Heart rhythm : the official journal of the Heart Rhythm Society
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Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown. ⋯ In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.
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The best protocol for cardiovascular preparticipation screening (PPS) in young athletes is uncertain. ⋯ ECG adds value to PPS through increased detection of arrhythmogenic and structural cardiovascular conditions associated with sudden cardiac death. Use of modern ECG interpretation standards allows a low false-positive rate. Routine echo may detect other clinically important cardiac abnormalities, but its role in PPS remains uncertain.
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Ebstein's anomaly is associated with a high incidence of atrial and ventricular arrhythmias. The Cone procedure has become an effective hemodynamic intervention for this malformation. In response to two late postoperative sudden deaths in our early institutional Cone experience, a standardized plan for aggressive rhythm evaluation was instituted, including preoperative electrophysiologic studies (EPS) and intraoperative implantable loop recorder (ILR) placement. ⋯ Preoperative EPS has a high diagnostic and therapeutic yield in patients with Ebstein's anomaly undergoing the Cone operation. It is reasonable to recommend EPS as a routine preoperative test for this population.
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Comparative Study
Short- and long-term electrical performance of the 5086MRI pacing lead.
Owing to potential patient harm, magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices has traditionally been contraindicated. Following the EnRhythm MRI SureScan Study, an MR conditional pacemaker with modified leads was approved by the Food and Drug Administration. Electrical and handling characteristics of MR conditional pacing leads compared with those of traditional leads have not been established. ⋯ The 5086MRI lead demonstrates clinically acceptable electrical characteristics while providing safe access to MR-guided diagnostics. However, compared with the 5076 lead, the 5086MRI lead exhibits lower ventricular sensing, slightly higher ventricular capture thresholds, and higher acute lead dislodgement rate.
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Randomized Controlled Trial Comparative Study
Phased RF ablation in persistent atrial fibrillation.
Persistent and long-standing persistent atrial fibrillation (AF) often requires extensive and/or repeat radiofrequency (RF) ablation procedures. ⋯ Catheter ablation of persistent/long-standing persistent AF with the phased RF ablation system is effective with greater reduction of AF compared with MM. More intense anticoagulation strategies, careful attention to catheter placement relative to the pulmonary vein ostia, and elimination of electrode interaction are expected to reduce the risk of stroke, pulmonary vein stenosis, and asymptomatic cerebral emboli.