Since the first human implantation in 1980, implantable cardioverter-defibrillators (ICDs) have transformed the prevention of sudden cardiac death. Today, multiple ICD platforms are available, each with distinct strengths and limitations, making individualized device selection essential to optimize outcomes and minimize complications. The transvenous ICD (TV-ICD) remains the most established technology, offering reliable defibrillation, antitachycardia pacing (ATP), and pacing support, but is limited by lead-related complications and infection risk. The subcutaneous ICD (S-ICD) avoids intravascular leads and is particularly attractive in younger patients and those at high risk of infection, although it lacks ATP and has shorter device longevity. The extravascular ICD (EV-ICD) is an emerging alternative designed to combine the advantages of both systems by providing ATP and shock therapy without intravascular leads, though implantation is more complex and long-term evidence remains limited. Given these differences, ICD selection should be guided by patient-specific clinical characteristics rather than a one-size-fits-all approach. Key determinants include pacing indication, prior lead failure, infection risk, body mass index, age, and arrhythmic substrate. The proposed clinical pathway offers a practical framework to support tailored ICD selection by integrating these variables into a structured decision-making process. Such an individualized approach may improve patient outcomes, reduce device-related complications, and enhance the appropriate adoption of contemporary ICD technologies.

Mitral valve (MV) disease, particularly MV prolapse (MVP) and mitral regurgitation (MR), affects 2 to 5% of the population and poses a substantial arrhythmogenic risk, with 43% of MVP patients developing arrhythmias. Although less common in children, the absence of comorbidities can uniquely isolate early electromechanical alterations that may elucidate mechanisms later contributing to arrhythmic risk and devastating effects such as sudden cardiac death. Conventional echocardiography lacks sensitivity for MV electromechanics, motivating advanced approaches. We introduce Electromechanical Wave Imaging (EWI), a high-frame-rate echocardiography modality, to map MV-complex activation and diastolic recovery in N = 21 MVP, MR, and control pediatric subjects (13.10 ± 4.51 y old, 43% male). A preclinical canine study (n = 3) established EWI's ability to observe temporally coupled electromechanical wave propagation across the atrioventricular junction through the closed MV-following atrial and preceding ventricular activation (73.0 ms, 60 BPM). MVP patients exhibited significantly delayed left ventricular (LV) activation (76.04 ± 12.51 ms vs. 47.64 ± 2.57 ms in controls, P = 0.0013), primarily in papillary muscles. Both MVP and MR-only subjects exhibited prolonged LV recovery, with MR-only patients showing significantly longer recovery intervals (MR-only: 277.0 ± 27.61 ms, Control: 248.7 ± 10.43 ms, MVP vs. Control: MR-only vs. Control: P = 0.0395). In two arrhythmogenic MVP cases, EWI localized arrhythmic exit sites adjacent to LV papillary muscles, coinciding with regional delayed sinus activation, aligning with invasive electrophysiology. This study demonstrates that atrioventricular valve function dictates cardiac electromechanical function and establishes full-cycle EWI as a transformative tool for diagnosing MV disease electromechanical effects, assessing arrhythmic risk, guiding interventions, and advancing noninvasive cardiac imaging.

Acute myocardial infarction (AMI) remains one of the leading causes of sudden death with significant implications in both clinical and forensic practice. In forensic settings, AMI diagnosis traditionally relies on gross and histopathological findings. However, when ischemic changes are subtle or insufficiently developed, various cardiac biomarkers have been investigated to support postmortem diagnosis. Periostin, a matricellular protein involved in tissue remodeling and repair, has recently garnered attention for its role in cardiac pathology. Emerging evidence suggests that serum periostin may be a valuable biomarker for assessing cardiac injury and predicting outcomes after AMI. This study aimed to evaluate serum periostin levels in forensic autopsy cases of AMI. The subjects were 80 autopsy cases, categorized into AMI (n = 46), fatal asthma (n = 16), and traumatic deaths (n = 18). Serum periostin levels were significantly elevated in AMI compared with asthma and trauma cases, with median values of 728.50 ng/mL (IQR 465.25-1139.75) in AMI, 410.50 ng/mL (IQR 253.00-756.00) in asthma, and 386.50 ng/mL (IQR 229.75-532.50) in trauma. Serum periostin showed no significant correlation with postmortem interval and was minimally influenced by patients' characteristics or comorbidities. These findings provide baseline data on serum periostin levels in forensic autopsy cases and suggest that periostin measurement may assist in the postmortem evaluation of AMI.

Through a constructivist qualitative design and semi-structured, in-depth interviews with 11 adults, this study examines how Arab-Muslims retrospectively make sense of childhood maternal loss and how it continues to shape them in adulthood. Analysis identified two interrelated themes: participants experienced sudden maternal death as a biographical rupture dividing life into a "before" and "after," and they sustained ongoing bonds with their deceased mothers, neither fully absent nor present, through everyday relational practices. These themes suggest that participants move from rupture toward relational continuity, reconstructing access to maternal presence over time. Highlighting the evolving meanings of childhood maternal loss, the study challenges detachment-oriented and stage-based grief models; contributes to qualitative social work scholarship, showing how sudden loss, cultural context, and relational continuity intersect in shaping identity and belonging; and informs culturally responsive bereavement support.

Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, with autopsy-confirmed fatal cases remaining uncommon. This report presents a rare case of sudden death in a 13-year-old male adolescent caused by rupture of a noncoronary SVA into the right atrium, resulting in acute circulatory dysfunction, with vomiting as the only initial symptom. The cause of death was confirmed through comprehensive forensic autopsy, histological examination, and toxicological analysis. Additionally, a review of relevant autopsy case reports published in the past two decades on PubMed and Web of Science identified 13 cases of SVA-related mortality. We summarized the anatomical origin of aneurysms, gender distribution, clinical manifestations, rupture-associated fatal mechanisms, and pathological features observed in these cases. The findings indicated that in SVA-related fatal cases, the most common rupture sites were the right coronary sinus, left coronary sinus, and noncoronary sinus. The rupture typically occurred into the atrium or pericardium. Chest pain and vomiting were frequently reported as prodromal symptoms. Imaging techniques such as echocardiography and computed tomography were useful in aiding diagnosis. Cardiac pathology in these cases was often accompanied by additional abnormalities, including cardiomegaly, atherosclerosis, inflammation, or congenital defects. This report, in conjunction with the literature review, provides important reference material for forensic autopsy.

Background Cardiac autonomic dysfunction is increasingly recognized in epilepsy and has been implicated in cardiovascular complications and sudden unexpected death in epilepsy (SUDEP). Heart rate variability (HRV) provides a non-invasive measure of cardiac autonomic modulation; however, the influence of interictal epileptiform discharges (IEDs) on resting HRV remains uncertain. This study compared HRV among patients with seizure disorders with and without IEDs and a non-seizure neurological comparison group using ECG signals extracted from archived routine electroencephalography (EEG) recordings. Methods This retrospective observational study included 45 adults (15 per group): seizure disorder with IEDs, seizure disorder without IEDs, and non-seizure neurological complaints. A stable, artifact-free five-minute lead II ECG segment was extracted from archived digital EEG recordings after completion of activation procedures. Short-term HRV analysis was performed using LabChart Pro (ADInstruments, Dunedin, New Zealand) and included time-domain, frequency-domain, and nonlinear parameters. Groups were compared using one-way ANOVA or the Kruskal-Wallis test, with appropriate post hoc analyses. Results Demographic characteristics were comparable across the three groups. pNN50 differed significantly among the groups (F(2,42) = 5.127, p = 0.010), with higher values in the non-seizure group than in both seizure groups. Total power (F(2,42) = 3.353, p = 0.045) and high-frequency (HF) power (F(2,42) = 3.905, p = 0.028) also differed significantly, with post hoc differences observed between the non-seizure comparison group and the seizure without IED and seizure with IED groups, respectively. No significant differences were observed in LF power, LF/HF ratio, or nonlinear HRV indices. No HRV parameter differed significantly between the two seizure groups. Conclusions Patients with seizure disorders demonstrated lower vagally mediated HRV than the non-seizure neurological comparison group, whereas the presence of IEDs was not associated with measurable additional alterations in resting cardiac autonomic modulation.

Sudden unexpected death in young adults is a significant challenge in forensic pathology. While atherosclerotic cardiovascular disease is the most common cause of sudden cardiac death, rare chronic inflammatory conditions such as coronary vasculitis are important and often overlooked. Amphetamine use is emerging as a factor linked to severe cardiovascular complications, including arrhythmia, myocardial infarction, and vasculitis. We report the sudden death of a 27-year-old male with no medical history of cardiac illness. Postmortem autopsy revealed acute myocardial infarction with no evidence of severe coronary atherosclerosis. Histopathology of the coronary arteries demonstrated active vasculitis, with significant luminal stenosis estimated at 70-80%, accompanied by dense inflammatory infiltrates, causing disruption of the arterial wall. Blood toxicological analysis confirmed the presence of toxic amphetamine levels of 1,008 ng/mL. This case report highlights coronary vasculitis as a rare but lethal cause of sudden cardiac death. It emphasizes the need for comprehensive histopathological examination in all forensic autopsies, particularly when typical atherosclerotic findings are absent. This case report contributes to the literature on the cardiotoxic effects of amphetamine and urges forensic pathologists to maintain a high index of suspicion for drug-associated inflammatory vascular disease in the context of stimulant abuse to ensure accurate determination of the cause of death.

Transcatheter device closure is the preferred treatment for secundum atrial septal defect (ASD) in young adults with suitable anatomy. In this population, routine coronary angiography is generally not recommended in the absence of ischemic symptoms or conventional cardiovascular risk factors. However, coronary imaging is selectively performed during ASD intervention to delineate anomalous coronary anatomy at risk of device-related compression, and emerging evidence indicates that clinically significant coronary artery disease may occasionally coexist silently in younger adults. We report the case of a 28-year-old asymptomatic woman undergoing transcatheter closure of a large secundum ASD with deficient rims, in whom coronary angiography performed during invasive catheterization unexpectedly revealed critical left main coronary artery stenosis. Intravascular ultrasound (IVUS) confirmed severe luminal compromise, and successful IVUS-guided left main coronary stenting was performed, followed by device-assisted ASD closure in the same procedural session. Retrospective clinical assessment revealed a history of premature sudden cardiac death in a first-degree relative. This case illustrates the potential for occult yet prognostically significant coronary artery disease in young adults undergoing congenital heart interventions and supports a selective, individualized, and context-driven approach to coronary evaluation, consistent with contemporary adult congenital heart disease guidelines.

Viral myocarditis (VM) affects over 1 million people yearly worldwide and may trigger arrhythmia, heart failure, or sudden death, bringing heavy clinical and economic burdens. TikTok and Bilibili are vital health information hubs, yet unregulated VM video content lacks quality evaluation on Chinese platforms. This cross-sectional study assessed VM video reliability and completeness on both platforms to support evidence-based health guidance. Data collection finished on February 15, 2026. We collected the top 100 default-ranked videos per platform via incognito new accounts searching "viral myocarditis." After screening out ads, irrelevant, recent and duplicate videos, 180 clips (TikTok = 91, Bilibili = 89) were analyzed. Two trained cardiologists scored videos with the 0 to 5 modified DISCERN (instrument for evaluating health information quality) scale and 1 to 5 Global Quality Score and graded 6 disease domains' completeness using a 3-point scale. Nonparametric tests and Spearman correlation were adopted, with P < .05 as the statistical significance threshold. TikTok videos had significantly higher median likes, comments, saves, and shares (all P < .001), while Bilibili videos were longer (139 vs 95 seconds, P = .002). Professional creators accounted for 71.43% of TikTok uploads versus 44.94% on Bilibili, which hosted more nonprofessional contributors. TikTok fully covered symptoms best (40.66%) but ignored epidemiology (83.52% uncovered); Bilibili offered more complete etiology, prevention, and symptom explanations yet lacked epidemiological content. Bilibili contained far more high-rating DISCERN (4-5) and 5-star Global Quality Score videos and no 1-point low-quality clips, unlike TikTok. Engagement metrics were strongly positively correlated on both platforms; video duration weakly negatively correlated with interaction on TikTok but moderately positively correlated on Bilibili. Inter-rater reliability was excellent (r = 0.81-0.96). Bilibili's VM videos outperform TikTok in information completeness and overall quality. TikTok's higher traffic often favors low-quality content, and preventive knowledge coverage is insufficient on both platforms. Such gaps arise from distinct user groups, content formats, and algorithms. Optimized algorithms, medical creator certification, and differentiated science communication can standardize VM online education and help patients access reliable disease management knowledge.

Methadone is a long-acting opioid used to treat opioid use disorder, cancer pain and provide perioperative analgesia. Methadone administration has been associated with QTc interval prolongation and consequently an increased risk of ventricular arrhythmias. This mechanism appears to be mediated by HERG channel inhibition, drug-drug interactions and genetic susceptibility. This protocol describes the methodology for a systematic review and meta-analysis aiming to evaluate the association between methadone administration and QTc prolongation and estimate the odds of major cardiac events. Our leading hypothesis is that methadone exerts a dose-dependent and time-dependent effect on QT prolongation.