Late unexpected complete fracture of a right ventricular lead still capturing the myocardium.

A 72-year-old man presented for routine dual chamber pacemaker interrogation 13 years following insertion for sick sinus syndrome. Increased noise, impedance and threshold of the right ventricular (RV) lead were identified. RV capture was maintained with an overall RV pacing burden of 47%.

Long-term outcome of myocardial scarring and deformation with cardiovascular magnetic resonance in out of hospital cardiac arrest survivors.

Aims: Cardiovascular magnetic resonance (CMR) is increasingly recognized as a diagnostic and prognostic tool in out of hospital cardiac arrest (OHCA) survivors. After assessing CMR findings early after ventricular fibrillation (VF) OHCA, we sought to explore the long-term outcome of myocardial scarring and deformation.

Methods And Results: We included 121 consecutive VF OHCA survivors (82% male, median 62 years) undergoing CMR within 2 weeks from cardiac arrest.

UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads.

Background: A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads.

The lung impedance monitoring in treatment of chronic heart failure (the LIMIT-CHF study).

Aims: To assess the usefulness of intrathoracic impedance monitoring (IIM) alerts in guiding empirical treatment of chronic heart failure (CHF) patients to prevent heart failure (HF) hospitalizations and unplanned HF care.

Methods And Results: Chronic heart failure patients with OptiVol or CorVue capable implantable cardioverter-defibrillators were randomized to either the active group (IIM alarm turned on and diuretic dose increased by 50% for 1 week in the event of alarm sounding) or the control group (IIM alarm turned off). The primary endpoint was the number of HF hospitalizations per patient at 1 year.

Demographic and Clinical Characteristics to Predict Paroxysmal Atrial Fibrillation: Insights from an Implantable Loop Recorder Population.

Background: There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk.

Clinical Predictors of Pacemaker Implantation in Patients with Syncope Receiving Implantable Loop Recorder with or without ECG Conduction Abnormalities.

Background: Implantable loop recorders (ILR) allow prolonged cardiac rhythm monitoring and improved diagnostic yield in syncope patients. Predictive factors for pacemaker (PM) implantation in the ILR population with unexplained syncope have not been adequately investigated. In this single center, retrospective, observational study we investigated factors that predict PM implantation in this population.

A highly effective technique for transseptal endocardial left ventricular lead placement for delivery of cardiac resynchronization therapy.

Background: Implantation of a left ventricular (LV) lead fails in 5% to 10% of patients in whom cardiac resynchronization therapy (CRT) is attempted. Alternatives for delivery of CRT are surgical epicardial and endocardial transvenous leads. Endocardial transseptal LV lead delivery is challenging because of the absence of dedicated equipment designed for this procedure.

Predictors of new onset atrial fibrillation in patients with heart failure.

Introduction: Stroke associated with atrial fibrillation (AF) is more frequent in heart failure. It is unknown what variables predict future AF in these patients and how AF might evolve over time. We investigated this in patients with implantable cardiac defibrillators (ICD) where AF detection is optimal.

A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial).

Background: Restoring sinus rhythm in patients with heart failure (HF) and atrial fibrillation (AF) may improve left ventricular (LV) function and HF symptoms. We sought to compare the effect of a catheter ablation strategy with that of a medical rate control strategy in patients with persistent AF and HF.

Methods And Results: Patients with persistent AF, symptomatic HF, and LV ejection fraction <50% were randomized to catheter ablation or medical rate control.

Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death.

Objective: To investigate whether catheter ablation of atrial fibrillation (AF) reduces stroke rate or mortality.

Methods: An international multicentre registry was compiled from seven centres in the U.K.

Characterization of fractionated atrial electrograms critical for maintenance of atrial fibrillation: a randomized, controlled trial of ablation strategies (the CFAE AF trial).

Background: Whether ablation of complex fractionated atrial electrograms (CFAE) modifies atrial fibrillation (AF) by eliminating drivers or atrial debulking remains unknown. This randomized study aimed to determine the effect of ablating different CFAE morphologies compared with normal electrograms (ie, debulking normal tissue) on the cycle length of persistent AF (AFCL).

Methods And Results: After pulmonary vein isolation left and right atrial CFAE were targeted, until termination of AF or abolition of CFAE before DC cardioversion.

Does ventricular dyssynchrony on echocardiography predict response to cardiac resynchronisation therapy? A randomised controlled study.

Objective: To determine the value of echocardiography in predicting response to cardiac resynchronisation therapy (CRT).

Methods: This is a prospective randomised study that recruited patients with (group 1) and without (group 2) echocardiographic evidence of mechanical dyssynchrony. 73 heart failure patients (NYHA III-IV) with a requirement for an implantable cardioverter defibrillator, QRS ≥120 ms and LV ejection fraction (EF) <35% were studied.

Impact of variant pulmonary vein anatomy and image integration on long-term outcome after catheter ablation for atrial fibrillation.

Aims: To investigate the impact of variant pulmonary vein (PV) anatomy and the use of three-dimensional image integration (3D-II) on long-term efficacy of catheter ablation for atrial fibrillation (AF).

Methods: Consecutive procedures from 2002 to 2007 were analysed from a prospective database. All patients underwent wide area circumferential ablation, with linear lesions added and complex fractionated electrograms targeted for persistent AF.

Validation of a classification system to grade fractionation in atrial fibrillation and correlation with automated detection systems.

Aims: We tested application of a grading system describing complex fractionated electrograms (CFE) in atrial fibrillation (AF) and used it to validate automated CFE detection (AUTO).

Methods And Results: Ten seconds bipolar electrograms were classified by visual inspection (VI) during ablation of persistent AF and the result compared with offline manual measurement (MM) by a second blinded operator: Grade 1 uninterrupted fractionated activity (defined as segments > or =70 ms) for > or =70% of recording and uninterrupted > or =1 s; Grade 2 interrupted fractionated activity > or =70% of recording; Grade 3 intermittent fractionated activity 30-70%; Grade 4 discrete (<70 ms) complex electrogram (> or =5 direction changes); Grade 5 discrete simple electrograms (< or =4 direction changes); Grade 6 scar. Grade by VI and MM for 100 electrograms agreed in 89%.

Management of atrial arrhythmias 3: paroxysmal atrial fibrillation.

This is the third in a series of four practical articles highlighting the important management steps for non-cardiologists and non-cardiac electrophysiologists dealing with patients with atrial fibrillation and common atrial flutter. This article will deal with care pathways and management principles for paroxysmal atrial fibrillation.

Practical management of common atrial arrhy thmias 2: common atrial flutter.

This is the second in a series of four practical articles highlighting the important management steps for noncardiologists and non-cardiac electrophysiologists dealing with patients with atrial fibrillation and common atrial flutter. This article will deal with care pathways and management principles for common atrial flutter.

Practical management of common atrial arrhythmias 1: cardioversion.

This is the first in a series of four practical articles highlighting the important management steps for non-cardiologists and non-cardiac electrophysiologists dealing with patients with atrial fibrillation and common atrial flutter. This article will deal with care pathways and management principles for cardioversion of atrial arrhythmias.

Ablation of supraventricular tachycardia in a 96 year old.

Atrioventricular nodal re-entrant tachycardia (AVNRT) is a common arrhythmia that is frequently encountered in clinical practice. Though more common in the younger population, it affects individuals of all ages. The elderly in particular are usually more symptomatic and more frequently require emergency treatment including urgent hospital admissions.