David K. Murdock

Ranolazine Reduces Ventricular Tachycardia Burden and ICD Shocks in Patients with Drug‐Refractory ICD Shocks

Background:  There are limited options for patients who present with antiarrhythmic‐drug (AAD)‐refractory ventricular tachycardia (VT) with recurrent implantable cardioverter defibrillator (ICD) shocks. Ranolazine is a drug that exerts antianginal and antiischemic effects and also acts as an antiarrhythmic in isolation and in combination with other class III medications. Ranolazine may be an option for recurrent AAD‐refractory ICD shocks secondary to VT, but its efficacy, outcomes, and tolerance are unknown.

Feature topic: Clinical use of abciximab: Coronary artery stenting for suboptimal PTCA results in acute myocardial infarction in patients treated with abciximab: Early and six-month outcome

Emergent percutaneous transluminal coronary angioplasty (PTCA) is an effective treatment for acute myocardial infarction. However, occasionally results of angioplasty are suboptimal due to coronary dissection or elastic recoil, leading to a high chance of recurrent ischemia. Coronary stents are occasionally employed in such settings, but a high incidence of stent thrombosis was noted by early investigators when stents were placed into areas of active thrombus formation. Since coronary thrombosis and stent thrombosis are both initiated by platelets, the potent antiplatelet agent abciximab might be useful in preventing stent thrombosis. Little information is available concerning early outcome or 6-month clinical event rate when coronary artery stents are placed for suboptimal angioplasty results for acute myocardial infarction in patients given abciximab. We deployed 75 stents as part of angioplasty for acute myocardial infarction in 40 patients given abciximab. All patients had suboptimal angioplasty results leading to stent deployment. Each obtained normal flow angiographically and no stent thrombosis or acute closure was observed. Early mortality occurred in 1 patient. All patients were followed at least 6 months, and no patient died after hospital discharge. Three patients experienced recurrent ischemic events within the first 6 months. Two of these events were due to infarct vessel restenosis. We conclude the combined use of coronary artery stents and abciximab for suboptimal PTCA results during acute myocardial infarction is associated with a low incidence of culprit vessel recurrent ischemic events within 6 months of intervention.

Augmentation of Cardiac Output by External Cardiac Pacing: Pacemaker‐Induced CPR

Transthoracic cardiac pacing is frequently associated with simultaneous stimulation of skeletal muscle and nerves. We describe a patient in cardiogenic shock and complete heart block in whom the associated vigorous abdominal and chest muscle contractions caused by transthoracic cardiac pacing resulted in a marked augmentation of cardiac output and systemic blood pressure via a “CPR” effect

New technique for prepping the Johnson & Johnson stent delivery system.

Current prepping of the Johnson & Johnson stent deployment balloon can be suboptimal. This simple technique allows for an improved preparation of the stent delivery balloon prior to deployment, resulting in less air in the balloon during inflation.

Pacemaker Malfunction Simulated by Amplifier Saturation

In this case report, pacemaker malfunction is simulated by prolonged pauses after each pacemaker discharge. The pauses were due to saturation of the input of the telemetry monitor amplifier by the discharge voltage of the pacemaker. It is important to recognize amplifier saturation as a form of artifact that can mimic pacemaker malfunction.