Acute exanthem and pancreatic panniculitis in a patient with primary HIV infection and haemophagocytic syndrome

Summary We report a patient with an acute infection with the human immunodeficiency virus (HIV), who initially presented due to a mononucleosis-like illness that included a rash on the upper trunk and limbs, and oral ulceration. The patient developed a Hemophagocytic syndrome with severe systemic involvement. Three weeks after the initial presentation, lesions of a pancreatic panniculitis appeared on both legs.     

Transient ST Elevation After Ketamine Intoxication: A New Cause of Acquired Brugada ECG Pattern

Brugada Syndrome and Ketamine Overdose. A 31‐year‐old man was referred for ketamine overdose. He presented initially with transient major Brugada ECG pattern. Complete investigation led to the diagnosis of slowly resolvent toxic myocarditis. Brugada‐like ECG was suspected to be caused by the ketamine intoxication in this case. (J Cardiovasc Electrophysiol, Vol. 22, pp. 91‐94, January 2011)     

Detection of Bm86 antigen in different strains of Boophilus microplus and effectiveness of immunization with recombinant Bm86

The control of tick populations by using conventional strategies poses several problems, including the appearance of organophosphate resistant strains, among others. The possibility of using alternative strategies such as vaccination with tick antigens has been suggested by several authors. One particular antigen (Bm86) has been described and shown to be able to induce a protective immunity against the cattle tick Boophilus microplus. In this paper we demonstrate by means of immunohistochemical staining that this antigen is conserved among several strains of this species. These results correlate with those showing that animals vaccinated with a preparation of recombinant Bm86 were protected against challenge with the four different strains tested, including one resistant to organophosphates. These results favour the immunization with recombinant Bm86 for the control of the cattle tick B. microplus.     

Influence of Filtering Techniques on the Time-Domain Analysis of Signal-Averaged P Wave Electrocardiogram

Differences in P Wave Filtering Techniques. introduction : The advent of signal-averaged ECG (SAECG) systems for P wave analysis has made it important to determine if the use of different filtering techniques in these systems is diagnostically equivalent.
Methods and Results : Three different high-pass filtering techniques and two cutoff frequency values were used: 29- and 40-Hz Butterworth bidirectional filter (BB29, BB40), 29-and 40-Hz Butterworth unidirectional filter (UB29, UB40), and 29- and 40-Hz least mean square filter (LIV1S29, LMS40). Normal healthy volunteers (n = 36) and patients with documented paroxysmal atrial fibrillation (n = 23) were analyzed. A custom-built SAECG system and standard bipolar orthogonal leads were used. Noise was reduced to < 0.3 μV. P wave total duration, root mean square voltage of the terminal 20, 30, and 40 msec of the filtered vector magnitude, and the area under the curve between the onset and offset of averaged unfiltered and filtered P wave vector magnitude were analyzed. Only the duration of the P wave showed statistically significant differences between groups, being longer in the PAF group for all filters and cutoff frequencies studied. A bias increment of -20 msec was detected in unidirectional and least mean square filters as compared to the bidirectional filter. Sensitivity, specificity, and predictive accuracy were > 70% for all filters; the BB40 filter yielded the best performance.
Conclusion : The normality limits derived from one filter cannot be applied directly to recordings obtained from the other filters. Critical limits must be established individually for different software settings.     

Electrocardiographic Identification of Mid-Septal Accessory Pathways in Close Proximity to the Atrioventricular Conduction System

In order to identify ECG characteristics of overt midseptal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid-septal AP, Mean patient age was 31 ± 16 years, and 13 were male. The 40° right anterior oblique view was used to divide the mid-septal area into 3 zones: 1 (anteriorportion); 2 (intermediate); and 3 (posterior portion). The 12-lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V₂ in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid-septal AP in close proximity to the AV conduction system.     

Catheter Ablation of Ventricular Tachycardia Occurring Late After Myocardial Infarction: A Point-of-View

A Point-of-View. Venfricular tachycardia can be cuntwUed by radiofrequency or chemical ablation of the site of origin of the arrhythmia. However, these techniques are far from being accepted as routine treatment for this problem. This article describes the theoretical and practical background of catheter ablation of ventricuiar tachycardia occurring late after myocardial infarction.     

The Rationale for Prophylactic Implantation of a Defibrillator in "High Risk" Patients

The increasing technological developments have made it possible to have implantable defibrillators with a wide range of diagnostic and therapeutic capabilities, which can be implanted without the need for a thoracotomy. It is not surprising, therefore, that the indications for implantation of a defibrillator have rapidly evolved. Defining populations of patients in whom a true "prophylactic" implantation (before the first episode of ventricular tachycardia or ventricular fibrillation) may be justified is still difficult. However, the time has certainly come to provide a cardioverter defibrillator to all patients who have suffered from one episode of ventricular tachycardia or ventricular fibrillation and who are at real risk of sudden arrhythmic death. Identification of these patients is relatively easy. It can be done using simple variables from the clinical history. Results from an ongoing multicenter trial testing the hypothesis that clinical variables can indeed be used to stratify the risk of sudden death and to select candidates for a defibrillator have proven the validity of this approach. There is no medical justification to withhold implantation of a cardioverter defibrillator in the truly "high risk" patient. One has to realize, however, that the concept of "high risk" is relative, and that the indications for the implantable defibrillator will continue to broaden.     

Pseudo-atrial dissociation: a respiratory artifact

Atrial dissociation is an electrocardiographic phenomenon characterizedby the occurrence of two separate atrial rhythms. A patientis presented, showing electrocardiographic signs suggestivefor atrial dissociation. The dissociated, non-conducted, atrialrhythm showing micro-oscillations after its P wave, is shownto be a respiratory artifact. It is concluded that the micro-oscillationsseen on the surface electrocardiogram after a dissociated Pwave are probably diagnostic for pseudo-atrial dissociation.     

The Impact of New and Emerging Clinical Data on Treatment Strategies for Atrial Fibrillation

AF Treatment Strategies . Introduction: The Atrial Fibrillation (AF) Exchange Group, an international multidisciplinary group concerned with the management of AF, was convened to review recent advances in the field and the potential impact on treatment strategies. Methods: Issues discussed included epidemiology and the impact of the rising incidence of AF on health care systems, developments in pharmacological and surgical interventions in the management of arrhythmias and thromboprophylaxis, the potential to affect treatment strategies, and barriers to implementing them. Results: The incidence of AF and the associated burden on health care systems are increasing with aging populations, prevalence of comorbidities and more effective treatment of cardiovascular diseases. Advances in available medical treatments, in particular dronedarone and dabigatran, with other products in development, offer the possibility of changes in treatment paradigms and a greater emphasis on reducing hospitalizations and improvement in long‐term outcomes instead of a symptom/safety‐driven approach in which the priority is symptom suppression without provoking drug toxicity. Developments in catheter ablation techniques may mean that, in experienced centers, ablation may be offered as first‐line treatment in selected patient populations. Barriers to optimal treatment include underdiagnosis, lack of recognition as a serious condition and as a risk factor for stroke, limited access to care, inadequate implementation of guidelines, and poor adherence to treatment. Conclusions: The focus of the management of AF may be changing as a consequence of new treatments based on the outcome improvements they offer. However, the benefits will not be fully realized if guidelines and guidance are not observed in routine clinical practice. (J Cardiovasc Electrophysiol, Vol. 21, pp. 946‐958, August 2010)