Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement.

Background: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with severe aortic stenosis. Despite newer generation valves, atrioventricular (AV) conduction disturbance is a common complication, necessitating permanent pacemaker (PPM) implantation in about 10% of patients. Hence, it is imperative to improve periprocedural risk stratification to predict PPM implantation after TAVR.

Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices: Clinical Incidence and Predictors.

Importance: Risk stratification and management paradigms for patients with cardiovascular implantable electronic devices (CIEDs) requiring radiotherapy (RT) vary widely and are based on limited clinical data.

Objective: To identify the incidence and predictors of CIED malfunction and describe associated clinical consequences in a large cohort of patients treated with photon- and electron-based RT.

Design, Setting, And Participants: Retrospective analysis of all patients with a functioning CIED who underwent RT between August 2005 and January 2014 with CIED interrogation data following RT at an academic cancer center.

Bradycardia as a Marker of Chronic Cocaine Use: A Novel Cardiovascular Finding.

Few studies have examined the effects of chronic cocaine use on the resting surface electrocardiogram (ECG) between exposures to cocaine. Researchers compared 12-lead ECGs from 97 treatment-seeking cocaine-dependent patients, with ECG parameters from 8,513 non-cocaine-using control patients from the Atherosclerosis Risk in Communities study. After matching and adjusting for relevant covariates, cocaine use demonstrated large and statistically reliable effects on early repolarization, bradycardia, severe bradycardia, and heart rate.

Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors.

Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT.

Methods And Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution.

Recurrent syncope in a cancer patient: a case report and review of the literature.

A 59-year-old male with invasive squamous cell carcinoma of the left preauricular region, treated with several chemotherapy regimens and radiation therapy, was admitted for recurrent syncopal episodes. He was found to be suffering from neurocardiogenic reflex-mediated syncope secondary to mechanical compression of the carotid baroreceptors and glossopharyngeal nerve by the tumor. We discuss the pathophysiology of this case and the available treatment options.

Noncompacted ventricular myocardium: is syncope the only warning sign?

We present a case of a 14-year-old young boy with ventricular noncompaction and coexistent Wolff-Parkinson-White syndrome who presented with syncope. Detailed testing was performed, and an ablation was successful for Wolff-Parkinson-White syndrome; however, because of patient/family desires, an implantable cardiodefibrillator was placed. A careful review of the literature highlights the complex decision making involved with this condition.

Multiple shocks after upgrade of an implantable cardioverter-defibrillator to a cardiac resynchronization therapy-defibrillator device.

Inappropriate shocks from implantable cardioverter-defibrillators (ICDs) may occur for many reasons. Inappropriate shocks are not simply painful inconveniences for patients; they also may result in the need for further operative procedures, and sometimes even death. Herein, we report the case of a patient who after upgrade of an ICD to a cardiac resynchronization therapy-defibrillator device (CRT-D), returned with multiple shocks due to altered sensing and defibrillation polarities that resulted from actual physical reversal of the distal (-) and proximal (+) lead terminals in the header of the device.

Arrhythmogenic right ventricular cardiomyopathy with implantable cardioverter defibrillator placement in pregnancy.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder that predominantly affects the right side of the heart and causes ventricular arrhythmias. In many patients the disease is familial. ARVC may account for as many as 5% of unexpected sudden deaths.