Brugada electrocardiographic pattern induced during febrile state with marked leukocytosis

Several agents and conditions have been reported to unmask or accentuate the electrocardiographic pattern of Brugada syndrome including fever. At a molecular level, sodium channels have been showed to be temperature dependent. Herein, we describe a case of Brugada electrocardiographic pattern unmasked during febrile state and marked leukocytosis.     

Catheter ablation of atrial fibrillation in the elderly

Background Atrial fibrillation （AF） catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly popula-tion. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were≥65 years （48 males, mean age 68.9 ± 3.0 years old） and 221 patients were〈65 years old （130 males, mean age 52.5 ± 10.4 years old）. After a mean follow-up period of 34.0 ± 15.1 months, 55 （57.9%） patients in the elderly group were free from ar-rhythmia recurrence compared with 149 （67.4%） patients in the younger group （P=0.169）. Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter （P=0.003）, hypertension （P=0.001）, dyslipidemia （P=0.039）, and coronary artery disease （P=0.018） were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF.     

Segmental wall motion abnormalities alter vulnerability to ventricular ectopic beats associated with acute increases in aortic pressure in patients with underlying coronary artery disease

Objective—To evaluate whether patients with coronary artery disease are susceptible to pressure related ventricular arrhythmias, and if so to identify possible risk factors.
Design—Interventional study.
Methods—Metaraminol was given to 43 patients undergoing coronary arteriography for ischaemic heart disease to increase their aortic pressure, provided their systolic blood pressure was < 160 mm Hg and they were in sinus rhythm, without any ventricular ectopic activity (or with fewer than six ventricular ectopic beats a minute) during a five minute control period.
Results—During the metaraminol infusion, systolic aortic pressure rose from 131 (15) to 199 (12) mm Hg (mean (SD)). Ventricular ectopy appeared (or ventricular ectopic beats increased by > 100%) in 13/43 patients. Ventricular ectopy was not related to age, sex, presence of hypertension, history of myocardial infarction, use of β blockers, positive exercise test, number of vessels diseased, or heart rate change during metaraminol infusion. There was a strong relation between the appearance of ventricular arrhythmia and segmental wall motion abnormalities: 1/19 (5.3%, 95% confidence interval 0.1% to 26.0%) without abnormality; 2/12 (16.7%, 2.1% to 48.4%) with hypokinesia; and 10/12 (83.3%, 51.6% to 97.1%) with akinesia or dyskinesia, χ² = 22.7, p < 0.001). Ejection fraction was also a significant but not independent risk factor.
Conclusions—Patients with segmental wall motion abnormalities are predisposed to ventricular ectopic beats during an increase in systolic aortic pressure. This could be explained by associated electrophysiological inhomogeneity. The presence of mechanical inhomogeneity, as may occur in postinfarction akinesia or dyskinesia, may affect the aortic pressure above which ventricular arrhythmias appear.

Keywords: mechanoelectrical feedback;  segmental wall motion;  akinesia;  dyskinesia;  ventricular ectopic beats;  arrhythmias     

Amniotic fluid pressure during pregnancy

Intrauterine pressure was measured, at the time of diagnostic amniocentesis or cordocentesis, in 200 pregnancies at 10-38 weeks' gestation. Mean pressure decreased exponentially with gestation from 9 mm Hg at 10 weeks reaching a plateau of 5 mm Hg at 30 weeks. These findings are compatible with Laplace's law of pressure in spheroids.     

For debate . . . Individual contributions to multiauthor papers

The curricula vitae of four candidates for a professorial appointment at Athens University were examined to estimate the actual contribution of each candidate to the papers of which he was a coauthor. A total of 879 research papers by the four candidates were analysed in terms of the number of authors, the sequence of names, and the year of publication. The four authors presented 364, 349, 96, and 70 papers. If an equal contribution of all coauthors is assumed, the actual number of papers (all papers divided by the number of authors), is about 106, 83, 28, and 26, respectively, so that the rank of the four candidates did not change. On the assumption that the contribution was related to the candidate's position in the order of the coauthors' names, the numbers of papers were corrected to 84, 95, 26, 33 using one statistical method and to 88, 94, 28, 31 using another. These assumptions may not be valid, however, especially as the last author may be more important than the intermediate ones. It is suggested that the journals require authors to state their specific contribution to a paper, such as original idea, planning, collecting data, writing up, etc.     

Direct current shock and antidysrhythmic drugs

A review is given of 457 episodes of atrial fibrillation that occurred in 318 patients and were treated by DC shock. Antidysrhythmic drugs, such as quinidine, procainamide, and propranolol, given singly or in combination, were used concomitantly in 389 instances, and DC shock alone was given in 68 instances. The combined effects of quinidine and DC shock, and of procainamide and DC shock were studied in the experimental animal.