1/46. Transthoracic pacing in a very low birth weight infant with congenital complete atrioventricular block.We report our experience of pacemaker treatment in a premature infant of 830 g with congenital complete atrioventricular block due to maternal sjogren's syndrome. The infant was delivered by cesarean section at an estimated gestational age of 26 weeks because of fetal bradycardia, decreasing fetal movements, and hydrops. Immediate postnatal transesophageal ventricular pacing was not successful, whereas transthoracic pacing with self-adhesive patch electrodes adapted to body size resulted in an effective increase of the infant's heart rate until operative application of temporary epimyocardial pacing wires allowed external stimulation of the heart.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/46. A case of fetal complete heart block recorded by magnetocardiography, ultrasonography and direct fetal electrocardiography.Fetal magnetocardiograms (FMCGs) were recorded in a case of fetal complete heart block (CHB) from the 30th to the 37th week of gestation using the multichannel SQUID system (Hitachi, japan). M-mode ultrasonography and direct fetal electrocardiography using needle electrodes revealed fetal CHB. We identified independent fetal P-waves and QRS complexes in the FMCG recorded in the 32nd week of gestation when the fetal atriums were close to the FMCG sensor. We also recorded FMCG P-waves in the 37th week of gestation when the fetal heart was larger. fetal heart position and size are important for obtaining a useful FMCG. To establish FMCG as a diagnostic tool of fetal arrhythmia, comparative studies with FECG are needed.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/46. Electroanatomic substrate of idiopathic left ventricular tachycardia: unidirectional block and macroreentry within the purkinje network.BACKGROUND: An abnormal potential (retroPP) from the left posterior Purkinje network has been demonstrated during sinus rhythm (SR) in some patients with idiopathic left ventricular tachycardia (ILVT). We hypothesized that this potential can specifically be identified and be a critical substrate for ILVT. methods AND RESULTS: In 9 patients with ILVT and 6 control patients who underwent mapping of the left ventricle during SR using 3-dimensional electroanatomic mapping, an area with retroPP was found within the posterior Purkinje fiber network only in patients with ILVT. The earliest and latest retroPP was 185.4 /-57.4 and 465.2 /-37.3 ms after Purkinje potential; in the other patient with ILVT, an entire left ventricle mapping demonstrated a slow conduction area and passive retrograde activation along the posterior fascicle during ILVT. ILVT was noninducible in 3 patients after SR mapping. Diastolic potentials critical for ILVT during ILVT coincided with the earliest retroPP during SR in 7 patients. Mechanical termination of ILVT occurred in 5 patients. A single radiofrequency pulse was applied at the site with mechanical translation in 5 patients and the site with diastolic potential in 2 patients, and 3 radiofrequency pulses were delivered to the site with the earliest retroPP in the other 3 patients without inducible ILVT after SR mapping. No ILVT was inducible during control stimulation, and none recurred during follow-up of 9.1 /-5.1 months. CONCLUSION: In patients with ILVT, abnormal retroPP within the posterior Purkinje fiber network is a common finding. The earliest retroPP critical for ILVT substrate can be used for guiding successful ablation.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/46. Intraventricular dissociation due to complete intraventricular block.Intraventricular dissociation due to intraventricular block occurred in a patient with cardiac arrest due to massive cerebral hemorrhage. The electrocardiogram showed complete atrioventricular block with three different types of accelerated ventricular rhythm. The ectopic beats did not interfere with each other because of the existence of an area of complete block surrounding the areas in which impulse formation occurred. Hence, the corresponding QRS complexes did not result from depolarization of all the ventricular muscle mass but only of certain regions. The latter were large enough to produce ventricular complexes of enough size to be recorded at the body surface. This phenomenon is the clinical counterpart of the multiple isolated focal contractions which may be seen directly in the ventricules of dying hearts.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/46. Wenckebach phenomenon occurring in the distal conducting system in a young adult.This report describes the case of a young man who presented with right bundle-branch block and second degree atrioventricular block; intermittent episodes of Wenckebach periods were recorded. His bundle electrograms demonstrated progressive prolongation of the HV interval followed by block occurring distal to His. This report emphasizes the fact that the Wenckebach phenomenon as a manifestation of the distal conducting system disease can occur in young adults. The observations lend credence to the concept that Lenegre's disease can occur in young people.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/46. Sudden death associated with aortitis and fibrosclerosing disease of the conduction system.aortitis is known to complicate a number of autoimmune diseases and syphilis. In most patients with autoimmune disease, arthritis is the initial presentation followed by aortic insufficiency. We report two cases of ostensibly healthy, middle-aged men in whom the initial manifestation of aortitis was sudden death. In each patient, there was extension of inflammation from the aorta into the atrioventricular node. These cases emphasize the importance of examining the conducting system in cases of sudden death associated with aortitis and no grossly evident cause of death. To our knowledge, this is the first report of aortitis presenting as sudden death.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/46. Permanent pacemaker implantation in premature infants less than 2,000 grams of body weight.Pacemaker implantation in premature infants presents technical problems because of the relatively larger size of the pulse generator compared with their bodies. A new technique with which successful generator implantation was performed in 2 premature infants less than 2,000 g of body weight is described. The generator is wrapped in a Gore-Tex surgical membrane. A piece of membrane overlying the electrical contact surface of the generator is removed, and the generator is fixed to the abdominal wall in the peritoneal cavity. The technique is simple to perform and would give relative ease in generator exchange.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/46. Complete heart block in the pediatric patient.Care for the pediatric patient with CHB focuses on signs and symptoms associated with respiratory failure and shock. Differences in size among pediatric patients--and in anatomy, physiology, and possible causes--should be considered. In children, cardiac arrest is usually secondary to respiratory arrest. Respiratory arrest should be anticipated in a pediatric patient with (1) decreased level of consciousness, (2) poor muscle tone, (3) increased respiratory rate or respiratory effort (nasal flaring, intercostal, subcostal, and suprasternal retractions); or (4) cyanosis. shock is the failure of the cardiovascular system to perfuse vital organs adequately. Organ perfusion is determined by cardiac output, which in turn results from the heart rate times stroke volume. In CHB the slowing of heart rate can significantly decrease cardiac output, so the signs and symptoms of shock--especially level of consciousness, peripheral circulation, and blood pressure--must continually be reassessed.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/46. Spontaneous coronary artery dissection in a patient with systemic lupus erythematosis.Spontaneous coronary artery dissection (SCAD) is an uncommon condition that may lead to sudden coronary artery occlusion resulting in a fatal acute myocardial infarction. It usually affects young to middle age women. A medline search from 1966 to 2001 (using keywords: coronary artery dissection and systemic lupus erythematosis) revealed no prior reports of coronary dissection in a patient with systemic lupus erythematosis (SLE). We describe a 48-year old woman with SLE who sustained a fatal spontaneous left main coronary artery dissection. Coronary angiogram was notable for marked variability in the size of coronary lumen from systole to diastole. This case demonstrates the need to consider SCAD in the evaluation of chest pain and myocardial infarction in patients with SLE. Furthermore, in the absence of classical angiographic findings of coronary dissection, a detailed review of phasic changes in coronary lumen during a cardiac cycle could help reach this diagnosis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/46. Congenital complete heart block: fetal management protocol, review of the literature, and report of the smallest successful pacemaker implantation.Fetuses with complete heart block have an increased mortality with most deaths occurring in utero or during infancy. The cardiac evaluation of these fetuses is difficult since the ventricular rate is low and the heart is dilated. We have implemented a strategy that includes the biophysical profile, which assesses fetal well-being, in combination with the cardiovascular profile that assesses cardiac function and the circulation. We present two cases of fetal complete heart block in which early delivery was recommended due to worsening cardiovascular profile scores. Biophysical profile scores were normal. Both babies were successfully treated, despite having risk factors that predicted poor outcomes. We hypothesize that our management protocol initiated intervention before fetal compromise, hydrops, and myocardial damage occurred. We recommend an evaluation of heart function in addition to an assessment of fetal well-being in fetuses with complete heart block. Early delivery should be considered if there is evidence of distress and/or deteriorating cardiac function.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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