Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), or Bland-White-Garland syndrome, is a rare but life-threatening congenital cardiac defect. Its clinical presentation, particularly in infants, is often nonspecific and can be mistaken for common conditions like myocarditis or dilated cardiomyopathy. We present a case of a 1-month-old infant where the initial presentation strongly suggested viral myocarditis, but characteristic electrocardiographic findings were pivotal in leading to the correct diagnosis of ALCAPA.
Junctional ectopic tachycardia (JET), a tachyarrhythmia originating from the atrioventricular (AV) node and/or bundle of His, is commonly observed in pediatric patients following congenital heart surgery. JET is characterized by a heart rate above the 95th percentile for age, whereas rates below this threshold are referred to as accelerated junctional rhythm (AJR). Although AJR with a potential risk of developing AV block has been reported following transcatheter aortic valve replacement (TAVR), no cases of JET following TAVR have been documented. We report a case of JET and complete AV block observed after TAVR, which was effectively managed with medication and permanent pacemaker implantation.
Patients with structural heart disease undergoing catheter ablation (CA) for VT have shown higher procedural-related adverse events. However, periprocedural outcomes comparing CA for VT in different cardiomyopathies are not well known. We aim to study short-term outcomes of CA in ischemic (ICM) compared to non-ischemic dilated cardiomyopathy (NIDCM).
The national readmission database (2016–2020) was used to identify hospitalizations for CA for VT. Cohorts were stratified based on underlying cardiomyopathy. A Propensity Score Matching (PSM) model matched ICM to NIDCM patients. Pearson's Chi-squared test was applied to PSM-matched cohorts to compare outcomes.
Among 7081 hospitalizations for VT ablation, 17.5% of patients had underlying NIDCM, while 82.5% of patients had ICM. On a PSM analysis (N: 3534), ICM patients had higher incidences of sudden cardiac arrest (SCA) (7.9% vs. 5.6%, p < 0.001), major adverse cardiac events (11.1% vs. 9%, p: 0.006), and cardiogenic shock (10.8% vs. 8.5%, p: 0.001). Interestingly, NIDCM patients were found to have much higher rates of pericardial complications (6.09% vs. 1.90%, p < 0.001), while the mortality difference was not significant (p > 0.05). From 2016 to 2020, in-hospital mortality rates have not changed significantly in ICM and NIDCM cases admitted for VT ablation (p-trend > 0.05); however, there was a decreasing trend of SCA cases in NIDCM hospitalizations (8.7%–3.4%, p-trend: 0.028). NIDCM patients had higher readmission rates at 30 days (18% vs. 15.5%, p: 0.01), 90-day (32.3% vs. 29.6%, p: 0.041), and 180-day (44% vs. 38.2%, p: 0.001).
VT ablation in ICM patients was associated with higher non-fatal periprocedural events. NIDCM patients showed higher all-cause readmission rates.
Cardiovascular autonomic neuropathy (CAN), a serious complication of type 1 diabetes mellitus (T1DM), requires early detection for timely prevention of disease progression. Although traditional autonomic function tests effectively identify advanced neuropathic abnormalities, they lack sensitivity for early-stage CAN in young individuals. Heart rate recovery (HRRec) and heart rate variability (HRV) following exercise are potential early markers of autonomic dysfunction in this group.
HRRec and HRV from Holter-ECG recordings after a standardized exercise test were compared between 43 individuals with T1DM, aged 10–30 years, subject to modern treatment with advanced technology and with moderate to good metabolic control (mean HbA1c 57 mmol/mol), and 43 healthy controls, matched for age and sex. HRV was additionally assessed on a reference Holter-ECG recording without prior exertion.
Twice as many participants with T1DM (33%) compared to controls (16%) maintained a heart rate > 100 beats/min beyond two hours after the exercise test. HRV did not differ between groups on reference Holter-ECG without prior exertion, but nocturnal HRV was significantly lower in the T1DM group compared to controls after the standardized exercise test (p < 0.05), primarily among individuals with a lower physical capacity. Long-term HbA1c correlated negatively with nocturnal high-frequency HRV in T1DM participants (p < 0.05).
Heart rate variability post-exercise may be a pertinent tool for the assessment of early autonomic cardiac dysfunction in young individuals with T1DM with moderate to good metabolic control.
Coronary artery fistula (CAF) complicated by thrombotic cyst formation is a rare cause of ventricular tachycardia (VT), involving ischemia and mechanical compression.
A 55-year-old woman presented with palpitations, chest pain, monomorphic VT (negative V1–V6), and elevated troponin I. Imaging revealed a large right ventricular cyst. Surgical resection confirmed a thrombotic cyst communicating with a CAF. Postoperative VT recurred, leading to cardiogenic shock and death.
CAF-related thrombotic cysts can cause irreversible myocardial fibrosis, creating a persistent VT substrate unresponsive to anatomical intervention alone. ECG markers (fragmented QRS, ST depression) reflect irreversible damage.
Circumferential pulmonary vein isolation (CPVI) plus left atrial low-voltage areas (LVA) modification is a useful method to treat paroxysmal atrial fibrillation (PAF); however, it is hard to predict LVA burden before the procedure. The existence of chronic kidney disease (CKD) increases the prevalence of left atrial LVA. In this study, we explored the relationship between renal function and the LVA burden in elderly patients with PAF.
We retrospectively analyzed the 435 elderly patients with PAF who underwent ablation. Based on the LVA burden measured during the procedure, the patients were divided into four groups: Group 1 (LVA burden ≤ 5%, n = 356), Group 2 (LVA burden 5%–10%, n = 39), Group 3 (LVA burden 10%–15%, n = 16), and Group 4 (LVA burden > 15%, n = 24).
Increasing LVA burden was associated with a progressive decline in eGFR. A significant difference was observed between Group 1 and Group 4 (86.6 ± 12.9 vs. 76.4 ± 17.7, p = 0.003). eGFR was identified to be a predictor for LVA burden > 10%, with the optimal cut-off value for GFR being 75.7 mL/min/1.73 m2, having a sensitivity of 54.2% and specificity of 80.4%.
A lower eGFR is associated with higher LVA burden in elderly patients with PAF.
We present the case of a 74-year-old man who developed 28 episodes of electrical storm secondary to aconitine poisoning from homemade herbal wine consumption, followed by complete recovery through 28 electrical cardioversions, hemopurification, and continuous magnesium sulfate infusion after 4 days. This case suggests that magnesium sulfate, by antagonizing calcium overload and stabilizing membrane potential, forms a synergistic effect with electrical resuscitation and hemopurification, and is the key to reversing the electrical storms caused by aconitine poisoning.
A 26-year-old woman with recurrent syncope was diagnosed with Andersen-Tawil syndrome (ATS) following abnormal electrocardiographic (ECG) findings. Her history of ventricular arrhythmias and prominent U waves on ECG led to genetic testing, which identified a KCNJ2 mutation. This case underscores the importance of recognizing ATS-specific ECG patterns, including broad U waves, in diagnosing arrhythmias. Following medication adjustments, her symptoms improved, highlighting the significance of tailored treatment for ATS-associated arrhythmias.
We read with great interest the systematic review by Ahmad et al. on dual-chamber implantable cardioverter defibrillators (ICDs) for left bundle branch area pacing (LBBAP) [1]. The authors commendably synthesize nascent evidence for this innovative strategy. Their findings—significant QRS narrowing (170 ± 17.4 ms to 121 ± 17.3 ms), improved LVEF (50% improvement in 2 studies), and no short-term complications in 34 patients—are promising, suggesting LBBAP-ICD as a viable alternative to cardiac resynchronization therapy defibrillators (CRT-D).
In conclusion, Ahmad et al. provide a valuable synthesis confirming the feasibility and short-term promise of LBBAP-ICD. However, this review powerfully highlights the preliminary nature of the evidence. Substantial investment in robust, comparative, long-term trials is now needed to determine if this approach fulfills its promise as a safe and effective alternative for patients.
The author takes full responsibility for the conception, design, data interpretation, and drafting of this manuscript.
The author declares no conflicts of interest.
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