Search

Introduction: Systemic sclerosis (SSc) is a rare connective tissue disease characterized by immune dysfunction, vascular damage, and fibrosis affecting the skin and multiple internal organs, such as the cardiovascular and respiratory systems. In some women with preexisting SSc, pregnancy is associated with negative maternal outcomes. Tachyarrhythmia is a common clinical manifestation of cardiovascular damage in SSc patients. However, few studies have reported the use of catheter ablation and an implantable cardioverter defibrillator (ICD) in patients with SSc complicated by ventricular tachycardia (VT). Case: A 19‐year‐old woman known case of SSc referred to our center with recurrent VT during pregnancy and after delivery. Two‐dimensional Echocardiogram showed severe systolic dysfunction with a left ventricular ejection fraction (LVEF) of 30%. Considering, recurrent VT despite medical treatment and the progressive nature of systemic sclerosis radiofrequency catheter (RF) ablation and ICD implantation were performed. Conclusion: We report a case of systemic sclerosis complicated by VT and left ventricular (LV) dysfunction during pregnancy that was successfully treated with RF ablation. [ABSTRACT FROM AUTHOR]

Introduction: Epicardial pacemakers are known as an alternative for endocardial pacemakers in some cases such as heart block, and complex congenital heart diseases. Considering recent advances and improvement of epicardial lead subtypes, it is essential to investigate the long‐term function of them. In this study, we aimed to assess the sensing and pacing characteristics, and survival of bipolar steroid‐eluting and unipolar nonsteroid‐eluting epicardial pacemakers. Methods: We conducted an entirely concentrated search on the documents of all patients who had undergone epicardial lead implantation in the Shaheed Rajaie Cardiovascular, Medical & Research Center during 2015–2018. Implant, and follow‐up data were extracted. Kaplan–Meier analysis and Weibull regression hazards model were applied for the survival analysis. Results: Eighty‐nine leads were implanted for 77 patients. Of the total leads, 52.81%, 53.93%, and 47.19% were implanted in children (under 18‐year‐old), females, and patients with congenital heart diseases, respectively. Bipolar steroid‐eluting leads comprised 33.71% of 89 leads. The pacing threshold of unipolar nonsteroid‐eluting leads that were implanted on the left ventricle and right atrium increased significantly during the follow‐up to greater records than bipolar steroid‐eluting leads. Survival analysis also revealed that bipolar steroid‐eluting leads are significantly better in 48‐month survival (Weibull hazard ratio [HR]: 0.13 (95% confidence interval [CI]: 0.02–0.99), p =.049). Age, ventricular location of the lead, and acute pacing characteristics were not associated with survival. Conclusions: Bipolar steroid‐eluting epicardial leads have an acceptable survival compared with unipolar nonsteroid‐eluting, without a significant difference regarding patients age. Therefore, they could be an excellent alternative for endocardial ones. [ABSTRACT FROM AUTHOR]

The inability to ablate left accessory pathways (APs) from endocardial approaches may suggest an epicardial location. We report on a 43‐year‐old woman presenting with a wide QRS tachycardia with Right Bundle Branch Block (RBBB) morphology, right inferior axis, and the "pattern break" appearance in V2 resembled the outflow tract ventricular tachycardia. An electrophysiology study confirmed an antidromic atrioventricular reentrant tachycardia using an antegrade slow, decrementally conducting AP that was successfully ablated in the great cardiac vein‐anterior interventricular vein junction after failure of endocardial approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atrioventricular node (AVN) is an interatrial septum structure located at the apex of triangle of Koch that modulates the transmission of impulses from atria to the ventricles. Vagally mediated AVN block with high frequency stimulation (HFS) was investigated in a few animal and human studies, but prolonged ventricular asystole that was induced by a low frequency proximal coronary sinus (CS) overdrive pacing has rarely been reported. CASE REPORT: A 40-year-old man was admitted in our hospital for evaluation of syncope and palpitation. He presented with prolonged ventricular asystole by proximal CS pacing during electrophysiological study (EPS). CONCLUSION: There is no comprehensive clinical study to investigate the association of vasovagal syncope with vagally mediated atrioventricular block (AVB) which is induced by posteroseptal area stimulation. Radiofrequency catheter ablation of ganglionated plexi (GP) located close to sinus node and AVN was reported to eliminate the vagal efferent output during vasovagal syncope as a new treatment strategy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence increases with advancing age. Pulmonary vein isolation is a standard approach in drug refractory paroxysmal AF which could be performed by cryoballoon ablation (CBA). We tried to evaluate its efficacy and safety in Iranian patients with AF. METHODS: From 2015 to 2017, 97 patients with paroxysmal and persistent AF were enrolled in our observational historical cohort study. They were visited 1 and 6 months post-procedure in order to assess the efficacy (recurrence) and safety. Recurrence was defined as 30 seconds of arrhythmia on their 48-hours Holter monitoring. RESULTS: Ninety-seven patients enrolled in the study, 64 (66.0%) of them were men, and their mean age was 55 ± 12 years. Hypertension was reported in 41 patients (42.3%), as the most common cardiac risk factor. 71 patients (73.2%) patients with paroxysmal AF and 15 patients (15.5%) with persistent AF underwent the procedure. After 6 months, recurrence was documented in only 17 patients (17.5%), and 82.5% of the patients were free from the recurrence. Post-procedural complication was detected only in 3 patients (3.1%). CONCLUSION: In our study, the mid-term success and safety of CBA in patients with paroxysmal AF was showed. CBA is a safe and effective method in paroxysmal AF, and even in some cases with persistent AF. [ABSTRACT FROM AUTHOR]

The catheter ablation of idiopathic ventricular arrhythmias is accepted as a first-line treatment as it successfully eliminates about 90.0% of such arrhythmias. One of the most challenging ventricular arrhythmias originates from the left ventricular summit (LVS), a triangular epicardial space with the left main bifurcation as its apex. This area accounts for about 14.0% of LV arrhythmias. The complex anatomy of this region, accompanied by proximity to the major epicardial coronary arteries and the presence of a thick fat pad in this region, renders it a challenging area for catheter ablation. This article presents a review of the anatomy of the LVS and relevant regions and discusses novel mapping and ablation techniques for eliminating LVS ventricular arrhythmias. Additionally, we elaborate on the electrocardiographic (ECG) manifestations of arrhythmias from the LVS and their successful ablation via the direct approach and the adjacent structures., (Copyright © 2022 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)