Group of conditions in which the heartbeat is irregular, too fast, or too slow
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In this episode, the CardioNerds (Dr. Naima Maqsood, Dr. Akiva Rosenzveig, and Dr. Colin Blumenthal) are joined by renowned educator in electrophysiology, Dr. Joshua Cooper, to discuss everything atrial flutter; from anatomy and pathophysiology to diagnosis and management. Dr. Cooper's expert teaching comes through as Dr. Cooper vividly describes atrial anatomy to provide the foundational understanding to be able to understand why management of atrial flutter is unique from atrial fibrillation despite their every intertwined relationship. A foundational episode for learners to understand atrial flutter as well as numerous concepts in electrophysiology. Audio editing for this episode was performed by CardioNerds intern Dr. Bhavya Shah. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls "The biggest mistake is failure to diagnose”. Atrial flutter, especially with 2:1 conduction, is commonly missed in both inpatient and outpatient settings so look carefully at that 12-lead EKG so you can mitigate the stroke and tachycardia induced cardiomyopathy risk Decremental conduction of the AV node makes it more challenging to rate control atrial flutter than atrial fibrillation Catheter Ablation is the first line treatment for atrial flutter and is highly successful, but cardioversion can be utilized as well prior to pursuing ablation in some cases. Class I AADs like propafenone and flecainide may stability the atrial flutter circuit by slowing conduction and thus may worsen the arrhythmia. Therefore, the preferred anti-arrhythmic medication in atrial flutter are class III agents. Atrial flutter can be triggered by firing from the left side of the heart, so in patients with both atrial fibrillation and flutter, ablating atrial fibrillation makes atrial flutter less likely to recur. BONUS PEARL: Dr. Cooper's youtube video on atrial flutter is a MUST SEE! Notes Notes: Notes drafted by Dr. Akiva Rosenzveig What are the distinguishing features of atrial fibrillation and flutter? Atrial flutter is an organized rhythm characterized by a wavefront that continuously travels around the same circuit leading to reproducible P-waves on surface EKG as well as a very mathematical and predictable relationship between atrial and ventricular activity Atrial fibrillation is an ever changing, chaotic rhythm that consists of small local circuits that interplay off each other. Consequently, no two beats are the same and the relationship between the atrial activity and ventricular activity is unpredictable leading to an irregularly irregular rhythm What are common atrial flutter circuits? Cavo-tricuspid isthmus (CTI)-dependent atrial flutter is the most common type of flutter. It is characterized by a circuit that circumnavigates the tricuspid valve. Typical atrial flutter is characterized by the circuit running in a counterclockwise pattern up the septum, from medial to lateral across the right atrial roof, down the lateral wall, and back towards the septum across the floor of the right atrium between the IVC and the inferior margin of the tricuspid valve i.e. the cavo-tricuspid isthmus. Surface EKG will show a gradual downslope in leads II, III, and AvF and a rapid rise at end of each flutter wave. Atypical CTI-dependent flutter follows the same route but in the opposite direction (clockwise). Therefore, we will see positive flutter waves in the inferior leads Mitral annular flutter is more commonly seen in atrial fibrillation patients who've been treated with ablation leading to scarring in the left atrium. Roof-dependent flutter is characterized by a circuit that travels around left atrium circumnavigating a lesion (often from prior ablation), traveling through the left atrial roof, down the posterior wall, and around the pulmonary veins Surgical/scar/incisional flutter is seen in people with a history of prior cardiac surgery and have iatrogenic scars in right atrium due to cannulation sites or incisions How does atrial flutter pharmacologic management differ from other atrial arrhythmias? The atrioventricular (AV) node is unique in that the faster it is stimulated, the longer the refractory period and the slower it conducts. This characteristic is called decremental conduction. In atrial fibrillation, the atrial rate is so fast that the AV node becomes overwhelmed and only lets some of those signals through to the ventricles creating an irregular tachycardia but at lower rates. In atrial flutter, the atrial rate is slower, therefore the AV node has more capability to conduct allowing for higher ventricular rates. Therefore, to achieve rate control one will need a higher dose of AV blocking medications. Atrial tachycardia may require even higher doses due to the increased ability of the AV node to conduct, as the atrial rates are slower than in atrial flutter. Sodium channel blockers (Class I) such as flecainide and propafenone slow wavefront propagation, making it easier for the AV node to handle the atrial rates. This will end up leading to increased ventricular rates which can be dangerously fast. That is why AV nodal blockers should be used in conjunction with flecainide and propafenone. What is the role of cardioversion in atrial flutter management? Due to high success rate with atrial flutter ablation, ablation is the first line treatment. However, sometimes cardioversion may be utilized in patients depending on how symptomatic they are and how long it will take to get an ablation. Cardioversion may also be utilized preferentially when the atrial flutter was triggered by infection or cardiac surgery to see if it will come back. If cardioversion is pursued, the patient will need to be anticoagulated due to the stroke risk after the procedure due to post-conversion stunning. How effective is atrial flutter ablation? The landmark Natale et al study in 2000 demonstrated 80% success rate after radiofrequency ablation as compared to 36% in patients on anti-arrhythmic therapy. The LADIP study in 2006 further corroborated these findings. Contemporary data shows above 90% success rate of atrial flutter ablation. In patients who have had both atrial fibrillation and atrial flutter, most electrophysiologists would ablate both. However, in patients with atrial fibrillation, the atrial flutter usually is initiated by trigger spots firing in the left atrium. Once the atrial fibrillation is ablated, the flutter will become less likely. Therefore, there are those who say there's no need to ablate the flutter circuit as well. Alternatively, if a patient has severe comorbidities and/or is high risk for ablation, one may consider performing the atrial flutter ablation only since atrial flutter is harder to manage medically compared with atrial fibrillation. How do you manage atrial flutter in the acute inpatient setting? In the inpatient setting, electrical cardioversion is often limited by blood pressure and the hypotensive effects of the sedatives required. If one is awake and too hypotensive, chemical cardioversion can be pursued. The most effective anti-arrhythmic for this is ibutilide. Amiodarone is not effective for acute cardioversion. Since ibutilide prolongs refractoriness in atrial and ventricular tissue, there's a risk of long QT induced torsades de pointes. Pretreating with magneisum reduces the risk to 1-2%. References Jolly WA, Ritchie WT. Auricular flutter and fibrillation. 1911. Ann Noninvasive Electrocardiol. 2003;8(1):92-96. doi:10.1046/j.1542-474x.2003.08114.x McMichael J. History of atrial fibrillation 1628-1819 Harvey - de Senac - Laënnec. Br Heart J. 1982;48(3):193-197. doi:10.1136/hrt.48.3.193 Lee KW, Yang Y, Scheinman MM; University of Califoirnia-San Francisco, San Francisco, CA, USA. Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr Probl Cardiol. 2005;30(3):121-167. doi:10.1016/j.cpcardiol.200 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e167. doi:10.1161/ Cosío F. G. (2017). Atrial Flutter, Typical and Atypical: A Review. Arrhythmia & electrophysiology review, 6(2), 55–62. https://doi.org/10.15420/aer.2017.5.2 https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Atrial-flutter-common-and-main-atypical-forms Natale A, Newby KH, Pisanó E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol. 2000;35(7):1898-1904. doi:10.1016/s0735-1097(00)00635-5 Da Costa A, Thévenin J, Roche F, et al. Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation. 2006;114(16):1676-1681. doi:10.1161/CIRCULATIONAHA.106.638395 https://www.acc.org/Membership/Sections-and-Councils/Fellows-in-Training-Section/Section-Updates/2015/12/15/16/58/Atrial-Fibrillation#:~:text=The%20first%20'modern%20day'%20account,in%20open%20chest%20animal%20models.&text=In%201775%2C%20William%20Withering%20first,(purple%20foxglove)%20in%20AFib.
EP Lab Digest speaks with Dr Eli Friedman, director of sports cardiology at the Smidt Heart Institute at Cedars-Sinai, about the launch of the institute's new Sports Cardiology Program.
Welcome to today's episode, hosted by wilderness medicine expert Dr. Kathy Vidlock. In this episode, Dr. Vidlock walks us through a real case from the backcountry—a hiker who developed supraventricular tachycardia, or SVT, away from definitive medical care.Dr. Vidlock explains what SVT is, why it can strike suddenly even in otherwise healthy individuals, and how the stressors of the wilderness—dehydration, exhaustion, heat, stimulants, and altitude—can increase the risk. She breaks down the signs and symptoms you might see in yourself or a companion, from rapid heart rate to anxiety, dizziness, and chest discomfort.
Everything Remade episode 277. Thanks so much to Aaron for taking the time to chat with me. Intro/outro track: The Dense Macabre by Coma Regalia featured tracks: Ink Labyrinth, The Rose Gold Hour and Arrhythmia by incaseyouleave hear more: incaseyouleave.bandcamp.com If you are enjoying what you hear and would like to support the growth of this podcast directly you can do so by way of donation via paypal: middlemanrecords@gmail.com venmo: @ediequinn or subscribe to our patreon: patreon.com/humanmachine
Host: Susanna Price Guest: Stephanie Schwarting Want to watch the episode? Go to: https://esc365.escardio.org/event/2176 Want to watch the extended interview on Arrhythmias in Cardiac Amyloidosis? Go to: https://esc365.escardio.org/event/2176?resource=interview Disclaimer: ESC TV Today is supported by Bristol Myers Squibb and Novartis through an independent funding. The programme has not been influenced in any way by its funding partners. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. The ESC is not liable for any translated content of this video. The English language always prevails. Declarations of interests: Stephan Achenbach, Yasmina Bououdina, Nicolle Kraenkel and Susanna Price have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. John-Paul Carpenter has declared to have potential conflicts of interest to report: stockholder Mycardium AI. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Konstantinos Koskinas has declared to have potential conflicts of interest to report: honoraria from MSD, Daiichi Sankyo, Sanofi. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada. Stephanie Schwarting has declared to have potential conflicts of interest to report: advisory board for Alnylam, Bayer, Pfizer; principal investigator in trials sponsored by Alexion, Novo Nordisk and Intellia. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.
This episode covers: Cardiology This Week: A concise summary of recent studies Arrhythmias in cardiac amyloidosis Taking the 'O' out of HOCM: managing LVOT obstruction Snapshots Host: Susanna Price Guests: Carlos Aguiar, Stephanie Schwarting, Ahmad Masri Want to watch that episode? Go to: https://esc365.escardio.org/event/2176 Want to watch that extended interview on Arrhythmias in Cardiac Amyloidosis? Go to: https://esc365.escardio.org/event/2176?resource=interview Disclaimer: ESC TV Today is supported by Bristol Myers Squibb and Novartis through an independent funding. The programme has not been influenced in any way by its funding partners. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. The ESC is not liable for any translated content of this video. The English language always prevails. Declarations of interests: Stephan Achenbach, Yasmina Bououdina, Nicolle Kraenkel and Susanna Price have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. John-Paul Carpenter has declared to have potential conflicts of interest to report: stockholder Mycardium AI. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Konstantinos Koskinas has declared to have potential conflicts of interest to report: honoraria from MSD, Daiichi Sankyo, Sanofi. Ahmad Masri has declared to have potential conflicts of interest to report: research grants from Pfizer, Ionis, Attralus, Cytokinetics and Janssen. Consulting fees from Cytokinetics, BMS, BridgeBio, Pfizer, Ionis, Lexicon, Attralus, Alnylam, Haya, Alexion, Akros, Edgewise, Rocket, Lexeo, Prothena, BioMarin, AstraZeneca, Avidity, Neurimmune, and Tenaya. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada. Stephanie Schwarting has declared to have potential conflicts of interest to report: advisory board for Alnylam, Bayer, Pfizer; principal investigator in trials sponsored by Alexion, Novo Nordisk and Intellia. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.
Send us a textWe share community updates and new events, then sit down with Ayrton Beatty to unpack how an antidepressant triggered Long QT syndrome, what symptoms to watch for, and the everyday tactics that keep them safe while honoring Edward's memory. The conversation blends hard science, lived experience, and practical steps anyone can use to advocate with confidence.• Red Hat Society join and conference highlights• Down syndrome and CHD awareness link• Upcoming Zoom listening session details• Live recording on transition and life stages• Ayrton's diagnosis of drug‑induced Long QT• Warning signs during exercise and daily walks• Role of wearables in spotting heart‑rate thresholds• Tapering off venlafaxine and mental health impact• Switching to citalopram and ongoing vigilance• Triggers to avoid including sudden noises and swimming• Practical safety tips including hydration and potassium• Advocacy advice and seeking second opinions• Remembering Edward and hidden electrical disordersJoin us on November 25th, 2025 at 4 p.m. Central Time for a Zoom listening event to hear Ellen Boyer's episode "Shattering Stereotypes in the World of Down Syndrome and Congenital Heart Defects.” Here is the Zoom link: https://tinyurl.com/HUGZoomRoomPatrons, meet us on October 30th at 4 p.m. Central Time for our live recording on "Transition and Life Changes." Here is the Zoom link: https://tinyurl.com/HUGZoomRoomSupport the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite
In our latest episode, Associate Editor Dr. Jason Carter (Baylor University, Robbins College of Health and Human Sciences) interviews authors Dr. Alex Carll and Brittany Reynolds (University of Louisville School of Medicine), along with expert Dr. Jessica Bradshaw (University of North Texas Health Science Center), about the recent work by Reynolds et al. There are an estimated 68 million e-cigarette users worldwide, and the use of e-cigarettes during pregnancy has been on a steady rise in recent years. Evidence shows that 1 in 5 smokers or ex-smokers who become pregnant use e-cigarettes during pregnancy, yet the effects of vaping on maternal health during and after pregnancy are poorly understood. Reynolds et al. developed a preclinical mouse model of e-cigarette use during pregnancy to assess maternal autonomic control and ventricular arrhythmias, which further solidifies the relevance of animal research to the NIH mission to enhance health, lengthen life, and reduce illness and disability. The authors measured the dams at 3 weeks postpartum and found lasting increases in catecholamines, which indicates increased sympathetic activation. In addition, the authors found increases in the occurrence of spontaneous ventricular premature beats, which are indications of increased risk for sudden cardiac death and heart failure. What impact does vaping have on maternal cardiovascular health, both during pregnancy and in the postpartum period? Listen now to find out more. Brittany R. Reynolds, Sean M. Raph, Anand Ramalingam, Shweta Srivastava, Pawel Lorkiewicz, Lillian E. Watson, Kenneth R. Brittian, Helen E. Collins, and Alex P. Carll Don't go vaping my heart: e-cigarette exposure during pregnancy promotes peripartum ventricular arrhythmias and sympathetic dominance Am J Physiol Heart Circ Physiol, published September 22, 2025. DOI: 10.1152/ajpheart.00509.2025
In this week's Talking Health, Jessica is joined by Rebecca Reid, a marathon world record holder who lives with an arrhythmia, to discuss how cardiovascular disease is the world's biggest killer.
The 2025 European Society of Cardiology Clinical Consensus Statement on Mental Health and Cardiovascular Disease calls for a rethinking of how cardiovascular care and mental health care intersect. To explore the implications for arrhythmia care, EP Lab Digest sat down with Professor Christi Deaton, one of the co-chairs of the consensus statement, to discuss the concept of the “Psycho-Cardio” team, the management of severe mental illness, and the pressing gaps that remain.
With David Erlinge and Sasha Koul, Lund University, Lund - Sweden Read the European Heart Journal paper Read the European Heart Journal editorial
With Stefan Simovic, Faculty of Medical Sciences, University of Kragujevac, Kragujevac - Serbia, Augusto Meretta, Leiden University Medical Center, Leiden - The Netherlands, and Jose Luis Merino, La Paz University Hospital, Madrid - Spain. During this podcast, Jose Luis Merino, Stefan Simovic and Augusto Meretta will discuss key insights and innovations behind the 2025 EHRA practical compendium on antiarrhythmic drugs, including its new classification system, clinical guidance across Europe, drug interactions, combination therapies, and the future of pharmacological rhythm control.
September 29 is World Heart Day, a day to raise awareness of heart disease and vascular conditions. Naomi Inoue, a film extra and photographer, first noticed symptoms of a rapid heartbeat at the age of ten. For more than 20 years, she was told that arrhythmia was “not unusual”. This story was first published in September 2024. - 9月29日は世界ハートの日(World Heart Day)。心臓病や血管病(脳卒中)への関心を高める日です。フィルムエキストラでフォトグラファーの井上直美さんは、10歳のときに頻脈の症状に気づきました。しかしその後20年以上にわたり、「不整脈は珍しくない」と言われ続けました。2024年9月放送。
Q-BANK: https://patreon.com/highyieldfamilymedicineIntro (0:35),Sinus tachycardia (1:52),Sinus bradycardia (2:53),Focal atrial tachycardia (4:08),Multifocal atrial tachycardia (5:00),Atrial fibrillation (5:56),Atrial flutter (12:16),Supraventricular tachycardia (13:27)Wolff-Parkinson-White (16:18),AV blocks (17:31),Right bundle branch block (21:16), Left bundle branch block (22:18),Premature ventricular complexes (24:12),Ventricular tachycardia (25:07),Torsades de Pointes (26:06),Ventricular Fibrillation (26:49),Electrical interventions overview (29:06),Practice questions (30:20)
This week we replay an episode from 2 years ago on postoperative ectopic atrial tachycardia (EAT) following congenital heart surgery in children. Are there risk factors for this arrhythmia and are any modifiable? What is the 'go to' therapy used by the electrophysiologists at Children's LA for the acute and chronic treatment of this arrhythmia in the postoperative period? Is the presence of EAT in a postoperative congenital heart patient a marker for a worse outcome? These are amongst the questions posed to Children's of Los Angeles pediatric electrophysiologist, Dr. Jonathan Uniat. · DOI: 10.1007/s00246-022-03068-8
Please join HRS Digital Education Committee Vice-Chair, Tina Baykaner, MD, MPH, of Stanford University, as she is joined by Heart Rhythm Society President Mina K. Chung, MD, FHRS, of the Cleveland Clinic, and Konstantinos C. Siontis, MD, FHRS of the May Clinic. The three met up in Altanta at HRX 2025 for this stimulating coversation. This study evaluated whether artificial intelligence applied to single-lead ambulatory ECGs could predict imminent sustained ventricular arrhythmias. Using deep learning models, the researchers demonstrated that AI could identify subtle ECG features preceding arrhythmic events, enabling accurate short-term risk prediction. The findings suggest a potential role for AI-enhanced ECG monitoring to improve early detection and prevention of life-threatening ventricular arrhythmias. To view bonus video recorded LIVE at HRX 2025 in Atlanta, view this episode on Heart Rhythm 365 or the HRX Innovation Hub! Article Authors Laurent Fiorina ∙ Tanner Carbonati∙ Kumar Narayanan ∙ Jia Li ∙ Christine Henry ∙ Jagmeet Singh ∙ Eloi Marijon Read the Article: https://www.heartrhythmjournal.com/article/S1547-5271(23)02195-1/fulltext Podcast Contributors and Disclosures Tina Baykaner, MD, MPH | Stanford University Mina K. Chung, MD, FHRS | Cleveland Clinic Konstantinos C. Siontis, MD, FHRS | Mayo Clinic All relevant financial relationships have been mitigated. T. Baykaner: •Honoraria/Speaking/Consulting: Volta Medical, Medtronic, Pacemate, Johnson and Johnson, Abbot Medical, Boston Scientific Research: NIH M. Chung: •Honoraria/Speaking/Consulting: University of Chicago, Cedars Sinai Medical Center, Asia Pacific Heart Rhythm Society, NIH, Baylor College of Medicine, Kansas City Heart Rhythm Symposium, American College of Cardiology, Geisinger Health Systems, ABIM, Academy for Continued Healthcare Learning, MediasphereMedical, Western AF Symposium, University of Minnesota, Stanford University, Canadian Heart Rhythm Society •Research: NIH, American Heart Association •Royalty Income: Elsevier, Wolters Kluver •Officer: American Heart Association K. Siontis: •Research: Anumana, Varian Medical Systems •Intellectual Property Right: Anumana •Speaking/Teaching/Consulting: EBAMedSA, AskBio
With Børge Nordestgaard and Anders Berg Wulff, Copenhagen University Hospital, Copenhagen - Denmark. Read the European Heart Journal - Cardiovascular Imaging paper Read the European Heart Journal - Cardiovascular Imaging editorial
Focus Issue on Arrhythmias and Genetics
With Stefan Simovic, Faculty of Medical Sciences, University of Kragujevac, Kragujevac - Serbia, Vera Maslova, University Medical Center of Schleswig-Holstein, Kiel - Germany, Daniel Scherr Medical University of Graz, Austria, and Michal Farkowski, Ministry of Interior and Administration National Medical Institute, Warsaw, Poland. During this podcast Daniel Scherr, Michal Farkowski, Stefan Simovic and Vera Maslova will explore the newly published 2025 ESC-EHRA Atlas on Heart Rhythm Disorders, featured in EP Europace journal offering key insights into global arrhythmia care.
CardioNerds guest host Dr. Colin Blumenthal joins Dr. Juma Bin Firos and Dr. Aishwarya Verma from the Trinity Health Livonia Hospital to discuss a fascinating case involving malignant ventricular arrhythmias. Expert commentary is provided by Dr. Mohammed Ali-Jazayeri. Audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes. This case explores the puzzling presentation of exercise-induced ventricular tachycardia in a young, otherwise healthy male who suffered recurrent out-of-hospital cardiac arrests. With no traditional risk factors and an unremarkable ischemic workup, the challenge lay in uncovering the underlying cause of his malignant arrhythmias. Electrophysiology studies and advanced imaging played a pivotal role in systematically narrowing the differentials, revealing an unexpected arrhythmogenic substrate. This episode delves into the diagnostic dilemma, the role of EP testing, and the critical decision-making surrounding ICD placement in a patient with a concealed but life-threatening condition. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Malignant Ventricular Arrhythmias This case highlights the challenges and importance of diagnosing and managing ventricular arrhythmias in young, seemingly healthy individuals. Here are five key takeaways from the episode: Electrophysiology (EP) studies play a crucial role in identifying arrhythmogenic substrates in patients with exercise-induced ventricular tachycardia (VT) without obvious structural heart disease. In this case, substrate mapping revealed late abnormal ventricular afterdepolarizations in the basal inferior left ventricle, providing valuable insights into the underlying mechanism. Cardiac MRI can be a powerful tool for detecting subtle myocardial abnormalities. The subepicardial late gadolinium enhancement (LGE) in the lateral and inferior LV walls suggested an underlying myocardial process, even when other imaging modalities appeared normal. The VT morphology can provide clues about the underlying mechanism. In this case, the right bundle branch block pattern with a northwest axis and shifting exit sites pointed towards a scar-mediated mechanism rather than a channelopathy or idiopathic VT. Implantable cardioverter-defibrillator (ICD) placement is crucial for secondary prevention of sudden cardiac death (SCD) in patients with malignant ventricular arrhythmias, even in young individuals. The patient's initial deferral of ICD implantation highlights the importance of shared decision-making and patient education in these complex cases. "Scar-mediated VT introduces the risk of new arrhythmogenic substrates over time, reinforcing the need for ICD therapy even when catheter ablation is considered." This pearl emphasizes the dynamic nature of the arrhythmogenic substrate and the importance of long-term risk mitigation strategies. Notes - Malignant Ventricular Arrhythmias Notes were drafted by Juma Bin Firos. 1. What underlying pathologies cause ventricular arrhythmias in young patients without overt structural heart disease? Myocardial fibrosis: Detected via late gadolinium enhancement (LGE) on cardiac MRI Present in 38% of nonischemic cardiomyopathy cases Increases sudden cardiac death (SCD) risk 5-fold Often localized to subepicardial regions, particularly in the inferolateral left ventricle (LV) May precede overt systolic dysfunction by years Subclinical cardiomyopathy: 67% of young VT patients show subtle cardiac dysfunction Suggests VT may be the first manifestation of cardiomyopathy
Can artificial intelligence map your heart and help prevent strokes, dementia, and even death from cardiac arrhythmias? In this episode, host Elaine Hamm, PhD, talks with Rob Krummen, JD, CEO of Vektor Medical, and Travis Manasco, MD, Principal at Solas BioVentures, about how AI is changing the game for diagnosing and treating heart rhythm disorders. They share how Vektor's vMap technology — the “Google map of your heart” — pinpoints arrhythmia sources using standard EKGs, fitting seamlessly into existing clinical workflows. The conversation also dives into what investors look for in AI-driven health innovations and how startups can stand out in a crowded field. In this episode, you'll learn: Why cardiac arrhythmias are more common — and more deadly — than most people realize. How vMap's AI-driven insights can improve outcomes, reduce repeat procedures, and expand care to rural hospitals. The key elements investors want to see in AI healthcare pitches, from workflow integration to reimbursement strategy. If you're interested in AI in medicine, medtech innovation, or how to pitch to venture capital, this episode delivers valuable lessons straight from the front lines of clinical care and investment. Links: Connect with Rob Krummen, JD, and check out Vektor Medical. Connect with friend of the show Travis Manasco, MD, and check out Solas BioVentures. Connect with Elaine Hamm, PhD, and learn about Tulane Medicine Business Development and the School of Medicine. Connect with vMap inventor David Krummen, MD, and Solas BioVentures co-founder David Adair, MD, MBA. Listen to our previous episode with Travis on Crafting a Pitch That Attracts Venture Capital. Connect with Ian McLachlan, BIO from the BAYOU producer. Check out BIO on the BAYOU and make plans to attend October 28 & 29, 2025. Learn more about BIO from the BAYOU - the podcast. Bio from the Bayou is a podcast that explores biotech innovation, business development, and healthcare outcomes in New Orleans & The Gulf South, connecting biotech companies, investors, and key opinion leaders to advance medicine, technology, and startup opportunities in the region.
Commentary by Dr. Jian'an Wang.
With Edward Hulten, Brown University, Providence, and Islam Shatla, University of Kansas Medical Center, Kansas City, USA. Link to edi
With Emma Svennberg, Karolinska Institute, Stockholm - Sweden, Sabine Ernst, Royal Brompton Hospital, London - UK, Stefan Simovic, Faculty of Medical Sciences, University of Kragujevac, Kragujevac - Serbia and Dominik Linz, Maastricht University Medical Centre (MUMC), Maastricht - The Netherlands. During this podcast, Emma Svennberg, Sabine Ernst, Stefan Simovic and Dominik Linz will tackle EHRA–ESC–HRS scientific statement sets new standards for trustworthy AI in electrophysiology, using a 29-item reporting checklist. EP Europace: State of the Art of Artificial Intelligence in Clinical Electrophysiology in 2025: A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), and the ESC Working Group on E-Cardiology
The VENTOUX study of endurance athletes, the 10,000 step myth was not busted, rate vs rhythm control for AF, and GLP1 drugs and observational studies are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Endurance Athletes and Arrhythmia (again) VENTOUX trial https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.125.018470 II Daily Step Count and Health — no myths were busted. Lancet Public Health: https://doi.org/10.1016/S2468-2667(25)00164-1 III Rate vs Rhythm Control of AF Medscape: Everyone Deserves a Shot at the American Dream: Sinus Rhythm https://www.medscape.com/viewarticle/everyone-deserves-shot-american-dream-sinus-rhythm-2025a1000jle This Week in Cardiology, July 11, 2025 https://www.medscape.com/viewarticle/1002704 AFFIRM trial https://www.nejm.org/doi/full/10.1056/NEJMoa021328 AFFIRM substudy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486560 IV GLP-1 Drugs and Observational Studies Neurodegeneration and Stroke After Semaglutide and Tirzepatide https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836412 SUSTAIN-6 https://www.nejm.org/doi/full/10.1056/NEJMoa1607141 SELECT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net
This week we go back in time to 2022 to re-enter the world of cardiogenetics and electrophysiology when we review the topic of catecholaminergic polymorphic ventricular tachycardia (CPVT). Is there a 'best' beta blocker for the treatment of this condition? Why is one better than others? How should one manage the patient who is intolerant of beta blockade but needs it for prevention of arrhythmia? What is the role of flecainide, sympathectomy or even ICD's for these patients? PhD candidate and physician Dr. Puck Peltenburg and CPVT world authority, Dr. Christian van der Werf (both of University of Amsterdam) share their deep insights this week. doi: 10.1161/CIRCULATIONAHA.121.056018. Epub 2021 Dec 7
Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses mechanistic insights into reduced arrhythmia prevalence in female endurance athletes.
With Francesca Coraducci Marche Polytechnic University of Ancona, Ancona - Italy, Marco Guglielmo, University Medical Center Utrecht, Utrecht - The Netherlands, and Anna Giulia Pavon, Cardiocentro Ticino Institute, Lugano - Switzerland. Link to editorial Link to paper
Commentary by Nina Nouravesh.
As will be the routine in 2025, the Extra Monday Episodes are dedicated to interpreting EKG rhythms. This month, the crew discusses, bradycardias, tachycardias and wide and narrow rhythms.
Message our hosts, Kieran and Jose.Season 3 of The Animal Heartbeat is all about the Veterinary Cardiology Icons - those who walk among us as legends of the veterinary cardiology world.This episode features Professor Sydney Möise, of Cornell University, CV Starr Professor Emerita of Cardiology. Prof Möise's research and education output on cardiac arrhythmias has shaped how many of us think about electrical problems of the heart, and she has become known as a pioneer of ambulatory ECG assessment of heart rate variability. Her recent collaborations with Wyatt Flanders, her son, has given the veterinary cardiology world free access to dynamic and 3D Poincaré plots in dogs, broadening our understanding of conduction system disease in animals.Join our hosts, Kieran and Jose, as they discuss canine cardiac arrhythmias with a legend in their field.
Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses mechanistic insights into reduced arrhythmia prevalence in female endurance athletes.
With Frank Flachskampf, Uppsala University, Uppsala - Sweden, and James Thomas, Northwestern University, Chicago - USA. Link to editorial Link to paper
Commentary by Satish Raj.
Heart attacks & strokes are down, but guess what's rising? ⚡ Atrial fibrillation,
This week we speak with Assistant Professor of Pediatrics at Harvard Medical School, Dr. Audrey Dionne about a recent work she co-authored on the topic of outcomes of ablation in the early postoperative period following congenital heart surgery. Who is a candidate for this intervention and what were the outcomes? How commonly were serious complications encountered and how successful were these procedures? Dr. Dionne reviews these and other aspects of this novel review this week. https://doi.org/10.1016/j.hrthm.2024.08.061
Many people assume that ingesting cannabis — whether through edibles, oils, or tinctures — eliminates the cardiovascular risks associated with smoking it. While it's true that edibles avoid the harmful byproducts of combustion (such as carbon monoxide and tar), ingested cannabis still carries significant heart health risks due to the effects of tetrahydrocannabinol (THC), its main psychoactive compound. When THC is absorbed through the digestive system, it can cause substantial increases in heart rate and blood pressure — sometimes more dramatically than when cannabis is smoked or vaped. This cardiovascular strain can persist for several hours, making the heart work harder for an extended period. For individuals with existing heart disease, high blood pressure, or other risk factors, this can significantly increase the chances of experiencing arrhythmias, heart attacks, or strokes. Additionally, edible cannabis products often contain higher doses of THC, and because their effects are delayed, people sometimes consume more than intended — compounding the cardiovascular impact. In short: while ingesting cannabis might seem safer than inhaling it, it still triggers systemic effects that can stress the heart and blood vessels — particularly in older adults or anyone with underlying cardiovascular conditions.
Focus Issue on Arrhythmias, Thrombosis and Antithrombotic Treatment
Sandeep A Saha, MD, MS, FHRS, Oregon Heart Center PC is joined by Saket Sanghai, MD, FHRS, Oregon Health & Science University, and Naga Venkata Krishna Chand Pothineni, MD, Kansas City Heart Rhythm Institute, to discuss how the study evaluated the effectiveness of implantable loop recorders (ILRs) in detecting arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Traditional monitoring methods, like Holter monitors, often miss intermittent arrhythmic events in HCM patients. ILRs, offering continuous long-term monitoring, were found to identify clinically significant arrhythmias that might otherwise go undetected. The findings suggest that ILRs can play a crucial role in risk stratification and management of HCM patients, potentially guiding decisions regarding interventions such as implantable cardioverter-defibrillator (ICD) implantation. Overall, ILRs enhance the detection of arrhythmias in HCM, leading to improved patient care. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.005 Host Disclosure(s): S. Saha: Honoraria/Speaking/Consulting Fee: Medtronic Membership on Advisory Committees: Medtronic Inc. Contributor Disclosure(s): S. Sanghai: Research: Siemens Healthcare Stocks (Publicly Traded): Apple Inc., Alphabet Inc., Amazon Stock Options (Publicly Traded): Intel K. Pothineni: Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific
Check out the TIES Sales Showdown at www.tx.ag/TIESVisit The Sales Lab at https://thesaleslab.org and check out all our guests' recommended readings at https://thesaleslab.org/reading-listTo listen to The Sales Lab Podcast on your favorite apps, visit https://thesaleslab.simplecast.com/ and select your preferred method of listening.Connect with us on Facebook at https://www.facebook.com/saleslabpodcastConnect with us on Linkedin at https://www.linkedin.com/company/thesaleslabSubscribe to The Sales Lab channel on YouTube at https://www.youtube.com/channel/UCp703YWbD3-KO73NXUTBI-Q
In this episode, we review the high-yield topic Ventricular Arrhythmia from the Cardiovascular section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode of the PFC Podcast, Dennis and Doug delve into the complexities of bradyarrhythmias, discussing their recognition, causes, and treatment options. They explore the importance of vital signs, differential diagnosis, and the various pharmacological and electrical interventions available for managing bradycardia. The conversation also touches on the implications of overdoses and the long-term management of patients with bradyarrhythmias, emphasizing the need for a comprehensive approach in emergency medicine.TakeawaysRecognizing bradycardia involves checking vital signs and symptoms.Not all bradycardias are the same; context matters.Altered mental status can indicate shock in bradycardia cases.Lyme disease is a significant cause of bradycardia in younger populations.Narcotic overdose can lead to bradycardia and requires immediate attention.Atropine is a quick and handy treatment for bradycardia.Transcutaneous pacing is a common emergency intervention.Dopamine is preferred for its targeting of heart rate in bradycardia.Glucagon is an expensive but necessary treatment for beta-blocker overdose.Treating hypoxia is crucial before addressing bradycardia.Chapters00:00 Introduction to Bradyarrhythmias03:01 Recognizing Bradycardia and Its Symptoms06:14 Causes of Bradycardia09:02 Differential Diagnosis in Bradycardia11:57 Stabilization and Treatment Approaches14:46 Pharmacological Interventions for Bradycardia17:59 Electrical Interventions: Pacing Techniques20:55 Managing Overdoses and Bradycardia23:48 Long-term Management and Follow-up26:54 Conclusion and Key TakeawaysLink to full podcast:https://creators.spotify.com/pod/show/dennis3211/episodes/Prolonged-Field-Care-Podcast-228-DImE-e32aek2Thank you to Delta Development Team for in part, sponsoring this podcast.deltadevteam.comFor more content, go to www.prolongedfieldcare.orgConsider supporting us: patreon.com/ProlongedFieldCareCollective or www.lobocoffeeco.com/product-page/prolonged-field-care
Posting tomorrow..Not all cardiac issues have to do with the heart.
Focus Issue on Cardiac and Vascular Surgery and Arrhythmias
Welcome, MedTech Gurus! Imagine a world where artificial intelligence and remote monitoring work together to detect and prevent life-threatening cardiac conditions before they escalate. That's exactly what today's guest, Stuart Long, CEO of InfoBionic.AI, is pioneering. With over 20 years in the medical device industry and leadership experience at companies like Monarch Medical Systems and CapsuleTech, Stuart is no stranger to driving transformative change in healthcare. At InfoBionic.AI, he's leading the charge in AI-powered remote cardiac monitoring, revolutionizing how arrhythmias—especially atrial fibrillation (A-Fib)—are detected, treated, and prevented. In this episode, we'll dive into how real-time, continuous monitoring is reshaping cardiac care, improving patient outcomes, and reducing hospital readmissions. Stay tuned—this is an episode you won't want to miss!
This special electrophysiology-themed issue of JACC, summarized by Dr. Valentin Fuster, dives into cutting-edge research on atrial fibrillation, pulsed field ablation, sudden cardiac arrest in athletes, and preventive strategies in congenital heart disease. From new therapies like finerenone to breakthrough mapping techniques, this episode captures the evolving sophistication and promise of arrhythmia management in modern cardiology.