The PPM implantation rate of about 20 % after TAVI is comparable to previously published data. The need for permanent pacing is linked to the valve type and preexistence of a right bundle branch block. At short-term more than half of the patients implanted with a device were not strictly PM-dependent, but presented an underlying intrinsic rhythm, indicating that temporary AV conduction disturbances may recover over time. This might justify a more conservative approach in some patients under watchful waiting. From another point of view, ventricular pacing at a regular or sensor-modulated rate may provide rhythm stability and chronotropy during the short-term period post-TAVI.

A structurally abnormal IAS was diagnosed in nearly half of the patients undergoing ablation therapy for AF. The information obtained by TEE is mandatory to exclude left atrial thrombi prior the ablation procedure. Moreover, detailed knowledge of morphologic characteristics of the IAS facilitates an optimized and safe performance of the transseptal puncture using long sheaths with large diameters.

Objective: The aim of this retrospective study was to investigate the association of atrioventricular nodal reentrant tachycardia (AVNRT) with other forms of arrhythmia in individual patients and its consequences for treatment. Subjects and Methods: This study comprised 493 consecutive patients aged 16-88 years (296 women and 197 men) who were diagnosed with a form of AVNRT via a standard 4-catheter electrophysiological study (EPS). Patients were clinically followed (range 0.5-12 years) at a single center. Results: Coexistence of AVNRT with other types of tachycardias was observed in 197 (40%) patients. Atrial fibrillation was found most frequently in 94 (19%) patients as follows: focal atrial tachycardia, n = 40 (8%); atrial flutter, n = 32 (6%), and AV reentrant tachycardia, n = 22 (4%). Double tachycardia was present in 140 (30%) patients, and more than 2 different types of tachycardias were present in 57 (12%) patients. Transitions between AVNRT and other tachycardias occurred in 25 (5%) patients. Two or more tachycardias were ablated in 42 (9%) patients. The majority of patients were free of symptoms at the first follow-up, whereas 130 (26%) patients reported a variety of symptoms. Conclusion: Coexistence of AVNRT with other types of arrhythmias was a common finding among these patients. The most frequently observed double tachycardia was the combination of AVNRT with atrial tachyarrhythmias, such as atrial fibrillation, with a potential significance for further patient management.

Background: Fluoroscopy is the main visualization technique for EP procedures. A radiation protection cabin (RPC) shielded with 2 mm lead-equivalent walls was tested as an alternative protection tool (Cathpax ® , Lemer Pax). Methods: To assess the scattered radiation to the operator inside the RPC an electronic personal dosimeter (EPD; Mk2, Thermo Electron) was placed at the neck level of the operator. A second EPD was located outside the RPC at 150 cm height from the floor, to record the presumable head radiation dose. Results: Radiation doses were measured in a total of 138 consecutive patients (age 54±16 yrs, BMI 28±5 kg/m 2 (18-45), 64% male) undergoing a variety of ablation procedures (SVT=75, AFL=32, AF=17, VT=14). Median fluoroscopy time was 39 min (7-140), the cumulative dose-area product (DAP) 4702 cGy.cm 2 (493-65620). Doses outside the RPC showed a median of 135 µSv (1-4881). Doses inside the RPC were detected only at sensitivity threshold or background levels (mean 0.2SD0.7 µSv, median 0.0, range 0-4). The dose reduction to the operator was highest for AF ablations (354 vs 0.5 µSv, respectively; p<0.001). The total accumulated dose outside the RPC was 37883 µSv for all 138 procedures, whereas for the protected operator inside only 30 µSv. Conclusions: There were highly concordant low dose values measured for the operator inside the RPC in comparison to high doses outside the RPC. The use of a RPC represents a major benefit over a lead apron and contributes to a significant dose reduction as low as reasonably achievable (ALARA principle).

Cardiovascular Implantable Electronic Devices (CIED) are gaining popularity in treating patients with heart disease. Remote monitoring through care management systems enables continuous surveillance of such patients by checking device functions and clinical events. These care management systems include decision support capabilities based on clinical guidelines. Data input to such systems are from different information sources including medical devices and Electronic Health Records (EHRs). Although evidence-based clinical guidelines provides numerous benefits such as standardized care, reduced costs, efficient and effective care management, they are currently underutilized in clinical practice due to interoperability problems among different healthcare data sources. In this paper, we introduce the iCARDEA care management system for atrial fibrillation patients with implant devices and describe how the iCARDEA care plan engine executes the clinical guidelines by seamlessly accessing the EHR systems and the CIED data through standard interfaces.