Intramyocardial Hematoma During Catheter Ablation for Scar-Related Ventricular Tachycardia.

Background: Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication.

Objectives: The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT.

Methods: From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions.

Worldwide Experience With an Irrigated Needle Catheter for Ablation of Refractory Ventricular Arrhythmias: Final Report.

Background: We previously reported feasibility of irrigated needle ablation (INA) with a retractable 27-G end-hole needle catheter to treat nonendocardial ventricular arrhythmia substrate, an important cause of ablation failure.

Objectives: The purpose of this study was to report outcomes and complications in our entire INA-treated population.

Methods: Patients with recurrent sustained monomorphic ventricular tachycardia (VT) or high-density premature ventricular contractions (PVCs) despite radiofrequency ablation were prospectively enrolled at 4 centers.

Ablation of ectopic atrial foci for successful management of symptomatic bradycardia: A case series (bradycardia and ectopic atrial beats).

Atrial premature contractions (PACs) that block at the atrio-ventricular (AV) nodal level and occurring in a bigeminal frequency are recognized as a cause of symptomatic bradycardia. Appropriate suppression of the PACs often results in restoration of a regular rhythm with resolution of bradycardia-related symptoms. We report a series of three patients with non-conducted bigeminal PACs arising from the mitral annulus that resulted in symptomatic bradycardia and who were referred for consideration of cardiac pacing.

Same-day discharge after transvenous lead extraction: feasibility and outcomes.

Aims: Same-day discharge (SDD) is safe for patients undergoing electrophysiology procedures. There is no existing data regarding SDD for patients undergoing transvenous lead extraction (TLE). We report our experience with SDD for patients undergoing TLE.

Proarrhythmic effect of radiofrequency catheter ablation on the right ventricular moderator band.

Following ablation on the RV moderator band for suppression of monomorphic PVCs, recurrent VT and VF were triggered by the same PVC at shorter coupling intervals. This is likely a pro arrhythmic effect of ablation on the moderator band.

Durable pulmonary vein isolation with diffuse posterior left atrial ablation using low-flow, median power, short-duration strategy.

Introduction: To target posterior wall isolation (PWI) in atrial fibrillation (AF) ablation, diffuse ablation theoretically confers a lower risk of conduction recovery compared to box set. We sought to assess the safety and efficacy of diffuse PWI with low-flow, medium-power, and short-duration (LF-MPSD) ablation, and evaluate the durability of pulmonary vein isolation (PVI) and PWI among patients undergoing repeat ablations.

Methods: We retrospectively studied patients undergoing LF-MPSD ablation for AF (PVI + diffuse PWI) between August 2017 and December 2019.

HeartMate 3: new challenges in ventricular tachycardia ablation.

Aim: To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA).

Methods And Results: Data were collected from patients with an HM3 system who underwent VTA in seven tertiary centres. Data included baseline patient characteristics, procedural data, mortality, and arrhythmia-free survival.

Percutaneous management of superior vena cava syndrome in patients with cardiovascular implantable electronic devices.

Background: There is no consensus regarding the optimal management of cardiovascular implantable electronic device (CIED)-related superior vena cava (SVC) syndrome.

Objective: We report our experience with transvenous lead extractions (TLEs) in the setting of symptomatic CIED-related SVC syndrome.

Methods: We reviewed all TLEs performed at a high-volume center over a 14-year period and identified patients in which TLE was performed for symptomatic SVC syndrome.

Frequency Content of Unipolar Electrograms May Predict Deep Intramural Excitable Substrate: Insights From Intramural Needle Catheter Ablation of Ventricular Tachycardia.

Objectives: This study sought to identify midmyocardial arrhythmogenic substrates by examining the frequency content of unipolar endocardial surface electrograms, comparing sites with transmural scar versus sites with intramural excitable substrate (IES) as identified during needle catheter ablation for ventricular tachycardia (VT).

Background: Midmyocardial arrhythmogenic substrates are a common reason catheter ablation for VT may fail.

Methods: A total of 659 intramural needle sites were studied in 26 patients (age 61 ± 9 years, 85% male, 69% nonischemic cardiomyopathy) who underwent intramural needle catheter ablation for VT.

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein.

Background: Idiopathic ventricular arrhythmias (IVAs) from the left ventricular (LV) summit may be successfully ablated from the distal great cardiac vein (dGCV). Using a 12-lead electrocardiogram (ECG) to localize IVAs that can be ablated from the dGCV is valuable for ablation planning.

Objective: To determine if a "w" wave, a notch in the Q wave in lead I, and other ECG features can identify IVAs that can be successfully ablated from the dGCV.

Outcomes in patients with cardiac amyloidosis and implantable cardioverter-defibrillator.

Aims: Cardiac amyloidosis (CA) is associated with increased mortality due to arrhythmias, heart failure, and electromechanical dissociation. However, the role of an implantable cardioverter-defibrillator (ICD) remains unclear. We conducted case-control study to assess survival in CA patients with and without a primary prevention ICD and compared outcomes to an age, sex, and device implant year-matched non-CA group with primary prevention ICD.

Percutaneous approaches for retrieval of an embolized or malpositioned left atrial appendage closure device: A multicenter experience.

Background: Experience with retrieval of a Watchman left atrial (LA) appendage (LAA) closure device (WD) is limited. An embolized or grossly malpositioned WD warrants retrieval to minimize the risk of thromboembolic complications and vascular occlusion.

Objective: The purpose of this study was to report approaches for percutaneous retrieval of a WD from multicenter experience.

Concomitant leadless pacemaker implantation and lead extraction during an active infection.

Introduction: The need for transvenous lead extractions due to cardiac implantable electronic device (CIED)-related infections continues to rise. Current guidelines recommend complete device removal in the setting of an active infection, which can be challenging in pacemaker-dependent patients.

Methods: We retrospectively reviewed all leadless pacemaker implants between January 2018 and November 2019 and identified a subset of patients who had undergone a concomitant CIED extraction in the setting of an active infection.

Candidemia in patients with cardiovascular implantable electronic devices.

Purpose: Current guidelines recommend complete extraction of cardiovascular implantable electronic devices (CIEDs) in the case of persistent or recurrent fungemia without other identifiable sources, though supporting evidence is lacking. We sought to evaluate the prognosis of patients with candidemia and CIEDs.

Methods: Twelve consecutive patients (54 ± 12 years, 8 male) with CIED and concurrent candidemia were reviewed.

Use of Implantable Electronic Devices in Patients With Cardiac Amyloidosis.

Arrhythmias are a major cause of morbidity and mortality in the course of cardiac amyloidosis (CA). Less commonly, they may be the initial manifestation that lead to the diagnosis. With improved therapeutic interventions for amyloidosis, it is no longer considered to be a terminal untreatable condition, and there is increasing recognition of the role of implantable electronic devices in CA.