Sang Yun Lee

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.

BACKGROUND: Patients with congenital or acquired right ventricular outflow tract dysfunction frequently require pulmonary valve replacement and are exposed to repeated surgical interventions due to prosthetic valve degeneration. The PULSTA self-expanding transcatheter pulmonary valve was designed to address a broad spectrum of native and surgically repaired right ventricular outflow tract anatomies. This study reports the midterm safety, hemodynamic performance, and durability outcomes of the prospective, multinational PULSTA CE approval trial (PULSTA Carpentier Edwards). METHODS: This premarket, multicenter, nonrandomized study enrolled 58 patients across 11 centers in 6 countries. Successful PULSTA implantation was achieved in 57 patients (98.3%), including 4 valve-in-valve procedures. Patients were followed for a median duration of 4.1 years. Primary end points included procedural or device-related serious adverse events, hemodynamic improvement, and sustained valve function. RESULTS: At 6 months, cardiac magnetic resonance imaging demonstrated significant reverse right ventricular remodeling, with marked reductions in right ventricular end-diastolic volume index, end-systolic volume index, and pulmonary regurgitation fraction (all P <0.001). Valve performance remained stable throughout follow-up, with 93.8% of patients exhibiting mild or less pulmonary regurgitation at 4.1 years. Freedom from reintervention was 98.2% at 5 years. One patient required a PULSTA-in-PULSTA implantation due to paravalvular leakage, and one case of infective endocarditis was successfully managed with antibiotic therapy. No stent fractures or structural valve deterioration were observed. CONCLUSIONS: The PULSTA transcatheter pulmonary valve demonstrated high procedural success, durable valve function, and sustained hemodynamic benefits. Its adaptability to diverse right ventricular outflow tract anatomies and favorable safety profile supports its role as an effective therapeutic option for patients with right ventricular outflow tract dysfunction. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03983512.

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

Ahn KJ, et al. Korean Circ J. 2027 ;57:e24. https://doi.org/10.4070/kcj.2026.0016

With the growing number of Fontan patients surviving into adulthood in Korea, there is a critical need for evidence-based, Korea-specific guidelines for their long-term management. The 2025 Clinical Practice Guidelines for the Management of Fontan Patients in Korea represent the first national consensus statement developed by the Committee for Clinical Practice Guidelines on Fontan Patients. The recommendations were formulated through systematic review, expert consultation, and integration of international guidelines with Korean cohort data. These guidelines provide graded recommendations and tailored follow

Background: Pediatric cardiologists (PCs) and pediatric cardiac surgeons (PedCSs) in Korea face growing workforce shortages due to declining birth rates, decreasing interest among trainees, and increasing burnout.Purpose: This study investigated the working conditions, job satisfaction, and burnout levels among Korean PCs and PedCSs.Methods: In June 2023, the Korean Pediatric Heart Society distributed a structured questionnaire via email to 149 members actively practicing pediatric cardiac care (115 PCs, 34 PedCSs). Responses from 122 members were analyzed. Descriptive statistics and regression analyses were performed to identify the factors associated with burnout (P51 hr/wk and 88.5% experiencing monthly emergency callbacks. Regional disparities were notable: 48.2% of PCs in the Seoul metropolitan area (SMA) performed >51 catheterizations annually versus 7.1% in other regions, while 62.5% of PedCSs in the SMA performed >30 surgeries annually versus 20% elsewhere. Litigation, reported by 66.7% of PCs versus 84.6% of PedCSs, contributed to dissatisfaction and burnout. The key drivers included limited research time, legal risks, and nonspecialized duties. Overall, 64.0% of the PCs and 61.6% of the PedCSs reported experiencing burnout. In the multivariable analysis, answering ≥6 emergency callbacks/mo (adjusted odds ratio [aOR], 7.91; 95% confidence interval [CI], 1.28–48.79), occupational dissatisfaction (aOR, 2.57; 95% CI, 1.09–6.04), and work environment dissatisfaction (aOR, 2.74; 95% CI, 1.16–7.14) independently predicted burnout, whereas the working >51 hr/wk variable did not remain significant postadjustment.Conclusion: Excessive workload, frequent emergency callbacks, regional maldistribution of case volumes, litigation pressure, and occupational dissatisfaction drive high burnout among Korean pediatric cardiac specialists. These findings highlight persistent workforce challenges in Korea’s pediatric cardiac system. Regular surveys and ongoing research are essential to ensuring sustainable pediatric cardiac care.