Concealed antegrade penetration of the atrio-ventricular node.

We present a patient with paroxysmal, non-sustained atrial tachycardia (AT) on routine surveillance 24-hour Holter post pulmonary vein isolation (PVI). Several asymptomatic ventricular pauses are noted to follow each burst of AT. We postulate that these pauses are due to the resultant concealed penetration of the atrio-ventricular node (AVN) in combination with sino-atrial node overdrive suppression. Recognition of this physiological phenomenon may help avoid unnecessary intervention arising from Holter recording misinterpretation.

Superior approach for radiofrequency ablation of atrio-ventricular nodal reentrant tachycardia in a patient with anomalous inferior vena cava and azygos continuation.

We present a 45-year-old woman with supraventricular tachycardia. During placement of diagnostic catheters, an interruption of the inferior vena cava was suspected. An MRI confirmed the interruption of the inferior vena cava above the level of the renal veins with azygos vein continuation up to the superior vena cava. Catheter ablation was performed using a superior approach via the left subclavian vein.

Burnout, perceived stress, and depression among cardiology residents in Argentina.

OBJECTIVE: Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes. METHODS: The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory. RESULTS: One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group. CONCLUSION: Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.