This case report demonstrates that the ICPM-A/V setting in open window mapping reduces misannotations and improves mapping accuracy for accessory pathways.
This case report demonstrates that the ICPM-A/V setting in open window mapping reduces misannotations and improves mapping accuracy for accessory pathways.
Patients search online content to improve their understanding of medical procedures. The quality of online patient education materials (OPEMs) on catheter ablation of ventricular arrhythmias (VAs) requires investigation.
Six predetermined search terms relating to VA ablation were used to search Google, Bing and Yahoo for written OPEMs, and YouTube for video OPEMs. Written OPEMs were assessed for readability using five readability indices to produce a required reading grade level, and quality using the DISCERN and Journal of the American Medical Association (JAMA) instruments. Video OPEMs were assessed for quality according to compliance with a list of investigator-developed essential discussion points.
1200 written and 480 videos were identified using the search strategy, of which 60 and 25 respectively were unique OPEMs included in this study. The mean reading grade level for written OPEMs was 11.3 ± 1.9, with no articles being written at the 6th grade level recommended by the American Medical Association. Using quality metrics, only 26.7% of written OPEMs attained a ‘high-quality’ JAMA rating, and 30% had a DISCERN score of ‘good’ or better. Video OPEMs similarly had poor quality, only discussing a mean of 3.50 ± 2.57 out of 18 total essential criteria.
There is a paucity of online patient-directed materials on VA catheter ablation. Available OPEMs are of insufficient quality to adequately convey essential information, and written OPEMs are written at a level higher than the recommended reading level.
High-resolution mapping with Ripple and LAM modules enabled precise identification of slow pathway ablation targets in a PLSVC patient. This novel approach overcame anatomical challenges, offering a more effective strategy for AVNRT treatment in complex cases.
The efficacy of artificial intelligence (AI)-enhanced electrocardiography (ECG) for detecting hypertrophic cardiomyopathy (HCM) and its dilated phase (dHCM) has been developed, though specific ECG characteristics associated with these conditions remain insufficiently characterized.
This retrospective study included 19,170 patients, with 140 HCM or dHCM cases, from the Shinken Database (2010–2017). The 140 cases (HCM-total) were categorized into basal-only HCM (HCM-basal, n = 75), apical involvement (HCM-apical, n = 46), and dHCM (n = 19). We analyzed 438 ECG parameters across the P-wave (110), QRS complex (194), and ST-T segment (134). High parameter importance (HPI) was defined as 1/p > 104 in univariate logistic regression, while multivariate logistic regression was used to determine the area under the receiver operating characteristic curves (AUROC).
In HCM-basal and HCM-apical, HPI was predominantly observed in the ST-T segment (49% and 51%, respectively), followed by the QRS complex (29% and 27%). For dHCM, HPI was lower in the ST-T segment (16%) and QRS complex (22%). The P-wave had low HPI across all subtypes. AUROCs for models with total ECG parameters were 0.925 for HCM-basal, 0.981 for HCM-apical, and 0.969 for dHCM. While AUROCs for the top 10 HPI models were lower than the total ECG parameter model for HCM total, they were comparable across HCM subtypes.
As HCM progresses to dHCM, a shift in HPI from the ST-T segment to the QRS complex provides clinically relevant insights. For HCM subtypes, the top 10 ECG parameters yield predictive performance similar to the full parameter set, supporting efficient approaches for AI-based diagnostic models.
Oral anticoagulants (OAC) can reduce ischemic stroke/systemic embolism (SSE) in patients with non-valvular atrial fibrillation (AF) while increasing the risk of major bleeding. We aimed to analyze the number needed to treat for the net benefit (NNTnet) of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs).
We analyzed the results from multicenter national AF registry from 27 hospitals in Thailand. Follow-up data were collected every 6 months until 3 years. Main outcomes were SSE, major bleeding, and intracranial hemorrhage (ICH). NNT was calculated from the absolute risk reduction (ARR) of SSE or absolute risk increase (ARI) of major bleeding or ICH. We compared NNTnet of warfarin versus no OAC, NOACs versus no OAC, and NOACs versus warfarin. Warfarin was also categorized into time in therapeutic range (TTR) < and ≥65%.
We studied a total of 3405 patients (mean age 67.8 ± 11.3 years, 1424 (41.8%) were female). The incidence rates of SSE, major bleeding, and ICH were 1.51, 2.25, and 0.78 per 100 person-years, respectively. Warfarin had negative NNTnet −37 compared to no OAC. NOACs had positive NNTnet 101 and 27 compared to no OACs and warfarin. Warfarin with TTR 65% had positive NNTnet 42 compared to no OAC. NOACs had comparable NNTnet as warfarin with TTR ≥65%.
Warfarin had a negative NNTnet compared to no OAC. Only warfarin with TTR 65% has positive NNTnet. NOACs had positive NNTnet compared to no OAC and when compared to warfarin.
When we recapture the Micra system, we capture the body by pulling the tether attached to the delivery catheter and retrieve it, but sometimes it is difficult, and the Micra is dislodged and fixed in the tricuspid valve annulus. Using a single snare catheter from the superior vena cava and pushing the tines changes the orientation of the device and enables recapture.
The leading cause of death in patients with ischemic cardiomyopathy is sudden cardiac death caused by ventricular arrhythmias. Accurate determination of arrhythmic risk in these patients is vital to allow clinicians to take appropriate preventive measures.
To review and summarize the literature on electrocardiographic imaging (ECGi) metrics that could be used to predict arrhythmic risk in patients with ischemic cardiomyopathy.
A comprehensive literature search was performed to retrieve research articles on non-invasive electrocardiographic mapping techniques. Inclusion criteria of the studies required the involvement of patients with ischemic cardiomyopathy or ischemic heart disease.
A total of 17 papers were identified, five of which specifically utilized ECGi to acquire metrics associated with an increased risk of ventricular arrhythmia (VA). ECGi metrics, including activation time, repolarization time, activation-recovery interval, and voltage amplitude, were distinguishable between patients with ischemic cardiomyopathy, patients with a history of VA, and healthy controls.
ECGi allows non-invasive measurement of metrics which are associated with an increased risk of ventricular arrhythmias in patients with ischemic cardiomyopathy. ECGi may be a useful tool for risk assessment in these patients. Prospective studies are warranted for further validation and prediction of clinical endpoints.
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