[Extraordinary findings after radiofrequency ablation]. / Aussergewöhnliche Befunde nach Radiofrequenzablation.

We report the successful treatment with Heparin and Phenprocoumon of a large, free-floating, right atrial thrombus that developed after radiofrequency ablation (RFA) of an accessory pathway in a 24 year old patient with Wolff-Parkinson-White (WPW) Syndrome. In addition, "T-wave memory", a relatively common phenomenon after RFA in WPW-Syndrome, is demonstrated.

Value of routine holter monitoring for the detection of paroxysmal atrial fibrillation in patients with cerebral ischemic events.

BACKGROUND AND PURPOSE: Holter monitoring for the detection of paroxysmal atrial fibrillation (PAF) is a routine procedure after cerebral ischemic events, although its value is unknown. The aim of this study was to evaluate the incidence of PAF and its impact on drug treatment modifications in this population. METHODS: Retrospective evaluation of all Holter ECGs in patients with cerebral ischemic events was done. Chart analysis with regard to drug treatment modification and cardiovascular drug therapy was performed in all patients. RESULTS: Between January 2000 and December 2002, 425 hospitalized patients (median age, 68 years) had routine Holter ECG after a cerebral ischemic event. PAF was diagnosed in 9 patients (2.1%): in 2, oral anticoagulation was contraindicated; 1 had severe carotid stenosis as an additional risk factor; 1 had PAF but was on oral anticoagulation for basilar thrombosis; 2 had had PAF before and were on aspirin; and 3 had a new diagnosis of PAF. The last 5 patients were put on oral anticoagulation. Thus, routine Holter ECG resulted in drug treatment modification in only 5 of 425 patients (1.2%). CONCLUSIONS: PAF in cerebral ischemic event patients has a low incidence and, if diagnosed, rarely leads to drug modification. Therefore, routine Holter monitoring for PAF screening is not recommended in this patient population.

Elevated troponin levels in absence of coronary artery disease after supraventricular tachycardia.

Generally speaking elevated troponin levels are consistent with the diagnosis of acute coronary syndrome and haemodynamically relevant coronary artery stenosis. However, they may also point to minor myocardial injury in other circumstances. Four patients with elevated troponin levels after supraventricular tachycardia without evidence of coronary artery disease and very low risk scores for acute coronary syndrome are described and discussed.

[Amiodarone-induced thyrotoxicosis]. / Amiodaron-induzierte Hyperthyreose.

Amiodarone is the most important drug in the treatment of ventricular arrhythmias and is widely used for atrial fibrillation. Thyrotoxicosis, a classical side effect, was thought to be iodine induced, but recent evidence suggests that other mechanisms play an important role (toxic effect on thyreocytes, immunological effects). Thyrotoxicosis due to amiodarone is difficult to treat and is further complicated by the pro-arrhythmic potential of thyrotoxicosis and the fading antiarrhythmic effect after amiodarone withdrawal. The mechanism, diagnosis and therapy of amiodarone-induced thyrotoxicosis are discussed in the light of the available literature.

Placement of a temporary pacemaker electrode through a persistent left superior vena cava.

Perioperative temporary pacing was needed in a patient with congenital skeletal malformations and a cardiac conduction disturbance with incomplete trifascicular block. We report the successful placement of the pacemaker electrode through a persistent left superior vena cava (SVC).

New ICD-technologies: first clinical experience with dual-chamber sensing for differentiation of supraventricular tachyarrhythmias.

Inappropriate ICD therapy for supraventricular arrhythmias remains an unsolved problem and may lead to serious clinical situations. Current algorithms for differentiation of supraventricular and ventricular arrhythmias are based on ventricular sensing solely and, therefore, lack sensitivity and specificity. This preliminary analysis from a multicenter trial comprises data from the first 26 patients who received a Res-Q Micron active-can ICD (Sulzer Intermedics) with a ventricular defibrillation lead and an additional bipolar lead for atrial sensing. Digitized atrial and ventricular waveform storage as well as interval charts from 102 induced and 30 spontaneous arrhythmia episodes were prospectively collected and analyzed with regard to appropriateness of ICD therapy. From all 132 arrhythmia episodes, high-quality stored dual-chamber intracardiac electrograms (IEGM) could be retrieved for further analysis: in 40 (30%) episodes, atrial fibrillation (AF with rapid ventricular response 22, AF with VT 9, AF with VF 9) was identified as the underlying intrinsic rhythm, and inappropriate ICD therapy was delivered in 4/22 (18%) episodes of AF with rapid ventricular response. In the remaining 92 (70%) episodes, sinus rhythm was the underlying atrial rhythm (SR with VT 13, SR with VF 79), and no inappropriate therapy was observed. Three of 22 (15%) high-energy shocks delivered for ventricular arrhythmias (VT 9, VF 9, rapid AF 4) terminated AF at the same time. In total, there were 3 complications (2 atrial lead dislodgments, 1 revision for bleeding). Both atrial lead dislodgments occurred in the 2 patients with passive-fixation leads compared to none in the 24 patients with active-fixation leads (p = 0.003). In conclusion, dual-chamber sensing and waveform storage of the new Res-Q Micron offer very helpful diagnostic tools for the detection of inappropriate ICD-therapy. Placement of an additional atrial lead is safe and does not interfere with proper ICD function. However, for avoidance of atrial lead dislodgment, active fixation leads are recommended. With the tested active-can lead configuration, the efficacy of successful atrial cardioversion by high-energy shocks delivered for ventricular arrhythmias seems to be low.

[Anaphylactoid reaction to Physiogel SRK 4%--a contribution to the controversy about plasma substitutes]. / Anaphylaktoide Reaktion auf Physiogel SRK 4%--ein Beitrag zur Kontroverse um Plasmaersatzstoffe.

Allergic reactions caused by colloid plasma substitutes are a well known complication in infusion therapy. The incidence of these adverse effects depends on the type of colloid used. Severe anaphylactic or anaphylactoid reactions are generally rare. Nevertheless, the risk of adverse allergic effects is an important aspect of the crystalloid-versus-colloid controversy. The exact pathophysiologic mechanisms remain as yet unclear; reliable prophylactic measures are not universally available. To draw attention to these problems we report a case of severe anaphylactoid reaction to Physiogel SRK.