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}
Pub Date : 2025-09-27DOI: 10.1016/j.ipej.2025.09.005
Ibrahim Antoun, Xin Li, Ahmed Abdelrazik, Mahmoud Eldesouky, Kaung Myat Thu, Mokhtar Ibrahim, Harshil Dhutia, Riyaz Somani, G André Ng
Sudden cardiac death (SCD) from ventricular arrhythmias (VAs) remains a leading cause of mortality worldwide. Traditional risk stratification, primarily based on left ventricular ejection fraction (LVEF) and other coarse metrics, often fails to identify a large subset of patients at risk and frequently leads to unnecessary device implantations. Advances in artificial intelligence (AI) offer new strategies to improve both long-term SCD risk prediction and near-term VAs forecasting. In this review, we discuss how AI algorithms applied to the 12-lead electrocardiogram (ECG) can identify subtle risk markers in conditions such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and coronary artery disease (CAD), often outperforming conventional risk models. We also explore the integration of AI with cardiac imaging, such as scar quantification on cardiac magnetic resonance (CMR) and fibrosis mapping, to enhance the identification of the arrhythmogenic substrate. Furthermore, we investigate the application of data from implantable cardioverter-defibrillators (ICDs) and wearable devices to predict ventricular tachycardia (VT) or ventricular fibrillation (VF) events before they occur, thereby advancing care toward real-time prevention. Amid these innovations, we address the medicolegal and ethical implications of AI-driven automated alerts in arrhythmia care, highlighting when clinicians can trust AI predictions. Future directions include multimodal AI fusion to personalize SCD risk assessment, as well as AI-guided VT ablation planning through imaging-based digital heart models. This review provides a comprehensive overview for general medical readers, focusing on peer-reviewed advances globally in the emerging intersection of AI, VAs, and SCD prevention.
{"title":"Artificial intelligence in ventricular arrhythmias and sudden cardiac death: A guide for clinicians.","authors":"Ibrahim Antoun, Xin Li, Ahmed Abdelrazik, Mahmoud Eldesouky, Kaung Myat Thu, Mokhtar Ibrahim, Harshil Dhutia, Riyaz Somani, G André Ng","doi":"10.1016/j.ipej.2025.09.005","DOIUrl":"10.1016/j.ipej.2025.09.005","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) from ventricular arrhythmias (VAs) remains a leading cause of mortality worldwide. Traditional risk stratification, primarily based on left ventricular ejection fraction (LVEF) and other coarse metrics, often fails to identify a large subset of patients at risk and frequently leads to unnecessary device implantations. Advances in artificial intelligence (AI) offer new strategies to improve both long-term SCD risk prediction and near-term VAs forecasting. In this review, we discuss how AI algorithms applied to the 12-lead electrocardiogram (ECG) can identify subtle risk markers in conditions such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and coronary artery disease (CAD), often outperforming conventional risk models. We also explore the integration of AI with cardiac imaging, such as scar quantification on cardiac magnetic resonance (CMR) and fibrosis mapping, to enhance the identification of the arrhythmogenic substrate. Furthermore, we investigate the application of data from implantable cardioverter-defibrillators (ICDs) and wearable devices to predict ventricular tachycardia (VT) or ventricular fibrillation (VF) events before they occur, thereby advancing care toward real-time prevention. Amid these innovations, we address the medicolegal and ethical implications of AI-driven automated alerts in arrhythmia care, highlighting when clinicians can trust AI predictions. Future directions include multimodal AI fusion to personalize SCD risk assessment, as well as AI-guided VT ablation planning through imaging-based digital heart models. This review provides a comprehensive overview for general medical readers, focusing on peer-reviewed advances globally in the emerging intersection of AI, VAs, and SCD prevention.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193295","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.2025.07.015
Anand Manickavasagam , Priya Chockalingam , Arthur AM. Wilde
{"title":"Signature ECG 3: A case of long QT 3 syndrome (LQT3)","authors":"Anand Manickavasagam , Priya Chockalingam , Arthur AM. Wilde","doi":"10.1016/j.ipej.2025.07.015","DOIUrl":"10.1016/j.ipej.2025.07.015","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 357-358"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733605","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.2025.08.003
Shivaraj Patil MBBS, Nayani Makkar MBBS, Abhishek J. Deshmukh MBBS
{"title":"A high-resolution mirage: Navigating atrial flutter circuits in the era of automated mapping","authors":"Shivaraj Patil MBBS, Nayani Makkar MBBS, Abhishek J. Deshmukh MBBS","doi":"10.1016/j.ipej.2025.08.003","DOIUrl":"10.1016/j.ipej.2025.08.003","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 341-342"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856592","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.2025.10.001
Behzad B. Pavri
{"title":"Jumps and concealed conduction: Interactions between a manifest anteroseptal accessory pathway and the fast and slow pathways of the atrioventricular node","authors":"Behzad B. Pavri","doi":"10.1016/j.ipej.2025.10.001","DOIUrl":"10.1016/j.ipej.2025.10.001","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 374-378"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330253","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.2025.07.001
Vivek Narasimha V , Nagalaxmi Patnala , Anoop Agrawal , B. Hygriv Rao
We present the case of a young lady with prior implanted ICD presenting with Electrical storm (ES) of short coupled ventricular fibrillation (SCVF). The clinical emergency was managed by a novel technique of fluoroscopy guided stellate ganglion ablation followed by 3D mapping guided ectopy ablation. This is to the best of our knowledge the first report of such a malignant phenotype treated by the combination and sequence of these treatment modalities.
{"title":"Electrical storm of short coupled ventricular fibrillation- management by neuromodulation and trigger ablation","authors":"Vivek Narasimha V , Nagalaxmi Patnala , Anoop Agrawal , B. Hygriv Rao","doi":"10.1016/j.ipej.2025.07.001","DOIUrl":"10.1016/j.ipej.2025.07.001","url":null,"abstract":"<div><div>We present the case of a young lady with prior implanted ICD presenting with Electrical storm (ES) of short coupled ventricular fibrillation (SCVF). The clinical emergency was managed by a novel technique of fluoroscopy guided stellate ganglion ablation followed by 3D mapping guided ectopy ablation. This is to the best of our knowledge the first report of such a malignant phenotype treated by the combination and sequence of these treatment modalities.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 323-327"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627335","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.2025.10.008
Sheetal Vasundara Mathai, Fengwei Zou, Luigi Di Biase
Atrial fibrillation is the most prevalent sustained cardiac arrhythmia, and the therapeutic landscape for stroke prevention has expanded to include catheter ablation for rhythm control and left atrial appendage closure in patients unsuitable for long-term oral anticoagulation. Although minimally invasive, these interventions present complex thrombotic challenges. The left atrial and appendage environment is inherently prothrombotic due to structural remodeling, endothelial injury, blood stasis, and abnormal hemostasis-processes further amplified by procedural instrumentation such as transseptal puncture during left-sided ablation and structural interventions. Antithrombotic management requires a balance between thromboembolic prevention and bleeding risk. Pre-procedural imaging with transesophageal echocardiography or cardiac computed tomography remains essential for thrombus detection and risk stratification peri-procedurally. Direct oral anticoagulants provide pharmacokinetic advantages over vitamin K antagonists, including shorter half-lives and greater predictability, thereby facilitating periprocedural management. Post-procedural therapy must be individualized on the basis of stroke risk, device-related findings, and patient-specific characteristics. This review synthesizes current evidence on antithrombotic strategies in the setting of left-sided cardiac interventions.
{"title":"Antithrombotic management in left sided- ablation and appendage device-closure procedures","authors":"Sheetal Vasundara Mathai, Fengwei Zou, Luigi Di Biase","doi":"10.1016/j.ipej.2025.10.008","DOIUrl":"10.1016/j.ipej.2025.10.008","url":null,"abstract":"<div><div>Atrial fibrillation is the most prevalent sustained cardiac arrhythmia, and the therapeutic landscape for stroke prevention has expanded to include catheter ablation for rhythm control and left atrial appendage closure in patients unsuitable for long-term oral anticoagulation. Although minimally invasive, these interventions present complex thrombotic challenges. The left atrial and appendage environment is inherently prothrombotic due to structural remodeling, endothelial injury, blood stasis, and abnormal hemostasis-processes further amplified by procedural instrumentation such as transseptal puncture during left-sided ablation and structural interventions. Antithrombotic management requires a balance between thromboembolic prevention and bleeding risk. Pre-procedural imaging with transesophageal echocardiography or cardiac computed tomography remains essential for thrombus detection and risk stratification peri-procedurally. Direct oral anticoagulants provide pharmacokinetic advantages over vitamin K antagonists, including shorter half-lives and greater predictability, thereby facilitating periprocedural management. Post-procedural therapy must be individualized on the basis of stroke risk, device-related findings, and patient-specific characteristics. This review synthesizes current evidence on antithrombotic strategies in the setting of left-sided cardiac interventions.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 359-369"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356091","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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