Atrial Fibrillation and Obstructive Lung Disease: Don ’t Fear the Beta-Blocker
Atrial fibrillation (AF) and obstructive lung disease are both growing public health problems associated with increased mortality.1, 2 Notably, patients with AF and obstructive lung disease have higher symptom burden, worse quality of life, and worse cardiovascular and bleeding outcomes.3 Heart rate control is an important component of AF management that improves symptoms and prevents tachycardia-induced cardiomyopathy.4 However, older studies of beta blocker (BB) administration in patients with asthma demonstrated acute drops in expiratory volumes and concerns for acute bronchoconstriction due to beta-receptor antagonism....
Source: Heart Rhythm - July 19, 2018 Category: Cardiology Authors: Zak Loring, Jonathan P. Piccini Source Type: research

An Alternative Under-valve Approach to Ablate Right-sided Accessory Pathways
Right-sided accessory pathway (RAP) ablation sometimes is very challenging. (Source: Heart Rhythm)
Source: Heart Rhythm - July 18, 2018 Category: Cardiology Authors: Jun Yang, Gang Yang, Hongwu Chen, Weizhu Ju, Bing Yang, Fengxiang Zhang, Yan Jin, Jianing Cao, Lingmei Qian, Minglong Chen Source Type: research

Structural remodeling and conduction velocity dynamics in the human left atrium: relationship with reentrant mechanisms sustaining atrial fibrillation
Rate-dependent conduction velocity (CV) slowing is associated with atrial fibrillation (AF) initiation and reentry mechanisms. (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Shohreh Honarbakhsh, Richard J. Schilling, Michele Orini, Rui Providencia, Emily Keating, Malcolm Finlay, Simon Sporton, Anthony Chow, Mark J. Earley, Pier D. Lambiase, Ross J. Hunter Source Type: research

The Importance of Bipolar Electrode Orientation on Local Electrogram Properties
Direct impact of bipolar orientation on electrograms remains unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Masateru Takigawa, Jatin Relan, Ruairidh Martin, Steven Kim, Takeshi Kitamura, Antonio Frontera, Ghassen Cheniti, Konstantinos Vlachos, Gr égoire Massoullié, Claire A. Martin, Nathaniel Thompson, Michael Wolf, Felix Bourier, Anna Lam, Josselin Duchateau Source Type: research

Cryoballoon or contact force-guided radiofrequency catheter ablation for persistent atrial fibrillation: different strategies with similar results
- editorial commentary (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Justin Hayase, Eric Buch Source Type: research

Supraventricular tachycardias, conduction disease and cardiomyopathy in three families with the same rare variant in TNNI3K (p.Glu768Lys)
Rare genetic variants in TNNI3K encoding Troponin-I interacting kinase have been linked to a distinct syndrome consisting primarily of supraventricular tachycardias and variably expressed conduction disturbance and dilated cardiomyopathy in two families. (Source: Heart Rhythm)
Source: Heart Rhythm - July 15, 2018 Category: Cardiology Authors: Svitlana Podliesna, Julian Delanne, Lindsey Miller, David J. Tester, Merujan Uzunyan, Shoji Yano, Mischa Klerk, Bryan C. Cannon, Apichai Khongphatthanayothin, Gabriel Laurent, Geraldine Bertaux, Sylvie Falcon-Eicher, Shengnan Wu, Hai-Yun Yen, Hanlin Gao, Source Type: research

What is the real recurrence rate after cryoballoon-based pulmonary vein isolation? Lessons from rhythm follow-up based on implanted cardiac devices with continuous atrial monitoring
Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). However rhythm follow-up after PVI is mainly based on Holter ECG of limited duration. (Source: Heart Rhythm)
Source: Heart Rhythm - July 15, 2018 Category: Cardiology Authors: Christian-Hendrik Heeger, Verena Tscholl, Omar Salloum, Erik Wissner, Thomas Fink, Laura Rottner, Peter Wohlmuth, Barbara Bellmann, Mattias Roser, Shibu Mathew, Bruno Rei ßmann, Christine Lemeš, Tilman Maurer, Francesco Santoro, Britta Goldmann, Ulf Lan Source Type: research

Feasibility of Left Atrial Appendage Device Closure Following Chronically Failed Surgical Ligation
Incomplete surgical left atrial appendage occlusion (S-LAAO) with a narrow neck has been shown to predict an increased rate of embolic stroke. Patients with a previously attempted S-LAAO were systematically excluded from all clinical trials of LAA closure devices. (Source: Heart Rhythm)
Source: Heart Rhythm - July 15, 2018 Category: Cardiology Authors: Christopher R. Ellis, Mohamed Metawee, Robert N. Piana, Jeremy M. Bennett, Mias Pretorius, Robert J. Deegan Source Type: research

Transvenous Lead Extraction During Uninterrupted Warfarin Therapy: Feasibility and Outcomes
Uninterrupted anticoagulation is important for patients at high risk of thromboembolism. Bridging with heparin/lovenox increases the risk of hematoma and infection. There is no published data on the feasibility of transvenous lead extraction (TLE) during uninterrupted anticoagulation. (Source: Heart Rhythm)
Source: Heart Rhythm - July 15, 2018 Category: Cardiology Authors: Qi Zheng, Melanie Maytin, Roy M. John, Ammar M. Killu, Laurence M. Epstein Source Type: research

Silent Cerebral Events/Lesions after Second-generation Cryoballoon Ablation ∼ How can we reduce the risk of silent strokes? ∼
Atrial fibrillation (AF) ablation is associated with a substantial risk of silent cerebral events/lesions (SCEs/SCLs) detected on magnetic resonance imaging (MRI). (Source: Heart Rhythm)
Source: Heart Rhythm - July 12, 2018 Category: Cardiology Authors: Shinsuke Miyazaki, Takatsugu Kajiyama, Kazuya Yamao, Masahiro Hada, Masao Yamaguchi, Hiroaki Nakamura, Hitoshi Hachiya, Hiroshi Tada, Kenzo Hirao, Yoshito Iesaka Source Type: research

Impact of atrial fibrillation on improvement of functional mitral regurgitation in cardiac resynchronization therapy
Functional mitral regurgitation (FMR) and atrial fibrillation (AF) are frequent heart failure (HF) complications. Cardiac resynchronization therapy (CRT) can improve FMR; however, little is known about the influence of AF on FMR improvement. (Source: Heart Rhythm)
Source: Heart Rhythm - July 12, 2018 Category: Cardiology Authors: Pieter van der Bijl, Ngoc Mai Vo, Melissa Leung, Nina Ajmone Marsan, Victoria Delgado, Gregg W. Stone, Jeroen J. Bax Source Type: research

Cardiac impact of R-wave triggered irreversible electroporation therapy
Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. It is unclear whether these electric pulses of high field strength can cause cardiac damage and/or ablation induced arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - July 12, 2018 Category: Cardiology Authors: Michael Kostrzewa, Erol Tueluemen, Boris Rudic, Nils Rathmann, Ibrahim Akin, Thomas Henzler, Volker Liebe, Stefan O. Schoenberg, Martin Borggrefe, Steffen J. Diehl Source Type: research

Device-Guided Anticoagulation in Atrial Fibrillation: Not yet ready for prime time
Atrial fibrillation (AF), the most common sustained arrhythmia encountered in clinical practice, is associated with a three- to five-fold increased risk of stroke (accounting for>20% of all strokes).1 Independent of age and other risk factors, AF-associated strokes are relatively more severe, causing greater resource utilization, long-term disability, and mortality compared to non-AF stroke. Oral anticoagulants (OACs) are paramount in preventing AF-associated stroke and systemic thromboembolism. (Source: Heart Rhythm)
Source: Heart Rhythm - July 10, 2018 Category: Cardiology Authors: Christopher C. Cheung, Jason G. Andrade Source Type: research

Early Experience with Intravenous Sotalol in Children with and without Congenital Heart Disease
Arrhythmias are common in the pediatric population. In patients unable to take oral medications or in need of acute therapy, options of intravenous (IV) anti-arrhythmics are limited. Recently IV sotalol has become readily available, but experience in children is limited. (Source: Heart Rhythm)
Source: Heart Rhythm - July 9, 2018 Category: Cardiology Authors: Santiago O. Vald és, Christina Y. Miyake, Mary C. Niu, Caridad M. de la Uz, S. Yukiko Asaki, Andrew P. Landstrom, Andrew E. Schneider, Craig G. Rusin, Raajen Patel, Wilson W. Lam, Jeffrey J. Kim Source Type: research

Multisite Pacing: Have We Reached the Tipping Point of Managing Cardiac Resynchronization Therapy Non-Responders?
Disclosures (Source: Heart Rhythm)
Source: Heart Rhythm - July 7, 2018 Category: Cardiology Authors: David F. Brice ño, David Lin Source Type: research

Leadless pacemaker implantation after explantation of infected conventional pacemaker systems: a viable solution?
Conventional cardiac device infections are increasing in incidence causing significant morbidity and mortality. Leadless pacemaker (LP) therapy may provide new opportunities for the management of pacemaker (PM) infections as it does not require implantation of transvenous leads and a pectoral pocket. (Source: Heart Rhythm)
Source: Heart Rhythm - July 6, 2018 Category: Cardiology Authors: Niek E.G. Beurskens, Fleur V.Y. Tjong, Kosse J. Dasselaar Bsc, Wichert J. Kuijt, Arthur A.M. Wilde, Reinoud E. Knops Source Type: research

Brugada syndrome: keep an eye on the ECG
No conflict of interest to disclose. (Source: Heart Rhythm)
Source: Heart Rhythm - July 6, 2018 Category: Cardiology Authors: Vincent PROBST, Jean-Baptiste Gourraud Source Type: research

Intermittent anticoagulation guided by continuous atrial fibrillation burden monitoring using dual-chamber pacemakers and implantable cardioverter-defibrillators: Results from the Tailored Anticoagulation for Non-Continuous Atrial Fibrillation (TACTIC-AF) pilot study
Chronic anticoagulation is recommended for atrial fibrillation (AF) patients with thromboembolic risk factors regardless of AF duration/frequency. Continuous rhythm assessment with pacemakers (PMs)/implantable cardioverter-defibrillators (ICDs) and use of direct-acting oral anticoagulants (DOACs) may allow anticoagulation only around AF episodes, reducing bleeding without increasing thromboembolic risk. (Source: Heart Rhythm)
Source: Heart Rhythm - July 5, 2018 Category: Cardiology Authors: Jonathan W. Waks, Rod S. Passman, Jason Matos, Matthew Reynolds, Amit Thosani, Theofanie Mela, David Pederson, Taya V. Glotzer, Peter Zimetbaum Source Type: research

Intermittent Anticoagulation Guided by Continuous Atrial Fibrillation Burden Monitoring Using Dual Chamber Pacemakers and Implantable Cardioverter-Defibrillators –Results from the Tailored Anticoagulation for Non-Continuous Atrial Fibrillation (TACTIC-AF) Pilot Study
Chronic anticoagulation is recommended in atrial fibrillation (AF) patients with thromboembolic risk factors regardless of AF duration/frequency. Continuous rhythm assessment with pacemakers/implantable cardioverter-defibrillators (ICDs) and use of direct-acting oral anticoagulants (DOACs) may allow anticoagulation only around AF episodes, reducing bleeding without increasing thromboembolic risk.Objectives: To evaluate feasibility/safety of intermittent DOAC use guided by continuous remote AF monitoring via dual-chamber pacemakers or ICDs. (Source: Heart Rhythm)
Source: Heart Rhythm - July 5, 2018 Category: Cardiology Authors: Jonathan W. Waks, Rod S. Passman, Jason Matos, Matthew Reynolds, Amit Thosani, Theofanie Mela, David Pederson, Taya V. Glotzer, Peter Zimetbaum Source Type: research

Cryoballoon Antral Pulmonary Vein Isolation vs. Force-Sensing Radiofrequency Catheter Ablation for Pulmonary Vein and Posterior Left Atrial Isolation in Patients with Persistent Atrial Fibrillation
The role of cryoballoon ablation (CBA) for antral pulmonary vein isolation (APVI) has not been well established in persistent atrial fibrillation (PerAF). A left atrial (LA) posterior wall box lesion set (BOX) after APVI has been suggested to improve the efficacy of radiofrequency catheter ablation (RFA) in PerAF. (Source: Heart Rhythm)
Source: Heart Rhythm - July 4, 2018 Category: Cardiology Authors: Miki Yokokawa, Aman Chugh, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Krit Jongnarangsin, Ryan Cunnane, Mohammed Saeed, Bipin Sunkara, Mehmet Tezcan, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral Source Type: research

Brugada Syndrome: Let ’s Talk About Sex
The phenotype of Brugada Syndrome (BrS) continues to intrigue cardiologists with unsolved mysteries. Originally considered an autosomal dominant, single gene disease, the mystery of an abundance of gene elusive sporadic cases has opened up possibilities that the genetics of this condition is not so simple. An additional mystery is the seemingly male preponderance, despite the absence of any evidence supporting sex-linked inheritance. As such, most of our knowledge on BrS is derived from cohorts representing large populations of men and little is known of gender differences in relation to clinical presentation, risk and out...
Source: Heart Rhythm - July 4, 2018 Category: Cardiology Authors: Christian Jons, Michael H. Gollob Source Type: research

Screening for Atrial Fibrillation using Smartphone-based Technology and Layperson Volunteers: High-Tech Meets Community Participatory Research for the Best of Both Worlds
Atrial fibrillation (AF), usually asymptomatic and not previously-diagnosed, increases risk of stroke by five times1 and accounts for 15-25% of strokes. 2 Asymptomatic AF is estimated to affect 600,000 Americans, with an estimated cost of 3 billion dollars per year.3 Just because we can identify a risk factor does not mean screening for it will save lives. AF, however, meets most criteria laid out in the World Health Organization ’s manifesto on screening, “Principles and Practice of Screening for Disease”. (Source: Heart Rhythm)
Source: Heart Rhythm - July 4, 2018 Category: Cardiology Authors: Rachel Lampert Source Type: research

Rate control and clinical outcomes in patients with atrial fibrillation and obstructive lung disease
Rate-control medications are considered first-line treatments for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in AF, often makes it difficult to use those medications due to the lack of studies on new-onset AF in patients with OLD. (Source: Heart Rhythm)
Source: Heart Rhythm - July 3, 2018 Category: Cardiology Authors: Seng Chan You, Min Ho An, Dukyong Yoon, Ga-Young Ban, Pil-Sung Yang, Hee Tae Yu, Rae Woong Park, Boyoung Joung Source Type: research

Protamine to expedite vascular hemostasis after catheter ablation of atrial fibrillation: a randomized controlled trial
There are no randomized, controlled studies on the efficacy and safety of protamine sulfate to reverse anticoagulant effects of heparin after catheter ablation (CA) of atrial fibrillation (AF). (Source: Heart Rhythm)
Source: Heart Rhythm - July 3, 2018 Category: Cardiology Authors: Michael Ghannam, Aman Chugh, Patrick Dillon, Daniel Alyesh, Konstantinos Kossidas, Shikha Sharma, John Coatney, Auras Atreya, Miki Yokokawa, Mohammed Saeed, Ryan Cunnane, Hamid Ghanbari, Rakesh Latchamsetty, Thomas Crawford, Krit Jongnarangsin, Frank Bogu Source Type: research

Implantable Cardioverter Defibrillator Use in Catecholaminergic Polymorphic Ventricular Tachycardia: A Systematic Review
The implantable cardioverter defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated. (Source: Heart Rhythm)
Source: Heart Rhythm - July 3, 2018 Category: Cardiology Authors: Thomas M. Roston, Karolina Jones, Nathaniel M. Hawkins, J. Martijn Bos, Peter J. Schwartz, Frances Perry, Michael J. Ackerman, Zachary W.M. Laksman, Padma Kaul, Krystien V.V. Lieve, Joseph Atallah, Andrew D. Krahn, Shubhayan Sanatani Source Type: research

The 12 Lead ECG During Ventricular Tachycardia: Still an Important Tool for Ventricular Tachycardia Localization in Structural Heart Disease
The use of the 12-lead ECG recorded during ventricular tachycardia (VT) to regionalize its origin was first described by Josephson and colleagues in 1981 (1). The paper had 11 figures, unheard of by current publication standards, each showing one to five 12-lead ECG patterns during VT corresponding to a region of origin on the cardiac silhouette. Specific, but relatively simple rules based on the 12-lead ECG pattern were described. Basal left ventricular (LV) VTs have large R-waves across most precordial leads while apical VTs have no or poor R-wave progression or early regression. (Source: Heart Rhythm)
Source: Heart Rhythm - July 2, 2018 Category: Cardiology Authors: Victor Bazan, Francis E. Marchlinski Source Type: research

Unique role of epicardial adipose tissue in atrial fibrosis: ‘Atrial remodeling of a new sort’
Pivotal studies over the last few decades have identified the important role of electrical and structural remodeling in different atrial fibrillation (AF) substrates.1 More recently, epicardial adipose tissue (EAT) has emerged as an important pro-arrhythmic substrate for AF and may in part explain the clinical association between obesity and AF.2, 3 Expansion of EAT, which often occurs as a consequence of weight gain, has been shown to predict greater risk for AF development and severity, as well as poorer outcomes following rhythm control strategies. (Source: Heart Rhythm)
Source: Heart Rhythm - July 2, 2018 Category: Cardiology Authors: Thomas A. Agbaedeng, Dominik Linz, Dennis H. Lau, Prashanthan Sanders Source Type: research

Ventricular fibromas in children: Surgical resection can be a cure to lethal arrhythmias
Cardiac tumors are rare at all ages and even less common in infants and children with an incidence of 0.02% to 0.04% (1). Most of the tumors reported in children are benign, with rhabdomyomas being the most common type followed by fibromas. The clinical manifestations of cardiac tumors vary widely from asymptomatic presentations to life-threatening cardiac events. Nonspecific heart murmur, arrhythmia, respiratory symptoms, and congestive heart failure are the most common symptoms and usually related to the tumor size and location rather than the tumor type (2-5). (Source: Heart Rhythm)
Source: Heart Rhythm - July 2, 2018 Category: Cardiology Authors: Hiroko Asakai Source Type: research

Seasonal variation in the risk of ischemic stroke in patients with atrial fibrillation: A nationwide cohort study
Several cardiovascular diseases exhibit seasonal variations, but data about cold temperature and risk of ischemic stroke in patients with atrial fibrillation (AF) are limited. (Source: Heart Rhythm)
Source: Heart Rhythm - July 2, 2018 Category: Cardiology Authors: Jo-Nan Liao, Tze-Fan Chao, Chia-Jen Liu, Su-Jung Chen, Chung-Lieh Hung, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y.H. Lip, Shih-Ann Chen Source Type: research

A change from atrial fibrillation into a wide QRS tachycardia in a 69-year-old man
A 69-year-old man experienced a myocardial infarction 2 years ago and was treated for heart failure (left ventricular ejection fraction 40%) with an angiotensin-converting enzyme inhibitor, a beta-blocking agent, a statin, and a diuretic. He presented to the hospital because of symptoms of palpitations accompanied by shortness of breath. At that time, the ECG shown in Figure  1A was recorded. Figure 1B shows sinus rhythm after electric cardioversion of both tachycardias. (Source: Heart Rhythm)
Source: Heart Rhythm - June 26, 2018 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research

Comparative study of acute and mid-term complications with leadless and transvenous cardiac pacemakers
Leadless cardiac pacemakers (LCPs) aim to mitigate lead- and pocket-related complications seen with transvenous pacemakers (TVPs). (Source: Heart Rhythm)
Source: Heart Rhythm - June 26, 2018 Category: Cardiology Authors: Daniel J. Cantillon, Srinivas R. Dukkipati, John H. Ip, Derek V. Exner, Imran K. Niazi, Rajesh S. Banker, Mayer Rashtian, Kenneth Plunkitt, Gery F. Tomassoni, Yelena Nabutovsky, Kevin J. Davis, Vivek Y. Reddy Tags: Clinical Source Type: research

Accelerated Conversion of Atrial Fibrillation to Normal Sinus Rhythm by Pulmonary Delivery of Flecainide Acetate in a Porcine Model
Pulmonary delivery of antiarrhythmic agents has the potential to increase targeted drug concentrations in pulmonary veins and left atrium rapidly to terminate atrial fibrillation (AF). (Source: Heart Rhythm)
Source: Heart Rhythm - June 26, 2018 Category: Cardiology Authors: Richard L. Verrier, Alexandre L. Bortolotto, Bruna A. Silva, Alexandre A. Marum, Fernando G. Stocco, Ederson Evaristo, Victor Z. de Antonio, Anderson C. Silva, Luiz Belardinelli Source Type: research

EP News: Clinical
Abdelrahman et  al (J Am Coll Cardiol 2018;71:2319, PMID 29535066) evaluated clinical outcomes of His bundle pacing (HBP) compared to right ventricular pacing (RVP). HBP was attempted in consecutive patients at 1 hospital over a 3-year period and RVP at a sister hospital. HBP was successful in 304 of 332 consecut ive patients (92%), whereas 433 patients underwent RVP. The primary end point of death, heart failure hospitalization (HFH), or upgrade to biventricular pacing (BiVP) was significantly reduced in the HBP group (83 of 332 patients [25%]) compared to the RVP group (137 of 433 patients [32%]) (hazard r atio [HR]...
Source: Heart Rhythm - June 26, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Erratum
Regarding the article titled “2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry” by Jonathan S. Steinberg, Niraj Varma, and Iwona Cygankiewicz, et al that published in the July 2017 issue of Heart Rhythm (2017;14:e55–e96), the conflicts of author Mintu P. Turakhia, MD, who was inadvertently left off the original author list, are noted below. The omission is regretted. (Source: Heart Rhythm)
Source: Heart Rhythm - June 26, 2018 Category: Cardiology Tags: Erratum Source Type: research

Sleep characteristics that predict atrial fibrillation
The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - June 25, 2018 Category: Cardiology Authors: Matthew A. Christensen, Shalini Dixit, Thomas A. Dewland, Isaac R. Whitman, Gregory Nah, Eric Vittinghoff, Kenneth J. Mukamal, Susan Redline, John A. Robbins, Anne B. Newman, Sanjay R. Patel, Jared W. Magnani, Bruce M. Psaty, Jeffrey E. Olgin, Mark J. Ple Source Type: research

Electrophysiological Features and Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Patients with Persistent Left Superior Vena Cava
The electrophysiological features and roles of persistent left superior vena cava (PLSVC) in supraventricular tachycardia (SVT) are not known. (Source: Heart Rhythm)
Source: Heart Rhythm - June 25, 2018 Category: Cardiology Authors: Jae-Sun Uhm, Jong-Il Choi, Yong Soo Baek, Hee Tae Yu, Pil-Sung Yang, Yun Gi Kim, Suk-Kyu Oh, Hee-Soon Park, Kwang No Lee, Tae-Hoon Kim, Jaemin Shim, Boyoung Joung, Hui-Nam Pak, Moon-Hyoung Lee, Young-Hoon Kim Source Type: research

Progression of ECG abnormalities Associated with Initial Ventricular Fibrillation in Asymptomatic Patients with Brugada Syndrome
Various risk stratifications in asymptomatic patients with Brugada syndrome (BrS) have been proposed, but the electrophysiological change that promotes ventricular fibrillation (VF) is still unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - June 25, 2018 Category: Cardiology Authors: Hiroshi Morita, Masakazu Miyamoto, Atsuyuki Watanabe, Saori Tsukuda, Yoshimasa Morimoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito Source Type: research

To the Editor — Fusion during entrainment at the cavotricuspid isthmus: When entrainment does not match our expectation
I read with great interest the May 2018 Unknown of the Month by Shen et  al,1 a case of longitudinal dissociation in the cavotricuspid isthmus (CTI) resulting in an unexpected entrainment response. The cycle length (CL) of the CTI-dependent circuit is 281 ms, but the postpacing interval (PPI) from the CTI is 337 ms with a change in coronary sinus (CS) activation during entrainment. During CTI ablation, the tachycardia shifts with CS activation same as during entrainment and CL prolongation to 330 ms. (Source: Heart Rhythm)
Source: Heart Rhythm - June 22, 2018 Category: Cardiology Authors: Amit Noheria Tags: Letter to the Editor Source Type: research

Fusion during entrainment at the cavotricuspid isthmus: When entrainment does not match our expectation
I read with great interest the May 2018 Unknown-of-the-Month by Shen et al.,1 a case of longitudinal dissociation in the cavotricuspid isthmus (CTI) resulting in an unexpected entrainment response. The cycle length (CL) of the CTI dependent circuit is 281 ms, but the post-pacing interval (PPI) from CTI is 337 ms with a change in the coronary sinus (CS) activation during entrainment. During CTI ablation the tachycardia shifts with CS activation same as during entrainment and CL prolongation to 330 ms. (Source: Heart Rhythm)
Source: Heart Rhythm - June 22, 2018 Category: Cardiology Authors: Amit Noheria Source Type: research

Reply to the Editor — Fusion During Entrainment at the Cavotricuspid Isthmus: When Entrainment Does Not Match Our Expectation
We appreciate the interest and the insightful comments expressed by Noheria on our case where entrainment on the cavotricuspid isthmus (CTI) showed conflicting response in typical CTI-dependent flutter. We proposed a single tachycardia involving two different groups of muscle fibers on the CTI: fast pathway and slow pathway, each of which has different conduction velocity, effective refractory period and connecting site to the coronary sinus. An alternative explanation raised by Noheria is that there are two tachycardias utilizing different groups of muscle fibers on the CTI that connect to the coronary sinus separately an...
Source: Heart Rhythm - June 22, 2018 Category: Cardiology Authors: Mark J. Shen, Bradley P. Knight, Susan S. Kim Source Type: research

Long-term Reverse Remodeling by Cardiac Resynchronization Therapy with MultiPoint Pacing: A Feasibility Study of Noninvasive Hemodynamics Guided Device Programming
Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint ™ Pacing [MPP]) improves acute hemodynamics and chronic outcomes over conventional biventricular pacing (BiV), though MPP programming questions persist. (Source: Heart Rhythm)
Source: Heart Rhythm - June 22, 2018 Category: Cardiology Authors: Peter Lercher, Maurizio Lunati, Roberto Rordorf, Maurizio Landolina, Nima Badie, Fujian Qu, Cyrille Casset, Kyungmoo Ryu, Stefano Ghio, Jagmeet P. Singh, Christophe Leclercq Source Type: research

EP News: Allied Professionals
In a single-center study of patients with implantable cardioverter-defibrillators (ICDs) presenting with electrical storm (ES), Chatzidou et  al (J Am Coll Cardiol 2018;71:1897, PMID 29699616) randomized patients to receive either propranolol (group A) or metoprolol (group B) in addition to intravenous (IV) amiodarone to assess the efficacy of treatment in terms of number and timing of subsequent arrhythmic events. ES was defined as 3 o r more episodes of either ventricular tachycardia (VT), ventricular fibrillation (VF), or both, separated by at least 5 minutes that resulted in device therapy. (Source: Heart Rhythm)
Source: Heart Rhythm - June 18, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Basic and Translational
Cardiomyocytes from the apex but not the base of the heart increase contractility in response to β2-adrenoceptor (β2AR) stimulation, which may underlie the development of Takotsubo cardiomyopathy. However, both cell types produce comparable cytosolic amounts of the second messenger cyclic adenosine monophosphate (cAMP). Wright et al (Cell Rep 2018;23:459, PMID 29642004) investigated this dis crepancy using nanoscale imaging techniques and found that, structurally, base cardiomyocytes have more organized membranes (higher T-tubular and caveolar densities). (Source: Heart Rhythm)
Source: Heart Rhythm - June 16, 2018 Category: Cardiology Authors: Penelope A. Boyden Tags: EP News Source Type: research

EP News: Heart Rhythm Case Reports
Ablation of right-sided annular arrhythmias such as premature ventricular contractions (PVCs), ventricular tachycardia (VT), or atrioventricular bypass tracts can be challenging, with reduced efficacy related to catheter instability from annular motion and intracardiac atrial and ventricular anatomic obstacles. Enriques et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.02.010) presented a case series of 5 patients that highlights the use of intracardiac echocardiography (ICE) to guide ablation of right-sided annular arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - June 16, 2018 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

Addition of minute ventilation to rate-responsive pacing improves heart rate score more than accelerometer alone
Heart rate score (HRSc) ≥70%, a novel parameter, predicts risk of mortality in patients with implantable cardioverter-defibrillators and identifies patients who have survival benefit with DDDR vs DDD pacing. (Source: Heart Rhythm)
Source: Heart Rhythm - June 13, 2018 Category: Cardiology Authors: Mark Richards, Brian Olshansky, Arjun D. Sharma, Nicholas Wold, Paul Jones, David Perschbacher, Bruce L. Wilkoff Source Type: research

Gender Differences in Patients with Brugada Syndrome and Arrhythmic Events: Data from a Survey on Arrhythmic Events in 678 Patients
There is limited information on gender differences in patients with Brugada syndrome (BrS) who experienced arrhythmic events (AEs). (Source: Heart Rhythm)
Source: Heart Rhythm - June 13, 2018 Category: Cardiology Authors: Anat Milman, Jean-Baptiste Gourraud, Antoine Andorin, Pieter G. Postema, Frederic Sacher, Philippe Mabo, Giulio Conte, Carla Giustetto, Georgia Sarquella-Brugada, Aviram Hochstadt, Sung-Hwan Kim, Jimmy JM. Juang, Shingo Maeda, Yoshihide Takahashi, Tsukasa Source Type: research

The Addition of Minute Ventilation to Rate Responsive Pacing Improves Heart Rate Score More than Accelerometer Alone
Heart Rate Score (HRSc) ≥70%, a novel parameter, predicts risk of mortality in patients with implantable defibrillators and identifies patients who have survival benefit with DDDR versus DDD pacing. (Source: Heart Rhythm)
Source: Heart Rhythm - June 13, 2018 Category: Cardiology Authors: Mark Richards, Brian Olshansky, Arjun D. Sharma, Nicholas Wold, Paul Jones, David Perschbacher, Bruce L. Wilkoff Source Type: research

Repolarization heterogeneity in patients with cardiac resynchronization therapy and its relation to ventricular tachyarrhythmias
s: Cardiac resynchronization therapy (CRT) has shown to induce left ventricular reverse remodelling, but little is known about its influence on ventricular repolarization. (Source: Heart Rhythm)
Source: Heart Rhythm - June 13, 2018 Category: Cardiology Authors: Marta Cviji ć, Bor Antolič, Luka Klemen, Igor Zupan Source Type: research

Association of fibrotic remodeling and cytokines/chemokines content in epicardial adipose tissue with atrial myocardial fibrosis in patients with atrial fibrillation
Epicardial adipose tissue (EAT) is associated with atrial fibrillation (AF), but the underlying mechanisms remain to be fully elucidated. (Source: Heart Rhythm)
Source: Heart Rhythm - June 13, 2018 Category: Cardiology Authors: Ichitaro Abe, Yasushi Teshima, Hidekazu Kondo, Haruka Kaku, Shintaro Kira, Yuki Ikebe, Shotaro Saito, Akira Fukui, Tetsuji Shinohara, Kunio Yufu, Mikiko Nakagawa, Naoki Hijiya, Masatsugu Moriyama, Tatsuo Shimada, Shinji Miyamoto, Naohiko Takahashi Source Type: research

Ventricular fibromas in children, arrhythmia risk, and outcomes: A multicenter study
Although ventricular fibromas are rare, they are the second most common type of cardiac tumor in children. While histologically benign, they have a propensity to cause malignant arrhythmias, with cardiac arrest often being the first presentation. (Source: Heart Rhythm)
Source: Heart Rhythm - June 12, 2018 Category: Cardiology Authors: John P. Jones, Tristan Ramcharan, Milind Chaudhari, Vinay Bhole, Karen Mcleod, Shankar Sadagopan, Orhan Uzun, Andrew Parry, Jan Till, Colin J. McMahon, Alan G. Stuart, Mark A. Walsh Source Type: research