Electro-mechanical noise from the interaction of multiple coronary wires can inhibit pacing with a risk of asystole in pacemaker-dependent patients. Awareness of this phenomenon is important to guide prompt management with adjustment of device sensitivity, asynchronous pacing, removal of a coronary wire or insertion of a temporary pacing system.
Severely ill patients with coronavirus disease 2019 (COVID-19) show an increased risk of new-onset atrioventricular blocks (AVBs), associated with high rates of short-term mortality. Recent data suggest that the uncontrolled inflammatory activation observed in these patients, specifically interleukin (IL)-6 elevation, may play an important pathogenic role by directly affecting cardiac electrophysiology. The aim of our study was to assess the acute impact of IL-6 changes on electrocardiographic indices of atrioventricular conduction in severe COVID-19.
We investigated (1) the behavior of PR-interval and PR-segment in patients with severe COVID-19 during active phase and recovery, and (2) their association with circulating IL-6 levels over time.
During active disease, COVID-19 patients showed a significant increase of PR-interval and PR-segment. Such atrioventricular delay was transient as these parameters rapidly normalized during recovery. PR-indices significantly correlated with circulating IL-6 levels over time. All these changes and correlations persisted also in the absence of laboratory signs of cardiac strain/injury or concomitant treatment with PR-prolonging drugs, repurposed or not.
Our study provides evidence that in patients with severe COVID-19 and high-grade systemic inflammation, IL-6 elevation is associated with a significant delay of atrioventricular conduction, independent of concomitant confounding factors. While transient, such alterations may enhance the risk of severe AVB and associated short-term mortality. Our data provide further support to current anti-inflammatory strategies for severe COVID-19, including IL-6 antagonists.
Atrial tachycardias in young patients may portend ominous prognosis. We present the case of a 17-year-old male with atrial tachycardia and extensive low-voltage areas in the right atrium, its treatment, and discuss potential diagnoses.
Femoral venous access is routinely used for radiofrequency catheter ablation (RFA) procedures. Deep vein thrombosis (DVT), which is often sub-clinical, is uncommon following RFCA. Point-of-care ultrasound (POCUS) is a cost-effective way to diagnose DVT. Identification of DVT incidence, especially if sub-clinical, can direct change in practice to reduce DVT and lay ground for cost-effective screening strategies postprocedures. The aim of our study is to determine the incidence of DVT after right-sided radiofrequency cardiac catheter ablation using POCUS.
We conducted a single-center prospective cross-sectional study in patients undergoing right-sided RFCA. Within 24 h postprocedure, the participants underwent compression venous duplex ultrasonography using POCUS to look for evidence of DVT in cannulated limb. The contralateral limb that was not cannulated was scanned as a control.
A total of 194 patients were scanned post-right-sided RFCA procedures. Average age was 43.5 ± 13.2 years and 131 (67.5%) were women. A total of 148 (76.3%) patients underwent AVNRT ablation. Ten (5.2%) patients developed DVT, of which nine had sub-clinical DVT. Age (>53 years), greater sum of sheaths used (>3) and longer duration of bed rest maintained (up to 4.0 h vs. >4.0 h, p = 0.006) were identified as risk factors.
Most of the DVTs after right-sided catheter ablation are sub-clinical. Routine scanning for DVT after right-sided catheter ablation as well as reducing number of sheaths and bed rest should be considered.
We present a case of catheter ablation of a premature ventricular complex complicated by left main injury. During ablation from the left coronary cusp, a sudden rise in impedance was followed by ST elevation on the ECG. Angioplasty and stenting were performed immediately; however, the stent subsequently developed repeated stenosis.
A case report involving incessant multi-types of supraventricular tachycardia and acute decompensated heart failure required a rescuing electrophysiology study and ablation. Ventricular fibrillation occurred due to coronary spasm, complicating the deteriorating heart. However, aggressive therapies, including extracorporeal support and the timely elimination of the culprit accessory pathway, successfully resolved the patient's condition.
This case demonstrated the feasibility of administering emergent intravenous thrombolysis followed by Dabigatran reversal with idarucizumab in a patient who underwent atrial fibrillation ablation. The consideration of transitioning anticoagulant therapy to dabigatran for scheduled AF ablation in patients at high risk of stroke should be carefully evaluated.
An electrical storm ensued following multiple shocks by an implantable cardioverter defibrillator (ICD). The prevention of such electrical storms is prognostically important and includes revision of medical therapy, modification of ICD settings, cardiac sympathectomy, and ablations.
Pulsed-field ablation (PFA) has emerged as an innovative alternative to radiofrequency (RF) and cryoablation because it selectively targets myocardial tissue. Thus, we aim to estimate the efficacy and safety of PFA versus thermal ablation for atrial fibrillation (AF) ablation.
A systematic review and meta-analysis were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023480321
We included 17 studies with a total of 2255 patients. PFA was significantly associated with a decreased incidence of AF recurrence (RR: 0.66 with 95% CI [0.51, 0.87], p = .003). However, there was no significant difference between PFA and thermal ablation in arrhythmia recurrence (RR: 0.92 with 95% CI [0.74, 1.46], p = .42). PFA was significantly associated with decreased total procedure time (MD: −15.15 with 95% CI [−20.23, −10.07], p < .00001), decreased heart rate change (MD: −7.39 with 95% CI [−12.16, −2.62], p = .002), decreased phrenic nerve palsy (RR: 0.38 with 95% CI [0.15, 0.98], p = .05), and reduced esophageal lesions (RR: 0.09 with 95% CI [0.01, 0.69], p = .02). On the contrary, PFA was significantly associated with increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], p = .01).
PFA was significantly associated with decreased AF recurrence, total procedure time, heart rate change, phrenic nerve palsy, esophageal lesion, and increased incidence of pericardial tamponade compared with thermal ablation.
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