HRCR Rare Diseases Article Collection
Multiple recurrent episodes of pacemaker-associated postcardiac injury syndrome
Postcardiac injury syndrome (PCIS) is an autoimmune disease that causes damage to the pericardium, myocardium, and pleura after myocardial infarction, cardiac surgery, or trauma. Although most cases are benign, anti-inflammatory agents may be used to treat PCIS. Rarely, PCIS may become refractory or recur after anti-inflammatory treatment.1 In such cases, long-term oral corticosteroids are usually prescribed2; however, the optimal duration of administration remains unclear. We report a patient who experienced multiple recurrent episodes of pacemaker lead–related PCIS that were treated with oral prednisone and pericardial drainage.Idiopathic premature ventricular contraction–triggered ventricular fibrillation: Subcutaneous implantable cardioverter-defibrillator (S-ICD) template matched ablation in the absence of inducible clinical premature ventricular contraction
Idiopathic ventricular fibrillation is diagnosed in patients who have survived sudden cardiac arrest from ventricular fibrillation (VF) without identifiable structural heart disease.1 It is the main cause of unexplained sudden cardiac death, particularly in young patients under the age of 35.2 An implantable cardioverter-defibrillator (ICD) is usually recommended for the secondary prevention of sudden cardiac death. VF ablation is recommended for clinical VF recurrence and for reducing the number of ICD shocks.An unexpected finding by epicardial mapping: Atrial fibrillation in a 14-month-old patient with short QT syndrome
Short QT syndrome (SQTS) is a very rare channelopathy accompanied by familial clustering and sudden cardiac death.1 It has an estimated prevalence ranging from 0.02% up to 2% in the adult population, but only 0.05% among pediatric patients.2–6 To date, 9 mutations in 6 different genes have been identified, including KCNH2, KCNQ1, KCNJ1, CACNA1C, CACNB2, and CACNA2D1. In pediatric patients, SQTS is characterized by shortening of the corrected QT interval (QTcB <316 ms, J-Tpeak cB <181 ms, and the presence of early repolarization) on the surface electrocardiogram (ECG).Right ventricular outflow tract ablation close to an anomalous right coronary artery: When imaging meets electrophysiology
Catheter ablation is a commonly undertaken and highly effective treatment for symptomatic right ventricular outflow tract (RVOT) ventricular ectopy / ventricular tachycardia (VT).1 Despite the high chance of cure with ablation, caution is required to avoid collateral injury to coronary arteries in certain well-described locations. Anomalous coronary arteries are rare2 and may have an unfamiliar path involving the outflow tracts, posing a significantly increased risk with ablation. The approach to outflow tract ablation in a patient with an anomalous coronary artery has not been previously reported.Novel trans-2,3-enoyl-CoA reductase–like variant associated with catecholaminergic polymorphic ventricular tachycardia type 3
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by polymorphic ventricular tachycardia, usually provoked by emotional stress or exercise, in the absence of any structural cardiac abnormality, and in the presence of often normal resting electrocardiogram (ECG).1 It is a highly lethal disease with an overall mortality of 30%–40% if left untreated.2 Studies have shown that almost 35% of affected individuals become symptomatic before the age of 10 and 75% before the age of 20 years.Left bundle branch area pacing for the treatment of painful left bundle branch block syndrome
Painful left bundle branch block (LBBB) syndrome causes intermittent or chronic chest pain and/or shortness of breath in the absence of myocardial ischemia.1 Given its low prevalence and association with coronary artery disease, it is frequently not recognized, making its true prevalence unknown. The mechanistic nature of the associated chest pain has not been completely elucidated but is thought to be related to ventricular dyssynchrony2 and interoceptive hypersensitivity.3 Treatment options include the use of beta-blockers to reduce heart rate and cardiac pacing therapy aimed at reestablishing normal ventricular activation, through biventricular or His bundle pacing (HBP).Groin lymphorrhea after catheter ablation of atrial fibrillation: A case report
Catheter ablation is a well-established therapeutic option for the treatment of atrial fibrillation (AF).1,2 Although nowadays performed on a routine basis, catheter ablation of atrial fibrillation (AFCA) is associated with a non-negligible complication rate of up to 16% with significant discrepancies in incidence and type, with vascular access site complications being the most common (groin hematoma, femoral arterial pseudoaneurysms, and femoral arteriovenous fistula).1–4 We report a case of a 75-year-old White male patient with right groin lymphorrhea as an access site–related complication after second catheter ablation of recurrent atrial fibrillation.A case of successful catheter ablation for biatrial reentrant tachycardia after a Mustard operation for dextro-transposition of the great arteries
Mustard and Senning operations are atrial switch techniques for dextro-transposition of the great arteries (d-TGA) that have been mainly performed during a period from the 1960s to the mid-1980s.Incessant atrioventricular nodal reentrant tachycardia resulting in tachycardia-induced cardiomyopathy and catastrophic embolization of left ventricular thrombus
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common paroxysmal supraventricular tachycardia (SVT) featuring repetitive salvos with spontaneous termination. Few reports exist demonstrating incessant AVNRT with chronically uncontrolled ventricular rates and tachycardia-induced cardiomyopathy (TIC).1,2 Persistent cases of incessant AVNRT resulting in TIC and intracavitary thrombus are exceedingly rare.2 We report a case of incessant slow/fast AVNRT associated with TIC and catastrophic embolization of left ventricular (LV) thrombus treated with acute radiofrequency slow pathway modification.Successful ablation of ventricular tachycardia in a patient with Chagas disease using ethanol ablation in the coronary venous system: A case report
Chagas disease is a parasitic zoonosis that constitutes a severe public health problem and is endemic in 21 Latin American countries.1 It is estimated that between 6 and 8 million people are infected with Trypanosoma cruzi (T cruzi), with an additional 65 million at risk of acquiring the disease by vector-borne transmission, blood or congenital transmission, or food-borne transmission.2,3 Chagas disease has an acute, indeterminate, and chronic phase. If untreated, the acute phase may transition to an indeterminate phase characterized by seropositivity for T cruzi in the absence of clinical symptoms.Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report
Cardioneuroablation (CNA) has been proposed as an alternative treatment for patients with refractory vasovagal syncope (VVS), functional atrioventricular block (AVB), or functional bradyarrhythmia instead of classical treatment or pacemaker.1 Vagal denervation is achieved by endocardial catheter ablation targeting atrial fibrillation nests (AFN)2 and ganglionic plexus (GP)-related areas. We describe a clinical case of cardioinhibitory carotid sinus syndrome (CSS) treated with CNA, where partial vagal denervation was achieved over sinus node.
