Seung Min Baek

Song MK, et al. Korean Circ J. 2027 ;57:e54. https://doi.org/10.4070/kcj.2025.0506

Background: Ventricular arrhythmias (VA) after percutaneous pulmonary valve implantation (PPVI) have been mainly reported with balloon‐expandable valves. Data on VA following self‐expandable valves, particularly the Pulsta valve, remain limited. Aims: To evaluate the incidence, clinical characteristics, and predictors of clinically significant VA after Pulsta valve implantation in patients with native right ventricular outflow tract (RVOT) disease. Methods: We retrospectively reviewed 129 consecutive patients who underwent PPVI with the Pulsta valve. All patients received continuous telemetry monitoring until discharge. Clinically significant VA was defined as VA requiring antiarrhythmic therapy. Clinical, electrocardiographic, RVOT morphological, and valve‐related variables were analyzed using univariable logistic regression. Results: The median age at PPVI was 27 years (interquartile range, 22.0–36.0). Over a median follow‐up of 3.3 years, any VA occurred in 42 patients (32.6%), predominantly transient premature ventricular complexes (PVCs; 16.3%) or non‐sustained ventricular tachycardia (VT; 16.3%). Among patients with non‐sustained VT, antiarrhythmic therapy was required in 5 patients (3.9%), with only 2 patients (1.6%) remaining on medication at discharge. No sustained VT, hemodynamic instability, or persistent arrhythmia requiring long‐term therapy was observed. Proximal RVOT implantation was the strongest predictor of VA (odds ratio 5.74, 95% confidence interval 1.08–30.57 vs. mid/distal RVOT, p = 0.039). Other clinical, electrocardiographic, anatomical, and valve‐related factors were not associated with VA. Conclusions: In patients with native RVOT disease treated with self‐expandable Pulsta valve, clinically significant VA was rare, and most VAs were benign and self‐limited. Pulsta valve implantation at proximal RVOT was the key determinant of VA risk.

Aims: Awareness of long-term arrhythmia complications after Fontan surgery is increasing, but the impact of surgical type and risk factors on arrhythmia development remain incompletely understood. Methods and results: We retrospectively analysed 1492 Fontan patients from the Korean multicentre registry (1979–2019), categorized into atriopulmonary connection (AP) (n = 106), lateral tunnel (LT) (n = 234), and extracardiac conduit (ECC) (n = 1143) with a median follow-up of 14 years. Arrhythmias occurred in 13.3% of patients at a median age of 17.3 years (tachyarrhythmias 9.9%, bradyarrhythmias 6.8%). At 20 years, freedom from any arrhythmia, tachyarrhythmia, and bradyarrhythmia was 82.5%, 86.9%, and 90.5%, respectively. On multivariable analysis, AP (HR 5.89, 95% CI 3.75–9.25; P < 0.001) and LT (HR 2.85, 95% CI 1.93–4.21; P < 0.001) were associated with a higher risk of arrhythmia compared with ECC. Older age at Fontan surgery also independently increased arrhythmia risk (HR 1.06, 95% CI 1.03–1.10; P < 0.001). Compared with ECC Fontan, LT Fontan and AP Fontan were associated with a progressively higher risk of both tachyarrhythmias (HR 2.99 and 8.20, respectively) and bradyarrhythmias (HR 2.63 and 5.47, respectively; all P < 0.001). The all-cause mortality rate and Fontan failure rate were 9.3% (0.69 per 100 patient-years) and 20.0% (1.61 per 100 patient-years), respectively. Late-onset arrhythmias were associated with an increased risk of mortality and Fontan failure (P = 0.003 and P < 0.001). Conclusion: This large, long-term registry shows that ECC Fontan confers a lower arrhythmia risk than LT or AP, and arrhythmias serve as a marker of Fontan failure and mortality in post-Fontan patients.

Objectives: This study aimed to evaluate the surgical outcomes of cone reconstruction (CR) in paediatric patients with Ebstein anomaly (EA). Methods: We retrospectively reviewed seventeen paediatric patients (<18 years) with EA (Carpentier types A, B, and C in 3, 12, and 2, respectively) who underwent CR without prosthetic annuloplasty materials between January 2014 and December 2024. Clinical outcomes, including tricuspid valve (TV) and biventricular function and size, were evaluated using echocardiography and cardiac magnetic resonance imaging (CMR). Results: The median age and body weight at surgery were 7.8 years and 21.2 kg, respectively. No operative mortality occurred; however, 3 patients required permanent pacemaker implantation before discharge. No late deaths, reoperations, or significant tricuspid regurgitation (TR, ≥moderate) or stenosis (mean pressure gradient ≥5 mmHg) occurred during the 8.2-year median follow-up. TR was significantly reduced postoperatively (odds ratio 1.34, 95% CI, 1.10-1.64, P = .008) and remained stable without recurrence of significant TR during follow-up. The mean TV annulus z-score decreased significantly after CR (1.81 [1.19] preoperatively versus −1.74 [0.92] at discharge, mean difference: −3.55, 95% CI, −4.30 to −2.80, P < .001) and remained within the normal range during follow-up (−1.74 [0.92] at discharge versus −1.61 [1.11] at the last follow-up, mean difference: 0.04, 95% CI, −0.02-0.10, P = .207). Postoperative CMR demonstrated significantly reduced TR fraction and right heart volumetric parameters, except functional right ventricular end-systolic volume and pulmonary forward flow volume indices. Based on CMR, left ventricular end-diastolic (change 2.40, 95% CI, 0.52-4.27, P = .014) and systolic (change 1.75, 95% CI, 0.74-2.76, P = .002) volume indices significantly increased over time. Conclusions: Long-term outcomes after CR without prosthetic annuloplasty materials were favourable in paediatric patients with EA. CR can achieve durable reduction of TR with sustained TV growth, potentially facilitating biventricular reverse remodelling.

Background: Patients with Fontan circulation experience significant morbidity from supraventricular tachyarrhythmias (SVTs). However, the electrophysiological features of SVT and the efficacy and safety of catheter ablation in patients with Fontan circulation are poorly understood. This study aimed to elucidate the electrophysiological features of SVT and evaluate the efficacy and safety of catheter ablation in patients with Fontan circulation. Methods: Forty-nine patients (age, 29.2±10.0 years; 27 males) with functional single ventricle and Fontan circulation who had undergone electrophysiological study for SVT were retrospectively enrolled. Parameters analyzed included underlying congenital heart disease, Fontan type, conduit puncture technique, tachycardia mechanisms, tachycardia origin site, acute success rate, procedure-related complications, and recurrence. Results: Fifty-nine SVTs were induced, and 69 catheter ablations were performed. The Fontan types included atriopulmonary connection (APC, 18.4%), lateral tunnel (LT, 38.8%), and extracardiac conduit (ECC, 42.9%). Inducible tachycardias included intra-atrial reentrant tachycardia (IART, 39.0%), focal atrial tachycardia (AT, 28.8%), atrioventricular reentrant tachycardia (11.9%), atrioventricular nodal reentrant tachycardia (10.2%), and atrioventricular reciprocating tachycardia involving the twin atrioventricular nodes (10.2%). The right atrial (RA) lateral wall was the most common location of IART and focal AT. The acute success and complication rates were 73.5% and 4.1%, respectively. Recurrence rate was 34.7% during follow-up of 78.0±71.9 months. The cumulative recurrence rate was significantly lower in patients who underwent LT or ECC Fontan procedures than in those who underwent the APC Fontan procedure ( P <0.001). Conclusions: Catheter ablation for SVT is effective and safe in patients who have undergone LT and ECC Fontan procedures. What is known?: The incidence of arrhythmia is higher in patients with Fontan circulation than the general population. Catheter ablation for arrhythmia in patients undergoing lateral tunnel or extracardiac conduit Fontan procedures is more challenging because of the complex cardiovascular anatomy and limited accessibility. What the study adds: Intra-atrial reentrant tachycardia (IART) and focal atrial tachycardia (AT) were the most common supraventricular tachycardias (SVT) in patients with Fontan circulation. The right atrial lateral wall was the most common site of critical IART isthmus and focal AT origin in patients with Fontan circulation. Catheter ablation for SVT was effective and safe in patients who underwent the lateral tunnel or extracardiac conduit Fontan procedures.

Background: Hemodynamically significant patent ductus arteriosus (hsPDA) leads to left‐sided chamber dilatation and mitral valve (MV) annular stretching, potentially resulting in mitral regurgitation (MR). While transcatheter PDA closure often improves MR, persistent MR may be associated with adverse outcomes. This study aimed to identify echocardiographic predictors of persistent MR following transcatheter PDA closure in pediatric patients. Methods: We conducted a retrospective study of 183 pediatric patients (aged 1–18 years) who underwent transcatheter PDA closure at Seoul National University Hospital between 2004 and 2021. Echocardiographic parameters, including left ventricular internal diameter in diastole (LVIDd), MV annulus diameter, and MR severity were analyzed before and after the procedure. Cardiac catheterization data were also reviewed. Results: The mean age at the time of the procedure was 1.92 years, and the average pulmonic end diameter of PDA was 2.91 mm. After transcatheter PDA closure, LVIDd (Z‐score), LVIDd/BSA, and MV annulus (Z‐score) significantly decreased. The prevalence of MR decreased from 22.4% (preclosure) to 8.2% (postclosure). Multivariate analysis identified preclosure LVIDd (Z‐score), postclosure MV annulus diameter (mm), MV annulus (Z‐score), and the presence of MV prolapse as independent predictors of persistent MR. ROC analysis demonstrated that a preclosure LVIDd (Z‐score) ≥ 2.95 predicted persistent MR with a sensitivity of 66.7% and a specificity of 83.9%. Conclusions: Persistent MR after transcatheter PDA closure is predicted by preclosure LVIDd (Z‐score), postclosure MV annulus diameter, and the presence of MV prolapse. Recognizing these factors may help guide clinical management and improve outcomes for patients at the risk of persistent MR.

Pericardiocentesis serves both diagnostic and life-saving purposes across a range of clinical scenarios. Despite its importance, there remain limited data

Park WY, et al. Int J Arrhythm. 2026 ;27:e13. https://doi.org/10.18501/ija.2026.27.e13

OBJECTIVES: This study aimed to evaluate the surgical outcomes of tricuspid valve (TV) leaflet augmentation using fresh autologous pericardium (FAP) in patients with pulmonary atresia with intact ventricular septum (PA-IVS). METHODS: Nine patients with PA-IVS underwent TV leaflet augmentation (TVLA) using FAP between January 2017 and April 2024. Native TV failure (NTVF) was defined as significant (≥moderate) tricuspid regurgitation and/or stenosis (mean pressure gradient> 5 mmHg). Clinical outcomes including both TV and right ventricle (RV) size and functions were evaluated using echocardiography and magnetic resonance imaging (MRI). RESULTS: The median age and body weight at the time of surgery were 5.4 years and 21.2 kg, respectively. No operative mortality occurred. During the follow-up period, no late mortalities, reoperations, or significant TV leaflet-related complications were observed; NTVF was not observed in any patients, except one with significant tricuspid regurgitation. Biventricular repair was performed in all patients except one who had undergone preoperative one-and-a-half ventricle repair. After TVLA using FAP, the median TV annulus z-score remained within the normal ranges (preoperative -0.42[-0.62 to 0.57] vs postoperative -0.51[-0.95 to -0.13], mean difference: 0.231, 95% confidence interval: -0.338 to 0.800, p = 0.377) and tricuspid regurgitation improved significantly (mean difference: 2.111, 95% confidence interval: 1.510–2.712, p = 0.040). Postoperative MRI showed that RV function and cardiac output were preserved within acceptable ranges. CONCLUSIONS: TVLA using FAP could be a considerable and viable approach to optimize RV growth while preserving RV and TV functions in the long-term in young patients with PA-IVS.