Ten Steps in Adoption of Emerging Procedural Techniques: An Experience With Ethanol Ablation of Vein of Marshall (VOM).

Proceduralists must update their skill sets to provide patients with better care because of the addition of new and effective strategies post-training. For example, the current procedural strategy of pulmonary vein isolation for treating persistent atrial fibrillation (AF) is inadequate. However, the addition of ethanol ablation of the vein of Marshall (VOM), a relatively new procedural technique, can improve outcomes. Furthermore, the purpose of this report was to briefly explain VOM ethanol ablation, its role in atrial fibrillation and atypical flutter ablation, and to provide a template for performing a new procedural technique in the field.

Block of branching portion of bundle of His from catheter shaft during ablation of left ventricular outflow tract ventricular premature complexes.

Ventricular premature contractions are often located in the left ventricular outflow tract (LVOT). Components of the normal atrioventricular conduction apparatus are located just below the aortic valve in proximity to the membranous septum, between the noncoronary cusp and right coronary cusp. We present a case of injury to the bundle of His during an ablation of a ventricular premature contraction in the LVOT below the left coronary cusp, remote from the bundle of His, due to pressure from the proximal shaft of the catheter between the noncoronary cusp and the right coronary cusp.

Implantable defibrillators in long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy.

Sudden death is often the first manifestation in inherited cardiac arrhythmia syndromes. Patients with long QT syndrome who have an episode of syncope while on beta-blockade should be offered an implantable cardioverter-defibrillator (ICD). In Brugada syndrome and hypertrophic cardiomyopathy, ICDs are often the most effective treatment of primary and secondary prevention of cardiac arrest. Risk stratification is crucial in identifying those at greatest risk to provide lifesaving therapy with an ICD while avoiding complications in those unlikely to receive benefit.

New paradigms in the prevention of sudden cardiac arrest and heart failure treatment.

Congestive heart failure is a very real public health issue not only in the United States, but worldwide. Mortality in patients with congestive heart failure is typically either sudden cardiac death or pump failure. Paradoxically, patients with less severe heart failure are at higher relative risk of sudden cardiac death. Defining which patients are best treated with implantable defibrillators and resynchronization is the purpose of this review.

Role of adenosine antagonism in the cardiorenal syndrome.

Acute decompensated heart failure (ADHF), generally related to signs and symptoms of volume overload, is one the most common reasons for hospitalization in the United States. Recently, it has been observed that the majority of patients with ADHF have baseline renal dysfunction. Moreover, heart failure (HF) treatment is limited by worsening renal function despite persistent volume overload. This connection between HF and renal dysfunction has been termed the cardiorenal syndrome and has made treatment of patients with stable and unstable HF challenging. Selective adenosine A1 receptor antagonists are novel pharmacologic agents that are currently under development to treat volume overload in HF while protecting or possibly improving renal function. In this article, we review the cardiorenal syndrome, the role of adenosine in renal function, and emerging data regarding the safety and efficacy of adenosine A1 receptor antagonists in patients with advanced HF.