Impact of a dedicated center for atrial fibrillation on resource utilization and costs.

Background: Atrial fibrillation (AF) affects millions of Americans each year and can lead to high levels of resource utilization through emergency department (ED) visits and inpatient stays.

Hypothesis: We hypothesized that referral of patients to a dedicated Center for AF from the ED would reduce costs of care.

Methods: The University of Pittsburgh Center for AF serves as a rapid referral center for patients with AF to avoid unnecessary inpatient admissions and provide specialized care.

Cardiac resynchronization therapy using a pacemaker or a defibrillator: Patient selection and evidence to support it.

Cardiac resynchronization therapy (CRT) is an established treatment for patients with heart failure (HF), myocardial dysfunction and prolonged ventricular depolarization on surface electrocardiogram. CRT can be delivered by a pacemaker (CRT-P) or a combined pacemaker-defibrillator (CRT-D). Although these two types of devices are very different in size, function, and cost, current published guidelines do not distinguish between them, leaving the choice of which device to implant to the treating physician and the informed patient.

Extraction of defibrillator leads recalled for cable externalization and failure.

Background: The Riata implantable cardioverter-defibrillator lead was recalled by the Food and Drug Administration because of an increased rate of failure associated with cable externalization. Because of its mechanical separation, the Riata lead may be challenging to extract. We therefore examined the experience with Riata lead extractions at our institution.