Basel Al Aloul

Radiofrequency ablation (RFA) of atrial flutter (AFL) is a commonly performed procedure with low risk of complications. Several case reports and animal studies cautioned about the risk of right coronary artery (RCA) injury following AFL ablation. This risk is due to the anatomic proximity of the RCA to the cavo-tricuspid isthmus where ablation is performed. We present a case report that demonstrates postmortem evidence of RCA injury following RFA of AFL. J Clin Med Res. 2015;7(4):270-273 doi: http://dx.doi.org/10.14740/jocmr1986w

The value of Single Photon Emission Computed Tomography stress myocardial perfusion imaging (SPECT-MPI) for detecting graft disease after coronary artery bypass surgery (CABG) has not been studied prospectively in an unselected cohort.

Radiofrequency ablation of atrial flutter is a commonly performed procedure. Ablation success depends upon complete transmural atrial tissue injury to achieve bidirectional cavotricuspid isthmus (CTI) block. Transmural ablation increases risk of injury to the adjacent right coronary artery (RCA). Distance between the RCA and the endocardium within the CTI area is not well described. We aimed to perform in vivo measurements of the distance between the CTI area and adjacent RCA. Thirty-three consecutive patients underwent electrocardiogram-gated contrast-enhanced computed tomography. CTI area was divided into nine segments based on three common catheter locations (paraseptal, central, and lateral or 5, 6, and 7 o'clock) and ventricular to atrial ablation line. Mean age was 64 ± 11 years and 97% of the participants were male. Paraseptal, central, and lateral measurements at the tricuspid annulus ridge showed endocardial to RCA distance 9 ± 3, 6 ± 2, and 5 ± 3 mm, respectively (range 2-17 mm). Corresponding measurements for the ventricular side were 5 ± 3, 4 ± 2, and 4 ± 2 mm and atrial side measurements were 3 ± 2, 3 ± 2, and 3 ± 3 mm. Distance was ≤2 mm in 14% of segments on the ventricular side and 39% of segments on the atrial side. Paired t-test showed significant difference (P < 0.001) between tricuspid annulus ridge measurements and adjacent atrial or ventricular measurements. Distance between endocardium and RCA lumen is reduced in areas adjacent to the tricuspid annulus ridge.

Background:In patients with atrial fibrillation (AF) and atrial flutter (AFL), the value of the 12-lead surface electrocardiogram (ECG) in predicting direct current cardioversion (DCCV) outcomes has not been thoroughly investigated. We sought to determine whether the type of atrial arrhythmia (AF versus AFL) and the characteristics of the atrial fibrillatory waves (fine versus coarse) on the...

Patients with hypertrophic cardiomyopathy (HCM) are inherently prone to arrhythmias. Electroconvulsive therapy (ECT), a well‐known treatment in psychiatry, leads to a catecholamine surge and may cause arrhythmias in patients with severe coronary and valvular heart diseases and heart failure. Whether ECT is safe in HCM is unknown. We systematically investigated the effects of ECT on the arrhythmia profile and left ventricular outflow obstruction of a HCM patient by serial ambulatory Holter electrocardiograms and echocardiograms before and after ECT. Our observations provide insight into the evaluation and management of a HCM patient undergoing ECT.

In teaching hospitals, the majority of central venous catheters are placed by medical residents. No studies have examined residents' adherence to safe practices during these procedures. We conducted a survey to gather self-reported data on the techniques that internal medicine residents use when placing a central venous catheter to minimize their own risk of infection and their patients' risk of bleeding-related complications.

The emergence of Brugada pattern on electrocardiogram in response to class IA or IC antiarrhythmic agents is widely utilized to diagnose concealed Brugada syndrome and recognized as a risk factor for sudden death. Phenytoin, a class IB antiarrhythmic agent, has not been reported to induce Brugada pattern. We report a patient who presented with Brugada electrocardiogram at supratherapeutic phenytoin level. Considering that patients with syncope may falsely be labeled to have seizures and some epilepsy patients are at increased risk of sudden death, all patients with supratherapeutic phenytoin level should be evaluated with an electrocardiogram for emergence of Brugada pattern.

Aldosterone is a major regulator of the body potassium stores through its role in potassium excretion by the kidney. However, it is unclear whether aldosterone affects transcellular distribution of potassium in atrial myocytes, and whether hypokalemia associated with primary hyperaldosteronism increases susceptibility to atrial fibrillation (AF). We report a case of a 58-year-old male with Conn's syndrome in whom symptomatic AF was related to hypokalemia.