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Discusses a case of a woman with a narrow complex tachycardia with ventriculoatrial dissociation after catheter ablation of atrioventricular nodal reentrant tachycardia. Factors that favor nodofascicular tachycardia; Observation on the junctional tachycardia related to injury to the atrioventricular node; Differential diagnosis.

Background: High plasma levels of pro-inflammatory cytokines play an important role in the pathophysiology of congestive heart failure (CHF). Therefore, we conducted a case-control study to determine the correlations between plasma levels of cytokines, i.e., tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-6, and the severity and mortality in patients with CHF., Methods: One-hundred and 18 cases (62+/-15 years old) were classified into 3 groups: group 1 comprised 44 control cases with normal coronary arteriogram and left ventriculography and without valvular disorders or cardiomyopathy; group 2 comprised of 37 cases with mild CHF in New York Heart Association (NYHA) functional class (FC) II; group 3 had 37 cases with moderate/severe CHF in NYHA FC III or IV. Pre-catheterization plasma levels of TNF-alpha and IL-6 along with clinical and hemodynamic variables and follow-up data of cardiac death were assessed., Results: Patients of group 3 had smaller body mass index, lower systolic and diastolic blood pressures, faster heart rates, higher left ventricular end-diastolic pressure and lowered triglyceride levels than the patients of groups 1 and 2. The plasma levels of TNF-alpha and IL-6 increased significantly in patients of group 3 in comparison with patients of groups 1 and 2 (both p < 0.001). Over the following 1.5 years, 13 patients died. Univariate analysis identified the following variables to be associated with poor prognosis: NYHA FC (p < 0.001), plasma TNF-alpha (p = 0.013), plasma IL-6 (p < 0.001), systolic blood pressure (p = 0.001), heart rate (p = 0.045) and left ventricular end-diastolic pressure (p = 0.021). Multivariate Cox regression analysis identified the independent predictors of cardiac death as FC (p = 0.007) and plasma IL-6 (p = 0.021)., Conclusions: Our findings indicate that the plasma levels of IL-6 and TNF-alpha and especially the former, is a useful marker to correlate the progression of severity and late cardiac death in patients with CHF.

Background: This study investigated the electrophysiologic characteristics, atrial activation pattern, and effects of radiofrequency (RF) catheter ablation guided by noncontact mapping system in patients with focal atrial tachycardia (AT)., Methods and Results: In 13 patients with 14 focal ATs, noncontact mapping system was used to map and guide ablation of AT. AT origins were in the crista terminalis (n=8), right atrial (RA) free wall (n=3), Koch triangle (n=1), anterior portion of RA-inferior vena cava junction (n=1), and superior portion of tricuspid annulus (n=1); breakout sites were in the crista terminalis (n=5), RA free wall (n=5), middle cavotricuspid isthmus (n=2), and RA-superior vena cava junction (n=2). ATs arose from the focal origins (11 ATs inside or at the border of low-voltage zone), with preferential conduction, breakout, and spread to the whole atrium. After applications of RF energy on the earliest activation site or the proximal portion of preferential conduction from AT origin, 13 ATs were eliminated without complication. During the follow-up period (8+/-5 months), 11 (91.7%) of the 12 patients with successful ablation were free of focal ATs., Conclusions: Focal AT originates from a small area and spreads out to the whole atrium through a preferential conduction. Application of RF energy guided by noncontact mapping system was effective and safe in eliminating focal AT.