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Late presentation of constrictive pericarditis after limited epicardial ablation for inappropriate sinus tachycardia  Adam Oesterle, MD, Amita Singh,

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Presentation on theme: "Late presentation of constrictive pericarditis after limited epicardial ablation for inappropriate sinus tachycardia  Adam Oesterle, MD, Amita Singh,"— Presentation transcript:

1 Late presentation of constrictive pericarditis after limited epicardial ablation for inappropriate sinus tachycardia  Adam Oesterle, MD, Amita Singh, MD, Husam Balkhy, MD, Aliya N. Husain, MD, Deborah Moyer, APN, Roderick Tung, MD, FHRS, Hemal M. Nayak, MD, FHRS  HeartRhythm Case Reports  Volume 2, Issue 5, Pages (September 2016) DOI: /j.hrcr Copyright © 2016 Heart Rhythm Society Terms and Conditions

2 Figure 1 Left anterior oblique fluoroscopic image showing the inflated angioplasty balloon in the epicardial space to increase the separation between the endocardial ablation catheter and the phrenic nerve. CS = coronary sinus catheter; ICE = intracardiac echocardiography catheter. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

3 Figure 2 Electrocardiograms (ECGs). (A) ECG obtained the day after the procedure with diffuse ST-segment elevations in leads I, II, and V2–V6 with ST-segment depression in aVR consistent with acute pericarditis. (B) ECG obtained at the 1-month follow-up visit, demonstrating resolution of the ST-segment elevation. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

4 Figure 3 Cardiac magnetic resonance imaging (MRI). (A) Cardiac MRI late gadolinium imaging demonstrating circumferential enhancement of the pericardium, consistent with constriction. (B) Postcontrast T1-weighted black blood image demonstrating thickening of pericardium >6 mm. (C) Follow-up postoperative cardiac MRI with late gadolinium imaging showing decreased enhancement in the pericardium, demonstrating resolution of the constricted pericardium. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

5 Figure 4 Simultaneous left and right heart catheterization. (A) Simultaneous pulmonary capillary wedge (red) and right atrial (green) tracings demonstrating the equalization of diastolic pressures and the rapid y descent. (B) Simultaneous left and right heart catheterization pressure tracings demonstrating equalization of diastolic pressures and the classic dip and plateau. The red tracing is the left ventricle and the green tracing is the right ventricle. HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

6 Figure 5 Pericardial pathology. High-power photomicrograph of pericardium shows fibrosis, lymphocytes, plasma cells, and focal hemosiderin deposits (hematoxylin-eosin stain). HeartRhythm Case Reports 2016 2, DOI: ( /j.hrcr ) Copyright © 2016 Heart Rhythm Society Terms and Conditions

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