Pre-excitation related to Mahaim physiology

ESC CardioMed ◽  
2018 ◽  
pp. 2094-2100
Author(s):  
Carlo Pappone ◽  
Vincenzo Santinelli
Keyword(s):  
Treatment Options ◽  
Pharmacological Therapy ◽  
Anatomical Location ◽  
Conducting System ◽  
Bundle Branch Block ◽  
Accessory Pathways ◽  
Histopathological Correlation ◽  
Definitive Therapy ◽  
Block Pattern ◽  
Decremental Conduction

Rare accessory pathways, such as Mahaim fibres, have been postulated to result in cardiac pre-excitation. However, most lack the histopathological correlation that has been demonstrated for the Wolff–Parkinson–White pattern. This chapter will discuss the Mahaim fibre tachycardias with left bundle branch block pattern. Mahaim fibres are characterized by the presence of different accessory pathways with decremental conduction (Mahaim physiology, i.e. conduction slows at faster heart rates), which only conducts in an antegrade fashion. The Mahaim fibres have a different anatomical location and distribution that characteristically terminate in the ventricles into or near the conducting system and are responsible for the constellation of electrophysiological features that define Mahaim tachycardias. Similar to other types of pre-excitation syndromes, there are two treatment options available for the treatment of Mahaim fibre tachycardias: pharmacological therapy and/or curative ablation. Catheter ablation offers the greatest chance at definitive therapy for symptomatic patients experiencing frequent Mahaim tachycardias.

scholarly journals A rare complication of implantable cardiac defibrillator placement

2020 ◽  
Author(s):  
João Ferreira ◽  
Célia Marques Domingues ◽  
Susana Isabel Costa ◽  
Maria Fátima Franco Silva ◽  
Lino Manuel Martins Gonçalves
Keyword(s):  
Heart Failure ◽  
Right Bundle Branch Block ◽  
Left Ventricular Systolic Dysfunction ◽  
Rare Complication ◽  
Systolic Dysfunction ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Refractory Ascites ◽  
Bundle Branch Block ◽  
Block Pattern

Abstract Background Implantable cardiac defibrillators (ICD) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. Case presentation The authors present a case of a 64-year-old woman with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block pattern and later confirmed by echocardiography which showed the lead tip in contact with the mid segment of the left ventricular antero-lateral wall. As the patient hospitalisation was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. Conclusions An electrocardiogram showing a right bundle branch block pattern during VVI pacing should arise the suspicion of inadvertent placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.

scholarly journals Clinical practice guidelines for insomnia disorder

2017 ◽  
Vol 59 (3) ◽  
pp. 45-51
Author(s):  
Lucille Malan ◽  
Nokuthula Dlamini
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Treatment Options ◽  
Early Morning ◽  
Behavioural Therapy ◽  
Pharmacological Therapy ◽  
Chronic Insomnia ◽  
First Line Therapy ◽  
Insomnia Disorder ◽  
Cognitive Behavioural ◽  
Falling Asleep

Insomnia disorder is defined as difficulty in falling asleep, maintaining sleep, and early morning awakenings. Common daytime consequences experienced are fatigue, mood instability and impaired concentration. In chronic insomnia these symptoms persist over a period of at least three months. Chronic insomnia can also be a symptom of a variety of disorders. The pathophysiology of insomnia is theorised as a disorder of nocturnal and daytime hyper-arousal as a result of increased somatic, cortical and cognitive activation. The causes of insomnia can be categorized into situational, medical, psychiatric and pharmacologically-induced. To diagnose insomnia, it is required to evaluate the daytime and nocturnal symptoms, as well as psychiatric and medical history. The Diagnostic and Statistical Manual 5 Criteria (DSM-5) also provides guidelines and criteria to be followed when diagnosing insomnia disorder. Goals of treatment for insomnia disorder are to correct the underlying sleep complaint and this, together with insomnia symptoms, their severity and duration, as well as co-morbid disorders will determine the choice of treatment. In the majority of patients, insomnia can be treated without pharmacological therapy and cognitive behavioural therapy is considered first-line therapy for all patients with insomnia. The most common pharmacological insomnia treatments include benzodiazepines and benzodiazepines receptor agonists. To avoid tolerance and dependence, these hypnotics are recommended to be used at the lowest possible dose, intermittently and for the shortest duration possible. A combination of cognitive behavioural therapy and pharmacological treatment options is recommended for chronic insomnia.

scholarly journals Genetic characterization of colorectal cancer using a next generation sequencing approach to identify a specific pattern of somatic alterations in tumors arising from different anatomic sites

2016 ◽  
Author(s):  
Carmelo Laudanna ◽  
Gianluca Santamaria ◽  
Simona Migliozzi ◽  
Duarte Mendes Oliveira ◽  
Donatella Malanga ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Copy Number ◽  
Treatment Options ◽  
Copy Number Variations ◽  
Specific Pattern ◽  
Surgical Approaches ◽  
Anatomical Location ◽  
Molecular Alterations ◽  
Somatic Alterations ◽  
Novel Biomarkers

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths worldwide, with nearly 1.4 million new cases diagnosed in 2012. CRC results from the accumulation of multiple genetic and epigenetic aberrations. Tumor localization in the large intestine tract determines different surgical approaches and treatment options. Considering the heterogeneous nature of these tumors we hypothesized that different patterns of molecular alterations could be associated with a specific anatomical location. To identify distinct genomic alterations (e.g, copy number variations and mutations) associated to different CRC anatomical sites we sequenced 32 CRCs samples from different location (right-sided, left-sided etc.) using the Ion AmpliSeq™ Comprehensive Cancer Panel that covered the whole coding sequence of 409 tumor suppressor genes and oncogenes frequently altered in cancer. Interestingly left-sided tumors were generally more altered respect to right-sided ones. Cluster analysis of all samples allowed the identification of 21-gene core that were significantly mutated in all sample groups. As expected, KRAS and APC mutations were frequently in the tumors resected from different anatomical localizations. Unsupervised analysis of copy number variations reveals a core of 160-gene significantly altered. In addition to the expected SRC, MYC and CEBPA, we found interestingly genes in validation status. Despite missing a significant number of cases, gene panel provides a solid alternative approach to WES in order to characterize a signature of alterations correlated with CRC tumor and the identification of novel biomarkers in colorectal carcinoma that could be used as potential clinical target.

scholarly journals Update on the Treatment of Idiopathic Hypersomnia

2019 ◽  
Vol 5 (4) ◽  
pp. 207-214
Author(s):  
M. S. Schinkelshoek ◽  
R. Fronczek ◽  
G. J. Lammers
Keyword(s):  
Treatment Options ◽  
Pharmacological Therapy ◽  
Small Sample ◽  
Treatment Modalities ◽  
Lifestyle Advice ◽  
Pharmacological Interventions ◽  
First Choice ◽  
Idiopathic Hypersomnia ◽  
Small Sample Sizes

Abstract Purpose of Review Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia. Recent Findings Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms. Conclusion Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.

scholarly journals 216-70: QRS duration and bundle branch block pattern - Prevalence in heart failure with preserved ejection fraction

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i159-i159
Author(s):  
Liam Toner ◽  
Alex Voskoboinik ◽  
Michelle Ord ◽  
Andrew Teh ◽  
Han Lim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction ◽  
Bundle Branch Block ◽  
Qrs Duration ◽  
Block Pattern

scholarly journals Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

2011 ◽  
Vol 21 (3) ◽  
pp. 118-124 ◽  
Author(s):  
T. J. F. ten Cate ◽  
J. C. Kelder ◽  
H. W. M. Plokker ◽  
J. F. Verzijlbergen ◽  
N. M. van Hemel
Keyword(s):  
Left Bundle Branch Block ◽  
Cardiac Risk ◽  
Myocardial Spect ◽  
Current Management ◽  
Bundle Branch Block ◽  
Block Pattern

scholarly journals Biliary Tract Cancers: Molecular Heterogeneity and New Treatment Options

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3370
Author(s):  
Nicola Personeni ◽  
Ana Lleo ◽  
Tiziana Pressiani ◽  
Francesca Colapietro ◽  
Mark Robert Openshaw ◽  
...  
Keyword(s):  
Biliary Tract ◽  
Advanced Disease ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Resistance Mechanisms ◽  
Anatomical Location ◽  
Molecular Heterogeneity ◽  
Isocitrate Dehydrogenase 1 ◽  
Tract Cancer

Most patients with biliary tract cancer (BTC) are diagnosed with advanced disease, relapse rates are high in those undergoing surgery and prognosis remains poor, while the incidence is increasing. Treatment options are limited, and chemotherapy is still the standard of care in both adjuvant and advanced disease setting. In recent years, different subtypes of BTC have been defined depending on the anatomical location and genetic and/or epigenetic aberrations. Especially for intrahepatic cholangiocarcinoma (iCCA) novel therapeutic targets have been identified, including fibroblast growth factor receptor 2 gene fusions and isocitrate dehydrogenase 1 and 2 mutations, with molecularly targeted agents having shown evidence of activity in this subgroup of patients. Additionally, other pathways are being evaluated in both iCCA and other subtypes of BTC, alongside targeting of the immune microenvironment. The growing knowledge of BTC biology and molecular heterogeneity has paved the way for the development of new therapeutic approaches that will completely change the treatment paradigm for this disease in the near future. This review provides an overview of the molecular heterogeneity of BTC and summarizes new targets and emerging therapies in development. We also discuss resistance mechanisms, open issues, and future perspectives in the management of BTC.

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