Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Mar 2013
Case ReportsCardiac resynchronization therapy: double cannulation approach to coronary venous lead placement via a prominent thebesian valve.
We report identification of a prominent Thebesian valve by cardiovascular computed tomography (CT) angiography impeding cannulation of the coronary sinus, with subsequent successful coronary venous lead placement with cannulation of the coronary sinus ostium via a transvenous femoral vein approach and subsequent cannulation of the ostium with the coronary venous lead with a left subclavian approach. A 57-year-old man with nonischemic dilated cardiomyopathy, New York Heart Association Class III heart failure, left bundle branch block, and an ejection fraction of 15%, underwent an attempted cardiac resynchronization therapy implantable cardiac defibrillator (ICD). ⋯ Reattempted transvenous cardiac resynchronization therapy was accomplished successfully with a double cannulation approach: cannulation of the coronary sinus ostium with a catheter via a transvenous femoral vein approach and subsequent cannulation with the coronary venous lead via a left subclavian approach. When a prominent Thebesian valve is identified as an obstacle to transvenous left ventricular lead placement, cannulation of the coronary sinus by an alternate venous approach may allow for a coronary venous route rather than necessitate an epicardial approach.
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Pacing Clin Electrophysiol · Mar 2013
Case ReportsA life-threatening flecainide overdose treated with intravenous fat emulsion.
Flecainide is a Vaughan Williams Class Ic antidysrhythmic associated with PR, QRS, and QTc prolongation on the electrocardiogram and development of life-threatening cardiac toxicity in overdose. The cornerstone of treatment is fluid resuscitation and the administration of magnesium and sodium bicarbonate. We report a case of flecainide overdose associated with life-threatening hemodynamic compromise successfully treated with intravenous fat emulsion (IFE) therapy. IFE should be considered as a novel adjunctive therapy in patients with life-threatening toxicity following flecainide overdose.
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Pacing Clin Electrophysiol · Mar 2013
Comparative StudyUse of a noninvasive continuous monitoring device in the management of atrial fibrillation: a pilot study.
Outpatient ambulatory cardiac rhythm monitoring is a routine part of the management of patients with paroxysmal atrial fibrillation (AF). Current systems are limited by patient convenience and practicality. ⋯ The Zio(®) Patch was well tolerated, and allowed significantly longer continuous monitoring than a Holter, resulting in an improvement in clinical accuracy, the detection of potentially malignant arrhythmias, and a meaningful change in clinical management. Further studies are necessary to examine the long-term impact of the use of the Zio(®) Patch in AF management.