Feasibility study for echocardiography-guided lead insertion for permanent cardiac implantable electronic devices.

Background: Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE).

Successful Radiofrequency Ablation of Recurrent Supraventricular Tachycardia in a Patient with Complex Congenital Heart Disease.

BACKGROUND Radiofrequency ablation (RFA) is the criterion standard treatment for patients with atrioventricular nodal reentrant tachycardia (AVNRT). Knowledge about RFA in patients with dextrocardia and situs inversus is limited due to their rare incidence and complexity. The incidence of dextrocardia is reported to be 1 in 12 000 births, with situs inversus occurring in one-third of the cases.

Implantation success and infection in cardiovascular implantable electronic device procedures utilizing an antibacterial envelope.

Background: Cardiovascular implantable electronic device (CIED) infection rates are increasing faster than implantation rates. More effective antimicrobial prophylaxis may help reduce CIED infections and improve clinical outcomes. The AIGIS(Rx)(®) antibacterial envelope is a polymer mesh implanted in the generator pocket with the CIED.

Ejection fraction and QRS width as predictors of event rates in patients with implantable cardioverter defibrillators.

Objectives: The Multicenter Automatic Defibrillator Implantation Trial II in 2002 recommended implantable cardioverter defibrillators (ICDs) prophylactically for all patients with a prior myocardial infarction and ejection fraction (EF) of 30% or less. In June of 2003, the Centers for Medicare and Medicaid Services approved reimbursement for ICD placement in patients with an EF of 30% or less who have a QRS interval greater than 120 ms. The purpose of this study was therefore to determine the value of QRS duration in predicting the occurrence of ventricular arrhythmias within the first year after ICD implantation.

QRS width and its impact on inducibility of ventricular arrhythmia at the time of electrophysiology study.

The inducibility of sustained ventricular arrhythmia by programmed electrical stimulation is a well-established marker of an increased risk of ventricular tachyarrhythmia. The purpose of this investigation was to determine whether there was a significant difference in the QRS duration or ejection fraction (EF) amongst patients who could be induced and those who could not be induced into ventricular arrhythmia at the time of standard electrophysiology study (EPS). All the patients who were studied for inducibility of ventricular arrhythmias between March 2003 and March 2004 (a total of 137 patients) were included in the study.

Focal origin of ventricular fibrillation in a patient with ischemic cardiomyopathy.

A 65-year-old patient with history of ischemic cardiomyopathy admitted to the hospital for chest pain and subsequently experienced incessant ventricular fibrillation (VF), requiring repeated defibrillation. Coronary angiogram was unchanged, compared to a study a year before, and acute ischemia was not considered to be the etiology of the VF. A particular premature ventricular contraction morphology was noted on telemetry prior to each episode of VF.