Appropriateness of implantable cardioverter-defibrillator device implants in the United States.

Background: The appropriate use criteria (AUCs) are a diverse group of indications aimed to better evaluate the benefits of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy.

Objective: The purpose of this study was to quantify the proportion of ICD and cardiac resynchronization therapy with defibrillator (CRT-D) implants as appropriate, may be appropriate (MA), or rarely appropriate (RA) on the basis of the AUC guidelines.

Methods: This is a multicenter retrospective study of patients within the National Cardiovascular Data Registry undergoing ICD implantation between April 2018 and March 2019 at >1500 US hospitals.

A new machine learning approach for predicting likelihood of recurrence following ablation for atrial fibrillation from CT.

Objective: To investigate left atrial shape differences on CT scans of atrial fibrillation (AF) patients with (AF+) versus without (AF-) post-ablation recurrence and whether these shape differences predict AF recurrence.

Methods: This retrospective study included 68 AF patients who had pre-catheter ablation cardiac CT scans with contrast. AF recurrence was defined at 1 year, excluding a 3-month post-ablation blanking period.

Outcomes of Pulmonary Vein Isolation in Athletes.

Objectives: The aims of this study were to assess outcomes of pulmonary vein isolation (PVI) performed on athletes at a tertiary care center and to characterize its efficacy and physiological effects.

Background: The incidence of atrial fibrillation (AF) is increased in highly trained athletes and poses unique management challenges.

Methods: Athletes were identified through a database of patients undergoing PVI from January 2000 through October 2015.

Clinical Outcomes and Characteristics With Dofetilide in Atrial Fibrillation Patients Considered for Implantable Cardioverter-Defibrillator.

Background: Dofetilide is one of the only anti-arrhythmic agents approved for atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF). However, postapproval data and safety outcomes are limited. In this study, we assessed the incidence and predictors of LVEF improvement, safety, and outcomes in patients with AF with LVEF ≤35% without prior implantable cardioverter defibrillator, cardiac resynchronization therapy, or AF ablation.

Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia.

Background: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support.

Methods: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017).

Results: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included.

A fast score test for generalized mixture models.

In biomedical studies, testing for homogeneity between two groups, where one group is modeled by mixture models, is often of great interest. This paper considers the semiparametric exponential family mixture model proposed by Hong et al. (2017) and studies the score test for homogeneity under this model.

Outcomes of Atrial Fibrillation Ablation in Morbidly Obese Patients Following Bariatric Surgery Compared With a Nonobese Cohort.

Background: Morbid obesity is associated with unacceptable high recurrence rates following atrial fibrillation ablation. The role of risk-factor modification including weight loss and improved glycemic control in reducing arrhythmia recurrence following ablation has been highlighted in recent years. In this study, we compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients following atrial fibrillation ablation in addition to morbidly obese patients who did not undergo BS.

Left atrial appendage closure device implantation in patients at very high risk for stroke.

Background: Little is known about the role of left atrial appendage closure using the Watchman device (Boston Scientific) in patients who are at very high risk for stroke.

Objective: The purpose of this study was to assess the role of Watchman in patients with CHADS-VASc ≥5.

Methods: All patients undergoing procedures for Watchman implant at our institution were enrolled in a prospective registry.

Transvenous Lead Extraction in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.

Objectives: This study aimed to evaluate the effectiveness and safety of transvenous lead extraction (TLE) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

Background: ARVC is an increasingly diagnosed cardiomyopathy that often requires device implantation to prevent sudden death. Little is known about TLE in this setting, which has potential challenges and risks, primarily due to right ventricular (RV) wall thinning and fragility.

Life-Threatening Complications of Atrial Fibrillation Ablation: 16-Year Experience in a Large Prospective Tertiary Care Cohort.

Objectives: This study sought to assess the incidence and outcomes of life-threatening complications from atrial fibrillation ablations in a high volume center.

Background: With increasing rates of atrial fibrillation ablation procedures, an increase in life-threatening procedure-related complications has been reported despite improvements in technology and ablation strategies.

Methods: Between 2000 and 2015, 10,378 patients underwent atrial fibrillation ablation at our institution and were enrolled in a prospectively maintained data registry.

New Model of Automated Patient-Reported Outcomes Applied in Atrial Fibrillation.

Background The value of patient-reported outcomes (PRO) is increasingly recognized in patient-centered care. Longitudinal data collection may be challenging and cost prohibitive. Automation of PRO collection may complement routine clinical follow-up, especially for procedures aiming to improve quality of life, such as atrial fibrillation (AF) ablation.

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons.

This document is the second of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. The first document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas this document addresses this topic with regard to structural (nonvalvular) heart disease. While dealing with different subjects, the 2 documents do share a common structure and feature some clinical overlap.

Left atrial appendage closure device implantation in patients with prior intracranial hemorrhage.

Background: The Watchman device (Boston Scientific), used for left atrial appendage closure (LAAC), was approved for stroke prevention in patients with atrial fibrillation (AF) and an appropriate rationale to avoid long-term oral anticoagulation. Patients with AF and prior intracranial hemorrhage (ICH) were excluded from clinical trials because of perceived risks of perioperative anticoagulation.

Objective: The purpose of this study was to study the efficacy and safety of LAAC using Watchman in patients with AF and prior ICH.

In Vivo Effects of Methionine Sulfoxide Reductase Deficiency in .

The deleterious alteration of protein structure and function due to the oxidation of methionine residues has been studied extensively in age-associated neurodegenerative disorders such as Alzheimer's and Parkinson's Disease. Methionine sulfoxide reductases (MSR) have three well-characterized biological functions. The most commonly studied function is the reduction of oxidized methionine residues back into functional methionine thus, often restoring biological function to proteins.

Occupational and patient radiation doses in a modern cardiac electrophysiology laboratory.

Purpose: Technological advancements have greatly expanded the field of cardiac electrophysiology, requiring greater demands on imaging systems and potentially delivering higher radiation doses to patients and operators. With little contemporary research on occupational and patient radiation risk in the electrophysiology laboratory, the aim of this study was to analyze radiation doses, including occupational fetal doses, over approximately the last decade. We benchmarked the occupational data to our patient radiation dose data to allow for comparison and to put into perspective the associated radiation risks.

Assessing the accuracy of an automated atrial fibrillation detection algorithm using smartphone technology: The iREAD Study.

Background: The Kardia Mobile Cardiac Monitor (KMCM) detects atrial fibrillation (AF) via a handheld cardiac rhythm recorder and AF detection algorithm. The algorithm operates within predefined parameters to provide a "normal" or "possible atrial fibrillation detected" interpretation; outside of these parameters, an "unclassified" rhythm is reported. The system has been increasingly used, but its performance has not been independently tested.

Clinical presentation of ventricular-Hisian and ventricular-nodal accessory pathways.

Background: Narrow QRS tachycardia or premature beat with bystander atrial activation or ventricular-atrial dissociation is an unusual arrhythmia that can present diagnostic and therapeutic challenges. When ventricular-atrial conduction is robust, these arrhythmias can be difficult to distinguish from atrioventricular nodal reentry.

Objective: The purpose of this study was to describe the electrophysiology characteristics, diagnostic maneuvers, and treatment of these types of arrhythmias in a series of 7 cases.

Atrial Fibrillation and Pulmonary Venous Electrical Conduction Recovery After Full Surgical Resection and Anastomosis of the Pulmonary Veins: Insights From Follow-Up and Ablation Procedures in Lung Transplant Recipients.

Objectives: The authors report their experience with atrial fibrillation (AF) rates and ablation findings in lung transplant recipients.

Background: Pulmonary venous (PV) conduction recovery accounts for most failed atrial fibrillation (AF) catheter ablation procedures. Lung transplantation involves full surgical resection and replacement of the recipient's PVs with donor's PVs, which may represent the ultimate PV ablation.