'RotaShock' - A Revolution in Calcium Modification: Long-term Follow-up from a Single High-volume Centre.

Background: Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are well-established technologies for modification of coronary calcification. Given their contrasting mechanisms of action, there has been interest in whether the use of these devices in conjunction could potentially be synergistic and offer improved procedural results. The aim of this study was therefore to evaluate the efficacy, procedural safety and long-term outcomes of combining RA and IVL, termed 'RotaShock' (RSK), for the treatment of severe coronary calcification.

An analysis of long-term clinical outcome following the use of excimer laser coronary atherectomy in a large UK PCI center.

Background: Excimer laser atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI). Despite this there are a lack of contemporary outcome data, particulary longer-term, forpatients treated with ELCA PCI.

Aims: To evaluate the contemporary use ofELCA in PCI, the frequency of periprocedural complications and the longer-term outcomes associated with ELCA PCI.

Novel application of intravascular lithotripsy in stent under-expansion: A single-center experience.

Introduction: Stent under-expansion due to calcification is associated with a less durable result. The development of intravascular lithotripsy (IVL) has provided clinicians with a readily available, simple-to-use treatment option for coronary calcification, but the use of IVL within a previously stented segment is currently off-license. There are, however, developing data suggesting that the use of IVL can be an effective treatment option for patients with calcific stent under-expansion.

Rotablation in the Very Elderly - Safer than We Think?

Background/purpose: Calcified coronary artery stenosis remains a challenge for Percutaneous Coronary Intervention (PCI). Calcium modification is facilitated by rotablation and is used in 1-3% of cases. Data on rotablation in patients ≥80 years is limited and perceived to be high risk.

Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction.

Background Impaired microcirculatory reperfusion worsens prognosis following acute ST-segment-elevation myocardial infarction. In the T-TIME (A Trial of Low-Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low-dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio.

Towards Low Energy Atrial Defibrillation.

A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF) power transmitter (ex vivo) and a passive (battery free) implantable power receiver (in vivo) that enables measurement of the intracardiac impedance (ICI) during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter) and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform). An initial prototype was implemented and tested.

Fluoroscopic and electrical assessment of implantable cardioverter defibrillator leads: a prospective observational study.

Background: Insulation defects resulting in conductor externalization (CE) have been reported in the Riata family of implantable cardioverter defibrillator (ICD) leads (St. Jude Medical, Sylmar, CA, USA). The aim of this study was to identify, prospectively, the rate of CE and outcomes following this, within a group of patients with a Riata ICD lead.

Fluoroscopic and electrical assessment of a series of defibrillation leads: prevalence of externalized conductors.

Introduction: Insulation defects with externalized conductors have been reported in the St. Jude Riata(®)  family of defibrillation leads (St. Jude Medical, Sylmar, CA, USA).

Short-term efficacy of palliative balloon aortic valvuloplasty in selected patients with high operative risk.

Unlabelled: With the introduction of transcatheter aortic valve implantation (TAVI), the precise role of balloon aortic valvuloplasty (BAV) remains to be established.

Methods: Between August 2008 and November 2010, consecutive patients undergoing BAV for severe aortic stenosis (AS) in our center were enrolled. The primary endpoint was survival to hospital discharge.

Waveform optimization for internal cardioversion of atrial fibrillation.

Introduction: A novel atrial defibrillator was developed at the Royal Victoria Hospital in collaboration with the Nanotechnology and Integrated Bio-Engineering Centre, University of Ulster. This device is powered by an external pulse of radiofrequency energy and designed to cardiovert using low-tilt monophasic waveform (LTMW) and low-tilt biphasic waveform (LTBW), 12 milliseconds pulse width. This study compared the safety and efficacy of LTMW with LTBW for transvenous cardioversion of atrial fibrillation (AF).