Journal of cardiovascular electrophysiology
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J. Cardiovasc. Electrophysiol. · Oct 2011
ReviewNon-surgical left atrial appendage closure for stroke prevention in atrial fibrillation.
Non-Surgical Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. The most feared complication associated with atrial fibrillation (AF) is stroke, the risk of which increases with advanced age. Because of its complex anatomy and diminished blood flow during AF, the left atrial appendage (LAA) has been a common site of left atrial thrombi and presumed source of thromboembolism. ⋯ The nonsurgical approaches to excluding the LAA from the central circulation can be divided into 3 broad categories: transseptally placed devices, percutaneous epicardial approach, and hybrid approaches. The availability of several approaches will allow physician selection of the optimal approach for a given patient based on clinical, physiological, and anatomical considerations. LAA exclusion stands to become an increasingly attractive option for patients with nonvalvular AF because it can be offered to elderly AF patients, and eliminates the long-term cumulative bleeding risks and adherence challenge of anticoagulants.
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J. Cardiovasc. Electrophysiol. · Mar 2011
ReviewVentricular tachycardia in the era of ventricular assist devices.
Sustained ventricular tachycardia (VT) in patients with advanced cardiomyopathy is a potentially life-threatening arrhythmia. Newer treatment strategies have evolved that combine the use of catheter ablation to target the substrate for VT and ventricular assist devices (VADs) to hemodynamically support the failing ventricle. This editorial is targeted to the practicing clinician caring for these difficult patients. The current article reviews the use of percutaneous VADs to support catheter ablation of VT, the use of durable VADs to support the failing heart in patients with recurrent VT, ventricular arrhythmias in patients with durable VADs, and the use of catheter ablation to treat VT in patients with durable VADs.
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J. Cardiovasc. Electrophysiol. · May 2010
ReviewOptimizing survival from out-of-hospital cardiac arrest.
Cardiac arrest is an important public health problem and often occurs in the out-of-hospital setting in patients without a prior history of heart disease. Very few communities or emergency medical service (EMS) systems report survival rates for out-of-hospital cardiac arrest. ⋯ Important current initiatives to improve cardiac arrest survival include hands-only CPR delivered by laypersons prior to the arrival of EMS, dispatcher-assisted CPR, and implementation of hospital-based therapeutic hypothermia protocols to improve postresuscitation care. Optimizing cardiac arrest survival requires a team effort between EMS directors, emergency physicians, cardiologists, hospital leadership, and the public.
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J. Cardiovasc. Electrophysiol. · Jun 2009
ReviewStrategies for epicardial mapping and ablation of ventricular tachycardia.
Catheter ablation for ventricular tachycardia (VT) is becoming an essential component of the successful management of patients with structural heart disease and refractory ventricular arrhythmias. Despite detailed mapping and ablation from the endocardium, nearly a third of VT circuits remain inaccessible. ⋯ Potential risks include risk of injury to an epicardial coronary artery, the phrenic nerve, subdiaphragmatic vessels, and right ventricle. We describe the indications for and approach to catheter ablation of VT for the pericardial space.
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J. Cardiovasc. Electrophysiol. · May 2009
ReviewThe work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities.
In patients with newly diagnosed AV block and/or ventricular tachycardia, cardiac sarcoidosis should always be considered in the differential diagnosis. In addition to the pacemaker implant, cardiac resynchronization therapy (CRT) should be selected for severe heart failure patients who have class III or IV heart failure, LVEF