Statement from the Asia Summit: Current state of arrhythmia care in Asia

On May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit-22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life-threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region due to differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present

Large isolated major aortopulmonary collateral artery causing dilated left ventricle

Isolated major aortopulmonary collateral artery (MAPCA), in the absence of evidence of structural heart disease, is a very rare observation. This anomaly usually appears in preterm newborns. In the majority of babies, isolated MAPCAs cause no symptoms and regress spontaneously after birth and their conservative management is usually sufficient. We report a case of an asymptomatic full-term 5-month-old infant presenting with heart murmur as the only sign during clinical evaluation. Echocardiography revealed a dilated left ventricle, with no pulmonary hypertension. Computed tomography angiogram showed a large MAPCA arising from the descending thoracic aorta and supplying blood to the left lower lobe. The condition was managed successfully by percutaneous obliteration with Amplatzer vascular plugs. Isolated MAPCA is usually a benign anomaly, presenting no clinical finding and requiring no specific treatment. However, in a small minority of infants, this congenital disorder may progress, with detrimental impacts on cardiac structure before clinical symptoms appear. Early intervention may be required to prevent irreversible sequelae

Dynamic substrate map and isopotential maps of noncontact mapping.

<p>(A) Normalized peak negative voltage (PNV) distribution of the RV in a posterior caudal view. The orange border zone rerepresents areas with voltages around 30% of the peak negative potential. (B) Isopotential map shows the activation sequence (frames 1–4). Color scale has been set so that white indicates the most negative potential and purple indicates the least negative potential. Virtual electrodes (V1-1 to V1-4) are placed along the propagation of activation wavefront from EA site (Frame 1) to BO site (Frame 4). The green arrows indicate the activation wavefron propagating from EA to BO site, then spreading out at BO site. The virtual unipolar electrograms reveal a QS pattern at the origin.</p

Noncontact mapping findings of triggers.

<p>BO = breakout; EA = earliest activation; Eg = electrogram; PNV = peak negative value; Other abbreviations are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140167#pone.0140167.t001" target="_blank">Table 1</a>.</p><p>Noncontact mapping findings of triggers.</p

Baseline Clinical Characteristics of 35 Patients.

<p>* Measured by ventriculogram</p><p>^† Data are presented as median (range).</p><p>ARVC = arrhythmogenic right ventricular cardiomyopathy; ICD = implantable cardioverter-defibrillator; LVEF = left ventricular ejection fraction; NS = nonsignificant; PVC = premature ventricular contraction; RVEF = right ventricular ejection fraction; RVOT = right ventricular outflow tract; VT = ventricular tachycardia.</p><p>Baseline Clinical Characteristics of 35 Patients.</p

Radiofrequency ablation and follow-up.

<p>RF = radiofrequency; Other abbreviations are the same as <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140167#pone.0140167.t001" target="_blank">Table 1</a>.</p><p>Radiofrequency ablation and follow-up.</p