Recent European guidelines have emphasized the association of vegetation size with embolic risk in endocarditis (1). On these grounds, left-sided vegetations >1 cm, and right-sided vegetations >2 cm are considered to be an indication for surgery. In this issue of iJACC, investigators from the MEDIC (Multicenter Electrophysiologic Device Cohort) registry report the importance of vegetation size ...

Background Imaging patients with a pacemaker (PM) or AICD has been mostly taboo in the MRI environment. However, with current improvements in PMlead and generator development along with very vigilant and knowledgeable personnel in pacemaker safety, MRI procedures can be implemented successfully. However, safe performance, not withstanding the risks, leads one to question if the results from the...

Twiddler’s syndrome, a rare but hazardous complication of cardiac pacemaker treatment, characterized by device malfunction due to dislodgement of cardiac leads resulting from some form of manipulation by the patient. In this report we present a case of pacemaker Twiddler’s syndrome in a middle aged lady who presented with recurrent syncopes after 1 month of initial implantation. Our patient was...

Late rising in pacing threshold is an uncommon complication of permanent pacing. Treatment with high dose systemic steroid could spare the patient another procedure. We report a case of late rising pacing threshold that responded to high dose systemic steroid which lowered the pacing threshold to one volt, then rose again to around 2 volts.

Background MRI has generally been contraindicated in patients (pts) with pacemakers (PM) or defibrillators (ICD) due to concern of a variety of potential complications. Several recent series have suggested potential safety of MRI in pts with cardiac devices, but most excluded cardiac or thoracic imaging. Additionally there is very limited data on safety of CMR in pts with devices, especially in...

BACKGROUND Permanent artificial pacemaker is one of the important therapies for treatment of cardiac conduction system problems. The present study aimed to determine the association between some predictive variables and all-cause and cause-specific mortality in the patients who had undergone pacemaker implantation. METHODS This study was conducted on 1207 patients who had undergone permanent ...

Cardiac amyloidosis (CA) as a part of a systematic infiltrative process is characterized by left ventricular (LV) and right ventricular (RV) thickening along with systolic and diastolic function impairment. Its poorer prognosis compared with other causes of LV wall thickening along with contemporary therapeutic options make the early detection and differential diagnosis of CA extremely important.