or whether other mechanisms are at (inter)play warrants targeted research. A further explanation for such dominance of football and ice hockey, respectively, could be that both athletes buy time: To this end, automized motor skills may allow their predictive brains to make better use of time than other players to read the games and plan ahead. Deconstructing predictive minds of outperforming individuals like Gretzky and Messi could provide unique options to elucidate how differential time perception may make performances in athletes, and beyond, more swift and more efficient

Combination of a subcutaneous ICD in a patient with a baroreceptor activation device: Feasibility, safety, and precautions: A Case Report

We present a case of a patient with a baroreflex activation therapy (BAT) receiving a subcutaneous implantable cardioverter defibrillator (S-ICD). We anticipated two possible hazardous interactions between the two devices. Stimulation by the BAT could be adjudicated as noise and result in underdetection of ventricular arrhythmias or it might be misinterpreted as ventricular arrhythmias and lead to inappropriate shocks. Postop ensing occurred, the upper limit of pulse width of the BAT was limited because of noise detection by the S-ICD, but the upper limit of amplitude was limited by patient's discomfort. In this patient, the combination of a BAT and an S-ICD was safe

The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation

Background First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia (TM)) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported. Objectives We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice. Methods Patients (pts) undergoing CA for VE or VT using the Intellamap Orion (TM) paired with the Rhythmia (TM) automated-mapping system were included in this study. For LV access, transseptal and retrograde access were compared. Results All 32 pts (29 men, age 63 +/- 15 years) underwent CA for VE (17 pts) or VT (15 pts). For mapping of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 +/- 21.2 min for VE ablation and 212.0 +/- 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 +/- 1672 map points and annotation of 140 +/- 98 automated mapping points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 +/- 2.1% to 2.8 +/- 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU. Conclusion Use of a high-resolution mapping system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal