Electrocardiographic J Wave: Early Repolarization, Brugada Wave and Conduction Delay
J wave is a deflection between the QRS and ST segment of which polarity is commonly in the same major direction of the QRS complex. J wave may stand as a distinct delta wave following the QRS, or be partially buried inside of the QRS as QRS notching or slurring.1-3 Since J wave occurs at the junction that marks completion of ventricular depolarization and beginning of ventricular repolarization, it can be part of either conduction delay or early repolarization. In other words, J wave is simply an ECG definition that does not clearly tell us whether it belongs to ventricular depolarization or repolarization. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2018 Category: Cardiology Authors: Datun Qi, Yuan Gao, Gan-Xin Yan Source Type: research

Identification of paroxysmal atrial fibrillation subtypes in over 13,000 individuals
Paroxysmal atrial fibrillation (PAF) is broadly defined despite high variability in the occurrence and duration of PAF episodes. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2018 Category: Cardiology Authors: Nathan E. Wineinger, Paddy M. Barrett, Yunyue Zhang, Ikram Irfanullah, Evan D. Muse, Steven R. Steinhubl, Eric J. Topol Source Type: research

What have we learned in the last 20 years? A Comparison of a Modern Era Pediatric and Congenital Catheter Ablation Registry to Prior Pediatric Ablation Registries
Since the onset of pediatric catheter ablation, the pediatric electrophysiology community has reported outcomes via various registries (PAPCA and the Pediatric Catheter Ablation registry (PCAR)). Most recently, a modern era pediatric and congenital ablation registry (MAP-IT) was developed for eventual incorporation into the NCDR IMPACT registry. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2018 Category: Cardiology Authors: Anne M. Dubin, Neal W. Jorgensen, Andrew E. Radbill, David J. Bradley, Jennifer N. Silva, Sabrina Tsao, Ronald J. Kanter, Ronn E. Tanel, Bhavya Trivedi, Ming-Lon Young, Andreas Pflaumer, Jorge McCormack, Stephen P. Seslar Source Type: research

Letter to the Editor —TB or not TB? That is the question
We read with interest the article on the use of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography (PET) in patients with unexplained atrioventricular (AV) block.1 Danwade et  al1 identified a case of tuberculosis (TB) with a positive PET scan and concluded that TB may be an important cause of unexplained AV block in developing countries. (Source: Heart Rhythm)
Source: Heart Rhythm - August 13, 2018 Category: Cardiology Authors: Ashley Chin, Chisala Chisala Source Type: research

Reply to the Editor —TB or not TB: That is the question
Myocarditis due to granulomatous inflammation is being increasingly recognized now compared to past when the diagnosis was usually made during autopsy. It comprises cardiac sarcoidosis (CS), cardiac tuberculosis (CTB), and other rare granulomatous disorders. It presents as ventricular tachycardia, atrioventricular conduction block with or without cardiomyopathy, and heart failure. The paucity of constitutional symptoms and the lack of awareness result in delayed diagnosis. (Source: Heart Rhythm)
Source: Heart Rhythm - August 13, 2018 Category: Cardiology Authors: Tamiruddin A. Danwade, Calambur Narasimhan Source Type: research

TB or not TB? That is the question.
We read with interest the article on the use of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography (PET) in patients with unexplained atrioventricular (AV) block.(1) The authors identified a case of tuberculosis (TB) with a positive PET scan and conclude that TB may be an important cause of unexplained AV block in developing countries. (Source: Heart Rhythm)
Source: Heart Rhythm - August 13, 2018 Category: Cardiology Authors: Ashley Chin, Chisala Chisala Source Type: research

"TB OR NOT TB: That is the Question."
Myocarditis due to granulomatous inflammation is being increasingly recognised compared to past when the diagnosis was usually made during autopsy. It comprises cardiac sarcoidosis (CS), cardiac tuberculosis (CTB) and other rare granulomatous disorders. It presents as ventricular tachycardias, atrio-ventricular conduction blocks with or without cardiomyopathy and heart failure. Paucity of constitutional symptoms and lack of awareness results in delayed diagnosis. (Source: Heart Rhythm)
Source: Heart Rhythm - August 13, 2018 Category: Cardiology Authors: Tamiruddin A. Danwade, Calambur Narasimhan Source Type: research

Coronary artery compression from epicardial leads: More common than we think
A child with an epicardial pacemaker presented with sudden death at our institution, secondary to coronary artery compression. This case prompted enhanced surveillance of all patients with epicardial pacing or defibrillation systems. (Source: Heart Rhythm)
Source: Heart Rhythm - August 12, 2018 Category: Cardiology Authors: Douglas Y. Mah, Ashwin Prakash, Diego Porras, Francis Fynn-Thompson, Elizabeth S. DeWitt, Puja Banka Source Type: research

More epicardial electrode issues to remember
Cardiac pacing using epicardial electrodes has been an important tool since the beginning of cardiac pacing. This is especially true not only in small patients but also when the risk of thrombus formation is high or when no direct venous access to the ventricle exists (eg, after the Fontan procedure). It is also becoming more widely used in the adult population because of the increase in the adult congenital heart disease population and the need for left ventricular pacing when optimal coronary sinus lead position cannot be achieved. (Source: Heart Rhythm)
Source: Heart Rhythm - August 12, 2018 Category: Cardiology Authors: Gerald A. Serwer Tags: Editorial Commentary Source Type: research

Clinical presentation of ventricular-Hisian and ventricular-nodal accessory pathways
Narrow QRS tachycardia or premature beat with bystander atrial activation or ventricular-atrial dissociation is an unusual arrhythmia that can present diagnostic and therapeutic challenges. When ventricular-atrial conduction is robust, these arrhythmias can be difficult to distinguish from atrioventricular nodal reentry. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2018 Category: Cardiology Authors: Roy Chung, Oussama Wazni, Thomas Dresing, Mina Chung, Walid Saliba, Bruce Lindsay, Patrick Tchou Source Type: research

Updated Performance of the Micra Transcatheter Pacemaker in the Real-World Setting: A Comparison to the Investigational Study and a Transvenous Historical Control
Early results from the Micra investigational trial (IDE) and Micra post-approval registry (PAR) demonstrated excellent safety and efficacy performance; however, intermediate-term results across a large patient population in the real-world setting have not been evaluated. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2018 Category: Cardiology Authors: Mikhael F. El-Chami, Faisal Al-Samadi, Nicolas Clementy, Christophe Garweg, Jose Luis Martinez-Sande, Jonathan P. Piccini, Saverio Iacopino, Michael Lloyd, Xavier Vi ñolas Prat, Michael Dilou Jacobsen, Philippe Ritter, Jens Brock Johansen, Claudio Tondo, Source Type: research

Clinical Presentation of Ventricular-Hisian and Ventricular-Nodal Accessory Pathway
Narrow QRS tachycardia or premature beats (PB) with bystander atrial activation or ventricular-atrial (VA) dissociation is an unusual arrhythmia that can present diagnostic and therapeutic challenges. When VA conduction is robust, these arrhythmias can be difficult to distinguish from atrioventricular nodal reentry. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2018 Category: Cardiology Authors: Roy Chung, Oussama Wazni, Thomas Dresing, Mina Chung, Walid Saliba, Bruce Lindsay, Patrick Tchou Source Type: research

Device Longevity: Making Sense of the Tower of Babel
Dr. Kenneth Ellenbogen has received honoraria, lecture honoraria, grant support from Medtronic, and Boston Scientific; honoraria and consulting from St. Jude Medical, and honoraria and consulting from Biotronik. (Source: Heart Rhythm)
Source: Heart Rhythm - August 3, 2018 Category: Cardiology Authors: Gurukripa N. Kowlgi, Kenneth A. Ellenbogen Source Type: research

Chronic in  vivo angiotensin II administration differentially modulates the slow delayed rectifier channels in atrial and ventricular myocytes
In the heart, slow delayed rectifier channels provide outward currents (IKs) for action potential (AP) repolarization in a region- and context-dependent manner. In diseased hearts, chronic elevation of angiotensin II (Ang II) may remodel IKs in a region-dependent manner, contributing to atrial and ventricular arrhythmias of different mechanisms. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2018 Category: Cardiology Authors: Dimitar P. Zankov, Fadi N. Salloum, Min Jiang, Gea-Ny Tseng Source Type: research

Chronic In Vivo Angiotenisn Ii Administration Differentially Modulates The Slow Delayed Rectifier Channels In Atrial And Ventricular Myocytes
In the heart, slow delayed rectifier channels provide outward currents (IKs) for action potential (AP) repolarization in a region- and context-dependent manner. In diseased hearts, chronic elevation of angiotensin II (Ang II) may remodel IKs in a region-dependent manner, contributing to atrial and ventricular arrhythmias of different mechanisms. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2018 Category: Cardiology Authors: Dimitar P. Zankov, Fadi N. Salloum, Min Jiang, Gea-Ny Tseng Source Type: research

Minimally Invasive Transtracheal Cardiac Plexus Block for Sympathetic Neuromodulation
Bilateral thoracoscopic stellectomy has antiarrhythmic effects, however, the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window (APW), anterior to the trachea. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2018 Category: Cardiology Authors: Fabrizio R. Assis, Diana H. Yu, Xun Zhou, Sunjeet Sidhu, Anisha Bapna, Zoar J. Engelman, Satish Misra, David R. Okada, Jonathan Chrispin, Ronald Berger, Kaushik Mandal, Hans Lee, Harikrishna Tandri Source Type: research

Techniques for Reducing Air Bubble Intrusion into the Left Atrium during Radiofrequency Catheter and Cryoballoon Ablation Procedures: An Ex Vivo Study with a High-Resolution Camera
Air embolisms are serious complications during catheter ablation procedures. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2018 Category: Cardiology Authors: Mitsuru Takami, Ryudo Fujiwara, Yoichi Kijima, Ryoji Nagoshi, Amane Kozuki, Yasuhide Mochizuki, Hiroyuki Shibata, Shinsuke Nakano, Yusuke Fukuyama, Daichi Fujimoto, Shunsuke Kakizaki, Eri Masuko, Hiroyuki Kurimoto, Shokan Kyo, Tomohiro Miyata, Junya Shite Source Type: research

Accessory Pulmonary Vein Insertion into the Left Atrial Appendage Revealed During Intended Interventional LAA Occlusion
A 64-year-old male with paroxysmal atrial fibrillation and a recent stroke presented with internal carotid artery re-stenosis after prior angioplasty. Cardiovascular risk factors included arterial hypertension, hyperlipidemia, obesity, positive family history, heart failure, and active smoking. Due to high risk of cerebral ischemia as well as periinterventional bleeding complications, the patient was scheduled for interventional left atrial appendage (LAA) closure prior to carotid artery surgery. (Source: Heart Rhythm)
Source: Heart Rhythm - July 30, 2018 Category: Cardiology Authors: Octavian Maniuc, Jonas M üntze, Maria Moritz, Peter Nordbeck Source Type: research

Defibrillation testing and clinical outcomes after implantable cardioverter –defibrillator implantation in patients in atrial fibrillation at the time of implant: An analysis from the SIMPLE trial
The Shockless IMPLant Evaluation (SIMPLE) trial showed that defibrillation testing (DT) at the time of implantable cardioverter –defibrillator (ICD) implant did not improve shock efficacy or reduce mortality. There are no data regarding the risk of complications, including stroke, among patients with atrial fibrillation (AF) who undergo DT. (Source: Heart Rhythm)
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Stefan Bogdan, Michael Glikson, Stuart J. Connolly, Jia Wang, Stefan H. Hohnloser, Ursula Appl, Jorg Neuzener, Philippe Mabo, Xavier Vinolas, Frederick Gadler, Lieselot van Erven, Josef Kautzner, Brandi Meeks, Janice Pogue, Jeff S. Healey Source Type: research

Nonsynonymous TNNI3K mutations and phenotypes: More than a “simple” cardiomyopathy
In the past years, a plentitude of genes (and subsequently genetic variants) have been associated with the broad phenotypic spectrum of cardiomyopathies: hypertrophic cardiomyopathy (HCM), noncompaction (NCMP; left ventricular noncompaction [LVNC]), dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). In addition, the occasional overlap in clinical presentation seen using cardiac imaging and electrocardiography led to additional, more descriptive categories such as arrhythmogenic cardiomyopathy (AC) and detailed cardiomyopathy classifications in progres...
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Sven Dittmann, Eric Schulze-Bahr Tags: Editorial Commentary Source Type: research

Seeing is Believing: The Importance of Continuous Monitoring to Unmask the Real-World Atrial Fibrillation Recurrence after Ablation
Atrial fibrillation (AF) is a common arrhythmia encountered in clinical practice that contribute to hemodynamic abnormalities, thromboembolic events and hospitalizations.1 The prevalence of AF is around 1% in the general population, substantially increases with age and is estimated to reach 4% in 2050.2, 3 Compared with patients without AF, patients with AF has an increased risk of dementia (hazard ratio [HR]=1.56), myocardial infarction (HR=1.62), sudden cardiac death (HR=1.83), mortality (HR=2.61), heart failure (HR=3.31) and ischemic stroke (HR=3.34). (Source: Heart Rhythm)
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Ting-Yung Chang, Chin-Yu Lin, Shih-Ann Chen Source Type: research

Predicted Longevity of Contemporary Cardiac Implantable Electronic Devices: A Call for Industry-wide “Standardized” Reporting
Battery longevity is an important factor that may influence the selection of cardiac implantable electronic devices (CIEDs). Unfortunately, there remains a lack of industry-wide standardized reporting of predicted CIEDs longevity to facilitate informed decision making for implanting physicians and payers. (Source: Heart Rhythm)
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Dian A. Munawar, Rajiv Mahajan, Dominik Linz, Geoffrey R. Wong, Kashif B. Khokhar, Anand Thiyagarajah, Kadhim Kadhim, Mehrdad Emami, Ricardo Mishima, Adrian D. Elliott, Melissa E. Middeldorp, Kurt C. Roberts-Thompson, Glenn D. Young, Prashanthan Sanders, Source Type: research

Defibrillation testing and clinical outcomes after implantable cardioverter defibrillator implantation in patients in atrial fibrillation at the time of implant: An analysis from the SIMPLE trial
The Shockless IMPLant Evaluation (SIMPLE) showed that defibrillation testing (DT) at the time of implantable cardioverter defibrillator (ICD) implant did not improve shock efficacy or reduce mortality. There are no data regarding the risk of complications, including stroke, among patients with atrial fibrillation (AF) who undergo DT. (Source: Heart Rhythm)
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Stefan Bogdan, Michael Glikson, Stuart J. Connolly, Jia Wang, Stefan H. Hohnloser, Ursula Appl, Jorg Neuzener, Philippe Mabo, Xavier Vinolas, Frederick Gadler, Lieselot van Erven, Josef Kautzner, Brandi Meeks, Janice Pogue, Jeff S. Healey Source Type: research

Has Intravenous Sotalol Come of Age as An Alternative Treatment for Arrhythmias in the Young Heart?
Cardiac arrhythmias happen frequently enough in childhood that the pediatric electrophysiologist needs a diverse armamentarium of intravenous (IV) medications to treat acute arrhythmias. Cardiac ablation has proven very successful in eliminating the more common recurrent childhood arrhythmias. However, IV pharmacologic options to control acute-onset arrhythmias have been limited to a few choices in the current era, the effectiveness and safety of which continues to be debated.1,2,3 No prospective randomized trials exist comparing IV antiarrhythmic agents in terms of their efficacy in controlling specific arrhythmias or ass...
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Jeffrey P. Moak Source Type: research

Irreversible Electroporation: Proceed with Caution
Electroporation is a biological phenomenon that was discovered in the 1960s.1,2 It is characterized by disruption of lipid membrane and creation of nanoscale aqueous pathways (electropores) in the cell membrane, resulting from the delivery of high-voltage electrical pulses. These effects of strong electric field can last for seconds3,4 before the cell membrane recovers and reseals the electropores. This ability of the cell membrane to reseal electropores is referred to as ” reversible electroporation” and has been used for gene transfection5 (electrogenetherapy) and for introducing impermeable anti-cancer drugs...
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Kedar K. Aras, Igor R. Efimov Source Type: research

Non-synonymous TNNI3K mutations and phenotypes: More than a ‘simple’ cardiomyopathy
In the past years, a plentitude of genes (and subsequently genetic variants) have been associated with the broad phenotypic spectrum of cardiomyopathies, i.e. hypertrophic (HCM), non-compaction (NCMP/LVNC), dilated (DCM), restrictive (RCM) and arrhythmogenic right ventricular (ARVC) cardiomyopathy. In addition, the occasionally occurring overlap in clinical presentation using cardiac imaging and electrocardiography led to additional, more descriptive categories such as ‘arrhythmogenic cardiomyopathy’ (AC) and detailed cardiomyopathy classifications in progress. (Source: Heart Rhythm)
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Sven Dittmann, Eric Schulze-Bahr Source Type: research

Response of secondary mitral regurgitation to cardiac resynchronization therapy: is the atrium to blame?
Secondary mitral regurgitation (MR) is common in patients eligible for cardiac resynchronization therapy (CRT). The prevalence is estimated between 15% in NYHA functional class I-II patients and 40% in NYHA class III-IV patients.1 The mechanisms underlying secondary MR in this population are multifactorial. Left ventricular (LV) and mitral annulus dilatation due to ischemic or non-ischemic cardiomyopathy impair leaflet coaptation of a structurally normal mitral valve resulting in functional MR. More specifically in CRT candidates, mechanical dyssynchrony, together with LV dysfunction contributes to apical and lateral papil...
Source: Heart Rhythm - July 28, 2018 Category: Cardiology Authors: Vincent Galand, Raphael P. Martins, Claude Daubert Source Type: research

A narrow QRS tachycardia showing ventriculoatrial conduction lengthening during catheter ablation
The patient was a 34-year-old man with a 4-year history of episodes of rapid heart rates that varied in duration from a few minutes to several hours. The ECG recorded during sinus rhythm showed AV conduction over a right posteroseptal accessory pathway (AP). (Source: Heart Rhythm)
Source: Heart Rhythm - July 27, 2018 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research

Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience
Pulmonary vein isolation (PVI) in conjunction with isolation of the posterior left atrial wall (PVI+PWI) is associated with improved clinical outcomes in certain patients with atrial fibrillation (AF). (Source: Heart Rhythm)
Source: Heart Rhythm - July 27, 2018 Category: Cardiology Authors: Arash Aryana, James H. Baker, Martin A. Espinosa Ginic, Deep K. Pujara, Mark R. Bowers, P. Gearoid O ’Neill, Kenneth A. Ellenbogen, Luigi Di Biase, André d’Avila, Andrea Natale Tags: Featured Article Source Type: research

Using the cryoballoon for posterior wall isolation: Thinking inside “the box”
Catheter ablation for paroxysmal atrial fibrillation (AF) is becoming increasingly common, particularly as success rates improve. In this population, pulmonary vein (PV) isolation (PVI) is the cornerstone of therapy.1,2 However, in patients with persistent AF, the optimal lesion set has not been determined. While small studies have demonstrated that additional ablation beyond PVI is associated with decreased AF recurrence, randomized data have not corroborated this notion.3 –5 The combination of PVI and posterior wall isolation (PWI) is an attractive lesion set for a number of reasons. (Source: Heart Rhythm)
Source: Heart Rhythm - July 27, 2018 Category: Cardiology Authors: Travis Richardson, Gregory F. Michaud Tags: Editorial Commentary Source Type: research

Adaptive Servo-Ventilation reduces Atrial Fibrillation Burden in Patients with Heart Failure and Sleep Apnea
Patients with heart failure and sleep apnea are at increased risk of developing arrhythmias. It is unknown whether treatment of sleep apnea reduces arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - July 27, 2018 Category: Cardiology Authors: Jonathan P. Piccini, Sean D. Pokorney, Kevin J. Anstrom, Olaf Oldenburg, Naresh M. Punjabi, Mona Fiuzat, Gudaye Tasissa, David J. Whellan, JoAnn Lindenfeld, Adam Benjafield, Holger Woehrle, Amy Blase, Christopher M. O ’Connor Source Type: research

EP News: Clinical
Tseng et  al (Circulation 2018;137:2689, PMID 29915095) conducted a medical examiner–based investigation to determine the incidence and autopsy-defined causes of all sudden cardiac deaths (SCDs). Over a 3-year period beginning in 2011, all incident adult deaths from out-of-hospital cardiac arrest were pro spectively identified for autopsy, toxicology, and histology. Comprehensive records were evaluated to determine whether out-of-hospital cardiac arrest deaths met World Health Organization (WHO) criteria for SCD. (Source: Heart Rhythm)
Source: Heart Rhythm - July 26, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Basic and Translational
While SCN5A is the cardiac sodium channel gene, the role of SCN10A in cardiac conduction is not well characterized. Macri et  al (Circ Genom Precis Med 2018;11:e001663, PMID 29752399) sequenced SCN10A locus in 3699 European-ancestry individuals to identify variants associated with cardiac conduction and replicated findings in 21,000 individuals of European ancestry. They examined human atrial tissues and the biophysics o f ion channel function and identified 2 intronic single nucleotide polymorphisms in high linkage disequilibrium with each other to be the strongest signals for PR and QRS intervals. (Source: Heart Rhythm)
Source: Heart Rhythm - July 26, 2018 Category: Cardiology Authors: Penelope A. Boyden Tags: EP News Source Type: research

EP News: Heart Rhythm Case Reports
HBP is as an alternative to ventricular pacing and can minimize electrical and mechanical dyssynchrony. Lead-related tricuspid valve dysfunction is a known complication of transvenous systems and can negatively affect long-term outcomes. Optimization of HBP may result in the lead insertion site at the atrial or ventricular aspect of the His bundle. Hasumi et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.06.003) presented a case series of 45 patients who underwent HBP. In 6 patients (13%), the lead was placed on the tricuspid valve or under it. (Source: Heart Rhythm)
Source: Heart Rhythm - July 26, 2018 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Allied Professionals
Using data on patients in the United States Renal Data System (USRDS), Siontis et  al (Circulation 2018; https://doi.org/10.1161/CIRCULATIONAHA.118.035418 [Epub ahead of print], PMID 29954737) sought to assess patterns of apixaban use and outcomes related to use of anticoagulants in patients with end-stage renal disease (ESRD) and atrial fibrillation (AF). As background, patient s with ESRD have both higher risk of bleeding and higher risk of stroke with AF. The Food and Drug Administration has approved updated labeling for the use of apixaban in patients with ESRD on the basis of a small pharmacokinetic study. (Source: Heart Rhythm)
Source: Heart Rhythm - July 26, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

Incidence, patterns, and outcomes after transvenous cardiac device lead macrodislodgment: Insights from a population-based study
Lead dislodgment is a relatively infrequent complication after implantation of transvenous cardiac implantable electronic devices (CIEDs). The incidence of lead dislodgment is estimated at 1% –8%.1,2 Lead macrodislodgment (LMD) refers to leads that are grossly dislodged as seen on chest radiography or other cross-sectional imaging studies. Previous studies categorized the various types and mechanisms of LMD using the terms twiddler, reel, reverse reel, and ratchet syndrome.3–6 Patien t characteristics such as female sex, obesity, and presence of multiple transvenous leads have been associated with LMD. (Source: Heart Rhythm)
Source: Heart Rhythm - July 24, 2018 Category: Cardiology Authors: Andrew S. Tseng, Justin N. Shipman, Justin Z. Lee, Lanyu Mi, Mustapha Amin, Ammar M. Killu, Abhishek Deshmukh, Malini Madhavan, Christopher J. McLeod, Komandoor K. Srivathsan, Win-Kuang Shen, Michael J. Osborn, Yong-Mei Cha, Samuel J. Asirvatham, Paul A. Tags: Creative Concepts Source Type: research

Incidence, Patterns, and Outcomes following Transvenous Cardiac Device Lead Macrodislodgement: Insights from a Population-Based Study
Lead dislodgement is a relatively infrequent complication after implantation of transvenous cardiac implantable electronic devices (CIED). The incidence of lead dislodgement is estimated at 1%-8% 1, 2. Lead macro dislodgement (LMD) refers to leads that are grossly dislodged as seen on chest radiography or other cross-sectional imaging studies. Previous studies categorized the various types and mechanisms of LMD using the terms “twiddler,” “reel,” “reverse reel” and “ratchet syndrome” 3-6. Patient characteristics such as female sex, obesity and the presence of multiple transve...
Source: Heart Rhythm - July 24, 2018 Category: Cardiology Authors: Andrew S. Tseng, Justin N. Shipman, Justin Z. Lee, Lanyu Mi, Mustapha Amin, Ammar M. Killu, Abhishek Deshmukh, Malini Madhavan, Christopher J. McLeod, Komandoor K. Srivathsan, Win-Kuang Shen, Michael J. Osborn, Yong-Mei Cha, Samuel J. Asirvatham, Paul A. Source Type: research

Dynamicity of hypothermia-induced J waves and the mechanism involved
J waves develop during hypothermia, but the dynamicity of hypothermia-induced J waves is poorly understood. (Source: Heart Rhythm)
Source: Heart Rhythm - July 23, 2018 Category: Cardiology Authors: Yoshifusa Aizawa, Yukio Hosaka, Hirotaka Oda, Koichi Fuse, Masaaki Okabe, Yoshiaki Kaneko, Naohiko Takahashi, Hirofumi Zaizen, Yoshiyasu Aizawa, Keiichi Fukuda Tags: Clinical Source Type: research

Silent cerebral embolism in cryoballoon ablation of atrial fibrillation: When details matter
Although the clinically manifest stroke rate related to pulmonary vein isolation (PVI) is rare and currently (Source: Heart Rhythm)
Source: Heart Rhythm - July 23, 2018 Category: Cardiology Authors: Jacopo Marazzato, Roberto De Ponti Tags: Editorial Commentary Source Type: research

Dynamicity of Hypothermia-Induced J Waves and the Mechanism
J waves develop during hypothermia, but the dynamicity of hypothermia-induced J waves is poorly understood. (Source: Heart Rhythm)
Source: Heart Rhythm - July 23, 2018 Category: Cardiology Authors: Yoshifusa Aizawa, Yukio Hosaka, Hirotaka Oda, Koichi Fuse, Masaaki Okabe, Yoshiaki Kaneko, Naohiko Takahashi, Hirofumi Zaizen, Yoshiyasu Aizawa, Keiichi Fukuda Source Type: research

Silent cerebral embolism in cryoballoon ablation of atrial fibrillation: when details matter.
Although the clinically manifest stroke rate related to pulmonary vein isolation (PVI) is rare and currently (Source: Heart Rhythm)
Source: Heart Rhythm - July 23, 2018 Category: Cardiology Authors: Jacopo Marazzato, Roberto De Ponti Source Type: research

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

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

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

Effect of bipolar electrode orientation on local electrogram properties
The direct effect of bipolar orientation on electrograms (EGMs) remains unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Masateru Takigawa, Jatin Relan, Ruairidh Martin, Steven Kim, Takeshi Kitamura, Antonio Frontera, Ghassen Cheniti, Konstantinos Vlachos, Gr égoire Massoullié, Claire A. Martin, Nathaniel Thompson, Michael Wolf, Felix Bourier, Anna Lam, Josselin Duchateau Tags: Clinical Source Type: research

Importance of bipolar electrode orientation on local electrogram properties
The direct effect of bipolar orientation on electrograms (EGMs) remains unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Masateru Takigawa, Jatin Relan, Ruairidh Martin, Steven Kim, Takeshi Kitamura, Antonio Frontera, Ghassen Cheniti, Konstantinos Vlachos, Gr égoire Massoullié, Claire A. Martin, Nathaniel Thompson, Michael Wolf, Felix Bourier, Anna Lam, Josselin Duchateau Source Type: research

Cryoballoon or contact force –guided radiofrequency catheter ablation for persistent atrial fibrillation: Different strategies with similar results
Since the identification of pulmonary triggers in the genesis of atrial fibrillation,1 pulmonary vein isolation (PVI) has emerged as an established treatment of several forms of atrial fibrillation (AF) in humans and has remained a constant component of most strategies for catheter ablation of AF. Current guidelines support the use of this treatment for AF refractory to antiarrhythmic drugs or as first-line therapy in selected cases.2 There is uncertainty about the best strategy for AF ablation, and despite improvements in technology and techniques, outcomes are still suboptimal, especially for persistent AF. (Source: Heart Rhythm)
Source: Heart Rhythm - July 16, 2018 Category: Cardiology Authors: Justin Hayase, Eric Buch Tags: Editorial Commentary Source Type: research

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

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

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