EUROPEAN JOURNAL OF ARRHYTHMIA & ELECTROPHYSIOLOGY – VOLUME 9 SUPPLEMENT 1 – 2023

Background: Catheter ablation (CA) of ventricular tachycardia (VT) reduces ICD therapies in patients with VT due to structural heart disease (SHD). A structured ablation pathway may guide pre-ablation optimization of antiarrhythmic drugs (AAD) and ICD programming. We aimed to investigate impact of an ablation pathway on VT ablation outcome. Methods: The study recruited consecutive patients with SHD […]

Background: Risk models have been utilised to predict major adverse events (MAEs) following transvenous lead extraction (TLE). We evaluated whether applying machine learning (ML-) techniques incorporating chest radiographs increased the ability of existing models to predict MAE (defined as procedure-related major complication and procedure-related deaths). Methods: Two models were assessed whether ML would improve risk […]

Background: Extending implantable cardioverter defibrillator (ICD) detection windows improves outcomes by reducing unnecessary therapies; a 1% reduction in therapies results in ~1% reduction in mortality. However, waiting too long for episodes to self-terminate may prolong cardiac ischaemia, which could compromise the effectiveness of ICD treatments. We have previously shown that laser Doppler perfusion monitoring, combined […]

Background: Patients with persistent atrial fibrillation (AF) may experience reduced left ventricular ejection fraction (LVEF) despite rate-control. The non-normal distribution of R–R intervals may be poorly represented by the mean heart rate and a non-parametric measure of the proportion of short R–R intervals may more sensitively characterize the AF-mediated component of left ventricular systolic dysfunction. […]

Introduction: 3D models derived from late gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR) can reduce ventricular tachycardia (VT) ablation procedure times and improve outcomes. Clinician-led manual segmentation is time and resource intensive. However, neural networks can be trained to identify and segment cardiac structures, mimicking clinician decisions, whilst operating at a fraction of the time with […]

Background: Subtle, prognostically-meaningful ECG features may not be apparent to physicians. In the course of supervised machine learning (ML) training, many thousands of ECG features are identified. These are not limited to conventional ECG parameters and morphology. These novel NN-derived ECG features may have clinical, phenotypic and genotypic associations and prognostic significance. Methods and results: […]

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Estimated prevalence in England is 2.5% and increases with age. It is associated with a five-fold increase in stroke risk. Anticoagulation can reduce this risk by 64%.1 Guidelines recommend anticoagulation for patients with paroxysmal or persistent AF who are at risk of stroke. The National Institute for […]

Introduction: There are half a million people with cardiac pacemakers in the UK who are denied access to magnetic resonance imaging (MRI) when clinically indicated. Patients are fifty times less likely to be referred and there is a thirty-fold service under provision because provision is logistically difficult – it needs experts in both MRI and cardiology […]

Introduction: With the ever-increasing importance of home monitoring for the follow-up of cardiac implanted electronic devices (CIED), emphasised during the COVID pandemic, the workload for CIED follow-up clinics has grown exponentially. The demand on services is exceeding resource, with innovative solutions needed to maximise efficiency, safety and quality. One potential solution has been offered by […]

Background: Implantable loop recorders (ILRs) were traditionally inserted in the cardiac catheter lab on a consultant-led list. The most modern generation of devices (e.g. Medtronic LINQ II) are designed to be injected subcutaneously. The relative simplicity of the procedure brings it within the skillset of Allied Health Professionals (AHPs), freeing up medical staff, available cath lab […]

Background: Several  (ICMs) are available to enable the diagnosis and monitoring of arrhythmias. Clinicians are faced with different ICM options and must balance the workload associated with episode review alongside device performance and ensuring receipt of clinically actionable data. Objective: To compare in-time physician-adjudicated performance and clinical actionability of ICMs from different manufacturers that are currently in […]

Introduction: Right ventricular (RV) pacing, which is the standard treatment for patients with bradycardia, results in a broad QRS complex with dyssynchronous left ventricular contraction. Long-term RV pacing is associated with adverse remodelling of the left ventricular, which can contribute to, or cause, left ventricular (LV) systolic dysfunction, and heart failure (HF). A specialist clinic for […]

Objectives: Paroxysmal supraventricular tachycardia (PSVT) causes economic burden due to a frequent need for medical interventions and emergency department (ED) visits with substantial costs. The NODE-301 study evaluated the efficacy and safety of the novel, fast-acting, investigational intranasal calcium channel blocker etripamil for conversion of PSVT in an at-home setting. This analysis assessed the impact of […]

Introduction: Contemporary imaging methods allow to assess structural alterations implicated in initiation and maintenance of AF. It is thought that left atrial wall thickness (LAWT) increases in the presence of AF and may further promote its perpetuation. Tissue thickness may also be important to the success and safety of AF ablation to create transmural lesions without […]

Background: Direct current electrical cardioversion (DCCV) is utilized for managing patients with symptomatic persistent atrial fibrillation (AF) as part of a rhythm-control strategy. Rates of acute conversion and maintenance of sinus rhythm (SR) following DCCV improve with concomitant use of anti-arrhythmic drugs (AAD) such as amiodarone, which has the greatest efficacy amongst various agents, albeit with […]

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and the prevalence is increasing every year, especially for persistent atrial fibrillation. The evidence base for rhythm control strategies in persistent atrial fibrillation remains contentious. Cryoballoon ablation is one of the conventional rhythm-control therapies in treatment-resistant AF, and has emerged as a successful therapeutic option as […]

Introduction: ECG changes diagnostic for Brugada syndrome may be precipitated by sodium channel blocker (SCB) challenge. The SCB ajmaline has been demonstrated to be an effective pharmacological agent of choice. Published studies recommend a dose of 1 mg/kg bodyweight (maximum 100 mg) given either as a continuous infusion or by repeated boluses at 10 mg/minute intervals. […]

Background: Atrial fibrillation (AF) is a prevalent cardiac arrhythmia linked with a five-fold increased risk of ischaemic stroke. Despite the need for pulse rhythm checks of reasonable duration in selectively identified high-risk patients, the NHS is under pressure to perform these tasks to prevent stroke during daily practice in primary care. Purpose: This program aimed to establish […]

Introduction: Atrial fibrillation (AF) increases the risk of stroke by up to five-fold and costs the UK economy £2 billion per year. Direct-acting oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) are offered to eligible individuals to reduce their thromboembolic risk, yet are not suitable for all patients, for instance due to significant drug–drug interactions. Off-label […]

Introduction: Cardiac resynchronization therapy (CRT) is widely used for the management of patients with heart failure (HF) and severe left ventricular (LV) systolic dysfunction with a wide QRS duration.1 However, there is currently limited evidence on its effectiveness in patients with atrial fibrillation (AF). The purpose of this study is to investigate response to CRT in […]

Introduction: Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia that can be caused by many factors, such as the patients’ underlying cardiac condition and importantly the cardiac scar. However, initiation of VT can be multi-factorial, and be associated with other factors, such as lifestyle, glycaemic control and respiratory disease. An implantable cardioverter defibrillator (ICD) is […]

Background: In patients presenting following a first implantable cardioverter defibrillator (ICD) therapy, the risk of a subsequent ICD therapy is elevated. The most effective way to treat these patients is unknown. We hypothesised that in patients presenting following their first ICD therapy, a multifaceted approach combining treatment strategies would lead to a reduction in the risk […]

Background: Obesity-related cardiac remodelling may be reflected through electrocardiogram (ECG) changes. Based on this premise, we hypothesised that an artificial intelligence (AI)-ECG model could be trained to predict body mass index (BMI), and that the difference between AI-ECG predicted BMI and measured BMI (delta BMI) would be a marker of cardiometabolic health. Additionally, we sought to […]

Introduction: The increasing use of remote monitoring (RM) for implantable cardiac devices presents challenges for device services in managing the volume and nature of information received. Detecting a patient’s death through RM transmissions is a significant but infrequent event. This study aims to describe the characteristics of alert transmissions indicating the possibility of death and propose […]

Background: Periodic breathing pattern is a poor prognostic factor of advanced systolic heart failure (HF). It can manifest as exercise-induced oscillatory ventilation (EOV) on cardio-pulmonary exercise testing (CPET); a result of impaired homeostasis. Atrial fibrillation (AF) is also associated with exertional dyspnoea and EOV has not been described in patients with AF and HF. Objective: To report […]

Background: Improving outcomes with ablation of non-paroxysmal AF has proved challenging because of large interindividual variability in the underlying electrical and anatomical substrate. Computational models personalized to patient electroanatomic mapping (EAM) data can provide an inexpensive technology to predict outcomes for non-PV ablation strategies in terms of success, failure or reduced AF complexity on a patient-specific […]

Background: The spatial resolution of a mapping catheter is determined by factors such as the quantity of electrodes, their inter-electrode spacing, and the various configurations in which they are utilized. These factors impact the interpretation of wavefront dynamics during cardiac arrhythmias. Virtual patient models incorporating simulated arrhythmias offer an ideal dataset for evaluating the spatial resolution […]

Introduction: Recent clinical and mechanistic modelling studies have identified the significance of the right atrium (RA) in understanding the mechanisms underlying atrial fibrillation (AF) recurrence, though its role for each individual patient remains unclear. Predicting patient-specific response to treatment to guide therapy requires a framework for integrating personalised anatomy, fibrosis, and electrophysiology data. The first aim […]

Introduction: Scar and autonomic remodelling are proposed pathophysiological mechanisms in atrial fibrillation (AF). Autonomic remodelling has been shown to trigger ectopy that initiates AF. In animal models, autonomic remodelling shortens the atrial effective refractory period and wavelength of the cardiac impulse, which in turns increases the probability of multiple re-entrant circuits existing simultaneously and thereby enhance […]

Background: The way that dual chamber pacemakers are programmed can affect the estimated battery longevity. This remaining battery life is calculated by the device itself; it is unknown how specific variables such as reduced ventricular pacing modes/algorithms and rate response effect the estimated battery longevity. This therefore forms the primary aim of this study. Whilst current […]

Background: Twiddler syndrome, and the variant Reel syndrome, are rare but important complications of pacemaker implantation. Case summary: We describe a rare complication of conventional permanent pacemaker implantation of rhythmic arm twitching secondary to brachial plexus stimulation from a displaced pacing lead caused by Reel syndrome. Discussion: Twiddler syndrome and its variants are rare but important complications of […]

Background and objectives: Cardiac resynchronization therapy (CRT) using bi-ventricular pacing is class I recommendation for symptomatic patients with heart failure (LVEF ≤35%), QRS duration ≥150 msec and LBBB QRS morphology. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. The aim of this study was to assess the feasibility and […]

Introduction: Transcatheter leadless pacemakers are increasingly being used for the treatment of bradyarrhythmia. Data following conventional transvenous pacemaker implantation suggests same-day discharges are safe and have become the standard of care in many institutions around the world. There is limited data regarding same-day discharges in patients undergoing leadless pacemaker implantation. Purpose: To assess the feasibility and safety […]

Introduction: With advances in cardiac resynchronisation therapy (CRT) equipment and operator experience, implant success is increasing. However, the commonest cause for procedural failure remains a lack of suitable pacing site due to an absent or insufficiently sized target vein. The role of computed tomography (CT) prior to CRT remains investigational, but improved imaging techniques allow […]

Introduction: The use of remote monitoring (RM) to undertake cardiac implantable electronic device (CIED) follow-up is becoming increasingly common, particularly following the COVID-19 pandemic. This method of CIED assessment has been shown to be non-inferior to face-to-face only assessments. Purpose: We sought to assess the safety of adopting a strategy of alert based follow up in selected […]

Introduction: Understanding post-infarct VT substrate relies on a combination of voltage and activation mapping. These maps are often analysed separately. Omnipolar electrograms (Omni-EGMs) offer a novel approach to mapping, with local activation displayed as a vector. We describe an approach to characterize the post-infarct ventricular arrhythmic substrate using omni-vectors superimposed onto omni-voltage maps for review ‘in […]

Introduction: Identifying ablation targets for persistent atrial fibrillation (PersAF) remains challenging. Dominant frequency (DF) and organization index (OI) of atrial electrograms (AEGs) are proposed to identify driver sites that contribute to AF perpetuation. This work aims to use DF and OI together to identify atrial regions with organised, fast activation rates based on electrophysiologic responses following […]

Introduction: Very high power, short duration ablation (Vhpsd) involves using radiofrequency (RF) ablation powers of 90 W for just 4 seconds per lesion, delivered using the Q-DOT ablation catheter (Biosense Webster). We have shown how shorter ablation lesions improve patient comfort during pulmonary vein isolation (PVI) and may obviate the need for general anaesthesia. It is […]

Aims: Compare catheter ablation (CA) using second-generation pulmonary vein ablation catheter (PVAC) gold technique with clinical treatment in elderly patients with symptomatic paroxysmal AF (PAF), without structural heart diseases. Methods: Prospective randomized study selected consecutive patients with paroxysmal AF ≥65 years in 2 groups: (1) the PVAC CA group and (2) the antiarrhythmic drug (AAD) therapy group. […]

Introduction: The restriction of activation mapping to the ventricular surface of contemporary mapping systems often leads to failure to correctly identify the true site of origin (SOO) of intramural and/or sub-epicardial Vas and lower procedural success. Electromechanical wave imaging (EWI) is a non-invasive echocardiography-based high frame rate technology that offers direct transmural activation mapping and may […]

Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice. Previous studies have demonstrated that AF may result in high symptom burden and reduced quality of life (QoL). Rhythm control in the form of catheter ablation has become an established treatment option for AF. Certain risk factors are associated with the development and […]

Introduction: The relationship between ABO blood group and Rhesus status with survival outcomes in patients with heart failure (HF) managed with CRT-P/D remains unclear. Understanding this association could provide valuable insights for developing innovative therapeutic approaches, guiding risk-stratification methods, and predicting clinical response to treatment. This retrospective single-centre observational study aimed to evaluate the role […]

Introduction: Over the past 10 years, the indications for implantable loop recorder (ILR) have broadened and the device size has reduced substantially. The implant procedure has moved from the physician-led catheter-lab environment to non-physician-led outpatient procedures. ILR explant procedures have not transitioned in parallel. We implemented a non-physician, outpatient ILR explant service in 2021 and […]

Background: Conduction system pacing is a novel pacing technique that aims to maintain physiological activation of the ventricles. It can be achieved by pacing the His-bundle or the left bundle branch area. Left bundle branch area pacing (LBBAP) has many advantages over His-bundle pacing including being technically easier and having more stable and lower thresholds. […]

Background: Conduction system pacing has the potential to offer improved outcomes compared with other forms of pacing. His bundle pacing (HBP) can be technically more difficult to achieve and pacing thresholds can be unreliable compared with left bundle branch area pacing (LBBAP). There are no reports describing the feasibility of performing both procedures in the […]

Background: Patients with adult congenital heart disease (ACHD) are more prone to atrial arrhythmia, which increases their morbidity and mortality and risk of hospital admissions when compared with the same population where atrial arrhythmias are absent. Objective: Compare the use of OCTARAY™ to PENTARAY™ for atrial tachycardia mapping in a patient with ACHD to understand […]

Introduction: Cryptogenic stroke (CS) accounts for 30–40% of all ischaemic strokes and there is substantial evidence to suggest arrhythmogenic cardioembolic involvement following the development of atrial fibrillation (AF). CS related to AF are often devastating, with around 70% mortality or significant disability. CS recurrence in the context of AF can be reduced with initiation of […]

Introduction: Crucial for future healthcare delivery is supporting people in self-management. Postural tachycardia syndrome (PoTS) is considered to be underdiagnosed and under-treated, yet has a high impact on disability and quality of life comparable to other long-term conditions. This study addresses the gap for a PoTS-specific supportive self-management programme. The aim was to co-design and […]

Background: The National Institute for Health and Care Excellence (NICE) guidelines for atrial fibrillation (AF) diagnosis and management 2021 recommends offering patients with AF and a CHA2DS2VASc >2 anticoagulation with a direct-acting oral anticoagulant (DOAC) first line where appropriate for stroke prevention. For patients on vitamin-K antagonists, their anticoagulation control is assessed according to time […]

Background: Catheter ablation is an effective therapy for ventricular tachycardia (VT) secondary to ischaemic heart disease (IHD), but its wider adoption is limited by procedure complexity and safety. Pre-procedural planning with cardiac computer tomography (CT) or magnetic resonance (MR) and their integration into electro-anatomical mapping (EAM) during ablation have sought to address some of the […]

Background: Radiation therapy (RT) is a standard modality for cancer treatment for patients with cardiac implantable electronic devices (CIEDs). The increased ageing population has influenced the number of patients receiving radiation therapy, and concurrently the number of patients undergoing implantation of CIEDs. Identification of risk factors and safety concerns for RT to CIEDs must therefore […]

Introduction: Cardiac implantable electronic device (CIED) diagnostics are of significant clinical utility when managing the heart failure (HF) population. This report highlights a novel service in which cardiac physiologists act autonomously upon CIED diagnostics to identify and manage patients at risk of decompensated HF. Patient presentation: A 71-year-old female with ischaemic heart disease and paroxysmal atrial […]

Introduction: The rate of cardiac implantable electronic device (CIED) placement is increasing. CIED placement comes with complications. CIED infection is a major complication increasing both morbidity and mortality. International guidelines do not recommend the local use of specific antimicrobial agents during implantation because adequate scientific studies supporting their use are not available or not supportive. In […]

Aim: This scoping review examined the key characteristics of empirical research and their clinical implications pertaining to diagnosis, symptomology and treatment across the postural tachycardia syndrome (PoTS) literature field. Methods: An a priori protocol, article eligibility criteria and peer-reviewed systematic search strategy were first made available on Open Science Framework.1 The developed search strategy was deployed (initial = […]

Introduction: Continuous cardiac monitoring (CCM) is vital for observing patients at risk of arrhythmia. It can, however, restrict mobility and increase the risk of falls and delirium in susceptible patients. Its use should therefore be rationalised and regularly reviewed to ensure ongoing monitoring remains indicated. In our centre, there are currently no guidelines for the […]

Introduction: Implantable cardioverter defibrillators (ICDs) reduce mortality in people at risk of sudden cardiac death. During ventricular tachycardias (VT), cardiac output is reduced due to fast heart rates reducing diastolic filling time, loss of atrio-ventricular synchrony and loss of bi-ventricular synchrony. Improving haemodynamic status during VT may allow more time for VT to self-terminate and […]

Introduction: Implantable loop recorder (ILR) implantation has become a mainstay for management of infrequent symptoms suspected to be of arrhythmic origin. Since their first documented use in 1990, these devices have seen multiple iterations and are now self-contained injectable systems that can be implanted by non-medical staff with additional training. Cardiac physiologist (CP)-led implant services […]

A 76-year-old male attended clinic for routine annual follow up of a dual chamber pacemaker which was implanted just over 2 years prior for bifascicular block and multiple episodes of syncope. Presenting rhythm over the device lifetime had typically been sinus rhythm with <5% VP. The following lead parameters were measured: RV lead impedance – […]

Case background: An 82-year-old male was referred for outpatient device implantation for symptomatic junctional bradycardia. A dual chamber Boston Scientific generator was implanted with active fixation leads secured in the right atrial appendage and right ventricular septum. The procedure was without complication and the device was programmed DDD 50–130 bpm. Implant parameters: R wave 9.8 Mv and […]

Introduction: Technological innovations, catalyzed by the COVID-19 pandemic, have opened new avenues for remote monitoring, screening and diagnostics in cardiovascular care. Atrial fibrillation (AF) has a huge healthcare burden within our health service and is a major contributor to presentations to health services, hospitalizations, morbidity and mortality. We identified an opportunity to digitize and enhance our […]

Introduction: Cardiac arrest in relatively young patients is a difficult presentation to manage, with multiple potential causes. Establishing an accurate diagnosis is crucial and has implications on first-degree relatives. Here we present the case of a 56-year-old female with a first presentation of cardiac arrest, highlighting some of the diagnostic and treatment challenges encountered. Case […]

Introduction: Atrial fibrillation (AF) is the most common arrhythmia globally in adults and its prevalence increases with age. The incidence of mild cognitive impairment (MIC) also increases with age. Both MCI and AF share important risk factors. Aims: This study aimed to examine the relationship between MCI and AF through a phased approach. Phase one […]

Introduction: The NHS Long Term Plan identifies CVD as the single biggest area where lives can be saved. Primary care provides a crucial role in the management of patients at risk of CVD. Offering a programme can help empower and improve confidence and management of high-risk conditions among clinicians. Methods: We held series of monthly […]

Background: TriageHF (Medtronic) is a remote monitoring algorithm that stratifies a patient’s risk of a heart failure (HF) event within the next 30 days as high, medium or low, based on integrated cardiac resynchronization therapy (CRT) device diagnostic data. TriageHF remote monitoring became part of standard care at King’s College Hospital in 2021. Physiologists are […]

Background: DC-cardioversion of atrial fibrillation may be immediate or delayed after shock delivery. Objective: To characterize each phenomenon, the immediate or delayed reversion of atrial fibrillation. Patients and methods: Patients with persistent atrial fibrillation who reverted to sinus rhythm with DC-cardioversion were included in this case series study. One group showed immediate reversion and the […]

Background: Post-atrial fibrillation (AF) ablation clinics are typically in person, whereby 12-lead electrograms (ECG) and/or Holter monitors can detect recurrence. During the COVID-19 pandemic, at our site, nurse-led clinics were telephonic, and timely access to these investigations became difficult. Objective: To determine if the validated smartphone application FibriCheck, which uses photoplethysmography to detect AF, can […]

Introduction: Medical therapy for heart failure with reduced ejection fraction (HfrEF) improves quality of life, reduces heart failure hospitalization and mortality, and reduces the risk of ventricular arrhythmias. International guidelines recommend four key drug classes for all patients with HfrEF. However, many patients do not receive them. Implementing clinical pathways to increase access to HfrEF […]

Introduction: Advanced clinical practice (ACP) is an established structured university programme available to registered non-medical clinicians. ACP training prepares those healthcare professionals to safely manage clinical care within both in- and outpatient setting, and incorporates complex clinical decisions and a high degree of autonomy. Aim: To assess the service impact, safety and efficiency of a […]

Atrial fibrillation and COVID 19 are two different diseases, but both are upper body issues. Atrial fibrillation is an upper chamber heart issue, while COVID 19 is an upper respiratory issue. Linked together by their disease factors. Knowing your hearts rhythm and rate is of importance in early detection of atrial fibrillation; just a simple […]

Background: Atrial fibrillation (AF) is a prevalent arrhythmic condition that affects millions of individuals across the globe. Direct current cardioversion (DCCV) is frequently utilized to restore sinus rhythm, but its long-term success rates are not optimal. Recent meta-analysis has concluded pre-treatment with anti-arrhythmic drugs improves acute restoration and maintenance of sinus rhythm after electrical cardioversion. […]

Introduction: Atrial fibrillation and heart failure often coexist, and are associated with increased morbidity and mortality. Their temporal association may not always be clear, with clinicians often facing a ‘chicken-or-egg dilemma’. In this cohort of patients with persistent AF and LV dysfunction, electrical cardioversion is often undertaken to elucidate the aetiology of the LV dysfunction […]

Background: Atrial fibrillation (A-Fib) effects over 33.5 million people globally, being one of the most popular causes for hospitalization. Maintaining sinus rhythm and symptom-free patients is the goal post electrophysiology ablation (EP-Ab). Ideally, a preprocedural computed tomography (CT) should be used to assess left atrial (LA) anatomy, pulmonary vein (PV) sizes and to exclude intracardiac […]

Background: Recent trial evidence suggests an early rhythm control strategy in managing atrial fibrillation (AF) reduces adverse cardiovascular outcomes. ESC guidelines recommend an integrated approach to AF management, including arrhythmia nurse specialist involvement in follow-up. Published data is limited for initiation and long-term monitoring of patients with AF on rhythm control drugs through an independent […]

Introduction: The phospholamban (PLN) cardiomyopathy is a highly prevalent cause of inherited cardiomyopathies in Dutch populations, caused by a single arginine deletion in the phospholamban gene (PLNR14del), which presents with an early-onset of heart failure and spontaneous lethal ventricular arrhythmias leading to sudden cardiac death. Currently, there is still no effective treatment to prevent or […]

Introduction: Sudden cardiac arrest (SCA) in sport is a tragic event. Elite footballers are at increased risk compared with the general population. The risk in non-elite but competitive individuals is unknown. Rapid response to SCA events is critical to ensure a good clinical outcome. At non-elite, competitive levels of football in the United Kingdom (UK), […]

Introduction: Optimization of heart failure medications has a vital role in improving the prognosis of patients with heart failure with reduced ejection fraction even after intervention with cardiac resynchronization therapy (CRT). We sought to determine the extent and impact of drug optimization in patients following CRT at our centre. Methods: We conducted a retrospective, observational, […]

Introduction: Leadless left ventricular (LV) endocardial pacing with the WiSE-CRT System (EBR Systems Inc) is a novel treatment in the field of cardiac resynchronization therapy (CRT). The system was designed to provide lateral wall LV pacing (LVP) in response to detection of a right ventricular pacing (RVP) stimulus from a co-implanted device. The result is […]

Introduction: Conventional right ventricular pacing can cause left ventricular systolic dysfunction, heart failure symptoms and atrial fibrillation in the long run. Early upgrade to biventricular stimulation or physiological stimulation may be able to prevent these adverse outcomes. His bundle pacing (HBP) has several pitfalls which include lack of capture at acceptable thresholds, incremental threshold values […]

Case: A 58-year-old male with dual chamber pacemaker implanted 14 years previously for sinus node disease presented with red papular rash and burning pain over pacemaker site. He was initially treated with antibiotics for presumed device relate infection. Normal white cell count (WCC) and C-reactive protein (CRP), with negative blood cultures. Rash resolved during admission. […]

Inappropriate implantable cardioverter-defibrillator (ICD) therapies are associated with adverse outcomes. The aim of this study is to determine the frequency and cause of inappropriate therapies in patients under the care of Royal Papworth Hospital NHS Foundation Trust, UK. All patients with ICDs on remote follow-up between January and December 2021 who experienced therapy were included […]

Introduction: In patients eligible for cardiac implantable electronic device (CIED) placement with the need of a high percentage of ventricular pacing, early indication for CIED placement able to deliver cardiac resynchronization therapy (CRT) is advantageous, because it may prevent a pacemaker syndrome (left ventricular ejection fraction deterioration in patients with apicoseptal right ventricular lead placement […]

Background: Structural remodelling is a proposed pathophysiological mechanism in AF, but its impact on electrophysiological parameters remains limited. Personalized computational models include the effects of personalised anatomy and AF remodelling in a framework that can be used to investigate patient-specific AF mechanisms and test treatment response. These models require calibration to electrophysiology data. However, it is […]

Background: Trials to detect a mortality benefit in heart failure require long follow up periods and large numbers of participants, which is costly and time-consuming. It is quicker and more feasible to assess quality of life. The Minnesota Living With Heart Failure (MLWHF) Questionnaire is one of the most commonly used outcome measures in heart failure […]

Introduction: We introduced RETRO-mapping as a software for mapping activation during atrial fibrillation (AF). We subsequently suggested features, such as cycle length (CL) and conduction velocity, to detect plane activity. In this work, we suggest an algorithm for automatic classification of wavefronts. We also explore the relationship between CL and degree of organization of activity. […]

Introduction: The unpredictable and sporadic nature of arrhythmias can cause a challenging diagnosis during a single ECG test. Often a more comprehensive method to detect an arrhythmia is necessary. Wearable cardiac devices, such as the CardiacSense watch, have the ability to continuously monitor heart rate. CardiacSense also enables patients to record an on-the-spot ECG when […]

Background: Conduction system pacing (CSP) can be achieved with His bundle pacing (HBP) or left bundle branch area pacing (LBBAP). Both result in physiological activation of the ventricles, but LBBAP is perceived to be technically easier and result in more reliable sensing, with lower thresholds. Acute and medium-term experience of CSP in district general hospitals […]

Introduction: Implantable cardiac defibrillators (ICDs) are a lifesaving therapy for children at risk of life-threatening arrhythmias. Often, such children will present with sudden cardiac arrest, and ICDs are vital for secondary prevention of further life-threatening events. If high-risk young patients are identified early, ICDs can ideally be implanted for primary prevention. Method: We performed a […]

Background: Adoption of electronic health records (EHR) improved the availability of medical documentation for research purposes. However, significant proportion of data is in textual information that cannot be utilized for scientific purposes until it is analyzed through manual chart review. Utilization of only structured data from EHR is insufficient for comprehensive cohort characterization and of […]

Introduction: There are currently no FDA-approved drug therapies for use in the at-home setting for an acute treatment of sustained supraventricular tachycardia (SVT); therefore, vagal manoeuvres (VM) are recommended in some patients with SVT to increase parasympathetic tone to terminate the arrhythmia. However, the efficacy of VM has not been previously well-reported. Objective/purpose: To determine […]