PR-segment deviation during cryoballoon ablation.

Item does not contain fulltext1 december 201

Ice vs. fire: cryoballoon ablation for the prevention of inappropriate implantable cardioverter-defibrillator shocks in a 14-year-old girl with Brugada syndrome

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Out of the frying-pan into the fire: a supraventricular tachycardia triggering a ventricular tachycardia in a patient with ischaemic cardiomyopathy and an implantable-cardioverter defibrillator.

Item does not contain fulltext1 oktober 201

Accelerated idioventricular rhythm during ajmaline test: a case report.

Contains fulltext : 87846.pdf (publisher's version ) (Open Access)We present an unusual transient pro-arrhythmic effect of ajmaline in a patient with resuscitated cardiac arrest and a left ventricular apical aneurysm. We discuss the clinical presentation and the possible physio-pathological explanation for this new pro-arrhythmic effect linked to administration of intravenous ajmaline

Carotid sinus hypersensitivity following radiotherapy delivery in a patient with bilateral glomus jugular tumour

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First experience of monitoring with cardiac event recorder electrocardiography Omron system in childhood population for sporadic, potentially arrhythmia-related symptoms

Item does not contain fulltextAIMS: To document symptomatic episodes of palpitations with traditional methods such as24 h Holter monitoring (HM) or loop recorders remains a big challenge in clinical practice. Clinical trials with patient-activated electrocardiography (ECG) recorders show increased diagnostic yield in such patients. However, studies in the paediatric population are limited. We want to present a first experience with an event-recording system Omron HeartScan in children with symptomatic palpitations. METHODS AND RESULTS: Thirty paediatric patients (age 4-16 years) were followed with the Omron at our centre. All patients had a normal echocardiogram, a normal baseline 12-lead ECG and a normal 24 h HM. Indications with regard to monitoring were palpitations (n = 30). Two of them also had episodes of pre-syncope. The average of palpitation episodes in the past 3 months was 13.2 +/- 8.3. The mean age of the study population was 9.7 +/- 2.3 years [17 males (56.7 %)]. In all patients (n = 30) a diagnostic event could be recorded with the studied system. Four patients were diagnosed with supraventricular tachycardia (SVT) and underwent catheter ablation. The remaining patients (n = 26; 87%) were diagnosed with sinus tachycardia. Two patients with SVT additionally had episodes of pre-syncope. None of the patients could be diagnosed with previous 24 h HM. CONCLUSION: This event recorder has a high diagnostic yield in the childhood population. The children enjoyed the ease of using the system under daily-life conditions. In this study the system was able to record a diagnostic event in all patients with palpitations

Malignant ventricular arrhythmia in a case of adult onset of spinal muscular atrophy (Kugelberg-Welander disease).

Item does not contain fulltextWe present a case of a 43-year-old male patient with adult onset of spinal muscular atrophy (SMA). The patient first came to our attention with atrioventricular (AV) block. A dual-chamber pacemaker (DDD-PM) was implanted. Four years later, the PM data log showed occurrence of frequent episodes of nonsustained ventricular tachycardia (NSVT). The episodes progressed in duration and frequency. An electrophysiological study revealed prolonged His-ventricular (HV) interval duration and induction of sustained ventricular tachycardia. The patient was successfully upgraded to a prophylactic dual-chamber cardioverter defibrillator. Our case is the first description of a patient with adult-onset SMA (Kugelberg-Welander disease [KWD]) and malignant ventricular arrhythmias

A critical analysis of the scientific evidence behind international guidelines related to cardiac arrhythmias

Item does not contain fulltextBACKGROUND: Guidelines have become very important in assisting with decision making in clinical practice. However, few studies have analyzed the level of evidence (LOE) underlying guidelines critically. This study aims to assess the accuracy of the referenced literature that has led to recommendations with a level of evidence A (LOE-A) rating. METHODS AND RESULTS: The latest updates of the practice guidelines related to arrhythmia posted on the European Society of Cardiology (ESC) web site were analyzed. The referenced literature for LOE-A recommendation was analyzed to reassess the proposed grading scheme for LOE-A. Furthermore, the clearly defined positive (Class I) and negative (Class III) recommendations with correctly referenced LOE-A were assessed. A median of 5.4% of all recommendations per guideline (interquartile range 4.9% to 9.7%) were categorized as LOE-A, but only 3.7% (IQR 3.4% to 4.9%) were accurately referenced as LOE-A. In total, 27 of 698 recommendations (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III LOE-A recommendations implying definite evidence-based positive or negative conclusion. CONCLUSIONS: Our findings raise the question of the accuracy of LOE-A in medical guidelines in general and highlight the importance of a critical use of all recommendations. Moreover, they underline the need for improving the guideline-writing process. Further randomized double-blinded and/or crossover-designed studies should focus on areas with a gap in the evidence, such as existing but not yet convincing (LOE-B) or conflicting (Class II) evidence

Role of home monitoring in children with implantable cardioverter defibrillators for Brugada syndrome

Item does not contain fulltextAIMS: Implementation of remote home monitoring systems (HM) in clinical practice has become undoubtedly an added value for all patients with implantable cardiac devices. The aim of this study was to investigate the impact of HM in a population of children with Brugada syndrome (BS) who received an implantable cardioverter defibrillator (ICD). METHODS AND RESULTS: Eleven children (age between 6 months and 18 years) implanted with an ICD were followed either by means of HM and with conventional in-hospital visits in our centre. Alerts and/or device-related clinical events were recorded, analysed, and subsequent clinical decisions were made if needed. During an average observation time of 26 months a total of 16 relevant alerts (13 pre-emptive alerts) were recorded in seven patients of our population. One patient experienced appropriate therapies for life-threatening ventricular arrhythmias. Three patients experienced inappropriate therapies due to supraventricular tachycardia and lead dislodgement. By means of HM two patients were discovered to have lead problems because of dislodgement or lead fracture. Mean anticipation of treatment based on the alerts was 76 +/- 59 days. CONCLUSION: Remote monitoring systems substantially improve the proper management of children with BS