Adiponectin is an adipocyte specific cytokine which, in contrast to other adipokines, has been described to have antiinflammatory, antithrombotic, and anti-atherogenic properties. This study evaluates the association between plasma adiponectin levels with acute coronary syndrome (ACS) and angiographic coronary lesion severity in Indian population. Ninety patients included in the study were divided in two groups in 1 : 1 ratio—patients admitted with a diagnosis of ACS and those without ACS. Adiponectin and other risk markers are measured in forty-five consecutive patients in each group undergoing coronary angiography. Patients without ACS were found to have higher adiponectin (16.47 ± 7.88 μg/mL) levels than patients with ACS (9.03 ± 3.13 μg/mL) (P < 0.001). In multiple regression analysis adjusted for all other risk markers, higher adiponectin levels remain positively associated with a lower risk of ACS (P value > 0.002). The greatest increase in risk for ACS was seen at adiponectin levels ≤12.20 μg/mL in study subjects. The adiponectin levels were inversely related to the angiographic severity of coronary artery stenosis increases (P value > 0.02). The study concluded that higher adiponectin levels are independently associated with lower risk of ACS, and patients with severe angiographic coronary artery disease have lower levels of adiponectin.

Real world data on management and outcomes of ventricular tachycardia (VT) storm are scarce. This prospective study evaluates the clinical profile, in-hospital outcome and intermediate outcome in patients presenting with VT Storm. A majority (36/50, 72%) were male and the age was 54 ± 15 years. Scar VT was the most common underlying substrate for VT stormand pleomorphic VT was the predominant morphology. Twenty-one (42%) patients underwent cardiac sympathetic denervation, 6 (12%) patients underwent radiofrequency ablation (RFA), 3 (6%) patients amongst these underwent both the precedures in addition to conventional medical management. The overall mortality was 18% and VT free survival was 54%at 6 months follow up. VT recurrence was more common with severe LV dysfunction.

"Digitalis toxicity, often candidly indexed as poisoning, has plagued the medical profession for over 200 years. The situation qualifies as a professional disgrace on the basis of three items: the situation persists, physicians are often slow to recognize it and, over the decades, writers have been harsh in their denunciation of fellow physicians when toxicity has occurred…." These are the opening remarks of an essay published in 1983 on the 2nd centenary of William Withering's 'magic potion from foxglove's extract for dropsy.' Even today, after many decades, these words appear relevant! We present and discuss an interesting ECG of digitalis toxicity.

We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

We present an interesting case of a 2½-year-old child with Tetrology of Fallot with a large intracardiac mass in the left ventricle presenting with fever and bilateral stroke, that resolving with antitubercular therapy alone.

Use of atrial pacing has been known, yet underutilized tool for effective temporary pacing whenever needed early after cardiac surgery. The reasons may be frequent failures of epicardial wires (fixed over atria intra-operative) leading to loss of capture. Endocardial atrial pacing sites for temporary pacing are unstable and hence continuous pacing with acceptable thresholds is impossible. We describe a case of ischemic cardiomyopathy and severe left ventricle systolic dysfunction who required atrial pacing post coronary artery bypass grafting (CABG) surgery for around 48–72 hours starting 4th day post operation when he had multiple episodes of ventricular fibrillation (VF) needing many defibrillation shocks. VF episodes were triggered by premature ventricular complexes (PVC) falling on as R on T. Episodes were refractory to anti-arrhythmic drugs and general anesthesia. These PVC were successfully overdriven by atrial pacing by fluoroscopically placing pacing lead in coronary sinus. This led to complete suppression of PVC induced VF for next 48–72 hours while the antiarrhythmic drugs were continued. Subsequently the patient was discharged in stable state. Atrial pacing, though quite valuable during the post-operative period after cardiac surgery, is underutilized, especially when pacing through surgically placed epicardial wire fails. This report is helpful in drawing attention towards coronary sinus (CS) as an alternate site for achieving stable, temporary atrial pacing during the post-operative period. This site can also be utilized for short term dual chamber pacing if required in post-operative state using transvenous CS site for atrial pacing and intraoperatively placed epicardial wire for ventricular pacing.

Background:The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). Methods:Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction.In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB.Results: Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p < 0.001).Conclusion: Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording. K E Y W O R D Scardiac rhythm event recorders, electrophysiologic study, supraventricular tachycardia, tachycardia mechanisms

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