Incidence of sleep apnea and association with atrial fibrillation in an unselected pacemaker population: results from the observational RESPIRE study
Patients with atrial fibrillation (AF) often have sleep apnea (SA), but diagnosis of SA with polysomnography is costly. SA monitoring (SAM) is a pacemaker feature that measures respiratory disturbance index (RDI), the sum of abnormal respiratory events divided by sleep duration. (Source: Heart Rhythm)
Source: Heart Rhythm - September 4, 2019 Category: Cardiology Authors: Julio Marti-Almor, Pedro Marques, Laurence Jesel, Rodrigue Garcia, Enrico Di Girolamo, Fabio Locati, Pascal Defaye, Paul Venables, Antoine Dompnier, Aina Barcelo, Herbert N ägele, Haran Burri Source Type: research

Cerclage parahisian septal pacing through the septal perforator branch of the great cardiac vein: Bedside-to-bench development of a novel technique and lead
Physiological biventricular pacing is an attractive alternative to conventional right ventricular (RV) pacing in the management of conduction system disease.1 RV septal pacing is effective but dogged by lead instability2,3 and occasional serious tricuspid valve injury.4 Permanent His-bundle pacing has been achieved5 –11 but challenges remain, including high pacing threshold, low ventricular electrogram amplitude, lead instability, and procedural complexity.12 We recently described an alternative pacemaker lead trajectory to achieve physiological pacing, by lead implantation into the interventricular septum th rough t...
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Min Soo Cho, Min Ku Chon, Jin Hee Choi, Ki Won Hwang, Jeong-Wook Seo, Robert J. Lederman, June Hong Kim, Gi-Byoung Nam Tags: Creative Concepts Source Type: research

Wearable cardioverter-defibrillators in pediatric cardiomyopathy: A cost-utility analysis
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children. Patients with severe cardiac dysfunction are thought to be at risk of sudden cardiac arrest (SCA). After diagnosis, a period of medical optimization is recommended before permanent implantable cardioverter-defibrillator (ICD) implantation. Wearable cardioverter-defibrillators (WCDs) provide an option for arrhythmia protection as an outpatient during this optimization. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Patrick D. Evers, Jeffrey B. Anderson, Thomas D. Ryan, Richard J. Czosek, Timothy K. Knilans, David S. Spar Source Type: research

Cerclage para-Hisian septal pacing through the septal perforator branch of the great cardiac vein: bedside-to-bench development of a novel technique and lead
Physiologic biventricular pacing is an attractive alternative to conventional right ventricular (RV) pacing in the management of conduction system disease.1 RV septal pacing is effective but dogged by lead instability2,3 and occasional serious tricuspid valve injury.4 Permanent His-bundle pacing has been achieved,5-11 but challenges remain including high pacing threshold, low ventricular electrogram amplitude, lead instability, and procedural complexity.12 We recently described an alternative pacemaker lead trajectory to achieve physiologic pacing, by lead implantation into the interventricular septum through the septal pe...
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Min Soo Cho, Min Ku Chon, Jin Hee Choi, Ki Won Hwang, Jeong-Wook Seo, Robert J. Lederman, June Hong Kim, Gi-Byoung Nam Source Type: research

Surgical Procedure for Targeting Arrhythmogenic Substrates in the Treatment of Ventricular Tachycardia Associated with Cardiac Tumors
Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomical mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in non-resectable cardiac tumors. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Shun-Ichiro Sakamoto, Atsushi Hiromoto, Hiroshige Murata, Kenji Suzuki, Jiro Kurita, Yasuhiro Kawase, Takashi Sasaki, Yasuo Miyagi, Yosuke Ishii, Tetsuro Morota, Wataru Shimizu, Takashi Nitta Source Type: research

ECG screening in the Unites States: Are we there yet?
No controlled clinical trial has determined whether ECG screening saves lives. Nonetheless, this is happening at state, local, and grass roots levels in the United States (US). A Texas lawmaker recently introduced a bill requiring pre-participation sports screening —including an ECG—in high school students1. Similar bills have seeped into other state legislatures. Researchers, clinicians, lawmakers, patients, and advocacy groups have well-intentioned, thoughtful, and often emotional arguments on both sides of the ECG screening debate. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Mary Niu, Susan Etheridge Source Type: research

Stylet-Directed His Bundle Lead Placement: Early Days of an Emerging Contender
The development process for medical therapies rarely goes to plan. Even the soundest hypotheses, derived from first principles, either succeed via unanticipated mechanisms or fail to generate meaningful results. His bundle pacing (HBP), however, delivers on the simple concept that utilizing the native conduction system is preferable to direct myocardial capture. Since its first description of use in clinical practice1 and subsequent increase in utilization, His bundle pacing has demonstrated superiority over both right ventricular and biventricular pacing with respect to measures of electrical synchrony, hemodynamics, and ...
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Aron B. Bender, Olujimi A. Ajijola Source Type: research

Wearable Cardioverter Defibrillators in Pediatric Cardiomyopathy: A Cost-Utility Analysis
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children. Patients with severe cardiac dysfunction are thought to be at risk for sudden cardiac arrest (SCA). Following diagnosis, a period of medical optimization is recommended prior to permanent implantable cardioverter-defibrillator (ICD) implantation. Wearable cardioverter defibrillators (WCD) provide an option for arrhythmia protection as an outpatient during this optimization. (Source: Heart Rhythm)
Source: Heart Rhythm - August 30, 2019 Category: Cardiology Authors: Patrick D. Evers, Jeffrey B. Anderson, Thomas D. Ryan, Richard J. Czosek, Timothy K. Knilans, David S. Spar Source Type: research

Acceleration of a wide complex tachycardia: What is the mechanism?
A 21-year-old man with recurrent palpitations refractory to medical therapy was referred for ablation of supraventricular tachycardia (SVT). Baseline electrocardiogram (ECG) showed sinus rhythm having typical left bundle branch block (LBBB) pattern with QRS width of 130 ms. The PR interval was 148 ms without manifest pre-excitation. During electrophysiological study, the baseline HV interval during sinus rhythm was 10 ms. Clinical SVT with LBBB pattern was induced with programmed extrastimuli from the high right atrium. (Source: Heart Rhythm)
Source: Heart Rhythm - August 28, 2019 Category: Cardiology Authors: Zenith A. Jameria, Takuro Nishimura, Hemal M. Nayak, Roderick Tung Tags: Unknown of the Month Source Type: research

HRS 40th anniversary viewpoints: Carpe diem
They tell me that when I was 7 years old, when asked what I wanted to be when I grew up, I unhesitatingly answered, “a cardiologist.” Except for 2 weeks in college I never ever wavered. My father, who escaped from Russia, was a first-class cardiologist and clinician with superb ears, hands, and brain, who could diagnose a pancreatic mass by palpation. I used to go with him to his hospital in New York City jus t to be in the medical environment. He communicated with the greats in the field if he had questions or comments and wrote many original papers, mainly having to do with electrocardiography (which I typed ...
Source: Heart Rhythm - August 28, 2019 Category: Cardiology Authors: Nora Goldschlager Tags: Viewpoint Source Type: research

Right free-wall accessory pathway with branched atrial insertions: Clinical, electrocardiographic, and electrophysiological characteristics
Right free-wall (RFW) accessory pathway (AP) with branched atrial insertions is a rare, underrecognized AP that may be associated with initial ablation failure. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Meng-Meng Li, Jing-Ye Li, Cai-Hua Sang, Chen-Xi Jiang, Xue-Yuan Guo, Xin Zhao, Song-Nan Li, Wei Wang, Ri-Bo Tang, De-Yong Long, Jian-Zeng Dong, Xin Du, Chang-Sheng Ma Source Type: research

Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias
Ventricular arrhythmias (VAs) are the most common cause of death in athletes. The differences in the electroanatomic substrate in athletes and nonathletes with complex VA are unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Maria Lucia Narducci, Gemma Pelargonio, Giulio La Rosa, Frediano Inzani, Giulia d ’Amati, Valeria Novelli, Riccardo Marano, Francesco Perna, Gianluigi Bencardino, Gaetano Pinnacchio, Maurizio Genuardi, Michela Cammarano, Vincenzo Palmieri, Paolo Zeppill Source Type: research

The role of extensive diagnostic work-up in young athletes and non-athletes with complex ventricular arrhythmias
Ventricular tachyarrhythmias (VA) represent the first cause of death in athletes. The difference between electroanatomic substrate in athletes and non-athletes with complex VA is unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Maria Lucia Narducci, Gemma Pelargonio, Giulio La Rosa, Frediano Inzani, Giulia d ’Amati, Valeria Novelli, Riccardo Marano, Francesco Perna, Gianluigi Bencardino, Gaetano Pinnacchio, Maurizio Genuardi, Michela Cammarano, Vincenzo Palmieri, Paolo Zeppill Source Type: research

Right free wall accessory pathway with branched atrial insertions: Clinical, electrocardiographic, and electrophysiological characteristics
Right free wall accessory pathway (RFW-AP) with branched atrial insertions is a rare, under-recognized AP which may be associated with initial ablation failure. (Source: Heart Rhythm)
Source: Heart Rhythm - August 27, 2019 Category: Cardiology Authors: Meng-meng Li, Jing-ye Li, Cai-Hua Sang, Chen-Xi Jiang, Xue-Yuan Guo, Xin Zhao, Song-Nan Li, Wei Wang, Ri-Bo Tang, De-yong Long, Jian-zeng Dong, Xin Du, Chang-sheng Ma Source Type: research

EP News: Case Reports
Implantation of a traditional implantable cardioverter-defibrillator (ICD) remains a challenge in small children because of their size and the anticipation of skeletal and vascular growth. Subcutaneous ICDs (S-ICDs) do not require leads, but their use in small children is unclear because of the generator size that can cause erosion and one lead size designed for adults. von Alvensleben et  al (DOI: https://doi.org/10.1016/j.hrcr.2019.05.004) shared a case of a 5-year-old girl (13.5 kg) who had ventricular fibrillation cardiac arrest. (Source: Heart Rhythm)
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Clinical
Reddy et  al (Am Coll Cardiol 2019;74:315, PMID 31085321) evaluated whether pulse field ablation (PFA) allows durable pulmonary vein (PV) isolation without damage to collateral structures. Two trials assessed the safety and effectiveness of catheter-based PFA in paroxysmal atrial fibrillation. Invasive elec trophysiological mapping was repeated after 3 months to assess the durability of PV isolation. In 81 patients, all PVs were acutely isolated by monophasic (n = 15) or biphasic (n = 66) PFA with ≤3 minutes elapsed delivery per patient, a skin-to-skin procedure time of 92.2 ± 27.4 minutes, and a fl uoroscop...
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
In this paper by DeWitt et  al (J Am Coll Cardiol 2019;74:346–358, PMID 31319917), the authors describe the variable phenotype (clinical characteristics) in a group of children diagnosed with arrhythmogenic cardiomyopathy (AC). In this single-center retrospective study, the authors searched their database for all patients (Source: Heart Rhythm)
Source: Heart Rhythm - August 26, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

Redefining the Electroanatomy of the Cardiac Conduction System
Decades of meticulous study by anatomists, embryologists, and physiologists have provided the framework for understanding the cardiac conduction system and its role in establishing normal ventricular activation. 1-6 It is this background that enabled the field of interventional cardiac electrophysiology to evolve in becoming a highly impactful field eliminating previously only controllable arrhythmias like accessory pathway-related tachycardias and typical atrial flutter.7 Recent advances in electrophysiology testing whether ventricular fibrillation represents an ablatable arrhythmia as well as stimulatory cardiac devices ...
Source: Heart Rhythm - August 23, 2019 Category: Cardiology Authors: Adetola Ladejobi, Samuel J. Asirvatham Source Type: research

EP News: Basic and Translational
The steep voltage dependence of gating of the voltage-gated Na channel (NaV) is essential for electrical excitability. However, the structural basis of voltage gating mechanisms remains uncertain because the resting state exists only at deeply negative membrane potentials. In the current study, Wisedchaisri et  al (Cell 2019;DOI:10.1016/j.cell.2019.06.031, PMID 31353218) stabilized the resting conformation by inserting voltage-shifting mutations and introduced a disulfide crosslink in the voltage-sensing module (VS) of the ancestral bacterial Na channel NaVAb. (Source: Heart Rhythm)
Source: Heart Rhythm - August 21, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

A novel homozygous mutation in the TRDN gene causes a severe form of pediatric malignant ventricular arrhythmia
Triadin is a protein expressed in cardiac and skeletal muscle with an essential role in the structure and functional regulation of calcium release units and excitation-contraction coupling. Mutations in the triadin gene (TRDN) have been described in different forms of human arrhythmia syndromes with early onset and severe arrhythmogenic phenotype, among which the triadin knockout syndrome. (Source: Heart Rhythm)
Source: Heart Rhythm - August 19, 2019 Category: Cardiology Authors: Daniela Rossi, Lorenzo Gigli, Alessandra Gamberucci, Roberta Bordoni, Alessandro Pietrelli, Stefania Lorenzini, Enrico Pierantozzi, Giovanni Peretto, Gianluca De Bellis, Paolo Della Bella, Maurizio Ferrari, Vincenzo Sorrentino, Sara Benedetti, Simone Sala Source Type: research

HRS 40th Anniversary Viewpoints: Historical aspects of the use of radiofrequency energy vs DC ablation to treat arrhythmias
I first observed the treatment of arrhythmias by catheter ablation in Paris when I took a sabbatical in 1979 –1980 under the supervision of Dr Guy Fontaine. At that time, catheter ablation was performed using high-energy direct current (DC) shock (fulguration) by inserting a catheter localized to the site of ventricular arrhythmias. Fulguration was limited to areas of the thick myocardium to avoid perfor ation. Therefore, only ablation of the atrioventricular (AV) node, septal accessory pathways and left ventricular tachycardia could be performed. (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Frank I. Marcus Tags: Viewpoint Source Type: research

HRS 40th Anniversary Viewpoints: Research and  teaching—A view from the university and private practice
Thar ’s more in the man than thar is in the land.Sidney Lanier, 1869 (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Eric N. Prystowsky Tags: Viewpoint Source Type: research

HRS 40th Anniversary Viewpoints: Historical Aspects of the Use of Radiofrequency Energy to Treat Arrhythmias
I first observed the treatment of arrhythmias by catheter ablation in Paris when I did a sabbatical in 1979-1980 under the supervision of Dr. Guy Fontaine. At that time, catheter ablation was performed using high energy DC shock (fulguration) by inserting a catheter localized to the site of ventricular arrhythmias (VA). Fulguration was limited to areas of thick myocardium to avoid perforation. Therefore, only ablation of the AV node, septal accessory pathways and left ventricular tachycardia (VT) could be performed. (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Frank I. Marcus Source Type: research

HRS 40th Anniversary Viewpoints: Research and Teaching —A view from the university and private practice
“Thar’s more in the man than thar is in the land”. Sidney Lanier 1869 (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Eric N. Prystowsky Source Type: research

Inflate a cuff and reduce atrial fibrillation?
Some non-invasive interventions (such as positive airway pressure ventilation) have the potential to improve outcome of invasive cardiac procedures. Remote ischemic preconditioning (RIPC) - induced by repetitive pre-interventional inflations of an arm-cuff to suprasystolic values - is one of them and effects on atrial fibrillation (AF) ablation are worth exploring. The RIPPAF (remote ischemic preconditioning for prevention of AF) study by Kosiuk et al. 1 is the first to measure electrophysiological effects of preconditioning in man with a view to potential antiarrhythmic effects. (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: Joachim R. Ehrlich Source Type: research

When it comes to the left atrial appendage, first do no harm
Primum non nocere, first, do no harm, is a directive inherent to the practice of medicine. The phrase is often ascribed to the Hippocratic oath, however it is found in Hippocrates treatise (Source: Heart Rhythm)
Source: Heart Rhythm - August 17, 2019 Category: Cardiology Authors: T.Jared Bunch Source Type: research

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system
The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. (Source: Heart Rhythm)
Source: Heart Rhythm - August 16, 2019 Category: Cardiology Authors: Michael V. Orlov, David Casavant, Ioannis Koulouridis, Mikhail Maslov, Aharon Erez, Amy Hicks, Ahad Jahangir, Joe Aoun, John V. Wylie Source Type: research

Permanent His Bundle Pacing using Stylet Directed, Active Fixation Leads Placed via Coronary Sinus Sheaths as Compared to Conventional Lumen-less System
The use of coronary sinus sheaths to deliver stylet-driven leads for His bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a styletless lead delivered through a customized catheter. (Source: Heart Rhythm)
Source: Heart Rhythm - August 16, 2019 Category: Cardiology Authors: Michael V. Orlov, David Casavant, Ioannis Koulouridis, Mikhail Maslov, Aharon Erez, Amy Hicks, Ahad Jahangir, Joe Aoun, John V. Wylie Source Type: research

High-sensitivity troponin and the risk of atrial fibrillation in chronic kidney disease: Results from the Chronic Renal Insufficiency Cohort Study
Patients with chronic kidney disease (CKD) are at an increased risk of atrial fibrillation (AF). There is a need for novel biomarkers to reliably and accurately predict AF in this population. High-sensitivity troponin (HsTP) allows the detection of low troponin concentrations. The utility of HsTP for evaluating the risk of AF in CKD has not been established. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2019 Category: Cardiology Authors: Scott E. Janus, Jamal Hajjari, Sadeer Al-Kindi Source Type: research

High Sensitivity Troponin and the Risk of Atrial Fibrillation in Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study
Patients with chronic kidney disease (CKD) are at increased risk for atrial fibrillation (AF). There is a need for novel biomarkers to reliably and accurately predict AF in this population. High sensitivity troponin (HsTP) allows detection of very low troponin concentrations. The utility of HsTP for evaluating the risk of AF in CKD has not been established. (Source: Heart Rhythm)
Source: Heart Rhythm - August 14, 2019 Category: Cardiology Authors: Scott E. Janus, Jamal Hajjari, Sadeer Al-Kindi Source Type: research

Catheter ablation in children and patients with congenital heart disease: Review of 1021 procedures at a high-volume single center in Japan
Although pediatric catheter ablation therapy has often been described, there are few reports on outcomes in a large series of patients at a single center. (Source: Heart Rhythm)
Source: Heart Rhythm - August 12, 2019 Category: Cardiology Authors: Yuko Kato, Tsugutoshi Suzuki, Yoko Yoshida, Noriyasu Ozaki, Hisaaki Aoki, Shintaro Kishimoto, Shuichiro Yoshida, Shigeo Watanabe, Yoshihide Nakamura Source Type: research

Chronic venous obstruction during cardiac device revision: Incidence, predictors, and efficacy of percutaneous techniques to overcome the stenosis
In recent years, upgrade and revision procedures of cardiac implantable electronic devices (CIEDs) have become increasingly frequent. Patency of the access veins is critical for procedural success. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2019 Category: Cardiology Authors: Giovanni Morani, Bruna Bolzan, Sergio Valsecchi, Martina Morosato, Flavio Luciano Ribichini Source Type: research

Chronic Venous Obstruction During Cardiac Device Revision: Incidence, Predictors and Efficacy Of Percutaneous Techniques to Overcome the Stenosis
In the recent years, upgrade and revision procedures of cardiac implantable electronic device (CIED) have become increasingly frequent. The patency of the access veins is critical for procedural success. (Source: Heart Rhythm)
Source: Heart Rhythm - August 10, 2019 Category: Cardiology Authors: Giovanni Morani, Bruna Bolzan, Sergio Valsecchi, Martina Morosato, Flavio Luciano Ribichini Source Type: research

To the Editor — Temperature measurement from both electrodes during bipolar radiofrequency ablation—It is feasible
We have read with interest a recent HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias, particularly a chapter on bipolar radiofrequency catheter ablation. The authors state that one of the limitations of this emerging approach is the fact that temperature measurements can be obtained only from 1 of 2 catheters used.1 Actually this can be done if temperature data from the thermistor located at the tip of catheter used as a ground are transferred to a temperature monitor (ie, a second radiofrequency generator). (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Piotr Futyma, Piotr Ku łakowski Tags: Letter to the editor Source Type: research

Reply to the Editor — Temperature measurement from both electrodes during bipolar radiofrequency ablation—It is feasible
We thank Drs Futyma and Ku łakowski for their interest in the recently published 2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias and further thank the authors for bringing to our attention their work on catheter tip size, which was published after the completion of the cli nical document.1 We agree that temperature monitoring of both catheter tips is possible, but that such a system is not yet, to our knowledge, commercially available or approved. (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Edmond M. Cronin, Frank M. Bogun, Luis Aguinaga, John L. Sapp, William G. Stevenson Source Type: research

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In this issue of HeartRhythm, Hu et  al1 present an interesting article strengthening the importance of ablation of the area overlapping the right anterior ganglionated plexus (GP) as a primary target for cardioneuroablation (CNA).2 The study is remarkable because it confirms the initial publication, emphasizing the finding with a no teworthy cohort of 115 patients with vasovagal syncope, followed by 21.4 ± 13.1 months. One hundred six patients (92.2%) had no more syncope. The authors endorsed that ablation of the right anterior GP persistently increases the heart rate, reinforcing the idea that CNA promotes pe...
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Jose Carlos Pachon-M Tags: Editorial Commentary Source Type: research

Cardioneuroablation for Neurocardiogenic Syncope
CNA was proposed for treating several conditions related to vagal hyperactivity:[2] reflex and/or functional bradyarrhythmias and vagal atrial fibrillation (AF). In the nineties, was observed that ablation of AF-Nests (AFN)[3], a kind of atrial myocardium with disconnected cells, resulted in vagal denervation, reducing drastically de heart rate variability and making the heart nonresponsive to atropine[2,4]. Therefore, in 2005 was published the first study describing the CNA by ablating the AFN, mainly the ones overlapping the main GPs. (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Jose Carlos Pachon-M Source Type: research

Author's Reply to: Temperature measurement from both electrodes during bipolar radiofrequency ablation - it is feasible
We thank Drs. Futyma and Ku łakowski for their interest in the recently published 2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias and further thank the authors for bringing to our attention their work on catheter tip size, which was published after completion of the clinica l document.1 We agree that temperature monitoring of both catheter tips is possible, but that such a system is not yet, to our knowledge, commercially available or approved. Monitoring of impedance and temperature during bipolar catheter ablation is not straightforward and the optimal setup and para ...
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Edmond M. Cronin, Frank M. Bogun, Luis Aguinaga, John L. Sapp, William G. Stevenson Source Type: research

Temperature measurement from both electrodes during bipolar radiofrequency ablation - it is feasible
Refers to: 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm. 2019 May 8. pii: S1547-5271(19)30210-3. https://doi.org/10.1016/j.hrthm.2019.03.002. (Source: Heart Rhythm)
Source: Heart Rhythm - August 9, 2019 Category: Cardiology Authors: Piotr Futyma, Piotr Ku łakowski Source Type: research

Risk of thromboembolic events after percutaneous left atrial appendage ligation in patients with atrial fibrillation: Long-term results from a multi-center study
Percutaneous left atrial appendage (LAA) occlusion with Lariat has emerged as a viable alternative to oral anticoagulation (OAC) to prevent thromboembolic (TE) events in patients with atrial fibrillation (AF). (Source: Heart Rhythm)
Source: Heart Rhythm - August 7, 2019 Category: Cardiology Authors: Sanghamitra Mohanty, Carola Gianni, Chintan Trivedi, Varuna Gadiyaram, Domenico Giovani Della Rocca, Bryan MacDonald, Rodney Horton, Amin Al-Ahmad, Douglas N. Gibson, Matthew Price, Andrew K. Krumerman, Eugen C. Palma, Luigi Di Biase, Dhanunjaya Lakkiredd Source Type: research

Caring for the Pregnant Woman with an Inherited Arrhythmia Syndrome
Pregnancy is a period of heightened cardiovascular risk in a woman ’s life. In the setting of an inherited arrhythmia syndrome (IAS), cardiologists and obstetricians may be unfamiliar with cardiovascular optimization and risk stratification in pregnancy. Historically, there were few data addressing the safety of pregnancy in these rare disorders. Recent advances suggest that no type of IAS represents an absolute contraindication to pregnancy. However, it is imperative that obstetric and cardiovascular clinicians understand the major forms of IAS and how they affect the risks and course of pregnancy. (Source: Heart Rhythm)
Source: Heart Rhythm - August 7, 2019 Category: Cardiology Authors: Thomas M. Roston, Christian van der Werf, Christopher C. Cheung, Jasmine Grewal, Brianna Davies, Arthur A.M. Wilde, Andrew D. Krahn Source Type: research

Long-term Outcomes After Low Power, Slower Movement versus High Power, Faster Movement Irrigated-Tip Catheter Ablation for Atrial Fibrillation
High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation. (Source: Heart Rhythm)
Source: Heart Rhythm - August 6, 2019 Category: Cardiology Authors: T. Jared Bunch, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, Charles Mallender, J. Peter Weiss, Jeffrey S. Osborn, John D. Day Source Type: research

EP News: Quality Improvement and Outcomes
In this issue of HeartRhythm, we present recent publications relevant to quality of care and outcomes, particularly in relation to clinical decision support and shared decision making. (Source: Heart Rhythm)
Source: Heart Rhythm - August 2, 2019 Category: Cardiology Authors: Jennifer M. Wright, Anne Marie Smith, Paul D. Varosy Tags: EP News Source Type: research

Human subpulmonary infundibulum has an endocardial network of specialized conducting cardiomyocytes
The right ventricular outflow tract is the most common source of ventricular arrhythmias in nonstructural heart disease. Most of these arrhythmias are of endocardial origin, but their morphologic substrate is mostly unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2019 Category: Cardiology Authors: Marcos C. De Almeida, Robert S. Stephenson, Robert H. Anderson, Luiz A. Benvenuti, Marios Loukas, Vera D. Aiello Source Type: research

Electrical parameters with His-bundle pacing: Considerations for automated programming
Programming of His-bundle pacing may be challenging because current implantable pulse generators are not specifically designed for this pacing modality. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2019 Category: Cardiology Authors: Neasa Starr, Nicolas Dayal, Giulia Domenichini, Carine Stettler, Haran Burri Source Type: research

The human subpulmonary infundibulum has an endocardial network of specialized conducting cardiomyocytes. Short title: Human subpulmonary infundibular network
The right ventricular outflow tract is the most common source of ventricular arrhythmias in non-structural heart disease. Most of these arrhythmias are of endocardial origin, but their morphological substrate is mostly unknown. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2019 Category: Cardiology Authors: Marcos C. De Almeida, Robert S. Stephenson, Robert H. Anderson, Luiz A. Benvenuti, Marios Loukas, Vera D. Aiello Source Type: research

Thromboembolic, Bleeding, and Mortality Risks among Patients with Nonvalvular Atrial Fibrillation Treated with Dual Antiplatelet Therapy versus Oral Anticoagulants: A Population-Based Study
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is used for stroke prevention in patients with atrial fibrillation (AF) when patients refuse to use oral anticoagulants (OAC) in clinical practice. However, there are limited clinical data comparing these treatments. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2019 Category: Cardiology Authors: Wallis C.Y. Lau, Ian J. Douglas, Ian C.K. Wong, Liam Smeeth, Gregory Y.H. Lip, Wai K. Leung, Chung-Wah Siu, Bernard M.Y. Cheung, Michael T.C. Mok, Esther W. Chan Source Type: research

Electrical parameters with His bundle pacing: considerations for automated programming
Programming of His bundle pacing may be challenging because current implantable pulse generators are not specifically designed for this pacing modality. (Source: Heart Rhythm)
Source: Heart Rhythm - August 1, 2019 Category: Cardiology Authors: Neasa Starr, Nicolas Dayal, Giulia Domenichini, Carine Stettler, Haran Burri Source Type: research

EP News: Allied Professionals
Cardiomyopathy caused by a mutation in the LMNA (lamin) gene is associated with a high risk of sudden death due to ventricular arrhythmias (VAs). As such, guidelines published by the European Society of Cardiology (Priori et  al, Eur Heart J 2015;36:2793–2867, PMID 26320108) and the American College of Cardiology/American Heart Association (Al-Khatib et al, Heart Rhythm 2018;10:e190–e252, PMID 29097320) recommend implantable cardioverter-defibrillator (ICD) in patients with laminopathy and ≥2 high-risk features. (Source: Heart Rhythm)
Source: Heart Rhythm - July 30, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Basic and Translational
In the current study, Lussier et  al (Sci Rep 2019;9:9113, PMID 31235733) tested the functional significance of the stoichiometries of the 4 hyperpolarization-activated cyclic nucleotide–gated (HCN) channel isoforms and their auxiliary subunit KCNE2 using single-molecule subunit counting. The number of KCNE2 subunits in complex with the pore-forming subunits of human HCN channels differs with each HCN isoform and is dynamic with respect to concentration. Moreover, these interactions can be altered by KCNE2 gene variants. (Source: Heart Rhythm)
Source: Heart Rhythm - July 30, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research