Electromechanically Optimized Right Ventricular Pacing for Obstructive Hypertrophic Cardiomyopathy (EMORI-HCM).

Background: Many patients with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) have devices capable of right ventricular pacing (RVP). Although pacing can reduce left ventricular outflow tract gradient (LVOTg), it can also reduce cardiac output, so its net effect is variable.

Objective: We tested whether electromechanical optimisation of the programmed atrio-ventricular delay (AVD) allows RVP to achieve a net benefit on symptoms.

High-Precision Hemodynamic and Echocardiographic Assessment of Pacing in Obstructive Hypertrophic Cardiomyopathy.

Background: Left ventricular outflow obstruction drives symptoms and outcomes in obstructive hypertrophic cardiomyopathy (oHCM). Right ventricular pacing (RVP) can desynchronize the left ventricle to relieve this and allows control of atrioventricular delay (AVD) but may impair ventricular function. We used high-precision assessment to quantify the hemodynamic and echocardiographic effects of RVP in oHCM.

Results from a national observational survey of UK cardiologists on antibiotic envelope use during cardiac electronic device implantation.

Objective: The aim of this study was to conduct a survey of cardiac device implanting physicians to report utilisation trends, barriers and attitudes around the use of antibiotic envelope utilisation in the UK.

Design: An online survey devised by an implanting physician focus group, which included a mixture of multiple-choice and open text questions, was sent via email to UK-based physicians.

Participants: 500 implanting physicians across 159 sites in the UK, identified from the National Institute for Cardiovascular Outcomes Research Database.

Physiological pacing: mechanisms, clinical indications, and perspectives.

Normal cardiac function depends on a highly efficient cardiac conduction system. Conduction system disease impairs cardiac function, which can reduce exercise capacity, cause symptoms such as breathlessness and fatigue, and, if severe, result in syncope and death. Pacemakers were originally developed to treat profound bradycardia caused by complete heart block.

An in silico guide for ventriculo-ventricular delay programming for left bundle branch-optimized cardiac resynchronization therapy.

Aims: Left bundle branch pacing (LBBP)-optimized cardiac resynchronization therapy (LOT-CRT) can improve left ventricular (LV) activation when LBBP alone or conventional biventricular pacing are ineffective. However, the optimal programming settings for ventriculo-ventricular delay (VVD) for LOT-CRT are unknown. We aim to investigate how to optimally program VVD for LOT-CRT in the presence of various LV conduction substrates using computational modelling.

Conduction system pacing compared with biventricular pacing for cardiac resynchronization therapy in patients with heart failure and mildly reduced left ventricular ejection fraction: Results from International Collaborative LBBAP Study (I-CLAS) Group.

Background: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).

Objective: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.

Therapeutic potential of conduction system pacing as a method for improving cardiac output during ventricular tachycardia.

Background: Ventricular tachycardia (VT) reduces cardiac output through high heart rates, loss of atrioventricular synchrony, and loss of ventricular synchrony. We studied the contribution of each mechanism and explored the potential therapeutic utility of His bundle pacing to improve cardiac output during VT.

Methods: Study 1 aimed to improve the understanding of mechanisms of harm during VT (using pacing simulated VT).

Catheter Ablation for Ventricular Tachycardia After MI: A Reconstructed Individual Patient Data Meta-analysis of Randomised Controlled Trials.

Background: The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question. We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after MI.

Methods: We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI.

Heart Failure and Cardiac Device Therapy: A Review of Current National Institute of Health and Care Excellence and European Society of Cardiology Guidelines.

Guidelines help clinicians to deliver high-quality care with therapies based on up-to-date evidence. There has been significant progress in the management of heart failure with regards to both medication and cardiac device therapy. These advances have been incorporated into national and international guidelines with varying degrees of success.

Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis.

Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades.

Catheter ablation improves cardiovascular outcomes in patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials.

Aims: The effect of atrial fibrillation catheter ablation on cardiovascular outcomes in heart failure is an important outstanding research question. We undertook a meta-analysis of randomized controlled trials comparing ablation to medical therapy in patients with AF and heart failure.

Methods And Results: We systematically identified all trials comparing catheter ablation to medical therapy in patients with heart failure and atrial fibrillation.

Opioid-induced myoclonus and hyperalgesia following a short course of low-dose oral morphine.

A 76-year-old man was admitted to hospital with a right-sided fractured neck of femur requiring repair via a cemented hemiarthroplasty. Intraoperatively he received 10 mg of intravenous morphine. Post-operatively he received a short course of low-dose oral opioids and subsequently developed myoclonic jerks and hyperalgesia.

Giant Coronary Artery Aneurysm in a Middle-Aged Woman.

Giant coronary artery aneurysm (CAA) is a rare clinicopathologic entity, and there is a dearth of information regarding presentation, diagnosis, and subsequent management. We present a case of a giant aneurysm of the proximal right coronary artery (RCA) that was 1.5 × 1.