Ventricular tachycardia following myocardial infarction is often sustained by complex reentrant circuits that are challenging to characterize and treat using conventional electroanatomical mapping. Computational modeling provides a powerful complementary approach to understanding conduction pathway dynamics more effectively and supporting ablation strategies. Here, we present a reproducible and data-driven clinically guided computational framework for the retrospective analysis of post-infarction ventricular tachycardia and ablation procedures. The method integrates patient-specific electroanatomical mapping data-including local activation times, voltage maps, and electrograms-to build a personalized model that captures both structural and functional remodeling via a viability-based scalar field. A novel calibration procedure is introduced to locally estimate tissue conductivity, enabling accurate reproduction of observed activation patterns. The model is used to simulate arrhythmia inducibility and sustainability, and to retrospectively evaluate the impact of clinical radiofrequency ablation, accounting for lesion size and transmurality. In silico exploration of alternative ablation strategies is also performed to minimize lesion volume while maintaining arrhythmia suppression. The entire workflow is designed for rapid execution using a GPU-accelerated monodomain solver and is fully compatible with existing clinical practices, offering a practical tool for substrate interpretation and patient-specific ablation planning.

Management of patients with an implantable cardioverter defibrillator (ICD) and ventricular tachycardia (VT) is a common clinical challenge. Suppression is often warranted. Catheter ablation (CA) is being used increasingly with expanding indications, and novel procedural strategies are being investigated for refractory cases. The purpose of the review is to synthesize the evidence for ventricular tachycardia suppression and the modalities.

Coronary artery disease is the most common type of heart disease. Revascularization with coronary artery bypass grafting can improve survival in patients with severe coronary artery disease and reduced left ventricular ejection fraction. The Impella 5.5 (Abiomed) with SmartAssist intravascular microaxial blood pump can provide safe and effective perioperative support in patients with severely reduced left ventricular ejection fraction of less than 20%. However, no research has been conducted on Impella 5.5 use with patients who have left ventricular ejection fraction of less than 20% and persistent nonsustaining ventricular tachycardia. More research is needed on the use of the Impella device, specifically regarding patient profile, timing, and device management. This case report describes the outcomes of a 4-vessel coronary artery bypass grafting revascularization procedure assisted by Impella use and dobutamine in combination with antiarrhythmic agents for a patient with both severe coronary disease and persistent nonsustaining ventricular tachycardia postoperatively.

Holter-ECG monitoring is a critical component of post-stroke diagnostics, guiding cardiac work-up and secondary stroke prevention. Abnormal ECG findings beyond atrial fibrillation (AF) in stroke patients remain understudied. The prospective multicenter MonDAFIS trial randomized patients with acute ischemic stroke or transient ischemic attack (TIA) without known AF to Holter-ECG recording up to 7 days or usual care. Holter-ECG findings from the first 72 h of the intervention arm were analyzed to provide a reference guide in clinical practice. Furthermore, 24-hour and 72-hour Holter-ECG monitoring were compared to analyze the value of prolonged monitoring. 24-hour Holter-ECGs from 1,665 patients (median age 67; 40.4% women) identified supraventricular tachycardia (SVT) in 4.1% and newly-diagnosed AF in 2.2% of patients. Premature ventricular complexes were common (85.8%), ventricular couplets (28.0%) or bigeminy (14.0%) less common. Non-sustained ventricular tachycardia (nsVT) was detected in 1.7% of patients. Extended 72-hour-monitoring in 1,283 patients led to higher detection rates across all abnormalities, doubling nsVT (4.4%) and SVT (8.8%) detection rates. Generally, we observed higher detection rates with older age. Detection rates of supraventricular arrhythmias were higher in women, whereas men exhibited higher rates of ventricular abnormalities. Post-stroke ECG monitoring detects various arrhythmias beyond AF in a substantial proportion of individuals. Longer monitoring and older age are associated with increased detection rates, with notable sex-specific differences.

The cardiac ryanodine receptor (RyR2) is a critical calcium release channel essential for normal cardiac contraction. Dysregulation of RyR2 function is a key pathogenic factor in various cardiac diseases, notably arrhythmias and heart failure. The clinical spectrum of RyR2-related diseases (ryanodinopathy) has expanded beyond the well-established gain-of-function (GOF) mutations causing catecholaminergic polymorphic ventricular tachycardia (CPVT). Recent research has now delineated two additional distinct clinical entities: exon 3 deletion syndrome (E3DS), which presents with CPVT along with structural abnormalities, and calcium release deficiency syndrome (CRDS), caused by loss-of-function (LOF) mutations. CRDS is characterized by impaired calcium release from the sarcoplasmic reticulum and fundamentally differs from the classical CPVT phenotype, necessitating distinct approaches to its diagnosis, clinical management, and therapeutic intervention. This review provides a comprehensive overview of the current understanding of CRDS. We discuss its clinical manifestations, scrutinize the underlying molecular mechanisms, evaluate available diagnostic strategies, and explore potential therapeutic avenues. By synthesizing latest findings, this review aims to illuminate the complexities of RyR2-mediated pathologies and foster further progress in this evolving field.

Myocarditis is an underrecognized cause of malignant ventricular arrhythmias, particularly in young adults with preserved cardiac structure on initial evaluation. We report a 37-year-old previously healthy man who presented with hemodynamically unstable ventricular tachycardia accompanied by significant troponin elevation but normal coronary arteries and preserved left ventricular systolic function on echocardiography. The arrhythmia initially mimicked idiopathic fascicular ventricular tachycardia. Cardiac magnetic resonance imaging subsequently revealed subepicardial late gadolinium enhancement and myocardial edema, establishing the diagnosis of acute myocarditis as the arrhythmogenic substrate. Therapy was adjusted with good clinical stability and no recurrence of arrhythmia. This case underscores the diagnostic challenges and the value of cardiac magnetic resonance imaging in unexplained ventricular tachycardia and emphasizes the importance of thorough history followed by etiology-directed management in myocarditis-related arrhythmias, and that clinicians must maintain a high index of suspicion for myocarditis in similar presentations.

Pregnancy involves numerous physiological changes in the cardiovascular system to guarantee foetal metabolic demands. In patients with cardiovascular disease, these adaptations can decompensate their underlying condition, leading to maternal and obstetric complications.We report a case of arrhythmogenic cardiomyopathy presenting as an electrical storm during pregnancy, highlighting both diagnostic and management challenges.