A Case of Left Ventricular Noncompaction Accompanying Fasciculo-Ventricular Accessory Pathway and Atrial Flutter

Left ventricular hypertrabeculation/noncompaction (LVHT) is an uncommon type of genetic cardiomyopathy characterized by trabeculations and recesses within the ventricular myocardium. LVHT is associated with diastolic or systolic dysfunction, thromboembolic complications, and arrhythmias, including atrial fibrillation, ventricular arrhythmias, atrioventricular block and Wolff-Parkinson-White syndrome. Herein, we describe a patient who presented with heart failure and wide-complex tachycardia. Echocardiography showed LVHT accompanied with severe mitral regurgitation. The electrophysiologic study revealed a fasciculo-ventricular accessory pathway and atrial flutter (AFL). The AFL was successfully treated with catheter ablation.

Optimal Antithrombotic Strategy in Patients With Atrial Fibrillation After Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI. SUBJECTS AND METHODS: Three hundred sixty-two patients (68.0% men, mean age: 68.3+/-7.8 years) with AF and who had undergone PCI with stent implantation between 2005 and 2007 were enrolled. The clinical, demographic and procedural characteristics were reviewed and the stroke risk factors as well as antithrombotic regimens were analyzed. RESULTS: The accompanying comorbidities were as follows: hypertension (59.4%), diabetes (37.3%) and congestive heart failure (16.6%). The average number of stroke risk factors was 1.6. At the time of discharge after PCI, warfarin was prescribed for 84 patients (23.2%). Cilostazol was used in addition to dual antiplatelet therapy in 35% of the patients who did not receive warfarin. The mean follow-up period was 615+/-385 days. The incidences of major adverse cardiac events (MACE), stroke and major bleeding were 11.3%, 3.6% and 4.1%, respectively. By Kaplan-Meier survival analysis, warfarin treatment was not associated with a lower risk of MACE (p=0.886), but it was associated with an increased risk of major bleeding (p=0.002). CONCLUSION: Oral anticoagulation therapy after PCI may increase hemorrhagic events in Korean AF patients.

Rapidly Progressive Cardiac Manifestation of Behcet's Disease Involving Conduction System and Aortic Valve

Cardiac conduction system impairment is a rare clinical manifestation of Behcet's disease. We report a patient who showed 1st degree atrioventricular block at first presentation, and showed aggravated finding of 3rd degree atrioventricular block on five months later. His cardiac manifestation finally developed to acute severe aortic regurgitation on six months later from his first cardiac manifestation. We observed this rapid progression during 6 months and successfully improved symptom and disease severity of the patient with treatment targeting Behcet's disease.

A Case of Hemodynamically Unstable Bradycardia after Risperidone Overdose

Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illness, such as schizophrenia. It has strong serotonin and dopamine receptor antagonism and antagonist activity at alpha-adrenergic receptors and histamine receptors. An overdose of risperidone can cause tachycardia, hypertension, hypotension, prolonged QT interval, and bradycardia. Risperidone overdose is rare,but life-threatening. Here, we present the rare case of a 33- year-old woman who ingested risperidone overdose for the purposes of suicide, developing hemodynamically unstable bradycardia with trifascicular block, leading to fatality. Lessons from our case report are of urgent consideration for temporary pacemaker insertion, and use of alpha-1 agonist, such as phenylephrine in cases of hemodynamically unstable bradycardia by risperidone overdose. Prompt and appropriate identification and interventions are essential for the successful management of risperidone overdose.