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Pacing and Clinical Electrophysiology: PACE

Nitin Kulkarni, Curtiss Moore, Ambarish Pandey, Demetrio Castillo, Colby Ayers, Jose Joglar, Richard Wu
BACKGROUND: Atrioventricular Junction (AVJ) ablation is conventionally performed by localizing the His bundle electrogram (HBE). Identification of HBE in presence of Atrial Fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His bundle pacing (HBP). METHODS: Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach, and 11 ablations using HBP...
January 13, 2017: Pacing and Clinical Electrophysiology: PACE
Arun Raghav Mahankali Sridhar, Madhav Lavu, Vivek Yarlagadda, Madhu Reddy, Sampath Gunda, Rizwan Afzal, Donita Atkins, Rakesh Gopinathanair, Buddhadeb Dawn, Dhanunjaya R Lakkireddy
INTRODUCTION: Implantation of cardiac implanted electronic device (CIEDs) has exploded lately. This resulted in a rise in cardiac device-related infections (CDI) and inevitably, lead extractions. We examined recent national trend in the incidence of CIED infections and lead extractions in hospitalized patients and associated mortality. METHODS: Using the Nationwide Inpatient Sample for the years 2003 to 2011 we identified patients diagnosed with a CDI associated infection as determined by discharge ICD-9 diagnostic codes...
January 13, 2017: Pacing and Clinical Electrophysiology: PACE
Yanhong Chen, Yonghua Zhang, Weiping Huang, Keqiang Huang, Bei Xu, X I Su
BACKGROUND: Atrial fibrillation (AF) is associated with increased stroke risk resulting from cardiac embolism of the left atrial appendage (LAA). Stroke tends to recur in NVAF patients. Yet safety and feasibility of secondary stroke preventions with LAA closure (LAAC) have not been assessed in detail. This retrospective study was designed to compare the feasibility and safety of LAAC in primary and secondary stroke preventions, in a real-world setting of Chinese patients . METHODS: From 2014 to 2015, non-valvular AF patients with CHA2DS2-VASc ≥1 were selected for percutaneous LAAC operations...
January 13, 2017: Pacing and Clinical Electrophysiology: PACE
Hirotoshi Ichibori, Koji Fukuzawa, Kunihiko Kiuchi, Akinori Matsumoto, Hiroki Konishi, Hiroshi Imada, Kiyohiro Hyogo, Jun Kurose, Kazuhiro Tatsumi, Hidekazu Tanaka, Ken-Ichi Hirata
BACKGROUND: Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed. METHODS: We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT...
January 13, 2017: Pacing and Clinical Electrophysiology: PACE
Pau Alonso, Joaquín Osca, Oscar Cano, Pedro Pimenta, Ana Andrés, Jaime Yagüe, José Millet, Joaquín Rueda, María José Sancho-Tello
BACKGROUND: Information regarding suitability for S-ICD implant in Tetralogy of Fallot (ToF) population is scarce and needs to be further explored. THE AIMS OF OUR STUDY WERE: (i) to determine the proportion of patients with ToF eligible for S-ICD, (ii) to identify the optimal sensing vector in ToF patients, (iii) to test specifically the eligibility for sICD with right-sided screening, and (iv) to compare with the proportion of eligible patients in a non-selected ICD population...
January 10, 2017: Pacing and Clinical Electrophysiology: PACE
Christopher Reithmann, Bernhard Herkommer, Thomas Remp, Michael Fiek
BACKGROUND: Typical left bundle branch block (LBBB) during ventricular tachycardia (VT) is a diagnostic criterion of bundle branch reentry tachycardia (BBRT) with activation of the right bundle in the anterograde direction. METHODS AND RESULTS: 11 patients (7 male, 60 ± 12 years) with non-ischemic cardiomyopathy (left ventricular ejection fraction 37 ± 16 %) presenting with BBRT were successfully treated by ablation of the right bundle. Among them, 5 patients had atypical surface ECGs differing from a typical left bundle branch block during the VT...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
Alessandro Blandino, Francesca Bianchi, Stefano Grossi, Giuseppe Biondi-Zoccai, Maria Rosa Conte, Luca Gaido, Fiorenzo Gaita, Marco Scaglione, Francesco Rametta
BACKGROUND: This meta-analysis aims to assess the impact of a voltage-guided substrate modification by targeting low-voltage area (LVA) in addition to pulmonary vein isolation (PVI) in patients undergoing catheter ablation for atrial fibrillation (AF). METHODS: MEDLINE/PubMed, Cochrane Library and references reporting AF ablation and 'voltage* OR substrate* OR fibrosis OR fibrotic area* were screened and studies included if matching inclusion and exclusion criteria...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
Alan D Enriquez, Timothy Churchill, Sandeep Gautam, Jason S Chinitz, Chirag R Barbhaiya, Saurabh Kumar, Roy M John, Usha B Tedrow, Bruce A Koplan, William G Stevenson, Gregory F Michaud
BACKGROUND: Patients on rivaroxaban have variable INRs, but it is uncertain if INR impacts procedural heparin requirement during left atrial ablation. We sought to examine the determinants of heparin dosing in this patient population. METHODS: We reviewed consecutive patients who received rivaroxaban within 24 hours of left atrial ablation and compared them to patients on uninterrupted warfarin. The determinants of heparin requirement were evaluated using regression analysis...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
Lukas R C Dekker, Bart Gerritse, Avram Scheiner, Lilian Kornet
AIMS: Central Sleep Apnea Syndrome, correlated with the occurrence of heart failure, is characterized by periods of insufficient ventilation during sleep. This acute study in 15 patients aims to map the venous system and determine, if diaphragmatic movement can be achieved by phrenic nerve stimulation at various locations within the venous system. METHODS: Subjects underwent a scheduled catheter ablation procedure. During the procedural waiting time, one multi-electrode EP catheter was subsequently placed at the the superior and inferior vena cava and the junctions of the left jugular and left brachiocephalic vein and right jugular and right brachiocephalic vein, for phrenic nerve stimulation (1-2 seconds ON / 2-3 seconds OFF, 40 Hz, pulse width 210 μs)...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
Auroa Badin, Alan R Parr, Sandeep Banga, Rebecca R Wigant, Timir S Baman
INTRODUCTION: It is unclear whether patients and physicians understand that atrial fibrillation ablation (AFA) has been shown to only improve symptomology and not reduce morbidity or mortality. METHODS: 177 of 445 (40%) consecutive patients referred to an electrophysiology clinic for atrial fibrillation (AF) management responded anonymously to our survey via mail. 105 of 656 (15%) physicians responded to our survey via email. Comparisons among groups were conducted using Chi- Square test for categorical variables...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
Yasuhiro Shirai, Masahiko Goya, Seiko Ohno, Minoru Horie, Shozaburo Doi, Mitsuaki Isobe, Kenzo Hirao
We report on a patient diagnosed with CPVT who underwent catheter ablation of VPCs induced by epinephrine. VPCs were classified roughly into 3 types. Type 1 and Type 2 VPCs (RBBB configuration and inferior axis) were eliminated by radio frequency applications at the left aortic sinus of Valsalva and the anterolateral papillary muscle (APM), respectively. Although no spontaneous VPCs were seen after the elimination of Type 1 and 2 VPCs, pacing resulting in capture at the APM induced type 3 VPC (RBBB configuration and superior axis) reproducibly...
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Gaetano Barbato, Valeria Carinci, Sergio Fortiparri, Piercamillo Pavesi, Francesco Pergolini, Giuseppe DI Pasquale
Subxiphoid puncture is considered the standard approach for epicardial ablation of ventricular arrhythmia but in some cases this access is impracticable due to the patient's anatomy. We describe the case of a patient with electrical storm and abnormal subdiaframmatic anatomy that precluded the usual subxiphoid approach. In this patient the pericardial space was gained through a direct thorax puncture at the fifth intercostals space close to the mammary line. The tools and technique utilized in this case were similar to what is usually used for traditional subxiphoid puncture...
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Satoshi Higuchi, Morio Shoda, Nobuhisa Hagiwara
No abstract text is available yet for this article.
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Marcin Michalak, Andrzej Cacko, Marcin Grabowski
In the Pacing and Clinical Electrophysiology (PACE) we have read with great interest the article by Worden et al. on long-term stability and reliability of atrial sensing in Biotronik's ICD DX system.1 The data on that topic is still very limited. On the other hand more and more electrophysiologists choose DX system instead of classic single chamber ICDs because of its diagnostic and potential therapeutic advantages. Unfortunately there are no specific recommendations on patient selection and technique of implantation (type of lead, apical vs other lead position) of DX leads...
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Huan Sun, Guohui Liu, Hongliang Yang, Yuquan He, Ping Yang
We read with great interest the paper by Mills et al.(1) published in PACE recently. The authors showed that there was no difference in tachycardia cycle length (TCL) between AVRT and AVNRT when controlling for age, and there was a linear relationship between TCL and ages in pediatric patients. This implies that TCL should not be used for distinguishing AVRT from AVNRT, which will further change the physicians' differential diagnosis and risk assessment approaches. However, we hold the following interpretations This article is protected by copyright...
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Blair P Grubb
At first I thought that I might die, then I was worried I might not. In the nightmare months that followed my diagnosis of renal cancer I had endured prolonged surgeries and recurrent hospitalizations that had left me weak and debilitated This article is protected by copyright. All rights reserved.
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Se Yong Jang, Yongkeun Cho, Nam Kyun Kim, Chang-Yeon Kim, Jihyun Sohn, Jae-Hyung Roh, Myung Hwan Bae, Jang Hoon Lee, Dong Heon Yang, Hun Sik Park, Shung Chull Chae, Tak-Hyuk Oh, Gun Jik Kim
BACKGROUND: Left cardiac sympathetic denervation (LCSD) has been underutilized in patients with hereditary ventricular arrhythmia syndromes such as congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The purpose of this study was to investigate the safety and efficacy of video-assisted thoracoscopic (VATS) LCSD in such patients. METHODS: Fifteen patients (4 men, 24.6 ± 10.5 years old) who underwent VATS-LCSD between November 2010 and January 2015 for hereditary ventricular arrhythmia syndromes at Kyungpook National University Hospital were enrolled in this study...
December 24, 2016: Pacing and Clinical Electrophysiology: PACE
Neha Bansal, Sharmeen Samuel, Kathleen Zelin, Peter P Karpawich
BACKGROUND: Patients (pts) with congenital heart defects (CHD) often present more challenges to pacing therapy due to anatomy than those without CHD. The lumenless, 4.1Fr diameter M3830 pacing lead (Medtronic, Inc), approved for use in 2005, has, to date, reported to have excellent short-term (< 6y) lead performance. Unfortunately, very long-term performance is unknown, especially among CHD pts and with implants at alternate pacing (AP) sites. This study reports a 10-year clinical experience with the M3830 lead...
December 22, 2016: Pacing and Clinical Electrophysiology: PACE
Raja J Selvaraj, Binay Kumar, Sasinthar Rangasamy
No abstract text is available yet for this article.
December 21, 2016: Pacing and Clinical Electrophysiology: PACE
Mukund Aravind Prabhu, Praveen Gopalakrishna Pai, Anjith Vupputuri, Saritha Shekhar, Madhavankutty Santhakumari Harikrishnan, Kumaraswamy Umayammal Natarajan
INTRODUCTION: Atrioventricular (AV) block is rare in Takotsubo cardiomyopathy (TC). CASE REPORT: A 66 years old woman presented with fatigue. Her electrocardiogram revealed 3:2 Mobitz Type II AV block, confirmed to be suprahisian by electrophysiological study. Echocardiogram and left ventricular angiogram showed moderate left ventricular dysfunction and apical ballooning, whereas coronary angiogram revealed mildly ectatic coronaries. At 2 weeks AV block persisted, needing permanent pacemaker implantation...
December 21, 2016: Pacing and Clinical Electrophysiology: PACE
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