scholarly journals Left bundle branch block revealing a primary small bowel carcinoid metastasizing to the interventricular septum

2020 ◽  
Vol 31 (3) ◽  
pp. 408-410
Author(s):  
Sameh M Said ◽  
Prabhjot Nijjar ◽  
Molly Klein ◽  
Ranjit John
Keyword(s):  
Small Bowel ◽  
Metastatic Disease ◽  
Left Bundle Branch Block ◽  
Interventricular Septum ◽  
Bundle Branch Block ◽  
Carcinoid Tumours ◽  
Hepatic Involvement ◽  
The Right ◽  
Primary Small Bowel

Abstract Carcinoid tumours of the heart occur most commonly as a result of metastatic disease and usually affect the right side of the heart. We report a case of a solitary carcinoid metastasis to the interventricular septum without hepatic involvement in a 74-year-old man.

Best Site on Right Ventricle for Open-Chest Biventricular Pacing

2007 ◽  
Vol 15 (5) ◽  
pp. 427-431 ◽  
Author(s):  
Giampaolo Luzi ◽  
Andrea Montalto ◽  
Vincenzo Polizzi ◽  
Cesare C D'Alessandro ◽  
Mariano Vicchio ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Bundle Branch Block ◽  
Biventricular Pacing ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Lead ◽  
The Right

Cardiac resynchronization therapy is effective in patients with a low ejection fraction and left bundle branch block, but 20%–30% do not respond despite selection of the optimal site for pacing on the left ventricle. We investigated whether optimizing the site for placement of the pacing lead on the right ventricle could further improve left ventricular function during cardiac resynchronization in 19 patients (mean age, 63 ± 5 years) undergoing coronary artery bypass with post-ischemic dilated myocardiopathy (ejection fraction, 25.8% ± 2%) and left bundle branch block. The hemodynamic response to pacing was tested with the right ventricular lead positioned at the interventricular septum, atrioventricular junction, acute margin, and the pulmonary trunk. Biventricular stimulation improved left ventricular function. When the right ventricular lead was sited at the interventricular septum, a significant improvement in all hemodynamic parameters compared to the other sites was obtained. Biventricular pacing is important to optimize cardiac resynchronization. Although further studies are needed to confirm these findings, accurate lead placement is recommended for cardiac resynchronization therapy in patients with poor cardiac function and left bundle branch block.

scholarly journals Relationship between left bundle branch block patterns and super-response to cardiac resynchronization therapy in patients with heart failure

2021 ◽  
Vol 26 (7) ◽  
pp. 4227
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
V. V. Todosiychuk ◽  
A. M. Soldatova ◽  
D. V. Krinochkin
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Septal Wall ◽  
Group I

Aim. To assess a relationship of left bundle branch block (LBBB) patterns defined by electrocardiography (ECG) and echocardiography with super-response (SR) to cardiac resynchronization therapy (CRT).Material and methods. Sixty patients (mean age, 54,5±10,4 years) were examined at baseline and during follow-up (10,6±3,6 months). Patients were divided into groups: group I (n=31) — decrease of left ventricular end-systolic volume (ESV) ≥30% (super-responders) and II group (n=29) — decrease of LV ESV <30% (non-super-responders). Three strain-markers of LBBB assessed by tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) were used: early contraction of basal or midventricular segment in the septal wall and early stretching of basal or midventricular segment in the lateral wall (marker 1); early peak contraction of the septal wall occurred in the first 70% of the systolic ejection phase (marker 2, septal flash (SF)); early stretching wall that showed peak contraction after aortic valve closure (marker 3). The classical LBBB pattern was defined if all three strain-markers were present. The heterogeneous LBBB pattern was defined if two from three strain-markers were present.Results. At baseline, groups did not differ in main clinical characteristics, including QRS width and LBBB assessed by ECG. Mechanical abnormalities were found only in group I: SF (32,3% vs 0,0%; p=0,001) and apical rocking (19,4% vs 0,0%; p=0,024), as well as classic LBBB mechanical pattern (20,8% vs 0,0%; p=0,05). The complex of heterogeneous LBBB mechanical pattern (odds ratio (OR), 7,512; 95% CI, 1,434-39,632; р=0,025), interventricular mechanical delay (OR, 1,037; 95% CI, 1,005-1,071; р=0,017) and longitudinal strain of interventricular septum mid segment (OR, 0,726; 95% CI, 0,540-0,977; р=0,035) had an independent relationship with SR. According to the ROC analysis, the sensitivity and specificity of model in SR prediction were 77,3% and 91,3% (AUC=0,862; p<0,001).Conclusion. SR is associated with both LBBB mechanical patterns assessed by STE and TDI. LBBB defined by ECG did not have significant association with SR to CRT.

scholarly journals Primary Small Bowel Liposarcoma (Atypical Lipomatous Tumour) with Myogenic Differentiation

Sarcoma ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
J. Patel ◽  
R. Deb ◽  
W. Speake ◽  
T. A. MacCulloch
Keyword(s):  
Small Bowel ◽  
Bowel Wall ◽  
Myogenic Differentiation ◽  
Iliac Fossa ◽  
Current Case ◽  
Lipomatous Tumour ◽  
Small Intestinal ◽  
Well Differentiated ◽  
The Right ◽  
Primary Small Bowel

Primary small intestinal liposarcomas originating in the small bowel are uncommon with a generally poor prognosis due to the advanced stage at the time of diagnosis. We describe a case of primary small bowel dedifferentiated liposarcoma presenting as a solid mass in the right iliac fossa. The current case is unusual as the tumour seemingly originated from the bowel and the well-differentiated component was seen extensively infiltrating the bowel wall including the small bowel submucosa.

scholarly journals Ablation of Supraventricular Tachycardias From Concealed Left-Sided Nodoventricular and Nodofascicular Accessory Pathways

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Ricardo Cardona-Guarache ◽  
Frederick T. Han ◽  
Duy T. Nguyen ◽  
Alexandru B. Chicos ◽  
Nitish Badhwar ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Atrioventricular Node ◽  
Premature Ventricular Contractions ◽  
Bundle Branch Block ◽  
Accessory Pathways ◽  
Transseptal Approach ◽  
Overdrive Pacing ◽  
Atrial Electrogram ◽  
The Right ◽  
Supraventricular Tachycardias

Background: Nodoventricular and nodofascicular accessory pathways (AP) are uncommon connections between the atrioventricular node and the fascicles or ventricles. Methods: Five patients with nodofascicular or nodoventricular tachycardia were studied. Results: We identified 5 patients with concealed, left-sided nodoventricular (n=4), and nodofascicular (n=1) AP. We proved the participation of AP in tachycardia by delivering His-synchronous premature ventricular contractions that either delayed the subsequent atrial electrogram or terminated the tachycardia (n=3), and by observing an increase in VA interval coincident with left bundle branch block (n=2). The APs were not atrioventricular pathways because the septal VA interval during tachycardia was <70 ms in 3, 1 had spontaneous atrioventricular dissociation, and in 1 the atria were dissociated from the circuit with atrial overdrive pacing. Entrainment from the right ventricle showed ventricular fusion in 4 out of 5 cases. A left-sided origin of the AP was suspected after failed ablation of the right inferior extension of atrioventricular node in 3 cases and by observing a VA increase with left bundle branch block in 2 cases. The nodofascicular and 3 of the nodoventricular AP were successfully ablated from within the proximal coronary sinus (CS) guided by recorded potentials at the roof of the CS, and 1 nodoventricular AP was ablated via a transseptal approach near the CS os. Conclusions: Left-sided nodofascicular and nodoventricular AP appear to connect the ventricles with the CS musculature in the region of the CS os. Mapping and successful ablation sites can be guided by recording potentials within or near the CS os.

scholarly journals Reversal of left bundle branch block–induced cardiomyopathy by His bundle pacing

2019 ◽  
Vol 48 (2) ◽  
pp. 030006051988418
Author(s):  
Fei Liu ◽  
Lijun Zeng ◽  
Xiaomeng Yin ◽  
Lianjun Gao ◽  
Yunlong Xia ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Heart Function ◽  
Nonischemic Cardiomyopathy ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Temporary Pacemaker ◽  
Nonischemic Dilated Cardiomyopathy ◽  
The Right

A 61-year-old woman was referred to our institution for evaluation of severe nonischemic dilated cardiomyopathy and left bundle branch block (LBBB). After permanent His bundle pacing, the LBBB was immediately corrected; however, the right bundle branch was injured during the procedure. Subsequent recovery of the right bundle branch block and normalization of heart function were observed during follow-up. This case indicates that LBBB might result in the development of nonischemic cardiomyopathy and emphasizes the necessity of a temporary pacemaker during His bundle pacing for patients with LBBB.

scholarly journals Mechanisms of Abnormal Systolic Motion of the Interventricular Septum During Left Bundle-Branch Block

2011 ◽  
Vol 4 (3) ◽  
pp. 264-273 ◽  
Author(s):  
Ola Gjesdal ◽  
Espen W. Remme ◽  
Anders Opdahl ◽  
Helge Skulstad ◽  
Kristoffer Russell ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Interventricular Septum ◽  
Bundle Branch Block

scholarly journals Right Atrial Diverticulum in an Adult Woman with Left Bundle Branch Block

2020 ◽  
Vol 20 (4) ◽  
pp. e394-396
Author(s):  
Behnam Shakerian ◽  
Mohammad H. Mandegar
Keyword(s):  
Left Bundle Branch Block ◽  
Imaging Study ◽  
Right Atrial ◽  
Magnetic Resonance Imaging Study ◽  
Resonance Imaging ◽  
Bundle Branch Block ◽  
Clinical Presentations ◽  
History Of ◽  
The Right

Right atrial diverticulum is a very rare anomaly. It is an outpouching arising from the right atrial free wall. Clinical presentations vary widely but some cases are associated with supraventricular tachycardia and atrial flutter/fibrillation. The incidence/prevalence of this anomaly is not available because only a few cases have been reported. We report a 38-year-old female patient who presented to the Heart Clinic, Tehran, Iran in 2019 with a history of dyspnea and chest pain. Electrocardiography revealed left bundle branch block. Following a magnetic resonance imaging study, the patient was diagnosed with a right atrial diverticulum. She underwent surgical resection of the diverticulum. The post-operative course was uneventful and no recurrence of the arrhythmia was detected during the six months of follow-up. To the best of the authors’ knowledge, this combination has not been described in the literature. Keywords: Right Atrium; Diverticulum; Left Bundle Branch Block; Case Report; Iran.

scholarly journals QT interval estimation in patients with right bundle branch block using validated formulas for left bundle branch block

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Garcia Gomez ◽  
E Garcia Izquierdo Jaen ◽  
S Mingo Santos ◽  
A Martinez Mingo ◽  
J Toquero Ramos ◽  
...  
Keyword(s):  
Right Bundle Branch Block ◽  
Left Bundle Branch Block ◽  
Qt Interval ◽  
Cycle Length ◽  
Pulmonary Veins ◽  
Interventricular Septum ◽  
Intraclass Correlation ◽  
Interval Estimation ◽  
Qtc Interval ◽  
Bundle Branch Block

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Adequate measurement of the QT interval is of paramount importance in order to identify patients at higher risk for ventricular arrhythmias. Previous studies have described different methods to estimate baseline QT in patients with left bundle branch block (LBBB). However, the evidence regarding the assessment of QT interval in the setting of right bundle branch block (RBBB) is scarce.  PURPOSE We aimed to analyze the feasibility and accuracy of the different formulas described for LBBB in the estimation of the QT interval in RBBB.  METHODS We enrolled patients who underwent left sided electrophysiologic procedures. All patients were in sinus rhythm and had narrow QRS. Pacing was performed from the left atrial appendage for baseline measurements, and from the left aspect of the interventricular septum (selective capture of the left bundle was attempted) to measure RBBB QT and QRS. Pacing cycle length was 800 ms or slightly below patients´ intrinsic rhythm at both locations. Measurements were performed manually (using digital calipers) according to current recommendations and corrected using Bazett. Validated formulas for LBBB QT considered are described in table 1.  RESULTS 50 patients (42 cryoballoon pulmonary veins isolation (PVI), 4 radiofrequency PVI, 4 concealed left accessory pathways). 70% were male. Mean age was 62 ± 11 years old. Left ventricle ejection fraction was 58 ± 10%. 66% and 60% of the patients were taking betablockers and antiarrhythmic drugs, respectively. Mean pacing cycle length was 707 ± 99 ms. Baseline measurements: QRS 95 ± 10, QT 391 ± 36, QTc 467 ± 39 ms. RBBB measurements: QRS 165 ± 21, QT 448 ± 46, QTc 531 ± 52 ms. Correlations between baseline and estimated QTc were good for all the formulas (table 1). Reliability analysis showed that both Yankelson and Wang methods had the highest intraclass correlation coefficients (ICC) when trying to estimate baseline QTc.  CONCLUSIONS Previously described formulas for LBBB exhibit marked differences regarding reliability in the estimation of QTc interval in the setting of RBBB. According to our results, Yankelson’s method shows the most consistent agreement when estimating baseline QTc interval in patients with RBBB. Table 1.LBBB METHODFormula to estimate baseline QTcPearson’s R correlation coefficientCI (95%)Intraclass correlation coefficientCI (95%)YankelsonQTc - QRS + 95 (m) or 88 (f)0.805(0.632-0.977)0.882(0.788-0.934)Bogossian**QT - (QRS/2)0.813(0.644-0.982)0.756(-0.127-0.919)Wang**QT - (0.86*QRS - 71)0.801(0.627-0.974)0.834(0.465-0.930)Tang-Rabkin0.945*QTcRabkin - 260.722(0.521-0.923)0.711(0.019-0.885)RautaharjuQT - 155*(60/heart rate - 1) - 0.93*(QRS - 139) - 22 (m) or - 34 (f)0.780(0.599-0.961)0.105(-0.017-0.381)**Bogossian and Wang required additional HR correction (Bazett).  Abstract Figure 1. Bland-Altman

Max Brödel: Illustrating Healed Valve Ring Abscesses

2005 ◽  
Vol 129 (9) ◽  
pp. 1155-1158
Author(s):  
Brendan P. Lucey ◽  
Caroline Bedell Thomas ◽  
Grover M. Hutchins
Keyword(s):  
Diuretic Therapy ◽  
Interventricular Septum ◽  
Severe Congestive Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Aortic Sinus ◽  
Bundle Branch Block ◽  
Johns Hopkins University ◽  
Cardiac Lesions ◽  
The Right

Abstract A 14-year-old adolescent girl presented with severe congestive heart failure, progressive throughout 3 months. A precordial thrill, machinery-like murmur, and right bundle branch block were noted. Death occurred despite digitalis and diuretic therapy and removal of pleural and ascitic fluid. The autopsy revealed 2 multilocular cystic structures in the interventricular septum consistent with being spontaneously drained valve ring abscesses. One of these lesions formed a fistulous communication that penetrated through the interventricular septum between the right aortic sinus of Valsalva and the crista supraventricularis that connected to the right ventricle. Another lesion, an adjacent separate but similar cystlike structure, communicated only with the left ventricular cavity. Although the cause of these lesions is uncertain, it seems probable that they are the residue of spontaneously drained and healed valve ring abscesses. Max Brödel, a medical illustrator and the first director of the Department of Art as Applied to Medicine at The Johns Hopkins University, drew previously unpublished figures of this patient's cardiac lesions. These illustrations exhibit Brö del's superb command of both art and medicine essential to his ability to make complex anatomic relationships demonstrable. We discuss Brödel's career and his influence on both the art and science of medicine.

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