Update of the European Association of Cardiovascular Imaging (EACVI) Core Syllabus for the European Cardiovascular Magnetic Resonance Certification Exam.

An updated version of the European Association of Cardiovascular Imaging (EACVI) Core Syllabus for the European Cardiovascular Magnetic Resonance (CMR) Certification Exam is now available online. The syllabus lists key elements of knowledge in CMR. It represents a framework for the development of training curricula and provides expected knowledge-based learning outcomes to the CMR trainees, in particular those intending to demonstrate CMR knowledge in the European CMR exam, a core requirement in the CMR certification process.

Dual-chamber pacemaker malfunction mimicking atrial capture by the ventricular electrode.

A 78-year-old man came for a scheduled check up one month after the implantation of a permanent dualchamber pacemaker for symptomatic transient atrioventricular conduction disturbances (intermittent Mobitz II atrioventricular block). The patient's ECG indicated a loss of atrial capture by the atrial electrode with 1:1 atrioventricular conduction. A subsequent X-ray examination showed that both electrodes were well placed and in their correct sites. A detailed check of the pacemaker using the programmer, together with an echocardiographic examination, revealed the true nature of the malfunction: there was a significant delay between the atrial capture and atrial depolarisation and systole, as well as a loss of ventricular capture because of an acute increase in the threshold. Normal pacemaker function and pacing ECG were restored through modification of the pacemaker's functional parameters.

Three-dimensional echocardiographic documentation of pacemaker lead perforation presenting as acute pericarditis.

Myocardial perforation is a rare complication of permanent pacemaker insertion and is usually detected during the first month after implantation. Pericardial effusion often occurs at the same time, and as a consequence may generate difficulties in the diagnostic workup due to the various aetiologies of its origin. Computed tomography has been used for the documentation of lead perforation, but its diagnostic accuracy in comparison to echocardiographic examination has not been validated. We report a case of ventricular perforation causing pericarditis, initially undetected by computed tomography, that was finally diagnosed by means of real-time three-dimensional echocardiography.

High power radiofrequency ablation of incessant atrioventricular re-entrant tachycardia in a patient with a Para-Hisian accessory pathway.

Radiofrequency ablation is the interventional therapy of choice for the definitive cure of patients with tachycardias facilitated by accessory pathways. Ablation of an accessory pathway at sites close to the His bundle is inevitably associated with an increased risk of causing complete atrioventricular block. Here we describe the case of a patient with pre-excitation syndrome and episodes of supraventricular tachycardia, in whom an electrophysiological study identified an accessory pathway so close to the His bundle that discrete sites between the pathway and the His bundle were extremely difficult to find. After a first, unsuccessful attempt at ablation the patient developed incessant supraventricular tachycardia. The accessory pathway was successfully ablated in a second session using high power radiofrequency current, although this entailed a great increase in the risk of causing complete atrioventricular block.