Wide QRS tachycardia with ventriculoatrial dissociation in early postoperative aortic valve replacement period: an atypical nodal reentry presentation.

We report an atypical presentation of atrioventricular (AV) nodal reentry tachycardia with periods of ventriculoatrial Wenckebach and complete ventriculoatrial dissociation which appeared in a male patient in the postoperative period following aortic valve replacement and plication of Valsalva's posterior sinus. The context for the onset of this AV nodal reentry tachycardia and the concurrent electrophysiological findings support the hypothesis of a strictly nodal location of the circuit and suggest that the electrical modifications sustained by the perinodal region are the triggering agent for the reentry mechanism. Therefore, the AV nodal reentry is a mechanism that must be considered when tachycardia appears in the early postoperative period following aortic valve replacement.

Late gadolinium-enhanced cardiovascular magnetic resonance identifies patients with standardized definition of ischemic cardiomyopathy: a single centre experience.

BACKGROUND: Definition of ischemic cardiomyopathy (IC) is not always obvious, which is why new criteria based on prognosis and the extent of the coronary artery disease (CAD) have been proposed. In the present study, we assess the capability of late gadolinium-enhanced cardiovascular magnetic resonance (CMR) for predicting IC as determined by standardized criteria previously reported. METHODS AND RESULTS: 123 patients with heart failure (HF) and left ventricular (LV) systolic dysfunction, underwent both late gadolinium-enhanced CMR and coronary angiography 37/123 (30%) of patients were assigned to the IC group and 86/123 (70%) to the non-IC group. Subendocardial late gadolinium enhancement (LGE) was found in 35/37 (94%) of patients in the IC group, whereas only 12/86 (14%) had this distribution in the non-IC group (p<0.001). There was a significant positive correlation between the extent of subendocardial LGE and that of the CAD as determined by the CAD Prognostic Index (r=0.78, p<0.01), the number of coronary stenoses > or = 50% (r=0.76, p<0.01) and the number of coronary stenoses of any percentage (r=0.70, p<0.01). CONCLUSION: In patients with HF and LV systolic dysfunction presence of subendocardial LGE makes an excellent indicator of underlying significant CAD, and the extent of the LGE correlates with the severity of the disease. It is therefore appealing as a method for diagnosing IC.