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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A second procedure for recurrent atrial fibrillation (AF) may be associated with the need for a different positioning of the puncture site and may increase the difficulty and complications. This study investigated whether the transseptal puncture site changed and whether the difficult punctures increased in the patients who received a repeat ablation procedure for recurrent AF. ⋯ The incidence of a difficult puncture was higher in the second procedure compared with the first procedure. The transseptal puncture site moved higher in the second procedure. Chronic scarring over the previous transseptal site is a reasonable hypothesis to explain the observations. The difficult punctures experienced during the second procedure might be overcome by changing the needle curve from a small curve to a large curve design.
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In post-operative setting after cardiac surgery, the choice of the optimal ventricular pacing site remains an issue, particularly in patients with ischaemic cardiomyopathy. We aimed to investigate the impact of the left ventricular (LV) pacing site in an animal model of incremental myocardial ischaemia. ⋯ Pacing within an ischaemic area has detrimental impact on acute global and regional LV function. More studies are needed to assess the impact of multi-LV pacing in chronic ischaemic conditions.
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Inefficacy of implantable cardioverter/defibrillator (ICD) shocks or inappropriate shocks in ICD patients may occur due to mechanical or technical failure of the device. In our unusual case of ICD defibrillation failure, faulty insertion and configuration of the defibrillation lead in the header port resulted in ineffective shock therapies and a non-determinable defibrillation threshold. In cases of successless defibrillations during or after ICD implantation, this problem should be considered.
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Cardiac remote telemetry (CR-TEL) is in wide use in cardiac units, but its diagnostic value in the setting of unexplained syncope is unknown. ⋯ Cardiac remote telemetry appears to be a useful tool in the management of patients with unexplained syncope, especially in those older and presenting heart failure on admission.