Double valve replacement in a patient with implantable cardioverter defibrillator with severe left ventricular dysfunction.

Recent data from landmark trials suggest that the indications for cardiac pacing and implantable cardioverter defibrillators (ICDs) are set to expand to include heart failure, sleep‑disordered breathing, and possibly routine implantation in patients with myocardial infarction and poor ventricular function.[1] This will inevitably result in more patients with cardiac devices undergoing surgeries. Perioperative electromagnetic interference and their potential effects on ICDs pose considerable challenges to the anesthesiologists.[2] We present a case of a patient with automatic ICD with severe left ventricular dysfunction posted for double valve replacement.

Paroxysmal atrial fibrillation: an unusual association of leptospirosis.

A 60 year old nonsmoker, non-diabetic, normotensive farmer presented with 4 days history of fever, myalgia & headache. He had relative bradycardia, eye congestion, diffuse muscle tenderness and tender hepatomegaly at presentation. He developed subconjunctival hemorrhage on 3rd in-hospital day. His investigations showed thrombocytopenia, hepatic and renal dysfunctions. His leptospira serology was positive. He was treated with injection crystalline penicillin and supportive therapy. While on treatment, even though he did not have any known cardiac risk factors, except for his age & gender, he developed 3 paroxysms of atrial fibrillation on 5th - 7th in-hospital days, without hemodynamic instability. His cardiac markers and echocardiogram during the paroxysms were otherwise normal. He had uneventful recovery, remained in sinus rhythm and stable at follow-up. This paroxysmal atrial fibrillation may be a coincidence or attributed as unusual association of leptospirosis.