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Welcome to the Bulgarian Cardiology Journal Website

OCCURRENCE OF SEVERE LEFT VENTRICULAR DYSFUNCTION IN A PATIENT WITH CONGENITAL LONG QT SYNDROME AND PREVIOUSLY IMPLANTED CARDIOVERTER-DEFIBRILLATOR – WHAT IS THE MECHANISM?

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.

Introduction

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.

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PHARMACOLOGIC PROPHYLAXIS OF POSTOPERATIVE ATRIAL FIBRILLATION

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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