Ahmet Akyol

Late Perforation of the Heart, Pericardium, and Diaphragm by an Active-Fixation Ventricular Lead

This case report describes a late perforation of right heart wall, pericardium, and diaphragm by an active‐fixation ventricular lead without development of pericardial effusion and cardiac tamponade even under oral warfarin treatment.

Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure

Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy.

An electrocardiographic algorithm for determining the location of pacemaker electrode in patients with right bundle branch block configuration during permanent ventricular pacing

The expected morphology of right ventricular pacing is a left bundle branch block (LBBB) pattern. However, right bundle branch block (RBBB) can also be seen during permanent right ventricular pacing. The aim of this study was to develop an electrocardiographic algorithm to differentiate this benign condition from septal and free wall perforation with subsequent left ventricular pacing. Three hundred consecutive patients who had permanent ventricular or dual-chamber pacemaker implantation between 1999 and 2000 were screened and 25 patients (8.3%) who exhibited RBBB configuration were included in the study. Echocardiograms and chest radiographs were evaluated in order to identify the pacing lead location in this group. The authors formed a study group with their own 25 patients and 22 cases of RBBB with permanent pacemaker from previous publications (total 47 patients). Frontal axis, QRS morphology in lead V1, and the precordial transition point, which is defined as the precordial lead where R wave amplitude is equal to S wave amplitude, were examined. Placement of precordial leads V1 and V2 1 interspace lower than the standard location (Klein maneuver) eliminated the RBBB pattern in 12 patients. RBBB pattern with “true right ventricular pacing” was detected in 24 of the 25 patients, and in 11 of the 22 patients reported in the literature (total 35 patients). Right ventricular pacing was correctly identified in 34 of 35 patients with use of criteria including left superior axis deviation, RS or qR morphology in lead V1, and precor-dial transition at lead V3 with a high sensitivity and specificity. A simple surface electrocardiogram can accurately predict the lead location in patients having RBBB morphology with right ventricular pacing.

Inhibition of biventricular pacing by far-field left atrial activity sensing: case report.

OGUZ, E., et al.: Inhibition of Biventricular Pacing by Far‐Field Left Atrial Activity Sensing: Case Report. This case report describes a patient with biventricular pacemaker in whom a far‐field sensing of left atrial activity by the pacemakers ventricular channel resulted in ventricular pacing inhibition. Placing of the left ventricular pacing electrode in the proximal part of the coronary sinus tributary resulted in this far‐field sensing problem, which was resolved following decreasing the ventricular sensitivity. The authors suggest that the far‐field sensing of the left atrial activity should be kept in mind for troubleshooting of an atrio‐biventricular pacing system.

An Unusual Cause of Reflex Cardiovascular Syncope: Vagal Paraganglioma

Vagal paraganglioma is one of the rare tumors of the neuroendocrine system. We are reporting a vagal paraganglioma case presented with uncommon features of the disease: asystole and syncope. Syncope episodes occurred 3 years before the major symptoms of the disease. Dual chamber pacemaker failed to prevent syncope attacks because of the vasodepressor component. The patient was treated successfully with en bloc removal of tumor and vagal nerve. Syncope episodes disappeared after operation.

Noncardiogenic pulmonary edema associated with clopidogrel: A serious but unexpected side effect of clopidogrel

Clopidogrel has a favourable side effect profile, in which the most serious complications are related to bleeding diathesis. Drug reactions represent frequently encountered clinical problems that can also be life-threatening. In the present case, serious noncardiogenic pulmonary edema was observed as an idiosyncratic reaction after clopidogrel use. Using the Naranjo adverse drug reactions probability scale, a possible likelihood of this putative interaction between clopidogrel and pulmonary edema was calculated. Such an adverse effect of clopidogrel has never been reported before. The present report shows the importance of recognizing rare adverse reactions of newer drugs, such as clopidogrel, in clinical practice.