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  • reverse transcriptase br Short case report A year

    2019-06-11


    Short case report A 65-year-old man with persistent AF underwent multi-detector computed tomography (CT) before catheter ablation. An anomalous muscular band connecting the posterior side of the left atrial roof and the right edge of fossa ovalis in the left atrium was detected (Fig. 1). During the ablation procedure, sheaths were inserted into the left atrium through a preexisting patent foramen ovale without trans-septal puncture; the band was detected as a translucent structure on angiography (Fig. 2A). Direct cardioversion caused atrial premature complex, originating from the left inferior reverse transcriptase (PV), and subsequent AF. Left PV isolation suppressed the AF recurrence. Therefore, we ended this session after isolating the left PV to avoid damaging the anomalous muscular band by catheter manipulation. A second ablation procedure was performed 6 months later owing to recurrence of paroxysmal AF. For this procedure, we re-isolated the left PV and then carefully passed the ablation catheter posterior and anterior to the band in order to completely isolate the right PV, thus preventing damage to the band itself (Fig. 2B). AF has not recurred for more than 3 years since the second session.
    Discussion The incidence of anomalous muscular bands in the left atrium was previously found to be 2% among autopsy cases (22 of 1100 autopsies) [2]. In most of these cases (19/22), this band was found to connect the left atrial side of the fossa ovalis with other areas of the left atrial endocardium. In addition, the presence of Chiari׳s network (27%), a patent foramen ovale (23%), and premature atrial complex (41%) were also observed in these cases. In the current case, we were able to perform catheter ablation through a preexisting patent foramen ovale. However, we were still unable to determine the presence of any other possible malformations and an AF-triggering premature complex arising from the band in our patient.
    Conclusion
    Conflict of interest
    In the , we previously reported the case of a 55-year-old woman with variant angina who was implanted with a pacemaker to treat cardiopulmonary arrest due to complete atrioventricular block and pulseless electrical activity . In this report, we follow the clinical outcome of the pacemaker implantation in this patient. Upon implantation, we simulated the proper and effective response of the pacemaker to prepare for the possibility that the patient might encounter coronary ischemia-induced bradycardia. A high output setting was selected in order to prevent pacing failure and a rate drop response (RDR) setting was selected both to ensure efficient pacing in the case of an angina attack and to conserve battery power during periods when there was no angina. Three years have passed since the pacemaker was implanted. During this time, the patient appears to have been in remission of vasospastic activity and the patient is doing well without symptomatic angina. We also evaluated the pacemaker data and found that an episode of paroxysmal atrioventricular block occurred asymptomatically and that the RDR response was functioning appropriately (). Finally, the ventricular pacing rate was 0.4% and the average battery longevity was 11.5 years (range, 9.5–13 years), which was longer than that of the ordinary setting. Conflict of interest
    These original images were encountered during interventional procedures. Awareness about the abnormalities that they depict is important to identify them. We present an original image of the coronary sinus lead. The lead was placed in the posterolateral branch of the coronary sinus during cardiac resynchronization therapy combined with implantation of an implantable cardioverter-defibrillator. We observed that the lead achieved a heart shape in the left anterior oblique position (). We would like to dedicate this image to all physicians who are devoted to their work. Conflict of interests