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Background and Aims: Antipsychotic drugs are critical in managing psychosis but they also carry risks when misused, leading to toxicity. Case Presentation: A patient overdosed on olanzapine, resulting in anticholinergic toxidrome with symptoms like tachycardia and altered mental status. Immediate recognition and management of antipsychotic toxicity-induced toxidromes in emergency settings are crucial. Treatment strategy includes maintaining airway, breathing and circulation along with decontamination. There is no specific antidote. Conclusion: This case underscores the need for emergency physicians to remain vigilant and proactive in identifying and addressing such toxicity by identification of toxidromes to prevent complications and missed diagnosis in emergency department. [ABSTRACT FROM AUTHOR]

Background: Mapping of atypical atrial arrythmias arising in the left atrium is often challenging. The Local Activation Time (LAT) Histogram, a new function of the 3D color mapping system CARTO version 7, may help improve identification of atrial tachycardia circuits. We aimed to assess the effectiveness of the LAT Histogram for identification of left atrial tachycardia circuits. Methods: This retrospective study compared 25 consecutive cases of left atrial tachycardia that were treated before use of LAT Histogram (unused group) and 25 consecutive cases that were treated after introduction of LAT Histogram (used group) at Nagano Chuo Hospital. We evaluated whether we could identify the circuit of left atrial tachycardia from the electrophysiology lab data during ablation and the CARTO system data and whether we could perform effective ablation. Results: Door‐to‐door time, skin‐to‐skin time, and fluoroscopy time (p ≤.011) were all shorter in the LAT Histogram used group versus unused group, while mapping analysis times were longer in the used group (p ≤.019). A significantly greater number of cases in the LAT Histogram used compared with the unused group had ablation for entrance or exit points (19 vs. 10 cases; p =.001 for first map). Ablation resulted in a return to sinus rhythm and changed cycle length at the first mapping in 20 cases (80%) in the LAT Histogram unused group and in 24 cases (96%) in the used group. Conclusions: LAT Histogram may provide a simple and effective method to identify entrance and exit locations in left atrial tachycardia. [ABSTRACT FROM AUTHOR]

Background: Isolated pulmonic valve endocarditis is a rare heart valve infection, and constitutes about 1% to 2% of all infective endocarditis cases. Modified Duke's criteria were used to diagnose culture negative pulmonic valve endocarditis. Case presentation: A 52-year-old male patient presented with generalized body swelling of 1 month duration associated with prolonged fever, malaise, fatigue, and lassitude. He had productive cough, dyspnea on mild exertion, and reddish discoloration of urine. Upon physical examination, blood pressure (BP) = 140/90 mmHg, pulse rate (PR) = 104 beats per minute, respiratory rate (RR) = 26 breaths per minute, temperature (T0) = 38.3°C, and Sp02 = 90% at ambient air. He had signs of bilateral pleural effusion. Cardiovascular examination revealed tachycardia, raised jugular venous pressure, murmurs of pulmonic regurgitation, and tricuspid regurgitation. There was grade 2 ascites and bilateral leg edema. On laboratory investigation, there were normochromic, normocytic anemia; raised ESR; positive Rheumatoid factor, elevated serum creatinine; and active urinary sediments on urinalysis. Two sets of blood culture were negative on days 1, 5, and 7. Chest-X-ray showed cardiomegaly with bilateral pleural effusion. ECG revealed sinus tachycardia with regular P-waves and QRS complexes. 2D Transthoracic echo showed vegetation on pulmonic valves, pulmonary valve lesions, dilated right atrium and right ventricle, and elevated right ventricular systolic pressure. Abdominal ultrasound revealed enlarged and echogenic kidneys, and ascites. Definitive diagnosis of PVE was made using modified Duke's criteria which was evidenced by 1 major (echo-proven vegetation on pulmonic valve), and 3 minors (suspected congenital pulmonic stenosis, fever, and immunologic phenomena [acute glomerulonephritis, positive rheumatoid factor]). The patient's clinical condition markedly improved after 2 weeks of intravenous antibiotics and loop diuretics, and discharged home after completing 6 weeks of parenteral antibiotics. Conclusion: Modified Duke's criteria could play a major role in the management decision about diagnosis and empiric treatment of infective endocarditis in the absence of positive bacterial cultures. [ABSTRACT FROM AUTHOR]

Background: An accurate display of scar‐related atrial tachycardia (ATs) is a key determinant of ablation success. The efficacy of ripple mapping (RM) in identifying the mechanism and critical isthmus of scar‐related ATs during coherent mapping is unknown. Methods: A total of 97 patients with complex ATs who underwent radiofrequency catheter ablation at our center between October 2018 and September 2022 were included. ATs was mapped using a multielectrode mapping catheter on the CARTO3v7 CONFIDENCE module. Coherent and RM were used to identify the reentrant circuit. Results: The mechanisms of 128 ATs were analyzed retrospectively (84 anatomic‐reentrant ATs and 44 non‐anatomic reentrant ATs). The median AT cycle length was 264 ± 25ms. The correct diagnosis was achieved in 83 ATs (68%) using only coherent mapping. Through coherent mapping plus RM, 114 ATs (84.2%) were correctly diagnosed (68% vs. 89%, p =.019). In non‐anatomical reentrant ATs, 81% of the diagnostic rate was achieved by reviewing both coherent and ripple mapping compared to reviewing coherent mapping alone (81% vs. 52%, p =.03). Reviewing coherent mapping and ripple mapping showed a higher diagnostic rate in patients who underwent cardiac surgery than those with Coherent mapping alone (64% vs. 88%, p =.04). Conclusion: Coherent mapping combined with RM was superior to coherent mapping alone in identifying the mechanism of scar‐related ATs post‐cardiac surgery and non‐anatomic reentrant ATs. [ABSTRACT FROM AUTHOR]

Introduction: Ablation of scar‐related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well‐suited to analyze the irregularly‐structured data obtained in mapping procedures and may be used to identify potential isthmuses. Methods: Electroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off‐line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas. Results: A total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group. Conclusion: A GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old girl with fever, headache, and rash in Southern Arizona, U.S. likely due to Rocky Mountain spotted fever (RMSF), discussing its clinical presentation, diagnosis, and treatment recommendations.

The article presents a case study of a 46-year-old man with a history of ventricular tachycardia/ventricular fibrillation (VT/VF) on amiodarone therapy, chronic severe systolic heart failure, and Medtronic Claria CRT-D. It delves into the mechanisms behind the misclassification of ventricular tachyarrhythmia as sinus tachycardia, shedding light on the potential factors contributing to the failure of ICD therapy in this specific case.

Atrial tachycardia (AT) is a common rhythm disorder, especially in patients with atrial structural abnormalities. Although voltage mapping can provide a general picture of structural alterations which are mainly secondary to prior ablations, surgery or pressure/volume overload, data is scarce regarding the functional characteristics of low voltage regions in the atrium to predict critical isthmus of ATs. Recently, functional substrate mapping (FSM) emerged as a potential tool to evaluate the functionality of structurally altered regions in the atrium to predict critical sites of reentry. Current evidence suggested a clear association between deceleration zones of isochronal late activation mapping (ILAM) during sinus/paced rhythm and critical isthmus of reentry in patients with left AT. Therefore, these areas seem to be potential ablation targets even not detected during AT. Furthermore, abnormal conduction detected by ILAM may also have a role to identify the potential substrate and predict atrial fibrillation outcome after pulmonary vein isolation. Despite these promising findings, the utility of such an approach needs to be evaluated in large‐scale comparative studies. In this review, we aimed to share our experience and review the current literature regarding the use of FSM during sinus/paced rhythm in the prediction of re‐entrant ATs and discuss future implications and potential use in patients with atrial low‐voltage areas. [ABSTRACT FROM AUTHOR]

Introduction: Jejunogastric intussusception (JGI) is a rare but potentially lethal complication following gastrectomy or gastrojejunostomy surgeries. Diagnosis of this condition can be challenging due to its rarity and non-specific symptoms. This article presents a case report of a 60-year-old male with a history of trans mesocolic gastrojejunostomy who developed acute symptoms of JGI. Case report: The patient presented with acute epigastric pain, vomiting, and hematemesis. Physical examination and laboratory tests indicated dehydration, tachycardia, and leukocytosis. Computed tomography (CT) revealed intussuscepted loops within the stomach. Emergency laparotomy was performed, and the intussusception was manually reduced without the need for resection. The patient recovered well and was discharged five days post-surgery. Discussion: Retrograde jejunogastric intussusception is a rare complication, often occurring years after gastric surgery. It can be classified into acute and chronic forms, with the former presenting with intense pain and potential hematemesis. The condition can arise in different surgical contexts and even spontaneously. The cause of JGI remains unclear, but factors such as hyperacidity, abnormal motility, and increased intra-abdominal pressure have been implicated. Diagnosis can be made through endoscopy or alternative imaging modalities such as CT. Surgical intervention is the treatment of choice, with various options available based on intraoperative findings. Conclusion: Retrograde jejunogastric intussusception is challenging to diagnose and treat due to its rarity and lack of understanding of its causes. Imaging techniques and endoscopy play important roles in diagnosis, while surgery remains the primary treatment option. Vigilance is necessary among medical professionals to consider JGI in cases of acute abdominal pain and vomiting following gastric surgery, allowing for prompt diagnosis and intervention to prevent bowel necrosis. Further research is needed to establish optimal surgical strategies and evaluate recurrence rates. [ABSTRACT FROM AUTHOR]

Objective: Mercury poisoning is a condition with multiple-organ dysfunction that has effects on the central nervous system, gastrointestinal system, cardiovascular system, skin, lungs, and kidneys. It can be fatal or may result in sequelae such as neurological disturbances, if treated late or left untreated. The endocrinological effects of mercury exposure are not well-known. We aimed to evaluate patients with mercury poisoning. Materials and Methods: A total of 6 cases of mercury poisoning from 3 families were included in the study. Clinical, laboratory, and follow-up data were recorded. Results: Thyroid dysfunction was presented as high thyroid hormones and normal thyrotropin level (unsuppressed) in 5 cases (83.3%). On the other hand, pheochromocytoma-like syndrome was detected in 5 cases (83.3%) with hypertension. The 4 cases were the first to use methimazole for mercury poisoning due to tachycardia and hypertension despite antihypertensive treatment due to catecholamine excess and thyroid dysfunction. Hyponatremia was detected in 3 cases (50%). Conclusion: Mercury poisoning is difficult to diagnose because it is rare and presents with nonspecific physical and laboratory findings. Early diagnosis and providing appropriate treatment are essential in order to prevent sequelae. Mercury poisoning should be considered in patients with unexplained hypertension and tachycardia suggesting the involvement of thyroid hormones and catecholamines. [ABSTRACT FROM AUTHOR]

Objective: To enable the intelligent diagnosis of a variety of common Electrocardiogram (ECG), we investigate the deep learning‐based ECG diagnosis system. Methods: From January 2015 to December 2019, four consecutive years of 100,120 conventional 12‐lead ECG data were collected in our hospital. Utilizing this dataset, we constructed a deep learning model designed to intelligently diagnose prevalent ECG anomalies by employing a multi‐task learning framework. The system performance was evaluated using various metrics, including sensitivity, specificity, negative predictive value, positive predictive value, and so forth. Additionally, we employed an ECG intelligent diagnostic platform for clinical application to undertake real‐time online analysis of 2500 conventional 12‐lead ECG samples in June 2020, aiming to validate our model. At this stage, we compared the performance of our model against the traditional manual identification method. Results: The efficacy of the ECG intelligent diagnostic model was notably high for common and straightforward ECG patterns, such as sinus rhythm (F1 = 98.01%), sinus tachycardia (F1 = 96.26%), sinus bradycardia (F1 = 94.88%), and a normal electrocardiogram (F1 = 91.71%), as well as for Premature Ventricular Contractions (F1 = 91.62%). Nevertheless, when diagnosing rarer and more intricate ECG anomalies, the system requires an increased number of samples to refine the deep learning models. During the validation stage, our model exhibited better efficiency in terms of accuracy, labor time and labor cost when compared to the manual identification approach. Conclusions: Our deep learning‐driven intelligent ECG diagnostic model clearly demonstrates significant clinical utility. The integrated artificial intelligence diagnosis system not only has the potential to augment physicians in their diagnostic processes but also offers a viable avenue to reduce associated labor costs. [ABSTRACT FROM AUTHOR]

Background: Neonatal electrocardiogram (ECG) screening can potentially identify congenital long QT syndrome and other heart diseases. Early identification is likely to reduce mortality. A barrier is the difficulty in obtaining a 12‑lead ECG in an infant. We aimed to assess the feasibility of using a single lead ECG recorded with a handheld device (Eko DUO) in neonates. Methods: This cross‑sectional study included neonates in the first 3 days of life. We recorded a single‑lead ECG using the Eko DUO. Time from the beginning of recording until a satisfactory recording was measured with a stopwatch and reported as mean and standard deviation. We reported the ratio of interpretable recordings and the proportion of those with any abnormalities. Results: The mean time for recording was 198.1 ± 94.7 s. The total number of interpretable recordings was 63% (n = 63). Of the interpretable recordings, one neonate was found to have tachycardia (1.6%). Conclusions: Neonatal ECG screening using Eko DUO is feasible. However, the fidelity of the recorded ECG is suboptimal. While most of the ECGs were interpretable for rate and rhythm, QT interval measurement was not possible in most neonates. [ABSTRACT FROM AUTHOR]

Introduction: Acquired Wolff–Parkinson–White (WPW) syndrome can occur after congenital heart disease (CHD) surgery. Methods and Results: A 27‐year‐old male with Ebstein's anomaly and manifest WPW syndrome received catheter ablation twice. The first electrophysiology study (EPS) induced orthodromic atrioventricular reentrant tachycardia and successfully eliminated the posteroseptal accessory pathway (AP). Six months after the Cone procedure, the patient suffered from palpitation. The second EPS was performed and abolished the right lateral AP. Conclusion: The appearance of a new AP after the reconstruction of CHD is a rare finding and should raise suspicion of an acquired AP connection. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 68-year-old woman with non-ischemic cardiomyopathy experiencing recurrent sustained wide QRS tachycardia. Through an electrophysiology study, the authors identify four types of tachycardia, including ventricular tachycardia (T1), ventricular tachycardia with alternating QRS complex morphologies (T2), a narrower QRS tachycardia with a 1:1 atrioventricular relationship (T3), and pure supraventricular tachycardia (T4).

Mapping and ablation of atrial tachycardia (AT) in patients who have had prior cardiac surgery can be a challenge for clinical electrophysiologists. High density mapping (HDM) technology has been widely used in these patients because it provides a better characterization of the substrate and the mechanisms with an unprecedented high resolution. In this review, we summarize how the latest HDM technologies can reveal the mechanism of AT in different types of patients post‐cardiac surgery and guide a specifically tailored ablation strategy. [ABSTRACT FROM AUTHOR]

To provide an overview of the current application of high‐density mapping (HDM) in the mechanism of complex atrial tachycardias (ATs). Complex ATs are frequently scar‐related, after history of previous cardiac surgery and large scars. These scar‐related ATs are difficult to manage medically and frequently recur after electrical cardioversion. HDM technologies have enabled rigorous elucidation of AT mechanisms in patients post cardiac surgery. This article showed the application of HDM technology in complex ATs from the mechanisms of complex ATs, the development of HDM technology, and the identification of scars or critical isthmus from HDM. HDM‐guided approach is highly effective for identifying the ATs mechanism and critical isthmus. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome is a rare neurological complication that presents in pregnancy and postpartum. We present a case of a 23-year-old Gravida 2 Para 1 Living 1 with 39 weeks of gestation and previous lower (uterine) segment cesarean section (LSCS) who presented with nonspecific symptoms in the antenatal period and progressed to develop symmetrical progressive ascending paralysis in the postpartum period with no antecedent history of infection. The patient was managed by a multidisciplinary team and treated with plasma exchange, with complete recovery at follow-up. We are reporting this case because of the rarity of Guillain-Barre syndrome in pregnancy and postpartum and the nonspecific initial presentation with an unexpected diagnosis in the immediate postpartum. [ABSTRACT FROM AUTHOR]

Introduction: Insertable cardiac monitors (ICMs) are commonly used to diagnose cardiac arrhythmias. False detections in the latest ICM systems remain an issue, primarily due to inaccurate R‐wave sensing. New discrimination algorithms were developed and tested to reduce false detections of atrial fibrillation (AF), pause, and tachycardia episodes in ICMs. Methods: Stored electrograms (EGMs) of AF, pause, and tachycardia episodes detected by Abbott Confirm Rx™ ICMs were extracted from the Merlin.net™ Patient Care Network, and manually adjudicated to establish independent training and testing datasets. New discrimination algorithms were developed to reject false episodes due to inaccurate R‐wave sensing, P‐wave identification, and R–R interval patterns. The performance of these new algorithms was quantified by false positive reduction (FPR) and true positive maintenance (TPM), relative to the existing algorithms. Results: The new AF detection algorithm was trained on 5911 EGMs from 744 devices, resulting in 66.9% FPR and 97.8% TPM. In the testing data set of 1354 EGMs from 119 devices, this algorithm achieved 45.8% FPR and 97.0% TPM. The new pause algorithm was trained on 7178 EGMs from 1490 devices, resulting in 70.9% FPR and 98.7% TPM. In the testing data set of 1442 EGMs from 340 devices, this algorithm achieved 74.4% FPR and 99.3% TPM. The new tachycardia algorithm was trained on 520 EGMs from 204 devices, resulting in 57.0% FPR and 96.6% TPM. In the testing data set of 459 EGMs from 237 devices, this algorithm achieved 57.9% FPR and 96.5% TPM. Conclusion: The new algorithms substantially reduced false AF, pause, and tachycardia episodes while maintaining the majority of true arrhythmia episodes detected by the Abbott ICM algorithms that exist today. Implementing these algorithms in the next‐generation ICM systems may lead to improved detection accuracy, in‐clinic efficiency, and device battery longevity. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 69-year-old woman with a wide complex tachycardia (WCT) and a suggestion diagnosis of supraventricular tachycardia (SVT). Examinations showed the correct diagnosis of atrial tachycardia (AT) with the site of origin inside the coronary sinus (CS) ostium that was successfully ablated. No changes were noted in atriohis (AH) interval after ablation.

Atrial echo beats due to a dual‐atrioventricular nodal pathway are a possible cause of fluctuating tachycardia in cycle length (CL) but have not been reported so far. Here, we present a case of an 82‐year‐old man with symptomatic atrial tachycardia (AT), which was accompanied by periodic fluctuations in atrial sequence at the coronary sinus. Electrophysiological study (EPS) for atrioventricular conduction and three‐dimensional (3D) electro‐anatomical mapping system explained that the mechanism of periodic fluctuations was due to atrial echo beats through a dual‐atrioventricular nodal pathway. [ABSTRACT FROM AUTHOR]

Suppression of atrial fibrillation (AF) arising within the superior vena cava (SVC) requires SVC electric isolation (SVCI) without sinus node (SN) injury. If an ectopic rhythm and AF trigger coexist within the SVC, the intra‐SVC ectopic rhythm complicates the pre‐SVCI search for the SN. This coexistence is without precedent; however, it is important to carefully locate the SN to prevent injury during SVCI. This case shows a paroxysmal AF with both phenomena coexisting in the SVC. Moreover, outpatient electrocardiographic assessment for tall P‐waves in inferior leads before catheter ablation could predict these phenomena and enable safer SVCI. [ABSTRACT FROM AUTHOR]

Bi‐atrial tachycardia (BiAT) is not rare after extensive atrial ablation or cardiac surgery. The complexity of bi‐atrial reentrant circuits poses a great challenge for clinical practice. With recent advances in mapping technologies, we are now able to characterize atrial activation in detail. However, given the involvement of both atria and multiple epicardial conductions, endocardial mapping for BiATs is not easy to understand. Knowledge of the atrial myocardial architecture is the foundation for the clinical management of BiATs; as it is required to understand the possible mechanism of the tachycardia and identify the optimal target of ablation. In this review we summarize current knowledge about the anatomy of interatrial connections as well as other epicardial fibers and discuss the interpretation of electrophysiological findings and ablation strategies for BiATs. [ABSTRACT FROM AUTHOR]

Introduction: The advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management. Methods: We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as wrongly diagnosed AF, ST, SB, IVCD, or PAC into the correct diagnosis and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta‐blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. Results: A total of 4969 ECGs were screened with diagnoses of AF (2282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.0%) were misinterpreted. Wrongly diagnosed AF (58.4%) was the most common followed by wrongly diagnosed PAC (14.9%), wrongly diagnosed ST (12.9%), wrongly diagnosed IVCD (7.9%), and wrongly diagnosed SB (6.0%). Patients with misinterpreted ECGs were aged 76.6 ± 11.6 years with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (6.9%) in patients with wrongly diagnosed AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Conclusions: Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG's, especially those interpreted as having AF. [ABSTRACT FROM AUTHOR]

A structural flaw in the globin gene causes hemoglobinopathies, while a flaw in the globin chain's synthesis causes thalassemia. One of the most prevalent hemoglobinopathies worldwide is sickle cell disease. Any region of the body can be affected, but the spleen is one of the most often afflicted and the first organs to suffer damage in sickle cell anemia (SCA). Splenomegaly, splenic infarction, hypersplenism, and acute splenic sequestration are the most common manifestations. Usually enlarged in the first 10 years of life, it gradually atrophies and eventually requires an autosplenectomy. It is well established that splenic complications from SCA are linked to higher rates of morbidity and in some cases, even death. This case report discusses a unique presentation of a patient who has hypersplenism together with beta-thalassemia and sickle cell trait. This is a case report of the adult patient admitted in Dhiraj General Hospital, SBKS MIRC, Sumandeep Vidyapeeth, Waghodia, Piparia, Vadodara-391760. The high-performance liquid chromatography (HPLC) technique was used to diagnose thalassemia trait and sickle cell trait. The clinical, ultrasonographic and computed tomography scan methods have been used to identify splenomegaly. The patient had clinical symptoms suggestive of beta-thalassemia and sickle cell trait with hypersplenism. This was supported by his peripheral smear, ultrasonography, contrast-enhanced abdomen–pelvis, HPLC, and bone marrow biopsy. It is imperative that clinicians remain cognizant of this infrequent consequence. Hence, early diagnosis and genetic counseling are of great importance for improving the prognosis of these patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 75-year-old male on twice weekly renal replacement therapy with dyspnea of 3 days duration linked to palpitations. Examinations showed continuous tachycardia despite pacemaker-mediated tachycardia (PMT) intervention, and the probable mechanism of initiation and perpetuation of the tachycardia. Also noted are the PMT termination algorithm's stoppage, and the resolution of symptoms by a Post Ventricular Atrial Refractory Period (PVARP) extension.

The 12‐lead electrocardiogram (ECG) is a fundamental modality to help determine the mechanism and the localization of atrial tachycardias (ATs). Although macroreentrant ATs and focal ATs typically show F‐waves and discrete P‐waves respectively on the 12‐lead ECG, this is not universally the case in scar‐related ATs.1, We present three cases clearly showing the discrepancy between the AT morphology on the 12‐lead ECG and the AT‐mechanism. [ABSTRACT FROM AUTHOR]

The article presents a case of a 60-year-old woman with recurrent narrow QRS tachycardia and a structurally normal heart. Through an electrophysiology study, the authors diagnose the patient with both typical atrioventricular nodal reentrant tachycardia (AVNRT) and atrial tachycardia, highlighting the challenges in identifying and treating dual tachycardias.

Background: Oxidative stress is associated with atrial fibrillation recurrence following catheter ablation. Urinary isoxanthopterin (U‐IXP) is one of the noninvasive markers which reflect the reactive oxygen species; however, its ability to predict atrial tachyarrhythmias (ATAs) occurrence following catheter ablation remains uncertain. Methods: Among the patients who received scheduled catheter ablation for atrial fibrillation, baseline U‐IXP levels were measured just before the procedure. The prognostic impact of baseline U‐IXP upon postprocedural ATAs occurrence was investigated. Results: Among 107 patients (71 years old, 68% men), baseline U‐IXP level was 0.33 nmol/gCr on the median. During a mean of 603 days of follow‐up, 32 patients had ATAs. Baseline higher U‐IXP was independently associated with the occurrence of ATAs following catheter ablation with a hazard ratio of 4.69 (95% confidence interval: 1.82–12.37, p =.001) adjusted for the left atrial diameter, a persistent type, and hypertension which were potential confounders, with a cutoff of 0.46 nmol/gCr, which stratified cumulative incidence of ATAs occurrence (p <.001). Conclusion: U‐IXP can be used as the noninvasive predictive biomarker for ATAs following catheter ablation for atrial fibrillation. [ABSTRACT FROM AUTHOR]

Background : Palpitations are a frequent reason for referral to pediatric cardiology providers and diagnostic workup includes ambulatory cardiac monitoring. While common practice, the diagnostic yield is unknown in the pediatric population. The objective is to evaluate the diagnostic yield of 24-h Holter and extended ambulatory cardiac monitoring in pediatric patients with palpitations. Methods and Results : All pediatric patients aged 10-18 years who had ambulatory cardiac monitoring (1-30 days) through the Pocket Electrocardiogram (PocketECG™) system (Medi-Lynx) between January 2016 and July 2020 were included. Patients with an International Classification of Diseases-10 diagnosis code of palpitations (R00.2) during enrollment were evaluated separately. Tachyarrhythmia diagnoses included atrial fibrillation (AF), nonsustained supraventricular tachycardia (nSVT), supraventricular tachycardia (SVT), nonsustained ventricular tachycardia (nVT), and ventricular tachycardia (VT). Age, heart rates, arrhythmia type, and symptomatic transmission data were collected and analyzed. A total of 2388 patients (mean age 11.6 years, 58% F) with the R00.2 code had ambulatory cardiac monitoring (28% 24-h Holter, 72% extended) performed during the study period and there were 6287 total patients (mean age 13.9 years, 54% F) that underwent ambulatory cardiac monitoring (42% 24-h Holter, 58% extended) during that time. Of 2388 patients, 321 (13%) were diagnosed with tachyarrhythmia: AF (9), nSVT (192), SVT (59), and nVT (61). In the overall cohort, 764 (12%) patients were diagnosed with tachyarrhythmia: AF (22), nSVT (478), SVT (85), nVT (177), and VT (2). Symptomatic transmissions with normal cardiac rhythm were common in the R00.2 ( n = 1697, 71%) and overall (n = 3848, 61%) groups. No episodes of nSVT, SVT, nVT, or VT were associated with symptomatic transmissions. Conclusion : Ambulatory cardiac monitors are an integral part of the diagnostic workup for pediatric palpitations patients and have demonstrated a high yield of combined positive arrhythmia diagnoses and symptomatic normal transmissions. Further prospective study of this population with the integration of clinical information is warranted. [ABSTRACT FROM AUTHOR]

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Cardiovascular involvement is rare in tuberculosis & high index of suspicion is must in diagnosing these cases in high burden setting to have successful treatment outcome. In this case report, 26-year male, presented with constitutional symptoms for three months duration with acute deterioration with tachycardia and tachypnea with hypoxia. Radiological investigations documented conglomerated miliary tuberculosis and confirmed by sputum smear microscopy. Cardiac investigations revealed sinus tachycardia in ECG, raised cardiac enzymes, and echocardiography as 'global left ventricular hypokinesia' with reduced ejection fraction. Treatment initiated with steroids with anti-tuberculosis and recorded near complete radiological resolution, bacteriological cure and restored cardiac function after six months with good compliance. We recommend cardiac workup in all pulmonary tuberculosis cases with disproportionate tachycardia. [ABSTRACT FROM AUTHOR]

Introduction: Critical isthmuses of atypical atrial flutters (AAFLs) are usually located at slow conduction areas that exhibit fractionated electrograms. We tested a novel software, intended for integration with a commercially available navigation system, that automatically detects fractionated electrograms, to identify the critical isthmus in patients with AAFL ablation. Methods and Results: All available patients were analyzed; 27 patients with 33 AAFLs were included. The PentaRay NAV catheter (Biosense Webster) was used for mapping. The novel software was retrospectively applied; fractionated points with duration ≥80 ms and bipolar voltage between 0.05 and 0.5 mV were highlighted on the surface of maps. In 10 randomly chosen AAFLs, an expert electrophysiologist evaluated the positive predictive value of the algorithm to detect true fractionation: 74.4%. We tested the capacity of the software to identify areas of fractionation (defined as clusters of ≥3 adjacent points with fractionation) at the critical isthmus of the AAFLs (defined using conventional mapping criteria). An area of fractionation was identified at the critical isthmus in 30 cases (91%). Globally, 144 areas of fractionation (median number per AAFL 4 [3–6]) were identified. Duration of the fractionation or the surface of the areas was not different between areas at critical isthmuses and the rest. Setting the fractionation score filter of the software in nine provided best performance. Conclusions: The novel software detected areas of fractionation at the critical isthmus in most AAFLs, which may help identify the critical isthmus in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Swallowing‐associated arrhythmias are rare and most commonly present as atrial tachycardias. Methods: We present a case of a 45‐year‐old female who experienced frequent episodes of palpitations and dyspnea occurring immediately after swallowing solid food. She was noted to have atrial tachycardia with deglutition that was recorded on the 12‐lead electrocardiogram. She underwent fluoroscopic esophagram that demonstrated atrial tachycardia as the barium passed through the distal esophagus and gastroesophageal junction. Conclusion: Swallowing induced arrhythmias occur rarely and can be confirmed by EKG obtained during deglutition. Gastroesophageal evaluation is required to rule out primary esophageal disorders. Treatment of such arrhythmias is required if symptoms are intractable and can include pharmacotherapy and radiofrequency ablation. [ABSTRACT FROM AUTHOR]

Background. The most common arrhythmia which have been reported frequently in COVID-19 patients is sinus tachycardia. As COVID-19 is usually misdiagnosed with other respiratory tract diseases, introduction of a rapid clinical indicator for out of proportional sinus tachycardia in the diagnosis of COVID-19 during the early viral replication stage is essential for better cost-effective use of resources. Objectives. This study was conducted to determine the diagnostic accuracy of sinus tachycardia as an independent indicator of COVID-19. Material and methods. This is a cross-sectional analytical study. It included 152 healthcare workers who fulfilled the inclusion criteria. Multiple logistic regression analysis was conducted to investigate the factors associated with COVID-19 among the entire study sample and among each group. Results. Among our participants, 32.9% were male, while 67.1% were female, with a mean age of 35.47 ± 7.09 years. It was found that 51.3% of our sample were COVID-19 PCR positive, and the mean number of days of symptoms at presentation was 2.01 ± 1.29. It was found that the prevalence of out of proportional sinus tachycardia among the participants diagnosed with COVID-19 in 2021 was triple that of the participants who were recruited in 2020 (61%, 26%, respectively). It was found that there was significant association between pulse rate and COVID-19, with gender, age, temperature or days of symptoms having no effect. Conclusions. The study highlights the diagnostic accuracy of sinus tachycardia as an independent indicator of COVID-19, especially the Omicron variant, as a higher pulse rate is associated with higher odds of having COVID-19 [ABSTRACT FROM AUTHOR]

Introduction: A 13 old girl presented with recurrent wide QRS tachycardia since she was 4. Methods: An electrophysiologic study was performed. Results: The electrophysiologic study showed that QRS complexes identical to those of the tachycardia could be elicited with premature atrial extrastimuli but with a shorter atrioventricular (AV) delay when the QRS was wide compared with narrow QRS complexes. The tachycardia was ablated at 9 o'clock on the tricuspid annulus demonstrating the presence of an atriofascicular fiber. Conclusion: We believe that this atypical behavior can be explained by AV nodal like longitudinal dissociation of a slowly conducting accessory pathway. [ABSTRACT FROM AUTHOR]

The article presents a case of a 74-year-old female with frequent paroxysmal supraventricular tachycardias who was presented to a hospital for catheter ablation to discuss the possible mechanism of her tachycardias and the recommended treatment strategies. Also cited are her potential differential diagnoses like sequential antegrade conduction over fast and slow atrioventricular (AV) nodal pathways and ventricular/junctional ectopy (junctional tachycardia).

A case study of 5-year-old girl was brought in to the emergency department (ED) by emergency medical services after a syncopal episode reported it to be weak and performed cardiopulmonary resuscitation. Topics include decreased oral intake and nonspecific abdominal pain for several days; and usual state of health except for an active head lice (Pediculosis capitis) infestation admitted to the pediatric intensive care unit for further observation and management.

Although it is common for bi‐atrial tachycardia (AT) circuits to include the Bachmann bundle, there are few reports of its role in left AT circuits. A 77‐year‐old man was admitted for recurrent AT with a cycle length of 425 ms. The endocardial and epicardial activation map revealed an AT circuit located in the left atrial anterior wall and transverse pericardial sinus, showing a centrifugal pattern stemming from the left atrial appendage. After radiofrequency ablation, AT was no longer induced. This case suggests that the Bachmann bundle may be part of the left AT circuit. [ABSTRACT FROM AUTHOR]

Establishing the precise mechanism of cardiac arrhythmias in the electrophysiology laboratory is one of the main requisites for a successful and safe ablation. This article provides an organized approach to the differential diagnosis of narrow and wide complex tachycardias based on the analysis of electrical activation patterns, followed by specific pacing maneuvers in each case., Competing Interests: Disclosures The authors have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

The article focuses on investigating the mechanism behind varying HV intervals observed during wide QRS tachycardia in a 32-year-old female. Topics include the identification of pathway-to-pathway atrioventricular re-entry tachycardia involving right and left free wall pathways, the role of retrograde conduction via a left lateral accessory pathway, and the implications of these findings for electrophysiological study and ablation therapy in managing recurrent palpitations and arrhythmias.