Minimally Invasive Percutaneous Epicardial Placement of a Prototype Miniature Pacemaker with Leadlet under Direct Visualization: A Feasibility Study in an Infant Porcine Model
Pacemaker implantation in infants is limited to epicardial lead placement and an abdominal generator pocket. We propose a minimally invasive solution using a prototype miniature pacemaker with a steroid-eluting leadlet that can affix against the epicardium under thoracoscopy. (Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Authors: Rohan N. Kumthekar, Justin D. Opfermann, Paige Mass, Bradley C. Clark, Jeffrey P. Moak, Elizabeth D. Sherwin, Teresa Whitman, Mark Marshall, Charles I. Berul Source Type: research

A regular rhythm showing a change in rate and QRS width in a 41-year-old woman
The ECG shown in Figure  1 was recorded in a 41-year-woman with a 3-year history of palpitations of sudden onset, which lasted a few minutes and terminated spontaneously. The frequency of those episodes had increased during the past 2 months. (Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research

HRS 40th anniversary viewpoints: What ’s it all about?
I am honored to be one of the individuals asked to write a point-of-view article in connection with the 40th anniversary of HRS/NASPE. In his invitation, Dr Chen stated, “The writer can talk about their career or anything else they would like to share.” I’ll do both. (Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Authors: Raymond E. Ideker Tags: Viewpoint Source Type: research

Left atrial appendage closure with the Watchman device using intracardiac vs transesophageal echocardiography: Procedural and cost considerations
Imaging guidance for left atrial appendage (LAA) closure (LAAC) conventionally consists of transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA). Intracardiac echocardiography (ICE) can eliminate the need for GA, expedite procedural logistics, and reduce the patient experience to a simple venous puncture. (Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Authors: Majd E. Hemam, Kenji Kuroki, Paul A. Schurmann, Amish S. Dave, Diego A. Rodr íguez, Luis C. Sáenz, Vivek Y. Reddy, Miguel Valderrábano Tags: Featured Article Source Type: research

Reviewer Thanks
(Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Source Type: research

Remarkable Reviewers
(Source: Heart Rhythm)
Source: Heart Rhythm - February 28, 2019 Category: Cardiology Source Type: research

Author ’s Reply to “Interpretation of Electrograms is key to Understand the Clinical Potential of Ecgi”
We thank Dr Cluitmans et al. for their interest in our work and for pinpointing some of the key challenges in ECGi. (Source: Heart Rhythm)
Source: Heart Rhythm - February 27, 2019 Category: Cardiology Authors: Josselin Duchateau, Michel Ha ïssaguerre, Rémi Dubois Source Type: research

Interpretation of electrograms is key to understand the clinical potential of ECGI
With great interest we read the publication of Duchateau et al. on clinical validation of noninvasive electrical activation mapping by comparing electrocardiographic imaging (ECGI) with epicardial invasive contact mapping.1 We commend the authors for performing this much-needed study, which helps to further define the value of ECGI in the cardiology clinic. Overall, we find the approach of these investigators sound, but we also consider that the paper falls short in explaining the reported discrepancies. (Source: Heart Rhythm)
Source: Heart Rhythm - February 27, 2019 Category: Cardiology Authors: Matthijs JM. Cluitmans, Job Stoks, Paul GA. Volders Source Type: research

Reply to the Editor —Interpretation of electrograms is key to understand the clinical potential of ECGi
We thank Cluitmans et  al for their interest in our work and for pinpointing some of the key challenges in electrocardiographic imaging. (Source: Heart Rhythm)
Source: Heart Rhythm - February 26, 2019 Category: Cardiology Authors: Josselin Duchateau, Michel Ha ïssaguerre, Rémi Dubois Source Type: research

To the Editor — Interpretation of electrograms is key to understand the clinical potential of ECGI
With great interest we read the article of Duchateau et  al1 on clinical validation of noninvasive electrical activation mapping by comparing electrocardiographic imaging (ECGI) with epicardial invasive contact mapping. We commend the authors for performing this much-needed study, which helps to further define the value of ECGI in the cardiology clinic. Overall, we find the approach of these investigators sound, but we also consider that the study falls short of explaining the reported discrepancies. (Source: Heart Rhythm)
Source: Heart Rhythm - February 26, 2019 Category: Cardiology Authors: Matthijs J.M. Cluitmans, Job Stoks, Paul G.A. Volders Tags: Letter to the Editor Source Type: research

Erratum
In the article titled “Acute biventricular hemodynamic effects of cardiac resynchronization therapy in right bundle branch block” that published in the October 2018 issue of Heart Rhythm (Heart Rhythm. 2018 Oct;15(10):1525-1532), there was an error in figure 3. (Source: Heart Rhythm)
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Tags: Erratum Source Type: research

Periodic Repolarization Dynamics as Risk Predictor after Myocardial Infarction: Prospective Validation Study
Periodic Repolarization Dynamics (PRD) is a novel electrocardiographic phenomenon that refers to sympathetic-activity associated low-frequency modulations of cardiac repolarization. Retrospective post myocardial infarction (MI) studies revealed that increased PRD indicates increased risk for subsequent death. (Source: Heart Rhythm)
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Authors: Konstantinos D. Rizas, Angela J. Doller, Wolfgang Hamm, Nikolay Vdovin, Lukas von Stuelpnagel, Christine S. Zuern, Axel Bauer Source Type: research

Cardiac Sympathectomy For Refractory Ventricular Arrhythmias in Cardiac Sarcoidosis
Ventricular arrhythmias (VA) in cardiac sarcoidosis (CS) are frequently refractory to both anti-arrhythmic drug therapy (AAD) and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter- defibrillator (ICD) shocks in patients with non-ischemic cardiomyopathy. (Source: Heart Rhythm)
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Authors: David R. Okada, Fabrizio R. Assis, Nisha A. Gilotra, Jinny S. Ha, Ronald D. Berger, Hugh Calkins, Jonathan Chrispin, Kaushik Mandal, Harikrishna Tandri Source Type: research

Evolution of Post-Pulmonary Vein Isolation Atrial Fibrillation Inducibility at Redo Ablation: Electrophysiological Evidence of Extra-Pulmonary Vein Substrate Progression
The electrophysiological substrate underlying atrial fibrillation (AF) progression remains difficult to identify. (Source: Heart Rhythm)
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Authors: Nicolas Johner, Dipen C. Shah, Georgios Giannakopoulos, Anne Girardet, Mehdi Namdar Source Type: research

Antiarrhythmic and proarrhythmic effects of subcutaneous nerve stimulation in ambulatory dogs
High output subcutaneous nerve stimulation (ScNS) remodels the stellate ganglia and suppresses cardiac arrhythmia. (Source: Heart Rhythm)
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Authors: Juyi Wan, Mu Chen, Yuan Yuan, Zhuo Wang, Changyu Shen, Michael C. Fishbein, Zhenhui Chen, Johnson Wong, Maria B. Grant, Thomas H. Everett, Peng-Sheng Chen Source Type: research

Why did this patient experience a sudden cardiac arrest? Follow your curiosity!
When a young individual survives a sudden cardiac arrest (SCA) in a neurologic intact state and there is no obvious noncardiac or reversible cause identified, a defibrillator is not infrequently implanted in the absence of a complete diagnostic workup. Unfortunately, an incomplete diagnostic workup increases the odds of a wrongful diagnosis of idiopathic ventricular fibrillation (IVF), because this is a diagnosis per exclusionem. Some “true” and partially overlapping IVF subtypes, e.g. short-coupled torsades de pointes1 including the Dutch IVF subtype linked to a haplotype containing the DPP6 gene2, have been i...
Source: Heart Rhythm - February 25, 2019 Category: Cardiology Authors: Christian van der Werf, Arthur A.M. Wilde Source Type: research

Evolution of post –pulmonary vein isolation atrial fibrillation inducibility at redo ablation: Electrophysiological evidence of extra–pulmonary vein substrate progression
The electrophysiological substrate underlying atrial fibrillation (AF) progression remains difficult to identify. (Source: Heart Rhythm)
Source: Heart Rhythm - February 24, 2019 Category: Cardiology Authors: Nicolas Johner, Dipen C. Shah, Georgios Giannakopoulos, Anne Girardet, Mehdi Namdar Source Type: research

Corrigendum
In the article titled “Acute biventricular hemodynamic effects of cardiac resynchronization therapy in right bundle branch block” that published in the October 2018 issue of Heart Rhythm (Heart Rhythm. 2018 Oct;15(10):1525-1532), there was an error in figure 3. (Source: Heart Rhythm)
Source: Heart Rhythm - February 24, 2019 Category: Cardiology Tags: Corrigendum Source Type: research

Periodic repolarization dynamics as a risk predictor after myocardial infarction: Prospective validation study
Periodic repolarization dynamics (PRD) is a novel electrocardiographic phenomenon that refers to sympathetic activity –associated low-frequency modulations of cardiac repolarization. Retrospective post–myocardial infarction (MI) studies revealed that increased PRD indicates an increased risk of subsequent death. (Source: Heart Rhythm)
Source: Heart Rhythm - February 24, 2019 Category: Cardiology Authors: Konstantinos D. Rizas, Angela J. Doller, Wolfgang Hamm, Nikolay Vdovin, Lukas von Stuelpnagel, Christine S. Zuern, Axel Bauer Source Type: research

EP News: Case Reports
Up to 4% of patients who receive an initial implantable cardioverter-defibrillator (ICD) or receive a generator replacement have an elevated defibrillation threshold (DFT). The current use of DF-4 devices and a trend toward implantation of single-coil vs dual-coil defibrillator leads have negatively affected simple programming changes that can improve DFTs. Mitra (DOI: https://doi.org/10.1016/j.hrcr.2018.10.006) shared a case of a 48-year-old man with arrhythmogenic right ventricular cardiomyopathy and refractory ventricular arrhythmias with an ICD the required battery replacement. (Source: Heart Rhythm)
Source: Heart Rhythm - February 23, 2019 Category: Cardiology Authors: T. Jared Bunch Source Type: research

EP News: Quality Improvement and Outcomes
In this issue of HeartRhythm, we present a new quarterly feature highlighting quality improvement in the delivery of heart rhythm care. These quarterly features will summarize key publications of relevance to the electrophysiology community and provide a forum for recognizing the growing importance of measuring, reporting, and improving the quality of heart rhythm care. (Source: Heart Rhythm)
Source: Heart Rhythm - February 21, 2019 Category: Cardiology Authors: Paul D. Varosy, Anne Marie Smith, Jonathan P. Piccini Tags: EP News Source Type: research

EP News: Clinical
Robinson et  al (Circulation 2019;139:313, PMID 30586734) prospectively evaluated noninvasive cardiac radioablation in adults with treatment-refractory episodes of ventricular tachycardia (VT) or cardiomyopathy related to premature ventricular contractions (PVCs). Arrhythmogenic scar was targeted using noninva sive anatomic and electric cardiac imaging with standard stereotactic body radiation. The primary safety end point was serious adverse events in the first 90 days. The primary efficacy end point was reduction in VT episodes or PVC burden. (Source: Heart Rhythm)
Source: Heart Rhythm - February 21, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
Using data from the American Heart Association ’s Get With the Guidelines – Atrial Fibrillation (GWTG-AFIB) program registry, Piccini et al (Circulation, January 31, 2019; Epub ahead of print, PMID 30700141) sought to assess whether adherence to guideline-directed oral anticoagulation (OAC) use would increase over time and whether this impr ovement would be associated with enhanced in-hospital outcomes. Data were obtained from 115 centers using the GWTG-AFIB program, which includes education for providers and patients along with tools to aid in shared decision making. (Source: Heart Rhythm)
Source: Heart Rhythm - February 21, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Basic and Translational
Right ventricular (RV) outflow tract (RVOT) is a common site of ventricular arrhythmias in the athlete ’s heart. In the present study, Gülan et al (Sci Rep 2019;9:100, PMID 30643204) tested the roles of RVOT in ventricular arrhythmias during exercise when the thin-walled RVOT is expected to be exposed to high wall shear stress (WSS). Phase contrast magnetic resonance imaging was used to obtain RV and RVOT flow patterns from 2 healthy athletic male proband’s hearts and 2 patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. (Source: Heart Rhythm)
Source: Heart Rhythm - February 21, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

Anchoring in a storm: the importance of substrate in polymorphic ventricular arrhythmias
Management of drug refractory recurrent polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) is a unique challenge in electrophysiology. When there is no reversible cause and medications are ineffective, patients face an immediately life-threatening condition and agonizing recurrent defibrillations. This situation represents a true EP emergency. The patient ’s clinical condition may deteriorate from the repeated shocks and/or prolonged periods of hypotension in the resuscitation effort requiring cardiopulmonary bypass or other forms of life-support. (Source: Heart Rhythm)
Source: Heart Rhythm - February 19, 2019 Category: Cardiology Authors: Jeffrey S. Arkles, Francis E. Marchlinski Source Type: research

Erratum
In the article “Prognostic efficacy of platelet count in patients with nonvalvular atrial fibrillation” by Jiesuck Park, et al that published in the February 2019 issue of Heart Rhythm (2019;16:197-203), the Methods noted that “Written informed consent was obtained from each participant for registration.” However, the study population was retrospectively analyzed based on the dedicated review of electronic medical records of the patients of a single center cohort. Therefore, the study protocol was waived from informed consent for the study population. (Source: Heart Rhythm)
Source: Heart Rhythm - February 15, 2019 Category: Cardiology Tags: Erratum Source Type: research

Feasibility Of Percutaneous Epicardial Mapping And Ablation For Refractory Atrial Fibrillation: Insights Into Substrate And Lesion Transmurality
Recurrences of atrial fibrillation (AF) after ablation have been attributed to conduction gaps and non-transmural ablation lesions (Source: Heart Rhythm)
Source: Heart Rhythm - February 15, 2019 Category: Cardiology Authors: Ruhong Jiang, Eric Buch, Jean Gima, Gaurav A. Upadhyay, Hemal M. Nayak, Andrew D. Beaser, Zaid Aziz, Kalyanam Shivkumar, Roderick Tung Source Type: research

Corrigendum
In the article “Prognostic efficacy of platelet count in patients with nonvalvular atrial fibrillation” by Jiesuck Park, et al that published in the February 2019 issue of Heart Rhythm (2019;16:197-203), the Methods noted that “Written informed consent was obtained from each participant for registration.” However, the study population was retrospectively analyzed based on the dedicated review of electronic medical records of the patients of a single center cohort. Therefore, the study protocol was waived from informed consent for the study population. (Source: Heart Rhythm)
Source: Heart Rhythm - February 14, 2019 Category: Cardiology Tags: Corrigendum Source Type: research

Autoimmune and inflammatory K+-channelopathies in cardiac arrhythmias: clinical evidence and molecular mechanisms.
Cardiac K+-channelopathies account for a significant proportion of arrhythmias and sudden cardiac death (SCD) in subjects without structural heart disease. It is well recognized that genetic defects are key factors in many cases and in practice, the term cardiac channelopathies currently coincides with that of inherited cardiac channelopathies. However, mounting evidence demonstrate that not only genetic alterations but also autoimmune and inflammatory factors can cause cardiac K+-channel dysfunction and arrhythmias in the setting of a structurally normal heart. (Source: Heart Rhythm)
Source: Heart Rhythm - February 14, 2019 Category: Cardiology Authors: Pier Leopoldo Capecchi, Franco Laghi-Pasini, Nabil El-Sherif, Yongixa QU, Mohamed Boutjdir, Pietro Enea Lazzerini Source Type: research

Internal insulation breaches in an implantable cardioverter-defibrillator lead with redundant conductors
Internal insulation breaches (IBR) may result ICD lead failure and adverse clinical events. Concerns exist that the Durata lead may be prone to IBR. (Source: Heart Rhythm)
Source: Heart Rhythm - February 14, 2019 Category: Cardiology Authors: Robert G. Hauser, Jay Sengupta, Edward J. Schloss, Larissa I. Stanberry, Moses K. Wananu, Raed Abdelhadi Source Type: research

Implication of Ventricular Pacing Burden and Atrial Pacing Therapies on the Progression of Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Atrial fibrillation (AF) is common after pacemaker implantation. Nevertheless, the impact of pacemaker algorithms in AF prevention is not well understood. (Source: Heart Rhythm)
Source: Heart Rhythm - February 14, 2019 Category: Cardiology Authors: Dian A. Munawar, Rajiv Mahajan, Thomas A. Agbaedeng, Anand Thiyagarajah, Darragh J. Twomey, Kashif Khokar, Catherine O ’Shea, Glenn D. Young, Kurt C. Roberts-Thomson, Muhammad Munawar, Dennis H. Lau, Prashanthan Sanders Source Type: research

Patient-Reported Triggers of Paroxysmal Atrial Fibrillation
Triggers for discrete atrial fibrillation (AF) events remain poorly studied and incompletely characterized. (Source: Heart Rhythm)
Source: Heart Rhythm - February 14, 2019 Category: Cardiology Authors: Christopher A. Groh, Madelaine Faulkner, Shiffen Getabecha, Victoria Taffe, Gregory Nah, Kathi Sigona, Debbe McCall, Mellanie True Hills, Kathleen Sciarappa, Mark J. Pletcher, Jeffrey E. Olgin, Gregory M. Marcus Source Type: research

Autoimmune and inflammatory K+ channelopathies in cardiac arrhythmias: Clinical evidence and molecular mechanisms
Cardiac K+ channelopathies account for a significant proportion of arrhythmias and sudden cardiac death (SCD) in subjects without structural heart disease. It is well recognized that genetic defects are key factors in many cases, and in practice, the term cardiac channelopathies currently coincides with inherited cardiac channelopathies. However, mounting evidence demonstrate that not only genetic alterations but also autoimmune and inflammatory factors can cause cardiac K+-channel dysfunction and arrhythmias in the setting of a structurally normal heart. (Source: Heart Rhythm)
Source: Heart Rhythm - February 13, 2019 Category: Cardiology Authors: Pier Leopoldo Capecchi, Franco Laghi-Pasini, Nabil El-Sherif, Yongixa Qu, Mohamed Boutjdir, Pietro Enea Lazzerini Tags: Contemporary Review Source Type: research

The 50 Year Anniversary of the His Bundle Recording and Pacing in Clinical Medicine
The discovery of the muscular connection between the atria and the ventricles was embroiled in controversy when Wilhelm His Jr. described the muscular connection in the heart that bears his name [1]. About the same time, Stanley Kent found multiple A-V connections [2] that were later found to be features of Wolff-Parkinson-White syndrome. Jesus Alanis and his associates [3] recorded the His bundle (HB) potential flanked by atrial and ventricular potentials. They were able to show that in atrial pacing with incremental frequencies, the atrium-to-His interval prolonged until only the atria potential remained with the loss of...
Source: Heart Rhythm - February 12, 2019 Category: Cardiology Authors: Benjamin J. Scherlag, Sunny S. Po Source Type: research

HRS 40th anniversary viewpoints: The 50-year anniversary of the His bundle recording and pacing in  clinical medicine
The discovery of the muscular connection between the atria and the ventricles was embroiled in controversy when Wilhelm His Jr1 described the muscular connection in the heart that bears his name. About the same time, Stanley Kent2 found multiple atrioventricular (AV) connections that were later found to be features of Wolff-Parkinson-White syndrome. Jesus Alanis and his associates3 recorded the His bundle (HB) potential flanked by atrial and ventricular potentials. They were able to show that in atrial pacing with incremental frequencies, the atrium-to-His interval prolonged until only the atria potential remained with the...
Source: Heart Rhythm - February 11, 2019 Category: Cardiology Authors: Benjamin J. Scherlag, Sunny S. Po Tags: Viewpoint Source Type: research

The 50-year anniversary of the His bundle recording and pacing in clinical medicine
The discovery of the muscular connection between the atria and the ventricles was embroiled in controversy when Wilhelm His Jr1 described the muscular connection in the heart that bears his name. About the same time, Stanley Kent2 found multiple atrioventricular (AV) connections that were later found to be features of Wolff-Parkinson-White syndrome. Jesus Alanis and his associates3 recorded the His bundle (HB) potential flanked by atrial and ventricular potentials. They were able to show that in atrial pacing with incremental frequencies, the atrium-to-His interval prolonged until only the atria potential remained with the...
Source: Heart Rhythm - February 11, 2019 Category: Cardiology Authors: Benjamin J. Scherlag, Sunny S. Po Tags: Viewpoint Source Type: research

Evidence of Relevant Electrical Connection between the Left Atrial Appendage and the Great Cardiac Vein During Catheter Ablation of Atrial Fibrillation
Atrial fibrillation (AF) triggers within the coronary sinus (CS)/great cardiac vein (GCV) and the left atrial appendage (LAA) have been recognized as non-pulmonary veins (PV) triggers of AF. (Source: Heart Rhythm)
Source: Heart Rhythm - February 11, 2019 Category: Cardiology Authors: Luigi Di Biase, Jorge Romero, David Briceno, Miguel Valderrabano, Javier E. Sanchez, Domenico G. Della Rocca, Prasant Mohanty, Rodney Horton, G. Joseph Gallinghouse, Sanghamitra Mohanty, Chintan Trivedi, Salwa Beheiry, Carola Gianni, Claude S. Elayi, J. D Source Type: research

Differentiation of Fasciculoventricular Fibers from Anteroseptal Accessory Pathways Using the Surface Electrocardiogram
Fasciculoventricular fibers (FVFs) are responsible for 1-5% of cases of asymptomatic pre-excitation on surface electrocardiogram (ECG). Unlike ventricular pre-excitation seen in Wolff-Parkinson-White (WPW) syndrome, FVFs are not associated with sudden cardiac death from pre-excited atrial fibrillation. (Source: Heart Rhythm)
Source: Heart Rhythm - February 11, 2019 Category: Cardiology Authors: Edward T. O ’Leary, Elizabeth S. Dewitt, Douglas Y. Mah, Kimberlee Gauvreau, Edward P. Walsh, Vassilios J. Bezzerides Source Type: research

Exercise Testing Oversights Underlie Missed and Delayed Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia in Young Sudden Cardiac Arrest Survivors
Catecholamingergic polymorphic ventricular tachycardia (CPVT) is characterized by adrenergically-induced VT, syncope, and sudden cardiac arrest (SCA). In the absence of structural disease, exercise-provoked premature ventricular contractions in bigeminy/couplets and non-sustained VT are highly predictive of CPVT. (Source: Heart Rhythm)
Source: Heart Rhythm - February 11, 2019 Category: Cardiology Authors: John R. Giudicessi, Michael J. Ackerman Source Type: research

Reply to the Editor —Performance and limitations of noninvasive activation mapping
We thank Dr Rudy for his remarkable contribution to the development of noninvasive electrocardiographic (ECG) mapping and for his interest in our work.1 The term ECGi was used in reference to an epicardial potential formulation using the method of fundamental solutions, as termed in previous publications. This method is used in the commercial system we evaluated. Historical validation of ECGi was performed by studying animal hearts placed in a tank filled with conductive saline, which we believe may overestimate the accuracy of the reconstruction. (Source: Heart Rhythm)
Source: Heart Rhythm - February 6, 2019 Category: Cardiology Authors: Josselin Duchateau, Michel Ha ïssaguerre, Rémi Dubois Source Type: research

Author reply to « Comments on ECGI and Activation Mapping »
Thank you for your remarkable contribution to the development of non-invasive ECG mapping and for your interest in our work1. The term ECGi was used in reference to an epicardial potential formulation using the method of fundamental solutions, as termed in prior publications. This method is used in the commercial system we evaluated. As you know, historical validation of ECGi was carried-out by studying animal hearts placed in a tank filled with conductive saline, which we believe may overestimate the accuracy of the reconstruction. (Source: Heart Rhythm)
Source: Heart Rhythm - February 6, 2019 Category: Cardiology Authors: Josselin Duchateau, Michel Ha ïssaguerre, Rémi Dubois Source Type: research

Reply to the Editor —Performance and limitations of noninvasive cardiac activation mapping
We thank Dr Rudy for his remarkable contribution to the development of noninvasive electrocardiographic (ECG) mapping and for his interest in our work.1 The term ECGi was used in reference to an epicardial potential formulation using the method of fundamental solutions, as termed in previous publications. This method is used in the commercial system we evaluated. Historical validation of ECGi was performed by studying animal hearts placed in a tank filled with conductive saline, which we believe may overestimate the accuracy of the reconstruction. (Source: Heart Rhythm)
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Josselin Duchateau, Michel Ha ïssaguerre, Rémi Dubois Tags: Letter to the Editor Source Type: research

Atrial Ca2+/calmodulin-dependent protein kinase II: A druggable master switch of atrial fibrillation-associated atrial remodeling?
Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased morbidity and mortality, with heart failure (HF) and thromboembolism including stroke being the major consequences.1 Thus, stroke prevention with oral anticoagulants is crucial, but highly challenging, for AF management in many patients.2,3 Although our understanding of the underlying molecular mechanisms promoting AF increased substantially over the years, contemporary approaches using drugs are only moderately effective and have substantial side effects, including proarrhythmia. (Source: Heart Rhythm)
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Dobromir Dobrev Tags: Editorial Commentary Source Type: research

Comments on ECGI and Activation Mapping
ECGI is a general approach for noninvasive reconstruction of epicardial potentials, from which activation-time and repolarization maps can be constructed. Duchateau1 compares noninvasive and invasive activation mapping, as conducted in their laboratory, using commercial systems. It is not general evaluation of ECGI. Accuracy of ECGI depends strongly on the exact methodology used and details of execution. Our laboratory experimental ECGI system employs armamentarium of custom methods/algorithms. Here I address points in Duchateau1 based on my extensive experience with ECGI. (Source: Heart Rhythm)
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Yoram Rudy Source Type: research

Atrial Ca2+/calmodulin-dependent Protein Kinase-II: a Druggable Master Switch of Atrial Fibrillation-Associated Atrial Remodeling?
Dr. Dobrev is on the Scientific Advisory Board of OMEICOS and ACESION and received speaker ’s fees for educational lectures from Boston Scientific, Novartis, and Bristol Myers Squibb. (Source: Heart Rhythm)
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Dobromir Dobrev Source Type: research

The sympathetic nervous system and arrhythmogenic right ventricular cardiomyopathy: Further evidence of a strong tie
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiac disorder characterized by a progressive fibrofatty replacement predominantly affecting the right ventricle (RV) with an epicardium to endocardium gradient. The cardiac sympathetic nervous system (SNS) is deeply involved in the pathogenesis of the disease suggesting a potential role for neuromodulation among the possible therapeutic approaches. (Source: Heart Rhythm)
Source: Heart Rhythm - February 5, 2019 Category: Cardiology Authors: Veronica Dusi, Gaetano M. De Ferrari Source Type: research

Letter to the Editor —ECG imaging and activation mapping
Electrocardiographic imaging (ECGi) is a general approach to noninvasive reconstruction of epicardial potentials, from which activation-time and repolarization maps can be constructed. Duchateau et  al1 compared noninvasive and invasive activation mapping, as conducted in their laboratory, using commercial systems. It is not a general evaluation of ECGi. The accuracy of ECGi depends strongly on the exact methodology used and the details of execution. Our laboratory experimental ECGi system us es an armamentarium of custom methods/algorithms. (Source: Heart Rhythm)
Source: Heart Rhythm - February 4, 2019 Category: Cardiology Authors: Yoram Rudy Source Type: research

Role of the Purkinje system in Heritable Arrhythmias
Much has been written about arrhythmias in structurally normal hearts. Here we have focused on rapid ventricular arrhythmias that occur in hearts where a pathogenic genetic variant has been found in families in which arrhythmias occur. We discuss these mutations in terms of their effect on cardiac cell electrical function and initiation of arrhythmias (see Supplement). In addition, we have focused on the Purkinje cell, their anatomic networks and molecular signatures as the sites of origin of arrhythmias. (Source: Heart Rhythm)
Source: Heart Rhythm - February 1, 2019 Category: Cardiology Authors: Arthur A.M. Wilde, Hasan Garan, Penelope A. Boyden Source Type: research

HRS 40th anniversary viewpoints: The journey is more important than the finish
I am often asked for advice by younger colleagues who have the (misplaced?) belief that since I have more gray hair than they do, I must have the wisdom to match. In responding, I  often stress several things that have guided me: family first; follow your heart; find a great mentor; focus and become expert in something; persevere even when (especially when!) the going gets tough. And most critical, remember that the journey is more important than the finish because life is a long race, not a sprint. (Source: Heart Rhythm)
Source: Heart Rhythm - February 1, 2019 Category: Cardiology Authors: Douglas P. Zipes Tags: Viewpoint Source Type: research

A wide QRS tachycardia followed by alternating bundle branch block
A 72-year-old man presented to the emergency department with palpitations and dizziness. His history revealed myocardial infarction 4 years ago. Figure  1 shows the electrocardiogram (ECG) on admission. The lower panel is the continuation of the upper panel. (Source: Heart Rhythm)
Source: Heart Rhythm - February 1, 2019 Category: Cardiology Authors: Hein J. Wellens Tags: Josephson and Wellens ECG Lessons: A Monthly Visit to the 12 Lead ECG Source Type: research