Cardiol J
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The interval from the pacemaker stimulus to the onset of the earliest paced QRS complex (latency) may be prolonged during left ventricular (LV) pacing. Marked latency is more common with LV than right ventricular (RV) pacing because of indirect stimulation through a coronary vein and higher incidence of LV pathology including scars. During simultaneous biventricular (BiV) pacing a prolonged latency interval may give rise to an ECG dominated by the pattern of RV pacing with a left bundle branch block configuration and commonly a QS complex in lead V1. ⋯ During LV only pacing (RV channel turned off) RV anodal pacing may also occur in a more obvious form so that the ECG looks precisely like that during BiV pacing. RV anodal stimulation may complicate threshold testing and ECG interpretation and should not be misinterpreted as pacemaker malfunction. Programming the V-V interval (LV before RV) in the setting of RV anodal stimulation cancels the V-V timing to zero.
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We report a 47 year-old male patient with coexistence of left ventricular noncompaction and Brugada syndrome. He presented malignant ventricular arrhythmias followed by cardioverter- -defibrillator implantation, atrial fibrillation and flutter and progressive heart failure. This case could be an example of the coexistence of two rare diseases of various genetic patterns that only partially showed overlapping symptomatology and complications, particularly ventricular arrhythmias.
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Case Reports
Acute myocarditis mimicking acute myocardial infarction associated with pandemic 2009 (H1N1) influenza A virus.
The prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. ⋯ Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection.