Parasystole in a Mahaim Accessory Pathway

AbstractAutomaticity has been described in Mahaim pathways, both spontaneously and during radiofrequency ablation. We describe an unusual case of automatic rhythm from a Mahaim pathway presenting as parasystole. The parasystolic beats were also found to initiate tachycardia, resulting in initial presentation with incessant tachycardia and tachycardia induced cardiomyopathy

Ventricular Tachycardia in Repaired Double Chambered Right Ventricle - Identification of the Substrate and Successful Ablation

A 35 year old female presented with recurrent ventricular tachycardia 5 years after she had undergone surgical repair of double chambered right ventricle. Electroanatomical mapping showed a localised scar in the apex with double potentials and good pace map. Ablation here resulted in non-inducibility of ventricular tachycardia. We hypothesise that the scarring in the apex is the result of sustained pressure overload and becomes arrhythmogenic similar to the apical scar in patients with mid-ventricular hypertrophic cardiomyopathy

Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) in HIV patients with culture confirmed pulmonary tuberculosis in India and the potential role of IL-6 in prediction

Background: The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively. Methods: HIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS. Results: Of 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14–47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7–16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9–23). Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis. Conclusion: Paradoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions

COVID-19 vaccine hesitancy in patients with heart disease

Introduction: COVID-19-infected people with preexisting comorbidities show high mortality. Vaccine hesitancy among this high-risk group was assessed through this study. We aimed to determine the proportion of patients with heart disease showing hesitancy to COVID-19 vaccination and to identify the factors contributing to hesitancy. Subjects and Methods: This was a cross-sectional study including patients older than 18 years with any form of heart disease. Patients who had severe disease while at rest were excluded from the study. Patients attending the cardiology outpatient department were recruited if they met the inclusion criteria. Consenting patients were interviewed with a standard questionnaire. The proportion of hesitant patients was calculated. The importance of each of the causes contributing to hesitancy and methods used to overcome hesitancy were expressed as percentages. Results: The proportion of patients who were hesitant to vaccination was 69.1%. The main reason for hesitancy was “fear of danger in patients with heart disease when vaccinated.” Conclusions: COVID vaccine hesitancy is high in patients with heart disease. Targeting vaccine-hesitant groups with measures that are considered effective by the concerned population can help overcome vaccine hesitancy

Coronary sinus diameter by echocardiography to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia

Background: Coronary sinus (CS) has been shown to be larger in patients with atrioventricular nodal reentrant tachycardia (AVNRT). We sought to determine if echocardiographically measured CS diameter can help identify the mechanism of tachycardia in patients with narrow complex tachycardia without preexcitation before the invasive electrophysiology study.Methods: Forty four patients with documented narrow complex, short RP tachycardia who were scheduled for an electrophysiology study were included. Based on the electrophysiology study, patients were divided into those with AVNRT and those with a concealed accessory pathway and atrioventricular reentrant tachycardia (AVRT). Proximal CS diameter (CSp) measured at the ostium and mid CS diameter (CSm) 1 cm distal to the ostium using transthoracic echocardiography.Results: CSp was significantly larger in patients with AVNRT than AVRT (14.1 ± 5 vs. 9.9 ± 2 mm, p < 0.0001). CSm diameter was not significantly different between the two groups. A cut-off of CSp > 11.2 mm identified AVNRT with a sensitivity of 92.6% and specificity of 76.9%. CSp was a better discriminant (AUC 0.89, 95% CI 0.75–0.97) compared to age (AUC 0.74, 95% CI 0.58–0.87) or tachycardia rate (AUC 0.60, 95% CI 0.44–0.76).Conclusions: Echocardiographic measurement of the diameter of CS ostium can help in identifying the mechanism of the tachycardia before the invasive electrophysiology study.