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}
Pub Date : 2025-09-01DOI: 10.1016/j.ipej.2025.09.003
Yotam Kolben , Marianna Vander , Bernard Belhassen
A 76-year-old male called an emergency medical service after his smartwatch detected rapid heart rate. ECG obtained on ambulance recorded a regular, wide QRS tachycardia (150 bpm) having a morphology of right bundle branch block and left QRS axis. Two main diagnoses were discussed: a) any type of supraventricular tachycardia associated with ventricular aberration; b) ventricular tachycardia originating close to the posterior fascicle of the left ventricle. The final diagnosis was made after performing carotid sinus massage.
{"title":"A regular wide QRS tachycardia with right bundle branch block morphology and left QRS axis deviation","authors":"Yotam Kolben , Marianna Vander , Bernard Belhassen","doi":"10.1016/j.ipej.2025.09.003","DOIUrl":"10.1016/j.ipej.2025.09.003","url":null,"abstract":"<div><div>A 76-year-old male called an emergency medical service after his smartwatch detected rapid heart rate. ECG obtained on ambulance recorded a regular, wide QRS tachycardia (150 bpm) having a morphology of right bundle branch block and left QRS axis. Two main diagnoses were discussed: a) any type of supraventricular tachycardia associated with ventricular aberration; b) ventricular tachycardia originating close to the posterior fascicle of the left ventricle. The final diagnosis was made after performing carotid sinus massage.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 5","pages":"Pages 379-381"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259523","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 : 2025-08-28DOI: 10.1016/j.ipej.2025.08.009
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.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.ipej.2025.08.009","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972486","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 : 2025-08-02DOI: 10.1016/j.ipej.2025.07.018
Bernard Belhassen, Anat Milman
At the beginning of the last century, quinidine had been shown to be highly effective in the management of atrial fibrillation and soon after of ventricular arrhythmias. At the end of the same century, quinidine was quickly abandoned, and its manufacturing ceased, resulting in limited accessibility across numerous countries. Paradoxically, this decline in use occurred alongside accumulating evidence supporting quinidine's therapeutic benefit in managing rare, life-threatening ventricular arrhythmias occurring in patients with no organic heart disease (Idiopathic ventricular fibrillation, Brugada syndrome, Early repolarization syndrome, Short QT syndrome, Multifocal ectopic Purkinje-related premature contractions), as well as those with organic heart disease involving the Purkinje network such as those occurring after acute myocardial infarction or in patients with hypertrophic cardiomyopathy. The present review will extensively deal with all these topics.
{"title":"Theory and Practice of Present Clinical Use of Quinidine in the Management of Cardiac Arrhythmias.","authors":"Bernard Belhassen, Anat Milman","doi":"10.1016/j.ipej.2025.07.018","DOIUrl":"https://doi.org/10.1016/j.ipej.2025.07.018","url":null,"abstract":"<p><p>At the beginning of the last century, quinidine had been shown to be highly effective in the management of atrial fibrillation and soon after of ventricular arrhythmias. At the end of the same century, quinidine was quickly abandoned, and its manufacturing ceased, resulting in limited accessibility across numerous countries. Paradoxically, this decline in use occurred alongside accumulating evidence supporting quinidine's therapeutic benefit in managing rare, life-threatening ventricular arrhythmias occurring in patients with no organic heart disease (Idiopathic ventricular fibrillation, Brugada syndrome, Early repolarization syndrome, Short QT syndrome, Multifocal ectopic Purkinje-related premature contractions), as well as those with organic heart disease involving the Purkinje network such as those occurring after acute myocardial infarction or in patients with hypertrophic cardiomyopathy. The present review will extensively deal with all these topics.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785518","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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