Slow Pathway Modification in a Patient with D-Transposition of the Great Arteries and Atrial Switch Procedure
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Emily Sue Ruckdeschel, Joseph Kay, Paul Varosy, Duy Thai NguyenTeaser Patients with systemic right ventricles are often not able to tolerate frequent, rapid, or incessant atrial arrhythmias without developing significant symptoms and ventricular dysfunction. Atrial arrhythmias are associated with an increased risk of ventricular arrhythmias and sudden cardiac death. Rhythm disturbances must be aggressively addressed in this population with frequent screening, follow-up, and treatment. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

A Confused Pacemaker
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Bernard Abi-Saleh, Mohammad ElBaba, Maurice Khoury, Marwan M. RefaatTeaser The electrocardiogram (ECG) raises the question of inappropriate device behavior and the possibility of ventricular lead oversensing causing failure of ventricular pacing. Careful analysis of the ECG proved that the mode of pacing was set to managed ventricular pacing (MVP) mode. The MVP mode should not be used in the setting of a complete atrioventricular conduction block. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Pleomorphic Ventricular Tachycardias in Nonischemic Cardiomyopathy
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Babak Nazer, Henry H. HsiaTeaser Compared to patients with prior myocardial infarction, mapping and ablation of ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) patients represents a unique challenge, often with non-endocardial myocardial substrate, multiple VT morphologies, and higher incidence of arrhythmia recurrence post-ablation. Multi-modality imaging and detailed electroanatomic mapping demonstrated two predominant regional scar distributions: basal inferolateral and basal anteroseptal location...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Ventricular Tachycardia in a Patient with Biventricular Noncompaction
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Jaime E. Gonzalez, Wendy Tzou, William H. Sauer, Duy Thai NguyenTeaser Patients with ventricular noncompaction are susceptible to developing ventricular tachycardia. Commonly, the origin of ventricular tachycardia is endocardial; however, epicardial origins and scar cannot be excluded and should be considered when poor endocardial mapping is present. Other cardiomyopathies, such as arrhythmogenic right ventricular cardiomyopathy, can coexist with ventricular noncompaction and should be excluded in these patients. (S...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

An Approach to Endovascular Ventricular Pacing in a Patient with Ebstein Anomaly and a Mechanical Tricuspid Valve
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Matthew M. Zipse, Daniel W. Groves, Amber D. Khanna, Duy T. NguyenTeaser In the presence of a mechanical tricuspid valve, endocardial right ventricular pacing is contraindicated, and permanent pacing is usually achieved via a surgically implanted epicardial lead. In a patient with Ebstein anomaly, a mechanical tricuspid valve, and complete heart block, transvenous pacing was achieved by implantation of a pace-sense lead in a coronary sinus ventricular branch. Noninvasive cardiac imaging can provide information regar...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Narrow Complex Tachycardia
This article presents a diagnostic dilemma in which atrioventricular nodal reentrant tachycardia (AVNRT) and junctional tachycardia (JT) were differentiated based on tachycardia initiation with atrial extrastimulus as well as on the response to progressive decremental atrial extrastimuli. The progressive increase in A2H2′ and H2H2′ in response to atrial extrastimuli favors reentry as the mechanism of the tachycardia. This is a novel mechanistic differentiation of AVNRT from focal JT. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Acquired Pulmonary Vein Isolation in a Patient with Friedreich Ataxia
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Matthew M. Zipse, Ryan G. AleongTeaser The electrophysiologic nature of atrial fibrillation (AF) and related atrial arrhythmias in Friedreich ataxia has not previously been characterized. In the presented case, dense atrial scar had progressed to the point of acquired pulmonary vein (PV) isolation before the delivery of a single radiofrequency lesion. AF was induced, and ultimately organized spontaneously into a microreentrant atrial tachycardia. Other atrial tachycardias were also identified near scar border zones; t...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Inappropriate Implantable Cardioverter-Defibrillator Shock from QRS Double Counting in the Setting of Hyperkalemia
Publication date: Available online 13 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Akash Dadlani, Jonathan W. Dukes, Nitish BadhwarTeaser This case shows the complexity of arrhythmia management in patients with implantable cardioverter-defibrillators (ICDs) who present with hyperkalemia. In order to prevent inappropriate ICD shock, consideration should be given to the suspension of ICD therapies while intensive care treatment of extreme electrolyte derangements is being pursued. Patients in these setting should be closely monitored until their electrocardiograms have normalized, after which the dev...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Arrhythmogenic Right Ventricular Cardiomyopathy Caused by a Novel Frameshift Mutation
Publication date: Available online 16 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Marwan M. Refaat, Paul Tang, Nassier Harfouch, Julianne Wojciak, Pui-Yan Kwok, Melvin M. ScheinmanTeaser Arrhythmogenic right ventricular cardiomyopathy is a rare cardiomyopathy that might be asymptomatic or symptomatic, causing palpations or syncope, and might lead to sudden cardiac death. It is recommended that physical exertion be reduced. It is also recommended that those with syncope and ventricular tachycardia/ventricular fibrillation have an implantable cardioverter-defibrillator placed. β-Blockers, an...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Challenging Cases, Match Wits with the Masters
Publication date: Available online 16 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Melvin Scheinman (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Ablation of Atrial Fibrillation in a Patient with a Mechanical Mitral Valve
Publication date: Available online 16 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Matthew M. Zipse, Duy Thai NguyenTeaser Clinicians must be mindful of the left ventricular lead when cannulating the coronary sinus with a decapolar catheter or an ablation catheter. Left atrial catheter ablation for the treatment of atrial fibrillation in patients with a mechanical mitral valve, when approached carefully, can be performed safely and effectively. Block across linear lines should be confirmed using differential activation and/or differential pacing to decrease risks of proarrhythmias. (Source: Cardiac ...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Ventricular Tachycardia in Congenital Pulmonary Stenosis
Publication date: Available online 16 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Emily Sue Ruckdeschel, Joseph Schuller, Duy Thai NguyenTeaser With modern surgical techniques, there is significantly increased life expectancy for those with congenital heart disease. Although congenital pulmonary valve stenosis is not as complex as tetralogy of Fallot, there are many similarities between the 2 lesions, such that patients with either of these conditions are at risk for ventricular arrhythmias and sudden cardiac death. Those patients who have undergone surgical palliation for congenital pulmonary ste...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Ventricular Tachycardias
Publication date: Available online 16 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Henry H. HsiaTeaser Ventricular tachyarrhythmia is an important cause of morbidity and sudden death. Although implantable cardioverter-defibrillator (ICD) reduces the risk of arrhythmic death, ICD therapies are associated with an increased mortality and worsening quality of life. Antiarrhythmic drugs may be effective in preventing arrhythmia recurrences but have an increased adverse effects and non-cardiac mortality. Catheter ablation has evolved into an effective intervention in patients with and without structural he...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Ventricular Tachycardia Following Surgical Repair of Complex Congenital Heart Disease
Publication date: Available online 19 January 2016 Source:Cardiac Electrophysiology Clinics Author(s): Sherrie Joy Baysa, Ronald J. KanterTeaser A nine year old boy with complex congenital heart disease requiring right ventricular outflow tract surgery and palpitations had inducible monomorphic ventricular tachycardia at 300 bpm by programmed ventricular stimulation. He was treated with enteral phenytoin. With a therapeutic plasma level, repeat electrophysiological study was negative for inducible ventricular tachycardia using an aggressive pacing protocol. An insertable loop recorder was implanted, and the family was ...
Source: Cardiac Electrophysiology Clinics - February 8, 2016 Category: Cardiology Source Type: research

Cardiac Resynchronization Therapy
Publication date: Available online 1 October 2015 Source:Cardiac Electrophysiology Clinics Author(s): Giuseppe Boriani, Martina Nesti, Matteo Ziacchi, Luigi PadelettiTeaser Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not...
Source: Cardiac Electrophysiology Clinics - October 1, 2015 Category: Cardiology Source Type: research

Arrhythmogenic Potential of Acute Idiopathic Pericarditis
Publication date: Available online 26 September 2015 Source:Cardiac Electrophysiology Clinics Author(s): Lovely Chhabra, Venugopal Brijmohan Bhattad, Sarfaraz Memon, David H. Spodick (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - September 27, 2015 Category: Cardiology Source Type: research

Containing the Cost of Heart Failure Management
Publication date: Available online 14 September 2015 Source:Cardiac Electrophysiology Clinics Author(s): Dwarakraj Soundarraj, Vini Singh, Vaibhav Satija, Ranjan K. ThakurTeaser Heart failure (HF) consumes a large proportion of the total national health care budget. Incidence and prevalence of HF are increasing and may give rise to an unsustainable increase in health care spending. Hospitalizations account for the vast majority of HF-related expenses, and 20% to 25% of patients discharged with a diagnosis of HF are readmitted within 60 days. Thus, efforts to reduce HF readmissions are a reasonable target for red...
Source: Cardiac Electrophysiology Clinics - September 14, 2015 Category: Cardiology Source Type: research

Atrioventricular Node Ablation
Publication date: Available online 12 September 2015 Source:Cardiac Electrophysiology Clinics Author(s): Maurizio GaspariniTeaser Cardiac resynchronization therapy (CRT) is a device-based, nonpharmacologic approach that has shown to improve the outcome in patients with heart failure in terms of mortality and morbidity reduction. Large randomized trials have virtually enrolled patients in New York Heart Association class III–IV, with reduced left ventricular ejection fraction, with evidence of electrical dyssynchrony, and receiving optimal medical therapy and who were in sinus rhythm. Guidelines remain imprecise as...
Source: Cardiac Electrophysiology Clinics - September 13, 2015 Category: Cardiology Source Type: research

To Extract or Retain a Sterile, Nonfunctional Lead
Publication date: Available online 10 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Samir SabaTeaser Decision-making regarding extracting or abandoning sterile but nonfunctioning ICD leads has to be individualized. Providing recommendations to patients and their families requires a careful weighing of pros and cons and understanding of the availability of local expertise. Decision models to help with these clinical scenarios have started to become available but remain in their infancy. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - July 16, 2015 Category: Cardiology Source Type: research

Extraction of Sterile Leads Is the Preferred Approach Rather than Implanting a New Lead
Publication date: Available online 19 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Emilce Trucco, Lluis MontTeaser Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by...
Source: Cardiac Electrophysiology Clinics - July 16, 2015 Category: Cardiology Source Type: research

Generator Exchange in a Primary Prevention Cardiac Resynchronziation Responder
Publication date: Available online 9 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Jaime E. Gonzalez, William H. SauerTeaser This case-based review discusses the benefits of cardiac resynchronization therapy (CRT) and whether defibrillation function is necessary in CRT responders. An evaluation of the literature and evidence to date is discussed. Recommendations based on these data, expert opinion, and recently published appropriate use criteria are given. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - July 16, 2015 Category: Cardiology Source Type: research

Left Atrial Appendage Closure Is Preferred to Chronic Warfarin Therapy
Publication date: Available online 10 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Moustapha Atoui, Sampath Gunda, Dhanunjaya LakkireddyTeaser 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. Cardiac interventions that can obviate long-term oral anticoagulation hol...
Source: Cardiac Electrophysiology Clinics - July 16, 2015 Category: Cardiology Source Type: research

The Value of a Healthy Debate
Publication date: Available online 11 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Emile G. Daoud , Raul Weiss (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - July 12, 2015 Category: Cardiology Source Type: research

Controversies in Electrophysiology
Publication date: Available online 11 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Ranjan K. Thakur , Andrea Natale (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - July 12, 2015 Category: Cardiology Source Type: research

Left Atrial Appendage Closure Is Preferred to Chronic Warfarin Therapy The Pro Perspective
Publication date: Available online 10 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Moustapha Atoui , Sampath Gunda , Dhanunjaya LakkireddyTeaser 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. Cardiac interventions that can obviate long-term oral anticoagulation hold...
Source: Cardiac Electrophysiology Clinics - July 10, 2015 Category: Cardiology Source Type: research

Generator Exchange in a Primary Prevention Cardiac Resynchronziation Responder Do You Reimplant a Defibrillator?
Publication date: Available online 9 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Jaime E. Gonzalez , William H. SauerTeaser This case-based review discusses the benefits of cardiac resynchronization therapy (CRT) and whether defibrillation function is necessary in CRT responders. An evaluation of the literature and evidence to date is discussed. Recommendations based on these data, expert opinion, and recently published appropriate use criteria are given. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - July 9, 2015 Category: Cardiology Source Type: research

Device Therapy in the Setting of Long QT Syndrome
Publication date: Available online 8 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Troy Rhodes , Raul WeissTeaser Congenital long QT syndrome (LQTS) is an inherited disorder of myocardial repolarization characterized by prolongation of the QT interval associated with life-threatening polymorphic ventricular tachycardia. The treatment of congenital LQTS involves antiadrenergic therapies: β-blockers and surgical left cardiac sympathetic denervation (LCSD) to decrease sympathetic input to the heart, cardiac pacing, and implantable cardioverter-defibrillator (ICDs). Although this article focuses on the r...
Source: Cardiac Electrophysiology Clinics - July 8, 2015 Category: Cardiology Source Type: research

Electrophysiology Testing and Catheter Ablation Are Helpful When Evaluating Asymptomatic Patients with Wolff-Parkinson-White Pattern The Con Perspective
Publication date: Available online 7 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Allan C. Skanes , Manoj Obeyesekere , George J. KleinTeaser The association between asymptomatic Wolff-Parkinson-White (WPW) syndrome and sudden cardiac death (SCD) has been well documented. The inherent properties of the accessory pathway determine the risk of SCD in WPW, and catheter ablation essentially eliminates this risk. An approach to WPW syndrome is needed that incorporates the patient’s individualized considerations into the decision making. Patients must understand that there is a trade-off of a small immed...
Source: Cardiac Electrophysiology Clinics - July 7, 2015 Category: Cardiology Source Type: research

The Role of Defibrillation Testing
Publication date: Available online 3 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Guy Amit , Jeff S. HealeyTeaser The induction and termination of ventricular fibrillation at the time of defibrillator insertion (defibrillation testing [DT]) has traditionally been an integral component of implantable cardioverter-defibrillator (ICD) implantation. However, over the last 10 years, published series suggested a high rate of first-shock efficacy for clinical ventricular arrhythmias, even if no DT was done. Over the same time, several published reports and series have shown uncommon but serious complicatio...
Source: Cardiac Electrophysiology Clinics - July 4, 2015 Category: Cardiology Source Type: research

Catheter Ablation of Atrial Fibrillation Should Be Offered as Primary Therapy: What’s Your Hurry?
Publication date: Available online 2 July 2015 Source:Cardiac Electrophysiology Clinics Author(s): Erich F. Wedam , Mark C.P. HaigneyTeaser The appropriate initial treatment of a middle-aged individual with symptomatic paroxysms of atrial fibrillation, diabetes, and hypertension should focus on eliminating the underlying causes of disease to safely reduce morbidity and prolong life. An initial strategy using ablation temporarily reduces arrhythmia symptoms and exposes the individual to potentially needless risk and repeat procedures. Randomized trials have not established the superiority of ablation to antiarrhythmic dru...
Source: Cardiac Electrophysiology Clinics - July 2, 2015 Category: Cardiology Source Type: research

Management of Pace-Terminated Ventricular Arrhythmias
Publication date: Available online 29 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Sean D. Pokorney , Sana M. Al-KhatibTeaser An implantable-cardioverter defibrillator (ICD) can terminate ventricular arrhythmias by delivering a shock or by antitachycardia pacing (ATP). The ATP works by capturing the excitable gap and disrupting re-entrant ventricular arrhythmias. Multiple studies have demonstrated that ATP is successful at terminating ventricular tachycardia (VT). Shocks from the ICD are associated with higher mortality. The data are conflicting about whether appropriate ATP is associated with higher mor...
Source: Cardiac Electrophysiology Clinics - June 29, 2015 Category: Cardiology Source Type: research

Approach to Ablation of Unmappable Ventricular Arrhythmias
This article discusses the main aspects of the proposed techniques and substrate ablation targets. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 27, 2015 Category: Cardiology Source Type: research

Device Therapy for Acute Systolic Heart Failure and Atrial Fibrillation
Publication date: Available online 26 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Steven K. Carlson , Rahul N. DoshiTeaser Patients with newly diagnosed cardiomyopathy require careful assessment of cause and initiation of treatment before the decision is made to implant an internal cardiac defibrillator. In patients with medicine-refractory atrial fibrillation and cardiomyopathy, atrioventricular node ablation and implantation of a biventricular pacemaker is the therapy of choice when tachycardia-induced cardiomyopathy is suspected and curative therapy is not possible. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 26, 2015 Category: Cardiology Source Type: research

Ethical Considerations for Turning off Pacemakers and Defibrillators
Publication date: Available online 24 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Kyle E. Karches , Daniel P. SulmasyTeaser The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option ...
Source: Cardiac Electrophysiology Clinics - June 24, 2015 Category: Cardiology Source Type: research

Patients with Nonischemic Cardiomyopathy Requiring Cardiac Resynchronization Therapy Should Also Undergo Implantation of a Primary Prevention Defibrillator The CON Perspective
This article describes a 45-year-old lady with longstanding dilated cardiomyopathy, who has progressed to New York Heart Association class III and has failed to respond to optimal pharmacologic therapy. On the basis of gender and the presence of an left bundle branch block, she has good prospects of responding to cardiac resynchronization therapy. In the background of nonischemic cardiomyopathy and the absence of myocardial scarring on cardiovascular magnetic resonance, her annualized risk of sudden cardiac death is low, estimated at 2.6%. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 24, 2015 Category: Cardiology Source Type: research

Management of Device-detected Atrial High-rate Episodes
Publication date: Available online 23 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Todd T. Tomson , Rod PassmanTeaser 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. These subclinical device-detected AHREs are associated with an increased stroke risk, similar to, but to a lesser degree than, clinically apparent atrial fibrillation detec...
Source: Cardiac Electrophysiology Clinics - June 23, 2015 Category: Cardiology Source Type: research

Biventricular Pacemaker/Defibrillators Versus Biventricular Pacemakers in Patients with Non-ischemic Cardiomyopathy
Publication date: Available online 23 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): John Lacy Sturdivant , Michael R. GoldTeaser The decision to employ defibrillator therapy in patients with non-ischemic cardiomyopathy is driven by reduction in mortality. The strength of data supporting this therapy has led to its incorporation in medical guidelines and general practice across the world. Cardiac resynchronization therapy has also been proven to reduce heart failure hospitalization and improve quality of life. Although trends toward reduction in arrhythmic events have been observed, results in multicenter,...
Source: Cardiac Electrophysiology Clinics - June 23, 2015 Category: Cardiology Source Type: research

Patients with Minimal Atrial Fibrillation Events Should Not Undergo Concomitant Atrial Ablation During Open Heart Procedures
This article reviews the data on surgical ablation of atrial fibrillation as it pertains to these important issues. As shown the evidence does not support surgical ablation at the time of coronary artery bypass graft in some patients. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 19, 2015 Category: Cardiology Source Type: research

Extraction of Sterile Leads Is the Preferred Approach Rather than Implanting a New Lead The Con Perspective
Publication date: Available online 19 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Emilce Trucco , Lluis MontTeaser Lead malfunction is a common problem in implantable cardiac device patients and is expected to increase with the aging of leads. There is a weak indication for extraction of superfluous leads with the potential for cardiac implantable electronic device interference and abandoned or redundant leads; much remains to be learned from clinical practice. Lead extraction, although safe in experienced hands, remains a high-risk procedure, especially in lower-volume centers and/or when performed by ...
Source: Cardiac Electrophysiology Clinics - June 19, 2015 Category: Cardiology Source Type: research

Cardiac Resynchronization Therapy Is Appropriate for All Patients Requiring Chronic Right Ventricular Pacing The CON Perspective
This article summarizes the relevant studies demonstrating that BiV pacing is not appropriate therapy for all patients who require chronic RV pacing. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 16, 2015 Category: Cardiology Source Type: research

To Extract or Retain a Sterile, Nonfunctional Lead The Case for Extraction
Publication date: Available online 10 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Samir SabaTeaser Decision-making regarding extracting or abandoning sterile but nonfunctioning ICD leads has to be individualized. Providing recommendations to patients and their families requires a careful weighing of pros and cons and understanding of the availability of local expertise. Decision models to help with these clinical scenarios have started to become available but remain in their infancy. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - June 11, 2015 Category: Cardiology Source Type: research

Left Atrial Appendage Closure Device in Atrial Fibrillation
Publication date: Available online 10 June 2015 Source:Cardiac Electrophysiology Clinics Author(s): Michael C. Giudici , Prashant D. BhaveTeaser The relationship of stroke and atrial fibrillation seems to become more complex as we gain more knowledge of the issue. Recent studies have questioned the temporal relationship between the two, which also questions causation. Left atrial appendage closure is an attractive, but unproven technology when compared with the 50-year experience with warfarin. In a patient who is on warfarin and having no issues with bleeding, medication intolerance, or lack of efficacy, it is difficult...
Source: Cardiac Electrophysiology Clinics - June 10, 2015 Category: Cardiology Source Type: research

Arrhythmias in Chagasic Cardiomyopathy
Publication date: June 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 2 Author(s): Chris Healy , Juan F. Viles-Gonzalez , Luis C. Sáenz , Mariana Soto , Juan D. Ramírez , Andre d’AvilaTeaser Chagas disease, a chronic parasitosis caused by the protozoa Trypanosoma cruzi, is an increasing worldwide problem because of the number of cases in endemic areas and the migration of infected individuals to more developed regions. Chagas disease affects the heart through cardiac parasympathetic neuronal depopulation, immune-mediated myocardial injury, parasite persistence in cardiac tissue with se...
Source: Cardiac Electrophysiology Clinics - May 20, 2015 Category: Cardiology Source Type: research

The Role of Cardiovascular Magnetic Resonance in Sudden Death Risk Stratification in Hypertrophic Cardiomyopathy
Publication date: June 2015 Source:Cardiac Electrophysiology Clinics, Volume 7, Issue 2 Author(s): Martin S. MaronTeaser Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in young patients, but current risk stratification strategies do not identify all patients at risk. Contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can identify areas of abnormal myocardial substrate comprising fibrosis, the structural nidus for potentially life-threatening ventricular arrhythmias. More recently, follow-up studies have demonstrated a strong relationship between ex...
Source: Cardiac Electrophysiology Clinics - May 20, 2015 Category: Cardiology Source Type: research

Historical Perspectives on the Implantable Cardioverter–Defibrillator and Prevention of Sudden Death in Hypertrophic Cardiomyopathy
Publication date: Available online 14 April 2015 Source:Cardiac Electrophysiology Clinics Author(s): Barry J. MaronTeaser The implantable cardioverter–defibrillator (ICD) was not originally envisioned as a treatment to prevent sudden death (SD) in young people with genetic heart diseases. In the case of hypertrophic cardiomyopathy (HCM), initially it was not known whether the ICD would be effective in patients with a disease very different morphologically and functionally from coronary artery disease. Nevertheless, several observational clinical studies have shown that the ICD reliably terminates life-threatening v...
Source: Cardiac Electrophysiology Clinics - May 11, 2015 Category: Cardiology Source Type: research

Left Ventricular Hypertrophy and Arrhythmogenesis
Publication date: Available online 11 April 2015 Source:Cardiac Electrophysiology Clinics Author(s): Mohammad Shenasa , Hossein Shenasa , Nabil El-SherifTeaser Left ventricular hypertrophy (LVH) poses an independent risk of increased morbidity and mortality, including atrial arrhythmias, ventricular arrhythmias, and sudden cardiac death. The most common causes of LVH are hypertension and valvular heart disease. Electrocardiogram and echocardiography are the first steps in the diagnosis and evaluation of therapy in patients with LVH. Cardiac MRI is the gold standard in the diagnosis and response to therapy. Management of ...
Source: Cardiac Electrophysiology Clinics - April 11, 2015 Category: Cardiology Source Type: research

Arrhythmias in Left Ventricular Noncompaction
Publication date: Available online 10 April 2015 Source:Cardiac Electrophysiology Clinics Author(s): Christina Y. Miyake , Jeffrey J. KimTeaser Left ventricular noncompaction (LVNC) is a newly recognized form of cardiomyopathy that has been associated with heart failure, arrhythmias, thromboembolic events, and sudden death. Both ventricular and supraventricular arrhythmias are now well described as prominent clinical components of LVNC. Throughout the spectrum of age, these arrhythmias have been associated with prognosis and outcome, and their clinical management is therefore an important aspect of patient care. The risk...
Source: Cardiac Electrophysiology Clinics - April 10, 2015 Category: Cardiology Source Type: research

Arrhythmias in Takotsubo Cardiomyopathy
This article focuses on the arrhythmic complications associated with TCM and explores the underlying etiology of these arrhythmias. (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - April 10, 2015 Category: Cardiology Source Type: research

Arrhythmias in Cardiomyopathies
Publication date: Available online 10 April 2015 Source:Cardiac Electrophysiology Clinics Author(s): Mohammad Shenasa , Martin Maron , Mark Link (Source: Cardiac Electrophysiology Clinics)
Source: Cardiac Electrophysiology Clinics - April 10, 2015 Category: Cardiology Source Type: research

Arrhythmia in Stem Cell Transplantation
Publication date: Available online 9 April 2015 Source:Cardiac Electrophysiology Clinics Author(s): Shone O. Almeida , Rhys J. Skelton , Sasikanth Adigopula , Reza ArdehaliTeaser Stem cell regenerative therapies hold promise for treating diseases across the spectrum of medicine. While significant progress has been made in the preclinical stages, the clinical application of cardiac cell therapy is limited by technical challenges. Certain methods of cell delivery, such as intramyocardial injection, carry a higher rate of arrhythmias. Other potential contributors to the arrhythmogenicity of cell transplantation include reen...
Source: Cardiac Electrophysiology Clinics - April 9, 2015 Category: Cardiology Source Type: research