Representation of the His Bundle Cloud on a Three-dimensional Electroanatomical Map and Its Implications for His Bundle Pacing.

His bundle pacing has been proposed as a more physiologic approach to chronic ventricular stimulation, yet the achievement of permanent His bundle pacing can be challenging.

A novel and practical technique to facilitate lead insertion at the His bundle region.

Background: His bundle (HB) pacing techniques are challenging and time-consuming. This is primarily due to the limitations in locating the relatively small area of the HB body for pacing.

Methods: Permanent HB pacing was performed in 133 consecutive patients with symptomatic bradycardia.

Risk Factors and Hospital Mortality in Surgical and Non-surgical Patients with Delirium.

Introduction: Delirium is a common neuropsychiatric syndrome with severe consequences, especially for elderly patients with pre-existing cognitive impairment.

Methodology: Descriptive study of one retrospective cohort, with the aim of comparing risk factors and mortality between surgical treatment and non-surgical treatment in a group of hospitalised patients with delirium.

Results: Of the 184 hospitalised patients with delirium analysed, 29.

Transendocardial mesenchymal stem cells and mononuclear bone marrow cells for ischemic cardiomyopathy: the TAC-HFT randomized trial.

Importance: Whether culture-expanded mesenchymal stem cells or whole bone marrow mononuclear cells are safe and effective in chronic ischemic cardiomyopathy is controversial.

Objective: To demonstrate the safety of transendocardial stem cell injection with autologous mesenchymal stem cells (MSCs) and bone marrow mononuclear cells (BMCs) in patients with ischemic cardiomyopathy.

Design, Setting, And Patients: A phase 1 and 2 randomized, blinded, placebo-controlled study involving 65 patients with ischemic cardiomyopathy and left ventricular (LV) ejection fraction less than 50% (September 1, 2009-July 12, 2013).

Transvenous cardiac implantable electronic devices and hemodialysis catheters: recommendations to curtail a potentially lethal combination.

Abnormal renal function is an independent risk factor for cardiac implantable electronic device (CIED) infection. The risk of CIED infection increases as the degree of renal dysfunction worsens with the highest risk observed in patients with stage V chronic kidney disease. A significant portion of these patients use a tunneled hemodialysis catheter (TDC) for dialysis therapy.

Safety of serial MRI in patients with implantable cardioverter defibrillators.

Objective: While patients with cardiac implantable electronic devices could benefit from magnetic resonance (MR) imaging, the presence of such devices has been designated as an absolute contraindication to MR. Although scanning algorithms are proposed for cardiac implantable electronic devices, their safety remains uncertain. To address this issue, the safety of serial cardiac MR scans was evaluated in patients with implantable cardioverter defibrillators (ICDs).

Intramyocardial stem cell injection in patients with ischemic cardiomyopathy: functional recovery and reverse remodeling.

Rationale: Transcatheter, intramyocardial injections of bone marrow-derived cell therapy produces reverse remodeling in large animal models of ischemic cardiomyopathy.

Objective: We used cardiac MRI (CMR) in patients with left ventricular (LV) dysfunction related to remote myocardial infarction (MI) to test the hypothesis that bone marrow progenitor cell injection causes functional recovery of scarred myocardium and reverse remodeling.

Methods And Results: Eight patients (aged 57.

Interatrial septal aneurysm and patent foramen ovale: diagnosis and dynamic evaluation with electrocardiogram-gated multidetector-row computed tomography imaging.

We describe an elderly woman with paroxysmal atrial fibrillation who was evaluated by electrocardiogram-gated multidetector-row computed tomography (MDCT) prior to left atrial radiofrequency ablation therapy to rule out coronary artery disease and to obtain a 3-dimensional anatomical map of the left atrium and pulmonary veins. MDCT documented the dynamic bidirectional motion of an interatrial septal aneurysm associated with a patent foramen ovale. MDCT findings correlated well with transesophageal and intracardiac echocardiograms.

Epicardial cardiac rhythm devices for dialysis patients: minimizing the risk of infection and preserving central veins.

Transvenous leads of cardiac rhythm devices (CRDs) are known to cause central stenosis and are vulnerable to contamination during hemodialysis access-related bacteremia. In this retrospective study, nine consecutive chronic hemodialysis patients with transvenous CRD infection due to dialysis access-related bacteremia and recurrent central stenosis are presented. Four patients with tunneled hemodialysis catheters (TDCs) and three with arteriovenous grafts experienced access-related bacteremia that spread to the transvenous CRD.

Risk stratification for sudden cardiac death: current approaches and predictive value.

Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification.

Patency rates for angioplasty in the treatment of pacemaker-induced central venous stenosis in hemodialysis patients: results of a multi-center study.

While hemodialysis access ligation has been used to manage pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead-induced central venous stenosis (CVS), percutaneous transluminal balloon angioplasty (PTA) has also been employed to manage this complication. The advantages of PTA include minimal invasiveness and preservation of arteriovenous access for hemodialysis therapy. In this multi-center study we report the patency rates for PTA to manage lead-induced CVS.

Deep myocardial ablation lesions can be created with a retractable needle-tipped catheter.

RF catheter ablation of ventricular tachycardia is sometimes limited by inadequate lesion depth. This study investigated the use of a retractable needle-tipped catheter to create deep RF lesions in vivo in porcine myocardium. An 8 Fr electrode catheter with an extendable 27-gauge needle at the tip was modified for RF ablation by embedding a thermocouple and attaching a pin connector.

Identification and ablation of three types of ventricular tachycardia involving the his-purkinje system in patients with heart disease.

Introduction: Ventricular tachycardia (VT) with involvement of the His-Purkinje system (HPS) can be difficult to recognize in patients with heart disease, but it may be particularly susceptible to ablation targeting the HPS. This study defines the incidence and types of HPS involvement in VT.

Methods And Results: Involvement of the HPS was sought during electrophysiologic study with catheter mapping in 234 consecutive patients referred for catheter ablation of recurrent VT associated with heart disease.

Chronic inappropriate sinus tachycardia in elderly females.

Background: The vast majority of reports of inappropriate sinus tachycardia (IST) had included predominantly young females with ages ranging between 15 and 46 years. In contrast, the present study presents the findings in four elderly females (aged 61-71 years) with long-standing symptoms of palpitations, more than 15 years, in whom IST was diagnosed in their 6th or 7th decade.

Methods: Clinical and laboratory examinations including electrocardiograms, echocardiograms, and heart rate variability studies were retrospectively reviewed in four of the nine elderly female patients with long-standing cardiac symptoms.

Effects of carvedilol on heart rate dynamics in patients with congestive heart failure.

Background: Patients with congestive heart failure (CHF) have alterations in the traditional and nonlinear indices of heart rate (HR) dynamics, which have been associated with an increased risk of mortality. This study was designed to test the effects of carvedilol, a nonselective beta-blocker with alpha-1 blocking properties, on HR dynamics in patients with CHF.

Methods: We studied 15 patients with CHF secondary to ischemic or idiopathic cardiomyopathy who met the following inclusion criteria: NYHA functional class II-III, optimal conventional medical therapy, normal sinus rhythm, left ventricular ejection fraction (LVEF) of < 40%, and resting systolic blood pressure greater than 100 mmHg.

[New pharmacological agents in heart failure].

Heart failure is a common and growing public health problem, with increasing incidence and prevalence over the last 2 decades. Despite improvements in its current management, heart failure is still associated with significant morbidity and mortality. This has motivated the search for newer therapeutic modalities, which are based on a better understanding on the pathophysiologic events that lead to heart failure.

Dynamics of the uncorrected QT interval during vagal-induced lengthening of RR intervals.

Analysis of 21 episodes of vagal-induced atrioventricular block showed that the uncorrected QT intervals at the end of the corresponding RR pauses were not prolonged, in reference to the pre-block QT intervals, with pauses shorter than 1,280 ms. Subsequently, they gradually lengthened as the RR pauses progressively increased to 13,710 ms. This dynamic behavior of the QT interval in subjects without structural heart disease could have resulted from a complex interaction between the cumulative effects of previous cycle lengths (memory effect?) and the autonomic nervous system.

Spontaneous paroxysmal atrioventricular block in patients with positive tilt tests and negative electrophysiologic studies.

A subgroup of patients with neurocardiogenic syncope and negative electrophysiologic studies and adenosine tests (in 5 of 6 cases), who developed symptomatic paroxysmal atrioventricular block in the natural, ambulatory state, had positive tilt tests without advanced block. Lack of concordance between electrocardiographic changes may have reflected differential effects of the autonomic nervous system in the sinus and atrioventricular nodes, occurring in diverse circumstances and less likely because of the protocol used for tilt testing.

[Ischemic sudden death: critical analysis of risk markers. Part VIII].

Coronary artery disease is responsible for approximately 75-80% of sudden cardiac deaths in most industrialized countries. Risk factors can be divided in those which suggest structural heart disease and those reflecting abnormal physiological markers. Therapeutic strategies for primary prevention of sudden cardiac death require careful scrutiny.

Decreased heart rate variability in appropriate sinus tachycardia and effects of rapid rate.

This study revealed that conventional temporal and spectral indexes of heart rate variability were reduced in patients with sinus tachycardia due to various, easily detectable, causes. These findings were attributed to the fast rates, per se, regardless of the cause, without reflecting a particular shift in the degree of autonomic activity and tone.