Pulmonary vein (PV) antrum isolation (PVAI) is a useful treatment strategy for atrial fibrillation (AF) worldwide1. Moreover, a complete PVAI is essential to prevent AF initiation and recurrence1. However, recent reports have demonstrated that approximately 10% of patients with AF2 have bidirectional or unidirectional3,4 epicardial connections (ECs) between the atrium and PV inside the PVAI…

Taser™ (Axon Enterprise, Inc. Seattle, WA) and other electronic control devices (ECD) are near-ubiquitous law enforcement tools that utilize darts fired from a handgun shaped device to deliver an electrical shock to a human with the intention of non-lethal muscular tetany and incapacitation. A commonly used device discharges 50,000 volts in short pulses of .110-.150ms at a frequency of 19…

Recently, a wealth of observational data has identified a strong link between sleep apnea (SA) and its contribution to cardiac arrhythmogenesis. Several mechanisms have been proposed to explain this association including repetitive hypoxia causing oxidative stress, autonomic nervous system imbalance and direct mechanical and hemodynamic alterations that ultimately induce remodelling of cardiac…

Leadless cardiac pacemakers were introduced as a novel approach to treat bradyarrhythmias overcoming the risk of lead and pocket associated complications of transvenous pacemakers.1-3 Recently, a system with an accelerometer capable of detecting mechanical atrial activity has been introduced offering the opportunity for AV-synchronous pacing.4-6 Due to their intracardiac position, leadless…

Catheter ablation is an effective treatment for drug-refractory post-infarct ventricular fibrillation (VF) storm. Purkinje-related premature ventricular contractions (PVCs) are the main triggers of VF in patients with post-myocardial infarction. [1–4] However, the detailed activation pattern of the Purkinje network preceding PVCs has not been well recognized. The axis of activation is considered…

Leadless cardiac pacemakers (LCP) became commercially available in Europe in 2012. Since that time, implant volumes have steadily grown as the capabilities of these devices have improved beyond simple VVI pacing. Additional advances to these devices including dual chamber leadless pacing, conduction system pacing and the ability to pair with extravascular or subcutaneous defibrillators are among…

Conduction system pacing (CSP) is progressively gaining mainstream practise for offering a more physiological form of antibradycardia pacing compared to right ventricular (RV) pacing, as well as an alternative to biventricular pacing for treating heart failure. CSP usually involves His bundle pacing or left bundle branch area pacing (LBBAP). Distal right bundle branch pacing (RBBP) has only been…

The signal-averaged electrocardiogram (SA-ECG) is a noninvasive diagnostic tool to evaluate the risk of future sudden cardiac death, especially in patients with ischemic cardiomyopathy.1,2 Late potentials (LPs) are subtle cardiac electrical abnormalities detected by the SA-ECG, which reflects an arrhythmogenic substrate in a diseased myocardium. However, for about 4 decades, the clinical…

A Chiari network is a fenestrated reticulum in the right atrium (RA) that is present in approximately 2% of the population.1 We present a case involving a 63-year-old-woman with symptomatic atrial premature depolarizations (APDs) who presented for a catheter ablation. Despite prior echocardiograms and during the initial electrophysiology study, her Chiari network was not appreciated. It was only…

The relationship between cardiac arrhythmias with both obstructive sleep apnea (OSA) and central sleep apnea (CSA) is increasingly being recognized. This association is especially well established between sleep apnea and atrial fibrillation.1,2 The interaction seems to go beyond the co-existence of the two disorders due to shared risk factors. The mechanism between ventricular arrhythmias and…