Noncentrifugal activation patterns in focal RVOT PVC/VT: New insights from high density multielectrode mapping.

Background: Activation from an automatic focus is thought to show centrifugal spread. In patients with premature ventricular complex/ventricular tachycardia (PVC/VT) from the right ventricular outflow tract (RVOT), the presence of preferential conduction and epicardial connections could however also lead to noncentrifugal wavefront propagation.

Objective: To study endocardial activation in RVOT PVC/VT using high-resolution 3D activation mapping.

Mechanical Circulatory Support During Catheter Ablation of Ventricular Tachycardia: Indications and Options.

Mapping of scar-related ventricular tachycardia (VT) in structural heart disease is fundamentally driven by identifying the critical isthmus of conduction that supports re-entry in and around myocardial scar. Mapping can be performed using activation and entrainment techniques during VT, or by substrate mapping performed in stable sinus or paced rhythm. Activation and entrainment mapping requires the patient to be in continuous VT, which may not be haemodynamically tolerated, or, if tolerated, may lead to adverse sequelae related to impaired end organ perfusion.

Clinically Significant Pocket Hematoma Increases Long-Term Risk of Device Infection: BRUISE CONTROL INFECTION Study.

Background: The BRUISE CONTROL trial (Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial) demonstrated that a strategy of continued warfarin during cardiac implantable electronic device surgery was safe and reduced the incidence of clinically significant pocket hematoma (CSH). CSH was defined as a post-procedure hematoma requiring further surgery and/or resulting in prolongation of hospitalization of at least 24 h, and/or requiring interruption of anticoagulation. Previous studies have inconsistently associated hematoma with the subsequent development of device infection; reasons include the retrospective nature of many studies, lack of endpoint adjudication, and differing subjective definitions of hematoma.

Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia.

Introduction: Sarcoidosis is a granulomatous disease of unknown etiology, which involves the heart in 5-25% of cases. Although ventricular tachycardia (VT) has been reported as the first presentation of sarcoidosis, its prevalence has not previously been investigated. In this prospective study, we sought to systematically investigate the prevalence of cardiac sarcoidosis (CS) in patients presenting with monomorphic VT (MMVT) and no previous history of sarcoidosis.

Isolated cardiac sarcoidosis: establishing the diagnosis with electroanatomic mapping-guided endomyocardial biopsy.

Diagnosing isolated cardiac sarcoidosis can be challenging, and requires a high index of suspicion. We report a case of a young woman who presented with sustained ventricular tachycardia, intermittent atrioventricular block and epsilon wave on electrocardiogram. Although the patient fulfilled Task Force criteria for arrhythmogenic right ventricular cardiomyopathy, sarcoidosis was suspected because of the presence of intermittent atrioventricular block.

Anticoagulation bridging around device surgery: compliance with guidelines.

Background: Current guidelines recommend bridging anticoagulation in patients undergoing cardiac rhythm device surgery with a "moderate to high risk" of thromboembolism. Patients at "low risk" are advised to stop oral anticoagulation without bridging to the procedure. This study examines real world adherence to accepted guidelines and the clinical sequelae of nonadherence.

Degenerating regenerating torsades de pointes.

Ventricular fibrillation (VF) commonly ends in death. Isolated case reports describe the uncommon occurrence of spontaneous termination of VF. Torsades de pointes (TdP), a peculiar form of polymorphic ventricular tachycardia associated with a prolonged QT interval on the surface electrocardiogram, most often spontaneously terminates and then returns to the underlying rhythm.

Cardiac resynchronization therapy: expanding clinical indications and refining patient selection.

Purpose Of Review: Cardiac resynchronization therapy (CRT) can reduce morbidity and mortality in patients with heart failure. However, a proportion of patients do not respond to CRT. This review addresses important clinical questions regarding patient selection for CRT.

Greater response to cardiac resynchronization therapy in patients with true complete left bundle branch block: a PREDICT substudy.

Aims: Cardiac resynchronization therapy (CRT) benefits patients with heart failure and a wide QRS complex. Still, one-third derive no clinical benefit and a majority of patients demonstrate no objective improvement of left ventricular (LV) function. Left bundle branch block (LBBB) is a strong predictor of response to CRT.

Prevalence and risk factors for cervical and lumbar spondylosis in interventional electrophysiologists.

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Introduction: The volume and complexity of interventional electrophysiology procedures have increased greatly over the last 20 years. Anecdotal reports from Canada and elsewhere have suggested an important prevalence of neck and back problems in interventional electrophysiologists.

Methods And Results: To quantify the scope of neck and back problems, we surveyed 70 interventional electrophysiologists in Canada using an electronic survey with in person and email reminders.

Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review.

Background: Whether patients with right bundle branch block (RBBB) benefit from cardiac resynchronization therapy (CRT) is unclear.

Objective: The purpose of this study was to systematically review the published data from randomized clinical trials of CRT on the outcomes in patients with baseline RBBB.

Methods: Randomized controlled trials of CRT in heart failure and left ventricular systolic dysfunction were identified from MEDLINE (1950-2010), EMBASE (1980-2010, week 45), Cochrane Controlled Trials Register (2009), Cochrane Database of Systematic Reviews, National Institutes of Health Clinical Trials.

Psychological adjustment in ICD patients living with advisory fidelis leads.

Unlabelled: Psychological Adjustment and Fidelis ICD Leads. 

Introduction: Implantable cardioverter defibrillators (ICD) advisory notices present treatment dilemmas for physicians and patients. On one side, the risk of device malfunction and the likely severity of clinical sequelae have to be estimated.

Predictors of fracture risk of a small caliber implantable cardioverter defibrillator lead.

Introduction: The Sprint Fidelis 6949 implantable cardioverter defibrillator (ICD; Medtronic Inc., Minneapolis, MN, USA) lead has a high rate of fracture. Identification of predictors of subsequent fracture is useful in decision making about lead replacement and for future lead design.