Arrhythmia is a common and potentially life-threatening cardiovascular condition. Photoplethysmography (PPG) has emerged as a noninvasive alternative to electrocardiography for cardiac rhythm monitoring, yet most PPG-based methods remain limited to binary classification. In this study, a new deep learning approach is suggested for categorizing six arrhythmia types from PPG data: sinus rhythm (SR), premature ventricular contraction (PVC), premature atrial contraction (PAC), ventricular tachycardia (VT), supraventricular tachycardia (SVT), and atrial fibrillation (AF). The raw PPG signal is enhanced by extracting its first and second derivatives to capture morphological features not readily apparent in the original signal. A hybrid architecture, VGG-BiLSTM, is utilized, merging VGG convolutional layers for spatial features extraction with bidirectional long short-term memory layers for modeling temporal dependencies. A stratified data splitting strategy is further adopted to address class imbalance across arrhythmia types. A publicly available dataset containing 46,827 PPG segments from 91 individuals was employed to assess the effectiveness of the suggested technique. The method yielded an overall accuracy, sensitivity, specificity and F1 score of 88.7%, 78.5%, 97.6% and 80.5% correspondingly.

Tachycardia mediated cardiomyopathy (TMC) is a reversible form of cardiomyopathy that results from persistent or incessant tachyarrhythmias. TMC may progress rapidly and present with symptoms of decompensated heart failure, cardiogenic shock, or multisystem organ dysfunction, sometimes in individuals with no prior cardiac history. Prompt recognition of the arrhythmia and early elimination of the underlying tachycardia are crucial, as restoration of sinus rhythm typically leads to complete or near-complete recovery of ventricular function [1]. Incessant supra-ventricular tachycardia (SVT) can be challenging to diagnose when patients present with advanced heart failure and multiorgan involvement and misinterpretation may delay definitive therapy. This case highlights an extreme presentation of incessant orthodromic AVRT causing biventricular failure, severe hepatic congestion and metabolic acidosis, with complete recovery following catheter ablation of a concealed left-sided accessory pathway.

The underlying mechanism of focal atrial tachycardia (AT) is usually considered to be abnormal automaticity, typically with a cycle length (CL) exceeding 120 ms. We present a case of a 29-year-old female with recurrent symptomatic palpitations. She was referred for electrophysiologic study and catheter ablation. Twelve-lead ECG showed a sinus rhythm with incessant atrial ectopic beats and occasional aberrant conduction. P-wave morphology during ectopic revealed positive deflections in Leads I, II, aVL, aVF, and V1-V6, suggesting a left-sided origin. Intracardiac recordings obtained using a circular multipolar mapping catheter demonstrated incessant, repetitive, regular spike potentials with an extremely short CL at the posterior aspect of the right inferior pulmonary vein (RIPV). The tachycardia CL within the RIPV was approximately 70 ms and was conducted to the left atrium (LA) with variable exit block ranging from 2:1 to 4:1 conduction. Successful ablation was performed at the earliest activation and shortest CL site outside the RIPV with exit block from the RIPV to LA. The mechanism for this tachycardia is uncertain, but the very short CL suggests that a localized spiral wave re-entry may be involved.

Hyoscyamus niger (henbane) is a toxic plant containing tropane alkaloids that can cause anticholinergic toxicity. Pediatric presentations may differ from adults and may include atypical behavioral manifestations such as hyperactivity and euphoria without agitation. An 11-year-old previously healthy boy presented with sudden behavioral changes, hyperactivity, and unexplained euphoria. Approximately four hours earlier, he had ingested about one tablespoon of fresh Hyoscyamus niger seeds. Physical examination revealed minimal mydriasis and mild flushing. The patient was cooperative but disoriented, with visual hallucinations. Laboratory tests were normal, and electrocardiography showed sinus tachycardia. Findings were consistent with anticholinergic toxicity. Activated charcoal and physostigmine were not administered due to delayed presentation and absence of severe or life-threatening symptoms. Symptoms resolved completely within 24 hours with supportive care. In conclusion, Hyoscyamus niger intoxication may present predominantly with hyperactivity and euphoria without agitation, representing an atypical behavioral phenotype in pediatric patients. Plant-derived toxicities should be considered when acute behavioral changes occur, especially in rural settings.

Neurologic and cardiovascular symptoms are uncommon complications of laparoscopic adjustable gastric banding (LAGB). Alterations in vagal tone have been reported, most commonly as vasovagal syncope or bradycardia. We describe a unique presentation of sinus tachycardia and paresthesias resulting from vagal nerve irritation due to gastric band adjustments. A 51-year-old woman with a past medical history of rheumatoid arthritis and laparoscopic adjustable gastric band surgery presented with episodic right-sided paresthesias, palpitations, and sinus tachycardia occurring predominantly during and after meals. Vital signs were normal, and initial blood tests were unremarkable. Telemetry revealed periods of sinus tachycardia up to 160 beats per minute. Extensive neurologic, infectious, and cardiopulmonary evaluation was unrevealing. Further history revealed similar symptoms following prior gastric band adjustment. After removing 4.2 mL of fluid from the gastric band, the patient had complete resolution of symptoms. Surgical placement of an adjustable gastric band is close to the anterior vagal trunk, which courses near the gastroesophageal junction. Placement or adjustments of the gastric band can irritate or compress the vagal nerve, leading to unintended autonomic responses. Even without symptoms at rest, expansion of the stomach from food can lead to a similar response. While vagal nerve stimulation normally produces bradycardia, this case demonstrates that vagal dysfunction can present with paradoxical sinus tachycardia and sensory symptoms, all of which resolved with decreased gastric band pressure. In patients with prior adjustable gastric banding, vagal nerve stimulation should be considered for unexplained autonomic or neurologic symptoms. Early recognition can prevent unnecessary testing and facilitate prompt management. This case highlights the importance of recognizing neurologic and cardiovascular complications of gastric banding to provide appropriate management.