Abstracts Archive 2004

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Endocardial Pacemaker Implantation in Infants Weighing 10 Kilograms

Endocardial permanent pacing is feasible and effective in children 10 kg and an acceptable alternative to epicardial pacing.
 

Relation Between the AH Interval and the Ablation Site in Patients with Atrioventricular Nodal Reentrant Tachycardia

There is a significant correlation between the AH interval during slow pathway conduction and the distance of the successful ablation site from the His bundle. This relationship (1) suggests that, in addition to functional factors, anatomic factors influence slow pathway conduction and (2) may be helpful in determining the initial energy application site during slow pathway ablation.
 

Prevalence and Characteristics of Idiopathic Outflow Tract Tachycardia with QRS Alteration Following Catheter Ablation Requiring Additional Radiofrequency Ablation at a Different Point in the Outflow Tract

Changes in QRS morphology consistently included an increase or decrease in R wave amplitude in all inferior leads. Detailed continuous observation of QRS morphology in OTVT, especially R wave amplitude in inferior leads, is important for identifying changes of QRS morphology during catheter ablation. Mapping and ablation at a different portion of the outflow tract is then needed for cure.
 

Frequency of arrhythmic events during head-up tilt testing in patients with suspected neurocardiogenic syncope or presyncope

Of 2,242 patients, ventricular fibrillation occurred in 1 patient (0.04%). Thus, bradyarrhythmias were the most common arrhythmic events during HUT with isoproterenol provocation. Serious ventricular tachyarrhythmia rarely occurred.

Biventricular Pacing and Left Ventricular Pacing in Heart Failure

Although LVP and BVP provide similar hemodynamic improvement, LVP results in more homogeneous but substantially delayed LV contraction, leading to shortened filling time and less reduction in postsystolic contraction. These data may influence the choice of individual optimal pacing configuration.

Incidence of Hospitalized Rhabdomyolysis in Patients Treated With Lipid-Lowering Drugs

Rhabdomyolysis risk was similar and low for monotherapy with atorvastatin, pravastatin, and simvastatin; combined statin-fibrate use increased risk, especially in older patients with diabetes mellitus. Cerivastatin combined with fibrate conferred a risk of approximately 1 in 10 treated patients per year.




 

Angiotensin-Converting–Enzyme Inhibition in Stable Coronary Artery Disease

In patients with stable coronary heart disease and preserved left ventricular function who are receiving "current standard" therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in terms of death from cardiovascular causes, myocardial infarction, or coronary revascularization.
 

Long-Term Clinical Course of Patients After Termination of Ventricular Tachyarrhythmia by an Implanted Defibrillator

Successful appropriate therapy by an ICD for VT or VF is associated with 80% survival at 1 year after arrhythmia termination. These patients are at increased risk for heart failure and nonsudden cardiac death after device termination of VT or VF and should receive special attention for the prevention and management of progressive left ventricular dysfunction during long-term follow-up.


 

Effect of democracy on health: ecological study

Data are now available to enable the measurement of the global impact on health of a wide range of political and economic variables. As a result the World Health Organization commission on macroeconomics and health has produced valuable information on associations between health and wealth. Yet information is still lacking on the relation between the extent of freedom of a particular country and the health of its people. Each year, Freedom House, a non-profit making, independent organisation promoting democracy, publishes a freedom rating for most countries, classifying them as free, partially free, or not free. These ratings could be used as a proxy to explore the effects of democracy on health, as has been done recently with democracy and the provision of public services.

Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination

Acute infections are associated with a transient increase in the risk of vascular events. By contrast, influenza, tetanus, and pneumococcal vaccinations do not produce a detectable increase in the risk of vascular events.

Implantable Defibrillators for the Prevention of Mortality in Patients With Nonischemic Cardiomyopathy A Meta-analysis of Randomized Controlled Trials

ICD therapy appears to significantly reduce mortality in selected patients with NICM.

Prophylactic Use of an Implantable Cardioverter–Defibrillator after Acute Myocardial Infarction

Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.

Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time. The Holidays as a Risk Factor for Death

The Christmas/New Year’s holidays are a risk factor for cardiac and noncardiac mortality. There are multiple explanations for this association, including the possibility that holiday-induced delays in seeking treatment play a role in producing the twin holiday spikes.

 

Outpatient Treatment of Recent-Onset Atrial Fibrillation with the "Pill-in-the-Pocket" Approach

In a selected, risk-stratified population of patients with recurrent atrial fibrillation, pill-in-the-pocket treatment is feasible and safe, with a high rate of compliance by patients, a low rate of adverse events, and a marked reduction in emergency room visits and hospital admissions.

Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation

Rate control is a cost-effective approach to the management of atrial fibrillation compared with maintenance of sinus rhythm in patients with atrial fibrillation similar to those enrolled in AFFIRM.


 

Short-Term Effects of Right-Left Heart Sequential Cardiac Resynchronization in Patients With Heart Failure, Chronic Atrial Fibrillation, and Atrioventricular Nodal Block

Simultaneous BiV pacing acutely enhances both systolic and diastolic function over single-site RV or LV pacing in congestive heart failure patients with atrial fibrillation and advanced AV block. Sequential RV-LV stimulation offers minimal benefit on average and should perhaps be considered only in targeted subsets such as nonresponding patients.



 

Obesity and the Risk of New-Onset Atrial Fibrillation

Obesity is an important, potentially modifiable risk factor for AF. The excess risk of AF associated with obesity appears to be mediated by left atrial dilatation. These prospective data raise the possibility that interventions to promote normal weight may reduce the population burden of AF.


 

Mechanism of Repolarization Change During Initiation of Supraventricular Tachycardia

Repolarization changes during SVT initiation were caused mainly by concurrent hemodynamic change after SVT initiation with abrupt cycle length shortening.
 

Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction

Abnormal glucose tolerance is a strong risk factor for future cardiovascular events after myocardial infarction. Since it is common and possible to detect even during the hospital phase it may be a target for novel secondary preventive efforts.

Improved Localization of Right-Sided Accessory Pathways with Microcatheter-Assisted Right Coronary Artery Mapping in Children

Mapping in the right coronary artery with a microcatheter is an effective method to improve localization and successful ablation of difficult right-sided accessory pathways.

Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study

This is preliminary evidence that SUD may be preceded by intraindividual increases in both inflammation and autonomic dysfunction. Both may be causal in genesis but, even if they are not, intraindividual increases in either may be convenient markers to identify patients at high risk of impending SUD. Larger studies are needed to confirm the observation from this pilot study.

Fever as a Precipitant of Idiopathic Ventricular Fibrillation in Patients with Normal Hearts

We present a series of patients in whom an apparently benign febrile illness was associated with malignant ventricular arrhythmias in the absence of cardiac disease or other factors known to precipitate sudden cardiac death. Physicians should be aware of this possible phenomenon in cases of febrile illness associated with syncope.

Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery. Results from a Department of Veterans Affairs Cooperative Study

The 10-year patency of IMA grafts is better than SVGs. The 10-year patency for SVGs is better and the 10-year patency for IMA grafts is worse than expected. The 10-year patency of SVGs to the LAD is better than that to the right or circumflex. The best long-term predictors of SVG graft patency are grafting into the LAD and grafting into a vessel that is >2.0 mm in diameter.

Prevalence, Predictors, and Mortality Significance of the Causative Arrhythmia in Patients with Electrical Storm

Of 2,028 patients assessed in the ICD clinic, 208 (10%) presented with ES. VF was the cause of ES in 99 of 208 patients, for an overall prevalence of 48%. The initial ICD indication, coronary artery disease, and amiodarone therapy are predictors of the causative arrhythmias in ES. There does not appear to be any mortality difference between ES patients with VT and VF, but mortality is increased in patients with ES versus control ICD patients without ES.

Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing

Specific echocardiographic measurements of ventricular dyssynchrony are highly correlated with hemodynamic changes and may be a useful adjunct in the selection and optimization of BVP. Individually optimized sequential BVP provided a significant early hemodynamic improvement compared with simultaneous BVP.

Incidence and Risk Factors of Early Venous Thrombosis Associated with Permanent Pacemaker Leads

Established risk factors for venous thrombosis and the presence of multiple pacemaker leads contribute substantially to the occurrence of thrombosis associated with permanent pacemaker leads. Risk factor assessment prior to implantation may be useful for identifying patients at risk for thrombotic complications. Preventive management in these patients is warranted.
 

Warfarin for non-rheumatic atrial fibrillation: five year experience in a district general hospital

Computerised long term oral anticoagulation for NRAF in a community setting of elderly and diverse patients is safe and effective. Anticoagulation control, bleeding events, thromboembolic episodes, and stroke rates are directly comparable with those reported in major clinical trials. The authors therefore support the strategy of rate control with long term oral anticoagulation for NRAF in general clinical practice.

Effects of Resynchronization Therapy on Cardiac Function in Pacemaker Patients "Upgraded" to Biventricular Devices

"Upgrading" RV paced patients with advanced heart failure to CRT improves measures of electrical and LV mechanical synchrony and improves systolic function.
 

Public Access Defibrillation in Out-of-Hospital Cardiac Arrest: A Community-Based Study

PAD was involved in only a small but increasing proportion of out-of-hospital cardiac arrests.

Left ventricular mechanics during right ventricular apical or left ventricular-based pacing in patients with chronic atrial fibrillation after atrioventricular junction ablation

In the short term, LV-based pacing is superior to RV apical pacing in terms of contractile function and LV filling after AVJ ablation for drug-refractory AF.
 

Left Cardiac Sympathetic Denervation in the Management of High-Risk Patients Affected by the Long-QT Syndrome

LCSD is associated with a significant reduction in the incidence of aborted cardiac arrest and syncope in high-risk LQTS patients when compared with pre-LCSD events. However, LCSD is not entirely effective in preventing cardiac events including sudden cardiac death during long-term follow-up. LCSD should be considered in patients with recurrent syncope despite ß-blockade and in patients who experience arrhythmia storms with an implanted defibrillator.

Percutaneous pulmonary valve replacement in a large right ventricular outflow tract: An experimental study

Non-surgical implantation of a pulmonary valve is possible in ewes with all types of pulmonary trunk, regardless of its size. A “downsize” stent is needed to allow valve implantation in a large trunk. Further refinements will make this technique feasible in humans.

Effects of Acute Mental Stress and Exercise on T-Wave Alternans in Patients With Implantable Cardioverter Defibrillators and Controls

Mental stress can induce cardiac electrical instability, as assessed via TWA, among patients with arrhythmic vulnerability and occurs at lower heart rates than with exercise. Pathophysiological mechanisms of mental stress–induced arrhythmias may therefore involve central and autonomic nervous system pathways that differ from exercise-induced arrhythmias.

Long-term prognosis of inducible ventricular flutter: Not an innocent finding

The long-term prognosis of patients with inducible VFL is similar to that of patients with inducible SMVT, even when VFL is induced with a relatively aggressive protocol.

Implantable Cardioverter/Defibrillator Therapy in Arrhythmogenic Right Ventricular Cardiomyopathy: Single-Center Experience of Long-Term Follow-Up and Complications in 60 Patients

These results strongly suggest an improvement in long-term prognosis by ICD therapy in high-risk patients with ARVC. However, meticulous placement and long-term observation of transvenous lead performance with focus on sensing function are required for the prevention and/or early recognition of disease progression and lead-related morbidity during long-term follow-up of ICD therapy in ARVC.

Relationships Between Sinus Rhythm, Treatment, and Survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study

Warfarin use improves survival. SR is either an important determinant of survival or a marker for other factors associated with survival that were not recorded, determined, or included in the survival model. Currently available AADs are not associated with improved survival, which suggests that any beneficial antiarrhythmic effects of AADs are offset by their adverse effects. If an effective method for maintaining SR with fewer adverse effects were available, it might be beneficial.

Prognostic significance of right ventricular extrasystole

Patients with RVES carry a good prognosis in terms of morbidity and mortality no matter whether echomorphologic abnormalities are present or not.

The prognostic significance of exercise-induced atrial arrhythmias

In this large cohort of patients, the occurrence of AE was predictive of an increased risk of MI. However, the association did not persist after adjustment for clinical and exercise variables known to predict adverse long-term cardiovascular outcomes. The rate of long-term cardiac death or revascularization was not influenced by the development of stress-induced atrial arrhythmias.

A comparison between oral antiarrhythmic drugs in the prevention of atrial fibrillation after cardiac surgery: The pilot study of prevention of postoperative atrial fibrillation (SPPAF), a randomized, placebo-controlled trial

Oral active prophylaxis with either sotalol or amiodarone plus metoprolol may reduce the rate of AF after cardiac surgery in a population at high risk for postoperative AF. Treatment with metoprolol alone resulted in a trend to a lower risk for postoperative AF.

Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation : The ACUTE economic data at eight weeks

In patients with AF >2 days duration undergoing electrical cardioversion, the TEE-guided group showed little difference in patient costs compared with the conventional group. The TEE strategy had higher initial treatment costs but lower outcome-associated costs. Cumulative costs were 24% higher in the conventional group, primarily due to bleeding. The TEE-guided strategy is an economically feasible approach compared with the conventional strategy.

Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure

In patients with severe congestive heart failure, sinus rhythm, and left bundle-branch block despite optimal pharmacological treatment, left univentricular pacing is feasible and results in significant midterm benefit in exercise tolerance and left ventricular function.

Clinical efficacy of sildenafil in primary pulmonary hypertension: A randomized, placebo-controlled, double-blind, crossover study

Sildenafil significantly improves exercise tolerance, cardiac index, and QOL in patients with PPH.




 

The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: Approaches to control rate in atrial fibrillation

Rate control in AF is possible in the majority of patients with AF. Beta-blockers were the most effective drugs. To achieve the goal of adequate rate control in all patients, frequent medication changes and drug combinations were needed.




 

Acute haemodynamic benefits of biatrial atrioventricular sequential pacing: comparison with single atrial atrioventricular sequential pacing

Biatrial pacing yielded the most significant improvements in haemodynamic variables. These haemodynamic benefits may play a part in reducing intra-atrial pressure and preventing atrial fibrillation.



 

Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

Mortality risk in patients with ejection fractions 30% increases as a function of time from MI. The survival benefit associated with ICDs appears to be greater for remote MI and remains substantial for up to 15 years after MI.

 

Sequential Biventricular Pacing: Evaluation of Safety and Efficacy

This sequential biventricular pacemaker was safe and efficacious.

Application of Radiofrequency Energy in Surgical and Interventional Procedures: Are There Interactions with ICDs?

There was no oversensing, reprogramming, or damage of any defibrillator caused by RF energy. Despite the lack of undesired interactions, ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation not be possible, or the achievement uncertain, electromagnetic interference is highly unlikely.

Three-Year Outcome After Coronary Stenting Versus Bypass Surgery for the Treatment of Multivessel Disease

Three-year survival rates without stroke and myocardial infarction are identical in both groups, and the cost/benefit ratio of stenting is determined primarily by the increasing need for revascularization in the PCI group.

QRS Duration and Shortening to Predict Clinical Response to Cardiac Resynchronization Therapy in Patients with End-Stage Heart Failure

QRS duration at baseline is not predictive for response to CRT; responders exhibit a significant reduction in QRS duration after CRT, but individual response varies highly, not allowing adequate selection of responders.
 

Postoperative atrial fibrillation and mortality after coronary artery bypass surgery

The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study.
 

Addition of a Defibrillation Electrode in the Low Right Atrium to a Right Ventricular Lead Does Not Reduce Ventricular Defibrillation Thresholds

Despite a reduction in total impedance, the addition of a defibrillation coil in the low right atrium does not reduce ventricular defibrillation thresholds.
 

Pacemaker and Implantable Cardioverter Defibrillator Implantation Without Reversal of Warfarin Therapy

The complication rate in the anticoagulated group was similar to those in patients with a normal INR. Routine normalization of coagulation factors prior to pacemaker/ICD placement may not be necessary.
 

Evaluation of Safety and Efficacy of Pacemaker and Defibrillator Implantation by Axillary Incision in Pediatric Patients

This approach avoids skin erosion when implanting large devices such as defibrillators or biventricular devices in small patients with limited muscle mass while achieving superior aesthetic results. The axillary or extrathoracic venous entry site avoids subclavian crush syndrome.

Does Sinus Rhythm Beget Sinus Rhythm? Long-term Follow-Up of the Patient Activated Atrial Defibrillator

Regular early use of the atrial defibrillator, increased the duration of sinus rhythm in a minority of patients during long-term follow-up. Most patients had regular recurrences of AF requiring patient-activated cardioversion.

Localization of Accessory Pathways by the Electrocardiogram: Which Is the Degree of Accordance of Three Algorithms in Use?

The observed agreement among algorithms is clearly lower than the expected one. Minimal preexcitation, limited number of patients, and arbitrarily defined regions were possibly the reasons for some unexpected results.

Optimal Pacing for Symptomatic AV Block: A Comparison of VDD and DDD Pacing

The lower cost, high reliability, and abbreviated implantation time suggest that VDD pacing is a viable alternative to DDD pacing in patients with high degree AV block and normal sinus node function.

Shock on T Versus Direct Current Voltage for Induction of Ventricular Fibrillation: A Randomized Prospective Comparison

A constant DC voltage induction of VF may be more effective than T shock for induction of VF in a clinical setting because it reduces the number of attempts required to induce VF. By either method, VF appears to be more difficult to induce in women. DC induction has the advantage of simple programming of only duration of stimulation. These findings have implications particularly for ICD implantation with conscious sedation.

 

Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches

The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.
 

Radiofrequency Catheter Ablation in Small Children: Relationship of Complications to Application Dose

The decision to proceed with RFCA, and the application duration and number should be guided by patient size, balanced against the risks of the arrhythmia, and reserved for dire circumstances.

Left Atrial Vein Pacing: A Technique of Biatrial Pacing for the Prevention of Atrial Fibrillation

Pacing in a greater proportion of patients might be achieved by the development and use of smaller (3, 4, and 5 Fr) electrodes. Furthermore, these smaller leads would obviously allow deeper advancement into the LA veins with the potential advantages of greater interatrial synchronization and lead stability and lesser far-field R wave sensing.

 

Enhanced Detection of Arrhythmia Vulnerability Using T Wave Alternans, Left Ventricular Ejection Fraction, and Programmed Ventricular Stimulation: A Prospective Study in Subjects with Chronic Ischemic Heart Disease

The combined use of TWA, LVEF, and PVS is a promising new approach to arrhythmia risk stratification that permits identification of high-risk and very-low-risk patients.

A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy

On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.

 

Prospective Randomized Study of Mode Switching in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction

Atrial fibrillation (AF) is common in pacemaker patients with sinus node dysfunction (SND) and may result in rapid ventricular pacing (RVP) in the DDDR mode. Mode switching (MS) reduces pacemaker reprogramming due to RVP during AHREs in a small number of patients but does not improve QOL or cardiovascular symptoms overall among patients with SND.
 

Comparison of recurrence rates after direct-current cardioversion for new-onset atrial fibrillation in patients receiving versus those not receiving rhythm-control drug therapy

The high incidence of treatment failure with rhythm-control therapy suggests that rate control with anticoagulation should be preferred in patients with new-onset persistent AF if AF recurs after DC cardioversion.

Comparison of the effects of removal of chest hair with not doing so before external defibrillation on transthoracic impedance

Chest hair contributes significantly to transthoracic impedance (TTI) during defibrillation. The magnitude of this effect has not been established using external paddles. We compared TTI in 40 men before elective cardiac surgery, and before and after shaving their chests. Chest hair causes a significant increase in TTI during external defibrillation, the magnitude of the effect being related to both the quantity of hair and force applied to the defibrillation paddles. When the chests of nonhirsute patients were shaved, a decrease in TTI occurred, which was probably related to the creation of low-impedance pathways through skin abrasions.

Use of a Wearable Defibrillator in Terminating Tachyarrhythmias in Patients at High Risk for Sudden Death: Results of WEARIT/BIROAD

The results of the present study suggest that a wearable defibrillator is beneficial in detecting and effectively treating ventricular tachyarrhythmias in patients at high risk for sudden death who are not clear candidates for an ICD and may be useful as a bridge to transplantation or ICD in some patients.
 

Implications of Implantable Cardioverter Defibrillator Therapy in Congenital Heart Disease and Pediatrics

ICD therapy can effectively manage malignant arrhythmias in selected pediatric and congenital heart patients. Spurious shocks or ICD storm may increase morbidity and emphasize the need for concomitant medical and ablative therapy. ICD lead failure was relatively frequent in this population.         

Incidence of Nonsustained and Sustained Ventricular Tachyarrhythmias in Patients with an Implantable Cardioverter Defibrillator

ICD patients with NSVT represent a population more likely to experience sustained VT/VF episodes with a temporal association between an NSVT surge and sustained VT/VF occurrence.

Standard Right Atrial Ablation is Effective for Atrioventricular Nodal Reentry with Earliest Activation in the Coronary Sinus

Successful RF ablation can be performed at standard sites in the triangle of Koch regardless of earliest site of atrial activation. The incidence of CS as earliest retrograde atrial activation site in AVNRT is 8%.          

Is Mobitz type I atrioventricular block benign in adults?

Mobitz I block is not usually benign in patients  45 years of age. Pacemaker implantation should be considered, even in the absence of symptomatic bradycardia or organic heart disease.

Canadian Trial of Physiological Pacing: Effects of Physiological Pacing During Long-Term Follow-Up

The CTOPP extended study does not show a difference in cardiovascular death or stroke, or in total mortality, or in stroke between patients implanted with ventricular or physiological pacemakers over a mean follow-up of >6 years. However, there is a persistent significant reduction in the development of atrial fibrillation with physiological pacing.

Automatic adjustment of pacing output in the clinical setting

AutoCapture (AC) is a programmable feature that enables the pacemaker to both track the capture threshold and automatically adjust the output on a beat-by-beat basis. Reprogramming the pacemaker output significantly enhanced its estimated longevity; AC added a moderate but significant extension over manual reprogramming and was associated with increased safety in patients with large ventricular threshold variations.

Comparison of the effects of removal of chest hair with not doing so before external defibrillation on transthoracic impedance

Chest hair causes a significant increase in TTI during external defibrillation, the magnitude of the effect being related to both the quantity of hair and force applied to the defibrillation paddles. When the chests of nonhirsute patients were shaved, a decrease in TTI occurred, which was probably related to the creation of low-impedance pathways through skin abrasions.

Sudden Death Associated With Short-QT Syndrome Linked to Mutations in HERG

Three families with hereditary short-QT syndrome and a high incidence of ventricular arrhythmias and sudden cardiac death were studied.

Clinical spectrum of neurally mediated reflex syncopes

 The clinical features of situational, carotid sinus, tilt-induced and complex neurally mediated syncope were very similar. By contrast, typical vasovagal syncope differed from other neurally mediated syncopes not only in terms of its precipitating factors (fear, strong emotion, etc.), which constituted predefined diagnostic criteria, but also in the variety of its clinical features (lower age and prevalence of organic heart disease, higher prevalence of prodromal symptoms, and of autonomic prodromes, longer duration of prodromes, higher prevalence of symptoms during the recovery phase and lower prevalence of trauma).

Value of the implantable loop recorder for the management of patients with unexplained syncope

The ILR is a valuable and effective tool to establish an arrhythmic cause for unexplained syncope. The results of head-up tilt testing (HUTT) and electrophysiological study (EPS) are neither sufficiently sensitive nor specific enough in this patient group.

Automatic adjustment of pacing output in the clinical setting

AutoCapture (AC) is a programmable feature that enables the pacemaker to both track the capture threshold and automatically adjust the output on a beat-by-beat basis. Reprogramming the pacemaker output significantly enhanced its estimated longevity; AC added a moderate but significant extension over manual reprogramming and was associated with increased safety in patients with large ventricular threshold variations.

Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: A randomized, digoxin-controlled trial

The rapid infusion of sotalol or amiodarone in patients with symptomatic recent-onset atrial fibrillation results in rapid control of ventricular rate. Even with high-dose rapid infusions, all 3 agents are associated with a poor overall reversion rate within 12 hours.

Conduction system abnormalities in patients with obstructive hypertrophic cardiomyopathy following septal reduction interventions

In 174 patients without a preexisting permanent pacemaker, a pacemaker was implanted in 22% versus 13% of patients who underwent PTSMA (overall and without preexisting conduction block, respectively) and 10% versus 2% of patients with myectomy. RBBB often develops after PTSMA and LBBB is very frequently produced by myectomy.

Long-term survival after pacemaker implantation

Multivariate analysis revealed several independent factors: age, gender, decade of implantation, type of pacemaker, index arrhythmia and initial symptoms. Interestingly, if only the patients of the last decade were analysed multivariately, neither pacing mode nor index arrhythmia were independently associated with survival.

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