Enhancing Geometric Fidelity of 3-Dimensional Electroanatomic Mapping During Open Chest Epicardial Radiofrequency Catheter Ablation.

Although electroanatomic mapping techniques have been previously applied to open chest epicardial ablation procedures, such efforts have often been limited by significant geometric distortions introduced by the need to use nonstandard mapping patch placements and by intrathoracic conductance changes introduced by having the pericardial space exposed. In this article, we present a case of a patient with recurrent hemodynamically unstable ventricular tachycardia who underwent a successful open chest epicardial ablation procedure with electroanatomic mapping in which geometric distortions were minimized by judicious placement of mapping patches and the use of a saline bath within the pericardial space.

Implementation and impact analysis of a transitional care pathway for patients presenting to the emergency department with cardiac-related complaints.

Background: Cardiac-related complaints are leading drivers of Emergency Department (ED) utilization. Although a large proportion of cardiac patients can be discharged with appropriate outpatient follow-up, inadequate care coordination often leads to high revisit rates or unnecessary admissions. We evaluate the impact of implementing a structured transitional care pathway enrolling low-risk cardiac patients on ED discharges, 30-day revisits and admissions, and institutional revenues.

Implementing an innovative consent form: the PREDICT experience.

Background: In the setting of coronary angiography, generic consent forms permit highly variable communication between patients and physicians. Even with the existence of multiple risk models, clinicians have been unable to readily access them and thus provide patients with vague estimations regarding risks of the procedure.

Methods: We created a web-based vehicle, PREDICT, for embedding patient-specific estimates of risk from validated multivariable models into individualized consent documents at the point-of-care.

The azygos defibrillator lead for elevated defibrillation thresholds: implant technique, lead stability, and patient series.

Background: Conventional insertion of implantable cardioverter-defibrillator (ICD) includes an evaluation of the defibrillation threshold (DFT). Implanting an ancillary defibrillation lead in the azygos vein has been introduced as a therapeutic option in patients with "high" DFT. This study reports the efficacy and stability of azygos defibrillation coils implanted for elevated DFTs.

Converting the informed consent from a perfunctory process to an evidence-based foundation for patient decision making.

Background: Standard consent forms result in highly variable communication between patients and physicians. To enhance the consent process and facilitate shared decision making, we developed a World Wide Web-based program, PREDICT (Patient Refined Expectations for Deciding Invasive Cardiac Treatments), to systematically embed patient-specific estimates of death, bleeding, and restenosis into individualized percutaneous coronary intervention informed consent documents. We then compared patients' experiences with informed consent before and after implementation of PREDICT.

Identifying heart failure patients at high risk for near-term cardiovascular events with serial health status assessments.

Background: Identification of heart failure outpatients at increased risk for clinical deterioration remains a critical challenge, with few tools currently available to assist clinicians. We tested whether serial health status assessments with the Kansas City Cardiomyopathy Questionnaire (KCCQ) can identify patients at increased risk for mortality and hospitalization.

Methods And Results: We evaluated 1358 patients with heart failure after an acute myocardial infarction in the Eplerenone's Neurohormonal Efficacy and Survival Study, a multicenter randomized trial that included serial KCCQ assessments.

Prognostic value of health status in patients with heart failure after acute myocardial infarction.

Background: Disease-specific health status instruments such as the Kansas City Cardiomyopathy Questionnaire (KCCQ) can quantify symptoms, functional limitations, and quality of life in patients with heart failure. Understanding the relationship between KCCQ scores and prognosis may assist clinicians in both interpreting KCCQ scores and stratifying risk in patients.

Methods And Results: We examined the prognostic value of the KCCQ in a prospective, international cohort of 1516 patients with heart failure after a recent acute myocardial infarction.

Interactive computer simulations of knee-replacement surgery.

Objective: Current surgical training programs in the United States are based on an apprenticeship model. This model is outdated because it does not provide conceptual scaffolding, promote collaborative learning, or offer constructive reinforcement. Our objective was to create a more useful approach by preparing students and residents for operative cases using interactive computer simulations of surgery.