Indian Pacing and Electrophysiology Journal最新文献

{"title":"Recurrent inappropriate ICD shocks following lead fracture due to blunt chest Trauma: A case report.","authors":"Anshu Man Singh, Shubham Srivastava, Roopali Khanna, Aditya Kapoor","doi":"10.1016/j.ipej.2026.09.008","DOIUrl":"10.1016/j.ipej.2026.09.008","url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death; however, lead-related complications remain an important cause of device malfunction. Lead fracture may result in oversensing and inappropriate shocks, significantly affecting patient morbidity. We report a 48-year-old man with ischemic cardiomyopathy and a single-chamber ICD who presented with multiple inappropriate shocks following a motor vehicle accident. Device interrogation demonstrated high-frequency non-physiological noise, abrupt reduction in lead impedance, and premature battery depletion. Fluoroscopy confirmed ventricular lead fracture. The fractured lead was abandoned, and a new ventricular lead was successfully implanted. Inappropriate shocks resolved completely following lead revision. Trauma-related lead fracture should be considered in patients presenting with inappropriate ICD therapies after blunt chest trauma. Prompt device interrogation and lead revision are essential for appropriate management.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Society of Cardiology (ESC) Congress 2026, Munich: when rhythm science looks in the mirror.","authors":"Devendra S Bisht, Kamal K Sethi","doi":"10.1016/j.ipej.2026.09.009","DOIUrl":"10.1016/j.ipej.2026.09.009","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple pacing maneuvers for differentiating right versus left-sided approach in manifest posteroseptal accessory pathway ablation.","authors":"Marwan S Mahmoud, Antony Sameh Rassmy, Salah Atta","doi":"10.1016/j.ipej.2026.09.007","DOIUrl":"10.1016/j.ipej.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>Accurate localization of posteroseptal (inferior paraseptal) APs during electrophysiological study (EPS) often pose diagnostic challenges due to the complex anatomy of the inferior paraseptal region.</p><p><strong>Aim: </strong>We aimed to study simple pacing maneuvers for differentiating manifest posteroseptal APs, which can be ablated from a right- or left-sided approach.</p><p><strong>Patients and methods: </strong>65 patients with possible manifest posteroseptal AP were included in a prospective observational study. EPS and ablation were done for all patients. During EPS, we measured the stimulus to atrial (SA) interval during right ventricular (RV) posterobasal septal and apical pacing (basal & apical SA) in sinus rhythm, SA index (basal SA-apical SA interval) and, the number of QRS complexes showing fixed SA interval in the transition zone during RV entrainment of orthodromic atrioventricular tachycardia.</p><p><strong>Results: </strong>65 patients (48% male) were included with a mean age of 32.8 ± 10 years. SA interval during posterobasal RV pacing can significantly predict the right septal approach at a cut-off ≤113 with 73.1% sensitivity, 77.3% specificity (P < 0.001 and AUC = 0.836). SA index <0 can also predict right septal approach with 87.5% sensitivity and 100% specificity (P < 0.001). Also, the number of QRS with fixed SA in the transition zone predict the right septal approach group, with a cut-off of >2, yielding 100.0% sensitivity and 93.3% specificity (P < 0.001, AUC = 0.990).</p><p><strong>Conclusion: </strong>Our study demonstrated that simple and practical pacing maneuvers can effectively predict the optimal ablation approach for manifest posteroseptal accessory pathways with near-perfect diagnostic accuracy.</p><p><strong>Trial registration number (irb): </strong>04-2023-200550.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessory pathways in arrhythmogenic right ventricular cardiomyopathy: A two-case series and literature review.","authors":"Tiago Luiz Luz Leiria, Gustavo Glotz de Lima, Allan Cássio Baroni, Vidal Essebag","doi":"10.1016/j.ipej.2026.09.003","DOIUrl":"10.1016/j.ipej.2026.09.003","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by fibrofatty replacement of ventricular myocardium, associated with ventricular arrhythmias and sudden cardiac death (SCD). While supraventricular arrhythmias occur in approximately 25% of ARVC patients, the coexistence of accessory pathways is exceptionally rare, particularly concealed pathways without ventricular pre-excitation.</p><p><strong>Case presentation: </strong>We describe two young patients with ARVC and concealed accessory pathways. Case 1: A 27-year-old male with family history of SCD presented with supraventricular tachycardia mediated by a left lateral retrograde-only accessory pathway. Following successful ablation, sustained ventricular tachycardia (VT) was inducible, prompting implantable cardioverter-defibrillator (ICD) implantation. Case 2: A 22-year-old female survived out-of-hospital cardiac arrest. Cardiac MRI revealed right ventricular aneurysms and late gadolinium enhancement. Electrophysiological study demonstrated a decremental right posterior pathway consistent with permanent junctional reciprocating tachycardia (PJRT). Ablation successfully eliminated the tachycardia, and an ICD was implanted for secondary prevention.</p><p><strong>Discussion: </strong>Both patients exhibited concealed accessory pathways with exclusive retrograde conduction-one fast, one decremental-without surface ECG pre-excitation. This rare association increases arrhythmic burden and risk of inappropriate ICD therapies. Catheter ablation was essential for eliminating supraventricular tachycardias and preventing ICD complications. Literature review confirms that while atrial fibrillation and flutter are relatively common in ARVC, accessory pathways remain exceptionally rare.</p><p><strong>Conclusion: </strong>The coexistence of ARVC and concealed accessory pathways is exceedingly rare. Recognition is crucial, as catheter ablation prevents supraventricular arrhythmias and inappropriate ICD therapies, while ICD implantation remains essential for protection against malignant ventricular arrhythmias.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic simulation and digital twins in atrial fibrillation: Complementary roles and current limitations.","authors":"Samer G Salman, Isha Tripuraneni, Sai Madhav Yedupati, Zane G Salman, Ryan T Zeitouny, Ajay Tripuraneni","doi":"10.1016/j.ipej.2026.09.005","DOIUrl":"10.1016/j.ipej.2026.09.005","url":null,"abstract":"<p><p>Atrial fibrillation (AF) management relies on established risk scores, with CHA₂DS₂-VASc supporting thromboembolic risk assessment and HAS-BLED identifying modifiable bleeding risks rather than determining anticoagulation eligibility. Although widely validated and guideline-endorsed, these population-based models provide limited personalization and do not capture temporal dynamics, patient heterogeneity, or evolving disease trajectories. Advances in artificial intelligence, machine learning, dynamic simulation, and digital twin methodologies may enable more individualized and temporally adaptive decision-making. This narrative review evaluates the emerging role of dynamic simulation and digital twins in AF care, focusing on their potential to complement established frameworks, the evidence supporting their use, and barriers to clinical implementation. Current applications remain largely limited to feasibility studies, mechanistic modeling, and procedural use cases such as patient-specific ablation planning. Machine learning models may modestly improve prediction over traditional risk scores but are generally static or only episodically updated. Fully adaptive digital twins capable of recurrent updating and individualized clinical guidance have not been validated in routine practice, and reported gains primarily reflect predictive accuracy or simulation fidelity rather than improved patient outcomes. Major barriers include fragmented data ecosystems, limited longitudinal multimodal datasets, lack of prospective validation, unresolved regulatory and ethical issues, limited interpretability, clinician trust, and workflow integration. Digital twins and dynamic simulation should therefore be viewed as complementary rather than replacement tools: machine learning may refine risk estimation, mechanistic simulation may support procedural planning and investigation, and adaptive digital twins remain investigational without an established clinical role in AF.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrogram recording: Unipolar, bipolar, omnipolar and multipolar electrograms.","authors":"Ikram U Haq, Ahmad Amin, Hanxu Niu, Nayani Makkar, Samuel J Asirvatham","doi":"10.1016/j.ipej.2026.09.004","DOIUrl":"10.1016/j.ipej.2026.09.004","url":null,"abstract":"<p><p>The intracardiac electrogram is the basis of cardiac electrophysiology, but the signal displayed on the review screen is not the raw signal from the heart. Rather, it passes through a series of steps: acquisition, amplification, conversion, and filtering. Each of these can alter signal morphology with clinical consequences for the electrophysiologist. This review follows the signal from its acquisition to its display, examining how it changes at each step and what those changes mean clinically. We explain how noise enters the recording and how to remove it. We then review unipolar and bipolar electrograms, covering the strengths, limits, and pitfalls of each. We examine newer vendor-specific electrogram constructions, including omnipolar electrograms and near-field discrimination through spatial and frequency-based techniques. For each, we explain how it works and where it fails. Throughout, we draw on real clinical examples from our laboratory to illustrate these concepts.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tachycardia with AV dissociation in a neonate - a rare challenging case.","authors":"Mohan Prasad Akkineni, Manoj Kumar Rohit, Krishna Prasad Akkineni, Rahul Bundela","doi":"10.1016/j.ipej.2026.09.001","DOIUrl":"10.1016/j.ipej.2026.09.001","url":null,"abstract":"<p><p>A neonate on day 1 of life presented with tachypnea with ECG showing narrow complex tachycardia with a heart rate of 167 beats per minute with AV dissociation, and Echo showing features suggestive of tachycardiomyopathy. The diagnostic approach and management of this case is discussed in detail.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standalone PFA for complex macro-reentrant and fibrillatory substrates following Mustard-atrial switch.","authors":"Narathorn Kulthamrongsri, Nopavit Mohpichai, Pattara Rattanawong, Narut Prasitlumkum","doi":"10.1016/j.ipej.2026.08.005","DOIUrl":"10.1016/j.ipej.2026.08.005","url":null,"abstract":"<p><p>The emergence of pulsed field ablation (PFA) has revolutionized atrial arrhythmia (AA) ablation practice, mainly in adults with normal structural hearts. Little is known about its applicability in adults with CHD. A 41-year-old male with d-transposition of the great arteries (d-TGA) status post Mustard procedure, with longstanding atrial arrhythmia and multiple prior ablations, presented with recurrent symptomatic AA refractory to medical therapy. Endocardial AA ablation was performed using a standalone PFA-based approach. Following comprehensive bilateral atrial mapping, a critical isthmus was identified along a prior incisional scar related to the interatrial baffle, consistent with incisional atrial flutter. Immediate termination was achieved following the first PFA delivery using a pentaspline catheter (FARAWAVE, Boston Scientific). Additional scar homogenization was delineated entirely with only PFA. The patient has remained clinically free from AA at 4-month follow-up. This case underscores the novelty and potential applicability of a standalone PFA approach not only in patients with normal cardiac structure, but also in adults with CHD.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biatrial macro-reentrant tachycardia in an uncorrected large atrial septal defect.","authors":"Ramanathan Velayutham, Bhagwati Prasad Pant, Avinash Anantharaj, Raja J Selvaraj","doi":"10.1016/j.ipej.2026.08.004","DOIUrl":"10.1016/j.ipej.2026.08.004","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very short-coupled regular monomorphic wide QRS tachycardia in a young woman with Wolff-Parkinson-White syndrome.","authors":"Yair Elitzur, Orr Tomer, Bernard Belhassen","doi":"10.1016/j.ipej.2026.08.003","DOIUrl":"10.1016/j.ipej.2026.08.003","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}