Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"The Rhythms of the Moon: Can the Moon Affect Cardiac Arrhythmias?","authors":"Athanasios Ziakos, Armin Sause, Melchior Seyfarth","doi":"10.19102/icrm.2025.16034","DOIUrl":"10.19102/icrm.2025.16034","url":null,"abstract":"<p><p>Diagnosing paroxysmal cardiac arrhythmias early poses a challenge, yet it holds paramount significance. Certain patients hold strong beliefs regarding the moon's impact on cardiac arrhythmias. This study aims to examine the potential correlation. In our emergency room, each patient presentation is assigned an \"admission diagnosis.\" An analysis was conducted on admission diagnoses from 2012-2020 (before the coronavirus disease 2019 pandemic). The frequency of rhythmological diagnoses was investigated, both collectively and separately, as well as categorized by the underlying pathomechanism, in relation to the lunar phase and the moon's proximity to the Earth at the time of admission. Moreover, the impacts of sex, age, and weight were evaluated. A total of 58,230 patient presentations were recorded, with 16.9% coded with rhythmological diagnoses. No significant differences were found in the distribution of cardiac arrhythmias concerning lunar phases or the moon-Earth distance. Sex, age, and weight did not influence this distribution, except in a small group of underweight patients (<55 kg), where a statistically significant difference was observed with greater moon distance. To verify this result, we investigated all existing Holter records of underweight patients presenting to the emergency room between 2017 and 2020. In 195 24-h Holter recordings, a uniform burden of supraventricular extrasystoles and atrial fibrillation/flutter irrespective of the moon's distance from the Earth was observed. Contrary to patients' beliefs, the moon does not seem to affect the presentations with rhythmological complaints and diagnoses in our single-center analysis, irrespective of age, sex, or the arrhythmia type. The moon cannot aid in diagnosing paroxysmal arrhythmias.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6220-6222"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2025.16038","DOIUrl":"https://doi.org/10.19102/icrm.2025.16038","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"A7-A8"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Optimizing\" the Anesthetic for Cardiac Contractility Modulation Devices.","authors":"Samit Ghia, Ashanay Allen, Ranjit Suri, Himani Bhatt","doi":"10.19102/icrm.2025.16032","DOIUrl":"10.19102/icrm.2025.16032","url":null,"abstract":"<p><p>We present a case report of a patient undergoing implantation of a cardiac contractility modulation (CCM) device. The Optimizer^® Smart Implantable Pulse Generator (Impulse Dynamics, Orangeburg, NY, USA) provides electrical energy to the right ventricular septum to modulate cardiac contractility and improve cardiac function in heart failure patients. The non-excitatory electrical signals are delivered by transvenous leads during the refractory period. Anesthetic administration during implantation can affect appropriate lead positioning. Propofol at high doses can attenuate diaphragmatic contraction and discomfort from inappropriate lead positioning, resulting in diaphragm stimulation. Therefore, local or conscious sedation is preferred during CCM device implantation. In patients undergoing procedures with this CCM device in situ, the Optimizer^® activity causes upward deflections of the RS segment on the electrocardiogram. Also, strong electromagnetic fields can disrupt device function. This case report reviews the novel CCM device and its major anesthetic considerations.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6223-6228"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitor-induced Myocarditis: A Case Report of Complete Heart Block and Challenges in a Patient on Pembrolizumab.","authors":"Viraj Panchal, Elina Momin, Shubhika Jain, Anaiya Singh, Guntas Ghuman, Vijaywant Brar","doi":"10.19102/icrm.2025.16033","DOIUrl":"10.19102/icrm.2025.16033","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by modulating immune responses, leading to enhanced anti-tumor activity. ICIs, including agents targeting cytotoxic T-lymphocyte antigen 4, programmed cell death 1, and programmed cell death ligand, are now widely used in various malignancies, either as monotherapy or in combination with chemotherapy, radiotherapy, or targeted therapies. However, ICIs are associated with immune-related adverse events, affecting multiple organ systems, with myocarditis emerging as a rare but potentially fatal complication. We present a 67-year-old man with a history of prostate and renal cell carcinoma treated with pembrolizumab and lenvatinib, who developed myocarditis secondary to ICI therapy. The patient initially presented with generalized fatigue and bradycardia, later progressing to more severe symptoms, including sinus bradycardia and elevated troponin levels. An electrocardiogram revealed a sinus rhythm with first-degree atrioventricular block, non-specific intraventricular conduction delay, and elevated high-sensitivity troponin levels progressively increasing to 50,000 pg/mL. A comprehensive diagnostic workup ruled out ischemic causes, leading to the diagnosis of ICI-induced myocarditis. The patient was treated with high-dose corticosteroids, intravenous immunoglobulin, and temporary pacemaker insertion, resulting in clinical improvement. This case highlights the need for vigilance and prompt intervention in patients receiving ICI therapy, as early recognition and treatment of myocarditis are crucial to optimizing patient outcomes in this high-risk population.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6215-6219"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive Vagus Nerve Stimulation as an Adjunct Treatment for Inappropriate Sinus Tachycardia.","authors":"Ashley Houff, Bernard Gros, Svetlana Blitshteyn, Rebecca Guido, David Fries","doi":"10.19102/icrm.2025.16037","DOIUrl":"10.19102/icrm.2025.16037","url":null,"abstract":"<p><p>Inappropriate sinus tachycardia (IST) is a type of cardiovascular autonomic dysfunction (CVAD) that mainly affects young women and has a prevalence of 1%-2%. IST is characterized by a sinus heart rate of >100 bpm at rest with a mean 24-h heart rate of >90 bpm associated with distressing symptoms such as palpitations, dizziness, and syncope. Here, we discuss a case of a 30-year-old woman who presented with complaints of tachycardia and associated symptoms, including dizziness, diaphoresis, and sudden loss of consciousness. The 24-h Holter monitoring was consistent with the diagnosis of IST. The patient had minimal improvement on β-blocker therapy. Due to persistent symptoms consistent with IST, she was started on non-invasive vagal nerve stimulation (n-VNS) therapy. Following 2 months of n-VNS applied twice daily over the carotid artery, the patient noted near-complete relief of her tachycardia and other debilitating symptoms. While n-VNS has recently been reported as a possible treatment for postural orthostatic tachycardia syndrome, another type of CVAD, to the best of our knowledge, this is the first report of low-level n-VNS as a treatment for IST. Our case study highlights the need for further clinical studies on the benefits of n-VNS in treating IST.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6231-6234"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Checking Ablation Lines-Is Bidirectional Block Sufficient?","authors":"Sebastian Weyand, Stephanie Löbig, Peter Seizer","doi":"10.19102/icrm.2025.16031","DOIUrl":"10.19102/icrm.2025.16031","url":null,"abstract":"<p><p>This case report presents a 71-year-old man undergoing repeat ablation for atypical atrial flutter after prior pulmonary vein isolation and subsequent re-ablation involving an anterior mitral line and a posterior box. High-density mapping revealed reconnection at the left superior pulmonary vein, which was successfully re-isolated. Although bidirectional block of the anterior mitral line was confirmed via local activation time (LAT) mapping during differential pacing, burst stimulation induced atrial flutter. Further LAT mapping during flutter identified very slow conduction through a gap in the anterior mitral line. Ablation at this site restored sinus rhythm, and the arrhythmia was no longer inducible. This case highlights that bidirectional block confirmation alone may not suffice to detect gaps with slow conduction. It underscores the necessity of arrhythmia induction and mapping to reliably identify and address such gaps.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6229-6230"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 EP Fellows Summit: Letter from the Program Directors.","authors":"William Sauer, Wendy Tzou","doi":"10.19102/icrm.2025.16036","DOIUrl":"https://doi.org/10.19102/icrm.2025.16036","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 3","pages":"6206"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brugada Phenocopy due to Hyponatremia: A Case Report and Review of the Literature.","authors":"Christos S Konstantinou, Dimitrios Sfairopoulos, Konstantinos Zekios, Konstantinos P Letsas, Panagiotis Korantzopoulos","doi":"10.19102/icrm.2025.16026","DOIUrl":"10.19102/icrm.2025.16026","url":null,"abstract":"<p><p>Brugada phenocopy (BrP) is the electrocardiographic appearance of a Brugada pattern due to various reversible causes that is completely resolved after the correction of the underlying abnormalities. In this short communication, we describe a 56-year-old man who had a transient BrP induced by hyponatremia due to thiazide diuretic therapy. A detailed review of the literature revealed that hyponatremia represents an uncommon cause of BrP while, in many of the published cases, concomitant electrolyte disturbances such as hyperkalemia were present. However, even isolated hyponatremia may provoke a BrP. Clinicians should be aware of this rare cause of BrP, which is reversible and has a favorable outcome.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 2","pages":"6177-6183"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological Ventricular Pacing from the Right Side of the Septum by Engaging the Subendocardial Purkinje Network.","authors":"Atul Prakash, Iyad Farouji, Richard Sutton","doi":"10.19102/icrm.2025.16025","DOIUrl":"10.19102/icrm.2025.16025","url":null,"abstract":"<p><p>Right ventricular (RV) pacing, particularly from the RV apex, causes bilateral ventricular dyssynchrony, reducing systolic and diastolic function, by delayed activation of the lateral left ventricle, resulting in a wide QRS with a left bundle branch block (LBBB) morphology. Alternative pacing strategies, such as His-bundle pacing and LBB area pacing, tend to be more physiological, avoiding this problem. The feasibility of attaining a narrow paced QRS from the RV septum has not been methodically examined. This study aimed to test the hypothesis that, through pacing at select RV septal sites by careful mapping, it is possible to achieve a narrow \"paced QRS,\" facilitating physiological pacing. The underlying assumption is that a narrow paced QRS prevents long-term deterioration of cardiac function. During dual-chamber pacemaker implantation with standard active fixation leads, the RV septum was mapped carefully before fixing the lead. A characteristic spike potential was identified at some sites which, on stimulation, yielded a narrow paced QRS. The paced QRS duration was measured at different mapping sites; the narrowest paced complex was chosen for long-term pacing. Sixteen consecutive patients underwent pacemaker implantation using this mapping technique. A narrow paced QRS was achieved in 12 patients, whereas narrow paced complexes could not be achieved in 4 patients. Among the 12 narrow paced QRS patients (mean age, 81.5 ± 8.2 years), the indication for pacing was atrioventricular block in 6 patients and sick sinus syndrome in 6 patients. Two patients showed a negative paced QRS in leads 1 and aVL, suggesting an early left-sided septal activation. In the 12 narrow paced QRS patients, the post-pacing mean QRS duration (121.5 ± 14.9 ms) was not significantly different from the pre-pacing mean QRS duration (118.2 ± 23.5 ms) (<i>P</i> > .5); the QRS morphology was normal in seven patients, while four patients had LBBB and one patient had right bundle branch block. In all 12 patients, the narrowest paced complex was associated with a characteristic potential in the endocardial electrogram. Detailed RV septal mapping can yield a narrow paced QRS associated with a characteristic endocardial potential in the pre-pacing electrogram, suggesting possible direct native conduction system access.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 2","pages":"6199-6205"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Wide QRS Complex Tachycardia with Variation of Ventriculoatrial Interval: What is the Mechanism?","authors":"Engin Algul, Idriz Merovci, Meryem Kara, Elif Hande Ozcan Cetin, Duygu Kocyigit Burunkaya, Hamza Sunman, Ahmet Korkmaz, Firat Ozcan, Serkan Cay, Ozcan Ozeke, Ozcan Ozdemir, Dursun Aras, Serkan Topaloglu","doi":"10.19102/icrm.2025.16021","DOIUrl":"10.19102/icrm.2025.16021","url":null,"abstract":"<p><p>The differential diagnosis for wide complex tachycardia includes all causes of narrow complex tachycardia with bundle branch block, all causes of narrow complex tachycardia with antegrade pre-excitation, ventricular tachycardia, and antidromic and other pre-excited reciprocating tachycardias. The variation in a specific intracardiac interval that causes a subsequent change in the tachycardia cycle length or another intracardiac interval can be diagnostic in these arrhythmias.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"16 2","pages":"6173-6176"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}