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Summary: Nivolumab can cause fatal myocarditis. We aimed to analyze the clinical characteristics of nivolumab-induced myocarditis and provide evidence for clinical diagnosis, treatment, and prevention. Studies involving nivolumab-induced myocarditis were identified in electronic databases from 2000 to 2023 for retrospective analysis. A total of 66 patients were included, with a median age of 68 years. The median onset time of myocarditis is 11.5 days. The main organs affected in persons presented with myocarditis are heart (100.0%) and skeletal muscle (22.7%). The main clinical manifestations are dyspnea (49.2%), fatigue (47.6%), and myalgias (25.4%). The levels of troponin, troponin T, troponin I, creatine kinase, creatine kinase myocardial band, creatine phosphokinase, C-reactive protein, brain natriuretic peptide, and N-terminal brain natriuretic peptide precursor were significantly increased. Histopathology often shows lymphocyte infiltration, myocardial necrosis, and fibrosis. Myocardial immunological parameters usually present positive. Cardiac imaging often suggests complete heart block, intraventricular conduction delay, arrhythmia, myocardial infarction, edema, left ventricular ejection fractions reduction, ventricular dysfunction, and other symptoms of myocarditis. Forty-two (63.6%) patients achieved remission within a median time of 8 days after discontinuation of nivolumab and treatment with systemic corticosteroids, immunoglobulins, plasmapheresis, and immunosuppressant. Thirty-five patients eventually died attributed to myocarditis (68.6%), cancer (20.0%), respiratory failure (5.7%), and other reasons (5.7%). Nivolumab-induced myocarditis should be comprehensively diagnosed based on clinical symptoms, histopathological manifestations, immunological parameters, and cardiac function imaging examinations. Nivolumab should be discontinued immediately, plasmapheresis and systemic corticosteroids combined with immunoglobulins or immunosuppressants may be an effective treatment. [ABSTRACT FROM AUTHOR]

Introduction: LMNA splicing mutations occur in 9.1% of cases with cardiac involvement cases, but the phenotype and severity of disease they cause have not yet been systematically studied. The aim of this study was to understand the clinical and pathogenic characteristics of the LMNA splice-site mutation phenotype in patients with LMNA-related dilated cardiomyopathy (DCM) and sudden cardiac death (SCD). Methods and Results: First, we reported a novel family with LMNA-related DCM and SCD, and the clinical characteristics of all current patients with LMNA splicing mutations were further summarized through the ClinVar database. Seventeen families with a total of 134 individuals, containing a total of 15 LMNA splicing mutation sites, were enrolled. A total of 42 subjects (31.3%) had SCD. Compared without with the non-DCM group (n = 56), the patients within the DCM group (n = 78) presented a lower incidence of atrioventricular block (AVB) (p = 0.015) and a higher incidence rates of non-sustained ventricular tachycardia (p = 0.004),) and implantable cardioverter defibrillator (ICD) implantation (p = 0.005). Kaplan--Meier survival analysis showed that the patients with pacemaker (PM) implantation had a significantly reduced the occurrence of SCD compared to patientswith those without PM implantation (log-rank p < 0.001), while there was no significant difference in ICD implantation between the two groups (log-rank p = 0.73). Second, we identified the family that we reported with a mutation in an LMNA c.513+1 G>A mutation in the reported family, and pathogenic prediction analysis showed that the mutation site was extremely harmful. Next, we conducted gene expression levels and cardiac pathological biopsy studies on the proband of this family. We found that the expression of normal LMNA mRNA from the proband was significantly downregulated in peripheral blood mononuclear cells than incompared with healthy individuals. Finally, we comprehensively summarized the pathological characteristics of LMNA-related DCM, including hypertrophy, atrophy, fibrosis, white blood cell infiltration, intercalated disc remodeling, and downregulation of desmin and connexin 43 (Cx43) expression. Discussion: Above all, Cardiaccardiac involvement in patients with LMNA splicesite mutation presented with a high rate of SCD. Implanting a pacemaker significantly reduced the SCD rate in non-DCM patients with AVB. The pathogenic characterization was not only haveinvolved suppressed the expression of the healthy LMNA allele, but was also associated with abnormal expression and distribution of desmin and Cx43. [ABSTRACT FROM AUTHOR]

In this bicentric study, we report the outcomes of combined transcatheter aortic valve replacement combined with minimally invasive mitral valve surgery. We included a cohort of six patients (79.6 ± 3.2 years, 83% women) with high-risk profiles and deemed to be non-operable with combined mitral and aortic valvular disease. All patients had unsuitable anatomies for transcatheter mitral valve edge-to-edge repair (TEER). Moreover, most of the patients (5/6) suffered a combined aortic valve lesion, which complicates the efficiency of cardioplegia in the case of CBP through minimally invasive incisions. The first stage was implanting a TAVI valve to achieve aortic valve competency and hence facilitate the infusion of cardioplegia after clamping the aorta during endoscopic mitral valve surgery. After one week, we performed the minimally invasive mitral valve repair. Most patients (n = 5; 83%) underwent successful endoscopic mitral valve repair. Intraoperatively, the mean ischemic time was 42 min, and the total bypass time was 72 min. Postoperatively, the mean intubation time was 0 h. Postoperative complications included reoperation for bleeding in one patient (16.7%) and a new heart block requiring pacemaker implantation in one patient (16.7%). There was neither in-hospital mortality nor 1-year mortality. [ABSTRACT FROM AUTHOR]

Patients with bladder cancer (BLCA) still show high recurrence after surgery and chemotherapy. Hesperetin (HE), as a natural compound, has attracted researchers' attention due to its low toxicity and easy access. However, the inhibitory effect of HE on BLCA remains unknown. The hub genes and enrichment pathways regulated by HE in the treatment of BLCA were predicted by network pharmacology. The molecular docking of HE and hub proteins was visualized. Colony and CCK8 assays were used to test cell proliferation, and BLCA migration was confirmed by transwell and wound healing assays. In addition, the occurrence of apoptosis and ferroptosis was demonstrated by Hoechst staining, transmission electron microscopy (TEM) and ROS (reactive oxygen species) assay. Western Blotting was performed to validate the hub proteins, target functions and pathways. SRC, PIK3R1 and MAPK1 were identified as hub targets for HE in BLCA, involving the PI3k/AKT pathway. Furthermore, HE inhibited the proliferation and migration of BLCA cells. The MMP2/MMP9 proteins were significantly inhibited by HE. The increased expression of Bax and cleaved caspase-3 indicated that HE could promote BLCA cell apoptosis. In addition, Hoechst staining revealed concentrated and illuminated apoptotic nuclei. The activation of ROS and the decline of GPX4 expression suggested that HE might induce ferroptosis as an anti-BLCA process. Shrunk mitochondria and apoptotic bodies were observed in BLCA cells treated with HE, with reduced or absent mitochondrial cristae. We propose for the first time that HE could inhibit the proliferation and migration of BLCA cells and promote apoptosis and ferroptosis. HE may act by targeting proteins such as SRC, PIK3R1 and MAPK1 and the PI3K/AKT pathway. [ABSTRACT FROM AUTHOR]

This article discusses the treatment of congenital heart block (CHB) in pregnancies of mothers with autoimmune disease. CHB is a rare complication that can lead to high mortality rates in newborns and the need for a pacemaker in patients. The article presents a case study of a fetus with CHB and describes the management strategies used, including the use of Hydroxychloroquine and ASS for the mother and IVIG therapy for the child. The article concludes that IVIG therapy can be a viable option for treating CHB-related tachycardia, and that the timing of pacemaker implantation should be carefully considered. The article also suggests that immunoadsorption may be a preventive option for high-risk pregnancies. [Extracted from the article]

This article discusses the incidence and characteristics of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI). The study analyzed a population of 3,144 patients who underwent TAVI for severe aortic valve stenosis, with 359 patients requiring PPI either during their hospital stay or in follow-up. The type of prosthesis used did not affect PPI rates, and the most common indication for PPI was third-degree atrioventricular block. The study also found that PPI can occur late after TAVI, with different indications compared to early implantation. Approximately 40% of patients showed a permanent ventricular pacing dependency. [Extracted from the article]

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease. Many patients remain asymptomatic when no cardiac lesions are present (isolated ccTGA). In ccTGA, the atrioventricular conduction system may be abnormal, resulting in progressive dysfunction and, eventually, a Complete Heart Block (CHB). In ccTGA with situs inversus, the conduction pathway resembles a normal tract, but the atrioventricular node is located posteriorly. Compared with situs solitus, spontaneous CHB is uncommon in ccTGA patients with situs inversus. We report the case of a 40-year-old female without previous medical conditions or having a family or personal history of heart disease presented with loss of consciousness. At admission, electrocardiography revealed bradycardia, CHB, and hypertrophy of the right ventricle. Cardiovascular imaging tests detected an isolated ccTGA with situs inversus and levocardia. The Holter monitor revealed intermittent CHB. Exercise testing demonstrated chronotropic incompetence. An epicardial pacemaker was implanted, and the patient was discharged symptom-free. At a two-years follow-up remains asymptomatic. This case illustrates the importance of cardiovascular imaging in defining cardiac anatomy, ruling out other congenital heart defects, and facilitating pacing therapy in complex congenital heart disease. Congenital heart disease patients should be treated by a multidisciplinary team with expertise in permanent pacing. [ABSTRACT FROM AUTHOR]

This study aims to analyze the clinical characteristics and risk factors of high-risk groups of neonatal lupus erythematosus (NLE) in term infants. High-risk groups of NLE infants whose mothers were positive for anti-SSA, anti-SSB or anti-U1RNP antibodies during pregnancy were enrolled. They were born between February 2013 and February 2020, with a gestational age not less than 37 weeks. We analyzed their clinical data from birth to 24 months after birth. A total of 105 patients in the NLE high-risk group were included. Among them, 30 patients were diagnosed with NLE (NLE group), and 75 patients were not (non-NLE group). The affected systems of the NLE group included the dermal (13.3%), hepatic (76.0%), and hematological systems (43.3%). Hepatic involvement, anemia and thrombocytopenia did not emerge until 60 days, 41 days and 22 days after birth, respectively, in some cases. Systemic involvement could be cured within 3 to 12 months after birth. The clearance time of specific autoantibodies was 12 months after birth. There was no significant difference in the clinical characteristics of babies and their mothers between the two groups, neither in the positive rate nor in the clearance time of specific autoantibodies. Conclusion: After standardized prenatal health care, there is still a high risk of dermal, hepatic, or hematological system involvement for high-risk groups of NLE. There are no specific indicators for the prediction of whether babies will develop NLE. All of these patients need to be followed up closely within one year after birth. What is Known: • Neonatal lupus erythematosus (NLEs) can affect the cardiac, dermal, hepatic, and hematological systems of infants. What is New: • After standardized prenatal health care employing good multidepartment cooperation in our center, no neonates had cardiac block in this study. However, dermal, hepatic, and hematological system involvement of NLE can still gradually appear (as long as 60 days after birth in some cases) during follow-up, and some of these conditions are serious and require timely and active intervention. No single factor has been found to predict whether offspring at high-risk of NLE whose mothers are positive for anti-SSA, SSB and/or RNP will develop NLE. [ABSTRACT FROM AUTHOR]

This article discusses the case of three children with severe idiopathic uveitis, a type of eye inflammation, who did not exhibit any evidence of arthritis. The patients were initially treated with topical and systemic corticosteroids, but their ocular inflammation was not adequately controlled. They were then successfully treated with tumor necrosis factor-α inhibitors. The article emphasizes the severity of pediatric uveitis and the need for prompt involvement of ophthalmologists to improve visual outcomes. The authors also discuss the potential role of autoimmune dysregulation in the pathogenesis of the disease. [Extracted from the article]

Transcatheter closure of VSD remains a complex procedure in infants with technical challenges and carries the risk of significant complications, due to its complex anatomical morphology and closed proximity to the atrioventricular valves and the conduction system. In this article, we presented transcatheter VSD closure in infants under 10 kg using the Lifetech Konar-MF device via only venous route without TEE guidance and arterial access. Between January 2021 and May 2023, a total of 34 patients weighing less than 10 kg who underwent transcatheter VSD closure antegradely with Lifetech™ Konar-Multifunctional (MF) occluder were included in the study. The mean age of the patients was 8.1 (3.5–35) months. Average weight was 6.5 kg (range 4.5–10 kg). VSD was perimembranous in 27 patients (79.4%). Successful device placement was achieved in all 34 patients. However, device embolization occurred in three patients. One of the patients was successfully implanted with a one size larger device, the surgical closure was performed other two cases. TR occurred in seven patients (20.6%) after releasing devices. None of the patients developed complete heart block. Right bundle branch block developed in two patients. Residual shunt was observed in 9 patients (six small, two moderate, and one large). During follow-up, residual shunt disappeared in six of these patients and only mild residual shunt remained in the other four patients which have not required any further intervention. Transcatheter closure of VSD with Lifetech Konar-MF device is safe and effective in infants less than 10 kg via only venous access with a high success rate and low complication rate. In these patients, transcatheter VSD closure can be performed by excluding the risk of complications that may occur due to AV loop formation, arterial intervention, endotracheal intubation and TEE use. [ABSTRACT FROM AUTHOR]

Fetal congenital heart block is a widely recognized complication of pregnancies with anti Ro/La antibodies. Less common presentations, including dilated cardiomyopathy, myocarditis, valvular insufficiency, and endocardial fibroelastosis, have also been described in these fetuses. We present two cases where recognition of isolated basal echogenicity of the fetal heart, an unconventional manifestation of anti-SSA antibodies during pregnancy, led to a suspicion and ultimately diagnosis of antibody positivity in the mother. These cases highlight the importance of being aware of this rare manifestation of anti-SSA antibodies during pregnancy, as early recognition of antibody positivity may lead to improve fetal and maternal outcomes. [ABSTRACT FROM AUTHOR]

We present a compelling case of a 37-year-old male who, after three decades of asymptomatic living, was diagnosed with congenitally corrected transposition of great arteries (CCTGA). Initially presenting with troubling symptoms of dizziness and syncope, further evaluation revealed complete heart block, a significant finding necessitating intervention. Despite the rarity of symptomatic presentation in CCTGA, the severity of the heart block prompted the implantation of a DDD pacemaker to ensure adequate management. With meticulous care and precision, the implantation procedure was successfully executed, offering hope for improved cardiac function and symptom relief. Remarkably, the patient remained asymptomatic during subsequent follow-up visits, highlighting the effectiveness of the intervention in mitigating the risks associated with high atrioventricular block in CCTGA. This case serves as a testament to the importance of vigilant monitoring and timely intervention in managing complex cardiac anomalies, ultimately enhancing patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Neonatal lupus (NL) is extremely rare and is caused by the transplacental passage of maternal IgG autoantibodies against Ro, La, and/or RNP proteins into the fetal circulation, which can cause congenital complete atrioventricular block (CCAB), permanent skin lesions, and liver involvement. Objective: To know the prevalence of NL in patients with CCAB and the clinical course in long-term follow-up. Methods: From January 1992 to December 2017, patients with CCAB were included. The presence of anti-SSA/Ro and anti-SSB/La antinuclear antibodies in maternal serum confirmed NL. Results: Eight patients were included with a follow-up of 10 ± 6 years; NL was concluded in 62.5%; two were male. One of them was diagnosed in utero, two at birth, and a pacemaker was implanted in them, one at 12 years of age and another at 15. The other two cases were diagnosed at 18 and 26 years of age, and permanent pacemakers were implanted 8 and 5 years later, respectively. In one case, a definitive pacemaker was not implanted in a newborn with only 1 year of follow-up. At delivery, 60% of the mothers were free of rheumatic disease, and altogether, they all had 19 children; none of them presented NL manifestations. Conclusions: CCAB is rare and frequently associated with a maternal autoimmune disease, practically all of them will require a definitive pacemaker at some point in their lives. [ABSTRACT FROM AUTHOR]

Amyloidosis is a common comorbidity in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR). This study aims to assess the impact of amyloidosis on the clinical outcomes of TAVR. This is a retrospective study of the National Inpatient Sample database that identified adult patients (≥18 years) with AS hospitalized for TAVR from 2016 through 2020 to compare outcomes in those with versus without amyloidosis. Our primary outcome was in-hospital mortality. Secondary outcomes included procedural complications, hospital length of stay (LOS), and total costs. TAVR trends in both cohorts were also evaluated. The total cohort included 304,710 patients with AS undergoing TAVR, of whom 410 had amyloidosis. Over the study period, TAVR trends increased significantly in patients with and without amyloidosis (both p trend < 0.01). Patients with amyloidosis were more likely to be older males with atrial fibrillation/flutter, congestive heart failure, renal disease, and dementia compared to non-amyloidosis patients. After adjustment for baseline characteristics, patients with amyloidosis had similar odds of in-hospital mortality (adjusted odds ratio [aOR] 1.66, 95 % confidence interval [CI] 0.34–3.63), heart block (aOR 1.33, 95 % CI 0.84–2.10), permanent pacemaker insertion (aOR 0.67, 95 % CI 0.27–1.66), stroke (aOR 0.90, 95 % CI 0.32–3.13), acute kidney injury, major bleeding, blood transfusion, vascular complications, in addition to similar LOS (p = 0.21) and total costs (p = 0.18) compared to patients without amyloidosis. In patients with AS undergoing TAVR, comorbid amyloidosis is associated with similar in-hospital mortality and procedural complications compared to patients without amyloidosis. • Amyloidosis is a common comorbidity in elderly patients with aortic stenosis. • In patients undergoing TAVR, in-hospital mortality was similar between those with and without comorbid amyloidosis. • Procedural complications, LOS, and total costs were also similar in patients with and without amyloidosis. • From 2016 through 2020, TAVR trends increased significantly in patients with and without amyloidosis. • From 2016 through 2020, TAVR LOS and total costs decreased significantly in patients with and without amyloidosis. [ABSTRACT FROM AUTHOR]

Background: For the unclear pathogenesis of Sjogren's syndrome (SS), further exploration is necessary. Mesenchymal stem cells (MSCs) and derived exosomes (MSCs‐exo) have exhibited promising results in treating SS. Object: This study aimed to investigate the effect and mechanism of human umbilical cord MSCs (UC‐MSCs) on SS. Methods: Nonobese Diabetic (NOD) mouse splenic T cells were co‐cultured with UC‐MSCs and UC‐MSCs‐exo, and interferon‐gamma (IFN‐γ), interleukin (IL)‐6, IL‐10, prostaglandin E2 (PGE2), and transforming growth factor‐β1 (TGF‐β1) levels in the supernatant were assessed by quantitative real‐time polymerase chain reaction and enzyme‐linked immunosorbent assay. Co‐cultured T cells were injected into NOD mice via the tail vein. The inflammatory cell infiltration in the intestine and the submandibular gland was characterized by hematoxylin‐eosin staining. Treg/Th17 homeostasis within the spleen was determined by flow cytometry. Gut microbiota was detected by 16S rRNA sequencing, and the relationship between differential microbiota and Treg/Th17 cytokines was analyzed by the Pearson correlation coefficient. Results: UC‐MSCs, UC‐MSCs‐exo, and NOD mouse splenic T cells were successfully cultured and identified. After T cells were co‐cultured with UC‐MSCs and UC‐MSCs‐exo, both IFN‐γ and IL‐6 were decreased while IL‐10, PGE2, and TGF‐β1 were increased in transcriptional and translational levels. UC‐MSCs and UC‐MSCs‐exo partially restored salivary secretion function, reduced Ro/SSA antibody and α‐Fodrin immunoglobulin A levels, reduced inflammatory cell infiltration in the intestine and submandibular gland, raised proportion of Treg cells, decreased IFN‐γ, IL‐6, IL‐2, IL‐17, lipopolysaccharide, and tumor necrosis factor‐alpha levels, and raised IL‐10, Foxp3, and TGF‐β1 levels by affecting co‐cultured T cells. The intervention of UC‐MSCs and UC‐MSCs‐exo improved intestinal homeostasis in NOD mice by increasing microbiota diversity and richness. Additionally, differential microbiota was significantly associated with Treg/Th17 cytokine levels. Conclusion: Human UC‐MSCs and UC‐MSCs‐exo improved disease characterization of SS in NOD mice through regulation of gut microbiota and Treg/Th17 cellular immunity. [ABSTRACT FROM AUTHOR]

Coronary artery lesions related to pacemaker implantation are rare complications. With the increasing adoption of the technique of permanent transseptal pacing of the left bundle branch area pacing (LBBAP), an increase in the incidence of these complications may be expected. We report two cases of coronary lesions after permanent transeptal pacing of the LBBAP: the first with a small coronary artery fistula, and the second with an extrinsic coronary compression. Both complications occurred with stylet‐driven pacing leads with extendable helix. In the first case, since the shunt volume was small and no major complications were reported, the patient was treated conservatively with good outcome. The second case required lead repositioning due to acute decompensated heart failure. [ABSTRACT FROM AUTHOR]

Mercury poisoning is most frequently associated with multiorgan toxicity involving the brain, lungs, and kidneys. Cardiotoxic effects of mercury are rare and often overlooked. We demonstrate mercury poisoning–induced cardiotoxicity through a case study and then provide a review of the incidence, pathophysiology, and associated management plans. This case illustrates the importance of thorough history-taking to promote early recognition of toxicity. [ABSTRACT FROM AUTHOR]

Background Twiddler syndrome (TS) is a complication of cardiac implantable electronic device (CIED) implantation, caused by the deliberate or unconscious manipulation of the device by the patient himself, which results in dislocation of the leads by retraction towards the subcutaneous pocket. Case summary This report describes two clinical cases that occurred in our centre, for which two different solutions were successfully implemented. In the first case, a complete removal of the stimulation system was performed, and a leadless pacemaker (PM; Medtronic Micra VR) was implanted. In the second case, the patient underwent a revision procedure. The PM was disconnected, and the electrodes were debrided, a submuscular pocket for the PM was created, and at the end of the procedure, the PM was anchored to the pectoralis major. Discussion Twiddler syndrome is a not so rare and serious complication of CIED implantation, leading to device malfunctioning and higher risk of infection of the pocket due to multiple re-interventions. In these two cases, different surgical solutions were performed, both resulting to be effective to solve the effects of TS. [ABSTRACT FROM AUTHOR]

Background Coronary pseudoaneurysm is a rare, potentially fatal, complication of coronary intervention. A challenging management case of a giant right coronary pseudoaneurysm is presented. Case summary A 56-year-old man presented with an atypical presentation for ST-elevation myocardial infarction. Initial angiogram showed a crescent-shaped ostial lesion with probable connection to the aorta, which disappeared after placing a drug-eluting stent. A few hours later, patient was found to have staph aureus bacteraemia and infective endocarditis for which he received a prolonged antibiotic course. Patient presented a few weeks later with second degree heart block. Echocardiography showed a large cystic lesion adjacent to the right coronary cusp suspicious for a coronary pseudoaneurysm, which was confirmed with angiography. Attempts to treat it with a covered stent were unsuccessful and patient ultimately underwent surgical resection. Discussion Coronary pseudoaneurysm develops when there is a contained breach of all three layers of the vessel. It may develop from direct iatrogenic trauma to the vessel wall but can be infectious in aetiology. The treatment approach remains uncertain due to limited evidence. Here, we present the diagnostic and technical challenges of managing such an uncommon entity and discuss an algorithm for management. [ABSTRACT FROM AUTHOR]

Background Primary cardiac lymphoma (PCL) is rare and its presentation can be variable. Thorough workup of suspected PCL or other cardiac tumours typically incorporates a range of imaging techniques and laboratory investigations but ultimately diagnosis is confirmed by histological analysis of myocardial tissue. Case Summary An 80-year-old Caucasian female presented with complete heart block and symptomatic cardiac tamponade. A pericardiocentesis was performed and a dual-chamber permanent pacemaker was implanted for the management of her complete heart block. Subsequently, a right atrial mass was discovered on imaging and the patient underwent endomyocardial biopsy of the mass. Histological analysis of the sample confirmed a primary cardiac lymphoma. The patient opted to forgo treatment with chemotherapy and died from her disease 1 month later. Discussion Cardiac arrhythmias can occur in PCL due to infiltration of conduction pathways. Characterization of cardiac masses on various imaging modalities and laboratory tests guides diagnosis. Tissue diagnosis is required to confirm PCL. The location of a cardiac mass may present technical challenges when undertaking a biopsy, so the best approach to tissue sampling should be considered on an individual basis. Without treatment survival is less than one month but with modern chemoimmunotherapy five-year survival may exceed 50%. [ABSTRACT FROM AUTHOR]

The electrocardiogram (ECG) is a fundamental tool in cardiology, providing invaluable insights into cardiac physiology and detecting various abnormalities. This review article presents a comprehensive overview of ECG interpretation, focusing on the procedure, application, and methodology. The placement of electrodes, ECG paper speed, and measurements of intervals and blocks are discussed in detail. The article emphasizes the importance of a systematic approach to ECG interpretation, highlighting six main sections: determination of heart rhythm, calculation of heart rate, assessment of intervals and blocks, analysis of atrial depolarization patterns, assessment of ventricular depolarization complexes, and delving into the intricate characteristics of ST segments and exploration of the electrocardiographic T-wave manifestations. Specific criteria for identifying abnormalities in each section are provided, along with their associated etiologies and clinical implications. Furthermore, the limitations of ECG as a diagnostic tool are acknowledged, emphasizing the need for clinical correlation and consideration of additional tests. The abstract encapsulates the breadth and depth of the review, conveying the relevance and the profound significance of ECG interpretation in the realm of clinical practice and scientific inquiry. [ABSTRACT FROM AUTHOR]

Prolonged atrioventricular conduction (first-degree heart block) is a well-known symptom of ARF, occurring in one-fifth to three-fifths of patients. This condition is a minor criterion for diagnosing ARF based on Jones's criteria. Advanced conduction delay, such as a second-degree or a complete atrioventricular (AV) block, is a rare condition of ARF that can occur before symptoms like carditis, polyarthritis, and Sydenham chorea appear. We present a case of ARF in an adolescent with complete AV block. [ABSTRACT FROM AUTHOR]

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Objective: Temporary permanent pacing (TPP) remains an underutilized yet crucial procedure involving active fixation leads connected to a pulse generator affixed to the patient's skin surface. We aim to conduct a retrospective study to examine the indications, duration, procedural complications, and outcomes of TPP interventions conducted at our center over a 2-year period. Methods: This is a retrospective, single-centre observational study done in the Department of Cardiology & Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research (SJICSR), a tertiary care medical centre in Bengaluru, Karnataka. This retrospective study examines the indications, duration, procedural complications, and outcomes of TPP interventions conducted at our centre over a 2-year period from December 2021 to December 2023. Results: Seventeen patients underwent TPP, with 64.6% necessitating pacing during the postexplant/extraction period due to device-related infections. Additionally, 11.8% presented with complete heart block (CHB) and sepsis, while another 11.8% were post-aortic valve replacement patients experiencing sepsis with transient atrioventricular block. Singular cases comprised a CHB patient with stroke (5.9%) and a pre-operative CHB patient (5.9%). The mean TPP duration was 18.5±6.7 days (range: 10 to 30 days). Complications included superficial skin infection (11.9%) and lead dislodgment (5.8%), with no recorded mortalities. Conclusion: Our findings, in conjunction with existing literature, affirm TPP as a safe and reliable pacing method for up to a one-month period. Encouraging education and broader adoption of TPP among emergency care providers and cardiologists is imperative. [ABSTRACT FROM AUTHOR]

Acute coronary syndrome (ACS) patients can be successfully treated with percutaneous coronary intervention (PCI). The anti-anginal drug Nicorandil works to improve microvascular circulation and boost coronary blood flow. During percutaneous coronary intervention (PCI), an intracoronary injection of nicorandil can be utilized to treat the severe no-reflow phenomena. By enhancing microvascular circulation in those with acute myocardial infarction, it also lessens the occurrence of the slow-flow phenomena. We describe case series pertaining to complete heart block following intracoronary administration of nikorandil during percutaneous coronary intervention. Electrocardiography monitor of cath-lab unit showed complete heart block during hemodynamic monitoring while PCI.Coronary angioplasty was done in all three patients. In all three the patients after placing a stent in proximal RCA, coronary angiography showed TIMI grade 2 flow in RCA, 2 mg nicorandil was intracoronary administrated. Immediately, there was complete heart block following Nicorandil administration, the rhythm reverted to sinus after immediate administration of 0.6 mg atropine. All patients had a good outcome during follow-up after 1 month. Addition to the literature: Up to now, there has been no report of complete heart block caused by intracoronary administration of nicorandil. Although intracoronary nicorandil is one of the most often employed techniques to increase coronary flow, much more focus should be placed on nicorandil's side effects. [ABSTRACT FROM AUTHOR]

We present a case of a patient with a transient ischaemic attack (TIA) likely due to paradoxical embolism through a patent foramen ovale (PFO). Her medical history included 2nd-degree heart block Mobitz II, which manifested with recurrent syncopes and was treated with a dual chamber pacemaker. During the interventional PFO closure procedure, we noted entrapment of the atrial pacemaker lead between the right-sided occluder disc and the interatrial septum. We were able to successfully move the lead aside using a 24 mm sizing balloon and subsequently developed the right-sided occluder disc in the correct position. In conclusion, pacemaker-lead entrapment between a PFO occluder disc and the interatrial septum can be prevented using a sizing balloon. [ABSTRACT FROM AUTHOR]

Background: TRPM4 is a calcium-activated channel that selectively permeates monovalent cations. Genetic variants of the channel in cardiomyocytes are associated with various heart disorders, such as progressive familial heart block and Brugada syndrome. About97% of all known TRPM4 missense variants are classified as variants of unknown clinical significance (VUSs). The very large number of VUSs is a serious problem in diagnostics and treatment of inherited heart diseases. Methods and results: We collected 233 benign or pathogenic missense variants in the superfamily of TRP channels from databases ClinVar, Humsavar and Ensembl Variation to compare performance of 22 algorithms that predict damaging variants. We found that ClinPred is the best-performing tool for TRP channels. We also used the paralogue annotation method to identify disease variants across the TRP family. In the set of 565 VUSs of hTRPM4, ClinPred predicted pathogenicity of 299 variants. Among these, 12 variants are also categorized as LP/P variants in at least one paralogue of hTRPM4. We further used the cryo-EM structure of hTRPM4 to find scores of contact pairs between parental (wild type) residues of VUSs for which ClinPred predicts a high probability of pathogenicity of variants for both contact partners. We propose that 68 respective missense VUSs are also likely pathogenic variants. Conclusions: ClinPred outperformed other in-silico tools in predicting damaging variants of TRP channels. ClinPred, the paralogue annotation method, and analysis of residue contacts the hTRPM4 cryo-EM structure collectively suggest pathogenicity of 80 TRPM4 VUSs. [ABSTRACT FROM AUTHOR]

We aimed to dissociate the autoantibody response against the Ro52 protein in patients with anti-synthetase or anti-melanoma differentiation-associated gene 5 (MDA5) antibodies to explore the potential roles of different anti-Ro52 autoantibody responses in disease subclassification. This study used a single-center, prospective myositis cohort involving 122 consecutive patients with anti-synthetase antibodies identified by RNA immunoprecipitation (RNA-IP) and 34 patients with anti-MDA5 antibodies detected using enzyme immunoassay (EIA). Anti-Ro52 antibodies were measured using commercial EIA kits, while anti-Ro/SSA antibodies were identified using RNA-IP. Clinical features and outcomes were stratified according to two different patterns of autoantibody responses against Ro52, including "isolated anti-Ro52", defined by positive anti-Ro52 and negative anti-Ro/SSA antibodies, and "anti-SSA-Ro52", defined by positive anti-Ro52 and anti-Ro/SSA antibodies. Isolated anti-Ro52 positivity was the most prevalent autoantibody response in patients with both anti-synthetase (40/122; 32.8%) and anti-MDA5 antibodies (8/34; 23.5%). Isolated anti-Ro52 or anti-SSA-Ro52 positivity was associated with Gottron's sign in patients with anti-synthetase antibodies, while in patients with anti-MDA5 antibodies, isolated anti-Ro52 positivity was associated with respiratory insufficiency at initial presentation and poor overall survival. Isolated anti-Ro52 positivity could be a potential biomarker for patient stratification; however, the clinical significance of dissociating isolated anti-Ro52 positivity from overall anti-Ro52 positivity was not evident. [ABSTRACT FROM AUTHOR]

Limited data exist regarding the long-term outcomes of systemic atrioventricular valve (SAVV) intervention (morphologic tricuspid valve) in congenitally corrected transposition (ccTGA). The goal of this study was to evaluate the mid- and long-term outcomes of SAVV surgery in ccTGA. We performed a retrospective review of 108 ccTGA patients undergoing SAVV surgery from 1979 to 2022. The primary outcome was a composite endpoint of mortality, cardiac transplantation, or ventricular assist device implantation. The secondary outcome was long-term systemic right ventricular ejection fraction (SVEF). Cox proportional hazard and linear regression models were used to analyze survival and late SVEF data. The median age at surgery was 39.5 years (Q1-Q3: 28.8-51.0 years), and the median preoperative SVEF was 39% (Q1-Q3: 33.2%-45.0%). Intrinsic valve abnormality was the most common mechanism of SAVV regurgitation (76.9%). There was 1 early postoperative mortality (0.9%). Postoperative complete heart block occurred in 20 patients (18.5%). The actuarial 5-, 10-, and 20-year freedom from death or transplantation was 92.4%, 79.1%, and 62.9%. The 10- and 20-year freedom from valve reoperation was 100% and 93% for mechanical prosthesis compared with 56.6% and 15.7% for bioprosthesis (P < 0.0001). Predictors of postoperative mortality were age at operation (P = 0.01) and preoperative SVEF (P = 0.04). Preoperative SVEF (P < 0.001), complex ccTGA (P = 0.02), severe SAVV regurgitation (P = 0.04), and preoperative creatinine (P = 0.003) were predictors of late postoperative SVEF. SAVV surgery remains a valuable option for the treatment of patients with ccTGA, with low early mortality and satisfactory long-term outcomes, particularly in those with SVEF ≥40%. Timely referral and accurate patient selection are the keys to better long-term outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Cardiac manifestation of congenital heart block (CHB) in neonates following maternal anti-Ro and anti-La autoantibodies is a serious complication of neonatal lupus with a prevalence of 1: 22000 live birth and is associated with high morbidity and mortality. Disturbance of calcium homeostasis which leads to electrical conduction abnormality and eventually fibrosis of the heart tissue is the well-known pathogenesis of CHB. Most of the babies with CHB ended up with third-degree heart block and need a pacemaker as it is an irreversible injury. Case series: Here, we reported four case series of neonatal lupus with cardiac manifestation in mothers with positive anti-Ro or anti-La which have been detected during pregnancy within 24 to 32 weeks of gestation. All four cases of newborns ended up with third-degree heart block which required a permanent pacemaker by the latest age of two months old. Conclusion: A better understanding of the aetiology of the development of CHB and identifying the risk factors in mothers is crucial for the outcomes of CHB newborns. Early diagnosis through early screening, enhanced diagnostic tools for CHB, and timely treatment of the mother may aid clinicians in better management and improve the survival rate of infants with CHB. [ABSTRACT FROM AUTHOR]

Introduction: Cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to a pulmonary vein isolation has been expected to improve the clinical outcomes post‐atrial fibrillation (AF) ablation. We demonstrated the characteristics and efficacy of CBA of the LA roof through our experience with a large volume of procedures. Methods: Among 1036 AF ablation procedures with CBA of the LA roof, 834 patients who underwent a de novo ablation were analyzed. Results: Complete LA roof line conduction block was obtained in 767 patients (92.0%) solely by CBA (Group A). Compared with the other patients (Group B), the mean nadir balloon temperature during CBA of the LA roof (−44.5 ± 5.6°C for Group A vs. −40.5 ± 7.5°C for Group B, p <.01) and number of cryoballoon applications during the LA roof ablation with a circular mapping catheter located in the left superior pulmonary vein (1.3 ± 0.8 for Group A vs. 1.6 ± 1.0 for Group B, p =.02) were significantly lower in Group A. A multivariate analysis revealed that those were predictors of a complete LA roof conduction block after only CBA. The 1‐year Kaplan–Meier atrial arrhythmia free rate estimates were 80.6% for Group A and 59.0% for Group B (p <.01). Conclusion: Complete LA roof line conduction block could be obtained with a cryoballoon without touch‐up ablation in most cases. The LA roof CBA with a circular mapping catheter located in the right superior pulmonary vein was preferable to obtaining complete LA roof conduction block, which was important with regard to the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: Ablation of anteroseptal accessory pathways (AS‐AP) is challenging, with lower success and more complications compared to other APs. AS‐APs can be successfully ablated from the right atrium (RA) or the aortic valve's noncoronary cusp (NCC). We report two patients who required a hybrid ablation approach to achieve successful abolition of both anterograde and retrograde AS‐AP conduction. Methods and Results: A 21‐year‐old female with supraventricular tachycardia (SVT) and pre‐excitation on electrocardiogram (ECG) underwent electrophysiology study (EPS) confirming an AS‐AP with anterograde and retrograde conduction. Ablation in the NCC achieved immediate and persistent anterograde conduction block. Electrophysiological maneuvers showed persistent retrograde AP conduction and orthodromic reciprocating tachycardia (ORT) remained easily inducible. Additional ablation in the NCC did not eliminate retrograde conduction. Further ablation in the RA opposite the NCC at the site of earliest retrograde atrial activation during ORT restored sinus and eliminated retrograde AP conduction. A 52‐year‐old male with SVT and ECG with pre‐excitation underwent EPS that confirmed an AS‐AP with anterograde and retrograde conduction. Ablation was performed in the NCC resulting in immediate elimination of pre‐excitation. Retrograde conduction was still present and confirmed by repeating electrophysiological maneuvers. Ablation was performed in the RA opposite the successful ablation site in the NCC, eliminating retrograde AP conduction. Conclusion: Two cases of AS‐AP with anterograde and retrograde conduction and successful elimination of pathway conduction required a hybrid ablation approach from the NCC and RA. This approach may be helpful in other cases to improve success rates without using excessive ablation near the normal conduction system. [ABSTRACT FROM AUTHOR]

Anti‐neutrophil cytoplasmic antibody (ANCA) ‐positive vasculitis is a small‐vessel vasculitis that affects multiple body systems. Salivary gland involvement in ANCA‐associated vasculitis is rare. When present, it mimics infection or malignancy, which might lead to misdiagnosis. In this report, we describe a 72‐year‐old man who presented with parotid and submandibular gland pain and swelling in addition to dry mouth and eyes. He had bilateral non‐tender parotid gland lumps and no lymphadenopathies. Laboratory tests were positive for ANCA, hematuria, and proteinuria but negative for Anti‐Ro and ‐La. He was treated with corticosteroids and cyclophosphamide for acute kidney injury. Unfortunately, the patient died a few months later. This case report sheds light on a rare manifestation of salivary gland involvement in ANCA‐associated vasculitis that mimics Sjögren syndrome and the challenges associated with its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background. Pacemakers are used to treat syncope in patients with bradyarrhythmia; however, the risk of recurrent syncope has only been investigated in few and smaller studies. Objective. The aim of this study was to investigate the risk of recurrent syncope after pacemaker implantation in patients with bradyarrhythmia and prior syncope. Methods. This retrospective, population-based cohort study included patients with a prior syncope and implantation of a pacemaker using data from the Danish nationwide registers from 1996 to 2017. Cumulative incidence and cox regression was used to estimate the 5-year incidence and the risk of recurrent syncope, respectively. Results. In total, 11,126 patients (median age: 78 years, interquartile range: 69-85, 56% male) were included and the 5-year cumulative incidence of recurrent syncope was 19.6% (95% confidence interval (CI): 18.8-20.3%). Sinus node dysfunction (hazard ratio [HR]: 1.29, 95%CI: 1.17-1.42) and unspecified type of bradyarrhythmia (HR: 1.32, 95%CI: 1.15-1.52) were associated with an increased risk of syncope compared to advanced atrioventricular (AV) block. Male sex (HR: 1.22, 95%CI: 1.22-1.34), cerebrovascular disease (HR: 1.17, 95%CI: 1.05-1.30), and prior number of syncopes were significantly associated with a higher HR of recurrent syncope. Conclusion. Almost one-in-five patients with bradyarrhythmia and prior syncope who had a pacemaker implanted had a recurrent syncope within five years. A higher risk of syncope was observed among patients with sinus node dysfunction and unspecified type of bradyarrhythmia compared to AV block. Male sex, cerebrovascular disease, and prior number of syncopes were associated risk factors of recurrent syncope. [ABSTRACT FROM AUTHOR]

Fangji Huangqi Tang (FHT) is a well‐known Chinese herbal formula that is prescribed as treatment for rheumatoid diseases. In this study, we aimed to investigate the potential therapeutic targets, efficacy, and safety of FHT in the treatment of Sjogren's syndrome (SS). The Gene Expression Omnibus (GEO) database was used to screen differentially expressed genes (DEGs) in SS. Further, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the potential biological functions of the DEGs. Subsequently, an FHT‐herb‐active compound‐target network was constructed to identify the relationship between the active compounds in FHT and the related targets. Then, enrichment analysis involving the DEGs and protein–protein interaction (PPI) network analysis were performed to analyze the biological functions of potential targets and screen hub genes. Further, molecular docking was employed to verify the binding affinity between the active compounds and the hub targets, and in vivo experiments involving NOD/LtJ mice were conducted to verify the therapeutic effects of FHT on SS‐like symptoms. Finally, inhibition of PIK3CK/Akt pathway by FHT was validated by WB and rt‐qPCR. A total of 1836 DEGs were identified in SS based on the GSE159574 dataset, and 114 targets of the active compounds in FHT were screened. Further, via network pharmacology analysis and molecular docking, six active compounds and five hub targets were obtained, and enrichment analysis showed that the anti‐SS effect of FHT was predominantly associated with immune cells, such as T cells and neutrophils. In vivo, FHT effectively reduced lymphocyte infiltration foci, increased saliva flow rate, and inhibited increases in the levels of SS‐related autoantibodies (anti‐SSA and anti‐SSB). Furthermore, the biosafety of FHT was verified via the serological examination of liver and kidney function. WB and rt‐qPCR analysis confirmed that FHT could inhibit the expression of PIK3CG and the activation of PIK3CG/Akt pathway. Via network pharmacological analysis, molecular docking, and in vivo verification, we demonstrated the multicomponent and multitarget characteristics of FHT in SS treatment, thereby providing novel insights into the pathogenesis of SS and the therapeutic targets of FHT for SS. [ABSTRACT FROM AUTHOR]

Pacing indications in children are clearly defined, but whether an epicardial (EPI) or an endocardial (ENDO) pacemaker performs better remains to be elucidated. This systematic review and meta-analysis aimed to directly compare the incidence of pacemaker (PM) lead-related complications, mortality, hemothorax and venous occlusion between EPI and ENDO in children with atrioventricular block (AVB) or sinus node dysfunction (SND). Literature search was conducted in MEDLINE (via PubMed), Scopus by ELSEVIER, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and OpenGrey databases until June 25, 2022. Random-effects meta-analyses were performed to assess the pacing method's effect on lead failure, threshold rise, post-implantation infection and battery depletion and secondarily on all-cause mortality, hemothorax and venous occlusion. Several sensitivity analyses were also performed. Of 22 studies initially retrieved, 18 were deemed eligible for systematic review and 15 for meta-analysis. Of 1348 pediatric patients that underwent EPI or ENDO implantation, 542 (40.2%) had a diagnosis of congenital heart disease (CHD). EPI was significantly associated with higher possibility of PM-lead failure [pooled odds ratio (pOR) 3.00, 95% confidence interval (CI) 2.05–4.39; I2 = 0%]; while possibility for threshold rise, post-implantation infection and battery depletion did not differ between the PM types. Regarding the secondary outcome, the mortality rates between EPI and ENDO did not differ. In sensitivity analyses the results were consistent results between the two PM types. The findings suggest that EPI may be associated with increased PM-lead failure compared to ENDO while threshold rise, infection, battery depletion and mortality rates did not differ. [ABSTRACT FROM AUTHOR]

Background: Permanent pacemaker (PPM) implantation is a well‐established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns. Methods: Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan‐Meier plots and compared using the log‐rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30‐day and 1‐year all‐cause mortality of inpatient implant. Results: Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log‐Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1‐year all‐cause mortality (HR 3.40, 95% CI 1.97–5.86, p < 0.001) on multivariable analysis. Conclusions: SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy. [ABSTRACT FROM AUTHOR]

Background: Efficiency and safety of ablation using half normal saline (HNS) has been shown in refractory ventricular tachycardia (VT), but no evaluation in unselected larger populations has been made. Objective: To evaluate the efficiency and safety of systematic HNS ablation in VT ablation. Methods: All successive VT ablations in patients with structural heart disease from 2018 to 2021 used HNS in our center and were retrospectively included. Results: One hundred seventy‐seven successive VT ablation procedures using HNS have been performed in 148 patients (91% males, mean 64 ± 12 years, ischemic cardiomyopathy 64%, left ventricular ejection fraction 38 ± 13%). A mean of 19 ± 7.5 min of RF was delivered, with a mean power of 44 ± 7 W. Relevant complications happened in 9% (strokes 2%, tamponades 3%, atrioventricular block during septal ablations 5%). Over a mean follow‐up of 15 ± 9 months, VT recurred in 46%. Final recurrence rate after one or several procedures was 36% (18 months follow‐up). Number of VT episodes decreased from 14 ± 35 before to 2.5 ± 10 after ablation (p <.0001) and number of ICD shocks decreased from 4.8 ± 6.8 to 1.5 ± 0.8 (p =.027). Conclusion: Systematic use of HNS during VT ablations in patients with structural heart disease leads to long‐term recurrences rates and complications in the range of what is reported using normal saline. Although controlled studies are needed for demonstrating the superiority of such attitude, the use of HNS in every scar‐related VT ablation seems safe for standard cases and may be furthermore useful in case of refractory arrhythmias due to difficult‐to‐ablate substrates. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous pacemaker implantation in patients post bidirectional Glenn anastomosis in one‐and‐a‐half ventricle repair is usually not feasible. However, with a modified surgical technique for Glenn anastomosis and a combined interventional and electrophysiologic approach, the transvenous pacemaker was successfully implanted. Findings and Conclusions: We reported a novel technique of pacemaker implantation in a 27‐year‐old woman, underlying Ebstein anomaly of the tricuspid valve, who developed intermittent complete atrioventricular block at 5 years after surgical repair. The patient had a tricuspid valve replacement and a novel modified bidirectional Glenn anastomosis for one‐and‐a‐half ventricle repair. The Glenn circuit was conducted by opening a window between the posterior wall of the superior vena cava (SVC) and the anterior wall of the right pulmonary artery (RPA), combined with putting a Goretex membrane in the SVC below the SVC‐RPA window without disconnecting the SVC from the right atrium. The transvenous pacemaker was implanted by perforating the Goretex membrane, then passing the leads from the axillary vein through the perforated membrane and placing them in the coronary sinus and right atrium. [ABSTRACT FROM AUTHOR]

A 12-lead ECG is a noninvasive diagnostic tool that detects and records cardiac electrical activity and can identify cardiac pathology. This article discusses select ECG abnormalities including myocardial infarction, bundle-branch blocks, and heart blocks. This is part 2 of a two-part series. Part 1 was published in the November 2023 issue of Nursing2023. [ABSTRACT FROM AUTHOR]

In this paper, we propose a method of extracting features from ECG signals based on the sparse representation of double-threshold Stagewise orthogonal matching Pursuit. First, the ECG signal was de-noised and then the K singular value decomposition algorithm (KSVD) was used to iterate the ECG data set to obtain a supercomplete dictionary of ECG signals. Then, through the double-threshold Stagewise orthogonal matching Pursuit, a sparse atomic matrix with the best reconstruction effect is finally selected to obtain the characteristics of ECG signals. Normal, atrial fibrillation, and ventricular fibrillation ECG signals from MIT ’ s ECG Signal Database (MIT-BIH) were used to evaluate the proposed method. Experimental results show that in the binary classification experiment, the comprehensive recognition rate of the proposed algorithm for normal ECG signals, ventricular fibrillation and atrial fibrillation is 93.96%, 1.26% higher than that of CNN, and 3.99% higher than that of wavelet transform. Meanwhile, the five parameters of the proposed algorithm, such as comprehensive Kappa and comprehensive root relative square error, are the best. In addition, this paper carries out three-classification recognition of normal, atrial fibrillation, and ventricular fibrillation signals. The average recognition rate of the proposed algorithm among the three classifiers is 89.17%. The average recognition rate is 3.2% and 6.67% higher than that of convolutional neural networks and wavelet transform, respectively. The experimental results show that the features extracted in this paper have high recognition performance for arrhythmia ECG signals. [ABSTRACT FROM AUTHOR]

Surgery for congenital heart disease may compromise atrioventricular (AV) nodal conduction, potentially resulting in postoperative AV block. In the majority of cases, AV nodal function recovers during the early postoperative period and may only require short-term pacing support, typically provided via temporary epicardial wires. Permanent pacing is indicated when the postoperative AV block persists for more than 7 to 10 days due to the risk of mortality if a pacemaker is not implanted. Although there is a subset of patients who may have late recovery of AV nodal function, those with continued postoperative AV block will need lifelong pacing therapy. [ABSTRACT FROM AUTHOR]

This case report describes events that occurred under general anaesthesia of a dog undergoing transvenous pacemaker implantation for third‐degree atrioventricular block. Following premedication with acepromazine and buprenorphine, general anaesthesia was induced with alfaxalone, and maintained with isoflurane in oxygen. The dog developed severe hypotension during the procedure with concurrent bradycardia before commencement of pacing. In order to increase the heart rate, terbutaline was administered intravenously. This was followed by a worsening of the hypotension, with only a small increase in heart rate. Blood pressure improved following noradrenaline infusion. The animal recovered uneventfully in intensive care, and was sedated due to its anxious temperament to avoid dislodgement of the pacemaker device in the postoperative period. [ABSTRACT FROM AUTHOR]

Background Lyme carditis (LC) complete heart block (CHB) is typically treated with i.v. antibiotics without requiring permanent pacing. In patients with high degree atrioventricular (AV) block, suspicious index in Lyme carditis (SILC) scoring is highly sensitive for diagnosing LC. Case summary We present a case of CHB where a permanent pacemaker (PPM) was implanted prior to LC diagnosis. Suspicious index in Lyme carditis score was 2 at the time of exam, indicating a low risk for LC. However, per further discussion at follow-up, his score was retroactively increased to an intermediate risk of 4 and Lyme titres returned positive. An outpatient oral antibiotic regimen was given, and 2 months later, the patient had <0.1% V-pacing on interrogation with a subsequent unremarkable event monitor. The pacemaker was removed after considerations ensuring full conduction recovery. The patient is doing well at follow-up > 1 year. Discussion Lyme carditis spontaneous resolution of CHB is common. Once safe extraction parameters have been established, it is appropriate to engage patients without ongoing pacer requirements about explantation of their PPM. For CHB patients without clear aetiology, SILC scoring may be a predictive measure to help prevent unnecessary PPM placement in the future. [ABSTRACT FROM AUTHOR]

Background Ebstein's anomaly occurs when there is an apical displacement of the tricuspid valve with septal and posterior valve leaflets tethering. This condition often occurs in association with other congenital, structural, or conduction system diseases, including intracardiac shunts, valvular lesions, arrhythmias, accessory conduction pathways, and first-degree atrioventricular (AV) block. We present for the first time a case of a patient with Ebstein's anomaly who presented with second-degree Mobitz II AV block and was successfully treated with conduction system pacing (CSP) due to her young age and the likelihood of a long-term high percentage of pacing. Case summary We present a case of a 42-year-old lady with a background of complex congenital heart disease, including severe pulmonary stenosis, Ebstein anomaly, and atrial septal defect (ASD). She required complex surgical intervention, including tricuspid valve (TV) repair and subsequently replacement, ASD closure, and pulmonary balloon valvuloplasty. She presented to our hospital with symptomatic second-degree Mobitz II AV block (dizziness, shortness of breath, and exercise intolerance) and right bundle branch block (RBBB) on her baseline ECG. Her echocardiogram showed dilated right ventricle (RV) and left ventricle (LV) with low normal LV systolic function. Due to her young age and the likelihood of a long-term high percentage of RV pacing, we opted for CSP after a detailed discussion and patient consent. The distal HIS position is the preferred pacing strategy at our centre. We could not cross the TV with the standard Medtronic C315 HIS catheter, so we had to use the deflectable C304 HIS catheter. Mapping and pacing of the distal HIS bundle were achieved by Medtronic Selectsecure 3830, 69 cm lead. HIS bundle pacing led to the correction of both second-degree Mobitz II AV block and pre-existing RBBB. The implantation was uneventful, and the patient was discharged home the next day without any acute complications. Discussion Distal HIS pacing is feasible in patients with surgically treated complex Ebstein anomaly and heart block. This approach can normalize the QRS complex with a high probability of preserving or improving LV function. [ABSTRACT FROM AUTHOR]

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