Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.

ABSTRACTCardiac resynchronization therapy (CRT) essentially targets electrical dyssynchrony, one of the key drivers in heart failure (HF). Its efficacy depends on both the quality (QRS morphology) and quantity (QRS duration) of dyssynchrony, requiring individualized patient selection. While drug therapy for HF has a limited effect on this substrate, early implantation of CRT can prevent irreversible remodeling and facilitate optimization of medical therapy. CRT should be recognized as an essential component within a comprehensive strategy for HF management in patients with appropriate indications.

ABSTRACTBackgroundRight ventricular (RV) dysfunction is independently predictive of sudden cardiac death. This study aimed to compare the performance of different risk stratification methods for death and appropriate implantable cardioverter‐defibrillator (ICD) therapy using echocardiography and cardiac magnetic resonance imaging (CMR) to quantify RV function.MethodsConsecutive patients undergoing ICD implantations who had completed both preprocedural echocardiography and CMR were retrospectively enrolled. Patients with channelopathies or arrhythmogenic right ventricular disease were excluded. The RV fractional area change (RVFAC) and estimated pulmonary artery pressure (EPAP) were calculated from echocardiography. The contraction pressure index (CPI) was defined as the quotient of the RVFAC divided by the EPAP. Both metrics were used to predict the composite endpoint of death and an appropriate ICD therapy. RV dysfunction was defined by either RVFAC < 35% or RV ejection fraction (RVEF) < 45%.ResultsIn total, 88 patients (60.4 ± 14.7 years, 61 males) including 15 with ischemic cardiomyopathy were retrospectively enrolled. Forty‐two patients received ICDs as secondary prevention. The mean RVFAC, CPI, and RVEF were 35.9% ± 9.22%, 1.4% ± 0.7%/mmHg, and 39.5% ± 14.4%, respectively. Regarding the composite endpoint, the best cut‐off value of the CPI was 1.59 (specificity 0.45, sensitivity 0.96, ROC‐AUC 0.68). The hazard ratio of a low RVFAC was 3.28 (95% CI: 1.39–7.77, p = 0.007, concordance = 0.622), a low CPI, 14.2 (95% CI: 1.91–104.9, p = 0.010, c = 0.665), and a low RVEF, 3.44 (95% CI: 1.17–10.1, p = 0.003, c = 0.620).ConclusionBoth CMR‐derived RVEF and the echocardiographic CPI predicted appropriate ICD therapy and death. The CPI may provide superior risk stratification.

Implantable cardioverter-defibrillator undersensing may delay therapy in ventricular fibrillation with low-amplitude signals. Ventricular fibrillation therapy assurance (VFTA) detected persistent VF after initial shock failure, enabling timely shock delivery and successful resuscitation. VFTA may help optimize device programming by preventing misclassification and treatment delay in life-threatening arrhythmias.

This case illustrates both termination and re-initiation of repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) visualized on a standard 12-lead ECG. It highlights how pacemaker algorithms such as VIP and PVC response, together with abnormal atrial refractoriness, can trigger or terminate RNRVAS.

ABSTRACTBackgroundPulsed‐field ablation (PFA) is increasingly used for catheter ablation of atrial fibrillation (AF), but older patients remain underrepresented in clinical trials. This study aimed to compare procedural outcomes and mid‐term effectiveness of PFA in patients aged ≤ 75 and > 75 years.MethodsIn this retrospective single‐center cohort, 479 consecutive patients underwent PFA for AF between January 2022 and April 2024. Patients were grouped by age (≤ 75 vs. > 75 years at ablation). Procedural parameters and acute complications were compared. Arrhythmia‐free survival was assessed with Kaplan–Meier analysis after an 8‐weeks blanking period, and predictors of recurrence were evaluated using Cox regressions.ResultsOf 479 patients (mean age 65.0 ± 12.1 years; 73.6% males), 104 (21.7%) were > 75 years at ablation. Patients > 75 years had more comorbidities, including hypertension and impaired renal function. Pulmonary vein isolation was achieved in 99.8% of cases. Acute complication rates were similar between groups (7.7% in > 75 vs. 8.5% in ≤ 75, p = 1.00), with low rates of tamponade (1.5%) and stroke (1.3%). Kaplan–Meier analysis showed no difference in arrhythmia‐free survival. At 6 months, freedom from atrial arrhythmia was 81.4% in the > 75 group and 83.8% in the ≤ 75 group (p = 0.57); corresponding rates at 12 months were 60.1% and 68.6%. Age was not an independent predictor of recurrence. At last follow‐up, 75.7% of patients were off antiarrhythmic drugs.ConclusionsPFA in patients > 75 years is associated with low complication rates and favorable rhythm outcomes, comparable to those in younger patients. These findings support the use of PFA in elderly patients with AF.

[This corrects the article DOI: 10.1002/joa3.70238.].