{"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}
Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.06.009
Devendra S. Bisht, Kamal Kishor
Background
Basal crux ventricular tachycardia (VT) is traditionally considered an idiopathic arrhythmia. However, its occurrence in patients with structural heart disease, especially ischemic heart disease (IHD), is often under recognised.
Case summary
We report two patients with a history of myocardial infarction who presented with basal crux VT. In both cases, VT was rendered non-inducible, and both patients experienced recovery of their left ventricular ejection fraction (LVEF), indicating a significant burden of arrhythmia-induced cardiomyopathy.
Discussion
It is unclear whether IHD is purely coincidental or contributes to the underlying substrate promoting arrhythmogenesis.
Conclusion
Basal crux VT can occur in patients with IHD and may resemble idiopathic epicardial VT. Ablation in the proximal middle cardiac vein (MCV) may be potentially curative.
{"title":"Basal Crux Ventricular Tachycardia in Ischemic Heart Disease","authors":"Devendra S. Bisht, Kamal Kishor","doi":"10.1016/j.ipej.2025.06.009","DOIUrl":"10.1016/j.ipej.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Basal crux ventricular tachycardia (VT) is traditionally considered an idiopathic arrhythmia. However, its occurrence in patients with structural heart disease, especially ischemic heart disease (IHD), is often under recognised.</div></div><div><h3>Case summary</h3><div>We report two patients with a history of myocardial infarction who presented with basal crux VT. In both cases, VT was rendered non-inducible, and both patients experienced recovery of their left ventricular ejection fraction (LVEF), indicating a significant burden of arrhythmia-induced cardiomyopathy.</div></div><div><h3>Discussion</h3><div>It is unclear whether IHD is purely coincidental or contributes to the underlying substrate promoting arrhythmogenesis.</div></div><div><h3>Conclusion</h3><div>Basal crux VT can occur in patients with IHD and may resemble idiopathic epicardial VT. Ablation in the proximal middle cardiac vein (MCV) may be potentially curative.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 318-320"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369346","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.2025.10.002
Fabrizio Drago (Dr)
{"title":"Low voltage bridge strategy in ablation of slow pathway: Technical tips","authors":"Fabrizio Drago (Dr)","doi":"10.1016/j.ipej.2025.10.002","DOIUrl":"10.1016/j.ipej.2025.10.002","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 336-337"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233710","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.2025.09.001
Parth Aphale, Shashank Dokania, Himanshu Shekhar
{"title":"Navigating the complex relationship between COPD severity and AF recurrence: Correspondence","authors":"Parth Aphale, Shashank Dokania, Himanshu Shekhar","doi":"10.1016/j.ipej.2025.09.001","DOIUrl":"10.1016/j.ipej.2025.09.001","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Page 382"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058607","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.2025.09.006
Ree Lu , Devin Skoll , Ahmed Y. Gasmelseed , Geoffrey A. Rubin , Elaine Y. Wan , Amardeep S. Saluja , Jose M. Dizon , Angelo B. Biviano , Hasan Garan , Hirad Yarmohammadi
Background
Patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular mortality compared to patients with AF alone. Consequently, employing rhythm control strategies such as AF catheter ablation could offer substantial benefits to patients with COPD. However, the impact of COPD on AF ablation outcomes is not well established.
Methods
In this single-center case control study, we retrospectively analyzed 200 patients with AF and COPD, 52 of whom underwent AF catheter ablation. Those who underwent ablation were matched with a control group of patients with AF but without COPD who underwent ablation. Ablation outcomes were compared between the groups. Univariate and multivariable analysis were conducted for prediction of AF recurrence.
Results
Compared to the controls, cases with COPD were more likely to have AF recurrence following catheter ablation (OR 13.42, P-value = 0.0001). Multivariable analysis revealed predictors of AF recurrence following catheter ablation included decreased use of loop diuretics and amiodarone. Patients with severe or very severe COPD were more likely to have left atrial enlargement than patients with mild or moderate COPD (OR 2.28, P-value = 0.026).
Conclusion
Patients with AF and COPD were more likely than patients with AF but without COPD to experience AF recurrence following catheter ablation. Predictors of AF recurrence included decreased use of loop diuretics and amiodarone. Our study demonstrates that while ablation in patients with COPD is safe, ablation in patients with COPD is associated with higher AF recurrence rates.
{"title":"Chronic obstructive pulmonary disease is associated with higher recurrence rates of atrial fibrillation following catheter ablation","authors":"Ree Lu , Devin Skoll , Ahmed Y. Gasmelseed , Geoffrey A. Rubin , Elaine Y. Wan , Amardeep S. Saluja , Jose M. Dizon , Angelo B. Biviano , Hasan Garan , Hirad Yarmohammadi","doi":"10.1016/j.ipej.2025.09.006","DOIUrl":"10.1016/j.ipej.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular mortality compared to patients with AF alone. Consequently, employing rhythm control strategies such as AF catheter ablation could offer substantial benefits to patients with COPD. However, the impact of COPD on AF ablation outcomes is not well established.</div></div><div><h3>Methods</h3><div>In this single-center case control study, we retrospectively analyzed 200 patients with AF and COPD, 52 of whom underwent AF catheter ablation. Those who underwent ablation were matched with a control group of patients with AF but without COPD who underwent ablation. Ablation outcomes were compared between the groups. Univariate and multivariable analysis were conducted for prediction of AF recurrence.</div></div><div><h3>Results</h3><div>Compared to the controls, cases with COPD were more likely to have AF recurrence following catheter ablation (OR 13.42, P-value = 0.0001). Multivariable analysis revealed predictors of AF recurrence following catheter ablation included decreased use of loop diuretics and amiodarone. Patients with severe or very severe COPD were more likely to have left atrial enlargement than patients with mild or moderate COPD (OR 2.28, P-value = 0.026).</div></div><div><h3>Conclusion</h3><div>Patients with AF and COPD were more likely than patients with AF but without COPD to experience AF recurrence following catheter ablation. Predictors of AF recurrence included decreased use of loop diuretics and amiodarone. Our study demonstrates that while ablation in patients with COPD is safe, ablation in patients with COPD is associated with higher AF recurrence rates.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 383-384"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193317","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.2025.07.014
Erick Sánchez-Rodriguez, Jose Luis Morales-Velázquez, Pio Iran Coria Sandoval, Hugo Enrique Coutiño Moreno
We present the case of a 75-year-old man with a history of hypertension, type 2 diabetes, and concentric left ventricular hypertrophy who presented with palpitations. The initial electrocardiogram suggested atrial flutter; however, detailed analysis using a ladder diagram revealed a focal atrial tachycardia with alternating 2:1 and 3:1 conduction. Some deflections initially interpreted as flutter waves were identified as T waves, highlighting the importance of differentiating true atrial activity from ventricular repolarization. The presence of exit block further supported a focal origin. This case underscores the value of ladder diagrams in accurately interpreting complex supraventricular arrhythmias.
{"title":"ECG Challenge: Focal atrial tachycardia mimicking flutter: Diagnosis clarified by ladder diagrams","authors":"Erick Sánchez-Rodriguez, Jose Luis Morales-Velázquez, Pio Iran Coria Sandoval, Hugo Enrique Coutiño Moreno","doi":"10.1016/j.ipej.2025.07.014","DOIUrl":"10.1016/j.ipej.2025.07.014","url":null,"abstract":"<div><div>We present the case of a 75-year-old man with a history of hypertension, type 2 diabetes, and concentric left ventricular hypertrophy who presented with palpitations. The initial electrocardiogram suggested atrial flutter; however, detailed analysis using a ladder diagram revealed a focal atrial tachycardia with alternating 2:1 and 3:1 conduction. Some deflections initially interpreted as flutter waves were identified as T waves, highlighting the importance of differentiating true atrial activity from ventricular repolarization. The presence of exit block further supported a focal origin. This case underscores the value of ladder diagrams in accurately interpreting complex supraventricular arrhythmias.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 310-312"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754570","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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