Use of an active-fixation coronary sinus lead to implant a biventricular pacemaker via the femoral vein.

Cardiac resynchronization therapy, which involves the placement of a pacing lead in the right atrium and in each ventricle, is effective in treating heart failure that is caused by left bundle branch block and cardiomyopathy. The left ventricular lead is usually placed into a lateral branch of the coronary sinus via the subclavian route. When the subclavian route is unavailable, insertion of a standard, passive-fixation coronary sinus lead via the femoral approach is feasible; however, the likelihood of subsequent dislodgment is high. Herein, we describe the placement of a novel, self-retaining, active-fixation coronary sinus lead--the Attain StarFix Model 4195 OTW Lead--in an elderly heart-failure patient, via the femoral approach. We believe that this is the 1st report of this procedure.

The prevalence of Brugada ECG in adult patients in a large university hospital in the western United States.

The prevalence of Brugada ECG in the United States is controversial and has not been studied in the western United States. The goal of this study is to evaluate the prevalence of Brugada syndrome appearing on ECGs in a large university hospital located in California. A total of 1348 ECGs performed at a university hospital in southern California in 1995 were randomly selected and reviewed for fulfilling 1 of the 3 types of Brugada criteria. Patients' baseline data were recorded, including age, sex, and race. Only 2 (0.14%) ECGs were consistent with 1 of the 3 types of Brugada syndrome. Both were classified as type 2. One of the patients was an Asian woman and the second was a Hispanic man. The mean age of study population was 52.7+/-16.2 years and consisted of 55% Caucasian patients followed by 20.8% Hispanic patients. The incidence of Brugada is rare among adult patients at a university hospital in the western United States.

Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla cardiomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy.

BACKGROUND: Transient left ventricular apical ballooning syndrome, also called "Tako-Tsubo cardiomyopathy," is increasingly being recognized as a cause of cardiomyopathy occurring during stress, with characteristic apical ballooning appearance of the left ventricle and the finding of normal coronary arteries on angiogram. In this manuscript, we review the available literature about the pathogenesis and characteristics of this syndrome.

Early diagnosis of stress-induced apical ballooning syndrome based on classic echocardiographic findings and correlation with cardiac catheterization.

Stress-induced apical ballooning has been described as a reversible condition involving the apical left ventricular wall, sparing the base, and causing a ballooning appearance of the left ventricle during systole despite normal coronaries. We are presenting 4 cases of apical ballooning seen at our institution with echocardiographic correlation. Echocardiography showed similar anatomical apical ballooning of the left ventricular apex. The diagnosis of apical ballooning syndrome was suspected based on echocardiography in conjunction with clinical data before cardiac catheterization was performed. In one case, in addition to classic left ventricular apical ballooning, marked right ventricular apical akinesia was present on the initial echocardiographic examination. This makes diagnosis of apical ballooning syndrome most likely in this patient before cardiac catheterization. Therefore, we suggest using echocardiography more often for the early diagnosis of this disease, based on careful anatomic evaluation in conjunction with clinical data. Wall motion analysis should reveal an apical ballooning appearance involving many coronary territories. Furthermore, the additional presence of right ventricular apical akinesia during echocardiographic examination makes the diagnosis of this syndrome more likely.

Clinical characteristics, demographics and prognosis of transient left ventricular apical ballooning syndrome.

BACKGROUND: Transient left ventricular apical ballooning syndrome also called Tako-Tsubo cardiomyopathy is defined as a syndrome consisting of stress induced apical ballooning of the left ventricle and normal coronary arteries. The majority of the published reports are case reports or case series with a small number of patients. The goal of this study was to perform statistical analysis of reported cases and case series in the literature in order to study demographic, clinical characteristics and prognosis of this syndrome. METHOD: A PubMed search of the terms transient left ventricular apical ballooning, Tako-Tsubo, takotsubo, and apical cardiomyopathy was conducted for this study. All reports that contained information about individual patients were included in the statistical analysis. RESULTS: The majority of the patients were women (93.5%). Asians were the largest group (57.2%) followed by Caucasians (40%). The presentations mimics an acute myocardial infarction. The most frequent presenting symptom was chest pain (65.9%) followed by dyspnea (16.2%). ST elevation was the most common ECG abnormality (87.5%). Contrary to most reports, this is not a benign disease with complications occurring in 18.9% and death in 3.2%. The most common complication was shock followed by left ventricular thrombus formation and congestive heart failure. CONCLUSION: Apical ballooning syndrome occurs most commonly in women and is associated with high complication rate. There are significant differences in presenting symptoms between race and gender which warrant further investigation.