The Fontan operation has sustained life for patients with the most complex group of congenital heart lesions. Arrhythmias remain a major contributor to late morbidity and mortality and require new, improved solutions. Meanwhile, the increasing lifespan of patients with a single ventricle is bringing new arrhythmia topics to light.

Short QT syndrome (SQTS) is an inherited arrhythmia syndrome characterized by a markedly shortened QT interval on the surface electrocardiogram (ECG) and a high risk of sudden cardiac death.1 Its history illustrates how an initially underestimated ECG abnormality proved to be the marker of a highly malignant condition.

Catheter ablation of atrial and ventricular arrhythmias in patients with cardiac resynchronization therapy (CRT) may require cannulation of the coronary sinus (CS) for mapping or ablation, raising concerns regarding safety in the presence of an indwelling CS lead. The safety of CS access for mapping and ablation in CRT patients has not been systematically evaluated. Prior studies reported a low risk of lead dislodgment or malfunction during ablation in patients with cardiac implantable electronic devices;1 however, concerns remain regarding lead integrity during more complex procedures such as vein of Marshall (VOM) ethanol ablation or CS venous alcohol infusion.

This PRO argument supports the routine incorporation of point-of-care viscoelastic testing (VET) into perioperative bleeding management algorithms for all cardiac surgery patients. This group of patients remains among the highest consumers of allogeneic blood products, and transfusion is independently associated with increased morbidity, mortality, and cost. Standard laboratory tests have significant limitations in diagnosing coagulopathy and are not designed to guide intraoperative bleeding management.

This PRO argument supports the routine incorporation of point-of-care viscoelastic testing (VET) into perioperative bleeding management algorithms for all cardiac surgery patients. This group of patients remains among the highest consumers of allogeneic blood products, and transfusion is independently associated with increased morbidity, mortality, and cost. Standard laboratory tests have significant limitations in diagnosing coagulopathy and are not designed to guide intraoperative bleeding management.

Early identification of atrial fibrillation (AF) allows for timely interventions to reduce cardiovascular complications. Risk scores including C2HEST and CHA2DS2-VASc have limitations in capturing cardiovascular remodeling. Given the association between hypertension, cardiovascular remodeling, and AF, integrating echocardiographic and demographic parameters may improve AF risk assessment in hypertension.

Early identification of atrial fibrillation (AF) allows for timely interventions to reduce cardiovascular complications. Risk scores including C2HEST and CHA2DS2-VASc have limitations in capturing cardiovascular remodeling. Given the association between hypertension, cardiovascular remodeling, and AF, integrating echocardiographic and demographic parameters may improve AF risk assessment in hypertension.