Journal of Arrhythmia最新文献

J-wave syndromes (JWS)—comprising Brugada syndrome (BrS) and early repolarization syndrome (ERS)—are important causes of malignant ventricular arrhythmias and sudden cardiac death in patients whose hearts appear structurally normal. Since the 2016 consensus, advances in genetics, pathophysiology, and therapy have redefined both understanding and management. BrS, once viewed as a purely electrical disorder, is now recognized along a microstructural–electrical continuum, with sodium-channel dysfunction and subtle epicardial fibrosis of the right ventricular outflow tract as key contributors. Likewise, ERS—historically considered benign—carries significant risk when inferolateral J-waves coexist with arrhythmic events. Genetically, SCN5A remains the sole gene with definitive disease association, while polygenic susceptibility materially modulates risk, underscoring complex inheritance. Risk stratification remains challenging: patients with prior cardiac arrest or arrhythmic syncope are highest risk, whereas asymptomatic individuals warrant multiparametric assessment integrating clinical features, ECG markers, electrophysiologic studies, and genetics. For decades, treatment centered on implantable cardioverter-defibrillators and quinidine, both limited by availability, tolerance, and device complications. More recently, epicardial substrate ablation has emerged as a transformative therapy, with large registries and randomized trials demonstrating durable suppression of ventricular fibrillation and acceptable safety. This APHRS-organized international consensus updates and extends the 2016 Expert Consensus and the 2022 ESC Guidelines, providing contemporary diagnostic frameworks, pragmatic risk-stratification tools, and treatment algorithms for BrS and ERS. It emphasizes JWS as a microstructural–electrical disease spectrum and elevates substrate ablation as a major therapeutic advance, while outlining priorities for genetics, risk-stratification and treatment algorithms.

This case represents the first reported instance of an inappropriate S-ICD shock caused by a public electric bath in Japan.

Unidirectional counter-clockwise manipulation of the Evolution RL sheath after adequate dissection enables controlled lead body rotation and gradual unscrewing. This technique may reduce myocardial injury during non-retractable screw-in lead removal.

During circumferential ablation of the right pulmonary veins (PVs), high-power, short-duration (HPSD) ablation at the anterior wall of the right PVs, corresponding to the left atrial septal side, resulted in an abrupt impedance increase from 120 to 180 Ω, occurring 11 s after RF delivery initiation (A). After an abrupt impedance rise, withdrawal of the ablation catheter from the long sheath revealed a circumferential thrombus adhering directly above the irrigation holes at the catheter tip (B). The catheter tip after thrombus removal is shown in (C), and the ring-shaped thrombus that adhered to the catheter tip is displayed in (D).

High-density activation mapping with a multipolar catheter revealed a triple loop atrial flutter occurring after a lung transplant in which two electrical connections between the recipient left atrium and the donor left pulmonary vein cuff and a surgical scar at the mitral isthmus acted as a substrate.

Intracardiac echocardiography (ICE) enabled safe, contrast-free implantation of an Aveir VR leadless pacemaker in a high-risk patient with severe contrast allergy and prior device infection, allowing real-time assessment of right ventricular anatomy and myocardial wall thickness to minimize perforation risk.

Roof-dependent atrial flutter (AFL) can sometimes be challenging to treat with endocardial catheter ablation due to the thickness of the atrial myocardium and the separation of outer epicardial conductive fibers from the endocardial myocardium. This case highlights the utility of peak frequency (PF) analysis during the AFL, which can visualize a narrow endocardial channel and help physicians select an optimal therapeutic target to achieve a transmural line of block.