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The article describes the case of a 54-year old male athlete who was diagnosed with adenosine-sensitive ventricular tachycardia. Results of the patient's intracardiac electrograms revealed A-V dissociation on the coronary sinus electrograms during trachycardia. A pace-mapping was performed on the patient with an ablation catheter and radiofrequency energy was applied to destroy the site of the trachycardia origin. The differential diagnosis of trarchycardia is also discussed.

A man in his 40s who was previously well had an out-of-hospital cardiac arrest. Postresuscitation ECG showed ST-elevation myocardial infarction (MI). Emergency coronary angiogram revealed MI with non-obstructive coronary arteries (MINOCA) with evidence of spasm in the right coronary artery. Both his echocardiogram and cardiac MRI revealed a normal heart. Further workup showed markedly elevated free T4 (99.5 pmol/L) and free T3 (26.7 pmol/L) with low thyroid stimulating hormone (<0.02 pmol/L) in keeping with thyroid storm. He also had an elevated adjusted calcium level (2.84 mmol/L), which could have contributed to his coronary artery spasm. His peak troponin T was elevated at 798 ng/L (<14) suggesting myocardial damage. He was treated with propylthiouracil, steroids, beta-blocker, calcium channel blocker and intravenous fluids. The patient achieved a full recovery and was discharged home. This is an unusual case of thyroid dysfunction resulting in coronary artery spasm, cardiac arrest and MINOCA. [ABSTRACT FROM AUTHOR]

Introduction: Before ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO. Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24‐h ambulatory ECGs retrospectively analysed (derivation cohort). Percentage ventricular ectopic (VE) burden, hourly VE values, episodes of trigeminy/bigeminy, and the variability in these parameters were evaluated for their ability to distinguish right from left‐sided SOO. Effective parameters were then prospectively tested on a validation cohort of consecutive patients undergoing their first OTVA ablation. Results: High VE variability (coefficient of variation ≥0.7) and the presence of any hour with <50 VE, were found to accurately predict RVOT SOO in a derivation cohort of 40 patients. In a validation cohort of 29 patients, the correct SOO was prospectively identified in 23/29 patients (79.3%) using CoV, and 26/29 patients (89.7%) using VE < 50. Including current ECG algorithms, VE < 50 had the highest Youden Index (78), the highest positive predictive value (95.0%) and the highest negative predictive value (77.8%). Conclusion: VE variability and the presence of a single hour where VE < 50 can be used to accurately predict SOO in patients with OTVA. Accuracy of these parameters compares favorably to existing ECG algorithms. [ABSTRACT FROM AUTHOR]

Background: The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV‐Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV‐Comp isolation is an alternative strategy for persistent AF ablation. Methods: Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n = 100; PV‐Comp isolation, n = 100) were selected by propensity score matching. Both groups were followed up for 1 year. Results: At 6‐ and 12‐month follow‐up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P =.006) and 33 patients (P <.001) in PV‐Comp isolation group, respectively. PV‐Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV‐Comp isolation: 10 months, log‐rank P <.001) and a lower probability of recurrence (odds ratio [OR] = 0.32; 95% confidence of interval [CI] = 0.18‐0.56, P <.001), with no increase in procedural complications (PVI: 5 of 100, PV‐Comp isolation: 6 of 100, P =.76). Procedure duration was longer in PV‐Comp isolation group (PVI: 186 ± 42 min, PV‐Comp isolation: 238 ± 44 min, P <.001), as well as fluoroscopy time (PVI: 22 ± 16 min, PV‐Comp isolation: 31 ± 21 min, P =.001). Conclusion: PV‐Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications. [ABSTRACT FROM AUTHOR]