Incessant tachycardia in a patient with advanced heart failure and left ventricular assist device: What is the mechanism?

AbstractWe present a case of incessant wide-complex tachycardia in a patient with left-ventricular assist device, and discuss the differential diagnosis with an in-depth analysis of the intracardiac tracings during the invasive electrophysiologic study, including interpretation of the relative timing of the fascicular signals during tachycardia and in sinus rhythm, and interpretation of pacing and entrainment maneuvers

Rationale and current perspective for early rhythm control therapy in atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design

withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Dual chamber pacing mode in an atrial antitachycardia pacing device without a ventricular lead – A necessary evil

We present a case of a single chamber atrial pacemaker implanted for sinus node dysfunction and treatment of macroreentrant atrial tachycardias with atrial antitachycardia pacing. The patient presented with sustained atrial tachycardia above the detection rate, however, the device was unable to detect the tachycardia and did not deliver the programmed therapy. We discuss the nuances of the atrial tachyarrhythmia detection algorithms, and the programming strategies to maximize detection of atrial arrhythmias in a single chamber atrial pacemaker

Response to Letters Regarding Article, "Stroke or Transient Ischemic Attack in Patients With Transvenous Pacemaker or Defibrillator and Echocardiographically Detected Patent Foramen Ovale"

Arlington National Cemetery, Arlington, VA 22211exterior, facade, portic

Coincidental impact of transcatheter patent foramen ovale closure on migraine with and without aura — A comprehensive meta-analysis

Background: We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. Methods: We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Results: Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of follow-up. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p = 0.002), but not for studies on complete resolution of migraine (p = 0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Conclusions: Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura

Shoulder Joint Dislocation as an Unusual Complication of Defibrillation Threshold Testing Following Subcutaneous Implantable Cardioverter-Defibrillator Implantation

A 53-year-old man underwent implantation of a totally subcutaneous ICD (S-ICD; Boston Scientific). He was positioned supine, with the left arm abducted, externally rotated (i.e. palm up) and strapped to the arm extender. The generator was placed in the left mid-axillary line along the 5th-6th intercostal spaces and the defibrillation coil was tunneled anterior to the sternum. Defibrillation threshold (DFT) testing with 65 Jcaused a forceful pectoralis twitch. The patient woke up with a painful anteriorly dislocated left shoulder. Glenohumeral dislocation due to DFT testing has not been previously reported. It is likely that this complication is specific to the S-ICD implantation, and is related to positioning with the arm abducted, externally rotated, and immobilized, and use of greater defibrillation energy with current pathway through the bulk of the pectoralis muscle.Precautions may include extending the arm palm down, strapping the arm loosely, and adduction of the arm for DFT testing