Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within  min. DC-ECV was successful in all patients (100%) within  min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA.</jats:p

Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation

A 66-year-old woman underwent successful radiofrequency catheter ablation for long-lasting, drug refractory fast atrial flutter. Two days later she had a cardiac arrest due to torsades de pointes (TdP) tachycardia attributed to relative sinus bradycardia and QT interval prolongation. After successful resuscitation further episodes of TdP occurred, which were treated with temporary pacing. Because of concomitant systolic dysfunction due to ischemic and valvular heart disease she was finally treated with an implantable defibrillator. In conclusion we strongly advise prolonged monitoring for 2 or more days for patients with structural heart disease following successful catheter ablation for long lasting tachyarrhythmias

Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention

Ventricular diverticulum: Definition, pathophysiology, clinical manifestations and treatment

Ventricular diverticula are rare abnormalities of the heart, whose origin is not fully understood yet. They are mostly congenital, either isolated or associated with other cardiac and extracardiac defects (Cantrell’s pentalogy). Although their etiology is not clear, an embryologic developmental defect has been proposed. Yet, some of them are associated with cardiomyopathies, inflammation or trauma. We discuss the case of a patient with hypertrophic cardiomyopathy and an apical diverticulum. The hypothesis made was that, an obstructing hypertrophic mass, localized in the midportion of the left ventricle, creates a pressure gradient between the apical and basal portions which finally leads to the creation of the diverticulum. Acute rupture, ventricular arrhythmias, peripheral arterial embolism and infective endocarditis are few of their complications. Besides transthoracic 2-D echocardiography and left ventriculography, magnetic resonance imaging (MRI) is the gold standard means of diagnosis. The opinions in the literature, as far as the pharmacological treatment or surgical resection, are controversial