Reconnection Rate and Long-Term Outcome with Adenosine Provocation During Cryoballoon Ablation for Pulmonary Vein Isolation.

Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA).

Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed.

Bronchial effects of cryoballoon ablation for atrial fibrillation.

Background: Damage to extracardiac structures, including the esophagus and phrenic nerve, is a known complication of cryoballoon ablation (CBA) during pulmonary vein (PV) isolation for atrial fibrillation (AF). Other adjacent structures, including the pulmonary bronchi and lung parenchyma, may be affected during CBA at the PV ostia.

Objective: The purpose of this study was to prospectively study the bronchial effects of CBA in humans undergoing CBA for PV isolation.

Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF).

The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices.

Rationale And Objectives: Studies reporting the safety of magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED) have mostly excluded examinations with the device in the magnet isocenter. The purpose of this study was to describe the safety of cardiac and thoracic spine MRI in patients with a CIED.

Materials And Methods: The medical records of patients with a CIED who underwent a cardiac or thoracic spine MRI between January 2011 and December 2014 were reviewed.

Modulation of Cardiac Potassium Current by Neural Tone and Ischemia.

The cardiac action potential is generated by intricate flows of ions across myocyte cell membranes in a coordinated fashion to control myocardial contraction and the heart rhythm. Modulation of the flow of these ions in response to a variety of stimuli results in changes to the action potential. Abnormal or altered ion currents can result in cardiac arrhythmias.

Constitutive Expression of a Dominant-Negative TGF-β Type II Receptor in the Posterior Left Atrium Leads to Beneficial Remodeling of Atrial Fibrillation Substrate.

Rationale: Fibrosis is an important structural contributor to formation of atrial fibrillation (AF) substrate in heart failure. Transforming growth factor-β (TGF-β) signaling is thought to be intricately involved in creation of atrial fibrosis.

Objective: We hypothesized that gene-based expression of dominant-negative type II TGF-β receptor (TGF-β-RII-DN) in the posterior left atrium in a canine heart failure model will sufficiently attenuate fibrosis-induced changes in atrial conduction and restitution to decrease AF.

Real-world performance of an enhanced atrial fibrillation detection algorithm in an insertable cardiac monitor.

Background: Insertable cardiac monitors (ICMs) are used for long-term ECG monitoring. The Reveal LINQ ICM has an improved atrial fibrillation (AF) detection algorithm.

Objective: The purpose of this study was to investigate the algorithm's real-world performance in patients with syncope, cryptogenic stroke, and known AF.

Cardiac Monitoring for Atrial Fibrillation in Cryptogenic Stroke.

Despite an extensive initial evaluation, the cause of up to a third of ischemic strokes remains undetermined. The detection of atrial fibrillation (AF) in these patients with cryptogenic stroke is critical as the diagnosis of AF would warrant anticoagulation to reduce the risk of recurrent stroke. Observational studies and prospective randomized controlled trials have shown that a substantial proportion of patients with cryptogenic stroke have AF detected by post-stroke cardiac monitoring with higher AF detection rates observed with longer monitoring periods.

Appropriate Implantable Defibrillator Therapy in Adults With Hypertrophic Cardiomyopathy.

Introduction: Implantable cardioverter-defibrillators (ICDs) are effective at terminating the ventricular arrhythmias that cause sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, identifying patients at risk for SCD remains an ongoing challenge.

Methods And Results: We retrospectively studied all adult patients with HCM treated with ICDs at our referral center from 2000 to 2013 to determine the risk factor profile, rates of appropriate ICD therapy, and complications associated with ICD implantation and discharge.

Targeted Anticoagulation for Atrial Fibrillation Guided by Continuous Rhythm Assessment With an Insertable Cardiac Monitor: The Rhythm Evaluation for Anticoagulation With Continuous Monitoring (REACT.COM) Pilot Study.

Introduction: Chronic anticoagulation is recommended for patients with AF and additional stroke risk factors, even during long periods of sinus rhythm. Continuous rhythm assessment with an insertable cardiac monitor (ICM) and use of rapid onset novel oral anticoagulants (NOACs) allow for targeted anticoagulation only around an AF episode, potentially reducing bleeding complications without compromising stroke risk.

Methods: This multicenter, single-arm study enrolled patients on NOAC with nonpermanent AF and CHADS2 score 1 or 2.

Management of device-detected atrial high-rate episodes.

Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs) with atrial leads. These atrial tachyarrhythmias are detected as atrial high-rate episodes (AHREs) by the CIED. AHREs may be brief, infrequent, and asymptomatic, and may be detected before clinical arrhythmia is apparent.

The Reveal LINQ insertable cardiac monitor.

Insertable cardiac monitors (ICMs) are leadless subcutaneous devices that continuously monitor the heart rhythm and record events over a timeframe measured in years, allowing for the diagnosis of infrequent rhythm abnormalities that can be the cause of palpitations, syncope and stroke. To date, ICMs have primarily been used in the work-up and management of syncope; however, their use in other areas of rhythm evaluation, particularly atrial fibrillation monitoring, is increasing. The Reveal LINQ™ is the smallest and most versatile ICM available and represents a dramatic leap forward in ICM technology that has the potential to transform patient care in a number of circumstances.

The Impact of Early Detection of Atrial Fibrillation on Stroke Outcomes.

Early detection of atrial fibrillation (AF) before an AF-related stroke potentially allows for prevention, but the best methods are uncertain. Population screening trials have demonstrated the ability to increase detection in older individuals by systematic screening. The subset of patients with implantable cardiac rhythm management devices are at particular risk.

Risk of stroke and atrial fibrillation after radiofrequency catheter ablation of typical atrial flutter.

Background: Studies suggest that 18%-50% of the patients develop atrial fibrillation (AF) after typical atrial flutter (AFL) ablation. However, little data exist about the incidence of and risk factors for stroke and AF after successful ablation of typical AFL.

Objectives: To determine the risk of stroke and AF after radiofrequency ablation of typical AFL.

Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study.

Background: The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF.

Human papillomavirus vaccines for the prevention and treatment of cervical cancer.

The identification of human papillomavirus (HPV) as a cause of cervical cancer and its precursor lesions indicates that HPV vaccines can potentially be used to prevent or treat cervical cancer and other HPV-associated malignancies. Prophylactic HPV vaccines aim to prevent infection by producing neutralizing antibodies against HPV capsid proteins L1 and L2. However, because HPV-infected basal keratinocytes and HPV-transformed cells generally do not express L1 or L2, therapeutic HPV vaccines are being developed to treat established HPV infections and HPV-associated malignancies by targeting non-structural early viral antigens of HPV, such as E6 and E7 (two viral oncogenic proteins required for the induction and maintenance of malignant cancer).