Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation.

Background: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to transvenous implantable cardioverter-defibrillator. General anesthesia (GA) is considered the standard sedation approach because of the pain caused by the manipulation of subcutaneous tissue with S-ICD implantation. However, GA carries several limitations, including additional risk of adverse events, prolonged in-room times, and increased costs.

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.

Clinical Impact of Heparin Kinetics During Catheter Ablation of Atrial Fibrillation: Meta-Analysis and Meta-Regression.

Introduction: Appropriate activated clotting time (ACT) during catheter ablation of atrial fibrillation (CA-AF) is essential to minimize periprocedural complications.

Methods And Results: An electronic search was performed using major databases. Outcomes were thromboembolic (TE) and bleeding complications according to ACT levels (seconds).

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.

The Prognostic Value of Early Repolarization with ST-Segment Elevation by Age and Gender in the Hispanic Population.

Background: Early repolarization (ER), once thought to be a benign finding on electrocardiograph (ECG), has recently been associated with an increased risk of sudden cardiac death. As there are limited data in the Hispanic population, we investigated possible associations between automated ECG ER readings and overall mortality, using the classic definition involving J-point elevation with ST segment elevation.

Methods: An ECG and electronic medical record (EMR) database from a regional medical center was interrogated.

Left Atrial Appendage Occlusion Device and Novel Oral Anticoagulants Versus Warfarin for Stroke Prevention in Nonvalvular Atrial Fibrillation: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Nonvalvular atrial fibrillation is the most common arrhythmia. Patients with nonvalvular atrial fibrillation are at increased risk of stroke; therefore, we evaluated the efficacy and safety of different approaches to prevent this major complication.

Methods And Results: We conducted electronic database searches of phase III randomized controlled trials.

Methadone Therapy in Underserved Urban Community: QTc Prolongation and Life-Threatening Ventricular Arrhythmias.

Aims: Methadone has been associated with QTc prolongation and ventricular arrhythmias but the prevalence of QTc prolongation and association with ventricular arrhythmias remains unclear. We investigated this in our inner city urban community (Bronx, New York) that has a large number of patients on methadone.

Methods: Telemetry records, nursing documentation and electronic charts of 291 patients spanning856 encounters were evaluated.

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.

A left hemiblock improves cardiac resynchronization therapy outcomes in patients with a right bundle branch block.

Background: The current recommendation for cardiac resynchronization therapy (CRT) in congestive heart failure (CHF) patients is based on QRS duration, not on QRS morphology.

Hypothesis: This study was performed to compare the effects of CRT in CHF patients with pure RBBB vs those with a coexisting left hemiblock (LHB). METHODS AND PATIENT POPULATION: A total of 271 consecutive patients who underwent CRT at Montefiore Medical Center were analyzed.

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.