Personalized Heart Digital Twins Detect Substrate Abnormalities in Scar-Dependent Ventricular Tachycardia.

Background: Current outcomes from catheter ablation for scar-dependent ventricular tachycardia (VT) are limited by high recurrence rates and long procedure durations. Personalized heart digital twin technology presents a noninvasive method of predicting critical substrate in VT, and its integration into clinical VT ablation offers a promising solution. The accuracy of the predictions of digital twins to detect invasive substrate abnormalities is unknown.

The Impact of Coronary Ischemia Assessment on Outcomes in Those With Scar-Dependent Ventricular Tachycardia.

Background: Guidance and outcomes of coronary ischemia assessment (IA) in those with structural heart disease (SHD), presenting with monomorphic ventricular tachycardia (MMVT) is unclear.

Objectives: To assess the impact of IA on arrhythmic and non-arrhythmic outcomes in those with SHD.

Methods: Patients presenting with MMVT over a 6-year period to a tertiary center were retrospectively analyzed.

Cardiac arrest in myocardial infarction with non-obstructive coronary artery (MINOCA) secondary to thyroid dysfunction.

A man in his 40s who was previously well had an out-of-hospital cardiac arrest. Postresuscitation ECG showed ST-elevation myocardial infarction (MI). Emergency coronary angiogram revealed MI with non-obstructive coronary arteries (MINOCA) with evidence of spasm in the right coronary artery.

Contemporary Management of Complex Ventricular Arrhythmias.

Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed.

Short-coupled ventricular ectopics leading to cardiac arrest in a young woman.

Background: This case report highlights the importance of recognizing that ventricular ectopy may be a cause for syncope and sudden cardiac death, through triggered disorganized arrhythmia. In the context of syncope, ventricular ectopy should be carefully assessed for coupling interval and morphology.

Case Presentation: A 39-year-old woman, who had presented with recurrent syncope, had a cardiac arrest shortly after admission that required emergency defibrillation.

Hourly variability in outflow tract ectopy as a predictor of its site of origin.

Introduction: Before ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO.

Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24-h ambulatory ECGs retrospectively analysed (derivation cohort).

Bipolar Radiofrequency Ablation of Septal Ventricular Tachycardia Facilitated by an Intramural Catheter.

Intramural septal substrate presents a challenge in patients undergoing ventricular tachycardia ablation, in terms of both accurate mapping and ablation with unipolar radiofrequency energy. We present the first use of the novel 2-F octapolar catheter in accurately defining intramural septal scar and facilitating bipolar ablation. ().

Percutaneous management of lead-related cardiac perforation with limited use of computed tomography and cardiac surgery.

Background: Cardiac implantable electronic device (CIED)-related perforation is uncommon but potentially lethal. Management typically includes the use of computed tomography (CT) scanning and often involves cardiac surgery.

Methods: Patients presenting to a single referral centre with CIED-related cardiac perforation between 2013 and 2019 were identified.

Contact force sensing in ablation of ventricular arrhythmias using a 56-hole open-irrigation catheter: a propensity-matched analysis.

Purpose: The effect of adding contact force (CF) sensing to 56-hole tip irrigation in ventricular arrhythmia (VA) ablation has not been previously studied. We aimed to compare outcomes with and without CF sensing in VA ablation using a 56-hole radiofrequency (RF) catheter.

Methods: A total of 164 patients who underwent first-time VA ablation using Thermocool SmartTouch Surround Flow (TC-STSF) catheter (Biosense-Webster, Diamond Bar, CA, USA) were propensity-matched in a 1:1 fashion to 164 patients who had first-time ablation using Thermocool Surround Flow (TC-SF) catheter.

Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity-matched analysis.

Background: The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV-Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV-Comp isolation is an alternative strategy for persistent AF ablation.

Mapping and Ablation of Ventricular Outflow Tract Arrhythmias.

Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish.

The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: A review article.

Catheter ablation of persistent atrial fibrillation (AF) is an evolving field. In this review, we discuss the rationale for isolation of the pulmonary venous component of the left atrium to control AF. The review describes the embryologic origin of this component and makes the important distinction between the true posterior wall and the pulmonary venous component, which forms the dome of the left atrium.

Endocardial ablation of ventricular ectopic beats arising from the basal inferoseptal process of the left ventricle.

Background: Idiopathic ventricular ectopy (VE) shows predilection to sites within the left ventricular (LV) base such as the outflow tract/aortic sinuses, LV summit, and areas adjacent to the aortomitral continuity. We characterize VE arising from the inferior septum of the LV base that was successfully managed by LV endocardial ablation from the inferoseptal recess of the LV.

Objective: The purpose of this study was to determine the incidence, electrocardiographic (ECG) findings, electrophysiological findings, and anatomical features associated with VE arising from the basal inferoseptal process of the LV (ISP-LV) ablated using an LV endocardial approach via the inferoseptal recess of the LV.

Cardiac sarcoidosis: electrophysiological outcomes on long-term follow-up and the role of the implantable cardioverter-defibrillator.

Objectives: The objectives of this study were to identify the predictors of life-threatening ventricular arrhythmias in patients with cardiac sarcoidosis (CS) and to evaluate the role of the implantable cardioverter-defibrillator (ICD) in this patient population.

Background: ICD implantation is a class IIA recommendation for patients with CS. However, some indications for ICD implantation in CS patients are still unclear and not enough data are available to establish predictors of malignant ventricular tachyarrhythmias in this group of patients.

Functional Pulmonary Vein Isolation During Atrial Fibrillation Ablation.

We report a case of apparent isolation of the right inferior pulmonary vein during atrial fibrillation ablation coincident with the onset of an atrial tachycardia. This report highlights the importance of assessing pulmonary vein conduction during sinus or paced rhythm at relatively long cycle length, rather than in atrial fibrillation or atrial tachycardia.

Genetic biomarkers in Brugada syndrome.

Brugada syndrome is an inherited arrhythmia syndrome predisposing to sudden cardiac death. Six years after its initial description as a clinical entity, the first mutations in SCN5A encoding the cardiac sodium channel Nav1.5 were reported.

Defibrillation threshold testing in patients with hypertrophic cardiomyopathy.

Introduction: Implantable cardioverter-defibrillators (ICDs) decrease sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). One of the vital aspects of ICD implantation is the demonstration that the myocardium can be reliably defibrillated, which is defined by the defibrillation threshold (DFT). We hypothesized that patients with HCM have higher DFTs than patients implanted for other standard indications.

Idiopathic ventricular fibrillation in a 10-year-old boy: technical aspects of radiofrequency ablation and utility of antiarrhythmic therapy.

Idiopathic ventricular fibrillation (VF) is defined as spontaneous VF in the absence of structural heart disease. No prior reports exist addressing the technical aspects of idiopathic VF ablation in a child. We present the case of a 10-year-old boy with idiopathic VF, who presented a unique management challenge, particularly as regards the technical aspects of the ablation procedure.

The influence of fat thickness on the human epicardial bipolar electrogram characteristics: measurements on patients undergoing open-heart surgery.

Aims: Reference values exist for endocardial but not for epicardial (EPI) substrate mapping in cases of cardiomyopathy-associated ventricular tachycardia. We sought to establish such values for EPI electrogram voltage, including areas with overlying fat.

Methods And Results: Ten patients (six males) undergoing cardiac surgery were studied.

Ancient Egyptian medicine and the concept of heart failure.

Background: The cardiac glosses of the Ebers papyrus comprise the concepts and notions of the Egyptian physicians about the heart and its diseases. We sought to analyze some of the cardiac glosses of the Ebers papyrus, focusing on those which may describe early concepts of the syndrome of heart failure.

Methods And Results: Review of Joachim's German translation and both Bryan's and Ghalioungui's English translations of the Ebers papyrus.