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Int J Cardiol 2021 May 4. Epub 2021 May 4.

Cardiothoracovascular Department, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy.

Objectives: The aim of our study was to investigate the benefit of antiarrhythmic drugs (AAD) - beta-blockers, sotalol or amiodarone - in a cohort of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) patients with long-term longitudinal follow up.

Background: AAD are prescribed in ARVC to prevent ventricular arrhythmias and control symptoms. However, there are no controlled clinical trials and knowledges regarding the efficacy of AAD in ARVC are limited. Read More

Anatol J Cardiol 2021 May;25(5):313-322

Department of Pediatric Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.

Objective: Pediatric ventricular tachycardias (VTs) have heterogeneous etiology and different clinical features. This study aimed to evaluate the clinical spectrum and long-term course of pediatric sustained VTs.

Methods: Patients diagnosed as having sustained VT between 2010 and 2020 were evaluated retrospectively. Read More

J Innov Card Rhythm Manag 2021 Apr 15;12(4):4477-4481. Epub 2021 Apr 15.

Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.

A 39-year-old man presented with lifelong palpitations, a mildly reduced left ventricular ejection fraction, and incessant tachycardia. Electrocardiography revealed a regular, one-to-one supraventricular tachycardia with superiorly directed P-waves and a long R-P interval. The differential diagnosis of the tachycardia, response to invasive electrophysiologic maneuvers, and treatment with catheter ablation are discussed. Read More

Am J Emerg Med 2021 Apr 29;46:156-159. Epub 2021 Apr 29.

Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA 22903, United States of America.

Introduction: Prolongation of QTc interval, a common electrocardiographic (ECG) abnormality encountered in the toxicology patient, is reportedly associated with an increased risk of malignant ventricular dysrhythmias (MVD), such as ventricular tachycardia (VT, with and without a pulse), ventricular fibrillation (VF), and/or cardiac arrest. Quantifiable cardiac arrest risk in relation to specific QTc interval length is not known in this population.

Methods: We conducted a retrospective, observational study to assess the rate of cardiac arrest and its association with degree of QTc prolongation in a cohort of patients requiring toxicology consultation. Read More

J Electrocardiol 2021 Apr 22;66:136-138. Epub 2021 Apr 22.

Department of Maternal and Child Health, "Santa Maria Goretti" Hospital, Sapienza University of Rome, Latina, Italy.

Paroxysmal supraventricular tachycardia (PSVT) is a prevalent pediatric arrhythmia. Neonatal and infantile-onset presentation is unspecific, thus making differential diagnosis essential in not delaying crucial intervention. We here describe the case of an undetected PSVT in an infant performing repeated abdominal contractions, thus presenting with projectile vomiting. Read More

Heart Rhythm 2021 May 3. Epub 2021 May 3.

Department of Cardiology, Willem Einthoven Center of Arrhythmia research and Management, Leiden University Medical Center, The Netherlands. Electronic address:

Background: Cardiac sarcoidosis (CS) with right ventricular (RV) involvement can mimic arrhythmogenic right ventricular cardiomyopathy (ARVC). Histopathological differences may result in disease-specific RV activation patterns, detectable on the 12-lead electrocardiogram (ECG). Dominant subepicardial scar in ARVC leads to delayed activation of areas with reduced voltages, translating into terminal activation delay and occasionally (epsilon) waves with small amplitude. Read More

Heart Rhythm 2021 May 3. Epub 2021 May 3.

Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy.

Background: Bipolar EGM duration is indicative of local activation property and, if prolonged, is useful to discover areas of slow conduction favoring arrhythmias.

Objective: This study aimed to create a map of EGM duration during the VT (VEDUM Map) to verify if the area with the slowest activation is crucial for reentry and could represent a suitable target for rapid VT interruption during ablation.

Methods: Prospectively 30 patients (pts) were enrolled for this study. Read More

Surg Infect (Larchmt) 2021 May 5. Epub 2021 May 5.

Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Patients with traumatic brain injury (TBI) frequently develop leukocytosis, fever, and tachycardia that may lead to extensive medical investigations to rule out an infectious process. Cerebrospinal fluid (CSF) is often acquired during this workup, however, the utility of this practice has not been studied previously. We hypothesized that CSF cultures would unlikely yield positive results in patients with TBI. Read More

Ann Noninvasive Electrocardiol 2021 May 6:e12846. Epub 2021 May 6.

Bezmialem Vakif University, Istanbul, Turkey.

Background: Since there was no proven treatment of coronavirus disease 2019 (COVID-19), hydroxychloroquine-azithromycin (HCQ-AZM) combination is being used in different countries as a treatment option. Many controversies exist related to the safety and effectiveness of this combination, and questions about how HCQ-AZM combination affects the ventricular repolarization are still unknown.

Objective: The aim of the study was to show whether the hydroxychloroquine-azithromycin (HCQ-AZM) combination prolonged Tpeak-to-end (TpTe) duration and TpTe/QT interval ratio or not. Read More

Ann Noninvasive Electrocardiol 2021 May 6:e12850. Epub 2021 May 6.

First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Syncope represents a relatively uncommon symptom of supraventricular tachycardia (SVT). It is likely that an impaired autonomic vasomotor response to the hemodynamic stress of tachycardia is the determinant of hemodynamic changes leading to cerebral hypoperfusion and syncope. In this regard, tilt-table test may detect abnormalities in the autonomic nervous function and predict the occurrence of syncope during SVT. Read More

Cureus 2021 Apr 2;13(4):e14255. Epub 2021 Apr 2.

Cardiology, Carmel Medical Center, Haifa, ISR.

Background: Myocardial ischemia may lead to lethal arrhythmias. Treatment of these arrhythmias without addressing the cause of ischemia may be futile. The length of resuscitation is an important parameter for determining when to stop resuscitation but with shockable rhythms and reversible cause of the cardiac arrest, the decision to terminate resuscitation is complex. Read More

Proc (Bayl Univ Med Cent) 2021 Jan 22;34(3):378-379. Epub 2021 Jan 22.

Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Flecainide is an antiarrhythmic agent indicated for patients with supraventricular arrhythmias without ischemic or structural heart disease. Flecainide toxicity is a rare condition in which patients may present with bradycardia, widening of QRS, PR prolongation, ventricular tachycardia, syncope, malaise, dizziness, visual disturbance, nausea, vomiting, and/or lethargy. It carries an associated mortality rate of approximately 10%. Read More

Intern Med 2021 1;60(9):1409-1415. Epub 2021 May 1.

Department of Clinical Pathology, Yawatahama City General Hospital, Japan.

In a patient with variant angina of the proximal left anterior descending coronary artery, myocardial ischemia changed the QRS-ST-T configurations without J-waves into those resembling "lambda" waves at maximal ST-segment elevation, and couplets or triplets of supraventricular extrasystole (SVE) changed the ischemia-induced "lambda" waves into QRS-ST-T configurations resembling a "tombstone" morphology or "monophasic QRS-ST complex." At the resolution phase of coronary spasm, the QRS-ST-T configurations returned to those without J-waves and were changed by SVE into "lambda" waves. Interestingly, neither ischemia- nor SVE-induced "lambda" waves or SVE-induced "tombstone" morphology or "monophasic QRS-ST complex" were complicated by ventricular tachyarrhythmia. Read More

Trends Cardiovasc Med 2021 May 2. Epub 2021 May 2.

Brigham and Women's Hospital, Boston, MA; Harvard Medical Schools. Electronic address:

Stereotactic ablative radiotherapy (SABR), or stereotactic body radiotherapy (SBRT), has recently been applied in the field of arrhythmia management. It has been most widely assessed in the treatment of ventricular tachycardia (VT) but may also have potential in the treatment of other arrhythmias as well, often termed stereotactic arrhythmia radiotherapy (STAR). The non-invasive delivery of treatment for VT has the potential to spare an often physiologically vulnerable group of patients the burden of long catheter ablation procedures with the potential for prolonged periods of hemodynamic instability. Read More

Ann Noninvasive Electrocardiol 2021 May 5:e12840. Epub 2021 May 5.

Department of Cardiology, The Cardiovascular Center, Interventional Medical Center, Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.

Background: The whole exome sequencing (WES) with targeted gene analysis is an effective diagnostic tool for cardiomyopathy. The early-onset sudden cardiac death (SCD) was commonly associated with dilated cardiomyopathy (DCM) induced by pathogenic genetic mutations.

Methods: In a Chinese Han family, the patient of 24 years old occurred with early-onset and DCM and died of SCD associated with ICD storms induced by repetitive ventricular tachycardia/fibrillation (VT/F). Read More

PLoS One 2021 4;16(5):e0251178. Epub 2021 May 4.

Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany.

Background: Myocardial infarction is the most frequent cause for out-of-hospital cardiac arrest (OHCA) in adults. Patients with ST-segment elevations (STE) following return of spontaneous circulation (ROSC) are regularly admitted to the catheterisation laboratory for urgent coronary angiography. Whether patients without obvious STE (NSTE) should receive coronary angiography as part of a standardised diagnostic work-up following OHCA is still debated. Read More

J Am Heart Assoc 2021 May 3:e016676. Epub 2021 May 3.

Department of Emergency Medicine and The Heart and Vascular Research Center MetroHealth Campus Case Western Reserve University Cleveland OH.

Background Amiodarone is administered during resuscitation, but its antiarrhythmic effects during targeted temperature management are unknown. The purpose of this study was to determine the effect of both therapeutic hypothermia and amiodarone on arrhythmia substrates during resuscitation from cardiac arrest. Methods and Results We utilized 2 complementary models: (1) In vitro no-flow global ischemia canine left ventricular transmural wedge preparation. Read More

ESC Heart Fail 2021 May 2. Epub 2021 May 2.

Department of Pharmacology, Regional Pharmacovigilance Centre, Pitié-Salpêtrière Hospital, Sorbonne Université, INSERM CIC-1901, AP-HP, Paris, France.

Aims: The major cardiovascular (CV) adverse effects observed with sipuleucel-T from large multi-institutional clinical trials included thromboembolic events, myocardial infarction, and congestive heart failure in up to 0.3% of patients with CV risk factors. The incidence, outcomes, and mechanisms in real-world clinical settings of these CV adverse effects to date have not been fully elucidated. Read More

Curr Oncol Rep 2021 May 3;23(7):78. Epub 2021 May 3.

Division of Cardiology, Northwestern Feinberg School of Medicine, 675 N. St. Clair St. Ste 19-100, Chicago, IL, 60611, USA.

Purpose Of Review: This review provides a contemporary overview of current studies outlining the incidence and characteristics of CAR T-cell cardiotoxicity in an effort to identify future directions for research and potential opportunities for prevention and intervention.

Recent Findings: Cardiovascular events occurred in anywhere between 10 and 36% of patients in CAR T-cell clinical trials, ranging from tachycardia, hypotension, arrhythmia, decreased left ventricular systolic function to cardiogenic shock and death. Cardiac events are more often associated higher grades (> 2) of cytokine release syndrome and frequently proceeded by an elevated troponin. Read More

J Innov Card Rhythm Manag 2021 Apr 15;12(4):4467-4472. Epub 2021 Apr 15.

Department of Cardiology, Westmead Hospital, Sydney, Australia.

In ischemic cardiomyopathy, endocardial reentry has traditionally been the mechanistic paradigm for understanding ventricular tachycardia (VT). However, recognition is growing that epicardial myocardium is a critical component for VT substrate, even in patients with ischemic cardiomyopathy. In this report, we present a novel case of a three-dimensional VT reentry involving epicardial components and an endocardial exit. Read More

Arrhythm Electrophysiol Rev 2021 Apr;10(1):38-44

Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK.

Post-infarct-related ventricular tachycardia (VT) occurs due to reentry over surviving fibres within ventricular scar tissue. The mapping and ablation of patients in VT remains a challenge when VT is poorly tolerated and in cases in which VT is non-sustained or not inducible. Conventional substrate mapping techniques are limited by the ambiguity of substrate characterisation methods and the variety of mapping tools, which may record signals differently based on their bipolar spacing and electrode size. Read More

Arrhythm Electrophysiol Rev 2021 Apr;10(1):33-37

Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy.

Mitral valve prolapse (MVP) is the most common valvular heart disease, affecting 2-3% of the general population. Barlow's disease is a clinical syndrome characterised by MVP. Initially thought a benign condition, MVP is now recognised as a cause of sudden cardiac death and ventricular arrhythmias. Read More

Clin Case Rep 2021 Apr 16;9(4):1968-1972. Epub 2021 Feb 16.

Department of Cardiology Yokohama Rosai Hospital Yokohama Japan.

During an initial diagnosis of IVF, an arrhythmic substrate may be missed for several reasons such as lack of information; thus, a careful follow-up is important. A three-dimensional mapping may identify a possible missed arrhythmic substrate in IVF. Read More

Heart Rhythm 2021 Apr 29. Epub 2021 Apr 29.

Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address:

Background: Prior studies of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients, relying on limited numbers of procedures, have not reported VT-free survival in parallel for single and multiple procedures (i.e., after the last procedure). Read More

JACC Clin Electrophysiol 2021 Apr 22. Epub 2021 Apr 22.

Department of Cardiology, Prince Charles Hospital, Brisbane, Queensland, Australia.

Objectives: This study reports the sensing and arrhythmia detection performance of a novel extravascular (EV) implantable cardioverter-defibrillator (ICD) in a first-in-human pilot study.

Background: The EV ICD lead is implanted in the substernal space, resulting in novel sensing and detection challenges. It uses a programmable sensing profile with new or modified discrimination of oversensing and of ventricular tachycardia (VT) from supraventricular tachycardia (SVT). Read More

JACC Clin Electrophysiol 2021 Apr 21. Epub 2021 Apr 21.

Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy; Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi," Marche Polytechnic University, Ancona, Italy.

Objectives: This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications.

Background: Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. Read More

BMC Cardiovasc Disord 2021 May 1;21(1):224. Epub 2021 May 1.

Department of Radiodiagnostic, Biruni University of Medical Faculty, Istanbul, Turkey.

Background: Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this case presentation is to emphasise the typical electrocardiographic findings that are detected with massive pulmonary embolism along with the electrocardiographic S1Q3 and S1Q3T3 accompanied by T negativity at the D3 derivation based on prevalent T negativity.

Case Presentation: We present the case of an adult male who presented with a massive pulmonary embolism that was associated with tachycardia, haemoptysis and typical S1Q3T3 electrocardiographic findings. Read More

Pacing Clin Electrophysiol 2021 May 1. Epub 2021 May 1.

Heart Rhythm Center, Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Introduction: The efficacy of stereotactic body radiation therapy (SBRT) as an alternative treatment for recurrent ventricular tachycardia (VT) is still unclear. This study aimed to report the outcome of SBRT in VT patients with nonischemic cardiomyopathy (NICM).

Methods: The determination of the target substrate for radiation was based on the combination of CMR results and electroanatomical mapping merged with the real-time CT scan image. Read More

Pacing Clin Electrophysiol 2021 May 1. Epub 2021 May 1.

Department of Cardiac Pacing and Electrophysiology, Univ. Bordeaux, Bordeaux University Hospital (CHU), Pessac-Bordeaux, 33600, France.

Background: Conventional bipolar electrodes (CBE) may be suboptimal to detect local abnormal ventricular activities (LAVAs). Microelectrodes (ME) may improve the detection of LAVAs. This study sought to elucidate the detectability of LAVAs using ME compared with CBE in patients with scar-related ventricular tachycardia (VT). Read More

ESC Heart Fail 2021 May 1. Epub 2021 May 1.

Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.

Aim: Wearable cardioverter defibrillator (WCD, LifeVest, and Zoll) therapy has become a useful tool to bridge a temporarily increased risk for sudden cardiac death. However, despite extensive use, there is a lack of evidence whether patients with myocarditis and impaired LVEF may benefit from treatment with a WCD.

Methods And Results: We conducted a single-centre retrospective observational study analysing patients with a WCD prescribed between September 2015 and April 2020 at our institution. Read More