Cardiac Resynchronization Defibrillator Therapy for Nonspecific Intraventricular Conduction Delay Versus Right Bundle Branch Block.

Background: The benefits of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (LBBB) conduction abnormality have not been fully explored.

Objectives: This study sought to evaluate clinical outcomes among Medicare-aged patients with nonspecific intraventricular conduction delay (NICD) versus right bundle branch block (RBBB) in patients eligible for implantation with a CRT with defibrillator (CRT-D).

Methods: Using the National Cardiovascular Data Registry implantable cardioverter-defibrillator (ICD) registry data between 2010 and 2013, the authors compared outcomes in CRT-eligible patients implanted with CRT-D versus ICD-only therapy among patients with NICD and RBBB.

Occurrence, mortality and predictors of complicated cardiac perforation in patients with CRT-D: Based on the National Inpatient Sample registry.

Background: Cardiac Resynchronization Therapy Defibrillator (CRT-D) has been one of the most important therapies for patients with cardiomyopathy over the last decades. Cardiac perforation occurs infrequently but can be fatal. The occurrence of cardiac perforation after CRT-D implantation has not been studied well.

Different responses to exercise between Andersen-Tawil syndrome and catecholaminergic polymorphic ventricular tachycardia.

Aims: Andersen-Tawil Syndrome (ATS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) are both inherited arrhythmic disorders characterized by bidirectional ventricular tachycardia (VT). The aim of this study was to evaluate the diagnostic value of exercise stress tests for differentiating between ATS and CPVT.

Methods And Results: We included 26 ATS patients with KCNJ2 mutations from 22 families and 25 CPVT patients with RyR2 mutations from 22 families.

Persistent tachycardia within isolated pulmonary veins during atrial fibrillation ablation.

During circumferential pulmonary vein (PV) isolation for ongoing atrial fibrillation (AF), distinguishing passive conduction to the pulmonary vein (PV) from rapid PV arrhythmia in the isolated PV is difficult. Hence, the purpose of this study is to investigate both the feasibility of distinguishing the PV tachycardia after circumferential PV isolation and the electrophysiological characteristics of these tachycardia. Among 178 consecutive patients who underwent circumferential PV isolation during ongoing AF, fibrillatory PV converted to a regular cycle length PV tachycardia independent of the atrial rhythm (=independent PV tachycardia) in 13 PVs among 12 (7%) patients.

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) Associated With Ryanodine Receptor (RyR2) Gene Mutations - Long-Term Prognosis After Initiation of Medical Treatment.

Background: The long-term prognosis of cardiac ryanodine receptor (RyR2) positive catecholaminergic polymorphic ventricular tachycardia (CPVT) patients after initiation of medical therapy has not been well investigated. This study aimed to assess the recurrence of fatal cardiac event after initiation of medical therapy inRyR2-positive CPVT patients.

Methods and results: Thirty-fourRyR2-positive CPVT patients with a history of cardiac events were enrolled.

The Occurrence of Implantable Cardioverter Defibrillator Therapies After Generator Replacement in Patients Who No Longer Meet Primary Prevention Indications.

Introduction: At the time of generator replacement, after ICD implantation for primary prevention, many patients may no longer meet implantation criteria. We investigated the occurrence of ICD therapy after generator replacement in patients initially implanted ICD for primary prevention.

Methods: Patients from 3 hospitals undergoing ICD generator replacement, who were initially implanted for primary prevention, were retrospectively evaluated for occurrence of appropriate ICD therapy after generator replacement.

Pocket infections of cardiac implantable electronic devices treated by negative pressure wound therapy.

Aims: Managing an infection of the pocket of a cardiac implantable electronic device (CIED) is frequently challenging. The wound is often treated with a drain or wet-to-dry dressings that allow healing by secondary intention. Such treatment can prolong the hospital stay and can frequently result in a disfiguring scar.

Significance of non-type 1 anterior early repolarization in patients with inferolateral early repolarization syndrome.

Objectives: The aim of this study was to investigate the significance of non-type 1 anterior early repolarization (NT1-AER) combined with inferolateral early repolarization syndrome (ERS).

Background: Inferolateral ERS might be a heterogeneous entity, although it excludes type 1 Brugada syndrome (BS).

Methods: Of 84 patients with spontaneous ventricular fibrillation, 31 ERS patients were divided into 2 groups.

Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: a novel risk factor for Brugada syndrome with ventricular fibrillation.

Background: Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF).

Objective: To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF.

Methods: We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.

Utility and safety of temporary pacing using active fixation leads and externalized re-usable permanent pacemakers after lead extraction.

Aims: After extraction of an infected cardiac implantable electronic device (CIED) in a pacemaker-dependent patient, a temporary pacemaker wire may be required for long periods during antibiotic treatment. Loss of capture and under sensing are commonly observed over time with temporary pacemaker wires, and patient mobility is restricted. The use of an externalized permanent active-fixation pacemaker lead connected to a permanent pacemaker generator for temporary pacing may be beneficial because of improved lead stability, and greater patient mobility and comfort.

Gender difference in coronary sinus anatomy and left ventricular lead pacing parameters in patients with cardiac resynchronization therapy.

Background:  Recent studies have suggested better outcomes from cardiac resynchronization therapy (CRT) in women. Gender differences in coronary sinus (CS) anatomy and left ventricular (LV) lead parameters in patients undergoing CRT, however, have not been well studied.

Methods And Results:  Two hundred and twenty-three consecutive patients, undergoing CRT at the University of California in San Diego Medical Center from 2003 to 2011 were included in this study.

Successful slow pathway ablation in a patient with a rare unroofed type coronary sinus.

We report a case of atrioventricular nodal reentrant tachycardia coexistent with a coronary sinus (CS) anomaly. During a standard electrophysiological study, the CS could not be cannulated despite several attempts. A persistent left superior vena cava angiogram through the left brachial vein confirmed an unroofed type CS.

Electrocardiographic characteristics and SCN5A mutations in idiopathic ventricular fibrillation associated with early repolarization.

Background: Recently, we and others reported that early repolarization (J wave) is associated with idiopathic ventricular fibrillation. However, its clinical and genetic characteristics are unclear.

Methods And Results: This study included 50 patients (44 men; age, 45 ± 17 years) with idiopathic ventricular fibrillation associated with early repolarization, and 250 age- and sex-matched healthy controls.

Clinical impact of the number of extrastimuli in programmed electrical stimulation in patients with Brugada type 1 electrocardiogram.

Background: Use of programmed electrical stimulation (PES) for risk stratification of Brugada syndrome (BrS) is controversial.

Objective: To elucidate the role of the number of extrastimuli during PES in patients with BrS.

Methods: Consecutive 108 patients with type 1 electrocardiogram (104 men, mean age 46 ± 12 years; 26 with ventricular fibrillation [VF], 40 with syncope, and 42 asymptomatic) underwent PES with a maximum of 3 extrastimuli from the right ventricular apex and the right ventricular outflow tract.

Effect of sodium-channel blockade on early repolarization in inferior/lateral leads in patients with idiopathic ventricular fibrillation and Brugada syndrome.

Background: A high incidence of early repolarization (ER) pattern in the inferolateral leads has been reported in patients with idiopathic ventricular fibrillation (IVF). Brugada syndrome (BS) is characterized by J-point or ST-segment elevation in the right precordial leads and ventricular fibrillation, and some patients with BS also have ER in the inferolateral leads.

Objective: To compare the clinical characteristics and effects of sodium-channel blockade on ER between IVF patients with ER (early repolarization syndrome [ERS]) and BS patients with or without ER.

Clinical effect of implantable cardioverter defibrillator replacements: when should you resume driving after an implantable cardioverter defibrillator replacement?

Background: The intervals of the driving restrictions after an implantable cardioverter defibrillator (ICD) replacement vary across the different countries around the world. However, little is known regarding the appropriate duration for driving restrictions after an ICD replacement. The aim of this study was to investigate the clinical effect of ICD replacements and to elucidate when to resume driving an automobile after an ICD replacement.

Abrupt heart rate fallings in a patient with biventricular pacing: latent risk for exacerbation of heart failure.

This case report describes abrupt heart rate fallings below the lower pacing rate limit in a patient with cardiac resynchronization therapy (CRT). Interrogated information including stored episodes or data regarding the lead did not show any device problems and only simultaneous intracardiac electrogram revealed the cause, T-wave oversensing during biventricular pacing. At this moment, CRT has become an established modality for patients with severe heart failure.