Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"A Case Report of Irregular Narrow Complex Tachycardia: Atrioventricular Nodal Re-entrant Tachycardia with a Lower Common Pathway Wenckebach.","authors":"Sudipta Mondal, Rajesh Nanda, Nadeem Afroz Muslim","doi":"10.19102/icrm.2026.17083","DOIUrl":"10.19102/icrm.2026.17083","url":null,"abstract":"<p><p>Previous reports have established the occurrence of atrioventricular (AV) nodal re-entrant tachycardia (AVNRT) exhibiting fixed AV ratios (most commonly 1:1, but also 2:1 or higher grade) or fixed/alternating ventriculoatrial ratios (eg, 1:1, 2:1, 3:2, 4:3, or higher grade). In contrast, the manifestation of an irregularly irregular rhythm during sustained AVNRT combined with a lower common pathway Wenckebach periodicity is exceedingly rare. We formally present a case demonstrating this unusual and complex electrophysiological phenomenon.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6827-6831"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897884","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":"Electrocautery-assisted Pacemaker Lead Extraction: A Comparative Evaluation of Cutting Versus Coagulation Modes on a Porcine Muscle Model with Clinical Translation.","authors":"Malugari Anish Reddy, Daljeet Kaur Saggu, Muthiah Subramanian, Sachin Yalagudri, Dinakar Bootla, Sridevi Chennapragada, Prabhakar Reddy, C Narasimhan","doi":"10.19102/icrm.2026.17086","DOIUrl":"10.19102/icrm.2026.17086","url":null,"abstract":"<p><p>The increasing use of cardiac implantable electronic devices has led to a rise in transvenous lead extractions (TLEs). The most common indications for TLE are infections and lead malfunction. Over time, leads develop fibrotic encapsulation that makes extraction difficult and increases the risk of myocardial injury. Given the thin myocardial wall, particularly in the right atrial appendage and right ventricular apex, the use of advanced powered tools near the lead tip is contraindicated, posing additional challenges. Electrosurgical energy (EE) has been explored as an adjunct to manual extraction to facilitate safe lead tip removal. This study compares the efficacy and safety of cut and coagulation modes of EE using a porcine tissue model and reports its clinical application in a human case. In the porcine model, the cut mode achieved rapid separation of the lead tip but resulted in deeper tissue penetration. In contrast, the coagulation mode (fulguration setting) enabled controlled dissection with minimal depth of penetration without any collateral injury. The application of the coagulation mode during an actual lead extraction with a dwell time of 8 years in a human patient resulted in complete removal with no postoperative complications. These findings suggest that the coagulation mode of EE offers a safer and more controlled technique for lead tip extraction.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6837-6842"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897901","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":"Separate Electrograms and Morphologically Distinct QRS Complexes During Ventricular Tachycardia: Critical Versus Noncritical Isthmus.","authors":"Ozcan Ozeke, Dursun Aras, Serkan Topaloglu","doi":"10.19102/icrm.2026.17081","DOIUrl":"10.19102/icrm.2026.17081","url":null,"abstract":"<p><p>The electrogram morphology and its timing within the ventricular tachycardia (VT) cycle enable electrophysiologists to infer the location of the scar and its relationship to the VT circuit. This becomes particularly important in the presence of double-entrance or double-exit configurations, where distinguishing the critical isthmus from a noncritical bystander is essential.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 8","pages":"6819-6821"},"PeriodicalIF":0.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897460","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":"Evaluation and Classification of Atrial Arrhythmias from Signatures in Electrographic Flow Metrics.","authors":"Steven Castellano, Melissa H Kong, Joshua D'Arcy, Dmytro Perekrestenko, Kent R Nilsson, John D Hummel","doi":"10.19102/icrm.2026.17075","DOIUrl":"10.19102/icrm.2026.17075","url":null,"abstract":"<p><p>In patients undergoing atrial fibrillation (AF) ablation, it can be difficult at times to distinguish between AF, micro-re-entrant atrial flutters (AFLs), and focal atrial tachycardias (ATs). Understanding the mechanism of arrhythmogenesis can guide ablation lesion sets. Electrographic flow (EGF) mapping displays global atrial wavefront propagations in near-real time. Patterns of EGF can show both regions of stable flow direction over time and disorganized electrical wavefronts. In so doing, it can differentiate mechanisms of arrhythmogenesis. The objective of this study was to evaluate the EGF patterns and metrics that may be used to successfully differentiate mechanisms of arrhythmogenesis. A total of 2933 recordings from 151 patients who underwent EGF mapping were analyzed to determine metrics that could distinguish between mechanisms of arrhythmogenesis. These EGF-derived metrics include: (1) electrographic flow consistency (EGFC), (2) flow angle variability (FAV), (3) source activity, (4) atrial cycle length, (5) mean R-R correlation, and (6) disorganization score. The disorganization score varied the most between AF and AFL or AT (<i>P</i> < .0001), while the mean EGFC varied the most between AFL and AT (<i>P</i> < .0001). The mean FAV was found to be strongly correlated with both EGFC (<i>r</i> ² = 0.767; <i>P</i> < .0001) and the disorganization score (<i>r</i> ² = 0.552; <i>P</i> < .0001); therefore, the mean FAV was shown to contain the composite information of the other two metrics. A multilayer perceptron trained and tested on an equal number of recordings in each arrhythmia was also able to accurately determine the rhythm from previously unseen samples with 81% accuracy when given only the five remaining metrics. Additionally, it was 100% successful at distinguishing AF from the more organized rhythms. In conclusion, summative EGF metrics that characterize vector flow provide signature patterns of global atrial wavefront propagations in different atrial arrhythmias, which can be used to successfully determine the mechanisms of atrial arrhythmias.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"6788-6797"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229005","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":"Failure of Implantable Cardioverter-defibrillator Pacing Capture in BRASH Syndrome with Severe Hyperkalemia.","authors":"Stephen Roche, Michael Kanan, Deana Mikhalkova","doi":"10.19102/icrm.2026.17071","DOIUrl":"10.19102/icrm.2026.17071","url":null,"abstract":"<p><p>This case report describes a 54-year-old woman with end-stage renal disease and heart failure who presented with BRASH syndrome: a synergistic cycle of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. The patient, who was adherent to metoprolol and amiodarone, presented with a profound ventricular escape rhythm of 16 bpm and hemodynamic instability after missing 4 days of hemodialysis. An interesting complication was the failure of her implantable cardioverter-defibrillator (ICD) to achieve pacing capture, a phenomenon likely driven by a potassium level of 7.8 mEq/L causing myocardial inexcitability. Additionally, the recent uptitration of a carotid sinus nerve stimulator for baroreflex activation therapy may have contributed to the bradycardic cycle. Immediate medical management of hyperkalemia with calcium, insulin, and dextrose successfully restored ICD capture, followed by emergent dialysis, which normalized her rhythm. This case emphasizes that BRASH syndrome should be considered in undifferentiated bradycardia, particularly when refractory to atropine, and highlights that correcting the underlying metabolic derangement is essential to restoring cardiac excitability and device function.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"6784-6787"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229016","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":"Postextrastimulus Termination of Ventricular Tachycardia: An Indicator of a Good Ablation Site?","authors":"Meryem Kara, Ozcan Ozeke, Elif Hande Ozcan Cetin, Duygu Kocyigit Burunkaya, Muhammet Genes, Ahmet Korkmaz, Firat Ozcan, Serkan Cay, Dursun Aras, Serkan Topaloglu","doi":"10.19102/icrm.2026.17072","DOIUrl":"10.19102/icrm.2026.17072","url":null,"abstract":"<p><p>Entrainment mapping, or continuous resetting of a re-entrant tachycardia, provides a powerful tool for distinguishing between focal and re-entrant ventricular tachycardias (VTs) and for identifying critical circuit components, such as the entrance, critical isthmus (CI), and exit sites. However, this technique is not always feasible and, in some cases, may itself terminate VT during the entrainment attempt. Whereas local capture of the CI without global ventricular capture (nonglobal capture [NGC]) can terminate VT by creating a bidirectional block (orthodromic or nonorthodromic capture) within the CI, the VT termination may also occur due to a rate-dependent block in the slow-conduction zone during pacing or as a result of spontaneous or mechanical trauma-related ventricular extrasystoles. Such NGC-related termination does not carry the same mechanistic implications as termination due to NGC. Although this termination is usually observed incidentally, it can also be demonstrated intentionally, eg, by delivering a single extrastimulus during tachycardia, as shown in the present case. Therefore, a careful analysis of the response to entrainment is essential.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"6798-6801"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228984","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":"Pulsed Field Ablation for Cardiac Arrhythmias: Industry Landscape and US Food and Drug Administration-approved Platforms (2025).","authors":"Amar Ghaleb, Abimbola Kolawole, Usher Khan, Arfaat M Khan","doi":"10.19102/icrm.2026.17073","DOIUrl":"10.19102/icrm.2026.17073","url":null,"abstract":"<p><p>Pulsed field ablation (PFA) has rapidly advanced from an experimental modality to a front-line therapy for catheter ablation of atrial fibrillation (AF). Unlike thermal approaches such as radiofrequency (RF) or cryoablation, PFA relies on irreversible electroporation, producing rapid and selective myocardial lesions with minimal risk of collateral injury. This review examines the contemporary landscape of PFA technology, with emphasis on recent United States Food and Drug Administration (FDA) approvals that have expanded PFA from single-energy, single-shot systems toward focal and hybrid ablation strategies. Particular focus is placed on FDA-approved platforms, including PulseSelect™ (Medtronic, Minneapolis, MN, USA), FARAPULSE™ (Boston Scientific, Marlborough, MA, USA), and VARIPULSE™ (Biosense Webster, Diamond Bar, CA, USA), as well as next-generation systems such as the Affera Sphere-9™ dual-energy RF-PFA platform (Medtronic) and the Volt™ focal PFA system (Abbott, Chicago, IL, USA). Differences in catheter design, energy delivery, workflow, mapping integration, regulatory labeling, and clinical outcomes are reviewed. By contextualizing these platforms within evolving ablation strategies, this review highlights a second evolutionary phase of PFA focused on procedural flexibility, lesion durability, and integration with established electrophysiology (EP) workflows, with implications for future AF management and EP lab practice.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"6813-6818"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229035","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.2026.17074","DOIUrl":"https://doi.org/10.19102/icrm.2026.17074","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"A5-A6"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707739","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":"Impact of Frailty on Recurrence After Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-analysis.","authors":"Mustafa Bilal Ozbay, Mehmet Esad Demirhan, Serhat Degirmen, Firat Ozcan","doi":"10.19102/icrm.2026.17076","DOIUrl":"10.19102/icrm.2026.17076","url":null,"abstract":"<p><p>Frailty is an increasingly recognized marker of biological vulnerability in patients with atrial fibrillation (AF). Although catheter ablation (CA) is an established rhythm-control strategy, atrial tachyarrhythmia (AT) recurrence remains common, particularly in patients with advanced age and comorbidity burden. The impact of frailty on post-ablation recurrence has not been systematically quantified. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies evaluating the association between frailty and AT recurrence following CA for AF. Eligible studies compared frail and non-frail adults undergoing CA and reported post-procedural recurrence. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Four studies totaling 1096 patients were included, of whom 266 (24.3%) were frail. Across the included studies, the mean age of participants ranged from approximately 61 to 76 years. Frailty was associated with a significantly higher risk of AT recurrence after CA compared with non-frailty (RR, 1.57; 95% CI, 1.26-1.94; <i>P</i> < .001; <i>I</i> ² = 0%). This association remained significant in subgroup analyses limited to studies with ≤12 months of follow-up (RR, 1.46; 95% CI, 1.13-1.89; <i>P</i> = .004; <i>I</i> ² = 0%). Leave-one-out sensitivity analyses confirmed robustness. In conclusion, frailty is independently associated with increased AT recurrence following CA for AF and should be considered in pre-procedural risk stratification.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 7","pages":"6802-6812"},"PeriodicalIF":0.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229057","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":"Left Bundle Branch Tachycardia: A Nightmare Confluence of Tachycardia and Bradycardia.","authors":"Sudipta Mondal, Nadeem Afroz Muslim, Tapan Kr Matia, Debargha Dhua","doi":"10.19102/icrm.2026.17063","DOIUrl":"https://doi.org/10.19102/icrm.2026.17063","url":null,"abstract":"<p><p>A frail nonagenarian presented with incessant wide complex tachycardia exhibiting a left bundle branch block (LBBB) morphology. The arrhythmia was transiently responsive to adenosine boluses but proved refractory to direct-current cardioversion, exhibiting a pattern of immediate reinitiation. Upon transient termination, the baseline electrocardiogram demonstrated sinus rhythm with varying degrees of LBBB aberrancy. Intracardiac electrogram analysis was used to narrow the differential diagnosis of the tachycardia mechanism. Crucially, post-termination recordings documented a rare phenomenon of alternating bundle conduction during bradycardia. This was characterized by a severely diseased infra-Hisian conduction system with an H-V interval of 306 ms-representing one of the longest documented intervals in the literature. This case highlights the capacity for extremely slow, albeit tenuous, conduction within a profoundly diseased conduction system.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"6777-6783"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391897","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}