Indian Pacing and Electrophysiology Journal最新文献

Background: Cryoballoon ablation is an established therapy for atrial fibrillation, but complete pulmonary vein (PV) occlusion can be challenging in large or anatomically complex veins. The size-adjustable cryoballoon (POLARx™ FIT), expandable to 31 mm, was developed to improve occlusion; however, downsizing to a 28-mm balloon is sometimes required. The impact of PV morphology, particularly ovality, on occlusion performance remains unclear.

Methods: In vitro PV models with long-axis diameters of 30 mm and 24 mm were created, each including multiple ovality indices. Occlusion was assessed using 28-mm and 31-mm POLARx™ FIT cryoballoons. Intraluminal PV pressure was measured as an index of occlusion efficacy, with three repeated measurements averaged for each model.

Results: For the 31-mm balloon, a significant negative correlation was observed between ovality index and PV pressure in both model sizes (p < 0.0001), indicating reduced occlusion with increasing ovality. No such correlation was observed for the 28-mm balloon. In 24-mm models, the 28-mm balloon achieved higher and more consistent pressures.

Conclusion: Pre-freeze mechanical occlusion differed according to balloon size and PV geometry. The 31-mm balloon performed best in larger, more circular veins, whereas the 28-mm balloon showed more uniform performance across varying shapes, likely reflecting differences in stiffness and compliance. These findings provide mechanistic insight into balloon-PV interactions and warrant further experimental and clinical validation.

Objective: To investigate the safety and efficacy of ganglionated plexus ablation of the left atrium for patients with refractory vasovagal syncope.

Methods: From May 2019 to December 2023, 39 patients with refractory vasovagal syncope (VVS) underwent ganglionated plexus (GP) ablation at our institution. Associations between post-ablation VVS recurrence and factors including average heart rate on Holter monitoring, preoperative head-up tilt table test (HUTT), for GP identification methods, and sex were analyzed.

Results: During the follow-up period 18.7 months, 30 of the 39 patients (76.9 % vs 23.1 %, p = 0.001) were symptom-free after GP ablation. The remaining 9 patients exhibited significant symptomatic improvement, with a marked reduction in the number of syncopal episodes (2.11 ± 1.27 vs 7.13 ± 3.57, p = 0.00). The mean heart rate after procedure (87.10 ± 11.22 bpm) was significantly higher than pre-procedures (70.33 ± 7.56 bpm, p = 0.00), indicating effective VVS control. Preoperative HUTT classifications and GP localization methods showed no significant association with recurrence, although female sex was associated with a higher likelihood of recurrent VVS. No procedure-related complication occurred.

Conclusion: GP ablation of the left atrium is a safe and effective treatment for patients with refractory vasovagal syncope.

The sudden death of an athlete causes grave concern among the medical, sporting, and lay communities, considering athletes epitomise the healthiest segment of society. Most decedents are asymptomatic, therefore screening to identify vulnerable individuals seems appropriate, particularly since most aetiologies can be detected during life and several therapeutic interventions can be implemented to minimise the risk. Given the diversity of conditions implicated in exercise related SCD, no single test will detect all disorders. Furthermore, the low incidence of SCD allows for a cost-effective approach using the simplest and most readily available tools. The 12-lead electrocardiogram has emerged as the most effective tool for detecting electrical diseases and raising suspicion of cardiomyopathy. The international recommendations for ECG interpretation allows for physiological remodelling, substantially reducing false positive rates. Nonetheless, the challenge remains, since the ECG will fail to identify up to 20 % of diseases implicated in young sudden cardiac death and is of limited value in middle-aged and older athletes, in whom atherosclerotic coronary artery disease dominates. Therefore, mitigation of risk extends beyond screening to encompass timely resuscitation, universal defibrillator access, and education in cardiac awareness. The future of screening for cardiovascular disease in athletes is likely to combine traditional evaluation with artificial intelligence, including the use of wearable monitoring, and equal access for effective screening worldwide.

Atrial fibrillation (AF) is the most common chronic arrhythmia worldwide. AF related complications include ischemic stroke, which can be prevented for largely by the use of direct oral anticoagulants. This review focuses on the randomized trial and large registries on edoxaban, a direct factor Xa inhibitor. The ENGAGE-AF TIMI 48 study demonstrated that edoxaban 60/30 mg was non-inferior to warfarin for stroke or systemic embolism (SEE) prevention, while superior with regard to major bleeding. In ELDERCARE-AF, the non-approved dose of edoxaban 15 mg versus placebo resulted in a lower risk of stroke/SEE and a numerically higher major bleeding risk in elderly patients from Japan with a contraindication for anticoagulation. These results are echoed in many sub analyses, generally showing preserved efficacy and safety of edoxaban versus warfarin, in patients with varying absolute risk for clinical outcomes. Asian patients with AF, who have a different risk profile than non-Asian patients, and edoxaban proved an effective and safe anticoagulant in Asian patients too. In the ETNA-AF Global registry, comprising patients from Europe and Asia, as well as in other non-randomized real-world studies, the efficacy and safety of edoxaban was confirmed. In conclusion, edoxaban is an effective and safe direct anticoagulant for stroke prevention in AF. The large evidence base in Asian patients, in patients with cardiovascular and non-cardiovascular comorbidities and with different dosing regimens provide clinicians with a valuable option for stroke prevention in their patients with AF.

14-year-old boy presented with aborted sudden cardiac arrest during exertion. His brother died suddenly at 16 years of age during an emotional situation. On stress testing, patient developed classical bidirectional PVCs typical of CPVT (Catecholaminergic polymorphic ventricular tachycardia). The genetic testing showed pathogenic heterozygous variant in CASQ₂ gene. Patient was started on propranolol and flecainide and advised to avoid strenuous physical activity.