Scar-Related Monomorphic Ventricular Tachycardia After Treated Right Ventricular Metastatic Diffuse Large B-Cell Lymphoma.

A patient with ventricular tachycardia (VT) and right ventricular (RV) metastatic diffuse large B-cell lymphoma had persistent RV gadolinium enhancement following chemotherapy and disease remission. Electrophysiology study demonstrated inducible sustained monomorphic VT requiring subcutaneous implantable cardioverter-defibrillator implantation. This highlights the arrhythmogenic potential of residual scar after resolution of cardiac masses.

Electrical storm after left ventricular assist device (LVAD) implantation.

INTRODUCTION: Ventricular tachycardia storm or electrical storm (ES) is a common complication following left ventricular assist device (LVAD) implantation. The factors contributing to ES and outcomes are less studied. The study aimed to determine the factors associated with ES and the probability of survival in patients undergoing LVAD in three tertiary centers over a span of 15 years. METHODS: We performed a retrospective cohort study on all patients who underwent LVAD implantation at the Mayo Clinic (Rochester, Phoenix, and Jacksonville) from January 1, 2006 to December 31, 2020. ES was defined as ≥3 episodes of sustained ventricular tachycardia over a period of 24 h with no identifiable reversible cause. Detailed chart reviews of the electronic health records within the Mayo Clinic and outside medical records were performed. RESULTS: A total of 883 patients who underwent LVAD implantation were included in our study. ES occurred in 7% (n = 61) of patients with a median of 13 days (interquartile range [IQR]: 5-297 days) following surgery. We found 57% of patients (n = 35) developed ES within 30 days, while 43% (n = 26) patients developed ES at a median of 545  (IQR 152-1032) days after surgery. Following ES, 26% of patients died within 1 year. Patients with ES had a significant association with a history of ventricular arrhythmias and implantable cardioverter defibrillator (ICD) shocks before the procedure. ES was significantly associated with reduced survival compared to patients without ES (hazards ratio [HR]: 1.92, 95% CI: 1.39-2.64, p < .001). CONCLUSION: Following LVAD implantation, the rate of ES was 7% with majority of ES occurring within 30 days of LVAD. Risk factors for ES included pre-implant history of ventricular arrhythmias and ICD shock. ES was significantly associated with reduced survival compared to patients without ES.

A case of irreversible bradycardia after rituximab therapy for diffuse large B-cell lymphoma.

This is a case of a middle-aged woman with underlying cardiac conduction system with episodes of AV Wenckebach, who subsequently developed significant AV conduction system abnormalities after receiving one standard dose of Rituximab infusion for diffuse large B-cell lymphoma. Rituximab, being a monoclonal antibody against CD-20 antigen, is effective in treatment of B-cell lymphoma but may also cause bradyarrythmias likely due to the calcium ion channel property of CD-20 antigen.

Does diabetes accelerate progression of calcific aortic stenosis?

AIMS: Calcific aortic valve stenosis (CAS) is an active disease like atherosclerosis. Effect of diabetes (D) on severity of CAS is not well documented. METHODS AND RESULTS: We retrospectively analysed 166 consecutive patients with CAS and multiple echocardiograms from January 1997 to March 2005. Aortic valve area (AVA) was measured using the continuity equation. CAS severity was categorized using AVA. D and non-D patients were compared for differences in sex, hypertension, smoking, statin use using chi(2) tests. Comparisons between D and non-D for changes in AVA per year were performed using ANOVA. Study cohort included 166 males with age 70 +/- 9 years, of which 72 (43%) had D. Baseline CAS was mild in 66 subjects, moderate in 75, and severe in 25. D subjects smoked less (P = 0.02), but all other variables were similar (P > 0.05). The interaction between D and baseline CAS severity was significant (P = 0.0191), indicating comparisons should be viewed by baseline CAS severity. D had significantly larger change in AVA than non-D (P = 0.0016) for those with moderate CAS at baseline only. Adjusting for statin use did not alter the results. CONCLUSION: CAS severity progresses faster in D than in non-D in subjects with moderate CAS at baseline. Statins do not affect progression of CAS.

Sudden cardiac death complicating alcohol septal ablation: a case report and review of literature.

Over the years, alcohol septal ablation has become an effective and well-accepted modality in the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to standard medical therapy. Malignant tachyarrythmias infrequently complicates the procedure and are usually self-terminating. We describe a case of alcohol septal ablation complicated by sudden cardiac death occurring immediately following the procedure requiring prolonged resuscitative efforts with eventual complete recovery. We also discuss the pathophysiologic significance of this event in the setting of this cardiomyopathy and its relevance as a complication of the procedure.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a cardiac disease characterized by fibrofatty replacement of the cardiac myocytes. Patients with ARVD/C frequently present with ventricular tachycardia and many are thought to have sudden cardiac death as the initial manifestation of the disease. Over the past decade, our understanding of the disease has increased dramatically along with delineation of the genetic basis of ARVD/C and characteristic features on diagnostic imaging. The management of patients with ARVD/C remains a challenge, especially in the light of incomplete genotype-phenotype characterization, and poor predictors of sudden cardiac death. In this article, we review the pathologic and genetic basis of ARVD/C, focusing on the diagnostic features and therapeutic challenges emerging with our enhanced knowledge of this rare disease.