Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.04.010
{"title":"Multiple ventricular fibrillation therapy triggered at slower ventricular tachycardia rate – What is the mechanism?","authors":"","doi":"10.1016/j.ipej.2024.04.010","DOIUrl":"10.1016/j.ipej.2024.04.010","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000494/pdfft?md5=0d62260436716cdfc370f2bbd1ffb46d&pid=1-s2.0-S0972629224000494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.05.001
Premature ventricular contraction (PVC) is usually eliminated in the earliest activation site based on the conventional electrode of ablation catheter. However, the large size electrode may contain far-field potential. The QDOT MICRO ablation catheter has three micro electrodes with 0.33 mm electrode length, in addition to the conventional electrode with 3.5 mm electrode length. The micro electrodes can reflect only near-field potential.
A 78-year-old with symptomatic frequent PVCs underwent catheter ablation. PVC-1 showed good pace-mapping in distal great cardiac vein (GCV). The local bipolar electrograms in the conventional electrode of ablation catheter preceded the PVC-QRS onset by 32 ms in distal GCV and 13 ms in left coronary cusp (LCC), but those in the micro electrodes preceded only by 13 ms both in distal GCV and LCC. PVC-1 was eliminated by radiofrequency (RF) application, not in distal GCV, but in LCC. PVC-2 showed good pace-mapping in LCC. The local bipolar electrograms in both the conventional electrode and the micro electrodes of ablation catheter preceded the PVC-QRS onset by 32 ms in LCC. PVC-2 was eliminated by RF application in LCC.
Comparing the local electrograms of micro electrodes and the conventional electrodes may be important for identifying depth of the origin of PVCs.
{"title":"Insight from the microelectrodes in case of two different types of premature ventricular contractions originating from left ventricular summit","authors":"","doi":"10.1016/j.ipej.2024.05.001","DOIUrl":"10.1016/j.ipej.2024.05.001","url":null,"abstract":"<div><p>Premature ventricular contraction (PVC) is usually eliminated in the earliest activation site based on the conventional electrode of ablation catheter. However, the large size electrode may contain far-field potential. The QDOT MICRO ablation catheter has three micro electrodes with 0.33 mm electrode length, in addition to the conventional electrode with 3.5 mm electrode length. The micro electrodes can reflect only near-field potential.</p><p>A 78-year-old with symptomatic frequent PVCs underwent catheter ablation. PVC-1 showed good pace-mapping in distal great cardiac vein (GCV). The local bipolar electrograms in the conventional electrode of ablation catheter preceded the PVC-QRS onset by 32 ms in distal GCV and 13 ms in left coronary cusp (LCC), but those in the micro electrodes preceded only by 13 ms both in distal GCV and LCC. PVC-1 was eliminated by radiofrequency (RF) application, not in distal GCV, but in LCC. PVC-2 showed good pace-mapping in LCC. The local bipolar electrograms in both the conventional electrode and the micro electrodes of ablation catheter preceded the PVC-QRS onset by 32 ms in LCC. PVC-2 was eliminated by RF application in LCC.</p><p>Comparing the local electrograms of micro electrodes and the conventional electrodes may be important for identifying depth of the origin of PVCs.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000524/pdfft?md5=5896e657f2054434025bc6e2c4b41b0d&pid=1-s2.0-S0972629224000524-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.06.002
{"title":"Unearthing an artifact: Managed ventricular pacing pseudo-malfunction in an 81-year-old puerto rican female","authors":"","doi":"10.1016/j.ipej.2024.06.002","DOIUrl":"10.1016/j.ipej.2024.06.002","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000718/pdfft?md5=6223ceb461122b9ba27e3b6498fecf81&pid=1-s2.0-S0972629224000718-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.07.003
{"title":"To monitor, or not to monitor, that is the question","authors":"","doi":"10.1016/j.ipej.2024.07.003","DOIUrl":"10.1016/j.ipej.2024.07.003","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000822/pdfft?md5=48304bd8aece87bd7d98fb06fb43da7a&pid=1-s2.0-S0972629224000822-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.06.003
Introduction
The risk of complications associated with transvenous ICDs make the subcutaneous implantable cardiac defibrillator (S-ICD) a valuable alternative in patients with adult congenital heart disease (ACHD). However, higher S-ICD ineligibility and higher inappropriate shock rates-mostly caused by T wave oversensing (TWO)- are observed in this population. We report a novel application of deep learning methods to screen patients for S-ICD eligibility over a longer period than conventional screening.
Methods
Adult patients with ACHD and a control group of normal subjects were fitted with a 24-h Holters to record their S-ICD vectors. Their T:R ratio was analysed utilising phase space reconstruction matrices and a deep learning-based model to provide an in-depth description of the T: R variation plot for each vector. T: R variation was compared statistically using t-test.
Results
13 patients (age 37.4 ± 7.89 years, 61.5 % male, 6 ACHD and 7 control subjects) were enrolled. A significant difference was observed in the mean and median T: R values between the two groups (p < 0.001). There was also a significant difference in the standard deviation of T: R between both groups (p = 0.04).
Conclusions
T:R ratio, a main determinant for S-ICD eligibility, is significantly higher with more tendency to fluctuate in ACHD patients when compared to a population with normal hearts. We hypothesise that our novel model could be used to select S-ICD eligible patients by better characterisation of T:R ratio, reducing the risk of TWO and inappropriate shocks in the ACHD patient cohort.
{"title":"Using artificial intelligence and deep learning to optimise the selection of adult congenital heart disease patients in S-ICD screening","authors":"","doi":"10.1016/j.ipej.2024.06.003","DOIUrl":"10.1016/j.ipej.2024.06.003","url":null,"abstract":"<div><h3>Introduction</h3><p>The risk of complications associated with transvenous ICDs make the subcutaneous implantable cardiac defibrillator (S-ICD) a valuable alternative in patients with adult congenital heart disease (ACHD). However, higher S-ICD ineligibility and higher inappropriate shock rates-mostly caused by T wave oversensing (TWO)- are observed in this population. We report a novel application of deep learning methods to screen patients for S-ICD eligibility over a longer period than conventional screening.</p></div><div><h3>Methods</h3><p>Adult patients with ACHD and a control group of normal subjects were fitted with a 24-h Holters to record their S-ICD vectors. Their T:R ratio was analysed utilising phase space reconstruction matrices and a deep learning-based model to provide an in-depth description of the T: R variation plot for each vector. T: R variation was compared statistically using <em>t</em>-test.</p></div><div><h3>Results</h3><p>13 patients (age 37.4 ± 7.89 years, 61.5 % male, 6 ACHD and 7 control subjects) were enrolled. A significant difference was observed in the mean and median T: R values between the two groups (p < 0.001). There was also a significant difference in the standard deviation of T: R between both groups (p = 0.04).</p></div><div><h3>Conclusions</h3><p>T:R ratio, a main determinant for S-ICD eligibility, is significantly higher with more tendency to fluctuate in ACHD patients when compared to a population with normal hearts. We hypothesise that our novel model could be used to select S-ICD eligible patients by better characterisation of T:R ratio, reducing the risk of TWO and inappropriate shocks in the ACHD patient cohort.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000731/pdfft?md5=ac57435926d04f66f8b2cf52cb4ef08f&pid=1-s2.0-S0972629224000731-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.06.006
{"title":"Entrainment responses from a reentrant circuit with 2 entry sites: When the antidromic wavefront can drive","authors":"","doi":"10.1016/j.ipej.2024.06.006","DOIUrl":"10.1016/j.ipej.2024.06.006","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000755/pdfft?md5=49d285bca78cca211dc374b09b993c86&pid=1-s2.0-S0972629224000755-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.04.011
{"title":"The usefulness of \"reversed U-curve\" HD grid mapping","authors":"","doi":"10.1016/j.ipej.2024.04.011","DOIUrl":"10.1016/j.ipej.2024.04.011","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000512/pdfft?md5=3a049c3a359e4770e0b42b9c2f4fe6f5&pid=1-s2.0-S0972629224000512-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.04.008
The coexistence of different types of wide QRS complex tachycardias induced by the same trigger has rarely been observed. The electrical instability and incessant nature of tachycardias can cause tachycardiomyopathy and will not allow accurate diagnosis during an electrophysiological study (EPS). In case of an electrical storm, elimination of the trigger may be the first approach to provide patient stability. We report a successfully managed case of repetitive initiation of pleomorphic ventricular tachycardia and Mahaim-type antidromic atrioventricular reentrant tachycardia, induced by a premature ventricular complex in the right ventricular outflow tract.
{"title":"Challenging wide QRS tachycardia diagnosis: One trigger two mechanisms","authors":"","doi":"10.1016/j.ipej.2024.04.008","DOIUrl":"10.1016/j.ipej.2024.04.008","url":null,"abstract":"<div><p>The coexistence of different types of wide QRS complex tachycardias induced by the same trigger has rarely been observed. The electrical instability and incessant nature of tachycardias can cause tachycardiomyopathy and will not allow accurate diagnosis during an electrophysiological study (EPS). In case of an electrical storm, elimination of the trigger may be the first approach to provide patient stability. We report a successfully managed case of repetitive initiation of pleomorphic ventricular tachycardia and Mahaim-type antidromic atrioventricular reentrant tachycardia, induced by a premature ventricular complex in the right ventricular outflow tract.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000500/pdfft?md5=ec85b3cd13112fde893c5acf3d9eab30&pid=1-s2.0-S0972629224000500-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.05.005
Vasospastic angina is a clinical condition characterized by coronary artery spasm in angiographically normal coronary arteries. Vasospastic angina can often lead to ventricular arrhythmias, sudden cardiac death, or life-threatening bradyarrhythmias, such as high-degree atrioventricular block or asystole. We present the unusual case of a woman with depressive syndrome who underwent emergency surgery for hemostasis of a neck lesion that caused hemorrhagic shock after a suicide attempt. During surgery, the electrocardiogram revealed inferior and posterior ST-segment elevation, total atrioventricular block and torsades de pointes; the patient also suffered 4 minutes of cardiac arrest. A temporary pacemaker was placed. Coronary angiography showed right coronary artery vasospasm. Following a second similar episode after tracheostomy, a permanent pacemaker was implanted. The indication for definitive electrostimulation in such a context and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.
Learning objective
The indication for definitive electrostimulation in a context of recurrent episodes of high-degree atrioventricular block during vasospastic angina and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.
血管痉挛性心绞痛是一种以血管造影正常的冠状动脉痉挛为特征的临床症状。血管痉挛性心绞痛通常会导致室性心律失常、心脏性猝死或危及生命的缓慢性心律失常,如高度房室传导阻滞或心搏骤停。我们介绍了一例不寻常的病例:一名患有抑郁综合征的女性在自杀未遂后,因颈部病变导致失血性休克而接受了急诊手术止血。手术过程中,心电图显示 ST 段下段和后段抬高、完全性房室传导阻滞和室性心动过速;患者还出现了 4 分钟的心跳骤停。为其安装了临时起搏器。冠状动脉造影显示右冠状动脉血管痉挛。在气管插管术后第二次出现类似情况后,又植入了永久起搏器。在这种情况下进行明确电刺激的适应症以及血管痉挛背后的颈动脉窦刺激机制构成了这一临床病例的有趣之处。学习目标:在血管痉挛性心绞痛期间反复发作高度房室传导阻滞的情况下进行明确电刺激的指征以及血管痉挛基础上的颈动脉窦刺激机制构成了本临床病例的重点。
{"title":"Refractory coronary vasospasm complicated by complete atrio-ventricular block during neck surgery: is there an indication for pacing?","authors":"","doi":"10.1016/j.ipej.2024.05.005","DOIUrl":"10.1016/j.ipej.2024.05.005","url":null,"abstract":"<div><p>Vasospastic angina is a clinical condition characterized by coronary artery spasm in angiographically normal coronary arteries. Vasospastic angina can often lead to ventricular arrhythmias, sudden cardiac death, or life-threatening bradyarrhythmias, such as high-degree atrioventricular block or asystole. We present the unusual case of a woman with depressive syndrome who underwent emergency surgery for hemostasis of a neck lesion that caused hemorrhagic shock after a suicide attempt. During surgery, the electrocardiogram revealed inferior and posterior ST-segment elevation, total atrioventricular block and torsades de pointes; the patient also suffered 4 minutes of cardiac arrest. A temporary pacemaker was placed. Coronary angiography showed right coronary artery vasospasm. Following a second similar episode after tracheostomy, a permanent pacemaker was implanted. The indication for definitive electrostimulation in such a context and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.</p></div><div><h3>Learning objective</h3><p>The indication for definitive electrostimulation in a context of recurrent episodes of high-degree atrioventricular block during vasospastic angina and the stimulation mechanisms of the carotid sinus underlying vasospasm constitute the interesting points of this clinical case.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000561/pdfft?md5=6f9ae79d688f0c87500739aacacba37d&pid=1-s2.0-S0972629224000561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}