To compare the acute and long-term outcomes of high-power ablation for typical atrial flutter using a 4-mm irrigated catheter (4-IC) versus an 8-mm non-irrigated catheter (8-NIC).

Aconitine poisoning produces lethal ventricular arrhythmias through persistent activation of cardiac sodium channels. We critically comment on a recent case report describing 28 biphasic shocks for aconitine-induced electrical storm, addressing three fundamental questions. First, we demonstrate that verapamil is contraindicated as it worsens hypotension and reflex sympathetic activation without antagonizing sodium channel toxicity. Second, we review the evidence for magnesium sulfate: while basic science and observational data support its mechanistic role as a calcium antagonist and sodium channel modulator, Class IC antiarrhythmics (flecainide) demonstrate superior conversion rates (86% vs. 22% for magnesium monotherapy). Magnesium should be viewed as an evidence-based adjunct, not mandated first-line therapy. Third, we identify critical monitoring gaps including dynamic electrolyte assessment, ionized calcium repletion, and toxin quantification that must be addressed in future cases. We propose a practical, evidence-based algorithm emphasizing: (1) first-line flecainide 2 mg/kg IV, (2) magnesium sulfate adjunct targeting serum levels of 1.5-2.0 mmol/L, (3) aggressive calcium repletion to > 1.00 mmol/L, (4) early high-flux hemoperfusion within 6 h, and (5) VA-ECMO for refractory cases. Verapamil, diltiazem, and β-blockers as sole agents should be explicitly avoided.

A 9-year-old boy presented with repeated exteriorization of four implantable cardioverter-defibrillators (ICDs), despite changes in implantation site and the use of antimicrobial or polymeric envelopes. The initial device was placed following an episode of ventricular fibrillation, with imaging revealing non-obstructive hypertrophic cardiomyopathy. Over subsequent procedures, he developed hypertrophic incisional scarring and granulomatous inflammation. Titanium hypersensitivity was confirmed via dermal testing, though all wound and blood cultures remained negative. After partial exteriorization of a fifth device, a gold-coated ICD was implanted, with improved wound healing. This case underscores the need to consider allergic reactions to device materials when managing recurrent pocket complications.

A 26-year-old woman with recurrent syncope was diagnosed with Andersen-Tawil syndrome (ATS) following abnormal electrocardiographic (ECG) findings. Her history of ventricular arrhythmias and prominent U waves on ECG led to genetic testing, which identified a KCNJ2 mutation. This case underscores the importance of recognizing ATS-specific ECG patterns, including broad U waves, in diagnosing arrhythmias. Following medication adjustments, her symptoms improved, highlighting the significance of tailored treatment for ATS-associated arrhythmias.

Cardiovascular autonomic neuropathy (CAN), a serious complication of type 1 diabetes mellitus (T1DM), requires early detection for timely prevention of disease progression. Although traditional autonomic function tests effectively identify advanced neuropathic abnormalities, they lack sensitivity for early-stage CAN in young individuals. Heart rate recovery (HRRec) and heart rate variability (HRV) following exercise are potential early markers of autonomic dysfunction in this group.

Circumferential pulmonary vein isolation (CPVI) plus left atrial low-voltage areas (LVA) modification is a useful method to treat paroxysmal atrial fibrillation (PAF); however, it is hard to predict LVA burden before the procedure. The existence of chronic kidney disease (CKD) increases the prevalence of left atrial LVA. In this study, we explored the relationship between renal function and the LVA burden in elderly patients with PAF.

Patients with structural heart disease undergoing catheter ablation (CA) for VT have shown higher procedural-related adverse events. However, periprocedural outcomes comparing CA for VT in different cardiomyopathies are not well known. We aim to study short-term outcomes of CA in ischemic (ICM) compared to non-ischemic dilated cardiomyopathy (NIDCM).

Coronary artery fistula (CAF) complicated by thrombotic cyst formation is a rare cause of ventricular tachycardia (VT), involving ischemia and mechanical compression.

Junctional ectopic tachycardia (JET), a tachyarrhythmia originating from the atrioventricular (AV) node and/or bundle of His, is commonly observed in pediatric patients following congenital heart surgery. JET is characterized by a heart rate above the 95th percentile for age, whereas rates below this threshold are referred to as accelerated junctional rhythm (AJR). Although AJR with a potential risk of developing AV block has been reported following transcatheter aortic valve replacement (TAVR), no cases of JET following TAVR have been documented. We report a case of JET and complete AV block observed after TAVR, which was effectively managed with medication and permanent pacemaker implantation.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), or Bland-White-Garland syndrome, is a rare but life-threatening congenital cardiac defect. Its clinical presentation, particularly in infants, is often nonspecific and can be mistaken for common conditions like myocarditis or dilated cardiomyopathy. We present a case of a 1-month-old infant where the initial presentation strongly suggested viral myocarditis, but characteristic electrocardiographic findings were pivotal in leading to the correct diagnosis of ALCAPA.

Iron deficiency anemia (IDA) is a common global health issue affecting over two billion people and is associated with cardiovascular complications. Electrocardiographic (ECG) abnormalities may reflect cardiac involvement in IDA. The Morphology-Voltage-P wave Duration (MVP) score, which assesses P-wave duration, voltage, and morphology, is linked to atrial fibrillation (AF) risk. This study aimed to investigate the relationship between IDA and MVP score to evaluate its potential in cardiac risk assessment.

We present the case of a 74-year-old man who developed 28 episodes of electrical storm secondary to aconitine poisoning from homemade herbal wine consumption, followed by complete recovery through 28 electrical cardioversions, hemopurification, and continuous magnesium sulfate infusion after 4 days. This case suggests that magnesium sulfate, by antagonizing calcium overload and stabilizing membrane potential, forms a synergistic effect with electrical resuscitation and hemopurification, and is the key to reversing the electrical storms caused by aconitine poisoning.

To investigate two conditions that have been poorly investigated in the medical literature before in the context of atrial fibrillation: the coexistence and association of right or left bundle branch block and axis deviation in patients with permanent atrial fibrillation compared to the control group of healthy subjects with sinus rhythm.

This letter provides a critical appraisal of the study by Wei et al. on clinical and electrocardiographic predictors of left circumflex artery occlusion in NSTEMI patients. While the authors identified STV5 + STV6 ≥ 2.5 mm and T-wave imbalance as potential markers, concerns remain regarding the single-center, retrospective design, limited sensitivity of ECG findings, and the lack of significant differences in clinical outcomes. Prior meta-analyses suggest a higher risk in patients with occluded culprit arteries, highlighting inconsistencies with the present study. Future research should employ multicenter prospective designs and advanced diagnostic modalities, including posterior ECG leads and artificial intelligence-based analysis, to improve detection and risk stratification of culprit LCX occlusion in NSTEMI.

The long-term prognostic value of resting electrocardiogram (ECG) in the prediction of ischemic heart disease (IHD) incidence and mortality in the asymptomatic middle-aged population is not well characterized. This study was designed to assess the prognostic value of major and minor ischemic changes in ECG as a potential screening tool in healthy adults.

This letter critically appraises the recent study by Long et al. investigating the role of transesophageal echocardiography (TEE) in guiding and evaluating left atrial appendage occlusion (LAAO) among patients with non-organic heart disease. While the authors demonstrate the procedural utility of TEE, its limitations, including invasiveness, patient tolerance, and lack of long-term data, remain notable. Current literature highlights the growing role of intracardiac echocardiography (ICE) and computed tomography (CT) as alternative or complementary modalities. Larger multicenter studies integrating these approaches are warranted to optimize procedural outcomes and patient safety in atrial fibrillation-related stroke prevention.