Cardiac echinococcosis, a multidisciplinary approach in the diagnosis and treatment of this rare entity: two case reports and literature review.

We present two case reports of cardiac echinococcosis. Case 1 was a 33-year-old woman with hepatic and cardiac echinococcosis. The parasitic cyst was located intramyocardially in the free wall of the left ventricle leading to cranial dislocation of the left circumflex coronary artery (LCx). The patient was successfully operated. Case 2 was a 28-year-old woman with hepatic and cardiac echinococcosis. The parasitic cyst was located in the left ventricular myocardium in the area of the apex and manifested clinically as paroxysms of ventricular tachycardia. The ultrasound study showed a 3.2×2.8 cm cyst dislocating the papillary muscles and causing moderate mitral regurgitation.Bulgaria ranks first in the European Union in terms of the number of echinococcosis patients. Although cardiac involvement is uncommon, occurring in only 0.5%-2% of cases, it can cause a wide range of clinical symptoms. Multimodal imaging is a key step in the management of patients with cardiac involvement.

Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia.

PURPOSE: To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology. METHODS: Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value <0.05. RESULTS: The population was aged 48.5 ± 15.7 (12-85) years; males were 38.5%. AH jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation - in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% - only by burst pacing; in 14.8% - only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = -0.204, Р<0.001. CONCLUSION: Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients.

The non-fluoroscopic navigation reduces significantly not only the fluoroscopic exposure during catheter ablation of the cavotricuspid isthmus but the total radiofrequency time as well.

Objective The non-fluoroscopic navigation (NFN) is known to reduce the fluoroscopic time during catheter ablation of various arrhythmias. We aimed to study the impact of NFN over several procedural parameters during radiofrequency (RF) catheter ablation of the cavo-tricuspid isthmus (CTI) in patients with CTI-dependent atrial flutter. Methods Data about 124 consecutive patients with CTI ablation performed were retrospectively collected. The patients were divided into two groups: (1) ablation with two diagnostic catheters deployed in the coronary sinus and around the tricuspid annulus (NFN-, n = 62); (2) ablation with the same two catheters plus NFN system using cutaneous patches (NFN+, n = 62). Several procedural parameters were analysed. The non-parametric Mann-Whitney test was used for statistical analysis. A P-value <0.05 was considered significant. Results Acute success was achieved in 122 patients (98.4%), recurrences of atrial flutter were observed in 11 patients (8.9%). There were no significant differences between the NFN + and NFN- groups in the procedural duration (169.6 vs 157.6 min) and the recurrences (6.5 vs 11.3%). In the NFN + group the fluoroscopic time was shorter (9.4 vs 16.7 min), DAP was lower (2,128.3 vs 4,129.9 µGy*m2), the total RF time was shorter (1,870.5 vs 2,335.5 sec), Р < 0.05 for all parameters. Conclusions NFN reduces significantly not only the x-ray exposure but the total RF time as well. It does not influence the procedural duration and the recurrence rate. The acute and long-term success of catheter ablation of CTI is high irrespective of the use of NFN.