ABSTRACT
Three-dimensional (3D) reconstruction by means of electroanatomic mapping (EAM) systems, allows for the understanding of the mechanism of focal or re-entrant arrhythmic circuits, which can be identified by means of dynamic (activation and propagation) and static (voltage) color-coded maps. However, besides this conventional use, EAM may offer helpful anatomical and functional information for tissue characterisation in several clinical settings. Today, data regarding electromechanical myocardial viability, scar detection in ischaemic and nonischaemic cardiomyopathy and arrhythmogenic right ventricle dysplasia (ARVC/D) definition are mostly consolidated, while emerging results are becoming available in contexts such as Brugada syndrome and cardiac resynchronisation therapy (CRT) implant procedures. As part of an invasive procedure, EAM has not yet been widely adopted as a stand-alone tool in the diagnostic path. We aim to review the data in the current literature regarding the use of 3D EAM systems beyond the definition of arrhythmia.
Subject(s)
Cardiovascular Diseases/diagnosis , Electrophysiologic Techniques, Cardiac/methods , Arrhythmogenic Right Ventricular Dysplasia/diagnosis , Brugada Syndrome/diagnosis , Cardiac Resynchronization Therapy Devices , Cardiomyopathies/diagnosis , Cicatrix/diagnosis , Humans , Imaging, Three-Dimensional , Myocardium/pathologyABSTRACT
Three-dimensional (3D) reconstruction by means of electroanatomic mapping (EAM) systems, allows for the understanding of the mechanism of focal or re-entrant arrhythmic circuits along with pacing techniques. However, besides this conventional use, EAM may offer helpful anatomical and functional information. Data regarding electromechanical scar detection in ischaemic (and nonischaemic) cardiomyopathy are mostly consolidated, while emerging results are becoming available in contexts such as arrhythmogenic right ventricular dysplasia (ARVC/D) definition and Brugada syndrome. As part of an invasive procedure, EAM has not yet been widely adopted as a stand-alone tool in the diagnostic path. We aim to review the current literature regarding the use of 3D EAM systems for right ventricle (RV) functional characterisation beyond the definition of arrhythmia.
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia , Heart Ventricles , Arrhythmias, Cardiac/diagnostic imaging , Arrhythmogenic Right Ventricular Dysplasia/diagnostic imaging , Heart Ventricles/diagnostic imaging , Humans , Imaging, Three-Dimensional , Predictive Value of Tests , SyndromeABSTRACT
A 76-year-old woman with permanent atrial fibrillation and a mechanical aortic valve came to our attention. Echocardiography showed a 50-55% ejection fraction (EF) with good prosthesis performance. For symptomatic bradyarrhythmia, she received a VVI pacemaker (Proponent MRI L2010 model; Boston Scientific.). During follow-up, frequent symptomatic (presyncopal) episodes of nonsustained episodes of ventricular tachycardia (VT) were detected. Amiodarone proved unsuccessful; she was then offered an upgrade to an implantable cardioverter defibrillator (ICD) and a subcutaneous ICD (S-ICD) was chosen by the patient. A few weeks later, two sustained VT were detected and effectively treated with 80-J shock delivery. In both cases, device interrogation revealed a VT rate around 163 bpm (370 ms cycle length), below the lowest device detection cutoff. The report is a case-based review.
Subject(s)
Defibrillators, Implantable , Tachycardia, Ventricular/therapy , Aged , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Humans , Pacemaker, Artificial , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathologyABSTRACT
In the first volume of the New England Journal of Medicine of 1812, J. Warren published a paper on the subject of angina pectoris, in which clearly emerge the difficulties facing the physicians of that time in trying to formulate a correct diagnosis and prescribe the right therapy. We thought it would be certainly of interest to offer our readers an Italian translation of this article, obviously with some stylistic modifications and supplemented with information coming from other historical scientific works. William Heberden in his report on " breast pain" was the first physician to use the term "angina" and the description of symptoms that he gave in 1772 is still today valid and correct.
Subject(s)
Angina Pectoris/history , Cardiology/history , Chest Pain/history , History, 18th Century , History, 19th Century , Humans , London , United KingdomABSTRACT
Amiodarone is an antiarhytmic drug used in many clinical situations for its probed effect; it is also preferred in particular groups of patients (heart failure, post-ischemical) for its safe and its prognostic benefits. However, a substantial proportion of amiodarone treated patients develop either hypothyroidism or thyrotoxicosis. Both abnormalities may occur in apparently normal glands or in glandes with pre-existed abnormalities. It may be difficult to recognize the dysfunction because of the many changes in thyroid function test results that occur in euthyroid patients who are receiving amiodarone. Hypothyroidism is a well defined clinical situation managable thanks to common guidelines. The occurrence of hypothyroidism does not necessitate withdrawing amiodarone while instituting L-T4 replacement therapy, although many cases are transient and will spontaneously remit after amiodarone withdrawal. At the opposite, hyperthyroidism needs more attention to be diagnosed and to be treated, in fact there is a "personal" clinical-therapeutical behave towards it, caused by the lack of big trials made on this clinical situation. Effective strategies exist for the management of thyroid dysfunction, these should be tailored to the needs of the individual patient.
