Once a saint, now a sinner: An appropriate or inappropriate shock?

Critical analysis of electrograms of any therapy delivery event is paramount to identify the etiology, specificity, and sensitivity of the programmed algorithms to differentiate supraventricular versus ventricular tachycardia, its effectiveness, and potential interventions to prevent recurrence. Besides the aspects mentioned above, this case delves into the potential limitations of existing algorithms and the adverse effects of anti-tachycardia pacing.

Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source.

Background And Objectives: Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE.

Rare Presentations of Takayasu Arteritis: A Case Series.

Takayasu arteritis (TA) is a form of large vessel vasculitis that may lead to fibrosis, stenosis, or aneurysm formation of vessels. Its presentation varies depending on the arterial beds involved. We report 3 cases out of around 150 cases of TA with rare initial presentations of brachial plexopathy caused by an axillary artery aneurysm, complicated type A intramural hematoma, and renal artery aneurysms along with abdominothoracic TA presenting as a pulsatile abdominal mass.

Triple pacing spikes on QRST: What is the mechanism?

A septuagenarian man underwent dual chamber pacemaker (DDDR - Boston Scientific Massachusetts, U.S.) insertion for a complete heart block.

Phenotypes of South Asian patients with atrial fibrillation and holistic integrated care management: cluster analysis of data from KERALA-AF Registry.

Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients.

Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia.

Long-term outcome of permanent epicardial pacemaker implantation in neonates: Experience from an Indian center.

Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems.

Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute.

Left ventricular apical aneurysm in Takayasu arteritis and chronic active Epstein-Barr virus infection.

Background: Takayasu arteritis (TA) is a chronic inflammatory disease of unknown etiology characterized by a large vessel vasculitis involving the aorta and its branches. Myocardial involvement is extremely unusual in TA and is mostly in the form of myocarditis, ventricular hypertrophy, and ventricular dysfunction secondary to coronary ischemia. Submitral aneurysms have been reported in TA and has been attributed to the chronic inflammatory process in TA.

Pacing on the tail of paced QRS: What is the mechanism?

An electrocardiogram on the day after implantation of a dual-chamber pacemaker revealed 2 closely coupled pacing spikes at 100-ms intervals, with the latter being on the trailing edge of the paced QRS complex. Differential diagnoses of such closely coupled pacing pulses include atrial lead displacement, lead reversal on the pulse generator, ventricular premature complex in the post-atrial ventricular blanking period, and backup pacing pulse following a loss of capture. Critical analysis of the pacemaker timing intervals led to the mechanism and cause of the problem.

Predicting stroke in Asian patients with atrial fibrillation using machine learning: A report from the KERALA-AF registry, with external validation in the APHRS-AF registry.

Atrial fibrillation (AF) is a significant risk factor for stroke. Based on the higher stroke associated with AF in the South Asian population, we constructed a one-year stroke prediction model using machine learning (ML) methods in KERALA-AF South Asian cohort. External validation was performed in the prospective APHRS-AF registry.

Response to spontaneous and induced His refractory ventricular premature beats during long RP tachycardia: What is the mechanism?

This electrophysiology tracing demonstrates a graded postexcitation response of the retrograde limb of an orthodromic reentrant tachycardia circuit with varying His refractory VPB coupling intervals, which reiterates the decrementally conducting retrograde limb of the tachycardia circuit.

Bump termination of an atriofascicular tachycardia. Where is the level of block?

This electrophysiological tracing localizes the level of block distal to the recorded Mahaim potential during bump termination mapping of an atriofascicular pathway at the tricuspid annulus.

Left cardiac sympathetic denervation in children with Jervell Lange-Nielsen syndrome and drug refractory torsades - A case series.

Introduction: Long QT syndrome is an inherited malignant channelopathy which leads to life-threatening arrhythmia, with multiple genotypes. Jervell and Lange-Nielsen syndrome (JLNS) is an autosomal recessive subtype of this disease, characterized by congenital sensorineural deafness and a high incidence of sudden cardiac death (SCD).

Methodology: We prospectively followed up six children who underwent left cardiac sympathetic denervation (LCSD) for JLNS in view of high-risk features despite being on maximally tolerated doses of oral propranolol.