An unusual cause of recurrent syncope in a patient with implantable cardioverter defibrillator.

Electromagnetic interferences (EMI) deriving from electrical devices may affect implantable cardioverter defibrillators (ICD). Improved algorithms have been developed in order to minimize adverse effects. However, caution should be still recommended in ICD recipients when handling electrical devices. Here we describe the case of an ICD patient with recurrent syncopal episodes due to inhibition of pacing by oversensing of electrical noise from a not properly grounded washing machine.

Reconstruction of the terminal of an abandoned fractured unipolar coronary sinus lead: a feasible solution to restore effective cardiac resynchronization therapy.

Complications related to coronary sinus lead are not infrequent in recipients of cardiac resynchronization devices. We describe the case of a patient with a biventricular implantable cardioverter defibrillator with persistent phrenic nerve stimulation, previous coronary sinus lead fracture, and severe left subclavian vein stenosis. The reimplantation of a new coronary sinus lead on the left side, ipsilateral to the original implant, was unsuccessful. In order to avoid more complex and risky procedures, we performed the repair of the fractured abandoned lead with the reconstruction of the unipolar lead terminal. Effective biventricular pacing was obtained with satisfactory electrical parameters and it was maintained at twelve months follow-up.

Apical ballooning syndrome (takotsubo cardiomyopathy) after permanent dual-chamber pacemaker implantation.

Apical ballooning syndrome, also called takotsubo cardiomyopathy, has been recently reported. It may mimic acute myocardial infarction and is typically observed in postmenopausal women after stressful events. A 75-year-old female after permanent dual chamber pacemaker implant complained of chest pain with repolarization alterations suggesting acute myocardial ischemia. Echocardiography showed a left ventricle with akinesia of the apical portions and reduced global systolic function. The patient was treated with antithrombotic agents and intravenous nitrates. No coronary lesions were found at angiography. At ventriculography, a typical takotsubo-like shape of the left ventricle was observed. The clinical and echocardiographic picture normalized at discharge.

Diagnostic capabilities of devices for cardiac resynchronization therapy.

Atrial fibrillation and chronic heart failure often coexist. Asymptomatic atrial fibrillation is common in patients with known atrial fibrillation but also in patients with no history of previous atrial fibrillation. The enhanced diagnostic capabilities of modern implantable devices for cardiac resynchronization therapy allow collecting of data on the clinical status of the patient in addition to information on device performance and cardiac rhythm. We present a paradigmatic case of newly diagnosed atrial fibrillation with hemodynamic consequences detected by the diagnostics of a biventricular implantable cardioverter-defibrillator. We discuss the clinical utility of device-based monitoring and the potential advantages of wireless remote-control systems of implantable devices in the management of heart failure patients.

Regression of warfarin-resistant left atrial appendage thrombus after ablation of atrial fibrillation and permanent pacing.

Atrial fibrillation is the most common rhythm disturbance and can also occur in absence of true cardiac disease. However, also in these cases, it can generate left atrial appendage thrombi with systemic embolic potential. A regular and well conducted anticoagulant therapy with dicoumarol derivatives, as indicated in these patients, is not always successful. We report the case of a patient with lone atrial fibrillation and a left atrial appendage thrombus resistant to anticoagulant therapy with warfarin, which disappeared after catheter ablation of atrial fibrillation by electrical disconnection of the pulmonary veins, restoration of sinus rhythm and dual-chamber pacemaker implantation.