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Among patients requiring device system revision for Twiddler's syndrome, the use of nonabsorbable antimicrobial pouches was associated with significantly fewer recurrences of lead dislodgement events.

The PACED-OP protocol implementation was associated with a significant reduction in the odds of device reprogramming without a significant difference in the odds of CRMD-related complications.

ElectrocardiogramsDuring electrophysiology study or device implantation, the surface ECG was monitored continuously and stored on a computer-based digital recording system (LabSystemPro, Bard Electrophysiology, Lowell, MA).© 2014 American Heart Association, Inc. Original ArticleBackground-Definitive diagnosis of bilateral bundle-branch delay/block may be made when catheter-induced right bundlebranch block (RBBB) develops in patients with baseline left bundle-branch (LBB) block. We hypothesized that a RBBB pattern with absent S waves in leads I and aVL will identify bilateral bundle-branch delay/block. Methods and Results-Fifty patients developing transient RBBB pattern in lead V1 during right heart catheterization were studied.Patients were grouped according to whether the baseline ECG demonstrated a normal QRS, left fascicular blocks, or LBB block pattern. The RBBB morphologies in each group were compared. The prevalence of bilateral bundle-branch delay/block pattern was examined in our hospital ECG database. All patients with baseline normal QRS complexes (n=30) or left fascicular blocks (4 anterior, 5 posterior) developed a typical RBBB pattern. Among the 11 patients with a baseline LBB block pattern, 7 developed an atypical RBBB pattern with absent S waves in leads I and aVL and the remaining 4 demonstrated a typical RBBB. The absence of S waves in leads I and aVL during RBBB was 100% specific and 64% sensitive for the presence of pre-existing LBB block. Among the consecutive 2253 hospitalized patients with RBBB, 34 (1.5%) had the bilateral bundle-branch delay/block pattern. Conclusions-An ECG pattern of RBBB in lead V1 with absent S wave in leads I and aVL indicates concomitant LBB delay.Pure RBBB and bifascicular blocks are associated with S waves in leads I and aVL. (Circ Arrhythm Electrophysiol. 2014;7:640-644.)Key Words: bundle-branch block ◼ heart block

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