Atrial Tachycardias After "Multiple" Previous Ablations for Tachyarrhythmias: Treatment by Anti-arrhythmic Drugs or Additional Ablation?

Pulmonary vein (PV) isolation (PVI) ablation as the first-line therapy for atrial fibrillation (AF) and repeat PVIs for patients who had symptomatic improvement with the index PVI but who develop AF recurrence are directed by practice guidelines. How many catheter ablation (CA) procedures constitute the definition of "multiple" ablations is not known. Whether atrial tachyarrhythmias (AF, atrial tachycardia [AT], atrial flutter [AFL]) that occur post-ablation are due entirely to the proarrhythmic effects of CA or a continuum of the arrhythmia spectrum from the underlying atriopathy is debatable.

Are antiarrhythmic agents indicated in premature ventricular complex-induced cardiomyopathy and when?

Introduction: Premature ventricular complexes (PVCs) are the most common ventricular arrhythmia that are encountered in the clinical practice. Recent data suggests that high PVC burden may lead to the development of PVC-induced cardiomyopathy (PVC-CM) even in patients without structural heart disease. Treatment for effective suppression of PVCs, can reverse PVC-CM.

Open-window mapping for ablation of Wolff-Parkinson-White syndrome related hemodynamically unstable tachycardia.

During catheter ablation (CA) of tachycardia, conventional point-by-point mapping may be hindered due to hemodynamic instability. We performed open-window mapping (CARTO, Biosense Webster, USA) in a patient who developed hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT) and unwarranted induction of AVRT during attempts to map accessory pathway (AP) with ventricular pacing. With over 11,000 points acquired rapidly, the system accurately identified AP at the mitral valve (MV) annulus where the application of single radiofrequency (RF) lesion promptly eliminated AP's conduction.

Persistently abnormal device-detected thoracic impedance and OptiVol fluid index related to breast reconstruction surgery.

With significant correlation shown between intrathoracic impedance and intrathoracic fluid volume, the utility of OptiVol fluid index (Medtronic, Minneapolis, MN, USA) in the management of patients with heart failure has been well-described. Although intrathoracic impedance is mainly affected by the changes in the intrathoracic fluid volume, a "false-positive" OptiVol fluid index can occur in the absence of overt congestive heart failure. We present a case of false positive Optivol fluid index elevation in a woman following breast reconstruction surgery.

One year outcomes of atrial fibrillation ablation: Contemporary analysis of the United States Nationwide Readmission Database.

Background: Data on long-term outcomes of catheter ablation (CA) for atrial fibrillation (AF) in outside of clinical trials settings are sparse.

Objective: We aimed to assess outcomes and readmissions at 1 year following admission for CA for AF.

Methods: Utilizing the Nationwide Readmissions Database (2016-2018), we identified patients with CA among all patients with a primary admission diagnosis of AF, and a control group by propensity score match adjusted for age, sex, comorbidities, CHA₂DS₂-VASc scores, and the hospital characteristics.

Implications of "slower" ventricular tachycardia on clinical management and detection and therapy function of implantable cardioverter defibrillators.

Sophisticated dual-chamber atrioventricular and rate-responsive pacing therapies, cardiac resynchronization therapy (CRT), detection and therapies for ventricular tachycardia and fibrillation (VT/VF) form some major components of multitask functions of current implantable cardioverter defibrillators (ICDs). Appropriate programming of these devices is necessary for them to perform all such tasks precisely. In this report, we describe a case of a patient with Chagas cardiomyopathy with marked cardiomegaly, scarred ventricles, prior epicardial and endocardial ablations and on antiarrhythmic pharmacotherapy for VT, who presented with symptomatic wide complex tachycardia at a slower rate than definition of VT, and in whom programming for detection and therapy for "slow" VT could not be performed due to default technological limitation of the CRT-D.

Cardiac resynchronization therapy in patients with heart failure and narrow QRS complexes (≤ 130 ms): role of speckle tracking echocardiography and different interventricular (VV) pacing intervals.

Purpose: Response to cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFrEF) depends on the degree of correction of interventricular (VV) electromechanical dyssynchrony between the left and right ventricles (LV, RV). Wide (> 130 ms [ms]) QRS interval is used as a qualifying ECG parameter for CRT device implantation. In this study, we aimed to evaluate myocardial strain (S) and myocardial strain patterns (SP) and strain rate (SR) by speckle tracking echocardiography (STE) and mechanical characteristics at different VV intervals in acute settings and long-term outcome from "sequential LV-RV" pacing programming in patients with narrow (< 130 ms) and wide (> 130 ms) QRS complexes as a basis for extending CRT in select patients with narrow QRS.

Safety and complications of catheter ablation for atrial fibrillation: Predictors of complications from an updated analysis the National Inpatient Database.

Background: Catheter ablation is increasingly employed in the management of atrial fibrillation (AF). Data regarding safety of ablation of AF is largely derived from controlled clinical trials.

Objectives: The aim of this study was to analyze safety and complications of AF ablation performed in a "real world" setting outside of clinical trials, and obtain insights on predictors of complications.

Myocardial strain characteristics at different interventricular pacing timings: implications for device programming and long-term clinical outcomes in patients with cardiac resynchronisation therapy.

Aims: Response to cardiac resynchronisation therapy (CRT) in patients with heart failure depends on the degree of correction of electromechanical dyssynchrony between the left and right ventricles (LV, RV). It is not known whether chronic programming of interventricular (VV) intervals based on characterisation of myocardial strain at different pacing intervals performed acutely would have better long-term clinical outcomes. We hence aimed to evaluate this relationship between speckle tracking strain patterns and rates at different VV intervals and long-term clinical outcomes of programmed VV pacing in patients with CRT in a prospective, longitudinal follow-up study.

Low-dose rituximab as an adjuvant therapy in pemphigus.

Background: Pemphigus is a chronic autoimmune blistering disease where systemic steroids and immunosuppressants are the mainstay of therapy, but long-term treatment with these agents is associated with many side effects. Rituximab, a chimeric monoclonal anti-CD20 antibody, in low doses has shown efficacy as an adjuvant to reduce the dose of steroids.

Aim: To study the clinical efficacy and safety of low-dose rituximab as an adjuvant therapy in pemphigus.

Pacing to prevent atrial fibrillation.

Purpose Of Review: Pacemakers are frequently implanted in patients with atrial fibrillation. Many patients with pacemakers also develop atrial fibrillation. Over a period of time, through many studies on different pacing modes, sites, and algorithms, significant insights have been gained in the field of treatment and prevention of atrial fibrillation.

Nodal and infranodal atrioventricular conduction block: electrophysiological basis to correlate the ECG findings.

A 68-year-old woman with a history of dilated non-ischemic cardiomyopathy presented with syncope. The index ECG showed sinus rhythm with left bundle branch block. On telemetry episodes of sinus rhythm with narrower QRS complexes conduced in 2:1 pattern were noted.

Chagas disease in Latin American immigrants with dilated cardiomyopathy in New York City.

Chagas disease-associated cardiomyopathy is clinically similar to other causes of cardiomyopathy and, therefore, the diagnosis can be easily overlooked. We found a 13% point prevalence of Chagas disease in a sample of New York City immigrants with dilated cardiomyopathy.

Reuse of explanted permanent pacemakers donated by funeral homes.

Poor patients in developing countries may not receive permanent pacemakers (PPMs) even as lifesaving measures because of their high cost. In this report we examined whether PPMs that were explanted and donated by funeral homes in the United States could be safely and effectively reused in indigent patients in India. With permission from the deceased patients' families, 121 PPMs were explanted and donated by funeral homes for reuse.

Long-term outcome following successful pulmonary vein isolation: pattern and prediction of very late recurrence.

Background: Despite encouraging results of pulmonary vein isolation (PVI) ablation for atrial fibrillation (AF), it is unclear whether there is genuine cure or there is an important attrition rate. We sought to determine the long-term outcome of the initial responders who experienced a prolonged AF-free complete response.

Methods: From a series of 350 consecutive patients who underwent PVI for AF, 264 patients (75%) (males 71%, age 57 +/- 12 years, paroxysmal AF 87%) who demonstrated >or=1 year AF-free follow-up on no antiarrhythmic drugs were followed for 1-5 years.

Dexmedetomidine related cardiac arrest in a patient with permanent pacemaker; a cautionary tale.

Dexmedetomidine (Precedex), an alpha-2 adrenergic receptor agonist is frequently and safely used as sedative agent during surgical procedures. We report a case of a 76-year-old woman who developed cardiac arrest from the use of dexmedetomidine during pacemaker lead extraction procedure.