Lead perforation is a less-recognized delayed complication of device implantation. Delay in recognition may prove fatal. Predictors of postimplantation pericardial effusion, which serves as a marker of perforation, include concomitant use of transvenous pacemaker, steroid use within 7 days, and older age. The authors report a case of an 86-year-old patient who presented with a lead perforation 16 months following the original pacemaker insertion. Following surgical repair with sternotomy, a new ventricular lead was placed via a transvenous approach at the right ventricular septum. A higher clinical suspicion should be maintained in the elderly in whom perforation occurs more frequently, and consideration should be given to implanting the lead in sites other than the right ventricular apex to minimize the risk of this late complication.

Objectives: QT dispersion (QT_d) measures the variability of the ventricular recovery time. QT_d may identify patients at risk for ventricular arrhythmias and sudden cardiac death (SCD). The purpose of our study was to determine the effect of obstructive sleep apnea (OSA) on QT_d. Methods: There were 199 patients studied: 101 patients (28 women, 73 men) with OSA diagnosed in our sleep center and 98 patients (49 women, 49 men) without OSA from the outpatient clinic, representing the control group. QT intervals (milliseconds) were measured in each of the 12 leads of a standard surface electrocardiogram during wakefulness and QT_d calculated (QT_max – QT_min). QT^c_d, which corrects for heart rate, was also calculated. Results: Mean age and heart rate were similar in men and women with or without OSA. Control patients exhibited a significant difference (p < 0.001) in QT_d between men (48 ± 19) and women (31 ± 13). Men and women with OSA had similar QT_d (56 ± 35 vs. 54 ± 21) but higher QT_d compared to the control group. QT^c_d results were similar to QT_d. Conclusions: Patients with OSA and no structural heart disease have a higher QT_d/QT^c_d compared to an overtly healthy patient population, possibly serving as a marker for an increased risk of SCD.

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BackgroundDetecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography.MethodsThe study population consisted of 68 patients who underwent a cardiac MRI followed by an echocardiogram within a median time of 2.0 days and 49 of these patients who had a cardiac catheterization, median time of 2.0 days. The inter-rater agreement statistic (Kappa) was used to evaluate the agreement.ResultsThere was moderate agreement between cine MRI and Doppler echocardiography in assessing mitral regurgitation severity, with a kappa value of 0.47, confidence interval (CI) 0.29–0.65. There was also fair agreement between cine MRI and cardiac catheterization with a kappa value of 0.36, CI of 0.17–0.55.ConclusionCine MRI offers a reasonable alternative to both Doppler echocardiography and, to a lesser extent, cardiac catheterization for visually assessing the severity of mitral regurgitation with specific visual parameters during routine clinical cardiac MRI.

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We present a case demonstrating the utility of cardiovascular magnetic resonance (CMR) in the diagnosis of a cardiac mass. A 70-year-old female who presented with chest pressure and left sided jaw pain was found to have a cardiac mass on transthoracic and transesophageal echocardiography that was diagnosed as an atrial myxoma. A cardiac magnetic resonance test determined the mass to be more consistent with a thrombus than a myxoma through a stepwise approach using multiple pulse sequences. Thus, unwarranted and potentially risky thoracic surgery was avoided by the incorporation of a systematic evaluation by cardiac MRI.

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PCI risk scores utilizing easily collected variables are useful in discriminating risk and predicting death. NYRS might be simplified by removing the gender and left main coronary stenosis variables from its algorithm.