In the clinic, blood pressure is measured almost exclusively using non-invasive intermittent techniques, of which the auscultatory (Riva-Rocci/Korotkoff, RRK) and the computerized oscillometric method are most often used. However, both methods only provide a momentary value. In addition, the accuracy is hampered by phenomena such as cuff response and white coat hypertension, thus providing artefactually increased values. The vascular unloading technique of Penáz together with the Physiocal criteria of Wesseling provide reliable, non-invasive and continuous estimates of blood pressure. This technique is thus an alternative to the invasive intra-arterial measurements in many cases, without the risks and ethical questions inherent to invasive measurements. Since the pressure waveform is available continuously, computations such as pulse contour and Modelflow cardiac output, spectral analysis and baroreflex sensitivity provide further information on the dynamics of the cardiovascular system on a beat-to-beat basis, similar to intra-arterial measurements.

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Three shocks of 2 joules (2,000 volts within 0.3 msec) were given to a patient with ventricular tachycardia of right ventricular origin at the site of the earliest activation. A standard 6 Fr USCI mapping catheter was used. After the first shock the cycle length prolonged from 385 to 531 msec. After the second shock, the tachycardia was no longer inducible and it remained so after 1 week. No recurrences were seen during a follow-up period of 8 months. This is the first report demonstrating efficacy of modified low energy shocks for ventricular tachycardia.

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Atrial septal defects (ASD) are among the most common forms of congenital heart disease. Although surgical correction was the only available therapy for decades, its long-term complications remain unknown and many patients do not have structured medical follow-up in later life. However, increasing evidences suggest that late-onset cardiac problems, such as complete heart block (CHB), can arise after surgery and therefore, long-term follow-up should be advised in these patients. We hereby present an interesting case of CHB occurring in a 30-year-old patient who had undergone surgical secundum ASD closure approximately 21 years prior to this event and now presented with episodes of dizziness and pre-syncope. Seven-day Holter reported seven episodes of CHB, corresponding to the presenting complaints. The patient was successfully managed with conduction system pacing and he remained asymptomatic on further follow-up. The case description is followed by a brief overview of the available literature.