BACKGROUND Cavo-tricuspid isthmus (CTI) block is currently assessed by coronary sinus (CS) pacing or low lateral and septal atrial pacing. Occasionally, CS catheterization through the femoral route can be difficult to perform or right atrial pacing can be problematic because of catheter instability or saturation of the atrial electrograms recorded near the catheter. OBJECTIVES Our aim was to ...

We present a case of a single chamber atrial pacemaker implanted for sinus node dysfunction and treatment of macroreentrant atrial tachycardias with atrial antitachycardia pacing. The patient presented with sustained atrial tachycardia above the detection rate, however, the device was unable to detect the tachycardia and did not deliver the programmed therapy. We discuss the nuances of the atri...

This advisory summarizes the current database on pacing modalities and algorithms used to prevent and terminate atrial fibrillation (AF). On the basis of the evidence indicating that ventricular pacing is associated with a higher incidence of AF in patients with sinus node dysfunction, a patient who has a history of AF and needs a pacemaker for bradycardia should receive a physiological pacemak...

Sinus node dysfunction in patients after repair of the secundum atrial septal defect has been ascribed to surgical damage. We studied 15 consecutive patients with secundum atrial septal defect before operative intervention. Noninvasive testing included 34-hour electrocardiographic monitoring and a standard 13-lead ECG. Intracardiac electrophysiologic techniques included corrected sinus node rec...

OBJECTIVES This study sought to characterize direction-dependent and coupling interval-dependent changes in left atrial conduction and electrogram morphology in uniformly classified patients with paroxysmal atrial fibrillation (AF) and normal bipolar voltage mapping. BACKGROUND Although AF classifications are based on arrhythmia duration, the clinical course, and treatment response vary betwe...

BACKGROUND The purpose of this study was to evaluate the long-term outcome of all pediatric epicardial pacing leads. METHODS AND RESULTS All epicardial leads and 1239 outpatient visits between January 1, 1983, and June 30, 2000, were retrospectively reviewed. Pacing and sensing thresholds were reviewed at implant, at 1 month, and at subsequent 6-month intervals. Lead failure was defined as th...

Various pacing technologies have been developed during the past 50 years since the first pacemaker was implanted in 1958. Dual-chamber pacing, rate responsiveness, programmable and rate-responsive atrioventricular (AV) intervals, alternative-site pa0cing, and new multichamber pacing devices are all attempts to mimic normal cardiac physiology as much as feasible. The categories of alternative-si...

A 78-year-old male patient underwent implantation of cardiac resynchronization devise with defibrillator (CRT-D) for dilated cardiomyopathy and congestive cardiac failure. Patient received a Guidant CRT-ICD. RV lead during implantation, subclavian access was obtained by venogram assisted extra thoracic puncture of the subclavian vein. Right atrial (RA) lead was initially attempted in the right ...

P a t i e n t s 453 patients (mean age 64 y, 68% men) who had moderate or severe (New York Heart Association [NYHA] functional class III or IV) chronic heart failure resulting from ischemic or nonischemic cardiomyopathy; received stabilized doses of medication for ≥ 1 month (≥ 3 mo for β-blockers); and had left ventricular ejection fraction ≤ 35%, a QRS interval ≥ 130 msec, and a 6-minute walki...

There has been a recent upsurge of interest in permanent His bundle pacing, given increased understanding and appreciation of the role dyssynchronous ventricular activation plays in congestive heart failure and atrial fibrillation. Permanent His bundle pacing gives implanters the ability to avoid causing ventricular dyssynchrony in patients dependent on ventricular pacing, and can provide an al...