{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:42:31Z","timestamp":1791214951889,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy, Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Total situs inversus (TSI) is a rare genetic anomaly, and approximately half of the affected individuals also have other associated cardiovascular anomalies. Thus, the concomitance of conduction and rhythm disturbances is seldom described in the medical literature. Methods: We searched the medical literature for similar cases published as full text, in English, on Clarivate, PubMed, and Google Scholar between 2016 and 2025. Results: We found 9 reports on TSI patients also having sick sinus syndrome (SSS) associated with rhythm disturbances, mainly atrial fibrillation, raising diagnostic and procedural challenges due to the anatomical anomalies requiring a peculiar approach. We describe the case of a 43-year-old woman diagnosed with TSI associated with ventricular arrhythmias in 2015 who experienced SSS requiring the implantation of a pacemaker during 10 years of follow-up but continued to have frequent episodes of nonsustained ventricular tachycardia (NSVT), raising multiple diagnoses and therapeutic challenges. After developing heart failure with preserved ejection fraction, she received guideline-adjusted treatment and, surprisingly, her clinical status improved, and NSVT diminished in frequency and then disappeared. Conclusions: Highlighting TSI\u2032s clinical implications, often associated with other cardiovascular abnormalities, is important for an accurate diagnosis and adapted therapeutic management, considering the procedural challenges and potential complications.<\/jats:p>","DOI":"10.3390\/jcdd12110419","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T02:03:48Z","timestamp":1761185028000},"page":"419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic Challenges in Total Situs Inversus Associated with Sick Sinus Syndrome, Ventricular Arrhythmias, and Heart Failure with Preserved Ejection Fraction: Narrative Review and Case Report"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-741X","authenticated-orcid":false,"given":"Cristina","family":"Tudoran","sequence":"first","affiliation":[{"name":"Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy \u201cVictor Babes\u201d Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Center of Molecular Research in Nephrology and Vascular Disease, Faculty of the Victor Babes University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"County Emergency Hospital \u201cPius Brinzeu\u201d, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8989-5899","authenticated-orcid":false,"given":"Mariana","family":"Tudoran","sequence":"additional","affiliation":[{"name":"Cabinet Medical Dr. Tudoran, Str. Glad, Nr. 35 A, 300480 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7378-7787","authenticated-orcid":false,"given":"Dragos","family":"Cozma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Tmimisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6376-5751","authenticated-orcid":false,"given":"Cristina","family":"V\u0103c\u0103rescu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Institute of Cardiovascular Diseases Tmimisoara, 300310 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6185-0960","authenticated-orcid":false,"given":"Ahmed","family":"Abu-Awwad","sequence":"additional","affiliation":[{"name":"County Emergency Hospital \u201cPius Brinzeu\u201d, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania"},{"name":"Department XV\u2014Discipline of Orthopedics\u2014Traumatology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"},{"name":"Research Center University Professor Doctor Teodor \u0218ora, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6793-5361","authenticated-orcid":false,"given":"Simona-Alina","family":"Abu-Awwad","sequence":"additional","affiliation":[{"name":"County Emergency Hospital \u201cPius Brinzeu\u201d, L. Rebreanu, Nr. 156, 300723 Timisoara, Romania"},{"name":"Department XII\u2014Discipline of Obstetrics and Gynecology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7827-818X","authenticated-orcid":false,"given":"Dragos","family":"Jianu","sequence":"additional","affiliation":[{"name":"Department VIII, Clinic of Neurology I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timi\u0219oara, Romania"},{"name":"Centre for Cognitive Research in Neuropsychiatric Pathology (Neuropsy-Cog), Faculty of Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5960-9043","authenticated-orcid":false,"given":"Florica","family":"Voita-Mekeres","sequence":"additional","affiliation":[{"name":"Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Psychiatry Department, County Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.2147\/IJGM.S295444","article-title":"Situs Inversus Totalis: A Clinical Review","volume":"15","author":"Eitler","year":"2022","journal-title":"Int. J. Gen. 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