Functional uni-ventricular heart due to post-myocardial infarction ventricular septum rupture.

Ventricular septum defect (VSD) is an often lethal complication caused by myocardial infarction. We report a rare case of post-myocardial infarction ventricular septum rupture in a patient after extracorporeal cardiopulmonary resuscitation (eCPR). In the bedside echocardiography after VA ECMO cannulation, we noticed the circular, hypertrophied left ventricle with the disintegrated inter-ventricular septum (maximum dehiscence 3.3 cm), accompanied by decreased left-ventricular ejection fraction and the right ventricle being compressed by the left ventricle's free septal wall. There was no pressure-relevant inter-ventricular separation resulting in left-to-right-shunting and therefore resulting in a fully functional uni-ventricular heart.

The use of a high-resolution mapping system may facilitate standard clinical practice in VE and VT ablation.

BACKGROUND: First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported. OBJECTIVES: We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice. METHODS: Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automated-mapping system were included in this study. For LV access, transseptal and retrograde access were compared. RESULTS: All 32 pts (29 men, age 63 ± 15 years) underwent CA for VE (17 pts) or VT (15 pts). For mapping of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 ± 21.2 min for VE ablation and 212.0 ± 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 ± 1672 map points and annotation of 140 ± 98 automated mapping points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 ± 2.1% to 2.8 ± 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU. CONCLUSION: Use of a high-resolution mapping system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal.

Exercise time cues (zeitgebers) for human circadian systems can foster health and improve performance: a systematic review.

BACKGROUND: Circadian system time cues (zeitgebers) acting synergistically at the right times can foster chronobiological homeostasis and ultimately health. Modern 24/7 societies are challenging chronobiological homeostasis and public health. Exercise has been discussed as a potential zeitgeber for the human circadian system. Thus, if timed correctly, exercise may help in maintenance of chronobiological homeostasis and foster public health amidst increasingly challenging 24/7 lifestyles. OBJECTIVE: To test, using a systematic review of the literature, the following hypothesis: exercise is a zeitgeber for the human circadian system. DATA SOURCES: The PubMed database was systematically searched on 19 October 2017 for relevant scientific studies and reports concerning chronobiology and exercise. Eligibility criteria were defined to include articles considering exercise as a potential zeitgeber for human circadian rhythmicity or chronobiological effects of exercise on health and/or physical performance. Cognitive effects and effects on children were excluded from the synthesis. RESULTS: Our systematic literature search and synthesis is compatible with the validity of the hypothesis. We report that potential exercise-zeitgeber properties may be used to improve health and performance. CONCLUSIONS: Informed timing of exercise, specific to the circadian rhythm phase and zeitgeber exposure of the individual, must be advocated in performance and disease contexts as an adjunct therapeutic or preventative strategy and physical enhancer.

Combination of a subcutaneous ICD in a patient with a baroreceptor activation device: Feasibility, safety, and precautions: A Case Report.

We present a case of a patient with a baroreflex activation therapy (BAT) receiving a subcutaneous implantable cardioverter defibrillator (S-ICD). We anticipated two possible hazardous interactions between the two devices. Stimulation by the BAT could be adjudicated as noise and result in underdetection of ventricular arrhythmias or it might be misinterpreted as ventricular arrhythmias and lead to inappropriate shocks. Postop ensing occurred, the upper limit of pulse width of the BAT was limited because of noise detection by the S-ICD, but the upper limit of amplitude was limited by patient's discomfort. In this patient, the combination of a BAT and an S-ICD was safe.

The discovery of slowness: Time to deconstruct Gretzky's and Messi's predictive brains.

Jafari and Smith hypothesized that time during games may pass slower for the world's best football player, Lionel Messi, from Argentina. This hypothesis leads to two questions: How can we explain such temporal paradox and how could this explain his dominant performances? Remarkably, the Argentinian's case was preceded by the equally astonishing case of Wayne Gretzky: The Canadian considered ice hockey as a rather slow game and was the best player in the sport's history. Whether Messi's and Gretzky's motor neurons fire faster, (inter)act differently or whether other mechanisms are at (inter)play warrants targeted research. A further explanation for such dominance of football and ice hockey, respectively, could be that both athletes "buy time": To this end, automized motor skills may allow their predictive brains to make better use of time than other players to read the games and plan ahead. Deconstructing predictive minds of outperforming individuals like Gretzky and Messi could provide unique options to elucidate how differential time perception may make performances in athletes, and beyond, more swift and more efficient.