Outcome of tailored therapy in rheumatic heart disease with persistent atrial fibrillation (RHD-AF).

Introduction: Rheumatic heart disease with persistent atrial fibrillation (RHD-AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD-AF.

Diastolic mitral regurgitation after dual chamber pacemaker.

First-degree Atrioventricular (AV) block can lead to symptoms of heart failure, due to AV dyssynchrony. We report a case of 40-year-old male with symptomatic 2:1 AV block with intermittent first-degree AV block who was implanted with dual chamber pacemaker with conduction system pacing (CSP). With conventional programming of managed ventricular pacing (MVP) and long AV delays, patient developed dyspnea due to diastolic mitral regurgitation because of AV dyssynchrony.

Optimizing diastolic filling by pacing in nonobstructive hypertrophic cardiomyopathy.

Background: Treatment options for symptomatic patients with nonobstructive hypertrophic cardiomyopathy (nHCM) are limited.

Objective: The purpose of this study was to determine the effect of sequential atrioventricular (AV) pacing, from different right ventricular (RV) sites with varying AV delays, on the diastolic function and functional capacity of patients with nHCM.

Methods: Twenty-one patients with symptomatic nHCM and normal left ventricular (LV) systolic function were prospectively enrolled.

Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (the AP-AF study).

Unlabelled: The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India.

High rate episodes in a dual chamber pacemaker: What is the mechanism?

Detection of high rate episodes can potentially result from oversensing of physiological or nonphysiological signals. Assessment of lead integrity, lead connection and analysis of noise characteristics on electrograms are decisive steps in the evaluation of oversensing. We report a case of high atrial and ventricular rate episodes due to minute ventilation oversensing in the presence of lead connector issues.

His-bundle pacing versus cardiac resynchronisation therapy: Effect on ECG parameters of repolarization.

Introduction: Cardiac resynchronization therapy (CRT) by biventricular pacing (BiV) may worsen indices of ventricular repolarization. The impact of His bundle pacing (HBP) on repolarization is not well studied in patients with left ventricular systolic dysfunction. The aim of the study is to compare the repolarization parameters in ECG between these two pacing modalities.

Prevalence, clinical profile, and stroke risk of atrial fibrillation in rural Andhra Pradesh, India (The AP-AF study) - Rationale and design.

Introduction: The epidemiology of atrial fibrillation (AF) in India has not been studied systematically in large scale population based surveys. Stroke is one of the leading causes of death and disability in India. As AF is a major contributor of stroke, it is important to know the burden of AF and stroke risk in the population.

Refractory heart failure with LBBB - Pause before CRT.

In this report, we describe complete disappearance of LBBB with normalization of LV function in two patients with cardiac sarcoidosis (CS) after immunosuppressive therapy. Both of these patients were ideal Class IA candidates for CRT (Complete LBBB, QRS ≥ 150 ms, EF < 30%). If CS is identified early, immunosuppressive treatment can lead to not only improvement of left ventricular function but also disappearance of the left bundle branch block.

Impact of interventricular delay on repolarization parameters in patients with biventricular pacing.

A 48-year-old man who was previously a responder to cardiac resynchronization therapy (CRT) presented with worsening of heart failure and reduction in the percentage biventricular (BiV) pacing. Device interrogation revealed T-wave oversensing that was eliminated by optimizing the interventricular (VV) delay. Compared to simultaneous BiV pacing, both sequential left ventricle-right ventricle (LV-RV) and univentricular LV pacing shortened the QTc, T peak-end intervals and reduced the T wave amplitude.

Inappropriate defibrillator shock due to oversensing. What is the mechanism?

Implantable cardioverter defibrillator (ICD) is often advised for secondary prevention of sudden cardiac death. Inappropriate shocks from ICD is uncommon but can seriously affect the quality of life. One of the reasons for inappropriate ICD shock is loose set screw, which may remain undetected by device interrogation and/or fluoroscopy.

Underdiagnosis of VT due to cycle length variation among cardiac sarcoidosis patients having ICD: Problem with stability discriminator.

Background: Implantable cardioverter defibrillator (ICD) is recommended for patients with ventricular tachycardia (VT) due to cardiac sarcoidosis (CS). Programming supraventricular tachycardia (SVT) discriminators (onset, stability, and morphology/template match) is generally recommended to minimize inappropriate therapies. However, VT in patients with CS is known to show cycle length variability (CLV) and pleomorphism.

Impact of the inflammation on the outcomes of catheter ablation of drug-refractory ventricular tachycardia in cardiac sarcoidosis.

Introduction: Catheter ablation (CA) of ventricular tachycardia (VT) in cardiac sarcoidosis (CS) has been reported with varying success. However, there is a scarcity of data on the outcomes of CA based on ongoing inflammation.

Objective: We hypothesized that the response to VT ablation depends upon the stage of the disease.

Device implantation for patients on antiplatelets and anticoagulants: Use of suction drain.

Background And Objectives: Cardiovascular implantable electronic devices (CIED) are frequently implanted in patients on anti-thrombotic agents. Pocket hematomas are more likely to occur in these patients. The use of a sterile surgical drain in the pulse generator pocket site could prevent hematomas, but fear of infection precludes its use.

Prognostic value of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography in patients with unexplained atrioventricular block.

Background: The cause of atrioventricular conduction block (AVB) remains unexplained in a significant number of patients. Granulomatous myocarditis is an uncommon but important cause of AVB. Fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography (18-FDG PET) scan has emerged as a sensitive tool for diagnosing granulomatous myocarditis.

Safety and efficacy of epicardial approach to catheter ablation of ventricular tachycardia - An institutional experience.

Background And Aim: Epicardial approach to VT ablation increases the success rate of ablation but is not without complications. We studied the safety and efficacy of epicardial VT ablations performed at our institute.

Methods: All patients who underwent epicardial VT ablation at our institute were studied retrospectively.

Tailored approach for management of ventricular tachycardia in cardiac sarcoidosis.

Introduction: Treating ventricular tachycardia (VT) in patients with cardiac sarcoidosis (CS) is challenging as patients present in different phase of the disease (inflammatory, scar, or sometimes both). A  customized approach to treatment is required for better outcomes. We describe our experience in the management of VT in CS based on the phase of the disease.

Use of a novel pacing mode to achieve biventricular pacing in a patient with recurrent atrial lead dislodgement after CRT-D implantation.

Cardiac resynchronization therapy device (CRT-P and CRT-D) implantation has increased tremendously with increasing operator experience, eligible patients and expansion of indications. Refinements in devices and algorithms now aid physicians to improve biventricular pacing and optimize CRT. We report a case in which an interesting device program was used to achieve biventricular pacing after repeated dislodgement of the atrial lead in a patient implanted with CRT-D.

Prevalence of atrial fibrillation in an urban population in India: the Nagpur pilot study.

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice with major public health impact mainly due to the increased risk of stroke. The recent Global Burden of Disease Study reported a lack of prevalence data from India. Our goal was to conduct a pilot study to evaluate the feasibility of assessing AF prevalence and stroke prophylaxis in an urban Indian community.

Effectiveness of Ventricular Intrinsic Preference (VIP™) and Ventricular AutoCapture (VAC) algorithms in pacemaker patients: Results of the validate study.

Background: Several past clinical studies have demonstrated that frequent and unnecessary right ventricular pacing in patients with sick sinus syndrome and compromised atrio-ventricular conduction (AVC) produces long-term adverse effects. The safety and efficacy of two pacemaker algorithms, Ventricular Intrinsic Preference™ (VIP) and Ventricular AutoCapture (VAC), were evaluated in a multi-center study in pacemaker patients.

Methods: We evaluated 80 patients across 10 centers in India.

Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm.

Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD) reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT) from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.