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Beaware of Intracardiac Potentials Induced by Intravascular Lithotripsy.

Catheter Cardiovasc Interv

January 2025

Department of Cardiology, Ageo Central General Hospital, Saitama, Japan.

Background: Intravascular lithotripsy (IVL), that generates shockwaves through spark gap discharge between emitters, has been increasingly used to treat severely calcified coronary artery lesions. However, there is a question as to whether IVL has no electrical effects on endocardial tissues or cardiac implantable devices (CIEDs).

Aims: The aim of this study was to investigate the effects of IVL-induced intracardiac potentials on cardiac electrophysiology and CIEDs.

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A young man in his 30s presented to us with multiple episodes of syncope and exertional dyspnoea for the last 2 weeks. He was diagnosed with squamous cell carcinoma of the lower one-third of the oesophagus in 2021 for which he was treated with neoadjuvant chemoradiotherapy, followed by McKeown oesophagectomy. At 2-year follow-up, he had developed a soft tissue swelling in the scalp, which was diagnosed as a tumour recurrence and radiotherapy was initiated.

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Rationale: Thrombus is the most common occupying lesion in the cardiac chambers, it is often distinguished from cardiac neoplastic occupations. Among them, the most common is cardiac myxoma, whose imaging manifestations are often confused with thrombus. However, the 2 types of lesions have different therapeutic strategies and are both potentially high-risk sources of embolism, so early differentiation between intracardiac thrombus and cardiac tumor is essential.

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Background: Metastatic tumours are the most common malignant tumours affecting the heart. Cardiac metastatic tumour progression is rapid, with no specific treatments available, and the prognosis is typically poor. Significant challenges remain in the diagnosis and treatment of cardiac metastases.

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Mechanical forces continuously provide feedback to heart valve morphogenetic programs. In zebrafish, cardiac valve development relies on heart contraction and physical stimuli generated by the beating heart. Intracardiac hemodynamics, driven by blood flow, emerge as fundamental information shaping the development of the embryonic heart.

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