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Aim: This study compares different parameters of right atrial size evaluated by two-dimensional (2D) echocardiography with right atrial volume measured using three-dimensional echocardiography (3DE). Methods and Results: One hundred sixty-three consecutive patients with a history of atrial arrhythmias were studied by standard two-dimensional and by real time 3DE. Of these 142 (87%) recordings were of sufficient quality for interpretation of the right atrium by both imaging techniques. The following parameters of right atrial size were measured: apical four-chamber short-axis diameter (4CH short axis), apical four-chamber long axis diameter (4CH long axis), and apical four-chamber planimetry area. The 2D-derived right atrial volume was calculated by using the single plane area-length method (4CH area-length). The 2D parameters were then correlated with right atrial volume measured by real time 3DE. Linear regression analysis showed moderate correlation for four-chamber planimetry area (r = 0.72, P < 0.001) and 2D-derived volume calculation (r of 4CH single plane area-length RA volume = 0.70, P < 0.001). Diameters correlated clearly less well with 3DE volume (r of 4CH short axis = 0.61, 4CH long axis = 0.59, P < 0.001 respectively). Conclusion: Real time 3DE is highly feasible for right atrial volume determination. The results demonstrate that measurements of dimensions using 2D echocardiography may not accurately assess right atrial size. If 3DE is not available, apical 4CH planimetry area is a simple alternative that may be used for evaluating right atrial size in clinical practice. The 2D-derived right atrial volume by single plane area-length method was not better correlated with 3DE volume than four-chamber planimetry area. [ABSTRACT FROM AUTHOR]

Introduction: During implantation of biventricular devices, manipulation of the guiding sheath during localization of the coronary sinus (CS) ostium may result in injury to the right bundle and complete heart block. A preventive measure is to implant the right ventricular (RV) lead first, though this may interfere with manipulation of the guiding sheath and dislodge the permanent lead. We tested the feasibility of backup pacing with a 0.035' guidewire, advanced through the guiding sheath during CS localization. Methods: One hundred six consecutive patients (mean age = 70 ± 11 years, 81 men) undergoing biventricular device implantation were studied. A 0.035\'02\'02 guidewire with an uncoated tip was advanced into the right ventricle through the guiding sheath, and unipolar capture threshold, R-wave sensing amplitude, and pacing impedance were measured. Results: RV pacing was successful in all patients. The mean capture threshold was 3.8 ± 2.1 V/0.5 ms, R-wave amplitude 5.4 ± 4.3 mV, and pacing impedance 226 ± 78 omega. No arrhythmia was observed during the tests. Two patients developed complete heart block during the implant procedure and were successfully paced temporarily using the 0.035' guidewire. Conclusion: Temporary RV pacing, using a 0.035' guidewire within the guiding sheath, is a simple, reliable, and safemethod that allows backup pacing in case of traumatic complete heart block, developing during the implantation of biventricular devices. [ABSTRACT FROM AUTHOR]

The article presents the diagnostic images of a case of systolic dysfunction induced by right ventricular apical pacing by a real-time, transthoracic, three-dimensional echocardiogram performed using a Sonos 7500 Live 3D echocardiograph. The panel depicts regional volume curves and global left ventricular systolic function, during intrinsic ventricular rhythm. A dyssynchrony was noted, which is a result from right ventricular apical pacing shown by regional volume curves.

Describes the case of a diagnostic pitfall in a patient with an implantable cardioverter-defibrillator. Admission of the patient to the hospital due to repeated shocks from his Guidant Ventak Prizm dual chamber implantable cardioverter-defibrillator.

Presents a case of a 41-year-old woman diagnosed with papillary fibroelastoma which causes cardioembolic stroke. Nuclear magnetic resonance imaging of the brain; Transesophageal echocardiography; Surgery for ablation of the mass with preservation of the aortic valve.

A 42-year-old woman was referred after the discovery of a 3/6 diastolic murmur maximal at the aortic region, with vigorous pulsation of the suprasternal notch. Echocardiography followed by magnetic resonance imaging revealed a fusiform aneyurism of the ascending aorta, without evidence of dissection, extending from the aortic root up to the brachiocephalic artery, associated with severe aortic regurgitation. Histological examination of the operative material showed a Erdheim-Gsell cystic medial necrosis of the aorta.

Objectives: This meta-analysis compared amiodarone with placebo and class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF), defined as lasting less than seven days.Background: Despite the lack of trials that support its efficacy convincingly, amiodarone is widely used for conversion of recent-onset AF.Methods: We searched Medline and EMBASE databases, as well as the Cochrane Controlled Trials Register for randomized trials on recent-onset AF comparing amiodarone to placebo or class Ic drugs. Data were combined according to a fixed effect model. The primary end point was the rate of conversion at 24 h. To study time-dependency of the drugs, efficacy at 1 to 2 h, 3 to 5 h, 6 to 8 h, and at 24 h was analyzed.Results: We found six studies randomizing amiodarone versus placebo (595 patients) and seven studies versus class Ic drugs (579 patients). There was no significant difference between amiodarone and placebo at 1 to 2 h, but significant efficacy was found after 6 to 8 h (relative risk [RR] 1.23, p = 0.022) and at 24 h (RR 1.44, p < 0.001). Efficacy with amiodarone was inferior to class Ic drugs for up to 8 h (RR 0.67, p < 0.001) but no difference was seen at 24 h (RR 0.95, p = 0.50). There were no major adverse effects.Conclusions: Amiodarone is superior to placebo for cardioversion of AF, and even though the onset of conversion is delayed, its efficacy is similar at 24 h compared with class Ic drugs. These results favor amiodarone as a reasonable alternative for patients with recent AF in whom class Ic and other, more rapidly acting antiarrhythmic drugs cannot be used. [ABSTRACT FROM AUTHOR]

We report the case of an elderly patient who presented with poorly tolerated episodes of atrial arrhythmia refractory to medical treatment. AV node ablation was identified as the only alternative expected to be efficacious for symptom relief. However, this usually simple intervention failed. The goal of creating a complete AV block was finally achieved through ablation of the anterior fascicle of the His bundle, which represented the only pathway for residual conduction in this patient. [ABSTRACT FROM AUTHOR]

Introduction et but de l’étude L’impédancemétrie corporelle bioélectrique est une méthode recommandée pour mesurer la composition corporelle. L’évaluation nutritionnelle est essentielle chez les patients souffrants de maladies chroniques comme l’insuffisance cardiaque sévère à fraction d’éjection ventriculaire gauche réduite, souvent porteurs d’un défibrillateur cardioverteur implantable, car le risque de dénutrition est élevé. Les guidelines de l’ESPEN [1] déconseillent l’utilisation de l’impédancemétrie corporelle bioélectrique chez ces patients à cause des interférences électromagnétiques qui pourraient notamment provoquer des chocs inappropriés. Matériel et méthodes Durant 3 mois consécutifs, la composition corporelle a été mesurée par impédancemétrie corporelle bioélectrique utilisant un générateur/analyseur de courant (Nutriguard M, DataInput, Allemagne) à 800 mAmp et 3 fréquences (5, 50, 100 kHz) chez des patients ambulatoires venant contrôler leurs défibrillateur cardioverteur implantable. Les niveaux de sensibilités du défibrillateur cardioverteur implantable étaient réglés à leurs maximums pour maximiser le risque d’interférences électromagnétiques. Les thérapies du défibrillateur cardioverteur implantable étaient inactivées le temps de la mesure. L’électrogramme intracardiaque était surveillé en temps réel pour évaluer la présence d’interférences électromagnétiques durant la mesure par impédancemétrie corporelle bioélectrique. Résultats Ont été inclus 63 patients (54 hommes) porteurs de défibrillateur cardioverteur implantable (simple et double-chambre, biventriculaire) provenant des 5 fabricants principaux : Biotronik ( n = 11), Boston scientific ( n = 15), Medtronic ( n = 20), Sorin ( n = 4), et St-Jude ( n = 13). L’âge moyen était de 64,8 ± 14,6 ans, la fraction d’éjection ventriculaire gauche moyenne de 32,1 ± 16,5 %. Quarante-trois pour cent étaient classés > 2 pour la dyspnée selon la New York Heart Association. Le temps moyen depuis l’implantation du défibrillateur cardioverteur implantable était de 23,8 ± 21 mois. Aucune interférence électromagnétique n’a été détectée par le défibrillateur cardioverteur implantable chez ces patients, et aucun artéfact n’était visualisé sur les électrogrammes. Conclusion L’ impédancemétrie corporelle bioélectrique peut être effectuée en toute sécurité chez les patients porteurs d’un défibrillateur cardioverteur implantable. Cela est un message important afin d’améliorer le dépistage et la prise en charge de la dénutrition chez les patients atteints d’insuffisance cardiaque sévère, qui sont à haut risque nutritionnel. Les guidelines de l’ESPEN [1] concernant les modalités d’utilisation de l’impédancemétrie corporelle bioélectrique pourraient être mis à jour. [ABSTRACT FROM AUTHOR]