Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results of a multicenter study.

Background: Percutaneous left atrial appendage (LAA) occlusion with Lariat has emerged as a viable alternative to oral anticoagulation (OAC) to prevent thromboembolic (TE) events in patients with atrial fibrillation.

Objective: We evaluated the long-term TE risk in post-Lariat patients.

Methods: Consecutive patients undergoing LAA ligation with the Lariat device at multiple centers with at least 1-year follow-up were included in the analysis.

Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: Results from an international survey.

Purpose: Survey the usage and application protocol of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device (CIED) infection prophylaxis.

Background: Local antibiotic usage for CIED infection prophylaxis, in particular pocket irrigation, is a well-known strategy but with little data on its clinical effectiveness.

Methods: An anonymous voluntary online survey was sent to a total of 2,092 arrhythmia-oriented cardiologists in 51 countries (1,490 from the United States).

Clinical Implications of Leaks Following Left Atrial Appendage Ligation With the LARIAT Device.

Objectives: The aim of this study was to evaluate the incidence and clinical implications of leaks (acute incomplete occlusion, early and late reopenings) following LAA ligation with the LARIAT device.

Background: Percutaneous LAA ligation with the LARIAT device may represent an alternative for stroke prevention in high-risk patients with atrial fibrillation with contraindications to oral anticoagulation.

Methods: This was a retrospective, multicenter study of 98 consecutive patients undergoing successful LAA ligation with the LARIAT device.

Referral Patterns for Primary Prophylaxis Implantable Cardioverter Defibrillator Therapy for an Urban US Population.

Implantable cardioverter defibrillators (ICDs) have been demonstrated to improve survival for both primary and secondary prevention of sudden cardiac arrest. However, studies suggest that ICD therapy is underused in appropriate candidates. Sex and racial disparities in ICD use have been suggested.

Prognostic value of automatically detected early repolarization.

Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm.

Rate of cardiovascular implantable electronic device (CIED) re-extraction after recurrent infection.

Background: Patients who develop a cardiovascular implantable electronic device (CIED) infection requiring extraction may have risk factors that make them prone to developing another infection of the reimplanted CIED. However, the rate of a second infection requiring repeat extraction in such patients is unknown and may have important clinical implications.

Methods: We retrospectively reviewed all patients at our institution from January 2001 to October 2012 who underwent a CIED extraction for an infection and then required reimplantation.

Impact of metabolic syndrome on the risk of atrial fibrillation recurrence after catheter ablation: systematic review and meta-analysis.

Purpose: The impact of metabolic syndrome (MetS) on recurrence of atrial fibrillation (AF) after catheter ablation remains uncertain. We conducted a meta-analysis to summarize the relative risks (RR) of AF recurrence after catheter ablation in patients with vs. without MetS and its components.

Subclavian venoplasty may reduce implant times and implant failures in the era of increasing device upgrades.

Background: The incidence of subclavian venous occlusions (SCVOs) may be an increasing problem in the era of device upgrades, especially to cardiac resynchronization therapy. Venoplasty (VP) performed by the electrophysiologist as a way of managing SCVOs may be advantageous.

Methods: We reviewed the implantable cardioverter defibrillator (ICD) implants of the past 5 years at Montefiore Medical Center and searched for SCVOs that required intervention and compared cases where VP was performed with cases where it was not.

Transvenous dual site left ventricular pacing to lower elevated pacing thresholds.

Dual site left ventricular pacing through two left ventricular pacing leads, located in discrete vessels, significantly lowered pacing thresholds from 6 V at 1 ms and 4.25 V at 0.5 ms through the leads individually, to 0.

2:1 left to right interatrial block and other effects of ibutilide during non-isthmus-dependent atrial flutter.

The effects of ibutilide on non-isthmus-dependent atrial flutter (NIDAFL) and the left atrium are not completely known. We describe a case report of 2:1 left to right interatrial block as a result of ibutilide during NIDAFL. This is a 68-year-old man with history of right atrial flutter ablation who presented with recurrence of atrial flutter and underwent a diagnostic electrophysiology study.

Venoplasty of innominate bridge during implantation of single-chamber ICD in a patient with a persistent left-sided superior vena cava.

The persistent left-sided superior vena cava (PLSVC) is a common congenital abnormality, occurring in approximately 1% of patients. The presence of a PLSVC can complicate the implantation of a pacemaker or an automatic implantable cardioverter-defibrillator (AICD). In this case, we report a procedure, venoplasty of an innominate branch, to facilitate implantation of a right ventricular lead in a single-chamber AICD.

Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel.

Aims: Primary: to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary: to assess cost effectiveness of such sedation.

Methods: Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database.

DP+1: another simple endpoint for atrial flutter ablation.

Background: When double potentials (DP) on the line of block are difficult to see, we propose another simple method to verify complete bidirectional block (CBDB) at the end of an atrial flutter ablation. We measured the interval between the electrograms immediately on either side of the line of block on a multipole catheter spanning the isthmus. We called this interval "DP+1" because it is one pair of electrodes away from the DP on the line of block.

Atrial fibrillation ablation: reaching the mainstream.

Introduction And Aims: Ablation of atrial fibrillation (AF) has evolved rapidly in the decade since its inception. We aimed to review the results of this evolution as reflected in the published literature.

Methods: Publications through 2005 were reviewed, and data included if there was information on the technique used, and follow-up of at least 6 months.

Effects of cardioactive medications on retrograde conduction: continuing relevance for current devices.

Introduction: Retroconduction (ventriculo-atrial conduction) remains a problem for patients with implanted cardiac rhythm devices. Pacemaker algorithms can detect and terminate endless loop tachycardia (ELT), but actual prevention of ELT may require anti-arrhythmic drugs (AADs). Similarly, AADs can affect ICD rhythm discrimination algorithms that depend on atrio-ventricular ratios.

Severe left ventricular systolic dysfunction increases atrial fibrillation after ablation of atrial flutter.

Background: Atrial fibrillation (Afib) that occurs after a successful atrial flutter (AFL) ablation may negate the potential benefits of the ablation. Afib occurs more often when severe left ventricular systolic dysfunction (LVSD) is present. We hypothesized that even after a successful AFL ablation, the incidence of postablation Afib is increased when severe LVSD is present.

Value of pre-hospital discharge defibrillation testing in recipients of implanted cardioverter defibrillators.

Opinions vary regarding the need to perform defibrillation testing prior to hospital discharge in recipients of state-of-the-art cardioverter defibrillators (ICDs). Our protocol is to perform predischarge ICD testing 1 day after implant. This report includes 682 consecutive implants.

Easy surgical approach for completion of biventricular pacing.

Placement of a pacing lead into a branch of the coronary sinus for biventricular pacing sometimes is difficult or impossible. Surgical completion typically has included immediate or subsequent thoracotomy lead placement with hookup to the device at the time of chest surgery. We describe an alternative procedure of complete device-lead hookup and permanent pocket closure in the electrophysiology laboratory.

Comparison of rectilinear biphasic waveform energy versus truncated exponential biphasic waveform energy for transthoracic cardioversion of atrial fibrillation.

Success rates of cardioversion with a defibrillator using the truncated exponential biphasic waveform (with a maximum energy of 360 J) and a defibrillator using the rectilinear biphasic waveform (with a maximum energy of 200 J) were randomly compared in 145 patients. Success rates at 50, 100, 150, and 200 J were not significantly different, but 2 patients who did not achieve cardioversion after a 200-J maximum energy shock by the rectilinear device underwent successful cardioversion with a 360-J shock by the truncated exponential device after crossover.

Pacemakers and implantable cardioverter defibrillators: device longevity is more important than smaller size: the patient's viewpoint.

The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices.