Risk of Appropriate Implantable Cardioverter-Defibrillator Therapies and Sudden Cardiac Death in Patients With Heart Failure With Improved Left Ventricular Ejection Fraction.

Background: The benefit of implantable cardioverter-defibrillator (ICD) therapy is controversial in patients who have heart failure with improved left ventricular ejection fraction (EF) to >35% after implantation (HFimpEF).

Methods: Databases (Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar) were queried for studies in patients with ICD that reported the association between HFimpEF and arrhythmic events (AEs), defined as the combined incidence of ventricular arrhythmias, appropriate ICD intervention, and sudden cardiac death (primary composite end point).

Results: A total of 41 studies and 38,572 patients (11,135 with HFimpEF, 27,437 with persistent EF ≤35%) were included; mean follow-up was 43 months.

Randomized controlled trial of liberal vs. standard fasting instructions in percutaneous cardiac procedures.

Background: Pre-procedural fasting to reduce aspiration risk is usual care prior to surgery requiring anesthesia. Prolonged fasting, however, can result in dehydration and may adversely affect patient experience and outcomes. Previous studies suggest that providing a supplemental beverage to patients undergoing cardiac and a variety of other surgical procedures improves patients' subjective assessment of thirst and hunger and potentially decreases the need for inotrope and vasopressor therapy.

Effects of GLP-1 Agonists on mortality and arrhythmias in patients with Type II diabetes.

Background: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RA) are frequently used for the management of diabetes. The impact of GLP-1 RA on cardiovascular outcomes is unclear. We aim to assess the effect of GLP-1 RA on mortality, atrial and ventricular arrhythmias, and sudden cardiac death in patients with type II diabetes.

Prognostic value of late-gadolinium enhancement on cardiac magnetic resonance in patients with cardiac sarcoidosis.

Background: Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS), but available studies had small sample sizes and did not consider all relevant endpoints.

Objective: To evaluate the association between LGE on CMR in patients with CS and mortality, ventricular arrhythmias (VA) and sudden cardiac death (SCD), and heart failure (HF) hospitalization.

Methods: A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints.

Rhythm versus rate control for atrial fibrillation in heart failure with preserved ejection fraction.

Background: There are few prospective studies assessing the benefits of rhythm control of atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF), which accounts for 50% of all heart failure patients.

Objective: Conduct a meta-analysis to assess the effects of rhythm control (ablation and/or antiarrhythmic medications) vs rate control on all-cause mortality in AF patients with HFpEF.

Methods: Databases were searched for studies reporting the effect of rhythm control vs rate control on mortality in patients with HFpEF (Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL).

Identification and Endocardial Ablation of the Ligament of Marshall for Pulmonary Vein Isolation.

Objectives: The aims of this study were to establish criteria for identifying ligament of Marshall (LOM) connections that are responsible for pulmonary vein isolation (PVI) failure, assess their incidence, and determine if they can be targeted by focal endocardial ablation at the anterior carina of the left superior pulmonary vein (LSPV).

Background: Wide antral ablation of the left pulmonary veins (PVs) may not achieve PVI, sometimes requiring empirical ablation of the PV carina. The mechanism could be due to epicardial conduction along the LOM, which courses adjacent to the anterior carina.

Implantable cardioverter defibrillators and permanent pacemakers: prevalence and patient outcomes after trauma.

Background: The prevalence and outcomes of older trauma patients with implantable cardioverter defibrillators (ICDs) or permanent pacemakers (PPMs) is unknown.

Methods: The trauma registry at a regional trauma center was reviewed for blunt trauma patients, aged ≥ 60 years, admitted between 2007 and 2014. Medical records of cardiac devices patients were reviewed.

Case report: Perioperative pacemaker-mediated tachycardia in the patient with a dual chamber implantable cardioverter-defibrillator.

Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator.

Novel use of atrial overdrive pacing to rapidly differentiate junctional tachycardia from atrioventricular nodal reentrant tachycardia.

Background: Distinguishing between junctional tachycardia (JT) and atrioventricular nodal reentrant tachycardia (AVNRT) is essential to minimize unnecessary catheter ablation and the risk of heart block during treatment of AVNRT.

Objective: The purpose of this study was to investigate whether the tachycardia response to atrial overdrive pacing at a cycle length (CL) slightly shorter than tachycardia CL can differentiate between JT and AVNRT. We hypothesized that atrial overdrive pacing would transiently suppress JT but would entrain AVNRT.

Long- and short-term temporal stability of complex fractionated atrial electrograms in human left atrium during atrial fibrillation.

Background: Complex fractionated atrial electrograms (CFAEs) have been reported as targets for catheter ablation of atrial fibrillation (AF). However, the temporal stability of CFAE sites remains poorly defined.

Methods And Results: The study consisted of two phases.

Baseline myocardial perfusion predicts response to cardiac resynchronization therapy: a prospective observational study.

Purpose: We prospectively determined whether preimplant myocardial perfusion imaging (MPI) predicts outcome with biventricular pacing (BiVP).

Methods: Single-photon emission computed tomography (SPECT) MPI, left ventricular (LV) volumes, ejection fraction (EF), 6-min hall walk (6MW) were assessed at baseline and at 4 months in 19 patients with ischemic cardiomyopathy undergoing BiVP. Clinical and hemodynamic responses were correlated with MPI.

Impact of heart rhythm status on registration accuracy of the left atrium for catheter ablation of atrial fibrillation.

Introduction: Registration accuracy is of crucial importance to the successful use of image integration technique to facilitate atrial fibrillation (AF) ablation. It is well known that a patient's heart rhythm can switch from sinus rhythm (SR) to AF or vice versa during an AF ablation procedure. However, the impact of the heart rhythm change on the accuracy of left atrium (LA) registration has not been studied.

Evaluation of left atrial and posterior mediastinal anatomy by multidetector helical computed tomography imaging: relevance to ablation.

Introduction: Increasing use of catheter ablation in the left atrium (LA) requires understanding of substrate anatomy, especially with regard to potential damage to adjacent structures.

Methods And Results: We reviewed multidetector helical computed tomography (MDCT) imaging on 42 subjects, 26 imaged before planned LA ablation for atrial fibrillation (AF), and 16 without AF. LA volume and dimensions were larger in patients with AF (p < 0.

Circumferential ablation with pulmonary vein isolation in permanent atrial fibrillation.

Each of the main approaches to catheter ablation of atrial fibrillation (AF, segmental and circumferential) is associated with limited efficacy in patients with permanent AF. The objective is to report outcomes of circumferential ablation with pulmonary vein (PV) isolation, determined using a circular mapping catheter, in patients with permanent AF and determine relations between the duration of permanent AF and efficacy. The patient population was composed of 41 consecutive patients (34 men; age 58 +/- 11 years) with permanent AF who underwent radiofrequency catheter ablation through circumferential ablation with PV isolation.

Incidence and time course of early recovery of pulmonary vein conduction after catheter ablation of atrial fibrillation.

Background: Although it is well recognized that recovery of pulmonary vein (PV) conduction is common among patients who fail atrial fibrillation (AF) ablation, little is known about the precise time course of recurrence.

Objective: To determine the incidence and time course of early recurrence of conduction after PV isolation during AF ablation.

Methods: The patient population was composed of 14 consecutive patients (9 men [64%]; age 56 +/- 7 years) with AF who underwent radiofrequency catheter ablation via circumferential ablation with PV isolation, determined by a circular mapping catheter.

Three-dimensional rotational angiography of the left atrium and esophagus--A virtual computed tomography scan in the electrophysiology lab?

Background: Three-dimensional (3D) reconstruction of the heart and surrounding structures has been supplementing traditional two-dimensional imaging to guide diagnostic and therapeutic electrophysiologic procedures. Current methods using computed tomography (CT)/magnetic resonance imaging (MRI) reconstruction have certain limitations.

Objective: We investigated the feasibility of rotational angiography (RA) combined with simultaneous esophagogram to create an intraprocedural 3D reconstruction of the left atrium (LA) and the esophagus.