S. Kirubakaran

Trends, indications and outcomes of cardiac implantable device system extraction: a single UK centre experience over the last decade

Background:  The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade.

Male gender and chronic obstructive pulmonary disease predict a poor clinical response in patients undergoing cardiac resynchronisation therapy

Aims:  Current guidelines advocate cardiac resynchronisation therapy (CRT) in patients with class III/IV New York Heart Association (NYHA) heart failure, depressed left ventricular function and a broad QRS. However, a significant proportion of patients do not derive any benefit from CRT. The aim of this study was to identify clinical, electrocardiographic and echocardiographic predictors of response to CRT.

Lower incidence of inappropriate shock therapy in patients with combined cardiac resynchronisation therapy defibrillators (CRT‐D) compared with patients with non‐CRT defibrillators (ICDs)

Introduction:  A significant number of patients experience inappropriate shock therapy (IST) from implantable cardioverter‐defibrillators (ICD). An increasing number of patients with advanced heart failure receive combined ICD and cardiac resynchronisation therapy devices (CRT‐D). The incidence of IST in this group is less well described. We aimed to assess the incidence and predictors of IST in CRT‐D patients.

Acute myocardial infarction due to a coronary embolus during left atrial ablation for persistent atrial fibrillation

Catheter ablation is increasingly used to treat symptomatic patients with atrial fibrillation (AF). We report a rare case of embolization to the left anterior descending artery, which was successfully treated by thrombectomy. A 49-year-old man underwent ablation for persistent AF. Transoesophageal echocardiography did …

Giant sinus of Valsalva aneurysm: the role of multimodality imaging

An 82-year-old man presented with severe exertional breathlessness to the outpatient clinic. Previous medical history included hypertension and transient ischaemic attack. During routine workup, transthoracic echocardiography was performed. A large defect (*) in the anterior wall of the aortic sinus of Valsalva was identified (figure 1A) which extended into a cavity containing spontaneous echo-contrast (see online supplementary data video S1). Further imaging by CT with three-dimensional reconstruction (figure 1B,C) and cardiac magnetic …

Trends, indications and outcomes of cardiac implantable device system extraction: a single UK centre experience over the last decade: Lead extraction

Background:  The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade.

Trends, indications and outcomes of cardiac implantable device system extraction

Background:  The rising number of device implantation has seen a parallel in the rising numbers of lead extraction. Herein we have analysed our experience in cardiac device and lead extraction in a single tertiary centre over the last decade.

Inadvertent identification of the left pericardiophrenic vein following laser lead extraction to guide left ventricular lead placement

Phrenic nerve stimulation (PNS) is a frequent occurrence in patients implanted with a cardiac resynchronization therapy device. We present a case where identification of the left pericardiophrenic vein, which runs alongside the phrenic nerve, was used to guide left ventricular lead placement in order to minimize the risk of PNS.

The importance of an ECG: back to basics

A 48-year-old man presented to accident and emergency with syncope on a background history of 3 weeks of increasing shortness of breath. He collapsed at home prompting admission. He was a smoker with a 30-pack-year history. On examination, he was found to be tachypnoeic and hypoxic, with a raised JVP and quiet heard sounds. He was haemodynamically stable and a chest x-ray showed right upper-lobe collapse. His resting ECG demonstrated electrical alternans prompting urgent referral to the cardiologist for echocardiography. This revealed a large pericardial effusion with evidence of right ventricular diastolic collapse. In view of this, he underwent urgent pericardiocentesis. A subsequent CT scan showed bilateral pleural effusions and multiple lung nodules. Both pericardial and pleural fluid cytology were reported as metastatic non-small cell adenocarcinoma. The pericardial fluid continued to reaccumulate requiring a pericardial window. He was referred to the oncology team for palliative chemotherapy.