Early repolarization pattern in an ethnically diverse population: Increased risk in Hispanics.

Background: Early repolarization (ER) pattern on ECG is associated with an increased mortality in Caucasians. This study analyzed the association between ER pattern and all-cause mortality in a population of multiple ethnicities.

Methods: A total of 20 000 individuals were randomly selected and their ECGs were analyzed for ER pattern using the 2015 consensus: end-QRS notching or slurring with a J-point (Jp) ≥0.

Use of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device infection prophylaxis: Results from an international survey.

Purpose: Survey the usage and application protocol of antimicrobial agent pocket irrigation for cardiovascular implantable electronic device (CIED) infection prophylaxis.

Background: Local antibiotic usage for CIED infection prophylaxis, in particular pocket irrigation, is a well-known strategy but with little data on its clinical effectiveness.

Methods: An anonymous voluntary online survey was sent to a total of 2,092 arrhythmia-oriented cardiologists in 51 countries (1,490 from the United States).

Efficacy and Safety Outcomes of Direct Oral Anticoagulants and Amiodarone in Patients with Atrial Fibrillation.

Background: Direct oral anticoagulants (DOACs) and amiodarone are widely used in the treatment of nonvalvular atrial fibrillation. The DOACs are P-glycoprotein (P-gp) and cytochrome p-450 (CYP3A4) substrates. Direct oral anticoagulant levels may be increased by the concomitant use of potent dual P-gp/CYP3A4 inhibitors, such as amiodarone, which can potentially translate into adverse clinical outcomes.

Referral Patterns for Primary Prophylaxis Implantable Cardioverter Defibrillator Therapy for an Urban US Population.

Implantable cardioverter defibrillators (ICDs) have been demonstrated to improve survival for both primary and secondary prevention of sudden cardiac arrest. However, studies suggest that ICD therapy is underused in appropriate candidates. Sex and racial disparities in ICD use have been suggested.

Prognostic value of automatically detected early repolarization.

Early repolarization associated with sudden cardiac death is based on the presence of >1-mm J-point elevations in inferior and/or lateral leads with horizontal and/or downsloping ST segments. Automated electrocardiographic readings of early repolarization (AER) obtained in clinical practice, in contrast, are defined by ST-segment elevation in addition to J-point elevation. Nonetheless, such automated readings may cause alarm.

Rate of cardiovascular implantable electronic device (CIED) re-extraction after recurrent infection.

Background: Patients who develop a cardiovascular implantable electronic device (CIED) infection requiring extraction may have risk factors that make them prone to developing another infection of the reimplanted CIED. However, the rate of a second infection requiring repeat extraction in such patients is unknown and may have important clinical implications.

Methods: We retrospectively reviewed all patients at our institution from January 2001 to October 2012 who underwent a CIED extraction for an infection and then required reimplantation.

Chest radiographs are valuable in demonstrating clinically significant pacemaker complications that require reoperation.

Purpose: To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation.

Methods: In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43-95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation.

The psychological impact of implantable cardioverter-defibrillator recalls and the durable positive effects of counseling.

Background: It is known that patients with lifesaving devices such as implantable cardioverter-defibrillators (ICDs) may be alarmed and worried by recalls or alerts related to their ICDs.

Objectives: This study aimed to determine whether counseling has any short- or long-term benefits, and to look for characteristics that identify those most worried and those most in need of counseling.

Methods: Among 100 patients with recall or alert ICDs, 14 were pacer dependent; 50 had ICDs for 1 degrees prevention and 22 were women.

Clinical utility of intraprocedural transesophageal echocardiography during transvenous lead extraction.

Background: Transvenous lead extraction carries a risk of significant complications. Although intraoperative transesophageal echocardiography (TEE) is widely used to monitor cardiac performance and structures, its utility during transvenous lead extraction has not been well described.

Objective: This study evaluates the utility of TEE during transvenous lead extraction.

Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel.

Aims: Primary: to determine the safety and efficacy of intravenous sedation for cardiac procedures administered by non-anesthesia personnel. Secondary: to assess cost effectiveness of such sedation.

Methods: Anesthesiologists trained non-anesthesia personnel, and established our sedation protocol, which was then used in 9,558 patients who had cardiac procedures with sedation by non-anesthesia personnel, recorded on a computerized database.

Rate responsive pacemakers: a rapid assessment protocol.

Background: Rate responsive (RR) pacemakers are commonly implanted with nominal conservative factory-set responsiveness, which is usually accepted because established exercise protocols are time-consuming. We aimed for efficient assessment of RR pacemaker settings.

Methods: We tested exercise heart rates in controls and paced patients using a brief exercise test that approximates real-life levels of exertion.

Prevalence and characterization of asymptomatic pacemaker and ICD lead perforation on CT.

Background: Pacemakers and implantable cardiac defibrillators (ICDs) are widely used for the management of cardiac arrhythmias and congestive heart failure (CHF). Acute implantation complication rates range from 3% to 7%. The aim of this study is to describe the incidence of lead perforation on computed tomography (CT), and correlate these findings with electrophysiologic data.

Effects of cardioactive medications on retrograde conduction: continuing relevance for current devices.

Introduction: Retroconduction (ventriculo-atrial conduction) remains a problem for patients with implanted cardiac rhythm devices. Pacemaker algorithms can detect and terminate endless loop tachycardia (ELT), but actual prevention of ELT may require anti-arrhythmic drugs (AADs). Similarly, AADs can affect ICD rhythm discrimination algorithms that depend on atrio-ventricular ratios.

Value of pre-hospital discharge defibrillation testing in recipients of implanted cardioverter defibrillators.

Opinions vary regarding the need to perform defibrillation testing prior to hospital discharge in recipients of state-of-the-art cardioverter defibrillators (ICDs). Our protocol is to perform predischarge ICD testing 1 day after implant. This report includes 682 consecutive implants.

Comparison of rectilinear biphasic waveform energy versus truncated exponential biphasic waveform energy for transthoracic cardioversion of atrial fibrillation.

Success rates of cardioversion with a defibrillator using the truncated exponential biphasic waveform (with a maximum energy of 360 J) and a defibrillator using the rectilinear biphasic waveform (with a maximum energy of 200 J) were randomly compared in 145 patients. Success rates at 50, 100, 150, and 200 J were not significantly different, but 2 patients who did not achieve cardioversion after a 200-J maximum energy shock by the rectilinear device underwent successful cardioversion with a 360-J shock by the truncated exponential device after crossover.

Pacemakers and implantable cardioverter defibrillators: device longevity is more important than smaller size: the patient's viewpoint.

The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices.

Lead stuck (frozen) in header: salvage by bone cutter versus other techniques. jfisher@montefiore.org.

It is occasionally difficult to disconnect leads from headers at the time of pulse generator replacement without injuring the fragile leads. Over a 2.5-year period we encountered this problem in six cases (1.

Broad applicability of ultrarapid train stimulation as an efficient alternative to conventional programmed electrical stimulation.

Background And Study Objective: Conventional programmed electrical stimulation (PES) is useful for establishing inducibility or noninducibility of clinical ventricular arrhythmias (VA), but is complex and time-consuming. This study compared a standard PES protocol with ultrarapid train stimulation (UTS) in a broad range of patients with and without a history of ventricular arrhythmias or structural heart disease.

Methods: Patients prospectively underwent electrophysiologic testing with both UTS and conventional PES protocols in a randomized, crossover design.

Simplified tilt table test protocol with continuous upright position during medication administration and no hydration.

Recommendations for head-up tilt testing (HUT) often include the prolonged abstaining from food and water consumption (nothing by mouth [NPO]) and intravenous fluids administration before HUT. After the baseline test, supine equilibration periods are recommended before and between each dose of medication. The aim of this study was to determine if similar results are obtainable with a simpler protocol.