Coronary artery disease in patients aged 35 or less - a different beast?

To assess the extent and severity of coronary artery disease [CAD] in 200 consecutive patients aged 35 years or less undergoing diagnostic coronary angiography. Findings in these 200 patients [

use of ECG gated myocardial perfusion SPECT in the evaluation of septal wall perfusion defect in patients with LBBB

Left bundle branch block [LBBB], affects septal wall thickening during systole, due to abnormal polarization pattern. However, in patients with LBBB, frequent septal perfusion defects are reported in Myocardial Perfusion SPECT even when there is no coronary stenosis on angiography. GATED Myocardial Perfusion SPECT [Single Photon Emission Tomography] is an accurate indicator and has shown high sensitivity and specificity to diagnose CAD. Septal perfusion defects in patients with LBBB is intensified during stress perfusion scintigraphy due to abnormal systolic phase in the septum, and abnormal conduction which gives a false appearance of reduced perfusion during the systolic phase. Stress-rest Gated Myocardial Perfusion SPECT using Tc99m myoview was performed in 20 subjects with LBBB with probability of CAD. Visual analyses of the slice images and revision results of Gated SPECT study were done on end diastolic [ED], end systolic [ES] images, regional wall motion and wall thickness for evaluation of the perfusion of septum. Visual analysis of stress-rest slices: 1] Reversible septal hypoperfusion was noted in 13 [65%] patients. 2] Fixed septal defects in 4 [20%]. 3] Three patients [15%] had normal septal perfusion. Quantitative analysis of gated study: 1] Out of the 13 patients with reversible hypoperfusion, 8 [40%] show normal findings on Gated SPECT and only the remaining 5 [25%] patients had true reversible hypoperfusion. 2] The 4 patients with fixed septal defects show normal findings on Gated SPECT. The use of Gated myocardial perfusion scintigraphy particularly end-diastolic images can help in the evaluation of septal perfusion, wall motion and thickening and hence differentiate true perfusion defects from false patterns in cases of LBBB

Radiofrequency ablation of ventricular tachycardia in post myocardial infarction patients: Kuwait experience

We evaluated prospectively 5 patients with previous myocardial infarction who had ventricular tachycardia. The objective of this study was to describe the arrhythmogenic areas and ablate the ischemic VT successfully with multiple radiofrequency applications. All patients were considered eligible irrespective of the presence of Automatic implantable cardioverter-defibrillator implants. Coronary artery bypass graft was performed for two patients. One patient had developed ventricular tachycardia/ventricular fibrillation post surgery requiring radiofrequency ablation followed by AICO implantation. Three patients with ischemic cardiomyopathy, who had AICO, developed VT prior to the radio frequency ablation therapy. In 5 patients with ventricular tachyarrhythmias three dimensional mapping was performed using non contact mapping [EnSite]. RF ablations targeted the arrhythmogenic areas of infarcted zone. All patients were rendered completely non inducible at the end of the procedure. The mean procedure time measured was 3 hours. No complications were observed in any of those patients. On follow up, all patients improved clinically with regard to the quality of life and number of AICD shocks. One post AICD patient had non sustained ventricular tachycardia, during the follow up period. This is a limited study of our local experience in the successful radio frequency ablation of ischemic ventricular tachycardia