Raffaele Corbisiero

Clinical results of an advanced SVT detection enhancement algorithm

Introduction: Supraventricular tachycardia (SVT) has many characteristics that are similar to ventricular tachycardia (VT). This presents a significant challenge for the SVT‐detection algorithms of an implantable cardioverter defibrillator (ICD). A newly developed ICD, which utilizes a Vector Timing and Correlation algorithm as well as interval‐based conventional SVT discrimination algorithms (Rhythm ID™), was evaluated in this study.

Does Size Really Matter? A Comparison of the Riata Lead Family Based on Size and Its Relation to Performance

Background: Recently, the performance and safety of smaller diameter implantable cardioverter defibrillator (ICD) leads has been questioned. The purpose of this analysis was to determine the impact of size on lead performance and perforation rates by comparing the performance of 7 French (7F) and 8 French (8F) leads with similar design characteristics implanted by a single operator.

Pacemaker Implantation in a Patient with Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava

A 79 year old white male was admitted for symptoms of congestive heart failure. He had a history of mitral valve replacement using a Carpentier Edwards prosthesis for congenital dysplastic mitral valve, and single vessel coronary artery bypass surgery one year prior. Although the presence of a left persistent, and absence of a right superior vena cava may have been discovered at the time of open heart surgery, it was not communicated. Over the year he had several episodes of rapid atrial fibrillation. He received treatment with beta blockers and calcium channel blockers for rate control, resulting in sick sinus syndrome. These agents were discontinued and treatment with amiodarone was initiated. Despite reloading of amiodarone and two attempts at electrical cardioversion, the patient experienced breakthrough episodes of atrial fibrillation resulting in heart failure. Transesophageal echocardiogram performed prior to cardioversion revealed a large coronary sinus with a large left superior vena cava and no evidence of a right superior vena cava. The patient presented in congestive heart failure associated with paroxysms of rapid atrial fibrillation. After treatment with intravenous amiodarone and metoprolol, the patient converted to sinus rhythm but had episodes of severe, symptomatic bradycardia. AV node ablation and permanent pacemaker implantation appeared to be the best clinical option. AV node ablation was performed via the right femoral vein without difficulty. An attempt at pacer lead insertion via the left subclavian approach was made, as it was not certain at that time that the right superior vena cava was completely absent. This attempt failed as the lead traveled straight across to the right subclavian vein, and could not be turned acutely downward into the left persistent superior vena cava despite multiple attempts with lead reshaping. Successful lead insertion from the right cephalic vein was then performed due to the limitations of this anomaly. The lead was passed via the right subclavian vein, which drained into the persistent left superior vena cava, then to the coronary sinus. This approach had less of an acute angle between the right subclavian vein and the left superior vana cava, allowing a more direct entry into the coronary sinus and on to the right atrium and ventricle. St. Jude Tendril DX #1388T active fixation leads were placed in the right atrium and right ventricular outflow tract. Active fixation leads were the best choice given the uncertainty of lead position, and were as important as the choice of approach. Normal sensing and capture were obtained for both leads. The leads were connected to a Guidant Discovery DR 1274 generator set to DDDR. The patient has remained asymptomatic. At one year follow up, pacer interrogation revealed AV paced rhythm with continued normal lead sensing and capture.

Adaptive Bi‐Atrial Pacing Improves the Maintenance of Sinus Rhythm

Introduction: Multiple pacing modalities have been shown to individually decrease atrial fibrillation (AF) burden and relieve symptoms of AF. This investigation retrospectively evaluated whether a combination of bi‐atrial pacing with dynamic atrial overdrive (DAO) AF suppression would further decrease AF burden as compared to AF suppression (DAO) alone.

Profile of St. Jude Medical’s Allure Quadra quadripolar pacemaker system for cardiac resynchronization therapy

Congestive heart failure is a major public health epidemic and economic burden in the USA and worldwide. Cardiac resynchronization therapy is an effective therapy for treating congestive heart failure in conjunction with pharmacologic therapy. The average congestive heart failure admission costs approximately US

Can Intra-Cardiac Electrogram Amplitudes Be Used To Differentiate Ventricular Tachycardia from Ventricular Fibrillation in Implantable Devices?

8 billion annually. Current cardiac resynchronization therapy pacemaker systems from various manufacturers deliver therapy-utilizing bipolar leads including the left ventricle, with electrode spacing ranging from 8 to 22 mm. The Quartet LV™ lead model 1458Q (St. Jude Medical Sylmar, CA) is a quadripolar lead with a 4.0 Fr. tip electrode and three 4.7 Fr. ring electrodes located 20, 30 and 47 mm from the tip. The Quartet lead and Allure Quadra TM allows 14 pacing configurations, providing benefits, including reductions in phrenic nerve stimulation, reduced pacing thresholds, improved battery longevity and potential reductions, in non-responders to cardiac resynchronization therapy. In addition, there is cost benefit data from utilizing quadripolar technology compared with traditional bipolar cardiac resynchronization therapy.

Feasibility of using multivector impedance to monitor pulmonary congestion in heart failure patients

Rapid Onset of Fulminant Myocarditis Portends a Favorable Prognosis and Ability To Bridge Mechanical Support to Recovery Pavan Atluri, Brant W. Ullery, Jessica L. Howard, William Hiesinger, J. Raymond Fitzpatrick, Mariell Jessup, Michael A. Acker, Rohinton J. Morris, Y. Joseph Woo; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA; Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA