Identification of patients at risk of sudden cardiac death in congenital heart disease. The PRospEctiVE study on implaNTable cardIOverter defibrillator therapy and suddeN cardiac death in Adults with Congenital Heart Disease: PREVENTION-ACHD
Sudden cardiac death (SCD) is the main preventable cause of death in adult congenital heart disease (ACHD) patients. Since robust risk stratification methods are lacking, we developed a risk score to predict SCD in ACHD patients: PREVENTION-ACHD. (Source: Heart Rhythm)
Source: Heart Rhythm - January 16, 2021 Category: Cardiology Authors: Jim T. Vehmeijer, Zeliha Koyak, Jan M. Leerink, Aeilko H. Zwinderman, Louise Harris, Rafael Peinado, Erwin N. Oechslin, Dani ëlle Robbers-Visser, Maarten Groenink, S. Matthijs Boekholdt, Robbert J. de Winter, José M. Oliver, Berto J. Bouma, Werner Budts Source Type: research

Causes of syncopal recurrences in patients treated with permanent pacing for bradyarrhythmic syncope: findings from the SYNCOPACED registry
Few studies have examined the causes of syncope/collapse recurrences in patients with a previously implanted pacemaker for bradyarrhythmic syncope. (Source: Heart Rhythm)
Source: Heart Rhythm - January 16, 2021 Category: Cardiology Authors: Pietro Palmisano, Gabriele Dell ’Era, Pier Luigi Pellegrino, Ernesto Ammendola, Matteo Ziacchi, Federico Guerra, Vittorio Aspromonte, Mattia Laffi, Lorenzo Pimpini, Francesco Santoro, Enrico Boggio, Alessandro Guido, Giuseppe Patti, Natale Daniele Brune Source Type: research

Heart Beat Music
The heart is a central player within a hierarchical system of clocks operating within an autonomic neuro-visceral axis that creates and synchronizes rhythmic functions ranging from msec to days and beyond.1 (Source: Heart Rhythm)
Source: Heart Rhythm - January 16, 2021 Category: Cardiology Authors: Edward G. Lakatta Source Type: research

EP News: Basic and Translational
Sodium channel β1 subunits participate in regulated intramembrane proteolysis-excitation coupling (Source: Heart Rhythm)
Source: Heart Rhythm - January 16, 2021 Category: Cardiology Authors: Nipavan Chiamvimonvat Source Type: research

Epigenetics in atrial fibrillation: a reappraisal
Atrial fibrillation (AF) is the most common cardiac arrhythmia and an important cause of morbidity and mortality globally. Atrial remodeling includes changes in ion channel expression and function, structural alterations, and neural remodeling, which create an arrhythmogenic milieu resulting in AF initiation and maintenance. Current therapeutic strategies for AF involving ablation and antiarrhythmic drugs are associated with a relatively high recurrence and pro-arrhythmic side effects respectively. (Source: Heart Rhythm)
Source: Heart Rhythm - January 10, 2021 Category: Cardiology Authors: Rosa Do ñate Puertas, Rishi Arora, Sophie Rome, Babken Asatryan, H. Llewelyn Roderick, Philippe Chevalier Source Type: research

Cardiac Resynchronization Therapy and Ventricular Tachyarrhythmia Burden
Cardiac resynchronization therapy-defibrillator (CRT-D) may reduce the incidence of first ventricular tachyarrhythmia (VTA) in patients with heart failure (HF) and left bundle-branch-block (LBBB). (Source: Heart Rhythm)
Source: Heart Rhythm - January 10, 2021 Category: Cardiology Authors: Sinan Tankut, Ilan Goldenberg, Valentine Kutyifa, Wojciech Zareba, Nicola Luigi Bragazzi, Scott McNitt, David T. Huang, Mehmet K. Aktas, Arwa Younis Source Type: research

EP News: Case Reports
Both implantable cardioverter defibrillators (ICD) and pacemakers have a magnet activated switches. Wearable devices are increasingly used in the community and continue to evolve in complexity which augment the potential of interactions of these devices and implantable cardiac devices. Asher and colleagues (https://doi.org/10.1016/j.hrcr.2020.12.002) share a case of a 55-year-old female with an ICD for recurrent ventricular arrhythmias in the setting of arrhythmogenic right ventricular cardiomyopathy. (Source: Heart Rhythm)
Source: Heart Rhythm - January 8, 2021 Category: Cardiology Authors: T. Jared Bunch Source Type: research

Catheter Ablation of the Left and Right Atrial Appendages without Isolation in Persistent Atrial Fibrillation
Electrical isolation of the left atrial appendage (LAA) improves outcomes of patients with persistent atrial fibrillation (AF) but may increase the risk of thromboembolism. (Source: Heart Rhythm)
Source: Heart Rhythm - January 8, 2021 Category: Cardiology Authors: Michael Ghannam, Sina Jame, Krit Jongnarangsin, Yuet Wong Cheng, Sampath Gunda, Opeyemi Fadahunsi, Andrew Hughey, Zhigang Liu, Ghanshyam Shantha, Ronpichai Chokesuwattanaskul, Miki Yokokawa, Hakan Oral, Fred Morady, Aman Chugh Source Type: research

Connexin45 (GJC1) loss-of-function mutation contributes to familial atrial fibrillation and conduction disease
Atrial fibrillation (AF) represents the most common clinical cardiac arrhythmia and substantially increases the risk for cerebral stroke, heart failure and death. Although causative genes for AF have been identified, the genetic determinants for AF remain largely unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - January 8, 2021 Category: Cardiology Authors: Ruo-Gu Li, Ying-Jia Xu, Willy G. Ye, Yan-Jie Li, Honghong Chen, Xing-Biao Qiu, Yi-Qing Yang, Donglin Bai Source Type: research

EP News: Allied Professionals
Quality of life (QOL) was a pre-specified secondary outcome in the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation –Part II (STAR AF II) trial and the authors (Terricabras et al. JAMA Netw Open. 2020;3:e2025473. PMID: 33275151) sought to determine whether QOL measures were affected by procedural outcome. STAR AF II was a randomized controlled trial assessing 3 AF ablation strategies in patients with persistent AF. The patients were followed for 18 months after ablation and the primary outcome of freedom from AF lasting>30 seconds after a single procedure. (Source: Heart Rhythm)
Source: Heart Rhythm - January 8, 2021 Category: Cardiology Authors: Erica S. Zado Source Type: research

EP News Clinical January 2021
Gold and colleagues (Circulation 2021; 143:7-17. PMID: 33073614) evaluated the inappropriate shock (IAS) rate with the implantable cardioverter-defibrillator (ICD) in patients implanted with the subcutaneous (S)-ICD. Primary prevention patients with left ventricular ejection fraction ≤35% and no pacing indications were included. The primary end point was the IAS-free rate compared with a 91.6% performance goal, derived from the results for the ICD-only patients in the MADIT-RIT. Eighteen-month freedom from IAS was 95.9% in the 1111 patients. (Source: Heart Rhythm)
Source: Heart Rhythm - January 7, 2021 Category: Cardiology Authors: N. A. Mark Estes Source Type: research

The missing pieces in the puzzle of arrhythmic mitral valve prolapse: papillary muscles, mitral anulus disjunction and myocardial scarring
Mitral valve prolapse (MVP) is a common and mostly benign heart valve disease, affecting 2 –3% of the general population1. However, MVP has been associated with life-threatening ventricular arrhythmias and sudden cardiac death (SCD) in a small subset of patients, leading to the concept of malignant arrhythmic MVP (2-4). Recent studies have shed light into the prevalence and the pathophy siology of arrhythmic MVP. Among the various hypotheses, myocardial fibrosis has been implicated as an arrhythmic substrate in MVP patients (2). (Source: Heart Rhythm)
Source: Heart Rhythm - January 7, 2021 Category: Cardiology Authors: Stefania Rizzo, Martina Perazzolo Marra, Monica De Gaspari, Cristina Basso Source Type: research

Stimulation and Propagation of Activation in Conduction Tissue: Implications for Left Bundle Branch Area Pacing
Characterizing wave-front generation and impulse conduction in left bundle (LB) has implications for Left Bundle Branch Area Pacing (LBBAP). (Source: Heart Rhythm)
Source: Heart Rhythm - January 5, 2021 Category: Cardiology Authors: Ahmed Niri, Abhishek Bhaskaran, John Asta, St éphane Massé, Patrick F.H. Lai, Arulalan Veluppillai, Eugene Downar, Menashe Waxman, Kumaraswamy Nanthakumar Source Type: research

Intermediate Term Performance and Safety of His Bundle Pacing Leads: A Single Center Experience
The short-term safety, feasibility, and performance of the His bundle pacing (HBP) leads have been reported, however, their longer-term performance beyond 1 year remains unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - January 5, 2021 Category: Cardiology Authors: Todd Teigeler, Jeffrey Kolominsky, Chau Vo, Richard K. Shepard, Gautham Kalahasty, Jordana Kron, Jose F. Huizar, Karoly Kaszala, Alex Y. Tan, Jayanthi N. Koneru, Kenneth A. Ellenbogen, Santosh K. Padala Source Type: research

Life Saving Therapy Inhibition by Phones Containing Magnets
Implantable Cardioverter Defibrillator (ICD) remains the cornerstone therapy in the management of malignant ventricular arrythmia ’s for patients with high risk cardiac conditions. An ICD system contains a battery, capacitors, sensing/ pacing circuit together with an intra-or extra-cardiac lead. All ICD’s have an in-built switch (Reed switch, Hall-effect sensors, Giant magneto sensitive resistors or coils) which respond to an externally applied magnetic field. When an external magnet is applied to a defibrillator, high voltage shock therapy for ventricular tachycardia and ventricular fibrillation is suspended. ...
Source: Heart Rhythm - January 4, 2021 Category: Cardiology Authors: Joshua C. Greenberg, Mahmoud R. Altawil, Gurjit Singh Source Type: research

EP News: Pediatric and Congenital Electrophysiology
Atrioventricular Block in Children With Multisystem Inflammatory Syndrome (Source: Heart Rhythm)
Source: Heart Rhythm - January 4, 2021 Category: Cardiology Authors: Prince J. Kannankeril Source Type: research

Every journey begins with the first step: Reflections on the first catheter ablation in humans
Today, we take for granted the incredible role that catheter ablation plays in the therapy of patients with cardiac arrhythmias —it was not always this way. In the 1970s, patients with potentially life-threatening supraventricular arrhythmias were treated by open heart surgery with direct ligation or cryoablation of the atrioventricular (AV) junction. Patients with Wolff-Parkinson-White syndrome underwent open-chest surgic al ablation of the bypass tract. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2021 Category: Cardiology Authors: Melvin M. Scheinman Tags: Viewpoint Source Type: research

Twirling around the block —A complex case of cardiac sarcoidosis
I am indeed very honored to be invited to participate in this series that will serve as follow-up for the Josephson and Wellens ECG Lessons that appeared in this journal. In no way do I feel that I will be able to fill the shoes of these masters. A word about my colleague and cowriter C. Thomas (Tom) Peter, MD. We first met several decades ago when he took over as Chief of Electrophysiology (EP) at Cedars-Sinai in Los Angeles. I was immediately drawn to his intellect and deep knowledge of both electrocardiogram (ECG) interpretation and invasive EP. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2021 Category: Cardiology Authors: Christopher C. Cheung, Annahita Sarcon, Bernard Belhassen, Melvin Scheinman Tags: Scheinman/Peter Ecg Corner Source Type: research

Gender representation at the Heart Rhythm Society Annual Scientific Sessions: A success story for diversity and inclusion
The Heart Rhythm Society (HRS) Annual Scientific Sessions is a renowned international conference in the field of cardiac electrophysiology. Since it is one of the largest conferences attended by electrophysiologists, evaluating whether the faculty of the meeting are representative of the field of clinical cardiac electrophysiology as a whole may provide an indication of the attention to, and success of, efforts at diversity. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2021 Category: Cardiology Authors: Sunita J. Ferns, Anne B. Curtis Tags: Viewpoint Source Type: research

Focused and Other
If you are an Outlook user, you will recognize the words Focused and Other as they appear near the top of your screen. They are designed to funnel incoming e-mail into two sections to help organize your inbox. Over time, the e-mail server learns which messages are important enough to be delivered to your inbox and which items can be left in the background —for occasional review. The e-mails in the Focused category greet you every time you turn on your computer—asking to be read and handled. The e-mails in the Other category will be read when you have a minute—just to be sure there is nothing there that ne...
Source: Heart Rhythm - January 1, 2021 Category: Cardiology Authors: Patricia Blake Tags: Message from the CEO Source Type: research

State of the Journal 2021
Heart Rhythm Journal (HRJ) is entering its 18th year in 2021. Total citations to the journal rose quickly since its founding, and HRJ is the most cited arrhythmia-focused journal since 2013 (Figure  1). The 2019 impact factor is 5.731 (an increase from 5.225 for 2018), ranking 19 of 138 cardiology journals. The Elsevier CiteScore for HRJ is 9.6, and the journal ranks 22 of 324 in the Cardiology and Cardiovascular Medicine category and 12 of 99 in Physiology (medicine). The Google Scholar h5-i ndex for HRJ is 71, ranking 9 of all cardiology journals. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2021 Category: Cardiology Authors: Peng-Sheng Chen Tags: Editorial Source Type: research

High-Intensity Ultrasound Catheter Ablation Achieves Deep, Mid-Myocardial Lesions In-Vivo
Radiofrequency (RF) ablation of epicardial and mid-myocardial ventricular arrhythmias (VAs) is limited by lesion depth. (Source: Heart Rhythm)
Source: Heart Rhythm - December 29, 2020 Category: Cardiology Authors: Babak Nazer, David Giraud, Yan Zhao, James Hodovan, Miriam R. Elman, Ahmad Masri, Edward P. Gerstenfeld, Jonathan R. Lindner Source Type: research

The Decrease in Peak Atrial Longitudinal Strain in Patients with Atrial Fibrillation as a Practical Parameter for Stroke Risk Stratification
Decreased peak atrial longitudinal strain (LA strain) derived from two-dimensional speckle tracking is frequently observed in patients with atrial fibrillation (AF) and associated with the risk of ischemic stroke. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2020 Category: Cardiology Authors: Jo-Nan Liao, Tze-Fan Chao, Chung-Lieh Hung, Shih-Ann Chen Source Type: research

Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): Prospective, single-center study
Beyond pulmonary vein isolation (PVI), the optimal ablation strategy for persistent atrial fibrillation (AF) remains poorly defined. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2020 Category: Cardiology Authors: Nicolas Derval, Josselin Duchateau, Arnaud Denis, F. Daniel Ramirez, Saagar Mahida, Cl émentine André, Philipp Krisai, Yosuke Nakatani, Takeshi Kitamura, Masateru Takigawa, Remi Chauvel, Romain Tixier, Xavier Pillois, Frédéric Sacher, Mélèze Hocini, Source Type: research

Unique feature of novel activation mapping to identify the successful ablation site of atrial tachycardia
A 49-year-old man was referred to our hospital for catheter ablation of atrial tachycardia (AT; cycle length (CL), 360ms). He previously underwent pulmonary vein isolation and cavotricuspid isthmus ablation for paroxysmal atrial fibrillation (AF). Conventional activation mapping with the high-density RhythmiaR mapping system (Boston Scientific, Marlborough, MA) revealed the following features: (a) activation breaking out at the inferior wall below the left inferior pulmonary vein in a centrifugal pattern (Supplementary Figure), (b) AF was observed inside the left pulmonary vein (LPV) (Figure A-1, a)). (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2020 Category: Cardiology Authors: Jun Kishihara, Hidehira Fukaya, Jun Oikawa, Junya Ako Source Type: research

Arrhythmias in a Hall of Mirrors: Pediatric Heterotaxy Syndromes
Heterotaxy comes from the Greek words heteros, meaning “other than” and taxis, meaning “arrangement”. It is thought to be caused by an embryological failure to differentiate along the right-left axis and can impact the thoracic and abdominal visceral organs. There are several different classification schemes which are beyond the scope of this co mmentary, but in short they can be divided generally into “asplenia/polysplenia”, “right atrial isomerism/left atrial isomerism” based on morphology of the atrial appendages, and those that are not clearly mirror-image reflections of ...
Source: Heart Rhythm - December 28, 2020 Category: Cardiology Authors: Charles I. Berul, Elizabeth D. Sherwin Source Type: research

The Role of Timing in Treatment of Atrial Fibrillation: An AFFIRM Substudy
In contrast to historical trials, EAST-AFNET 4 suggests the superiority of early rhythm control compared to rate control in patients with recent-onset atrial fibrillation (AF). The relative contributions of timing versus improvement in AF therapeutics over time is unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2020 Category: Cardiology Authors: Eunice Yang, Olive Tang, Thomas Metkus, Ronald D. Berger, David D. Spragg, Hugh G. Calkins, Joseph E. Marine Source Type: research

Close-coupled Pacing to Identify the 'Functional' Substrate of Ventricular Tachycardia: Long-term Outcomes of the Paced Electrogram Feature Analysis (PEFA) Technique.
The conduction delay and block that comprises the critical isthmus of macro-reentrant ventricular tachycardia (VT) is partly 'functional', in that it only occurs at faster cycle lengths. Close-coupled pacing stresses the myocardium's conduction capacity, and may reveal late potentials (LPs) and fractionation. A growing interest has emerged in targeting this functional substrate. (Source: Heart Rhythm)
Source: Heart Rhythm - December 27, 2020 Category: Cardiology Authors: Derek Crinion, Victor Neira, Nasser Al Hamad, Anna de Leon, David Bakker, Adam Korogyi, Hoshiar Abdollah, Ben Glover, Christopher Simpson, Adrian Baranchuk, Sanoj Chacko, Andres Enriquez, Damian Redfearn Source Type: research

Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation
One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2020 Category: Cardiology Authors: Marek Jastrz ębski, Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Aleksander Kusiak, Tomasz Sondej, Adam Bednarski, Marek Rajzer, Pugazhendhi Vijayaraman Source Type: research

Fixation beats – a novel marker for reaching the left bundle branch area during deep septal lead implantation
One of the challenges of left bundle branch (LBB) pacing is to place the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2020 Category: Cardiology Authors: Marek Jastrz ębski, Grzegorz Kiełbasa, Paweł Moskal, Agnieszka Bednarek, Aleksander Kusiak, Tomasz Sondej, Adam Bednarski, Marek Rajzer, Pugazhendhi Vijayaraman Source Type: research

Long-term prognosis of women with Brugada syndrome and Electrophysiologic study.
A male predominance in Brugada syndrome (BrS) has been widely reported and scarce information is available in female patients with BrS. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2020 Category: Cardiology Authors: Mois és Rodríguez-Mañero, Paloma Jordá, Jaime Hernandez, Carmen Muñoz, Esther Zorio Grima, Amaya García-Fernández, María Victoria Cañadas-Godoy, Victor Jiménez-Ramos, Teresa Oloriz, Nuria Basterra, David Calvo, Luisa Pérez-Álvarez, Miguel A. A Source Type: research

Systematic Quantification of Histological Ventricular Fibrosis in Isolated Mitral Valve Prolapse and Sudden Cardiac Death
Cardiac fibrosis in mitral valve prolapse (MVP) is implicated in the development of sudden cardiac death (SCD), however, the pattern remains poorly characterized. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2020 Category: Cardiology Authors: Hui-Chen Han, Sarah A. Parsons, Claire L. Curl, Andrew W. Teh, Antonia J.A. Raaijmakers, Anoop N. Koshy, Trishe Leong, Louise M. Burrell, David O ’Donnell, Jitendra K. Vohra, Jonathan M. Kalman, Prashanthan Sanders, David L. Hare, Omar Farouque, Lea M.D Source Type: research

Identification of two preclinical canine models of atrial fibrillation to facilitate drug discovery
Atrial fibrillation (AF) is the most common human arrhythmia with a critical need for new treatment strategies. (Source: Heart Rhythm)
Source: Heart Rhythm - December 23, 2020 Category: Cardiology Authors: Till Freudenberger, Beate Kranz, Waldemar Lehmann, Katja Sch äfer, Klaus Münter, Kichang Lee, Patrick T. Ellinor, William J. Hucker Source Type: research

Self-reported Physical Activity and Atrial Fibrillation Risk: A Systematic Review and Meta-analysis
While physical activity (PA) is an important component of cardiovascular disease prevention and treatment, its role in atrial fibrillation (AF) risk is less well established. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2020 Category: Cardiology Authors: Ricardo S. Mishima, Christian V. Verdicchio, Jean Jacques Noubiap, Jonathan P. Ariyaratnam, Celine Gallagher, Dione Jones, Varun Malik, Thomas Agbaedeng, Melissa E. Middeldorp, Dennis H. Lau, Prashanthan Sanders, Adrian D. Elliott Source Type: research

To the Editor — Mexiletine in myotonic dystrophy: Beware of ventricular arrhythmias!
Vio et  al1 have reported data on the safety of mexiletine in patients with myotonic dystrophy type 1 (MD). They included cases without major conduction disturbances who did not develop serious bradyarrhythmic events after 9-year follow-up. These results are reassuring for daily practice, but mexiletine b enefits in patients with MD and HV interval> 70 ms and an implanted pacemaker must be carefully counterbalanced with the potential risk of ventricular arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Guillermo Guti érrez Ballesteros, Francisco José Bermúdez Jiménez, Juan Jiménez-Jáimez Tags: Letters to the Editor Source Type: research

Reply to the Editor —Mexiletine in Myotonic Dystrophy: Beware of Ventricular Arrhythmias!
We thank Ballesteros et  al for their interest on our article on treatment with mexiletine of patients with myotonic dystrophy type 1 (DM1).1 Our study results demonstrated the safety of the use of mexiletine, which was not associated with significant electrocardiogram modification or bradyarrhythmic complications. The pr oblem raised by Ballesteros et al that in patients with DM1 sudden death from tachyarrhythmias may occur despite pacemaker implantation goes beyond the objective of our study.2 The authors hypothesize that a subclinical infra-Hisian conduction impairment related to mexiletine might increase the ...
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Riccardo Vio, Alessandro Zorzi, Domenico Corrado, Chiara Calore Source Type: research

Prior myocarditis and ventricular arrhythmias: the importance of scar pattern
: multiple studies have already addressed the importance of anteroseptal scar in patients with non-ischemic cardiomyopathy. However, this pattern has never been fully evaluated in patients with prior myocarditis. (Source: Heart Rhythm)
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Michela Casella, Marco Bergonti, Maria Lucia Narducci, Simone Persampieri, Alessio Gasperetti, Edoardo Conte, Valentina Catto, Corrado Carbucicchio, Federico Guerra, Gianluca Pontone, Daniele Andreini, Cristina Basso, Luigi Di Biase, Pasquale Santangeli, Source Type: research

Catheter Ablation of Ventricular Arrhythmias in Left Ventricular NonCompaction Cardiomyopathy
There are limited data on ventricular arrhythmias (VA) associated with left ventricular noncompaction (LVNC) cardiomyopathy. (Source: Heart Rhythm)
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Juan Jos é Sánchez Muñoz, Carmen Muñoz Esparza, Pablo Peñafiel Verdú, Juan Martínez Sánchez, Francisco García Almagro, Ginés Elvira Ruiz, Juan Ramón Gimeno Blanes, Arcadio García Alberola Source Type: research

Mexiletine in Myotonic Distrophy: beware of ventricular arrhythmias!
Dr. Vio et al1 have reported data on the safety of mexiletine in Myotonic Dystrophy type (MD) 1 patients. They included cases without major conduction disturbances who did not develop serious bradyarrhythmic events after a 9 year follow up. These results are reassuring for daily practice, but mexiletine benefits in MD patients with HV interval> 70 ms and an implanted pacemaker must be carefully counterbalanced with the potential risk of ventricular arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Guillermo Guti érrez Ballesteros, Francisco José Bermúdez Jiménez, Juan Jiménez-Jáimez Source Type: research

Author's reply to Mexiletine in Myotonic Distrophy: beware of ventricular arrhythmias!
We thank Ballesteros et al for their interest on our article on treatment with mexiletine of patients with myotonic dystrophy type 1 (DM1).1 Our study results demonstrated the safety of the use of mexiletine which was not associated with significant ECG modification or bradyarrhythmic complications. The problem raised by Ballesteros et al. that in DM1 patients sudden death from tachyarrhythmias may occur despite pacemaker implantation goes beyond the objective of our study.2 The authors hypothesize that a subclinical infrahissian conduction impairment related to mexiletine might increase the risk of a bundle branch reentry...
Source: Heart Rhythm - December 17, 2020 Category: Cardiology Authors: Riccardo Vio, Alessandro Zorzi, Domenico Corrado, Chiara Calore Source Type: research

Etiology and prognosis of patients with unexplained syncope and mid-range left ventricular dysfunction
Syncope in patients with mid-range LVEF can be due to potentially serious arrhythmic causes. However, there is no clear consensus regarding the best way to manage these patients. (Source: Heart Rhythm)
Source: Heart Rhythm - December 14, 2020 Category: Cardiology Authors: Jaume Francisco-Pascual, Eduard Rodenas, Nuria Rivas-G ándara, Yassin Belahnech, Aleix Olivella San Emeterio, Jordi Pérez-Rodón, Begoña Benito, Alba Santos-Ortega, Àngel Moya-Mitjans, Guillem Casas, Javier Cantalapiedra-Romero, Jenson Maldonado, Igna Source Type: research

Staphylococcus bacteremia without evidence of a cardiac implantable electronic device infection
Staphylococcus bacteremia (SB) in the presence of a cardiac implantable electronic device (CIED) is frequently associated with CIED infection. In patients without clear CIED infection but SB, the role for empiric CIED removal is unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - December 12, 2020 Category: Cardiology Authors: Ikutaro Nakajima, Ryohsuke Narui, Kenichi Tokutake, Caleb A. Norton, William G. Stevenson, Travis D. Richardson, Christopher R. Ellis, George H. Crossley, Jay A. Montgomery Source Type: research

Twin Atrioventricular Nodes, Arrhythmias and Survival in Pediatric and Adult Patients with Heterotaxy Syndrome
Heterotaxy syndrome is likely to involve arrhythmias from associated conduction system abnormalities, which are distinct in different subtypes of isomerism and may change further after interventions and remodeling. (Source: Heart Rhythm)
Source: Heart Rhythm - December 12, 2020 Category: Cardiology Authors: Mei-Hwan Wu, Jou-Kou Wang, Sheunn-Nan Chiu, Wei-Chieh Tseng, Chun-Wei Lu, Hsin-Chia Lin, Ming-Tai Lin, Chun-An Chen Source Type: research

The possible association between COVID-19 and postural orthostatic tachycardia syndrome
Coronavirus disease-2019 (COVID-19), the illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), involves other body organs besides the lungs. In recovered patients “long haul” COVID-19 may include dysautonomia, in which changes in functioning of one or more components of the autonomic nervous system (ANS) adversely affect health. This viewpoint focuses on the dysautonomia postural tachycardia syndrome (POTS). (Source: Heart Rhythm)
Source: Heart Rhythm - December 10, 2020 Category: Cardiology Authors: David S. Goldstein Source Type: research

Radiofrequency Ablation Using a Needle Electrode Combined with Heated Saline Injection: Three Different Mechanisms of Tissue Heating
Dr. Nakagawa has received research grant support from and served as a consultant for Biosense Webster, Inc., Affera, Inc, Galaxy Medical, Inc., Japan Lifeline, Ltd, and Fukuda Denshi, Ltd. Other authors have reported no relationship. (Source: Heart Rhythm)
Source: Heart Rhythm - December 10, 2020 Category: Cardiology Authors: Hiroshi Nakagawa, Shunsuke Kuroda, Ayman A. Hussein Source Type: research

EP News: Allied Professionals
Appearing on line on the same day in the New England Journal of Medicine, there was not one but two randomized controlled trials of cryoballoon pulmonary vein isolation (PVI) versus antiarrhythmic medications (AAD) as first-line treatment for symptomatic paroxysmal atrial fibrillation (PAF) with similar results. (Source: Heart Rhythm)
Source: Heart Rhythm - December 10, 2020 Category: Cardiology Authors: Erica S. Zado Source Type: research

Three-dimensional guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in pediatric patients
Nonfluoroscopic 3-dimensional (3D) electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction. (Source: Heart Rhythm)
Source: Heart Rhythm - December 7, 2020 Category: Cardiology Authors: Massimo Stefano Silvetti, Vincenzo Pazzano, Irma Battipaglia, Fabio Anselmo Saputo, Chiara Mizzon, Fabrizio Gimigliano, Antonio Ammirati, Lucilla Rav à, Fabrizio Drago Source Type: research

3d-guided selective right ventricular septal pacing preserves ventricular systolic function and synchrony in paediatric patients
Non-fluoroscopic 3D-electroanatomic mapping systems (EAMs) have been developed to guide cardiac catheter navigation and reduce fluoroscopy. Selective right ventricular (RV) septal pacing could prevent pacing-induced left ventricular (LV) dysfunction. (Source: Heart Rhythm)
Source: Heart Rhythm - December 7, 2020 Category: Cardiology Authors: Massimo Stefano Silvetti, Vincenzo Pazzano, Irma Battipaglia, Fabio Anselmo Saputo, Chiara Mizzon, Fabrizio Gimigliano, Antonio Ammirati, Lucilla Rav à, Fabrizio Drago Source Type: research

Prognostic Value of Cardiac Magnetic Resonance Septal Late Gadolinium Enhancement Patterns for Periaortic Ventricular Tachycardia Ablation: Heterogeneity of the Anteroseptal Substrate in Nonischemic Cardiomyopathy
Ventricular tachycardia (VT) from the anteroseptal subtype of nonischemic cardiomyopathy has a high probability of recurrence after catheter ablation. (Source: Heart Rhythm)
Source: Heart Rhythm - December 7, 2020 Category: Cardiology Authors: Takuro Nishimura, Hena N. Patel, Shuo Wang, Gaurav A. Upadhyay, Heather L. Smith, Cevher Ozcan, Dalise Y. Shatz, Hemal M. Nayak, Amit R. Patel, Roderick Tung Source Type: research

EP News: Clinical
Wasni et  al (N Engl J Med November 16, 2020; https://doi.org/10.1056/NEJMoa2029554, PMID 33197158) investigated therapy for paroxysmal atrial fibrillation in a randomized trial of initial treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. The primary efficacy end point was treatment success, which was defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period. Of the 203 participants who underwent randomization and received treatment, 104 underwent ablation and 99 initially received d rug therapy. (Source: Heart Rhythm)
Source: Heart Rhythm - December 4, 2020 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research