T-wave over sensing occurs when the counter starts giving dual beeps for every CARDIAC cycle instead of one. This usually happens when the monitoring lead displays a tall T wave, which is also sharp. R wave sensing algorithms of the devices do not sense T wave because the slow rate of the T wave is much less than that of the R wave. But the slow rate of T waves may change with time and also because of parameters like potassium levels and hyperglycemia. We present a 67-year-old female who underwent the implantation of CARDIAC resynchronization therapy (CARDIAC resynchronization and implantable cardioverter defibrillator [CRT-D]) because of severe left ventricular systolic dysfunction and ventricular dyssynchrony experienced recurrent inappropriate implantable cardioverter-defibrillator (ICD) shocks and CRT failure. Device analysis showed that the CRT failure was in consequence of T-wave over sensing due to hyperglycemia. Elimination of the T-wave over sensing after hyperglycemia control conferred good biventricular PACING and good response to CRT during a 6-month follow-up period.

Objectives: Temporary epicardial PACING wires are commonly placed during pediatric CARDIAC surgery. Data are sparse on postoperative PACING in this population. The objective of this study was to determine the frequency of use and identify predictors for the use of temporary epicardial PACING wires.Methods: Perioperative data were prospectively collected on all patients who underwent CARDIAC surgery at our institution (n = 162).Results: A total of 117 (72%) patients had temporary epicardial PACING wires placed. Postoperatively, 23 (20%) of 117 patients had hemodynamic improvement with the useof temporary epicardial PACING wires. Indications for PACING were slow junctional rhythm (11/23 [48%]), junctional ectopic tachycardia (7/23 [31%]), pace termination of supraventricular tachycardia (3/23 [13%]) and atrial flutter (1/23 [4%]), and complete heart block (1/23 [4%]). By using univariate analysis, single-ventricle anatomy, heterotaxy, the Fontan procedure, use of circulatory arrest, intraoperative arrhythmia, PACING in the operating room, and use of vasoactive medications were predictors for hemodynamic improvement with the use of temporary epicardial PACING wires (P<.05). On multivariate analysis, the Fontan procedure, circulatory arrest, and intraoperative arrhythmias were independent predictors (P<.01). When excluding all patients with any of these 3 risk factors, only 2% were paced. Patients with clinically significant PACING had longer chest tube drainage (P < .01) and intensive care unit length of stay (P<.01). There were no complications associated with temporary epicardial PACING wires.Conclusions: The Fontan procedure, use of circulatory arrest, and intraoperative arrhythmias were associated with hemodynamic improvement with postoperative PACING and might represent indications for empiric intraoperative placement of temporary epicardial PACING wires. Patients without these risk factors were less likely to require PACING. Temporary epicardial PACING wires were safe and useful in the management of arrhythmias after pediatric CARDIAC surgery.Abbreviations and Acronyms CICU=CARDIAC intensive care unit; OR=odds ratio.

Introduction: To study effects of various sites of right ventricular PACING lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony.Methods: This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular PACING for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated.Results: The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2±50.2 vs.50.5±24, P<0.001; septal to posterior wall delay [SLWD] 63.5±27.5 vs.34±10.7, P<0.001, SPWD 112.5±58.1 vs.62.7±12.1, P=0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant.Conclusion: PACING in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.

Basic life support (BLS) following by Advanced CARDIAC life support (ACLS) is intended to rescue the patients with acute circulatory or respiratory failure or both. The most important determinant of short and long-term neurologically intact survival is the interval from the onset of the CARDIAC or respiratory onset to restoration of effective spontaneous functions of these vital activities.It is commonly accepted that every physician, regardless of specialty, should be able to  perform CPR. It must be also emphasized that CPR, almost invariably, necessitates a rapid interventional follow-care with ACLS procedure.Without well-performed basic life support, advanced CARDIAC life support is of no remark-: able benefit, BLS and ACLS are processes that must be performed step by step and with respect to the patient's condition.

Atrial fibrillation (AF) is the most common complication of coronary artery bypass graft surgery (CABG). The reported incidence of AF after CABG varies from 20% to 40%. Postoperative AF (POAF) is associated with increased incidence of hemodynamic instability, thromboembolic events, longer hospital stays, and increased health care costs. A variety of pharmacological and nonpharmacological strategies have been employed to prevent AF after CABG. Preoperative and postoperative beta blockers are recommended in all CARDIAC surgery patients as the first-line medication to prevent POAF. Sotalol and amiodarone are also effective and can be regarded as appropriate alternatives in high-risk patients.Corticosteroids and biatrial PACING may be considered in selected CABG patients but are associated with risk. Magnesium supplementation should be considered in patients with hypomagnesaemia. There are no definitive data to support the treatment with nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, procainamide, and propafenone, or anterior fat pad preservation to reduce POAF.