Defining the blanking period, using continuous ECG monitoring, after cryoballoon pulmonary vein isolation.

Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A blanking period (BP) of 3 months is used in clinical trials and practice. However, the optimal BP duration after PVI remains undefined.

Incidence, duration, pattern, and burden of atrial arrhythmias detected by continuous ECG monitoring using an implantable loop recorder following ablation of the cavotricuspid isthmus.

Background: Following cavotricuspid isthmus (CTI) ablation, many patients with atrial flutter (AFL) are diagnosed with atrial fibrillation (AF). The incidence, duration, pattern, and burden of AF remain undefined. These may have implications for the management of these patients.

Incidence and Predictors of Very Late Recurrence of Atrial Fibrillation Following Cryoballoon Pulmonary Vein Isolation.

Background: A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when the first recurrence of AF occurs ≥12 months following ablation. Prior studies characterizing VLR have not used an implantable loop recorder for ECG monitoring. Thus, it is unknown whether VLR truly occurs or whether these patients have simply had unrecognized AF.

Detection of atrial fibrillation using an implantable loop recorder following cryptogenic stroke: implications for post-stroke electrocardiographic monitoring.

Purpose: Approximately 10-40% of strokes are cryptogenic (CS). Long-term electrocardiographic (ECG) monitoring has been recommended in these patients to search for atrial fibrillation (AF). An unresolved issue is whether ambulatory ECG (AECG) monitoring should be performed first, followed by an implantable loop recorder (ILR) if AECG monitoring is non-diagnostic, or whether long-term ECG monitoring should be initiated using ILRs from the onset.

Brugada Syndrome Unmasked by Use of Testosterone in a Transgender Male: Gender Trumps Sex as a Risk Factor.

We describe a genetic female living as a transgender male through the use of exogenous testosterone supplementation. He developed Brugada pattern (that was unrecognized) and subsequently had an out-of-hospital cardiac arrest. Sustained ventricular arrhythmias were suppressed through treatment with quinidine; however, this medication could only be administered at very low doses due to the development of angioedema at higher doses.

The Efficacy of His Bundle Pacing: Lessons Learned From Implementation for the First Time at an Experienced Electrophysiology Center.

Objectives: This study sought to evaluate the clinical and procedural characteristics impacting outcomes during implementation of a His bundle pacing (HBP) program in a real-world setting.

Background: Right ventricular pacing is associated with an elevated risk of heart failure, but device reprogramming and upgrades have significant challenges. HBP has emerged as an alternative and is reported to be highly successful in the hands of highly experienced centers.

Focal impulse and rotor modulation: Acute procedural observations and extended clinical follow-up.

Background: Focal impulse and rotor modulation (FIRM) was based on the premise that atrial fibrillation (AF) is sustained by rotors that are sufficiently stable to be eliminated by targeted ablation. Early experience reported high success as compared to conventional strategies.

Objective: The purpose of this study was to report on a single-center experience with extended follow-up by using FIRM in a variety of patients with AF.

Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports.

Background: Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation.

Objective: To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality.

Methods: A systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol.

Comparative safety of periablation anticoagulation strategies for atrial fibrillation: data from a large multicenter study.

Background: There are a variety of periprocedural anticoagulation strategies for atrial fibrillation (AF) ablation, including the use of dabigatran. It is unclear which strategy is superior.

Objective: To compare the safety and efficacy of anticoagulation with uninterrupted warfarin, dabigatran, and warfarin with heparin bridging in patients undergoing ablation of AF at four experienced centers.

Very long-term outcome after initially successful catheter ablation of atrial fibrillation.

Background: The ablation of atrial fibrillation (AF) using pulmonary vein isolation is indicated when patients do not respond favorably to medical therapy. Successful procedures are accomplished in the majority of patients, but the outcome after many years of follow-up after ablation is unknown.

Objective: To describe the long-term recurrence rate and pattern of AF after successful ablation.

Comparison of endovascular versus epicardial lead placement for resynchronization therapy.

Cardiac resynchronization therapy (CRT) has been shown to improve survival and symptoms in patients with severe left ventricular (LV) dysfunction, congestive heart failure, and prolonged QRS duration. LV lead placement is achieved by placing the lead in the coronary sinus, an endovascular approach, or by a minimally invasive robotic-assisted thoracoscopic epicardial approach. There are no data directly comparing the 2 methods.

Cardiac implantable electronic device infections: incidence, risk factors, and the effect of the AigisRx antibacterial envelope.

Background: Cardiac implantable electronic device (CIED) infection is associated with morbidity and mortality.

Objectives: To determine the incidence and risk factors for CIED infection, to develop a scoring index for risk stratification, and to analyze the effect of the AIGISRx envelope on infection rates.

Methods: Consecutive patients who underwent a CIED procedure were identified and surveyed for 6 months for the development of an infection necessitating removal of all implanted hardware.

Correlation of QT interval correction methods during atrial fibrillation and sinus rhythm.

The calculation of the corrected QT interval (QTc) is particularly problematic in patients during atrial fibrillation (AF). The aims of this study were to compare the QTc calculated using Bazett's formula in AF and sinus rhythm (SR) and determine whether alternative methods for QT correction were superior to Bazett's, in an effort to define the optimal method for QT correction in patients with AF. We evaluated consecutive patients with persistent AF admitted for initiation of dofetilide.

Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter.

Background: In patients with atrial flutter who undergo cavotricuspid isthmus ablation, long-term electrocardiographic (ECG) monitoring may identify new onset of atrial fibrillation (AF).

Objectives: To ascertain, through the use of an implantable loop recorder (ILR) with a dedicated AF detection algorithm, the incidence, duration, and burden of new AF in these patients and to develop an optimal postablation ECG monitoring strategy.

Methods: We enrolled 20 patients with flutter, a CHADS2 score of 2-3, and no prior episode of AF.

Dexmedetomidine sedation leading to refractory cardiogenic shock.

Dexmedetomidine is frequently used for deep sedation during electrophysiology procedures. We report a case where, presumably, the use of dexmedetomidine resulted in a patient's death. The patient developed unexplained and refractory cardiogenic shock and could not be resuscitated.

Long-term outcome following successful pulmonary vein isolation: pattern and prediction of very late recurrence.

Background: Despite encouraging results of pulmonary vein isolation (PVI) ablation for atrial fibrillation (AF), it is unclear whether there is genuine cure or there is an important attrition rate. We sought to determine the long-term outcome of the initial responders who experienced a prolonged AF-free complete response.

Methods: From a series of 350 consecutive patients who underwent PVI for AF, 264 patients (75%) (males 71%, age 57 +/- 12 years, paroxysmal AF 87%) who demonstrated >or=1 year AF-free follow-up on no antiarrhythmic drugs were followed for 1-5 years.

Impact of systemic hypertension on the cardiovascular benefits of statin therapy--a meta-analysis.

The ASCOT-LLA and ALLHAT-LLT trials provide conflicting evidence of the efficacy of statins in decreasing cardiovascular (CV) morbidity and mortality in hypertensive patients. We performed a meta-analysis to compare the overall efficacy of statins in hypertensive and nonhypertensive patients enrolled in major randomized clinical trials. We systematically reviewed PubMed publications from 1985 onward for placebo-controlled randomized trials that examined the effect of statins on cardiac morbidity and mortality.

Cardioversion in patients with left ventricular thrombus is not associated with increased thromboembolic risk.

Objectives: The purpose of the study was to define the incidence of systemic embolism after cardioversion in patients with left ventricular (LV) thrombus.

Background: The risk of systemic embolization after cardioversion in patients with an atrial thrombus is well known. However, data on thromboembolic events after cardioversion in patients with LV thrombus are limited because of hesitance to perform cardioversion in this population.

Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.

Context: Early mechanical revascularization in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock is a therapeutic strategy that reduces mortality. It has been a class I recommendation in guidelines from the American College of Cardiology and the American Heart Association since 1999 for patients younger than 75 years. However, little is known about implementation of these guidelines in practice.