EP News: Basic and Translational
In a study reported by Zhu et  al (Circulation 2018;138:2682–2697, PMID 30571258), the investigators identified a rare, heterozygous ankyrin-B (ANK2) variant (p.Q1283H) in a proband with recurrent ventricular tachycardia. In order to determine the functional effects of the ANK2 variant, knockin (KI) mice harboring the p.Q1283 H variant were generated. The KI mice showed increased ventricular arrhythmias after catecholaminergic stimulation. Isoproterenol resulted in increased frequency of delayed afterdepolarizations and Ca2+ waves and sparks as well as decreased sarcoplasmic reticulum Ca2+ content in KI cardiomy...
Source: Heart Rhythm - January 28, 2019 Category: Cardiology Authors: Nipavan Chiamvimonvat Tags: EP News Source Type: research

2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
Glenn N. Levine, MD, FACC, FAHA, Chair (Source: Heart Rhythm)
Source: Heart Rhythm - January 28, 2019 Category: Cardiology Authors: Craig T. January, L. Samuel Wann, Hugh Calkins, Michael E. Field, Lin Y. Chen, Karen L. Furie, Joaquin E. Cigarroa, Paul A. Heidenreich, Joseph C. Cleveland, Katherine T. Murray, Patrick T. Ellinor, Julie B. Shea, Michael D. Ezekowitz, Cynthia M. Tracy, C Source Type: research

Medical misinformation: Vet the message!
“Mrs. Jones, based on your risk factors for having a heart attack, I recommend that we start you on a statin.”“No, thank you, doctor, I’ve read too many scary things about those drugs on the Internet. Plus, I worry that some in your profession make these recommendations for reasons of person al financial gain. I also found that online.” (Source: Heart Rhythm)
Source: Heart Rhythm - January 28, 2019 Category: Cardiology Authors: Joseph A. Hill, Stefan Agewall, Adrian Baranchuk, George W. Booz, Jeffrey S. Borer, Paolo G. Camici, Peng-Sheng Chen, Anna F. Dominiczak, Çetin Erol, Cindy L. Grines, Robert Gropler, Tomasz J. Guzik, Markus K. Heinemann, Ami E. Iskandrian, Bradley P. Kni Tags: Editorial Source Type: research

EP Match
The recent National Residency Matching Program (referred to as “the Match”’) for clinical cardiac electrophysiology (CCEP) fellowship did not end as many had hoped, with over half of all programs having slots left unfilled. Around one out of ten applicants who participated in the Match were not matched with one of their selected programs. We do not know t he results of the “scramble” that occurred among those 8 unmatched applicants, but we assume that they were able to secure an unfilled position. (Source: Heart Rhythm)
Source: Heart Rhythm - January 25, 2019 Category: Cardiology Authors: George H. Crossley, Jay Montgomery, Arvindh Kanagasundrum Source Type: research

To the Editor — Our doubts about the usefulness of the Tpeak-Tend interval
We read with keen interest the counterpoint by Antzelevitch and Di Diego1 in response to our point of view statement.2 First and foremost, we acknowledge the seminal nature of their work and its effect in stimulating experimental and clinical research. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Heikki V. Huikuri, Richard L. Verrier, Marek Malik, Federico Lombardi, Georg Schmidt, Markus Zabel Tags: Letter to the Editor Source Type: research

Reply to the Editor — Tpeak-Tend Is Alive and Well
We have read the letter to the editor submitted by Huikuri and coworkers in response to our counterpoint and are pleased to see that the authors ’ views have moderated considerably such that the issue of Tpeak-Tend as a marker of risk is no longer “dead” but has transitioned to one whose usefulness is subject to challenges including precise measurement, selection of lead(s), and appropriate heart rate correction, issues that apply to a ll interval-based arrhythmia risk markers. We wholeheartedly agree that additional research is needed to further define the use of these parameters. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Charles Antzelevitch, Jos é M. Di Diego Source Type: research

To the Editor — The site of origin of the ventricular premature complex in a patient with 2 different P-wave morphology
I have read the ECG lessons by Hein J. Wellens1 with great interest. The case provides an excellent answer for the 2 different P-wave morphologies; however, the premature ventricular complex (PVC) needs further clarification. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Ablofath Alizadeh, Ala Keikhavani Tags: Letter to the Editor Source Type: research

EP News: Case Reports
Left atrial appendage (LAA) isolation is increasingly being advocated for treatment of patients with persistent/longstanding persistent atrial fibrillation (AF) to improve long-term arrhythmia-free outcomes. The potential complications of empiric isolation of the LAA are now being fully recognized, with increased follow-up durations and expansion of the procedure to more centers and operators that have variable peri- and postablation approaches. Tilz et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.11.010) share the case of a 74-year-old man with persistent AF refractory to antiarrhythmic drugs who had undergone a pre...
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: T. Jared Bunch Tags: EP News Source Type: research

EP News: Clinical
Krahn et  al (J Am Coll Cardiol 2018;72:3098–3109, PMID 30545448) evaluated the effectiveness of incremental perioperative antibiotics to reduce device infection. Using a cluster randomized crossover trial with 4 randomly assigned 6-month periods, centers used either conventional or incremental periproced ural antibiotics for all cardiac implantable electronic device procedures. Conventional treatment was preprocedural cefazolin infusion. Incremental treatment was preprocedural cefazolin plus vancomycin, intraprocedural bacitracin pocket wash, and 2-day postprocedural oral cephalexin. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

EP News: Allied Professionals
In this study of 30 patients with Brugada syndrome (BrS), Pieroni et  al (J Am Coll Cardiol 2018;72:2747–2757, PMID 30497561) sought to assess the prevalence of structural and histologic abnormalities and the correlation to genetic abnormalities, symptoms, and clinical presentation. The study group comprised 30 patients with BrS diagnosed with spontaneous or provo ked (with infusion of sodium channel blocker) ST elevation in at least 1 right precordial lead (V1–V2). All patients had electrocardiogram (ECG), 24-hour Holter monitor, echocardiogram, programmed stimulation (PES), 3-dimensional electroanatomic ...
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Erica S. Zado Tags: EP News Source Type: research

The site of Origin of the Ventricular Premature Complex in a Patient with Two Different P Wave Morphology
I have read the ECG lessons by Hein J. Wellens (1) with a great interest. The case provides an excellent answer for the two different P wave morphologies; however, the premature ventricular complex (PVC) needs further clarification. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Ablofath Alizadeh, Ala Keikhavani Source Type: research

Dynamic programming of atrioventricular delay improves electrical synchrony in a multicenter cardiac resynchronization therapy study
Patient-specific programming of cardiac resynchronization therapy (CRT) is often neglected, despite significant non-response rates. The device-based SyncAV CRT algorithm dynamically adjusts atrioventricular delays (AVD) to the intrinsic AV interval, reduced by a programmable offset, to accommodate each patient ’s changing needs. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Bernard Thibault, Philippe Ritter, Kerstin Bode, Leonardo Cal ò, Blandine Mondésert, Jan O. Mangual, Nima Badie, Luke C. McSpadden, Carlo Pappone, Niraj Varma Source Type: research

Tpeak-Tend is Alive and Well
We have read the letter to the editor submitted by Huikuri and co-worker in response to our counterpoint and are pleased to see that the authors ’ views have moderated considerably such that the issue of Tpeak-Tend as a marker of risk is no longer “dead” but has transitioned to one whose usefulness is subject to challenges including precise measurement, selection of lead(s), and appropriate heart rate correction, issues that apply to a ll interval-based arrhythmia risk markers. We wholeheartedly agree that additional research is needed to further define the utility of these parameters. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Charles Antzelevitch, Jos é M. Di Diego Source Type: research

Our doubts about the usefulness of the Tpeak-Tend interval
We read with keen interest the counterpoint by Antzelevitch and DiDiego (1) in response to our point of view statement (2). First and foremost, we acknowledge the seminal nature of their work and its impact in stimulating experimental and clinical research. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Heikki V. Huikuri, Richard L. Verrier, Marek Malik, Federico Lombardi, Georg Schmidt, Markus Zabel Source Type: research

To the Editor — The site of origin of the premature ventricular complex in a patient with 2 different P-wave morphologies
I have read the ECG lessons by Hein J. Wellens1 with great interest. The case provides an excellent answer for the 2 different P-wave morphologies; however, the premature ventricular complex (PVC) needs further clarification. (Source: Heart Rhythm)
Source: Heart Rhythm - January 22, 2019 Category: Cardiology Authors: Ablofath Alizadeh, Ala Keikhavani Tags: Letter to the Editor Source Type: research

Multiple mechanisms underlie increased cardiac late sodium current
We recently reported a quantitative relationship between the degree of functional perturbation reported in the literature for 356 variants in the cardiac sodium channel gene SCN5A and the penetrance of resulting arrhythmia phenotypes. In the course of that work, we identified multiple SCN5A variants, including R1193Q, that are common in populations but are reported in HEK cells to generate large late sodium current (lNa-L). Objective: To compare the functional properties of R1193Q to those of the well-studied LQT3 mutation ΔKPQ. (Source: Heart Rhythm)
Source: Heart Rhythm - January 21, 2019 Category: Cardiology Authors: Brett M. Kroncke, Tao Yang, Dan M. Roden Source Type: research

Cardiac Sympathectomy For Refractory Ventricular Tachycardia in Arrhythmogenic Right Ventricular Cardiomyopathy
The sympathetic nervous system plays an important role in arrhythmogenesis in arrhythmogenic right ventricular cardiomyopathy (ARVC). Sudden cardiac death commonly occurs during exertion and beta-blockers are associated with reduction in arrhythmia burden. Bilateral cardiac sympathetic denervation (BCSD) has been shown to reduce implantable cardioverter-defibrillator (ICD) shocks in patients with structural heart disease and refractory ventricular tachycardia (VT), however data in ARVC are sparse. (Source: Heart Rhythm)
Source: Heart Rhythm - January 21, 2019 Category: Cardiology Authors: Fabrizio R. Assis, Aravind Krishnan, Xun Zhou, Cynthia A. James, Brittney Murray, Crystal Tichnell, Ronald Berger, Hugh Calkins, Harikrishna Tandri, Kaushik Mandal Source Type: research

Tpeak-Tend interval as a marker of arrhythmic risk
We have read the commentary by Malik et  al1 and the recent article by Srinivasan et al2 and offer the following observations. (Source: Heart Rhythm)
Source: Heart Rhythm - January 17, 2019 Category: Cardiology Authors: Charles Antzelevitch, Jos é M. Di Diego Tags: Point/Counterpoint Source Type: research

Is the Tpeak-Tend interval as a measure of repolarization heterogeneity dead or just seriously wounded?
This commentary relates to the article by Srinivasan et al [1], who studied relationships between intracardiac ventricular repolarization in normal human hearts in situ and the T-wave in the body surface ECG. They report not only that the slope of the T-wave upstroke in frontal precordial leads relates to repolarization differences between left and right ventricles but also that they found no meaningful relationship between myocardial repolarization heterogeneity, measured as differences in apicobasal, right-left ventricular, and transmural repolarization times, and duration of the Tpeak-Tend (Tpe) interval. (Source: Heart Rhythm)
Source: Heart Rhythm - January 17, 2019 Category: Cardiology Authors: Marek Malik, Heikki V. Huikuri, Federico Lombardi, Georg Schmidt, Richard L. Verrier, Markus Zabel, e-Rhythm group of EHRA Source Type: research

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 28, 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