EUROPEAN JOURNAL OF ARRHYTHMIA & ELECTROPHYSIOLOGY – VOLUME 5 SUPPLEMENT 1 – 2019

Background: Mechanisms that maintain ventricular fibrillation (VF) remain debated. There are both clinical and experimental data to support the existence of rotational drivers (RDs), though other conflicting studies have not demonstrated such drivers and suggested that VF is the result of disorganised myocardial activation. Abnormal electrical coupling between cardiomyocytes through gap junctions (GJ) has been considered […]

Introduction: Numerous imaging studies have firmly established epicardial adipose tissue (EAT) as an independent risk factor for all forms of AF. EAT hosts an array of immune cells and inflammatory mediators that can infiltrate the myocardium given the lack of fascial boundaries between them. However, the immune structure and cellular characterisation of EAT remains incompletely defined. […]

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrythmia characterised by abnormal electrical impulse conduction throughout the atria. Although many patients with AF respond well to rhythm control therapy (medication to restore sinus rhythm), others experience early AF recurrences. Our understanding of which patients will experience an AF recurrent event whilst on rhythm control […]

Aims: Atrial fibrillation (AF) is an independent risk factor for stroke recurrence in patients with prior stroke. However, there is conflicting evidence on the impact of AF type, either non-paroxysmal (NPAF) or paroxysmal (PAF), on thromboembolic recurrence. We conducted a systematic review and meta-analysis to describe the impact of AF type on the incidence and risk […]

Background: Mechanisms for persistent AF are unclear. On the basis that sites where ablation terminates persistent AF may have mechanistic relevance, we systematically compared maps created by three different techniques for analysing the same raw electrographic data in cases of clear termination of persistent AF by ablation in an international five-centre registry with data/code made available […]

Background: Recent studies have suggested pulmonary vein isolation (PVI) alone is as effective as strategies incorporating additional substrate modification in patients with persistent atrial fibrillation (AF). It remains unclear if PVI impacts upon the mechanisms that sustain or remove triggers initiating AF. Non-invasive mapping (ECGI) is able to panoramically map both atria simultaneously and identifies rotational […]

Introduction: Barts Heart Centre (BHC) has a population of approximately 4,000 implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT-D/CRT-P) patients. With this large cohort of high-risk patients, a specialised clinic was created in December 2018 to expedite the treatment of device patients with ventricular tachycardia (VT). Criteria for referral are treated ventricular tachycardia (with anti-tachycardia […]

Background: His bundle pacing (HBP) is rapidly growing in popularity as an alternative to right ventricular (RV) pacing. One major disadvantage of HBP is the high capture threshold. Achieving optimal His-bundle (HB) pacing location is technically challenging. Suboptimal location often requires a higher pacing stimulus voltage and pulse-widths are also frequently extended to 1.0 ms. Both […]

Purpose: In April 2017, the British Heart Rhythm Society (BHRS) published standards for implantation and follow up (FU) of cardiac rhythm devices. This document highlights that permanent pacemakers should be implanted within 24 hours of bradycardic emergencies. In 2014 the London Clinical Senate endorsed the arrhythmia triage pathway. This pathway allows London ambulance service (LAS) to […]

Background: Temporary cardiac pacing is an established method of pacing support in unstable bradyarrhythmias. Conventional temporary pacing is fraught with risks if used beyond few days. Extended period of pacing may be required where permanent system implant indication might either be unclear or not feasible due to an intercurrent illness. An alternative approach is using active […]

Background: The complex CIED implant and follow-up service was started at Croydon University Hospital (CUH) in November 2012. The service is currently supported by 3 consultants, 2 arrhythmia nurse specialists and 4 specialised cardiac physiologists and received a favourable report following an accreditation visit by NHS England in 2015. We reviewed the complex CIED implantation service […]

Background and introduction: The prevalence of atrial fibrillation (AF) in the UK is around 2%, affecting more than 10% of people aged over 80 years. AF is associated with a high risk of stroke. Early identification and treatment reduces this risk.1 The Capture AF service is an innovative service allowing seamless identification, treatment and management of patients […]

Background and introduction: Atrial fibrillation (AF) can be challenging to diagnose due to asymptomatic and paroxysmal presentation. Identifying predictors associated with prevalent AF would elucidate different underlying mechanisms causing AF and potentially refine screening procedures of at-risk patients. We developed a prognostic model for prevalent AF by repurposing deeply phenotyped individual patient data from four independent […]

Background: Mapping technologies are powerful techniques for spatially recording electrophysiological behaviour of cardiac tissue, exploited by both clinicians and basic researchers. Processing and analysis of mapping data is difficult to implement, preventing uptake of these technologies and reliance on proprietary, ‘black-box’ software. Hence, we have developed open-source software for high-throughput analysis from mapping datasets, ElectroMap (available […]

Background: QT-RR hysteresis describes the lag of the QT interval adaptation to heart rate changes. This phenomenon is typically observed during exercise when, for the same RR interval, the QT interval is longer while heart rate increases during exercise and shorter when heart rate decreases during recovery. Experimental studies have shown that parasympathetic blockade reverses this […]

Introduction: Irrigated catheters are the standard tool for radiofrequency (RF) ablation in the left atrium and ventricles. However, pathological studies of irrigated RF lesions show a “tear-drop” shape, with the widest diameter some depth below the endocardial surface and relative endocardial sparing. This results in the need for overlap of lesions to achieve contiguity at the […]

Introduction: Efforts to maintain sinus rhythm in patients with persistent atrial fibrillation (PsAF) remain challenging with sub-optimal long term outcomes seen with anti-arrhythmic medication, catheter ablation and stand-alone surgical approaches. For patients with a significant symptomatic burden this remains an unmet need. The convergent approach entails thoracoscopic epicardial left atrial (LA) posterior wall radiofrequency ablation followed […]

Background: Catheter ablation for atrial fibrillation (AF) often requires extensive creation of transmural thermal lesions in close proximity to the oesophagus. The resultant oesophageal injury accounts for the majority of ablation-related mortality. The purpose of this study is to compare an oesophageal temperature control device versus a standard temperature monitoring probe in its ability to protect […]

Introduction: The intrinsic cardiac autonomic nervous system comprises interconnected epicardial ganglionated plexuses (GP) that are implicated in the initiation of atrial fibrillation (AF). GPs can be stimulated and functionally identified by delivering high frequency stimulation (HFS) within the local atrial refractory period, which can cause atrial ectopy and AF. These GPs are called ’ectopy-triggering GP‘ (ET-GP). […]

Background: Some studies have shown that pre-implantation QRS area (QRSarea) predicts clinical outcomes after cardiac resynchronisation therapy (CRT). Objective: To determine whether post-implantation changes in QRSarea predicts clinical outcomes after CRT. Methods: In this retrospective study, QRSarea, derived from pre- and post-implantation vectorcardiography (VCG), were assessed in relation to the primary endpoint of cardiac mortality after CRT. Other endpoints […]

Introduction: The cardiac voltage-gated sodium current (INa) is a target of several anti-arrhythmic drugs for treatment of atrial fibrillation (AF). As current drugs do not specifically target atrial INa, there is increasing interest in development of atrial-specific ion channel blockers. Characterisation of INa biophysical properties in atria and ventricles is, therefore, crucial for development of selective antiarrhythmic […]

Background: Evidence supporting methodologies to measure local repolarisation time (RT) in the intact human heart using intracardiac electrograms is based on a limited number of studies reporting conflicting results. The Wyatt method (RTWyatt = dV/dtmax for both positive and negative T-waves, see Figures A–B) has a solid theoretical background, has been proven to correlate with ERP in patients […]

Background: Myocardial fibrosis is known to play a critical role in genesis and maintenance of ventricular fibrillation (VF). The quantity of fibrosis post myocardial infarction negatively correlates with survival. There is paucity of data on how the quantity and degree of fibrosis influences the mechanisms of VF. VF mechanisms remain debated, there are data supporting critical […]

Background: Adenosine is known to shorten atrial action potential duration and refractoriness, promoting atrial fibrillation (AF). It may also be used during non-contact mapping of atrial propagation to reduce the impact of far-field ventricular signals. However, the functional effect of adenosine on atrial propagation is poorly understood and may reveal mechanisms important in maintenance of persistent […]

Background: Heterogeneous phenotypic expression in hypertrophic cardiomyopathy (HCM) results in challenging risk stratification. Risk stratification is limited due to lack of hypertrophy visualized by transthoracic echocardiography (TTE) particularly of the lateral wall and apical hypertrophy. Cardiac magnetic resonance (CMR) provides better visualization and more accurate assessment of LV wall thickness and mass. In addition, the role […]

Background: This first-in-man study evaluated the long-term safety and efficacy of a new multi-electrode radiofrequency (RF) balloon catheter (HELIOSTAR, Biosense Webster, Irvine, CA, USA) to achieve pulmonary vein isolation (PVI). Methods: Patients with drug refractory paroxysmal atrial fibrillation were enrolled. Neurological assessment, cardiac and cerebral MRIs were performed pre and post procedure. Oesophageal endoscopy (OGD) was performed […]

Background: ECG Imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localising the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. Methods: During catheter ablation of VT simultaneous mapping was performed using electro-anatomical mapping (EAM) […]

Background: Uncorrected atrial septal defects (ASD) are associated with atrial arrhythmias however little is known about the bi-atrial arrhythmia substrate in ASD patients and optimal rhythm management strategies remain unclear. We hypothesised that the right atrium is important to atrial arrhythmogenesis in ASD patients and that 1) electrical and structural remodelling and 2) arrhythmia triggers/ectopic foci […]

Background: There are over 740 bradycardia pacemaker patients per million in Western Europe. Pacemakers are a safe and effective treatment to bradycardia to increase longevity and improve quality of life. Cross-sectional and retrospective studies have suggested left ventricular systolic dysfunction (LVSD) and heart failure (HF) are common in the pacemaker population. Personalised pacemaker programming in an […]

Introduction: Temporary cardiac pacing is commonly required following cardiac surgery. Suboptimal programming of temporary pacemakers is associated with an increased risk of atrial and ventricular arrhythmia, reduced cardiac output and prolonged Critical Care Unit stay. Our centre has not hitherto had a standard operating policy (SOP) for temporary pacing post-cardiac surgery. This audit was undertaken to […]

Background: Cardiac resynchronisation therapy (CRT) is an effective treatment for heart failure however, 30%–50% of patients fail to respond. Ischaemic cardiomyopathy (ICM) has been identified as a negative predictor of response to CRT, in part due the presence of scar within the left ventricle (LV). However, around 30% of patients with dilated cardiomyopathy (DCM) also possess […]

Introduction: Biventricular pacing (BVP) improves morbidity and mortality in patients with heart failure and Left Bundle Branch Block (LBBB), but there is considerable scope for improved outcomes if more effective resynchronisation could be achieved. His bundle pacing (HBP) appears to be able to overcome LBBB and is a new method for Cardiac Resynchronisation Therapy (CRT). We […]

Background: QRS area (QRSarea), derived from vectorcardiography (VCG) is a marker of delayed left ventricular (LV) activation. Objective: To determine whether changes in QRS area (ΔQRSarea) in LV lead vectors of a quadripolar lead (QUAD) relates to the acute haemodynamic response (AHR) to CRT. Methods: In this acute study, we performed 12-lead ECGs and measured LV pressure (LV dP/dtmax) […]

Introduction: Cardiac resynchronisation is an effective therapy in patients with heart failure with reduced ejection fraction (EF). A novel active fixation coronary sinus (CS) lead, Attain Stability, has been released in a bipolar and quadripolar configuration, with the hypothesis it will improve targeted lead positioning and stability independent of vessel anatomy. We sought to compare implant […]

Introduction: Palpitations are a common symptom that lead patients to consultation with healthcare providers and cardiology services. Achieving the diagnostic and therapeutic management of palpitations is challenging as palpitations are caused by wide range of different conditions and there are broad differential diagnoses. Electrocardiography (ECG) is a crucial investigation to get the definitive diagnosis, including symptom-rhythm […]

Background: The WiSE-CRT system delivers wireless endocardial pacing to achieve cardiac resynchronisation therapy. It consists of a subcutaneous transmitter, battery and endocardial electrode. The transmitter detects right ventricular pacing from the co-implant and delivers ultrasound energy to the electrode causing left ventricular (LV) pacing and cardiac resynchronisation. Ideally, the electrode should be placed in an area […]

Background: Activation mapping of atrial fibrillation (AF) wavefronts is labour intensive and often restricted to short time segments. RETRO-Mapping identifies uniform wavefronts, summates their vectors onto an orbital plot, and projects this onto the 3D geometry. Sequential mapping of different areas of atria enables a 5D choropleth map to be created, displaying every wavefront over the […]

Background: The optimal way to map localised drivers in persistent atrial fibrillation (AF) remains unclear. The study aim was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF and evaluate its ability to identify localised drivers using global and sequential mapping. In this study, global STAR maps created […]

Background: The presence of dynamic conduction and repolarisation changes facilitate functional block and re-entry in ventricular tachycardia (VT). Objectives: We aimed to study the dynamic delay in late potentials and late repolarisation in creating functional substrate changes that facilitate re-entry. Methods: Thirty patients (age 61 ± 5 yrs, 26 Male) underwent ablation. High-density multipolar mapping was performed […]

Background: The cardiac isochrone positioning system (CIPS) is a novel electrocardiographic imaging (ECGi) modality that integrates 12-lead ECG, body surface imaging and cardiac magnetic resonance (CMR). Objective: To validate CIPS against non-contact electroanatomical mapping (EAM) with respect to left ventricular (LV) activation patterns in patients undergoing cardiac resynchronisation therapy (CRT). Methods: CRT recipients (n=16; LBBB in 12, nonspecific […]

Introduction: Cardiac resynchronisation therapy (CRT) is a routine treatment for heart failure with reduced ejection fraction with conduction delay to improve symptoms and prognosis in patients. Technological advancements both in imaging cardiovascular magnetic resonance (CMR) and devices (sophisticated MRI-conditional modes) enable investigation of the haemodynamic response to CRT over a range of heart rates. Methods: Patients […]

Background and aims: Syncope guidelines 2018 recommend further research to estimate the effect of syncope clinics, and establish benefits of the nurse’s role. Data was collected from the nurse-led syncope clinic on the nurse’s effectiveness at risk stratifying for Implantable loop recorders (ILR) to aid symptom-rhythm correlation. Data was also collected on re-admission rates for syncope […]

The rare monogenic arrhythmogenic disorder catecholaminergic polymorphic ventricular tachycardia (CPVT) is characterised by episodic ventricular dysrhythmia triggered by exercise or emotion in individuals without structural cardiac defects. Next generation sequencing has now become more widely accessible and RYR2 in its entirety can be screened relatively easily. This has led to an increase in the number of RYR2 variants being […]

Background: In patients with heart failure (HF) and poor left ventricular function, atrial fibrillation (AF) is common, with approximately 2/3 of patients with HF over the age of 65 having AF. One form of treatment for patients with HF is cardiac resynchronisation therapy (CRT). With an ageing population, the prevalence of HF is only going to […]

Background: Catheter ablation of atrial arrhythmias in patients with congenital heart disease present significant challenges. Advances in electroanatomical mapping advocate an anatomical approach for ablation with linear lesions to connect low-voltage areas or annuli. However, long linear lesions with prolonged energy applications might be unnecessary or even proarrhythmic. We report our experience of the Rhythmia mapping […]

Background: Propafenone proarrhythmia (PPA) is a rare but potentially life-threatening complication of propafenone therapy (PT). PPA is defined as significant QRS widening on resting ECG during PT or wide QRS tachycardia during follow up. Limited data exist assessing the potential predictors for PPA in structurally normal heart patients and the benefit of exercise ECG (EECG) is […]

Background/Introduction: Atrial fibrillation (AF) is a common condition in patients presenting acutely to hospital. A simple model which could be applied as a point-of-care test could screen for patients needing referral for diagnostic testing or identify patients with asymptomatic AF. A model incorporating simple clinical characteristics and blood biomarkers has previously been developed using robust data-driven […]

Background: Atrial fibrillation (AFib), the most common arrhythmia affects an estimated six million people in the United States and affects approximately 2% of people younger than 65.3 AFib increases the risk of having an AF-related stroke by five times and attributes to 130,000 deaths annually.3 Arrhythmia Alliance1 (A-A) works to improve the diagnosis, treatment and quality of life for […]

Introduction: Ambulatory ECG Holter monitoring has historically been the conventional method through which symptom and arrhythmia are correlated for diagnostic purposes. Holter recorders (e.g. SpaceLabs) have traditionally comprised a three-lead ECG with attached wires to a wearable console. The innovation of device components has enabled smaller, wearable technology to be a reality and this has been […]

Background: Electrophysiology studies with radiofrequency cardiac ablation have heralded a new way to diagnose and treat cardiac dysrhythmias since their introduction in the late 1980s. Right-sided catheter ablation can be used to treat re-entrant supraventricular arrythmias, with ablation of certain pathways over 90% curative. Due to this success, the frequency of these procedures has been increasing […]

Introduction: Multiple independent investigations have demonstrated heterogeneity in radiofrequency (RF) effects during pulmonary vein isolation (PVI) in humans, with all data indicating significantly greater RF effects at the left side of the left atrial posterior wall (LAPW). Mechanisms underlying these findings have yet to be determined, however investigations of immediate pre-ablation impedance as an indication of […]

Introduction: Maintenance of sinus rhythm is challenging in patients with longstanding persistent atrial fibrillation (PeAF); outcomes from catheter ablation are suboptimal. We investigated whether combining minimally invasive surgical ablation with catheter ablation (‘Hybrid ablation’) improved outcomes versus catheter ablation alone. Methods: Forty-three consecutive patients (mean age 68.6 ± 7.7 years, median LVEF 50%, mean left atrial diameter […]

Background: Incidental LBBB (iLBBB) is a frequent cause for cardiology referrals. In such instances, there may be uncertainty as to its prognosis and need for clinical follow-up. Cardiovascular magnetic resonance (CMR) is the gold-standard for myocardial phenotyping. Objectives: To determine the utility of CMR in the risk stratification of patients with iLBBB. Methods: CMR was used to identify […]

Introduction: Severe left ventricular systolic dysfunction (LVSD) is associated with wors e outcomes in heart failure (HF) patients. Persistent atrial fibrillation (AF) is common in this patient group. As part of a nurse-led cardioversion service at a district general hospital we assessed the impact of elective cardioversion (DCCV) for AF in patients with LVSD on their […]

Introduction: Endocardial left ventricular (LV) ablation is associated with an increased risk of thromboembolic events. While many operators prescribe a course of post-operative antiplatelet or oral anticoagulant (OAC) medication to prevent thromboembolism, the benefit of this approach is unknown. Furthermore, the safety of using direct OACs (DOACs) for this indication is uncertain. We performed a single-centre […]

Introduction: Contrary to initial expectations, recent clinical data show that high-power, short-duration (HPSD) radiofrequency (RF) ablation can result in a similar oesophageal injury rate as traditional low-power, long-duration (LPLD) ablation. Existing methods to prevent oesophageal injury have yielded variable or uncertain results, and many can result in prolonged procedure time. An oesophageal cooling device currently available […]

Background: Cardiac fibrosis detected on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is associated with increased risk of ventricular arrhythmia and heart failure hospitalisation in ischaemic and non-ischaemic cardiomyopathy. Whilst left ventricular (LV) dysfunction is common in patients with pacemakers, the prevalence of cardiac fibrosis in this population has not been previously studied. The […]

Introduction: Day case device procedures are now standard practice however there still appears to be some uncertainty and no clear guidance in the post implant device check policies. The majority of complications with devices occur in-hospital or during the first 6 months following implantation. Although the British Heart Rhythm Society recommends patients should be monitored for […]

Background: Catheter ablation for atrial fibrillation may require repeat procedures. The impact of extensive AF ablation procedures on left atrial diastolic dysfunction is not well defined or quantified. The stiff left atrial syndrome is characterised by a combination of heart failure symptoms, pulmonary hypertension and left atrial diastolic dysfunction. This is a pilot study documenting the […]

Background: Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is potentially curative but little is known about the frequency or timing of repeat ablations. Purpose: To characterise repeat ablations in patients <65 years with PSVT. Methods: Retrospective study using demographic, enrolment, and claims data from the IBM MarketScan® research database to identify patients <65 years with […]

Background: The optimal technique to deliver enduring pulmonary vein isolation (PVI) using radiofrequency is under scrutiny with the introduction of Ablation Index technology and the CLOSE protocol. Modern techniques to deliver RF ablation lesions encircling the pulmonary veins often follow a nephroid geometry and in this study, this is compared to the traditional wide antral circumferential […]

Background: Large-tip radiofrequency ablation (RFA) catheters (LTC), 8 mm and 10 mm tip catheters, are both capable of creating large lesions and are more effective than conventional catheters for cavotricuspid isthmus (CTI) ablation. It is not clear whether complete CTI block can be achieved more efficiently using an 8 mm or a 10 mm catheter. […]

Background: The objective of this single-centre study was to compare the long-term efficacy and safety outcomes of the hybrid AF ablation approach with cryoballoon ablation procedure for the treatment of atrial fibrillation. In the absence of randomised clinical trials, we conducted a propensity-score-matched comparison of those that had AF ablation via the hybrid approach and cryoballoon […]

Introduction: Long QT syndrome (LQTS) is a rare, heterogenic inherited arrhythmia syndrome. Many affected patients are asymptomatic but LQTS is associated with an increased risk of sudden cardiac death. Decision making around risk management, particularly implantable cardioverter defibrillator (ICD) therapy can be difficult as despite their life saving properties, potential for device related complications and inappropriate […]

Introduction: We present a case of left-sided atrial flutter complicated by PentaRay Catheter (PRC) entrapment in the mechanical mitral valve (MVR) and the manoeuvre used to free the catheter. Background: Atrial fibrillation (AF) and flutter are common post MVR and confer a worse prognosis. AF is often refractory to pharmacological agents and radiofrequency ablation (RFA) is usually […]

Aims: To investigate the utility of adenosine administration to test the durability of cavotricuspid isthmus (CTI) block after radiofrequency (RF) catheter ablation for typical atrial flutter. Methods: Adenosine 10 mg was administered by bolus injection through a femoral sheath at 5 minutes after apparent completion of CTI ablation in consecutive patients, and its effect on CTI conduction […]

Background: Individuals with Brugada syndrome (BrS) in whom a variant can be found in SCN5A, the gene encoding the alpha subunit of the cardiac sodium channel, have a more marked phenotype. However, many SCN5A variants have little apparent effect on the sodium current INa. We asked whether in vitro functional assessment of SCN5A variants could refine the genotype-phenotype correlation. Methods: A systematic literature search was […]

Introduction: Cardiac resynchronisation therapy (CRT) can reduce morbidity and mortality in patients with left ventricular impairment and dyssynchrony. Elderly patients receiving CRT are less often studied. CRT implantation in elderly patients can be technically demanding and pose extra challenges. They may tolerate lengthy procedures less well and may be more severely affected by pneumothoraces. The use […]

Background: Syncope results in significant patient morbidity, healthcare burden and can be associated with increased mortality. The reported mortality risk following syncope hospitalisation is highly variable, ranging from 2–13 % at 1 year. Purpose: We sought to determine the 1-year mortality risk in patients discharged with a primary diagnosis of syncope at University Hospital Coventry and identify […]

Aims: Randomised, controlled trials have shown that cardiac resynchronisation therapy (CRT) prolongs survival in patients with heart failure (HF). No studies have explored survival after CRT in relation to individuals in the general population (relative survival, RS). We sought to determine observed and RS after CRT in a nationwide cohort undergoing CRT. Methods and results: A national […]

Background: Women are underrepresented in cardiac resynchronisation therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. Objectives: To explore clinical outcomes in women and men undergoing CRT-defibrillation (CRT-D) or -pacing (CRT-P) in real-world clinical practice. Methods: A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43,730 patients […]

Introduction: Premature ventricular complexes (PVC) are often encountered in general population and the frequent occurrence of PVC may induces left ventricular dysfunction in patient with or without structural heart disease. The left ventricle summit (LVS) is the triangular area, most superior portion of the LV epicardium bounded by bifurcation of left anterior descending coronary artery (LAD) […]

Background: Primary prevention implantable cardioverter defibrillator (ICD) therapy is indicated in patients with a LVEF <35%, but most cardiac arrest survivors have a LVEF ≥35%. Increasing evidence suggests that the myocardial phenotype predicts ventricular arrhythmias. Objective: To determine the cardiovascular magnetic resonance (CMR) characteristics of survivors of sustained ventricular tachycardia (VT) or fibrillation (VF) who underwent secondary […]

Introduction: The left atrial ganglionated plexus (GP) are implicated in atrial fibrillation (AF) and can be located by high frequency endocardial stimulation (HFS). In order to understand the role of GP in AF pathogenesis, we report reproducible electrophysiological phenomena seen during GP stimulation and ablation. Methods: Ninety-five patients with paroxysmal AF with or without previous pulmonary vein […]

Background: South Asians have a low prevalence of atrial fibrillation (AF) in comparison with Caucasians despite a higher burden of hypertension, diabetes mellitus and coronary artery disease. The reason for this disparity is unclear but may relate to variations in autonomic tone. Methods: A prospective cohort study was performed on 80 South Asian and 80 Caucasian healthy […]

Background: Ischaemic stroke is a leading cause of morbidity and mortality worldwide with around 100,000 individuals suffering a stroke in the United Kingdom each year. Around a fifth of these events are cardioembolic in origin, often due to arrhythmias such as atrial fibrillation (AF) or atrial flutter (AFl). Although national guidelines currently recommend prolonged ECG monitoring […]

Background: The presence of a spontaneous type 1 Brugada ECG pattern and previous syncope or cardiac arrest have consistently been associated with increased risk of sudden cardiac death (SCD) in Brugada Syndrome (BrS). In contrast asymptomatic individuals with a drug-induced type 1 pattern are at low risk. However, the ECG phenotype is known to be highly […]

Introduction: Cardiac resynchronisation therapy (CRT) is an effective treatment for patients with severe heart failure and a wide QRS duration (QRSd). This is particularly the case for patients with left bundle branch block (LBBB), where it is a class I recommendation by the European Society of Cardiology (ESC). In individuals with right bundle branch block (RBBB), […]

Background: Approximately 30% of patients with ICDs experience clinically significant anxiety and depression, but psychological support is often limited. Our aims were to clarify common psychological concerns amongst this population and to use these findings to develop a support group, pitched in an appropriate way and with relevant content to best meet patients’ needs. Methods: The project […]

Background: Ablation of persistent AF remains a significant challenge. Charge density mapping is a novel tool for use in atrial fibrillation (AF) ablation. The AcQMap system (Acutus Medical) maps the chamber via a non-contact static hybrid charge density/ultrasound catheter. Its algorithm identifies regions of interest (ROIs) according to three subtypes: local irregular activity (LIA), local […]

Introduction: Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients.1 New onset AF (NOAF) is linked with severity of disease and is associated with poorer outcomes, including prolonged ICU stays and higher mortality rates.1–3 In addition, we know that thrombocytopenia is an independent predictor of mortality and that patients with disseminated intravascular coagulation (DIC), […]

Introduction: One in 5 strokes in the UK are caused by atrial fibrillation (AF) and are associated with greater disability and mortality than non-AF strokes (SSNAP, 2017). Early detection of AF can reduce stroke due to timely initiation and optimization of treatment, yet it is estimated that 500,000 people in the UK have undiagnosed AF (PHE, […]

Recording significant arrhythmia in patients with palpitations and pre-syncope can be challenging given the unpredictable onset and duration of symptoms. Conventional rhythm monitoring devices are time limited, resource intensive and suffer from low diagnostic yield. Patient activated smartphone connected devices that record rhythm strips offer promise as an affordable and effective rhythm monitoring device. The […]

Introduction: Symptomatic cardiac involvement occurs in ~5% of patients with sarcoidosis, with up to ~25% occurrence seen in autopsy studies. Ventricular arrhythmias and cardiac arrest may be the first presenting event in otherwise asymptomatic patients. Implantable cardioverter-defibrillators (ICDs) are frequently deployed, but only a weak evidence base exists. Methods: We retrospectively reviewed the indication for ICD implantation […]

Introduction: Many patients are prescribed anticoagulants to prevent thromboembolism and stroke. Newer non vitamin-K oral anticoagulants (NOACs), were first used in 2008 and are an increasingly common medication. However, they may still be unfamiliar to patients and healthcare professionals. It is important for both groups to know what drug the patient is taking, why, and what […]

Introduction: Standard anti-bradycardia pacing aims to place a lead at the right ventricular (RV) apex, a technique that is well-practised and good for lead stability. However, chronic right RV pacing can cause left ventricular impairment, especially in patients with prior impaired LV function. Several studies suggest deleterious effects on left ventricular (LV) function with chronic […]

Introduction: The emergence of the subcutaneous implantable cardiac defibrillator (SICD), approved by the FDA in 2012, has been a major breakthrough in cardiac rhythm management. The foremost benefit concerns the lack of necessity to place a lead through the central venous system into the heart, thus avoiding the potential complications of vascular obstruction, thrombosis, infection, cardiac […]

Introduction: Coronary sinus (CS) diverticulae are a known cause of posteroseptal accessory pathway. These rare congenital anomalies can be diagnosed using different imaging modalities including coronary sinus angiography and transoesophageal echocardiography. Atrial fibrillation in the presence of an accessory pathway can be fatal though accessory pathway ablation provides a high success rate of cure. Case: A previously […]

Introduction: For patients with persistent atrial fibrillation (PeAF), pulmonary vein isolation (PVI) remains the standard of care, although outcomes are often sub-optimal. AcQMap is a novel non-contact high resolution imaging and AF mapping system using dipole density mapping to identify areas triggering and maintaining AF. Purpose: This two-centre retrospective observational study aimed to assess whether combined Cryoballoon […]

Background: Cardiac resynchronisation therapy (CRT) reduces patient morbidity and mortality, however, nearly 30–40% of patients fail to respond. The management of these so-called CRT non-responders (who remain symptomatic and have no evidence of reverse left ventricular (LV) remodelling following epicardial CRT) remains limited with few treatment options available. Studies have shown that endocardial LV pacing is […]

Introduction: Brugada syndrome (BrS) is an inherited cardiac disease in which a characteristic ECG pattern of coved-type ST-segment elevation is seen in the right precordial leads. Patients are at increased risk of sudden cardiac death and usually present in the fourth decade of life but cases have been described in children. BrS should therefore be considered […]

Introduction: BHRS 2013 guidance on how to conduct a device follow up clinic states that an ICD clinic should aim ‘to provide patient and family support and education together with any other healthcare professionals involved in the patient’s management.’ We devised a three-stage ICD patient education programme. We tested the impact of this programme with a […]

Background: Cardiac resynchronisation therapy (CRT) reduces patient morbidity and mortality. However, 30–40% of patients fail to respond and a proportion of these patients may have been implanted with unfavourable characteristics such as a narrow QRS duration leading to CRT non-response. Given these concerns, we developed a CRT preassessment clinic (CRT PAC) to act as a […]

Background: Cardiac resynchronisation therapy (CRT) is an important intervention in patients with dyssynchronous severe left ventricular systolic impairment. Appropriate patient selection is important, given 30–40% of patients fail to respond to CRT. Patient evaluation before CRT remains heterogenous across centres and it’s suspected a proportion of patients with unfavourable characteristics such as narrow QRS duration […]

Background: Catheter ablation is an important adjunct to device implantation for secondary prevention of ventricular tachycardia (VT). However, several factors may influence the success of ablations in terms of long-term freedom from VT recurrence. A thus far little examined factor is the use of general anaesthetic (GA) versus conscious sedation during the procedure, which has […]

Background: Predicting clinical outcomes after cardiac resynchronisation therapy (CRT) remains a challenge. Although QRS duration is crucial as an indication for CRT, it is a poor predictor of clinical outcomes. Objectives: To determine whether the direction of ventricular activation, measured using the ratio of the temporospatial isochrone to QRS duration (TSIQRSd) on vectorcardiography (VCG) predicts […]

Introduction: Catheter ablation is an effective first-line treatment for cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). Conventional fluoroscopic (FLUO) method may involve significant radiation dose with bidirectional CTI block requiring extensive ablation. Contact force (CF) guided ablation has shown reduced fluoroscopy time, but no other differences. Local impedance (LI) technology has not previously been evaluated […]

Background: Catheter ablation is a routine and effective treatment for supraventricular tachycardia (SVT). Femoral venous catheterisation presents an increased risk of venous thromboembolism (VTE). VTE can result in excess patient morbidity and mortality; however, data is limited regarding the incidence of post-procedure VTE in patients undergoing ablation. Current data comes from retrospective database studies. We […]

Introduction: The number of cardiac implantable devices continues to increase. With an increasing volume of implants and redo/upgrade procedures, monitoring procedural quality and outcomes remains important. Following the merger and establishment of Barts Heart Centre (BHC) in 2015, we have bi-annually audited device related complications and changed clinical practice accordingly. We report on our most […]

Introduction: Outcome data on patients undergoing implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) implantation with higher stages of chronic kidney disease (CKD) is lacking as patients with significant renal impairment are under-represented in the major clinical trials.1 Registry data suggests that there is a significant cohort of CKD patients with indications for these […]

Introduction: Informed consent is fundamental to good medical practice and reflects the ethical principles at the heart of realistic medicine. However, the practice of obtaining informed consent varies widely, with potentially severe medical and legal consequences. Bearing in mind that consent is a process and not a one-time event, we sought to assess the effectiveness […]

Background: Biventricular pacing has revolutionised the treatment of heart failure in patients with left bundle branch block; however, left ventricular-lead placement is not always technically possible. Direct left bundle pacing maybe a more physiological method of activating the heart and overcoming left bundle branch block. Therefore, this offers a promising alternative for cardiac resynchronisation when […]

Background: His-Bundle pacing (HBP) is rapidly growing in popularity as an alternative to right ventricular (RV) pacing. One major disadvantage of HBP is the high capture threshold. Achieving optimal His-bundle (HB) pacing location is technically challenging. Suboptimal location often requires a higher pacing stimulus voltage and pulse widths are also frequently extended to 1.0 ms. […]

Background: Detection of atrial fibrillation after stroke may be challenging and often requires prolonged monitoring. Atrial fibrillation is known to be associated with imaging markers of atrial structural remodelling such as left atrial dilatation and fibrosis. However, assessment of atrial morphology is challenging with previous approaches lacking standardisation. Objective: To determine if left atrial morphological […]

Introduction: Wolf Parkinson White disease is a pre-excitation syndrome with an accessory nodal pathway first described in 1930 by Doctors Wolf, Parkinson and White. This is due to the abnormal accessory pathway connecting the atrium and the ventricle on either side through which anterograde or retrograde transmission of sinus impulses occur. Among general population, incidence […]

Introduction: Implantable loop recorder (ILR) insertion can be safely performed outside of a cardiac catheter laboratory environment but to date has typically been a procedure performed by cardiologists. In our unit, we introduced an ILR insertion service undertaken by cardiac physiologists and nurses rather than doctors. The feasibility, safety and resource implications of this service […]

Background: A novel non-invasive three-dimensional (3D) mapping software, and its upgraded version, shows the unique feature of combining 3D DICOM data with 12-lead electrocardiographic (ECG) data to precisely localize ventricular arrhythmias. This allows to “move” the localisation diagnosis to the ward prior to the invasive cath lab procedure and is especially helpful in patients with […]

Introduction: Systemic Sclerosis (SSc) manifests as inflammation, vasculopathy and fibrosis of the skin and visceral organs. Cardiac involvement, defined as either pericarditis, congestive heart failure, severe arrhythmias, and/or atrioventricular conduction abnormalities, was found to be the leading cause of death (36%) in a large cohort of SSc patients, followed over 10 years. Literature reports 4–6% […]

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increase risk of stroke. NICE recommends that patients with AF are assessed for stroke risk using a validated risk score (e.g.  HA2DS2VASc). In the absence of contra-indications (use a score e.g. HAS-BLED to identify modifiable bleeding risk factors) patients […]

Background: A ‘fixed’ Type 1 Brugada (BrS) ECG is conventionally regarded as a marker of high risk, despite its absence in a significant number of sudden cardiac death survivors. The increased propensity for ventricular arrhythmias (VA) during different autonomic/physiological stressors suggests that the arrhythmogenic potential is dynamic, but the published evidence for this is scant. […]

Background: Nurse-led sedation protocols are common for many procedures, yet cardiac disease represents an additional risk factor (Sneyd, 2013). Subsequently, nurse-led procedural sedation and analgesia (NLPSA) during cardiac ablation is rarely practiced or studied (Conway et al., 2014). Such a protocol has potential benefits in resource management (Gaitan et al., 2011), without requiring the operator […]

Introduction: Permanent His Bundle pacing has been reported as a promising alternative to conventional right ventricular and biventricular pacing due to its ability to deliver and potentially correct intrinsic His-Purkinje conduction. We performed a medium term follow up study of patients who underwent His Bundle Pacing (HBP) to examine safety, feasibility and stability of lead […]

Aims: Palpitations are a distressing symptom for patients and present a difficult diagnostic challenge in primary care. Patients with benign palpitations are often referred onto secondary care services out of fear of missing more sinister conditions. Local guidelines have been provided to referrers to improve service delivery. We analysed the adherence to these. Methods: We […]

Background: One in four middle-aged adults in Europe and US will develop atrial fibrillation (AF). The 2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation outlined symptomatic relief of AF as a primary indication for ablation. Aims and objectives: To gauge AF cryoablation success rates, complications, age, gender distribution and the […]

Introduction: There are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. One of the many factors that may contribute is ethnicity. In an increasingly multi-ethnic population, we sought to investigate the impact of South Asian (SA) ethnicity in comparison to Caucasian ethnicity in the implantation of ICDs. Methods: […]

Introduction: In post-cardiac surgery patients, potassium (K+) supplementation is often given to maintain serum levels in the high-normal range, with the aim of preventing atrial fibrillation (AF). Evidence for this practice is poor and the strategy is associated with risks and costs. In future, we intend to perform a properly-powered, non-inferiority, randomised controlled study in […]

Introduction: There are few data on strategies to improve access to complex cardiac implantable electronic device (CIED) implantation and other treatments for heart failure (HF) or left ventricular systolic dysfunction (LVERSUSD). We hypothesized that a cohort of patients in primary care would already qualify for a CIED but had not received an implant. We set […]

Introduction: Research has shown that increasing cardiovascular fitness (Skielboe et al., 2017) and reducing body mass (Middeldorp et al., 2018) can reduce the burden of arrhythmias on patients’ health. In addition, if we can reduce other cardiovascular risk factors the prognostic risk of the arrhythmia or other cardiac events progressing is likely to be minimised. […]

Introduction: Worldwide utilisation of cardiac implantable electronic devices has increased in the past two decades (Mond et al., 2008). In the time following implant generator replacements/system upgrades it may be necessary for generator replacements or system upgrades due to battery depletion, device malfunction or disease progression. To date, few studies have assessed the complication rates […]

Introduction: Many referrals to cardiology outpatient clinics are for patients with palpitations. Patients can wait several months before their first appointment. Diagnosis, often dependent on symptom and ECG rhythm correlation, is further delayed due to the need to perform and review investigations. This results in delayed treatment and anxiety for many patients. Smartphone and wearable […]

Background: Leadless pacemaker therapy is associated with a significant reduction in complication rate as compared with conventional transvenous single chamber pacemaker. However, vascular access complication is around 1.2% due to large delivery femoral sheath (27Fr). We examined the importance of real-time ultrasound guidance venepuncture and Z suture to reduce total and major vascular complications. Method: […]

Introduction: The European Society of Cardiology (ESC) has recently provided risk stratified guidance to enable early diagnosis & management of suspected cardiac syncope.1 It describes recognition of a ”low-risk” cohort of patients who may not require admission to hospital. Aims: To analyse current practice at a busy south London DGH to ascertain what proportion of […]

Background: Internal cardioverter defibrillator (ICD) and cardiac resynchronisation defibrillator (CRTD) implantation rates have increased significantly. As these escalate, and patient survival improves, so has the need for generator change (GC), which carries important inherent risk. Objective: To assess the effect of GC on mortality in patients with ICD and CRTD. Methods: Consecutive patients implanted in […]

Introduction: There have been a number of advances in cardiac implantable device (CIED) implantation techniques which have reduced the number of device related infections. The risk of infection, however, still has significant impact on hospitalisation and mortality (Koerber SM et al., 2018). The adjunctive use of the Medtronic TYRXTM antibacterial envelope has been shown to […]

Background: His-bundle pacing (HBP) is rapidly growing in popularity as an alternative to right ventricular (RV) pacing. One major disadvantage of HBP is the high capture threshold. Achieving optimal His-bundle (HB) pacing location is technically challenging. Suboptimal location often requires a higher pacing stimulus voltage and pulse widths are also frequently extended to 1.0 ms. […]

Background: CRT (cardiac resynchronisation therapy) is widely known for improving LV (left ventricular) function in patients with heart failure and dyssynchrony. However, it is unsuccessful in approximately 30–40% of all implants. There have been many studies that have looked at multiple factors to predict response. During a CRT implant – one of the main aims […]

Background: His-bundle pacing (HBP) is rapidly growing in popularity as an alternative to right ventricular (RV) pacing. One major disadvantage of HBP is the high capture threshold. Achieving optimal His-bundle (HB) pacing location is technically challenging. Suboptimal location often requires a higher pacing stimulus voltage and pulse widths are also frequently extended to 1.0 ms. […]

Background: His-bundle pacing has grown in popularity in recent years. This form of conduction system pacing provides a more physiological pattern of ventricular activation (Lewis et al., 2019). Since then, studies about His-bundle pacing have come to light. What does it mean for us? And ‘us’ I mean physiologists. it means learning a new way […]

Introduction: New safe sedation guidelines were introduced by the Academy of Royal Colleges in 2013. We subsequently designed and introduced a new protocol to guide the use of conscious sedation in our electrophysiology labs in 2014. The protocol included pre-procedural risk assessment, routine capnography monitoring, protocolised prescribing of midazolam and fentanyl, dose-up titration guidance and […]

Introduction: The 12-lead electrocardiogram (ECG) is currently one of the most widely used, operator-dependent investigations in healthcare. To acquire an ECG, six recording electrodes are placed at precise anatomical locations on a person’s chest, and one electrode on each wrist and ankle. These are identified by palpation of standardised bony landmarks and in certain clinical […]

Introduction: Catheter ablation for symptomatic AF is a well-established treatment. The generally accepted model is for overnight hospital stay post-procedure but given the rising incidence of AF and number of AF ablations performed, streamlining of practice to minimise overnight stay could result in a significant reduction in waiting list times and procedure-related healthcare expenditure. However, […]

Patients with palpitations can pose a diagnostic challenge to any arrhythmia service. Traditional methods of ECG recording rely on the user experiencing symptoms when the monitor is attached. We invested in 30 Alivecor Kardia monitors for patients to use with their own smartphone to record a 30 second rhythm strip when they experience symptoms. The […]

Background: Battery longevity is an important factor in cardiac implantable electronic devices (CIEDs). Over the years, longevity has improved since devices started coming onto the market in the 1980s. As well as particular algorithms a device might have, longevity can highly influence the implant of certain devices. However, there is a lack of research on […]

Introduction: There have been many advances in reducing the rate of inappropriate ICD therapy through standardised programming and enhanced discrimination features (Friedman P et al., 2014). ICD discriminators have evolved over time and now offer better sensitivity and specificity in SVT versus VT detection. Despite this, there are instances where patients still receive inappropriate therapy […]

Introduction: The management of ICDs towards end of life present considerable challenges with modern day device technology. In particular, there is little data on cardiac resynchronisation therapy (CRT) patients who receive no therapy during the lifetime of the device however are pacing dependant. With the advent of devices which consist of DF-4 RV and IS-4 […]

Introduction: The medium-term maintenance of sinus rhythm (SR) following elective cardioversion (DCCV) for persistent atrial fibrillation (AF) is low. At our centre, AF recurrence within 6 months was 50% in a retrospective database of over 500 patients. As part of the nurse-led cardioversion service at a district general hospital we looked at the effect of […]

Aims: Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different aetiologies or outcomes. Methods and results: We searched the literature for peer-reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty-eight studies were identified and included in the review. […]

Introduction: The Cardiac Physiology led implantable Loop recorder (ILR) service has seen a yearly increase of implants over the past 3 years from 48 to 224. We therefore predict that due to the 3-year battery life of the device, explant referrals will increase. This traditionally has been physician led in the cath lab utilising a […]

Background: The demands on modern cardiology departments for advanced diagnostic and invasive services, has placed a large demand on the skills and services of experienced cardiac physiologists. This demand for experienced and accredited staff has meant that there are some occasions where less experienced staff may be required to program pacemakers to suit a particular […]

Background: Remote monitoring of implantable cardiac devices allows the clinician to assess patients’ diagnostic device and physiological information without any direct patient interaction. Modern alert-based systems transmit information which can be indicative of a patient’s heart failure status, parameters such as intrathoracic impedance, heart rate variability (HRV), nocturnal heart rate, patient activity and atrial and […]

Background/objective: A cardiac rhythm management (CRM) allied professional service was developed in 2015 utilising Medtronic Reveal LINQ ICM devices and advanced remote monitoring technology. Advances in technology have allowed for implantation in a procedure room by CRM specialist nurses and a cardiac physiologist. Following implant, all patients received remote monitoring equipment and access to a […]

Introduction: Oral anticoagulation (OAC) is known to reduce stroke risk by 60–80% in patients with Atrial Fibrillation (AF), however, only 50% of eligible patients receive OAC. While many AF patients present to the ED, few are offered OAC. This represents a significant gap in AF care. Methods: This was a multi-centre, pragmatic, three-phase before-after study, […]

Background: Cardiac infarction-induced necrosis is in long term considered as an electrical barrier that slows the pass by electrical conduction, forming the base of re-entry. However, this theoretic concept has never been demonstrated in the beating heart. Methods: We produced a necrotic area in the left ventricle of rats with absolute ethanol, and the changes […]

Background and objective: Abnormal impulse is a major trigger for ventricular arrhythmias in heart failure (HF). In the heart, myocytes are electrically coupled and mechanically stretched, how cardiac stretch and electrical coupling affects abnormal impulse initiation and propagation is poorly understood. Here, we investigated the impact of β-adrenergic stimulation and CaMKII activation, the two major […]

Background: Regular physiologist led cardiac device follow up appointments are useful in highlighting and troubleshooting device-detected issues in both the acute and late phase. While most programming concerns are generally dealt with by device physiologists, it is necessary at times to escalate issues which warrant a doctors input or adjudication for external referrals, medication prescriptions […]

Background: Cath lab time allocation for patients with suspicion of supraventricular tachycardia (SVT) is a challenging task. In this study, we aimed to identify the predictors of a negative electrophysiology study (EPS) in order to help optimizing booking times. Methods: We retrospectively included 282 patients booked for SVT ablation with a 2-hour slot at the […]

Introduction: NHS long-term plan has AF as one of its three priority areas – and is calling for 89% of people with AF to be diagnosed within this time-frame. There are currently half a million people unaware that they have AF and are, therefore, at risk of suffering a debilitating or life-threatening, AF-related stroke. The […]

This abstract has been withdrawn by the HRC organising committee from the electronic abstract book following a formal complaint. No authorisation was obtained from the study supervisor to submit the research and no acknowledgement of supervisor or co-investigator contributions were made. Further investigations are currently underway.

This abstract has been withdrawn by the HRC organising committee from the electronic abstract book following a formal complaint. No authorisation was obtained from the study supervisor to submit the research and no acknowledgement of supervisor or co-investigator contributions were made. Further investigations are currently underway.

Introduction: Trans-venous lead extraction (TLE) carries a risk of tricuspid valve injury with the potential for acute tricuspid regurgitation (TR). Currently there is little data on the incidence of valve trauma and clinical outcomes following TLE. We sought to establish the incidence of worsening TR post extraction in a high volume cardiac tertiary centre. Methods: […]

Introduction: Palpitations are a common reason for referral to cardiology. Correlation of patient symptoms with rhythm and thus diagnosis can be difficult. Conventional ambulatory monitoring often fails to yield a symptom-rhythm correlation. The MiCor A100 (MiTAC Europe, W Sussex, UK) is a CE-marked wearable patient-activated lead I ECG capable of recording 30 seconds per activation. […]

Background: Thoracoscopic surgical ablation (TSA) has recently emerged as an alternative to catheter ablation for atrial fibrillation (AF) with higher single procedure success rates. Electrophysiological conduction testing is key to achieve the best outcome for TSA. Two-step conduction block testing using surgical pen testing followed by multipolar electrophysiological catheter testing has been shown to be […]

Introduction: Post ablation atrial tachycardias can be complex and challenging. The Advisor HD Grid multielectrode catheter (Abbott, St Paul, MN, USA) is a high-density mapping catheter developed for mapping complex re-entrant atrial arrhythmias independent of activation wavefronts to electrode orientation, reducing the so-called “bipolar blindness”. The aim of this study was to compare the mapping […]

Introduction: Atrial fibrillation (AF) affects over 50 million people worldwide. Although ablation therapy has evolved, the success rates for persistent AF remain suboptimal. The minimally invasive hybrid approach for ablation is an emerging form of therapy to successfully restore sinus rhythm (SR) in patients with longstanding persistent AF. Methods: We conducted a prospective, single-centre UK study over […]

Introduction: Patients with congenital heart disease (CHD) are predisposed to a range of cardiac arrhythmias. This may be a result of the primary congenital lesion or a result of ensuing surgical or percutaneous interventions. Implantation of cardiac rhythm management (CRM) devices can be of huge benefit both symptomatically and prognostically, however the implant procedure and subsequent […]

Introduction: Clinical follow-up is recommended following catheter ablation of supraventricular tachycardia (SVT) and typical atrial flutter. However, decisions regarding further care are frequently based upon patients’ symptoms and physical examination is rarely required. There is increasing pressure on physical resources including out-patient capacity in secondary care within the NHS. Remote follow-up may relieve this pressure […]

Background: Ischaemic stroke is a leading cause of morbidity and mortality worldwide with around 100,000 individuals suffering a stroke in the United Kingdom each year. Around a fifth of these events are cardioembolic in origin, often due to arrhythmias such as atrial fibrillation (AF) or atrial flutter (AFl). Although national guidelines currently recommend prolonged ECG monitoring […]

Background: Cath lab time allocation for patients with suspicion of supraventricular tachycardia (SVT) is a challenging task. In this study, we aimed to identify the predictors of a negative electrophysiology study (EPS) in order to help optimizing booking times. Methods: We retrospectively included 282 patients booked for SVT ablation with a 2-hour slot at the Royal Papworth […]

Background: Atrial fibrillation termination to atrial tachycardia (AT) or atypical flutter (AFL) is increasingly common with ablation strategies targeting non-pulmonary vein drivers. These add a significant additional time and resource burden to procedural workflows. Currently, stable arrhythmia contact maps measure local activation times (LATs) across multiple cycles relative to a fiducial time reference. In order to […]

Introduction: Catheter ablation (CA) for the treatment of ventricular arrhythmia (VA) is a complex and evolving field and, in the United Kingdom (UK), in recent years, its use is expanding. Perhaps due to the complex and evolving nature of the procedure, there are many aspects that can be approached in a variety of ways. The […]

Background: Identifying ”high-utilisers” of health care services and developing interventions that improve their outcomes and reduce costs is a priority for any health care system. The Canadian Institutes of Health Information (CIHI) recently identified a dynamic cohort of high-utilisers, defined as patients who accounted for the top 10% of acute care costs in Canada. Objectives: To compare […]

It is known that the chirality of depolarisation and repolarisation processes may be basis for heart electrical instability. Purpose: The purpose of this investigation was to use graph theory, topology, convex analysis, mathematical modelling for diagnosis of the racemic Moebius strip like disturbances of heart rhythm and conduction. Object: The object of study was 100 electrocardiograms with […]

Introduction: Surviving myocardium within ischaemic ventricular scar can form a substrate for electrical re-entry. Several approaches have been described for ”substrate modification” of this surviving myocardium; targeting late abnormal ventricular activities (LAVAs) or late potentials (LP), scar homogenisation and scar encirclement amongst others. We have previously used ripple mapping (RM) to demonstrate distinct channels of surviving […]

Background: Pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation is an established treatment for symptomatic persistent atrial fibrillation (AF). Data from the international CRYO4PERSISTENT AF trial had recently demonstrated 61% single-procedural success at 12 months in treating persistent AF with Cryoablation (Cryo) using the Achieve catheter with a Cryoballoon. We propose to conduct a local […]

Introduction: Peri-mitral flutter (PMF) is common after ablation of atrial fibrillation (AF). Ablation therapy is conventionally aimed at creating a linear lesion, often between the mitral annulus and isolated left lower pulmonary vein, that transects the macroreentrant circuit. Conduction block across linear lesions is hard to achieve, often requiring epicardial ablation. Reconnection and subsequent recurrence is […]

The Norfolk and Waveney sustainability and transformation partnership (STP) in the east of England has one of highest estimated prevalence for atrial fibrillation (AF) in the country. The STP covers a population of around 1 million people and includes five clinical commissioning groups (CCGs). The estimated AF prevalence varies between 1.49% to 4.24% across the […]

Introduction: Subcutaneous implantable cardio-defibrillators (S-ICDs) can either be implanted in a pocket between latissimus dorsi and serratus anterior muscles or behind the serratus anterior muscle. Both techniques are used by operators at our centre. We performed a retrospective, observational study of outcomes including complications, patient discomfort, aesthetics and device circuit shock impedance to see if any […]

Background: During contact force (CF) and VISITAG™ Module (Biosense Webster) guided pulmonary vein isolation (PVI), ACCURESP™ respiratory motion adjustment is recommended, although without in vivo validation. Objective: Since accurate LAPW radiofrequency (RF) annotation is crucial to avoid oesophageal thermal injury, we compared ACCURESP™ setting (“on” versus “off”) on RF annotation at the left atrial posterior wall (LAPW). Methods: From a […]

Introduction: New-onset or decompensated atrial fibrillation (AF) is a common presenting complaint in the Emergency Department, and causes considerable morbidity. The acute management of AF presents challenging decisions regarding anticoagulation, rate and rhythm control, and whilst ESC and NICE guidelines are well-established, compliance with these recommendations is not always assured, particularly for the busy generalist. […]

Objective: To evaluate the effectiveness of biventricular stimulation after the destruction of AV-node in patients with persistent atrial fibrillation (AF) and chronic heart failure (CHF). Materials and methods: The observational single-centre study included 34 patients with mean age 61,8 ± 9.4 years. All the patients were diagnosed with CHF functional classes III, IV according to New […]

Introduction: Ablation Index (AI) integrates catheter power, contact force and time to better inform operators about lesion delivery, and has shown promise in delivering more enduring pulmonary vein isolation. Many centres including our own routinely use contact force sensing to guide lesion delivery for atrial flutter ablation. One may encounter anatomical challenges when delivering lesions […]

Introduction: Heart rate variability (HRV) has been established as an important clinical tool, especially in patients with underlying heart disease. Studies have shown its prognostic value. However, despite tens of thousands of publications, HRV and its underlying mechanisms remain controversial. Some have suggested that HRV is simply a feature of heart rate (HR) rather than […]

Background: Small- and medium-scale studies have suggested that increasing body mass index (BMI) is associated with corrected QT (QTc) interval prolongation, and thereby a higher risk of ventricular arrhythmia. However, there is a lack of large-scale studies to corroborate this finding. Given the increasing prevalence of obesity, we sought to investigate the association between anthropometric measurements […]

Background: Implantable loop recorder (ILR) use improves diagnostic yield in patients with unexplained syncope allowing for earlier diagnosis and interventions. We sought to determine whether syncope duration was associated with an ILR-guided intervention. Methods: One hundred and one consecutive patients underwent an ILR implant. Patients with syncope/pre-syncope were included. Data were collected on baseline demographics, symptom duration, […]

Background: The feasibility and safety of same day discharge for transvenous ICD systems is well established. Subcutaneous implantable cardioverter defibrillators (SQ-ICD) are increasingly being implanted as an alternative to transvenous ICDs. The feasibility as well as time and cost savings associated with same day discharge after implantation of these devices needs to be investigated. Purpose: To evaluate […]

Introduction: Cardiac resynchronisation therapy (CPT) is a powerful adjuvant therapy in patients with chronic heart failure (CHF) who have electrical dyssynchrony of cardiac activity, which reduces morbidity and increases survival in this group of patients. Between October 2015 and December 2016, 11,088 patients who received implantation of cardiac resynchronisation therapy (CPT) devices from 42 countries were […]

Introduction: Atrial fibrillation (AF) is the most common arrhythmia among elderly patients (over 75 years according to the WHO classification, 2015). Catheter ablation (CA) is one of the most common treatments for AF, but this method is not widely used in the treatment of elderly age persons with AF. Purpose: To evaluate the efficacy and safety of […]

Background and aim of the study: Recurrence of atrial fibrillation (AF) after radiofrequency ablation (RFA) of pulmonary veins is still an ongoing problem and its predictors have not been fully determined. Aim of this study was to identify whether Plasminogen Activator Inhibitor 1 (PAI-1) can predict the development of post-ablation AF recurrence. Methods: We enrolled 75 adult […]

Introduction: The annual report for the National Audit of Cardiac Rhythm Management (CRM) Devices describes procedural activity and complication rates; it is reported through the National Institute of Cardiovascular Outcomes Research (NICOR). NICOR sets a cut off of 15 months following implant to attribute device related complications. However, device related revisions can occur after 15 months […]

Aim: Recurrence rate of ventricular tachycardia (VT) after catheter ablation remains sub-optimal. The re-entry vulnerability index (RVI) is a metric combining activation and repolarisation timings designed to identify sites critical for re-entrant arrhythmia initiation without inducing VT. This study uses high-density mapping to test its capability of identifying VT sites of origin (VTSO). Methods: Eighteen VT […]

Introduction: There is growing concern regarding radiation hazards for both patients and staff. The aim of this study was to investigate the efficacy and safety of a new low-dose fluoroscopy technique for cardiac electronic device implantation, and compare it with a conventional approach. Methods: Low-dose fluoroscopy technique: Radiation exposure during fluoroscopy is directly proportional to the […]

Background: Many dilated cardiomyopathy (DCM) patients have improvement in cardiac function with therapy. TRED-HF investigated the safety and feasibility of therapy withdrawal in such patients. Methods: 45 participants from TRED-HF, (25 – control group and 20 – therapy withdrawal group), who had cardiopulmonary exercise testing (CPET) at baseline and follow-up were included (Figure 1). Change in VE […]

Background: There are increasing numbers of patients referred with suspected dysautonomia to electrophysiology clinics. Many referrals come from the internet, with one Californian website registering over 2,200 patients with POTS alone. Time constraints, unclear reimbursement and provider preferences have left many of these vulnerable patients without a cardiologist with interest or expertise in dysautonomias, or even […]

Introduction: Systemic Sclerosis (SSc) manifests as inflammation, vasculopathy and fibrosis of the skin and visceral organs. Cardiac involvement, defined as either pericarditis, congestive heart failure, severe arrhythmias, and/or atrioventricular conduction abnormalities, was found to be the leading cause of death (36%) in a large cohort of SSc patients, followed over 10 years. Literature reports 4–6% of […]

Background: Localised drivers in the form of intermittent focal and rotational activations have been proposed as mechanisms sustaining persistent AF. The possibility of a relationship between these phenomena has not been explored and any interaction with structural remodelling remains unclear. Methods: Patient undergoing catheter ablation for persistent AF were included. Patients underwent pulmonary vein isolation (PVI) with […]

Introduction: Despite ongoing debate over long term clinical outcomes, persistent AF termination rates have increased since the advent of AF driver mapping, but recent trials have cast doubt on the efficacy of complex fractionated atrial electrograms (CFAE) based mapping strategies. We set out to study a consecutive single centre series pre-and post- use of spatio-temporal […]

Purpose of the study: Evaluation of clinico-hemodynamic efficiency of cardio resynchronising therapy (CRT) in patients with chronic heart failure (CHF). Materials and methods: Seventy patients aged 42 to 80 years (42 men, 28 women) with CHF III, IV functional classes according to NYHA and complete blockage of the left bundle branch were examined, 56 devices were […]

Introduction: Patients with atrial fibrillation (AF) are up to six times greater risk of stroke than those without. However, management of AF remains sub-optimal. Long-term oral anticoagulation with warfarin is an effective treatment for reducing the risk of stroke in af but due to a variable pharmacokinetic profile and narrow therapeutic range, routine monitoring of warfarin is […]

Introduction: Post cardiac surgery, the management of haemodynamics in the ITU can be significantly influenced by appropriately programmed, temporary dual chamber pacing. More specifically, there should be a high importance placed on maintaining atrio-ventricular synchrony in patients who are already haemodynamically compromised. However, the surgical placement of an atrial wire intra-operatively must be balanced against […]

Background: Nottingham University Hospitals NHS Trust comprises two large hospitals. Cardiology services are located at the Nottingham City Hospital (NCH) whereas the Queens Medical Centre (QMC) houses the Emergency Department, Acute Medical Admissions and other acute specialties. Due to the national shortage of physiologists (Phys), the complement of Phys is fully utilised in the morning […]

Abstract: Sodium channel blockade (SCB) is used to investigate those thought to be at risk of harbouring a concealed form of Brugada syndrome (BRS). Most frequently this includes those undergoing evaluation following cardiac arrest, or a premature sudden death or diagnosis of BRS in a relative. However, a recent consensus document advised that an isolated drug […]

Background: Non-pulmonary vein drivers of psAF may present as rapid AF cycle length (AFCL). Measurement of AFCL by manual average and by dominant frequency do not take into account the beat-to-beat variability of AFCL. Current techniques to identify drivers of psAF relay heavily on non-objective criteria for driver identification have yet to proven successful in multicentre […]

Introduction: The benefit of implantable cardioverter defibrillators in non-ischaemic dilated cardiomyopathy (NIDCM) has been convincingly established, however, recent data has suggested a decline in device therapy rates. Evaluation in device therapy between primary and secondary prevention is also somewhat scarce. The aim of this analysis was to assess the rates of appropriate device therapy and to […]

Background: Ectopic atrial tachycardia (EAT) is an uncommon arrhythmia that is notoriously difficult to control. It is often associated with tachycardia induced cardiomyopathy and can be misdiagnosed as sinus tachycardia secondary to viral myocarditis. Medical management to control heart rate (HR) can be challenging and radiofrequency ablation (RFA) may offer definitive management. Iva bradine is […]

Background: Recognising the aetiology of sudden cardiac arrest (SCA) has an enormous impact on the management of victims and their immediate families. Despite advances in cardiac investigations, a large proportion of SCA survivors are not offered a diagnosis for such a life changing event. Although there is support for monitoring such patients, there is no clear […]

Introduction: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death, but transvenous ICD implants (T-ICD) are associated with significant complications. Subcutaneous ICDs (S-ICD) have been developed, however the advantages are offset by limitations in device function: currently subcutaneous devices cannot deliver brady pacing, anti-tachy pacing (ATP) or cardiac resynchronisation therapy (CRT). Current guidelines for S-ICD patient selection […]

Background: Upgrade of cardiac rhythm devices requires the operator to obtain additional venous access to accommodate additional pacing or defibrillator leads. This is conventionally done by either the axillary or subclavian venous route using fluoroscopically guided puncture. An alternative technique is to use venotomy of the cephalic vein under direct vision but this is usually […]

Introduction: Sudden death due to ventricular arrhythmias is a major cause of mortality in adults with repaired Tetralogy of Fallot (ToF). Consensus guidelines recommend implantable cardioverter defibrillators (ICD) in selected ToF patients with multiple risk factors for ventricular arrhythmia or following sustained ventricular tachycardia (VT) or cardiac arrest. However, data regarding ICD outcomes in this population […]

Introduction: Little is known regarding the aetiology or outcome of atrial fibrillation (AF) occurring in young adults. This retrospective analysis was performed to explore the demographics and efficacy of AF ablation in this population. Methods: Patients were included who had undergone ≥1 AF ablation under the age of 40 between 2006–18. Recurrence, defined as return of […]

Background: Subcutaneous implantable cardioverter defibrillators (S-ICD) have been implanted at the Nottingham University Hospitals NHS Trust since December 2014, by a single operator with no prior experience of implant technique, with a proctor for two cases. Objective: To report on demographics of patients selected for the S-ICD; procedural data and success, and complication rates. Methods: A […]

Eighteen-year-old man with a history of symptomatic atrial fibrillation (AF) and subtle signs of ventricular pre-excitation on his ECG was referred for electrophysiology testing. During sinus rhythm, earliest onset of ventricular activation was located at the His-bundle catheter, which was positioned proximally, to avoid the right bundle potential (AH 62 ms, HV 26 ms). Retrograde […]

De novo SCN1A mutations are seen in Dravet syndrome, a severe form of childhood epilepsy with a high incidence of sudden unexpected death. We describe the case of a patient with a homozygous SCN1A mutation who presented following an out of hospital arrest. Case Report: A 17-month-old girl presented following an out of hospital arrest with return of circulation […]