Prolonged QTc interval and torsades de pointes induced by citalopram.

Citalopram is a selective serotonin reuptake inhibitor with a favorable cardiac-safety profile. Corrected QT interval (QTc) prolongation and cardiac arrhythmias have not been previously reported in association with citalopram use except in the presence of overdose, abnormal electrolyte values, or renal or liver failure. Herein, we report the case of a 40-year-old woman with mental depression who presented with a prolonged QTc interval and torsades de pointes after the initiation of citalopram at therapeutic doses. The QTc interval improved when citalopram therapy was discontinued. We recommend that clinicians investigate the family history for sudden deaths and perform baseline electrocardiography before prescribing citalopram. We also recommend routine electrocardiographic testing during citalopram therapy, and that patients with long QT syndrome avoid taking citalopram.

Mycobacterium phlei, a previously unreported cause of pacemaker infection: thinking outside the box in cardiac device infections.

The increased use of cardiac rhythm management devices has led to an increase in cardiac device-related infections (CDI). Staphylococcus aureus and epidermidis account for the vast majority of CDI. CDI due to rapidly growing non-tuberculous mycobacteria is very rare, with only about ten cases having been reported. We report a case of pacemaker pocket infection with Mycobacterium phlei. There are only three published reports of human infection involving this typically non-pathogenic organism. To the best of our knowledge, this is the first report of CDI with Mycobacterium phlei.

Atrial flutter ablation in inducible patients during pulmonary vein atrum isolation: a randomized comparison.

BACKGROUND: The incidence of atrial flutter (AFL) post pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) is reported to be between 8% and 20%. The need for right or left AFL ablation during the initial PVAI procedure remains controversial. We prospectively compared mapping and ablation versus no ablative treatment of inducible AFL during PVAI. METHODS AND RESULTS: In 220 patients (167 men, mean age 56+/-15 years) with symptomatic AF presenting for PVAI, burst pacing from the high right atrium and coronary sinus was performed to determine AFL inducibility. A total of 25 patients with sustained (17 patients) or reproducible (eight patients) AFL were included in this study. Patients were randomized to mapping and ablation of AFL using the CARTO 3D mapping system (Biosense Webster, Diamond Bar, CA, USA) versus no further ablation. Typical AFL was induced in 48% of the patients. During a follow-up of 12+/-4 months, recurrences were determined by serial 48-h Holter and event monitors. Recurrence rates, time to recurrence, and AFL cycle length differences between both groups were not statistically significant. CONCLUSION: These data suggest that inducibility of AFL post PVAI does not predict long-term incidence of AFL. Moreover, this study demonstrates little benefit to mapping and ablation of these arrhythmias during the PVAI procedures.

New magnetic resonance imaging-based method for defining the extent of left atrial wall injury after the ablation of atrial fibrillation.

OBJECTIVES: We describe a noninvasive method of detecting and quantifying left atrial (LA) wall injury after pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF). Using a 3-dimensional (3D) delayed-enhancement magnetic resonance imaging (MRI) sequence and novel processing methods, LA wall scarring is visualized at high resolution after radiofrequency ablation (RFA). BACKGROUND: Radiofrequency ablation to achieve PVAI is a promising approach to curing AF. Controlled lesion delivery and scar formation within the LA are indicators of procedural success, but the assessment of these factors is limited to invasive methods. Noninvasive evaluation of LA wall injury to assess permanent tissue injury may be an important step in improving procedural success. METHODS: Imaging of the LA wall with a 3D delayed-enhanced cardiac MRI sequence was performed before and 3 months after ablation in 46 patients undergoing PVAI for AF. Our 3D respiratory-navigated MRI sequence using parallel imaging resulted in 1.25 x 1.25 x 2.5 mm (reconstructed to 0.6 x 0.6 x 1.25 mm) spatial resolution with imaging times ranging 8 to 12 min. RESULTS: Radiofrequency ablation resulted in hyperenhancement of the LA wall in all patients post-PVAI and may represent tissue scarring. New methods of reconstructing the LA in 3D allowed quantification of LA scarring using automated methods. Arrhythmia recurrence at 3 months correlated with the degree of wall enhancement with >13% injury predicting freedom from AF (odds ratio: 18.5, 95% confidence interval: 1.27 to 268, p = 0.032). CONCLUSIONS: We define noninvasive MRI methods that allow for the detection and quantification of LA wall scarring after RF ablation in patients with AF. Moreover, there seems to be a correlation between the extent of LA wall injury and short-term procedural outcome.