Catheter ablation of complex cardiac arrhythmias: Single-centre experience in Armed Forces.

BACKGROUND: Complex arrhythmia ablation remains a technical challenge despite advances in hardware and mapping techniques. The aim of the study was to analyse the efficacy of radiofrequency ablation of arrhythmias requiring complex electrophysiological procedures at a tertiary-care centre. METHODS: A retrospective study was done for catheter ablation of arrhythmias performed at a single centre from Aug 2012 to Nov 2016 (4 years 4 months). The standard ablation involved conventional catheters with antegrade right heart and retrograde left heart access. The procedure was considered complex, if it involved 3 D electro-anatomical (EA) guidance for mapping or required special hardware and/or trans-septal puncture. RESULTS: Of 333 electrophysiology (EP) cases 265 qualified for ablation. The cohort of arrhythmias requiring complex procedure (n = 94) comprised of supraventricular 15 (15.9%), atrioventricular 43 (44.7%) and ventricular 36 (38.3%). The procedure used three-dimensional EA mapping in 31; trans-septal puncture for left atrial access in 40; and use of special catheters and sheaths in all 94 procedures. The overall success in the complex group after the first procedure was 87.2% versus 88.3% (P < 0.05), and after redo procedure it was 90.4% vs 94.7% (P < 0.05). There were three complications (pericardial perforation: 2; cardioembolism: 1) only in the complex group. The fluoroscopy time for complex was longer than that of the standard procedure (25.10 ± 6.32 versus 15.23 ± 5.33 min, P = 2.54). CONCLUSION: Arrhythmias requiring complex electrophysiological procedure for ablation have a comparable success rate to standard ablation procedure but at the cost of extra hardware, complications and fluoroscopy time.

The armed forces medical services response to COVID-19.

The Indian Armed Forces have always responded to the Nation's call and the COVID-19 pandemic response has been no different. On instructions from the Government of India, the Armed Forces Medical Services (AFMS) pitched in right from the initial stages of the epidemic in India as part of a coordinated national response. Be it the execution of medical quarantine for Indian citizens evacuated from China and other COVID affected countries or establishing dedicated and mixed COVID hospitals for its own clientele as well as civilian patients, the AFMS worked in tandem with the national policies. The Armed Forces ensured force preservation and protection of its own troops and families by timely implementation of public health measures, even as it played its designated role in the national strategy. With vision, understanding and clarity, the AFMS continue to lend shoulder to India's response to this global public health challenge.

Biventricular thrombosis in a structurally normal heart at high altitude.

We present a rare case of biventricular thrombus in a young patient with a structurally normal heart at high altitude, complicated with pulmonary embolism. Detailed evaluation revealed him to have protein S deficiency. Altered environmental conditions at high altitude associated with protein S deficiency resulted in thrombus formation at an unusual location; the same is discussed in this case report.

Prevalence and association of lifestyle factors with extracranial carotid atherosclerosis in non-cardioembolic anterior circulation strokes in adult males less than 50 years: One year cross-sectional study.

BACKGROUND: Data is scarce on prevalence of extracranial carotid atherosclerosis (ECA) in strokes <50 years and its association with lifestyle factors. OBJECTIVE: Study role of (a) ECA in non-cardio-embolic anterior circulation young strokes, and (b) smoking and alcohol in ECA. MATERIALS AND METHODS: Cardiovascular risk factors and evidence of ECA on carotid doppler ultrasound (CDUS) was evaluated in an one-year preliminary cross-sectional study of consecutive strokes between 20 years and 49 years. Females were excluded. RESULTS: There were 46 male strokes (mean age 38.26 yrs), 17.39% had hypertension, 2.23% had coronary artery disease; none was diabetic. Tobacco users and alcohol consumers were 24/46 (52.17%) cases each. ECA was found in 14/46 (30.44%) cases. Seven of these 14 (50%) i.e., 7/46 cases (15.21%) had carotid occlusion, four had <50%, three had >70% stenosis. 'Smoking and smokeless tobacco use' was found in 71.42% (10/14) symptomatic carotid lesions compared to 43.75% (14/32) strokes without carotid lesions. Prevalence odds ratio for tobacco use and ECA was 3.21 (95% CI: 0.83-12.44) while that of alcohol and ECA was 1.33 (95% CI: 0.38-4.72). CONCLUSION: Prevalence of ECA in strokes <50 years was high due to lifestyle factors which predispose to atherosclerosis at younger age.

Two cases of medically-refractory spontaneous orthostatic headaches with normal cerebrospinal fluid pressures responding to epidural blood patching: Intracranial hypotension versus hypovolemia and the need for clinical awareness.

The diagnosis of spontaneous intracranial hypotension or cerebrospinal fluid (CSF) hypovolemia syndrome requires a high index of suspicion and meticulous history taking, demonstration of low CSF pressure and/or neuroimaging features. A 31-year-old male, presented with subacute onset moderate occipital and sub-occipital headaches precipitated by upright posture and relieved on recumbency and neck pain for 2 years. There was no trauma, cranial/spinal surgery. Clinical examination was normal and CSF opening pressure and laboratory study were normal. Magnetic resonance imaging (MRI) brain showed thin subdural hygroma. Another patient, 41-year-old male presented with 1 month of subacute onset severe bifrontal throbbing orthostatic headaches (OHs). CSF opening pressure was normal. Contrast MRI brain showed the presence of bilateral subdural hygromas, diffuse meningeal enhancement, venous distension, sagging of the brain, and tonsillar herniation. We report two cases of "spontaneous OHs" with normal CSF pressures who were successfully treated with epidural blood patching after poor response to conservative management.

Transcatheter closure of ruptured sinus of Valsalva aneurysm.

Congenital sinus of Valsalva aneurysm is a rare cardiovascular anomaly. Rupture of sinus of Valsalva (RSOV) is a rare occurrence, occurring in 10-20% of cases. Rupture into right atrium is further a rare occurrence. The rupture is usually a catastrophic event presenting as acute onset congestive cardiac failure in an apparently healthy individual in the 2(nd) or 3(rd) decade of life. Surgery used to be the mainstay of treatment of RSOV aneurysm, however, in past few years several reports of transcatheter closure of RSOV have come into light. We report a patient, who underwent device closure with a Duct Occluder device. Device was manipulated and deployed with an angle so as to prevent aortic valve dysfunction. © 2010 Wiley-Liss, Inc.