Background and Clinical Significance: The crista terminalis (CT) is a physiological fibromuscular ridge in the right atrium. While benign, rare cases of CT hypertrophy present a diagnostic challenge, as it can mimic a pathological right atrial mass on cardiac imaging. The CT also presents arrhythmogenic potential and is known to be associated with right atrial tachyarrhythmias. Case Presentation: We present the case of a 58-year-old female that presented with rapid, irregular palpitations, accompanied by hypertension. Holter electrocardiography (ECG) confirmed self-limiting episodes of atrial tachycardia (max heart rate 170 bpm). Initial transthoracic echocardiography (TTE) identified an echogenic, non-mobile mass on the posterolateral right atrial wall. Transesophageal echocardiography (TEE) confirmed a 12 × 9 mm homogenous structure with a broad base of implantation and no intrinsic mobility, initially raising the suspicion of an atrial lipoma. Subsequent cardiac computed tomography angiography (CCTA) provided high-resolution tissue characterization, identifying the mass as a hypertrophied CT due to its precise anatomical orientation and its lack of contrast enhancement, also ruling out neoplastic and thrombotic aetiologies. Conclusions: CT hypertrophy is a key differential diagnosis for right atrial masses, particularly in females in their sixth decade. A multimodal imaging approach, transitioning from TTE to TEE and finally CCTA or Cardiac Magnetic Resonance Imaging (CMR), is advantageous in preventing unnecessary invasive interventions or anticoagulation.

A 61-year-old woman presented to our hospital with palpitations and dyspnea persisting for several months. Electrocardiography revealed atrial tachycardia, and X-ray revealed bilateral hilar enlargement. Computed tomography (CT) was performed for suspected sarcoidosis of the respiratory system, which revealed hilar lymph node enlargement in the bilateral lungs. 18F-Fluorodeoxyglucose (18F-FDG)-positron emission tomography-CT revealed abnormal 18F-FDG uptake in the hilar lymph nodes, liver, and left atrium (LA), but not in the left ventricle. Contrast-enhanced cardiac magnetic resonance imaging revealed late gadolinium enhancement (LGE) in the LA. Mediastinal lymph node, transbronchial lung, and right ventricular biopsies were performed, but no specific pathological findings were observed. Echocardiography-guided liver biopsy was also performed, which revealed non-caseating epithelioid granulomas. We definitively diagnosed systemic sarcoidosis, including cardiac lesions. Following the initiation of immunosuppressive therapy, abnormal 18F-FDG uptake in the liver, lymph nodes, and LA resolved, and atrial tachycardia improved, likely owing to the suppression of atrial inflammation. However, LGE in the LA persisted after immunosuppressive therapy, suggesting that structural damage had persisted. In this case, multimodality imaging helped us understand the disease state and post-treatment course.

Tricuspid regurgitation (TR) is a prevalent cardiovascular disorder with significant clinical impact. TR is frequently silent and underdiagnosed and is estimated to impact over 70 million people globally. Characterized by retrograde blood flow from the right ventricle into the right atrium due to incomplete valve closure, TR leads to right heart dilation, systemic congestion, and eventually right-sided heart failure. Importantly, TR may contribute to the onset of atrial fibrillation (AF), the most common sustained arrhythmia, affecting approximately 59 million individuals worldwide. Despite its growing clinical importance, the pathophysiology of TR remains incompletely understood, and current animal models of TR, based on direct valve manipulation, limit translational applicability. We present a novel, minimally invasive porcine model of TR established via femoral/jugular vein catheterization with deployment of an inferior vena cava (IVC) filter. The filter partially impedes tricuspid valve closure, inducing TR without valvular injury. Validation was achieved through multimodal imaging, including fluoroscopy, echocardiography, and electrocardiography, confirming hallmark features of TR, including right atrial and ventricular enlargement and arrhythmic activity. This model provides a reproducible, minimally invasive platform for studying selected features of TR progression. Its minimally invasive nature and preservation of native valvular structure make it a useful preclinical platform for mechanistic and translational research.

ECG is the most used tools in cardiology. Some life-threatening arrhythmias and cardiac abnormalities can be diagnosed with ECG. The aim is to assess the role of ECG for the detection of cardiac disease in children, from September 2014 to January 2020, ECG was performed in 52 primary school in Como. 5793 children (49.4% female) aged 8.1 (± 1.3) years had an ECG; 79 (1.3%) were abnormal due to the following findings: 34 (43%) right bundle branch block (RBBB), 9 (11%) abnormal ventricular repolarization, 7 (9%) long QT, 7 atrio-ventricular block (AVB), 7 (9%) accessory pathway, 5 (5%) premature ventricular beat, 5 (5%) anterior hemiblock, 4 (5%) left ventricular hypertrophy, 1 (2%) ST alteration. Long QT syndrome was excluded in all children with long QT. Among those with RBBB, 2 had severe inter-atrial septal defect (one underwent to closure), while one had moderate mitral valve regurgitation and bicuspid aortic, and 2 had moderate mitral regurgitation. One child with AVB had pacemaker implantation. One child with accessory pathway had Wolf-Parkinson syndrome and undergone to catheter ablation. Among apparently healthy children, ECG may be useful to detect cardiac disease with potential consequence in the adulthood.

Artificial intelligence enhanced electrocardiography (AI-ECG) has shown promise in detecting cardiac abnormalities, but validation against cardiac magnetic resonance (CMR), the reference standard for cardiac structure and function, remains limited. We evaluated the diagnostic performance of six AI-ECG models in identifying CMR-defined cardiac abnormalities in a population-based cohort. This cohort study included 38,804 UK Biobank participants with paired 12-lead ECG and CMR data. AI-ECG models, originally developed using Korean hospital-based datasets, were externally validated in this sample. Cardiac abnormalities were defined as the top 1% of CMR-derived values. Outcomes were the performance of AI-ECG in detecting left and right ventricular dysfunction, based on ejection fraction (QCG-LVD and QCG-RVD) and strain (ECG-LVGLS and ECG-RVGLS), and structural abnormalities including left ventricular hypertrophy (LVH) and left atrial enlargement (LAE). Model performance was assessed using the area under the receiver operating characteristic curve (AUC), with subgroup analyses by age, sex, and comorbidities. Among 38,804 participants (mean age 64.2 years; 48.2% male), AI-ECG models showed high accuracy for detecting left ventricular dysfunction (AUC 0.887 for QCG-LVD and 0.896 for ECG-LVGLS) and right ventricular dysfunction (AUC 0.778 for QCG-RVD and 0.825 for ECG-RVGLS). In a sub-cohort of 21,267 individuals, AUCs were 0.824 for detecting LVH and 0.883 for LAE. Subgroup analyses showed consistent performance, with higher accuracy among older individuals, males, and those with hypertension or ischemic heart disease. In this large multiethnic cohort, AI-ECG models demonstrated strong performance in detecting CMR-defined abnormalities, supporting their potential as a scalable, noninvasive screening tool for cardiovascular disease.

Refractory atrial tachyarrhythmias frequently occur in patients with congenital heart disease (CHD) who have a markedly enlarged right atrium (RA). The obfective of this study was to elucidate arrhythmogenic substrates and evaluate the comprehensive treatment outcomes in patients with complex CHD and a giant RA (≥190 mL). Ten patients with complex CHD and a giant RA who underwent catheter ablation (CA) were evaluated (median age, 40 [interquartile range (IQR), 33 to 52] years). A total of 23 tachyarrhythmias were identified during CA. Three distinct electrophysiological mechanisms were observed: atrial fibrillation with coexisting reentrant atrial tachycardia in 3 patients, reentrant atrial tachycardia localized to low-voltage scar areas (<0.03 mV) in 2 patients, and atrial tachycardia likely involving epicardial pathways in 3 patients. CA alone achieved an overall success rate of 70%, with partial success in 50% of cases. Post-CA, 6 patients underwent surgical intervention, including RA volume reduction (RAVR) and RA/coronary sinus cryoablation, while 8 patients received pacemaker-based rhythm management. Among the 9 patients treated with either surgical or device-based therapy, the clinical arrhythmia severity score showed significant improvement (median Δ, -3 [IQR, -4.5 to -2], p = 0.004), accompanied by reductions in brain natriuretic peptide levels (median Δ = -39.5 [IQR, -114.7 to -26.0] pg/mL, p = 0.004) and cardiothoracic ratio (Δ = -6.8 [IQR, -11.9 to 0.1]%, p = 0.039). In conlusion, in CHD patients with markedly enlarged RA, CA alone is often insufficient. A combined strategy involving surgical intervention and pacemaker-based rhythm control appears to offer superior outcomes for both arrhythmia management and hemodynamic status.