The autonomic ether: emerging electrophysiologic associations.

As a result of large, multicenter trials supporting ICDs for prevention of sudden cardiac arrest, there has been an exponential increase in ICD device therapy. Cardiologists and general practitioners are increasingly faced with the challenge to evaluate and troubleshoot device problems. In this review, we provide an overview of basic ICD function and malfunction and show examples of common ICD problems and troubleshooting.

Impact of radiocontrast use during left ventricular pacemaker lead implantation for cardiac resynchronization therapy.

Aims: The risk of contrast-induced nephropathy (CIN) with radiocontrast use during left ventricular (LV) lead placement for cardiac resynchronization therapy (CRT) is unknown. It is unclear as to whether minimizing contrast use impacts adequacy of LV lead placement.

Methods And Results: A retrospective analysis was performed of all LV leads placed for CRT at Mayo Clinic, Rochester, MN from 16 March 2001 to 1 April 2009.

The Pericardial Space: Obtaining Access and an Approach to Fluoroscopic Anatomy.

The pericardial space is now increasingly used as a means and vantage point for mapping and ablating various arrhythmias. In this review, present techniques to access the pericardial space are examined and potential improvements over this technique discussed. The authors then examine in detail the regional anatomy of the pericardial space relevant to the major arrhythmias treated in contemporary electrophysiology.

Correlative anatomy for the electrophysiologist: ablation for atrial fibrillation. Part I: pulmonary vein ostia, superior vena cava, vein of Marshall.

Ablation procedures for atrial fibrillation (AF) have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of AF and ablation procedures are varied and include the pulmonary veins (PVs), other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms, and, importantly, to avoid complications from damage of adjacent structures within the chest.

Correlative anatomy for the electrophysiologist: ablation for atrial fibrillation. Part II: regional anatomy of the atria and relevance to damage of adjacent structures during AF ablation.

Ablation procedures for atrial fibrillation have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of atrial fibrillation and ablation procedures are varied and include the pulmonary veins, other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms and, importantly, to avoid complications from damage of adjacent structures within the chest.

Relevance of endocavitary structures in ablation procedures for ventricular tachycardia.

Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown.

Methods And Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation.

The Phrenic Nerve And Atrial Fibrillation Ablation Procedures.

Radiofrequency ablation is increasingly used as an option to optimally manage patients with symptomatic atrial fibrillation. Presently, ablationists strive to improve success rates, particularly with persistent atrial fibrillation, while simultaneously attempting to reduce complications. A well-recognized complication with atrial fibrillation ablation is injury to the phrenic nerve giving rise to diaphragmatic paresis and patient discomfort.

Anticoagulation During AF Ablation: The Balance between Thromboembolism and Bleeding.

Radiofrequency ablation for atrial fibrillation is being increasingly used to treat patients with symptomatic arrhythmia. The procedure is complex and associated with significant complications including thromboembolism, stroke, and bleeding. Despite significant advances in catheter design, online cardiac imaging, and greater operator experience, both stroke and major vascular complications continue to be problematic.