Pulmonary Vein Isolation vs Sham Intervention in Symptomatic Atrial Fibrillation: The SHAM-PVI Randomized Clinical Trial.

Importance: There are concerns that pulmonary vein isolation for atrial fibrillation may have a profound placebo effect, but no double-blind randomized clinical trials have been conducted.

Objective: To determine whether pulmonary vein isolation is more effective than a sham procedure for improving outcomes in atrial fibrillation.

Design, Setting, And Participants: Double-blind randomized clinical trial conducted at 2 tertiary centers in the UK between January 2020 and March 2024 among patients with symptomatic paroxysmal or persistent atrial fibrillation.

Occurrence of premature battery depletion in a large multicentre registry of subcutaneous cardioverter-defibrillator patients.

Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have become established in preventing sudden cardiac death, with some advantages over transvenous defibrillator systems, including a lower incidence of lead failures. Despite technological advancements, S-ICD carriers may suffer from significant complications, such as premature battery depletion (PBD), that led to an advisory for nearly 40 000 patients. This multicentre study evaluated the incidence of PBD in a large set of S-ICD patients.

Incidence, implications, and management of sense-B-noise failure in subcutaneous cardioverter-defibrillator patients: insights from a large multicentre registry.

Aims: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer potentially distinct advantages over transvenous defibrillator systems. Recent randomized trials showed significantly lower lead failure rates than transvenous ICD. Still, S-ICDs remain associated with the risk of inappropriate shocks (IAS).

Open Window Mapping of Accessory Pathways: A Literature Review and Practical Guide.

Catheter ablation is the treatment of choice for patients with symptomatic accessory pathways (APs) causing recurrent atrioventricular reciprocating tachycardia or in situations where APs conduct rapidly, posing a risk of sudden cardiac death. Conventional AP mapping relies on point-by-point assessment of local electrograms looking closely for pathway electrograms or early atrial or ventricular electrograms, which may be challenging and time consuming. Recently, open window mapping (OWM) using 3D navigational systems has emerged as a novel technique to help localise and ablate APs.

Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience.

Aims: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). There are limited data on the PolarX Cryoballoon. The study aimed to establish the safety, efficacy, and feasibility of same day discharge for Cryoballoon PVI.

A retrospective analysis of frailty status on atrial fibrillation catheter ablation outcomes.

Introduction: Catheter ablation for atrial fibrillation (AF) reduces symptoms and improves the quality of life compared with medical treatment. It is unclear if frailty impacts on the outcome of catheter ablation in patients with symptomatic AF. We sought to evaluate the association between frailty as measured by the validated NHS electronic Frailty Index (eFI) and outcomes post-AF ablation.

A randomized sham-controlled study of pulmonary vein isolation in symptomatic atrial fibrillation (The SHAM-PVI study): Study design and rationale.

Introduction: Pulmonary vein (PV) isolation has been shown to reduce atrial fibrillation (AF) burden and symptoms in patients. However, to date previous studies have been unblinded raising the possibility of a placebo effect to account for differences in outcomes.

Hypothesis & Methods: The objective of this study is to compare PV isolation to a sham procedure in patients with symptomatic AF.

A randomized comparison of retrograde left-sided versus anterograde right-sided ablation of the atrioventricular junction.

Background: Catheter ablation of the atrioventricular node (AVN) is an effective treatment for patients with symptomatic atrial fibrillation. This study compares the success rate, procedure time, radiation time, and complication rates of retrograde left-sided (LSA) and anterograde right-sided (RSA) AVN ablation in a randomised controlled trial.

Methods: Thirty-one patients undergoing AVN ablation were randomized to either LSA (15 patients) or RSA (16 patients).

Immediate implantable loop recorder implantation for detecting atrial fibrillation in cryptogenic stroke.

Introduction: Atrial fibrillation (AF) is suspected as the main cause of stroke in the majority of patients presenting with cryptogenic stroke (CS). Implantable loop recorders (ILR's) are indicated for detecting AF in these patients. The short term (<1 month) and long-term AF detection rates in patients inserted with an ILR immediately after CS is reported.

The long-term effect of thermal-guided second-generation cryoablation in paroxysmal and persistent atrial fibrillation.

Background: Second-generation cryoballoon ablation is safe and effective in patients with paroxysmal (PAF) and persistent atrial fibrillation (AF).

Objective: This study aimed to assess the long-term clinical outcomes and freedom from AF in patients undergoing thermal-guided cryoablation without the use of an electrical mapping catheter.

Methods: All patients who had undergone thermal-guided second-generation cryoablation without electrical mapping between January 2015 and April 2018 at Eastbourne District General Hospital were retrospectively analysed.

Long Term outcomes of percutaneous atrial fibrillation ablation in patients with continuous monitoring.

Introduction: There is limited data using continuous monitoring to assess outcomes of atrial fibrillation (AF) ablation. This study assessed long-term outcomes of AF ablation in patients with implantable cardiac devices.

Methods: 207 patients (mean age 68.

Utilising video technology in the cardiac catheter lab and operating theatre during the COVID-19 pandemic.

The COVID-19 pandemic has significantly altered working practices within hospitals. This includes surgical theatres and cardiac catheter laboratories. Here we describe how we have harnessed the use of video technology to improve the running of the cardiac catheter lab in our institution, reducing the exposure of staff members to COVID-19, reducing the need for personal protective equipment (PPE) and maintaining and enhancing educational and teaching opportunities for trainees.

How many patients with heart failure are eligible for cardiac contractility modulation therapy?

Background: Increasing evidence exists suggesting that cardiac contractility modulation therapy (CCM) improves symptoms in heart failure patients if various selection criteria are fulfilled. The aim of this study is to analyse an unselected sample of heart failure patients to establish what percentage of patients would meet the current criteria for CCM therapy.

Methods: All patients admitted to two district general hospitals in the UK in 2018 with a diagnosis of heart failure were audited for eligibility for CCM therapy.

An economic evaluation of an advanced video conferencing system for cardiac multidisciplinary team meetings.

Introduction: Current UK and international guidelines advocate the need for multidisciplinary team (MDT) discussion of selected patients undergoing either percutaneous or surgical cardiac procedures to decide the optimal treatment strategy. To date, it is unknown if using videoconference facilities is cost-effective. Therefore, we performed a cost analysis of using a high-speed internet video conferencing system compared with conventional face-to-face MDT meetings.

The effect of second-generation cryoablation without electrical mapping in persistent AF using continuous monitoring.

Background: Second-generation cryoballoon ablation is safe and effective in patients with persistent atrial fibrillation (AF). The aim of this study is to report the real long-term AF burden and freedom from AF post-cryoablation using continuous monitoring, and to assess whether intraoperative confirmation of pulmonary vein isolation using electrical mapping is necessary.

Methods: A total of 33 patients (mean age 75.

Care After REsuscitation: Implementation of the United Kingdom's First Dedicated Multidisciplinary Follow-Up Program for Survivors of Out-of-Hospital Cardiac Arrest.

Survival rates after cardiac arrest (CA) are increasing, with more patients and their families living with the psychological consequences of surviving a sudden CA. The currently available neuropsychological assessment tools and therapies were not designed for CA, and may be inadequate. The Essex Cardiothoracic Centre set up the United Kingdom's first dedicated multidisciplinary "Care After REsuscitation" (CARE) service, offering CA survivors and their caregivers systematic psychological, cognitive, and specialized medical support for the first 6 months after CA.

Delayed ventricular septal rupture complicating anterior wall myocardial infarction.

A 59-year-old woman was admitted to our hospital with acute pulmonary oedema and cardiogenic shock 35 days after anterior ST elevation myocardial infarction. She developed a new loud pan systolic murmur. Echocardiography revealed a ventricular septal rupture with a significant left to right shunt.

A rare cause of secondary hypertension.

Severe hypertension is a well-recognised cause for acute medical admission, and can have serious consequences if untreated. We present a 48 year old patient in whom coarctation of the aorta was identified following the finding of severe hypertension at the time of routine preoperative assessment, and subsequent finding of absent lower limb pulses. The patient had a past history of Apert syndrome, a rare autosomal dominant inherited condition characterised by craniosynostosis, facial dysmorphia, syndactyly of the hands and feet and cardiac abnormalities.

The effect of tumor necrosis factor-α antagonists on arterial stiffness in rheumatoid arthritis: a literature review.

Background: There is evidence that patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and thus have a higher cardiovascular risk. Under National Institute for Clinical Excellence guidelines, tumor necrosis factor-α (TNF-α) antagonists are indicated clinically in patients with severe active rheumatoid disease. TNF-α antagonists have been found to reduce inflammatory markers in RA; however, it is debatable if they have favorable effects on the cardiovascular system.