Convergent approach to persistent atrial fibrillation ablation: long-term single-centre safety and efficacy.

Background: Efforts to maintain sinus rhythm in patients with persistent atrial fibrillation (PsAF) remain challenging, with suboptimal long-term outcomes.

Methods: All patients undergoing convergent PsAF ablation at our centre were retrospectively analysed. The Atricure Epi-Sense® system was used to perform surgical radiofrequency ablation of the LA posterior wall followed by endocardial ablation.

Emergency out-of-hours catheter ablation for ventricular arrhythmia storm: a UK and Australian experience.

Aims: There are limited data on emergency catheter ablation (CA) for ventricular arrhythmia (VA) storm. We describe the feasibility and safety of performing emergency CA in an out-of-hours setting for VA storm refractory to medical therapy at 2 tertiary hospitals.

Methods And Results: Twenty-five consecutive patients underwent out-of-hours (5pm-8am [weekday] or Friday 5pm-Monday 8am [weekend]) CA for VA storm refractory to anti-arrhythmic drugs and sedation.

Can C-Reactive Protein Be Used to Predict Acute Septic Arthritis in the Adult Population?

Objectives: The objective of this study was to establish whether C-reactive protein (CRP) could be used to predict native joint septic arthritis (SA) in the adult population.

Methods: All patients who underwent native joint aspiration in accident and emergency settings between April 2012 and September 2016 were identified from laboratory microbiology records. Patients were divided into three groups for analysis: patients with SA, patients with crystal arthropathy, and patients with normal or osteo/inflammatory arthritic joints.

Epicardial ablation of ventricular tachycardia in a patient with arrhythmogenic right ventricular dysplasia after failed conventional endocardial ablation: A case for remote navigation with functional image integration.

Arrhythmogenic right ventricular dysplasia (ARVD) is an inheritable heart muscle disease that predominantly affects the right ventricle (RV) and predisposes to ventricular arrhythmias and sudden cardiac death (SCD). The natural history is predominantly related to ventricular electric instability which may lead to arrhythmic SCD, mostly in young people and athletes, but may progress with significant RV muscle disease and left-ventricular (LV) involvement and can result in right or biventricular heart failure. We report on a 54-year-old male with ARVD who underwent an epicardial ventricular tachycardia (VT) ablation using remote magnetic navigation (RMN) after functional imaging from a nuclear perfusion study was fused with a 3D segmentation from computed tomography (CT) imaging.

Signal Reconstruction of Pulmonary Vein Recordings Using a Phenomenological Mathematical Model: Application to Pulmonary Vein Isolation Therapy.

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is commonly initiated by ectopic beats originating from a small myocardial sleeve extending over the pulmonary veins. Pulmonary vein isolation therapy attempts to isolate the pulmonary veins from the left atrium by ablating tissue, commonly by using radiofrequency ablation. During this procedure, the cardiologist records electrical activity using a lasso catheter, and the activation pattern recorded is used as a guide toward which regions to ablate.

Increasing age does not affect time to appropriate therapy in primary prevention ICD/CRT-D: a competing risks analysis.

Aims: To evaluate the impact of age on the clinical outcomes in a primary prevention implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) population.

Methods And Results: A retrospective, multicentre analysis of patients aged 60 years and over with primary prevention ICD/CRT-D devices implanted between 1 January 2006 and 1 November 2014 was performed. Survival to follow-up with no therapy (T1), death prior to follow-up with no therapy (T2), delivery of appropriate therapy with survival to follow-up (T3), and delivery of appropriate therapy with death prior to follow-up (T4) were measured.

Safety and mid-term outcome of catheter ablation of ventricular tachycardia in octogenarians.

Aims: Radiofrequency (RF) catheter ablation (CA) is superior to standard medical therapy in controlling recurrent ventricular tachycardia (VT). The majority of procedures have been performed in a middle-aged population. The outcome of VT ablation in the elderly has not been described.

Catheter ablation of atrial fibrillation in patients with heart failure: impact of maintaining sinus rhythm on heart failure status and long-term rates of stroke and death.

Aims: Catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) can improve left ventricular (LV) function and HF symptoms. We aimed to investigate whether long-term maintenance of sinus rhythm impacts on hard outcomes such as stroke and death.

Methods And Results: An international multicentre registry was compiled from seven centres for consecutive patients undergoing catheter ablation of AF.

Catheter ablation of atrial fibrillation in patients with diabetes mellitus: a systematic review and meta-analysis.

Aims: Diabetes mellitus (DM) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within DM patients. Catheter ablation of AF (AFCA) is an established therapeutic option for rhythm control in drug resistant symptomatic patients. Its efficacy and safety among patients with DM is based on small populations, and long-term outcome is unknown.

Premature ventricular beats initiate recurrent ventricular fibrillation in early repolarization syndrome.

An early repolarization (ER) pattern on electrocardiography was historically considered a benign finding; however, this finding in the inferior and lateral leads has recently been associated with idiopathic ventricular fibrillation (VF). Here we describe a case of a 29-year-old man with an ER pattern, who experienced recurrent implantable cardioverter-defibrillator (ICD) shocks for ventricular tachycardia (VT) and VF. An ICD interrogation demonstrated how VF and VT were repeatedly initiated by closely coupled premature ventricular beats.

Vagal atrial fibrillation: What is it and should we treat it?

Vagal atrial fibrillation (AF) remains an under-recognised entity, affecting younger patients often with structurally normal hearts. Although there remains no universal definition or diagnostic criteria, in this review we describe recognised triggers and associated features, including a well-established association with athletic training. We explore potential mechanisms, including the role of the autonomic nervous system and ganglionated plexi in initiating and maintaining arrhythmia.

Extending helicopter operations to meet future integrated transportation needs.

Helicopters have the potential to be an integral part of the future transport system. They offer a means of rapid transit in an overly populated transport environment. However, one of the biggest limitations on rotary wing flight is their inability to fly in degraded visual conditions in the critical phases of approach and landing.

Demographic and Clinical Characteristics to Predict Paroxysmal Atrial Fibrillation: Insights from an Implantable Loop Recorder Population.

Background: There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk.

Clinical Predictors of Pacemaker Implantation in Patients with Syncope Receiving Implantable Loop Recorder with or without ECG Conduction Abnormalities.

Background: Implantable loop recorders (ILR) allow prolonged cardiac rhythm monitoring and improved diagnostic yield in syncope patients. Predictive factors for pacemaker (PM) implantation in the ILR population with unexplained syncope have not been adequately investigated. In this single center, retrospective, observational study we investigated factors that predict PM implantation in this population.

The use of hip radiographs in primary care: the inter-observer agreement of reporting native hip pathology.

Introduction: Plain radiographs are often the first line investigation in identifying the cause of hip pain, though they do not differentiate all morphologically normal and abnormal hips. Interpretation of radiographs is subjective, depending on the patient history and physical signs. A radiological report can be misleading and may lead to, unnecessary radiation exposure, a delay in referral and a delay to definitive treatment.

Development, implementation, and preliminary evaluation of a recovery-based curriculum for community navigation specialists working with individuals with serious mental illnesses and repeated hospitalizations.

A recovery-oriented curriculum for training the Community Navigation Specialists (CNSs) of the new Opening Doors to Recovery in Southeast Georgia program was developed, implemented, and preliminarily evaluated. This new mental health program provides mobile, community-based support services to individuals with serious mental illnesses and a history of psychiatric inpatient recidivism (and commonly past incarcerations and homelessness). Teams of CNSs include a licensed social worker, a family member of an individual with a serious mental illness, and a peer specialist with lived experience.

The effect of bolus administration of tranexamic acid in revision hip arthroplasty.

We assessed the efficacy of tranexamic acid in reducing transfusion requirements in patients undergoing revision hip arthroplasty. A prospective cohort study was designed comparing Tranexamic acid administration in 30 patients compared to 30 patients in a control group. Blood loss was measured in theatre, pre- and postoperative haemoglobin measurements were recorded and postoperative haemodynamic parameters were evaluated.

Epicardial catheter ablation for ventricular tachycardia in heparinized patients.

Aims: In patients undergoing epicardial catheter ablation of ventricular tachycardia (VT), current guidelines recommend obtaining pericardial access prior to heparinization to minimize bleeding complications. Consequently, access is obtained before endocardial mapping (leading to unnecessary punctures) or during an additional procedure. We present our experience of obtaining pericardial access during the index procedure in heparinized patients.

Opening doors to recovery: a novel community navigation service for people with serious mental illnesses.

This column describes Opening Doors to Recovery in Southeast Georgia, a partnership between public agencies, a private corporation, a not-for-profit organization, and an academic institution. Teams of community navigation specialists that include a licensed mental health professional, a family member of an individual with a serious mental illness, and a peer with lived experience in recovery seek to enhance participants' community integration, support them in developing a meaningful day, ensure access to adequate treatment, and facilitate stable housing, improved relationships, and desired vocational, volunteer, or educational activities.

A randomised comparison of Cartomerge vs. NavX fusion in the catheter ablation of atrial fibrillation: the CAVERN Trial.

Purpose: Integration of a 3D reconstruction of the left atrium into cardiac mapping systems can aid catheter ablation of atrial fibrillation (AF). The two most widely used systems are NavX Fusion and Cartomerge. We aimed to compare the clinical efficacy of these systems in a randomised trial.

Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death.

Objective: To investigate whether catheter ablation of atrial fibrillation (AF) reduces stroke rate or mortality.

Methods: An international multicentre registry was compiled from seven centres in the U.K.

Routine transthoracic echocardiography to assess pericardial collections in patients after extensive left atrial catheter ablation: a prospective study.

Introduction: Little is known about the incidence and timing of reactive pericardial collections developing after left atrial catheter ablation (LACA), and when and if transthoracic echocardiography (TTE) should be performed routinely in these patients postprocedure.

Methods And Results: Two hundred consecutive LACA patients for persistent atrial fibrillation (AF) (107), paroxysmal AF (75) or atrial tachycardia (AT) (18) underwent on-table TTE at the end of the procedure, and the next day prior to discharge. One patient developed tamponade at the time of transseptal puncture.

Do traditional VT zones improve outcome in primary prevention ICD patients?

Aims: We reviewed outcomes in our primary prevention implantable cardioverter defibrillator (ICD) population according to whether the device was programmed with a single ventricular fibrillation (VF) zone or with two zones including a ventricular tachycardia (VT) zone in addition to a VF zone.

Methods: This retrospective study examined 137 patients with primary prevention ICDs implanted at our institution between 2004 and 2006. Device programming and events during follow-up were reviewed.