Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis.

Study Design: Retrospective study.

Objective: (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes.

Background: Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS.

Radiofrequency lesion formation prediction with contact force versus local impedance.

Purpose Of Review: Safe and effective radiofrequency (RF) myocardial ablation requires real-time monitoring of lesion formation. Here, we review conventional and novel approaches proposed to guide titration of RF energy application.

Recent Findings: Conventional monitoring modalities, such as ablation electrode temperature, generator impedance, and tissue electrophysiological properties have been of limited value in predicting efficacy and safety of ablation.

Effects of Atrioventricular Optimization on Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results of the SMART-CRT Trial.

Background: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO.

Methods: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling.

Association of Myocardial Muscle Non-Compaction and Multiple Ventricular Septal Defects by Echocardiography.

The aim of this study is to examine the possible high association between multiple ventricular septal defect (mVSDs) and noncompaction cardiomyopathy (NCM) as same embryological origin, and the effect of depressed ventricular function in NCM cases during the follow-up, using echocardiography. A total of 150 patients with mVSDs were diagnosed in a single center in Saudi Arabia; 40 cases with isolated or associated with minor congenital heart disease were recruited. Three specialist echocardiography consultants confirmed the NCM diagnosis separately using Jenni, Chin and Patrick criteria, and myocardial function was estimated by ejection fraction at admission and at follow-up after surgery.

Outcome of transvenous lead extraction of leads older than 20 years.

Background: In patients undergoing transvenous lead extraction (TLE), lead dwell time has been recognized as a risk factor for extraction failure and procedure-related complications.

Objectives: The aim of this study was to evaluate the safety and effectiveness of TLE in patients with pacemaker or ICD leads with a dwell time of ≥20 years.

Methods: This is a single-center retrospective study of all patients who underwent TLE of at least 1 pacemaker or ICD leads a dwell time of ≥20 years.

Outcome of transvenous lead extraction in patients on minimally interrupted periprocedural direct oral anticoagulation therapy.

Background: Direct oral anticoagulants (DOACs) have increasingly been used for several indications for systemic anticoagulation in patients with cardiac implantable electronic devices (CIEDs). The optimal management of anticoagulation therapy in patients undergoing transvenous lead extraction (TLE) procedures remains uncertain.

Objectives: The aim of this study was to evaluate the feasibility and safety of TLE during minimally interrupted DOAC therapy.

Measurement of Left Ventricular Dimensions and Ejection Fraction in Neonates by Three-Dimensional Echocardiography: A Comparative Study Between Philips QLAB and TOMTEC Software-Are the Values Interchangeable?

Three-dimensional echocardiography is being used to evaluate left ventricular dimensions and ejection fraction in clinical practice. The validity and normal values have been established in a large group of normal adults, children and neonates. The aim of this study was to compare left ventricular dimensions and ejection fraction obtained from the same 3-dimensional echocardiography datasets using 2 commercially available applications: Philips QLAB and Tomtec 4D LEFT VENTRICLE-ANALYSIS.

Transvenous lead extraction in 1000 patients guided by intraprocedural risk stratification without surgical backup.

Background: Transvenous lead extraction (TLE) carries a significant risk of morbidity and mortality. Reliable preprocedural risk predictors to guide resource allocation and optimize procedural safety are lacking.

Objective: The aim of this study was to evaluate an intraprocedural approach to risk stratification during elective TLE procedures.

Combined Epicardial and Endocardial Sinus Node Modification Using the Orion™ Mini-basket Mapping Catheter.

In patients with inappropriate sinus tachycardia, conservative medical management targeting the relief of symptoms is the first line of therapy. Sinus node modification can offer a potential benefit in selected patients with severe, refractory inappropriate sinus tachycardia. Extensive endocardial radiofrequency (RF) ablation of the superior aspect of the sinus node complex is typically required but is often limited by the epicardial location of the sinus node and the proximity of the phrenic nerve.

Utility of fluoroscopy alone for monitoring of intrathoracic bleeding complications during transvenous lead extraction.

Background: Transvenous lead extraction (TLE) carries a significant risk of major complications, namely bleeding into the pericardial sac or thoracic cavity. While echocardiographic imaging has been recommended for intraprocedural monitoring for those complications, no studies had examined the potential benefits of fluoroscopy alone as an alternative to echocardiography. The aim of this study was to evaluate the utility of fluoroscopy for monitoring intrathoracic bleeding complications during TLE.

Feasibility and Safety of Percutaneous Lead Revision for Subacute and Delayed Cardiac Device Lead Perforation.

Objectives: This study assessed the management approach and outcome of subacute (1 to 30 days post-implantation) and delayed (>30 days) cardiac perforation by pacemaker or implantable cardioverter-defibrillator (ICD) leads.

Background: Implantation of pacemaker and ICD leads is associated with a small but serious risk of cardiac perforation. Appropriate management remains uncertain.

The World-wide Randomized Antibiotic Envelope Infection Prevention (WRAP-IT) trial: Long-term follow-up.

Background: The World-wide Randomized Antibiotic Envelope Infection Prevention trial reported a 40% reduction in major cardiac implantable electronic device (CIED) infections within 12 months of the procedure with the use of an antibacterial-eluting envelope (TYRX Absorbable Antibacterial Envelope, Medtronic, Mounds View, MN).

Objective: The purpose of this report was to describe the longer-term (>12 months) envelope effects on infection reduction and complications.

Methods: All trial patients who underwent CIED replacement, upgrade, revision, or initial cardiac resynchronization therapy - defibrillator implantation received standard-of-care infection prophylaxis and were randomized in a 1:1 ratio to receive the envelope or not.

Gothic aortic arch and cardiac mechanics in young patients after arterial switch operation for d-transposition of the great arteries.

Background: In patients who have undergone arterial switch operation (ASO) for d-transposition of the great arteries a gothic aortic arch (GA) morphology has been found and it has been associated with abnormal aortic bio-elastic properties.

Hypothesis: GA is frequent in ASO patients and may have an impact on cardiac mechanics. Our study aims were to assess 1- the occurrence of GA in a large sample of patients after ASO; 2- the association between GA and aortic bio-elastic properties; and 3- the impact of GA on left ventricular (LV) function using speckle tracking echocardiography (STE).

Left Ventricular Mechanics in Patients with Abnormal Origin of the Left Main Coronary Artery from the Pulmonary Trunk Late after Successful Repair.

Objective: Our aim was to evaluate left ventricular (LV) mechanics by using speckle tracking echocardiography (STE) in asymptomatic patients with abnormal origin of the left main coronary artery from the pulmonary trunk (ALCAPA), late after successful repair, in the presence of LV ejection fraction (EF) >50%.

Methods: We studied 30 ALCAPA patients (median age 4 years, range 1-25 years, NYHA class I, LVEF >50%) and 16 healthy age- and sex-matched controls (median age 5 years, range 1-25 years). All underwent standard echocardiographic evaluation and STE.

Left ventricular mechanics after arterial switch operation: a speckle-tracking echocardiography study.

Background: The arterial switch operation (ASO) is nowadays the standard procedure for the repair of dextro-transposition of the great arteries (d-TGA). Reduced exercise capacity, coronary artery abnormalities, and reversible myocardial perfusion defects have been demonstrated in patients who have undergone ASO. Despite this, indices of systolic function, assessed by standard echocardiography, are within the normal range.

Pulmonary Vein Isolation Using the Visually Guided Laser Balloon: A Prospective, Multicenter, and Randomized Comparison to Standard Radiofrequency Ablation.

Background: Balloon catheters have been designed to facilitate pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). The visually guided laser balloon (VGLB) employs laser energy to ablate tissue under direct visual guidance.

Objectives: This study compared the efficacy and safety of VGLB ablation with standard irrigated radiofrequency ablation (RFA) during catheter ablation of AF.

Venous hemostasis postcatheter ablation of atrial fibrillation while under therapeutic levels of oral and intravenous anticoagulation.

Purpose: Catheter ablation of atrial fibrillation (AF) requires utilizing multiple venous femoral sheaths in conjunction with aggressive periprocedural anticoagulation, which can lead to increased risk of vascular access complications. The objective of this study is to evaluate the safety and efficacy of the "figure-of-eight" ("F-8") suture technique for femoral venous hemostasis while on therapeutic doses of intravenous anticoagulation at the time of sheath removal.

Methods: In this case-control analysis, 376 consecutive patients underwent AF ablation while on uninterrupted oral anticoagulation and received intraprocedural heparin.

Normal Range of Left Ventricular Strain, Dimensions and Ejection Fraction Using Three-dimensional Speckle-Tracking Echocardiography in Neonates.

Aims: Three-dimensional speckle-tracking echocardiography (3D-STE) is a promising new technique to evaluate left ventricular (LV) mechanics. The feasibility and normal values of LV strain using 3D-STE have recently been established in adults and children. Unfortunately, no data are available in neonates.

Long-term follow-up in AV junction ablation via the SVC in patients undergoing concurrent device implantation: a single center experience.

Background: Ablation of the atrioventricular junction (AVJ) combined with pacemaker implantation (the "ablate and pace" approach) has been an effective treatment strategy for patients with atrial fibrillation (AF) when rate control is the goal of therapy and when rapid ventricular rates during AF is refractory to pharmacologic therapy.

Objective: This report describes the feasibility and safety of catheter ablation of AVJ via a superior vena cava (SVC) approach performed during concurrent pacemaker or defibrillator implantation.

Methods: A total of 170 consecutive patients with drug-refractory AF underwent combined AVJ ablation and pacemaker or defibrillator implantation using the axillary or subclavian venous approach.

Left ventricular function and right ventricular pacing for isolated congenital heart block.

BACKGROUND: Right ventricular pacing has been the treatment of choice in patients with congenital complete atrioventricular block (CAVB). However, the effect of chronic right ventricular pacing on left ventricular function in young patients is still controversial. AIM: The aim of the study was to assess the change in left ventricular systolic function in young patients (age ≤20 years) paced for isolated CAVB and to identify possible predictors of left ventricular systolic dysfunction.

Transarterial pacemaker lead implantation results in acute myocardial infarction.

We report a case of inadvertent transarterial implantation of dual-chamber pacemaker leads; the ventricular lead positioned across the aortic valve into the left ventricle and the atrial lead curving in the aortic root with the tip positioned into the left circumflex artery, resulting in acute myocardial infarction. The diagnosis was made based on the finding on the chest X-ray, surface ECG, and coronary angiography.