Intermittent ventricular pacing during supraventricular tachycardia—Tachycardia within a tachycardia?

Supraventricular tachycardias (SVT) are not uncommon phenomena in patients implanted with permanent pacemakers for sinus node dysfunction, especially in the presence of intact atrioventricular conduction. The utility of bedside programming maneuvers and intracardiac electrograms from device interrogation, coupled with observation from telemetry during the tachycardia, makes a clinical diagnosis of the underlying arrhythmia possible even before a definitive electrophysiological study in the EP laboratory. The present case elucidates the usefulness of combining the triumvirate of non-invasive strategies to arrive at a clinical diagnosis and aid in the management of the SVT.     

Catecholaminergic polymorphic ventricular tachycardia and midventricular Takotsubo cardiomyopathy: a novel association?

Takotsubo cardiomyopathy (TTC) is a recently recognized clinical syndrome characterized by transient ventricular dysfunction in the absence of obstructive coronary artery disease. TTC primarily affects postmenopausal women; TTC in children and adolescents is only rarely reported. Furthermore, simultaneous occurrence of Takotsubo cardiomyopathy and primary electrical diseases has been previously reported in only four recent cases of female patients with congenital long QT syndrome. Here, we report the novel association of catecholaminergic polymorphic ventricular tachycardias and a midventricular type of TTC observed in a young female patient.     

When to initiate and discontinue biologic treatments for rheumatoid arthritis?

The introduction of biologic therapies heralded a new era in the treatment for chronic inflammatory autoimmune diseases of which rheumatoid arthritis is one of the most prevalent. From a scientific point of view, these therapies demonstrated that the targeting of individual cytokines or cell-surface markers is a very effective approach. For the physician, the appropriate selection of patients in whom these therapies should be initiated is critical, as is the even more contentious issue of whether these therapies can or should be discontinued in selected patients with excellent clinical responses. Whereas the former issue has been addressed in a large number of clinical trials and observational studies, the latter remains poorly investigated and is currently the subject of further study.     

When does a Pringle Maneuver cause harm?

BackgroundThe Pringle Maneuver (PM) is considered to be safe and effective. However, data regarding perioperative outcomes after a PM are conflicting. Therefore, the aim of this analysis is to compare the outcomes of patients who have and have not undergone a PM in North America.MethodsPatients undergoing major (≥3 segments) or partial hepatectomy (≤2 segments) were identified in the 2014–17 ACS-NSQIP hepatectomy database. Patients with and without a PM were compared. Propensity matching was utilized, and subgroup analyses by liver texture, hepatectomy extent and pathology were performed.ResultsPrior to matching, 3706 (24%) of 15,748 hepatectomy patients underwent a PM. The PM was utilized in 1445 (27%) of major and 2261 (22%) of partial hepatectomies. After matching, 3295 patients with and 3295 without a PM were compared. Operative time was significantly increased for patients undergoing a PM (246 vs. 225 min, p < 0.001). Subgroup analyses revealed post-hepatectomy liver failure and septic shock to be significantly increased (both p < 0.05) for patients undergoing a PM during a partial hepatectomy or in patients with metastatic disease.ConclusionPatients undergoing a partial hepatectomy and those with metastatic disease have worse outcomes when a Pringle Maneuver is performed.     

Interpolated premature ventricular contractions with postponed compensatory pauses: a misnomer?

Selected strips of a Holter recording obtained from a healthy young person with rare unifocal premature ventricular contractions (PVCs) were obtained. Occasionally, the PVCs were interpolated and showed the phenomenon originally named postponed compensatory pause by Langendorf [Am Heart J 1953;46:401]. But this is a misnomer because, by definition, interpolated PVCs do not have compensatory pauses. Thus, it follows that what does not exist cannot be postponed. In reality, the basic manifest feature is a prolongation of the first RR interval that follows the interpolated beat. However, in view of its use for more than half a century, it is probably best to continue using this terminology, but only as long as its underlying mechanism and fundamental manifestations are properly understood.     

Malignant ventricular tachycardia and cardiac arrest induced by a micra™ leadless pacemaker

Leadless pacemaker implantation represents an important advancement in the treatment of bradycardia, and occupy an increasing part in the clinic. Major adverse effects associated with leadless pacemaker implantation are rare, with a serious complication being pericardial effusion. We present a case of a patient who had a leadless pacemaker implanted, which induced ventricular tachycardia and cardiac arrest during hospitalization.     

Repetitive ventricular tachycardia in a syncopal child: Cause or incidental finding ?

A 15‐year‐old girl suffered recurrent syncopal episodes during 7 years. Events were precipitated by exercise or emotional stress, leading to the diagnosis of reflex syncope. Exercise testing induced recurrent salvos of nonsustained right ventricular outflow tract tachycardia. This arrhythmia is often asymptomatic, reflex syncope is very frequent and both causes are related to the same triggering situations. It was therefore essential to obtain recordings during syncopal events and to observe the clinical evolution under effective treatment in order to make the right diagnosis.