Combined Epicardial and Endocardial Ablation for Atrial Fibrillation: Best Practices and Guide to Hybrid Convergent Procedures
The absence of strategies to consistently and effectively address non-paroxysmal atrial fibrillation (AF) by nonpharmacologic interventions has represented a longstanding treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. (Source: Heart Rhythm)
Source: Heart Rhythm - October 8, 2020 Category: Cardiology Authors: Kevin J. Makati, Nitesh Sood, Lawrence S. Lee, Felix Yang, Christian C. Shults, David B. DeLurgio, Juraj Melichercik, Jaswinder S. Gill, Riyaz A. Kaba, Syed Ahsan, Rukshen Weerasooriya, Pragnesh Joshi, Nicolas Lellouche, Yuri Blaauw, Konstantinos Zannis, Source Type: research

EP News: Allied Professionals
Disclosures: None (Source: Heart Rhythm)
Source: Heart Rhythm - October 7, 2020 Category: Cardiology Authors: Erica S. Zado Source Type: research

EP News: Case Reports
Neurally-mediated syncope is a common cause of syncope in pediatric patients and when recurrent, can significantly impact quality of life. In these patients, exposure to enhanced parasympathetic tone can result in both significant sinus slowing and conduction delay through the AV node. Historically, these patients were often treated with a pacemaker. Recently, cardioneuroablation of parasympathetic ganglion and inputs has shown promise as a therapeutic approach in adults, but its role in pediatric patients remains unclear. (Source: Heart Rhythm)
Source: Heart Rhythm - October 5, 2020 Category: Cardiology Authors: T. Jared Bunch Source Type: research

Implant, Performance, and Retrieval of an Atrial Leadless Pacemaker in Sheep
Medtronic is developing an atrial Micra ™ Transcatheter Pacing System and associated retrieval system. (Source: Heart Rhythm)
Source: Heart Rhythm - October 5, 2020 Category: Cardiology Authors: Pierce J. Vatterott, Michael D. Eggen, Katie E. Hilpisch, Ron A. Drake, Vladimir Grubac, Tom A. Anderson, Brian P. Colin, Kevin R. Seifert, Mary Lauren Mesich, Luis C. Ramon Source Type: research

Critical repolarization gradients determine the induction of reentry-based torsades de pointes arrhythmia in models of long QT syndrome
Torsades de pointes arrhythmia is a potentially lethal polymorphic ventricular tachyarrhythmia (pVT) in the setting of long QT syndrome. Arrhythmia susceptibility is influenced by risk factors modifying repolarization. (Source: Heart Rhythm)
Source: Heart Rhythm - October 4, 2020 Category: Cardiology Authors: Mathilde R. Rivaud, Jason D. Bayer, Matthijs Cluitmans, Jeanne van der Waal, Laura R. Bear, Bastiaan J. Boukens, Charly Belterman, Lisa Gottlieb, Fanny Vaillant, Emma Abell, Remi Dubois, Veronique M.F. Meijborg, Ruben Coronel Source Type: research

Blood-based 8-hydroxy-2 ′-deoxyguanosine level: a potential diagnostic biomarker for Atrial Fibrillation
Recent research findings revealed key role for oxidative DNA damage in the pathogenesis of atrial fibrillation (AF). Therefore, a circulating oxidative DNA damage marker 8-hydroxy-2 ′-deoxyguanosine (8-OHdG) may represent a biomarker to stage AF and identify patients at risk for AF recurrence and POAF after treatment. (Source: Heart Rhythm)
Source: Heart Rhythm - October 3, 2020 Category: Cardiology Authors: Jin Li, Deli Zhang, Kennedy S. Ramos, Luci ënne Baks, Marit Wiersma, Eva A.H. Lanters, Ad J.J.C. Bogers, Natasja M.S de Groot, Bianca J.J.M. Brundel Source Type: research

Critical repolarization gradients determine the induction of reentry-based Torsade de Pointes arrhythmia in models of long QT syndrome.
Torsade de Pointes arrhythmia is a potentially lethal polymorphic ventricular tachyarrhythmia (pVT) in the setting of long QT syndrome. Arrhythmia susceptibility is influenced by risk factors modifying repolarization. (Source: Heart Rhythm)
Source: Heart Rhythm - October 3, 2020 Category: Cardiology Authors: Mathilde R. Rivaud, Jason D. Bayer, Matthijs Cluitmans, Jeanne van der Waal, Laura R. Bear, Bastiaan J. Boukens, Charly Belterman, Lisa Gottlieb, Fanny Vaillant, Emma Abell, Remi Dubois, Veronique M.F. Meijborg, Ruben Coronel Source Type: research

Left Atrial Appendage Occlusion Using Intracardiac Echocardiography
Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative prevention strategy for patients with non-valvular atrial fibrillation and contraindications to long term anticoagulation.1 In randomized trials studying the Watchman device (Boston Scientific, St. Paul, MN), implantation was performed under transesophageal (TEE) guidance.1 Use of TEE often mandates the presence of general anesthesia and an additional cardiologist or anesthesiologist to perform the TEE. This utilizes greater health care resources and adds additional complexity to the procedure. (Source: Heart Rhythm)
Source: Heart Rhythm - October 3, 2020 Category: Cardiology Authors: Apoor Patel, Rajesh Venkataraman, Paul Schurmann, Amish Dave, Miguel Valderrabano Source Type: research

Anticoagulation for Stroke Prevention in Patients With Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Review
Atrial fibrillation is the most common arrhythmia in patients with hypertrophic cardiomyopathy with a prevalence and incidence of 23% and 3.1% respectively. The risk of thromboembolism is high in patients with hypertrophic cardiomyopathy regardless of the CHADS2VASC score. This review includes five observational studies that focused on prevention of thromboembolism in patients with hypertrophic cardiomyopathy and atrial fibrillation. These papers evaluated and compared outcomes between patients on either warfarin or direct oral anticoagulants. (Source: Heart Rhythm)
Source: Heart Rhythm - October 2, 2020 Category: Cardiology Authors: M. Farhan Nasser, Sanjay Gandhi, Robert J. Siegel, Florian Rader Source Type: research

Ventricular-ventricular-atrial response after ventricular entrainment pacing for a narrow QRS tachycardia with intermittent atrioventricular dissociation: What is the mechanism?
In the Case presentation (Source: Heart Rhythm)
Source: Heart Rhythm - October 1, 2020 Category: Cardiology Authors: Atsushi Doi, Naoko Miyazaki, Tomohiko Goda, Takayuki Yamada Source Type: research

Mapping and ablation of clinical spontaneous perimitral atrial tachycardias using an ultra –high-resolution mapping system
Perimitral atrial tachycardias (PMATs) are common atrial tachycardias (ATs), yet their mechanisms vary. (Source: Heart Rhythm)
Source: Heart Rhythm - September 29, 2020 Category: Cardiology Authors: Shinsuke Miyazaki, Kanae Hasegawa, Kazuya Yamao, Eri Ishikawa, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Junya Yamaguchi, Yuichiro Shiomi, Naoto Tama, Hiroyuki Ikeda, Yoshitomo Fukuoka, Kentaro Ishida, Hiroyasu Uzui, Yoshito Iesaka, Hiroshi Tada Source Type: research

Mapping and ablation of clinical spontaneous peri-mitral atrial tachycardias using an ultra-high resolution mapping system
Peri-mitral atrial tachycardias (PMATs) are common ATs, yet the mechanisms vary. (Source: Heart Rhythm)
Source: Heart Rhythm - September 28, 2020 Category: Cardiology Authors: Shinsuke Miyazaki, Kanae Hasegawa, Kazuya Yamao, Eri Ishikawa, Moe Mukai, Daisetsu Aoyama, Minoru Nodera, Junya Yamaguchi, Yuichiro Shiomi, Naoto Tama, Hiroyuki Ikeda, Yoshitomo Fukuoka, Kentaro Ishida, Hiroyasu Uzui, Yoshito Iesaka, Hiroshi Tada Source Type: research

In Memoriam: Jian-Ming Li (Jimmy), MD, PhD, FHRS, FAHA
Jian-Ming Li (Jimmy) passed away from sudden cardiac arrest on June 12, 2020, in his home in Eagan, MN. His 2 daughters, Stephanie Li and Laura Li, and his wife, Min Hu, survive him. (Source: Heart Rhythm)
Source: Heart Rhythm - September 28, 2020 Category: Cardiology Authors: Dan Hu, Yong-Mei Cha Tags: In Memoriam Source Type: research

Celebrating Frank Marcus
Dear Dr. Marcus:As current President and immediate Past-President of the Heart Rhythm Society (HRS), we would like to extend our sincerest gratitude for all you have contributed to the field of electrophysiology. You have served as a mentor, educator, and role model for so many in our field. Although we may not have had the opportunity to work with you directly, we all have benefited immensely from your dedication to education, research, and patient care. We all have learned so much from you. Your pioneering work on arrhythmogenic right ventricular cardiomyopathy and catheter ablation has forever changed the lives of so ma...
Source: Heart Rhythm - September 28, 2020 Category: Cardiology Authors: Christine M. Albert, Andrea M. Russo Tags: Leadership Letter Source Type: research

Hein Wellens: A personal perspective
I consider it a great honor to be invited to write a memorial to our master teacher and friend, Hein Wellens. I first met him in 1975 during my sabbatical at Duke University. He was a great friend of John Gallagher and was invited to give a series of lectures. We were all taken by both the clarity of his presentations and the extraordinary depth of his knowledge. By that time, he had already established himself as a preeminent cardiologist and had published one of the most important texts in clinical electrophysiology (EP), namely “Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias,”...
Source: Heart Rhythm - September 28, 2020 Category: Cardiology Authors: Melvin M. Scheinman Tags: In Memoriam Source Type: research

Goodbye to Hein Wellens, my mentor, colleague, and friend
Hein Wellens died on June 9, 2020. His passing marks the loss of a giant among the founders of clinical electrophysiology. Rather than document his many seminal contributions to the origin and continued development of this field of medicine, I would like to briefly reminisce about my own relationship with Hein that began in 1976 and that has lasted my whole lifetime. (Source: Heart Rhythm)
Source: Heart Rhythm - September 28, 2020 Category: Cardiology Authors: Andrew L. Wit Tags: In Memoriam Source Type: research

Erratum
In the article, “Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study” by Pajaree Mongkhon, Laura Fanning, Wallis C.Y. Lau, PhD, et al published in the May 2020 issue of Heart Rhythm (2020;17:706--713), there were two errors. (Source: Heart Rhythm)
Source: Heart Rhythm - September 23, 2020 Category: Cardiology Tags: Erratum Source Type: research

Erratum
In the article, “Modern mapping and ablation techniques to treat ventricular arrhythmias from the left ventricular summit and interventricular septum” by Jorge Romero, Kalyanam Shivkumar, Miguel Valderrabano, et al published in the September 2020 issue of Heart Rhythm (2020;17:1609–1620), Dr Shivkumar’s fi rst name was misspelled. (Source: Heart Rhythm)
Source: Heart Rhythm - September 22, 2020 Category: Cardiology Source Type: research

Differentiating Hereditary Arrhythmogenic Right Ventricular Cardiomyopathy from Cardiac Sarcoidosis Fulfilling 2010 ARVC Task Force Criteria
Cardiac sarcoidosis (CS) may resemble the clinical presentation of arrhythmogenic right ventricular cardiomyopathy (ARVC). (Source: Heart Rhythm)
Source: Heart Rhythm - September 21, 2020 Category: Cardiology Authors: Alessio Gasperetti, Valentina Rossi, Alessandra Chiodini, Michela Casella, Sarah Costa, Deniz Akdis, Ronny B üchel, Antoine Deliniere, Etienne Pruvot, Christiane Gruner, Corrado Carbucicchio, Robert Manka, Antonio Dello Russo, Claudio Tondo, Corinna Brun Source Type: research

Real-time visualization of left inferior pulmonary vein isolation by ethanol infusion into the Marshall vein
A 64-year-old man diagnosed with persistent atrial fibrillation underwent a first ablation procedure. The ablation strategy consisted of liner ablations, including the roof, bottom, and mitral isthmus, as well as pulmonary vein isolation. Ethanol 5 mL was infused into the Marshall vein before pulmonary vein isolation while locating the Advisor HD grid mapping catheter (Abbott, St Paul, MN) and checking the real-time voltage map using the EnSite LiveView Dynamic Display (Abbott). First, the voltage colored area on the posterior side of the left inferior pulmonary vein was eliminated. (Source: Heart Rhythm)
Source: Heart Rhythm - September 19, 2020 Category: Cardiology Authors: Masayuki Ishimura, Masashi Yamamoto, Yoshiharu Himi, Yoshio Kobayashi Source Type: research

The real-time visualization of left inferior pulmonary vein isolation by ethanol infusion into the Marshall vein
A 64-year-old man diagnosed with persistent atrial fibrillation underwent a first ablation process. The ablation strategy consisted of liner ablations, including the roof, bottom, and mitral isthmus, as well as pulmonary vein isolation. Ethanol infusion of 5 mL into the Marshall vein was performed prior to pulmonary vein isolation while locating the AdvisorTM HD grid-mapping catheter (Abbott, St Paul, Minnesota, USA) and checking the real-time voltage map using the EnSiteTM LiveView Dynamic Display (Abbott). (Source: Heart Rhythm)
Source: Heart Rhythm - September 19, 2020 Category: Cardiology Authors: Masayuki Ishimura, Masashi Yamamoto, Yoshiharu Himi, Yoshio Kobayashi Source Type: research

Atrial Arrhythmias and Patient-Reported Outcomes in Adults with Congenital Heart Disease: an International Study
Atrial arrhythmias, i.e., intra-atrial reentrant tachycardia and atrial fibrillation, are a leading cause of morbidity and hospitalizations in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. (Source: Heart Rhythm)
Source: Heart Rhythm - September 18, 2020 Category: Cardiology Authors: Benjamin Casteigt, Michelle Samuel, Laurence Laplante, Azadeh Shohoudi, Silke Apers, Adrienne H. Kovacs, Koen Luyckx, Corina Thomet, Werner Budts, Junko Enomoto, Maayke A. Sluman, Chun-Wei Lu, Jamie L. Jackson, Stephen C. Cook, Shanthi Chidambarathanu, Lu Source Type: research

Effects of subcutaneous nerve stimulation with blindly inserted electrodes on ventricular rate control in a canine model of persistent atrial fibrillation
Subcutaneous nerve stimulation (ScNS) delivered directly to large subcutaneous nerves can be either antiarrhythmic or proarrhythmic, depending on the stimulus output. (Source: Heart Rhythm)
Source: Heart Rhythm - September 17, 2020 Category: Cardiology Authors: Takashi Kusayama, Juyi Wan, Yuan Yuan, Xiao Liu, Xiaochun Li, Changyu Shen, Michael C. Fishbein, Thomas H. Everett, Peng-Sheng Chen Source Type: research

Cardiac arrhythmias in epilepsy: Troublemaker, accomplice, or innocent bystander?
Patients with epilepsy experience an excess burden of morbidity and mortality. Premature death occurs at twice the rate expected for age, and sudden unexplained death in epilepsy (SUDEP) is the leading epilepsy-related cause of death.1 Peri-ictal arrhythmias were first described in the late 19th and 20th centuries.2 However, the clinical significance of heart rhythm disturbance in epilepsy and, in particular, their potential role in SUDEP remains unclear. Case reports and case series dominate the available literature, most commonly in the setting of inpatient video electroencephalography with the limitations of short-term ...
Source: Heart Rhythm - September 16, 2020 Category: Cardiology Authors: Julia C. Isbister, Raymond W. Sy, Christopher Semsarian Tags: EDITORIAL COMMENTARY Source Type: research

Cardiac Arrhythmiasin Epilepsy: Troublemaker, Accomplice or Innocent Bystander?
Patients with epilepsy experience an excess burden of morbidity and mortality. Premature death occurs at twice the rate expected for age, and sudden unexplained death in epilepsy (SUDEP) is the leading epilepsy-related cause of death.1 Peri-ictal arrhythmias were first described in the late 19th and 20th century.2 However, the clinical significance of heart rhythm disturbance in epilepsy and in particular, their potential role in SUDEP remains unclear. Case reports and case-series dominate the available literature, most commonly in the setting of inpatient video electroencephalography with the limitations of short-term mon...
Source: Heart Rhythm - September 16, 2020 Category: Cardiology Authors: Julia C. Isbister, Raymond W. Sy, Christopher Semsarian Source Type: research

Calcium signaling consequences of RyR2 mutations associated with CPVT1 introduced via CRISPR/Cas9 gene editing in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs): Comparison of RyR2-R420Q, F2483I and Q4201R
hiPSC-CMs created from catecholaminergic polymorphic ventricular tachycardia (CPVT1) patients have been used to study the pathology of CPVT1. (Source: Heart Rhythm)
Source: Heart Rhythm - September 11, 2020 Category: Cardiology Authors: Xiao-hua Zhang, Hua Wei, Yanli Xia, Martin Morad Source Type: research

Right bundle branch block –type wide QRS complex tachycardia with a reversed R/S complex in lead V6: Development and validation of electrocardiographic differentiation criteria
Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Minsu Kim, Chang Hee Kwon, Ji Hyun Lee, Ki Won Hwang, Hyung Oh Choi, Yong-Giun Kim, Kwang-No Lee, Jinhee Ahn, Hyoung-Seob Park, Gi-Byoung Nam Source Type: research

Lead-related superior vena cava syndrome: Management and outcomes
Superior vena cava (SVC) syndrome includes the clinical sequalae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important nonmalignant causes of this syndrome. There are little data on the effectiveness of venoplasty and lead extraction in the management of these patients. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Yingyot Arora, Roger G. Carrillo Source Type: research

Remote retrieval of automated external defibrillator data —Isn’t it about time?
It was 4:40 PM when the pager screeched its intrusive tone. I knew this meant only one thing —I’d be pushing off dinner plans yet again for the infamous “late admission.” The emergency department (ED) sign out was typical: 34M, syncope. OK, not so bad. I consulted my weathered pocket guide to get a head start on the case. Discharging this young man from the ED seemed like a real pos sibility! Little did I know, I would soon become part of a story my attending deemed “the case of my career.” (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Taylor L. Paskey, Noah Q. Haroian, Howard H. Weitz Tags: Creative Concepts Source Type: research

Right Bundle Branch Block-type Wide QRS Complex Tachycardia with a Reversed R/S Complex in Lead V6: Development and Validation of Electrocardiographic Differentiation Criteria
Differentiation of supraventricular tachycardia (SVT) with right bundle branch block (RBBB)-pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Minsu Kim, Chang Hee Kwon, Ji Hyun Lee, Ki Won Hwang, Hyung Oh Choi, Yong-Giun Kim, Kwang-No Lee, Jinhee Ahn, Hyoung-Seob Park, Gi-Byoung Nam Source Type: research

Remote Retrieval of Automated External Defibrillator (AED) Data - Isn ’t It About Time?
It was 4:40 pm when the pager screeched its intrusive tone. I knew this only meant one thing - I ’d be pushing off dinner plans yet again for the infamous “late admission.” The emergency department (ED) sign out was typical: 34M, syncope. Ok, not so bad. I consulted my weathered pocket guide to get a head start on the case. Discharging this young man from the ED seemed like a real possibi lity! Little did I know, I would soon become part of a story my attending deemed "the case of my career." (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Taylor L. Paskey, Noah Q. Haroian, Howard H. Weitz Source Type: research

Lead Related Superior Vena Cava Syndrome: Management and Outcomes
Superior Vena Cava (SVC) syndrome includes the clinical sequalae of facial and bilateral upper extremity edema, dizziness, and occasional syncope. Historically, most cases have been associated with malignancy and treatment is palliative. However, cardiac device leads have been identified as important non-malignant causes of this syndrome. There is little data on the effectiveness of venoplasty and lead extraction in the management of these patients. (Source: Heart Rhythm)
Source: Heart Rhythm - September 9, 2020 Category: Cardiology Authors: Yingyot Arora, Roger G. Carrillo Source Type: research

EP News: Allied Professionals
In the Prospective Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy (PRAETORIAN) trial, the investigators (Knops RE et al, N Engl J Med 2020;363:526-536. PMID:32757521) from Europe and the United States sought to compare subcutaneous implantable cardioverter defibrillator (SICD) with tradition tranvenous (TV) ICD systems in a randomized non-inferiority trial. Participants had an indication for ICD implantation, but no pacing indication (bradycardia pacing or cardiac resynchronization) and no history of ventricular tachycardia (VT) (Source: Heart Rhythm)
Source: Heart Rhythm - September 8, 2020 Category: Cardiology Authors: Erica S. Zado Source Type: research

EP News: Basic and Translational
The current phase 3 multi-center, randomized, double-blind, placebo-controlled trial (Olivotto et al, Lancet 2020, 10.1016/S0140-6736(20)31792-X; PMID: 32871100) was conducted to evaluate the efficacy and safety of mavacamten, a first-in-class cardiac myosin inhibitor, in symptomatic obstructive hypertrophic cardiomyopathy. Cardiac muscle hypercontractility is a key pathophysiological abnormality in hypertrophic cardiomyopathy. A total of 251 patients with hypertrophic cardiomyopathy with a left ventricular outflow tract (LVOT) gradient of 50 mm Hg or greater and New York Heart Association (NYHA) class II-III symptoms were...
Source: Heart Rhythm - September 8, 2020 Category: Cardiology Authors: Nipavan Chiamvimonvat Source Type: research

Cardiac arrhythmias and sudden unexpected death in epilepsy: Results of long-term monitoring
Cardiac rhythm and conduction disorders are common in patients with epilepsy and are presumably one of the leading causes of sudden unexpected death. There are only a few published reports on ictal cardiac arrhythmias detected by continuous monitoring, and the majority had a small sample size. (Source: Heart Rhythm)
Source: Heart Rhythm - September 7, 2020 Category: Cardiology Authors: Svetlana Serdyuk, Karapet Davtyan, Sergey Burd, Oksana Drapkina, Sergey Boytsov, Evgeniy Gusev, Arpi Topchyan Source Type: research

Safety of magnetic resonance imaging scanning in patients with cardiac resynchronization therapy –defibrillators incorporating quadripolar left ventricular leads
Magnetic resonance imaging (MRI) scanning of magnetic resonance (MR)-conditional cardiac implantable cardioverter-defibrillators (ICDs) can be performed safely following specific protocols. MRI safety with cardiac resynchronization therapy –defibrillators (CRT-Ds) incorporating quadripolar left ventricular (LV) leads is less clear. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Christopher A. Rinaldi, Paji J. Vitoff, Devi G. Nair, Robert Bernstein, Stavros E. Mountantonakis, Antonio Rapacciuolo, Nathan Carter, Hung Fat Tse, Ulrika Birgersdotter Green Source Type: research

EP News: Clinical
Knopps et  al (N Engl J Med 2020;383:526–536, PMID 32757521) conducted a noninferiority trial in patients with an indication for an implantable cardioverter-defibrillator (ICD) but no indication for pacing. Patients (N = 849) were randomized to receive a subcutaneous ICD (S-ICD; n = 426) or transvenous ICD (T-ICD; n = 423). The primary endpoint was the composite of device-related complications and inappropriate shocks. Secondary endpoints included death and appropriate shocks. Over 49.1 months, a primary endpoint event occurred in 68 S-ICD patients and 68 T-ICD patients (48-month incidence 15.1% and 15.7%, respe...
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: N.A. Mark Estes Tags: EP NEWS Source Type: research

Electrical and structural remodeling contribute to atrial fibrillation in type 2 diabetic db/db mice
Atrial fibrillation (AF) is highly prevalent in diabetes mellitus (DM), yet the basis for this is poorly understood. Type 2 DM may be associated with unique patterns of atrial electrical and structural remodeling; however, this has not been investigated in detail. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Loryn J. Bohne, Hailey J. Jansen, Irene Daniel, Tristan W. Dorey, Motahareh Moghtadaei, Darrell D. Belke, Martin Ezeani, Robert A. Rose Source Type: research

Safety of Magnetic Resonance Imaging Scanning in Patients with Cardiac Resynchronization Therapy Defibrillators Incorporating Quadripolar Left Ventricular Leads
Magnetic resonance imaging of MR Conditional cardiac implantable cardioverter-defibrillators (ICDs) can be safely scanned following specific protocols. MRI safety with cardiac resynchronization-therapy defibrillators (CRT-Ds) incorporating quadripolar left ventricular (LV) leads is less clear. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Christopher A. Rinaldi, Paji J. Vitoff, Devi G. Nair, Robert Bernstein, Stavros E. Mountantonakis, Antonio Rapacciuolo, Nathan Carter, Hung Fat Tse, Ulrika Birgersdotter Green Source Type: research

EP News: Case Reports
De Novo Subcutaneous Implantable Cardioverter-Defibrillator in Patient with Left Ventricular Assist Device (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: T. Jared Bunch Source Type: research

Computer versus Cardiologist: Is a machine learning algorithm able to outperform an expert in diagnosing phospholamban (PLN) p.Arg14del mutation on ECG?
Phospholamban (PLN) p.Arg14del mutation carriers are known to develop dilated and/or arrhythmogenic cardiomyopathy and typical electrocardiographic (ECG) features have been identified for diagnosis. Machine learning is a powerful tool used in ECG analysis and has shown to outperform cardiologists. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Hidde Bleijendaal, Lucas A. Ramos, Ricardo R. Lopes, Tom E. Verstraelen, Sarah W.E. Baalman, Marinka D. Oudkerk Pool, Fleur V.Y. Tjong, Francisco M. Melgarejo-Meseguer, F. Javier Gimeno-Blanes, Juan R. Gimeno-Blanes, Ahmad S. Amin, Michiel Winter, Henk A. Source Type: research

Cardiac arrhythmias and sudden unexpected death in epilepsy: results of long-time monitoring
Cardiac rhythm and conduction disorders are common in patients with epilepsy and are presumably one of the leading causes of sudden unexpected death. There are only a few published reports on ictal cardiac arrhythmias detected by continuous monitoring, and the majority had a small sample size. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Svetlana Serdyuk, Karapet Davtyan, Sergey Burd, Oksana Drapkina, Sergey Boytsov, Evgeniy Gusev, Arpi Topchyan Source Type: research

Effects of 60-Hertz Notch Filtering on Local Abnormal Ventricular Activities
It is known that electrical signals can be affected by notch filtering. (Source: Heart Rhythm)
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: Xiaoxiong Zhou, MD; Yunqiu Jiang, Daniel Sohinki, Wei Liu, Sunny S. Po Source Type: research

EP News Clinical September 2020
Knopps et al (N Engl J Med 2020;383(6):526-536. PMID: 32757521) conducted a noninferiority trial in patients with an indication for an ICD but no indication for pacing. Patients (849) were randomized to receive a subcutaneous ICD (S-ICD, 426) or transvenous ICD (T-ICD,423). The primary end point was the composite of device-related complications and inappropriate shocks. Secondary end points included death and appropriate shocks. Over 49.1 months, a primary end-point event occurred in 68 S-ICD patients and 68 T-ICD patients (48-month incidence, 15.1% and 15.7%, respectively; HR, 0.99; P = 0.01 for noninferiority; P = 0.95 f...
Source: Heart Rhythm - September 6, 2020 Category: Cardiology Authors: N. A. Mark Estes Source Type: research

Right Bundle Branch Block Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy More Commonly Originates from the Right Ventricle: Criteria for Identifying Chamber of Origin
Right-bundle branch block (RBBB) ventricular tachycardia (VT) morphology is a criterion for left ventricular (LV) involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC). (Source: Heart Rhythm)
Source: Heart Rhythm - August 31, 2020 Category: Cardiology Authors: Dylan F. Marchlinski, Cory M. Tschabrunn, Erica S. Zado, Pasquale Santangeli, Francis E. Marchlinski Source Type: research

Long QT syndrome type 1 and 2 patients respond differently to arrhythmic triggers: The TriQarr in  vivo study
In patients with long QT syndrome (LQTS), swimming and loud noises have been identified as genotype-specific arrhythmic triggers in LQTS type 1 (LQTS1) and LQTS type 2 (LQTS2), respectively. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2020 Category: Cardiology Authors: Peter Marstrand, Kasim Almatlouh, J ørgen K. Kanters, Claus Graff, Alex Hørby Christensen, Henning Bundgaard, Juliane Theilade Source Type: research

Long QT Syndrome Type 1 and 2 Patients Respond Differently to Arrhythmic Triggers – The TriQarr In Vivo Study
In patients with long QT syndrome (LQTS), swimming and loud noises have been identified as genotype-specific arrhythmic triggers in LQTS type 1 and LQTS type 2, respectively. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2020 Category: Cardiology Authors: Peter Marstrand, Kasim Almatlouh, J ørgen K. Kanters, Claus Graff, Alex Hørby Christensen, Henning Bundgaard, Juliane Theilade Source Type: research

Diagnostic utility of atrial entrainment for differentiation of long RP tachycardia
A 56-year-old man who had a history of paroxysmal supraventricular tachycardia (SVT) with a long RP interval was referred for electrophysiology study. Clinical tachycardia was induced spontaneously without an AH jump. A His refractory premature ventricular contraction (PVC) was delivered via the right ventricular (RV) electrodes, and the responses of tachycardia are shown in Figure  1A. The response of tachycardia to entrainment from the RV and distal coronary sinus are shown in Figures 1B and 1C, respectively. (Source: Heart Rhythm)
Source: Heart Rhythm - August 28, 2020 Category: Cardiology Authors: Jeong-Wook Park, Yeong-Woong Ha, Sung-Hwan Kim, Yong-Seog Oh Tags: Unknown of the Month Source Type: research

N-terminal pro –B-type natriuretic peptide is a specific predictor of appropriate device therapies in patients with primary prevention implantable cardioverter-defibrillators
Sudden death risk stratification of patients with left ventricular systolic dysfunction remains challenging. Retrospective studies have suggested N-terminal pro –B-type natriuretic peptide (NT-proBNP) may be a useful risk stratification tool. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2020 Category: Cardiology Authors: Jakub Sroubek, Jason Matos, Andrew Locke, Vladimir Kaplinskiy, Yehoshua C. Levine, Changyu Shen, Alfred E. Buxton Source Type: research

N-terminal pro-B-type natriuretic peptide is a specific predictor of appropriate device therapies in patients with primary prevention ICDs.
Sudden death risk stratification of patients with LV systolic dysfunction remains challenging. Retrospective studies have suggested N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be a useful risk-stratification tool. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2020 Category: Cardiology Authors: Jakub Sroubek, Jason Matos, Andrew Locke, Vladimir Kaplinskiy, Yehoshua C. Levine, Changyu Shen, Alfred E. Buxton Source Type: research