The effects of multiphasic prepulses on automatic and attention-modulated prepulse inhibition.

Prepulse inhibition (PPI) is widely viewed as an operational measure of sensorimotor gating. Previous research has shown that sensorimotor gating can occur automatically and also can be influenced by selective attention. The present research investigated the relationship of the transient detection response (TDR) with automatic and attention-modulated PPI using a novel "multiphasic" prepulse stimulus.

Risk of ventricular tachyarrhythmias following improvement of left ventricular ejection fraction in patients with implantable cardiac defibrillators implanted for primary prevention of sudden cardiac death.

Purpose: In patients who undergo implantable cardiac defibrillator (ICD) implantation for primary prevention of sudden cardiac death (SCD), data is unclear whether their ICD generator needs to be replaced at end of life if their left ventricular ejection fraction (EF) improves. Despite improvement in EF, the underlying scar may represent a potential substrate for ventricular arrhythmias.

Methods: Data on 280 patients who underwent ICD implantation for primary prevention of SCD was obtained from two centers.

Cardiac Implantable Electronic Device-Related Infection and Extraction Trends in the U.S.

Background: Implantation of cardiac implanted electronic device (CIED) has surged lately. This resulted in a rise in cardiac device-related infections (CDI) and inevitably, lead extractions. We examined the recent national trend in the incidence of CIED infections and lead extractions in hospitalized patients and associated mortality.

Electromagnetic Interference in a Private Swimming Pool: Case report.

Although current lead design and filtering capabilities have greatly improved, Electromagnetic Interference (EMI) from environmental sources has been increasingly reported in patients with Cardiac Implantable Electronic Device (CIED) [1]. Few cases of inappropriate intracardiac Cardioverter Defibrillator (ICD) associated with swimming pool has been described [2]. Here we present a case of 64 year old male who presented with an interesting EMI signal that was subsequently identified to be related to AC current leak in his swimming pool.

Partial Brain Tissue Oxygen Levels Predict Arrhythmia and Prognosis in Patients With Brain Injury.

The objective of this study was to examine the clinical determinants of incidence and prognosis of arrhythmias in the setting of acute brain injury. Acute brain injury is known to cause electrocardiographic abnormalities and cardiac arrhythmias. The relation between partial brain tissue oxygen (PBTO) and intracranial pressure (ICP) with arrhythmia incidence and prognosis remains unknown.

Left Atrial Appendage Closure for Stroke Prevention: Devices, Techniques, and Efficacy.

Left atrial appendage closure can be performed either surgically or percutaneously. Surgical approaches include direct suture, excision and suture, stapling, and clipping. Percutaneous approaches include endocardial, epicardial, and hybrid endocardial-epicardial techniques.

Remote Ischemic Preconditioning for Cardiac Surgery: Reflections on Evidence of Efficacy.

Ever since its discovery more than two decades ago, remote ischemic preconditioning (RIPC) has generated tremendous interest among scientists and clinicians alike. However, two recent large, well-conducted, randomized controlled trials (RCTs) have failed to identify any significant benefit of RIPC during cardiac surgery. A reconciliatory yet objective review of cumulative evidence with regard to cardiac surgery reveals that RIPC in preclinical studies reduced infarct size after experimental myocardial infarction, which is different from cardiac surgery; improved release of biomarkers, but not hard clinical end-points, in proof-of-concept clinical trials with discordant results; and failed to produce significant improvement in outcomes in meta-analyses.

Cardiac Resynchronization Therapy: US Trends and Disparities in Utilization and Outcomes.

Background: The use of cardiac resynchronization therapy (CRT) has increased significantly since its initial approval in 2001 for use in patients with advanced heart failure. However, trends in utilization of CRT have not been systematically characterized.

Methods And Results: We used the Nationwide Inpatient Sample database to identify all patients with CRT implantation during 2002 to 2010.

Left atrial appendage closure is preferred to chronic warfarin therapy: the pro perspective.

Atrial fibrillation (AF) is associated with increased rates of death, stroke, heart failure, hospitalization, degraded quality of life, reduced exercise capacity, and left ventricular dysfunction. An oral anticoagulant reduces the risk of stroke; however, it places the patient at risk for bleeding complications. Weighing the stroke and bleeding risks remains the key for optimal treatment.

A call for long-term data in clinical studies of infrainguinal peripheral arterial revascularization: The DURABILITY II Study delivers.

The DURABILITY II study provides outcomes in 220 patients treated with nitinol self-expanding stent placement for femoro-popliteal disease out to three years. In this core lab adjudicated study, the EverFlex™ (Covidien, Plymouth, MN) self-expanding stents had a low stent fracture rate (0.9%).

Disparities in lipid control and statin drug use among diabetics with noncoronary atherosclerotic vascular disease vs those with coronary artery disease.

Background: Diabetes mellitus (DM), coronary artery disease (CAD), and noncoronary atherosclerotic vascular diseases (NCVDs) have similar risks of cardiovascular events and similar recommendations for lipid control. There are limited data regarding lipid control in diabetic patients with NCVD in current clinical practice.

Objective: To assess current day practice of lipid control in patients with DM with NCVD vs those with CAD.

Alternative medicine in atrial fibrillation treatment-Yoga, acupuncture, biofeedback and more.

The last decade has seen a significant improvement in the management of atrial fibrillation (AF) with the development of newer medications and improvement in catheter ablation techniques. Recurrence of AF remains a significant problem in these patients and medications offer limited supportive role. Complementary and alternative treatment strategies therefore remain a viable option for these AF patients.

Clinical utility and prognostic significance of measuring troponin I levels in patients presenting to the emergency room with atrial fibrillation.

Background: The clinical significance of mildly elevated troponins in patients presenting to the emergency room (ER) with atrial fibrillation (AF) is not well understood.

Hypothesis: We hypothesized that mildly elevated troponin in these patients is associated with adverse cardiovascular outcomes.

Methods: In a multi-center, retrospective study, 662 patients with AF were divided into 3 groups based on troponin levels: group 1, mildly elevated; group 2, normal; and group 3, troponin not measured.

Comparison of lipid management in patients with coronary versus peripheral arterial disease.

Peripheral arterial disease (PAD), similar to coronary artery disease (CAD), is a significant predictor of cardiovascular morbidity and mortality. Guidelines recommend a low-density lipoprotein (LDL) goal of <100 mg/dl for both groups. We assessed whether lipid control and statin use were as aggressively applied to PAD as to patients with CAD.

Age-Dependent Impact of Fluoroscopic Radiation on the Gender of Off-Spring: An International Survey of Cardiologists.

Fluoroscopic radiation has been implicated in reducing the sex ratio (M:F) by potentially damaging the Y chromosome. We examined the effects of exposure to fluoroscopic radiation on gender of offspring of cardiologists across the world. An internet based survey was e-mailed worldwide to 8000 physicians who practice invasive electrophysiology and/or interventional cardiology.

Massive pulmonary embolism with shock: role of thrombolysis using central venous access.

Background: Massive pulmonary embolism (PE) complicated with shock has an extremely high mortality rate with medical treatment. Since access to emergency vascular surgery or endovascular specialists is not readily available in most centers, patients are frequently treated with thrombolytic agents delivered via a peripheral venous access. Patients with shock, however, have poor peripheral perfusion, and peripheral administration of thrombolytic agents may thus not reliably deliver the agent to the embolus, reducing treatment efficacy.

Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters: a systematic review and meta-analysis.

Background: Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach.

Methods And Results: A total of 50 studies (enrolling 2625 patients) identified by database searches through January 2012 were included.

Vitamin D deficiency and supplementation and relation to cardiovascular health.

Recent evidence supports an association between vitamin D deficiency and hypertension, peripheral vascular disease, diabetes mellitus, metabolic syndrome, coronary artery disease, and heart failure. The effect of vitamin D supplementation, however, has not been well studied. We examined the associations between vitamin D deficiency, vitamin D supplementation, and patient outcomes in a large cohort.

Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves: a feasibility, safety, and efficacy study.

Background: Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients.

Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves.