There are reports documenting that electromagnetic waves generated by deep brain stimulation devices can interfere with cardiac pacemakers. This might be even a life-threatening problem in cardiac pacemaker-dependent patients. Herein, we present a case report on a patient with bilaterally implanted deep brain stimulation devices, who concomitantly had the indications for permanent cardiac pacing. The report shows that a leadless AV pacemaker may be a safe and reasonable option in these cases.

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Aims  To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. Methods and results  Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457–3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10–2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00–1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02–5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59–0.80, P = 0.0007). Conclusion  All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.

Atypical atrial flutter is a rare supraventricular tachyarrhythmia which is extremely challenging to visualize using well-known mapping systems. A new approach using ultra-fast, high-resolution 3D mapping systems could be a step forward in understanding and treatment of this arrhythmia. We report a case of a 54-year-old man with paroxysmal, atypical atrial flutter who was admitted to a tertiary cardiology center. The patient had undergone pulmonary vein isolation due to atrial fibrillation and as a result of the intervention he developed atypical atrial flutter. The arrhythmia had previously been treated with electrical cardioversion but without any success. An ultra-fast, high-density 3D mapping system (Rhythmia, Boston Scientific) was used to determine the arrhythmia localization. Ablation was done with a 8.5F basket mapping catheter equipped with 64 low-noise electrodes. This system allowed for precise and adequate mapping, thus enabling the patient's arrhythmia to convert to sinus rhythm.

In case of the need of pacemaker implantation, patients with artificial tricuspid valve are a special group of subjects, because of high risk of dysfunction of the prosthesis. In case of mechanical prosthesis of tricuspid valve the leads of pacemaker are usually located in coronary sinus. In case of biological prosthesis of tricuspid valve despite of the risk of prosthesis damage the electrodes are implanted endocardially. The leadless pacemakers seems to be promising alternative in patients with artificial tricuspid valve because of minor risk of valve damage. The case report concerns to the patient with tachycardia-bradycardia syndrome and biological prosthesis of tricuspid valve in whom the leadless pacemaker Micra was implanted.