Cardiac Resynchronization Therapy in Congenital Heart Disease Patients with Systemic Right Ventricle
Although patients with systemic right ventricle (SRV) represent a significant proportion of patients with congenital heart disease (CHD) implanted with cardiac resynchronization therapy (CRT), there are very limited and conflicting data in this specific patient group. (Source: Heart Rhythm)
Source: Heart Rhythm - December 1, 2021 Category: Cardiology Authors: Etienne Jacquemart, Nicolas Combes, Guillaume Duthoit, Francis Bessi ère, Magalie Ladouceur, Laurence Iserin, Mikael Laredo, Charlène Bredy, Alice Maltret, Sylvie Di Filippo, Sébastien Hascoët, Jean-Luc Pasquié, Eloi Marijon, Victor Waldmann Source Type: research

Long-term Monitoring of Arrhythmias with Cardiovascular Implantable Electronic Devices in Patients with Cardiac Sarcoidosis.
Risk stratification for sudden cardiac death (SCD) in cardiac sarcoidosis (CS) is challenging in patients without overt cardiac symptoms. (Source: Heart Rhythm)
Source: Heart Rhythm - November 26, 2021 Category: Cardiology Authors: Annelies Bakker, Harold Mathijssen, Galina Dorland, Jippe Balt, Vincent F. van Dijk, Marcel Veltkamp, Fatima Akdim, Jan C. Grutters, Martijn C. Post Source Type: research

Mechanistic insights into the interaction of cardiac sodium channel Nav1.5 with MOG1 and a new molecular mechanism for Brugada syndrome
Mutations in cardiac sodium channel Nav1.5 cause Brugada syndrome (BrS). MOG1 is a chaperon that binds to Nav1.5, facilitates Nav1.5 trafficking to cell surface, and enhances amplitude of sodium current INa. (Source: Heart Rhythm)
Source: Heart Rhythm - November 26, 2021 Category: Cardiology Authors: Hongbo Xiong, Xuemei Bai, Zhuang Quan, Dong Yu, Hongfu Zhang, Chi Zhang, Lina Liang, Yufeng Yao, Qin Yang, Zhijie Wang, Longfei Wang, Yuan Huang, Hui Li, Xiang Ren, Xin Tu, Tie Ke, Chengqi Xu, Qing Wang Source Type: research

Risk Factors for Atrioventricular Block after Occlusion for Perimembranous Ventricular Septal Defect
The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - November 26, 2021 Category: Cardiology Authors: Li Lin, Jianwen Liu, Xiufen Guo, Hang Chen, Yu Huang, Huiying Zheng, Wanhua Chen, Lianglong Chen, Liangwan Chen, Zhaoyang Chen Source Type: research

The Importance of Early Evaluation after Cardiac Resynchronization Therapy to Redefine Response: Pooled Individual Patient Analysis from Five Prospective Studies
Cardiac resynchronization therapy (CRT) reduces mortality and improves outcomes in appropriately selected patients with heart failure (HF); however, response may vary. (Source: Heart Rhythm)
Source: Heart Rhythm - November 26, 2021 Category: Cardiology Authors: Eugene S. Chung, Michael R. Gold, William T. Abraham, James B. Young, Cecilia Linde, Christopher Anderson, Xiaoxiao Lu, Joshua O. Ikuemonisan, Dedra H. Fagan, Stelios I. Tsintzos, John Rickard Source Type: research

Developmental Changes in Cardiac Expression of KCNQ1 and SCN5A Spliceoforms Implications for Sudden Unexpected Infant Death
Sudden, Unexpected Infant Death (SUID) occurs unpredictably and remains unexplained after scene investigation and autopsy. Approximately 1 in 7 cases of SUID can be related to a cardiac cause, and developmental regulation of cardiac ion channel genes may contribute to SUID. (Source: Heart Rhythm)
Source: Heart Rhythm - November 26, 2021 Category: Cardiology Authors: Alexandra F. Williams, Audra F. Bryan, Kelsey Tomasek, Carlos A. Fulmer, Kyle Gregory, Cole Bozeman, Feng Li, Tarek S. Absi, Yan Ru Su, Prince J. Kannankeril Source Type: research

Are ICD electrogram recordings of triggering ectopy the key to successful ablation of polymorphic ventricular tachycardia/ventricular fibrillation?
Current guidelines recommend catheter ablation of reproducible stereotypic triggering ventricular ectopy for suppressing polymorphic ventricular tachycardia/ventricular fibrillation (PMVT/VF), both idiopathic, and in the setting of structural heart disease (1). Short coupled ventricular premature complexes (VPCs) with a coupling interval of 200-400 ms, typically with an ‘R on T’ wave appearance, were first documented to reproducibly trigger polymorphic VT either non-sustained or degenerating into VF in 1981 (2). (Source: Heart Rhythm)
Source: Heart Rhythm - November 25, 2021 Category: Cardiology Authors: Dipen Shah Source Type: research

An overview of heart rhythm disorders and management in myotonic dystrophy type 1
Myotonic dystrophy type 1 (DM1) is the commonest adult form of muscular dystrophy, presenting with a constellation of systemic findings secondary to a CTG triplet expansion of the non-coding region of the DMPK gene. Cardiac involvement is frequent, with conduction disease, supraventricular and ventricular arrhythmias being the most prevalent cardiac manifestations, often developing from a young age. The development of cardiac arrhythmias has been linked to increased morbidity and mortality, with sudden cardiac death well described. (Source: Heart Rhythm)
Source: Heart Rhythm - November 25, 2021 Category: Cardiology Authors: Thomas D. Gossios, Rui Providencia, Antonio Creta, Oliver R. Segal, Nikoletta Nikolenko, Chris Turner, Luis R. Lopes, Karim Wahbi, Konstantinos Savvatis Source Type: research

Atrial Resynchronization Therapy: An Emerging Potential to Advance Physiologic Pacing?
Sick sinus syndrome (SSS) represents the most common indication for permanent pacemaker implantation.1 SSS is characterized by atrial arrhythmias and sinus node dysfunction manifesting as sinus pauses, bradycardia, and chronotropic incompetence. 1 The prevalence of atrial fibrillation (AF), the most common atrial arrhythmia in patients with SSS, increases exponentially with age.1 Both the sinus node dysfunction and atrial arrhythmias results from age related structural and electrophysiological changes. (Source: Heart Rhythm)
Source: Heart Rhythm - November 25, 2021 Category: Cardiology Authors: N. A. Mark Estes, Samir Saba Source Type: research

Toward radiofrequency catheter ablation of atrial fibrillation
Curative treatments of supraventricular arrhythmias —that is, aiming at the elimination of arrhythmic substrate—were initially performed in the 1970s during cardiac surgery as a last resort. A tandem team of surgeons and electrophysiologists intervened, as the individual location of substrate required mapping guidance of the electrical anomaly. I n the early 1980s, catheter ablation began using direct current (DC) shocks, with most procedures being palliative as they aimed at interrupting atrioventricular (AV) conduction in patients with uncontrolled ventricular rate associated with atrial fibrillation (AF) or ...
Source: Heart Rhythm - November 24, 2021 Category: Cardiology Authors: Michel Ha ïssaguerre Tags: Viewpoint Source Type: research

Heart Rhythm Society: What ’s the value proposition?
Heart Rhythm Society (HRS) traces its roots to a first meeting in 1979 when J. Warren Hawthorne discussed the idea of developing a national professional society focused on cardiac pacing and electrophysiology with Seymour Furman, Victor Parsonnet, Dryden Morse, Michael Bilitch, and colleagues. The founders and early members realized the importance of having an independent organization dedicated to science and education in the nascent fields of cardiac pacing and electrophysiology that would provide a forum for collaboration among multiple stakeholders. (Source: Heart Rhythm)
Source: Heart Rhythm - November 24, 2021 Category: Cardiology Authors: Fred M. Kusumoto Tags: President's Page Source Type: research

Nurse-led syncope and loop-recorder implantation clinics —a win-win approach for patients, clinicians, and hospitals
The vast expansion of electrophysiological procedures1 has created challenges in care delivery, with emerging trends in practice patterns rising to meet those challenges. One is the advent of specialized clinics for management of specialized problems, such as atrial fibrillation, rhythm device, and syncope clinics. Syncope clinics, providing a standardized approach to diagnosis and treatment of syncope delivered by specialists in the field, has been recommended by the most recent European Society of Cardiology guidelines on syncope. (Source: Heart Rhythm)
Source: Heart Rhythm - November 24, 2021 Category: Cardiology Authors: Alicia Burr, Rachel Lampert Source Type: research

Familial atrial myopathy in a large multi-generational heart-hand syndrome pedigree carrying LMNA missense variant in rod 2B domain (p.R335W)
The literature on laminopathy with ventricular phenotype is extensive. However, the pathogenicity of LMNA variations in atrial lesions still lacks research. (Source: Heart Rhythm)
Source: Heart Rhythm - November 19, 2021 Category: Cardiology Authors: Yike Zhang, Yongping Lin, Yanjuan Zhang, Yuanqing Wang, Zhaomin Li, Yue Zhu, Hailei Liu, Weizhu Ju, Chang Cui, Minglong Chen Source Type: research

Sotalol versus amiodarone for postoperative junctional tachycardia following congenital heart surgery
Junctional ectopic tachycardia (JET) is a common arrhythmia following congenital heart disease (CHD) surgery. There is variability in choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent which may be useful for JET. (Source: Heart Rhythm)
Source: Heart Rhythm - November 18, 2021 Category: Cardiology Authors: Ellis Rochelson, Santiago O. Valdes, Vicken Asadourian, Raajen Patel, Katherine Lemming, Taylor S. Howard, Tam Dan N. Pham, Christina Y. Miyake, Jeffrey J. Kim Source Type: research

Bradyarrhythmias Detected by Extended Rhythm Recording in Patients Undergoing Transcatheter Aortic Valve Replacement (BRADY-TAVR Study)
Bradyarrhythmias leading to permanent pacemaker (PPM) continue to be a complication after Transcatheter Aortic Valve Replacement (TAVR) (Source: Heart Rhythm)
Source: Heart Rhythm - November 18, 2021 Category: Cardiology Authors: Khaldoun G. Tarakji, Divyang Patel, Amar Krishnaswamy, Ayman Hussein, Walid Saliba, Bruce L. Wilkoff, Kathy Wolski, Lars Svensson, Oussama M. Wazni, Samir R. Kapadia Source Type: research

“Sotalol versus amiodarone for postoperative junctional tachycardia following congenital heart surgery”
Junctional ectopic tachycardia (JET) is a common arrhythmia following congenital heart disease (CHD) surgery. There is variability in choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent which may be useful for JET. (Source: Heart Rhythm)
Source: Heart Rhythm - November 18, 2021 Category: Cardiology Authors: Ellis Rochelson, Santiago O. Valdes, Vicken Asadourian, Raajen Patel, Katherine Lemming, Taylor S. Howard, Tam Dan N. Pham, Christina Y. Miyake, Jeffrey J. Kim Source Type: research

A Phenotype-Enhanced Variant Classification Framework to Decrease the Burden of Missense Variants of Uncertain Significance in Type 1 Long QT Syndrome
Pathogenic/likely pathogenic (P/LP) variants in the KCNQ1-encoded Kv7.1 potassium channel cause type 1 long QT syndrome (LQT1). Despite the revamped 2015 American College of Medical Genetics (ACMG) variant interpretation guidelines, the burden of KCNQ1 variants of uncertain significance (VUS) in patients with LQTS remains ∼30%. (Source: Heart Rhythm)
Source: Heart Rhythm - November 16, 2021 Category: Cardiology Authors: Sahej Bains, Steven M. Dotzler, Christian Krijger, John R. Giudicessi, Dan Ye, Hennie Bikker, Ram K. Rohatgi, David J. Tester, J. Martijn Bos, Arthur A.M. Wilde, Michael J. Ackerman Source Type: research

TEMPORARY REMOVAL: Does the Holiday Heart Syndrome Extend to the Ventricles?
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal. (Source: Heart Rhythm)
Source: Heart Rhythm - November 15, 2021 Category: Cardiology Authors: Stacey J. Howell, Gregory M. Marcus Source Type: research

Does the Holiday Heart Syndrome Extend to the Ventricles?
The relationship between alcohol consumption and cardiovascular health is complex. While observational studies have consistently revealed a J-shaped association between alcohol and cardiovascular mortality,1 the most compelling and consistent evidence in the realm of alcohol and cardiology falls in the category of cardiac electrophysiology: specifically, that alcohol heightens the risk of atrial fibrillation (AF). Whether chronic consumption is assessed as a predictor of the eventual diagnosis of the disease2 or acute consumption is evaluated as a harbinger of a discrete AF episodes only a few hours later,3 more alcohol is...
Source: Heart Rhythm - November 15, 2021 Category: Cardiology Authors: Stacey J. Howell, Gregory M. Marcus Source Type: research

Erratum
In the article titled “Radiofrequency ablation in Brugada syndrome” by Koonlawee Nademanee, MD, FHRS, that published in the October issue of Heart Rhythm Journal (2021: 18: 1805-1806), “Sosa technique” was misspelled as “Sousa technique” in the fifth paragraph. The author regrets the error. (Source: Heart Rhythm)
Source: Heart Rhythm - November 15, 2021 Category: Cardiology Source Type: research

QT prolongation in patients with index evaluation for seizure or epilepsy is predictive of all-cause mortality
Refractory epilepsy confers a considerable lifetime risk of sudden unexplained death (SUDEP). Mechanisms may overlap with sudden cardiac death (SCD), particularly regarding QTc prolongation. Guidelines in the US do not mandate the use of ECG in diagnostic evaluation of seizures or epilepsy. (Source: Heart Rhythm)
Source: Heart Rhythm - November 11, 2021 Category: Cardiology Authors: C. Anwar A. Chahal, Joseph A. Gottwald, Erik K. St. Louis, Jiang Xie, Peter A. Brady, Rabe E. Alhurani, Paul Timm, Prabin Thapa, Jay Mandrekar, Elson L. So, Janet E. Olson, Michael J. Ackerman, Virend K. Somers Source Type: research

Adding Six Short Lines on Pulmonary Vein Isolation Circumferences Reduces Recurrence of Paroxysmal Atrial Fibrillation: Results from the Multicenter, Single-blind, Randomized Trial
Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) is associated with a non-negligible long-term recurrence rate. (Source: Heart Rhythm)
Source: Heart Rhythm - November 11, 2021 Category: Cardiology Authors: Jian Sun, Mu Chen, Qunshan Wang, Peng-Pai Zhang, Wei Li, Rui Zhang, Bin-Feng Mo, Bing Han, Xian-Jin Li, Wei Du, Liang Zhao, Hao Wang, Bing Yang, Yizhang Wu, Xingxing Cai, Cheng Li, Tai-Zhong Chen, Yi-Gang Li Source Type: research

Bachmann ’s bundle potential during atrial lead placement: a case series
In 1914 Sir Thomas Lewis observed that differences in the speed of atrial impulse propagation are influenced by myofiber orientation.1 Two years later Jean George Bachmann reported that left atrial (LA) activation occurs primarily over a muscular band of longitudinally arranged fibers immediately adjacent to the Crista terminalis (CT), which became known as Bachmann ’s bundle (BB).2 Damage to BB results in interatrial conduction delay (IACD) manifesting as prolonged P-wave duration (PWD)>120 milliseconds (ms) on the surface electrocardiograph (ECG). (Source: Heart Rhythm)
Source: Heart Rhythm - November 11, 2021 Category: Cardiology Authors: Margaret Infeld, Nicole Habel, Kramer Wahlberg, Sean Meagher, Markus Meyer, Daniel Lustgarten Source Type: research

EP News: Basic and Translational
In the current study, Harley et al (Proc Natl Acad Sci U S A 2021 ;118(44):e2108796118; PMID: 34716268) investigated the roles of the cytosolic assembly formed by the Per-Arnt-Sim (PAS) and cyclic nucleotide binding homology (CNBh) domains of the hERG K+ channel in channel gating, using single-chain variable fragment (scFv) antibodies. The authors mapped the scFv2.12 epitope to a site overlapping with the PAS/CNBh domain interface. ScFv binding in vitro and in the cell is incompatible with the PAS interaction with CNBh. (Source: Heart Rhythm)
Source: Heart Rhythm - November 10, 2021 Category: Cardiology Authors: Nipavan Chiamvimonvat Source Type: research

EP News: Allied Professionals
There has been conflicting data regarding whether supplementation with omega 3 fatty acids increases the risk of atrial fibrillation (AF). The investigators (Gencer et al. Circulation 2021; online ahead of print. PMID: 34612056) sought to answer the question of whether use of omega 3 fatty acid increases risk of AF and to assess whether the dose of supplementation has an effect, through the use of meta-analysis of randomized trials. Following PRISMA guidelines for meta-analysis, the investigators searched databases for randomized, controlled, double-blind trials of omega 3 supplements versus placebo. (Source: Heart Rhythm)
Source: Heart Rhythm - November 10, 2021 Category: Cardiology Authors: Erica S. Zado Source Type: research

Clinical performance of implantable cardioverter-defibrillator lead monitoring diagnostics
Implantable cardioverter-defibrillator (ICD) lead monitoring diagnostic alerts facilitate the diagnosis of structural lead failure. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Jeanne E. Poole, Charles D. Swerdlow, Khaldoun G. Tarakji, Suneet Mittal, Kenneth A. Ellenbogen, Arnold J. Greenspon, Charles Kennergren, Berit T. Philbert, JoEllyn Moore, R. Chris Jones, Robert D. Schaller, Riple Hansalia, Timothy Simmers, Attila Mihalcz Source Type: research

Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants
Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Helen Eftekhari, Hejie He, James Doug Lee, Geeta Paul, Albiona Zhupaj, Thomas Lachlan, Michael Kuehl, Tarv Dhanjal, Sandeep Panikker, Shamil Yusuf, Sajad Hayat, Faizel Osman Source Type: research

Magnetic Field-Induced Interactions between Phones Containing Magnets and Cardiovascular Implantable Electronic Devices – Flip it to be Safe?
Recent case reports and small studies have reported activation of the magnet-sensitive switches in cardiovascular implantable electronic devices (CIED) by the new iPhone 12 series, initiating asynchronous pacing in pacemakers and suspension of anti-tachycardia therapies in ICDs. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Philipp Lacour, Phi Long Dang, Frank R. Heinzel, Abdul Shokor Parwani, Felix B ähr, Andreas Kucher, Felix Hohendanner, Thoralf Niendorf, Faezeh Rahimi, Nandita Saha, Haopeng Han, Kerstin Rubarth, Mohammad Sherif, Leif-Hendrik Boldt, Burkert Pieske, Flori Source Type: research

Clinical Performance of Implantable Cardioverter Defibrillator Lead Monitoring Diagnostics
Implantable cardioverter defibrillator (ICD) lead monitoring diagnostic alerts facilitate diagnosis of structural lead failure. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Jeanne E. Poole, Charles D. Swerdlow, Khaldoun G. Tarakji, Suneet Mittal, Kenneth A. Ellenbogen, Arnold J. Greenspon, Charles Kennergren, Berit T. Philbert, JoEllyn Moore, R. Chris Jones, Robert D. Schaller, Riple Hansalia, Timothy Simmers, Attila Mihalcz Source Type: research

Safety and Outcome of Nurse-Led Syncope Clinics and ILR-implants
Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on their diagnostic yield, on nurse-led syncope clinics and nurse-led ILR implants are limited. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Helen Eftekhari, Hejie He, James Doug Lee, Geeta Paul, Albiona Zhupaj, Thomas Lachlan, Michael Kuehl, Tarv Dhanjal, Sandeep Panikker, Shamil Yusuf, Sajad Hayat, Faizel Osman Source Type: research

Pediatric T-wave memory after accessory pathway ablation in Wolff-Parkinson-White syndrome
Altered ventricular depolarization due to manifest accessory pathway conduction, Wolff-Parkinson-White syndrome, leads to repolarization abnormalities that persist after pathway ablation. The term T-wave memory (TWM) has been applied to these changes, as the post-ablation T-wave vector “remembers” the preexcited QRS vector. In adults, these abnormalities can be misinterpreted as ischemia leading to unnecessary interventions. To date, there have been no comprehensive studies evaluating this phenomenon in the pediatric population. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Karyn M. Austin, Mark E. Alexander, John K. Triedman Source Type: research

Sex-specific aspects of phospholamban cardiomyopathy: the importance and prognostic value of low-voltage ECGs
A pathogenic variant in the gene encoding phospholamban (PLN), a protein regulating calcium homeostasis of cardiomyocytes, causes PLN cardiomyopathy. It is characterized by a high arrhythmic burden and can progress into severe cardiomyopathy. Risk assessment guides ICD therapy and benefits from personalization. It is unknown whether sex-specific differences in PLN cardiomyopathy exist. (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2021 Category: Cardiology Authors: Remco de Brouwer, Laura M.G. Meems, Tom E. Verstraelen, Belend Mahmoud, Virginnio Proost, Arthur A.M. Wilde, Laurens P. Bosman, Esm ée van Drie, Paul A. van der Zwaag, J. Peter van Tintelen, Arjan C. Houweling, Maarten P. van den Berg, Rudolf A. de Boer Source Type: research

Pacing through a pandemic —Coping with the “tip of the iceberg”
The coronavirus disease 2019 (COVID-19) pandemic has presented a once in a generation challenge to our health care systems worldwide. In its early phases, confusion existed about modes of transmission, levels of infection control, and risk to health care personnel. This combined with lack of resources for adequate personal protective equipment (PPE) generated high levels of anxiety for medical teams and rationing of PPE in the early phase. Advise and local guidelines were changing on an almost daily basis, with major challenges in procedural risk assessment in the absence of immediate polymerase chain reaction testing: COV...
Source: Heart Rhythm - November 7, 2021 Category: Cardiology Authors: Pier D. Lambiase Tags: Editorial Commentary Source Type: research

EP News: Pediatric and Congenital Electrophysiology
Valsartan in early-stage hypertrophic cardiomyopathy: a randomized phase 2 trial (Source: Heart Rhythm)
Source: Heart Rhythm - November 7, 2021 Category: Cardiology Authors: Vicki A. Freedenberg Source Type: research

Pacing Through a Pandemic-Coping with the “Tip of the Iceberg”
The Covid-19 pandemic has presented a once in a generation challenge to our healthcare systems worldwide. In its early phases, confusion existed regarding modes of transmission, levels of infection control and risk to healthcare personnel. This combined with lack of resources for adequate PPE generated high levels of anxiety for medical teams and rationing of PPE in the early phase. Advise and local guidelines were changing on an almost daily basis with major challenges in procedural risk assessment in the absence of immediate PCR testing- COVID-19 positivity was assumed until proven otherwise. (Source: Heart Rhythm)
Source: Heart Rhythm - November 7, 2021 Category: Cardiology Authors: Pier D. Lambiase Source Type: research

EP News: Clinical
Miles et  al (J Am Coll Cardiol 2021;78:1511, PMID 34620408) evaluated the presence and distribution of ventricular myocardial fibrosis in a cohort of decedents experiencing sudden cardiac death caused by Brugada syndrome (BrS). The investigators evaluated 28 whole hearts from consecutive sudden cardiac dea th cases attributed to BrS and 29 hearts from a comparator group comprising noncardiac deaths (control subjects). Of 28 BrS decedents (75% men; median age of death 25 years), death occurred in sleep or at rest in 24 of 28 (86%). (Source: Heart Rhythm)
Source: Heart Rhythm - November 4, 2021 Category: Cardiology Authors: N.A. Mark Estes Source Type: research

EP News: Case Reports
In the setting of a general transition to remote management of cardiac implantable devices, manufacturers are increasing using this form of monitoring for device advisories. Recently, Abbott Medical (Lake Forest, IL) issued a safety notification for a subset of their pacemakers due to the potential of premature battery depletion and a higher risk of rapid transition from elective replacement indicated (ERI) status to end of life (EOL) that could compromise device function. Melman et al (https://doi.org/10.1016/j.hrcr.2021.09.013) share the cases of two patients with rapid pacemaker generator dysfunction that occurred befor...
Source: Heart Rhythm - November 4, 2021 Category: Cardiology Authors: T. Jared Bunch Source Type: research

EP News Clinical November 2021
Miles and colleagues (J Am Coll Cardiol, 2021;78(15):1511-1521.PMID: 34620408) evaluated the presence and distribution of ventricular myocardial fibrosis in a cohort of decedents experiencing sudden cardiac death caused by Brugada Syndrome (BrS). The investigators evaluated 28 whole hearts from consecutive sudden cardiac death cases attributed to BrS and 29 hearts from a comparator group comprised of noncardiac deaths (control subjects). Of 28 BrS decedents (75% men; median age of death 25 years), death occurred in sleep or at rest in 24 of 28 (86%). (Source: Heart Rhythm)
Source: Heart Rhythm - November 4, 2021 Category: Cardiology Authors: N. A. Mark Estes Source Type: research

Mechanism of the Effects of Sodium Channel Blockade on the Arrhythmogenic Substrate of Brugada Syndrome
The mechanisms by which sodium channel blockade and high-rate pacing modify electrogram substrates of Brugada syndrome (BrS) have not been elucidated. (Source: Heart Rhythm)
Source: Heart Rhythm - November 3, 2021 Category: Cardiology Authors: Koonlawee Nademanee, Gumpanart Veerakul, Akihiko Nogami, Qing Lou, M élèze Hocini, Ruben Coronel, Elijah R. Behr, Arthur Wilde, Bastiaan J. Boukens, Michel Haissaguerre Source Type: research

Multisite conduction block in the epicardial substrate of Brugada syndrome
The Brugada pattern manifests as spontaneous variability of the ECG marker suggesting a variability of underlying electrical substrate. (Source: Heart Rhythm)
Source: Heart Rhythm - October 31, 2021 Category: Cardiology Authors: Michel Ha ïssaguerre, Koonlawee Nademanee, Frédéric Sacher, Ghassen Cheniti, Mélèze Hocini, Elodie Surget, Rémi Dubois, Edward Vigmond, Olivier Bernus Source Type: research

EMPIRIC ABLATION OF POLYMORPHIC VENTRICULAR TACHYCARDIA/FIBRILLATION IN THE ABSENCE OF A MAPPABLE TRIGGER: Prospective Feasibility and Efficacy of Pacemap Matching to Defibrillator Electrograms
Catheter ablation strategies for ventricular fibrillation and polymorphic ventricular tachycardia (VF/PMVT) are not established when spontaneous triggers are rare or absent. (Source: Heart Rhythm)
Source: Heart Rhythm - October 29, 2021 Category: Cardiology Authors: Pablo Salazar, Andrew Beaser, Gaurav Upadhyay, Zaid Aziz, Stephanie Besser, Dalise Y. Shatz, Hemal Nayak, Roderick Tung Source Type: research

Sudden death in a “healthy” youth: Lessons learned
A 19-year-old athletic man presented with cardiac arrest. Two years earlier, he had experienced an episode of rapid palpitations during competition associated with presyncope. At that time, his vital signs were stable, electrocardiogram (ECG) was normal (QTc 440 ms), and exercise echocardiogram was normal. He was advised to add salt to his diet. Months later, the patient again experienced rapid palpitations while walking to his dormitory, but this time he collapsed with documented ventricular fibrillation that terminated after a defibrillator shock. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Ayhan Yoruk, Melvin Scheinman Tags: Scheinman/Peter ECG Corner Source Type: research

Radiofrequency ablation of ventricular fibrillation
Nearly 30 years ago, the first report on ventricular fibrillation (VF) ablation was published (Supplemental Figure  1).1 However, to better understand the evolution of VF ablation since then, we must go back over one century earlier. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Philipp Krisai, Josselin Duchateau, Ghassen Cheniti, Takamitsu Takagi, Tsukasa Kamakura, F. Daniel Ramirez, Thomas Pambrun, Nicolas Derval, Fr édéric Sacher, Pierre Jaïs, Michel Haïssaguerre, Mélèze Hocini Tags: Viewpoint Source Type: research

Peering yet a little more behind the veil: Further insights from the ECG
The ECG has no secrets left- (Nobody said that) (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: John M. Miller, Mithilesh K. Das Tags: Editorial Commentary Source Type: research

Adopting evidence-based optimal implantable cardioverter-defibrillator programming: Overcoming the inertia
When implantable cardioverter-defibrillators (ICDs) first became available, they were indicated for those fortunate enough to have survived cardiac arrest. Compared to today ’s ICDs, charge times were long, shock energies were low, and monophasic waveforms were used. The primary concern was delivering a shock rapidly to promptly restore coordinated electrical activity. When indications for ICDs expanded beyond secondary prevention, there was an increasing realization that while lifesaving therapy would benefit some, many patients would experience the downsides of living with an ICD. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Martin K. Stiles Tags: Editorial Commentary Source Type: research

What is ventricular fibrillation?
The mechanisms of ventricular fibrillation (VF) have been in debate for more than a century 1,2. Experimental and computer simulation studies in the last few decades have demonstrated that foci, reentry, or a mixture of the two are all possible electrical activities for VF, depending on the disease or experimental conditions 3. A reentry can occur around an anatomical structure, such as a scar, called anatomical reentry, or in structurally normal tissue, called functional reentry. A functional reentry is a spiral wave or a rotor whose rotation center is called a phase singularity (PS) 4, a term first coined by Arthur Winfr...
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Zhilin Qu Source Type: research

Peering Yet a Little More Behind the Veil – Further Insights From the ECG
“The ECG has no secrets left” – (Nobody said that) (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: John M. Miller, Mithilesh K. Das Source Type: research

Leadless Pacemaker Implant, Anticoagulation Status, and Outcomes: Results From The Micra Transcatheter Pacing System Post-Approval Registry
Early results from the Micra investigational trial and Micra post-approval registry (PAR) demonstrated excellent safety and device performance; however, outcomes based upon anticoagulation status at implant have not been evaluated. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Mikhael F. El-Chami, Christophe Garweg, Saverio Iacopino, Faisal Al-Samadi, Jose Luis Martinez-Sande, Claudio Tondo, Jens Brock Johansen, Xavier Vi ñolas Prat, Jonathan P. Piccini, Yong Mei Cha, Eric Grubman, Pierre Bordachar, Paul R. Roberts, Kyoko Soej Source Type: research

Supraventricular Tachycardia with Double Trouble
A 23 year old healthy woman who was 10 weeks pregnant presented to the hospital with palpitations. Her presenting rhythm is shown in Figure 1A. The tachycardia terminated with administration of Adenosine, and her baseline sinus rhythm ECG is shown in 1B. Metoprolol was initiated, but she had a recurrence of tachycardia. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Stacey J. Howell, Adam Lee, Melvin Scheinman Source Type: research

An inherited sudden cardiac arrest syndrome may be based on primary myocardial and autonomic nervous system abnormalities
A recently discovered sudden cardiac arrest (SCA) syndrome is linked to a risk haplotype which harbours the dipeptidyl-peptidase 6 (DPP6) gene as plausible culprit. (Source: Heart Rhythm)
Source: Heart Rhythm - October 28, 2021 Category: Cardiology Authors: Hein J. Verberne, Marieke T. Blom, Abdenasser Bardai, John M. Karemaker, Hanno L. Tan Source Type: research