Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology

BACKGROUND: For bradycardic patients after cardiac surgery, it is unknown how long to wait before implanting a permanent pacemaker. Current recommendations vary and are based on observational studies. METHODS AND RESULTS: We conducted first a study of patients in our institution, and second a systematic review of studies examining conduction disturbance and pacing after cardiac surgery.Of 5849 operations over a 6 year period, 103 (1.8%) patients required PPM implantation...

BACKGROUND: Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD, and has evolved over the years. OBJECTIVE: To evaluate the rate of inappropriate shocks (IS), appropriate therapies and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation...

BACKGROUND: Leadless pacemakers (LP) may mitigate the risk of lead failure and pocket infection related to conventional transvenous pacemakers. Atrial LP are currently being investigated. However, the optimal and safest implant site is not known. OBJECTIVES: We aimed to evaluate the right atrial (RA) anatomy and the adjacent structures using complementary analytic models (gross anatomy, cardiac MRI, and computer simulation), to identify the optimal safest location to implant an atrial LP human...

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INTRODUCTION: Electrophysiology (EP) is a growing field in cardiology, with an increasing involvement of young people. Nevertheless, concerns about radiation exposure and its impact on reproduction and pregnancy may discourage the choice of an EP career. OBJECTIVE: To investigate the level of awareness and main sources of concern about the effects of radiation on reproductive potential and pregnancy, explore the safety measures adopted in different EP Labs and verify the adherence to the current guidelines...

AIMS: Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analyzed its impact on fluoroscopy use and acute procedural and clinical outcomes...

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BACKGROUND: Infections resulting from cardiac implantable electronic device (CIED) implantation are severely impacting on patients' and on health care systems. The use of TYRXTM absorbable antibiotic-eluting envelope has proven to decrease major CIED infections within 12 months of CIED surgery. AIMS: to evaluate the impact of the envelope use on infection-related clinical events in a real-world contemporary patient population. METHODS: Data on patients undergoing CIED surgery were collected prospectively by participating centers of the One Hospital ClinicalService project...

BACKGROUND AND AIMS: The effectiveness of pulmonary vein isolation (PVI) guided by VISITAG SURPOINT (VS) has been demonstrated in Western populations. However, data for Asian populations are limited. VS settings may differ for Asians, given their smaller body size. This study aimed to describe outcomes of radiofrequency atrial fibrillation (AF) ablation guided by VS in a large Asian population. METHODS: The prospective, observational, multicenter MIYABI registry collected real-world data from patients undergoing VS-guided AF ablation using Thermocool SmartTouch and Thermocool SmartTouch SF catheters from 50 Japanese centers...

BACKGROUND AND AIMS: After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) versus external cardiac monitor (ECM) after ischaemic stroke. METHODS: Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within three months...

BACKGROUND AND AIMS: Atrial extrasystoles (AES) provoke conduction disorders and may trigger episodes of atrial fibrillation (AF). However, the direction- and rate-dependency of electrophysiological tissue properties on epicardial unipolar electrogram (EGM) morphology is unknown. Therefore, this study examined the impact of spontaneous AES on potential amplitude, -fractionation, -duration and low-voltage areas (LVA), and correlated these differences with various degrees of prematurity and aberrancy...

BACKGROUND AND AIMS: Intracardiac echocardiography (ICE) is a useful but operator-dependent tool for left atrial (LA) anatomical rendering during atrial fibrillation (AF) ablation. The CARTOSOUND FAM Module, a new deep learning (DL) imaging algorithm, has the potential to overcome this limitation. This study aims to evaluate feasibility of the algorithm compared to cardiac computed tomography (CT) in patients undergoing AF ablation. METHODS: In 28 patients undergoing AF ablation, baseline patient information were recorded and 3D shells of LA body and anatomical structures (LAA/LSPV/LIPV/RSPV/RIPV) were reconstructed using the DL algorithm...

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BACKGROUND: This study assessed associations of minimum final extrastimulus coupling interval utilised within electrophysiology study (EPS) after MI and possible site of origin of induced ventricular tachycardia (VT) with long-term occurrence of spontaneous ventricular tachyarrhythmia and longterm survival. METHODS: This prospective study recruited consecutive patients with LVEF ≤ 40% who underwent EPS day 3-5 after MI between 2004-2017. Positive EPS was defined as sustained monomorphic VT cycle length ≥200 ms for ≥10 seconds, or shorter duration if hemodynamic compromise occurred...

BACKGROUND AND AIMS: Electroanatomical mapping may be critical to identify atrial fibrillation (AF) subjects that require substrate modification beyond pulmonary vein isolation (PVI). The objective was to determine correlations between pre-ablation mapping characteristics and 12-month outcomes after a single PVI-only catheter ablation of AF. METHODS: This study enrolled paroxysmal AF (PAF), early persistent AF (PsAF; 7 days-3 months) and non-early PsAF (>3 months-12 months) subjects undergoing de novo PVI-only radiofrequency catheter ablation...

BACKGROUND AND AIMS: Sudden cardiac death (SCD) is challenging to predict. Electrocardiogram (ECG) derived, heart rate corrected QT-interval (QTc) is used for SCD-risk assessment. QTc is preferably determined manually, but vendor-provided automatic results from ECG-recorders are convenient. Agreement between manual and automatic assessments is unclear for populations with aberrant QTc. We aimed to systematically assess pairwise agreement of automatic and manual QT-intervals and QTc. METHODS: A multi-center cohort enriching aberrant QTc comprised ECGs of healthy controls and Long-QT Syndrome (LQTS) patients...

BACKGROUND AND AIMS: The ryanodine receptor (RyR2) is essential for cardiac muscle excitation-contraction coupling, dysfunctional RyR2 participates in the development of inherited arrhythmogenic cardiac disease. In this study, a novel RyR2 mutation A690E is identified from a patient with family inheritance of sudden cardiac death, and we investigated the pathogenic basis of the mutation. METHODS AND RESULTS: We generated a mouse model that carried the A690E mutation...