Gender-Related Differences in Outcomes of Patients with Cardiac Resynchronization Therapy.

Background: Gender-related differences (GRD) exist in the outcome of patients with cardiac resynchronization therapy (CRT).

Objectives: To assess GRD in patients who underwent CRT.

Methods: A retrospective cohort of 178 patients who were implanted with a CRT in a tertiary center 2005-2009 was analyzed.

Association between Red Cell Distribution Width and Mortality after Cardiac Resynchronization Therapy.

Background: Cardiac resynchronization therapy (CRT) is a non-pharmacological option for patients with heart failure and interventricular dyssynchrony. Elevated red cell distribution width (RDW) reflects higher size and heterogeneity of erythrocytes and is associated with poor outcome in patients with chronic heart failure.

Objectives: To examine the association between RDW levels and outcomes after CRT implantation.

Association of time of occurrence of electrical heart storms with environmental physical activity.

Aim: Many publications in recent decades have reported a temporal link between medical events and environmental physical activity. The aim of this study was to analyze the time of occurrence of electrical heart storms against levels of cosmological parameters.

Methods: The sample included 82 patients (71 male) with ischemic cardiomyopathy treated with an implantable cardioverter defibrillator at a tertiary medical center in 1999-2012 (5,114 days).

Pacemaker implantation after transcatheter aortic valve implantation.

Thirty- to 35% of patients after transcatheter aortic valve implantation undergo implantation of a permanent pacemaker (PPM) because of development of atrioventricular block (AVB) or development of a condition with high risk of progression to AVB. There are insufficient data regarding long-term follow-up on pacing dependency. From February 2009 to July 2011, 191 transcatheter aortic valve implantation procedures were performed at the Rabin Medical Center (125 CoreValve and 66 Edwards SAPIEN).

Clinical experience of two Israeli medical centers with the implantable loop recorder in patients with syncope: from diagnosis to treatment.

Background: The implantable loop recorder (ILR) is an important tool for the evaluation of unexplained syncope, particularly in cases of rarely occurring arrhythmia.

Objectives: To review the clinical experience of two Israeli medical centers with the ILR.

Methods: We reviewed the medical records of patients with unexplained syncope evaluated with the ILR at Rabin Medical Center (2006-2010) and Wolfson Medical Center (2000-2009).

Implantable cardioverter defibrillator with and without defibrillation threshold testing.

Background: Defibrillation threshold (DFT) testing at the time of implantable cardioverter defibrillator (ICD) insertion is performed routinely. This practice is being reconsidered due to doubts about its ability to improve ICD efficacy and evidence that survival may not be affected by the test.

Objectives: To compare the outcome of ICD recipients who underwent DFT testing and those who did not.

Prinzmetal angina in the differential diagnosis of syncope.

Prinzmetal (variant) angina may be associated with cardiac arrhythmias that can deteriorate to fatal ventricular arrhythmias. We present 2 patients with syncope where vasospastic angina and severe ventricular arrhythmias were found to be responsible for the syncopal episodes.

Right ventricular pacing increases tricuspid regurgitation grade regardless of the mechanical interference to the valve by the electrode.

Aims: The effect of right ventricular (RV) pacing on tricuspid regurgitation (TR) is debatable and is presumed to be related to an interference with valve closure by the electrode. The aim of the study was to determine the impact of pacing per se on TR grade.

Methods And Results: The study group included 23 clinically stable patients (13 males; mean age 78 +/- 12 years) with a permanent pacemaker at the RV apex (83% DDD mode) and normal left ventricular function.

Sick sinus syndrome in a patient with extensive cardiac lipomatosis (sinus node dysfunction in lipomatosis).

We present a case of a 45-year-old man with an incidental and longstanding diagnosis of extensive mediastinal and cardiac lipomatosis. Along the years, he had experienced various arrhythmias, mainly bradyarrhythmias, mostly asymptomatic. Recently after documenting a sinus pause of 6 seconds and runs of nonsustained ventricular tachycardias, he underwent an implantation of a cardioverter-defibrillator.

A life-threatening arrhythmia induced by inappropriate activation of an implantable cardioverter defibrillator.

We describe an unusual case of near fatal inappropriate implantable cardioverter defibrillator therapies due to atrial oversensing by a newly implanted ventricular lead. Chest X-ray revealed dislodgement of the active fixation lead to the tricuspid annulus area explaining the atrial oversensing and intermittent ventricular therapies.

Cardiac defibrillator implantation via persistent left superior vena cava facilitated by a coronary sinus delivery system.

Persistent left superior vena cava (PLSVC) is a benign vascular anomaly that complicates pacemaker or implantable cardioverter defibrillator (ICD) lead implantation. Thus far, right ventricular lead implantation via PLSVC has been mostly accomplished by forming a U-shaped stylet, necessitating considerable manoeuvring depending on the heart size and geometry. In this article we report a technique of ICD lead implantation via PLSVC, using a coronary sinus delivery system as used today in cardiac resynchronization therapy.

Timing of life-threatening arrhythmias detected by implantable cardioverter-defibrillators in relation to changes in cosmophysical factors.

Background: Studies have linked the natural history of many pathologies with environmental physical activity. This study investigated the relationship between the occurrence of ventricular tachycardia/fibrillation (VT/VF) recorded by implantable cardioverter defibrillators (ICD) and geomagnetic and cosmic ray (neutron) activity.

Methods: The study group included 85 patients (73 men) with cardiomyopathy (80% ischemic) who underwent ICD placement in the years 1995-2006; 74% had a left ventricular ejection fraction of < 30%.

Inflammatory biomarkers are not predictive of intermediate-term risk of ventricular tachyarrhythmias in stable CHF patients.

Background: Elevated levels of inflammatory biomarkers and brain natriuretic peptide (BNP) are associated with increased mortality in patients with heart failure (HF).

Hypothesis: : The aim of the current study was to assess the correlation between circulating biomarkers and ventricular tachyarrhythmias among patients with HF.

Methods: Blood samples from 50 stable ambulatory HF patients with moderate to severe systolic left ventricular (LV) dysfunction and an implantable cardioverter defibrillator (ICD) were analyzed for interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), high-sensitivity C-reactive protein (hsCRP) and BNP.

Bundle branch reentrant ventricular tachycardia.

Bundle branch reentrant (BBR) tachycardia is an uncommon form of ventricular tachycardia (VT) incorporating both bundle branches into the reentry circuit. The arrhythmia is usually seen in patients with an acquired heart disease and significant conduction system impairment, although patients with structurally normal heart have been described. Surface ECG in sinus rhythm (SR) characteristically shows intraventricular conduction defects.

Junctional rhythm quantity and duration during slow pathway radiofrequency ablation in patients with atrioventricular nodal re-entry supraventricular tachycardia.

Aim: The occurrence of accelerated junctional rhythm during radiofrequency energy delivery at the region of the slow pathway is a well-recognized marker of successful treatment of atrioventricular nodal re-entry tachycardia (AVNRT). Our aim was to evaluate if the quantity and duration of accelerated junctional rhythm during radiofrequency ablation of the slow pathway is correlated with residual slow pathway conduction.

Methods And Results: Forty consecutive patients with AVNRT undergoing radiofrequency ablation of slow pathway who developed accelerated junctional rhythm during ablation were included.

Are neutrons involved in the pathogenesis of life-threatening cardiac arrhythmias?

Geomagnetic fields protect the earth from the adverse effects of cosmic rays, whose activity can be indirectly measured by monitoring the level of neutrons in the environment. The number and days of discharges from automatic implantable cardioverter defibrillators (ICD) in patients with cardiac arrhythmias are inversely correlated with the daily level of geomagnetic activity (GMA). The aim of the present was to determine whether neutron levels on days of AICD discharges are higher than average.

Urgent cardiac resynchronization therapy in patients with decompensated chronic heart failure receiving inotropic therapy. A case series.

Background: It remains unknown whether patients with severe decompensated class IV heart failure (HF) receiving intravenous inotropic treatment benefit from cardiac resynchronization therapy (CRT).

Methods: We identified patients who underwent urgent CRT implantation due to decompensated class IV HF necessitating intravenous inotropic therapy.

Results: Of 10 patients with chronic ischemic cardiomyopathy (median QRS duration of 170 ms), CRT implantation was associated with symptomatic improvement in 8 patients.

Temporal relationship of implantable cardioverter defibrillator discharges and environmental physical activity.

Background: Studies by our group have shown an inverse relationship between sudden death and cardiac rhythm disturbances and environmental levels of geomagnetic activity (GMA). The aim of this study was to use the precise data provided by automatic implantable cardioverter defibrillators (ICDs) regarding the onset of ventricular fibrillation and ventricular tachycardia to link these events to GMA level.

Patients And Methods: The study group included 25 patients (22 men; 22 with ischemic cardiomyopathy) aged 28-81 years in whom an ICD had been implanted between 1995 and 2004.

Reperfusion-related polymorphic ventricular tachycardia as a possible mechanism of sudden death in patients with anomalous coronary arteries.

We describe a patient with anomalous origin of the left coronary artery in whom polymorphic ventricular tachycardia developed immediately after an episode of chest pain with ST segment elevation. This is the first report providing direct evidence that reperfusion arrhythmias may be the cause of sudden death in individuals with anomalous coronary arteries.

Is there a need to remove an old pacemaker when implanting a new device in the contralateral side?

Background: Device replacement or revision may constitute 25% of pacemaker procedures. In patients needing pacemaker system replacement the usual approach is from the ipsilateral side of the previous system. In cases where the contralateral side is used the previous pulse generator is removed.

Paroxysmal atrioventricular block: clinical experience with 20 patients.

Background: Paroxysmal atrioventricular (AV) block is an ill-defined entity, previously described in sporadic cases in association with vasovagal reaction, coronary angiography and distal conduction disease.

Methods: We describe 20 patients (10 women) aged 26 to 80 years with symptomatic paroxysmal AV block.

Results: Eight patients had ischemic heart disease-three with dilated cardiomyopathy, and two with co-existing carotid sinus hypersensitivity.

Bundle branch reentrant ventricular tachycardia in a patient with the Brugada electrocardiographic pattern.

A 55-year-old, previously healthy man presented with an episode of wide QRS tachycardia that had left bundle branch morphology and left superior axis. His electrocardiogram in sinus rhythm showed characteristic Brugada pattern with coved type ST-segment (J-point) elevation in leads V1-V2, mild QRS widening of 110 ms, and left axis deviation. The mechanism of the tachycardia was shown to be bundle branch reentry.

Perforation of the right ventricular free wall by an active fixation transvenous cardioverter defibrillator lead.

A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.