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1/48. Left ventricular end-diastolic extrasystole with pseudonormalization of a left bundle branch block unmasking inferior ischemia.

    An electrocardiogram tracing of a patient in conducted sinus rhythm with left bundle branch block is shown, in which occasional pseudonormalization of intraventricular conduction is seen. This event is attributed to ventricular fusions with end-diastolic extrasystoles of the left His-Purkinje system distal to the block site. This type of extrasystole is discussed. In this case, normalization of ventricular activation allowed for diagnosis of inferior subepicardial ischemia.
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ranking = 1
keywords = extrasystole
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2/48. Inappropriate implantable cardioverter-defibrillator therapy due to the detection of premature ventricular complexes.

    Inappropriate shocks delivered by implantable cardioverter-defibrillators may occur in 15%-40% of patients treated with these devices. This article describes a rare cause for inappropriate shocks. Two patients received inappropriate shocks due to the presence of premature ventricular complexes during attempted reconfirmation of ventricular fibrillation. knowledge of device algorithms for detection and reconfirmation of ventricular fibrillation, designed to have a high degree of sensitivity and therefore lower specificity, allows for reprogramming to avoid further inappropriate shocks.
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ranking = 0.00022409627417925
keywords = complex
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3/48. Dental anesthetic management of a patient with ventricular arrhythmias.

    During routine deep sedation for endodontic therapy, a dentist-anesthesiologist observed premature ventricular contractions (PVCs) on a 62-yr-old woman's electrocardiogram (EKG) tracing. The dentist was able to complete the root canal procedure under intravenous (i.v.) sedation without any problems. The dentist-anesthesiologist referred the patient for medical evaluation. She was found to be free from ischemic cardiac disease with normal ventricular function. The patient was cleared to continue her dental treatment with deep sedation. She subsequently continued to undergo dental treatment with deep intravenous sedation without incident, although her EKG exhibited frequent PVCs, up to 20 per minute, including couplets and episodes of trigeminy. This article will review indications for medical intervention, antiarrhythmic medications, and anesthetic interventions for perioperative PVCs.
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ranking = 0.012128299871692
keywords = contraction
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4/48. Giant cervico-mediastinal lipoma. A clinical case.

    The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.
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ranking = 0.16666666666667
keywords = extrasystole
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5/48. heart rate variability analysis of patients with idiopathic left ventricular outflow tract tachycardia: role of triggered activity.

    There have been several reports with respect to idiopathic ventricular tachycardias (VTs) originating from the left ventricular outflow tract (LVOT). A previous report suggested that triggered activity plays a partial role in idiopathic LVOT tachycardia from the electrophysiological as well as the electropharmacological viewpoint. However, the exact role of triggered activity in this type of VT remains unknown. In the present study the relationship of the frequency of premature ventricular contractions (PVCs) and heart rate was examined and heart rate variability (HRV) was analyzed in 2 cases of LVOT tachycardia using 24-h Holter electrocardiographic (ECG) monitoring. The relation between the PVCs frequency and heart rate showed a persistently positive correlation, indicating frequent PVCs as heart rate increased. In HRV analysis, NN50(%), a time-domain variable of parasympathetic activity, showed no change prior to ventricular arrhythmias. In frequency-domain analysis of HRV, the high frequency (HF) component tended to fall prior to repetitive PVCs and VTs. The ratio of the low frequency to high frequency (LF/HF) components increased prior to single PVCs, repetitive PVCs and VTs. Sympathetic predominance predisposes the genesis of these kinds of arrhythmias originating from the LVOT and it is suggested that triggered activity plays an important role in LVOT tachycardia, at least in its initiation.
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ranking = 0.012128299871692
keywords = contraction
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6/48. Concealed conduction in the reentrant pathway as a mechanism of stable ventricular quadrigeminy.

    This is the first report on the stable occurrence of ventricular quadrigeminy as a manifestation of concealed bigeminy in a case of fixed and late coupled ventricular extrasystoles. A 46-year-old man is reported in whom the period of ventricular bigeminy alternated with the period of ventricular quadrigeminy. Coupling intervals of the extrasystoles were fixed and much longer than sinus QT intervals. When the heart rate is decreased, the period of bigeminy changed to the period of quadrigeminy without gradual decrease in coupling of the preceding extrasystoles. Once such a change occurred, stable quadrigeminy is maintained for a period. These findings suggest the possibility that concealed electrotonic conduction of blocked impulses and interference of conducted impulses may occur in the reentrant extrasystolic pathway as a mechanism of stable ventricular quadrigeminy.
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ranking = 0.5
keywords = extrasystole
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7/48. Morphology of right ventricular paced beats in posterior myocardial infarction.

    Premature ventricular beats or paced beats can unmask new or old myocardial infarction when sinus beats fail to exhibit the typical infarct pattern. knowledge of their morphology is vital, since they may be the earliest or even the only evidence of a myocardial infarction in certain cases. Morphology of premature ventricular beats or paced beats in anterior, anteroseptal, and inferior infarct has been described but not in the setting of a posterior infarct. We describe the morphology of right ventricular paced beats in a patient with posterior infarct and discuss its significance.
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ranking = 0.25966062639793
keywords = beat
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8/48. First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure.

    tachycardia-induced cardiomyopathy is a well-recognized and reversible condition, but left ventricular dysfunction due to frequent isolated premature ventricular complexes (PVCs) has not been reported. We observed resolution of dilated cardiomyopathy in a patient after a focal source of PVCs was eliminated by radiofrequency ablation. In a subset of patients with heart failure, PVC-induced cardiomyopathy may be a potentially reversible cause of left ventricular dysfunction.
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ranking = 0.00022409627417925
keywords = complex
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9/48. Isolated congenital left ventricular diverticulum with perinatal dysrhythmia: a case report and review of the literature.

    We report a case of isolated congenital left ventricular diverticulum (LVD) with perinatal dysrhythmia, which disappeared spontaneously 1 week after birth. The LVD arose from the lateral wall of the LV, and the contraction of the LVD was synchronous with the kinetics of the main LV chamber. The LVD changed very little in size during the first 30 months after birth, and its relative size to the growing LV main chamber decreased. The patient had neither any symptoms nor complications during this time. The available literature on prenatal and neonatal cases with isolated LVD or LV aneurysm is also reviewed.
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ranking = 0.012128299871692
keywords = contraction
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10/48. Electrocardiographic manifestations: aberrant ventricular conduction.

    Aberrant ventricular conduction is a common electrocardiographic (EKG) manifestation that occurs when the supraventricular electrical impulse is conducted abnormally through the ventricular conducting system. This results in a wide QRS complex that may be confused with a ventricular ectopic beat. This differentiation is important because the treatment and prognosis is quite different. Hemodynamically unstable patients with a wide-complex tachycardia should be promptly cardioverted. Although up to 10% of cases will defy differentiation, ventricular tachycardia and aberrant conduction can be distinguished utilizing history, physical examination, and EKG criteria. The mechanisms of aberrant ventricular conduction are discussed.
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ranking = 0.089943659302887
keywords = ectopic beat, beat, supraventricular, complex
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