Novel approach to intracardiac defibrillator placement in patients with atriopulmonary Fontan: Ventricular defibrillation with an atrial positioned ICD lead.

Introduction: The Fontan procedure, used to palliate univentricular physiology, eliminates direct venous access to the ventricle and complicates implantable cardioverter-defibrillator (ICD) placement.

Methods And Results: We describe two patients with Fontan palliation who underwent a novel transvenous approach to ICD placement. The approach uses a transvenous bipolar lead placed in a coronary sinus branch for ventricular sensing, and a defibrillation lead placed in the right atrium for atrial sensing and ventricular defibrillation.

High-density mapping and ablation of concealed low-voltage activity within pulmonary vein antra results in improved freedom from atrial fibrillation compared to pulmonary vein isolation alone.

Background: Despite advancements, the goal of durable pulmonary vein isolation (PVI) in all patients undergoing ablation for atrial fibrillation (AF) remains elusive. New high-density mapping (HDM) allows detection of concealed low-voltage signals (CLVSs) that persist after PVI and may represent vulnerabilities in the lesion set.

Objective: The purpose of this study was to determine the incidence of CLVSs after PVI and the effect of CLVS ablation on outcomes.

Aspirin use is associated with an improved long-term survival in an unselected population presenting with unstable angina.

Background: Few published data are available on the benefits of aspirin use in patients with unstable angina (UA).

Hypothesis: Aspirin use carries a mortality benefit in a population-based cohort of patients presenting with UA.

Methods: All residents of Olmsted County, Minnesota presenting to local emergency departments with acute chest pain from January 1985 through December 1992 having symptoms consistent with UA were identified through medical records.

C-reactive protein predicts long-term mortality independently of low-density lipoprotein cholesterol in patients undergoing percutaneous coronary intervention.

Background: Few data are available on the association of high-sensitivity C-reactive protein (hs-CRP) and mortality independent of low-density lipoprotein (LDL) cholesterol in patients undergoing percutaneous coronary intervention (PCI).

Methods: Consecutive patients (N = 8,834) undergoing PCI between October 28, 2002, and December 31, 2006, were followed through June 30, 2007 (average and maximum follow-up of 1.9 and 4.