Leadless pacemaker tine damage and fracture: novel complications of a novel device fixation mechanism.

Background: Leadless pacemakers represent a paradigm-changing advancement. However, they required innovative and novel device design, including the use of nitinol tines for fixation.

Objective: We aimed to understand the potential for fracture in the novel tine-based fixation mechanism.

Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias.

Background: Oral sotalol is a class III antiarrhythmic commonly used for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). Recently, the Food and Drug Administration (FDA) approved the use of IV sotalol loading, based primarily on modeling data for the infusion. We aimed to describe a protocol and experience with IV sotalol loading for elective treatment of adult patients with AF and atrial flutter (AFL).

Externalized conductors and electrical dysfunction in transvenous ventricular leads: Results of the Cardiac Lead Assessment Study.

Background: The Cardiac Lead Assessment Study (CLAS) was a large prospective, multicenter, international postmarket surveillance study conducted at 45 sites.

Objective: The purpose of CLAS was to examine the prevalence and incidence of externalized conductors and electrical dysfunction in subjects with selected St. Jude Medical defibrillator and left ventricular leads.

Successful avoidance of superior vena cava injury during transvenous lead extraction using a tandem femoral-superior approach.

Background: Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique that incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein.

Long-term outcomes in patients treated with flecainide for atrial fibrillation with stable coronary artery disease.

Background: Class 1C antiarrhythmic drugs (AAD) have been associated with harm in patients treated for ventricular arrhythmias with a prior myocardial infarction. Consensus guidelines have advocated that these drugs not be used in patients with stable coronary artery disease (CAD). However, long-term data are lacking to know if unique risks exist when these drugs are used for atrial fibrillation (AF) in patients with CAD without a prior myocardial infarction.

Patient-reported outcomes and subsequent management in atrial fibrillation clinical practice: Results from the Utah mEVAL AF program.

Background: Atrial fibrillation (AF) significantly reduces health-related quality of life (HRQoL), previously measured in clinical trials using patient-reported outcomes (PROs). We examined AF PROs in clinical practice and their association with subsequent clinical management.

Methods: The Utah My Evaluation (mEVAL) program collects the Toronto AF Symptom Severity Scale (AFSS) in AF outpatients at the University of Utah.

ILEEM-survey on the Heart Team approach and team training for lead extraction procedures.

Background: The Heart Team approach has become an integral part of modern cardiovascular medicine. To evaluate current opinions and real-world practice among lead extraction practitioners, an online survey was created and distributed among a pool of lead extraction specialists participating in the International Lead Extraction Expert Meeting (ILEEM) 2018.

Methods: The online survey consisted of 10 questions and was performed using an online survey tool (www.

Systematic collection of patient-reported outcomes in atrial fibrillation: feasibility and initial results of the Utah mEVAL AF programme.

Aims: Incorporating patient-reported outcomes (PROs) into routine care of atrial fibrillation (AF) enables direct integration of symptoms, function, and health-related quality of life (HRQoL) into practice. We report our initial experience with a system-wide PRO initiative among AF patients.

Methods And Results: All patients with AF in our practice undergo PRO assessment with the Toronto AF Severity Scale (AFSS), and generic PROs, prior to electrophysiology clinic visits.

Salvage of Threatened Cardiovascular Implantable Electronic Devices: Case Series and Review of Literature.

Background: The treatment of infected or exposed cardiac pacing and defibrillator devices is controversial. The conservative and widely accepted management calls for removal of the device and leads with immediate or delayed replacement of new components in a new site. Lead extraction carries a 2% major complication risk.

"Vasovagal" response during ventricular fibrillation: incidence and implications.

Background: The purpose of this study was to assess the relationship between changes in sinus node cycle length (SNCL) during ventricular fibrillation (VF) and the peripheral changes in blood pressure (BP) and sympathetic nerve activity (SNA) in human subjects. We hypothesized that patients with no SNCL shortening during VF have a vasovagal-like response with a greater decrease in BP and SNA when compared to patients with SNCL shortening.

Methods: SNCL, BP, and SNA recordings were attempted in 24 patients undergoing the implantation of a dual-chamber implantable defibrillator.

Utility of intracardiac echocardiography for atrial baffle leak closure in repaired transposition of the great arteries.

A 27-year-old male with dextro-transposition of great arteries had Senning atrial switch repair in childhood and dual-chamber pacemaker placement for sinus node dysfunction in adulthood. Transthoracic echocardiography showed a lead in the systemic (anatomic right) ventricle. Multidetector computed tomography showed the lead perforating the baffle in the region of the body of the systemic venous atrium into the systemic ventricle.

Bipolar lumenless lead performance in children and adults with congenital heart disease.

Background: Because of small size and anatomic variation, implantation of intracardiac leads for permanent pacing in pediatric and congenital heart disease (CHD) patients can be challenging. A novel 4.1F bipolar catheter-delivered lead offers potential advantages for this population.

Modulation of the sinus rate during ventricular fibrillation.

Background: During supraventricular and ventricular tachycardia, the arterial baroreflex predominates with minimal contribution from the cardiopulmonary reflex. To our knowledge, the role of the arterial baroreflex gain (BRG) during and immediately following termination of ventricular fibrillation (VF) has not been characterized.

Objective: We hypothesized that (1) arterial BRG correlated with sinus node cycle length (SNCL) changes during VF, and that (2) the greater the arterial BRG, the greater the blood pressure (BP) recovery following successful defibrillation.

Performance of dedicated versus integrated bipolar defibrillator leads with CRT-defibrillators: results from a Prospective Multicenter Study.

Introduction: Right ventricular (RV) anodal stimulation may occur in cardiac resynchronization therapy defibrillators (CRT-D) when left ventricular (LV) pacing is configured between the LV lead and an electrode on the RV defibrillator lead. RV defibrillator leads can have a dedicated proximal pacing ring electrode (dedicated bipolar) or utilize the distal shocking coil as the proximal pacing electrode (integrated bipolar). This study compares the performance of integrated versus dedicated leads with respect to anodal stimulation incidence, sensing, and inappropriate ventricular tachyarrhythmia detection in patients implanted with CRT-D.