Bruce L. Wilkoff

Impact of coronary sinus lead position on biventricular pacing: mortality and echocardiographic evaluation during long-term follow-up.

Introduction: Biventricular pacing is an established treatment for congestive heart failure. Whether the anatomic location of the coronary sinus (CS) lead affects outcomes is unknown. The aim of this study was to evaluate the clinical response and mortality in patients who had transvenous CS leads placed in different anatomic branches for biventricular pacing.

Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac resynchronization therapy patients.

Introduction: Although numerous trials have shown benefit of implantable cardioverter defibrillators (ICDs) for either primary or secondary prevention, no trial has prospectively enrolled patients from both indications and analyzed ICD utilization between groups.

Cardiac resynchronization therapy in non-left bundle branch block morphologies.

Introduction: In select patients with systolic heart failure, cardiac resynchronization therapy (CRT) has been shown to improve quality of life, exercise capacity, ejection fraction (EF), and survival. Little is known about the response to CRT in patients with right bundle branch block (RBBB) or non‐specific intraventricular conduction delay (IVCD) compared with traditionally studied patients with left bundle branch block (LBBB).

Safe Scanning, but Frequent Artifacts Mimicking Bradycardia and Tachycardia During Magnetic Resonance Imaging (MRI) in Patients with an Implantable Loop Recorder (ILR)

Background: Patients with implantable devices are generally not permitted to undergo magnetic resonance imaging (MRI) because of potentially deleterious interactions. Little has been reported regarding the safety and effects of MRI scanning of patients with implantable loop recorders (ILRs). We evaluated the safety of scanning patients with ILRs and the output of the ILR after undergoing MRI.

Effect of Pacing for Soft Indications on Mortality and Heart Failure in the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

Background: The dual chamber and VVI implantable defibrillator (DAVID) trial demonstrated that dual chamber (DDDR) pacing in defibrillator candidates with impaired ventricular function and no established indication for pacing resulted in worsened congestive heart failure (CHF) or death. Many patients had abnormalities for which pacing is often advocated to improve the management of ventricular dysfunction.

Relationship between rehospitalization and future death in patients treated for potentially lethal arrhythmia.

Rehospitalization and Future Death. Introduction: It is generally considered that death is the only appropriate endpoint to evaluate interventions for preventing death; however, this belief may be based on the previous use of inappropriate or inadequate surrogates for death. The aim of this study was to evaluate whether rehospitalization following implementation of an intervention is a reasonable surrogate for death.

The Impact of Changing Antiseptic Skin Preparation Agent used for Cardiac Implantable Electronic Device (CIED) Procedures on the Risk of Infection

Cardiac implantable electronic device (CIED) infection is a major complication that is associated with increased morbidity and mortality. Recent data suggested a relationship between the antiseptic agent used for skin preparation at time of CIED procedure and risk for infection.

OPTIMIZED FIRST PHASE TILT IN PARALLEL-SERIES BIPHASIC WAVEFORM

“Parallel‐Series” Biphasic Waveform. Introduction: A biphasic defibrillation waveform can achieve a large second phase leading‐edge voltage by a “parallel‐series” switching system. Recently, such a system using two 30‐μF capacitances demonstrated better defibrillation threshold than standard waveforms available in current implantable devices. However, the optimized tilt of such a “parallel‐series” system had not been defined.

Lead-induced venous thrombosis:consequences?

A lag always exists between the initial implementation of a therapy and the true appreciation of the intended and unintended consequences. In the case of transvenous lead implantation, the handwriting has been on the wall for a long time but has mostly been ignored. Perhaps the appreciation opportunity is upon us. The number of patients with transvenous leads currently is estimated to be 1.81 million in the United States and 4.36 million around the world.1 The indications for pacemaker implantation have not changed significantly, but the role of implantable defibrillators and devices that impact cardiac function through biventricular stimulation have grown substantially. In many institutions, the current rate of implantable cardioverter defibrillator (ICD) placement has grown to exceed that of pacemaker implantation. Whatever the consequences of transvenous lead implantation, the magnitude of the impact will increase substantially. Even if the numbers of patients did not increase, the type of patients, that is, patients with comorbid conditions, has continued to build. Patients no longer are receiving simple, often single-lead devices for AV or sinus node dysfunction. Rather, patients with advanced left ventricular dysfunction, deteriorated functional status, and complicated interventions are receiving defibrillators and biventricular stimulation devices. Antiplatelet therapy, thrombolytics, dialysis, bypass surgery, percutaneous vascular interventions, and stenting commonly shape the complexity of treating these patients. In the same way, transvenous leads complicate each of the other conditions. Most relevant to this discussion is the competition for venous vascular access among patients. Central venous access is used for dialysis, chemotherapy, and antibiotic therapy; diagnostic, monitoring, and interventional procedures; and pacemaker and implantable defibrillator placement. Respect for the competitive demands for vascular access and preserving these vital conduits for lifelong use are increasingly important. In this issue of the Journal, Huisman et al.2 add to the limited literature defining the incidence and risk factors associated with transvenous pacemaker and ICD lead placement. The incidence of thrombosis is at least as high as the 23% documented in this population of pacemaker and implantable defibrillator patients. Considering the number of device patients, by any estimation this is a frequent phenomenon; however, the incidence undoubtedly is higher. In this series, one of the symptomatic complete occlusions was documented only by venography after being missed by the

Prognostic Significance of Atrial Arrhythmias in a Primary Prevention ICD Population

Introduction : We investigated whether primary prevention implantable cardioverter defibrillator (ICD) patients with atrial arrhythmias are at higher risk for ICD shocks and mortality compared to patients without atrial arrhythmias in a subanalysis of the PREPARE study.