Chandramohan Ramasamy

An unusual response to para-Hisian pacing: What is the explanation?

Case presentation A young man presented with recurrent left bundle branch block morphology tachycardia. Baseline electrocardiogram showed preexcitation suggestive of a posteroseptal accessory pathway. During electrophysiology study, ventricular programmed stimulation showed ventriculoatrial (VA) conduction with earliest atrial activation at the proximal coronary sinus and decrement in VA time at shorter coupling intervals. Para-Hisian pacing was performed by pacing from the distal His bipole and altering the output (Figure 1). What is the interpretation?

Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure

BACKGROUND Mitral stenosis may present with decompensated heart failure during pregnancy. Many patients do have advanced sub valve disease and present late with decompensated state. The outcomes of balloon mitral valvuloplasty (BMV) in such advanced sub valve disease with severe heart failure in pregnancy has not been specifically studied till now. METHODS A descriptive study looking at the immediate and long-term outcomes of pregnant patients with MS who presented with severe heart failure and sub valve disease who had undergone BMV. RESULTS Ninety-six patients were studied. The mean gestational age was 23.4 ± 10.9 weeks .Mean SpO2 was 89% at admission,17% were in cardiogenic shock and 33.33 were on mechanical ventilation. The mean Wilkins score was 9.71 ± 2.1 and sub valve score was 3.3 ± 0.12. BMV was successful in 77 (80.2%) patients and failed in 19. In 5.2% cases, acute severe MR occurred. There were 11 maternal deaths (six in failed and five in success group). A successful obstetric outcome was seen in 71 patients in success (92%) and 11/19 (57%) in failed (P < 0.001). The obstetric outcomes were better in success versus failure group. Anova post hoc analysis showed sustained gradient reductions at 1 and 5 year follow-up (P = 0.03) in success group. CONCLUSIONS BMV offers substantial improvement in clinical outcomes among pregnant patients with MS and heart failure even with severe sub valve disease. The morality rate among failed was high at 31%. The obstetric outcomes were poor after a failed BMV. Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure.

TCTAP A-179 Acute Complications Following Balloon Mitral Valvuloplasty – Analysis of 1450 Cases over 15-Year Period

Balloon mitral valvuloplasty (BMV) has in vogue for more than 3 decades. The complications of the procedure are well known. Few studies have analyzed the complications and its outcomes following BMV in a large cohort. Single center retrospective data analysis of acute complications following BMV

Seckel Syndrome with Severe Sinus Bradycardia

Seckel syndrome is an uncommon form of microcephalic dwarfism. The authors report a young boy with Seckel syndrome who presented with severe sinus bradycardia with symptoms of syncope and presyncope. Implantation of a permanent pacemaker was necessary in view of the severe symptoms. Although uncommon, cardiac abnormalities have been rarely reported in Seckel syndrome. This is the one of the few reports of rhythm abnormalities in this condition.

Wide Complex Tachycardia: What Is the Mechanism?

A 42-year-old male presented with palpitations and a regular broad complex tachycardia at 220 bpm. He had moderate left ventricular dysfunction and hypotension and was cardioverted. During catheter placement for the electrophysiology study, he developed broad complex tachycardia of RBBB morphology with a cycle length (CL) of 264 milliseconds and negative HV interval. Atrial pacing was performed at CL of 210 milliseconds (Fig. 1). What is the response and how should it be interpreted?

Parasystole in a Mahaim Accessory Pathway

Automaticity has been described in Mahaim pathways, both spontaneously and during radiofrequency ablation. We describe an unusual case of automatic rhythm from a Mahaim pathway presenting as parasystole. The parasystolic beats were also found to initiate tachycardia, resulting in initial presentation with incessant tachycardia and tachycardia induced cardiomyopathy.

Sequential Anterograde and Retrograde Conduction Block during Radiofrequency Ablation of an Accessory Pathway

We present an interesting image showing sequential loss of anterograde, and subsequently, retrograde conduction during radiofrequency ablation of an accessory pathway. We discuss the possible mechanisms and prior literature concerning this interesting finding.