ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease.

The American College of Cardiology (ACC) Foundation, along with key specialty and subspecialty societies, conducted an appropriate use review of stress testing and anatomic diagnostic procedures for risk assessment and evaluation of known or suspected chronic coronary disease (CCD), formerly referred to as stable ischemic heart disease (SIHD). This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging, stress echocardiography (echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis.

Postapproval Study of a Subcutaneous Implantable Cardioverter-Defibrillator System.

Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to avoid complications related to transvenous implantable cardioverter-defibrillator (TV-ICD) leads. Device safety and efficacy were demonstrated previously with atypical clinical patients or limited follow-up.

Objectives: The S-ICD PAS (Subcutaneous Implantable Cardioverter-Defibrillator System Post Approval Study) is a real-world, multicenter, registry of U.

Elevated fibrosis burden as assessed by MRI predicts cryoballoon ablation failure.

Introduction: Late-gadolinium enhancement magnetic resonance (LGE-MRI) imaging is increasingly used in management of atrial fibrillation (AFib) patients. Here, we assess the usefulness of LGE-MRI-based fibrosis quantification to predict arrhythmia recurrence in patients undergoing cryoballoon ablation. Our secondary goal was to compare two widely used fibrosis quantification methods.

Catheter ablation of atrial fibrillation results in significant QTc prolongation in the postoperative period.

Background: The corrected QT interval (QTc) is a measure of ventricular repolarization time, and a prolonged QTc increases risk for malignant ventricular arrhythmias. Pulmonary vein isolation (PVI) may increase QTc but its effects have not been well studied.

Objective: Determine the incidence, risk factors, and outcomes of patients presenting for PVI in sinus and atrial fibrillation with postoperative QTc prolongation in a large cohort.

Comparative outcomes of Riata and Fidelis lead management strategies: Results from the NCDR-ICD Registry.

Background: The Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi-center population are unknown. We aim to describe patients with functional, recalled ICD leads undergoing elective generator replacement and report outcomes according to lead management strategies.

Defibrillation Safety Margin Testing in Patients With Congenital Heart Disease: Results From the NCDR.

Objectives: This study analyzed the predictors of defibrillation safety margin (DSM) testing at the time of implantable cardioverter-defibrillator (ICD) insertion and factors associated with inadequate DSM in patients with congenital heart disease (CHD).

Background: There are few data about the prevalence and safety of DSM testing in those with CHD.

Methods: A retrospective analysis was performed of all patients with atrial or ventricular septal defect, tetralogy of Fallot, transposition of the great vessels, Ebstein anomaly, or common ventricle undergoing a transvenous ICD procedure in the National Cardiovascular Data Registry (NCDR) ICD Registry from April 2010 to March 2016, and DSM testing was assessed.

Outcomes of two versus three incision techniques: Results from the subcutaneous ICD post-approval study.

Background: Traditionally, implantation of the subcutaneous implantable cardioverter defibrillator (S-ICD) requires incisions near the lateral chest wall, the xyphoid, and the superior sternal region (three-incision technique [3IT]). A two-incision technique (2IT) avoids the superior incision and has been shown to be a viable alternative in small studies with limited follow-up.

Objectives: To report on the long-term safety and efficacy of the 2IT compared to the 3IT procedure in a large patient cohort.

Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review.

The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the 'blanket' disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM.

Do 'pathologic' cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death.

Objectives: We assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD).

Methods: We performed a retrospective analysis of 15 141 adolescents age 12-19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease.

Electrocardiogram interpretation in college athletes: Local institution versus sports cardiology center interpretation.

Background: Electrocardiogram (ECG) screening in athletes enhances the detection of conditions associated with sudden cardiac death (SCD), but concerns remain for false positive results when conducted outside of specialized centers. This study compared ECG interpretation in college athletes between local physicians and a sports cardiology center (SCC).

Methods: Screening ECGs in athletes from eight Pacific-12 Conference institutions performed between 2010 and 2016 were included.

From Local Explanations to Global Understanding with Explainable AI for Trees.

Tree-based machine learning models such as random forests, decision trees, and gradient boosted trees are popular non-linear predictive models, yet comparatively little attention has been paid to explaining their predictions. Here, we improve the interpretability of tree-based models through three main contributions: 1) The first polynomial time algorithm to compute optimal explanations based on game theory. 2) A new type of explanation that directly measures local feature interaction effects.

Comparison of cardiovascular screening in college athletes by history and physical examination with and without an electrocardiogram: Efficacy and cost.

Background: Preparticipation screening for conditions associated with sudden cardiac death (SCD) is required in college athletes. Previous cost analyses used theoretical models based on variable assumptions, but no study used real-life outcomes.

Objective: The purpose of this study was to compare disease prevalence, positive findings, and costs of 2 different screening strategies: history and physical examination alone (H&P) or with an electrocardiogram (H&P+ECG).

Unexpected Shocks From a Subcutaneous Implantable Cardioverter-Defibrillator Despite Attempted Reprogramming and Magnet Use: A Case Report.

We present the case of a patient with a subcutaneous implantable cardioverter-defibrillator (S-ICD) in situ. Device interrogation and reprogramming were unsuccessful due to a software mismatch between the device and programmer. The device manufacturer recommended magnet application to suspend antitachycardia therapy.

Bradycardia at the onset of pulseless electrical activity arrests in hospitalized patients is associated with improved survival to discharge.

Background: Recent studies have suggested that the incidence of in-hospital pulseless electrical activity (PEA) arrests is increasing. Bradycardia in patients with in-hospital PEA is common but it is unknown if it is associated with respiratory arrest or patient outcomes.

Objective: To determine risk factors and outcomes associated with bradycardic-PEA arrests, and relationship between bradycardia and respiratory arrest.

Prevalence, predictors and complications with defibrillation threshold testing in pediatric patients: Results from the NCDR.

Background: There are little data about the prevalence and safety of DFT testing in pediatric populations. We analyzed the predictors and outcomes of defibrillation threshold (DFT) testing at the time of implantable cardioverter-defibrillator (ICD) implant and factors associated with inadequate defibrillation safety margin (DSM) in pediatric patients.

Methods: We performed a retrospective analysis of initial transvenous ICD implantations in the National Cardiovascular Data Registry (NCDR) ICD Registry of patients ≤21 years.

ST-Segment Elevation Myocardial Infarction and Out-of-Hospital Cardiac Arrest: Contemporary Management From the Multicenter START Registry.

Background: Recent studies suggest that primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) improve outcome in ST-segment elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA). The objective of this study was to evaluate a contemporary series of patients with STEMI and OHCA to characterize treatment approaches and predictors of neurologic outcome.

Methods: From January 2009 through November 2012, a total of 239 patients who underwent emergent coronary angiography at 10 medical centers across the United States were enrolled.

Leadless Pacemakers: Recent and Future Developments.

Purpose Of Review: Leadless pacemakers were developed to reduce complications associated with transvenous pacemaker implant and long-term follow-up. Since initial market release, however, there have been registry and single-center reports documenting improvements in implant technique, reduced complication rates, and new patient populations studied.

Recent Findings: Most studies have demonstrated a further reduction in complication rates and safe implant in those on continuous anticoagulation.