Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.09.002
Subhrajit Lahiri, Maya Baman, Robert M. Huibonhoa, Sunita Ferns
<div><h3>Background</h3><div>Atrial septal defects (ASDs) are among the most common congenital heart defects, comprising about 10 % of cases in children. Transcatheter closure of ASDs has become a preferred treatment due to its minimally invasive nature, quicker recovery, and reduced risk compared to surgical closure. Despite its advantages, the procedure carries a risk of post-procedural arrhythmias, particularly bradyarrhythmias and tachyarrhythmias, occurring in approximately 7–10 % of patients. The development of these arrhythmias can be attributed to mechanical interference with conduction tissue or the formation of reentrant circuits around the closure device. These complications can present a challenge for long-term management and require careful monitoring and treatment.</div></div><div><h3>Case summary</h3><div>We describe the case of an 8-year-old female who presented with recurrent palpitations after transcatheter closure of two ASDs using a 25 mm Gore Cardioform device. Her initial procedure was uneventful, with complete closure of both defects confirmed by echocardiography. However, one month after the procedure, the patient began experiencing episodes of palpitations and dizziness. Electrocardiographic monitoring revealed regular narrow complex tachycardia, and she was referred for further evaluation. An electrophysiology study confirmed the presence of AV nodal reentrant tachycardia (AVNRT). Detailed mapping revealed significant anatomical distortion of the slow pathway region of the AV node due to proximity to the implanted closure device. Using high-density electroanatomical mapping (HD mapping), we were able to precisely identify the critical pathways for reentry and perform successful slow pathway ablation, eliminating the tachycardia without damaging the closure device or surrounding conduction tissue. The fluoroscopy time was 0.126 mins.</div></div><div><h3>Discussion</h3><div>This case highlights the potential complications that can arise following transcatheter ASD closure, particularly the development of arrhythmias like AVNRT. While arrhythmias following device closure are relatively rare, the mechanical interference caused by the device can result in structural changes to the heart's conduction system, predisposing patients to arrhythmias. In this case, the proximity of the Gore Cardioform device to the slow pathway in the AV node likely contributed to the development of AVNRT, as the device caused localized distortion of the anatomy, facilitating reentrant circuit formation. This case emphasizes the importance of long-term follow-up and the need for advanced mapping techniques in patients undergoing ASD closure who develop post-procedure arrhythmias. High-density electroanatomical mapping, in particular, was essential in this patient, allowing for the precise localization of the arrhythmogenic substrate while avoiding unnecessary damage to the closure device or surrounding healthy tissue. The use of this advanced techno
背景：房间隔缺损（ASDs）是最常见的先天性心脏缺陷之一，约占儿童病例的10%。与外科手术封堵相比，经导管封堵asd因其微创性、恢复速度快、风险低而成为首选的治疗方法。尽管有其优点，但该手术存在术后心律失常的风险，尤其是慢速心律失常和快速心律失常，约有7-10%的患者发生。这些心律失常的发展可归因于传导组织的机械干扰或在闭合装置周围形成重入电路。这些并发症可能对长期管理提出挑战，需要仔细监测和治疗。病例总结：我们描述了一名8岁的女性，她在使用25mm Gore Cardioform装置经导管关闭两个asd后出现复发性心悸。她最初的手术很顺利，超声心动图证实两个缺陷完全闭合。然而，手术一个月后，患者开始出现心悸和头晕发作。心电图监测显示有规律的窄性复杂心动过速，并转介进一步评估。一项电生理学研究证实存在房室结折返性心动过速（AVNRT）。详细的制图显示，由于靠近植入的闭合装置，房室结的慢通路区域存在明显的解剖扭曲。通过高密度电解剖测绘（HD mapping），我们能够精确识别再入的关键通道，并成功地进行慢通道消融，在不损坏闭合装置或周围传导组织的情况下消除心动过速。透视时间0.126 min。讨论：本病例强调了经导管ASD关闭后可能出现的潜在并发症，特别是像AVNRT这样的心律失常的发展。虽然装置关闭后的心律失常相对罕见，但装置引起的机械干扰可导致心脏传导系统的结构改变，使患者易患心律失常。在这种情况下，Gore Cardioform装置靠近房室结的慢路径可能促进了AVNRT的发展，因为该装置引起局部解剖扭曲，促进了可重入电路的形成。本病例强调了长期随访的重要性，以及对ASD闭合术中出现术后心律失常的患者需要先进的定位技术。高密度电解剖定位在该患者中尤为重要，可以精确定位致心律失常底物，同时避免对闭合装置或周围健康组织造成不必要的损害。这种先进技术的使用不仅提高了空间分辨率，而且通过减少辐射暴露和优化结果来提高手术安全性，特别是对于患有复杂先天性心脏病的儿科患者。此外，在先前的外部中心手术后进行的重做消融中，高密度测绘在区分斑块低压疤痕和真正的慢通路电位方面证明是有价值的。这种方法使我们能够靶向功能缓慢途径，同时避免瘢痕组织的消融。结论：总之，高密度定位在管理该患者的AVNRT中发挥了至关重要的作用，证明了高密度定位在处理既往经导管ASD闭合患者的复杂心律失常中的重要性。制图技术的持续进步将可能进一步改善先天性心脏病相关心律失常的干预管理。
{"title":"High-density mapping for AVNRT ablation with distorted conduction system anatomy post-ASD device closure–case report","authors":"Subhrajit Lahiri, Maya Baman, Robert M. Huibonhoa, Sunita Ferns","doi":"10.1016/j.ipej.2025.09.002","DOIUrl":"10.1016/j.ipej.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Atrial septal defects (ASDs) are among the most common congenital heart defects, comprising about 10 % of cases in children. Transcatheter closure of ASDs has become a preferred treatment due to its minimally invasive nature, quicker recovery, and reduced risk compared to surgical closure. Despite its advantages, the procedure carries a risk of post-procedural arrhythmias, particularly bradyarrhythmias and tachyarrhythmias, occurring in approximately 7–10 % of patients. The development of these arrhythmias can be attributed to mechanical interference with conduction tissue or the formation of reentrant circuits around the closure device. These complications can present a challenge for long-term management and require careful monitoring and treatment.</div></div><div><h3>Case summary</h3><div>We describe the case of an 8-year-old female who presented with recurrent palpitations after transcatheter closure of two ASDs using a 25 mm Gore Cardioform device. Her initial procedure was uneventful, with complete closure of both defects confirmed by echocardiography. However, one month after the procedure, the patient began experiencing episodes of palpitations and dizziness. Electrocardiographic monitoring revealed regular narrow complex tachycardia, and she was referred for further evaluation. An electrophysiology study confirmed the presence of AV nodal reentrant tachycardia (AVNRT). Detailed mapping revealed significant anatomical distortion of the slow pathway region of the AV node due to proximity to the implanted closure device. Using high-density electroanatomical mapping (HD mapping), we were able to precisely identify the critical pathways for reentry and perform successful slow pathway ablation, eliminating the tachycardia without damaging the closure device or surrounding conduction tissue. The fluoroscopy time was 0.126 mins.</div></div><div><h3>Discussion</h3><div>This case highlights the potential complications that can arise following transcatheter ASD closure, particularly the development of arrhythmias like AVNRT. While arrhythmias following device closure are relatively rare, the mechanical interference caused by the device can result in structural changes to the heart's conduction system, predisposing patients to arrhythmias. In this case, the proximity of the Gore Cardioform device to the slow pathway in the AV node likely contributed to the development of AVNRT, as the device caused localized distortion of the anatomy, facilitating reentrant circuit formation. This case emphasizes the importance of long-term follow-up and the need for advanced mapping techniques in patients undergoing ASD closure who develop post-procedure arrhythmias. High-density electroanatomical mapping, in particular, was essential in this patient, allowing for the precise localization of the arrhythmogenic substrate while avoiding unnecessary damage to the closure device or surrounding healthy tissue. The use of this advanced techno","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 330-335"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.11.001
Shivaraj Patil, Abhishek J. Deshmukh
{"title":"Biophysics of radiofrequency Ablation: An evolving paradigm","authors":"Shivaraj Patil, Abhishek J. Deshmukh","doi":"10.1016/j.ipej.2025.11.001","DOIUrl":"10.1016/j.ipej.2025.11.001","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 285-293"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atrial fibrillation (AF) is a prevalent and potentially serious cardiac rhythm disorder. Cryoballoon ablation using the Arctic Front catheter offers a modern treatment approach. This subanalysis evaluates the safety, efficacy, and impact on quality of life for patients undergoing t this procedure in Kazakhstan. The Cryo AF Global Registry (NCT02752737) is an ongoing prospective, multi-center observational post-market registry collecting global data on CBA procedures conducted with the Arctic Front™ Family of Cardiac Cryoablation Catheters.
Methods
The study included patients aged 18 and older with paroxysmal, persistent, and long-standing persistent AF. Key safety endpoints included serious adverse events related to the device or procedure. Efficacy was measured by the absence of AF, atrial flutter (AFL), and/or atrial tachycardia (AT) after a 90-day period of discontinuing antiarrhythmic medications.
Results
No injuries to the phrenic nerve or serious complications were reported. Three serious adverse events occurred, but these were not related to the procedure. At 12 months, the Kaplan-Meier analysis showed a 92.9 % rate of freedom from AF or other atrial arrhythmias after the 90-day blanking period. Two repeat ablations (2.9 %) were needed for AF.
Conclusion
This analysis supports the conclusion that cryoballoon ablation is both safe and effective for treating AF in Kazakhstan, resulting in significant improvements in patients' quality of life.
{"title":"Cryoballoon ablation for the treatment of atrial fibrillation in Kazakhstan: One year outcome from the Cryo Global Registry","authors":"Ayan Abdrakhmanov , Omirbek Nuralinov , Gulzhaina Rashbayeva , Azat Tursunbekov , Serik Bagibayev , Abay Bakytzhanuly , Zhandos Yessilbayev , Assel Chinybayeva , Zhanar Abdrakhmanova , Alessandro Salustri , Zhanasyl Suleymen , Rano Kirkimbayeva","doi":"10.1016/j.ipej.2025.06.008","DOIUrl":"10.1016/j.ipej.2025.06.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Atrial fibrillation (AF) is a prevalent and potentially serious cardiac rhythm disorder. Cryoballoon ablation using the Arctic Front catheter offers a modern treatment approach. This subanalysis evaluates the safety, efficacy, and impact on quality of life for patients undergoing t this procedure in Kazakhstan. The Cryo AF Global Registry (NCT02752737) is an ongoing prospective, multi-center observational post-market registry collecting global data on CBA procedures conducted with the Arctic Front™ Family of Cardiac Cryoablation Catheters.</div></div><div><h3>Methods</h3><div>The study included patients aged 18 and older with paroxysmal, persistent, and long-standing persistent AF. Key safety endpoints included serious adverse events related to the device or procedure. Efficacy was measured by the absence of AF, atrial flutter (AFL), and/or atrial tachycardia (AT) after a 90-day period of discontinuing antiarrhythmic medications.</div></div><div><h3>Results</h3><div>No injuries to the phrenic nerve or serious complications were reported. Three serious adverse events occurred, but these were not related to the procedure. At 12 months, the Kaplan-Meier analysis showed a 92.9 % rate of freedom from AF or other atrial arrhythmias after the 90-day blanking period. Two repeat ablations (2.9 %) were needed for AF.</div></div><div><h3>Conclusion</h3><div>This analysis supports the conclusion that cryoballoon ablation is both safe and effective for treating AF in Kazakhstan, resulting in significant improvements in patients' quality of life.</div></div><div><h3>Registration number</h3><div>NCT02752737.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 294-301"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fluoroscopy-free ablation techniques have gained popularity in recent years. However, coronary sinus (CS) cannulation via the femoral approach remains technically challenging, particularly when using specialized catheters like the BeeAT™. To demonstrate a reproducible technique for fluoroscopy-free CS cannulation using the BeeAT catheter guided by CARTO® electroanatomical mapping and intracardiac echocardiography (ICE). Forty three patients undergoing atrial fibrillation ablation were enrolled. After 3D mapping of the right atrium and CS ostium identification via ICE, a femoral-type BeeAT catheter was inserted. Direct advancement or RA loop techniques were applied based on anatomy. CARTO settings were adjusted to allow impedance-based catheter visualization. Successful CS cannulation without fluoroscopy was achieved in all 43 cases. The direct technique succeeded in 36 cases, and the RA loop method was used in 7. No complications occurred.
Conclusion
Fluoroscopy-free femoral CS cannulation with the BeeAT catheter is safe, feasible, and enhances procedural efficiency while avoiding radiation exposure.
{"title":"Fluoroless coronary sinus cannulation using a BeeAT catheter and the CARTO mapping system","authors":"Shintaro Yamagami , Tsukasa Motoyoshi , Takashi Kanda , Toshihiro Tamura","doi":"10.1016/j.ipej.2025.08.007","DOIUrl":"10.1016/j.ipej.2025.08.007","url":null,"abstract":"<div><div>Fluoroscopy-free ablation techniques have gained popularity in recent years. However, coronary sinus (CS) cannulation via the femoral approach remains technically challenging, particularly when using specialized catheters like the BeeAT™. To demonstrate a reproducible technique for fluoroscopy-free CS cannulation using the BeeAT catheter guided by CARTO® electroanatomical mapping and intracardiac echocardiography (ICE). Forty three patients undergoing atrial fibrillation ablation were enrolled. After 3D mapping of the right atrium and CS ostium identification via ICE, a femoral-type BeeAT catheter was inserted. Direct advancement or RA loop techniques were applied based on anatomy. CARTO settings were adjusted to allow impedance-based catheter visualization. Successful CS cannulation without fluoroscopy was achieved in all 43 cases. The direct technique succeeded in 36 cases, and the RA loop method was used in 7. No complications occurred.</div></div><div><h3>Conclusion</h3><div>Fluoroscopy-free femoral CS cannulation with the BeeAT catheter is safe, feasible, and enhances procedural efficiency while avoiding radiation exposure.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 343-346"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stellate ganglion modulation: An old therapy with a new twist for treatment of ventricular arrhythmias","authors":"Shail Avasthi BS , Marmar Vaseghi MD PhD FACC FHRS","doi":"10.1016/j.ipej.2025.10.011","DOIUrl":"10.1016/j.ipej.2025.10.011","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 328-329"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.06.005
Sanjeev S. Mukherjee , Ashesh Halder , Anil Kumar Singhi , K. Sivakumar
We report a case of atrioventricular (AV) block post successful percutaneous atrial septal defect (ASD) device closure. He had minimal fatigue and presented for his routine follow-up after intervention. His ECG showed 2:1 AV block. The interesting finding was appearance of varying PR interval in the conducted beats evoking possibility of complete heart block (CHB). We review the literature and conclude that changing PR is part of compensation to maintain R-R interval in a typical Wenckebach phenomenon.
{"title":"2: 1 AV block post ASD device closure - What is the mechanism","authors":"Sanjeev S. Mukherjee , Ashesh Halder , Anil Kumar Singhi , K. Sivakumar","doi":"10.1016/j.ipej.2025.06.005","DOIUrl":"10.1016/j.ipej.2025.06.005","url":null,"abstract":"<div><div>We report a case of atrioventricular (AV) block post successful percutaneous atrial septal defect (ASD) device closure. He had minimal fatigue and presented for his routine follow-up after intervention. His ECG showed 2:1 AV block. The interesting finding was appearance of varying PR interval in the conducted beats evoking possibility of complete heart block (CHB). We review the literature and conclude that changing PR is part of compensation to maintain R-R interval in a typical Wenckebach phenomenon.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 304-309"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.07.005
Ahmet Taha Sahin , Oznur Keskin , Ahmet Lutfu Sertdemir , Enes Elvin Gul
Alternating or variable paced QRS morphologies following pacemaker implantation is an important clinical observation. Patients undergoing pacemaker upgrade where contralateral implantation was performed, old generator usually removed. Some centers prefer either leaving the old device in the body or removal after few weeks due to risk of infection. Leaving old pacemaker in the body might lead to dangerous circumstances such as inhibiting new pacing system in a pacemaker dependent patient. This case highlights the complexities and potential complications of managing dual pacemakers.
{"title":"Is competition always good? dual pacemaker management pitfalls","authors":"Ahmet Taha Sahin , Oznur Keskin , Ahmet Lutfu Sertdemir , Enes Elvin Gul","doi":"10.1016/j.ipej.2025.07.005","DOIUrl":"10.1016/j.ipej.2025.07.005","url":null,"abstract":"<div><div>Alternating or variable paced QRS morphologies following pacemaker implantation is an important clinical observation. Patients undergoing pacemaker upgrade where contralateral implantation was performed, old generator usually removed. Some centers prefer either leaving the old device in the body or removal after few weeks due to risk of infection. Leaving old pacemaker in the body might lead to dangerous circumstances such as inhibiting new pacing system in a pacemaker dependent patient. This case highlights the complexities and potential complications of managing dual pacemakers.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 347-349"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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