Left VENTRICULAR aneurysms (LVAs) are characterized by a wide connection to the left ventricle and paradoxical systolic motions. Although patients with LVAs are usually asymptomatic, some may present with arrhythmias, heart failure, and even cardiac arrest. In this case report, we describe a 62-year-old male patient who presented to our emergency service with complaints of palpitation and shortness of breath of 2 hours’ duration. His blood pressure was 84/56 mm Hg, and he was in a confused state. An electrocardiogram revealed VENTRICULAR TACHYCARDIA (VT) with right bundle branch block and a VENTRICULAR rate of 188 bpm. The patient’ s hemodynamic instability necessitated a direct current cardioversion, which restored the sinus rhythm. During the in-hospital course, he had numerous recurrent VT episodes despite treatment with intravenous amiodarone and magnesium sulfate as well as radiofrequency ablation. Upon consensus with a cardiovascular surgeon’ s team, urgent surgery was performed due to the resistant VT episodes. The patient’ s clinical course was uneventful, and he was discharged on the 11th postoperative day. We have been following up the patient for almost 1 year, during which he has not experienced palpitations or associated symptoms. Our case indicates that surgery may be a preferable treatment option for patients with heart failure and resistant VT related to LVAs.

Background: By analyzing stored intracardiac electrograms during spontaneous monomorphic VENTRICULAR TACHYCARDIA (VT), we examined the possible mechanisms of the VT initiation in a group of patients with implantable cardioverter defibrillators (ICDs).Methods: Stored electrograms (EGMs) of monomorphic VTs from at least 5 beats before initiation and after the termination of VT were analyzed. Cycle length, sinus rate, and the prematurity index for each episode were noted.Results: We studied 182 episodes of VT among 50 patients with ICDs. VENTRICULAR premature complex (VPC) -induced episode (extrasystolic initiation) was the most frequent pattern (106; 58%), followed by 76 episodes (42%) in the sudden-onset group. Among the VPC-induced group, VPCs were different in morphology from subsequent VT in 85 episodes (80%).Sudden-onset episodes had longer cycle lengths (377±30ms) in comparison with the VPC induced ones (349±29 ms;p= 0.001). Sinus rate before VT was faster in the sudden-onset compared to the VPC-induced group (599±227 ms versus 664±213 ms;p=0.005). Both of these episodes responded similarly to ICD therapy. There was no statistically significant difference in coupling interval, prematurity index, underlying heart disease, ejection fraction, and ant arrhythmic drug use between the two groups (p=NS).Conclusions: Dissimilarities between VT initiation patterns could not be explained by differences in electrical (coupling interval, and prematurely index; p=NS) or clinical (heart disease, ejection fraction, and antiarrhythmic drugs; p=NS) variables among the patients. Information obtained by the analysis of stored EGMs could be helpful for the understanding of VT electrophysiology.

Background: Distinguishing the origin of VENTRICULAR TACHYCARDIA (VT) by electrocardiogram (ECG) which is performed in all patients, helps to diagnose the cause of VT before trying invasive procedures. The aim of this study was to compare the ECG findings in patients with VT originating from Right or Left VENTRICULAR Outflow Tracts (RVOT or LVOT).Methods: Fifty nine patients with VT originating from LVOT or RVOT were selected for this cross-sectional study. The patients were recruited while they were attending Shahid Rajaei Hospital in Tehran, Iran in2009-2010 for catheter ablation. The participants were evaluated for the prevalence of LVOT and RVOT and were compared for the success rate of radiofrequency catheter ablation.Results: Out of 59 patients, 44.1% were male and 55.9% were female. The mean age of the participants was41.67 (SD=13.76) years. QRS transition and notch in ECGs were significantly different (respectively, P=0.027 and P=0.007) between patients with LVOT and RVOT. R-to-QRS duration in precordial leads was significantly longer in patients with LVOT than those with RVOT [0.81 (SD=0.06) ms vs.0.69 (SD=0.16), P=0.015]. Successful ablation was performed in73.2% of patients with RVOT versus 93.3% of those with LVOT, but despite a higher rate the differences were not statistically significant (P=0.215).Conclusion: In this study, RF catheter ablation was successful like other studies on patients with VENTRICULAR TACHYCARDIA and RVOT VT and LVOT VT had significant differences in notch, QRS transition and R-to-QRS duration in precordial leads which are important in differentiating between the two conditions.

A 36-year-old man, who had a history of aortic valve replacement 8 years previously because of severe aortic stenosis and bicuspid aortic valve, presented to the emergency department with a hemodynamically unstable VENTRICULAR TACHYCARDIA. Echocardiography showed an asymmetrical left VENTRICULAR hypertrophy and a normal functioning prosthetic valve with a negligible transvalvular gradient and no evidence of patient-prosthetic mismatch. Cardiac magnetic resonance imaging revealed left VENTRICULAR hypertrophy with an apical aneurysm, diffuse late gadolinium enhancement, and a midcavitary obstruction, all in favor of hypertrophic cardiomyopathy. VENTRICULAR TACHYCARDIA ablation was done via the trans-septal approach, and an implantable cardioverter-defibrillator was inserted.

Background: One of the causes of mortality in acute myocardial infarction (AMI) is VENTRICULAR TACHYCARDIA. Potassium (K) level disturbances are one of the probable causes of VENTRICULAR TACHYCARDIA in patients with AMI. Objective: To determine the relationship between serum potassium level and frequency of VENTRICULAR TACHYCARDIA in early stages of AMI. Methods: Through a cross-sectional study on 162 patients with AMI in the C.C.U of Nour hospital in Isfahan (1999), the patients' serum potassium level was classified into three groups: 1) K<3.8 meq/lit, 2) 3.8≤k<4.5 meq/lit and 3) K≥4.5 meq/lit. Then, the incidence of VENTRICULAR TACHYCARDIA in the first 24 hours after AMI was determined in each group by Chi square statistical method. Findings: The frequency of VENTRICULAR TACHYCARDIA in the first 24 hours after AMI in K< 3.8 meq/lit, 3.8≤K<4.5 meq/lit and K≥4.5 meq/lit groups were 19.0%, 9.6% and 9.9% respectively. The frequency of this arrhythmia in the first group as compared with the second and the third group was significant (P<0.05). Conclusion: Hypokalemia increases the probability of VENTRICULAR TACHYCARDIA in patients with AMI. Thus , the follow up and treatment of hypokalemia in these patients is of special importance.