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Publisher: Elsevier   (Total: 3162 journals)

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Showing 1201 - 1400 of 3162 Journals sorted alphabetically
Growth Factors and Cytokines in Health and Disease     Full-text available via subscription   (Followers: 1)
Growth Hormone & IGF Research     Hybrid Journal   (Followers: 16, SJR: 1.059, CiteScore: 2)
Gynecologic Oncology     Hybrid Journal   (Followers: 25, SJR: 2.339, CiteScore: 4)
Gynecologic Oncology Reports     Open Access   (Followers: 10, SJR: 0.307, CiteScore: 1)
Gynécologie Obstétrique & Fertilité     Full-text available via subscription   (Followers: 1)
Habitat Intl.     Hybrid Journal   (Followers: 6, SJR: 1.336, CiteScore: 3)
Hand Clinics     Full-text available via subscription   (Followers: 5, SJR: 0.556, CiteScore: 1)
Hand Surgery and Rehabilitation     Full-text available via subscription   (Followers: 4, SJR: 0.358, CiteScore: 1)
Handai Nanophotonics     Full-text available via subscription  
Handbook of Adhesives and Sealants     Full-text available via subscription   (Followers: 2)
Handbook of Agricultural Economics     Full-text available via subscription   (Followers: 3)
Handbook of Algebra     Full-text available via subscription  
Handbook of Analytical Separations     Full-text available via subscription   (Followers: 3)
Handbook of Behavioral Neuroscience     Full-text available via subscription   (Followers: 3)
Handbook of Biological Physics     Full-text available via subscription  
Handbook of Chemical Neuroanatomy     Full-text available via subscription  
Handbook of Clinical Neurology     Full-text available via subscription   (Followers: 2, SJR: 1.007, CiteScore: 2)
Handbook of Clinical Neurophysiology     Full-text available via subscription  
Handbook of Complex Analysis     Full-text available via subscription  
Handbook of Computational Economics     Full-text available via subscription   (Followers: 1, SJR: 4.16, CiteScore: 2)
Handbook of Defense Economics     Full-text available via subscription   (Followers: 1)
Handbook of Development Economics     Full-text available via subscription   (Followers: 7)
Handbook of Differential Equations: Evolutionary Equations     Full-text available via subscription  
Handbook of Differential Equations: Ordinary Differential Equations     Full-text available via subscription  
Handbook of Differential Equations: Stationary Partial Differential Equations     Full-text available via subscription   (Followers: 2)
Handbook of Differential Geometry     Full-text available via subscription  
Handbook of Dynamical Systems     Full-text available via subscription   (Followers: 1)
Handbook of Econometrics     Full-text available via subscription   (Followers: 8)
Handbook of Economic Forecasting     Full-text available via subscription   (Followers: 1)
Handbook of Economic Growth     Full-text available via subscription   (Followers: 2)
Handbook of Environmental Economics     Full-text available via subscription   (Followers: 2)
Handbook of Experimental Economics Results     Full-text available via subscription   (Followers: 4)
Handbook of Exploration and Environmental Geochemistry     Full-text available via subscription   (Followers: 2)
Handbook of Exploration Geochemistry     Full-text available via subscription   (Followers: 1)
Handbook of Ferromagnetic Materials     Full-text available via subscription   (Followers: 1)
Handbook of Game Theory with Economic Applications     Full-text available via subscription   (Followers: 1)
Handbook of Geophysical Exploration: Seismic Exploration     Full-text available via subscription  
Handbook of Health Economics     Full-text available via subscription   (Followers: 10)
Handbook of Immunohistochemistry and in Situ Hybridization of Human Carcinomas     Full-text available via subscription   (Followers: 1)
Handbook of Income Distribution     Full-text available via subscription   (Followers: 2)
Handbook of Industrial Organization     Full-text available via subscription   (Followers: 3)
Handbook of Intl. Economics     Full-text available via subscription  
Handbook of Labor Economics     Full-text available via subscription   (Followers: 14)
Handbook of Law and Economics     Full-text available via subscription   (Followers: 17)
Handbook of Macroeconomics     Full-text available via subscription   (Followers: 6, SJR: 0, CiteScore: 2)
Handbook of Magnetic Materials     Full-text available via subscription   (Followers: 2, SJR: 0.467, CiteScore: 2)
Handbook of Mathematical Economics     Full-text available via subscription  
Handbook of Mathematical Fluid Dynamics     Full-text available via subscription   (Followers: 2)
Handbook of Metal Physics     Full-text available via subscription  
Handbook of Monetary Economics     Full-text available via subscription   (Followers: 5)
Handbook of Natural Resource and Energy Economics     Full-text available via subscription   (Followers: 3)
Handbook of Numerical Analysis     Full-text available via subscription   (Followers: 4)
Handbook of Perception and Action     Full-text available via subscription   (Followers: 2)
Handbook of Petroleum Exploration and Production     Full-text available via subscription   (Followers: 2)
Handbook of Population and Family Economics     Full-text available via subscription   (Followers: 3)
Handbook of Powder Technology     Full-text available via subscription   (Followers: 6)
Handbook of Public Economics     Full-text available via subscription  
Handbook of Regional and Urban Economics     Full-text available via subscription   (Followers: 1)
Handbook of Sensors and Actuators     Full-text available via subscription   (Followers: 10)
Handbook of Social Choice and Welfare     Full-text available via subscription   (Followers: 3)
Handbook of Statistics     Full-text available via subscription   (Followers: 7, SJR: 0.102, CiteScore: 0)
Handbook of Surface Science     Full-text available via subscription   (Followers: 4, SJR: 0.193, CiteScore: 0)
Handbook of Systemic Autoimmune Diseases     Full-text available via subscription   (Followers: 2)
Handbook of the Economics of Art and Culture     Full-text available via subscription   (Followers: 1)
Handbook of the Economics of Education     Full-text available via subscription   (Followers: 9, SJR: 0, CiteScore: 2)
Handbook of the Economics of Finance     Full-text available via subscription   (Followers: 6)
Handbook of the Economics of Giving, Altruism and Reciprocity     Full-text available via subscription  
Handbook of the Geometry of Banach Spaces     Full-text available via subscription   (Followers: 1)
Handbook of the History of Logic     Full-text available via subscription   (Followers: 1)
Handbook of Thermal Analysis and Calorimetry     Full-text available via subscription   (Followers: 1)
Handbook of Thermal Conductivity     Full-text available via subscription   (Followers: 4)
Handbook of Vapor Pressure     Full-text available via subscription  
Handbook on the Physics and Chemistry of Rare Earths     Full-text available via subscription   (Followers: 3, SJR: 0.755, CiteScore: 3)
Handbooks of Management Accounting Research     Full-text available via subscription   (Followers: 4)
HardwareX     Open Access  
Harmful Algae     Hybrid Journal   (Followers: 5, SJR: 1.531, CiteScore: 4)
HBRC J.     Open Access   (Followers: 2)
Health & Place     Hybrid Journal   (Followers: 15, SJR: 1.506, CiteScore: 3)
Health Outcomes Research in Medicine     Hybrid Journal   (Followers: 3)
Health Policy     Hybrid Journal   (Followers: 42, SJR: 1.252, CiteScore: 2)
Health Policy and Technology     Hybrid Journal   (Followers: 4, SJR: 0.322, CiteScore: 1)
Health Professions Education     Open Access   (Followers: 3)
Healthcare : The J. of Delivery Science and Innovation     Full-text available via subscription   (Followers: 1)
Hearing Research     Hybrid Journal   (Followers: 11, SJR: 1.35, CiteScore: 3)
Heart & Lung: The J. of Acute and Critical Care     Hybrid Journal   (Followers: 10, SJR: 0.757, CiteScore: 2)
Heart Failure Clinics     Full-text available via subscription   (Followers: 2, SJR: 1.153, CiteScore: 2)
Heart Rhythm     Hybrid Journal   (Followers: 10, SJR: 3.231, CiteScore: 4)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9, SJR: 0.599, CiteScore: 1)
HeartRhythm Case Reports     Open Access   (SJR: 0.232, CiteScore: 0)
Heliyon     Open Access   (SJR: 0.355, CiteScore: 1)
Hellenic J. of Cardiology     Open Access   (Followers: 1, SJR: 0.479, CiteScore: 1)
Hematology, Transfusion and Cell Therapy     Open Access   (Followers: 1)
Hematology/Oncology and Stem Cell Therapy     Open Access   (Followers: 4, SJR: 0.532, CiteScore: 1)
Hematology/Oncology Clinics of North America     Full-text available via subscription   (Followers: 6, SJR: 1.282, CiteScore: 3)
Hepatobiliary & Pancreatic Diseases Intl.     Full-text available via subscription   (Followers: 1, SJR: 0.711, CiteScore: 2)
High Energy Density Physics     Hybrid Journal   (Followers: 2, SJR: 0.933, CiteScore: 2)
Hipertensión y Riesgo Vascular     Full-text available via subscription   (SJR: 0.115, CiteScore: 0)
Historia Mathematica     Full-text available via subscription   (Followers: 1, SJR: 0.174, CiteScore: 0)
History of CERN     Full-text available via subscription   (Followers: 1)
History of Neuroscience in Autobiography     Full-text available via subscription   (Followers: 3)
HIV & AIDS Review     Full-text available via subscription   (Followers: 12, SJR: 0.134, CiteScore: 0)
Homeopathy     Hybrid Journal   (Followers: 6, SJR: 0.678, CiteScore: 1)
HOMO - J. of Comparative Human Biology     Hybrid Journal   (Followers: 2, SJR: 0.335, CiteScore: 1)
Hong Kong J. of Nephrology     Open Access   (Followers: 2, SJR: 0.137, CiteScore: 0)
Hong Kong J. of Occupational Therapy     Open Access   (Followers: 42, SJR: 0.237, CiteScore: 1)
Hong Kong Physiotherapy J.     Open Access   (Followers: 12, SJR: 0.183, CiteScore: 0)
Hormigón y Acero     Full-text available via subscription  
Hormones and Behavior     Hybrid Journal   (Followers: 12, SJR: 1.638, CiteScore: 4)
Horticultural Plant J.     Open Access   (Followers: 5)
Hospital Medicine Clinics     Full-text available via subscription   (Followers: 2, SJR: 0.107, CiteScore: 0)
Human Factors in Information Technology     Full-text available via subscription   (Followers: 35)
Human Immunology     Hybrid Journal   (Followers: 17, SJR: 0.856, CiteScore: 2)
Human Movement Science     Hybrid Journal   (Followers: 15, SJR: 0.756, CiteScore: 2)
Human Pathology     Hybrid Journal   (Followers: 26, SJR: 1.304, CiteScore: 3)
Human Pathology : Case Reports     Open Access   (Followers: 1, SJR: 0.136, CiteScore: 0)
Human Resource Management Review     Hybrid Journal   (Followers: 50, SJR: 1.675, CiteScore: 4)
Hydrometallurgy     Hybrid Journal   (Followers: 13, SJR: 1.208, CiteScore: 3)
IATSS Research     Open Access   (SJR: 0.37, CiteScore: 1)
Icarus     Hybrid Journal   (Followers: 73, SJR: 2.037, CiteScore: 3)
ICT Express     Open Access   (SJR: 0.234, CiteScore: 1)
IDCases     Open Access   (SJR: 0.344, CiteScore: 1)
IERI Procedia     Open Access   (Followers: 1)
IFAC-PapersOnLine     Open Access   (SJR: 0.26, CiteScore: 1)
IIMB Management Review     Open Access   (Followers: 9, SJR: 0.24, CiteScore: 1)
IJC Heart & Vessels     Open Access   (Followers: 1)
IJC Heart & Vasculature     Open Access   (Followers: 1, SJR: 0.342, CiteScore: 1)
IJC Metabolic & Endocrine     Open Access   (Followers: 1, SJR: 0.4, CiteScore: 1)
Image and Vision Computing     Hybrid Journal   (Followers: 15, SJR: 0.612, CiteScore: 3)
Imagen Diagnóstica     Full-text available via subscription   (SJR: 0.106, CiteScore: 0)
Imagerie de la Femme     Full-text available via subscription   (Followers: 1, SJR: 0.124, CiteScore: 0)
Immunity     Full-text available via subscription   (Followers: 53, SJR: 13.393, CiteScore: 16)
Immuno-analyse & Biologie Spécialisée     Full-text available via subscription   (Followers: 2)
Immunobiology     Hybrid Journal   (Followers: 9, SJR: 1.1, CiteScore: 3)
Immunology and Allergy Clinics of North America     Full-text available via subscription   (Followers: 6, SJR: 1.132, CiteScore: 3)
Immunology Letters     Hybrid Journal   (Followers: 12, SJR: 1.168, CiteScore: 3)
Immunotoxicology of Drugs and Chemicals: an Experimental and Clinical Approach     Full-text available via subscription   (Followers: 1)
Implantodontie     Full-text available via subscription  
Indagationes Mathematicae     Open Access   (Followers: 1, SJR: 0.685, CiteScore: 1)
Indian Heart J.     Open Access   (Followers: 4, SJR: 0.333, CiteScore: 1)
Indian J. of Medical Specialities     Hybrid Journal   (SJR: 0.118, CiteScore: 0)
Indian J. of Tuberculosis     Full-text available via subscription   (SJR: 0.221, CiteScore: 0)
Indian Pacing and Electrophysiology J.     Open Access   (SJR: 0.273, CiteScore: 0)
Industrial Chemistry Library     Full-text available via subscription   (Followers: 3)
Industrial Crops and Products     Hybrid Journal   (Followers: 5, SJR: 1.091, CiteScore: 4)
Industrial Marketing Management     Hybrid Journal   (Followers: 23, SJR: 1.663, CiteScore: 4)
Industrial Safety Series     Full-text available via subscription   (Followers: 16)
Infant Behavior and Development     Hybrid Journal   (Followers: 14, SJR: 0.784, CiteScore: 2)
Infectio     Open Access   (SJR: 0.133, CiteScore: 0)
Infection, Disease & Health     Open Access   (Followers: 8, SJR: 0.23, CiteScore: 1)
Infection, Genetics and Evolution     Hybrid Journal   (Followers: 5, SJR: 1.278, CiteScore: 3)
Infectious Disease Clinics of North America     Full-text available via subscription   (Followers: 5, SJR: 2.359, CiteScore: 5)
Informatics in Medicine Unlocked     Open Access   (SJR: 0.224, CiteScore: 1)
Information & Management     Hybrid Journal   (Followers: 56, SJR: 1.628, CiteScore: 5)
Information and Computation     Hybrid Journal   (Followers: 4, SJR: 0.504, CiteScore: 1)
Information and Organization     Hybrid Journal   (Followers: 39, SJR: 1.202, CiteScore: 3)
Information and Software Technology     Hybrid Journal   (Followers: 6, SJR: 0.581, CiteScore: 4)
Information Economics and Policy     Hybrid Journal   (Followers: 4, SJR: 0.63, CiteScore: 1)
Information Fusion     Hybrid Journal   (Followers: 2, SJR: 1.832, CiteScore: 7)
Information Processing & Management     Hybrid Journal   (Followers: 286, SJR: 0.92, CiteScore: 4)
Information Processing in Agriculture     Open Access   (SJR: 0.352, CiteScore: 2)
Information Processing Letters     Hybrid Journal   (Followers: 6, SJR: 0.412, CiteScore: 1)
Information Sciences     Hybrid Journal   (Followers: 341, SJR: 1.635, CiteScore: 5)
Information Security Technical Report     Full-text available via subscription   (Followers: 12)
Information Systems     Hybrid Journal   (Followers: 13, SJR: 0.805, CiteScore: 4)
Infosecurity     Full-text available via subscription   (Followers: 11)
Infrared Physics & Technology     Hybrid Journal   (Followers: 12, SJR: 0.54, CiteScore: 2)
Injury     Hybrid Journal   (Followers: 18, SJR: 0.99, CiteScore: 2)
Injury Extra     Open Access   (Followers: 2)
Inmunología     Full-text available via subscription   (Followers: 2)
Innovative Food Science & Emerging Technologies     Hybrid Journal   (Followers: 5, SJR: 1.201, CiteScore: 3)
Inorganic Chemistry Communications     Hybrid Journal   (Followers: 13, SJR: 0.43, CiteScore: 2)
Inorganica Chimica Acta     Hybrid Journal   (Followers: 9, SJR: 0.485, CiteScore: 2)
Insect Biochemistry and Molecular Biology     Hybrid Journal   (Followers: 3, SJR: 1.912, CiteScore: 4)
Instabilities in Silicon Devices     Full-text available via subscription   (Followers: 1)
Insulin     Full-text available via subscription   (Followers: 5)
Insurance: Mathematics and Economics     Hybrid Journal   (Followers: 9, SJR: 1.083, CiteScore: 2)
Integration, the VLSI J.     Hybrid Journal   (Followers: 6, SJR: 0.223, CiteScore: 1)
Integrative Medicine Research     Open Access   (Followers: 3)
Intellectual Economics     Open Access  
Intelligence     Hybrid Journal   (Followers: 7, SJR: 1.633, CiteScore: 3)
Intensive and Critical Care Nursing     Hybrid Journal   (Followers: 28, SJR: 0.611, CiteScore: 2)
Interdisciplinary Neurosurgery     Open Access   (SJR: 0.164, CiteScore: 0)
Interface Science and Technology     Full-text available via subscription  
Intermetallics     Hybrid Journal   (Followers: 22, SJR: 1.568, CiteScore: 4)
Internet Interventions : The application of information technology in mental and behavioural health     Open Access   (Followers: 4, SJR: 1.962, CiteScore: 4)
Interventional Cardiology Clinics     Full-text available via subscription   (Followers: 3, SJR: 0.156, CiteScore: 0)
Intl. Biodeterioration & Biodegradation     Hybrid Journal   (Followers: 1, SJR: 1.086, CiteScore: 4)
Intl. Business Review     Hybrid Journal   (Followers: 10, SJR: 1.012, CiteScore: 3)
Intl. Communications in Heat and Mass Transfer     Hybrid Journal   (Followers: 21, SJR: 1.553, CiteScore: 5)
Intl. Comparative Jurisprudence     Open Access   (Followers: 2)
Intl. Dairy J.     Hybrid Journal   (Followers: 6, SJR: 1.051, CiteScore: 2)
Intl. Economics     Hybrid Journal   (Followers: 4, SJR: 0.451, CiteScore: 1)
Intl. Emergency Nursing     Hybrid Journal   (Followers: 10, SJR: 0.461, CiteScore: 1)
Intl. Geophysics     Full-text available via subscription   (Followers: 3)
Intl. Immunopharmacology     Hybrid Journal   (Followers: 2, SJR: 1.051, CiteScore: 3)
Intl. J. for Parasitology     Hybrid Journal   (Followers: 11, SJR: 1.638, CiteScore: 4)
Intl. J. for Parasitology : Drugs and Drug Resistance     Open Access   (Followers: 4, SJR: 1.556, CiteScore: 4)
Intl. J. for Parasitology : Parasites and Wildlife     Open Access   (Followers: 2, SJR: 1.455, CiteScore: 3)
Intl. J. of Accounting     Hybrid Journal   (Followers: 1)
Intl. J. of Accounting Information Systems     Hybrid Journal   (Followers: 5, SJR: 0.399, CiteScore: 2)

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Journal Cover
Heart Rhythm
Journal Prestige (SJR): 3.231
Citation Impact (citeScore): 4
Number of Followers: 10  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1547-5271
Published by Elsevier Homepage  [3162 journals]
  • Brugada syndrome: keep an eye on the ECG
    • Abstract: Publication date: Available online 7 July 2018Source: Heart RhythmAuthor(s): Vincent PROBST, Jean-Baptiste Gourraud
       
  • Intermittent Anticoagulation Guided by Continuous Atrial Fibrillation
           Burden Monitoring Using Dual Chamber Pacemakers and Implantable
           Cardioverter-Defibrillators–Results from the Tailored Anticoagulation
           for Non-Continuous Atrial Fibrillation (TACTIC-AF) Pilot Study
    • Abstract: Publication date: Available online 6 July 2018Source: Heart RhythmAuthor(s): Jonathan W. Waks, Rod S. Passman, Jason Matos, Matthew Reynolds, Amit Thosani, Theofanie Mela, David Pederson, Taya V. Glotzer, Peter Zimetbaum BackgroundChronic anticoagulation is recommended in atrial fibrillation (AF) patients with thromboembolic risk factors regardless of AF duration/frequency. Continuous rhythm assessment with pacemakers/implantable cardioverter-defibrillators (ICDs) and use of direct-acting oral anticoagulants (DOACs) may allow anticoagulation only around AF episodes, reducing bleeding without increasing thromboembolic risk.Objectives: To evaluate feasibility/safety of intermittent DOAC use guided by continuous remote AF monitoring via dual-chamber pacemakers or ICDs.MethodsPatients with non-permanent AF, current DOAC use, CHADS2 score ≤3, St. Jude Medical dual-chamber PM or ICD, and rare AF episodes were followed with bi-weekly and AF-alert based remote transmissions. Patients free of AF episodes lasting ≥6 minutes with a total AF burden of
       
  • Screening for Atrial Fibrillation using Smartphone-based Technology and
           Layperson Volunteers: High-Tech Meets Community Participatory Research for
           the Best of Both Worlds
    • Abstract: Publication date: Available online 4 July 2018Source: Heart RhythmAuthor(s): Rachel Lampert
       
  • Cryoballoon Antral Pulmonary Vein Isolation vs. Force-Sensing
           Radiofrequency Catheter Ablation for Pulmonary Vein and Posterior Left
           Atrial Isolation in Patients with Persistent Atrial Fibrillation
    • Abstract: Publication date: Available online 4 July 2018Source: Heart RhythmAuthor(s): Miki Yokokawa, Aman Chugh, Rakesh Latchamsetty, Hamid Ghanbari, Thomas Crawford, Krit Jongnarangsin, Ryan Cunnane, Mohammed Saeed, Bipin Sunkara, Mehmet Tezcan, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral BackgroundThe role of cryoballoon ablation (CBA) for antral pulmonary vein isolation (APVI) has not been well established in persistent atrial fibrillation (PerAF). A left atrial (LA) posterior wall box lesion set (BOX) after APVI has been suggested to improve the efficacy of radiofrequency catheter ablation (RFA) in PerAF.ObjectiveTo compare characteristics and clinical outcomes of APVI by CBA vs APVI+BOX by contact force-guided RFA (CF-RFA) in patients with PerAF.MethodsAPVI was performed in 167 consecutive patients with PerAF (age: 64±9 years; LA diameter: 46±6 mm) using CBA (90) or CF-RFA (77). After APVI, a roof line was created in 33/90 patients (37%) in the CBA group, and BOX was performed in all of the 77 patients in the CF-RFA group.ResultsDuring 21±10 months of follow-up after a single ablation procedure, 37/90 (41%) in the CBA (APVI) and 39/77 (51%) in the CF-RFA (APVI+BOX) groups remained in sinus rhythm without antiarrhythmic drugs (AADs, P=0.22). During repeat ablation APVI+BOX using CF-RFA was performed in 20/90 (22%) and in 18/77 patients (23%) who initially underwent CBA or CF-RFA, respectively. At 19±10 months after repeat ablation, sinus rhythm was maintained in 55/90 (61%) and 52/77 (68%) patients in the CBA and CF-RFA groups without AADs, respectively (P=0.39).ConclusionIn PerAF, an initial approach of APVI by CBA or APVI+BOX by CF-RFA has a similar efficacy of 40-50% without AADs. After repeat ablation for APVI+BOX by CF-RFA in ∼25%, sinus rhythm is maintained in 60-70% of the patients without AADs.
       
  • Brugada Syndrome: Let’s Talk About Sex
    • Abstract: Publication date: Available online 4 July 2018Source: Heart RhythmAuthor(s): Christian Jons, Michael H. Gollob
       
  • PROTAMINE TO EXPEDITE VASCULAR HEMOSTASIS AFTER CATHETER ABLATION OF
           ATRIAL FIBRILLATION: A RANDOMIZED CONTROLLED TRIAL
    • Abstract: Publication date: Available online 3 July 2018Source: Heart RhythmAuthor(s): Michael Ghannam, Aman Chugh, Patrick Dillon, Daniel Alyesh, Konstantinos Kossidas, Shikha Sharma, John Coatney, Auras Atreya, Miki Yokokawa, Mohammed Saeed, Ryan Cunnane, Hamid Ghanbari, Rakesh Latchamsetty, Thomas Crawford, Krit Jongnarangsin, Frank Bogun, Frank Pelosi, Fred Morady, Hakan Oral BackgroundThere are no randomized, controlled studies on the efficacy and safety of protamine sulfate to reverse anticoagulant effects of heparin after catheter ablation (CA) of atrial fibrillation (AF).ObjectiveTo determine the efficacy and safety of protamine to expedite vascular hemostasis and ambulation after CA of AF.MethodsCA to eliminate AF (n=139) or left atrial flutter (n=11) was performed in 150 patients using radiofrequency catheter ablation (n=112) or cryoballoon ablation (n=38). CA was performed under uninterrupted anticoagulation with warfarin in 28, or after skipping a single dose of a novel oral anticoagulant (NOAC) in 122 patients who were randomized to receive protamine (n=77) or to the control group (n=73). Baseline and procedural characteristics were similar between the 2 groups. Hemostasis was achieved manually once the ACT returned to preprocedural values.ResultsThe maximum activated clotting times (ACT) during CA were 359±31s and 359±29s in the protamine and control groups, respectively (P=0.91). Time to hemostasis was 123±95 min in the protamine and 260±70 min in the control groups (P
       
  • Implantable Cardioverter Defibrillator Use in Catecholaminergic
           Polymorphic Ventricular Tachycardia: A Systematic Review
    • Abstract: Publication date: Available online 3 July 2018Source: Heart RhythmAuthor(s): Thomas M. Roston, Karolina Jones, Nathaniel M. Hawkins, J. Martijn Bos, Peter J. Schwartz, Frances Perry, Michael J. Ackerman, Zachary W.M. Laksman, Padma Kaul, Krystien V.V. Lieve, Joseph Atallah, Andrew D. Krahn, Shubhayan Sanatani BackgroundThe implantable cardioverter defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated.ObjectiveTo characterize the use and outcomes of ICDs for CPVT.MethodsWe conducted a systematic review using EMBASE, MEDLINE, Pubmed, and Google Scholar to identify studies that included CPVT patients with ICDs.ResultsFifty-three studies describing 1,429 CPVT patients were included. In total, 503 (35.2%) patients had an ICD (median age was 15.0 years (IQR 11.0-21.0)). Among ICD recipients with a reported medication status, 96.7% were prescribed beta-blockers, and 13.2% flecainide. Sympathetic denervation was performed in 23.2%. Nearly half of patients received an ICD for primary prevention (47.3%), and 12.8% were prescribed optimal anti-arrhythmic therapy. During follow-up, 40.1% had ≥1 appropriate shock(s), 20.8% experienced ≥1 inappropriate shock(s), 19.6% had electrical storm, and 7 (1.4%) patients died. An ICD-associated electrical storm was implicated in 4 deaths. Additional complications, such as lead failure, endocarditis, or surgical revisions were observed in 96 of 296 patients (32.4%). Sub-analysis of the 10 studies encompassing 330 patients with the most detailed ICD-related data showed similar trends.ConclusionsIn this CPVT population, ICDs were common, and associated with a high burden of shocks and complications. The reliance on primary prevention ICDs, and poor uptake of adjuvant anti-arrhythmic therapies, suggests that improved adherence to guideline-directed management could reduce ICD utilization and harm.Graphical abstractGraphical abstract for this article
       
  • Predicting arrhythmic risk in arrhythmogenic right ventricular
           cardiomyopathy: A systematic review and meta-analysis
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Laurens P. Bosman, Arjan Sammani, Cynthia A. James, Julia Cadrin-Tourigny, Hugh Calkins, J. Peter van Tintelen, Richard N.W. Hauer, Folkert W. Asselbergs, Anneline S.J.M. te RieleWhile many studies evaluate predictors of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC), a systematic review consolidating this evidence is currently lacking. Therefore, we searched MEDLINE and Embase for studies analyzing predictors of ventricular arrhythmias (sustained ventricular tachycardia/fibrillation (VT/VF), appropriate implantable cardioverter-defibrillator therapy, or sudden cardiac death) in patients with definite ARVC, patients with borderline ARVC, and ARVC-associated mutation carriers. In the case of multiple publications on the same cohort, the study with the largest population was included. This yielded 45 studies with a median cohort size of 70 patients (interquartile range 60 patients) and a median follow-up of 5.0 years (interquartile range 3.3 - 6.7 years). The average proportion of arrhythmic events observed was 10.6%/y in patients with definite ARVC, 10.0%/y in patients with borderline ARVC, and 3.7%/y with mutation carriers. Predictors of ventricular arrhythmias were population dependent: consistently predictive risk factors in patients with definite ARVC were male sex, syncope, T-wave inversion in lead>V3, right ventricular dysfunction, and prior (non)sustained VT/VF; in patients with borderline ARVC, 2 additional predictors—inducibility during electrophysiology study and strenuous exercise—were identified; and with mutation carriers, all aforementioned predictors as well as ventricular ectopy, multiple ARVC-related pathogenic mutations, left ventricular dysfunction, and palpitations/presyncope determined arrhythmic risk. Most evidence originated from small observational cohort studies, with a moderate quality of evidence. In conclusion, the average risk of ventricular arrhythmia ranged from 3.7 to 10.6%/y depending on the population with ARVC. Male sex, syncope, T-wave inversion in lead>V3, right ventricular dysfunction, and prior (non)sustained VT/VF consistently predict ventricular arrhythmias in all populations with ARVC.
       
  • Management of cardiac implantable electronic devices in the presence of
           left ventricular assist devices
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Valay Parikh, Andrew Sauer, Paul A. Friedman, Seth H. SheldonLeft ventricular assist devices (LVAD) are increasingly used in the management of patients with advanced heart failure. Many of these patients have or will be considered for a cardiac implantable electronic device (CIED) such as an implantable cardioverter–defibrillator or a cardiac resynchronization therapy device. Frequent interplay is often encountered due to the complexity of these devices and the underlying disease states. Proactive management strategies and an awareness of interactions may help reduce adverse events. Here we review the current literature, present management recommendations, and discuss potential future investigations for CIEDs in patients with LVADs.Graphical abstractGraphical abstract for this article
       
  • Cardiac electronic implantable devices after tricuspid valve surgery
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Raphaël P. Martins, Vincent Galand, Christophe Leclercq, Jean-Claude DaubertThe demand for tricuspid valve (TV) surgery has increased continuously in the last years. Recent registry data have confirmed that TV repair or replacement carry an increased risk of conduction disorders requiring permanent pacemaker implantation, specifically for patients having multivalve surgery. The implantation of an endocardial right ventricular lead in those patients may impair TV function, and some other approaches may be discussed to avoid traversing the valve. This contemporary review describes the different options currently available for patients requiring pacemaker or defibrillation leads implantation after TV surgery.
       
  • HuR-mediated SCN5A messenger RNA stability reduces arrhythmic
           risk in heart failure
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Anyu Zhou, An Xie, Tae Yun Kim, Hong Liu, Guangbin Shi, Gyeoung-Jin Kang, Ning Jiang, Man Liu, Euy-Myoung Jeong, Bum-Rak Choi, Samuel C. DudleyBackgroundDownregulated sodium currents in heart failure (HF) have been linked to increased arrhythmic risk. Reduced expression of the messenger RNA (mRNA)–stabilizing protein HuR (also known as ELAVL1) may be responsible for the downregulation of sodium channel gene SCN5A mRNA.ObjectiveThe purpose of this article was to investigate whether HuR regulates SCN5A mRNA expression and whether manipulation of HuR benefits arrhythmia control in HF.MethodsQuantitative real-time reverse-transcriptase polymerase chain reaction was used to investigate the expression of SCN5A. Optical mapping of the intact heart was adopted to study the effects of HuR on the conduction velocity and action potential upstroke in mice with myocardial infarct and HF after injection of AAV9 viral particles carrying HuR.ResultsHuR was associated with SCN5A mRNA in cardiomyocytes, and expression of HuR was downregulated in failing hearts. The association of HuR and SCN5A mRNA protected SCN5A mRNA from decay. Injection of AAV9 viral particles carrying HuR increased SCN5A expression in mouse heart tissues after MI. Optical mapping of the intact heart demonstrated that overexpression of HuR improved action potential upstroke and conduction velocity in the infarct border zone, which reduced the risk of reentrant arrhythmia after MI.ConclusionOur data indicate that HuR is an important RNA-binding protein in maintaining SCN5A mRNA abundance in cardiomyocytes. Reduced expression of HuR may be at least partially responsible for the downregulation of SCN5A mRNA expression in ischemic HF. Overexpression of HuR may rescue decreased SCN5A expression and reduce arrhythmic risk in HF. Increasing mRNA stability to increase ion channel currents may correct a fundamental defect in HF and represent a new paradigm in antiarrhythmic therapy.
       
  • Role for electrocardiographic imaging in cardiac resynchronization
           therapy'
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Yoram Rudy
       
  • Cardiac electrical dyssynchrony is accurately detected by noninvasive
           electrocardiographic imaging
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Laura R. Bear, Peter R. Huntjens, Richard D. Walton, Olivier Bernus, Ruben Coronel, Rémi DuboisBackgroundPoor identification of electrical dyssynchrony is postulated to be a major factor contributing to the low success rate for cardiac resynchronization therapy.ObjectiveThe purpose of this study was to evaluate the sensitivity of body surface mapping and electrocardiographic imaging (ECGi) to detect electrical dyssynchrony noninvasively.MethodsLangendorff-perfused pig hearts (n = 11) were suspended in a human torso-shaped tank, with left bundle branch block (LBBB) induced through ablation. Recordings were taken simultaneously from a 108-electrode epicardial sock and 128 electrodes embedded in the tank surface during sinus rhythm and ventricular pacing. Computed tomography provided electrode and heart positions in the tank. Epicardial unipolar electrograms were reconstructed from torso potentials using ECGi. Dyssynchrony markers from torso potentials (eg, QRS duration) or ECGi (total activation time, interventricular delay [D-LR], and intraventricular markers) were correlated with those recorded from the sock.ResultsLBBB was induced (n = 8), and sock-derived activation maps demonstrated interventricular dyssynchrony (D-LR and total activation time) in all cases (P < .05) and intraventricular dyssynchrony for complete LBBB (P < .05) compared to normal sinus rhythm. Only D-LR returned to normal with biventricular pacing (P = .1). Torso markers increased with large degrees of dyssynchrony, and no reduction was seen during biventricular pacing (P > .05). Although ECGi-derived markers were significantly lower than recorded (P < .05), there was a significant strong linear relationship between ECGi and recorded values. ECGi correctly diagnosed electrical dyssynchrony and interventricular resynchronization in all cases. The latest site of activation was identified to 9.1 ± 0.6 mm by ECGi.ConclusionECGi reliably and accurately detects electrical dyssynchrony, resynchronization by biventricular pacing, and the site of latest activation, providing more information than do body surface potentials.
       
  • Lack of genotype-phenotype correlation in Brugada Syndrome and Sudden
           Arrhythmic Death Syndrome families with reported pathogenic SCN1B variants
           
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Belinda Gray, Can Hasdemir, Jodie Ingles, Takeshi Aiba, Naomasa Makita, Vincent Probst, Arthur A.M. Wilde, Ruth Newbury-Ecob, Mary N. Sheppard, Christopher Semsarian, Raymond W. Sy, Elijah R. BehrBackgroundThere is limited evidence that Brugada Syndrome (BrS) is due to SCN1B variants (BrS5). This gene may be inappropriately included in routine genetic testing panels for BrS or Sudden Arrhythmic Death Syndrome (SADS).ObjectiveWe sought to characterize the genotype-phenotype correlation in families who had BrS and SADS with reportedly pathogenic SCN1B variants and to review their pathogenicity.MethodsFamilies with BrS and SADS were assessed from 6 inherited arrhythmia centers worldwide, and a comprehensive literature review was performed. Clinical characteristics including relevant history, electrocardiographic parameters and drug provocation testing results were studied. SCN1B genetic testing results were reclassified using American College of Medical Genetics criteria.ResultsA total of 23 SCN1B genotype-positive individuals were identified from 8 families. Four probands (17%) experienced ventricular fibrillation or sudden cardiac death at the time of presentation. All family members were free from syncope or ventricular arrhythmias. Only 2 of 23 genotype-positive individuals (9%) demonstrated a spontaneous BrS electrocardiographic pattern. Drug challenge testing for BrS in 87% (13 of 15) was negative. There was no difference in PR interval (161 ± 7 ms vs 165 ± 9 ms; P = .83), QRS duration (101 ± 6 ms vs 89 ± 5 ms; P = .35), or corrected QT interval (414 ± 35 ms vs 405 ± 8 ms; P = .7) between genotype-positive and genotype-negative family members. The overall frequency of previously implicated SCN1B variants in the Genome Aggregation Database browser is 0.004%, exceeding the estimated prevalence of BrS owing to SCN1B (0.0005%), including 15 of 23 individuals (65%) who had the p.Trp179X variant.ConclusionThe lack of genotype-phenotype concordance among families, combined with the high frequency of previously reported mutations in the Genome Aggregation Database browser, suggests that SCN1B is not a monogenic cause of BrS or SADS.
       
  • Amino acid–level signal-to-noise analysis of incidentally identified
           variants in genes associated with long QT syndrome during pediatric whole
           exome sequencing reflects background genetic noise
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Andrew P. Landstrom, Ernesto Fernandez, Jill A. Rosenfeld, Yaping Yang, Andrew L. Dailey-Schwartz, Christina Y. Miyake, Hugh D. Allen, Daniel J. Penny, Jeffrey J. KimBackgroundDue to rapid expansion of clinical genetic testing, an increasing number of genetic variants of undetermined significance and unclear diagnostic value are being identified in children. Variants found in genes associated with heritable channelopathies, such as long QT syndrome (LQTS), are particularly difficult to interpret given the risk of sudden cardiac death associated with pathologic mutations.ObjectiveThe purpose of this study was to determine whether variants in LQTS-associated genes from whole exome sequencing (WES) represent disease-associated biomarkers or background genetic “noise.”MethodsWES variants from Baylor Genetics Laboratories were obtained for 17 LQTS-associated genes. Rare variants from healthy controls were obtained from the GnomAD database. LQTS case variants were extracted from the literature. Amino acid–level mapping and signal-to-noise calculations were conducted. Clinical history and diagnostic studies were analyzed for WES subjects evaluated at our institution.ResultsVariants in LQTS case-associated genes were present in 38.3% of 7244 WES probands. There was a similar frequency of variants in the WES and healthy cohorts for LQTS1–3 (11.2% and 12.9%, respectively) and LQTS4–17 (27.1% and 38.4%, respectively). WES variants preferentially localized to amino acids altered in control individuals compared to cases. Based on amino acid–level analysis, WES-identified variants are indistinguishable from healthy background variation, whereas LQTS1 and 2 case-identified variants localized to clear pathologic “hotspots.” No individuals who underwent clinical evaluation had clinical suspicion for LQTS.ConclusionThe prevalence of incidentally identified LQTS-associated variants is ∼38% among WES tests. These variants most likely represent benign healthy background genetic variation rather than disease-associated mutations.
       
  • Diagnostic value and prognostic implications of early cardiac magnetic
           resonance in survivors of out-of-hospital cardiac arrest
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Alessandro Zorzi, Angela Susana, Manuel De Lazzari, Federico Migliore, Giovanni Vescovo, Daniele Scarpa, Anna Baritussio, Giuseppe Tarantini, Luisa Cacciavillani, Benedetta Giorgi, Cristina Basso, Sabino Iliceto, Chiara Bucciarelli Ducci, Domenico Corrado, Martina Perazzolo MarraBackgroundIn patients who survived out-of-hospital cardiac arrest (OHCA), it is crucial to establish the underlying cause and its potential reversibility.ObjectiveThe purpose of this study was to assess the incremental diagnostic and prognostic role of early cardiac magnetic resonance (CMR) in survivors of OHCA.MethodsAmong 139 consecutive OHCA patients, the study enrolled 44 patients (median age 43 years; 84% male) who underwent coronary angiography and CMR ≤7 days after admission. The CMR protocol included T2-weighted sequences for myocardial edema and late gadolinium enhancement (LGE) sequences for myocardial fibrosis.ResultsCoronary angiography identified obstructive coronary artery disease in 18 of 44 patients in whom CMR confirmed the diagnosis of ischemic heart disease by demonstrating subendocardial or transmural LGE. The presence of myocardial edema allowed differentiation between acute myocardial ischemia (n = 12) and postinfarction myocardial scar (n = 6). Among the remaining 26 patients without obstructive coronary artery disease, CMR in 19 (73%) showed dilated cardiomyopathy in 5, myocarditis in 4, mitral valve prolapse associated with LGE in 3, ischemic scar in 2, idiopathic nonischemic scar in 2, arrhythmogenic cardiomyopathy in 1, hypertrophic cardiomyopathy in 1, and takotsubo cardiomyopathy in 1. In this subgroup of 26 patients, 6 (23%) had myocardial edema. During mean follow-up of 36 ± 17 months, all 18 patients with myocardial edema had an uneventful outcome, whereas 9 of 26 (35%) without myocardial edema experienced sudden arrhythmic death (n = 1), appropriate defibrillator interventions (n = 5), and nonarrhythmic death (n = 3; P = .006).ConclusionIn survivors of OHCA, early CMR with a comprehensive tissue characterization protocol provided additional diagnostic and prognostic value. The identification of myocardial edema was associated with a favorable long-term outcome.Graphical abstractGraphical abstract for this article
       
  • Endocardial left ventricular pacing across the interventricular septum for
           cardiac resynchronization therapy: Clinical results of a pilot study
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): James H.P. Gamble, Neil Herring, Matthew R. Ginks, Kim Rajappan, Yaver Bashir, Tim R. BettsBackgroundCardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure, but it can be limited by the inability to place the left ventricular (LV) lead via the coronary sinus.ObjectiveThe purpose of this study was to develop an alternative approach, placing the LV lead endocardially via an interventricular septal puncture, and to assess the feasibility and safety of this technique.MethodsAll patients were anticoagulated with warfarin (international normalized ratio 2.5–3.5). A superior approach ventricular transseptal puncture using radiofrequency energy was performed. An active fixation pacing lead was delivered to the mapped site of latest electrical activation on the endocardial LV.ResultsTwenty patients were recruited, 15 with failed transvenous LV lead placement and 5 nonresponders to CRT. Mean (± SD) age was 67 ± 12, with 80% male, QRS duration 157 ± 14 ms, ischemic etiology 45%, New York Heart Association functional class 2.9 ± 0.4, and LV ejection fraction 28% ± 7%. The procedure was successful in all, with no serious complications. Clinical composite score improved at 6 months in 65% and worsened in 35%. LV ejection fraction improved>5% in 88%, from 28% ± 7% to 41% ± 9%. Six-minute walking distance improved>10% in 64%, from 248 ± 125 m to 316 ± 109 m. One patient suffered a lacunar ischemic stroke after 5 months with partial neurological recovery, associated with labile international normalized ratios. After 2.0 ± 1.0 years of follow-up, 3 patients died (2 pneumonia, 1 heart failure), and 2 patients suffered transient ischemic attacks.ConclusionLV endocardial pacing via interventricular septal puncture in patients for whom standard CRT is not possible is similarly effective and durable, with significant but potentially acceptable risks.
       
  • Effect of ventricular pacing lead position on tricuspid regurgitation: A
           randomized prospective trial
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): J. William Schleifer, Sorin V. Pislaru, Grace Lin, Brian D. Powell, Raul Espinosa, Celeste Koestler, Trena Thome, Lynn Polk, Zhuo Li, Samuel J. Asirvatham, Yong-Mei ChaBackgroundPacing lead–related tricuspid regurgitation (TR), a recognized complication of ventricular pacing lead implantation, may be affected by lead position or diameter.ObjectiveThis study sought to determine the effect of ventricular pacing lead position and diameter on pacing lead–related TR.MethodsA randomized prospective trial compared pacing leads in the right ventricular apex (RVA), right ventricular septum (RVS), or left ventricle via the coronary sinus (LV-CS) in a 1:1:1 fashion. Patients undergoing implantable cardioverter-defibrillator lead implantation in the RVA (RVA-ICD) were enrolled in a comparison group. Patients with preexisting moderate or greater TR were excluded. Prospective clinical evaluation, transthoracic echocardiograms, and device interrogation occurred 24 hours and 12 months after device implantation.ResultsSixty-three patients undergoing pacemaker implantation were randomized to RVA, RVS, or LV-CS pacing, and 48 RVA-ICD patients were enrolled as a comparison group. At 12 months, 6 patients (6.4%) developed moderate or greater TR. Moderate or greater TR was not significantly different between groups if analyzed by intention to treat (RVA 5.9%, RVS 10.0%, LV-CS 6.7%, and RVA-ICD 4.8%) or if analyzed by final lead location (RVA 4.8%, RVS 10.5%, LV-CS 8.3%, and RVA-ICD 5.1%). Ventricular lead–related complications occurred in 3 patients with right ventricular leads (3.2%) and 2 patients with LV-CS leads (11.1%) (P = .184).ConclusionNeither pacing lead position nor diameter appears to affect TR development significantly. LV-CS leads failed to achieve a statistically significant reduction in TR as compared with right ventricular leads.Graphical abstractGraphical abstract for this article
       
  • Association of regional epicardial right ventricular electrogram voltage
           amplitude and late gadolinium enhancement distribution on cardiac magnetic
           resonance in patients with arrhythmogenic right ventricular
           cardiomyopathy: Implications for ventricular tachycardia ablation
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Shuanglun Xie, Benoit Desjardins, Maciej Kubala, Jackson Liang, Jiandu Yang, Rob J. van der Geest, Robert Schaller, Michael Riley, David Callans, Erica Zado, Francis Marchlinski, Saman NazarianBackgroundCriteria for identification of anatomic ventricular tachycardia substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) are unclear.ObjectiveThe purpose of this study was to define (1) the association of regional right ventricular (RV) epicardial voltage amplitude with the distribution of LGE; and (2) appropriate image signal intensity (SI) thresholds for ventricular tachycardia substrate identification in ARVC.MethodsPreprocedural LGE-CMR and epicardial electrogram mapping were performed in 10 ARVC patients. The locations of epicardial electrogram map points, obtained during sinus rhythm with intrinsic conduction or RV pacing, were retrospectively registered to the corresponding LGE image regions. Standardized SI z-scores (standard deviation distance from the mean) were calculated for each 10-mm region surrounding map points.ResultsIn patient-clustered, generalized estimating equations models that included 3205 epicardial electroanatomic points and corresponding SI measures, bipolar (–1.43 mV/z-score; P
       
  • EP News: Allied Professionals
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Erica S. Zado
       
  • Does the CHA2DS2-VASc score reliably predict atrial arrhythmias'
           Analysis of a nationwide database of remote monitoring data transmitted
           daily from cardiac implantable electronic devices
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Giovanni Rovaris, Francesco Solimene, Antonio D'Onofrio, Gabriele Zanotto, Renato P. Ricci, Tiziana Mazzella, Saverio Iacopino, Paolo Della Bella, Giampiero Maglia, Gaetano Senatore, Fabio Quartieri, Mauro Biffi, Antonio Curnis, Valeria Calvi, Antonio Rapacciuolo, Matteo Santamaria, Alessandro Capucci, Massimo Giammaria, Andrea Campana, Fabrizio CaravatiBackgroundCHA2DS2-VASc is a validated score for predicting stroke in patients with atrial fibrillation (AF).ObjectiveThe purpose of this study was to assess whether the CHA2DS2-VASc score can predict new-onset AF in a cohort of patients with a cardiac implantable electronic device (CIED) followed with remote monitoring.MethodsUsing the database of the Home Monitoring Expert Alliance project, we selected 2410 patients with no documented AF who had received a CIED with diagnostics on atrial high rate episodes (AHREs). The primary endpoint was time to first day with cumulative AHRE burden ≥15 minutes, 5 hours, 24 hours, and ≥7 consecutive days.ResultsDuring a median duration of 24.1(11.5–42.9) months, the incidence of AHRE increased with increasing CHA2DS2-VASc. At 6 years, occurrence of ≥15-minute AHRE was 80.2% (CHA2DS2-VASc ≤1) vs 93.7% (CHA2DS2-VASc ≥5), whereas ≥5-hour AHRE incidence was 68.4% (CHA2DS2-VASc ≤1) vs 92.5% (CHA2DS2-VASc ≥5). Occurrence of ≥24-hour and ≥7-day AHREs also increased with increasing CHA2DS2-VASc: 9.1% and 3.9% (CHA2DS2-VASc ≤1) vs 40.4% and 28.7% (CHA2DS2-VASc ≥5), respectively. Adjusted hazard ratio for unitary CHA2DS2-VASc increase ranged from 1.09 (confidence interval 1.04–1.14; P 
       
  • Rhythm management in myotonic dystrophy: Progress has been made, but
           unsettled issues remain
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): William J. Groh
       
  • Effect of dual-chamber minimal ventricular pacing on paroxysmal atrial
           fibrillation incidence in myotonic dystrophy type 1 patients: A
           prospective, randomized, single-blind, crossover study
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Vincenzo Russo, Andrea Antonio Papa, Anna Rago, Carmine Ciardiello, Gerardo NigroBackgroundAtrial fibrillation (AF) is a common finding in the myotonic dystrophy type 1 (DM1) population. Pacemakers (PMs) may facilitate the diagnosis and management of frequent subclinical asymptomatic AF episodes.ObjectiveThe purpose of this study was to evaluate the effect of minimal ventricular pacing on paroxysmal AF incidence in DM1 patients during a 24-month follow-up period.MethodsWe enrolled 70 DM1 patients (age 43.4 ± 13.8 years; 39 women) who underwent dual-chamber PM implantation. Patients were randomized to minimizing ventricular pacing features (ON) or not (OFF). Patients crossed over to the opposite pacing programming 12 months later. We counted the number of DM1 patients with at least 1 episode of AF, the AF total duration, and the burden recorded by PM diagnostics during the MVP ON and OFF phases.ResultsTwenty-five DM1 patients (41.7%) showed at least 1 AF episode. Seven patients (11.7%) demonstrated AF episodes during MVP ON phase and 25 patients (41.7%) during MVP OFF phase (P 
       
  • Left atrial appendage ligation and atrial fibrillation: A tool to
           “snare” greater success'
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Sunil K. Sinha
       
  • Mechanical function of the left atrium is improved with epicardial
           ligation of the left atrial appendage: Insights from the LAFIT-LARIAT
           Registry
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Tawseef Dar, Muhammad R. Afzal, Bharath Yarlagadda, Shelby Kutty, Quanliang Shang, Sampath Gunda, Anweshan Samanta, Jahnavi Thummaluru, Kedareeshwar S. Arukala, Arun Kanmanthareddy, Madhu Reddy, Donita Atkins, Sudharani Bommana, Buddhadeb Dawn, Dhanunjaya LakkireddyBackgroundLeft atrial (LA) strain (ε) and ε rate (SR) analysis by 2-dimensional speckle tracking echocardiography is a novel method for functional assessment of the LA.ObjectiveThe purpose of this study was to determine the impact of left atrial appendage (LAA) exclusion by Lariat epicardial ligation on mechanical function of the LA by performing ε and SR analysis before and after the procedure.MethodsA total of 66 patients who underwent successful LAA exclusion were included in the study. Of these 66 patients, 32 had adequate paired data for ε and SR analysis. SR during ventricular systole (LA-SRs) represents LA reservoir function, and SR during early ventricular diastole (LA-SRe) represents LA conduit function. ε and SR were determined from apical 4- and 2-chamber views using the electrocardiographic QRS as a reference point. LA volume index as surrogate for LA remodeling was measured from apical views.ResultsMean patient age was 70 ± 9.2 years. LAA ligation resulted in improved reservoir function (LA-SRs: pre 0.72, confidence interval [CI] 0.63–0.83 vs post 0.81, CI 0.73–0.98; P = .043) and conduit function (LA-SRe: pre 0.74, CI 0.67–0.99 vs post 0.89, CI 0.82–1.07; P = .025). LA volume index improved significantly with the Lariat (pre 35.4, CI 29.4–37.2 vs post 29.2, CI 28.2–35.9; P
       
  • Cybersecurity vulnerabilities of cardiac implantable electronic devices:
           Communication strategies for clinicians—Proceedings of the Heart Rhythm
           Society's Leadership Summit
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): David J. Slotwiner, Thomas F. Deering, Kevin Fu, Andrea M. Russo, Mary N. Walsh, George F. Van Hare
       
  • Striking the right balance when addressing cybersecurity vulnerabilities
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): William H. Maisel, Jessica E. Paulsen, Matthew B. Hazelett, Kimberly A. Selzman
       
  • EP News: Clinical
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): N.A. Mark Estes
       
  • EP News: Basic and Translational
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Penelope A. Boyden
       
  • EP News: Heart Rhythm Case Reports
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): T. Jared Bunch
       
  • Tension pneumopericardium after pericardiocentesis: Useful
           echocardiographic obscured heart sign and effective postural change during
           air aspiration
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Yasushi Wakabayashi, Takekuni Hayashi, Takeshi Mitsuhashi, Hideo Fujita
       
  • A change from atrial fibrillation into a wide QRS tachycardia in a
           69-year-old man
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Hein J. Wellens
       
  • Would I do it again' Reflections on a career in academia and
           electrophysiology
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Michael R. Rosen
       
  • Implantation of the subcutaneous implantable cardioverter–defibrillator
           with truncal plane blocks
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Marc A. Miller, Himani V. Bhatt, Menachem Weiner, Tom F. Brouwer, Alexander J. Mittnacht, Ali Shariat, Christina L. Jeng, Caroline Eden, Hung-Mo Lin, Benjamin Salter, Srinivas R. Dukkipati, Vivek Y. Reddy
       
  • Pulmonary vein activity does not predict the outcome of catheter ablation
           for persistent atrial fibrillation: A long-term multicenter prospective
           study
    • Abstract: Publication date: July 2018Source: Heart Rhythm, Volume 15, Issue 7Author(s): Sandeep Prabhu, Manish Kalla, Kah Y. Peck, Aleksandr Voskoboinik, Alex J.A. McLellan, Bupesh Pathik, Chrishan J. Nalliah, Geoff R. Wong, Hariharan Sugumar, Sonia M. Azzopardi, Geoffrey Lee, Liang-Han Ling, Jonathan M. Kalman, Peter M. KistlerBackgroundPulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent atrial fibrillation (AF) (PeAF), although less successful than for paroxysmal AF. Whether rapid or fibrillatory (PV AF) PV firing may identify patients with PeAF more likely to benefit from a PV-based ablation approach is unclear.ObjectiveThe purpose of this study was to determine the relationship between the PV cycle length (PVCL) and the PV AF outcome after CA.MethodsBefore ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles. The presence of PV AF, the average PVCL of all 4 veins (PV4VAverage), the fastest vein average (PVFVAverage), the fastest cycle length (PVFast) both individually and relative to the average LAA cycle length were calculated. The ablation strategy included PVI and posterior wall isolation with a minimum of 12 months follow-up.ResultsA total of 123 patients underwent CA (age 62 ± 9.1 years; CHA2DS2-VASC score 1.6 ± 1.1; left ventricular ejection fraction 48% ± 13%; left atrial area 31 ± 8.7 cm2; AF duration 16 ± 17 months). PVI was achieved in 100% of patients. Multiprocedure success (MPS; freedom from AF/atrial tachycardia episodes lasting>30 seconds) was achieved in 76% of patients at 24 ± 8.1 months of follow-up after 1.2 ± 0.4 procedures. PV activity was not associated with MPS either absolutely (PV4VAverage [MPS no vs yes: 178 ± 27 ms vs 177 ± 24 ms; P = .92], PVFVAverage [P = .69], or PVFast [P = .82]) or as a ratio relative to the LAA cycle length (PV4VAverage/LAA 1.05 ± 0.11 vs 1.06 ± 0.21; P = .87). The presence of PV AF (31% vs 47%; P = .13) did not predict MPS.ConclusionThe rapidity of PV firing or presence of fibrillation within the PV was not predictive of outcome of CA for PeAF. PV activity does not identify patients most likely to benefit from a PV-based ablation strategy.
       
  • Seasonal variation in the risk of ischemic stroke in patients with atrial
           fibrillation: A nationwide cohort study
    • Abstract: Publication date: Available online 30 June 2018Source: Heart RhythmAuthor(s): Jo-Nan Liao, Tze-Fan Chao, Chia-Jen Liu, Su-Jung Chen, Chung-Lieh Hung, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y.H. Lip, Shih-Ann Chen BackgroundSeveral cardiovascular diseases exhibit seasonal variations, but data about cold temperature and risk of ischemic stroke in patients with atrial fibrillation (AF) are limited.ObjectivesWe aimed to investigate the risk of ischemic stroke in different seasons, testing the hypothesis that the cold weather season would increase the risk of stroke in AF.MethodsThis study used the “National Health Insurance Research Database” in Taiwan. From 2000 to 2012, a total of 289,559 AF patients were enrolled and 34,991 experienced ischemic stroke after a mean follow-up of 3 years. The relationship between risk of ischemic stroke and temperatures was analyzed.ResultsThe highest incidence of ischemic stroke was observed in winter, which was the coldest season, with an incidence rate of 0.33 per 100 person-months. When compared with summer period, the risk of ischemic stroke increased by 10% in spring (incidence Rate Ratio, IRR 1.10 (95% CI 1.07-1.13) and in winter, by 19% (IRR 1.15-1.22) but did not differ significantly between summer and autumn (IRR 1.00 (0.97-1.03)). In comparison with the days with an average temperature of 30°C, the risk of ischemic stroke for days with an average temperature below 20°C significantly increased. A lower 7-, 10- or 14-day average temperatures were significantly associated with an increased risk of ischemic stroke in the case-crossover analysis.ConclusionsIn this nationwide study, a seasonal variation of incidence of ischemic stroke in AF patients was observed, with an increased risk of stroke on days with an average temperature
       
  • Unique role of epicardial adipose tissue in atrial fibrosis: ‘Atrial
           remodeling of a new sort’
    • Abstract: Publication date: Available online 30 June 2018Source: Heart RhythmAuthor(s): Thomas A. Agbaedeng, Dominik Linz, Dennis H. Lau, Prashanthan Sanders
       
  • Ventricular fibromas in children: Surgical resection can be a cure to
           lethal arrhythmias
    • Abstract: Publication date: Available online 30 June 2018Source: Heart RhythmAuthor(s): Hiroko Asakai
       
  • The 12 Lead ECG During Ventricular Tachycardia: Still an Important Tool
           for Ventricular Tachycardia Localization in Structural Heart Disease
    • Abstract: Publication date: Available online 28 June 2018Source: Heart RhythmAuthor(s): Victor Bazan, Francis E. Marchlinski
       
  • EP News: Clinical
    • Abstract: Publication date: Available online 27 June 2018Source: Heart RhythmAuthor(s): N.A. Mark Estes
       
  • Erratum
    • Abstract: Publication date: Available online 27 June 2018Source: Heart RhythmAuthor(s):
       
  • Accelerated Conversion of Atrial Fibrillation to Normal Sinus Rhythm by
           Pulmonary Delivery of Flecainide Acetate in a Porcine Model
    • Abstract: Publication date: Available online 26 June 2018Source: Heart RhythmAuthor(s): Richard L. Verrier, Alexandre L. Bortolotto, Bruna A. Silva, Alexandre A. Marum, Fernando G. Stocco, Ederson Evaristo, Victor Z. de Antonio, Anderson C. Silva, Luiz Belardinelli BackgroundPulmonary delivery of antiarrhythmic agents has the potential to increase targeted drug concentrations in pulmonary veins and left atrium rapidly to terminate atrial fibrillation (AF).ObjectiveWe evaluated the efficacy of flecainide administered via intratracheal instillation in terminating AF in a reliable preclinical model.MethodsIn 11 closed-chest anesthetized Yorkshire pigs, AF was induced by intrapericardial administration of acetylcholine (1 mL of 102.5 mM solution) followed by burst pacing and allowed to continue for 2 min before intratracheal flecainide (0.4 or 0.75 mg/kg) administration.ResultsBoth the 0.4- and 0.75-mg/kg doses of intratracheal flecainide significantly reduced AF duration by 35% (p=0.02) and 54% (p=0.001), respectively, compared to no-drug baseline. There was a strong inverse correlation (r2=-0.87, p=0.03) between the duration of AF and the change in atrial depolarization duration in response to intratracheal flecainide. Induction of AF resulted in a marked increase in ventricular rate and corresponding reduction in mean arterial pressure (MAP) which returned to baseline levels within 5 min.ConclusionIntratracheal flecainide instillation is effective in rapidly converting AF to normal sinus rhythm and restoring MAP and heart rate to baseline values. The basis for this efficacy is likely rapid absorption of the drug through the lungs and delivery as a first-pass bolus to the left atrial and ventricular chambers and then to the coronary arterial circulation. The anti-AF effect of flecainide is inversely correlated to prolongation of atrial depolarization, implicating slowing of intra-atrial conduction as an important mechanism underlying conversion of AF to normal sinus rhythm.
       
  • Sleep characteristics that predict atrial fibrillation
    • Abstract: Publication date: Available online 26 June 2018Source: Heart RhythmAuthor(s): Matthew A. Christensen, Shalini Dixit, Thomas A. Dewland, Isaac R. Whitman, Gregory Nah, Eric Vittinghoff, Kenneth J. Mukamal, Susan Redline, John A. Robbins, Anne B. Newman, Sanjay R. Patel, Jared W. Magnani, Bruce M. Psaty, Jeffrey E. Olgin, Mark J. Pletcher, Susan R. Heckbert, Gregory M. MarcusBackgroundThe relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown.ObjectiveThe purpose of this study was to determine whether poor sleep itself is a risk factor for AF.MethodsWe first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005–2009 data from the California Healthcare Cost and Utilization Project.ResultsAmong 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14–1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17–1.51; P
       
  • Progression of ECG abnormalities Associated with Initial Ventricular
           Fibrillation in Asymptomatic Patients with Brugada Syndrome
    • Abstract: Publication date: Available online 25 June 2018Source: Heart RhythmAuthor(s): Hiroshi Morita, Masakazu Miyamoto, Atsuyuki Watanabe, Saori Tsukuda, Yoshimasa Morimoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito BackgroundVarious risk stratifications in asymptomatic patients with Brugada syndrome (BrS) have been proposed, but the electrophysiological change that promotes ventricular fibrillation (VF) is still unknown.ObjectiveThe aim of this study was to clarify the changes of ECG at the onset of VF compared to ECGs recorded when patients were still asymptomatic.MethodsThe subjects were composed of 14 patients with VF and 48 consecutive asymptomatic patients with BrS. We compared ECGs before the initial VF (>6 months, early phase) with ECGs at the initial VF episode (late phase). In asymptomatic patients, we evaluated ECGs at two time points with an interval of more than 6 months. We evaluated various ECG markers including type 1 ECG, fragmented QRS (fQRS, multiple spikes within the QRS complex).ResultsECG parameters of the early and late phases were not different except for decreased ST level and low incidence of type 1 ECG in asymptomatic patients. There were no differences in ECG parameters of the early phase between VF and asymptomatic patients. In VF patients, ECG at the late phase had longer QRS and Tpeak-Tend (Tpe) intervals and more frequent type 1 ECG and fQRS than did ECG at the early phase. Those changes were associated with initial VF events (odds ratio [OR]: QRS widening: 11.5, p
       
  • Electrophysiological Features and Radiofrequency Catheter Ablation of
           Supraventricular Tachycardia in Patients with Persistent Left Superior
           Vena Cava
    • Abstract: Publication date: Available online 25 June 2018Source: Heart RhythmAuthor(s): Jae-Sun Uhm, Jong-Il Choi, Yong Soo Baek, Hee Tae Yu, Pil-Sung Yang, Yun Gi Kim, Suk-Kyu Oh, Hee-Soon Park, Kwang No Lee, Tae-Hoon Kim, Jaemin Shim, Boyoung Joung, Hui-Nam Pak, Moon-Hyoung Lee, Young-Hoon Kim BackgroundThe electrophysiological features and roles of persistent left superior vena cava (PLSVC) in supraventricular tachycardia (SVT) are not known.ObjectiveTo elucidate the electrophysiological features and roles of PLSVC in patients with SVT.MethodsWe included 37 patients (age: 43.5 ± 17.1 years; men: 35.1%) with PLSVC and 510 patients (age: 43.9 ± 18.8 years; men: 48.2%) without PLSVC who underwent an electrophysiological study for SVT. The number of induced tachycardias, location of the slow pathway (SP) or accessory pathway (AP), and radiofrequency catheter ablation (RFCA) outcomes were compared between patients with and without PLSVC. During RFCA of the left AP, a coronary sinus (CS) catheter was placed into the left superior vena cava (LSVC group) or the great cardiac vein (GCV group). The RFCA outcomes were compared between the groups.ResultsIn the patients with PLSVC, 40 tachycardias were induced: atrioventricular nodal reentrant tachycardia (AVNRT) (n = 19), atrioventricular reentrant tachycardia (n = 17), and focal atrial tachycardia (n = 4). Among patients with AVNRT, an SP in the CS was significantly more frequent in patients with PLSVC than in those without PLSVC (47.4% versus 3.8%, P < .001). In patients with the left AP, the number of RFCA attempts and recurrence were lower in the GCV group than in the LSVC group.ConclusionsAn SP in the CS is prevalent in patients with AVNRT and PLSVC. It is useful to place a CS catheter into the great cardiac vein in patients with a left AP and PLSVC.
       
  • Fusion during entrainment at the cavotricuspid isthmus: When entrainment
           does not match our expectation
    • Abstract: Publication date: Available online 22 June 2018Source: Heart RhythmAuthor(s): Amit Noheria
       
  • Reply to the Editor— Fusion During Entrainment at the Cavotricuspid
           Isthmus: When Entrainment Does Not Match Our Expectation
    • Abstract: Publication date: Available online 22 June 2018Source: Heart RhythmAuthor(s): Mark J. Shen, Bradley P. Knight, Susan S. Kim
       
  • Long-term Reverse Remodeling by Cardiac Resynchronization Therapy with
           MultiPoint Pacing: A Feasibility Study of Noninvasive Hemodynamics Guided
           Device Programming
    • Abstract: Publication date: Available online 22 June 2018Source: Heart RhythmAuthor(s): Peter Lercher, Maurizio Lunati, Roberto Rordorf, Maurizio Landolina, Nima Badie, Fujian Qu, Cyrille Casset, Kyungmoo Ryu, Stefano Ghio, Jagmeet P. Singh, Christophe Leclercq BackgroundCardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing (MultiPoint™ Pacing [MPP]) improves acute hemodynamics and chronic outcomes over conventional biventricular pacing (BiV), though MPP programming questions persist.ObjectiveIn this multi-center feasibility study, we evaluated the feasibility of using noninvasive systolic blood pressure (SBP) to guide MPP programming, and assessed the chronic 6-month echocardiographic CRT response.MethodsPatients implanted with MPP-enabled CRT defibrillator (CRT-D) devices underwent noninvasive hemodynamic assessment (finger arterial pressure) during a pacing protocol that included atrial-only pacing and various BiV and MPP configurations. Each configuration was repeated 4 times, alternating with reference, to calculate the SBP difference relative to reference (ΔSBP). CRT configurations with the greatest ΔSBP were programmed. An independent core lab analyzed baseline and 6-month echocardiography, with CRT response defined as a 6-month reduction in LV end-systolic volume (ΔLVESV) ≥15%.ResultsForty-two patients (71% male, LV ejection fraction 30.3±7.5%, QRS duration 161±19ms, 26% ischemic) were enrolled in 4 European centers. Relative to atrial-only pacing, the best BiV and best MPP configurations produced significant SBP elevations of 3.1±4.2 (p
       
  • EP News: Allied Professionals
    • Abstract: Publication date: Available online 19 June 2018Source: Heart RhythmAuthor(s): Erica S. Zado
       
  • EP News: Basic and Translational
    • Abstract: Publication date: Available online 18 June 2018Source: Heart RhythmAuthor(s): Penelope A. Boyden
       
  • EP News: Heart Rhythm Case Reports
    • Abstract: Publication date: Available online 18 June 2018Source: Heart RhythmAuthor(s): T. Jared Bunch
       
  • Gender Differences in Patients with Brugada Syndrome and Arrhythmic
           Events: Data from a Survey on Arrhythmic Events in 678 Patients
    • Abstract: Publication date: Available online 13 June 2018Source: Heart RhythmAuthor(s): Anat Milman, Jean-Baptiste Gourraud, Antoine Andorin, Pieter G. Postema, Frederic Sacher, Philippe Mabo, Giulio Conte, Carla Giustetto, Georgia Sarquella-Brugada, Aviram Hochstadt, Sung-Hwan Kim, Jimmy JM. Juang, Shingo Maeda, Yoshihide Takahashi, Tsukasa Kamakura, Takeshi Aiba, Eran Leshem, Yoav Michowitz, Michael Rahkovich, Yuka MizusawaABSTRACTBackgroundThere is limited information on gender differences in patients with Brugada syndrome (BrS) who experienced arrhythmic events (AEs).ObjectivesTo compare clinical, electrocardiographic (ECG), electrophysiologic (EP) and genetic characteristics between males and females in BrS-patients with their first AE.MethodsThe multicenter Survey on AE in BrS (SABRUS) collected data on first AE in 678 BrS-patients including 619 (91.3%) males and 59 (8.7%) females aged 0.27 to 84 (mean 42.5±14.1) years at the time of AE.ResultsAfter excluding pediatric patients, females were older than males (49.5±14.4 vs. 43±12.7 years, respectively, P=0.001). Higher proportions of females were observed in the pediatric and elderly populations. In Asians, male/female ratio of AE was ≈9-fold higher compared to Caucasians. Spontaneous type 1 BrS-ECG was associated with earlier onset of AE in pediatric females. A similar prevalence (≈65%) of spontaneous type 1 BrS-ECG was present in males and females above age of 60 years.Females less frequently showed a spontaneous type-1 BrS-ECG (31% vs. 59%, P
       
  • The Addition of Minute Ventilation to Rate Responsive Pacing Improves
           Heart Rate Score More than Accelerometer Alone
    • Abstract: Publication date: Available online 13 June 2018Source: Heart RhythmAuthor(s): Mark Richards, Brian Olshansky, Arjun D. Sharma, Nicholas Wold, Paul Jones, David Perschbacher, Bruce L. Wilkoff BackgroundHeart Rate Score (HRSc)≥70%, a novel parameter, predicts risk of mortality in patients with implantable defibrillators and identifies patients who have survival benefit with DDDR versus DDD pacing.ObjectiveDDDR pacing lowers HRSc and dual-sensor with minute ventilation (MV) and accelerometer (XL) improves HRSc more than accelerometer (XL) alone in patients requiring pacemakers (PM).MethodsHRSc, the percent of all beats in the predominant 10 bpm bin, was calculated. Data from the LIFE study, a prospective, randomized PM study, comparing accelerometer (XL) to dual sensor (XL + MV) rate-responsive pacing, were analyzed retrospectively for HRSc changes from baseline. The relationship of patient activity (sensor-detected from device memory) to HRSc was examined.ResultsAmong 501 randomized patients, HRSc≥70% during DDD pacing occurred in 43% (n=215) of patients at baseline. In these, HRSc decreased after DDDR programming by 14.2% while it increased by 0.4% in those with a baseline HRSc
       
  • Repolarization heterogeneity in patients with cardiac resynchronization
           therapy and its relation to ventricular tachyarrhythmias
    • Abstract: Publication date: Available online 13 June 2018Source: Heart RhythmAuthor(s): Marta Cvijić, Bor Antolič, Luka Klemen, Igor Zupan Backgrounds: Cardiac resynchronization therapy (CRT) has shown to induce left ventricular reverse remodelling, but little is known about its influence on ventricular repolarization.ObjectiveThe aim of our study was to evaluate changes of ventricular repolarization of native conduction after CRT and its relation to ventricular tachycardia (VT) and ventricular fibrillation (VF) during long-term follow-up.MethodsWe prospectively included 64 patients with heart failure treated with CRT. QT interval, TpTe and TpTe/QT ratio were analysed from 20-minutes high-resolution ECGs that were recorded at baseline, 1, 3, 6, 9, and 12 months after CRT implantation. CRT was temporary inhibited during follow-up to record intrinsic ECG. Patients with a decrease of left ventricular end-systolic volume ≥15% at 12-month follow-up (mid-term follow-up) were considered as responders. During follow-up occurrences of VT/VF were noted.ResultsSignificant increase of repolarization heterogeneity in first months after implantation was observed (P0.260) was independently associated with high risk of VT/VF (hazard ratio 4.29; 95%CI 1.40-13.15; P=0.011).ConclusionCRT induces time dependent changes in repolarization parameters in first year after implantation. High repolarization heterogeneity at mid-term follow up was associated with higher rate of VT/VF during long-term follow-up.Graphical abstractGraphical abstract for this article
       
  • Association of fibrotic remodeling and cytokines/chemokines content in
           epicardial adipose tissue with atrial myocardial fibrosis in patients with
           atrial fibrillation
    • Abstract: Publication date: Available online 13 June 2018Source: Heart RhythmAuthor(s): Ichitaro Abe, Yasushi Teshima, Hidekazu Kondo, Haruka Kaku, Shintaro Kira, Yuki Ikebe, Shotaro Saito, Akira Fukui, Tetsuji Shinohara, Kunio Yufu, Mikiko Nakagawa, Naoki Hijiya, Masatsugu Moriyama, Tatsuo Shimada, Shinji Miyamoto, Naohiko Takahashi BackgroundEpicardial adipose tissue (EAT) is associated with atrial fibrillation (AF), but the underlying mechanisms remain to be fully elucidated.ObjectiveUsing human left atrial appendage (LAA) samples, we examined the interactive relationship between the EAT profile and atrial myocardial fibrosis through histological and biochemical analyses.MethodsLAA samples were obtained from 59 consecutive AF patients during cardiovascular surgery. In histological analysis, adipose tissue, atrial myocardial fibrosis, EAT fibrosis, macrophage infiltration, and matrix metalloproteinase 2 (MMP2) and hypoxia-inducible factor-1α (Hif-1α) expression were evaluated in LAA sections. In biochemical analysis, pro-inflammatory/fibrotic proteins in EAT, total collagen in the LA myocardium, angiopoietin-like protein 2 (Angptl2)-related proteins in EAT, and pro-inflammatory/fibrotic proteins in serum were evaluated.ResultsHistology revealed that the severity of fibrotic remodeling of EAT was associated with LA myocardial fibrosis. Immunohistochemical and electron-microscopic findings revealed that fibrotic remodeling of EAT was associated with the infiltration of macrophages and myofibroblasts. Protein-concentration analysis demonstrated that the total collagen in the LA myocardium was positively correlated with pro-inflammatory and pro-fibrotic cytokines/chemokines, including interleukin-6, monocyte chemoattractant protein-1, tumor necrosis factor-α, vascular endothelial growth factor, and MMP2 and MMP9 in EAT. The pro-inflammatory and pro-fibrotic cytokines/chemokines in EAT and the total collagen in the LA were also positively correlated with the Angptl2 in EAT.ConclusionOur study demonstrated that fibrotic remodeling and cytokines/chemokines in peri-LA EAT were associated with atrial myocardial fibrosis as a substrate of AF. Our results also suggested that overexpression of Hif-1α and Angptl2 may be involved in these processes.Graphical abstractGraphical abstract for this article
       
  • Ventricular Fibromas in Children, Arrhythmia Risk and Outcomes: A
           Multicentre Study
    • Abstract: Publication date: Available online 12 June 2018Source: Heart RhythmAuthor(s): John P. Jones, Tristan Ramcharan, Milind Chaudhari, Vinay Bhole, Karen Mcleod, Shankar Sadagopan, Orhan Uzun, Andrew Parry, Jan Till, Colin J. McMahon, Alan G. Stuart, Mark A. WalshBackgroundAlthough ventricular fibromas are a rare, they are the second most common type of cardiac tumor in children. While histologically benign, they have a propensity to cause malignant arrhythmias, with cardiac arrest often being the first presentation.;ObjectiveTo evaluate the arrhythmia risk, and management strategies for pediatric ventricular fibromas.MethodsFifteen centers in the British Paediatric Arrhythmia Group network were contacted to partake in the study to contribute cases. A detailed database search was performed in 2 hospitals for cases of ventricular fibromas.ResultsA total of 19 patients were included in the study. Arrhythmias were common, with 5 patients presenting in cardiac arrest and 5 others having documented ventricular tachycardia. Nine patients have undergone surgical resection at various hospitals and all of these patients have survived with good long-term outcomes. One patient, who had not had any treatment died, presumably from a ventricular arrhythmia; another died from metastatic disease. There were no recurrences of arrhythmia after surgery and the need for a defibrillator was alleviated in all cases.ConclusionVentricular fibromas have a high propensity to cause malignant arrhythmias and if they are not managed appropriately, the mortality is high. The outcomes from surgical resection are good, regardless of size, and this represents the best therapeutic option, with most patients being symptom free in the longer term.
       
  • Application of kinomic array analysis to screen for altered kinases in
           atrial fibrillation remodeling
    • Abstract: Publication date: Available online 11 June 2018Source: Heart RhythmAuthor(s): Roelien A.M. Meijering, Marit Wiersma, Deli Zhang, Eva A.H. Lanters, Femke Hoogstra-Berends, Jetse Scholma, Sander Diks, XiaoYan Qi, Natasja M.S. de Groot, Stanley Nattel, Robert H. Henning, Bianca J.J.M. BrundelBackgroundDysregulation of protein kinase–mediated signaling is an early event in many diseases, including the most common clinical cardiac arrhythmia, atrial fibrillation (AF). Kinomic profiling represents a promising technique to identify candidate kinases.ObjectiveIn this study we used kinomic profiling to identify kinases altered in AF remodeling using atrial tissue from a canine model of AF (atrial tachypacing).MethodsLeft atrial tissue obtained in a previous canine study was used for kinomic array (containing 1024 kinase pseudosubstrates) analysis. Three groups of dogs were included: nonpaced controls and atrial tachypaced dogs, which were contrasted with geranylgeranylacetone-treated dogs with AF, which are protected from AF promotion, to enhance specificity of detection of putative kinases.ResultsWhile tachypacing changed activity of 50 kinases, 40 of these were prevented by geranylgeranylacetone and involved in differentiation and proliferation (SRC), contraction, metabolism, immunity, development, cell cycle (CDK4), and survival (Akt). Inhibitors of Akt (MK2206) and CDK4 (PD0332991) and overexpression of a dominant-negative CDK4 phosphorylation mutant protected against tachypacing-induced contractile dysfunction in HL-1 cardiomyocytes. Moreover, patients with AF show down- and upregulation of SRC and Akt phosphorylation, respectively, similar to findings of the kinome array.ConclusionContrasting kinomic array analyses of controls and treated subjects offer a versatile tool to identify kinases altered in atrial remodeling owing to tachypacing, which include Akt, CDK4, and SRC. Ultimately, pharmacological targeting of altered kinases may offer novel therapeutic possibilities to treat clinical AF.
       
  • A QRS axis–based algorithm to identify the origin of scar-related
           
    • Abstract: Publication date: Available online 11 June 2018Source: Heart RhythmAuthor(s): David Andreu, Juan Fernández-Armenta, Juan Acosta, Diego Penela, Beatriz Jáuregui, David Soto-Iglesias, Vladimir Syrovnev, Elena Arbelo, José María Tolosana, Antonio BerruezoBackgroundPreviously proposed algorithms to predict the ventricular tachycardia (VT) exit site have been based on diverse left ventricular models, but none of them identify the precise region of origin in the electroanatomic map. Moreover, no electrocardiographic (ECG) algorithm has been tested to predict the region of origin of scar-related VTs in patients with nonischemic cardiomyopathy.ObjectiveThe purpose of this study was to validate a simple ECG algorithm to identify the segment of origin (SgO) of VT relative to the 17-segment American Heart Association model in patients with structural heart disease (SHD).MethodsThe study included 108 consecutive patients with documented VT and SHD (71% with coronary artery disease). A novel frontal plane axis-based ECG algorithm (highest positive or negative QRS voltage) together with the polarity in leads V3 and V4 was used to predict the SgO of VT. The actual SgO of VT was obtained from the analysis of the electroanatomic map during the procedure. Conventional VT mapping techniques were used to identify the VT exit.ResultsIn total, 149 12-lead ECGs of successfully ablated VT were analyzed. The ECG-suggested SgO matched with the actual SgO in 122 of the 149 VTs (82%). In 21 of the 27 mismatched ECG-suggested SgOs (77.8%), the actual SgO was adjacent to the segment suggested by the ECG. There were no differences in the accuracy of the algorithm based on the SgO or the type of SHD.ConclusionThis novel QRS axis-based algorithm accurately identifies the SgO of VT in the 17-segment American Heart Association model in patients with SHD.
       
  • Effectiveness of a nongovernmental organization–led large-scale
           community atrial fibrillation screening program using the smartphone
           electrocardiogram: An observational cohort study
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): Ngai-Yin Chan, Chi-Chung Choy, Chi-Kin Chan, Chung-Wah SiuBackgroundOpportunistic screening for atrial fibrillation (AF) in patients older than 65 years is currently recommended.ObjectiveWe aim to examine the effectiveness of a nongovernmental organization–led community-based AF screening program carried out by trained layperson volunteers.MethodsAF screening was performed using a smartphone electrocardiogram in 11,574 participants.ResultsAmong all participants, smartphone electrocardiograms were interpretable in 10,735 citizens (92.8%; 8564 female citizens [79.8%]; mean age 78.6 ± 8.1 years). Two hundred forty-four participants (2.3%; 95% confidence interval [CI] 2–2.6; 172 female participants [70.5%]; mean age 79.5 ± 7.9 years) had AF and were advised over phone by a nurse to seek medical attention. Newly diagnosed AF was found in 74 participants (0.69%; 95% CI 0.54–0.84) with a mean CHA2DS2-VASc score of 3.9 ± 1.5. Thirty-six of them (48%; 95% CI 36.6–59.4) were asymptomatic. The number needed to screen for 1 newly diagnosed AF was 145. Telephone follow-up of participants with AF was conducted 9 months after screening. Of 72 participants with newly diagnosed AF and indicated for oral anticoagulation, 47 (65.3%; 95% CI 54.3–76.3) sought medical attention, 17 (23.6%; 95% CI 13.8–33.4) received oral anticoagulants, and 16 (22.2%; 95% CI 12.6–31.8) had 100% compliance. The number needed to screen for 1 appropriately treated newly diagnosed AF was 671.ConclusionThis nongovernmental organization–led community-based AF screening program is effective in identifying citizens with newly diagnosed AF. However, the effectiveness of the program in subsequently leading them to receive appropriate oral anticoagulation therapy is weakened by the lack of a more structured downstream management pathway.
       
  • Mechanistic insight into an exonic splice defect mutation from native
           iPSC-derived cardiomyocytes
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): Zahurul A. Bhuiyan
       
  • To the Editor— Flecainide and propafenone: Good twins for premature
           ventricular contractions’ killing but not exactly superimposable
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): Alessandro Capucci, Giuseppe Ciliberti, Federico Guerra
       
  • Race and atrial fibrillation: A riddle, wrapped in a mystery, inside an
           enigma
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): Gregory M. Marcus
       
  • Reply to the Editor— Flecainide and Propafenone: Good Twins for
           Premature Ventricular Contractions’ Killing But Not Exactly
           Superimposable
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): David S. Frankel
       
  • Predicting cardiac resynchronization therapy outcomes: It is more than
           just left bundle branch block
    • Abstract: Publication date: Available online 8 June 2018Source: Heart RhythmAuthor(s): Hong-xia Niu, Michael R. Gold
       
  • Signal-processing enhancement to reduce oversensing of T waves without
           increasing undersensing of ventricular fibrillation in the subcutaneous
           implantable cardioverter-defibrillator
    • Abstract: Publication date: Available online 6 June 2018Source: Heart RhythmAuthor(s): Sandeep G. Nair, Charles D. Swerdlow
       
  • Predicting syncope: The first step in a long journey'
    • Abstract: Publication date: Available online 6 June 2018Source: Heart RhythmAuthor(s): Robert S. Sheldon, Satish Raj
       
  • Progression of intrahisian atrioventricular block: Will this presage a
           renaissance of His-bundle studies'
    • Abstract: Publication date: Available online 5 June 2018Source: Heart RhythmAuthor(s): Melvin M. Scheinman
       
  • Reflections on a career in academic medicine
    • Abstract: Publication date: Available online 2 June 2018Source: Heart RhythmAuthor(s): Melvin M. Scheinman
       
  • Can global longitudinal strain predict response to cardiac
           resynchronization therapy'
    • Abstract: Publication date: Available online 2 June 2018Source: Heart RhythmAuthor(s): John Gorcsan, Nobuyuki Kagiyama
       
  • Field of view of mapping catheters quantified by electrogram associations
           with radius of myocardial attenuation on contrast-enhanced cardiac
           computed tomography
    • Abstract: Publication date: Available online 2 June 2018Source: Heart RhythmAuthor(s): Satish Misra, Sohail Zahid, Adityo Prakosa, Nissi Saju, Hari Tandri, Ronald D. Berger, Joseph E. Marine, Hugh Calkins, Vadim Zipunnikov, Natalia Trayanova, Stefan L. Zimmerman, Saman NazarianBackgroundContrast-enhanced cardiac computed tomography (CE-CT) provides useful substrate characterization in patients with ventricular tachycardia (VT).ObjectiveThe purpose of this study was to describe the association between endocardial electrogram measurements and myocardial characteristics on CE-CT, in particular the field of view of electrogram features.MethodsFifteen patients with postinfarct VT who underwent catheter ablation with preprocedural CE-CT were included. Electroanatomic maps were registered to CE-CT, and myocardial attenuation surrounding each endocardial point was measured at a radius of 5, 10, and 15 mm. The association between endocardial voltage and attenuation was assessed using a multilevel random effects linear regression model, clustered by patient, with best model fit defined by highest log likelihood.ResultsA total of 4698 points were included. There was a significant association of bipolar and unipolar voltage with myocardial attenuation at all radii. For unipolar voltage, the best model fit was at an analysis radius of 15 mm regardless of the mapping catheter used. For bipolar voltage, the best model fit was at an analysis radius of 15 mm for points acquired with a conventional ablation catheter. In contrast, the best model fit for points acquired with a multipolar mapping catheter was at an analysis radius of 5 mm.ConclusionMyocardial attenuation on CE-CT indicates a smaller myocardial field of view of bipolar electrograms using multipolar catheters with smaller electrodes in comparison to standard ablation catheters despite similar interelectrode spacing. Smaller electrodes may provide improved spatial resolution for the definition of myocardial substrate for VT ablation.
       
  • Late-breaking updates from clinical trials and registries
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s):
       
  • Late-breaking clinical innovations
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s):
       
  • EP News: Case Reports
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): T. Jared Bunch
       
  • EP News: Basic and Translational
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Penelope A. Boyden
       
  • EP News: Clinical
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): N.A. Mark Estes
       
  • EP News: Allied Professionals
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Erica S. Zado
       
  • European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia
           Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society
           (LAHRS) expert consensus on arrhythmias and cognitive function: what is
           the best practice'
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Nikolaos Dagres, Tze-Fan Chao, Guilherme Fenelon, Luis Aguinaga, Daniel Benhayon, Emelia J. Benjamin, T. Jared Bunch, Lin Yee Chen, Shih-Ann Chen, Francisco Darrieux, Angelo de Paola, Laurent Fauchier, Andreas Goette, Jonathan Kalman, Lalit Kalra, Young-Hoon Kim, Deirdre A. Lane, Gregory Y.H. Lip, Steven A. Lubitz, Manlio F. Márquez
       
  • Significance of T-wave inversion triggered by spontaneous atrial premature
           beats in patients with long QT syndrome
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Nobuhiro Takasugi, Mieko Takasugi, Hiroko Goto, Takashi Kuwahara, Takashi Nakashima, Tomoki Kubota, Hiromitsu Kanamori, Masanori Kawasaki, Kazuhiko Nishigaki, Shinya Minatoguchi, Richard L. VerrierBackgroundIn patients with the long QT syndrome (LQTS), a sudden increase in heart rate can cause T-wave alternans (TWA) with beat-to-beat alternating polarity of T wave. We hypothesized that LQTS patients at high risk for torsades de pointes (TdP) may exhibit momentary atrial or sinoatrial premature beat-induced T-wave inversion (APB-TWI).ObjectiveThe purpose of this study was to assess the association of APB-TWI with TdP history and with microvolt TWA.MethodsTwenty-four–hour continuous 12-lead electrocardiograms (ECGs) were recorded in 18 healthy subjects and 39 consecutive patients with LQTS types 1 (n = 21), 2 (n = 4), 3 (n = 4), and unidentified (n = 10). Peak TWA was determined by the modified moving average method.ResultsThe 39 LQTS patients were divided into 2 groups: 10 LQTS patients with TdP history (TdP group) and 29 without (non-TdP group). None of the healthy subjects showed APB-TWI, whereas 38.5% of the LQTS patients (15/39) exhibited APB-TWI. The incidences of APB-TWI and TWA ≥42 μV were significantly higher in the TdP group than in the non-TdP group (APB-TWI: 80% vs 24.1%, P = .006; TWA ≥42 μV: 100% vs 65.5%, P = .04). APB-TWI was inferior in sensitivity for an association with TdP history to TWA ≥42 μV (80% vs 100%) but superior in specificity (75.9% vs 51.7%). Patients with APB-TWI exhibited significantly higher TWA values than those without [median (interquartile range) 73 (55–106.5) vs 48 (37.5–71.8) μV, P = .02].ConclusionAPB-TWI is an easily measurable ECG pattern and is strongly associated with TdP history as well as TWA ≥42 μV in LQTS patients. APB-TWI and TWA may share pathophysiological mechanisms.
       
  • Long-term morbidity and mortality after implantable
           cardioverter-defibrillator implantation with procedural complication: A
           report from the National Cardiovascular Data Registry
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Ryan Kipp, Jonathan C. Hsu, James Freeman, Jeptha Curtis, Haikun Bao, Kurt S. HoffmayerBackgroundLong-term outcomes and predictors of mortality after implantable cardioverter-defibrillator (ICD) implantation related complication are unclear.ObjectiveThe purpose of this study was to determine the risk of mortality and hospitalization after complication during ICD implantation and identify predictors of adverse outcomes.MethodsWe performed a retrospective registry study of Medicare beneficiaries who were first-time ICD recipients enrolled in the National Cardiovascular Data Registry ICD Registry between January 2006 and March 2010. Mortality and hospitalization rates were examined using Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression analysis. Covariates associated with mortality 3 years after ICD implantation complication were investigated.ResultsThe study cohort comprised 136,143 Medicare beneficiaries. Complications during the index hospitalization occurred in 7046 patients (5.18%), and complications within 90 days of device implantation occurred in 10,005 patients (7.34%). In adjusted analyses, complications within 90 days of implantation were associated with an increased risk of all-cause mortality at 1 year (hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.05–1.20; P = .006) and 3 years (HR 1.09; 95% CI 1.05–1.13; P
       
  • Techniques for successful early retrieval of the Micra transcatheter
           pacing system: A worldwide experience
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Muhammad R. Afzal, Emile G. Daoud, Ryan Cunnane, Shiva K. Mulpuru, Alan Koay, Azlan Hussain, Razali Omar, Koh Kok Wei, Anish Amin, Gregory Kidwell, Nirav Patel, Charles Love, Michael Lloyd, Maciej Sterliński, Seth Goldbarg, Miguel A. Leal, James Gabriels, Apoor Patel, Ram Jadonath, Eric GrubmanBackgroundExperience with retrieval of the Micra transcatheter pacing system (TPS) is limited because of its relatively newer technology. Although abandonment of the TPS at end of life is recommended, certain situations such as endovascular infection or device embolization warrant retrieval.ObjectiveThe purpose of this study was to report the worldwide experience with successful retrieval of the Micra TPS.MethodsA list of all successful retrievals of the currently available leadless pacemakers (LPs) was obtained from the manufacturer of Micra TPS. Pertinent details of retrieval, such as indication, days postimplantation, equipment used, complications, and postretrieval management, were obtained from the database collected by the manufacturer. Other procedural details were obtained directly from the operators at each participating site.ResultsData from the manufacturer consisted of 40 successful retrievals of the Micra TPS. Operators for 29 retrievals (73%) provided the consent and procedural details. Of the 29 retrievals, 11 patients underwent retrieval during the initial procedure (immediate retrieval); the other 18 patients underwent retrieval during a separate procedure (delayed retrieval). Median duration before delayed retrieval was 46 days (range 1–95 days). The most common reason for immediate retrieval was elevated pacing threshold after tether removal. The most common reasons for delayed retrieval included elevated pacing threshold at follow-up, endovascular infection, and need for transvenous device. Mean procedure duration was 63.11 ± 56 minutes. All retrievals involved snaring via a Micra TPS delivery catheter or steerable sheath. No serious complications occurred during the reported retrievals.ConclusionEarly retrieval of the Micra TPS is feasible and safe.
       
  • Chronic obstructive pulmonary disease and ventricular
           arrhythmia—Association or causation'
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Nathaniel M. Hawkins
       
  • Chronic obstructive pulmonary disease as a risk factor for ventricular
           arrhythmias independent of left ventricular function
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Tomas Konecny, Kiran R. Somers, Jae Yoon Park, Alan John, Marek Orban, Rahul Doshi, Paul D. Scanlon, Samuel J. Asirvatham, Charanjit S. Rihal, Peter A. BradyBackgroundThe association between chronic obstructive pulmonary disease (COPD) and sudden cardiac death has not been fully elucidated.ObjectiveThe purpose of this study was to investigate whether decreased left ventricular ejection fraction (LVEF) can explain the increased rate of ventricular tachycardia (VT) in COPD.MethodsThis retrospective study included consecutive adult patients who underwent pulmonary function testing (PFT), Holter monitoring, and transthoracic echocardiography. COPD was correlated with the frequency of VT in a multivariate analysis that adjusted for known confounders including LVEF. Long-term all-cause mortality of patients with COPD and VT was examined.ResultsOf the 6351 patients included in this study (age 66 ± 15 years; 48% woman; 92% Caucasian, LVEF 59% ± 12%), 2800 (44%) had PFT indicative of COPD. VT was nearly twice as likely to occur during Holter monitoring in COPD patients (13% vs 23%; P 
       
  • Should we consider the next implantable cardioverter-defibrillator trial
           in patients with acute coronary syndrome and monomorphic ventricular
           tachycardia'
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Wojciech Zareba
       
  • Image-based criteria to identify the presence of epicardial arrhythmogenic
           substrate in patients with transmural myocardial infarction
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): David Soto-Iglesias, Juan Acosta, Diego Penela, Juan Fernández-Armenta, Mario Cabrera, Mikel Martínez, Francesca Vassanelli, Alejandro Alcaine, Markus Linhart, Beatriz Jáuregui, Elena Efimova, Rosario J. Perea, Susana Prat-González, José T. Ortiz-Pérez, Xavier Bosch, Luis Mont, Oscar Camara, Antonio BerruezoBackgroundPatients with transmural myocardial infarction (MI) who undergo endocardial-only substrate ablation are at increased risk for ventricular tachycardia recurrence. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) can be used to assess infarct transmurality (IT). However, the degree of IT associated with an epicardial arrhythmogenic substrate (AS) has not been determined.ObjectiveThe purpose of this study was to determine the degree of IT observed by LGE-CMR and multidetector computed tomography (MDCT) that predicts the presence of epicardial AS.MethodsThe study included 38 post-MI patients. Ten patients with a subendocardial infarction underwent endocardial-only mapping, and 28 with a classic transmural MI (C-TMI), defined as hyperenhancement ≥75% of myocardial wall thickness (WT), underwent endo–epicardial mapping. LGE-CMR/MDCT data were registered to high-density endocardial or epicardial maps to be analyzed for the presence of AS.ResultsOf the 28 post-MI patients with C-TMI, 18 had epicardial AS (64%) and 10 (36%) did not. An epicardial scar area ≥14 cm2 on LGE-CMR identified patients with epicardial AS (sensitivity 1, specificity 1). Mean WT in the epicardial scar area in these patients was lower than in patients without epicardial AS (3.14 ± 1.16 mm vs 5.54 ± 1.78 mm; P = .008). A mean WT cutoff value ≤3.59 mm identified patients with epicardial AS (sensitivity 0.91, specificity 0.93).ConclusionAn epicardial scar area ≥14 cm2 on LGE-CMR and mean CT-WT ≤3.59 mm predict epicardial AS in post-MI patients.Graphical abstractGraphical abstract for this article
       
  • Is a little atrial fibrillation still too much'
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Rod Passman
       
  • Irregularity and lack of p waves in short tachycardia episodes predict
           atrial fibrillation and ischemic stroke
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Linda S.B. Johnson, Anders P. Persson, Per Wollmer, Steen Juul-Möller, Tord Juhlin, Gunnar EngströmBackgroundAtrial fibrillation (AF) is defined as an irregular supraventricular tachycardia (SVT) without p waves, with duration>30 seconds. Whether AF characteristics during short SVT episodes predict AF and stroke is not known.ObjectiveThe purpose of this study was to determine whether irregularity and lack of p waves, alone or in combination, during short SVT episodes increase the risk of incident AF and ischemic stroke.MethodsThe population-based Malmö Diet and Cancer study includes 24-hour ECG screening of 377 AF-free individuals (mean age 64.5 years; 43% men) who were prospectively followed for>13 years. There were 65 AF events and 25 ischemic stroke events during follow-up. Subjects with an SVT episode ≥5 beats were identified, and the longest SVT episode was assessed for irregularity and lack of p waves. The association between SVT classification and AF and stroke was assessed using multivariable adjusted Cox regression.ResultsThe incidence of AF increased with increasing abnormality of the SVTs. The risk-factor adjusted hazard ratio for AF was 4.95 (95% confidence interval 2.06–11.9; P
       
  • Noninvasive electrophysiology in risk assessment and screening
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Marek Malik, Alfred E. Buxton, Heikki Huikuri, Federico Lombardi, Georg Schmidt, Markus Zabel, e-Rhythm Study Group of EHRA
       
  • Prognostic significance of ventricular late potentials in patients with
           pulmonary sarcoidosis
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Kenji Yodogawa, Yoshihiko Seino, Toshihiko Ohara, Yu-ki Iwasaki, Meiso Hayashi, Yasushi Miyauchi, Arata Azuma, Wataru ShimizuBackgroundEarly detection of cardiac involvement in sarcoidosis is difficult but essential to achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect subtle cardiac electrical abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement.ObjectiveThis study aims to investigate the prognostic significance of LP in patients with pulmonary sarcoidosis.MethodsWe prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic peptide levels were also evaluated. We followed these patients for the evaluation of incidence of cardiac events including cardiac death, arrhythmias, and heart failure requiring hospital admission.ResultsOf the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up period of 9.8 years, 8 patients with LPs had cardiovascular events, including development of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event (heart failure). Multivariate analyses revealed that LPs were associated with an increased risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20–78.01; P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring, and echocardiographic parameters were not associated with subsequent cardiac events.ConclusionSAECG might possibly be useful for the early detection of cardiac sarcoidosis and, if independently validated, could eventually be considered as a screening test for further risk stratification.
       
  • HRS publications' online development
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Daniel P. Morin
       
  • Clinical impact of an additional left ventricular lead in cardiac
           resynchronization therapy nonresponders: The V3 trial
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Pierre Bordachar, Daniel Gras, Nicolas Clementy, Pascal Defaye, Pierre Mondoly, Serge Boveda, Frederic Anselme, Didier Klug, Olivier Piot, Nicolas Sadoul, Dominique Babuty, Christophe LeclercqBackgroundCardiac resynchronization therapy (CRT) is an effective treatment of heart failure (HF), but is limited by a substantial proportion of nonresponders. We hypothesized that adding a second left ventricular (LV) lead to deliver a triple-site CRT (V3 CRT) may improve clinical status of CRT nonresponders.ObjectiveWe assessed the feasibility and safety of adding a second LV lead to CRT nonresponders and its clinical impact.MethodsEighty-four recipients of a CRT system and considered as nonresponders as per clinical composite score (CCS) were enrolled in this multicenter study. They were randomized to the V3 arm (implantation of an additional LV lead; n = 43) or control arm (no change; n = 41). Implant success rate, incidence of severe adverse events, CCS, and secondary clinical and echocardiographic end points were evaluated at 12 and 24 months.ResultsPositioning of a second LV lead was successful at first (40 of 44 - 90.9%) or second (4 of 44 - 9.09%) attempt. The perioperative complication rate (infection, system explant, pneumothorax, and hematoma) was high (procedures or system-related complications for 9 patients- 20.4%). After 24 months, 35 systems (79.5%) were working properly. The multinomial logistic regression model showed that V3 treatment had no significant influence (P = .27) on the CCS, number of HF hospitalizations, time to first HF hospitalization, New York Heart Association class, and LV ejection fraction at 12 and 24 months.ConclusionAlthough addition of a second LV lead in CRT nonresponders is feasible with a high success rate, this approach is associated with a significant rate of severe adverse events and does not provide significant long-term clinical benefits (ClinicalTrials.gov Identifier No. NCT01059175).
       
  • Pushing and recognizing the limits of nonresponse to cardiac
           resynchronization therapy: A valuable “negative” trial
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Gaurav A. Upadhyay, Roderick Tung
       
  • Unipolar atrial electrogram morphology from an epicardial and endocardial
           perspective
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): Lisette J.M.E. van der Does, Paul Knops, Christophe P. Teuwen, Corina Serban, Roeliene Starreveld, Eva A.H. Lanters, Elisabeth M.J.P. Mouws, Charles Kik, Ad J.J.C. Bogers, Natasja M.S. de GrootBackgroundEndo–epicardial asynchrony (EEA) and the interplay between the endocardial and epicardial layers could be important in the pathophysiology of atrial arrhythmias. The morphologic differences between epicardial and endocardial atrial electrograms have not yet been described, and electrogram morphology may hold information about the presence of EEA.ObjectiveThe purpose of this study was to directly compare epicardial to endocardial unipolar electrogram morphology during sinus rhythm (SR) and to evaluate whether EEA contributes to electrogram fractionation by correlating fractionation to spatial activation patterns.MethodsIn 26 patients undergoing cardiac surgery, unipolar electrograms were simultaneously recorded from the epicardium and endocardium at the inferior, middle, and superior right atrial (RA) free wall during SR. Potentials were analyzed for epi–endocardial differences in local activation time, voltage, RS ratio, and fractionation. The surrounding and opposite electrograms of fractionated deflections were evaluated for corresponding local activation times in order to determine whether fractionation originated from EEA.ResultsThe superior RA was predisposed to delayed activation, EEA, and fractionation. Both epicardial and endocardial electrograms demonstrated an S-predominance. Fractionation was mostly similar between the 2 sides; however, incidentally deflections up to 4 mV on 1 side could be absent on the other side. Remote activation was responsible for most fractionated deflections (95%) in SR, of which 4% could be attributed to EEA.ConclusionLocal epi–endocardial differences in electrogram fractionation occur occasionally during SR but will likely increase during arrhythmias due to increasing EEA and (functional) conduction disorders. Electrogram fractionation can originate from EEA, and this study demonstrated that unipolar electrogram fractionation can potentially identify EEA.Graphical abstractGraphical abstract for this article
       
  • Mapping of atrial fibrillation: A test of faith
    • Abstract: Publication date: June 2018Source: Heart Rhythm, Volume 15, Issue 6Author(s): T. Jared Bunch
       
 
 
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