Sotalol is a class III antiarrhythmic drug used for the management of patients with atrial fibrillation to maintain sinus rhythm. Sotalol-induced QT interval prolongation can be proarrhythmic and is conventionally initiated in an inpatient setting where routine electrocardiographic (ECG) monitoring is available while sotalol reaches the steady state. The emergence of cellular-compatible home ECG devices, such as AliveCor's Kardia Mobile 6L, which offers 6-lead ECG, has made it possible to accurately measure QT intervals outside the hospital.

Pulsed field ablation (PFA) is a novel ablation energy source, which leads to selective and irreversible electroporation of cardiomyocytes with no collateral damage to adjacent tissues. The presence of mechanical prosthetic valves may pose some issues related to catheter manipulation and risk of electromagnetic interference.

Epilepsy is an important cause of disability and mortality worldwide. It can be frequently misdiagnosed, and detailed history and relevant investigations are needed to differentiate epilepsy from syncope. Electroencephalogram is a key noninvasive assessment of neurological function, and the diagnostic yield is increased when performed for an extended period in the ambulatory setting with concurrent electrocardiogram and video monitoring. People living with epilepsy may be affected by a diverse range of ictal (seizure-associated) arrhythmias. The prevalence of detected arrhythmias in people living with epilepsy is anticipated to rise in the context of increasingly available wearable technology and improved survival. Ictal bradycardia and asystole sometimes observed in temporal lobe epilepsy may be associated with falls and injury that can be prevented by cardiac pacing; however, seizure control with medical therapy is still crucial. Sudden unexpected death in epilepsy is likely explained by a different mechanism, in particular central cardiorespiratory autonomic dysfunction sometimes associated with generalized tonic-clonic seizures. Channelopathies encompassing the heart-brain axis are increasingly recognized and may explain the overlap between certain epileptic and arrhythmogenic syndromes, with potential for targeted therapy in the future. The QT interval is prognostically significant in epilepsy, with various seizure types affecting the QT interval differently. Certain antiseizure medications may cause electrocardiogram abnormalities and arrhythmias although there remains limited clinical data. This State-of-the-Art Review describes our current understanding regarding the relationship between epilepsy and cardiac arrhythmias, as well as delineating areas of unmet need.

Left bundle branch area pacing (LBBAP) has gained increased adoption globally with the use of both lumenless leads (LLLs) and stylet-driven leads (SDLs). As these leads have been developed for conventional endocardial pacing sites, concerns remain regarding the lead integrity with LBBAP.

Pacemakers and implantable cardioverter-defibrillators in pediatric and congenital heart disease (CHD) patients may be required for decades. In this population, there are sparse data on long-term lead functionality.

The elderly population with atrial fibrillation (AF) is growing. There is limited evidence to suggest AF ablation as an effective treatment for the elderly.

Pulsed field ablation (PFA) is a promising nonthermal method for treating atrial fibrillation. However, the potential for erythrocyte rupture and subsequent hemolysis remains a significant concern, particularly with high-intensity applications. In this study, we explored the protective effects of gadolinium-diethylenetriamine-penta-acetic acid (Gd-DTPA), a common magnetic resonance imaging contrast agent, against PFA-induced hemolysis both in vitro and in vivo. Our in vitro experiments involved subjecting fresh heparinized rat blood to PFA in the presence of various concentrations of Gd-DTPA. We found that Gd-DTPA concentrations of 100 μM and 1,000 μM significantly mitigated hemolysis caused by PFA application. For in vivo studies, rats were administered Gd-DTPA at dosages of 10 μmol/kg and 100 μmol/kg before PFA. The results indicated that preadministration of Gd-DTPA effectively reduced erythrocyte destruction and intravascular hemolysis after PFA. The protective effect of Gd-DTPA is attributed to its ability to stiffen erythrocyte membranes, rendering them more resistant to the destabilizing effects of PFA-induced electroporation. These findings suggest that Gd-DTPA could play a crucial role in minimizing hemolysis and associated complications in clinical applications of PFA for atrial fibrillation. Further studies are needed to confirm these protective effects in larger animal models and eventually in clinical settings.

While some chronic pathological substrates for sudden cardiac death (SCD) are well known (eg, coronary artery disease and left ventricular [LV] dysfunction), the acute vulnerable myocardial state predisposing to fatal arrhythmia remains a critical barrier to near-term SCD prevention.

Catheter ablation to prevent ventricular tachycardia (VT) that emerges late after a myocardial infarction aims to interrupt the re-entry substrate. Interruption of potential channels and regions of slow conduction that can be identified during stable sinus or paced rhythm is often effective and a number of substrate markers for guiding this approach have been described. While there is substantial agreement with different markers in some patients, the different markers select different regions for ablation in others. Mapping during VT to identify critical re-entry circuit isthmuses is likely more specific, and most useful when VT is incessant or frequent during the procedure or when sinus rhythm substrate ablation fails. Both approaches are often combined. These methods for identifying and characterizing post-infarct-related arrhythmia substrate and the re-entry circuits are reviewed.