Inter-atrial septal balloon dilation to facilitate intracardiac echocardiography guided left atrial appendage occlusion.

Introduction: Percutaneous left atrial appendage occlusion (LAAO) is traditionally performed under general anesthesia with trans-esophageal echocardiography guidance. Intracardiac echo (ICE)-guided LAAO closure is increasing in clinical use. The ICE catheter is crossed into LA via interatrial septum (IAS) after the septum is dilated with LAAO delivery sheath.

Outcomes in congenital and childhood complete atrioventricular block: A meta-analysis.

Background: The long-term outcomes of patients with congenital and childhood complete atrioventricular block (CCAVB/CAVB) after pacemaker implantation are unclear.

Methods: We performed a meta-analysis of all the studies of CCAVB. A systematic search of PubMed and CENTRAL databases from January 1, 1967 to January 31, 2020 was performed.

A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation.

Background: There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA.

Rhythm Control of Persistent Atrial Fibrillation in Systolic Heart Failure: A Bayesian Network Meta-Analysis of Randomized Controlled Trials.

Background And Objectives: Persistent atrial fibrillation (PeAF) with heart failure (HF) arguably constitutes the sickest subset of atrial fibrillation (AF) patients.

Methods: A systematic search was made in PubMed, Embase, and Scopus databases. Network meta-analysis (NMA) of PeAF patients with systolic HF comparing all-cause mortality, change in HF-related quality of life (QoL) and hospitalization due to heart failure (HHF) were performed among catheter ablation (CA) of AF, rate-controlling drugs (RCDs), anti-arrhythmic drugs (AADs), and atrio-ventricular nodal ablation (AVNA) using Bayesian random effect model.

Subcutaneous implantable cardioverter-defibrillator electrode fracture: Follow-up, troubleshooting, and evaluation.

The subcutaneous-implantable cardioverter-defibrillator (S-ICD) and its electrode were developed to avoid long-term complications of transvenous leads in the vasculature. We report a case of unexpected, inappropriate S-ICD shocks due to oversensing of high-amplitude, nonphysiologic, electrical noise artifacts that were not preceded by high-impedance alerts or sensing electrogram noise detections. Following explant, high-magnification X-ray imaging of the S-ICD electrode demonstrated partial fracture of the distal sensing conductor located near a short radius bend in the electrode at the electrode-header interface.

Renal Dysfunction following Direct Current Cardioversion of Atrial Fibrillation: Incidence and Risk Factors.

Introduction: Emerging data suggest that cardioversion for atrial fibrillation (AF) may be associated with acute kidney injury (AKI). However, limited data are available regarding the incidence and risk factors for AKI after direct current cardioversion (DCCV) of AF.

Methods: All patients undergoing DCCV at Mayo Clinic between 2001 and 2012 for AF were prospectively enrolled in a database.

MRI in patients with cardiac implantable electronic devices: A comprehensive review.

Magnetic resonance imaging (MRI) has become a commonly used non-ionizing radiation dependent imaging modality which has an excellent spatial resolution with the capability to provide physiological information. Cardiac implantable electronic devices (CIEDs) are used in modern cardiology with a frequency of 1:50 over 75 years of age and nearly one in three people in this population required MRI during their lifetime. Changes in the CIED structure, electronics, and algorithms paired with changes in the protocol design of MRI have created a relatively safe environment for performing MRI in patients with CIED.

Prospective evaluation of the utility of magnetic resonance imaging in patients with non-MRI-conditional pacemakers and defibrillators.

Background: Magnetic resonance imaging (MRI) in patients with legacy cardiovascular implantable electronic devices (CIEDs) in situ is likely underutilized. We hypothesized the clinical benefit of MRI would outweigh the risks in legacy CIED patients.

Methods: This is a single-center retrospective study that evaluated and classified the utility of MRI using a prospectively maintained database.

LV only pacing-mediated electrical storm with cardiac resynchronization therapy managed by simultaneous biventricular pacing.

Ventricular arrhythmia (VA) is a rare complication of cardiac resynchronization therapy (CRT). Little is known about ventricular proarrhythmia related to the pacing vector of CRT. This case report describes the elimination of ventricular arrythmia using biventricular pacing in a patient with VT-storm related to LV only pacing as part of the AdaptivCRT algorithm (Medtronic Inc).

Fibroplasty (venoplasty) to facilitate transvenous lead placement: A single-center experience.

Introduction: Venous stenosis is a well-recognized complication of transvenous leads (TVLs) that is encountered during lead revisions or device upgrades. We here report the outcomes of TVL placement facilitated by fibroplasty or tunneling (TUN) procedure.

Methods: We conducted a single-center retrospective cohort study of all patients undergoing TVL implantation requiring fibroplasty or TUN from 2005 to 2017.

Defining the substrate for ventricular tachycardia ablation: The impact of rhythm at the time of mapping.

Background: Voltage mapping is critical to define substrate during ablation. In ventricular tachycardia, abnormal potentials may be targets. However, wavefront of activation could impact local signal characteristics.

Sudden cardiac arrest and ventricular arrhythmias following first type I myocardial infarction in the contemporary era.

Introduction: Myocardial infarction (MI) is associated with an increase in subsequent heart failure (HF), recurrent ischemic events, sudden cardiac arrest, and ventricular arrhythmias (SCA-VA). The primary objective of the study to determine the role of intercurrent HF and ischemic events on the development of SCA-VA following first type I MI.

Methods And Results: A retrospective cohort study of patients experiencing first type 1 MI in Olmsted County, Minnesota (2002-2012) was conducted by identifying patients using the medical records linkage system (Rochester epidemiology project).

Safety of thoracic magnetic resonance imaging for patients with pacemakers and defibrillators.

Background: During magnetic resonance imaging (MRI), cardiac implantable electronic device (CIED) leads can be antennae to focus energy onto myocardium, leading to heating and arrhythmias. Clinical data on thoracic MRI safety for patients with legacy devices are limited.

Objective: The purpose of this study was to identify patients undergoing thoracic MRI with legacy devices, compare the incidence of adverse events of those patients with control patients undergoing brain MRI with legacy devices, and compare paired cardiac troponin T (cTnT) values.

Radiofrequency ablation of the cavotricuspid isthmus for management of atrial flutter in patients with congenital heart disease after tricuspid valve surgery: A single-center experience.

Background: Typical atrial flutter involving the cavotricuspid isthmus (CTI) is the most common reentrant arrhythmia in congenital heart disease and ablation is effective in its management. However, congenital heart disease patients often require surgical interventions on their tricuspid valve that utilize prosthetic material, making CTI ablation technically challenging.

Objective: To describe the techniques and outcomes of CTI ablation in the presence of prior tricuspid valve repair or replacement.

Potentially modifiable factors of dofetilide-associated risk of torsades de pointes among hospitalized patients with atrial fibrillation.

Purpose: There is a significant variation in the clinical approach of initiation and dose adjustment of dofetilide in atrial fibrillation (AF). Excessive QT prolongation could predispose patients to torsades de pointes (TdP), which can be fatal.

Methods: We performed a retrospective case-control study at Mayo Clinic Rochester (January 1, 2003 to December 31, 2016).

Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants.

Purpose: This study aimed to assess the risk of procedure-related complications of percutaneous epicardial access (EpiAcc) for radiofrequency catheter ablation (RFA) of ventricular arrhythmias (VAs) in patients chronically treated oral anticoagulants (OACs) with warfarin compared to those not on OACs.

Methods: We analyzed 205 patients (53 ± 16 years, 155 males) undergoing percutaneous EpiAcc as part of an RFA for VAs, and compared the outcome between patients chronically on OACs with warfarin (OAC group) and those without (non-OAC group).

Results: Forty-seven patients (23%) were chronically treated on OACs before their procedure.

Sleep Duration and Risk of Fatal Coronary Heart Disease, Sudden Cardiac Death, Cancer Death, and All-Cause Mortality.

Background: Sleep duration has been shown to be associated with all-cause mortality; however, its relationship with cause-specific fatal events remains uncertain. We examined the relationship between sleep duration and risk of fatal coronary heart disease, sudden cardiac death, cancer-related death, and all-cause mortality.

Methods: Sleep duration was self-reported at baseline examinations performed between March 20, 1984, and December 5, 1989, in 2361 men aged 42-61 years from the Kuopio Ischemic Heart Disease study.

Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads.

Background: During magnetic resonance imaging (MRI), abandoned leads may act as antennae that result in tissue heating and arrhythmia induction.

Objective: The purpose of this study was to assess the safety of MRI in patients with abandoned leads, with the addition of cardiac troponin T (cTnT) assessment to screen for myocardial damage.

Methods: We reviewed our prospectively collected database of patients with cardiovascular implantable electronic devices (CIEDs) undergoing MRI between 2008 and 2017 at Mayo Clinic, Rochester, MN, and selected patients who had abandoned leads.