The exact reentrant circuit of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) remains unclear. This case report demonstrates the reentrant circuit of ILVT. A 20-pole electrode catheter was placed along the left posterior fascicle during electrophysiologic study. ILVT was reproducibly induced by programmed ventricular stimulation. During the tachycardia, sequential diastolic potentials bridging the entire diastolic period were observed in the recordings from the electrodes positioned from left ventricular mid-septum to inferoapical septum. The slow conduction zone appeared to be composed of a false tendon in this patient. Entrainment of the ILVT from the right ventricular outflow tract at a different pacing cycle length revealed that a dominant conduction delay occurred at the proximal site of the slow conduction zone. Entrainment studies from several sites on the left ventricular septum confirmed that these sites where sequential electrical activity was recorded were included within the reentrant circuit. However, the left posterior fascicle itself seemed to be a bystander. This report provides the direct evidence of macroreentry as the underlying mechanism of this ILVT, adjacent to the left posterior fascicle.

An unusual case of atrial tachycardia (AT) originating from the superior vena cava (SVC) is reported. A 34-year-old man without structural heart disease underwent catheter ablation for drug-resistant AT. During the tachycardia, low-amplitude spiky electrograms with a cycle length of 120 to 175 msec were recorded in the SVC and exhibited 2:1 exit block to the atria, masquerading as the atrial activation observed with high right AT. These spiky electrograms also were observed during sinus rhythm, but they appeared immediately after the local atrial electrograms. The spikes were traced to a point 3 cm above the junction of the right atrium. Radiofrequency ablation at the site of the earliest appearance of the spike in the SVC successfully eliminated the tachycardia. During the following 15 months, no clinically significant atrial arrhythmias, including atrial fibrillation, occurred. This report indicates that careful mapping, including inside the SVC, will be a requisite in patients with high right atrial tachyarrhythmias.

No abstract

A 52-year-old man with Down's syndrome was implanted with a DDDR pacemaker for advanced atrioventricular block. He was admitted with development of skin eczema and partial exposure of the generator 1 year after reimplantation. There was no evidence of infection on laboratory data. A skin patch test was positive for the metal of the generator (purity 99.9% titanium) after 72 hours. These findings indicated pacemaker contact dermatitis. After the patient was reimplanted with a pacemaker wrapped with a polytetrafluoroethylene sheet, there has been no recurrence of the contact dermatitis during a follow-up period of 3 years.

Rapid measurement of D-dimer is useful for the screening of ACVD in the emergency setting.