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VIDEO: Screening for Atrial Fibrillation Using Single Lead ECG in the VITAL-AF Trial

Atrial Fibrillation | November 18, 2020

Steven Lubitz, M.D., MPH, cardiac electrophysiologist, Massachusetts General Hospital, presented the late-breaking VITAL-AF Trial at the 2020 American Heart Association (AHA) virtual meeting this week. The study looked at screening for atrial fibrillation (AF) in older adults at primary care visits using the AliveCor single-lead electrocardiogram (ECG) device that interfaces with a smartphone or iPad.

The study found screening for AF using a single-lead ECG at primary care visits was not associated with a significant increase in new AF diagnoses among individuals aged 65 years or older compared to usual care. However, screening may be associated with an increased likelihood of diagnosing AF among individuals aged 85 years or older. 

Undiagnosed AFib is associated with increased risk of stroke. There is uncertainty about how best to screen for AF and guidelines differ regarding screening using ECGs. Methods: We conducted a cluster-randomized trial to evaluate whether screening using single-lead ECGs at primary care visits is effective for diagnosing AF. 

Sixteen clinics were randomized 1:1 to an AF screening intervention which offered an AliveCor single-lead ECG to patients aged 65 years or older during routine vital sign assessments, or usual care. AliveCor readings were over-read by cardiologists. Confirmatory diagnostic testing and treatment decisions were made by the primary care provider. 

New AF diagnoses were ascertained based on electronic case identification and manually adjudicated by a clinical endpoint committee. Results: 35,308 patients were included in the trial (n=17,643 intervention [91% screened], n=17,655 control). Patient characteristics were well-balanced between the intervention and control groups, including 12.7% versus 13.2% with prevalent AF, respectively. At one year, 1.52% of individuals in the screening group had new AF diagnosed versus 1.39% in the control group (relative risk [RR] 1.10; 95% confidence interval [CI] 0.92-1.30; P=0.30). New AF diagnoses in the screening and control groups varied by age (0.95% versus 1.00% for age 65-74; P=0.74; 1.84% versus 1.70% for age 75-84; P=0.58; 4.05% versus 2.68% for age 85+; P=0.02) (see figure). New anticoagulation was prescribed in 2.98% versus 2.90% of individuals in the screening and control groups, respectively, overall (RR 1.03; 95%CI 0.91-1.18; P=0.61), and in 72.8% versus 71% with new AF diagnoses (RR 1.02; 95%CI 0.92-1.14; P=0.70).

Find more AHA news, video and late-breakers

EP Lab

Atrial Fibrillation | November 18, 2020

Steven Lubitz, M.D., MPH, cardiac electrophysiologist, Massachusetts General Hospital, presented the late-breaking VITAL-AF Trial at the 2020 American Heart Association (AHA) virtual meeting this week. The study looked at screening for atrial fibrillation (AF) in older adults at primary care visits using the AliveCor single-lead electrocardiogram (ECG) device that interfaces with a smartphone or iPad.

The study found screening for AF using a single-lead ECG at primary care visits was not associated with a significant increase in new AF diagnoses among individuals aged 65 years or older compared to usual care. However, screening may be associated with an increased likelihood of diagnosing AF among individuals aged 85 years or older. 

Undiagnosed AFib is associated with increased risk of stroke. There is uncertainty about how best to screen for AF and guidelines differ regarding screening using ECGs. Methods: We conducted a cluster-randomized trial to evaluate whether screening using single-lead ECGs at primary care visits is effective for diagnosing AF. 

Sixteen clinics were randomized 1:1 to an AF screening intervention which offered an AliveCor single-lead ECG to patients aged 65 years or older during routine vital sign assessments, or usual care. AliveCor readings were over-read by cardiologists. Confirmatory diagnostic testing and treatment decisions were made by the primary care provider. 

New AF diagnoses were ascertained based on electronic case identification and manually adjudicated by a clinical endpoint committee. Results: 35,308 patients were included in the trial (n=17,643 intervention [91% screened], n=17,655 control). Patient characteristics were well-balanced between the intervention and control groups, including 12.7% versus 13.2% with prevalent AF, respectively. At one year, 1.52% of individuals in the screening group had new AF diagnosed versus 1.39% in the control group (relative risk [RR] 1.10; 95% confidence interval [CI] 0.92-1.30; P=0.30). New AF diagnoses in the screening and control groups varied by age (0.95% versus 1.00% for age 65-74; P=0.74; 1.84% versus 1.70% for age 75-84; P=0.58; 4.05% versus 2.68% for age 85+; P=0.02) (see figure). New anticoagulation was prescribed in 2.98% versus 2.90% of individuals in the screening and control groups, respectively, overall (RR 1.03; 95%CI 0.91-1.18; P=0.61), and in 72.8% versus 71% with new AF diagnoses (RR 1.02; 95%CI 0.92-1.14; P=0.70).

Find more AHA news, video and late-breakers

Left Atrial Appendage (LAA) Occluders | October 02, 2020

Horst Sievert, M.D., is the director of the Cardiovascular Center Frankfurt, and associate professor of internal medicine-cardiology at the University of Frankfurt. He discusses left atrial appendage (LAA) device advances and new developments for more effective LAA closure to reduce the stroke risk in atrial fibrillation (AFib or AF) patients and new developments for more effective LAA closure to reduce the stroke risk in atrial fibrillation (AFib or AF) patients.

He said there are current limitations using the Boston Scientific Watchman FLX and Abbott Amplatzer Amulet devices. One of the new concepts in transcatheter LAA occlusion technology from Append Medical is a suture delivery system that eliminate permanent metal implants and mimics a surgical suture closure without the need for an open chest procedure.

Sievert has more than 30 years experience in cardiology and has been the principal investigator in a number of clinical trials and has authored more than 130 manuscripts and 500 abstracts in peer-reviewed journals and 50 books and book contributions. He is also chairman of Scientific Advisory for Append Medical, developer of a novel LAA closure device.

Read more about the Append device — First-Of-Its-Kind, No-Implant LAA Occluder Noted for Innovation at 2019 ICI Meeting
 

Find more LAA occluder technology news

 

EP Lab | October 01, 2020

Peter Weiss M.D., MSc, director of ventricular arrhythmia management and robotics, and assistant clinical professor of medicine at the Heart Institute, Banner University of Arizona Medical Center, Phoenix, takes a video tour of Banner's new robotic electrophysiology (EP) lab. It is the site of the first U.S. install of the Stereotaxis Genesis robotic system. It is a smaller, more refined system from the earlier generation from a decade ago. Weiss performs a guided tour of the lab and its mapping technologies. 

 

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Time to Take Another Look at Robotics in Electrophysiology — Article by Peter Weiss, M.D.

Stereotaxis Announces Next-generation Robotic Magnetic Navigation and Imaging Systems

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Find more news on robotic cath lab and EP lab systems

EP Lab | September 30, 2020

Peter Weiss M.D., MSc, director of ventricular arrhythmia management and robotics, and assistant clinical professor of medicine at the Heart Institute, Banner University of Arizona Medical Center, Phoenix, explains the advantages of using robotic navigation in the electrophysiology (EP) lab. He has used Stereotaxis robots for the past decade to reduce fluoro imaging and improve ablation outcomes. Banner just opened a new robotic EP lab with a Stereotaxis Genesis system, the first to be installed in the U.S. and only the second install in the world.

 

Related EP Robotic Systems Content:

VIDEO: Virtual Tour of the Robotic Electrophysiology Lab at Banner Health — Interview with Peter Weiss, M.D.

Time to Take Another Look at Robotics in Electrophysiology — Article by Peter Weiss, M.D.

Stereotaxis Announces Next-generation Robotic Magnetic Navigation and Imaging Systems

Stereotaxis and Acutus Medical Announce Strategic Collaboration
 

Find more news on robotic cath lab and EP lab systems

 

EP Lab | July 28, 2020

Devi G. Nair, M.D., FHRS, director of cardiac electrophysiology, St. Bernards Heart and Vascular Center, Jonesboro, Ark., explains the impact of COVID-19 (SARS-CoV-2) on her EP program and what was done to continue operations and recover procedural volume. She also shares how EP played a role in the team approach to treating coronavirus patients at her center.

Her experience is an example of how centers have dealt with issues related to the pandemic, including shutting down elective procedures, treating emergent cases, reopening services, new safety precautions and how telehealth played a role.

Nair is also chairman for the Heart Rhythm Society (HRS) member engagement sub-committee and is a board member of the Arkansas chapter of the American College of Cardiology (ACC).

Watch Nair in this interview — VIDEO: Overview of LAA Occlusion Using the Watchman FLX

 

 

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The Cardiovascular Impact of COVID-19

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VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.

ACC COVID-19 Clinical Guidance For the Cardiovascular Care Team

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

New Research Highlights Blood Clot Dangers of COVID-19

 

How to Manage AMI Patients During the COVID-19 Pandemic 

Older Critically Ill COVID-19 Patients May Have Increased Risk of Bradycardia With Lopinavir and Ritonavir

VIDEO: Where Have all the STEMI Cases Gone Amid COVID-19? — Interview with Thomas Maddox, M.D.

Left Atrial Appendage (LAA) Occluders | July 24, 2020

Devi G. Nair, M.D., FHRS, director of cardiac electrophysiology, St. Bernards Heart and Vascular Center, Jonesboro, Ark., was an investigator in the PINNACLE FLX clinical trial for the Boston Scientific Watchman FLX left atrial appendage (LAA) occluder device. 

The newest iteration of the Watchman was cleared by the U.S. Food and Drug Administration (FDA) in July 2020. Read more about the Watchman FLX 

The transcatheter implant is used in close the LAA, a pouch that forms part of the left atrium. The LAA is implicated in the formation of blood clots that cause stroke in patients with atrial fibrillation (AF). The Watchman FLX is indicated to reduce the risk of stroke in patients with non-valvular AF (NVAF) who need an alternative to oral anticoagulation therapy by permanently closing off the left atrial appendage.

Nair is currently involved with another trial of the Watchman FLX, OPTION FLX trial, which is examining the use of LAA occlusion in post-ablation patients.

Nair is also chairman for the Heart Rhythm Society (HRS) member engagement sub-committee and is a board member of the Arkansas chapter of the American College of Cardiology (ACC).
 

Watch Nair in this interview — VIDEO: Impact of COVID-19 on Electrophysiology Programs

 

Coronavirus (COVID-19) | May 29, 2020

Jay Mohan, D.O., RPVI, interventional cardiology fellow at William Beaumont Hospital, Royal Oak, Michigan, created this video. It shows other clinicians how he set up his home COVID-19 decontamination area where he changes clothes, shoes and sterilizes before entering his house in order to protect his family. He has been involved with direct care of COVID-19 patients the past two months.

Since the start of the SAR-CoV-2 pandemic, clinicians and first-responders who are in contact with, or possible contact with, COVID-19 patients have developed ways to not bring and viral contamination home with them. This often includes on transition spot in the garage or designed room where they can change out of work clothing and shoes and into new clothing and shoes. Shoes and coats are separated into ones used for home and those dedicated for use at work only. Those who wear and reuse N95 masks also have developed ways to take the mask off by the straps only so they do not touch it and strapping it over a tupperware container that can then be sealed, or stored inside a disposable paper or plastic bag.

Mohan is board certified in cardiology, internal medicine, echocardiography and nuclear cardiology. He also serves as vice president of the Dr. Ramesh Kumar Foundation

Mohan shares regular updates on Twitter about recent cardiology technology devices, takeaway points from conferences and short educational videos he produces. Follow or contact him via Twitter or Instagram at @cardiologyoncall.

Watch a video animation he created — VIDEO: The Latest Data on COVID-19 and Cardiovascular Disease.
 

Find more cardiovascular related COVID-19 content

Coronavirus (COVID-19) | May 28, 2020

Interview with Andrew D. Krahn, M.D.,FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia, and vice president of the Heart Rhythm Society (HRS). He is an expert in long QT syndrome (LQTS) and is involved with the National Long QT Registry. He explains the issues with the drugs being used to treat coronavirus (COVID-19, SARS-CoV-2) patients and why these combined with the cardiac impact of the virus is causing prolonged ECG QT segment prolongation, leading to deadly arrhythmias. COVID-19 can cause myocarditis that causes QT prolongation and the front-line COVID drugs hydroxychloroquine and azithromycin also cause QT prolongation.

The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication April 23, 2020, reminding doctors there are serious side effects when using hydroxychloroquine and chloroquine in the off-label use to treat COVID-19 patients. This includes potentially life-threatening heart rhythm problems. The FDA said case reports from the FDA Adverse Event Reporting System database, published medical literature and the American Association of Poison Control Centers National Poison Data System are reporting serious heart-related adverse events and patient deaths. Read more about this alert.

The FDA warning confirmed fears from the American Heart Association (AHA), the American College of Cardiology (ACC) and the Heart Rhythm Society (HRS). These societies April 8 jointly published a new guidance, “Considerations for Drug Interactions on QTc in Exploratory COVID-19 (Coronavirus Disease 19) Treatment,” to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The societies warned that use of  these agents in a large number of patients in combination would results in arrhythmias and deaths. Read more.

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID, but it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

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WHO Database Shows Serious Health Impact of Hydroxychloroquine and Azithromycin Being Used to Treat COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

 

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19 — Interview with William O'Neill, M.D.

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

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HRS | May 22, 2020

Interview with Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, and professor of medicine at the University of British Columbia. He is also vice president of the Heart Rhythm Society (HRS). He moderated the late-breaking sessions at 2020 HRS virtual meeting and explains the highlights of the new technologies and data presented. 

Technologies include a nasal spray to stop supraventricular tachycardia, pulsed field ablation technology that may offer improvement over current technology, subcutaneous ICD (S-ICD) technology performing as well as traditional transvenous lead ICDs, contact force sensing ablation improves outcomes, use of smart watches to help atrial fibrillation patients adhere to oral anticoagulation therapy, and the first pacemaker to interface with the patient's smart phone.

Watch another interview with Krahn in the VIDEO: Insights Into How HRS Organized its Virtual Meeting.

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.

Find more news and video from the Heart Rhythm Society.
 

Cardiovascular Education | May 22, 2020

Andrew D. Krahn, M.D., FHRS, head of the division of cardiology at St. Paul’s Hospital, professor of medicine  at the University of British Columbia and vice president of the Heart Rhythm Society (HRS), explains how HRS organized its virtual meeting after its in-person meeting was cancelled by the COVID-19 pandemic.  

Due to the continued global escalation of the novel coronavirus (COVID-19, SARS-CoV-2), HRS has cancelled its large annual in-person electrophysiology meeting in late-March and began planning for a virtual meeting instead. HRS broke its annual meeting into three online learning sessions over the course of May June and July. The first, which included the late-breaking sessions, was held May 5-9, 2020. Others will be held June 12 and July 1.

Using its online learning platform, Heart Rhythm 365 available on the www.hrsonline.org website, HRS is offering all its sessions at no cost.

Watch another interview with Krahn in the VIDEO: Top New EP Technologies at Heart Rhythm Society 2020.
 

Find a complete list of the Heart Rhythm 2020 meeting late-breaking studies with links to articles on each.
 

 

Coronavirus (COVID-19) | May 18, 2020

Marianne Pop, Pharm.D., BCPS, a clinical pharmacist and clinical assistant professor with the regional pharmacy program, University of Illinois at Chicago College of Pharmacy. She specializes in emergency medicine pharmacy as part of the regional pharmacy program at OSF Saint Anthony Medical Center in Rockford, Ill. In this interview she offers an overview of using hydroxychloroquine to treat COVID-19 (SARS-CoV-2) in relation to the recent FDA warning about its use causing increase cardiac issues, and data on its effectiveness to date.

Cardiology societies issued warnings soon after hydroxychloroquine started to be used as a treatment and the prevention of COVID-19. The drug has been used for decades to prevent malaria and to treat rheumatoid arthritis and lupus. However, some case reports indicate it can cause ECG QT-interval prolongation, which causes cardiac arrhythmias. Cardiologists say COVID also can cause myocarditis, which can initiate arrhythmias. Other drugs being used to treat COVID, such as azithromycin, also cause arrhythmias. These drugs combined with myocarditis can compound the arrhythmia issue, leading to serious adverse effects, including some patients deaths. This is what the FDA reported in a warning to clinicians in late April. 

However, there are numerous advocates that argue hydroxychloroquine needs to be used in less sick patients who are not already hypoxic to treat COVID and it is being used primarily in very sick patients where it is not effective. Advocates also argue the drug can be used to help prevent coronavirus, similar to the drug's effect in preventing malaria. In terms of drug safety, advocates argue the drug has been used in millions of patients for more than 50 years without a high risk of arrhythmias. Several trials are now underway in the United States to test its use against COVID-19, but enrollment has been hampered because of the FDA warning. There will likely be more interest in hydroxychloroquine after it was revealed May 18, 2020, that President Trump is taking the drug for prophylaxis against COVID-19.

 

Related Hydroxychloroquine Content:

FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine for COVID-19

COVID-19 Hydroxychloroquine Treatment Brings Prolonged QT Arrhythmia Issues

VIDEO: Why QT-prolongation Occurs in COVID-19 Patients on Hydroxychloroquine — Interview with Andrew Krahn, M.D.

FDA Reports of Deaths and Injuries From Use of Antimalarial hydroxychloroquine in COVID-19 Patients

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VIDEO: Cardiologists Manage Trial Testing if Hydroxychloroquine Protects Clinicians From COVID-19

First Large-scale U.S. Study on Hydroxychloroquine COVID-19 Prophylaxis Begins in Detroit

AHA, ACC, HRS Caution Use of COVID-19 Therapies Hydroxychloroquine and Azithromycin in Cardiac Patients

Coronavirus (COVID-19) | March 20, 2020

An interview with Ehtisham Mahmud, M.D., FSCAI, chief, Division of Cardiovascular Medicine, executive director of medicine, Cardiovascular Institute, director of  interventional cardiology and cardiac cath lab at UC San Diego Medical Center, and president of the Society for Cardiovascular Angiography and Interventions (SCAI). He explains the how cardiology departments in the U.S. are now postponing cardiovascular procedures due to novel coronavirus (COVID-19, SARS-CoV-2) containment efforts and new guidelines from Medicare calling for delay of all elective procedures in the country. 

Mahmud explains how patients are being prioritized, with acute myocardial infarction patients or others with acute, life-threatening conditions, or at high risk for a near term hospital admission, will still receive cardiac catheterizations, cardiovascular surgery or structural heart procedures for MitraClip and transcatheter aortic replacement (TAVR) under certain circumstances. All other procedures are being postponed until further notice based in the spread and infection rates of COVID-19. He said most hospitals, including his own, are moving to telehealth visits via phone or online to continue clinic work with patients, including those with chronic conditions such as heart failure.

The Centers for Medicare and Medicaid Services (CMS) announced March 18, 2020, that all elective surgeries, and non-essential medical, surgical and dental procedures should be delayed during the coronavirus outbreak. This move is three-fold. 
   1. It is to help with containment efforts by reducing patient and family travel to hospitals, which are at the center of the COVID-19 outbreak. 
   2. Delaying procedures will help preserve and inventory of personal protective equipment (PPE), hospital beds and ventilators and other medical supplies. 
   3. With the start of social distancing and the shut down of all large gatherings, this has severely impacted blood drives and other blood donations, so the nation's blood banks have severely limited supplies.

“The reality is clear and the stakes are high — we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up the healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work toward limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. 

Read Mahmud's SCAI President's letter The Evolving Pandemic of COVID-19 and Interventional Cardiology

 

Related Cardiology Related COVID-19 Content:

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Additional COVID-19 Resources for Clinicians:

   ACC COVID-19 Hub page   

   Johns Hopkins Coronavirus Resource Center with inteavtive map of cases in U.S. and worldwide 

   World Health Organization (WHO) COVID-19 situation reports

   World Health Organization (WHO) coronavirus information page

   U.S. Food and Drug Administration (FDA) COVID-19 information page

   Centers for Disease Control (CDC) COVID-19 information page

   Centers for Medicare and Medicaid Services (CMS) frequently asked questions and answers (FAQs) for healthcare providers regarding COVID-19 related payments
 

 

Structural Heart | February 27, 2020

Charles D. Resor, M.D., MSc, assistant director, cardiac catheterization lab, Tufts Medical Center and assistant professor of medicine, Tufts University School of Medicine, explains the structural heart program at Tufts Medical Center. He outlines the centers' use of a variety of transcatheter interventional devices, including the MitraClip to repair mitral valve and tricuspid valve; occluders to seal congenital holes in the heart; PFO closure to prevent cryptogenic stroke; and the Watchman device to close the left atrial appendage (LAA) in atrial fibrillation patients.

 

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

 

Find more content on Tufts Medical Center

 

Heart Valve Technology | February 18, 2020

Andrew Weintraub, M.D., FACC, associate director, of the Interventional Cardiology and Vascular Center, medical director of the Vascular and Structural Heart Center, Tufts Medical Center, discusses the use of temporary pacing in transcatheter aortic valve replacement (TAVR) patients. Implantation of TAVR valves can cause pressure from the valve against the septal wall of the heart, causing conduction delays. These delays do not necessarily mean the patient needs a permanent pacemaker.

Instead, Tufts Medical Center uses temporary pacing leads, a small catheter with two electrodes, placed in the right ventricle of the heart through a vein in the groin or neck. The lead is then connected to an external pacemaker allowing a physician to monitor and control a patient’s heart rate for up to several days.  The center uses the BioTrace Medical Tempo Lead, which incorporates a novel active fixation mechanism, bipolar electrodes and a soft tip. Stabilizers provide secure fixation and maintain stable pace capture. An elastomeric balloon may be inflated to aid passage of the lead through the venous vasculature and into the right ventricle, and  aids in wall apposition during deployment of the stabilizers. This design helps secure and stabilize the cardiac pacing lead with the goal of reducing complications and allowing patients to ambulate sooner after procedures.

 

Related Content:

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the Structural Heart Program at Tufts Medical Center — Interview with Charles D. Resor, M.D.,

 

Find more content on Tufts Medical Center

 

 

 

Pacemakers | February 13, 2020

This video illustrates how the Micra AV leadless pacemaker is delivered via catheter and enables atrioventricular (AV) synchrony. The device was cleared by the U.S. Food and Drug Administration (FDA) in January 2020, expanding the number of potential candidates who can receive leadless, catheter delivered pacemakers in the U.S.

The device is the world’s smallest pacemaker with atrioventricular (AV) synchrony. It is indicated for the treatment of patients with AV block, a condition in which the electrical signals between the chambers of the heart (the atria and the ventricle) are impaired. It is similar to the single chamber Micra TPS pacemaker that has been on the market since 2016. However, the Micra AV has several additional internal atrial sensing algorithms which detect cardiac movement, allowing the device to adjust pacing in the ventricle to coordinate with the atrium, providing “AV synchronous” pacing therapy to patients with AV block. The device senses when blood is flowing through the right ventricle. 

 

Related Micra Leadless Pacemaker Content:

FDA Clears Medtronic Micra AV to Treat AV Block

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Wearables | January 09, 2020

The Consumer Electronic Show (CES) is the world's gathering place for consumer technologies, with more than 175,000 attendees and more than 4,400 exhibiting companies. New healthcare technologies are among the top trends at CES. This video offers a quick look at the trends specific to healthcare technology.

Artificial intelligence (AI) is one of the hottest technology trends across all product across the CES floor this year. There is also discussion by key note speakers that the internet-of-things (IOT) concept introduced at CES nearly a decade ago is now morphing into a new meaning for the interconnectivity-of-things. This can be seen in healthcare products shown here and across all types of consumer and business products. 

The device technology at CES include many examples of how integrated wearables can digitally enable healthcare. The future of healthcare will include system where consumers are continuously monitored with sensors, software and services that can pinpoint digital biomarkers — earlier warning signs that predict health events. This is the prediction of Leslie Saxon, M.D., executive director of the University of Southern California (USC) Center for Body Computing (CBC), is speaking as a panelist about digital health trends and challenges in the session “Proving the Impact of Transformative Technology.” 

Saxon is a board-certified cardiologist and digital health expert who understands how developing technologies can more accurately assess wellness and human performance among elite athletes, military personnel and patients. She explained this digital healthcare model of the future is a vast contrast to the current point-of-care model.

 

 

Ablation Systems | September 26, 2019

Clifford Robinson, M.D., associate professor of radiation oncology, chief of the SBRT service, director of clinical trials, Washington University, St. Louis, Washington University School of Medicine in St. Louis, explains the longer term results of cardiac radiotherapy ablation to treat ventricular tachycardia. Image-guided cardiac radioablation dramatically reduces episodes of fast, abnormal heartbeats for more than two years in the ENCORE-VT trial.

In collaboration with Phillip Cuculich, M.D., associate professor of cardiology and radiation oncology at the Washington University School of Medicine in St. Louis, Robinson and his team developed a noninvasive, outpatient procedure for treating VT called EP-guided noninvasive cardiac radioablation (ENCORE-VT). This novel therapy fuses electrical (ECGs) and imaging (computed tomography, magnetic resonance imaging, positron emission tomography) data to pinpoint the scar tissue in the patient’s heart responsible for the arrhythmias, then targets it with a single dose of stereotactic body radiation therapy (SBRT), a type of high-dose radiation most commonly used to treat patients with cancer. ENCORE-VT requires no general anesthesia and allows patients to go home immediately after treatment. 

The results of the ENCORE-VT study were presented at ASTRO 2019. The results were also presented as a late-breaking trial at the Heart Rhythm Society (HRS) 2020 virtual meeting.

Read the article Noninvasive Radioablation Offers Long-term Benefits to High-risk Heart Arrhythmia Patients.

 

EP Lab | July 26, 2019

Mark Ibrahim, M.D., FACC, assistant professor of medicine and radiology, associate program director, advanced cardiac imaging fellowship, University of Utah, explains what radiologists and cardiologists need to know what is needed from CT imaging prior to ablation procedures for atrial fibrillation (AF) and ventricular fibrillation (VF). He spoke at a joint session of the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the 2019 SCCT meeting. 

 

Find more SCCT news and videos

EP Lab | July 25, 2019

Pierre Qian, MBBS, cardiac electrophysiologist fellow, Brigham and Women's Hospital, explains how his facility is working with radiation oncology to use radio therapy to noninvasively ablate ventricular tachycardia (VT). He spoke on this topics during a joint electrophysiology session by the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the SCCT 2019 meeting.

Here is a link to another radiotherapy EP project Qian recently had published - A Novel Microwave Catheter Can Perform Noncontact Circumferential Endocardial Ablation in a Model of Pulmonary Vein Isolation

 

Find more SCCT news and videos

Atrial Fibrillation | June 21, 2019

Sanjaya Gupta, M.D., electrophysiologist, St. Luke's Mid America Heart Institute, and assistant professor, University of Missouri–Kansas City School of Medicine, explains how his center developed an artificial intelligence (AI) application to automatically risk stratify atrial fibrillation (AFib) patients. The Epic-based app stratifies patients into those who should be placed on anticoagulation and those who are candidates for left atrial appendage (LAA) occlusion. He spoke at the 2019 AI-Med Cardiology conference

His center hopes to develop similar guidelines based AI apps for other types of cardiac risk scoring. Gupta said he is looking for other centers to partner with to co-develop and test these AI apps.    

 

Related Cardiology AI Content:

VIDEO: Overview of Artificial Intelligence and its Use in Cardiology — Interview with Anthony Chang, M.D.

VIDEO: ACC Efforts to Advance Evidence-based Implementation of AI in Cardiovascular Care — Interview with John Rumsfeld, M.D.

VIDEO: Artificial Intelligence Applications for Cardiology — Interview with Anthony Chang, M.D.

PODCAST: Fitting Artificial Intelligence Into Cardiology — Interview with Anthony Chang, M.D.

VIDEO: How Hospitals Should Prepare for Artificial Intelligence Implementation — Interview with Paul Chang, M.D.

Technology Report: Artificial Intelligence 

Left Atrial Appendage (LAA) Occluders | April 25, 2019

This video offers an overview of the Watchman left atrial appendage (LAA) occluder system, including information of its design, implantation and clinical data supporting its use. Catheter-based LAA occlusion is used to seal off the LAA in the heart, which is the source of most stroke-causing clots in patients with atrial fibrillation (Afib). The device be used in place of anticoagulation therapy for stroke prevention. 

 

Related LAA Occlusion Content:

VIDEO: New Data on LAA Occlusion From the PREVAIL and PROTECT Trials — Interview with Vivek Reddy, M.D.

Occluding the Left Atrial Appendage (LAA)

VIDEO: Comparison Between Watchman vs. Amulet LAA Occluders — Interview with Ashish Pershad, M.D.

Device-related Thrombus After Watchman LAA Closure Occurs in Small Number of Patients

Closure of Left Atrial Appendage During Heart Surgery Protects the Brain

 

March 28, 2019

Interview with Frederick Masoudi, M.D., FACC, FAHA, professor of cardiology at the University of Colorado Hospital, and a physician leader of the National Cardiovascular Data Registry (NCDR). The NCDR is the American College of Cardiology's suite of cardiovascular data registries helping hospitals and private practices measure and improve the quality of care they provide.

Additional videos and coverage of the University of Colorado Hospital

 

Wearables | March 26, 2019

Khaldoun Tarakji, M.D., MPH, staff physician in the Section of Electrophysiology and Pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute at the Cleveland Clinic, explains how wearable devices and smart phone apps can be used to aid electrophysiologists in patient care. He said the devices offer a constant remote monitoring of patient heart data, which can be helpful in diagnosing various types of arrhythmias and cardiac conditions. However, the main issue is how to sort through the large volumes of data and to figure out what the clinical value of some of this consumer data is through studies.  He spoke at the American College of Cardiology (ACC) 2019 meeting.

 

Other Cardiac Wearable Content:

VIDEO: Use of Wearable Medical Devices for Cardiac Rehabilitation — Interview with Robert Klempfner, M.D.

VIDEO: The Future of Wearables in Healthcare — Interview with Karl Poterack, M.D.

 

 

EP Lab | March 21, 2019

Khaldoun Tarakji, M.D., MPH, associate section head, section of electrophysiology and pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute at the Cleveland Clinic. He presented the WRAP-IT late-breaking trial at the American College of Cardiology (ACC) 2019 meeting. The trial looked at the use of an antibacterial envelope for pacemakers and ICDs to reduce infection risk. 

Read the ACC.19 article Medtronic Tyrx Envelope Significantly Reduces Major Infections in Cardiac Implantable Device Patients.

 

Rlated EP video From ACC.19:

VIDEO: Key Trends in Electrophysiology — Apple Watch to Detect AF and the CABANA Trial — Interview with Christine Albert, M.D.

 

 

EP Lab | February 27, 2019

This is a virtual heart with the same electrophysiology characteristics as the real patient being developed to help optimize cardiac resynchronization therapy (CRT) lead placement. CRT currently has a 30 percent nonresponder rate, which is mainly due to the placement of leads. This model allows virtual placement of the leads In various locations to test response prior to the implantation procedure. The green dot shows the location of the virtual lead. It was unveiled at the Healthcare Information Management and Systems Society (HIMSS) 2019 annual meeting in February by Siemens. This "digital twin" technology is in development and will be able to create virtual, digital organs from a patient’s ECG, MRI scan and other clinical data. Siemens said the technology also might have applications for testing virtual ablations strategies to save procedure time when the patient is in the EP lab

Read more about the digital twin technology.

Look through a photo gallery of other new technologies at HIMSS19. 

Find news and videos from HIMSS 2019.

 

EP Lab | January 03, 2019

This is a quick video tour of one of the dedicated electrophysiology (EP) labs at the University of Colorado Hospital. The room is built around a Siemens Artis Q.zen bi-plane angiography system. The system allows low radiation fluoro imaging, which reduced exposure to both patients and operators during long EP ablation procedures. 

Equipment in stock in this lab includes the Medtronic Artic Front cryoablation balloon.

Watch the VIDEO: Cryoballoon Ablation Best Practice Guidelines, an interview with Wilber Su, M.D.

Watch the related VIDEO: Cath Lab Walk Through at the University of Colorado Hospital
 

Find more articles and videos on the University of Colorado Hospital

EP Lab | November 15, 2018

Wilber Su, M.D., chief of cardiac electrophysiology, Banner University Medical Center, Phoenix, and clinical associate professor of medicine at the University of Arizona, explains the Heart Rhythm Society (HRS) best practices document on cryoballoon ablation. He led the development of that document. He spoke at the 2018 American Heart Association (AHA) meeting.

Read the HRS "Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3,000 procedures."

Read the related article "New Technologies to Improve Atrial Fibrillation Ablation."

 

 

Left Atrial Appendage (LAA) Occluders | October 01, 2018

Ashish Pershad, M.D., medical director, structural heart program, Banner University Medical Heart Institute, Phoenix, explains the difference he found between the FDA cleared Watchman left atrial appendage (LAA) occluder and the Abbott Amplatzer Amulet device now in U.S. trials. He spoke on these differences at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) conference. 

Watch the VIDEO: New Data on LAA Occlusion From the PREVAIL and PROTECT Trials — Interview with Vivek Reddy, M.D.

Read the article "Occluding the Left Atrial Appendage (LAA)."

#TCT2018

Stroke | May 09, 2018

A new clinical trial at The Ohio State University Wexner Medical Center is examining an implanted device that uses vagus nerve stimulation to help stroke patients regain motor function. The Vivistim device is similar to a pacemaker, which uses leads to electrically stimulate the brain. 

Read the article "New Therapy Rewires the Brain to Improve Stoke Recovery."
 

 

Sudden Cardiac Arrest | March 14, 2018

The Zoll LifeVest is a temporary, wearable defibrillator designed as a safety net for patients, especially those being evaluated for a permanent implantable cardioverter defibrillator (ICD). The Vest Prevention of Early Sudden Death Trial (VEST), presented at ACC 2018, was the first randomized, controlled, multi-center trial of the wearable cardioverter defibrillator. It looked to see if this device could effectively reduce sudden death in patients who had recently suffered a heart attack and had reduced heart function. Read more about the VEST Trial. 

Wearables | January 29, 2018

Take a video tour of some of the medical devices designed to improve patient care, improve patient engagement and increase physiologic monitoring highlighted at the 2018 Consumer Electronics Show (CES). One of the most interesting technologies is a flexible electronics ECG monitor that can bend and twist with the skin and interfaces with a smartphone app. The exhibition includes more than 3,000 vendors and more than 170,000 attendees. For more examples of future healthcare technologies, watch the VIDEO “Editor's Choice of Future Healthcare Technologies at HIMSS.” 
 

Magnetic Resonance Imaging (MRI) | December 13, 2017

Emanuel Kanal, M.D., director of MRI services and professor of radiology and neuroradiology at the University of Pittsburgh Medical Center, explains the new mobile application he developed, which lets users visually model the forces at work during an MRI exam on patients with implanted medical devices, at the 2017 Radiological Society of North America (RSNA) meeting.

Read the related article “The Changing Relationship Between MRIs and Pacemakers.”

Left Atrial Appendage (LAA) Occluders | November 14, 2017

Vivek Reddy, M.D., director of cardiac arrhythmia services and professor of medicine, cardiology, Mount Sinai Hospital, N.Y., explains the latest Watchman left atrial appendage (LAA) occluder study data presented at the 2017 Transcatheter Cardiovascular Therapeutics (TCT) conference.

Watch the VIDEO “Post-FDA Approval Experience of LAA Occluders,” with David Holmes, M.D.

Watch a VIDEO interview with Reddy at Heart Rhythm Society (HRS) 2017 on leadless pacing technologies

EP Mapping and Imaging Systems | October 24, 2017

This video, provided by Acutus Medical, demonstrates a patient case showing the use of the AcQMap high-resolution electrophysiology (EP) mapping system. The system was cleared by the U.S. Food and Drug Administration (FDA) in October 2017. Read about the FDA approval. See more about this system in the VIDEO "Editor's Choice of Most Innovative New Technology at HRS 2017."

Cardiovascular Ultrasound | June 29, 2017

Leyla Elif Sade, M.D., MESC, professor of cardiology at Başkent University, Ankara, Turkey, discusses use of echo for cardiac resychronization therapy (CRT) lead optimization at the 2017 American Society of Echocardiography (ASE) annual meeting.

 

Related Content:

VIDEO Echocardiography Strain Fundamentals Made Easy

A Glimpse Into the Future of Cardiac Ultrasound

Automation Enhances, Streamlines Echocardiography

What is New in Electrophysiology Technologies

Cardiovascular Business | June 06, 2017

Andrea Natale, M.D., FACC, FHRS, FESC, executive medical director, Texas Cardiac Arrhythmia Institute at St. David's Medical Center, discusses how to build an electrophysiology (EP) program at the 2017 Heart Rhythm Society (HRS) annual meeting.

He explains what centers need to consider when creating an EP program, including what is required for device programs that include pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT), as well as the technologies and know-how for catheter ablation programs. He discusses who should be involved in creating an EP program and how EP needs to interface with other departments and subspecialties around the hospital.

Natale is a world recognized leader in the field of electrophysiology. Prior to the establishment of Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Natale was a member of the Cardiovascular Medicine Department at the Cleveland Clinic from 1999 to 2007, and served as section head for the Department of Cardiac Pacing and Electrophysiology and as medical director for the Cleveland Clinic’s Center for Atrial Fibrillation. In 2006, Dr. Natale was named to the U.S. Food and Drug Administration (FDA) Task Force on Atrial Fibrillation.

Read the article "Growing a Cardiac Rhythm Program in a Community Setting."
 

 

Implantable Cardioverter Defibrillator (ICD) | June 01, 2017

Lucas Boersma, M.D., Ph.D., FESC, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands, discusses how subcutaneous implantable cardioverter defibrillator (S-ICD) technology works, selecting patient appropriate patients and new S-ICD technologies in development at the 2017 Heart Rhythm Society annual meeting. Read the article "Subcutaneous ICD System Shows Positive Outcomes in Largest Real-world Study."

Watch the related VIDEO: How to Install a Subcutaneous ICD System

Read the related article New Technology and Market Challenges Facing Implantable Cardioverter Defibrillators.