Para-Hisian atrial tachycardia: A neglected cause of severe heart failure in children.

Incessant focal atrial tachycardia (FAT) is the most common cause of tachycardia-induced cardiomyopathy in pediatric patients and is usually a reversible condition with effective management of tachycardia, either with medical treatment or ablation. These patients may be misdiagnosed, potentially leading to inappropriate treatment. Diagnosis is often late and should always be suspected in patients with congestive heart failure and unexplained persistent tachycardia. Para-Hisian atrial tachycardia is not an uncommon type of FATs; however, catheter ablation of anterior atrial septum-ATs has been a challenge because of its proximity to the AV node and the complex anatomy of its region.

Recovery of cardiogenic shock with ablation of incessant tachycardia in a neonate.

Supraventricular tachycardia (SVT) is one of the most common conditions in neonates that require emergency cardiac care. Its incidence in infancy is 0.06 and 0.25 per 1000 patients per year by the age of 1 month and one year respectively. The symptoms are usually nonspecific and include poor feeding, irritability, vomiting, cyanosis, and pallid spells. If the symptoms are unrecognized for hours to days, the infant can present with significant hemodynamic compromise or heart failure. Despite the success of conservative management in most cases, catheter ablation is required in cases of failure of medical treatment. We report a case of SVT ablation using a single catheter in a neonate who presented with tachycardia-inducedcardiomyopathy (TIC).

Prevalence and predictors of aortic root abscess among patients with left-sided infective endocarditis: a cross-sectional comparative study.

BACKGROUND: Aortic root abscess (ARA) is a major complication of infective endocarditis that is associated with increased morbidity and mortality. Limited data are present about patient characteristics and outcomes in this lethal disease. We aimed to study the clinical and echocardiographic characteristics of patients with ARA compared to patients with left-sided infective endocarditis without ARA. We included patients with a definite diagnosis of left-sided infective endocarditis according to modified Duke's criteria. The patients were classified into two groups according to the presence of ARA (ARA and NO-ARA groups). All the patients were studied regarding their demographic data, clinical characteristics, laboratory and imaging data, and complications. RESULTS: We included 285 patients with left-sided infective endocarditis. The incidence of ARA was 21.4% (61 patients). Underlying heart disease, mechanical prosthesis, bicuspid aortic valve, and prior IE were significantly higher in ARA. The level of CRP was higher in ARA (p = 0.03). ARA group showed more aortic valve vegetations (73.8% vs. 37.1%, p < 0.001), more aortic paravalvular leakage (26.7% vs. 4.5%, p < 0.001), and less mitral valve vegetations (21.3% vs. 68.8%, p < 0.001). Logistic regression analysis showed that the odds of ARA increased in the following conditions: aortic paravalvular leak (OR 3.9, 95% CI 1.2-13, p = 0.03), mechanical prosthesis (OR 3.6, 95% CI 1.5-8.7, p = 0.005), aortic valve vegetations (OR 3.0, 95% CI 1.2-8.0, p = 0.02), and undetected organism (OR 2.3, 95% CI 1.1-4.6, p = 0.02), while the odds of ARA decreased with mitral valve vegetations (OR 0.2, 95% CI 0.08-0.5, p = 0.001). We did not find a difference between both groups regarding the incidence of major complications, including in-hospital mortality. CONCLUSION: In our study, ARA occurred in one fifth of patients with left-sided IE. Patients with mechanical prosthesis, aortic paravalvular leakage, aortic vegetations, and undetected organisms had higher odds of ARA, while patients with mitral vegetations had lower odds of ARA.