Heart rhythm : the official journal of the Heart Rhythm Society
-
Case Reports
Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome.
The occurrence of metabolic acidosis, rhabdomyolysis, hyperkalemia, and sudden cardiac death after long-term, high-dose propofol infusion has been referred to as propofol infusion syndrome (PRIS). ⋯ Our findings indicate that development of an acquired Brugada-like ECG pattern in severely head-injured patients is a sign of cardiac electrical instability that predicts imminent cardiac death. Future studies will determine whether such an ECG pattern also predicts imminent cardiac arrhythmia in other patient populations.
-
Comparative Study
Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy.
Atrioventricular (AV) delay optimization can be an important determinant of the response to cardiac resynchronization therapy (CRT) in patients with medically refractory heart failure and a ventricular conduction delay. ⋯ AV delay optimization by Doppler echocardiography for patients with severe heart failure treated with a CRT device yields a greater systolic improvement when guided by the aortic VTI method compared with the mitral inflow method.
-
Comparative Study
Comparison of mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia.
Mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia (VT) have been evaluated in only small series of patients. ⋯ At sites with concealed entrainment, matching stimulus-QRS and electrogram-QRS intervals were superior to other criteria in differentiating a critical isthmus from bystander or noncritical sites in postinfarction VT.
-
Comparative Study
High-frequency jet ventilation: utility in posterior left atrial catheter ablation.
Percutaneous catheter ablation in the posterior left atrium (LA) is a technically demanding procedure that in our experience is best accomplished using general anesthesia, including endotracheal intubation and mechanical ventilation. However, using conventional intermittent positive-pressure ventilation (IPPV) technique, we were dissatisfied with motion of the posterior LA. This occurred during changes in lung volume, which destabilized ablation electrode-endocardial contact. We hypothesized that use of high-frequency jet ventilation (HFJV), a low-volume, fast-rate technique, would reduce posterior LA motion and thus facilitate the ablation procedure. ⋯ Relative to IPPV, HFJV yields a more stable posterior LA environment, thus facilitating catheter ablation. Use of HFJV may be applicable to other interventional cardiovascular procedures.