Imaging Modality Selection in Cardiac Ablation.

Catheter ablation as a treatment method for both ventricular and atrial arrhythmias has evolved significantly over the past 40 years since it was first performed in humans. This evolution has been paralleled by a similar expansion in both invasive and non-invasive imaging modalities directed at further elucidating cardiac morphology and arrhythmia substrate pathophysiology. Access to multimodality imaging options is a significant piece of the armamentarium available to interventional electrophysiologists who are tackling increasingly complex rhythm problems with catheter ablation.

Intraventricular Free-Floating Thrombus in an Impella-Supported Patient: Damage Control in a No-Win Scenario.

We describe the management and clinical decision making in a cardiogenic shock patient with a free-floating left ventricular thrombus found during temporary mechanical support with an Impella CP. The management of these patients can be challenging because there are no guidelines or data to support any particular treatment strategy. ().

Reexamination of the UN10 Rule to Discontinue Resuscitation During In-Hospital Cardiac Arrest.

Importance: Several clinical decision rules (CDRs) have been developed to help practitioners know when to safely terminate resuscitative efforts after in-hospital cardiac arrest (IHCA). The UN10 rule, a CDR that uses 3 intra-arrest variables, has been shown to predict a poor chance of survival to discharge. However, its large-scale applicability in clinical settings remains unknown.

Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure.

Background Increased blood pressure ( BP ) variability and nondipping status seen on 24-hour ambulatory BP monitoring are often observed in autonomic failure ( ATF ). Methods and Results We assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southwestern Medical Center between 2010 and 2017. SD , average real variability, and variation independent of mean were calculated from ambulatory BP monitoring.

Comparative Efficacy of Endovascular Revascularization Versus Supervised Exercise Training in Patients With Intermittent Claudication: Meta-Analysis of Randomized Controlled Trials.

Objectives: The authors performed a meta-analysis of randomized controlled trials to compare the efficacy of initial endovascular treatment with or without supervised exercise training (SET) versus SET alone in patients with intermittent claudication.

Background: Current guidelines recommend SET as the initial treatment modality for patients with intermittent claudication, in addition to optimal medical therapy. The role of endovascular therapy as primary treatment for claudication has been controversial.

Safety and Efficacy of Exercise Training in Patients With an Implantable Cardioverter-Defibrillator: A Meta-Analysis.

Objectives: In this study, the authors performed a meta-analysis of currently available comparative prospective studies to assess the efficacy and safety of exercise training in heart failure (HF) patients with implantable cardioverter-defibrillators (ICD).

Background: ICDs have been shown to improve survival in patients with HF. However, many patients with ICDs experience fear of shocks and avoid physical activity.

Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective.