Introduction: Antitachycardia pacing (ATP) effectively treats monomorphic ventricular tachycardia (VT). The VT may cease immediately upon ATP completion (type‐1 break), or it may persist or change to another tachyarrhythmia for one or more beats before termination (type‐2 break). We investigated the prevalence and characteristics of type‐2 breaks in ICD patients. Methods and Results: We analyzed VT episodes with stored electrograms that had at least one ATP therapy delivered in PainFREE R x trial, a multicenter trial with 220 coronary artery disease patients. Further subanalysis was performed by classifying the VT as slow or fast based on the cycle length (CL); slow VT: CL > 320 ms, fast VT: 240 ≤ CL ≤ 320 ms. To assess the effect of ATP on VT, comparison was performed of pre‐ATP and post‐ATP CL variability, average CL, and morphology. A total of 514 episodes (264 slow VT and 250 fast VT) were analyzed. The burst ATP terminated 457 (89%; 239 slow VT and 218 fast VT) of 514 episodes. Forty five (10%) episodes in 18 (32%) patients had type‐2 breaks. The mean number of beats during type‐2 breaks was 5.4 ± 3.1 (median 4). The mean time for episode termination measured from the end of ATP to return of first sinus/paced beat was 2.9 ± 1.2 seconds (median 2.6). The VT CL variability increased by 150% after ATP delivery. The ATP affected either VT CL or morphology, or both of 36 (80%) type‐2 breaks (9% accelerated, 47% decelerated, 22% changed in morphology only). Among the 9 (20%) episodes that remained unchanged in morphology and CL, four episodes (9%) were unaffected by ATP. Conclusion: Approximately 10% of VT episodes that were successfully terminated with burst ATP therapy had type‐2 breaks. Type‐2 breaks are associated with an increase in CL variability. Approximately 9% of all type‐2 episodes may be spontaneously terminating nonsustained VT given that ATP did not affect these episodes in any way. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1156‐1162, November 2003)
Introduction: Prosthetic valve thrombosis (PVT) is a serious complication seen with mechanical prosthetic cardiac valves and is associated with high mortality. Emergency surgery (thrombectomy or valve replacement) had been the traditional treatment, but now with intravenous thrombolytic therapy as an alternative to emergency surgery in patients with PVT has shown excellent success rate and acceptable risk. This study is aimed to determine efficacy and safety of use of thrombolytic agents (tPA or STK) in patients with PVT. Materials and Methods: This was a retrospective, single-center study of patients with PVT admitted between 2004 and 2020 at a tertiary care center in North India. The diagnosis of PVT was based on a history of prosthetic heart valve replacement, clinical presentation, and by diagnostic methods. All patients received either tenecteplase or streptokinase given as a bolus dose of 2.5 lac units over ½ h, followed by 1 lac units/h for 24–48 h depending on clinical response and complication, whereas tenecteplase (1 mg/kg of body weight) was given as bolus. Results: Of 72 patients, 45 patients received t-PA as a thrombolytic drug. Complete success was obtained in 39 patients (86.66%), whereas partial success in 3 (17.77%) and failure in 3 (6.66%). Among the patients who received streptokinase ( n = 27), complete success was found in 23 patients (85.19%), whereas partial success was seen in 3 (11.11%) and failure was seen in 1 patient (3.7%). Conclusion: Thrombolysis is a reasonable option in patients with PVT. Our study has reiterated that major factors for PVT are warfarin poor compliance and subtherapeutic international normalized ratio. Postclosure clinical follow-up along with patient education should be followed in patients with mechanical prosthetic valve.
This is a case of cannabis-induced catatonia in an 18-year-old Hispanic male with no prior psychiatric history. Shortly after consuming marijuana, the patient experienced catatonic symptoms and demonstrated resistance to several medicinal therapies. Electroconvulsive therapy (ECT) proved to be a useful treatment choice, resulting in significant improvement in symptoms. This example emphasizes the potential dangers of cannabis usage, particularly in susceptible individuals, and underscores the importance of recognizing and treating catatonia as a possible side effect of cannabis use.
The syndromic approach has been the cornerstone of management of sexually transmitted infections (STIs) in developing countries. This strategy has had a considerable impact in decreasing the burden of STI in society. It offers the advantages of treating the infection at the first visit itself, reducing the risk of complications, non-reliance on laboratory diagnostics, and easy integration into the primary healthcare system. Nonetheless, it is not without limitations, most often criticized for its inability to treat asymptomatic cases. Syndromic management has been found to be satisfactory for genital ulcer disease and urethral discharge in several settings. However, its performance is not as good in the treatment of vaginal discharge syndrome, as it does not allow a distinction between cervicitis and vaginitis. Diagnostic validation and a review of its performance should be done periodically to keep abreast of the changing aetiology of various syndromes and patterns of drug susceptibility. Supplementing the syndromic approach with point-of-care tests and simple laboratory tests where available can improve its results. Further, healthcare professionals should be imparted training for optimum patient care. This narrative review critically appraises the syndromic approach to STIs, discusses the challenges that it faces, and offers suggestions to improve its performance.
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