Sustained ventricular fusion simulating a biventricular pacing

An electrocardiogram from a patient implanted with a dual-chamber DDD pacemaker showed paced QRS complexes whose morphology and frontal-plane axis were consistent with biventricular stimulation with right ventricular lead located at the apex. However, some electrocardiographic findings were suggestive, rather, of univentricular right apical pacing and sustained ventricular fusion with competing native atrioventricular conduction in the presence of patient's spontaneous QRS showing right bundle branch block plus left anterior hemiblock. Shortening atrioventricular delay with magnet application advanced right ventricle stimulation and prevented the supraventricular impulse to contribute to ventricular depolarization, thereby making clear the mechanism of right ventricular apical pacing

Takotsubo syndrome: a neurocardiac syndrome inside the autonomic nervous system

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Preexcitation in infancy and childhood

Arrhythmic emergencies are fairly unusual during infancy; therefore, when they occur, they present a difficult diagnostic mad therapeutic problem. The supraventricular tachycardias are the most common ones in childhood, and the predominant among these is the reciprocating form through an accessory pathway

Supraventricular Tachycardia Initiated by Couplets of Atrial Extrasystoles but Not by Single Premature Atrial Beats: What Is the Mechanism?

The reported electrocardiogram shows several atrial extrasystoles (AEs) sometimes occurring in couplets. The former beat of each couplet is nonconducted, whereas the latter triggers a supraventricular tachycardia with negative P waves in inferior leads and RP > PR. This suggests an atypical atrioventricular nodal reentrant tachycardia involving the fast pathway anterogradely and the slow pathway retrogradely. The tachycardia is never precipitated by single AEs. The blocked AE of each pair is pivotal in tachycardia initiation, allowing the subsequent impulse to conduct down the fast pathway. A concealed slow pathway penetration during the blocked AE is invoked as the key mechanism

Author Response to LTE CLC 22970 of John Madias: Brain-heart pathway to injury in takotsubo syndrome

We would like to thank John Madias for his interest in our review about the mystery of the pathogenesis of Takotsubo cardiomyopathy (TC) .1 We agree with his semantic restraint of the eponym Wellens electrocardiographic (ECG) pattern, which needs a contextual disambiguation. Indeed, as stressed by Dr. Madias in a previous letter to the editor, this term is often used incorrectly in the literature2,3 . In this respect, through the words of Cato: "Nos vera vocabula rerum amisimus"4 (we have lost the real names of things), we would like to emphasize how the scientific world suffers from a sort of daily linguistic Babel, where words seem to have lost their capacity to communicate. This article is protected by copyright. All rights reserved

Association of prolonged QTc interval with Takotsubo cardiomyopathy: A neurocardiac syndrome inside the mystery of the insula of Reil

The Takotsubo cardiomyopathy is often considered autochthonous to the heart, although the primary problem may be not in the heart muscle itself. Instead, similar to several Takotsubo-like cardiac pathologies seen in acute neurological diseases, it may reflect the capacity of the nervous system to injure the heart. Persuasive evidence exists that shocking emotional stress promotes direct heart injuries. Moreover, clinical and laboratory research shows that cardiac structural damage can occur in the presence of a normal heart, especially in the context of seizures, stroke, and traumatic brain injury or under conditions of psychological stress. The aim of this review is to summarize the clinical implications of these observations, several of which focus on the pivotal role of the insula of Reil in the brain-heart connection, to unravel the mystery of Takotsubo cardiomyopathy pathogenesis

Important distinction between acute coronary syndromes and Takotsubo syndrome

[no abstract available

QTc interval prolongation and hepatic encephalopathy in patients candidates for liver transplantation: A valid inference?

QTc interval prolongation and hepatic encephalopathy in patients candidates for liver transplantation might have an inferenc