EUROPEAN JOURNAL OF ARRHYTHMIA & ELECTROPHYSIOLOGY – VOLUME 6 SUPPLEMENT 1 – 2020

Introduction: There are numerous approaches to treating Atrial Fibrillation (AF) using catheter ablation therapy. These approaches still require optimisation, with 41% of persistent AF patients reverting to AF 18 months after receiving pulmonary vein isolation (PVI). We aimed to use a virtual cohort of patient-specific left atrial models to compare ablation techniques targeting the anatomical, […]

Phosphatidylinositol-4,5-biphosphate (PIP2) is implicated in the regulation and modulation of the IKS channel. The channel is formed at the plasma membrane by the co-assembly of KCNQ1 and KCNE1. Patients with Congenital Long QT 1(LQT1) syndrome are predisposed to Polymorphic VT due to mutations in KCNQ1, leading to impaired channel activity. We initially transfect Human Embryonic Kidney (HEK) […]

Introduction: Antisense locked nucleic acids (LNA) GapmeRs are stable small oligonucleotides able to bind their mRNA target with high affinity and induce gene silencing. Small conductance calcium-activated potassium (SK) channels represent a novel target for rhythm control therapy in atrial fibrillation (AF). We designed specific SK3-LNA-GapmeRs, which in vitro demonstrated specific SK3-knockdown. Here, we show the effect […]

Introduction: Recently published data from a US nationwide database reported a strikingly high mortality rate of 0.46% within 30 days of a catheter ablation (CA) following atrial fibrillation (AF) procedure. We hypothesized that early mortality from AF ablation may generally be significantly higher than previously reported, and reported low mortality rates of <0.1% may be artefactual […]

Background: The autonomic nervous system may be a driver for atrial fibrillation (AF). High frequency stimulation (HFS) can locate distinct ganglionated plexus (GP) that trigger PV or atrial ectopy/AF (ET-GP), and atrioventricular (AV) dissociation causing significant bradycardia (AVD-GP). We hypothesised that ablating these sites prevent AF. Methods and results: In patients with paroxysmal AF, a […]

Background: Data on quantitative assessment of dynamic ST changes during 12-lead 24-hour ambulatory ECG in Brugada Syndrome (BrS) are limited. Aim: To investigate whether the quantitative analysis of ST changes during 12-lead 24-hour ambulatory ECG could contribute to the diagnosis and risk stratification of BrS. Methods: A total of 147 BrS patients (55% male, mean […]

Background: The 2015 Heart Rhythm Society consensus statement on remote interrogation and monitoring of cardiovascular implantable electronic devices (CIEDs) recommends that all CIEDs be checked through direct patient contact 2-12 weeks post implant. The COVID19 pandemic forced our pacemaker (PPM) service to deviate from this recommendation. We enrolled patients to remote monitoring (RM) from implant […]

Background: There is a gap in evidence regarding optimal management of patients approaching elective device replacement. We do not know what proportion of patients may benefit from a change in device prescription, whether upgrade or downgrade, as a result of changes in clinical status. To date there are no randomised controlled trials regarding changes to […]

Introduction: Covid 19-drove healthcare services to adapt in order to keep patients and staff safe from the virus. As a Cardiac Scientist (CS) manager, I was charged with developing a strategy for the Cardiac Device Follow-up service across a tertiary cardiac centre with satellite sites. We routinely performed face-to-face follow-up for 100 patients per day […]

Introduction: Clinical pharmacists are a new workforce in Primary Care Networks (PCN) and can play a critical role in realising the NHS Long Term Plan ambition, principally through secondary prevention.1 A centralised pharmacist model was implemented in the delivery of the NHSE Atrial Fibrillation (AF) patient optimisation demonstrator programme 2018-2020 aimed at preventing AF related stroke […]

Background: On the 23rd March 2020 the UK went into lockdown due to COVID-19 with vulnerable patients advised to shield at home. Patients with implantable devices still required battery changes and other interventions during this period, both clinically urgent and routine. A new strategy for identifying those needing urgent procedures was introduced at a tertiary […]

Introduction: Device follow up was routinely performed in person pre-March 2020. When the COVID pandemic caused lockdown in the UK this led to new methods of performing the 4-6-week check: utilising remote monitoring and patients sending wound images. We wanted to investigate the patient’s perspective of this experience: comparing traditional follow up vs remote only […]

Background: Atrial fibrillation (AF) is a common arrhythmia and is associated with a high risk of mortality and morbidity due to stroke, heart failure and dementia. AF is a major contributor to healthcare costs, but we need greater understanding of the main cost drivers (e.g. hospitalisations) of this increasingly prevalent arrhythmia. Such data would help […]

Introduction: Atrial fibrillation (AF) ablation is the most common arrhythmia procedure performed worldwide. The number of AF ablation procedures has increased exponentially over the past decade. This has a significant impact on healthcare resources and cost implications. The aim of this study is to evaluate the efficacy and safety of a same-day nurse led discharge […]

Introduction: The frequency of catheter ablation for atrial fibrillation (AF) has increased dramatically, stretching resources. Discharge on the same day as treatment may increase the efficiency and throughput. There are limited data regarding the safety of this strategy. Methods: We performed a retrospective analysis of consecutive patients undergoing AF ablation in a tertiary centre and […]

Background: Left atrial appendage (LAA) occlusion is offered for stroke prevention in patients with atrial fibrillation (AF) who are unsuitable for lifelong oral anticoagulation. Medium to long term follow up (FU) data for this high-risk cohort are sparse. Methods: We report 4-year FU outcomes in 73 patients (median age 78 [73-82] years; 34.2% female) who […]

Introduction: Second-generation cryoballoon ablation is safe and effective in patients with paroxysmal atrial fibrillation (AF). Previous studies have found there to be high acute rates of pulmonary vein (PV) isolation with the Artic Front Advance catheter. Reaching a nadir temperature of -40° has also been shown to achieve electrical isolation of the pulmonary veins. The […]

Introduction: Guidelines recommend providing primary care practitioners direct access to echocardiography (echo), prior to specialist cardiology input, in patients whom they suspect have heart failure, based on symptoms and raised N-Terminal pro Brain Natriuretic Peptide (NTproBNP). Early access can lead to increased detection of Heart Failure with a reduced Ejection Fraction (HFrEF). However, it is […]

Background: Prior studies have shown that a standardized pulmonary vein isolation (PVI) workflow guided by a single ablation index (AI) value and a maximum interlesion distance (ILD) between corresponding ablation tags is associated with high single-procedure 1-year clinical success. Improvement in 1-year success may translate to lower cardiovascular healthcare utilization. Purpose: To evaluate the effect […]

Background: The presence of dynamic substrate changes facilitates functional block and re-entry in ventricular tachycardia (VT) but are rarely studied as part of clinical VT mapping. We aimed to compare outcomes of ablation to dynamic functional substrate against standard institutional protocol. Methods: Thirty patients (age 67 ± 9 yrs, 27 male) with ischemic cardiomyopathy undergoing […]

Introduction: Access to the epicardial substrate is often required during scar-related ventricular tachycardia (VT) ablation, either as first approach or following a previous endocardial failure. Epicardial ablation is however far from being a widespread technique among electrophysiology labs, due to the intrinsic complications associated with this technique. In 2017, we described our initial results using […]

Background: Catheter ablation (CA) is the treatment of choice for patients with symptomatic recurrent atrioventricular reciprocating tachycardia, pre-excited atrial fibrillation and for those with asymptomatic pre-excitation with dangerous anterograde accessory pathway (AP) conduction properties.1 CA has a high acute success rate and low complication rate dependent upon AP location. Success rates at follow up are less […]

Background: As the best anthropometric surrogate of visceral adiposity, the effects of abdominal obesity on outcomes of catheter ablation in atrial fibrillation (AF) remain poorly investigated. In this study, we evaluate the effects of abdominal obesity on the long-term efficacy and safety of catheter AF ablation. Methods: We utilised the Korean National Health Insurance cohort […]

Introduction: Chronic high burden of right ventricular (RV) pacing is well known to cause deleterious effects on the left ventricular (LV) systolic function. However, there is variation in this effect with LV systolic function being maintained in some patients and worsening in others. We investigated characteristics amongst a cohort of patients with RV pacing burden […]

Introduction: Pacing-Induced Cardiomyopathy (PICM) can lead to significant morbidity, requiring treatment by device upgrade procedures. The risk of occurrence is directly related to the burden of right ventricular pacing, which can often be reduced by careful device programming. When however frequent ventricular stimulation cannot be avoided, pacing the conduction system may offer an alternative to […]

Background: Obesity is associated with pro-arrhythmic electrocardiographic (ECG) abnormalities, such as corrected QT (QTc) prolongation and increased QT dispersion (QTd), which confer a greater risk of ventricular arrhythmia and sudden cardiac death. Few studies have assessed specific measures of repolarisation (T-peak-to-T-end interval (Tpe) or the Tpe/QT, Tpe/QTc, Tpe/JT or Tpe/JTc ratios) in obesity. Owing to greater […]

Background: Uncorrected atrial septal defects (ASD) are associated with atrial arrhythmias however the bi-atrial arrhythmia substrate, and a result, rhythm management strategies, are ill-defined in this cohort. Timely ASD closure may reduce AA prevalence, but the effect of percutaneous ASD closure on AAs has not been systematically evaluated. We aimed to investigate the effects of […]

Introduction: Obesity which is characterised by excess adipose tissue (AT) has been associated with increased risk of arrhythmia. AT functions as an endocrine organ and secretes adipokines which may induce a proarrhythmic substrate. Specifically, epicardial AT (EAT) has been associated with increased arrhythmic risk and a greater proinflammatory adipokine profile than subcutaneous AT (SAT). Culture […]

Background: Freedom from AF following ablation remains at around 60% even with the addition of electrogram guided procedures alongside pulmonary vein isolation. Gap junctional (GJ) connexin proteins have been established as being deterministic in the development of atrial fibrillation (AF), therefore identifying areas of GJ abnormality (cellular uncoupling) may provide a target to guide ablation […]

Introduction: Hypertrophic cardiomyopathy (HCM) is the commonest inherited heart disease. Implantable cardioverter defibrillators (ICDs) are routinely implanted to protect against risk of sudden cardiac death (SCD) in those patients (pts) who meet criteria. Whilst the consequence of not having an ICD when needed is clear, the implantation of cardiac devices is not without short and […]

Background: Cardiac resynchronisation therapy (CRT) confers symptomatic and survival benefits in chronic heart failure with reduced ejection fraction (HFrEF). However, there remains a paucity of data on long-term performance of left ventricular pacing leads, including adverse sequelae. Methods: Adult patients receiving CRT for HFrEF between 2008 and 2014 were identified retrospectively from an outpatient electronic […]

Introduction: Not all patients respond favourably to CRT. Electrical programming may improve CRT response, but a universal programming strategy may be ineffective as patient specific factors can influence electrical timing within the heart. Moreover, there is little guidance for CRT programming, hence CRT devices are often left at suboptimal settings.1 Two emerging technologies, fusion pacing (e.g […]

Background: Cardiac Contractility Modulation therapy is a novel device-based technology, which may be used in selected heart failure patients. CCM therapy involves applying biphasic, high-voltage (≈7.5 V) and long-duration (≈20 milliseconds) electric signals to the right ventricular septal wall during the absolute myocardial refractory period, which invokes biochemical and cellular changes in the failing myocardium […]

Background: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat abnormal narrowing of the aortic valve in non-surgical candidates. Rapid ventricular pacing often facilitates optimal positioning of the TAVI valve. Traditionally, this has been Methods: The study was a retrospective service evaluation in sequential patients treated before and after the change from […]

Introduction: The Micra post-approval registry (PAR) and Micra Acute Performance regional cohort (MAP; conducted in Europe, Middle East, and Africa [EMEA]) are ongoing prospective registries designed to evaluate safety and performance of the Micra transcatheter pacing system in the post-market real-world setting. The patient profile and implant characteristics of patients undergoing Micra implant in the […]

Background: Voltage thresholds for ventricular scar definition are based on historic data collected using catheters with widely spaced bipoles. Modern multipolar mapping catheters employ smaller electrodes and interelectrode spacing that theoretically allows for mapping with increased resolution and reduced far-field electrogram (EGM) component. Despite the advancement in technology, historic cutoffs of <0.5 mV for dense […]

Introduction: The Barts Heart Centre was established in May 2015. Trends in EP procedural workflow and complications were examined as part of continuous audit. Methods: Procedural data were extracted from an internal database of all electrophysiology procedures (EP studies and ablations) performed between 1st January 2016 and 1st January 2020. Procedure reports and clinical records […]

Background: The identification of atrial fibrillation (AF) using artificial intelligence (AI), either with medically prescribed ECG monitors or non-prescription devices such as watches, is not to be taken lightly. Little focus has been placed on the cost, anxiety and potential therapeutic consequences of a false positive diagnosis. The potential value of AI in AF diagnostics is […]

Aims: Scar evaluation by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can assist ventricular tachycardia (VT) ablation, but co-registration with electro-anatomical maps (EAMs) and imaging artefact from implantable cardioverter defibrillators (ICDs) limit accuracy. We assessed the feasibility of using personalised co-registration algorithms to correlate low-voltage zones (LVZ) with optimised LGE-CMR scar imaging in patients with […]

Background: Ventricular Tachycardia (VT) mapping strategies for scar-dependent monomorphic VT have traditionally involved entrainment and pace mapping. The increasing importance of substrate mapping has emerged with several methods described to target the VT site of origin and diastolic conduction channels (CCs), such as, low amplitude ventricular activity (LAVA) potential and decrementing evoked potential (DEEP) mapping. […]

Background: Low radiofrequency (RF) powers are commonly used on the posterior wall of the left atrium (LA) for atrial fibrillation (AF) ablation to prevent oesophageal damage. Compared with higher powers, they require longer ablation durations to achieve a target lesion size index (LSI). Oesophageal heating during ablation is the result of a time-dependent process of […]

Background: The conventional route to insert cardiac implantable electronic devices (CIED) is not always possible. Devices implanted via the femoral route (F-CIED) remain an alternative option despite the advent of leadless and subcutaneous devices. However, the long-term outcomes of F-CIED, in particular complex F-CIED (implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) devices)), are not […]

Background: CRT improves prognosis in selected patients with systolic heart failure (HF). There is a paucity of data regarding longer-term outcomes in octogenarians who receive CRT. Purpose: To evaluate long-term morbidity, mortality and guideline-based HF treatment in an octogenarian cohort of CRT recipients. Methods: Retrospective analysis of 30 patients aged ≥80 years old who underwent […]

Introduction: Conduction tissue damage during cardiac surgery necessitates permanent pacemaker (PPM) implantation in approximately 4% of patients. Studies have demonstrated late recovery of conduction in 16-42% of patients, but the time course is unknown. It is also unclear whether the presence of an underlying rhythm (ULR) at the time of implant predicts late recovery. We […]

Introduction: Implantable Loop Recorder (ILR) procedures are now done by allied health professionals in outpatients; however, it is expensive with a single device costing £3,878. This is in spite of limited evidence regarding the diagnostic utility of ILR so we performed a detailed examination of its performance in the real-world. Methods: The detailed clinical records […]

Introduction: The ELECTRa registry indicated lower success rates and higher complication rates in low volume centres performing <30 transvenous lead extractions (TLE) per year. The UK lead extraction group met in 2018 to produce standards for lead extraction classifying procedures as low, medium or high risk. It recommended having a cardiac surgical team present for […]

Introduction: Catheter ablation is the treatment of choice for accessory pathways (APs). Currently, it is unclear whether the use of electro-anatomical mapping (EAM) systems results in better outcomes of radiofrequency (RF) AP ablations. To help answer this question we present a retrospective observational analysis of a modern single centre cohort. Methods: Clinical and electrophysiological data […]

Our trust recently replaced our defibrillators with the Zoll R Series Plus. This has a rectilinear biphasic waveform. Compared with traditional energies used with monophasic waveforms, the Zoll literature recommends lower energies for synchronised DC cardioversion of arrhythmias, starting at 75J (75J, 120J, 150J, 200J), based upon the results of clinical trials; the recommendations are to […]

Background: Elderly patients with atrial fibrillation (AF) may present with acute thromboembolic events, often in combination with high bleeding risk. There are limited data on such high-risk patients from China, as well as the benefits and harms of oral anticoagulants (OAC). Objective: To investigate the impacts on death, thromboembolism (TE), and acute coronary artery syndrome […]

Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related conditions that are both associated with a significant increase in major adverse cardiovascular events (MACE). The objectives of this study were to evaluate the impact of CKD on MACE in patients with AF and the predictive value of the 2MACE score. Methods: We […]

Background: Pneumothorax is an important early complication of cardiac pacemaker implantation however little is known about the modern incidence and outcomes. Current guidelines do not distinguish between causes of iatrogenic pneumothorax and so procedure specific data is needed to help guide cardiologists and respiratory clinicians alike. Method: Retrospective analysis of patients who developed a pneumothorax […]

Background: Delivery of cardiac resynchronisation therapy (CRT) using conventional systems can be limited by sub-optimal venous anatomy. The WiSE-CRT (EBR Systems, Sunnyvale, CA, USA) has been approved for use with existing right-sided systems. We report the case of a CRT recipient with a left ventricular (LV) lead in the middle cardiac vein (MCV) and who subsequently […]

Background: Pneumothorax is an important early complication of cardiac pacemaker implantation however little is known about the modern incidence and outcomes. Current guidelines do not distinguish between causes of iatrogenic pneumothorax and so procedure specific data is needed to help guide cardiologists and respiratory clinicians alike Method: Retrospective analysis of patients who developed a pneumothorax […]

Introduction: Atrial fibrillation (AF) disproportionately affects older people and the incidence of previously undiagnosed AF in long-term care (LTC) residents is high (approximately 14%). Prescription of oral anticoagulation (OAC) is integral to stroke prevention for AF but there is evidence of under-treatment in older people in LTC, likely due to clinicians’ concerns of iatrogenic harm […]

Background: Atrial fibrillation (AF) is the most common sustained heart arrhythmia and a major preventable cause of stroke, heart failure and dementia. AF already accounts for a significant amount of NHS funding, and over the coming years is highly likely to impose a growing cost on NHS budgets and the wider UK health care system. […]

Background: The presence of left atrial appendage (LAA) thrombus precludes endocardial LAA occlusion, but there are scant data on the management of these very high-risk atrial fibrillation (AF) patients. Our aim was to evaluate the efficacy and safety of short-term apixaban treatment for LAA thrombi detected prior to planned LAA occlusion in patients with contraindications […]

Introduction: Cryoballoon is an effective treatment for atrial fibrillation and is conventionally guided by fluoroscopy with contrast venography to confirm pulmonary vein (PV) occlusion.  The Kodex-EDP system (EDP Solutions, Philips) is a novel non-contact navigation and mapping system using the unique dielectric properties of biological tissue.  The system measures the varying potentials induced on standard […]

Introduction: Successful pulmonary vein isolation (PVI) requires the creation of continuous and durable transmural ablation lesions encircling the pulmonary veins (PV). During contact force (CF) radiofrequency (RF) delivery, catheter stability is clearly an important determinant of lesion creation. However, the precise extent to which cardiac and respiratory motion influence site-specific RF effects is presently unknown. […]

Introduction: Catheter ablation has been shown to be safe and effective in reducing atrial fibrillation (AF) burden and symptoms. However, there is limited long term data using continuous monitoring to assess the actual success of catheter ablation. This study assessed the long-term outcome of AF ablation in patients with implantable cardiac devices allowing beat-to-beat analysis […]

Introduction: Atrial fibrillation (AF) is a common arrhythmia in the intensive care setting. Observational studies of patients who develop new-onset AF during critical illness have demonstrated an increased risk of recurrence and increased morbidity and mortality, in both the short and long term, related to thromboembolic stroke and heart failure. Patients with new-onset AF on the […]

Aims: Cardiac perforations caused by pacemaker and implantable-cardioverter defibrillator (ICD) leads are serious events. Due in part to their infrequency, management options and outcomes are unclear. Methods: A single-centre retrospective study was conducted at a high-volume tertiary centre to identify patients in whom cardiac perforation occurred due to lead implantation or intervention. The search included […]

Introduction: Surgical “Maze” was first performed in 1987, although techniques have evolved since then. The most recent 2017 Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation (AF) recommends concomitant ablation for symptomatic AF alongside other cardiac surgery (Class I/IIa) and standalone ablation (Class IIa) for persistent and long-standing persistent AF. We sought […]

Introduction: Transvenous lead extraction (TLE) of cardiac implantable devices has been established as a safe and effective practice. Despite the advancement of methods and techniques, there is still a wide variation amongst centres. We present our own experience from 10 years of TLE procedures at the University Hospital of Birmingham. Methods: We retrospectively analysed the […]

Background: Remote monitoring (RM) for implanted cardiac devices has been increasing nationally. At a large tertiary cardiac centre with more than 5,000 patients enrolled on RM, a significant problem is disconnected RM. Disconnected RM can be detrimental, resulting in undetected arrhythmia, battery depletion or lead failure, all of which can result in deterioration in health or […]

Background: The IMPACT study established the role of esophageal temperature control in preventing esophageal injury during radiofrequency (RF) ablation for atrial fibrillation (AF). The procedures were performed using Ablation Index (AI) technology. Objective: To determine the effect of esophageal cooling on the formation of RF lesions and the characteristics of RF lesions associated with esophageal […]

Background: Reliable creation of durable transmural lesions is the key for successful catheter ablation procedures. Tissue impedance drop during radiofrequency delivery has been traditionally used as an indicator of lesion formation and size. More recently, Lesion Size Index (LSI) has become available in clinical settings as marker of lesion formation. In animal studies LSI correlates […]

Introduction: Current guidelines indicate that pacing methods that maintain physiologic ventricular activation (biventricular pacing or His-bundle pacing) should be chosen over right ventricular pacing among patients with EF 36-50% who are expected to require ventricular pacing >40% of the time. There are no guidelines to help predict which patients will receive a high burden of […]

Background: Cardiac resynchronization therapy (CRT) with MultiPoint Pacing (MPP) can improve electrical resynchronization of the left ventricle (LV) compared to conventional CRT. The SyncAV™ algorithm dynamically combines intrinsic atrioventricular (AV) conduction with pacing, improving electrical synchrony. The study objectives included assessment of the change in electrical synchrony with SyncAV and MPP, using non-invasive mapping with electrocardiographic […]

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in adult population with increased prevalence particularly in elderly. AV node ablation and pacemaker insertion (ablate and pace) is a widely accepted strategy for heart rate control in patients with symptomatic AF when rhythm control strategy fails or is deemed inappropriate. Patients usually receive a […]

Introduction: Complex atrial tachycardias (AT) are frequently encountered in patients after left atrial catheter abaltions. We aimed to evaluate the HD grid technology for high-resolution mapping of these challenging arrhythmias. Methods: Prospective observational study including consecutive patients undergoing de novo or redo catheter ablation for AT. Electroanatomical mapping during AT was performed using the Advisor […]

Background: DC cardioversion (DCCV) is commonly used to assess the symptomatic benefit of sinus rhythm (SR) when deciding whether to offer further rhythm control therapies such as AF ablation. However, acute failure of DCCV to achieve SR and early reversion to AF are common. This makes assessment of the symptomatic benefit of SR very difficult and […]

Introduction: It is widely accepted that the methods for optimising CRT vary in clinical practice. Electrical optimisation of CRT is becoming more popular with QRS narrowing and favourable ECG characteristics emerging as markers of success (1). The aim of this survey was to gauge current working practices of CRT within the UK and Ireland, with […]

Introduction: Atrial fibrillation (AF) is the most frequently encountered sustained arrhythmia. Electrical cardioversion is incompletely effective yet requires sedation and in-hospital monitoring. A “pill-in-the-pocket” Class IC anti-arrhythmic drug approach is often successful in restoring sinus rhythm but is limited by contraindications and safety concerns. This systematic review assessed the efficacy of single, high-dose oral amiodarone […]

Introduction: Accurate measurement of QRS duration is crucial in CRT to identify eligible patients. Furthermore, QRS narrowing is emerging as a key marker of successful CRT with a growing evidence base of improved response and long-term survival. Despite this, there is no agreed technique to measure QRS duration and different methods are used in clinical […]

Background: Leadless pacemakers were developed as an alternative pacing modality in patients who cannot undergo transvenous pacing. Early data suggested a good safety and efficacy profile, however real-world data is limited. Purpose: To report our single tertiary centre experience in leadless pacemaker implantation. Methodology: All consecutive patients who underwent leadless pacemaker implantation at Liverpool Heart […]

Introduction: Coronavirus disease 2019 (COVID-19) has presented unparalled challenges to the management of patients with cardiac implantable electronic devices (CIED). The need to limit exposure to healthcare staff and patients has increased reliance on remote monitoring (RM). This study summarises the change in workload of a device clinic in a Tertiary centre required to completely […]

Introduction: Radiofrequency catheter ablation therapy for atrial fibrillation (AF) patients ranges from pulmonary vein isolation (PVI) to more extensive ablation strategies consisting of PVI together with multiple additional lesions. AF patients represent a diverse population requiring a range of different treatment approaches; no single approach is right for all patients, with many patients responding to […]

Background/Introduction: The role of pulmonary veins (PVs) in triggering Atrial Fibrillation (AF) is well established. The diameter and morphological features of the PVs in relationship to AF have been studied in animal and human models. The PV sleeve length has not been characterised in vivo in patients undergoing AF ablation. We hypothesised that left atrial […]

Background/Objectives: Pacemakers detect subclinical atrial fibrillation that may be a predictor of risk of stroke. Evidence for the efficacy of algorithms for prevention and treatment of atrial fibrillation is controversial. The aim is to systematically review current evidence on the efficacy of atrial anti-tachycardia pacing (a-ATP) and atrial prevention (APP) algorithms in the reduction of […]

Background: MultiPoint Pacing (MPP) CRT may improve electrical resynchronization of the left ventricle (LV). Optimization with SyncAV dynamically combines intrinsic atrioventricular (AV) conduction and pacing. Objective: To assess regions of fixed and functional conduction block in patients with LBBB and the impact of MPP & SyncAV, evaluated by electrocardiographic imaging (ECGi). Methods: Patients in sinus […]

Introduction: Ventricular tachycardia (VT) storm is a medical emergency characterised by clustered episodes of ventricular arrhythmia seen in patients with structurally abnormal hearts. Effective management of this complex, life-threatening phenomenon requires an understanding of arrhythmia mechanisms and the multi-modality treatment options. Although ablation can be life-saving, it is associated with significant risk in this sick […]

Introduction: Retrospective studies have demonstrated catheter ablation can reduce premature ventricular complex (PVC) burden. However, the association between objective and patient reported outcomes is unclear, with reporting on the latter particularly limited. The aim of this study was to measure and correlate objective and subjective outcomes of patients undergoing PVC ablation for symptomatic benefit. Methods: […]

Introduction: Cardiac resynchronisation therapy (CRT) is used in select heart failure patients1,2 to improve quality of life and mortality.3-5 Some patients are reported to experience no benefit; so called ‘non-responders’. This retrospective service evaluation aimed to determine the CRT response rate at Rotherham General Hospital (RGH), exploring which variables may be influencing response. Methods: Medical […]

Summary: Arrhythmias affect more than two million people every year in the UK (NHS, 2018). Atrial Fibrillation (AF) is the most common cardiac arrhythmia, with over 1.5 million people diagnosed, however approximately 500,000 individuals remain undiagnosed, and at risk of suffering a life-threatening, debilitating AF-related stroke. It is paramount that these individuals are anticoagulated effectively […]

Introduction: COVID-19 (C19) is a novel coronavirus characterised as a severe acute respiratory syndrome. The UK government advised the cancellation of elective procedures in March 2020 to reduce virus transmission and to increase intensive care capacity. Several risk factors, including cardiovascular disease (CVD), have been shown to increase vulnerability to C19. In light of new […]

Introduction: Hypertrophic cardiomyopathy (HCM) is the commonest inherited heart disease. Implantable cardioverter defibrillators (ICDs) are routinely implanted to protect against risk of sudden cardiac death (SCD) in those patients who meet criteria. Whilst the consequence of not having an ICD when needed is clear, the implantation of cardiac devices is not without short and long-term […]

Background: Cardiac contractility modulation (CCM)  is a new device based technology which  applies non-excitatory electrical stimuli during the absolute refractory period, which enhances the strength of cardiac contractions. Increasing evidence exists suggesting that CCM improves symptoms in heart failure if various selection criteria are fulfilled. It is unknown how many people might benefit from this therapy. The aim […]

Introduction: Implantable cardioverter-defibrillators (ICDs) are conventionally programmed to deliver maximum energy shocks for the treatment of ventricular arrhythmias. DeFT Response™ is an algorithm available in Abbott ICDs that reduces the typical shock duration from 10.0 ms to 7.5-8.0 ms. This technology has been shown to reduce the risk of pro-arrhythmia, and has been successfully used […]

Background: Electrical cardioversion (ECV) is frequently performed for persistent atrial fibrillation (AF). Although several large trials have suggested that rate control in AF may be non-inferior to rhythm-based strategies, individual patients may have better outcomes in terms of quality of life if sinus rhythm (SR) is achieved and maintained. This real-world, prospective observational study aimed […]

Background: Applying conventional approaches of ‘window of interest’ setting and local activation time (LAT) assignment to map atrial fibrillation (AF) is difficult. We overcame this problem using an algorithm to time-shift for best match of adjacent electrograms, using these relative differences in timing to create wavefront activation maps. Understanding AF also requires the interpretation of […]

Introduction: In February 2020 the British Heart Rhythm Society (BHRS) published updated standards for the follow up of cardiac rhythm devices which included new standards for report writing following device interrogations. Creation and adherence to these guidelines can provide structured device reports to facilitate the safe delivery of high-quality patient care. These guidelines were used […]

Introduction: Long QT Syndrome type 1 (LQT1) is caused by mutations in KCNQ1. KCNQ1 co-assembles with KCNE1 to underlie the slow delayed rectifier potassium current (IKs). The relative contribution of IKs to ventricular repolarisation is thought to be greater during sympathetic activation. Beta-adrenergic receptor stimulation leads to activation of Protein Kinase A (PKA) and subsequent phosphorylation of […]

Introduction: The Micra TPS, a leadless single-chamber ventricular pacemaker, is increasingly preferred over the transvenous system. Its significantly smaller profile and fewer reported adverse effects, without compromising the pacing efficacy, makes it an innovative pacing device. We report the first sequential 75 Micra insertion cases in Northampton General Hospital (NGH) and 6 months post insertion […]

Background: Cardiac centres are facing increasing demand for elective AF ablation, which has conventionally required overnight admission due to potential procedural complications. Routine care has included trans-thoracic echocardiography (TTE) one day after ablation to exclude procedure-related pericardial effusion prior to discharge. Local audit suggested this did not detect significant new effusion compared to on table […]

Introduction: There is limited experience of ultrasound (US) guided axillary vein access for cardiac electronic device implantation in the United Kingdom. We investigated the safety, efficacy, learning curve, and radiation exposure of US-guided axillary vein access. Methods: US-guided axillary vein access was attempted in consecutive patients requiring cardiac device implantation between June 2018 and November […]

Background: Covid-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has resulted in a significant number of increased hospitalizations and excess deaths worldwide. Though reports regarding myocardial injury/inflammation relating to Covid-19 are known, little is known about larger scale effects of the virus on cardiac arrhythmias. Additionally, it is […]

Introduction: Extended cardiac monitoring increases atrial fibrillation (AF) detection after stroke but is unlikely to be available for all patients due to cost and may not be necessary for all patients. Identifying patients at higher or lower risk of AF detection after stroke may allow the duration of cardiac monitoring to be decided on a […]

Background: We evaluated the effect of adenosine upon mechanisms sustaining persistent AF through analysis of contact electrograms and ECGI mapping. Methods: Persistent AF patients undergoing catheter ablation were included. ECGI maps and cycle length (CL) measurements were recorded in the left and right atrial appendages and repeated following adenosine administration. Potential drivers (PDs) were defined […]

Background: Heart rhythm emergencies require specialist expertise from cardiologists and cardiologists who specialise in heart rhythm disorders. Currently access to such services across Liverpool and the wider UK is insufficient. This has led to a number of high-profile adverse events where in some cases have resulted in avoidable morbidity and mortality. In particular, patients presenting […]

Introduction: In addition to symptomatic improvement, catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular systolic function and functional capacity when performed in selected patients with heart failure. The impact of CA on long term outcome in the heart failure cohort is poorly understood. Furthermore, the impact of early ablation for all patients versus […]

Background: Electrogram (EGM)-guided catheter ablation for atrial fibrillation (AF) has poor long-term outcomes and requires further research. Although clinical studies are considered the gold standard, they are restricted by low numbers of volunteers, safety of procedures, and ethical considerations. Small animal models lack clinical translatability due to their lack of similarity to human hearts. Analysis of […]

Introduction: Clinical pharmacists are a new workforce in Primary Care Networks (PCN) and can play a critical role in realising the NHS Long Term Plan ambition, principally through secondary prevention.1 A centralised pharmacist model was implemented in the delivery of the NHSE Atrial Fibrillation (AF) patient optimisation demonstrator programme 2018-2020 aimed at preventing AF related stroke […]

Introduction: Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. We hypothesised that ablation index (AI) may further our understanding of energy delivery across the CTI. Methods: 38 patients underwent CTI ablation at two cardiothoracic hospitals. Operators delivered 682 lesions in total with a target AI of 600 Wgs. Ablation parameters were recorded every […]

Introduction: Shockable ventricular arrhythmias account for one third of all cardiovascular deaths worldwide. Several randomised control trials have demonstrated ICD and CRT-D devices reduce mortality however the primary concern for both patient and physician remain inappropriate shocks. Aside from the pain and psychological impact, inappropriate shocks have also been independently associated with mortality in patient’s […]

Introduction: Emergency out-of-hours destination cardiovascular implantable device (CIDs) insertion has become established as preferable to temporary pacing waiting in anticipation of a working hours procedure slot. A frequent conundrum is the patient who may benefit from a more complex CID such as implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT), but who requires immediate […]