Accelerated Bachmann bundle area pacing for atrial resynchronization in patients with non-obstructive hypertrophic cardiomyopathy and heart failure with preserved ejection fraction: A randomized crossover trial.

Background: Inter-atrial block (IAB) can contribute to the worsening of diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF).

Objective: To determine the effects of accelerated Bachmann bundle area pacing (BBAP) in symptomatic patients with non-obstructive hypertrophic cardiomyopathy (nHCM), HFpEF, and IAB.

Methods: Prospective, randomized, patient-blinded crossover study in symptomatic patients with nHCM, HFpEF, and IAB.

Optimizing Screening Strategies for Hypertension in India: A Consensus Statement.

Hypertension is a highly prevalent issue worldwide. The prevalence of underdiagnosed hypertension in India calls for the need for this consensus article, which aims to optimize screening strategies. In this article, a modified Delphi approach was used to develop consensus statements.

Utility of F-FDG PET/CT and Cardiac MRI in early Cardiac Sarcoidosis.

Background And Aims: Although F-FDG-PET/CT and CMR are commonly used to diagnose cardiac sarcoidosis(CS), their clinical utility in early-vs. late-stage disease is unclear. The objective of this study was to compare the diagnostic utility of 18-fluorodeoxyglucose positron emission tomography/computed tomography(F-FDG-PET/CT) and cardiac magnetic resonance imaging(CMR) in patients with early- and late-stage CS.

Electrogram-guided Bachmann bundle area pacing to correct interatrial block: Initial experience, safety, and feasibility.

Background: A lack of standard Bachmann bundle (BB) capture criteria has affected the clinical impact of Bachmann bundle area pacing (BBAP) in patients with interatrial block (IAB).

Objective: The purpose of this study was to evaluate the feasibility and safety of electrogram-guided Bachmann bundle pacing (BBP) using sheath assisted, stylet-driven atrial lead implantation.

Methods: Patients with baseline IAB undergoing dual-chamber pacemaker or implantable cardioverter-defibrillator implantation were enrolled in a single-center prospective study.

Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy.

Background: Compared to other non-ischemic substrates, there is limited data on the role and outcome of catheter ablation in HCM. The objective of this study is to assess the safety and efficacy of catheter ablation for the treatment of VT in patients with HCM.

Methods: Fourteen patients with HCM and drug refractory VT who underwent catheter ablation at a single center were included in this study.

Catheter ablation of ventricular tachycardia: strategies to improve outcomes.

Catheter ablation of ventricular arrhythmias has evolved considerably since it was first described more than 3 decades ago. Advancements in understanding the underlying substrate, utilizing pre-procedural imaging, and evolving ablation techniques have improved the outcomes of catheter ablation. Ensuring safety and efficacy during catheter ablation requires adequate planning, including analysis of the 12 lead ECG and appropriate pre-procedural imaging.

Optimizing diastolic filling by pacing in nonobstructive hypertrophic cardiomyopathy.

Background: Treatment options for symptomatic patients with nonobstructive hypertrophic cardiomyopathy (nHCM) are limited.

Objective: The purpose of this study was to determine the effect of sequential atrioventricular (AV) pacing, from different right ventricular (RV) sites with varying AV delays, on the diastolic function and functional capacity of patients with nHCM.

Methods: Twenty-one patients with symptomatic nHCM and normal left ventricular (LV) systolic function were prospectively enrolled.

Efficacy of SGLT2 Inhibitors in Patients With Diabetes and Nonobstructive Hypertrophic Cardiomyopathy.

The objective of this study was to evaluate the effects of sodium glucose co-transporter 2 inhibitors (SGLT2i) on functional capacity and diastolic function in patients with diabetes with nonobstructive hypertrophic cardiomyopathy (nHCM) and preserved left ventricular (LV) function. From January 2019 to October 2020, a prospective open-label study was performed on patients with type 2 diabetes mellitus and nHCM with New York Heart Association class II-III symptoms. Patients with a LV ejection fraction <50% were excluded.

Ventricular Tachycardia in Granulomatous Myocarditis: Role of Catheter Ablation.

Granulomatous myocarditis is an inflammatory disease of the myocardium, characterized by lymphocytic infiltration with characteristic granuloma formation. Although a host of disease processes can elicit myocardial granulomas, two common entities are cardiac sarcoidosis and cardiac tuberculosis. Cardiac arrhythmias in this condition are frequent and management of ventricular arrhythmias can be challenging, especially in those with drug-refractory ventricular tachycardia and electrical storm.

Catheter Ablation for Ventricular Arrhythmias in Hypertrophic Cardiomyopathy.

Implantable cardioverter-defibrillators are the mainstay of therapy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy (HCM). Catheter ablation is a useful option for patients with recurrent, drug refractory monomorphic ventricular tachycardia (VT), and device therapy. Compared with other nonischemic substrates, there are limited data on the role and outcomes of catheter ablation in HCM.

Best Practices for the Catheter Ablation of Ventricular Arrhythmias.

Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia.

High rate episodes in a dual chamber pacemaker: What is the mechanism?

Detection of high rate episodes can potentially result from oversensing of physiological or nonphysiological signals. Assessment of lead integrity, lead connection and analysis of noise characteristics on electrograms are decisive steps in the evaluation of oversensing. We report a case of high atrial and ventricular rate episodes due to minute ventilation oversensing in the presence of lead connector issues.

His-bundle pacing versus cardiac resynchronisation therapy: Effect on ECG parameters of repolarization.

Introduction: Cardiac resynchronization therapy (CRT) by biventricular pacing (BiV) may worsen indices of ventricular repolarization. The impact of His bundle pacing (HBP) on repolarization is not well studied in patients with left ventricular systolic dysfunction. The aim of the study is to compare the repolarization parameters in ECG between these two pacing modalities.

Putative role of prosthetic dental implants in the development of cardiac sarcoidosis: A case-control study.

Background: Etiopathogenesis of cardiac sarcoidosis is poorly understood. The objective of this study is to examine a possible role of previous dental procedures on the development of cardiac sarcoidosis (CS).

Methods: Clinical details of 73 patients with CS from the Granulomatous Myocarditis Registry were extracted.

CT-guided percutaneous epicardial access for ventricular tachycardia ablation: A proof-of-concept study.

Introduction: The objective of this study was to evaluate the safety and efficacy of preprocedural computed tomography (CT) to guide percutaneous epicardial puncture for catheter ablation of ventricular tachycardia.

Methods And Results: A preprocedural CT was used to plan the site, angle, and depth of needle insertion during epicardial access in 10 consecutive patients undergoing ventricular tachycardia (VT) ablation. Adjacent structures (right ventricle, diaphragm, liver, colon, internal mammary artery) were visualized and the course of the needle was planned avoiding these structures.

Refractory heart failure with LBBB - Pause before CRT.

In this report, we describe complete disappearance of LBBB with normalization of LV function in two patients with cardiac sarcoidosis (CS) after immunosuppressive therapy. Both of these patients were ideal Class IA candidates for CRT (Complete LBBB, QRS ≥ 150 ms, EF < 30%). If CS is identified early, immunosuppressive treatment can lead to not only improvement of left ventricular function but also disappearance of the left bundle branch block.

PVCs with multiple exits and single site of origin in the outflow tract: What is the mechanism?

A 40 year old man with frequent PVCs with two different morphologies was referred for catheter ablation. Although initial mapping in the RVOT revealed fragmented potentials 20ms earlier than PVC2 onset with a good pace map score, ablation at this site was unsuccessful. Subsequent mapping in the LCC/NCC junction revealed that local ventricular activation preceded QRS onset by 30 and 28 ms for PVC1 and PVC2, respectively.

Pre-Treatment Myocardial FDG Uptake Predicts Response to Immunosuppression in Patients With Cardiac Sarcoidosis.

Objectives: This study identified predictors of clinical (CR) and echocardiographic response (ER) following immunosuppressive therapy (IST) in patients with cardiac sarcoidosis (CS).

Background: IST has been the cornerstone of treatment for patients with CS and active myocardial inflammation. However, there are little data to explain the variable response to IST in CS.

Impact of interventricular delay on repolarization parameters in patients with biventricular pacing.

A 48-year-old man who was previously a responder to cardiac resynchronization therapy (CRT) presented with worsening of heart failure and reduction in the percentage biventricular (BiV) pacing. Device interrogation revealed T-wave oversensing that was eliminated by optimizing the interventricular (VV) delay. Compared to simultaneous BiV pacing, both sequential left ventricle-right ventricle (LV-RV) and univentricular LV pacing shortened the QTc, T peak-end intervals and reduced the T wave amplitude.

Stroke in cardiac sarcoidosis: Need to worry?

Objectives: The occurrence of stroke in patients with cardiac sarcoidosis (CS) is an under-recognized entity. The objective of this study is to evaluate the clinical presentation, risk factors, etiology, temporal relationship and management of stroke in patients with CS.

Methods: The data of 111 patients with CS from the Granulomatous Myocarditis Registry was analyzed.

The prognostic value of dispersion of repolarization in stress cardiomyopathy.

Introduction: Although abnormalities of ventricular repolarization are a hallmark of SC, their clinical impact on management remains to be determined. This study sought to evaluate the prognostic value of dispersion of repolarization in stress cardiomyopathy (SC) with regards to major cardiac events (MCE), recovery time, and recurrence.

Methods: This study analyzed data from258 patients with SC, from January 2009 to January 2018.