Limitation of standard ECG criteria to localize an outflow tract PVC.

Multiple ECG algorithms exist to localize outflow tract PVCs. They can be invaluable in pre-procedure planning and patient counseling. We describe a case where the published algorithm for PVC localization did not predict the site of origin and successful ablation site. This case highlights the strengths and limitations of established ECG PVC localization algorithms.

Bradyarrhythmias in patients with COVID-19: Marker of poor prognosis?

BACKGROUND: Despite descriptions of various cardiovascular manifestations in patients with coronavirus disease 2019 (COVID-19), there is a paucity of reports of new onset bradyarrhythmias, and the clinical implications of these events are unknown. METHODS: Seven patients presented with or developed severe bradyarrhythmias requiring pacing support during the course of their COVID-19 illness over a 6-week period of peak COVID-19 incidence. A retrospective review of their presentations and clinical course was performed. RESULTS: Symptomatic high-degree heart block was present on initial presentation in three of seven patients (43%), and four patients developed sinus arrest or paroxysmal high-degree atrioventricular block. No patients in this series demonstrated left ventricular systolic dysfunction or acute cardiac injury, whereas all patients had elevated inflammatory markers. In some patients, bradyarrhythmias occurred prior to the onset of respiratory symptoms. Death from complications of COVID-19 infection occurred in 57% (4/7) patients during the initial hospitalization and in 71% (5/7) patients within 3 months of presentation. CONCLUSIONS: Despite management of bradycardia with temporary (3/7) or permanent leadless pacemakers (4/7), there was a high rate of short-term morbidity and death due to complications of COVID-19. The association between new-onset bradyarrhythmias and poor outcomes may influence management strategies for acutely ill patients with COVID-19.

Cardiac arrest in a patient with normal coronary arteries.

We describe the case of a 47-year-old woman who presented with the clinical picture typical for the entity described as transient left ventricular apical ballooning syndrome (Takotsubo cardiomyopathy). She presented with chest pain secondary to vasospasm after an emotional argument. Her coronary anatomy was free of significant atherosclerotic lesions, and her ventriculogram revealed apical ballooning in the shape similar to the round-bottomed Japanese pot used for trapping octopus.

A rare case of "runaway" pacemaker in a modern CPU-controlled pacemaker.

"Runaway" pacemaker is a rare entity that occurs when a malfunctioning artificial cardiac pacemaker abruptly accelerates its pacing rate above the set upper rate limit. This can result in life-threatening dysrhythmia. Runaway pacemaker used to occur more frequently in older model pacemakers, but now with newer pacemaker generators, runaway pacemaker is a rare entity. We report the case of a runaway pacemaker in a modern CPU-controlled pacemaker in a 79-year-old man presenting with lightheadedness and review the literature regarding this rare entity.