Aims: Premature ventricular contractions (PVCs) in paediatric patients often present a benign course. However, a minority of patients may develop left ventricular (LV) dysfunction, and risk factors are still under debate. The aim of this systematic review and meta-analysis was to analyse the prevalence of PVC-induced cardiomyopathy (CMP) and understand the risk factors in paediatric patients with PVCs and structurally normal hearts. Methods and results: A systematic search strategy was performed to identify original reports published between 1 January 2000 and 31 August 2024. Studies including adult patients and patients with cardiomyopathies, congenital heart diseases, or channelopathies were excluded. Seventeen studies were included and comprised 1.701 patients, with a mean age of 11.4 years. The mean burden of PVCs across the included studies was 16% (12.2–19.7). Left ventricular systolic dysfunction occurred in 40 patients, and they showed older age at presentation. Premature ventricular contraction burden emerged as significant risk factor for PVC-induced CMP (mean burden among patients with and without LV dysfunction 32.5 and 15.47%, respectively). Shorter coupling intervals and longer QRS duration were predictors in a few studies. No major adverse cardiovascular events occurred. Left ventricular dysfunction recovered in all but one patient after spontaneous or pharmacologically induced PVC reduction. Class IC drugs showed greater efficacy than other drugs. Conclusion: Premature ventricular contraction–induced CMP is rare in children, and PVC burden is the key determinant of risk. The threshold burden associated with LV dysfunction is higher in paediatric patients than in adults. Most patients with PVC-induced CMP experience normalization of LV function during follow-up.

Introduction: Ultrasound (US)‐guided axillary vein puncture is a safe and effective approach for cardiac implantable electronic device (CIED) implantation, and it is highly recommended by the current consensus document. However, only reports on small populations are available in the current literature regarding the comparison of this technique with other traditional approaches (subclavian vein blind puncture and cephalic vein surgical cutdown).Purpose: We aimed to assess the effectiveness and safety of US‐ guided axillary vein puncture using a microintroducer kit for CIED implantation as compared to the aforementioned traditional approaches.Methods: All consecutive patients with an indication to CIED implantation were prospectively enrolled in our observational study from March 2021 to July 2023. Patients were divided into three groups based on venous access route, according to the operator's preference: cephalic vein surgical cutdown (G1), US‐guided axillary vein puncture (G2), and subclavian vein blind puncture (G3). Clinical and procedural characteristics, success and complication rates were considered for analysis.Results: A total of 1000 patients (65.2% male, mean age 75.5 ± 10.8 years) were enrolled. Cephalic vein surgical cutdown was chosen in 172 (G1, 17.2%), US‐guided axillary access in 433 patients (G2, 43.3%), and subclavian vein in 395 (G3, 39.5%). Success rate was 77.6% in G1, 96.3% in G2, and 97.2% in G3 (G2 vs. G3, p = 0.5; G1 vs. G2, p < 0.0001; G1 vs. G2. vs. G3, p < 0.0001). Compared to subclavian and cephalic groups, in the US‐guided axillary group, a successful access was obtained with a reduced mean number of puncture attempts (G2 vs. G3: 1.3 ± 0.9 vs. 1.8 ± 1, p < 0.0001) and needed reduced times to get access (G2 vs. G3: 15 s [10–30 s] vs. 40 [20–65 s]; p < 0.0001, G1 vs. G2: 210 s [180–247 s] vs. 15 s [10–30 s]; p < 0.0001) and to reach the superior vena cava, without differences in total procedural times (72.9 ± 30.4 vs. 75.7 ± 34.8 min, p = 0.24). Bailout fluoroscopy times [1 (0–8) s vs. 20 (10–58) s, p < 0.0001] and usage of vein angiography (11.9% vs. 51.3%, p < 0.0001) were lower in G2 as compared to G3. Complication rate did not differ among the three study groups (early complications: 2.9% in G1, 2.5% in G2, and 2.5% in G3, p = 0.96; late complications: 2.9% in G1, 1.6% in G2, and 0.8% in G3, p = 0.15).Conclusions: US‐guided axillary vein puncture for CIED implantation using a microintroducer kit is a safe technique with a very high success rate. Compared to other traditional approaches, it allows to get access with a lower number of puncture attempts and with reduced times, without prolonging the total procedural time. Moreover, x‐ray use and need for contrast medium are very rare in US‐guided axillary approach. Hence, it should be considered the strategy of choice for most patients undergoing CIED implantation.

Ventricular preexcitation (VP) may be intermittent in some patients. Historically, this has been thought to indicate a low-risk accessory pathway (AP) that conducts poorly in the anterograde direction.¹ However, rare cases of sudden cardiac death (SCD) in intermittent ventricular preexcitation (IVP) have been reported since the 1980s, and recently growing data have highlighted the potential risk of adverse events, even in patients with IVP.^2,3 Therefore, the most recent guidelines on asymptomatic VP in young patients suggest invasive risk stratification with electrophysiological testing (EPT) in these patients.^3,4

Recently, prognosis and survival of cancer patients has improved due to progression and refinement of cancer therapies; however, cardiovascular sequelae in this population augmented and now represe... Tweetable abstract In oncological patients the second cause of death is represented by cardiovascular diseases, due to heart failure, coronary artery disease and arrhythmias. In this review, we pro...

Background: Right free wall (RFW) accessory pathways (APs) represent a relatively rare form of AP, and transcatheter (TC) ablation of these APs carries high procedural failure rates, both with radiofrequency (RF) and cryoenergy. The aim of this study was to report the outcomes of a minimally invasive approach in non-fluoroscopic 3D TC ablation of RFW APs, comparing cryoenergy and RF. Methods: Between March 2010 and March 2024, 62 consecutive patients with RFW APs underwent transcatheter ablation at our institution with a minimally invasive approach. The ablation results were analyzed and compared. Results: The overall acute success rate was 83.9% [52/62 patients; 25/28 (89.3%) for right lateral (RL) APs, 18/19 (94.7%) for right anterior–lateral (RAL) APs, and 9/15 (60.0%) for right posterior–lateral (RPL) APs, p = 0.014], with very limited fluoroscopy use and no complications. There were no significant differences in the acute success rates between the RF and cryoablation groups (32/37 vs. 20/25, p = 0.506). The median follow-up was 24.8 months (IQR 12.5–49.8), and 16 recurrences (30.8%) were observed (3 in the cryoablation group and 13 in the RF group, p = 0.068). The RAL localization of the AP and age > 12 years were predictors of ablation success in multivariate regression analysis. Conclusions: In children, a minimally invasive 3D TC ablation of RFW APs is a completely safe and quite effective approach, with better results for RAL and RL APs, poorer results for RPL APs, and no significant differences between cryoenergy and RF.

Background/Objectives: Transcatheter ablation assisted by three-dimensional (3D) electroanatomical mapping (EAM) is the elective treatment for atrioventricular nodal reentrant tachycardia (AVNRT) in children and adolescents. In this population of patients, the most frequently employed EAM strategies are the low-voltage bridge (LVB) strategy and sinus rhythm propagation mapping (SRPM). However, the exact pathophysiology and anatomy of the AVNRT reentrant circuits are still poorly understood. The aim of this study was to investigate the relationship between SRPM and LVB and to shed light on nodal physiology in children and adolescents affected by AVNRT. Methods: We retrospectively collected data on pediatric patients who underwent cryoablation for AVNRT assisted by high-density 3D EAM by using the LVB strategy; maps were reviewed by two independent electrophysiologists and the SRPM was described. SRPM was defined as typical when only one collision area was identified and atypical whenever either no or ≥ two collision areas were localized. Results: Twenty-eight consecutive patients (11.3 ± 3.3 years) were enrolled. All procedures were acutely successful. Overall, atypical SRPM was present in 10 patients (35.7%), and it did not correlate with the presence of multiple SPs or electrophysiological data. Moreover, we observed an imperfect concordance between SRPM and LVB (only in 10/18 patients). When SRPM and LVB were assessed in different locations, the LVB identified the effective cryoablation site in more cases than SRPM (4/8 vs. 1/8). Lastly, in cases of double collision, one collision area co-localized with the LVB and the effective cryoablation spot, whereas the other was located superiorly, closer to the His bundle. Conclusions: Atypical sinus rhythm propagation in the Koch’s triangle is a frequent finding in pediatric AVNRT patients. In this series, LVB showed closer concordance with the successful cryolesion site than retrospectively reconstructed SRPM.