Approaches for Successful Implantation of Cardiac Implantable Devices in Patients with Persistent Left Superior Vena Cava.

Persistent left superior vena cava (PLSVC) is the most common congenital thoracic venous anomaly, with 0.47% of patients undergoing pacemaker or cardiac implantable device placement found to have PLSVC. This review article describes challenges and interventions to successfully insert cardiac implantable electronic device leads into patients with PLSVC by providing multiple unique case examples.

Cardiac arrhythmias associated with COVID-19 infection: state of the art review.

Introduction: COVID-19 infection is associated with many different systemic complications. Among these, cardiovascular system complications are particularly important as these are associated with significant mortality. There are many different subgroups of cardiovascular complications, with Arrhythmias being one of them.

Subcutaneous cardiac rhythm monitors: state of the art review.

: Subcutaneous cardiac rhythm monitors (SCRMs) provide continuous ambulatory electrocardiographic monitoring for surveillance of known and identification of infrequent arrhythmias. SCRMs have proven to be helpful for the evaluation of unexplained symptoms and correlation with intermittent cardiac arrhythmias. Successful functioning of SCRM is dependent on accurate detection and successful transmission of the data to the device clinic.

Resource Use and Economic Implications of Remote Monitoring With Subcutaneous Cardiac Rhythm Monitors.

Objectives: This study reports resource use and economic implications of rhythm monitoring with subcutaneous cardiac rhythm monitors (SCRMs).

Background: SCRMs generate a substantial amount of data that requires timely adjudication for appropriate clinical care. Resource use for SCRM monitoring is not known.

Comprehensive strategies to minimize radiation exposure during Interventional electrophysiology procedures: state-of-the-art review.

Introduction: Cardiac electrophysiology (EP) procedures are frequently performed in patients with cardiac arrhythmias, chronic heart failure, and sudden cardiac death. Most EP procedures involve fluoroscopy, which results in radiation exposure to physicians, patients, and EP lab staff. Accumulated radiation exposure is a known health detriment to patients and physicians.

Current state of leadless pacemakers: state of the art review.

: Leadless pacemakers (LPs) are the latest advancement in the field of pacing. Experience from pivotal trials and post-marketing studies has proven the feasibility and safety of these devices. The LPs obviate the need of pulse generator pocket and leads, which translates into lower incidence of lead related complications and pocket related infections.

Incidence of false-positive transmissions during remote rhythm monitoring with implantable loop recorders.

Background: Implantable loop recorder (ILR) is preferred strategy for prolonged rhythm monitoring.

Objective: The purpose of this study was to report the incidence and causes of false-positive (FP) diagnoses during remote monitoring with ILR.

Methods: During a 4-week study period, all consecutive remote transmissions in patients with ILR (Reveal LINQ, Medtronic) implanted for atrial fibrillation (AF) surveillance, cryptogenic stroke (CS), and syncope were reviewed.

Increased risk of hematoma with uninterrupted warfarin in patients undergoing implantation of subcutaneous implantable cardioverter defibrillator.

Background: The perioperative management of anticoagulation with the use of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is still evolving.

Objective: The purpose of this study was to assess whether it is safe to perform S-ICD implantation with uninterrupted warfarin.

Methods: This is a multi-center retrospective review of patients undergoing S-ICD implantation between October 1, 2012 and June 30, 2017.

Comprehensive strategy to reduce the incidence of lead dislodgement for cardiac implantable electronic devices.

Background: Lead dislodgement (LD) is a well-recognized complication during implantation of cardiac implantable electronic devices (CIEDs). An intraprocedural protocol, referred to as reduction of LD protocol, was developed to reduce the risk of LD.

Methods: The protocol involved (1) inserting a straight stylet down the right atrial lead and applying forward pressure while monitoring for fluoroscopic stability, (2) visualizing all leads during deep inspiration to determine if there is adequate lead redundancy, and (3) having the patient take a deep breath and cough while pacing just at capture threshold to assess for loss of capture in each lead.

Adenosine triphosphate/adenosine guided pulmonary vein isolation does not improve the outcomes of ablation: a meta-analysis of randomized controlled trials.

Background: Successful pulmonary vein isolation (PVI) is the most reliable predictor of success after ablation in patients with atrial fibrillation (AF). Adenosine triphosphate (ATP) unmasks the dormant conduction and can be used to improve the effectiveness of PVI. The impact of ATP guided PVI on clinical outcomes is discordant in various randomized controlled trials (RCTs).

Successful Denovo Implantation And Explanation Of An Old Malfunctioning Micratm Leadless Pacemaker.

An unknown mass in the left atrium can be challenging to differentiate, especially after previous heart transplant. A precise diagnosis is clinically crucial because of the therapeutic implications. CMR is a useful, non-invasive tool to distinguish intra-cardiac lesions, thereby enabling clinicians to initiate adequate therapy.

Role of exercise electrocardiogram to screen for T-wave oversensing after implantation of subcutaneous implantable cardioverter-defibrillator.

Background: During early experience with subcutaneous implantable cardioverter-defibrillators (S-ICD), several patients had inappropriate shocks from T-wave oversensing (TWOS) during exercise. This prompted some operators to perform routine treadmill exercise tests after implantation of S-ICD to screen for TWOS. Meanwhile, improvements have been made in the detection algorithms by the manufacturer.

Adjunctive ablation strategies improve the efficacy of pulmonary vein isolation in non-paroxysmal atrial fibrillation: a systematic review and meta-analysis.

Background: Pulmonary vein (PV) isolation (PVI) has suboptimal outcomes in patients with non-paroxysmal atrial fibrillation (AF). Adjunctive strategies employed to ablate non-PV triggers have shown favorable outcomes.

Aims: To delineate the incremental benefit of adjunctive ablation in patients with non-paroxysmal AF through a meta-analysis.

Stroke Risk in Patients with Implanted Cardiac Devices.

Atrial fibrillation (AF) is associated with embolic stroke. AF can be asymptomatic and the first detection of AF may be from the stored electrograms of cardiac implantable electronic devices. These devices can digitally record and store intracardiac electrograms that satisfy criteria for AF.

Cancer and pregnancy: an overview for obstetricians and gynecologists.

A relatively rare occurrence, pregnancy-associated cancer affects approximately 1 in 1000 pregnancies. Optimizing treatment of the cancer and minimizing harm to the fetus are often dependent on the extent of disease, treatment options required, and the impact on the pregnancy as well as the gestational age of pregnancy. When malignancy is diagnosed, the obstetrician-gynecologist plays a key role in the diagnosis, initial evaluation, and coordination of patient care.

Survivorship planning in gynecologic cancer patients.

Objective: There are over one million survivors from gynecologic malignancies currently living in the United States and this population is expected to increase by 33% over the next decade. Identifying the needs of these cancer survivors is often understudied and overlooked.

Methods: A literature review using MEDLINE was searched for research articles published in English from 1967 to 2013 focusing on survivorship care in women with gynecologic malignancies.

Recent innovations in the management of low-grade gliomas.

Advancement in the understanding of biologic mechanisms of low-grade glioma pathophysiology has allowed the modern era of patient-specific genetic profiling, molecular biology, and neuroimaging to design new methods of surgery, radiation, and chemotherapy in hopes of preventing malignant transformation and improving outcomes. Recent innovations in the understanding of MGMT promoter methylation, IDH1 and IDH2 mutations, temozolomide chemotherapy, vascular monoclonal antibody treatment, use of radiation therapy, choice of antiepileptic drugs, surgical resection, and neuroimaging of low-grade gliomas are reviewed.