Safety of screening procedures with hand-held metal detectors among patients with implanted cardiac rhythm devices: a cross-sectional analysis.

BACKGROUND: Case reports suggest that the hand-held metal detectors used for security screening generate electromagnetic fields that may interfere with pacemaker and implantable cardioverter-defibrillator (ICD) function. OBJECTIVE: To assess changes in function of pacemakers and ICDs after exposure to hand-held metal detectors. DESIGN: Cross-sectional study. SETTING: Two medical centers in Europe. PATIENTS: 388 patients (209 with pacemakers and 179 with ICDs) presenting for routine follow-up of device function between September 2009 and December 2010. MEASUREMENTS: Abnormalities on electrocardiography suggestive of rhythm device malfunction (pacing inhibition, loss of capture, inappropriate mode switch, ventricular oversensing, and spontaneous reprogramming) after 30 seconds of exposure to 2 widely used hand-held metal detectors with a maximal electromagnetic flux density of 6.3 µT. RESULTS: No change in device function, including pacing or sensing abnormalities or device reprogramming, was observed in any patient. LIMITATIONS: The study included a convenience sample of patients, and the number of different device models tested was small. Testing was conducted in 2 clinic settings. CONCLUSION: Hand-held metal detectors did not affect the function of pacemakers or ICDs in this sample. The use of hand-held metal detectors for security screening is probably safe for patients with pacemakers and ICDs, but these findings require confirmation. PRIMARY FUNDING SOURCE: None.

Trends in ablation procedures in Greece over the 2008-2018 period: Results from the Hellenic Cardiology Society Ablation Registry.

OBJECTIVE: In 2008, the radiofrequency ablation (RFA) procedures registry of the Hellenic Society of Cardiology was created. This online database allowed electrophysiologists around the country to input data for all performed ablation procedures. The aim of this study is to provide a thorough report and interpretation of the data submitted to the registry between 2008 and 2018. METHODS: In 2008, a total of 27 centers/medical teams in 24 hospitals were licensed to perform RFA in Greece. By 2018, the number had risen to 31. Each center was tasked with inserting their own data into the registry, which included patient demographics (anonymized), type of procedure and technique, complications, and outcomes. RESULTS: A total of 18587 procedures in 17900 patients were recorded in the period of 2008-2018. By 2018, slightly more than 70% of procedures were performed in 7 high-volume centers (>100 cases/year). The most common procedure since 2014 was atrial fibrillation ablation, followed by atrioventricular nodal reentry tachycardia ablation. Complication rates were low, and success rates remained high, whereas the 6-month relapse rates declined steadily. CONCLUSION: This online RFA registry has proved that ablation procedures in Greece have reached a very high standard, with results and complication rates comparable to European and American standards. Ablation procedures for atrial fibrillation are increasing constantly, with it being the most common intervention over the last 6-year period, although the absolute number of procedures still remains low, compared to other European countries.

Cardiac resynchronization therapy in becker muscular dystrophy.

A 44-year-old male patient with known Becker muscular dystrophy and concomitant non-ischemic dilated cardiomyopathy presented to our department because of worsening heart failure and presyncope. Upon admission, the patient was in New York Heart Association functional class III despite optimal pharmacological treatment; his ECG showed sinus rhythm with left bundle branch block and a wide QRS complex. Non-sustained ventricular tachycardia was recorded during 24-hour Holter monitoring. A complete three-dimensional echocardiographic study was performed and documented the dilatation and concomitant hypertrabeculation of the left ventricle (LV), with severely depressed systolic LV performance (ejection fraction 20%), as well as mechanical dyssynchrony--mainly in terms of intraventricular delay. A biventricular cardioverter-defibrillator (CRT-D) was implanted in this patient, with the LV lead in a lateral vein and the right ventricular defibrillating lead in the apical part of the interventricular septum. Echocardiography-guided device programming was performed in order to achieve the optimal atrio-, inter-, and intraventricular resynchronization. The patient's clinical condition was substantially improved within one month after the implantation.

Tachycardia induction due to inappropriate implantable cardioverter defibrillator therapy: what is the mechanism?

Antitachycardia therapies administered by implantable cardioverter defibrillators (ICDs) can occasionally prove proarrhythmic due to induction of ventricular tachyarrhythmias. In this report we present the case of a tachycardia induction as a result of inappropriate therapy delivery in an ICD recipient. Detailed analysis of the stored electrograms facilitated the delineation of the underlying mechanism of the recorded tachycardia.