Phased multipolar radiofrequency pulmonary vein isolation is as effective and safe as conventional irrigated point-to-point ablation. A prospective randomised 1-year implantable cardiac monitoring device follow-up trial.

Purpose: Pulmonary vein isolation (PVI) is conventionally performed using 3D electroanatomical mapping to guide point-to-point ablation. The Pulmonary Vein Ablation Catheter (PVAC)® is a phased multipolar ablation (PMRA) catheter designed for rapid PVI using radiological anatomical information. Comparison of these methods of PVI using continuous beat-to-beat monitoring was undertaken.

The natural history of atrial fibrillation in patients with permanent pacemakers: is atrial fibrillation a progressive disease?

Objectives: Atrial fibrillation (AF) is thought to be a progressive arrhythmia, starting with short paroxysmal episodes, until eventually, it becomes permanent. Evidence for this is limited to studies with short follow-up or with minimal cardiac rhythm monitoring. We utilised the continuous rhythm monitoring capabilities of implanted pacemakers to define better the natural history of AF.

Remote monitoring of cardiovascular disease: great promise, but do not forget the patient!

After more than 20 years, the conflict of interest (COI) movement has failed to substantiate its central claim that interactions between physicians, researchers and the medical products industry cause physicians to make clinical decisions that are adverse to the best interests of their patients. The COI movement's instigators have produced no solid evidence of harm commensurate with their extravagant allegations. At the same time, they have diverted resources away from more worthwhile pursuits, such as basic and applied medical research, clinical care and medical education towards onerous compliance exercises and obtrusive laws.

Prospective peer review of regional percutaneous interventional procedures: a tool for quality control and revalidation.

Aims: Current quality measures of percutaneous coronary intervention (PCI) procedures are based on the incidence of major adverse cardiac events (MACE). This crude marker ignores the many clinical nuances that make for sound decision making in PCI. We have established a prospective peer review audit tool to determine the quality of PCI within our cardiac network, which consists of five PCI hospitals serving a population of 1.

The efficacy of intraoperative atrial radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery-the Surgical Atrial Fibrillation Suppression (SAFS) Study.

Introduction: Studies assessing radiofrequency ablation (RFA) for atrial fibrillation (AF) performed at the time of concomitant cardiac surgery have reported high success rates. The efficacy of this treatment has primarily been determined by a single electrocardiogram (ECG) or 24-h Holter monitor at follow-up. We sought to assess the true efficacy of this procedure using prolonged cardiac rhythm monitoring.

It's good to talk! Changes in coronary revascularisation practice in PCI centres without onsite surgical cover and the impact of an angiography video conferencing system.

Introduction: Percutaneous coronary intervention (PCI) activity has increased more than 6 fold in the last 15 years. Increased demand has been met by PCI centres without on-site surgical facilities. To improve communication between cardiologists and surgeons at a remote centre, we have developed a video conferencing system using standard internet links.

The relationship between right ventricular pacing and atrial fibrillation burden and disease progression in patients with paroxysmal atrial fibrillation: the long-MinVPACE study.

Aims: In patients requiring permanent pacemaker implantation for sinus node disease (SND) or atrioventricular (AV) block, right ventricular (RV) pacing has been demonstrated to increase the risk of developing atrial fibrillation (AF). The effects of RV pacing in patients with paroxysmal AF are less well defined. Short- and medium-term studies have suggested no significant correlation between RV pacing and atrial fibrillation burden (AFB) measurement; we sought to assess for an effect in the long-term.

First time and repeat cardioversion of atrial tachyarrhythmias - a comparison of outcomes.

Introduction: Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006.

Methods: A total of 770 patients of mean age (SD) 70.

The usefulness of minimal ventricular pacing and preventive AF algorithms in the treatment of PAF: the 'MinVPace' study.

Introduction: The beneficial effects of atrial pacing on the incidence, duration and symptomatology of paroxysmal atrial fibrillation (PAF) may be negated by increased ventricular pacing. This prospective randomised study evaluates the effect of pacing algorithms that minimise ventricular pacing (MinVP) with and without anti-AF algorithms, on AF burden (AFB) in patients with symptomatic PAF.

Methods: Patients implanted with pacemakers with MinVP capability with AFB 1-70% were enrolled.

A randomised controlled trial comparing StarClose and AngioSeal vascular closure devices in a district general hospital--the SCOAST study.

Aims: AngioSeal and StarClose are vascular closure devices (VCDs) that can be used following cardiac catheterisation via the femoral artery to achieve haemostasis. Both devices have been demonstrated to be superior to conventional manual pressure, which reduce time to haemostasis and time to patient ambulation. We sought to compare these devices in a prospective, randomised trial.

A randomised controlled trial comparing the routine use of an Angio-Seal STS device strategy with conventional femoral haemostasis methods in a district general hospital.

Femoral artery closure devices reduce the time to haemostasis and ambulation. Most district general hospitals (DGHs) now perform day case angiography on site. The purpose of this study was to assess the Angio-Seal self-tightening suture (STS) device in comparison with manual compression in this environment.

A randomised prospective comparison of three protocols for head-up tilt testing and carotid sinus massage.

Introduction: Head-up tilt testing is an important tool in the diagnosis of syncope. Several different protocols are in use. This study aimed to compare three different protocols in an unselected population of patients with recurrent unexplained syncope and to assess long-term outcome using conventional tilt-directed management or implantable loop recorder (Reveal Plus)-directed management, allowing evaluation of the sensitivity and specificity of the technique.

Use of implantable loop recorders in the diagnosis and management of syncope.

Background: Syncope is a common, disabling symptom. The most useful data for diagnosing and managing syncope is the recording of physical parameters such as the ECG and blood pressure during a spontaneous event. Implantable loop recorders (ILR) provide an opportunity to record ECG data from a spontaneous event.

Does the use of a syncope diagnostic protocol improve the investigation and management of syncope?

Objectives: To assess the efficacy of a protocol designed to improve the diagnosis and management of syncope.

Design: Prospective outcome analysis of all patients presenting with syncope for the 12 month period from 1 November 2000 to 31 October 2001, compared with a retrospective study of all patients presenting with syncope during the calendar year 1998. Use of the protocol commenced in September 2000.

Late intervention after anterior myocardial infarction: effects on left ventricular size, function, quality of life, and exercise tolerance: results of the Open Artery Trial (TOAT Study).

Objective: We sought to conduct a randomized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infarction (AMI).

Background: In the absence of ischemia, the benefits of reperfusion late after AMI remain controversial. However, the possibility exists that an open infarct related artery benefits healing post AMI.

Safety, effectiveness and cost efficacy of diagnostic electrophysiology and radiofrequency ablation in a district general hospital.

Electrophysiological studies (EPS) are now being performed in district general hospitals (DGH) in the UK. In order to audit our results, a prospective database was established for all patients undergoing EPS and radiofrequency (RF) ablation at Eastbourne District General Hospital, East Sussex. Between 1 January 1997 and 1 July 2000, 300 EPS procedures were performed, resulting in 155 RF ablations.

How many people with heart failure are appropriate for biventricular resynchronization?

Aims: Increasing evidence exists suggesting that biventricular pacing improves outcome and symptoms in severe heart failure if various selection criteria are fulfilled. It is unsure how many people might benefit from this therapy. Our aim was to provide such data.

Atrial permanent pacing for sinus node dysfunction with absent right superior vena cava.

In patients with sinus node dysfunction and normal atrioventricular conduction, single chamber atrial pacing (AAI or AAIR mode) represents the most physiological treatment. Sinus node dysfunction is recognised in association with an absent right superior vena cava, and we present a case in which complete resolution of symptoms was achieved with endocardial atrial permanent pacing.

The effect of atrio-ventricular delay programming in patients with DDDR pacemakers.

Modern DDDR (dual chamber universal, rate responsive) pacemakers are complex, hugely capable devices incorporating new features that theoretically should enhance haemodynamics and therefore quality of life. Ten patients (mean age 48 years) with chronotropic incompetence and high grade A-V block had activity sensing DDDR devices implanted and underwent a randomized double-blind crossover assessment of rate responsive and different fixed atrio-ventricular delay (AVD) settings during 2 weeks of out-of-hospital activity in DDDR mode. Subjective assessment showed improved 'general wellbeing' and preference for 175 ms rate responsive AVD (P less than 0.

Open access exercise electrocardiography: a service to improve management of ischaemic heart disease by general practitioners.

An initial study of the use of open access exercise electrocardiography by general practitioners (GPs) in South East Kent showed that patient selection and interpretation of test results was frequently incorrect. After issuing guidelines, modifying the request form and instituting registrar review of all requests, significant improvements in both referral pattern, result interpretation and patient management have resulted. Forty-nine GPs requested 110 exercise tests during 1988/89.

Patent foramina ovale in elderly stroke patients.

Fifty elderly patients who had suffered cerebrovascular incidents from no obvious cause and 33 age-matched controls were investigated for the presence of a patent foramen ovale by contrast 2-dimensional echocardiography at rest and after the Valsalva manoeuvre. Right-to-left shunting was found in only one patient and in none of the controls. This finding is in contradistinction to young adult stroke patients in whom the prevalence of a haemodynamically significant patent foramina ovale is high.

Supraventricular tachycardia control with Tachylog II: long-term follow-up.

Ten patients aged 16-63 years (mean 36.3) had the Siemens P56T "Tachylog II" pacemaker implanted for treatment of drug refractory supraventricular tachycardia. The pacemaker incorporates a noninvasive electrophysiological study (EPS) facility and a sophisticated Holter function combined with a unique "learning" self-search antitachycardia algorithm.

Comparison of the normal sinus node with seven types of rate responsive pacemaker during everyday activity.

The heart rate response of 59 patients aged 17-79 years implanted with seven different types of rate responsive pacemakers was evaluated during graded exercise treadmill testing and during standardised daily activities. The heart rate response in patients with pacemakers was compared with the chronotropic response in 20 healthy controls of similar age and sex distribution who performed identical protocols. All pacemaker types adequately simulated the control heart rate response during the graded exercise treadmill test except during the early stages of exercise.