Renal denervation as an adjunctive therapy to cardiac sympathetic denervation for ablation refractory ventricular tachycardia
Autonomic modulation is finding an increasing role in the treatment of ventricular arrhythmias. Renal denervation (RDN) has been described as a treatment modality for refractory ventricular tachycardia (VT) in case series. (Source: Heart Rhythm)
Source: Heart Rhythm - September 17, 2019 Category: Cardiology Authors: Jason S. Bradfield, Justin Hayase, Kevin Liu, John Moriarty, Stephen T. Kee, Duc Do, Olujimi A. Ajijola, Marmar Vaseghi, Jean Gima, Julie Sorg, Shelly Cote, Geraldine Pavez, Eric Buch, Houman Khakpour, Yuliya Krokhaleva, Carlos Macias, Osamu Fujimura, Noe Source Type: research

Changes In Global Electrical Heterogeneity Associated With Dofetilide, Quinidine, Ranolazine, And Verapamil
ECG markers of antiarrhythmic drug (AAD) activity could be used to optimize efficacy and minimize toxicity. Vectorcardiographic (VCG) global electrical heterogeneity (GEH) is associated with ventricular arrhythmias and sudden death, but it is unclear how GEH measurements change in response to AADs. (Source: Heart Rhythm)
Source: Heart Rhythm - September 17, 2019 Category: Cardiology Authors: Hans Friedrich Stabenau, Changyu Shen, Larisa G. Tereshchenko, Jonathan W. Waks Source Type: research

Incidence and Causes of In-hospital Outcomes and 30-day Readmissions After Percutaneous Left Atrial Appendage Closure: A United States Nationwide Retrospective Cohort Study Using Claims Data
Percutaneous left atrial appendage closure (p-LAAC) emerged as an option for stroke prevention in atrial fibrillation (AF) patients ’ ineligible for long-term anticoagulation.Real-world data on its in-hospital and 30-day readmission measures are limited. (Source: Heart Rhythm)
Source: Heart Rhythm - September 17, 2019 Category: Cardiology Authors: Venkat L.K. Vuddanda, Mohit K. Turagam, Nikita A. Umale, Zubair Shah, Dhanunjaya R. Lakkireddy, Krzysztof Bartus, Finnian R. McCausland, Poonam Velagapudi, Moussa Mansour, E. Kevin Heist Source Type: research

EP News: Clinical
Schaff et  al (J Am Coll Cardiol 2019;74:645, PMID 31370956) evaluated the impact of conduction abnormalities on mortality in patients with obstructive hypertrophic cardiomyopathy after myectomy. The morality of 2482 patients with septal myectomy were analyzed. The mean age at operation was 54.2 ± 14.6 year s, and 1370 patients (55.2%) were men. Preoperatively, 2159 patients (87.0%) had normal conduction. Postoperatively, 38.8% developed left bundle branch block (LBBB), 1.1% developed right bundle branch block (RBBB), and 0.6% had complete heart block (CHB). (Source: Heart Rhythm)
Source: Heart Rhythm - September 16, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
Di Biase et  al (J Am Coll Cardiol 2019;74:1019, PMID 31439209) sought to assess the incidence of thromboembolic (TE) events such as stroke and transient ischemic attack (TIA) in patients with atrial fibrillation (AF) undergoing ablation for AF that included left atrial appendage (LAA) isolation (LAAI). The st udy group comprised all patients who underwent LAAI as part of their ablation strategy and who were without AF 6 months after ablation. All patients were continued on oral anticoagulation (OAC) with either warfarin or direct oral anticoagulant (DOAC) for the first 6 months. (Source: Heart Rhythm)
Source: Heart Rhythm - September 16, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Basic and Translational
Wren et  al (Circ Genom Precis Med August 27, 2019;https://doi.org/10.1161/CIRCGEN.119.002581, PMID 31454269) investigated the genotype-phenotype spectrum of calmodulinopathies. The authors identified 2 novel calmodulin (CaM) variants (CALM3-E141K in 2 cases; CALM1-E141V) and 1 previously reported CaM path ogenic variant (CALM3-D130G) in 4 independent probands with prolonged corrected QT (QTc) interval. The parents of all probands were asymptomatic with normal QTc duration. However, 2 of the families had multiple affected offspring or occurrences of intrauterine fetal demise (IUFD). (Source: Heart Rhythm)
Source: Heart Rhythm - September 16, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

A Prospective Evaluation of Entrainment Mapping as an Adjunct to New Generations High-Density Activation Mapping Systems of Left Atrial Tachycardias
Identification of atrial tachycardia (AT) mechanism remains challenging. (Source: Heart Rhythm)
Source: Heart Rhythm - September 14, 2019 Category: Cardiology Authors: Teresa Strisciuglio, Nele Vandersickele, Giuseppe Lorenzo, Enid Van Nieuwenhuyse, Milad El Haddad, Jan De Pooter, Maria Kyriakopoulou, Alexandre Almorad, Michelle Lycke, Yves Vandekerckhove, Ren é Tavernier, Mattias Duytschaever, Sebastien Knecht Source Type: research

Cost-Utility of Wearable Cardioverter Defibrillators in Children with Dilated Cardiomyopathy during Medical Optimization: Is it Worth the Wait?
Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy in both adults and children, and the estimated cost of caring for patients with this disease is in the order of billions of dollars annually in the United States alone. Although in adults, the etiology is usually related to coronary artery disease, in children, the mechanisms are far more varied, and the course is less well described and likely dependent on cause and presentation.1 An important facet of the management paradigm for these children includes approach to sudden death prevention, an area that continues to lack substantial data. (Source: Heart Rhythm)
Source: Heart Rhythm - September 14, 2019 Category: Cardiology Authors: Jeffrey J. Kim Source Type: research

Difficulties with Invasive Risk Stratification Performed Under Anesthesia in Pediatric Wolff-Parkinson-White Syndrome
Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI). (Source: Heart Rhythm)
Source: Heart Rhythm - September 12, 2019 Category: Cardiology Authors: Mark H. Shwayder, Carolina A. Escudero, Susan P. Etheridge, Brynn E. Dechert, Ian H. Law, Andrew D. Blaufox, James C. Perry, Anne M. Dubin, Shubhayan Sanatani, Kathryn K. Collins Source Type: research

Genetic Arrhythmias Complicating Patients with Dilated Cardiomyopathy
Sudden cardiac death due to malignant arrhythmias is a common cause of death in dilated cardiomyopathy (DCM). Whether genetic variants increase the risk of arrhythmias in DCM is unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - September 12, 2019 Category: Cardiology Authors: Zongzhe Li, Peng Chen, Chenze Li, Lun Tan, Jinchao Xu, Hong Wang, Yang Sun, Yan Wang, Chunxia Zhao, Mark S. Link, Arthur A.M. Wilde, Dao Wu Wang, Dao Wen Wang Source Type: research

The Many Faces of Early Repolarization Syndrome:A Single Center Case-Series
Early repolarization syndrome (ERS) is a rare but increasingly recognized cause of malignant ventricular arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - September 12, 2019 Category: Cardiology Authors: Aleksandr Voskoboinik, Henry Hsia, Joshua Moss, Vasanth Vedantham, Ronn E. Tanel, Akash Patel, Julianne Wojciak, Natalie Downs, Melvin M. Scheinman Source Type: research

Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias
Left atrial tachycardias (ATs) often occur after left atrial ablation. The incidence of symptomatic and silent cerebral embolism after radiofrequency catheter ablation of left ATs and the impact of the type of 3-dimesional electroanatomic mapping (3D-EAM) system on the incidence of cerebral embolism remain unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - September 10, 2019 Category: Cardiology Authors: Kohki Nakamura, Takehito Sasaki, Yutaka Take, Kentaro Minami, Mitsuho Inoue, Shohei Kishi, Shingo Yoshimura, Wataru Sasaki, Yoshinori Okazaki, Hiroyuki Motoda, Katsura Niijima, Yuko Miki, Koji Goto, Eiji Yamashita, Keiko Koyama, Nobusada Funabashi, Shiget Source Type: research

Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation
Fragmented QRS (fQRS) in 12-lead ECG is a non-invasive marker of intra-myocardial conduction delay due to ventricular scarring which has not been studied in AF before. (Source: Heart Rhythm)
Source: Heart Rhythm - September 10, 2019 Category: Cardiology Authors: Ugur Canpolat, Sanghamitra Mohanty, Chintan Trivedi, Qiong Chen, Huseyin Ayhan, Carola Gianni, Domenico G. Della Rocca, Bryan MacDonald, J. David Burkhardt, Mohammed Bassiouny, G. Joseph Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea N Source Type: research

Cardiac resynchronization therapy by left bundle branch area pacing in heart failure patients with left bundle branch block
Cardiac resynchronization therapy (CRT) via bi-ventricular pacing has demonstrated clinical benefits in heart failure (HF) patients with ventricular dyssynchrony. Other approaches of CRT is little known. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2019 Category: Cardiology Authors: Weiwei Zhang, Jingjuan Huang, Yiding Qi, Fei Wang, Lina Guo, Xuerui Shi, Weihua Wu, Xiaohong Zhou, Ruogu Li Source Type: research

S wave in ECG lead V6 predicts poor response to cardiac resynchronization therapy and long-term outcome
Cardiac resynchronization therapy (CRT) is a standard treatment for selected patients with chronic heart failure (HF). However, up to 30-50% of patients still do not respond to CRT. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2019 Category: Cardiology Authors: Zeyu Jiang, Yuanhao Qiu, Zhiyong Qian, Yao Wang, Yongwei Zhao, Xiaofeng Hou, Yanchun Liang, Liangrong Zheng, Geng Xu, Yangang Su, Xiang Gu, Jiangang Zou Source Type: research

Ondansetron effects on apamin-sensitive small conductance calcium-activated potassium currents in pacing induced failing rabbit hearts
Ondansetron, a widely prescribed antiemetic, has been implicated in drug-induced long QT syndrome. Recent patch clamp experiments have shown that ondansetron inhibits the apamin sensitive calcium activated potassium current (IKAS). (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2019 Category: Cardiology Authors: Dechun Yin, Na Yang, Zhipeng Tian, Adonis Z. Wu, Dongzhu Xu, Mu Chen, Nicholas J. Kamp, Zhuo Wang, Changyu Shen, Zhenhui Chen, Shien-Fong Lin, Michael Rubart-von der Lohe, Peng-Sheng Chen, Thomas H. Everett Source Type: research

Utilization of the genome aggregation database, in silico tools, and heterologous expression patch-clamp studies to identify and demote previously published type 2 long QT syndrome: Causative variants from pathogenic to likely benign
Loss-of-function variants in the KCNH2-encoded Kv11.1 potassium channel cause long QT syndrome (LQTS) type 2 (LQT2). Presently, hundreds of KCNH2 missense variants (MVs) have been published as “disease-causative.” However, an estimated 10% of rare published LQTS MVs may be “false positives.” (Source: Heart Rhythm)
Source: Heart Rhythm - September 5, 2019 Category: Cardiology Authors: Connor L. Mattivi, Dan Ye, David J. Tester, Daniel J. Clemens, Wei Zhou, John R. Giudicessi, Michael J. Ackerman Source Type: research

Utilization of the Genome Aggregation Database, In Silico Tools, and Heterologous Expression Patch Clamp Studies to Identify and Demote Previously Published Type 2 Long QT Syndrome-Causative Variants from Pathogenic to Likely Benign
Loss-of-function variants in the KCNH2-encoded Kv11.1 potassium channel cause type 2 long QT syndrome (LQT2). Presently, hundreds of KCNH2 missense variants (MVs) have been published as “disease-causative”. However, an estimated 10% of rare published LQTS MVs may be "false positives”. (Source: Heart Rhythm)
Source: Heart Rhythm - September 5, 2019 Category: Cardiology Authors: Connor L. Mattivi, Dan Ye, David J. Tester, Daniel J. Clemens, Wei Zhou, John R. Giudicessi, Michael J. Ackerman Source Type: research

Evaluation of a new ultralow-dose radiation protocol for electrophysiological device implantation: A near-zero fluoroscopy approach for device implantation
Radiation is one of the main hazards of electrophysiological device implantation, and insertion of cardiac resynchronization therapy (CRT) devices in particular is associated with high radiation doses. (Source: Heart Rhythm)
Source: Heart Rhythm - September 5, 2019 Category: Cardiology Authors: Martin Eichenlaub, Klaus Astheimer, Jan Minners, Thomas Blum, Christian Restle, Christian Maring, Saskia Schweitzer, Ulrike Thiel, Franz-Josef Neumann, Thomas Arentz, Heiko Lehrmann Source Type: research

Comparative spatial resolution of 12-lead electrocardiography and an automated algorithm
The spatial resolution of pacemapping using 12-lead ECG or PaSo is unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - September 4, 2019 Category: Cardiology Authors: Dhani Dharmaprani, Anandaroop Lahiri, Anand N. Ganesan, Nicole Kyriacou, Andrew D. McGavigan Source Type: research

Incidence of sleep apnea and association with atrial fibrillation in an unselected pacemaker population: results from the observational RESPIRE study
Patients with atrial fibrillation (AF) often have sleep apnea (SA), but diagnosis of SA with polysomnography is costly. SA monitoring (SAM) is a pacemaker feature that measures respiratory disturbance index (RDI), the sum of abnormal respiratory events divided by sleep duration. (Source: Heart Rhythm)
Source: Heart Rhythm - September 4, 2019 Category: Cardiology Authors: Julio Marti-Almor, Pedro Marques, Laurence Jesel, Rodrigue Garcia, Enrico Di Girolamo, Fabio Locati, Pascal Defaye, Paul Venables, Antoine Dompnier, Aina Barcelo, Herbert N ägele, Haran Burri Source Type: research

Cerclage para-Hisian septal pacing through the septal perforator branch of the great cardiac vein: bedside-to-bench development of a novel technique and lead
Physiologic biventricular pacing is an attractive alternative to conventional right ventricular (RV) pacing in the management of conduction system disease.1 RV septal pacing is effective but dogged by lead instability2,3 and occasional serious tricuspid valve injury.4 Permanent His-bundle pacing has been achieved,5-11 but challenges remain including high pacing threshold, low ventricular electrogram amplitude, lead instability, and procedural complexity.12 We recently described an alternative pacemaker lead trajectory to achieve physiologic pacing, by lead implantation into the interventricular septum through the septal pe...
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Min Soo Cho, Min Ku Chon, Jin Hee Choi, Ki Won Hwang, Jeong-Wook Seo, Robert J. Lederman, June Hong Kim, Gi-Byoung Nam Source Type: research

Surgical Procedure for Targeting Arrhythmogenic Substrates in the Treatment of Ventricular Tachycardia Associated with Cardiac Tumors
Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomical mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in non-resectable cardiac tumors. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Shun-Ichiro Sakamoto, Atsushi Hiromoto, Hiroshige Murata, Kenji Suzuki, Jiro Kurita, Yasuhiro Kawase, Takashi Sasaki, Yasuo Miyagi, Yosuke Ishii, Tetsuro Morota, Wataru Shimizu, Takashi Nitta Source Type: research

ECG screening in the Unites States: Are we there yet?
No controlled clinical trial has determined whether ECG screening saves lives. Nonetheless, this is happening at state, local, and grass roots levels in the United States (US). A Texas lawmaker recently introduced a bill requiring pre-participation sports screening —including an ECG—in high school students1. Similar bills have seeped into other state legislatures. Researchers, clinicians, lawmakers, patients, and advocacy groups have well-intentioned, thoughtful, and often emotional arguments on both sides of the ECG screening debate. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Mary Niu, Susan Etheridge Source Type: research

Stylet-Directed His Bundle Lead Placement: Early Days of an Emerging Contender
The development process for medical therapies rarely goes to plan. Even the soundest hypotheses, derived from first principles, either succeed via unanticipated mechanisms or fail to generate meaningful results. His bundle pacing (HBP), however, delivers on the simple concept that utilizing the native conduction system is preferable to direct myocardial capture. Since its first description of use in clinical practice1 and subsequent increase in utilization, His bundle pacing has demonstrated superiority over both right ventricular and biventricular pacing with respect to measures of electrical synchrony, hemodynamics, and ...
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Aron B. Bender, Olujimi A. Ajijola Source Type: research

Wearable Cardioverter Defibrillators in Pediatric Cardiomyopathy: A Cost-Utility Analysis
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children. Patients with severe cardiac dysfunction are thought to be at risk for sudden cardiac arrest (SCA). Following diagnosis, a period of medical optimization is recommended prior to permanent implantable cardioverter-defibrillator (ICD) implantation. Wearable cardioverter defibrillators (WCD) provide an option for arrhythmia protection as an outpatient during this optimization. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Patrick D. Evers, Jeffrey B. Anderson, Thomas D. Ryan, Richard J. Czosek, Timothy K. Knilans, David S. Spar Source Type: research

Acceleration of a wide complex tachycardia: What is the mechanism?
A 21-year-old man with recurrent palpitations refractory to medical therapy was referred for ablation of supraventricular tachycardia (SVT). Baseline electrocardiogram (ECG) showed sinus rhythm having typical left bundle branch block (LBBB) pattern with QRS width of 130 ms. The PR interval was 148 ms without manifest pre-excitation. During electrophysiological study, the baseline HV interval during sinus rhythm was 10 ms. Clinical SVT with LBBB pattern was induced with programmed extrastimuli from the high right atrium. (Source: Heart Rhythm)
Source: Heart Rhythm - August 28, 2019 Category: Cardiology Authors: Zenith A. Jameria, Takuro Nishimura, Hemal M. Nayak, Roderick Tung Tags: Unknown of the Month Source Type: research

HRS 40th anniversary viewpoints: Carpe diem
They tell me that when I was 7 years old, when asked what I wanted to be when I grew up, I unhesitatingly answered, “a cardiologist.” Except for 2 weeks in college I never ever wavered. My father, who escaped from Russia, was a first-class cardiologist and clinician with superb ears, hands, and brain, who could diagnose a pancreatic mass by palpation. I used to go with him to his hospital in New York City jus t to be in the medical environment. He communicated with the greats in the field if he had questions or comments and wrote many original papers, mainly having to do with electrocardiography (which I typed ...
Source: Heart Rhythm - August 28, 2019 Category: Cardiology Authors: Nora Goldschlager Tags: Viewpoint Source Type: research

The role of extensive diagnostic work-up in young athletes and non-athletes with complex ventricular arrhythmias
Ventricular tachyarrhythmias (VA) represent the first cause of death in athletes. The difference between electroanatomic substrate in athletes and non-athletes with complex VA is unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Maria Lucia Narducci, Gemma Pelargonio, Giulio La Rosa, Frediano Inzani, Giulia d ’Amati, Valeria Novelli, Riccardo Marano, Francesco Perna, Gianluigi Bencardino, Gaetano Pinnacchio, Maurizio Genuardi, Michela Cammarano, Vincenzo Palmieri, Paolo Zeppill Source Type: research

Right free wall accessory pathway with branched atrial insertions: Clinical, electrocardiographic, and electrophysiological characteristics
Right free wall accessory pathway (RFW-AP) with branched atrial insertions is a rare, under-recognized AP which may be associated with initial ablation failure. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Meng-meng Li, Jing-ye Li, Cai-Hua Sang, Chen-Xi Jiang, Xue-Yuan Guo, Xin Zhao, Song-Nan Li, Wei Wang, Ri-Bo Tang, De-yong Long, Jian-zeng Dong, Xin Du, Chang-sheng Ma Source Type: research

EP News: Case Reports
Implantation of a traditional implantable cardioverter-defibrillator (ICD) remains a challenge in small children because of their size and the anticipation of skeletal and vascular growth. Subcutaneous ICDs (S-ICDs) do not require leads, but their use in small children is unclear because of the generator size that can cause erosion and one lead size designed for adults. von Alvensleben et  al (DOI: https://doi.org/10.1016/j.hrcr.2019.05.004) shared a case of a 5-year-old girl (13.5 kg) who had ventricular fibrillation cardiac arrest. (Source: Heart Rhythm)
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Clinical
Reddy et  al (Am Coll Cardiol 2019;74:315, PMID 31085321) evaluated whether pulse field ablation (PFA) allows durable pulmonary vein (PV) isolation without damage to collateral structures. Two trials assessed the safety and effectiveness of catheter-based PFA in paroxysmal atrial fibrillation. Invasive elec trophysiological mapping was repeated after 3 months to assess the durability of PV isolation. In 81 patients, all PVs were acutely isolated by monophasic (n = 15) or biphasic (n = 66) PFA with ≤3 minutes elapsed delivery per patient, a skin-to-skin procedure time of 92.2 ± 27.4 minutes, and a fl uoroscop...
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
In this paper by DeWitt et  al (J Am Coll Cardiol 2019;74:346–358, PMID 31319917), the authors describe the variable phenotype (clinical characteristics) in a group of children diagnosed with arrhythmogenic cardiomyopathy (AC). In this single-center retrospective study, the authors searched their database for all patients (Source: Heart Rhythm)
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

Redefining the Electroanatomy of the Cardiac Conduction System
Decades of meticulous study by anatomists, embryologists, and physiologists have provided the framework for understanding the cardiac conduction system and its role in establishing normal ventricular activation. 1-6 It is this background that enabled the field of interventional cardiac electrophysiology to evolve in becoming a highly impactful field eliminating previously only controllable arrhythmias like accessory pathway-related tachycardias and typical atrial flutter.7 Recent advances in electrophysiology testing whether ventricular fibrillation represents an ablatable arrhythmia as well as stimulatory cardiac devices ...
Source: Heart Rhythm - August 23, 2019 Category: Cardiology Authors: Adetola Ladejobi, Samuel J. Asirvatham Source Type: research

EP News: Basic and Translational
The steep voltage dependence of gating of the voltage-gated Na channel (NaV) is essential for electrical excitability. However, the structural basis of voltage gating mechanisms remains uncertain because the resting state exists only at deeply negative membrane potentials. In the current study, Wisedchaisri et  al (Cell 2019;DOI:10.1016/j.cell.2019.06.031, PMID 31353218) stabilized the resting conformation by inserting voltage-shifting mutations and introduced a disulfide crosslink in the voltage-sensing module (VS) of the ancestral bacterial Na channel NaVAb. (Source: Heart Rhythm)
Source: Heart Rhythm - August 21, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

A novel homozygous mutation in the TRDN gene causes a severe form of pediatric malignant ventricular arrhythmia
Triadin is a protein expressed in cardiac and skeletal muscle with an essential role in the structure and functional regulation of calcium release units and excitation-contraction coupling. Mutations in the triadin gene (TRDN) have been described in different forms of human arrhythmia syndromes with early onset and severe arrhythmogenic phenotype, among which the triadin knockout syndrome. (Source: Heart Rhythm)
Source: Heart Rhythm - August 19, 2019 Category: Cardiology Authors: Daniela Rossi, Lorenzo Gigli, Alessandra Gamberucci, Roberta Bordoni, Alessandro Pietrelli, Stefania Lorenzini, Enrico Pierantozzi, Giovanni Peretto, Gianluca De Bellis, Paolo Della Bella, Maurizio Ferrari, Vincenzo Sorrentino, Sara Benedetti, Simone Sala Source Type: research

HRS 40th Anniversary Viewpoints: Research and  teaching—A view from the university and private practice
Thar ’s more in the man than thar is in the land.Sidney Lanier, 1869 (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Eric N. Prystowsky Tags: Viewpoint Source Type: research

HRS 40th Anniversary Viewpoints: Historical Aspects of the Use of Radiofrequency Energy to Treat Arrhythmias
I first observed the treatment of arrhythmias by catheter ablation in Paris when I did a sabbatical in 1979-1980 under the supervision of Dr. Guy Fontaine. At that time, catheter ablation was performed using high energy DC shock (fulguration) by inserting a catheter localized to the site of ventricular arrhythmias (VA). Fulguration was limited to areas of thick myocardium to avoid perforation. Therefore, only ablation of the AV node, septal accessory pathways and left ventricular tachycardia (VT) could be performed. (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Frank I. Marcus Source Type: research

HRS 40th Anniversary Viewpoints: Research and Teaching —A view from the university and private practice
“Thar’s more in the man than thar is in the land”. Sidney Lanier 1869 (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Eric N. Prystowsky Source Type: research

Inflate a cuff and reduce atrial fibrillation?
Some non-invasive interventions (such as positive airway pressure ventilation) have the potential to improve outcome of invasive cardiac procedures. Remote ischemic preconditioning (RIPC) - induced by repetitive pre-interventional inflations of an arm-cuff to suprasystolic values - is one of them and effects on atrial fibrillation (AF) ablation are worth exploring. The RIPPAF (remote ischemic preconditioning for prevention of AF) study by Kosiuk et al. 1 is the first to measure electrophysiological effects of preconditioning in man with a view to potential antiarrhythmic effects. (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Joachim R. Ehrlich Source Type: research

When it comes to the left atrial appendage, first do no harm
Primum non nocere, first, do no harm, is a directive inherent to the practice of medicine. The phrase is often ascribed to the Hippocratic oath, however it is found in Hippocrates treatise (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: T.Jared Bunch Source Type: research

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system
The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. (Source: Heart Rhythm)
Source: Heart Rhythm - August 16, 2019 Category: Cardiology Authors: Michael V. Orlov, David Casavant, Ioannis Koulouridis, Mikhail Maslov, Aharon Erez, Amy Hicks, Ahad Jahangir, Joe Aoun, John V. Wylie Source Type: research

Permanent His Bundle Pacing using Stylet Directed, Active Fixation Leads Placed via Coronary Sinus Sheaths as Compared to Conventional Lumen-less System
The use of coronary sinus sheaths to deliver stylet-driven leads for His bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a styletless lead delivered through a customized catheter. (Source: Heart Rhythm)
Source: Heart Rhythm - August 16, 2019 Category: Cardiology Authors: Michael V. Orlov, David Casavant, Ioannis Koulouridis, Mikhail Maslov, Aharon Erez, Amy Hicks, Ahad Jahangir, Joe Aoun, John V. Wylie Source Type: research

High-sensitivity troponin and the risk of atrial fibrillation in chronic kidney disease: Results from the Chronic Renal Insufficiency Cohort Study
Patients with chronic kidney disease (CKD) are at an increased risk of atrial fibrillation (AF). There is a need for novel biomarkers to reliably and accurately predict AF in this population. High-sensitivity troponin (HsTP) allows the detection of low troponin concentrations. The utility of HsTP for evaluating the risk of AF in CKD has not been established. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2019 Category: Cardiology Authors: Scott E. Janus, Jamal Hajjari, Sadeer Al-Kindi Source Type: research

High Sensitivity Troponin and the Risk of Atrial Fibrillation in Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study
Patients with chronic kidney disease (CKD) are at increased risk for atrial fibrillation (AF). There is a need for novel biomarkers to reliably and accurately predict AF in this population. High sensitivity troponin (HsTP) allows detection of very low troponin concentrations. The utility of HsTP for evaluating the risk of AF in CKD has not been established. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2019 Category: Cardiology Authors: Scott E. Janus, Jamal Hajjari, Sadeer Al-Kindi Source Type: research

Catheter ablation in children and patients with congenital heart disease: Review of 1021 procedures at a high-volume single center in Japan
Although pediatric catheter ablation therapy has often been described, there are few reports on outcomes in a large series of patients at a single center. (Source: Heart Rhythm)
Source: Heart Rhythm - August 12, 2019 Category: Cardiology Authors: Yuko Kato, Tsugutoshi Suzuki, Yoko Yoshida, Noriyasu Ozaki, Hisaaki Aoki, Shintaro Kishimoto, Shuichiro Yoshida, Shigeo Watanabe, Yoshihide Nakamura Source Type: research

Chronic venous obstruction during cardiac device revision: Incidence, predictors, and efficacy of percutaneous techniques to overcome the stenosis
In recent years, upgrade and revision procedures of cardiac implantable electronic devices (CIEDs) have become increasingly frequent. Patency of the access veins is critical for procedural success. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2019 Category: Cardiology Authors: Giovanni Morani, Bruna Bolzan, Sergio Valsecchi, Martina Morosato, Flavio Luciano Ribichini Source Type: research

Chronic Venous Obstruction During Cardiac Device Revision: Incidence, Predictors and Efficacy Of Percutaneous Techniques to Overcome the Stenosis
In the recent years, upgrade and revision procedures of cardiac implantable electronic device (CIED) have become increasingly frequent. The patency of the access veins is critical for procedural success. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2019 Category: Cardiology Authors: Giovanni Morani, Bruna Bolzan, Sergio Valsecchi, Martina Morosato, Flavio Luciano Ribichini Source Type: research

To the Editor — Temperature measurement from both electrodes during bipolar radiofrequency ablation—It is feasible
We have read with interest a recent HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias, particularly a chapter on bipolar radiofrequency catheter ablation. The authors state that one of the limitations of this emerging approach is the fact that temperature measurements can be obtained only from 1 of 2 catheters used.1 Actually this can be done if temperature data from the thermistor located at the tip of catheter used as a ground are transferred to a temperature monitor (ie, a second radiofrequency generator). (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Piotr Futyma, Piotr Ku łakowski Tags: Letter to the editor Source Type: research

Reply to the Editor — Temperature measurement from both electrodes during bipolar radiofrequency ablation—It is feasible
We thank Drs Futyma and Ku łakowski for their interest in the recently published 2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias and further thank the authors for bringing to our attention their work on catheter tip size, which was published after the completion of the cli nical document.1 We agree that temperature monitoring of both catheter tips is possible, but that such a system is not yet, to our knowledge, commercially available or approved. (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Edmond M. Cronin, Frank M. Bogun, Luis Aguinaga, John L. Sapp, William G. Stevenson Source Type: research