Pacemaker implantation in pediatrics requires a thorough assessment of the device features before the intervention and attentive monitoring during the placement to avoid complications. A reduced risk of infection, adaptation to growth and quicker return to full activity are important features of leadless pacemakers in the young population. The AVEIR (Abbott, Lake County, IL) device has the advantage of chronic retrievability and mapping prior to fixation. Specific considerations should be kept in mind, such as the choice of the venous access and the limited space for the implantation with possible mechanical interference with the tricuspid valve.

There exists a complex relationship between the autonomic nervous system (ANS) and the immune system. Dysregulation of one system disrupts the homeostatic equilibrium of the other. Appropriate recognition and treatment of the downstream effects of dysregulation is important in managing neuro-immunological diseases. Previous case reports have described this phenomena in the setting of Neuromyelitis Optica (NMO), Multiple Sclerosis, and Transverse Myelitis, however there are very few case reports describing this process in the setting of myelin oligodendrocyte glycoprotein associated disorder (MOGAD).

Duchenne muscular dystrophy (DMD) is an X-linked disorder that results from mutations in the dystrophin gene; it is characterized by fibrofatty replacement of skeletal and cardiac muscle. Recent studies have demonstrated that both the atrial and ventricular myocardium are affected in DMD, placing these patients at risk for not only dysfunction, but also for the development of ventricular and atrial arrhythmias.1 In addition to structural myocardial changes, patients with DMD often have comorbidities that further increase their risk of arrhythmias, such as sleep disordered breathing and increased adiposity from chronic steroid use.

Catheter ablation is a curative and effective therapeutic option for idiopathic and symptomatic right ventricular outflow tract (RVOT) ventricular tachycardia (VT).1 However, cases of coronary artery injury during catheter ablation have been reported.2–4 Anomalous aortic origin of the coronary artery (AAOCA) is a rare condition, usually associated with an abnormal trajectory of the involved vessels, being a “double-edged sword,” depending on whether the coronary artery is distant or close to the site of origin of the VT.

Atrial pace mapping (APM) is a technique for pinpointing the source of typically focal arrhythmias that do not maintain stability during an electrophysiological study and are unsuitable for activation mapping.1 This method uses pattern comparison between p-waves on a surface-electrocardiogram and intracardiac (IC) signals during atrial tachycardia (AT) and pacing from a suspected origin point. Traditionally, APM depended on subjective visual analysis of IC signals and paced P wave morphology. The CARTO® 3 system (Biosense Webster, Irvine, CA) has recently incorporated an automated intracardiac pattern matching (ICPM) algorithm which uses the unipolar signal from a reference electrode, typically placed in the coronary sinus (CS).