Grant R. Simons

Implantation success and infection in cardiovascular implantable electronic device procedures utilizing an antibacterial envelope.

Background:  Cardiovascular implantable electronic device (CIED) infection rates are increasing faster than implantation rates. More effective antimicrobial prophylaxis may help reduce CIED infections and improve clinical outcomes. The AIGISRx® antibacterial envelope is a polymer mesh implanted in the generator pocket with the CIED. After implantation it releases two antibiotics, minocycline and rifampin, that have been shown to reduce infections associated with other medical devices. The purpose of this retrospective cohort study is to determine the rate of CIED implantation success and CIED infection in procedures utilizing the antibacterial envelope.

Continuous nonfluoroscopic localization of the esophagus during radiofrequency catheter ablation of atrial fibrillation.

Introduction: Atrial‐esophageal fistula formation is a dreaded complication of radiofrequency catheter ablation for atrial fibrillation. Esophageal localization is of potential value in avoiding lesion placement where the left atrium is juxtaposed to the esophagus.

Response to the Center for Medicare & Medicaid Services coverage with evidence development request for primary prevention implantable cardioverter-defibrillators: Data from the OMNI study

BACKGROUND The Center for Medicare & Medicaid Services expanded coverage for primary prevention (PP) implantable cardioverter-defibrillators (ICDs) included a request for outcome comparisons between 3 Group B subgroup patients (left ventricular ejection fraction [LVEF] 31%-35%, nonischemic dilated cardiomyopathy [NDCM] duration of <9 months, and New York Heart Association class IV heart failure (HF) treated with cardiac resynchronization therapy/defibrillator [CRT/D]) and non-Group B patients (LVEF ≤30%, NDCM duration of ≥9 months, and New York Heart Association class III HF treated with CRT/D) using real-world observational studies. OBJECTIVE To compare outcomes in Center for Medicare & Medicaid Services Group B and non-Group B PP ICD patients. METHODS OMNI was a 4-year prospective observational study that enrolled 1464 PP ICD patients with a mean LVEF of 25%; 72% were men, 78% had class II-IV HF, and 66% had coronary disease. A total of 795 (54.3%) received ICDs, and 669 (45.7%) received CRT/Ds. Ventricular tachyarrhythmia therapy rates and mortality were compared over 39 ± 18.4 months. RESULTS Twenty-five percent received ventricular tachyarrhythmia therapies, and 21.2% died within 4 years. Patient-year therapy rates were not significantly different for LVEF of 31%-35% (0.36 per year) vs ≤30% (0.51/y) and CRT/D for class IV HF (0.21/y) vs class III HF (0.43 per year) but were lower for NDCM <9 months (0.3/y) vs ≥9 months (0.85/y; P = .02). Four-year mortality was similar for LVEF 30%-35% (22.6%) vs <30% (24.4%) and NDCM <9 months (14.2%) vs ≥9 months (12.3%) but was higher for CRT/D for class IV HF (48.6%) vs class III HF (27.4%) (P = .01). CONCLUSION Patient-year ventricular tachyarrhythmia therapy rates did not differ between non-Group B and Group B PP ICD patients, though NDCM <9 months was significantly lower. Survival at 4 years was lowest in patients with New York Heart Association class IV HF treated with CRT/D and similar between all other non-Group B and Group B patients.

A pilot study of cardiac electrophysiology catheters to map and pace bladder electrical activity.

This is a pilot study to evaluate the feasibility of using diagnostic cardiac electrophysiology catheters for recording intrinsic urinary bladder electrical activity and for electrical pacing capture of bladder tissue.

Investigation of the Utility of the Audible Alert in Recent Generation Medtronic Implantable Cardioverter‐Defibrillators

Medtronic implantable cardioverter defibrillators (ICDs; Medtronic Inc., Mounds View, MN, USA) are equipped with Patient Alert™, a feature in which the ICD generator emits a series of audible tones to notify patients of possible system malfunction. A prior study of this issue revealed that only 50% of patients with older Medtronic devices were able to hear alerts. More recently, Medtronic has incorporated modifications to the alert. Therefore, we studied how frequently alert tones emitted by the current generation of Medtronic ICDs are audible by patients.

Aortic Intramural Hematoma After Catheter Ablation for Atrial Fibrillation

Radiofrequency catheter ablation of atrial fibrillation carries a risk of thermal damage to extracardiac structures, including the esophagus and the phrenic nerves [(1–3)][1]; however, aortic complications have not been described previously. We report a case of aortic intramural hematoma in a 68-

Use of the Retained Guidewire Technique Facilitates Left Ventricular Epicardial Capture During Biventricular Defibrillator Implantation

We report a case of biventricular implantable cardioverter‐defibrillator (ICD) insertion in which standard lead placement techniques could not achieve left ventricular capture. Protrusion of the guidewire beyond a venous stenosis provided adequate left ventricular capture.