Johnson Francis

Atrial Fibrillation and Brugada Syndrome

Brugada syndrome is characterized by right bundle branch block pattern with ST-segment elevation in leads V(1) to V(3) and a propensity for sudden cardiac death due to ventricular arrhythmias. The arrhythmogenic substrate in Brugada syndrome may not be restricted to the ventricles, and atrial arrhythmias are being increasingly reported. Incidences of spontaneous atrial arrhythmias vary from 6% to 38% and those of inducible atrial arrhythmias from 3% to 100%. Atrial fibrillation (AF) is the most common atrial arrhythmia found in Brugada syndrome. Enhanced duration of atrial action potential and increased intra-atrial conduction time may contribute to the genesis of atrial arrhythmias in Brugada syndrome. Atrial arrhythmias are an important cause of inappropriate discharge of implantable defibrillators in patients with Brugada syndrome. Hence, implantation of dual-chamber defibrillators and careful programming of single-chamber devices have been recommended. Atrial fibrillation has been associated with mutations in both the sodium and calcium channels of the heart, as well as with cases of Brugada syndrome that could not genotyped to any of the known genes associated with the disease. This observation suggests that the substrate responsible for the development of ventricular arrhythmias also may contribute to arrhythmogenesis in the atria of the heart. The presence of a prominent transient outward current in atria and the observation that episodes of AF are triggered by closely coupled atrial extrasystoles point to the possibility that a substrate similar to that responsible for ventricular arrhythmogenesis underlies the development of AF in patients with Brugada syndrome.

Comparison of Proximal Isovelocity Surface Area Method and Pressure Half Time Method for Evaluation of Mitral Valve Area in Patients Undergoing Balloon Mitral Valvotomy

Background: The pressure half time (PHT) method is unreliable for measurement of mitral valve area (MVA) immediately after valvotomy. The proximal isovelocity surface area (PISA) method has been used to derive mitral valve area in patients with mitral stenosis. The aim of our study was to compare PISA method and PHT method in patients undergoing percutaneous balloon mitral valvotomy (BMV). Methods: The PISA was recorded from the apex and MVA was calculated using continuity equation by the formula 2πr2 Vr/Vm, where 2πr2 is the hemispheric isovelocity area, Vr is the velocity at the radial distance “r” from the orifice, and Vm is the peak velocity. A plain angle correction factor (θ)/180 was used to correct the inlet angle subtended by leaflet tunnel as a result of leaflet doming. Results: MVA calculated using PISA method (r = 0.5217, P < 0.0001, SE = 0.016) and PHT (r = 0.6652, P < 0.0001, SE = 0.017) correlated well with 2D method in patients with mitral stenosis before BMV. After BMV, MVA by PISA method correlated well with 2D planimetry (r = 0.5803, P < 0.0001, SE = 0.053) but PHT showed poor correlation (r = 0.1334, P = 0.199, SE = 0.036). The variability of measurement of MVA was most marked with PHT method in the post‐BMV period. Conclusion: The PISA method correlates well with 2D planimetry in patients with mitral stenosis before and after BMV and is superior to the PHT method in the post‐BMV period where the latter may be unreliable.

Idiopathic Dilatation of Right Atrium with Atrial Standstill Presenting as Stroke

A 48‐year‐old lady presenting with stroke was found to have idiopathic dilatation of right atrium with atrial standstill.

A Rare Association of Ebstein's Anomaly of Tricuspid Valve with Rheumatic Mitral Stenosis

Mitral valve abnormalities have been described in Ebsteins anomaly, but acquired rheumatic mitral valve disease is an extremely rare association. We describe a classical case of Ebsteins anomaly of tricuspid valve with severe rheumatic mitral stenosis. This patient had mild mitral regurgitation, pulmonary hypertension and atrial fibrillation.

Update on Ventricular Tachyarrhythmias and Related Sudden Cardiac Death

This section on EP Update – Clinical summarizes the recent literature on ventricular tachyarrhythmia and related sudden cardiac death from leading journals. The articles have been hand picked and reviewed by the editors of IPEJ for the benefit of readers.

Ventricular Tachycardia: The Spectrum Continues to Broaden Report of Naxos Disease

Naxos disease is a recessively inherited arrhythmogenic right ventricular cardiomyopathy (ARVC) in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair.1 A 55-year-old female of Asian-Indian origin presented with recurrent palpitation and syncope. She was not known to have had any significant illness in the past except for lesions on her palm and the sole of her foot. She did not have any conventional risk factors for coronary artery disease except for her postmenopausal status. Physical examination revealed woolly hair (Figure 1) and palmoplantar keratosis (Figure 2 and Figure 3 …Naxos disease is a recessively inherited arrhythmogenic right ventricular cardiomyopathy (ARVC) in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair.1 A 55-year-old female of Asian-Indian origin presented with recurrent palpitation and syncope. She was not known to have had any significant illness in the past except for lesions on her palm and the sole of her foot. She did not have any conventional risk factors for coronary artery disease except for her postmenopausal status. Physical examination revealed woolly hair (Figure 1) and palmoplantar keratosis (Figure 2 and Figure 3 …

Images in cardiovascular medicine. Ventricular tachycardia: the spectrum continues to broaden: report of Naxos disease.

Naxos disease is a recessively inherited arrhythmogenic right ventricular cardiomyopathy (ARVC) in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair.1 A 55-year-old female of Asian-Indian origin presented with recurrent palpitation and syncope. She was not known to have had any significant illness in the past except for lesions on her palm and the sole of her foot. She did not have any conventional risk factors for coronary artery disease except for her postmenopausal status. Physical examination revealed woolly hair (Figure 1) and palmoplantar keratosis (Figure 2 and Figure 3 …Naxos disease is a recessively inherited arrhythmogenic right ventricular cardiomyopathy (ARVC) in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair.1 A 55-year-old female of Asian-Indian origin presented with recurrent palpitation and syncope. She was not known to have had any significant illness in the past except for lesions on her palm and the sole of her foot. She did not have any conventional risk factors for coronary artery disease except for her postmenopausal status. Physical examination revealed woolly hair (Figure 1) and palmoplantar keratosis (Figure 2 and Figure 3 …

IPEJ: A journey of one and half decades.

It was along the sidelines of the National Interventional Council meeting at Kochi in May 2001 that a group of EP enthusiasts discussed about forming an active EP group at the national level. This was soon followed by the launching of a website for the Indian Pacing and Electrophysiology Group in line with the then popular British Pacing and Electrophysiology Group. The website had educational content in the form of interesting ECGs and EP tracings. This was soon followed by the launching of the online open access journal Indian Pacing and Electrophysiology Journal (IPEJ) in October 2001. IPEJ was unique among open access journals in that it gave open access to the content without adding any burden of author charges on the authors. The journal was maintained by the voluntary effort of medical professionals interested in maintaining free access to academic publications. The whole work of the journal including editorial processing, creation of website content and communications were done without any financial support. In 2001, the journal had Dr. Balbir Singh and Dr. Yash Lokhandwala as the editors-in-chief and myself as the founder and executive editor. Dr. Calambur Narasimhan took over as the editor-in-chief later, by which time the journal had become the official journal of the newly formed Indian Heart Rhythm Society. The journal was initially included in the Directory of Open Access Journals and later in EMBASE and

Ventricular arrhythmias in arrhythmogenic right ventricular dysplasia.

In this issue of EP Update we summarize the recent literature on arrhythmogenic right ventricular dysplasia (ARVD). The articles have been hand picked and reviewed by the editors of IPEJ for the benefit of readers.

Mayo Clinic Electrophysiology Manual. Editors: Sameul J Asirvatham, Yong-Mei Cha, Paul A Friedman. Mayo Clinic Scientific Press

Mayo Clinic Electrophysiology Manual is a concise book on cardiac electrophysiology from the Mayo Clinic Scientific Press, published by the Oxford University Press.xa0 Overall, this EP manual is one of the best for the electrophysiologist in training and good refresher for the practicing consultant.