Philipp Lacour

Performance of the New BioMonitor 2-AF Insertable Cardiac Monitoring System: Can Better be Worse?: NEW BIOMONITOR 2-AF PERFORMANCE

Implantable loop recorders (ILR) are valuable tools for the investigation of patients with suspected arrhythmias. The BioMonitor 2‐AF is a novel insertable ILR with enhanced atrial fibrillation (AF) detection algorithm and remote monitoring capability.

Managing periprocedural anticoagulation therapy in patients undergoing device implantation: survey in Germany, Austria and Switzerland.

Objective The management of patients who undergo cardiac implantable electronic device (CIED) surgery and receive concomitant oral anticoagulation therapy (OAT) is an important clinical topic, as physicians must balance the thromboembolic and bleeding risk when deciding on the perioperative anticoagulation medication. The object of the survey was to analyse the management of perioperative OAT with vitamin K antagonists or novel oral anticoagulant agents (NOACs) and time, type and dose of possibly heparin bridging in consideration of OAT indication during CIED implantation in Austria, Germany and Switzerland. Methods and results We performed a web-based survey across CIED implanting centres in Germany, Austria and Switzerland to collect data regarding the management of the perioperative anticoagulation therapy. In total, the survey was completed by 252 centres. In total, 65.2% of the Austrian, 46.0% of the German and 13.3% of the Swiss centres stop vitamin K antagonists before CIED implantation and bridge with heparin, targeted to a therapeutic level, in most cases. NOACs were stopped before CIED implantation in most centres (95.8% of the Austrian, 89.5% of the German and 87.5% of the Swiss centres) surveyed without heparin bridging. Conclusions Previous meta-analyses showed that heparin bridging in patients undergoing CIED implantation increases the risk of bleeding complications compared to continuation of vitamin K antagonist treatment but data from our survey shows that interruption of vitamin K antagonist treatment and bridging with heparin remains a commonly employed strategy. Data regarding CIED implantation with uninterrupted NOACs are limited; thus, most centres surveyed stop NOACs before CIED implantation without heparin bridging.

Catheter ablation of atrial flutter: A survey focusing on post ablation oral anticoagulation management and ECG monitoring

A considerable amount of patients with typical atrial flutter develop atrial fibrillation after cavotricuspid isthmus (CTI) ablation. No uniform recommendations are available to guide anticoagulation regimes or electrocardiogram (ECG) monitoring strategies after this procedure.

The effect of an ultra-low frame rate and antiscatter grid-less radiation protocol for cardiac device implantations

Antiscatter grids improve image contrast by absorbing scattered x‐ray beams, although by removing the antiscatter grid patient dose can be reduced as more x‐ray beams reach the image receptor. Additionally, there is a trend toward ultra‐low frame rates for radiation dose reduction during various electrophysiology procedures. As for most cardiac device implantations (CIED) image quality demands are usually modest, the purpose of this study was to assess the safety and efficacy of an ultra‐low frame rate and scatter grid‐less radiation protocol.

Cardiac device implantations in obese patients: Success rates and complications

Obesity is associated with increased complications and potentially worse outcomes for various cardiac interventions. This study analyzed the success rate and complication rates associated with implantation of cardiac implantable electronic devices (CIEDs) in obese patients.

Implantable loop recorders in patients with unexplained syncope:Clinical predictors of pacemaker implantation

BACKGROUND Implantable loop recorders (ILR) are a valuable tool for the investigation of unexplainedsyncopal episodes. The aim of this retrospective single center study was to identify predictive factors for pacemaker implantation in patients with unexplained syncope who underwent ILR insertion. METHODS One hundred six patients were retrospectively analyzed (mean age 59.1 years; 47.2% male) with unexplained syncope and negative conventional testing who underwent ILR implantation. The pri- mary study endpoint was detection of symptomatic or asymptomatic bradycardia requiring pacemaker implantation. RESULTS The average follow-up period after ILR implantation was 20 ± 15 months. Pacemaker im- plantation according to current guidelines was necessary in 22 (20.8%) patients, mean duration until index bradycardia was 81 ± 88 (2-350) days. Ten (45.5%) patients received a pacemaker due to sinus arrest, 7 (31.8%) patients due to third-degree atrioventricular block, 2 (9.1%) patients due to second- degree atrioventricular block and 1 (4.5%) patient due to atrial fibrillation with a slow ventricular rate. Three factors remained significant in multivariate analysis: obesity, which defined by a body mass index above 30 kg/m2 (OR: 7.39, p = 0.014), a right bundle branch block (OR: 9.40, p = 0.023) and chronic renal failure as defined by a glomerular filtration rate of less than 60 mL/min (OR: 6.42, p = 0.035). CONCLUSIONS Bradycardia is a frequent finding in patients undergoing ILR implantation due to un- explained syncope. Obesity, right bundle branch block and chronic renal failure are independent clinical predictors of pacemaker implantation.