Mariana Floria

Predictive Value of Thromboembolic Risk Scores Before an Atrial Fibrillation Ablation Procedure

Risk Scores for Atrial Fibrillation Ablation Introduction: It is not clear whether transesophageal echocardiography (TEE) should be performed prior to a planned atrial fibrillation (AF) ablation in all patients.

Early repolarization syndrome: electrocardiographic signs and clinical implications.

Early repolarization syndrome (ERS) was previously considered as a benign variant, but it has recently emerged as a risk marker for idiopathic ventricular fibrillation (VF) and sudden death. As measured by electrocardiogram (ECG), early repolarization is characterized by an elevation of the J point and/or ST segment from the baseline by at least 0.1 mV in at least two adjoining leads. In particular, early repolarization detected by inferior ECG leads was found to be associated with idiopathic VF and has been termed as ERS. This condition is mainly observed in young men, athletes, and blacks. Also, it has become evident that electrocardiographic territory, degree of J‐point elevation, and ST‐segment morphology are associated with different levels of risk for subsequent ventricular arrhythmia. However, it is unclear whether J waves are more strongly associated with a depolarization abnormality rather than a repolarization abnormality. Several clinical entities can cause ST‐segment elevation. Therefore, clinical and ECG data are essential for differential diagnosis. At present, the data set is insufficient to allow risk stratification in asymptomatic individuals. ERS, idiopathic VF, and Brugada syndrome (known as J‐wave syndromes) are three clinical conditions that share many common ECG features; however, their clinical consequences are remarkably different. This review summarizes the current electrocardiographic data concerning ERS with clinical implications.

Abnormal Atrioventricular Node Conduction and Atrioventricular Nodal Reentrant Tachycardia in Patients Older Versus Younger Than 65 Years of Age

Study Objective: We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age.

Coronary sinus thrombus without spontaneous contrast.

A 76-year-old man with chest pain and transient aggravation of chronic dyspnea was admitted through the emergency room. He had a medical history of chronic cor pulmonale due to pulmonary fibrosis. His ECG showed atrial fibrillation with fast ventricular rate, extreme right axis deviation and a rS pattern in all precordial leads (Fig. 1a); in a previous ECG the patient has had left bundle branch block. He was under chronic oral anticoagulation with acenocumarol, outside therapeutically range. Due to the high suspicion of pulmonary thromboembolism, a CTscan chest was performed. No thrombus in the pulmonary artery circulation was detected. However, the cross section of the coronary venous sinus (CS) showed its dilatation and an irregular mass (arrow) of about 8.3 mm inside the CS, most likely a thrombus (Fig. 1b, Supplementary movie 1). Transthoracic echocardiography revealed dilated right ventricular cavities and a pulmonary artery systolic pressure of 75–80 mmHg. Parasternal long axis views confirmed a visible thrombus (arrow) in a dilated CS (Fig. 1c, Supplementary movie 2), without spontaneous contrast in cardiac cavities. No coronary sinus lead or other invasive cardiac procedures were performed in this patient. After a few days of intravenous heparin, a novel oral anticoagulant was initiated. After 24 h the patient’s symptoms improved and in 7 days the CS thrombus image disappeared on transthoracic echocardiography. A more attentive examination on transthoracic echocardiography is mandatory in case of acute dyspnea in patients with dilated CS, even in the absence of spontaneous contrast.

Atrial fibrillation and gastroesophageal reflux disease: From the cardiologist perspective

We have read with interest the paper by Roman C. and colleagues discussing the relationship between gastroesophageal reflux disease and atrial fibrillation. The review is presenting the available evidence for the common pathogenic mechanisms. However, from a cardiologist perspective, some available data were not highlighted in the review, cardiovascular involvement in gastroesophageal reflux is less assessed. Hypertension, obesity or diabetes mellitus are substrate for left atrial remodeling that initiate and sustained atrial fibrillation development. One of the pathophysiologic mechanisms in atrial fibrillation is the presence of a trigger. Gastroesophageal reflux could be only a trigger for this arrhythmia. We believe that atrial fibrillation should be considered as possible extraesophageal syndrome in the gastroesophageal reflux classification.

Complication due to entrapment in the Chiari apparatus

A 58-year-old man was scheduled for typical atrial flutter ablation. During placement of the duodecapolar catheter, its tip was entrapped near …

Stroke and an unexplained dyspnea in an elderly patient: Platypnea-orthodeoxia syndrome

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A rare primary cardiac tumour : cavernous hemangioma of the tricuspid valve.

Tricuspid valve cavernous hemangioma is a rare and also an unusual primary benign tumour developed from endocardium, as cardiac valves are predominantly avascular structures; the incidence is <3% of all detected primary heart tumours. We describe a 52-year-old woman who presented with palpitations and atypical left chest pain. On admission, physical examination revealed normal heart sounds and no abnormal murmurs. Exercise test and 24-h Holter monitoring were non-concluding. Transthoracic echocardiography, including …

Variable morphologies of preexcitation due to a concomitant Brugada pattern

Since the first publication of the Brugada syndrome in 1992 several variants of this ECG pattern have been described. We report a very unusual case of preexcitation with changing electrocardiographic morphologies which appeared to be an association of a variable Brugada pattern with a persistent antegrade preexcitation.

Integrity of the Ganglionated Plexi is Essential to Parasympathetic Innervation of the Atrioventricular Node by the Right Vagus Nervez

Radiofrequency isolation of pulmonary vein can be accompanied by transient sinus bradycardia or atrioventricular nodal (AVN) block, suggesting an influence on vagal cardiac innervation. However, the importance of the atrial fat pads in relation with the vagal innervation of AVN in humans remains largely unknown. The aim of this study was to evaluate the role of ganglionated plexi (GP) in the innervation of the AVN by the right vagus nerve.