Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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Multicenter Study Clinical Trial
Safety, efficacy, and performance of new discrimination algorithms to reduce inappropriate and unnecessary shocks: the PainFree SST clinical study design.
Implantable cardioverter defibrillator (ICD) shock therapy improves survival of patients at risk for sudden cardiac death. The high sensitivity of ICDs to detect tachycardia events is accompanied by reduced specificity resulting in inappropriate and unnecessary shocks. Up to 30% of ICD patients may experience inappropriate shocks, which are most commonly caused by lead noise, oversensing of T-waves, and supraventricular tachycardias. The new Protecta ICD and cardiac resynchronization therapy devices have been designed to minimize inappropriate and unnecessary shocks through novel SmartShock(TM) technology algorithms targeting these causes. ⋯ Inappropriate and unnecessary shock delivery remains a significant clinical issue for patients receiving device therapies, which has considerable consequences for patients and the healthcare system. The PainFree SST study will investigate the ability of new algorithms to reduce inappropriate shocks. Results from this study are expected in mid-2013.
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Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture. This study aims to investigate the incidence, echocardiographic characteristics, and clinical outcome of persistent IASD after pulmonary vein isolation (PVI) by cryoballoon catheter delivered by a large transseptal sheath. ⋯ Persistent IASD is a common complication after PVI by cryoballoon catheter. Only left-to-right, but not right-to-left, interatrial shunting occurred as a result of the IASD. There was no clinical occurrence of paradoxical embolism. Patients should be screened for this complication after cryoballoon procedures and regular reassessment with echocardiographic or other techniques should be performed for monitoring.
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Coronary sinus (CS) lead placement for transvenous cardiac resynchronization therapy (CRT) even combined with transseptal left ventricular (LV) endocardial implantation from a superior approach still does not have 100% success rate. The aim of this study was to assess the feasibility of a femoral transseptal endocardial LV approach pacing in patients in whom a transvenous CS or a transseptal LV endocardial implantation with a superior approach had failed. We report our first experience with LV endocardial lead placement for CRT with a femoral transseptal technique followed by intravascular pull-through to the pectoral location. ⋯ This technique for LV endocardial lead implantation is an alternative for failed CS and superior transseptal attempts using standard techniques and equipment. It is also applicable for pacing sites that are more easily reached from a femoral approach.
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Interference between pacemakers or implantable cardioverter-defibrillators (ICDs) and electromagnetic fields are of great concern due to the potential harmful influence on the function of the device. We report a case of intermittent, erratic behaviour of an ICD secondary to electromagnetic interference (EMI) caused by small magnets that were incorporated into the patient's clothing.