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Narrow QRS-complex extrasystoles inducing a varying degree of AV block – what is the mechanism?


Iskra Bayraktarova, Milko Stoyanov, Tchavdar Shalganov

Cardiology Department

National Heart Hospital – Sofia


Address for correspondence:

Assoc. prof. Tchavdar Shalganov, MD, PhD

Cardiology Department

National Heart Hospital

65, Koniovitsa Str

1309 Sofia

Tel: +359-2-9211-411

Fax: +359-2-9211-402

This e-mail address is being protected from spambots. You need JavaScript enabled to view it


Extrasystolic arrhythmia is a common clinical finding. Treatment is indicated in case of limiting symptoms and/or large proportion of the ectopy. The possible treatment options as well as the long-term prognosis depend on the precise type of the extrasystoles. Standard surface electrocardiogram does not always provide sufficient information for a differential diagnosis. We present a case of rare extrasystolic arrhythmia with ECG features typical of both supraventricular and ventricular ectopy. The precise diagnosis was established through an electrophysiological study.

Key words: extrasystoles; atrioventricular block; electrocardiogram; electrophysiological study; radiofrequency ablation.


Supraventricular premature beats are commonly identified in clinical practice. Despite the possibility of sometimes identifying a precipitating factor for their occurrence (inflammation, ischaemia, hormonal imbalance, emotional or physical stress, alcohol usage, caffeine and nicotine-product consumption or other types of stimulants), it is not uncommon for extrasystoles to appear completely unprovoked. Their incidence rises with age, and the prognosis is in general favourable, except in cases where they trigger another type of supraventricular arrhythmia, for instance atrial flutter or atrial fibrillation. [3, 5] Therapy is indicated in cases of arrhythmia of a different type induced by the ectopic beats, or in the presence of disabling symptoms.


Acute double vessel myocardial infarction from the territory of te Left Anterior Descending artery (LAD) and the Right Coronary Artery (RCA), complicated by dissection of Left Main Coronary Artery (LMCA). A Case report.


Borislav Atzev, Yordan Dzhumean, Georgi Lyutov, Dima Vasenska
Clinic of Cardiology, MHAT “Puls”, 62 Slavyanska Str., Blagoevgrad 2700, Bulgaria
Tel. +359-88-8755-370
e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Summary: Acute myocardial infarction of two vascular territories is known as double or combined myocardial infarction. In this case report we have represented a fourty year old man with anterior and inferior myocardial infarction. Emergency coronary angiography showed thrombotic occlusion in the Left Anterior Descending artery (LAD) mid segment as well as subtotal thrombotic occlusion in the Right Coronary Artery (RCA) mid segment. Emergency coronary angiography was performed to the infarct related arteries. Due to iatrogenic dissection of the Left Main Coronary Artery (LMCA) we undertook percutaneous coronary intervention (PCI) of LMCA with good angiographic result. After one month, control coronary angiography showed no significant stenosis of the LAD, RCA and LM.

Key words: double vessel myocardial infarction, coronary artery disease, PCI.

Acute myocardial infarction (AMI) involving acute transmural ischemia of two vascular territories at the same time, is known as double or combined infarction [1]. It has been reported rarely in most series of patients admitted for AMI due to its poor clinical outcomes. The iatrogenic dissection of LMCA is uncommon, but potentially serious complication that requires prompt management using angioplasty.

We report a case of a 40-year old man who presented in the emergency department with constricting chest pain with onset at rest and of around two hours.


Treatment Strategies Of Atrial Fibrillation In Patients With Heart Failure

R.Pancheva, D.Vassilev

Cardiology Clinic, “Alexandrovska” University Hospital, Sofia Bulgaria



Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population. Its prevalence is estimated to at least double in the next 50 years as the population ages. Approximately the same is frequency of heart failure. Typical of these is the presence of common risk factors and mutual potentiation. Rhythm control in patients with heart failure and atrial fibrillation leads to improved left ventricular ejection fraction, quality of life and its longevity. Because many antiarrhythmic drugs are contraindicated in patients with structural heart disease, their suboptimal efficacy and significant adverse effects, we focus on non-pharmaceutical interventions as an opportunity to change the risks and benefits associated with the maintenance of sinus rhythm.

Keywords: atrial fibrillation, heart failure, rhythm control, rate control, catheter ablation



Tchavdar Shalganov, Milko Stoyanov, Nikolai Bonev, Joro Nichev
Cardiology Department
National Heart Hospital – Sofia

Address for correspondence:
Assoc. prof. T. Shalganov, MD, PhD
Cardiology Department, National Heart Hospital
65 Koniovitsa Street, 1309 Sofia, Bulgaria
Tel: +359-2-9211-411
Fax: +359-2-9211-402

Summary: We present a patient with congenital long QT syndrome and normal baseline left ventricular function in which several years after the implantation of an automatic cardioverter-defibrillator severe left ventricular dysfunction was found together with a peculiar ECG during antibradycardia pacing. The mechanism for the appearance of the unusual ECG and of the left ventricular dysfunction is discussed.

Key words: antibradycardia pacing; left ventricular dysfunction; LQTS; implantable cardioverter-defibrillator.


The implantation of a cardioverter-defibrillator (ICD) is a method of choice for preventing sudden cardiac death in patients with long QT syndrome (LQTS) which have syncope, cardiac arrest and/or documented polymorphic ventricular tachycardia (VT) or ventricular fibrillation (VF) while treated with beta-blockers. [9, 11] It is presumed that in primary electric cardiac disorders such as LQTS the effective termination of sustained life-threatening ventricular arrhythmias in the absence of structural heart disease or left ventricular (LV) dysfunction may result in normal or near-normal lifespan provided there are not device-related complications.



L. Demirevska and D. Gotchev

Clinic of Cardiology, Military Medical Academy – Sofia

Summary: Post-operative atrial fibrillation (POAF) is a frequent complication after surgery. It is associated with an increased risk of mortality and morbidity, predisposes patients to a higher risk of stroke and increases the costs of the post-operative care. The aim of this review is to present the current state of knowledge about the prevention of this complication. Evidence-based guidelines support the use of beta-blockers as standard prophylaxis of POAF, whereas amiodarone can be added in high-risk patients. There is evidence suggesting that angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, statins, corticosteroids, may be effective in preventing POAF. Additional large-scale, adequately powered clinical studies are needed to determine the benefit of these agents.

Keywords: postoperative atrial fibrillation, prophylaxis

Address for correspondence: Liliya Demirevska, MD, Clinic of Cardiology, Military Medical Academy, 3, Sv. G. Sofiiski St., 1606 Sofia, Bulgaria

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