Catheter Ablation for Channelopathies: When Is Less More?

Ventricular fibrillation (VF) is a common cause of sudden cardiac death in patients with channelopathies, particularly in the young population. Although pharmacological treatment, cardiac sympathectomy, and implantable cardioverter defibrillators (ICD) have been the mainstay in the management of VF in patients with channelopathies, they are associated with significant adverse effects and complications, leading to poor quality of life. Given these drawbacks, catheter ablation has been proposed as a therapeutic option for patients with channelopathies. Advances in imaging techniques and modern mapping technologies have enabled increased precision in identifying arrhythmia triggers and substrate modification. This has aided our understanding of the underlying pathophysiology of ventricular arrhythmias in channelopathies, highlighting the roles of the Purkinje network and the epicardial right ventricular outflow tract in arrhythmogenesis. This review explores the role of catheter ablation in managing the most common channelopathies (Brugada syndrome, congenital long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). While the initial results for ablation in Brugada syndrome are promising, the long-term efficacy and durability of ablation in different channelopathies require further investigation. Given the genetic and phenotypic heterogeneity of channelopathies, future studies are needed to show whether catheter ablation in patients with channelopathies is associated with a reduction in VF, and psychological distress stemming from recurrent ICD shocks, particularly relative to other available therapeutic options (e.g., quinidine in high-risk Brugada patients).

Gastruloid optimization.

The young field of gastruloids brings promise to modeling and understanding early embryonic development. However, being a complex model, gastruloids are prone to variability at different levels. In this perspective, we define the different levels of gastruloid variability, and parameters over which it can be measured. We discuss potential sources for variability, and then propose methods to better control and reduce it. We provide an example from definitive endoderm progression in gastruloids, where we harness gastruloid-to-gastruloid variation in early parameters to identify key driving factors for endoderm morphology. We then devise interventions that steer morphological outcome. A better control over the developmental progression of gastruloids will enhance their utility in both basic research and biomedical applications.

Idiopathic spontaneous pneumoperitoneum.

Spontaneous pneumoperitoneum is the presence of free air in the peritoneum without evidence of any perforation of hollow viscera. The usual presentation includes acute abdominal pain with leukocytosis and elevated inflammatory markers. Here we present a case of spontaneous pneumoperitoneum occurring recurrently in a 58-year-old man with inclusion body myositis and hypertension who presented with cellulitis of both legs. Abdominal computed tomography demonstrated retroperitoneal free air; however, colonoscopy, esophagogastroduodenoscopy, and a prior laparoscopy did not demonstrate any perforation of hollow viscera. Conservative management with antibiotics and symptom control with antiemetics and pain medicines led to clinical improvement, and the patient was discharged home in stable condition.

Proposed Pathogenesis, Characteristics, and Management of COVID-19 mRNA Vaccine-Related Myopericarditis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus causing coronavirus disease 2019 (COVID-19), has affected human lives across the globe. On 11 December 2020, the US FDA granted an emergency use authorization for the first COVID-19 vaccine, and vaccines are now widely available. Undoubtedly, the emergence of these vaccines has led to substantial relief, helping alleviate the fear and anxiety around the COVID-19 illness for both the general public and clinicians. However, recent cases of vaccine complications, including myopericarditis, have been reported after administration of COVID-19 vaccines. This article discusses the cases, possible pathogenesis of myopericarditis, and treatment of the condition. Most cases were mild and should not yet change vaccine policies, although prospective studies are needed to better assess the risk-benefit ratios in different groups.

A Rare Case of Herpes Zoster in an Adult Patient Recovered From Symptomatic Reinfection of COVID-19.

In coronavirus disease 2019 (COVID-19) patients, various dermatological conditions have been observed. Varicella zoster virus (VZV) and herpes simplex virus must be ruled out before considering vesicular exanthems linked to COVID-19. The immunological status of the host has an impact on the natural history of herpes zoster (HZ). Age is a major risk factor for most of the cases of HZ. Reactivation of VZV can be triggered by iatrogenic immunosuppression or disease-related immunocompromised state or age-related immunosenescence. Rarely, dermatological symptoms have been reported in recovered COVID-19 patients. We hereby present a rare case of HZ in a recovered patient from symptomatic reinfection of COVID-19.