Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in heart failure patients
Enhanced beat-to-beat variability of repolarization (BVR) is strongly linked to arrhythmogenesis and is largely due to variation in ventricular action potential duration (APD). Previous studies in humans have relied on QT interval measurements; however, a direct relationship between beat-to-beat variability of APD and arrhythmogenesis in humans has yet to be demonstrated. (Source: Heart Rhythm)
Source: Heart Rhythm - December 4, 2018 Category: Cardiology Authors: Bradley Porter, Martin J. Bishop, Simon Claridge, Nicholas Child, Stefan Van Duijvenboden, Julian Bostock, Benjamin J. Sieniewicz, Justin Gould, Baldeep Sidhu, Ben Hanson, Zhong Chen, Christopher A. Rinaldi, Peter Taggart, Jaswinder S. Gill Source Type: research

Atrial Fibrillation Occurring During Head-up Tilt Test: Once detected, AF should be monitored, regardless of how it is detected
Atrial fibrillation (AF) often progresses to more sustained forms and raises the risk of ischemic stroke or sinus node dysfunction (SND). However, there has been no data on the clinical outcomes of AF developed during head-up tilt testing (HUT). (Source: Heart Rhythm)
Source: Heart Rhythm - December 4, 2018 Category: Cardiology Authors: Jun Hyung Kim, Sung Ho Lee, Seung-Jung Park, Kyoung Min Park, Young Keun On, June Soo Kim Source Type: research

Incidence and Impact of Early Postoperative Ventricular Arrhythmias after Congenital Heart Surgery
Postoperative arrhythmias following pediatric congenital heart disease (CHD) surgery are a known cause of morbidity and are associated with mortality. A comprehensive evaluation of early postoperative ventricular arrhythmias (VAs) after CHD surgery has not been reported. (Source: Heart Rhythm)
Source: Heart Rhythm - December 4, 2018 Category: Cardiology Authors: Sarah R. Fuchs, Andrew H. Smith, Sara L. Van Driest, Kim F. Crum, Todd L. Edwards, Prince J. Kannankeril Source Type: research

Left Atrial Appendage Closure Device Implantation in Patients with Prior Intracranial Hemorrhage
The Watchman ™ device (Boston Scientific, MN), used for left atrial appendage closure (LAAC) was approved for stroke prevention in patients with atrial fibrillation (AF) and an appropriate rationale to avoid long-term oral anticoagulation. Patients with AF and prior intracranial hemorrhage (ICH) were excluded from clinical trials due to perceived risks of peri-operative anticoagulation. (Source: Heart Rhythm)
Source: Heart Rhythm - December 2, 2018 Category: Cardiology Authors: Erika Hutt, Oussama M. Wazni, Walid I. Saliba, Mohamed Kanj, Khaldoun G. Tarakji, Jose Aguilera, Amr F. Barakat, Peter Rasmussen, Ken Uchino, Andrew Russman, Shazam Hussain, Dolora Wisco, Samir Kapadia, Bruce D. Lindsay, Ayman A. Hussein Source Type: research

Variant of Ventricular Outflow Tract Ventricular Arrhythmias Requiring Ablation From Multiple Sites: Intramural Origin
The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs) is challenging as activation mapping can reveal similar activation times suggesting an intramural origin. (Source: Heart Rhythm)
Source: Heart Rhythm - November 29, 2018 Category: Cardiology Authors: Luigi Di Biase, Jorge Romero, Erica S. Zado, Juan Carlos Diaz, Carola Gianni, Patrick M. Hranitzki, Javier E. Sanchez, Sanghamitra Mohanty, Amin Al-Ahmad, Prasant Mohanty, Chintan Trivedi, Domenico Della Rocca, Pasquale Santangeli, J. David Burkhardt, Fer Source Type: research

Impact of Hypertrophic Cardiomyopathy on Prediction of Thromboembolism in Patients with Non-valvular Atrial Fibrillation
Anticoagulation is recommended in hypertrophic cardiomyopathy (HCM) with non-valvular atrial fibrillation (NVAF) according to European and American guidelines. However, it is unclear whether HCM is a risk factor for thromboembolism in NVAF in Japan, and the management for NVAF with HCM is not established. (Source: Heart Rhythm)
Source: Heart Rhythm - November 29, 2018 Category: Cardiology Authors: Toyonobu Tsuda, Kenshi Hayashi, Noboru Fujino, Tetsuo Konno, Hayato Tada, Akihiro Nomura, Yoshihiro Tanaka, Kenji Sakata, Hiroshi Furusho, Masayuki Takamura, Masa-aki Kawashiri, Masakazu Yamagishi, Hokuriku-plus AF Registry Investigators Source Type: research

Two different P waves after a single ventricular premature beat in a 33-year-old man
A 33-year-old man came to the outpatient clinic because of palpitations. He noticed their occurrence during the last 3  months. He denied to have felt rapid heart rhythms. (Source: Heart Rhythm)
Source: Heart Rhythm - November 28, 2018 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research

Termination of a narrow complex tachycardia by a single extrastimulus: What is the mechanism?
A 49-year-old woman with symptomatic Wolff-Parkinson-White syndrome underwent diagnostic electrophysiological study because of rapid palpitations and ECG-documented narrow complex tachycardia (NCT). Echocardiography was normal. Baseline atrio-His and His-ventricular intervals were 69 ms and 29 ms, respectively. Her clinical tachycardia was induced by rapid ventricular pacing and repeatedly terminated by a single extrastimulus delivered from the distal bipoles of a decapolar catheter (2-5-2 mm spacing) positioned in a posterolateral branch of the coronary sinus (CS) (Figures  1 and 2). (Source: Heart Rhythm)
Source: Heart Rhythm - November 28, 2018 Category: Cardiology Authors: Jonathan P. Logue, Arnold J. Greenspon, Reginald T. Ho Tags: Unknown of the Month Source Type: research

Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation flow velocity
Electrical isolation of the left atrial appendage (LAA) is associated with a lower rate of atrial fibrillation (AF) recurrence in patients undergoing radiofrequency catheter ablation. However, LAA isolation can significantly impair LAA contractility. (Source: Heart Rhythm)
Source: Heart Rhythm - November 28, 2018 Category: Cardiology Authors: Yun Gi Kim, Jaemin Shim, Suk-Kyu Oh, Kwang-No Lee, Jong-Il Choi, Young-Hoon Kim Tags: Featured Article Source Type: research

Left atrial appendage isolation at the time of atrial fibrillation ablation
Since the description of pulmonary vein firing as a trigger for atrial fibrillation (AF),1 pulmonary vein isolation (PVI) has formed the cornerstone of AF ablation. The success rate of PVI has been as high as 65% –70% in patients with paroxysmal AF.2 However, the success rates for persistent AF and long-standing persistent AF ablation have been as low as 40% in some studies.3 This has prompted a search for extra-pulmonary vein targets in order to increase the effectiveness of ablation of persistent and lon g-standing persistent AF. (Source: Heart Rhythm)
Source: Heart Rhythm - November 28, 2018 Category: Cardiology Authors: Nishant Verma, Bradley P. Knight Tags: Editorial Commentary Source Type: research

Engagement and collaboration: Working to advance the HRS vision
The Heart Rhythm Society (HRS) vision “to end death and suffering due to heart rhythm disorders” is bold in stance and global in scope. Scientific advances and improvements in care delivery have provided us with better tools to treat potentially serious conditions such as atrial fibrillation and sudden cardiac arrest. However, world wide demographic, economic, and lifestyle trends have resulted in an increase in both the prevalence and the incidence of heart rhythm disorders. Accordingly, to reach our audacious goal, we will need to engage committed individuals and collaborate with other organizations, with a f...
Source: Heart Rhythm - November 28, 2018 Category: Cardiology Authors: Thomas F. Deering Tags: President's Page Source Type: research

Characterizing localised reentry with high resolution mapping: evidence for multiple slow conducting isthmuses within the circuit.
Reentry circuits are considered to be critically dependent on a single protected slow conducting isthmus. (Source: Heart Rhythm)
Source: Heart Rhythm - November 27, 2018 Category: Cardiology Authors: Antonio Frontera, Rajiv Mahajan, Corentin Dallet, Konstantinos Vlachos, Takeshi Kitamura, Ghassen Cheniti, Masateru Takigawa, Claire Martin, Josselin Duchateau, Anne Lam, Felix Bourier, Thomas Pambrun, Meleze Hocini, Frederic Sacher, Arnaud Denis, Nicolas Source Type: research

EP News: Basic and Translational
Long noncoding RNAs (lncRNAs) are non –protein-coding transcripts longer than 200 nucleotides that have recently been shown as one of the critical players in biological regulation. Zhang et al (Nat Commun 2018;9:4176, PMID 30301979) identified a unique lncRNA (AK045950) to be downregulated in a mouse model of heart failure (HF) and i n patients with HF. The downregulation results in the slowing of cardiac conduction and enhances arrhythmogenicity in HF. The authors named this unique lncRNA as cardiac conduction regulatory RNA (CCRR) and demonstrated that CCRR silencing induces arrhythmias in healthy mice. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

EP News: Allied Professionals
From a single center located in an area with a high prevalence of human immunodeficiency virus (HIV) infection, Alvi et  al (J Am Heart Assoc 2018;7:e009857, PMID 30371221) sought to assess the incidence, predictors, and effects of implantable cardioverter-defibrillator (ICD) therapy in patients living with HIV (PHIV). They studied a group of patients admitted for decompensated heart failure (HF) who had an ICD and who were followed up at their center. Using retrospective chart review, they assessed a number of clinical variables and follow-up data over a median follow-up of 19 months. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Case Reports
Primary cardiac tumors are rare and vary in their clinical manifestations. Some of the arrhythmia manifestations are sustained ventricular tachycardia (VT) and sudden death. If possible, symptomatic surgical resection is an upfront therapy. Haskova et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.10.007) shared a case of a 34-year-old man who presented with multiple repetitive monomorphic VTs of different morphologies. Cardiac magnetic resonance imaging (MRI) revealed a large intramyocardial tumor with features consistent with a fibroma. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Clinical
Sindet-Pedersen et  al (J Am Coll Cardiol 2018;72:1790, PMID 30286922) investigated the risk of bleeding, ischemic stroke, myocardial infarction (MI), and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with atrial fibrillation (AF) after MI and/or percutaneous coronary intervention (PCI). Overall, 3222 patients were included in the retrospective registry analysis; 875 (27%) were treated with VKA+single antiplatelet therapy (SAPT), 595 (18%) were treated with DOAC+SAPT, 1074 (33%) were treate...
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Arrhythmias in Myocarditis: State of the Art
Many kinds of arrhythmias may occur in patients with myocarditis at any stage of the disease. However, as compared to the other clinical presentations, arrhythmic myocarditis has been poorly described so far in the literature. In fact, arrhythmias occurring in either ongoing or previous myocardial inflammation are complex and heterogeneous, and the disease itself is often underdiagnosed, thus limiting data collection and interpretation. However, differently from the other clinical presenations, arrhythmic myocarditis require specific diagnostic, prognostic and therapeutic considerations. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: Giovanni Peretto, Simone Sala, Stefania Rizzo, Giacomo De Luca, Corrado Campochiaro, Silvia Sartorelli, Giulia Bendetti, Anna Palmisano, Antonio Esposito, Moreno Tresoldi, Gaetano Thiene, Cristina Basso, Paolo Della Bella Source Type: research

The Benefit of Implantable Cardioverter Defibrillators beyond the First Generator
Implantable Cardioverter-Defibrillators (ICDs) are life-saving and are placed based on guideline recommendations for primary or secondary prevention from fatal-arrhythmic death due to underlying cardiomyopathic processes [1]. Although the benefits of ICD therapy are clear, there are potential drawbacks such as inappropriate shocks which can lead to significant morbidity and may be associated with increased mortality [2]. Moreover, indwelling leads and devices are prone to bloodstream infections [3]. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: Christopher V. DeSimone, Yong-Mei Cha Source Type: research

Development of a Biomarker Panel to Predict Cardiac Resynchronization Therapy Response: Results from the SMART-AV Trial
Predicting a favorable cardiac resynchronization therapy (CRT) response holds great clinical importance. (Source: Heart Rhythm)
Source: Heart Rhythm - November 23, 2018 Category: Cardiology Authors: Francis G. Spinale, Timothy E. Meyer, Craig M. Stolen, Jennifer E. Van Eyk, Michael R. Gold, Suneet Mittal, Stacia DeSantis, Nicholas Wold, John F. Beshai, Kenneth M. Stein, Kenneth A. Ellenbogen Source Type: research

Epicardial connection between the right-sided pulmonary venous carina and right atrium in patients with atrial fibrillation: A possible mechanism for preclusion of pulmonary vein isolation without carina ablation
Ablation of the pulmonary venous (PV) carina is occasionally required for PV isolation (PVI) despite its non-essential role in ipsilateral PVI from the anatomical (endocardial) viewpoint. Although Bachmann ’s bundle (BB) is a common and main interatrial band, local variations of small tongues of muscular fibers were frequently found in autopsy studies. (Source: Heart Rhythm)
Source: Heart Rhythm - November 19, 2018 Category: Cardiology Authors: Kentaro Yoshida, Masako Baba, Yasutoshi Shinoda, Tomohiko Harunari, Yasuaki Tsumagari, Naoya Koda, Kosuke Hayashi, Takumi Yaguchi, Hiroaki Watabe, Hideyuki Hasebe, Kazutaka Aonuma, Noriyuki Takeyasu, Akihiko Nogami, Masaki Ieda Source Type: research

Predictability in Complex Atrial Arrhythmias: the N/N-1 Algorithm to Guide Ablation of Atrial Tachycardias
Macro-reentry atrial tachycardias (ATs) are some of the most challenging cases to accurately map and successfully ablate.1 Since patterns of scar and wavefront propagation are unique to each patient, the ablation procedure tends to be complex, time-consuming, and sometimes frustrating. Complex and detailed activation maps are painstakingly created, targets identified and the tachycardia circuit successfully ablated; but frequently this results in the induction of a second, slower atrial tachycardia that requires repeating the entire process. (Source: Heart Rhythm)
Source: Heart Rhythm - November 19, 2018 Category: Cardiology Authors: Daniel W. Kaiser, Albert J. Rogers, Sanjiv M. Narayan Source Type: research

Ventricular Tachycardia induced by Antitachycardia Pacing for Ventricular Tachycardia: Not so Pain Free?
Anti-tachycardia pacing (ATP) has an important role in reducing shocks and improving quality of life and device longevity in patients with ICDs and monomorphic ventricular tachycardia (VT)1-4. ATP interrupts reentry, presumably by blocking conduction in a reentry circuit. However, when multiple potential reentry paths are present, pacing can alter the reentry circuit path or initiate reentry in another circuit, changing the VT. The PainFree Rx II trial5 demonstrated that ATP was effective for fast (between 188 and 250 beat/min) VTs without increasing syncope or decreasing efficacy of a subsequent shock as compared to slowe...
Source: Heart Rhythm - November 19, 2018 Category: Cardiology Authors: Arvindh N. Kanagasundram, Roy M. John, William G. Stevenson Source Type: research

Infero-lateral J wave Syndromes: A Reflection of Abnormal Repolarization, Depolarization, or Both?
The pathophysiologic mechanisms underlying the J wave syndromes (JWS), including the Brugada (BrS) and early repolarization syndromes (ERS), remain a matter of debate. At the heart of the controversy is the question of whether the electrocardiographic (ECG) phenotypes and arrhythmogenic substrates are due principally to abnormal depolarization, repolarization, or both. (Source: Heart Rhythm)
Source: Heart Rhythm - November 19, 2018 Category: Cardiology Authors: Jos é M. Di Diego, Charles Antzelevitch Source Type: research

A Novel Pacing Maneuver to Verify the Post-Pacing Interval Minus the Tachycardia Cycle Length While Adjusting for Decremental Conduction: Using ‘Dual Chamber Entrainment’ for Improved Supraventricular Tachycardia Discrimination
The post-pacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (e.g. failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI-TCL challenging. (Source: Heart Rhythm)
Source: Heart Rhythm - November 19, 2018 Category: Cardiology Authors: Daniel W. Kaiser, Javed M. Nasir, L. Bing Liem, Chad Brodt, Kara S. Motonaga, Scott R. Ceresnak, Mintu P. Turakhia, Anne M. Dubin Source Type: research

A targeted next-generation gene panel reveals a novel heterozygous nonsense variant in TP63 gene in Arrhythmogenic Cardiomyopathy patients
Arrhythmogenic Cardiomyopathy (ACM) is associated with arrhythmias and risk of sudden death. Mutations in genes encoding proteins of cardiac intercalated discs account for about 60% of ACM cases, but the remaining 40% is still genetically elusive. (Source: Heart Rhythm)
Source: Heart Rhythm - November 16, 2018 Category: Cardiology Authors: Giulia Poloni, Martina Calore, Ilaria Rigato, Elena Marras, Giovanni Minervini, Elisa Mazzotti, Alessandra Lorenzon, Ilena Egle Astrid Li Mura, Andrea Telatin, Ivano Zara, Barbara Simionati, Martina Perazzolo Marra, Jessica Ponti, Gianluca Occhi, Libero V Source Type: research

Harmonized Outcome Measures for Use in Atrial Fibrillation Patient Registries and Clinical Practice
Atrial fibrillation (AF) affects an estimated 33 million people worldwide, leading to increased mortality and an increased risk of heart failure and stroke. Many AF patient registries exist, but the ability to link and compare data across registries is hindered by differences in the outcome measures collected by each registry and a lack of harmonization. (Source: Heart Rhythm)
Source: Heart Rhythm - November 15, 2018 Category: Cardiology Authors: Hugh Calkins, Richard E. Gliklich, Michelle B. Leavy, Jonathan P. Piccini, Jonathan C. Hsu, Sanghamitra Mohanty, William Lewis, Saman Nazarian, Mintu P. Turakhia Source Type: research

Preoperative Imaging in Search of Ventricular Tachycardia Circuit
Patients with structural heart disease, especially ischemic cardiomyopathy (ICM), have an increased risk of sudden cardiac death and ventricular tachycardia (VT).1 In most of these patients the VT is dependent on a critical area of slow conduction within the myocardium. This slow conduction area typically resides in the border zone region around dense scar areas where viable cardiomyocytes exist within the fibrotic tissue.2 Catheter ablation has been proven to be an effective treatment for VT and in some cases shown to be effective when done even prophylactically. (Source: Heart Rhythm)
Source: Heart Rhythm - November 13, 2018 Category: Cardiology Authors: Kennosuke Yamashita, Ravi Ranjan Source Type: research

The Small Conductance Calcium Activated Potassium Current Modulates the Ventricular Escape Rhythm in Normal Rabbit Hearts
The apamin-sensitive small-conductance calcium-activated K (SK) current (IKAS) modulates automaticity of the sinus node; IKAS blockade by apamin causes sinus bradycardia. (Source: Heart Rhythm)
Source: Heart Rhythm - November 13, 2018 Category: Cardiology Authors: Juyi Wan, Mu Chen, Zhuo Wang, Thomas H. Everett, Michael Rubart-von der Lohe, Changyu Shen, Zhilin Qu, James N. Weiss, Penelope A. Boyden, Peng-Sheng Chen Source Type: research

Pacemaker Lead Surveillance and Failure: Is There a Signal in the Noise?
No Conflicts (Source: Heart Rhythm)
Source: Heart Rhythm - November 9, 2018 Category: Cardiology Authors: Laurence D. Sterns Source Type: research

Lower sarcoplasmic reticulum Ca2+ threshold for triggering afterdepolarizations in diabetic rat hearts
Type-2 diabetes (T2D) increases the arrhythmias risk through incompletely elucidated mechanisms. Ventricular arrhythmias could be initiated by delayed afterdepolarizations (DADs) resulting from elevated spontaneous sarcoplasmic reticulum (SR) Ca2+ release (SR Ca2+ leak). (Source: Heart Rhythm)
Source: Heart Rhythm - November 7, 2018 Category: Cardiology Authors: Iuliana Popescu, Guo Yin, Sathya Velmurugan, Jeffrey R. Erickson, Florin Despa, Sanda Despa Source Type: research

Outcomes Following Implantable Cardioverter-Defibrillator Generator Replacement in Patients with Recovered Left Ventricular Systolic Function: the National Cardiovascular Data Registry
Some patients with heart failure (HF) experience recovery of left ventricular (LV) systolic function by the end of their ICD generator battery-life. Outcomes following generator replacement in this setting are poorly understood. (Source: Heart Rhythm)
Source: Heart Rhythm - November 7, 2018 Category: Cardiology Authors: Isac C. Thomas, Yongfei Wang, Vincent Y. See, Karl E. Minges, Jeptha P. Curtis, Jonathan C. Hsu Source Type: research

Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study
Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program. (Source: Heart Rhythm)
Source: Heart Rhythm - November 6, 2018 Category: Cardiology Authors: Alexander Romanov, Evgeny Pokushalov, Dmitry Ponomarev, Sevda Bayramova, Vitaliy Shabanov, Denis Losik, Ilya Stenin, Dmitry Elesin, Igor Mikheenko, Artem Strelnikov, David Sergeevichev, Boris Kozlov, Sunny S. Po, Jonathan S. Steinberg Source Type: research

Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery
Postoperative atrial fibrillation (POAF) frequently complicates cardiac surgery and is associated with worse outcomes. The cardiac autonomic nervous system is implicated in the pathogenesis of POAF. (Source: Heart Rhythm)
Source: Heart Rhythm - November 6, 2018 Category: Cardiology Authors: Nathan H. Waldron, Mary Cooter, John C. Haney, Jacob N. Schroder, Jeffrey G. Gaca, Shu S. Lin, Martin I. Sigurdsson, Marat Fudim, Mihai V. Podgoreanu, Mark Stafford-Smith, Carmelo A. Milano, Jonathan P. Piccini, Joseph P. Mathew Source Type: research

Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35% A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay
It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His-bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). (Source: Heart Rhythm)
Source: Heart Rhythm - November 6, 2018 Category: Cardiology Authors: David J. Slotwiner, Merritt H. Raitt, Freddy Del-Carpio Munoz, Naseer Nasser, Siva K. Mulpuru, Pamela N. Peterson Source Type: research

2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary
ACC/AHA TASK FORCE MEMBERS (Source: Heart Rhythm)
Source: Heart Rhythm - November 6, 2018 Category: Cardiology Authors: Fred M. Kusumoto, Mark H. Schoenfeld, Coletta Barrett, Richard Lee, James R. Edgerton, Joseph E. Marine, Kenneth A. Ellenbogen, Christopher J. McLeod, Michael R. Gold, Keith R. Oken, Nora F. Goldschlager, Kristen K. Patton, Robert M. Hamilton, Cara N. Pel Source Type: research

2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay
References 127 (Source: Heart Rhythm)
Source: Heart Rhythm - November 6, 2018 Category: Cardiology Authors: Fred M. Kusumoto, Mark H. Schoenfeld, Coletta Barrett, Richard Lee, James R. Edgerton, Joseph E. Marine, Kenneth A. Ellenbogen, Christopher J. McLeod, Michael R. Gold, Keith R. Oken, Nora F. Goldschlager, Kristen K. Patton, Robert M. Hamilton, Cara N. Pel Source Type: research

To the Editor —10-Second ECG-Based RMSSD as Valid Measure of HRV
We thank Lombardi et  al1 for highlighting the relevance of our article2 in their editorial comment, but we strongly disagree with their conclusion that the results of our study based on short-term heart rate variability (HRV) are “difficult to interpret.” We initially shared the same skepticism and concerns regard ing the utility of ultrashort HRV measurements based on 10-second ECGs, which is why we set out to extensively test this in a validation study3 before using 10-second root mean square of successive differences (RMSSD) in our recent publication. (Source: Heart Rhythm)
Source: Heart Rhythm - November 1, 2018 Category: Cardiology Authors: Balewgizie Sileshi Tegegne, Tengfei Man, Arie M. van Roon, Harri ëtte Riese, Harold Snieder Tags: Letter to the Editor Source Type: research

Reply to the Editor —10-Second ECG-Based RMSSD as Approximate Measure of HRV
In response to our editorial comment,1 Tegegne et  al confirm, in agreement with previous reports, that demographic factors (age and sex) are major determinants of RMSSD, a short-term heart rate variability (HRV) parameter. More intriguing was their finding that the contribution of lifestyle and psychosocial factors was very small.2 If one accepts , based on vast literature, that HRV analysis is the most suitable noninvasive methodology to evaluate autonomic sinus nodal modulations, it is surprising that lifestyle or psychosocial factors would not play a major role. (Source: Heart Rhythm)
Source: Heart Rhythm - November 1, 2018 Category: Cardiology Authors: Federico Lombardi, Marek Malik Source Type: research

A 10-second ECG-based Root Mean Square of Successive Differences is a valid and reliable measure of heart rate variability
We thank Lombardi et al.1for highlighting the relevance of our paper2 in their editorial comment, but strongly disagree with their conclusion that the results of our study based on short-term heart rate variability (HRV) are “difficult to interpret”. We initially shared the same skepticism and concerns regarding the utility of ultra-short HRV measurements based on 10-second ECGs, which is why we set out to extensively test this in a validation study3 prior to using 10-second Root Mean Square of Successive Difference s (RMSSD) in our recent publication2. (Source: Heart Rhythm)
Source: Heart Rhythm - November 1, 2018 Category: Cardiology Authors: Balewgizie Sileshi Tegegne, Tengfei Man, Arie M. van Roon, Harri ëtte Riese, Harold Snieder Source Type: research

Author ’s Reply - A 10-second ECG-based root mean square of successive RR differences is only an approximate measure of heart rate variability
Responding to our editorial1 ,Tegegne et al confirm, in agreement with previous reports, that demographic factors (age and sex) are major determinants of RMSSD, a short-term heart rate variability (HRV) parameter. More intriguing was their finding that the contribution of lifestyle and psychosocial factors was very small.2 If one accepts, based on vast literature, that HRV analysis is the most suitable non-invasive methodology to evaluate autonomic sinus nodal modulations; it is very surprising that lifestyle or psychosocial factors would not play a major role. (Source: Heart Rhythm)
Source: Heart Rhythm - November 1, 2018 Category: Cardiology Authors: Federico Lombardi, Marek Malik Source Type: research

Depolarization versus repolarization abnormality underlying inferolateral J wave syndromes – new concepts in sudden cardiac death with apparently normal hearts
Early repolarization indicates a distinct electrocardiographic phenotype affecting the junction between the QRS complex and the ST segment in inferolateral leads (inferolateral J-Wave Syndromes). It has been considered a benign electrocardiographic variant for decades, but recent clinical studies have demonstrated its arrhythmogenicity in a small subset, supported by experimental studies showing transmural dispersion of repolarization. Here, we review the current knowledge and the issues of risk stratification which limit clinical management. (Source: Heart Rhythm)
Source: Heart Rhythm - November 1, 2018 Category: Cardiology Authors: Michel Ha ïssaguerre, Koonlawee Nademanee, Mélèze Hocini, Ghassen Cheniti, Josselin Duchateau, Antonio Frontera, Frédéric Sacher, Nicolas Derval, Arnaud Denis, Thomas Pambrun, Rémi Dubois, Pierre Jaïs, David Benoist, Richard D. Walton, Akihiko Noga Source Type: research

A peculiar ECG after an intracardiac intervention in a 41-year-old woman
A 41-year-old woman was referred to our clinic 9 days after an intracardiac intervention was performed elsewhere because of frequent episodes of a narrow QRS tachycardia. The ECG on admission is shown in Figure  1. (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research

Wide and narrow QRS complex tachycardia with four different cycle lengths: What is the mechanism?
A 31-year-old man underwent electrophysiology study (EPS) because of episodes of palpitations with documented narrow and wide QRS complex tachycardia on 24-hour Holter ECG. Baseline ECG showed normal sinus rhythm without ventricular pre-excitation. At baseline, in sinus rhythm with RR interval of 1076 ms, AH (82 ms) and HV (35 ms) intervals were normal. During EPS, tachycardias with 4 different cycle lengths (CLs) were present and converted from one to the other. At first, tachycardia was easily inducible with incremental atrial pacing. (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Ivan Zeljkovic, Sven Knecht, Christian Sticherling, Michael K ühne Tags: Unknown of the Month Source Type: research

Stroke in patients with cardiovascular implantable electronic device infection undergoing transvenous lead removal
Stroke can be a devastating complication in patients with cardiovascular implantable electronic device (CIED) infection. Paradoxical septic embolism can occur in the presence of device leads and patent foramen ovale (PFO) via embolic dislodgment during transvenous lead removal (TLR). (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Justin Z. Lee, Pradyumna Agasthi, Ahmed K. Pasha, Claudia Tarin, Andrew S. Tseng, Nancy N. Diehl, David O. Hodge, Christopher V. DeSimone, Ammar M. Killu, Peter A. Brady, Krishna Kancharla, Fred M. Kusumoto, Komandoor Srivathsan, Michael J. Osborn, Raul E Tags: Featured Article Source Type: research

Competitive athletes with implantable cardioverter –defibrillators—How to program? Data from the Implantable Cardioverter–Defibrillator Sports Registry
Athletes with an implantable cardioverter –defibrillator (ICD) may require unique optimal device-based tachycardia programming. (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Brian Olshansky, Gourg Atteya, David Cannom, Hein Heidbuchel, Elizabeth Saarel, Ole-Gunnar Anfinsen, Alan Cheng, Michael R. Gold, Andreas M üssigbrodt, Kristen K. Patton, Leslie Saxon, Bruce Wilkoff, Rik Willems, James Dziura, Fangyong Li, Cynthia Brandt Source Type: research

A simple mechanism underlying the behavior of reentrant atrial tachycardia during ablation
Ablation of complexed atrial tachycardias (ATs) is difficult (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Masateru Takigawa, Nicolas Derval, Claire A. Martin, Konstantinos Vlachos, Arnaud Denis, Takeshi Kitamura, Ghassen Cheniti, Felix Bourier, Anna Lam, Ruairidh Martin, Antonio Frontera, Nathaniel Thompson, Gr égoire Massoullié, Michael Wolf, Josselin Duch Source Type: research

Competitive Athletes with Implantable Cardioverter Defibrillators - How to Program? Data from the Implantable Cardioverter Defibrillator Sports Registry
Athletes with ICDs may require unique optimal device-based tachycardia programming. (Source: Heart Rhythm)
Source: Heart Rhythm - October 30, 2018 Category: Cardiology Authors: Brian Olshansky, Gourg Atteya, David Cannom, Hein Heidbuchel, Elizabeth Saarel, Ole-Gunnar Anfinsen, Alan Cheng, Michael R. Gold, Andreas M üssigbrodt, Kristen K. Patton, Leslie Saxon, Bruce Wilkoff, Rik Willems, James Dziura, Fangyong Li, Cynthia Brandt Source Type: research

Intracardiac Pulsed Field Ablation: Proof of Feasibility in a Chronic Porcine Model
We examined feasibility and safety of lesion formation using high amplitude, bipolar pulsed electric fields delivered from a multi-electrode array catheter. (Source: Heart Rhythm)
Source: Heart Rhythm - October 29, 2018 Category: Cardiology Authors: Mark T. Stewart, David E. Haines, Atul Verma, Nicole Kirchhof, Noah Barka, Erin Grassl, Brian Howard Source Type: research

EP News: Clinical
Olgin et  al (N Engl J Med 2018;379:1205, PMID 30280654) randomly assigned patients with acute myocardial infarction and an ejection fraction of ≤35% to receive a wearable cardioverter-defibrillator (WCD) plus guideline-directed therapy (device group) or to receive only guideline-directed therapy (control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. (Source: Heart Rhythm)
Source: Heart Rhythm - October 27, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
In this single-center study, Bumgarner et  al (J Am Coll Cardiol 2018;71:2381, PMID 29535065) sought to validate the accuracy of atrial fibrillation (AF) detection provided via the Kardia band (KB) that is used with an Apple watch coupled with an application (app) that provides immediate assessment of the information obtained. The patient places their thumb on the sensor of the KB for 30 seconds to record. The app then adjudicates the rhythm as AF, possible AF, normal, or unclassified and informs the patient as the recording completes. (Source: Heart Rhythm)
Source: Heart Rhythm - October 27, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research