Counterpoint Tpeak-Tend Interval as a Marker of Arrhythmic Risk
Supported by NIH grants HL47678 and HL138103 (Source: Heart Rhythm)
Source: Heart Rhythm - January 17, 2019 Category: Cardiology Authors: Charles Antzelevitch, Jos é M. Di Diego Source Type: research

Calcium/calmodulin-dependent protein kinase II causes atrial structural remodeling associated with atrial fibrillation and heart failure
– Atrial fibrillation (AF) is sustained by reentrant mechanisms that depend, in part, on atrial structural remodeling. Increased Ca2+/calmodulin-dependent protein kinase II (CaMKII) activity occurs in persistent AF. A general consensus has been that electrophysiological actions of CaMKII must be t he contributing factor, but electrical remodeling in AF differs considerably with electrophysiological effects of CaMKII. CaMKII has been associated with structural remodeling in several tissues, but not the cardiac atria. (Source: Heart Rhythm)
Source: Heart Rhythm - January 14, 2019 Category: Cardiology Authors: Zhao Liu, J Emanuel Finet, Julie A. Wolfram, Mark E. Anderson, Xun Ai, J Kevin Donahue Source Type: research

Left Atrial Appendage Closure Device Implantation in Patients with Atrial Fibrillation and Prior Intracranial Hemorrhage “No Man Left Behind”
Several LAA closure devices have been developed for patients with atrial fibrillation (AF) seeking an alternative to long-term oral anticoagulation (OAC). The PROTECT AF trial was the first multicenter randomized controlled trial (RCT) comparing LAA closure device vs. OAC with Warfarin. Primary safety events were statistically more frequent in the device group (7.4% vs. 4.4%). At a mean follow up of 3.8 years LAA closure device showed superiority for the primary efficacy endpoint (i.e., composite of stroke, cardiovascular death and systemic embolism), with a 34% relative risk reduction in total mortality1-3 However, with t...
Source: Heart Rhythm - January 14, 2019 Category: Cardiology Authors: Luigi Di Biase, Jorge Romero Source Type: research

Pulsed electric fields for cardiac ablation and beyond: A state-of-the-art review
Irreversible electroporation (IRE) occurs when a strong, pulsed electric field (PEF) causes permeabilization of the cell membrane, leading to cellular homeostasis disruption and cell death. IRE is a Food and Drug Administration –approved treatment of tumor ablation and has been gaining attention in cardiology as an ablation modality. Applications of PEF in cardiology are vast and include atrial fibrillation, ventricular fibrillation, septal ablation, and targeting vascular structures. PEF has appealing characteristics, i ncluding the ability to be tissue specific and its nonthermal nature. (Source: Heart Rhythm)
Source: Heart Rhythm - January 11, 2019 Category: Cardiology Authors: Elad Maor, Alan Sugrue, Chance Witt, Vaibhav R. Vaidya, Christopher V. DeSimone, Samuel J. Asirvatham, Suraj Kapa Tags: Contemporary review Source Type: research

Pulsed electric fields for cardiac ablation and beyond: A state of the art review
Irreversible electroporation (IRE) occurs when a strong, pulsed electrical field (PEF) causes permeabilization of the cell membrane, leading to cellular homeostasis disruption and cell death. IRE is a Food and Drug Administration approved treatment for tumor ablation, and has been gaining attention in cardiology as an ablation modality. Applications of PEF in cardiology are vast and include atrial fibrillation, ventricular fibrillation, septal ablation, and targeting vascular structures. PEF has appealing characteristics including ability to be tissue specific and non-thermal. (Source: Heart Rhythm)
Source: Heart Rhythm - January 11, 2019 Category: Cardiology Authors: Elad Maor, Alan Sugrue, Chance Witt, Vaibhav R. Vaidya, Christopher V. DeSimone, Samuel J. Asirvatham, Suraj Kapa Source Type: research

Leadless cardiac resynchronization therapy: An in  vivo proof-of-concept study of wireless pacemaker synchronization
Contemporary leadless pacemakers (PMs) only feature single-chamber ventricular pacing. However, the majority of patients require dual-chamber pacing or cardiac resynchronization therapy (CRT). Several leadless PMs implanted in the same heart would make that possible if they were able to synchronize their activity in an efficient, safe, and reliable way. Thus, a dedicated ultra-low-power wireless communication method for PM synchronization is required. (Source: Heart Rhythm)
Source: Heart Rhythm - January 10, 2019 Category: Cardiology Authors: Lukas Bereuter, Thomas Niederhauser, Martin Kucera, Dominic Loosli, Immanuel Steib, Marcel Schildknecht, Adrian Zurbuchen, Fabian Noti, Hildegard Tanner, Tobias Reichlin, Andreas Haeberlin Source Type: research

Leadless cardiac resynchronization therapy – an in-vivo proof-of-concept study of wireless pacemaker synchronization
Contemporary leadless pacemakers (PMs) only feature single-chamber ventricular pacing. However, the majority of patients requires dual-chamber pacing or cardiac resynchronization therapy (CRT). Several leadless PMs implanted in the same heart would make that possible if they are able to synchronize their activity in an efficient, safe and reliable way. Thus, a dedicated ultra-low-power wireless communication method for pacemaker synchronization is required. (Source: Heart Rhythm)
Source: Heart Rhythm - January 10, 2019 Category: Cardiology Authors: Lukas Bereuter, Thomas Niederhauser, Martin Kucera, Dominic Loosli, Immanuel Steib, Marcel Schildknecht, Adrian Zurbuchen, Fabian Noti, Hildegard Tanner, Tobias Reichlin, Andreas Haeberlin Source Type: research

Moderate alcohol consumption is associated with atrial electrical and structural changes: Insights from high-density left atrial electroanatomic mapping
Regular alcohol intake is an important modifiable risk factor associated with atrial fibrillation (AF) and left atrial (LA) dilation. (Source: Heart Rhythm)
Source: Heart Rhythm - January 9, 2019 Category: Cardiology Authors: Aleksandr Voskoboinik, Geoffrey Wong, Geoff Lee, Chrishan Nalliah, Joshua Hawson, Sandeep Prabhu, Hariharan Sugumar, Liang-Han Ling, Alex McLellan, Joseph Morton, Jonathan M. Kalman, Peter M. Kistler Source Type: research

Catheter Ablation In The Vicinity Of The Proximal Conduction System: Your Eyes Cannot See What Your Mind Does Not Know
The differential of narrow QRS complex tachycardias without constant V-A conduction includes atrio-ventrcular nodal reentry tachycardia (AVNRT), automatic junctional tachycardia, V-N tachycardia, V-H tachycardia, and “upper septal” fascicular VT. The mode of initiation and termination, response to pacing, activation sequence along the His bundle-right bundle-left bundle as well as HV interval compared between sinus rhythm and tachycardia are key parameters in determining the exact mechanism to plan catheter ablation. (Source: Heart Rhythm)
Source: Heart Rhythm - January 9, 2019 Category: Cardiology Authors: Jason S. Bradfield, Osamu Fujimura, Noel G. Boyle, Kalyanam Shivkumar Source Type: research

Prognostic Impact of Lead Tip Position Confirmed via Computed Tomography in Patients with Right Ventricular Septal Pacing
Although fluoroscopy-guided right ventricular (RV) lead placement in the ventricular septum is a widely performed procedure, variation in true RV lead tip position confirmed via computed tomography (CT) and its prognostic implications in patients with atrioventricular block (AVB) are not well understood. (Source: Heart Rhythm)
Source: Heart Rhythm - January 9, 2019 Category: Cardiology Authors: Masayuki Hattori, Yoshihisa Naruse, Yasushi Oginosawa, Yuya Matsue, Yuichi Hanaki, Shinya Kowase, Kenji Kurosaki, Akira Mizukami, Ritsuko Kohno, Haruhiko Abe, Kazutaka Aonuma, Akihiko Nogami Source Type: research

Effect of diurnal variations in the QRS complex and T waves on the eligibility for subcutaneous implantable cardioverter-defibrillators
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an established therapy for preventing sudden cardiac death. However, a considerable number of patients still undergo inappropriate shocks even after conventional preimplantation electrocardiographic (ECG) screening. (Source: Heart Rhythm)
Source: Heart Rhythm - January 4, 2019 Category: Cardiology Authors: Naoyuki Miwa, Yasutoshi Nagata, Tetsuo Yamaguchi, Masashi Nagase, Takeshi Sasaki, Toshihiro Nozato, Takashi Ashikaga, Masahiko Goya, Kenzo Hirao Source Type: research

Impact of diurnal variations in the QRS complex and T waves on the eligibility for subcutaneous implantable cardioverter-defibrillators
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an established therapy for preventing sudden cardiac death. However, a considerable number of patients still undergo inappropriate shocks even after conventional preimplantation electrocardiographic (ECG) screening. (Source: Heart Rhythm)
Source: Heart Rhythm - January 4, 2019 Category: Cardiology Authors: Naoyuki Miwa, Yasutoshi Nagata, Tetsuo Yamaguchi, Masashi Nagase, Takeshi Sasaki, Toshihiro Nozato, Takashi Ashikaga, Masahiko Goya, Kenzo Hirao Source Type: research

Impact of diurnal variations in the QRS complex and T-waves on the eligibility of subcutaneous implantable cardioverter-defibrillators
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an established therapy for preventing sudden cardiac death. However, a considerable number of patients still undergo inappropriate shocks even after conventional pre-implantation ECG screening. (Source: Heart Rhythm)
Source: Heart Rhythm - January 4, 2019 Category: Cardiology Authors: Naoyuki Miwa, Yasutoshi Nagata, Tetsuo Yamaguchi, Masashi Nagase, Takeshi Sasaki, Toshihiro Nozato, Takashi Ashikaga, Masahiko Goya, Kenzo Hirao Source Type: research

Ablation Index as a predictor of long-term efficacy in premature ventricular complex ablation: a regional target value analysis.
Radiofrequency catheter ablation (RFCA) effectiveness in atrial tachyarrhythmias correlates with lesion transmurality. Ablation Index (AI) is an index incorporating contact force, time, and RF power simultaneously, able to predict lesion size and outcomes in atrial fibrillation RFCA. (Source: Heart Rhythm)
Source: Heart Rhythm - January 4, 2019 Category: Cardiology Authors: Michela Casella, Alessio Gasperetti, Carola Gianni, Giulio Zucchelli, Pasquale Notarstefano, Amin Al-Ahmad, J.David Burkhardt, Ezio Soldati, Domenico Della Rocca, Valentina Catto, Benedetta Majocchi, Corrado Carbucicchio, Maria Grazia Bongiorni, Antonio D Source Type: research

Aequanimitas —The first thought before a long ablation procedure
Aequanimitas means imperturbability and was regarded by Sir William Osler as the premier quality of a good physician. Sir Osler, in his valedictory address at the University of Pennsylvania, May 1, 1889, described aequanimitas asImperturbability means coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril, ….As imperturbability is largely a bodily endowment, I regret to say that there are those amongst you, who, owing to congenital defects, may never be able to acquire it. (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Tags: Editorial Commentary Source Type: research

To the Editor — Thoughts on inducibility
With great interest we read the article of Mahida et  al,1 who analyzed the outcome of different treatment strategies for ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). They compared the time to VT recurrence after prescribing antiarrhythmic drugs with the time to VT recurrence after ablation. When  endocardial and combined endo-epicardial ablation were compared, an advantage (P = .05) for the combined approach was observed.1 No effect on mortality was found, irrespective of whether ablation or drug therapy was applied. (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Andreas M üssigbrodt, Arash Arya, Livio Bertagnolli, Borislav Dinov, Gerhard Hindricks Tags: Letter to the Editor Source Type: research

Reply to the Editor — Thoughts on Inducibility
We thank M üssigbrodt et al for their interest in our study. We agree that the approach of endocardial-only ablation if ventricular tachycardia (VT) is rendered noninducible is reasonable for patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and recurrent VT. Although epicardial ablation i s associated with better outcomes in our study and that of Wei et al, we do believe that epicardial procedures are associated with higher bleeding risk, which is of sufficiently low frequency to escape detection in reported ARVC series, but still an important consideration, as deaths have occurred. (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Saagar Mahida, William G. Stevenson Source Type: research

Thoughts on inducibility
With great interest we read the manuscript of Mahida et al. who analysed the outcome of different treatment strategies for ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C)1. They compared the time to VT recurrence after prescribing antiarrhythmic drugs with the time to VT recurrence after ablation. When endocardial and combined endo-epicardial ablation were compared, an advantage (p=0.05) for the combined approach was observed1. No impact on mortality was found, irrespective of whether ablation or drug therapy was applied1. (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Andreas M üssigbrodt, Arash Arya, Livio Bertagnolli, Borislav Dinov, Gerhard Hindricks Source Type: research

Aequanimitas – The First Thought Prior to a Long Ablation
Aequanimitas, the term means imperturbability and was regarded by Sir William Osler as the premier quality of a good physician. Sir Osler, in his valedictory address at the University of Pennsylvania, May 1, 1889 described aequanimitas as: (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Source Type: research

Authors Reply to Thoughts on Inducibility
We thank M üssigbrodt and colleagues for their interest in our study. We agree that the approach of endocardial-only ablation if ventricular tachycardia (VT) is rendered non-inducible is reasonable for ARVC patients with recurrent VT. Although epicardial ablation is associated with better outcomes in our stud y and that of Wei et al, we do believe that epicardial procedures are associated with greater bleeding risk, which is of sufficiently low frequency to escape detection in reported ARVC series, but still an important consideration, as deaths have occurred. (Source: Heart Rhythm)
Source: Heart Rhythm - January 3, 2019 Category: Cardiology Authors: Saagar Mahida, William G. Stevenson Source Type: research

A 29-year-old man with different tachycardia mechanisms
The ECG (Figure 1) shows 5 simultaneous ECG leads recorded from a 29-year-old man who had experienced several episodes of rapid heart action during the past 4 years. (Source: Heart Rhythm)
Source: Heart Rhythm - January 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

CHA2DS2-VASc scores and Intermountain Mortality Risk Scores for the joint risk stratification of dementia among patients with atrial fibrillation
High CHA2DS2-VASc scores in atrial fibrillation (AF) patients are generally associated with increased risks of stroke and dementia. At lower CHA2DS2-VASc scores, there remains an unquantifiable cranial injury risk, necessitating an improved risk assessment method within these lower-risk groups. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2019 Category: Cardiology Authors: Kevin G. Graves, Heidi T. May, Victoria Jacobs, Kirk U. Knowlton, Joseph B. Muhlestein, Donald L. Lappe, Jeffrey L. Anderson, Benjamin D. Horne, T. Jared Bunch Tags: Featured Article Source Type: research

HRS 40th anniversary viewpoints: Living better electrically
I was born in March of 1931, a year that coincided with the financial difficulties that led to the depression, which lasted from 1929 to 1939. Franklin D. Roosevelt became president in 1933, beginning a sequence of multiple terms that lasted until his death in 1945, when he died of a cerebral hemorrhage. My father emerged from the family farm in Bangor, Maine, and became the first member to attend college, a feat that he accomplished, over time, by working as a carpenter with his father or as an accountant in a lumber operation deep in the woods of Maine. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2019 Category: Cardiology Authors: John Warren Harthorne Tags: Viewpoint Source Type: research

Atrial fibrillation and dementia: Understanding the risks in hopes of brighter tomorrows
My fate cannot be mastered; it can only be collaborated with and thereby, to some extent, directed.Aldous Huxley (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2019 Category: Cardiology Authors: Michael Ghannam, Hakan Oral Tags: Editorial Commentary Source Type: research

Legacy: Why does it matter?
It has been said that it is up to us to live up to the legacy that was left for us and to leave a legacy that is worthy of future generations. As I approach my final months as your CEO, I  have been thinking a lot about what I found here when I first arrived and what I will be leaving behind. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2019 Category: Cardiology Authors: James H. Youngblood Tags: Message from the CEO Source Type: research

State of the Journal 2019
HeartRhythm is entering its 16th year in 2019. Since its premiere, the journal has grown steadily and is currently the most frequently cited journal in the field of heart rhythm disorders. The total journal citations in 2017 were 14,200 (Figure  1A), and the impact factor was 4.743. The journal’s Google Scholar h5-index is 69, which ranked 8th among all cardiology journals and 1st among all arrhythmia-focused journals. The average time from submission to first decision is 9.6 days, and submissions range from 1550 to 1700 per year. (Source: Heart Rhythm)
Source: Heart Rhythm - January 1, 2019 Category: Cardiology Authors: Peng-Sheng Chen Tags: Editorial Source Type: research

Reply to the Editor — The Site of Origin of the Ventricular Premature Complex in a Patient With 2 Different P-Wave Morphology
I welcome the letter of Drs Alizadeh and Keikhavani concerning the ventricular premature beat (VPB) in our recent article1 because it gives attention to our ability to locate ectopic ventricular rhythms by giving a close look at their QRS configuration. This is an increasingly important topic in relation to treatment by catheter ablation. While discussing the site of origin of the VPB in relation to QRS configuration, they refer to publications by the clinical electrophysiology group from Birmingham, AL, that contributed extensively to that issue. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2018 Category: Cardiology Authors: Hein J. Wellens Source Type: research

Reply to the Letter- “ The site of Origin of the Ventricular Premature Complex in a Patient with Two Different P Wave Morphology”
I welcome the letter of Drs Alizadeh and Keikhavani concerning the ventricular premature beat (VPB) in our recent article : Two different P waves after a single VPB (1) because it gives attention to our ability to locate ectopic ventricular rhythms by giving a close look at their QRS configuration. This is an increasingly important topic in relation to treatment by catheter ablation. In discussing the site of origin of the VPB in relation to QRS configuration they refer to publications by the clinical electrophysiology group from Birmingham, AL, who contributed extensively to that issue. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2018 Category: Cardiology Authors: Hein J. Wellens Source Type: research

Improved Engineering Standards for Transvenous Cardiac Leads: A Progress Report from the Association for the Advancement of Medical Instrumentation Cardiac Rhythm Management Device Committee Leads Working Group
Transvenous leads for cardiac implantable electronic devices (CIEDs) are intended to last for the remainder of a patient ’s life. Yet they are recognized as the most vulnerable system component, both for pacemakers and implantable cardioverter-defibrillators (ICDs). Engineering standards were first established for transvenous leads in 1997 and have been updated periodically since then.1 However, some leads that met this standard were recalled due to unacceptable failure rates. Other leads, which also were qualified in accordance with this standard, failed to provide acceptable performance. (Source: Heart Rhythm)
Source: Heart Rhythm - December 28, 2018 Category: Cardiology Authors: Daniel J. Cooke, Adam Himes, Charles D. Swerdlow Source Type: research

Reply to the Editor — The site of origin of the ventricular premature beat in a patient with 2 different P-wave morphologies
I welcome the letter of Drs Alizadeh and Keikhavani concerning the ventricular premature beat (VPB) in our recent article1 because it gives attention to our ability to locate ectopic ventricular rhythms by giving a close look at their QRS configuration. This is an increasingly important topic in relation to treatment by catheter ablation. While discussing the site of origin of the VPB in relation to QRS configuration, they refer to publications by the clinical electrophysiology group from Birmingham, AL, that contributed extensively to that issue. (Source: Heart Rhythm)
Source: Heart Rhythm - December 27, 2018 Category: Cardiology Authors: Hein J. Wellens Tags: Letter to the Editor Source Type: research

Hybrid thoracoscopic epicardial ablation of right ventricular outflow tract in patients with Brugada Syndrome
Abnormal delayed electrograms (EGM) from the anterior wall of the right ventricular outflow tract (RVOT) epicardium has become the ablation target in Brugada Syndrome (BrS). (Source: Heart Rhythm)
Source: Heart Rhythm - December 27, 2018 Category: Cardiology Authors: Francesca Salghetti, Carlo de Asmundis, Juan Sieira, Hugo Enrique Couti ño, Juan Pablo Abugattas, Varnavas Varnavas, Riccardo Maj, Muryo Terasawa, Thiago Guimarães Osório, Erwin Stroker, Lucio Capulzini, Saverio Iacopino, Gaetano Paparella, Vincent Umb Source Type: research

Safety and Outcomes of Catheter Ablation for Atrial Fibrillation in Adults with Congenital Heart Disease: A Multicenter Registry Study
An increasing number of adults with congenital heart disease (CHD) are undergoing catheter ablation for atrial fibrillation (AF). Data on ablation strategy and outcomes is limited in CHD. Rhythm control is often felt to be of greater importance among patients with complex CHD. (Source: Heart Rhythm)
Source: Heart Rhythm - December 26, 2018 Category: Cardiology Authors: Jackson J. Liang, David S. Frankel, Valay Parikh, Dhanujaya Lakkireddy, Sanghamitra Mohanty, J. David Burkhardt, Andrea Natale, Judit Szilagyi, Edward P. Gerstenfeld, Jeremy P. Moore, Kathryn K. Collins, Joseph D. Kay, Pasquale Santangeli, Francis E. Marc Source Type: research

EP News: Heart Rhythm Case Reports
Without evidence from a large randomized trial that evaluates His-bundle pacing compared with cardiac resynchronization therapy, the procedural benefits with His-bundle pacing associated with long-term risks and complications have been revealed primarily through registry, observational, case series, and case report data. One of the most common challenges with His-bundle pacing is elevated thresholds that can result in rapid battery depletion. Kim et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.11.007) shared a case of a 68-year-old woman who presented with presyncope and 2:1 atrioventricular block. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

Cardiorenal status using amino-terminal pro –brain natriuretic peptide and cystatin C on cardiac resynchronization therapy outcomes: From the BIOCRT Study
Cardiorenal syndrome comprises a heterogeneous group of disorders characterized by acute or chronic cardiac and renal dysfunction. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Quynh A. Truong, Jackie Szymonifka, James L. Januzzi, Jigar H. Contractor, Roderick C. Dea ño, Neal A. Chatterjee, Jagmeet P. Singh Source Type: research

Feasibility of complex transfemoral electrophysiology procedures in patients with inferior vena cava filters
The presence of inferior vena cava filters (IVCFs) has been considered a relative contraindication to electrophysiology (EP) procedures that require transfemoral venous placement of multiple catheters and/or long sheaths. There are inadequate data related to complex EP procedures in this population. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Todd B. Mendelson, Pasquale M. Santangeli, David S. Frankel, Jeffrey S. Arkles, Gregory E. Supple, David Lin, Michael P. Riley, David J. Callans, Saman Nazarian, Matthew C. Hyman, Ramanan Kumareswaran, Andrew E. Epstein, Rajat Deo, Sanjay Dixit, Fermin C. Source Type: research

EP News: Allied Professionals
In the BRUISE CONTROL-2 study, Birnie et  al (Eur Heart J 2018;39:3973, PMID 30462279) sought to assess the effect of continuation vs interruption of direct oral anticoagulants (DOACs) at the time of cardiac implantable electronic device (CIED) surgery. This was a multicenter, randomized study performed at 15 centers in Canada and 1 in Is rael in patients with atrial fibrillation (AF) who had CHA2DS2-VASc score ≥2 and were on DOAC for the prevention of thromboembolism undergoing CIED implantation or replacement surgery. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

EP News: Clinical
Bernie et  al (Eur Heart J 2018;39:3973, PMID 30462279) evaluated 2 strategies to manage direct oral anticoagulants (DOACs) at the time of pacemaker and defibrillator surgery. They hypothesized that performing device surgery without DOAC interruption would result in a reduced hematoma rate. The investigators randomly assigned patients with atrial fibrillation and CHA2DS2-VASc score ≥2 to continued vs interrupted DOAC (dabigatran, rivaroxaban, or apixaban). The primary outcome—pocket hematoma resulting in reoperation, interruption of anticoagulation, or prolongation of hospital stay—was blindly ev aluate...
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Case Reports
Without evidence from a large randomized trial that evaluates His-bundle pacing compared with cardiac resynchronization therapy, the procedural benefits with His-bundle pacing with associationed long-term risks and complications have been revealed primarily through registry, observational, case series, and case report data. One of the most common challenges with His-bundle pacing is elevated thresholds that can result in rapid battery depletion. Kim et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.11.007) shared a case of a 68-year-old woman who presented with presyncope and 2:1 atrioventricular block. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Basic and Translational
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a hereditary arrhythmia syndrome. Mutations in ryanodine receptor type 2 (RYR2) are responsible for ≈60% of cases of CPVT. In the present study, Pan et al (Circ Res 2018;123:953, PMID 30355031) tested whether in vivo genome editing using the CRISPR/Cas9 system could correct CPVT in mice heterozygous for RyR2 mutation R176Q (R176Q/+). Guide RNAs were designed to disrupt the mutant allele in the neonatal R176Q/+ mice with the SaCas9 (Staphylococcus aureus Cas9) genome editing system using a single subcutaneous injection of adeno-associated virus ...
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP NEWS Source Type: research

Feasibility of Complex Trans-Femoral Electrophysiology Procedures in Patients with Inferior Vena Cava Filters
Presence of inferior vena cava filters (IVCFs) have been considered a relative contraindication to electrophysiology (EP) procedures that require trans-femoral venous placement of multiple catheters and/or long sheaths. There are inadequate data related to complex EP procedures in this population. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Todd B. Mendelson, Pasquale M. Santangeli, David S. Frankel, Jeffrey S. Arkles, Gregory E. Supple, David Lin, Michael P. Riley, David J. Callans, Saman Nazarian, Matthew C. Hyman, Ramanan Kumareswaran, Andrew E. Epstein, Rajat Deo, Sanjay Dixit, Fermin C. Source Type: research

Cardiorenal Status using Amino Terminal Pro Brain Natriuretic Peptide and Cystatin C on Cardiac Resynchronization Therapy Outcomes: From the BIOCRT Study
Cardiorenal syndrome (CRS) comprises of a heterogeneous group of acute and chronic cardiac and renal dysfunction. (Source: Heart Rhythm)
Source: Heart Rhythm - December 24, 2018 Category: Cardiology Authors: Quynh A. Truong, Jackie Szymonifka, James L. Januzzi, Jigar H. Contractor, Roderick C. Dea ño, Neal A. Chatterjee, Jagmeet P. Singh Source Type: research

Pediatric and Congenital Electrophysiology Society Initiative on Device Needs in Pediatric Electrophysiology
There are few cardiovascular devices approved in children (Table1), with only 5 devices approved for use in the pediatric electrophysiology patient in the last 10 years. This lack of appropriate pediatric-tested technology has resulted in a high rate of off-label device utilization in children.1 Sutherell and colleagues found an off-label use of an approved device in 63% of patients treated in an interventional pediatric cardiology program.2 (Source: Heart Rhythm)
Source: Heart Rhythm - December 20, 2018 Category: Cardiology Authors: Anne M. Dubin, Bryan C. Cannon, Elizabeth V. Saarel, John K. Triedman, Charles I. Berul, Yaniv Bar-Cohen, Maully J. Shah, Jessica Paulsen, Hetal Patel, Jonathan Reich, Mark D. Carlson, Kenneth Stein, James O. Gilkerson, Robert C. Kowal, Vasum Peiris Source Type: research

Leadless pacemaker implantation: Is it possible to eliminate pericardial effusion as a complication?
The year 2018 celebrated the 60th anniversary of the first implanted pacemaker. During those 60 years, many considerable developments in the therapy for cardiac pacing were made. Current devices are complex and sophisticated. They have many algorithms intended to emulate normal cardiac physiology, with remote management and wireless communication representing the standard of care. However, conventional pacing with implanted generators and leads placed in the vasculature to the heart are associated with significant short- and long-term complications. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Paul R. Roberts Tags: Editorial Commentary Source Type: research

Refining the prediction of stroke in atrial fibrillation: An elusive endeavor
Atrial fibrillation (AF), the most common sustained arrhythmia, is responsible for>20% of all strokes.1 AF-associated strokes are more severe, causing significantly greater long-term disability, accounting for greater resource utilization, and resulting in significantly higher mortality compared to non-AF strokes.2 –4 Oral anticoagulants (OACs) are the standard of care for the prevention of AF-associated stroke and systemic thromboembolism. To date, OACs are the only therapeutic intervention that has been consistently and definitively shown to improve survival in the AF population. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Jason G. Andrade, Laurent Macle Tags: Editorial Commentary Source Type: research

More frequent postextrasystolic potentiation in patients with premature ventricular contraction –related cardiomyopathy: The missing link between premature ventricular contractions and cardiomyopathy?
Premature ventricular contractions (PVCs) are extrasystoles that originate from the ventricles. PVCs are frequently observed in patients with heart disease who require medical treatment to resolve the underlying issues. PVCs have also been observed in people with structurally normal hearts for whom medical treatment was deemed unnecessary. However, studies in a canine model have shown that exposing healthy hearts to frequent PVCs can cause cardiomyopathy (PVC-induced CM), evidenced by a decline in left ventricular (LV) ejection fraction (LVEF; to ≤40%) and LV end-systolic dilation. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Gea-Ny Tseng Tags: Editorial Commentary Source Type: research

Obstructive sleep apnea is associated with nonsustained ventricular tachycardia in patients with hypertrophic obstructive cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is associated with arrhythmias and cardiovascular death. Obstructive sleep apnea (OSA) is highly prevalent and independently associated with atrial fibrillation in patients with HCM. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Shengwei Wang, Hao Cui, Changpeng Song, Changsheng Zhu, Rong Wu, Liukun Meng, Qinjun Yu, Xiaohong Huang, Shuiyun Wang Source Type: research

Refining the Prediction of Stroke in Atrial Fibrillation. An elusive endeavor
Atrial fibrillation (AF), the most common sustained arrhythmia, is responsible for>20% of all strokes.1 AF-associated strokes are more severe, causing significantly greater long-term disability, accounting for greater resource utilization, and result in significantly higher mortality when compared to non-AF strokes.2-4 Oral anticoagulants (OACs) are the standard of care for the prevention of AF-associated stroke and systemic thromboembolism. To date OACs are the only therapeutic intervention that has been consistently and definitively shown to improve survival in the AF population. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Jason G. Andrade, Laurent Macle Source Type: research

Leadless Pacemaker Implantation – is it possible to eliminate pericardial effusion as a complication?
Paul Roberts has received honoraria from Medtronic for consultancy and speakers bureau. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Paul R. Roberts Source Type: research

Syncope, conduction disturbance, and negative electrophysiological test: predictive factors and risk score to predict pacemaker implantation during follow-up
Patients with syncope and bundle branch block (BBB) are at risk of atrioventricular block (AVB). Electrophysiological study (EPS) can help in identifying patients at higher risk of AVB but false-negative rate is remarkable. Few data are published about predictors of the need for pacemaker implantation during follow-up. (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Ivo Roca-Luque, Jaume Francisco-Pascual, Gerard Oristrell, Juli án Rodríguez-García, Alba Santos-Ortega, Gabriel Martin-Sanchez, Nuria Rivas-Gandara, Jordi Perez-Rodon, Ignacio Ferreira-Gonzalez, David García-Dorado, Angel Moya-Mitjans Source Type: research

More frequent post-extrasystolic potentiation in patients with premature ventricular contraction (PVC)-related cardiomyopathy – The missing link between PVC and cardiomyopathy?
Premature ventricular contractions (PVCs) are extrasystoles originating from the ventricles. PVCs are frequently observed in patients with heart diseases, who require medical treatment to resolve the underlying issues. PVCs have also been observed in people with structurally normal hearts, for whom medical treatment was deemed unnecessary. However, studies in a canine model have shown that exposing healthy hearts to frequent PVCs can cause cardiomyopathy (PVC-induced CM), evidenced by a decline in left ventricular ejection fraction (LVEF, to (Source: Heart Rhythm)
Source: Heart Rhythm - December 18, 2018 Category: Cardiology Authors: Gea-Ny Tseng Source Type: research