Countertraction is the cornerstone of the lead extraction in preventing of right ventricular (RV) inversion with less complications. Improvised technique, using telescopic system consisted of ablation catheter and deflectable sheath placement at RV apex, provided countertraction force whilst applying femoral lead extraction.

The appropriate site for mid-septal pacing is not defined. This study aimed to identify the site of mid-septal implantation as guided by right ventricular angiography and was validated by computed tomography.

Left bundle branch area pacing results in narrower paced QRS duration than right ventricular apical pacing with most commonly qR or Qr pattern in lead V1. Patients with baseline right bundle branch block showed lesser paced QRS shortening in comparison to patients with baseline left bundle branch block.

There were high incidences of the primary outcome (sudden cardiac death, sustained ventricular tachycardia/fibrillation, and appropriate implantable cardioverter-defibrillator therapy) and all-cause death within 12 months, especially within 3 months, after discharge in hospitalized Japanese patients with new-onset heart failure and LVEF ≤35%.

We enrolled patients with implantable cardioverter defibrillator (ICD) and structural heart disease and evaluated the surface electrocardiogram (ECG) and intracardiac electrogram (EGM) measurement of fQRS and the association between fQRS and arrhythmic events.Appropriate ICD therapies were significantly higher in patients with fQRS on both surface ECG and ICD EGM than in those without.Surface ECG and ICD-EGM measurement may help predict ventricular arrhythmic events.

The diagnosis of wide QRS tachycardia can be challenging, but is essential for appropriate therapy. The differentiation is often between supraventricular tachycardia with aberrant conduction and ventricular tachycardia. A review of historical, clinical, electrocardiographic information during wide QRS tachycardia while keeping in mind the pitfalls and exceptions, may help arrive at the correct diagnosis with reasonable accuracy and confidence

Despite distinct pathophysiology, several reports have suggested overlapping phenotypes between arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome. A Brugada ECG pattern was transiently recorded at least once in 5 out of 114 ARVC patients (4%). A transient Brugada ECG pattern (*) was associated with cardiac death in patients with ARVC.

HCQ/CQ + AZT concomitant treatment caused significant F-QTc lengthening, significantly increased Tp-e interval and increased Tp-e/QT ratio. Whereas, HCQ/CQ alone only caused significantly increased Tp-e interval. The incidences of severe QTc lengthening and severe QTc prolongation, as well as arrhythmia, were similarly low in HCQ/CQ alone and HCQ/CQ + AZT concomitant.

The incidence of NOAF is high in critically ill COVID-19 patients. Hospital mortality is high in severe COVID-19 patients with NOAF. Patients with NOAF are older and have co-existing comorbidities.

Our study found that in age <80, lung cancer and multiple myeloma have a strong association with AF while thyroid and pancreatic cancers have no association with AF at any age. In age greater than 80, NHL and prostate cancer have a significant association with AF. The highest mortality incidence in age <80 was found in lung cancer and in age >80 was seen in prostate cancer

High UA was associated with an increased risk for incident AF in the Japanese population. During 95 178 person-years of follow-up, we observed 311 cases of incident AF (204 cases in men and 107 cases in women). Compared to the subjects with UA of 4.0-4.9 mg/dL, multivariable-adjusted HR (95% CIs) of incident AF was 1.50 (1.01-2.25) for the subjects with UA ≥7.0 mg/dL.

General outcomes of the ChiOTEAF registry. AF, atrial fibrillation.

In real-world practice among Koreans with AF, there were no significant differences in the risk of S/SE between all NOAC comparisons. Apixaban was associated with lower risk of MB than dabigatran and rivaroxaban.

There are limited data regarding the acute and long-term efficacy and safety of applying higher power than conventional power targeting optimal ablation index (AI) value in our daily pulmonary vein isolation (PVI) procedure in patients with atrial fibrillation. In this study, we found that higher-than-conventional radiofrequency power PVI guided by optimal target AI showed comparable acute and long-term efficacy of PVI with reducing the procedure and ablation times without increasing the risk of complication. This study has shown that higher power strategy could be successfully implemented on the basis of conventional power AI guided PVI.

In high-power pulmonary vein isolation, impedance drop has a superiority to predict in-procedure gap as compared with ablation index.

Carina conduction after pulmonary vein isolation was studied. Especially, the relation between carina width and the necessity for carina ablation was observed using routine data from an electroanatomical mapping system.

The current strategy using the recent technology with intracardiac echocardiography, lesion index, and minimum substrate ablation was feasible and reduced procedure time and radiation exposure. However, the arrhythmia-free survival could not be improved.

LAPWI using CB-A is associated with a significantly higher freedom from atrial arrhythmias when compared with the RFCA mediated left atrial linear lesions on a mid-term follow-up of 12 months in patients with persAF undergoing a redo procedure.

In our study, spontaneous RA-SVC conduction block was observed in approximately 80% of the patients. The block group required fewer RF deliveries for SVC isolation than the non-block group and the procedural time to SVC isolation in the block group was significantly less than in the non-block group. The size of the isolated area in the block group was larger than that in the non-block group.

Atrial flutter (AFl) patients with prior occasionally recorded atrial fibrillation (AF) were randomly assigned to undergo cavo-tricuspid isthmus (CTI) ablation or CTI plus pulmonary vein isolation (combined atrial flutter ablation). AF was neither the predominant (67% of the population with only one recorded AF episode) nor the targeted arrhythmia. At 2-year FU, AF recurrences were significantly higher in atrial flutter ablation group vs combined atrial flutter group with similar AFL recurrences.

A zero-fluoroscopy catheter ablation (CA) of atrial flutter is safe and feasible. The use of ablation catheter with shaft visualization could improve the reproducibility of a successful zero-fluoroscopy CA.

Patients with LA dilatation, who obtain normal LA volume (LAVI <34 mL/m²) after AF ablation, had better long-term outcomes than those who do not.

This study revealed that 3.3% of patients following index atrial fibrillation ablation had acute gastroparesis (AGP) using rigorous screening tests after ablation. Middle-positioned esophagus and posterior wall ablation were risk factors of AGP.

HCN4 cardiac pacemaker channel mutations are one of the genetic mechanisms for sinus bradycardia. We identified a new variant in a different pacemaker channel, HCN1, in a patient of profound sinus bradycardia.

Although the Needle's Eye Snare (Cook Medical) has been considered useful for lead extraction, serious complications can occur. We presented a case of atrial septal perforation associated with the Needle's Eye Snare. Our case highlights the importance of not persisting with the Needle's Eye Snare to prevent atrial damage.

How to deal with SVC syndrome and fractured lead with a coronary wire and a coronary balloon. Step by step procedure: Detection of fracture ventricular lead -> Detection of SVC occlusion by venogram -> Unable to pass Terumo wire through obstructed SVC and trying with coronary wire and balloon-> Successful implanting a new ventricular lead.

Although a very VA interval (<60 ms in proximal CS) is suggestive of simultaneous atrial capture, rarely it can have exception. A very short VA shall not be discarded without analysing the electro grams.

We report a case of percutaneous epicardial left atrial appendage exclusion in a patient with the atrial septal closure

1. We demonstrate a case diffuse tombstone-like QRS-ST segment elevations in the inferior and anterolateral leads -shark Fin sign. The transient diffuse tombstone-like ECG changes (Shark fin sign) seen in our patient were most consistent with multivessel coronary vasospasm likely secondary to hemopericardium.

In a patient requiring pacing and defibrillation therapy, but without superior venous access, combined therapy with S-ICD and leadless pacemaker could be the best solution. An appropriate programming of both devices represents the technical challenge in order to avoid inappropriate shocks due to leadless pacing oversensing.

A 66-year-old lady presented with shortness of breath and a Wenckebach conduction pattern on the ECG. The EP study showed split his potentials and intrahisian Wenckebach. The case highlights the interesting finding of Wenckebach in the His bundle.

Ventricular tachycardia arising from the papillary muscles and other endocavitary structures are preferably ablated under intracardiac echocardiographic (ICE) guidance whenever feasible. However, the availability, need of trained operators, and the expenses involved restrict the routine use of ICE in many cath labs. Point density exclusion (PDX) mapping is a simple technique that doesn't demand any additional expense or tool apart from the routine electroanatomical mapping and thus can be widely applied in mapping of arrhythmias arising from endocavitary structures. The following report describes such a case and explains the method of performing PDX mapping

Effective biventricular pacing is important to improve survival in patients with heart failure. We report a case of a patient with heart failure, who underwent cardiac resynchronization therapy, who had loss of biventricular pacing when in low atrial rhythm. We discuss the probable mechanism for the same.

Seventy-three year-old male with history of diabetes, hypertension, and chronic kidney disease stage 3 presented with epigastric pain and hyponatremia. ECG showed new ST segment elevation at precordial leads consistent with Cove-type Brugada ECG pattern. Cardiac catheterization revealed non-significant coronary artery stenosis. He experienced pre-syncope and palpitations a year prior to admission with family history sudden cardiac death. Brugada syndrome was diagnosed. Cove-type Brugada ECG pattern and palpitations resolved with corrected sodium to 135.

Concealed functional extra-systole manifesting as pseudo Mobitz Type II Second Degree A-V Block.

CRT-D electroanatomic mapping system.