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Pacing and Clinical Electrophysiology: PACE

Onur Kaypakli, Mevlüt Koç, Gökhan Gözübüyük, Durmuş Yıldıray Şahin
AIM: CRT was shown to improve HF prognosis. But many patients do not benefit from CRT. Optimization of LV lead position to the latest activated LV area is important to increase CRT response. We aimed to detect the relationship between LV lead sensing delay and echocardiographic and electrocardiographic response to CRT treatment. METHODS: We prospectively included 156 consecutive patients with HF diagnosis, QRS≥120 ms, LBBB, NYHA II-IV, LVEF<35% and scheduled for CRT (100 male, 56 female; mean age 65...
October 18, 2016: Pacing and Clinical Electrophysiology: PACE
Kaylin T Nguyen, Rachel A Gladstone, Jonathan W Dukes, Babak Nazer, Eric Vittinghoff, Nitish Badhwar, Vasanth Vedantham, Edward P Gerstenfeld, Byron K Lee, Randall J Lee, Zian H Tseng, Jeffrey E Olgin, Melvin M Scheinman, Gregory M Marcus
INTRODUCTION: Atrial refractoriness may be an important determinant of atrial fibrillation (AF) risk, but its measurement is not clinically accessible. Because the QT interval predicts incident AF and the atrium and ventricle share repolarizing ion currents, we investigated the association between an individual's QT interval and atrial effective refractory period (AERP). METHODS: In paroxysmal AF patients presenting for catheter ablation, the QT interval was measured from the surface 12-lead ECG...
October 18, 2016: Pacing and Clinical Electrophysiology: PACE
Jeremiah Wasserlauf, Bradley P Knight, Zhi Li, Adin-Cristian Andrei, Rishi Arora, Alexandru B Chicos, Jeffrey J Goldberger, Susan S Kim, Albert C Lin, Nishant Verma, Martha M Bohn, Rod S Passman
BACKGROUND: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. METHODS: . Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff...
October 17, 2016: Pacing and Clinical Electrophysiology: PACE
Sergio Conti, Massimo Moltrasio, Claudio Tondo, Gaetano Fassini
Cryoballoon ablation is a widely diffuse technology to perform paroxysmal atrial fibrillation ablation. The new generation cryoballoon catheters have been redesigned in order to improve the cooling capability. During cryoballoon ablation it is not unusual to observe the formation of a contrast dye ice-cap on top of the balloon itself. The automated balloon deflation before dissolution of the ice cap may increase the risk of embolization of large ice-mixed-contrast crystals in the systemic circulation. In the case hereby reported, we describe an uneventful embolization of this contrast dye ice cap in the systemic circulation...
October 17, 2016: Pacing and Clinical Electrophysiology: PACE
Jason Huang, Kristen K Patton, Jordan M Prutkin
BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a novel implanted defibrillator for the prevention of sudden cardiac death that avoids intravascular access. Use of this device is limited by its inability to provide backup pacing. Combined use of the S-ICD with a permanent pacemaker may be the optimal choice in certain situations though experience with the use of both devices together remains limited. METHODS: We reviewed our single center experience with the S-ICD from March 2011 to November 2015...
October 13, 2016: Pacing and Clinical Electrophysiology: PACE
Giosuè Mascioli, Elena Lucca, Federica Michelotti, Giusy Alioto, Franco Santoro, Guido Belli, Cristina Rota, Ombretta Ornago, Giovanni Sirianni, Emanuela Pulcini, Matteo Pennesi, Carlo Savasta, Rosario Russo, Antonino Pitì
BACKGROUND: Patients with atrial fibrillation (AF) have an increased thromboembolic risk, that can be estimated with risk scores an require sometimes oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (R2 CHADS2 , CHADS2 and CHA2 DS2 -VASc) in predicting such events remains controversial MATERIAL AND RESULTS: Aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients...
October 12, 2016: Pacing and Clinical Electrophysiology: PACE
Lin Wang, Madhavi Kadiyala, Elana Koss, Abhimanyu Yarramaneni, Kathleen Rapelje, Stephanie Kampfer, Nathaniel Reichek, David Hoch, Vinay Jayam, Joseph Levine, Jie J Cao
BACKGROUND: We investigated CT angiography (CTA) in assessment of left atrial appendage (LAA) stasis and thrombus in pre-procedural evaluation for atrial fibrillation (AF) ablation in a large community cohort. METHODS AND RESULTS: We reviewed CTA and transesophageal echocardiographic images obtained in 861 consecutive patients with a history of AF undergoing same-day CTA and transesophageal echocardiogram (TEE) before AF ablation at a single hospital (2006-2013)...
October 12, 2016: Pacing and Clinical Electrophysiology: PACE
Yasunori Kanzaki, Yasuya Inden, Monami Ando, Yosuke Kamikubo, Tadahiro Ito, Yoshiaki Mizutani, Hiroyuki Kato, Aya Fujii, Satoshi Yanagisawa, Makoto Hirai, Toyoaki Murohara
BACKGROUNDS: Although several prognostic factors of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) have been investigated, the accurate prediction of AF recurrence remains difficult. We propose an ECG index, the P-wave force (PWF), which is the product of the amplitude of the negative terminal phase of the P-wave in the V1 electrode and the filtered P-wave duration (FPD), obtained by a signal-averaged P-wave analysis. This study was conducted to evaluate the impact of the PWF on the recurrence of AF after PVI...
October 10, 2016: Pacing and Clinical Electrophysiology: PACE
Ru-Hong Jiang, Gen-Sheng Hu, Qiang Liu, Xia Sheng, Ya-Xun Sun, L U Yu, Pei Zhang, Zu-Wen Zhang, Shi-Quan Chen, Yang Ye, Jun Zhu, Guo-Sheng Fu, Chen-Yang Jiang
BACKGROUND: The mechanisms underlying atrial fibrillation (AF) initiation and pulmonary vein isolation (PVI) effectiveness remain unclear. Ganglionated plexus (GPs) have been implicated in AF initiation and maintenance. In this study, we evaluated the impact of GP ablation in patients with PV firing after PVI. METHODS: Patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation therapy with PVI were screened. Amongst 840 cases over a 3...
October 10, 2016: Pacing and Clinical Electrophysiology: PACE
Jonathan D Salcedo, Victor G Pretorius, Jonathan C Hsu, Gautam G Lalani, Amir A Schricker, Shrinivas M Hebsur, Thomas J McGARRY, Jessica A Hunter, Kathryn E Lewis, David E Krummen, Gregory K Feld, Ulrika Birgersdotter-Green
BACKGROUND: Radiofrequency (RF) technology has improved detection of retained surgical sponges with a reported 100% sensitivity and specificity. However, the potential for interactions of the RF signals emitted by the detection system with cardiac implantable electronic devices (CIEDs) or temporary pacemakers may limit its use in those patients with these devices. This study investigated whether RF detection technology causes interference or clinically significant changes in the programmed settings of implanted pacemakers and defibrillators or temporary epicardial pacemakers...
October 6, 2016: Pacing and Clinical Electrophysiology: PACE
Konstantin V Zavadovsky, Victor V Saushkin, Mikhail S Khlynin, Sergey V Popov, Yuri B Lishmanov
BACKGROUND: The aim of the study was to evaluate the impact of idiopathic ventricular tachycardia and premature ventricular beats on cardiac function and dyssynchrony and to elucidate relationships between data of scintigraphic and intracardiac electrophysiology studies. METHODS: The study comprised 64 patients with idiopathic ventricular arrhythmias (VA) (median age of 14 years ranging from 8 to 18 years). Control group comprised 20 patients (median age of 12 ranging from 7 to 16 years) without cardiac arrhythmias...
September 23, 2016: Pacing and Clinical Electrophysiology: PACE
Fabrizio Drago, Mario Salvatore Russo, Irma Battipaglia, Gino Grifoni, Massimo Stefano Silvetti, Romolo Remoli, Vincenzo Pazzano, Fabio Anselmo Saputo, Michele Ciani
AIMS: Transcatheter cryoablation is a well-established technique for the treatment of AV nodal reentry tachycardia (AVNRT) in children. Nevertheless, A-V nodal slow pathway conduction may recur after an acutely successful procedure. The aim of this study was to evaluate the long-term outcome of acutely successful AVNRT cryoablations in pediatric patients in case of focal cryolesion and in case of need for High Density Linear Lesion (HDLL) cryoablation due to focal failure. METHODS: ...
September 22, 2016: Pacing and Clinical Electrophysiology: PACE
Marcos F Mills, Kara S Motonaga, Anthony Trela, Anne M Dubin, Kishor Avasarala, Scott R Ceresnak
BACKGROUND: There are limited adult data suggesting the tachycardia cycle length (TCL) of atrioventricular reentry tachycardia (AVRT) is shorter than atrioventricular nodal reentry tachycardia (AVNRT), though little data exist in children. We sought to determine if there is a difference in TCL between AVRT and AVNRT in children. METHODS: A single-center retrospective review of children with supraventricular tachycardia (SVT) from 2000 to 2015 was performed. INCLUSION CRITERIA: Age ≤ 18 years, invasive electrophysiology study (EPS) confirming AVRT or AVNRT...
September 22, 2016: Pacing and Clinical Electrophysiology: PACE
Takehito Sasaki, Kohki Nakamura, Shigeto Naito, Kentaro Minami, Keiko Koyama, Eiji Yamashita, Koji Kumagai, Shigeru Oshima
BACKGROUND: We aimed to identify the predictors of clinical outcomes after circumferential pulmonary vein isolation (CPVI) without any substrate modification for long-standing persistent atrial fibrillation (LSP-AF). METHODS: This study retrospectively analyzed 70 consecutive LSP-AF patients who underwent an initial CPVI and were followed up for more than one year. The right and left atrial volumes indexed to the body surface areas (RAVI and LAVI) were determined by pre-acquired contrast-enhanced computed tomography (CT)...
September 18, 2016: Pacing and Clinical Electrophysiology: PACE
Meghan M Good, Fady S Riad, Chester B Good, Alaa A Shalaby
BACKGROUND: Drugs and electrolyte imbalances are widely recognized as common triggers of a prolonged QT interval. We conducted a chart review to assess provider response to prolonged QT reported on a standard 12-lead electrocardiogram (EKG). METHODS: We identified all Veterans Affairs Pittsburgh Healthcare System patients in a 6-month period with an EKG reporting a corrected QT (QTc) >500 ms. We excluded confounding or uninterpretable EKGs. Charts were reviewed to assess medications and electrolytes at the time of the EKG as well as the setting (inpatient vs outpatient) in which the EKG was obtained...
September 15, 2016: Pacing and Clinical Electrophysiology: PACE
Hayrettin Hakan Aykan, Tevfik Karagoz, Mustafa Gulgun, Ilker Ertugrul, Ebru Aypar, Sema Ozer, Dursun Alehan, Alpay Celiker, Suheyla Ozkutlu
BACKGROUND: Despite concerns about complications with the implantable cardioverter-defibrillator (ICD), but it is effective for the prevention of sudden cardiac death. We aimed to analyze our mid-term experience with ICD in children and young adults. METHODS: This retrospective study included patients who were implanted with an ICD between 2001 and 2014. Demographic characteristics, clinical information, shock features and complications for all patients with ICD were analyzed...
September 13, 2016: Pacing and Clinical Electrophysiology: PACE
Krishna Kumar Mohanan Nair, Narayanan Namboodiri, Bharatraj Banavalikar, Ajitkumar Valaparambil, Anees Thajudeen, Jaganmohan Tharakan
A 53-year-old woman was referred for radiofrequency catheter ablation of narrow QRS tachycardia that was terminated with intravenous adenosine. Twelve-lead ECG was normal during sinus rhythm. She was taking calcium channel blockers and that was stopped 5 half lives prior to the procedure. The electrophysiological study showed a normal AH interval of 94 ms and HV interval of 42 ms during sinus rhythm. Retrograde conduction was central and decremental. Anterograde study demonstrated dual AV nodal physiology. Atrial pacing protocols easily and reproducibly induced narrow QRS tachycardia (Fig:1)...
September 9, 2016: Pacing and Clinical Electrophysiology: PACE
Tolga Aksu, Tümer Erdem Guler, Kivanc Yalin, Ali Oto
Pulmonary vein isolation has been accepted as potential target for ablation of paroxysmal atrial fibrillation (AF) given that the pulmonary veins are the main source of AF triggers. However, ablation strategies for persistent AF are less well defined. Mapping and ablation of complex fractionated atrial electrograms (CFAEs) is one strategy that has been proposed as a strategy for substrate modification although there is no consensus on their definition and procedural endpoints. Results of clinical studies have been conflicting...
August 26, 2016: Pacing and Clinical Electrophysiology: PACE
Susanne S Pedersen, Jens Cosedis Nielsen, Sam Riahi, Jens Haarbo, Regitze VidebAEk, Mogens Lytken Larsen, Ole Skov, Charlotte Knudsen, Jens Brock Johansen
BACKGROUND: Little systematic evidence is available on potential gender differences in patients with an implantable cardioverter defibrillator (ICD) from a real-world cohort. We designed the DEFIB-WOMEN study to examine gender differences on (i) patient reported outcomes (PROs), (ii) procedure- and device-related complications, and (iii) ventricular tachyarrhythmia and mortality. This presents the study design and baseline characteristics of the cohort. METHODS: DEFIB-WOMEN is a national, multi-center, prospective, observational study...
August 26, 2016: Pacing and Clinical Electrophysiology: PACE
Sun Moon Kim, Sebastiano Virgadamo, John Gurley, Claude S Elayi
Incessant scar related re-entrant ventricular tachycardia is an important cause of morbidity and mortality. In patients not amenable to emergent radiofrequency catheter ablation, selective transcoronary alcohol ablation has been successfully performed. In our case study, we introduce the novel use of cardioplegia as a mapping technique for identification of the critical ventricular tachycardia isthmus to guide efficient transcoronary alcohol ablation and prevent unnecessary myocardial damage. This article is protected by copyright...
August 26, 2016: Pacing and Clinical Electrophysiology: PACE
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