Pub Date : 2025-11-01DOI: 10.1016/j.ipej.2025.12.016
Javaid Ahmad Dar, Hariharan Narasaiyan, Anand Manickavasagam, John Roshan Jacob
{"title":"Atrial overdrive pacing in a short RP tachycardia. Understanding the mechanism behind the AHHA response","authors":"Javaid Ahmad Dar, Hariharan Narasaiyan, Anand Manickavasagam, John Roshan Jacob","doi":"10.1016/j.ipej.2025.12.016","DOIUrl":"10.1016/j.ipej.2025.12.016","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 6","pages":"Pages 463-465"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744952","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 : 2025-11-01DOI: 10.1016/j.ipej.2025.11.004
Devendra Singh Bisht, Kamal Kishor
Background
The exact nature of the circuit and the existence of the upper and lower common pathways in Atrioventricular nodal re-entrant tachycardia (AVNRT) are not well defined.
Methods and results
This report describes a case of re-entrant supraventricular tachycardia in which electrophysiologic manoeuvres confirmed an atypical AVNRT. During the tachycardia there was spontaneous variability in intracardiac intervals, and possible mechanisms are discussed. The tachycardia resolved after slow-pathway ablation.
Conclusion
Atypical AVNRT can cause spontaneous intracardiac interval variability that complicates diagnosis but is effectively treated with targeted slow-pathway ablation.
{"title":"Spontaneous variability in intracardiac intervals during supraventricular tachycardia: Electrophysiologic mechanisms","authors":"Devendra Singh Bisht, Kamal Kishor","doi":"10.1016/j.ipej.2025.11.004","DOIUrl":"10.1016/j.ipej.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>The exact nature of the circuit and the existence of the upper and lower common pathways in Atrioventricular nodal re-entrant tachycardia (AVNRT) are not well defined.</div></div><div><h3>Methods and results</h3><div>This report describes a case of re-entrant supraventricular tachycardia in which electrophysiologic manoeuvres confirmed an atypical AVNRT. During the tachycardia there was spontaneous variability in intracardiac intervals, and possible mechanisms are discussed. The tachycardia resolved after slow-pathway ablation.</div></div><div><h3>Conclusion</h3><div>Atypical AVNRT can cause spontaneous intracardiac interval variability that complicates diagnosis but is effectively treated with targeted slow-pathway ablation.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 6","pages":"Pages 414-416"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565701","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 : 2025-11-01DOI: 10.1016/j.ipej.2025.11.013
Diksha Mahendru , Harin D. Joshi , Peter Kowey
Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with significant morbidity, mortality, and healthcare burden worldwide. The management of AF remains complex, encompassing rate and rhythm control strategies, anticoagulation, and comorbidity optimization. Dofetilide, a class III antiarrhythmic agent, has emerged as an important therapeutic option for rhythm control due to its relatively selective blockade of the rapid component of the delayed rectifier potassium current (IKr). Unlike many other antiarrhythmics, it lacks significant negative inotropy, making it safe for use in patients with structural heart disease and left ventricular dysfunction. However, its use is limited by concerns regarding torsades de pointes, mandatory in-hospital initiation, and stringent monitoring requirements. This review provides a comprehensive analysis of dofetilide, including its pharmacology, clinical trial evidence, safety profile, guideline recommendations, role in special populations, real-world application in India, and future perspectives.
{"title":"Dofetilide in atrial fibrillation: A comprehensive review","authors":"Diksha Mahendru , Harin D. Joshi , Peter Kowey","doi":"10.1016/j.ipej.2025.11.013","DOIUrl":"10.1016/j.ipej.2025.11.013","url":null,"abstract":"<div><div>Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with significant morbidity, mortality, and healthcare burden worldwide. The management of AF remains complex, encompassing rate and rhythm control strategies, anticoagulation, and comorbidity optimization. Dofetilide, a class III antiarrhythmic agent, has emerged as an important therapeutic option for rhythm control due to its relatively selective blockade of the rapid component of the delayed rectifier potassium current (IKr). Unlike many other antiarrhythmics, it lacks significant negative inotropy, making it safe for use in patients with structural heart disease and left ventricular dysfunction. However, its use is limited by concerns regarding torsades de pointes, mandatory in-hospital initiation, and stringent monitoring requirements. This review provides a comprehensive analysis of dofetilide, including its pharmacology, clinical trial evidence, safety profile, guideline recommendations, role in special populations, real-world application in India, and future perspectives.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 6","pages":"Pages 451-457"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649599","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 : 2025-11-01DOI: 10.1016/j.ipej.2025.12.002
Satish C. Toal
{"title":"Updates from “True North” - our Canadian colleagues","authors":"Satish C. Toal","doi":"10.1016/j.ipej.2025.12.002","DOIUrl":"10.1016/j.ipej.2025.12.002","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 6","pages":"Pages 385-387"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670226","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 : 2025-11-01DOI: 10.1016/j.ipej.2025.11.015
Antoine H.G. Driessen
The Cox-Maze procedure is the cornerstone of surgical rhythm-control therapy for atrial fibrillation (AF). Developed to interrupt macro-reentrant conduction while preserving physiological atrial activation. It has evolved from the original cut-and-sew Maze I–III Operations, based on earlier strategies like a corridor surgery to today's energy-based Cox-Maze IV (CM-IV) and minimal invasive operations. Contemporary surgical ablation can be performed concomitantly with valve or coronary surgery, as a stand-alone operation, or via minimally invasive or hybrid strategies integrating electrophysiologic mapping.
Numerous works is done by Cox, providing the understanding, development and acceptance for this surgery. Later, early work was done by Ad and Damiano. The minimal invasive approach, originally developed by Wolff and later performed through VATS by van Boven was based on combining the work of Cox, with the landmark paper of Haissageurre in 1998, showing that the origin of AF is mostly situated in the PVI's. This was further developed in a Hybrid approach. Providing evidence, in diverse ways, from the groups of Maastricht and Amsterdam.
In concomitant operation, performing a Maze or a PVI beside another cardiac operation, current evidence shows durable sinus-rhythm restoration and survival benefit without added operative risk. Future directions center on advanced imaging, patient tailored lesion design and new energy sources like non-thermal pulsed-field ablation (PFA) next to combining surgical and catheter-based therapies in hybrid operating rooms. This review traces the evolution, evidence, technical refinements, and forward trajectory of Maze surgery.
Cox-Maze程序是心房颤动（AF）外科心律控制治疗的基石。发展中断宏观可重入传导，同时保持生理心房激活。它已经从最初的切割缝合迷宫I-III手术（基于早期的策略，如走廊手术）发展到今天基于能量的Cox-Maze IV （CM-IV）和微创手术。当代外科消融可以与瓣膜或冠状动脉手术同时进行，作为一个独立的手术，或通过微创或结合电生理定位的混合策略。考克斯做了大量的工作，为这种手术提供了理解、发展和接受。后来，早期的工作是由Ad和Damiano完成的。最初由Wolff开发，后来由van Boven通过VATS进行的微创入路是基于Cox的工作和Haissageurre在1998年的具有里程碑意义的论文相结合，该论文表明AF的起源主要位于PVI。这是进一步发展的混合方法。以不同的方式提供来自马斯特里赫特和阿姆斯特丹团体的证据。在合并手术中，在进行另一心脏手术的同时进行迷宫或PVI，目前的证据显示持久的窦性心律恢复和生存获益，而不增加手术风险。未来的发展方向将集中在先进的成像技术、针对患者的病灶设计和非热脉冲场消融（PFA）等新能源上，其次是在混合手术室中结合手术和导管治疗。本文回顾了迷宫手术的发展、证据、技术改进和前进轨迹。
{"title":"The MAZE procedure in atrial fibrillation: An evolution of rhythm surgery","authors":"Antoine H.G. Driessen","doi":"10.1016/j.ipej.2025.11.015","DOIUrl":"10.1016/j.ipej.2025.11.015","url":null,"abstract":"<div><div>The Cox-Maze procedure is the cornerstone of surgical rhythm-control therapy for atrial fibrillation (AF). Developed to interrupt macro-reentrant conduction while preserving physiological atrial activation. It has evolved from the original cut-and-sew Maze I–III Operations, based on earlier strategies like a corridor surgery to today's energy-based Cox-Maze IV (CM-IV) and minimal invasive operations. Contemporary surgical ablation can be performed concomitantly with valve or coronary surgery, as a stand-alone operation, or via minimally invasive or hybrid strategies integrating electrophysiologic mapping.</div><div>Numerous works is done by Cox, providing the understanding, development and acceptance for this surgery. Later, early work was done by Ad and Damiano. The minimal invasive approach, originally developed by Wolff and later performed through VATS by van Boven was based on combining the work of Cox, with the landmark paper of Haissageurre in 1998, showing that the origin of AF is mostly situated in the PVI's. This was further developed in a Hybrid approach. Providing evidence, in diverse ways, from the groups of Maastricht and Amsterdam.</div><div>In concomitant operation, performing a Maze or a PVI beside another cardiac operation, current evidence shows durable sinus-rhythm restoration and survival benefit without added operative risk. Future directions center on advanced imaging, patient tailored lesion design and new energy sources like non-thermal pulsed-field ablation (PFA) next to combining surgical and catheter-based therapies in hybrid operating rooms. This review traces the evolution, evidence, technical refinements, and forward trajectory of Maze surgery.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 6","pages":"Pages 388-396"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679046","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 : 2025-10-16DOI: 10.1016/j.ipej.2025.10.006
Jefri Lim, Beny Hartono, Evan J Gunawan, Dian L Munawar, Firman Tedjasukmana, Muhammad Munawar
Pulsed Field Ablation (PFA) is a novel non-thermal ablation technique with several advantages and fewer complications. A 70-year-old male with persistent atrial fibrillation, heart failure with preserved ejection fraction, and prior ischemic stroke who underwent pulmonary vein isolation using PFA with planned left atrial appendage closure (LAAC). Post-ablation transesophageal echocardiography revealed significant dense spontaneous echo contrast in the left atrial appendage (LAA) and left atrial ridge edema, leading to LAAC postponement and anticoagulation initiation. While PFA has advantages over conventional ablation, its impact on LAA structures requires further study, especially when considering concomitant with LAAC.
{"title":"Left atrial appendage edema and spontaneous echo contrast following pulsed field ablation for pulmonary vein isolation: A case report.","authors":"Jefri Lim, Beny Hartono, Evan J Gunawan, Dian L Munawar, Firman Tedjasukmana, Muhammad Munawar","doi":"10.1016/j.ipej.2025.10.006","DOIUrl":"10.1016/j.ipej.2025.10.006","url":null,"abstract":"<p><p>Pulsed Field Ablation (PFA) is a novel non-thermal ablation technique with several advantages and fewer complications. A 70-year-old male with persistent atrial fibrillation, heart failure with preserved ejection fraction, and prior ischemic stroke who underwent pulmonary vein isolation using PFA with planned left atrial appendage closure (LAAC). Post-ablation transesophageal echocardiography revealed significant dense spontaneous echo contrast in the left atrial appendage (LAA) and left atrial ridge edema, leading to LAAC postponement and anticoagulation initiation. While PFA has advantages over conventional ablation, its impact on LAA structures requires further study, especially when considering concomitant with LAAC.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318734","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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