Polymorphic Ventricular Tachycardia Detected by a Smartwatch in a Patient With Recurrent Syncope.

The diagnosis of vasospastic angina remains challenging. It may present with syncope and life-threatening arrhythmia. Patients with syncope usually require automatic modes of recording.

Trends in the Incidence of Cardiovascular Diagnoses and Procedures over the Years 2012-2021 in Israel: The Impact of the COVID-19 Pandemic.

Prior studies found reduced incidences of cardiovascular diagnoses and treatments in the initial phase of the COVID-19 pandemic. However, these studies included a limited number of outcomes and did not consider pre-pandemic trends. This study aimed to describe trends in the incidence of cardiovascular diagnoses and treatments over the years 2012-2021 in Israel and to compare the two years of the COVID-19 period with the preceding 8 years.

Arrhythmias Utilizing Concealed Nodoventricular or His-Ventricular Pathways: A Structured Approach to Diagnosis and Management.

Objectives: This study sought to describe the electrophysiologic characteristics, diagnostic maneuvers, and treatment of a series of arrhythmias using concealed nodoventricular (cNV) or His-ventricular (cHV) pathways.

Background: Confirming the presence and participation of cNV or cHV pathways in tachyarrhythmias is challenging.

Methods: We present 4 cases of tachycardias with a participatory cNV or cHV pathway.

Direct Admission of Patients With ST-Segment-Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain-to-Balloon and Door-to-Balloon Time Intervals but Only the Pain-to-Balloon Interval Impacts Short- and Long-Term Mortality.

Background Shortening the pain-to-balloon (P2B) and door-to-balloon (D2B) intervals in patients with ST-segment-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI-treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI-treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department.

Complex Re-Entrant Arrhythmias Involving the His-Purkinje System: A Structured Approach to Diagnosis and Management.

Objectives: This study sought to characterize the presentations, electrophysiological features and diagnostic maneuvers for a series of unique arrhythmias involving the HPS.

Background: By virtue of its unique anatomy and ion channel composition, the His-Purkinje system (HPS) is prone to a variety of arrhythmic perturbations.

Methods: The authors present a collaborative multicenter case series of 6 patients with HPS-related arrhythmias.

Modern Stents: Where Are We Going?

Coronary artery stenting is the treatment of choice for patients requiring coronary angioplasty. We describe the major advancements with this technology. There have been significant developments in the design of stents and adjunctive medical therapies.

Dual-Antithrombotic Therapy With DOACs After Acute Coronary Syndrome or Percutaneous Coronary Intervention in Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials.

Background: The choice of antithrombotic therapy for atrial fibrillation (AF) patients who have an acute coronary syndrome (ACS) or have undergone percutaneous coronary intervention (PCI) is challenging. We aimed to assess outcomes between dual-antithrombotic therapy with the use of direct-acting oral anticoagulants (DOACs) plus an antiplatelet agent (dual therapy) compared with warfarin plus 2 antiplatelet agents (triple therapy) for AF patients after PCI or with ACS.

Methods: Systematic searches of multiple major databases were performed from their inception through September 2019.

Optimal Timing for Coronary Intervention in Patients With Transient ST-Elevation Myocardial Infarction.

STEMI patients admitted urgently to the hospital but experience early complete resolution of both ischemic symptoms and ST-elevations on the electrocardiogram are diagnosed as transient STEMI (TSTEMI). Current evidence indicates that primary intervention is plausible but in certain circumstances intervention can be delayed. We sought to examine whether there is a time limit to such a delay that may affect long-term outcome.

Identifying Factors That Predict the Prescription of Non-vitamin K Antagonist Oral Anticoagulants in Older Individuals With Atrial Fibrillation.

Objectives: Factors that influence decision of non-vitamin K antagonist oral anticoagulants (NOACs) use among older atrial fibrillation (AF) patients in long-term care (LTC) facilities have not been well studied. The aim of this study was to assess whether increased frailty influenced physicians to prescribe NOACs over warfarin.

Design: We retrospectively reviewed the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada, in May 2015.

Single Versus Dual Lead Atrioventricular Sequential Pacing for Acquired Atrioventricular Block During Transcatheter Aortic Valve Implantation Procedures.

Atrioventricular block (AVB) after transcatheter aortic valve implantation (TAVI) is common. Pacing platforms that preserve atrioventricular (AV) synchrony may be beneficial in these patients. Single lead AV sequential pacemakers (VDD) allow AV synchrony and, by virtue of implanting a single lead, can be advantageous when compared with traditional dual lead (DDD) pacemakers.

On the diagnosis of wide QRS tachycardia.

Class IC antiarrhythmic drugs may be pro-arrhythmic. The diagnosis of the exact nature of the arrhythmia may be challenging. In most case, these drugs should be stopped regardless of the type of the arrhythmia.

Alternating trifascicular block and cardiac memory.

We describe a case of a 70year-old woman with effort dyspnea and alternating trifascicular conduction pattern, worsened with exercise to atrioventricular block (AV Block). The alternating conduction at rest resulted in marked T wave changes. We discuss the mechanism of T wave memory changes and the management of exercise-induced AV Block.

Mind the gap.

We present a case of a woman with an asymptomatic intermittent 2:1 atrioventricular block. The baseline ECG showed a wide QRS with right bundle branch block pattern. Measurement of the HV interval during electrophysiological study was normal.