Cardiac Ablation in the Pediatric Population at a Tertiary Care Center in a Developing Country.

Introduction: The aim of this study was to describe our experience and outcome of ablation therapy for arrhythmias in pediatrics at a tertiary care center.

Methods: Data was collected retrospectively from the hospital medical records. All pediatrics presenting to AUBMC between 2000 and 2020 who underwent cardiac ablation were included.

Safety of Amulet Left Atrial Appendage Occluder and Watchman Device for Left Atrial Appendage Closure in Patients With Atrial Fibrillation.

Background: Left atrial appendage (LAA) closure is an alternative to chronic anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation. Multiple devices were used for LAA closure, with the Amplatzer Amulet LAA Occluder (Abbott, Chicago, IL, USA) and Watchman device (Boston Scientific, Marlborough, MA, USA) being the most commonly used in clinical practice. In August 2021, the FDA approved the use of the Amplatzer Amulet LAA Occluder.

Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: A systematic review and meta-analysis.

Background: Low voltage areas (LVAs) on left atrial (LA) bipolar voltage mapping correlate with areas of fibrosis. LVAs guided substrate modification was hypothesized to improve the success rate of atrial fibrillation (AF) ablation particularly in nonparoxysmal AF population. However, randomized controlled trials (RCTs) and observational studies yielded mixed results.

Establishing Safe Working Parameters for Radiofrequency Ablation In Vitro Using Acoustic Sensing, Probability Mapping, and Catheter Contact Angle.

Surgical quality and safety in radiofrequency catheter ablation (RFA) are critical in arrhythmia procedures. Steam pops, in particular, are potentially catastrophic events that must be avoided; otherwise, they may cause significant damage to the myocardium. This study aimed to evaluate the effect of applied RFA inclination angle and tissue contact parameters on the ablated volume and "steam pop" formation.

QTc interval on 24-hour holter monitor: To trust or not to trust?

Introduction: QT interval represents the ventricular depolarization and repolarization. Its accurate measurement is critical since prolonged QT can lead to sudden cardiac death. QT is affected by heart rate and is corrected to QTc via several formulae.

Advances in telemedicine for the management of the elderly cardiac patient.

Telemedicine is the use of information and communication technology to deliver healthcare at a distance. It has been resorted to during the COVID-19 pandemic to lessen the need for in-person patient care decreasing the risk of transmission, and it can be of benefit afterward in the management of cardiac disease. The elderly population has unique challenges concerning the use of telehealth technologies.

Ivabradine: A Potential Therapeutic for Children With Refractory SVT.

In April 2015, ivabradine was approved by the Food and Drug Administration for the treatment of patients with coronary artery disease and heart failure (HF). The use of this medication has been linked with improved clinical outcomes and reduced rates of hospitalization in patients with symptomatic HF and a baseline heart rate of 70 bpm and above. Nonetheless, little is known about the use of ivabradine in pediatric patients with supraventricular tachycardia (SVT).

Safety of mapping in the sinus of valsalva region under intracardiac echocardiography guidance without angiography.

Background: Radiofrequency ablation at the region of the sinus of Valsalva carries a risk to the ostia of the coronary arteries. Coronary angiography is usually utilized to document a safe distance for mapping and ablation.

Objective: To show that catheter ablation in the aortic root could be guided by phased-array intra cardiac echocardiography (ICE) and electro anatomic mapping without the need for coronary angiography.

Erosion of Cardiovascular Implantable Device: Conservative Therapy or Extraction?

The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases. Despite the importance of lead extraction techniques, these techniques are complex and have some major risks. Success rates were high, but they are less favorable in patients with several comorbidities.

Genomic and Proteomic Study of the Inflammatory Pathway in Patients With Atrial Fibrillation and Cardiometabolic Syndrome.

Atrial fibrillation (AF) and cardiometabolic syndrome (CMS) have been linked to inflammation and fibrosis. However, it is still unknown which inflammatory cytokines contribute to the pathogenesis of AF. Furthermore, cardiometabolic syndrome (CMS) risk factors such as obesity, hypertension, insulin resistance/glucose intolerance are also associated with inflammation and increased level of cytokines and adipokines.

Fast pathway ablation in a patient with PR prolongation.

The classical form of typical atrioventricular node reentrant tachycardia (AVNRT) is a "slow-fast" pathways tachycardia, and the usual therapy is an ablation of the slow pathway since it carries a low risk of atrioventricular (AV) block. In patients with long PR interval and/or living on the anterograde slow pathway, an alternative technique is required. We report a case of a 42-year-old lady with idiopathic restrictive cardiomyopathy, persistent atrial fibrillation status post pulmonary vein isolation, and premature ventricular complex ablation with a systolic dysfunction, who presented with incessant slow narrow complex tachycardia of 110 bpm that appeared to be an AVNRT.

Out-of-hospital cardiopulmonary resuscitation: a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine.

Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Early cardiopulmonary resuscitation (CPR) and early defibrillation are key to improving outcomes of patients with OHCA including return of spontaneous circulation (ROSC) and survival to hospital discharge with good neurologic outcomes. Lebanon like other developing countries, suffers from absence of organized prehospital cardiac arrest care bundle and from absence of a legal framework for community involvement in cardiac arrest care.

Cardiac implantable electronic device infections: Observational data from a tertiary care center in Lebanon.

With increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections.

Non-familial cardiomyopathies in Lebanon: exome sequencing results for five idiopathic cases.

Background: Cardiomyopathies affect more than 0.5% of the general population. They are associated with high risk of sudden cardiac death, which can result from either heart failure or electrical abnormalities.

A Confused Pacemaker.

The electrocardiogram (ECG) raises the question of inappropriate device behavior and the possibility of ventricular lead oversensing causing failure of ventricular pacing. Careful analysis of the ECG proved that the mode of pacing was set to managed ventricular pacing (MVP) mode. The MVP mode should not be used in the setting of a complete atrioventricular conduction block.

Incessant Long R-P Tachycardia.

A 13-year-old boy had a positive P wave in V1 with a negative P wave in lead I, aVL, and aVR, as well as a positive P wave in the inferior leads, which correlated with a left atrial appendage (LAA) atrial tachycardia (AT) focus. P-wave morphologies can provide clues regarding an AT's origin, and this P-wave negative in lead I favored LAA AT. Careful mapping along the atria and coronary sinus to determine the earliest site of activation for the surface P wave is a reliable method for precisely localizing the AT origin as a target for catheter ablation.

Anatomic distribution of culprit lesions in patients with non-ST-segment elevation myocardial infarction and normal ECG.

Background: In patients presenting with non-ST-elevation myocardial infarction (NSTEMI), left anterior descending (LAD) coronary artery and three-vessel disease are the most commonly encountered culprit lesions in the presence of ST depression, while one third of patients with left circumflex (LCX) artery related infarction have normal ECG. We sought to determine the predictors of presence of culprit lesion in NSTEMI patients based on ECG, echocardiographic, and clinical characteristics.

Methods: Patients admitted to the coronary care unit with the diagnosis of NSTEMI between June 2012 and December 2013 were retrospectively identified.

Efficacy of ablation at the anteroseptal line for the treatment of perimitral flutter.

Background: Left atrial flutter following atrial fibrillation (AF) ablation is increasingly common and difficult to treat. We evaluated the safety and efficacy of ablation of the anteroseptal line connecting the right superior pulmonary vein (RSPV) to the anteroseptal mitral annulus (MA) for the treatment of perimitral flutter (PMF).

Methods: We systematically studied patients who were previously treated with AF ablation and who presented to the electrophysiology laboratory with atrial tachyarrhythmias between January 2000 and July 2010.

Discordant vs. concordant left bundle branch block: A potential clinical significance.

Aim: LBBB in heart failure patients has prognostic significance. Subtypes of LBBB (concordant and discordant) have not been considered when considering management. The aim of this study is to explore the clinical difference between the two subtypes.

CARDIAC DEFIBRILLATOR IMPLANTATION via PERSISTENT LEFT SUPERIOR VENA CAVA.

Persistent left superior vena cava (PLSVC) is an uncommon anomaly. We describe a case of a left-sided implantation of an implantable cardioverter defibrillator (ICD) through a PLSVC, assessing the technical approach to such a procedure, along with a review of the clinical implications that might ensue. Learning objectives: LSVC is a rare anatomical venous variation.

Worsening thoracic impedance as a ventricular tachyarrhythmia risk.

The use of heart failure classification to identify patients with systolic dysfunction who are at risk for ventricular tachyarrhythmias (VAs), sudden cardiac death, and shocks from implantable cardioverter defibrillators (ICDs) is limited by its subjectivity. Measurement of thoracic impedance offers a more objective tool for assessing worsening of heart failure. We sought to look at the correlation between ventricular arrhythmia and heart failure as assessed objectively by thoracic impedance.

Extraction of a tunneled jugular defibrillator lead via a superior approach.

Extraction of cardiac implantable electrical devices (CIED) is becoming an increasing necessity. Infection is among the most frequent and serious complications associated with the surge of CIED implants. We describe the extraction of an infected cardiac resynchronization therapy-defibrillator (CRT-D) in a patient with a tunneled implantable cardioverter defibrillator (ICD) lead implanted from the right jugular vein.