Unmasking Brugada Syndrome with Oral Flecainide Provocation. A Case Series of Three Patients

The present case series discuss three patients who had brugada type 2/ type 3 like ECG pattern that was converted to type 1 pattern with oral flecanide challenge test. Brugada syndrome is associated with a high incidence of sudden cardiac death, typical ECG pattern being ST-segment elevation in the right precordial leads with T wave inversion. Pharmacological provocation should only be performed when the baseline ECG is not diagnostic of Brugada Syndrome. PR prolongation in the baseline ECG is also a contraindication because of the risk of inducing AV block. Drug challenge is performed under strict monitoring of BP and 12-lead ECG and facilities for cardio version and resuscitation are available. Atypical RBBB pattern/type 2/3 Brugada pattern on ECG in patients of syncope or family history of sudden cardiac arrest is commonly encountered by a cardiologist. This can be performed to provoke type 1 brugada pattern on ECG. Diagnosed cases of Brugada may be treated with ICD with proper indication if needed and thus prevent sudden cardiac death.

Repeated fracture of pacemaker leads with migration into the pulmonary circulation and temporary pacemaker wire insertion via the azygous vein.

Repeated implantation of pacemaker in the same patient is a common occurrence because of the increased longevity of patients. However, repeated lead fracture in the same patient and migration of the pacemaker lead into the pulmonary circulation is rare. We describe a 56-year-old gentleman who had undergone pacemaker implantations thrice due to repeated lead fractures (thrice) and also had migration of the pacemaker lead into the pulmonary circulation. He also had an azygous vein which was noticed while placing the temporary pacemaker wire.

Splenic aspiration in childhood visceral leishmaniasis: an experience from Assir region of Saudi Arabia

To study the role of diagnostic splenic aspiration in Arabian childhood visceral leishmaniasis, in a situation where many children with possible visceral leishmaniasis remained undiagnosed by bone marrow aspiration alone. Prospective study of the safety and reliability of diagnostic splenic aspiration. Asir Central hospital, the regional referral hospital for Asir Province, an area endemic for visceral leishmaniasis. Hospitalized bone-marrow negative children with suspected visceral leishmaniasis in whom parental consent was available and a coagulopathy had been excluded or corrected. Percutaneous splenic aspiration using a small-calibre [22-gauge] needle, rapid-aspiration technique, and examination of Giemsa-stained smears for amastigote leishman Donovan bodies. Close monitoring of patients post-aspiration for complications. Parasites were detected in 12 of 12 [100%] children with visceral leishmaniasis and absent in two children with other illnesses. There were no failed taps or complications. Splenic aspiration is a safe and reliable alternative diagnostic method in bone marrow negative children with suspected visceral leishmaniasis in the appropriate hospital setting. Further experience is required to confirm our findings