Background: Activation mapping of scar mediated ventricular tachycardias (VT) are often limited by hemodynamic instability. Substrate mapping and 12-lead ECG localization of VT exit site is often limited by variable scar complexity. Emphasis on other mapping strategies in sinus rhythm would improve catheter ablation success in such cases. Objective: The aim was to investigate the level of agreement between artificial intelligence (AI) based 12-lead ECG localization of VT exit site and mapping utilizing pace-mapping and mapping of channels of slow conduction within the scar tissue of hemodynamically unstable VT. Methods: This was a single-center proof-of-concept study that included patients who underwent catheter ablation procedure of hemodynamically unstable scar mediated VT. The performance of AI-based ECG analysis of VT exit site (Vektor Medical, San Diego, CA) was compared with sites of successful ablation based on substrate mapping in sinus rhythm. Results: A total of 9 hemodynamically unstable VT rhythms were induced in 4 patients. In the 7 VTs were AI-based ECG mapping was used; there was a 100% level of agreement with the site of successful ablation based on substrate mapping. Ablation targeting those sites resulted in non-induction of all induced and mapped VTs. None of the 4 patients had device therapy for recurrent VT or all-cause mortality at 6-months of follow-up. Conclusion: A multi-strategic approach utilizing digitalized analysis of 12-lead ECG of VT exit site, pace-mapping and mapping of channels of slow conduction in scar tissue, has the potential to enhance successful catheter ablation of hemodynamically unstable VT.

Background: Cardiovascular implantable electronic device (CIED) technology continue to advance and improve overtime to help in the treatment of various bradyarrhythmia and prevent sudden cardiac death. Trends and types of various CIED insertion has been changing over the past two decades. No recent study has captured trends in procedures related to several categories of implantable devices in United States (US) subgroups. Objective: We conducted a nationwide subcategory analysis of trends in device implants from 2016 to 2019 using the US National Inpatient Sample (NIS) database. Methods: We used data from the NIS between January 2016 to December 2019 on hospitalized adults ≥18 years old undergoing CIED implants and/or device upgrades to study CIED device trends each year stratified by baseline characteristics and comorbid conditions. Linear regression for continuous outcomes and logistic regression for categorical outcomes were used to calculate p-value trends for each subcategory. Results: We found a significant increase in implantation rates of all CIEDs in the US from 2016 to 2019 (150,370 to 159,300). There was a significant increase in dual-chamber compared to single-chamber pacemaker and implanted cardioverter defibrillator devices implanted noted (p <0.001), and an increase in permanent pacemaker to cardiac resynchronization therapy pacemaker upgrades from 1,280 to 1,615 (p = 0.002). When stratified by gender, the percentage of all CIEDs were higher in males than females. No significant change was shown when stratified by age, race, or comorbidity. Conclusion: The findings likely mirror the increasing prevalence of conduction abnormalities in the US and account for the better understanding that dual pacing better emulates normal cardiac physiology and atrioventricular synchrony .

Congenital dyserythropoietic anemias (CDA) is a heterogeneous class of anemia of varying degrees of ineffective erythropoiesis and secondary hemochromatosis. We reported a case of CDA and showed our approach to reaching a diagnosis, highlighting the importance of the typical morphological appearance of bone marrow erythroblasts to reach the diagnosis.