Journal of Innovations in Cardiac Rhythm Management最新文献

{"title":"Letter from the Editor in Chief.","authors":"Devi Nair","doi":"10.19102/icrm.2026.17066","DOIUrl":"10.19102/icrm.2026.17066","url":null,"abstract":"","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"A5-A7"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391831","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":"Robotic Magnetic Navigation Versus Manual Catheter Ablation for Premature Ventricular Contractions: A Single-center Retrospective Cohort Study.","authors":"Moez Alnazeer, Jerry Fan, Thao Giang, Christopher Euell, Jessica Lee, Bright Izekor, Christopher Perez, Syed Zamin, Kaylee Pascarella, Javier Banchs, Gregory Olsovsky","doi":"10.19102/icrm.2026.17062","DOIUrl":"10.19102/icrm.2026.17062","url":null,"abstract":"<p><p>Robotic magnetic navigation (RMN) offers potential advantages for premature ventricular contraction (PVC) ablation, including improved catheter stability and reduced operator radiation exposure, but comparative data versus conventional manual ablation for PVCs are limited. The objective of this study was to compare procedural metrics and very short-term clinical outcomes-specifically, 1-month symptom status, class I/III anti-arrhythmic drug (AAD) use, and periprocedural complications-between RMN-guided and manual PVC ablation in a single-center experience. We performed a retrospective cohort study of consecutive patients undergoing PVC ablation at a single center between 2019 and 2023. Patients were categorized by technique: conventional manual ablation or RMN using the Niobe ES system (Stereotaxis, St. Louis, MO, USA). Of 93 unique patients, 74 initially underwent RMN and 19 underwent manual ablation. Seven RMN cases requiring intraprocedural conversion to manual ablation were excluded from the primary comparison, yielding a per-protocol analytic cohort of 86 patients (67 RMN and 19 manual). Baseline characteristics, including age, left ventricular ejection fraction (LVEF), comorbidities, pre-procedure PVC burden, and class I/III AAD use, were compared between groups. The primary endpoints were total procedure time and fluoroscopy time, while secondary endpoints included 1-month symptom resolution, post-procedure class I/III AAD use, and periprocedural complications. An intention-to-treat sensitivity analysis grouped converted cases with the RMN-initial cohort. Baseline characteristics were similar between the RMN and manual cohorts (mean age, 62.8 ± 13.1 vs. 62.2 ± 12.8 years; LVEF, 46.2% ± 13.5% vs. 50.8% ± 14.8%; left ventricular [LV] systolic dysfunction [LVEF < 50%], 44.8% vs. 31.6%; all <i>P</i> > .2). Mean procedure times were comparable (212.3 ± 67.3 vs. 218.5 ± 74.7 min; <i>P</i> = .747), as were fluoroscopy times (12.3 ± 7.2 vs. 12.4 ± 9.0 min; <i>P</i> = .968). At 1 month, symptom resolution was documented in 74.6% (47/63) of RMN patients and 62.5% (10/16) of manual patients (<i>P</i> = .514). Class I/III AAD use decreased from 89.6% to 61.2% in the RMN group and from 89.5% to 68.4% in the manual group (net change, -28.4% vs. -21.1%; <i>P</i> value for post-procedure comparison = .759) without a statistically significant between-group difference. Periprocedural complications did not differ significantly (3.0% RMN vs. 5.3% manual; <i>P</i> = .532): one tamponade occurred in the manual group, and one pericardial effusion and one pseudoaneurysm occurred in the RMN group. In this single-center retrospective cohort, RMN-guided PVC ablation achieved procedure times, fluoroscopy times, very short-term symptom outcomes, and complication rates comparable to conventional manual ablation, with substantial reductions in class I/III AAD use in both groups at 1 month. Findings were similar in an intention-to-treat sensitivity analysis that gr","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"6765-6776"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391864","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":"Three Empty Bottles and a Wide QRS: Rapid Alkalinization Rescue in Propafenone Overdose.","authors":"Afnan Chaudhry, Ibrahim Inanc, Saad Khan, George Prousi, Shilla Zachariah","doi":"10.19102/icrm.2026.17065","DOIUrl":"10.19102/icrm.2026.17065","url":null,"abstract":"<p><p>Propafenone is a class IC anti-arrhythmic agent with potent fast sodium channel blockade whose overdose may result in profound intraventricular conduction delay and malignant ventricular arrhythmias. Management strategies are largely derived from isolated case reports, and consensus guidelines are lacking. We describe a case of a young man with a history of supraventricular tachycardia who presented following intentional polysubstance ingestion, including at least 600 mg of propafenone. On presentation, he was hypoxemic, acidotic, and minimally responsive. Electrocardiography revealed sustained wide complex tachycardia with marked QRS widening. Initial laboratory testing demonstrated normal electrolyte levels with a modestly elevated troponin, along with severe anion-gap metabolic acidosis, elevated lactate levels, acute kidney injury, and toxic acetaminophen concentrations. Intravenous sodium bicarbonate was initiated to achieve mild alkalemia, along with aggressive electrolyte correction and supportive intensive care. Within 1 h of bicarbonate therapy, the ventricular tachycardia resolved with rapid narrowing of the QRS complex and restoration of sinus rhythm. Serial electrocardiograms over the ensuing 24 h showed continued normalization of conduction. This case highlights the electrophysiologic manifestations of propafenone toxicity and underscores the value of QRS duration as a dynamic marker of toxicity severity and treatment response. Early alkalinization with intravenous sodium bicarbonate may rapidly correct conduction disturbances and stabilize malignant arrhythmias in severe class IC anti-arrhythmic overdose.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"6759-6763"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391995","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":"Right Ventricular Implantation of an Aveir™ AR Device for Bradycardia in a 90-Year-Old Woman with Atrial Fibrillation and Small Right Ventricular Dimensions.","authors":"Ali Sovari, Leili Pourafkari, Jeong Hwan J Kim","doi":"10.19102/icrm.2026.17061","DOIUrl":"10.19102/icrm.2026.17061","url":null,"abstract":"<p><p>We report a case of implanting an Aveir™ AR (atrial) leadless pacemaker (Abbott, Chicago, IL, USA) in the right ventricle (RV) of a 90-year-old woman with permanent atrial fibrillation with pauses. The patient initially received an Aveir™ VR (ventricular) device for rate support. During implantation, elevated pacing thresholds and tricuspid valve (TV) interaction were noted, which improved with repositioning. The patient subsequently presented with recurrent loss of capture secondary to elevated thresholds. Device interrogation and imaging suggested that the Aveir™ VR device was suboptimal due to the patient's small RV cavity and interaction with TV. To address this, the pacemaker was extracted, and an Aveir™ AR device-featuring a smaller profile-was successfully implanted in the RV, achieving stable fixation. To the best of our knowledge, this is the first reported case of off-label RV implantation of an Aveir™ AR device. This case illustrates the versatility of modular leadless pacing systems and underscores the importance of tailoring device selection to individual cardiac anatomy, particularly TV, in elderly patients with small RV dimensions.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"6754-6757"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391823","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":"An Unusual Genetic Variant of Long QT Syndrome with Late Presentation in the Sixth Decade.","authors":"Arindam Pande, Sanjeev S Mukherjee, Ashesh Halder","doi":"10.19102/icrm.2026.17064","DOIUrl":"10.19102/icrm.2026.17064","url":null,"abstract":"<p><p>This case report describes a 57-year-old woman with a history of transient loss of consciousness, initially treated as epilepsy, who presented with recurrent torsades de pointes requiring direct-current cardioversion. Her evaluation revealed a prolonged corrected QT (QTc) interval, and, after excluding acquired causes, she was managed with a dual-chamber implantable cardioverter-defibrillator, β-blocker and mexiletine therapy, and a base rate of 80 bpm. Genetic analysis identified a previously unreported, possibly pathogenic compound heterozygosity in the <i>AKAP9</i> gene (c.9443C>T, p.Thr3148Met and c.10515_10520delAACCGG, p.Thr3506_Gly3507del). Upon diagnosis of congenital long QT syndrome, her antiepileptic drugs were discontinued. At 6-month follow-up, she remained free of arrhythmic events with noted improvement in her QTc interval, highlighting the critical importance of accurate diagnosis and genotype-guided therapy in such cases.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 6","pages":"6749-6752"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391825","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":"Concomitant Short QT Syndrome and Sick Sinus Syndrome: A Case Report.","authors":"Farzad Masoudkabir, Hamid Khederlou, Vanoushe Azimi Pirsaraei","doi":"10.19102/icrm.2026.17053","DOIUrl":"10.19102/icrm.2026.17053","url":null,"abstract":"<p><p>Short QT syndrome (SQTS) is a rare inherited cardiac channelopathy disease resulting from mutations in potassium channels. It has been associated with several dysrhythmias, including ventricular tachycardia, ventricular fibrillation, atrial fibrillation, and atrial flutter. We report, for the first time, a case of a 19-year-old man presenting with recurrent syncope due to SQTS concomitant with sick sinus syndrome, who underwent implantation of an implantable cardioverter-defibrillator.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 5","pages":"6744-6747"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200346","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":"Systemic Inflammation Is Associated with Resting Premature Atrial and Ventricular Contractions in American Older Adults.","authors":"Laith Ashour, Mohammad Obar, Afnan Yaser, Qusai Aref Fraihat, Batool Abuqudaira, Nour Ebeidat, Lara Al-Ghwiery, Mohammad Zaita, Enas Subbah, Abdelrahman Kaoukji, Lujain Badran","doi":"10.19102/icrm.2026.17056","DOIUrl":"10.19102/icrm.2026.17056","url":null,"abstract":"<p><p>Prior studies have demonstrated links between systemic inflammation and cardiac arrhythmias. However, evidence on the association between inflammatory biomarkers and resting premature atrial contractions (PACs) or premature ventricular contractions (PVCs) in a national sample of older adults remains limited. Using biomarker data from the Midlife in the United States (MIDUS 3) study (2017-2022), we conducted non-parametric univariate analyses to assess associations between inflammatory markers-specifically, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF)-α, C-reactive protein (CRP), and fibrinogen-and baseline electrocardiographic (ECG) findings categorized as normal, PVCs, or PACs. We conducted a subsequent multivariate analysis of covariance adjusted for age, waist-hip ratio (WHR), and creatinine, the only confounders showing significant associations. A total of 699 participants were included, 395 (57%) of whom were women, with a mean age of 65.7 years (standard deviation, 9.6 years). The Kruskal-Wallis tests demonstrated significant associations of ECG pattern with IL-6 (median, normal 0.98 vs. PVCs 1.06 vs. PACs 1.40; <i>P</i> = .006) and IL-8 (12.4 vs. 13.99 vs. 13.13; <i>P</i> = .028). No significant associations were found for IL-10, TNF-α, CRP, or fibrinogen (<i>P</i> > .05). After adjustment for age, WHR, and creatinine, the ECG pattern remained significantly associated with IL-6 and IL-8 (<i>P</i> = .034). Elevated IL-6 and IL-8 levels are associated with resting PVCs and PACs in older adults. WHR and renal function also represent significant related factors that warrant consideration in future pathophysiological research.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 5","pages":"6731-6738"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200287","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":"Percutaneous Retrieval of a Micra™ Leadless Pacemaker Using a One-tine-based Snaring Technique: The Tine Is Durable but Maybe It Should Be the Last Resort.","authors":"Mohamed Shokr","doi":"10.19102/icrm.2026.17054","DOIUrl":"10.19102/icrm.2026.17054","url":null,"abstract":"<p><p>Micra™ retrieval techniques involve snaring the proximal knob; however, device orientation can hinder knob access. Unorthodox retrieval methods included a two-snare approach and a \"snare-in-snare\" technique. We describe a single-tine-based snaring approach of a Micra™ leadless pacemaker (Medtronic, Minneapolis, MN, USA) 4 days after implantation due to loss of capture. An 89-year-old man with a history of chronic kidney disease, hypertension, and transcatheter aortic valve replacement complicated by complete heart block underwent Micra™ implantation. Four days later, he presented with syncope. Interrogation showed an elevated capture threshold with intermittent loss of capture. Chest radiography confirmed an upside-down orientation in the right ventricular outflow tract. A 27-Fr outer-diameter Aveir™ Introducer Sheath (Abbott, Chicago, IL, USA) was advanced via the right femoral vein. The Aveir™ leadless pacemaker (Abbott) was implanted in a lower septal position. Multiple attempts to snare the Micra™ device's retrieval knob using the Aveir™ Retrieval Catheter (Abbott) and a Goose Neck Snare (20-mm loop diameter, 102 cm; Covidien [Medtronic], Dublin, Ireland) through a steerable sheath failed. A figure-of-eight stitch was placed around the introducer sheath and left untied. The snare engaged a partially free tine. Gentle traction confirmed secure engagement, and controlled traction disengaged the remaining tines. The device was withdrawn into the inferior vena cava but could not be pulled into the sheath due to angulation. The entire system was removed, and the groin stitch was tied. However, the Micra™ dislodged into the groin subcutaneous tissue. Iliofemoral angiography via internal jugular vein access confirmed no extravasation, and the device was explanted through a small groin incision using forceps. Percutaneous retrieval of a Micra™ leadless pacemaker, with short dwell time, is feasible using a one-tine-based snaring technique when snaring of the proximal retrieval knob fails. The tine is durable; however, caution should be exercised.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 5","pages":"6739-6743"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200284","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 Contemporary Review of Subcutaneous and Extravascular Implantable Cardiac Defibrillators.","authors":"Ahmad Jalil, Wajeeha Zahid, Fatima Rajab, Mahmoud Gomaa, Ahsan Sakef, Muhammad R Afzal","doi":"10.19102/icrm.2026.17055","DOIUrl":"10.19102/icrm.2026.17055","url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) are life-saving devices used to prevent sudden cardiac death. Two newer types of ICDs-the extravascular ICD (EV-ICD) and the subcutaneous ICD (S-ICD)-offer alternatives to traditional transvenous ICDs. Additionally, efforts are being made to introduce defibrillation and pacing interventions through a single device called the modular cardiac rhythm management system (mCRM). This review compares the EV-ICD and S-ICD based on currently available clinical data, focusing on their safety and performance. Additionally, we review modular ICD systems, which integrate leadless pacing with defibrillation. We conducted a comprehensive literature search of PubMed and ScienceDirect, focusing on articles demonstrating the clinical outcomes of EV-ICDs and S-ICDs as well as modular systems. However, we found that sufficient studies are not available to determine the clinical efficacy and safety outcomes of EV-ICDs and the mCRM. Additionally, comparative studies between EV-ICDs and S-ICDs are still required to determine their relative roles in the field of electrophysiology, with the goal of empowering clinicians to understand these emerging technologies to support better patient care decision-making.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 5","pages":"6720-6729"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200204","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":"Sudden Cardiac Arrest in a Pregnant Woman with Wolff-Parkinson-White Syndrome with Fractionated Delta Wave Due to Middle Cardiac Vein Diverticulum.","authors":"Rahel M Sileshi, Amulya Gupta, Angela Martin, Siva Soma, Madhu Reddy, Amit Noheria","doi":"10.19102/icrm.2026.17051","DOIUrl":"10.19102/icrm.2026.17051","url":null,"abstract":"<p><p>A 26-year-old woman at 34 weeks' gestation presented with out-of-hospital cardiac arrest due to ventricular fibrillation. Her electrocardiogram (ECG) showed sinus rhythm with a short P-R interval and an unusually fractionated delta wave. The delta wave was positive in leads I and V2-V6, isoelectric in V1, and negative in inferior leads. An electrophysiology study revealed antegrade accessory pathway conduction with the earliest ventricular activation in the posteroseptal region. Three radiofrequency (RF) ablation procedures, including attempts with pulsed field ablation, were ultimately unsuccessful. Cardiac computed tomography angiography revealed a diverticulum of the middle cardiac vein (MCV). Irrigated RF ablation within the diverticulum successfully eliminated the accessory pathway conduction. We propose that multiple fibers of the coronary sinus or the MCV muscular coat may interface via the diverticulum with the ventricle, leading to multiple wavefronts of ventricular pre-excitation, and that the resultant delta-wave fractionation may allow identification of such an epicardial accessory pathway.</p>","PeriodicalId":36299,"journal":{"name":"Journal of Innovations in Cardiac Rhythm Management","volume":"17 5","pages":"6709-6718"},"PeriodicalIF":0.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200328","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}