The differential diagnosis for wide complex tachycardia includes all causes of narrow complex tachycardia with bundle branch block, all causes of narrow complex tachycardia with antegrade pre-excitation, ventricular tachycardia, and antidromic and other pre-excited reciprocating tachycardias. The variation in a specific intracardiac interval that causes a subsequent change in the tachycardia cycle length or another intracardiac interval can be diagnostic in these arrhythmias.
Left bundle branch area pacing (LBBAP) is a promising pacing technique aimed at mitigating pacing-induced cardiomyopathy; however, a gap in understanding persists concerning intraprocedural complications and their management. This case study sheds light on a rare complication associated with LBBAP. Through sheath penetration into the interventricular septum at a typical site, a septogram revealed the dissection of a large septal coronary vein. Herein, we propose the management strategy and its outcome.
Pulsed field ablation uses irreversible electroporation to interrupt cellular membranes and induce myocyte apoptosis. Reversible electroporation has been used in other specialties, but its utility in cardiac ablation is unknown. Here, a 69-year-old woman undergoing repeat ablation for atypical atrial flutter presented with extensive scar after cardiac surgery (including MAZE) and previous ablation, leading to a macro re-entry circuit. To minimize superfluous lesions and further arrhythmia, we used a single pulse confirming the isthmus location, with cessation of the arrhythmia. As a conclusion, reversible electroporation may be used to test areas of interest prior to irreversible lesion creation.
Heart failure (HF) is a complex and potentially life-threatening medical condition posing significant risks to individuals. It is associated with substantial health care expenditures, considerable morbidity and mortality, and a decline in functional capacity and quality of life. Cardiac contractility modulation (CCM) has emerged as a promising device-based treatment for patients with HF with reduced ejection fraction (HFrEF). Studies have shown that CCM treatment in HFrEF patients can improve exercise tolerance and quality of life and reduce HF hospitalizations. As CCM therapy becomes a more prevalent treatment for HFrEF, the natural learning curve inherent in the use of new technologies necessitates broader provider training and careful patient follow-up. To that end, this article highlights the importance of developing a fundamental troubleshooting algorithm to help optimize the management of patients who have an implanted CCM device.
Empirical left atrial appendage isolation (eLAAi) using a cryoballoon reduces atrial tachyarrhythmia recurrences in persistent atrial fibrillation. Nonetheless, the most significant concern associated with this procedure is the risk of thromboembolic events, particularly without consistent oral anticoagulant (OAC) use. This case highlights a late thrombus formation post-eLAAi despite proper OAC adherence, raising questions about OAC's effectiveness in such scenarios. The case suggests considering percutaneous left atrial appendage closure after eLAAi, even in patients with thrombus and ongoing OAC therapy.
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