Paul A. Friedman

Long-term outcome of atrial fibrillation ablation: Impact and predictors of very late recurrence

Long‐Term Outcome of AF Ablation. Introduction: Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow‐up, but very late recurrences may compromise long‐term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation.

Outcomes After Cardiac Perforation During Radiofrequency Ablation of the Atrium

Background: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter‐based radiofrequency ablation procedures in the left atrium.

Percutaneous epicardial left atrial appendage closure: preliminary results of an electrogram guided approach.

Background: Pharmacologic therapies to prevent stroke in atrial fibrillation (AF) have numerous limitations, prompting the development of device‐based therapies. We investigated whether an electrogram‐based approach using a novel hollow suture can safely capture and ligate the left atrial appendage (LAA).

Risk Factors for Implantable Defibrillator Lead Fracture in a Recalled and a Nonrecalled Lead

Risk Factors for ICD Lead Fracture. Introduction: The Medtronic Sprint Fidelis® implantable cardioverter defibrillator (ICD) lead was “recalled” in October 2007 after 268,000 implants worldwide due to increased failure risk. Manufacturer suggested monitoring has not been shown effective at preventing adverse events. Only limited data exist regarding clinical predictors of Fidelis® lead fracture. We sought to identify risk factors for Fidelis® fracture to guide clinical monitoring and compare its performance with a control lead.

Cardiovascular Implantable Electronic Device Infection in Patients with Staphylococcus aureus Bacteremia

Background: u2002Staphylococcus aureus bacteremia (SAB) in patients with cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPMs) and implantable cardioverter‐defibrillators (ICD), can be the sole manifestation of device infection.

Optimal Combination of Discriminators for Differentiating Ventricular from Supraventricular Tachycardia by Dual‐Chamber Defibrillators

Introduction: Dual‐chamber implantable cardioverter defibrillators (ICDs) use discriminators to differentiate between supraventricular tachycardias (SVTs) and ventricular tachycardias (VT), the accuracy of which may depend on the type and method used. ICDs can combine rate branching of tachyarrhythmias according to their A:V relationship with two SVT‐VT discriminators in each rate branch, using ANY (either) or ALL (both) logic. Our goal was to determine the optimal discriminator combination.

Intra‐Atrial Conduction Block Along the Mitral Valve Annulus During Accessory Pathway Ablation: Evidence for a Left Atrial “Isthmus”

Left Atrial Isthmus. Introduction: We observed a change in the atrial activation sequence during radiofrequency (RF) energy application in patients undergoing left accessory pathway (AP) ablation. This occurred without damage to the AP and in the absence of a second AP or alternative arrhythmia mechanism. We hypothesized that block in a left atrial “isthmus” of tissue between the mitral annulus and a left inferior pulmonary vein was responsible for these findings.

No Increased Bleeding Events with Continuation of Oral Anticoagulation Therapy for Patients Undergoing Cardiac Device Procedure

Background: Switching warfarin for heparin has been a practice for managing periprocedural anticoagulation in high‐risk patients undergoing device‐related procedures. We sought to investigate whether continuation of warfarin sodium therapy without heparin bridging is safe and, when it is continued, the optimal international normalized ratio (INR) without increased bleeding risk at time of device‐related procedure.

Successful ablation of atrial tachycardia in the right coronary cusp of the aortic valve in a patient with atrial fibrillation: what is the substrate?

Atrial tachycardias have been successfully ablated from the noncoronary cusp of the aortic valve. The anatomical substrate responsible for the arrhythmia in these patients is unknown. We report a case of intracardiac ultrasound confirmed ablation in the right coronary cusp of the aortic valve. Pacing maneuvers performed in this case, along with the regional anatomy of the right coronary cusp, strongly suggest that the ablated substrate is muscular extensions above the aortic valve. Ablation in the right coronary cusp eliminated tachycardia without valve damage or AV conduction abnormality.

Electrophysiological anatomy of typical atrial flutter: The posterior boundary and causes for difficulty with ablation

Electrophysiological Anatomy of Typical Atrial Flutter. Background: The electrophysiological anatomy of cavotricuspid isthmus‐dependent atrial flutter (CVTI‐AFL) has not been fully elucidated.