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Charlotte, NC, United States

Aung H.,Mayo Medical School | Espinosa R.E.,Mayo Medical School | Powell B.D.,Sanger Heart & Vascular Institute | Mcleod C.J.,Mayo Medical School
PACE - Pacing and Clinical Electrophysiology

Although rare, Chiari networks are elaborate embryological remnants that can pose distinct challenges for catheter and pacing lead manipulation within the right atrium. Device entrapment may require open thoracotomy for removal, with significant morbidity. We report an unusual case of pacing lead entanglement within this structure, followed by prompt intracardiac echocardiographic identification and laser sheath removal. ©2016 Wiley Periodicals, Inc. Source

Steinberg B.A.,Duke University | Steinberg B.A.,Duke Clinical Research Institute | Wehrenberg S.,Boston Scientific Inc. | Jackson K.P.,Duke University | And 9 more authors.
Journal of Interventional Cardiac Electrophysiology

Purpose: Cardiac resynchronization therapy (CRT) improves outcomes in patients with heart failure, yet response rates are variable. We sought to determine whether physician-specified CRT programming was associated with improved outcomes. Methods: Using data from the ALTITUDE remote follow-up cohort, we examined sensed atrioventricular (AV) and ventricular-to-ventricular (VV) programming and their associated outcomes in patients with de novo CRT from 2009–2010. Outcomes included arrhythmia burden, left ventricular (LV) pacing, and all-cause mortality at 4 years. Results: We identified 5709 patients with de novo CRT devices; at the time of implant, 34 % (n = 1959) had entirely nominal settings programmed, 40 % (n = 2294) had only AV timing adjusted, 11 % (n = 604) had only VV timing adjusted, and 15 % (n = 852) had both AV and VV adjusted from nominal programming. Suboptimal LV pacing (<95 %) during follow-up was similar across groups; however, the proportion with atrial fibrillation (AF) burden >5 % was lowest in the AV-only adjusted group (17.9 %) and highest in the nominal (27.7 %) and VV-only adjusted (28.3 %) groups. Adjusted all-cause mortality was significantly higher among patients with non-nominal AV delay >120 vs. <120 ms (adjusted heart rate (HR) 1.28, p = 0.008) but similar when using the 180-ms cutoff (adjusted HR 1.13 for >180 vs. ≤180 ms, p = 0.4). Conclusions: Nominal settings for de novo CRT implants are frequently altered, most commonly the AV delay. There is wide variability in reprogramming. Patients with nominal or AV-only adjustments appear to have favorable pacing and arrhythmia outcomes. Sensed AV delays less than 120 ms are associated with improved survival. © 2015, Springer Science+Business Media New York. Source

Fargnoli A.S.,Sanger Heart & Vascular Institute | Fargnoli A.S.,University of Pennsylvania | Katz M.G.,Sanger Heart & Vascular Institute | Williams R.D.,Sanger Heart & Vascular Institute | And 2 more authors.
Journal of Cardiovascular Translational Research

This study evaluates needleless liquid jet method and compares it with three common experimental methods: (1) intramuscular injection (IM), (2) left ventricular intracavitary infusion (LVIC), and (3) LV intracavitary infusion with aortic and pulmonary occlusion (LVIC-OCCL). Two protocols were executed. First (n = 24 rats), retention of dye was evaluated 10 min after delivery in an acute model. The acute study revealed the following: significantly higher dye retention (expressed as % myocardial cross-section area) in the left ventricle in both the liquid jet [52 ± 4] % and LVIC-OCCL [58 ± 3] % groups p < 0.05 compared with IM [31 ± 8] % and LVIC [35 ± 4] %. In the second (n = 16 rats), each animal received adeno-associated virus encoding green fluorescent protein (AAV.EGFP) at a single dose with terminal 6-week endpoint. In the second phase with AAV.EGFP at 6 weeks post-delivery, a similar trend was found with liquid jet [54 ± 5] % and LVIC-OCCL [60 ± 8] % featuring more LV expression as compared with IM [30 ± 9] % and LVIC [23 ± 9] %. The IM and LVIC-OCCL cross sections revealed myocardial fibrosis. With more detailed development in future model studies, needleless liquid jet delivery offers a promising strategy to improve direct myocardial delivery. © 2014, Springer Science+Business Media New York. Source

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