Pulsed field ablation (PFA) is a novel non-thermal ablation modality that has demonstrated efficacy and safety in the treatment of common arrhythmias such as atrial fibrillation (AF) and atrial flutter (AFL). However, evidence regarding its use in patients with dextrocardia remains scarce.

BACKGROUND Left ventricular summit ventricular tachycardia (LVSVT) originates in the epicardium of the superior left ventricular wall, between the origins of the main coronary arteries, with characteristic findings on 12-lead electrocardiogram (ECG) that can guide ablation. This report describes a 66-year-old man with dizziness and palpitations diagnosed with LVSVT using ECG and managed with radiofrequency ablation. CASE REPORT A 66-year-old man presented with 24 hours of dizziness and palpitations. He was hemodynamically stable, and the initial ECG showed frequent premature ventricular complexes with left bundle branch block-like morphology, inferior axis, and early precordial transition. Continuous monitoring and 24-hour Holter recording documented a high ventricular ectopic burden (~65%), with episodes of sustained and nonsustained monomorphic ventricular tachycardia of identical morphology. Echocardiography showed preserved left ventricular systolic function, and coronary angiography and cardiac magnetic resonance imaging excluded obstructive coronary disease, myocardial fibrosis, and scar. Because symptoms and arrhythmia burden persisted, an electrophysiological study was performed on day 4. Isoproterenol infusion induced ventricular tachycardia, activation mapping localized the earliest ventricular activation to the left ventricular summit, and radiofrequency ablation was performed from the great cardiac vein and adjacent left ventricular outflow tract and left coronary cusp sites after coronary angiography confirmed a safe distance from the coronary arteries. Ventricular ectopy was immediately suppressed, and no arrhythmia was inducible after ablation. At 30-day follow-up, the patient remained asymptomatic without recurrent ventricular arrhythmia on Holter monitoring. CONCLUSIONS Systematic ECG interpretation can localize LVSVT and guide effective catheter ablation.

Immune-mediated rippling muscle disease (iRMD) is a rare autoimmune myopathy characterized by mechanically triggered, wave-like skeletal muscle contractions. Its coexistence with myasthenia gravis (MG) has been described, but detailed clinicopathological and longitudinal characterization of anti-cavin-4-positive iRMD coexisting with isolated ocular MG remains limited. Here, we report a 35-year-old man who developed painless, water-like rippling movements of the right thigh in 2023, followed by occasional palpitations and mild creatine kinase elevation in 2024. In July 2025, he developed fluctuating right ptosis without diplopia, bulbar symptoms, or limb weakness. Serology showed anti-acetylcholine receptor antibody positivity and high-titer anti-cavin-4 antibodies. Electromyography revealed mild myogenic changes with electrically silent rippling activity. Muscle biopsy showed mild myopathic changes and mosaic caveolin-3 expression. Chest CT showed no thymic hyperplasia or thymoma, and cardiac evaluation showed no structural heart disease or clinically significant arrhythmia. These findings supported anti-cavin-4-positive iRMD coexisting with isolated AChR-positive ocular MG. At follow-up, the patient reported reduced rippling activity, preserved limb strength, and persistent mild fatigue-related ptosis. Among the cases identified in our search, this was the youngest documented case with isolated ocular MG and the first anti-cavin-4-positive ocular-MG case with muscle-biopsy documentation. The case extends the documented age and mild-severity spectrum of iRMD associated with MG or AChR antibody positivity.

BackgroundPeripartum cardiomyopathy (PPCM) is a rare, potentially life threatening condition with nonspecific heart failure symptoms, often leading to delayed diagnosis. Large language models (LLMs) may support differential diagnosis suggestion.ObjectivesTo assess whether commonly available LLMs can suggest PPCM and differential diagnoses based on typical symptoms.DesignComparative evaluation of three LLMs using standardized clinical scenarios.MethodsChatGPT (GPT-5), Gemini (2.5 Flash), and Claude (Sonnet 4.5) were queried with prompts describing a 34-year-old woman with PPCM-related symptoms, with and without postpartum context. Responses were analyzed for PPCM and key differential diagnoses recommended by the European Society of Cardiology.ResultsChatGPT and Claude consistently identified PPCM. Gemini suggested PPCM mainly when dyspnea or edema were present and required postpartum context when palpitations were reported. Claude listed the most differential diagnoses.ConclusionLLMs are a valuable tool among differential diagnosis suggestion but performance varies and cannot replace clinical judgment.

Permanent junctional reciprocating tachycardia (PJRT), also known as Coumel tachycardia, is a rare form of supraventricular tachycardia predominant in children and classically associated with tachycardia-induced cardiomyopathy. Its occurrence in adults is uncommon, and recurrence after a previously failed conventional ablation is even less frequently reported. We report the case of a 33-year-old woman with palpitations since childhood. At 12 years of age, she underwent a conventional electrophysiological study with radiofrequency ablation. However, symptoms persisted, requiring multiple antiarrhythmic drugs and frequent emergency department visits with only partial control, prompting a redo procedure. On this occasion, three-dimensional electroanatomical mapping with the "open-window" technique was used. During the procedure, orthodromic reciprocating tachycardia (ORT) using a right posteroseptal occult accessory pathway with decremental retrograde conduction was diagnosed. Radiofrequency ablation of the accessory pathway was successful, with a favorable clinical outcome at follow-up. Coumel tachycardia is an unusual type of supraventricular tachycardia, even more so in adults. The diagnostic approach begins with the electrocardiogram and extends to invasive methods such as electroanatomical mapping, which enable precise characterization of the arrhythmic substrate.

Endovascular therapy for occlusive lesion might reduce cardiac afterload and improve cardiac function potentially, but there is limited evidence regarding its effects on heart failure, particularly in patients with poorly controlled symptoms. One month earlier, this 80-year-old woman with paroxysmal atrial fibrillation had undergone left axillo-bifemoral bypass for acute aortoiliac occlusion and was transferred to a rehabilitation hospital. After that, she was returned to our hospital after developing palpitations, dyspnea, and hypoxia during post-operative rehabilitation. Laboratory tests showed anemia, mild renal dysfunction, and markedly elevated B type natriuretic peptide. Chest radiography demonstrated bilateral pulmonary congestion. She was diagnosed to acute heart failure, and treatment with intravenous furosemide at a dose of 40 mg/day and oral amiodarone at a dose of 100 mg/day was initiated. Because sinus rhythm could not be maintained despite medical therapy and pulmonary vein isolation, atrioventricular node radiofrequency catheter ablation and cardiac resynchronization therapy pacemaker implantation were performed on hospital Day 12. However, exertional oxygen desaturation persisted, BNP remained elevated, and rehabilitation was limited by bilateral intermittent claudication. On hospital Day 22, endovascular therapy for aortoiliac occlusive disease was performed. Subsequently, additional endovascular therapy was undertaken for chronic total occlusion of the left superficial femoral artery. She was able to ambulate 20 m with support without any intermittent claudication (ankle-brachial index increased from 0.67 to 0.91 on the right and from 0.81 to 0.98 on the left). Oxygen demand also gradually decreased (from 1 L/min to room air), and B type natriuretic peptide levels declined. Both systolic and diastolic blood pressure improved, and the patient was transferred back to the rehabilitation hospital on hospital Day 54 (32 days after endovascular therapy) without recurrence of heart failure symptoms. This case highlights two clinically relevant points. First, endovascular therapy for aortoiliac occlusive disease led to improvement in heart failure status. Second, B type natriuretic peptide levels showed a clear improvement following endovascular therapy.

Type 0 bicuspid aortic valve (BAV) with mild aortic regurgitation (AR) is generally considered a benign lesion. We report two pediatric cases of type 0 BAV with mild eccentric AR causing a previously undescribed complication: anterior mitral leaflet (AML) aneurysm and perforation through a novel "jet lesion" mechanism. A 13-year-old girl and an 8-year-old boy presented with palpitations and exertional dyspnea. Both had type 0 BAV with posteriorly or inferiorly directed mild eccentric AR. Transthoracic echocardiography identified a localized AML aneurysm with perforation resulting in severe secondary mitral regurgitation (MR). Inflammatory markers and blood cultures were negative, excluding infective endocarditis. Surgical exploration in one case confirmed a circular defect in the AML at the exact site where the AR jet impacted the leaflet. Pericardial patch repair was performed with successful restoration of mitral valve competence at 3-month follow-up. We propose that chronic low-velocity eccentric AR jets striking the AML induce endothelial denudation and localized myxomatous degeneration. Cyclic mechanical stress from regurgitant flow promotes progressive structural weakening, leading to aneurysm formation and eventual perforation with hemodynamically significant secondary MR. This observation challenges the assumption that mild AR in BAV is inconsequential. The temporal clustering of these cases suggests an underrecognized complication warranting heightened surveillance in BAV patients with posteriorly directed AR jets, regardless of AR severity. Systematic evaluation in larger cohorts is needed to clarify the prevalence, risk stratification, and optimal management strategies for this novel jet lesion complication in type 0 BAV disease.

Cardiac paragangliomas are rare neoplasms, comprising only 1%-3% of primary cardiac tumours, and often pose a diagnostic challenge.

Maternal cardiovascular disease is a leading cause of pregnancy-related death in the United States. Symptoms associated with cardiovascular disease include shortness of breath, palpitations, dizziness, syncope, chest pain, edema, and fatigue. Unfortunately, these symptoms are nonspecific and are common in pregnancy and postpartum. When a pregnant or postpartum person reports any of these symptoms, the provider needs a systematic approach to evaluate whether further work-up and consultation are needed or whether the patient can be reassured that the symptoms are likely "normal for pregnancy." The Society for Maternal-Fetal Medicine presents a checklist for triage of patients who report these symptoms and a checklist outlining the initial work-up of those who need further evaluation.

Brunner's gland hyperplasia (BGH) is an uncommon benign proliferative condition of the Brunner's glands. It is often asymptomatic and typically discovered incidentally during endoscopic procedures. We report a case of a patient with BGH diagnosed with endoscopic ultrasound biopsy after an initial negative endoscopic mucosal biopsy. A 52-year-old male presented with palpitations and exertional dyspnea as well as melenic stools of a 3-week duration. Laboratory testing was remarkable for a hemoglobin level of 5.9 g/dl and a mean corpuscular volume of 62 fl. Esophagogastroduodenoscopy and mucosal biopsy were inconclusive, necessitating endoscopic ultrasound with fine-needle biopsies. Due to bleeding, the mass was resected, and histological examination revealed the diagnosis of BGH. This case underscores the importance of considering BGH in the differential diagnosis of gastrointestinal bleeding.