Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm.

Among implantable cardioverter-defibrillator (ICD) recipients, there are patients with recurrent episodes of electrical storm (ES), retractable to the optimal antiarrhythmic drug therapy or invasive ablation procedures. A relatively novel anti-ischemic drug with also antiarrhythmic properties, ranolazine, may effectively suppress ventricular arrhythmias in such patients for a long period of time.

Pacing and Sensing of Human Heart for over 31 Years with the Same Apparatus (Generator and Lead).

Several patients receive a permanent pacemaker in a relatively young age, with multiple subsequent reoperations for pacemaker replacement. Pulse generator replacement is an invasive procedure, associated with the risk of various complications, mainly infection and skin erosion. A case of an extremely long-lasting pacemaker with a totally uneventful longevity period over 31 years is presented. The explanation for this quite rare pacemaker longevity (possibly unique) is analyzed and discussed.

Dual-chamber pacemaker malfunction mimicking atrial capture by the ventricular electrode.

A 78-year-old man came for a scheduled check up one month after the implantation of a permanent dualchamber pacemaker for symptomatic transient atrioventricular conduction disturbances (intermittent Mobitz II atrioventricular block). The patient's ECG indicated a loss of atrial capture by the atrial electrode with 1:1 atrioventricular conduction. A subsequent X-ray examination showed that both electrodes were well placed and in their correct sites. A detailed check of the pacemaker using the programmer, together with an echocardiographic examination, revealed the true nature of the malfunction: there was a significant delay between the atrial capture and atrial depolarisation and systole, as well as a loss of ventricular capture because of an acute increase in the threshold. Normal pacemaker function and pacing ECG were restored through modification of the pacemaker's functional parameters.

Radiofrequency ablation of typical atrial flutter via right subclavian/jugular vein access in a patient with implanted filter in the inferior vena cava.

Radiofrequency ablation of Cavotricuspid Isthmus-dependent Atrial Flutter (CTI AFL), a usual and safe therapeutic procedure in interventional electrophysiology with a high success rate, aiming to induce permanent block of conduction over CTI, is normally performed via the femoral access, which allows practical access to the CTI through the inferior vena cava (IVC). In rare cases of obstruction of IVC, ablation of CTI can be performed only through the superior vena cava (SVC) access. We present a case of typical atrial flutter that was ablated through the right subclavian/jugular veins because of iatrogenic obstruction of the IVC due to a previously implanted thrombus filter. Furthermore we discuss about how we resolved access-related problems of instability during catheter ablation on CTI.

Three-dimensional echocardiographic documentation of pacemaker lead perforation presenting as acute pericarditis.

Myocardial perforation is a rare complication of permanent pacemaker insertion and is usually detected during the first month after implantation. Pericardial effusion often occurs at the same time, and as a consequence may generate difficulties in the diagnostic workup due to the various aetiologies of its origin. Computed tomography has been used for the documentation of lead perforation, but its diagnostic accuracy in comparison to echocardiographic examination has not been validated. We report a case of ventricular perforation causing pericarditis, initially undetected by computed tomography, that was finally diagnosed by means of real-time three-dimensional echocardiography.

Left ventricular anatomical and functional changes with ageing in type 2 diabetic adults.

AIMS: Previous studies indicate that diabetic patients show evidence of coexisting systolic and diastolic myocardial dysfunction when examined by new echocardiographic techniques. Yet, there is no systematic investigation of the serial age-related changes of left ventricular anatomy and function in this patient population. METHODS AND RESULTS: One hundred and sixty type 2 diabetic patients and 110 non-diabetic controls, all with no evidence of heart disease, were studied. The participants were stratified into four distinct age-groups (A: <46, B: 46-60, C: 61-75, and D: >75 years) and underwent full echocardiographic examination. Conventional systolic and diastolic parameters were similar between the study groups. However, tissue Doppler imaging examination revealed an impaired systolic and diastolic longitudinal myocardial function in diabetic patients vs. controls, although these differences were not noticed within the youngest age-group. Diastolic dysfunction was established concomitantly in both diabetic and control subjects in age-group B. In contrast, diabetic patients showed an earlier induction of myocardial systolic dysfunction, evidenced by significantly lower average systolic longitudinal myocardial velocity in age-group B. Independent predictors of systolic myocardial dysfunction were age, glycated haemoglobin, and systemic blood pressure. CONCLUSION: Type 2 diabetic patients demonstrate an early and concomitant induction of systolic and diastolic myocardial dysfunction as a preclinical manifestation of diabetic cardiomyopathy.

Termination of ventricular tachycardia with antitachycardia pacing after ineffective shock therapy in an ICD recipient with hypertrophic cardiomyopathy.

Implantable Cardioverter Defibrillator (ICD) implantation is the only established therapy for primary or secondary prevention of sudden cardiac death in patients with Hypertrophic Cardiomyopathy (HCM). Ineffectiveness of shock therapy for the termination of potentially fatal ventricular arrhythmias in ICD recipients is rare in the presence of appropriate arrhythmia detection by the device. We report the case of a 48-year-old woman with HCM and a single chamber ICD, who received five inefficient high-energy (35 Joules) shocks for the termination of an appropriately detected episode of Ventricular Tachycardia (VT). The episode was safely terminated with a subsequent application of Antitachycardia Pacing (ATP) by the device. At the following ICD control, an acceptable defibrillation threshold was detected.

High power radiofrequency ablation of incessant atrioventricular re-entrant tachycardia in a patient with a Para-Hisian accessory pathway.

Radiofrequency ablation is the interventional therapy of choice for the definitive cure of patients with tachycardias facilitated by accessory pathways. Ablation of an accessory pathway at sites close to the His bundle is inevitably associated with an increased risk of causing complete atrioventricular block. Here we describe the case of a patient with pre-excitation syndrome and episodes of supraventricular tachycardia, in whom an electrophysiological study identified an accessory pathway so close to the His bundle that discrete sites between the pathway and the His bundle were extremely difficult to find. After a first, unsuccessful attempt at ablation the patient developed incessant supraventricular tachycardia. The accessory pathway was successfully ablated in a second session using high power radiofrequency current, although this entailed a great increase in the risk of causing complete atrioventricular block.

Contribution of electroanatomical mapping to the diagnosis of arrhythmogenic right ventricular cardiomyopathy in a patient with sustained ventricular tachycardia.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary cardiomyopathy, characterized mainly by anatomic and functional defects of the right ventricle. In many cases its diagnosis is quite difficult in spite of the existence of defined diagnostic criteria for the disease. We describe an interesting case of a patient with sustained ventricular tachycardia derived from the right ventricular outflow tract, in whom the diagnosis of ARVC was made with the contribution of electrophysiologic study and electroanatomical mapping, as the use of all other diagnostic tests and laboratory methods had left many unanswered questions. Based on our case, but also on other studies and case reports in the literature, we conclude that electroanatomical mapping is useful for the documentation of the diagnosis of ARVC, whenever this is not clear from the use of available diagnostic tests according to the defined criteria of the disease.

Second recurrence of cardiac myxoma in a young patient. A case report.

Two cardiac myxomas, one in the right ventricle and another one in the right atrium causing pulmonary embolism, was removed in a 21-year-old male. In this patient, we visualized two more recurrences 6 and 11 years later one in the left atrium and the other in the left and right atrium.

Coronary artery aneurysms and coronary artery fistula as a cause of angina pectoris.

Coronary artery aneurysm is an uncommon disease. Coronary artery fistulae are infrequent congenital anomalies. A extremely rare case report of combination of coronary artery aneurysms and coronary artery fistula is presented with a brief literature review.

Parental history of hypertension is associated with coagulation-fibrinolytic balance disorders.

It has been previously shown that essential hypertension (EH) is associated with coagulation-fibrinolytic balance disorders. Our study was conducted in order to investigate disturbances in coagulation-fibrinolysis in offsprings of hypertensive parents. Two groups were studied: 44 healthy normotensive individuals (17 male, 27 female, age range 12-22 years) with a documented family history of hypertension and 33 individuals (14 male, 19 female, age range 11-21 years) without a family history of essential hypertension. The following parameters were determined in both groups: plasminogen activator inhibitor-1 antigen, tissue plasminogen activator antigen, fibrinogen, fibrin degradation products, thrombomodulin, protein S antigen, protein C activity, von Willebrand factor Ag, factor VII and factor XII activity. Additionally, systolic and diastolic blood pressure, insulin levels, blood lipids and heart rate were determined. The two groups were not found to have differences with respect to age, gender, body mass index, blood lipids and insulin levels. Hypertensive offsprings had significantly higher plasma levels of plasminogen activator inhibitor-1 antigen, fibrinogen, fibrin degradation products, protein S antigen and factor XII activity, while no differences were observed to the other haemostatic variables studied. Hence, offsprings of hypertensives had significantly higher diastolic blood pressure and heart rate. In conclusion, alterations regarding blood pressure, heart rate and fibrinolytic function exist in offsprings of hypertensive parents compared to individuals without family history of hypertension.