Twisting until it breaks: A rare cause of ICD lead failure

We describe a rare case of Twiddler’s syndrome that resulted in a complex ICD lead fracture involving both the insulation and the conductor. The conductor fracture resulted in noise artefact that was interpreted by the device as ventricular fibrillation, but the patient had not received any shocks because the "episodes" were non-sustained. The patient did not have traditional risk factors for Twiddler’s syndrome

Pęknięcie na skutek skręcenia: rzadki przypadek uszkodzenia elektrody defibrylującej kardiowertera-defibrylatora serca

W niniejszej pracy opisano rzadki przypadek wystąpienia twiddler syndrome, który był przyczyną złożonego uszkodzenia elektrody kardiowertera-defibrylatora serca dotyczącego zarówno izolacji, jak i przewodnika. Pęknięcie przewodnika spowodowało wytworzenie szumu, który został zinterpretowany przez urządzenie jako migotanie komór, ale nie wystąpiło żadne wyładowanie, ponieważ epizody trwały krótko. U pacjenta nie stwierdzono czynników ryzyka typowych dla twiddler syndrome

Ventricular fibrillation effectively treated by wearable automatic defibrillator - a case report

We present a patient at risk of sudden cardiac death in whom ventricular fibrillation was effectively treated by wearable automatic defibrillator. We discuss the technical aspects of the device, current indications for this therapy and outcomes. Kardiol Pol 2011; 69, 1: 89-9

Heart failure with preserved ejection fraction update: A review of clinical trials and new therapeutic considerations

Between 2013 and 2016 there were approximately 6.2 million adults in the United States living with heart failure; nearly half had an ejection fraction that was preserved. Despite the high prevalence of heart failure with preserved ejection fraction (HFpEF), our understanding of this disease is limited and it still carries significant morbidity and mortality worldwide. At present, physicians are burdened by the inconclusive benefits of currently available treatment options. Recently the scientific community has seen an influx of new pathophysiology studies and outcome trials that have reshaped our understanding of HFpEF as a complex, multi-systemic disease. Pharmacological trials involving beta-blockers, angiotensin II receptor antagonists, aldosterone antagonists, and angiotensin-neprilysin inhibitors have demonstrated encouraging results, but have yet to reach the significance of advancements made in the treatment of heart failure with reduced ejection fraction. This review aims to summarize landmark clinical trials that have influenced current treatment guidelines, and reports on emerging evidence supporting/refuting new treatment modalities including pharmacotherapy, lifestyle modification and device therapy

Use of non−contact mapping to localise distant from endocardium origin of atrial tachycardia

A 65 year-old woman developed tachycardia and hypotension during haemodialysis. The non-contact mapping system was used to localise the origin of focal atrial tachycardia, and showed a remote from the endocardium focus. We discuss techniques that are helpful in identifying the origin, the area of preferential conduction, and the endocardial breakthrough of tachycardia.A 65 year-old woman developed tachycardia and hypotension during haemodialysis. The non-contact mapping system was used to localise the origin of focal atrial tachycardia, and showed a remote from the endocardium focus. We discuss techniques that are helpful in identifying the origin, the area of preferential conduction, and the endocardial breakthrough of tachycardia

Comparative Effectiveness of Various Radiofrequency Ablation Catheters in the Ablation of Typical Atrial Flutter

Abstract Introduction Although ablation of typical atrial flutter (AFL) can be easily achieved with radiofrequency energy (RF), no studies compare the effectiveness of different ablation catheters. Our study aimed to compare the efficacy of various types of ablation catheters in treating typical AFL. Methods We analyzed patients with AFL who underwent RF ablation by a single operator at our institution. Successful ablation was evidenced by a bidirectional conduction block (trans-isthmus conduction time ≥ 130 ms or double potentials ≥ 90 ms). Logistic regression was used to compare success rate and linear regression to compare lesion time. Results Out of 222 patients, only six did not meet the success criteria (2.7%). The catheters used were non-irrigated, large-tip, internally irrigated (Chili II Boston Scientific), and externally irrigated (non-force-sensing) catheters (Cool Path, Abbott). An externally irrigated force-sensing catheter (TactiCath, Abbott) was used with > 10 gm of force and (LPLD) setting (30 W− 45 °C− 60 s), and high-power short-duration (HPSD) setting (50 W− 43 °C − 12 s). No complications were encountered. The catheter type had no statistically significant association with ablation success. With the use of externally irrigated catheter with contract force-sensing and HPSD settings, statistically significantly shortening of lesion time was achieved 758.3 s, [CI − 1128.29, − 388.35 s] followed by LPLD by 419.0 s [CI − 808.49, − 29.47 s]. Conclusions The typical atrial flutter radiofrequency ablation procedure had a high success rate, which was not influenced by the type of ablation catheter. Contact force ablation catheter and HPSD are associated with shorter total lesion time