Venous Obstruction Following Pacemaker or Implantable Cardioverter-Defibrillator Implantation, Mini Review

Venous obstruction is relatively frequent following permanent pacemaker or implantable cardioverter-defibrillator (ICD) implantation. However, most of them are asymptomatic. Although the exact risk factor for this complication is not known, number of leads, heart failure and infection may prone the patient to this complication. The goal standard for detection of vein stenosis is venography; however, ultrasound sonography has an acceptable accuracy. Anticoagulant therapy may be considered for symptomatic patients. For device upgrading, non-functional leads removal, venoplasty and rarely surgical treatment may be indicated

His Bundle Extrasystole or A Dual Atrioventricular Nodal Response

A dual atrioventricular (AV) nodal response and His bundle extrasystole cannot be different in many cases with certainty. We present a 31-year-old man with episodes of palpitation and conducted and non-conducted His bundle extrasystole detected during an electrophysiology study

Cardiac Resynchronization Therapy With or Without Defibrillation

No abstract available

Strategy to manage T-Wave Oversensing in a Biventricular ICD

T-wave oversensing is a relatively prevalent cause of intracardiac signals oversensing in patients with Implantable Cardioverter Defibrillator (ICD). Some of these oversensings are typically corrected with device reprogramming. If reprogramming fails to resolve the issue, invasive options such as repositioning the implanted lead may be necessary. We present a patient with dilated cardiomyopathy and intermittent T wave oversensing by a cardiac resynchronization therapy (CRT) that was managed by altering V-V timing

Echocardiographic Findings of ICU-Admitted COVID-19 Patients: a Multicenter Retrospective Study

Background: The coronavirus disease 2019 (COVID-19) pandemic has left many victims and caused many problems for the healthcare systems of different countries. Many COVID-19 patients have cardiovascular complications, which are detectable using echocardiography. This study aimed to determine the echocardiographic findings and their association with mortality in an intensive care unit (ICU)-admitted COVID-19 patients. Materials and Methods: In this retrospective study, COVID-19 patients admitted to the ICU of four hospitals in Tehran, Iran, from April 2020 to March 2021 were recruited. Data were collected by the census method. We reviewed the medical records regarding demographic features, clinical history, laboratory results, and echocardiographic findings. Finally, variables were compared regarding disease outcomes at the end of hospitalization. We used the Chi-square test, Fisher’s exact test, independent-samples t-test, and logistic regression model to analyze the data. Results: This study showed that the mean age of 629 COVID-19 patients was 66.42±14.53 years. Overall, 56.8% of the patients were male. Multivariate regression analysis showed that age (OR=1.03; 95% CI: 1.01-1.05), left ventricular ejection fraction (OR=0.95; 95% CI: 0.92-0.98), and systolic pulmonary arterial pressure (OR=1.12; 95% CI: 1.06-1.18) were predictors of mortality. Conclusion: Cardiovascular involvement is prevalent among critically ill COVID-19 patients. Among echocardiographic findings, EF and s-PAP were significantly associated with the disease outcomes

Valsalva maneuver using a Handmade Device in Supraventricular Tachycardia Reversion; a Quasi Experimental Study

Introduction: The use of vagal nerve stimulation is identified as a proper treatment option in patients with stable supraventricular tachycardia (SVT). This study aimed to assess the success of Valsalva maneuver via a handmade device in reversion of SVT. Methods: In this quasi experimental study, using a handmade device, vagus nerve stimulation was performed for SVT patients presenting to emergency department or cardiac intervention unit and the success rate and its related factors were assessed. Results: 100 patients with the mean age of 53.05 ± 13.70 years were studied (67% female). 12 (12%) cases were unable to do the maneuver. Out of the 88 (88.0%) patients who could perform the maneuver, 75 (85.2%) cases were unsuccessful. Dysrhythmia was controlled in 6 (6.8%) cases on the first attempt and in 7 (8.0%) cases on the second one (14.8% total success rate). 12 of the 13 cases (92.3%) with successful maneuver had history of SVT (p = 0.031). There was not any significant association between success rate and sex (p = 0.084), age (p = 0.744), or other medical histories (p ≥ 0.05). Conclusion: Based on the results of the present study, the success rate of Valsalva maneuver with the mentioned handmade device was calculated to be 14.8%. The only independent related factor of successful reversion was SVT history.

Change in Atrial Activation Pattern during Ablation of Atrial Flutter

Different types of supraventricular tachycardia have been reported in patients with history of surgical repair of Tetralogy of Fallot. This report presents appearance of focal atrial tachycardia during radiofrequency ablation of the cavotricuspid isthmu

Cardiogenic Shock Following Acute Myocardial Infarction: A Retrospective Observational Study

Introduction: Cardiogenic shock is a sudden complication that occurs in 5 to 10% of patients with acute myocardial infarction. According to statistics, mortality and morbidity from this event, despite all hospital care, are approximately 70-80%.Methods: This study was conducted over three years (2012 to 2014) in 28 cases of acute myocardial infarction, which was complicated by cardiovascular shock, before or after admission. We compared the outcomes of patients according to the treatment strategy, thrombolytic therapy, primary percutaneous coronary intervention (PCI), or other medical stabilization. The 30-day follow-up was the first endpoint, and the 3- month follow up was the second endpoint of the study.Results: 28 patients with cardiogenic shock included in this study. The mean (± SD) age of the patients was 62.99 ± 13.99 years. The median time to the onset of shock was 648.75 ± 1393.58 minutes after infarction. Most of the patients who underwent coronary angiography had 3-vessel or left main involvement. Two patients missed in follow up and five (80%) patients who received thrombolytic therapy passed away. Nine (100%) patients in the medical stabilization group and six patients (50%) underwent primary PCI group passed away too. The mortality in the primary PCI group was significantly lower than the other groups (P = 0.04).Conclusion: Although cardiogenic shock is a potential risk of early death, it is important that the thrombolytic in these patients doesn't increase survival and the primary PCI is more effective than thrombolytic agents

Syncope during pregnancy in a patient with permanent cardiac pacemaker, due to increased pacing threshold.

A 22-year-old pregnant woman referred with syncope due to pacemaker malfunction. During the second trimester of pregnancy, the right ventricular (RV) lead pacing threshold increased and led to early generator depletion. We believe that this might happen due to lead micro-dislodgement or less probably effect of hormonal changes during pregnancy on electrode-myocardium interface