Longer-term outcomes of patients post transvenous lead extraction (TLE) are poorly understood in patients with cardiac resynchronization therapy (CRT) devices.

A propensity score (PS)-matched analysis evaluating outcomes post TLE in CRT and non-CRT populations was performed.

Data from consecutive patients undergoing TLE between 2000 and 2019 were prospectively collected. Patients surviving to discharge and reimplanted with the same device were included. The cohort was split depending on presence of CRT device. Associations with all-cause mortality and hospitalization were assessed by Kaplan-Meier estimates. An exploratory endpoint was evaluated whether early (<7 days) or late (>7 days) reimplantation was associated with poorer outcomes.

Of 1005 patients included, 285 (25%) had a CRT device. Median follow-up was 57.00 [27.00-93.00] months, age at explant was 67.7 ± 12.1 years, 83.3% were male, and 54.4% had an infective indication for TLE. PS was calculated using 43 baseline characteristics. Afteerved in a non-CRT population, suggesting prolonged periods without biventricular pacing should be avoided.

Quadripolar left ventricular (LV) leads are capable of sensing and pacing the left ventricle from 4 different electrodes, which may potentially improve patient response to cardiac resynchronization therapy (CRT).

We measured 3 different time intervals right ventricular (RV)-sensed to LV-sensed during intrinsic rhythm (RVs-LVs), RV-paced to LV-sensed (RVp-LVs), and LV-paced to LV-sensed (LVp-LVs, between distal [LV1] and proximal pole on a quadripolar LV lead), and assessed their association with CRT response in terms of LV end-systolic volume (LVESV) and a composite benefit index (CBI) comprising LVESV, LV ejection fraction (LVEF), brain natriuretic peptide level, and NYHA class.

A CRT-defibrillator system with quadripolar LV lead was implanted in 196 patients (mean age 69 years, mean LVEF 30%, left bundle-branch block [LBBB] 58%). Conduction intervals were measured before hospital discharge. At baseline and 7-month follow-up, echocardiographic and other components of CBI were determined.

The mean RVs-LV1s, RVp-LV1s, and LVp-LVs delays were 68 ± 38 ms, 132 ± 34 ms, and 99 ± 31 ms, respectively. From baseline to 7 months, LVESV decreased by 17.3% ± 28.6%. The RVs-LV1s interval correlated stronger with CBI (R

= 0.12,

< .00001) than with LVESV change (R

= 0.05,

= .006). In contrast, RVp-LV1s did not correlate and LVp-LVs correlated only weakly with CRT response. The subgroup of patients (44%) with LBBB and RVs-LV1s above the lower quartile (≥34 ms) showed the greatest response to CRT.

The RVs-LVs interval during intrinsic rhythm is relevant for CRT success, whereas RVp-LVs and LVp-LVs intervals did not predict CRT response.

The RVs-LVs interval during intrinsic rhythm is relevant for CRT success, whereas RVp-LVs and LVp-LVs intervals did not predict CRT response.

The right and left pulmonary artery branches (RPA, LPA) overlie inaccessible left atrial (LA) epicardium, containing the Bachmann bundle (BB), that participate in arrhythmia pathogenesis and offer an opportunity for natural surface epicardial mapping (NSEM).

We sought to assess the feasibility of NSEM of BB and LA roof arrhythmias.

Electrogram recording, pacing, and ablation was performed in 2 swine. Subsequently, NSEM and pacing from the RPA and LPA was performed in 11 consecutive patients undergoing ablation of atrial fibrillation or flutter. Pacing entrainment and ablation of LA epicardium, from the pulmonary artery (PA), was performed in cases of atypical flutter.

Swine specimens revealed no vascular disruption and LA epicardial lesions up to 7 mm in diameter and 3 mm in depth. In clinical cases, RPA mapping was performed in 11 (100%) and LPA mapping in 6 (55%) patients. Simultaneous leftward activation of the BB followed by rightward activation of the opposing LA endocardium was recorded during crista pacing. Right and left PA median signal amplitudes were 0.71 mV and 0.30 mV, respectively. Endocardial LA median distance was 9 mm to the RPA and 15.6 mm to the LPA and LA capture was successful in 7 of 8 (88%). In cases of atypical flutter, entrainment was successful in 3 of 3 (100%) and ablation was performed.

PA NSEM can enable safe recording and entrainment of the BB, providing otherwise inaccessible epicaridal arrhythmia measurements. The safety and efficacy of ablation from the PA requires further study.

PA NSEM can enable safe recording and entrainment of the BB, providing otherwise inaccessible epicaridal arrhythmia measurements. The safety and efficacy of ablation from the PA requires further study.

Esophageal injury (EI) remains a concern when performing pulmonary vein isolation (PVI) using the high-power short-duration (HPSD) technique.

We aim to indicate that high esophageal temperature during HPSD PVI does not correlate with positive esophageal endoscopy (EGD) findings.

A retrospective observational study was performed on 43 patients undergoing PVI using HPSD (50 W for 6-7 seconds per lesion) at Tulane Medical Center from July 2020 to January 2021. Esophageal temperature was monitored throughout the procedure using a temperature probe and patients underwent EGD the following day. Small ulcers, nonbleeding erosions, erythema, and/or esophagitis were considered positive EGD findings.

Mean age was 64.9 years; 46.5% of the patients were female. Eleven patients had positive EGD findings (group 1) and 32 patients had normal EGD (group 2). There was no statistical difference in mean esophageal peak temperature between group 1 and group 2 (43.9°C ± 2.9°C and 42.5°C ± 2.3°C, respectively,

=.17). There was no association between positive EGD results and esophageal temperature during PVI. Mean baseline esophageal temperature was similar in both groups (36.1°C,

= .78). Average contact force (

= .53), ablation time (

= .67), age (

= .3096), sex (

= .4), body mass index (

= .14), and other comorbidities did not correlate with positive endoscopy results. We found positive correlation between the distance of the left atrium (LA) to esophagus and positive EGD (

= .0001).

EI during HPSD PVI does not correlate to esophageal temperature changes during ablation. However, esophageal injury does correlate to a shorter proximity of the esophagus to the LA.

EI during HPSD PVI does not correlate to esophageal temperature changes during ablation. However, esophageal injury does correlate to a shorter proximity of the esophagus to the LA.

Pulsed field ablation (PFA) is a promising technology based on electroporation. It is unclear if different catheter designs imply efficacy and safety differences.

To vary geometry, blood exposure, and energy delivery methods among 3 representative catheter designs, and then compare lesion transmurality, extra-atrial safety, and embolic risk.

A computed tomography-derived computer model was used. Balloon, flexible-circuit splined, and circular catheters were placed near the left pulmonary veins. Four energy delivery methods were tested multi-unipolar, sequential unipolar, interlaced, and wide interlaced. A posterior wall target was defined. Efficacy was defined as percent target with >600 V/cm. Safety aspects included aortic/esophageal electroporation damage and a bubble-generation surrogate (electrode current density), with 90% transmurality requirement.

Balloon catheters had highest efficacy, followed by flexible polymer splined and circular catheters. On energy delivery methods, the multi-unipolaipolar energy delivery methods have a higher risk of electroporating aortic and esophageal tissue, when compared to bipolar interlaced methods. Considering embolic risks, circular catheters had the highest bubble-generating potential. A balloon or flexible circuit splined system with a wide interlaced delivery method showed the best balance in efficacy and safety.

Clinicians rarely scrutinize the full disclosure of a myriad of FDA-approved long-term rhythm monitors, and they relyon manufacturers to detect and report relevant rhythm abnormalities.

The objective of this study is to compare the diagnostic accuracy between mobile cardiac telemetry (MCT), which uses an algorithm-based detection strategy, and continuous long-term electrocardiography (LT-ECG) monitoring, which uses a human-based detection strategy.

In an outpatient arrhythmia clinic, we enrolled 50 sequential patients ordered to wear a 30-day MCT, to simultaneously wear a continuous LT-ECG monitor. LL37 Periods of concomitant wear of both devices were examined using the associated report, which was over-read by 2 electrophysiologists.

Forty-six of 50 patients wore both monitors simultaneously for an average of 10.3 ± 4.4 days (range 1.2-14.8 days). During simultaneous recording, patients were more often diagnosed with arrhythmia by LT-ECG compared to MCT (23/46 vs 11/46),

=.018. Similarly, more arrhythmia episodes were detected during simultaneous recording with the LT-ECG compared to MCT (61 vs 19),

< .001. This trend remained consistent across arrhythmia subtypes, including ventricular tachycardia (13 patients by LT-ECG vs 7 by MCT), atrioventricular (AV) block (3 patients by LT-ECG vs 0 by MCT), and AV node reentrant tachycardia (2 patients by LT-ECG vs 0 by MCT). Atrial fibrillation (AF) was documented by both monitors in 2 patients; however, LT-ECG monitoring captured 4 additional AF episodes missed by MCT.

In a time-controlled, paired analysis of 2 disparate rhythm monitors worn simultaneously, human-dependent LT-ECG arrhythmia detection significantly outperformed algorithm-based MCT arrhythmia detection.

In a time-controlled, paired analysis of 2 disparate rhythm monitors worn simultaneously, human-dependent LT-ECG arrhythmia detection significantly outperformed algorithm-based MCT arrhythmia detection.Glucocorticoids (GCs) regulate a myriad of physiological systems, such as the immune and nervous systems. Systemic GC levels in blood are often measured as an indicator of local GC levels in target organs. However, several extra-adrenal organs can produce and metabolize GCs locally. More sensitive and specific methods for GC analysis (i.e., mass spectrometry) allow measurement of local GC levels in small tissue samples with low GC concentrations. Consequently, is it now apparent that systemic GC levels often do not reflect local GC levels. Here, we review the use of systemic GC measurements in clinical and research settings, discuss instances where systemic GC levels do not reflect local GC levels, and present evidence that local GC levels provide useful insights, with a focus on local GC production in the thymus (immunosteroids) and brain (neurosteroids). Lastly, we suggest key areas for further research, such as the roles of immunosteroids and neurosteroids in neonatal programming and the potential clinical relevance of local GC modulators.Cancer represents a novel homeostatic challenge to the host system. How the brain senses and responds to changes in peripheral physiology elicited by tumor growth is a largely untapped area of research. This is especially relevant given the widespread prevalence of systemic problems that people with various types of cancer experience. These include disruptions in sleep/wake cycles, cognitive function, depression, and changes in appetite/food intake, among others. Critically, many of these problems are evident prior to diagnosis, indicating that their etiology is potentially distinct from the effects of cancer treatment or the stress of a cancer diagnosis. Psychoneuroimmunology (PNI) is well equipped to tackle these types of problems, as it uses approaches from multiple disciplines to understand how specific stimuli (endogenous and environmental) are transduced into neural, endocrine, and immune signals that ultimately regulate health and behavior. In this article, I first provide a brief historical perspective of cancer and PNI, introduce the idea of cancer as a systemic homeostatic challenge, and provide examples from preclinical literature supporting this hypothesis.