Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Mar 2011
Case ReportsProarrhythmic ECG deterioration caused by myocardial ischemia of the conus branch artery in patients with a Brugada ECG pattern.
The Brugada-type electrocardiogram (ECG) is characterized by ST-segment elevation in the right precordial ECG leads and has been reported to have the potential of sudden death. Right ventricular outflow tract supplied from the conus branch of the coronary artery (CB) is considered as the anatomopathologic substrate of Brugada syndrome. We experienced two asymptomatic patients with a saddleback Brugada-type ECG who exhibited a dynamic ECG conversion to a coved type following a ventricular fibrillation/ventricular tachycardia (VT/VF) episode when myocardial ischemia occurred exclusively at the CB. Some types of Brugada syndrome might be caused VT/VF by selective myocardial ischemia at the CB.
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Pacing Clin Electrophysiol · Mar 2011
Case ReportsIntercommissural lead placement into a right ventricular coronary sinus--utility of intracardiac echo guidance.
Patients with congenital heart disease and prosthetic valves frequently present management dilemmas related to cardiac pacing and lead placement. Permanent pacing of the right ventricle across a bioprosthetic tricuspid valve presents discreet issues related to its potential for traumatic injury and subsequent prosthetic valve dysfunction. ⋯ We report an unusual case in which the CS ostium was located ventricular to the tricuspid prosthesis. Intracardiac echocardiography was used to position a CS lead between the commissures of the tricuspid prosthesis resulting in trivial regurgitation acutely and at 1-year follow-up.