Anteroseptal accessory pathways make obvious the concerns of one of the most dreaded complications of SVT ablation: AV block. SVT most often occurs in young, otherwise healthy patients for whom AV block can be a much worse disease than the tachyarrhythmia. We present a case of an anteroseptal pathway in which the implications to the patient are made much more obvious by his intentions to become a professional athlete.

Laurie Smith, RCIS, is the Program Coordinator and Primary Instructor for the Cardiac Electrophysiology Technologist program at Carnegie Institute in Troy, Michigan (Troy is a northern suburb of Detroit). In this article, Carnegie’s Clinical Coordinator Michael Hacala meets with Laurie Smith to get a more in-depth view of the new electrophysiology program.

Dual chamber pacemakers became increasingly implanted, beginning in the early 1980s, because of the benefit of restoring atrio-ventricular (AV) synchrony. Recently, attention has been focused on the clinical consequences of pacing-induced dysynchrony with right ventricular (RV) apical pacing in both pacemaker and ICD patients.^1,2 RV pacing, with its induced LBBB morphology, has been linked with an increased risk of congestive heart failure and worsened morbidity and mortality in clinical trials of dual chamber pacing.^3,4

A permanent pacemaker ventricular lead positioned in the left ventricle (LV), “although its actual incidence is probably unknown,”¹ is “a rare and often undiagnosed complication of pacemaker implantation.”² The abnormal position is initially suspected when a 12-lead EKG displays a right bundle branch block (RBBB) while pacing the ventricle. Confirmation of the ventricular lead position is usually documented by a routine PA and lateral chest x-ray. An echocardiogram, and possibly a trans-esophageal echo (TEE), can also be helpful.

Please check out all the new responses this month (as well as a new question from an interesting source). If you would like to respond, please email us at eplabdigest@hotmail.com. Remember, when posting or responding to the discussion group, please let me know if you would like your name, location, and/or email address listed as well — that way you will get more instant results!

Spontaneous coronary artery dissection (SCAD) is a rarely documented etiology of myocardial infarction and sudden cardiac death (SCD). We present a case of a 37-year-old non-pregnant female who presented with a left anterior descending artery (LAD) dissection complicated by ventricular fibrillation arrest. After early diagnostic catheterization and medical management, our patient experienced a complete recovery, returning to her pre-SCD status without limitation. This case is unique in that the SCAD did not occur in the context of previously described associations. Also, this is only the second reported case of a patient with SCAD who survived documented SCD. Our case suggests that medical management is a reasonable option in patients with single-vessel non-left main/proximal LAD artery SCAD.

The Heart Rhythm Society recently sent letters to hospitals urging them to adhere to competency standards from the 2004 Clinical Competency Statement: Training Pathways for Implantation of Cardioverter Defibrillators (ICD) and Cardiac Resynchronization (CRT) Devices and 2005 Addendum (see sidebar). I recently asked Anne B. Curtis, MD, President of the Heart Rhythm Society, about the current state of the guidelines. Dr. Curtis is also Chief, Division of Cardiology, and Director and CEO, Cardiovascular Services, University of South Florida in Tampa, Florida.