Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy and is also called ARVD/C. In most cases, ARVD is inherited in an autosomal-dominant pattern and clinically is characterized by ventricular arrhythmias with an increased risk of sudden death. Although it is prominently a disease of the right ventricle (RV), involvement ...

We present an autopsy case of a male baby born at 35 weeks of gestation with pulmonary atresia with intact ventricular septum (PAIVS), who had coronary blood flow that was dependent on outflow from the right ventricle through the vessels described by Wearn. At 7 weeks of age, he underwent ...

The subject was a 70 year-old man who survived for 31 years after being diagnosed with right ventricular cardiomyopathy, having undergone right ventricular (RV) aneurysmectomy at the age of 39. His arrhythmia and syncopal attacks were effectively abolished after the original aneurysmectomy. Although he frequently suffered from right heart failure, ...

We study the formation of the mitral vortex ring during early diastolic filling in a patient-specific left ventricle using direct numerical simulation. The geometry of the left ventricle is reconstructed from Magnetic Resonance Imaging (MRI). The heart wall motion is modeled by a cell-based activation methodology, which yields physiologic kinematics ...

Fibromuscular dysplasia (FMD) is a segmental non-atherosclerotic, non-inflammatory vasculopathy typically of small-medium muscular arteries. Coronary FMD (CFMD) is believed to be rare. However, we have found an association between spontaneous coronary artery dissection (SCAD) and FMD as the cause of myocardial infarction in ∼25% of young women age <50. It ...

We describe a case of a 64-year-old man with constrictive pericarditis of unusual anatomy. Preoperative investigations revealed the thickened and calcified pericardial ring encircling the right and left ventricular cavity at the level of the atrioventricular (AV) groove and crossing the left anterior descending coronary artery, leading to strangulation of ...

A 31-year-old male was diagnosed with congestive heart failure due to left ventricular noncompaction and coarctation of the aorta by echocardiography and computed tomography. He also developed mitral valve prolapse of the posteromedial commissural leaflet due to rupture of chordae tendineae. Segmental leaflet resection was performed with ring annuloplasty. Aorto-bifemoral ...

Ischaemic mitral regurgitation after myocardial infarction results from geometric changes in left ventricular shape and displacement of papillary muscles with resultant tethering and incomplete leaflet coaptation of mitral leaflets. Post mitral valve repair, both valve apparatus related factors such as persistent leaflet tethering and progressive left ventricular adverse remodelling and ...

Ischemic mitral regurgitation (IMR) often persists, despite annular ring reduction. It has been hypothesized that persistent IMR following ring annuloplasty was related to a continued tethering of the mitral leaflets, as defined by the distance by which the papillary muscles (PMs) were displaced outside the mitral annular ring. Seven sheep ...

OBJECTIVE: The MiCardia DYANA annuloplasty system (MiCardia Corp, Irvine, Calif) is a nitinol-based dynamic complete ring that allows modification of the septal-lateral diameter under transesophageal echocardiography guidance in the loaded beating heart after mitral valve repair. Shape alteration is induced by radiofrequency via detachable activation wires. This multicenter study reports ...

We report the unusual case of a 72-year-old woman with a primary presentation of right heart failure in the setting of recently diagnosed Ebstein's anomaly with concomitant atrial fibrillation (AF). The patient had New York Heart Association (NYHA) class III dyspnea for 12 months, with refractory right heart failure prior ...

Undersized mitral annuloplasty (MA) is the preferred surgical treatment for chronic ischemic mitral regurgitation. However, the preferred shape of undersized MA is unclear. A previously described finite element model of the left ventricle with mitral valve based on magnetic resonance images of a sheep with chronic ischemic mitral regurgitation after ...

The stepwise approach to radiofrequency (RF) ablation of atrial fibrillation (AF) can include ablation of the coronary sinus (CS) by RF delivery at the left atrium (LA) and/or within the CS. In both cases, the energy is applied between the tip electrode of a percutaneous catheter and a dispersive electrode ...

An 80-year-old patient having a dual chamber DR pacer connected to a VDD lead presented with chronic lead dislodgment with the atrial ring displaced into the right ventricle. There was no ventricular capture at maximal ventricular output, and given the clinical settings, the condition was managed with a conservative approach, ...

OBJECTIVE: Transmitral blood flow during early left ventricular (LV) filling produces an intraventricular rotational body of fluid known as a "vortex ring" that enhances the hydraulic efficiency of early LV filling. The authors tested the hypothesis that exposure to cardiopulmonary bypass (CPB) attenuates intraventricular vortex formation time (VFT) in patients ...

Cardiac resynchronization therapy (CRT) demands high energy utilization due to continuous biventricular pacing. Current technology allows 6 pacing configurations for a bipolar left ventricular (LV) lead. Understanding the energy requirements for each configuration will allow optimization of pacing output. Pacing impedance, LV voltage threshold at 1.5 ms (rheobase) and 0.4 ...

Although low atrial septal (LAS) pacing may prevent atrial tachyarrhythmias in selected patients, far-field R-wave (FFRW) sensing in this region seems more likely than in the right atrial appendage. MetHODS AND RESULTS: We compared the clinical characteristics and prevalence of FFRW sensing in 31 recipients (mean age, 74 ± 10 ...

Coronary computed tomographic angiography (CTA) is a promising noninvasive tool that allows the visualization of plaque morphology. Plaques characterized by positive remodeling, low attenuation, and napkin ring circular enhancement on contrast-enhanced coronary CTA have been regarded as rupture-prone vulnerable plaques, which account for about 60% of all vulnerable lesions and ...

BACKGROUND: The impact of mitral valve surgery on left ventricular outflow tract (LVOT) dimensions is unclear. Real-time three-dimensional transesophageal echocardiography permits excellent visualization of the LVOT and might improve standard two-dimensional measurements. In this study, LVOT area and shape were assessed before and after mitral valve surgery. METHODS: Thirty-five patients ...

AimsVentricular arrhythmias arising from the fibrous rings have been demonstrated, but knowledge about the aortomitral continuity (AMC) as a source of the arrhytmias is still limited.  The objective is to describe the characteristics of ventricular arrhythmias originating from the AMC in patients without structural heart disease.Methods and resultsTen patients with ...

A 59-year-old man had, over a period of 5 years, three different clinical scenarios which led to dynamic left ventricular outflow tract obstruction (LVOTO). Initially, this man who suffered from hypertrophic cardiomyopathy presented with asymmetric septal hypertrophy and systolic anterior motion (SAM) of the anterior mitral leaflet, along with mitral ...

As a treatment for aortic stenosis, several companies have recently introduced prosthetic heart valves designed to be deployed through a catheter using an intravenous or transapical approach. This procedure can either take the place of open heart surgery with some ofthe devices or delay it with others. Real-time 3D ultrasound ...

Background Disrupted plaques are the major cause of acute coronary syndrome (ACS). Although the detection of vulnerable plaques by coronary CT (CCT) has been examined and reported, there has been no report on the detection of disrupted plaques by CCT. Objectives To test the ability of CCT to detect disrupted ...

During implantation of the HeartMate II left ventricular assist device, the inflow cannula is typically inserted in such a way that the sewing ring is placed within the ventricular cavity in contact with the endocardium. We describe a novel implantation technique in which the sewing ring is secured to the ...

We report a case of pseudo-pseudoaneurysm, which is a very rare complication of myocardial infarction. A 69-year-old man was admitted to our clinic with chest tightness and dyspnea. He had undergone aortic valve replacement with a pericardial bioprosthetic valve, ring mitral annuloplasty, and reconstruction of an aortic annular defect due ...

Evidence is mounting that mitral valve repair can improve symptoms in adults with dilated cardiomyopathy. Data is currently lacking for children with dilated cardiomyopathy and options for annuloplasty are limited in children. We report on the successful management of a 21 month-old child in heart failure from dilated cardiomyopathy and ...

A paced right bundle-branch block (RBBB) QRS morphology is present in most patients with biventricular pacing (BiVP) but is also present in some patients with right ventricular pacing (RVP). The aim of this study was to determine if there are electrocardiographic characteristics that distinguish BiVP from RVP in patients with ...

Dual site left ventricular pacing through two left ventricular pacing leads, located in discrete vessels, significantly lowered pacing thresholds from 6 V at 1 ms and 4.25 V at 0.5 ms through the leads individually, to 0.75 V at 0.5 ms by utilizing a Y-adaptor to connect the two leads.

Background: Chronic effect of right ventricular (RV) pacing on left ventricular (LV) rotational synchrony is unknown. The aim of this study is to assess chronic effect of RV pacing on LV rotational synchrony using two-dimensional ultrasound speckle tracking imaging. Methods and Results: Thirty-one patients who underwent dual-chamber pacemaker implantation for ...

For successful cardiac resynchronisation therapy (CRT) a spatial and electrical separation of right and left ventricular electrodes is essential. The spatial distribution of electrical delays within the coronary sinus (CS) tributaries has not yet been identified. Electrical delays within the CS are described during sinus rhythm (SR) and right ventricular ...

While for decades right ventricular (RV) apical pacing has been the standard of care for patients requiring pacemaker or defibrillator lead placement, investigators have sought alternatives to achieve more physiologic electrical activation of the heart and reduce long-term pathologic effects of nonphysiologic apical pacing. These investigations have included attempts at ...

high-rate pacing may have an inhibitory effect on the initiation of Torsade de Pointes arrhythmias (TdP). However, permanent pacing is only indicated in high-risk patients. We performed a proof of concept study into automatic overdrive pacing for prevention of drug-induced TdP, using short-term variability of repolarization (STV) as a feedback ...

Introduction:  In the right ventricle, selective site pacing (SSP) has been shown to avoid detrimental hemodynamic effects induced by right ventricular apical pacing and, in the right atrium, to prevent the onset of atrial fibrillation and to slow down disease progression. The purpose of our multicenter observational study was to ...

Velocity vector imaging (VVI) allows noninvasive measurement of left ventricular (LV) strain and rotation angle-independently. We investigated strain, rotation and myocardial synchrony when pacing at different sites in the right ventricle to determine which site yields the most physiological pacing, as determined with VVI imaging. Thirty-one patients with normal LV ...

BACKGROUND: Paced QRS duration, a good marker of ventricular asynchrony while pacing, has been accepted as a valuable predictor of new-onset heart failure in patients receiving right ventricular apical pacing. But nowadays we have little evidence for predicting paced QRS duration before the implantation. HYPOTHESIS: There might be relationships between ...

Paced QRS duration, a good marker of ventricular asynchrony while pacing, has been accepted as a valuable predictor of new-onset heart failure in patients receiving right ventricular apical pacing. But nowadays we have little evidence for predicting paced QRS duration before the implantation. There might be relationships between paced QRS ...

To quantify cardiac troponin-I (cTnI) concentration in dogs with symptomatic bradyarrhythmias before and after artificial pacing and to correlate cTnI concentration with diagnosis, echocardiographic parameters, serology, and outcome. Medical records from the University of Pennsylvania from 2006 to 2009 were reviewed, and 14 dogs with cTnI assay results before and ...

Temporary biventricular pacing to treat low output states after cardiac surgery is an active area of investigation. Reoperative cases are not studied due to adhesions, which preclude left ventricular mobilization to place epicardial pacing wires. In such patients, inserting a temporary left ventricular lead via the coronary sinus cardioplegia cannula ...

Chronic right ventricular apical (RVA) pacing has been associated with increased risk of heart failure and adverse outcome. The acute effects of RVA pacing on three-dimensional (3D) ventricular function and mechanical dyssynchrony are not well known. We performed a real-time 3D echocardiographic (RT3DE) study to assess global and regional left ...

The aim of this study was to examine the effects on left ventricular (LV) function of LV apical or/and lateral wall pacing during an experimental acute myocardial infarction. In 12 anesthetized pigs, epicardial LV pacing at the apex or lateral wall, or at both sites simultaneously, was performed before and ...

V-A and A-V Intervals During Atrial Flutter Ablation. Background: The success of cavotricuspid (CTI) ablation depends on the achievement of bidirectional block. Previous investigators have shown that right ventricular (RV) pacing can replace proximal coronary sinus (pCS) pacing in assessing clockwise CTI conduction block. Objective: We sought to assess bidirectional conduction ...

Background: Asynchronous electrical activation induced by right ventricular (RV) pacing can cause several abnormalities in left ventricular (LV) function. However, the effect of ventricular pacing on RV function has not been well established. We evaluated RV function in patients undergoing long-term RV pacing. Methods: Eighty-five patients and 24 healthy controls ...

We studied the acute effect of pacing at the right ventricular outflow tract (RVOT), right ventricular apex (RVA) and simultaneous RVA and RVOT-dual-site right ventricular pacing (DuRV) in random order on systolic function using impedance cardiography. Seventy-three patients (46 males), aged 52-89 years (mean 71.4 years) subjected to routine dual ...

Long-term right ventricular apical (RVA) pacing has been associated with adverse effects on left ventricular systolic function; however, the comparative effects of right ventricular outflow tract (RVOT) pacing are unknown. Our aim was therefore to examine the long-term effects of septal RVOT versus RVA pacing on left ventricular and atrial ...

Prolonged right ventricle (RV) apical pacing is associated with left ventricle (LV) dysfunction due to dysynchronous ventricular activation and contraction. Alternative RV pacing sites with a narrower QRS compared to RV pacing might reflect a more physiological and synchronous LV activation. The purpose of this study was to compare the ...

Extraction of passive fixation coronary sinus (CS) leads is typically easily achieved with manual traction. The ability to readily extract active fixation leads from the CS is less clear. Our first extraction experience with an active fixation CS lead was in a 58-year-old man with a 13-month-old Medtronic 4195 lead ...

The right ventricular outflow tract (RVOT) is used as an alternative pacing site, but its superiority to the RV apex remains to be established. This lack of proof may in part be explained by heterogeneity within the RVOT-paced group, due to poor definitions of the RVOT. The aim of the ...

Left ventricular (LV) remodeling has been attributed to the segmental loss of viable myocardium due to myocardial infarction (MI), which results in redistribution of cardiac workload, with increased regional wall stress in and around the infarct zone. Because ventricular pacing has been shown to reduce regional wall stress and workload ...

Aims When targeting the interventricular septum during pacemaker implantation, the lead may inadvertently be positioned on the anterior wall due to imprecise fluoroscopic landmarks. Surface electrocardiogram (ECG) criteria of the paced QRS complex (e.g. negativity in lead I) have been proposed to confirm a septal position, but these criteria have ...

A 59-year-old man with two different premature ventricular contractions (PVCs) forming a couplet underwent electrophysiological testing. Although pacing from the aorto-mitral continuity (AMC) produced an excellent pace map of one type of PVCs, a radiofrequency application within the right coronary cusp (RCC) eliminated all the PVCs. This case demonstrates that ...