Pub Date : 2025-11-01Epub Date: 2025-11-28DOI: 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 : 2025-11-01Epub Date: 2025-11-18DOI: 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 : 2025-10-16DOI: 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 : 2025-09-01Epub Date: 2025-08-12DOI: 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 : 2025-09-01Epub Date: 2025-10-17DOI: 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 : 2025-09-01Epub Date: 2025-07-26DOI: 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 : 2025-09-01Epub Date: 2025-07-11DOI: 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}
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