1/69. Right coronary artery occlusion as a complication of accessory pathway ablation in a 12-year-old treated with stenting.We describe a complication of radiofrequency ablation of a posteroseptal pathway that resulted in acute occlusion of a distal right coronary artery in a pediatric patient. The complication was treated with coronary stenting after unsuccessful angioplasty.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/69. Radiofrequency ablation of a concealed nodoventricular Mahaim fiber guided by a discrete potential.INTRODUCTION: We present the case of a 17-year-old woman who underwent an electrophysiological study and radiofrequency (RF) ablation of supraventricular tachycardia refractory to medical treatment. Two right-sided, concealed, nondecremental atrioventricular accessory pathways (AV-APs) involved in orthodromic circus movement tachycardias were identified. After RF ablation of both AV-APs, evidence of bidirectional dual AV nodal conduction was demonstrated and regular narrow complex tachycardia was induced. methods AND RESULTS: During the tachycardia, retrograde slow and fast AV nodal pathway conduction with second-degree ventriculoatrial (VA) block and VA dissociation were observed. During the tachycardia with second-degree VA block, ventricular extrastimuli elicited during His-bundle refractoriness advanced the next His potential or terminated the tachycardia. Mapping the right atrial mid-septal region, a distinct high-frequency activation P potential was recorded in a discrete area, two thirds of the way from the His bundle toward the os of the coronary sinus. Detailed electrophysiologic testing with the recordable P potential demonstrated that the tachycardia utilized a concealed nodoventricular AP arising from the proximal slow AV nodal pathway. CONCLUSION: The tachycardia with slow 1:1 VA conduction could be reset by ventricular extrastimuli elicited during His-bundle refractoriness advancing the subsequent activation P potential and atrial activation. RF ablation guided by recording of the activation P potential resulted in elimination of both the slow AV nodal pathway and the nodoventricular connection with preservation of the normal AV conduction system.- - - - - - - - - - ranking = 0.16666666666667keywords = coronary (Clic here for more details about this article) |
3/69. Coexistence of a left posteroseptal tract with persistent left superior vena cava. Ablation through an anomalous superior vena cava.A case of a young male with WPW syndrome due to a left posteroseptal tract associated with a persistent left superior vena cava is described. After unsuccessful ablation attempts with a number of different approaches at conventional target sites, the accessory connection was successfully ablated within the coronary sinus. This was achieved only when the ablation catheter was introduced through the persistent left superior vena cava.- - - - - - - - - - ranking = 0.16666666666667keywords = coronary (Clic here for more details about this article) |
4/69. Antidromic atrioventricular reentrant tachycardia mimicking ventricular tachycardia in the setting of previous myocardial infarction.The differentiation between ventricular tachycardia and broad-complex supraventricular tachycardia can be extremely difficult, particularly in emergency situations. We report a case of hemodynamically compromising broad-complex tachycardia in a 63-year-old man. The patient had previously sustained an anteroseptal myocardial infarction and had subsequently undergone coronary artery bypass surgery because of triple-vessel coronary artery disease. Intravenous treatment with ajmalin terminated the tachycardia and revealed preexcited QRS complexes compatible with the presence of a left-sided atrioventricular accessory pathway. An antidromic atrioventricular reentrant tachycardia (identical to the clinical tachycardia) was induced during an electrophysiologic study. In conclusion, there are several causes of broad-complex tachycardia, even in patients with previous myocardial infarction, and, where doubt exists, electrophysiologic studies should be performed.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
5/69. pulmonary atresia with intact ventricular septum, antegrade coronary-right ventricular sinusoidal communication, and wolff-parkinson-white syndrome.A fenestrated Fontan operation was performed successfully in a patient with pulmonary atresia with intact ventricular septum, an antegrade sinusoidal communication, and wolff-parkinson-white syndrome. Unlike most cases, blood flow in the sinusoidal communication was antegrade, from the left anterior descending artery to the right ventricle. This is the first report of the combination of pulmonary atresia with intact ventricular septum and wolff-parkinson-white syndrome.- - - - - - - - - - ranking = 0.66666666666667keywords = coronary (Clic here for more details about this article) |
6/69. Atrial double potentials associated with the elimination of the electrical connection between the coronary sinus (CS) and the left atrium in two cases of wolff-parkinson-white syndrome with a CS-connected accessory pathway.A curious retrograde conduction in connection with the coronary sinus (CS) musculature was observed in 2 patients. After the failed ablation procedure, the atrial electrogram during ventricular pacing presented double potentials, the first component of which was sharp and with an activation sequence that was the same before ablation (CS distal to proximal). The second component of the double potentials was dull and had a decremental property; its activation sequence was in reverse (proximal to distal). In both cases, the first component disappeared after successful ablation. These findings suggest that the first component was the CS electrogram conducted over the accessory pathway and the second component was the left atrial electrogram conducted through the inter-atrial septum. The separation of each electrogram is probably the result of a block between the accessory pathway connected to the CS musculature and the left atrium. These are unusual cases of an accessory pathway connected to the CS musculature, which separates the left atrial myocardium at the distal portion from the ostium.- - - - - - - - - - ranking = 0.83333333333333keywords = coronary (Clic here for more details about this article) |
7/69. myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries.Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there was no significant associated cardiac defect. The possible etiologies in relationship to myocardial infarction in the neonatal period are presented.- - - - - - - - - - ranking = 0.83333333333333keywords = coronary (Clic here for more details about this article) |
8/69. wolff-parkinson-white syndrome mimicking acute anterior myocardial infarction in a young male patient--a case report.A young male with wolff-parkinson-white syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V1-V6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed wolff-parkinson-white syndrome with two accessory pathways.- - - - - - - - - - ranking = 0.33333333333333keywords = coronary (Clic here for more details about this article) |
9/69. Accessory pathway associated with an anomalous coronary vein in a patient with wolff-parkinson-white syndrome.We report a case of wolff-parkinson-white syndrome coexistent with atresia of the coronary sinus (CS) ostium and persistence of the left superior vena cava. The accessory pathway was located at the blind end of the CS, which was bumped with mechanical loss of preexcitation during mapping by a catheter from within the CS. The accessory pathway was successfully ablated with radiofrequency energy applied to this site from the right atrium. This unique combination of anatomically matched anomalies may be important in suggesting a potential embryologic link between the accessory pathway and the coronary vein.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
10/69. Wolff Parkinson White (WPW) syndrome: what the critical care nurse needs to consider when administering antiarrhythmics.This paper discusses the importance of critical care and emergency nurses having an understanding of why pre-existing cardiac disorders can influence antiarrhythmic treatment. The patient with a pre-excitation syndrome is usually managed in a coronary care unit. However, these patients may be admitted to an intensive care unit (ICU) with complications of Wolff Parkinson White (WPW) syndrome; for example post cardiopulmonary arrest or WPW as a co-morbidity. It is common practice in critical care areas for registered nurses to administer antiarrhythmics without a doctor's prescription in life-threatening situations. Therefore, the critical care nurse must have knowledge of the implications of administering standard antiarrhythmic agents if this patient reverts into a tachyarrhythmia. If antiarrhythmics are administered that are contraindicated in patients with WPW syndrome, then there is potential for deleterious effects. This case study highlights the different pharmacological agents for treating tachyarrhythmias in a patient with WPW syndrome. The paper outlines the correct treatment and discusses the deleterious effects of incorrect administration of drugs in WPW syndrome.- - - - - - - - - - ranking = 0.16666666666667keywords = coronary (Clic here for more details about this article) |
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