Maneesh K. Rai

Prolonged Tpeak-end and Tpeak-end/QT ratio as predictors of malignant ventricular arrhythmias in the acute phase of ST-segment elevation myocardial infarction: A prospective case-control study

BACKGROUND Prolonged Tpeak-end (the interval from the peak of the T wave to the end of the T wave) and Tpeak-end/QT ratio have been shown to be markers of arrhythmogenesis in various cardiac disorders. OBJECTIVES The purpose of this study was to evaluate the utility of Tpeak-end and Tpeak-end/QT ratio at admission in patients with acute ST-segment elevation myocardial infarction (STEMI) in predicting malignant ventricular arrhythmias. METHODS The study group included 50 patients presenting with STEMI, in whom Tpeak-end and Tpeak-end/QT ratio were measured at admission; these patients were monitored for arrhythmias with a continuous electrocardiogram in the intensive care unit for 48 hours, and 50 healthy individuals acted as controls. RESULTS The Tpeak-end (0.11 ± 0.04 seconds vs 0.08 ± 0.006 seconds; P < .0010) and Tpeak-end/QT ratio (0.30 ± 0.06 vs 0.21 ± 0.02; P < .001) were prolonged in patients with STEMI. Three patients with STEMI who sustained ventricular fibrillation (VF) within 24 hours of admission had prolonged corrected QT interval (0.39 ± 0.04 seconds vs 0.46 ± 0.13 seconds; P = .019), Tpeak-end (0.10 ± 0.02 seconds vs 0.20 ± 0.11 seconds; P < .001), and Tpeak-end/QT ratio (0.26 ± 0.05 vs 0.41 ± 0.09; P < .001) as compared with patients with STEMI without VF. Tpeak-end > 0.1 seconds and Tpeak-end/QT ratio > 0.3 predicted VF with a sensitivity of 100%. However, the Tpeak-end/QT ratio had a higher specificity (82.9% for Tpeak-end/QT ratio vs 44.7% for Tpeak-end) and accuracy (84% for Tpeak-end/QT ratio vs 48% for Tpeak-end). CONCLUSION Tpeak-end and Tpeak-end/QT ratio are prolonged in patients with STEMI compared with healthy individuals, and Tpeak-end > 0.1 and Tpeak-end/QT ratio > 0.3 predict malignant ventricular arrhythmias within 24 hours of STEMI.

Transvenous permanent pacemaker implantation in dextrocardia: technique, challenges, outcome, and a brief review of literature

AIMS Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. METHODS AND RESULTS The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. CONCLUSION Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable.

Preventing a central nervous system catastrophe in a case of Takayasu’s arteritis presenting with critical stenosis of all three arch vessels

Multifocal and bilateral involvement of the arch vessels is a common presentation of Takayasu’s arteritis. Endovascular stenting of multiple supra aortic lesions in Takayasu’s arteritis has been described scarcely in literature. We describe the management of a case of Takayasu’s arteritis who presented with recurrent vertebro-basilar symptoms and a single surviving arch vessel. Whether routine revascularization of all three vessels is superior to symptom driven revascularization of individual lesions remains uncertain. The abundant collateral blood flow; the problems with stenting during the acute phase of the disease; the risk of restenosis that is considerably higher than atherosclerotic lesions; and the chances of progression of the disease have to be taken into account during endovascular revascularization of multiple supra aortic arch vessels.

Histopathological study of left and right atria in isolated rheumatic mitral stenosis with and without atrial fibrillation

Mitral stenosis (MS) has the highest incidence of atrial fibrillation (AF) in chronic rheumatic valvular disease. There are very few studies in isolated MS comparing histopathological changes in patients with sinus rhythm (SR) and AF.

Infiltrating cardiac lipoma presenting as ventricular tachycardia in a young adult

Jayaprakash Shenthar , Rajani Sharma , Maneesh K. Rai , Prasanna Simha d a Professor of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore 560069, Karnataka, India b Fellow in Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore 560069, Karnataka, India c Fellow in Cardiac Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore 560069, Karnataka, India d Professor of Cardiac Surgery, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Jayanagar 9th Block, Bangalore 560069, Karnataka, India

PROLONGED TPEAK-END AND TPEAK-END/QT RATIO AS A PREDICTOR OF MALIGNANT VENTRICULAR ARRHYTHMIAS IN THE ACUTE PHASE OF ST ELEVATION MYOCARDIAL INFARCTION: A PROSPECTIVE CASE CONTROL STUDY

Prolonged Tpeak-end and the ratio of Tpeak-end / QT have been shown to be markers of arrhythmogenesis in various cardiac disorders. Literature regarding the utility of these two indices in acute STEMI is limited. The aim of this study was to evaluate the utility of Tpeak-end and the ratio of Tpeak-

Diagnostic dilemma with a narrow QRS regular rhythm at normal rates in a patient with corrected transposition of great arteries.

A 35 year old male, known case of corrected transposition of great arteries presented with exertional dyspnea and recurrent pre-syncope. 12 lead electrocardiogram revealed a regular rhythm at 75 beats per minute, P waves occurring on the upstroke of T waves and apparent 1:1 P-QRS relationship. The possibilities to be considered – complete AV block with junctional escape, junctional rhythm with 1:1 retrograde conduction, junctional rhythm with isorhythmic AV dissociation and prolonged PR interval have been discussed.

Preexcited Tachycardia Mimicking Outflow Tract Ventricular Tachycardia Ablated from the Left Coronary Cusp

Wide QRS tachycardia can pose a diagnostic dilemma, and a number of electrocardiographic criteria have been proposed to differentiate ventricular tachycardia (VT) from supraventricular tachycardia with aberrancy.1 Wide QRS tachycardia with left bundle branch block (LBBB) morphology, “r” in V1, early precordial transition, peaked R in the inferior leads is supposed to suggest VT arising from aortic cusp.2 We report a case of accessory pathway (AP) with decremental conduction properties from the left coronary cusp (LCC) that mimicked VT from the aortic cusp.

Riata lead failure presenting as a life-threatening electrical storm: A novel manifestation of electrical lead failure

The Riata and Riata ST family of implantable cardioverter‐defibrillator leads are prone to a unique type of structural failure involving exteriorization of the conductor cables, which may present as electrical failure. We report a mode of lead failure that occurred in a patient with a Riata 1570 series dual coil 8F lead. In this case, the first appropriate shock for ventricular fibrillation resulted in noise, that in turn led to recurrent inappropriate shocks and proarrhythmia, that clinically mimicked a life‐threatening electrical storm.

Permanent pacemaker implantation in a patient with situs solitus, dextrocardia, and corrected transposition of the great arteries using a novel angiographic technique

Complex congenital heart diseases involving abnormalities of the atrial situs and cardiac malpositions like dextrocardia can pose a considerable challenge to transvenous permanent pacemaker implantation (PPI). Literature describing transvenous PPI techniques in patients with complex cardiac anomalies is scarce. In this report, we describe a novel angiography‐guided technique for the implantation of a dual chamber transvenous pacemaker in a patient with complete heart block with situs solitus, dextrocardia, and congenitally corrected transposition of the great arteries.