Stereotactic Cardiac Radiotherapy for Refractory Ventricular Tachycardia in Structural Heart Disease Patients: A Systematic Review.

Background: Among patients with structural heart disease with ventricular tachycardia (VT) refractory to medical therapy and catheter ablation, cardiac stereotactic body radiotherapy (SBRT) is a paradigm-changing treatment option.

Aims: To assess the efficacy of cardiac SBRT in refractory VT by comparing the rates of VT episodes, anti-tachycardia pacing (ATP) therapies, and implantable cardioverter-defibrillator (ICD) shocks post-SBRT with pre-SBRT.

Methods: We performed a comprehensive literature search and included all clinical studies reporting outcomes on cardiac SBRT for VT.

Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F Score.

Background: Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.

Ultrasound-guided vs. fluoro-guided axillary venous access for cardiac implantable electronic devices: a patient-based meta-analysis.

Aims: The use of ultrasound (US)-guided venous puncture for cardiac pacing/defibrillation lead placement may minimize the risk of periprocedural complications and radiation exposure. However, none of the published studies have been sufficiently powered to recommend this approach as the standard of care. We compare the safety and efficacy of ultrasound-guided axillary venous puncture (US-AVP) vs.

Sequential Isolation of Persistent Left Superior Vena Cava and Right Superior Vena Cava Using Pulsed-field Ablation with a Pentaspline Catheter for Recurrent Persistent Atrial Fibrillation.

Pulsed-field ablation (PFA) is a novel technology for atrial fibrillation (AF) ablation that can deliver energy precisely with a lower risk of damage to the surrounding organs. Persistent left superior vena cava (PLSVC) is a congenital variant that can act as a driver of AF, and its isolation may be required in recurrent persistent AF. We describe a case where PFA was used for isolation of the right superior vena cava, PLSVC, and posterior wall of the left atrium.

Cardiac resynchronization therapy for pacing induced cardiomyopathy: Role of baseline right ventricular pacing burden.

Background: Cardiac resynchronization therapy (CRT) is indicated for patients with heart failure with reduced left ventricular ejection fraction (LVEF) and chronic right ventricular (RV) pacing burden ≥40% (pacing-induced cardiomyopathy, PICM). It is uncertain whether baseline RV pacing burden impacts response to CRT.

Methods: We conducted a retrospective study of all CRT upgrades for PICM at our hospital from January 2017 to December 2018.

Electrocardiographic Z-axis QRS-T voltage-time-integral in patients with typical right bundle branch block - Correlation with echocardiographic right ventricular size and function.

Background: Right bundle branch block (RBBB) can be benign or associated with right ventricular (RV) functional and structural abnormalities. Our aim was to evaluate QRS-T voltage-time-integral (VTI) compared to QRS duration and lead V1 R' as markers for RV abnormalities.

Methods: We included adults with an ECG demonstrating RBBB and echocardiogram obtained within 3 months of each other, between 2010 and 2020.

Electrocardiographic prediction of left ventricular hypertrophy in women and men with left bundle branch block - Comparison of QRS duration, amplitude and voltage-time-integral.

Background: Standard ECG criteria for left ventricular (LV) hypertrophy rely on QRS amplitudes. However, in the setting of left bundle branch block (LBBB), ECG correlates of LV hypertrophy are not well established. We sought to evaluate quantitative ECG predictors of LV hypertrophy in the presence of LBBB.

UltraSound Axillary Vein Access (USAA): Learning curve and randomized comparison to traditional venous access for cardiac device implantation.

Background: Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation.

Objective: We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA).

Methods: Single-center prospective randomized controlled trial of patients undergoing CIED implantation.

Pulmonary Vein Occlusion After Surgical Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion.

We report a case of pulmonary vein (PV) occlusion in a patient with a history of surgical atrial fibrillation ablation and left atrial appendage occlusion with unsuccessful endovascular management. Delayed diagnosis of PV stenosis post-ablation can make interventional treatment options less likely to be successful. ().

Change in hospitalization rates following transcatheter left atrial appendage occlusion.

Introduction: Left atrial appendage occlusion (LAAO) is recommended in patients with non-valvular atrial fibrillation (AF) who have contraindications to or are intolerant of long-term oral anticoagulants (OAC), but its impact on hospitalization rates has not been well described. The objective of our study is to describe the incidence of all-cause, bleeding-related, and thrombosis-related hospitalizations before and after LAAO.

Material And Methods: We used the Nationwide Readmission Database to include patients aged ≥ 18 years with a diagnosis of AF who underwent transcatheter LAAO during the months of February-November in each year between 2016 and 2018.

Impact of ultra-conservative ICD programming in patients with LVADs: Avoiding potentially unnecessary tachy-therapies.

Background: Patients with left ventricular assist devices (LVAD) often tolerate ventricular arrhythmias (VA). We aim to assess the frequency and outcomes of ICD therapies averted by ultraconservative ICD programming (UCP) in LVAD patients.

Methods: This single center, retrospective cohort study included patients with LVADs and ICDs implanted from 2015 to 2019 that had UCP.

Electromagnetic interference from left ventricular assist devices detected in patients with implantable cardioverter-defibrillators.

Introduction: Electromagnetic interference (EMI) from left ventricular assist devices (LVADs) can cause implantable cardioverter-defibrillator (ICD) oversensing. We sought to assess the frequency of inappropriate shocks/oversensing due to LVAD-related EMI and prospectively compare integrated (IB) versus dedicated bipolar (DB) sensing in patients with LVADs.

Methods: Single-center study in LVAD patients with Medtronic or Abbott ICDs between September 2017 and March 2020.

Emerging Implantable-Device Technology for Patients at the Intersection of Electrophysiology and Heart Failure Interdisciplinary Care.

Cardiac implantable electronic devices, including implantable cardioverter-defibrillators and therapy, are part of guideline-indicated treatment for a subset of patients with heart failure with reduced ejection fraction. Current technological advancements in cardiac implantable electronic devices have allowed the detection of specific physiological parameters that are used to forecast clinical decompensation through algorithmic, multiparameter remote monitoring. Other recent emerging technologies, including cardiac contractility modulation and baroreflex activation therapy, may provide symptomatic or physiological benefits in patients without indications for cardiac resynchronization.

Ultrasound guided axillary vein access: An alternative approach to venous access for cardiac device implantation.

Introduction: Ultrasound guided axillary vein access (UGAVA) is an emerging approach for cardiac implantable electronic device (CIED) implantation not widely utilized.

Methods And Results: This is a retrospective, age and sex-matched cohort study of CIED implantation from January 2017 to July 2019 comparing UGAVA before incision to venous access obtained after incision without ultrasound (conventional). The study population included 561 patients (187 with attempted UGAVA, 68 ± 13 years old, 43% women, body mass index (BMI) 30 ± 8 kg/m , 15% right-sided, 43% implantable cardioverter-defibrillator, 15% upgrades).

Defining the substrate for ventricular tachycardia ablation: The impact of rhythm at the time of mapping.

Background: Voltage mapping is critical to define substrate during ablation. In ventricular tachycardia, abnormal potentials may be targets. However, wavefront of activation could impact local signal characteristics.