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28) (P less then 0.05 for StaphSR versus MRSA-only screening and StaphSR versus no testing). MRSA and methicillin-sensitive S. aureus SSIs occurred equally (n = 14 each). The MAX StaphSR assay provided accurate detection of both S. aureus and MRSA nasal colonization in presurgical patients, allowing infection prevention measures, including presurgical prophylaxis, to be implemented in a timely and consistent manner to avoid SSIs.Background Mutations in LMNA cause an arrhythmogenic cardiomyopathy (cardiolaminopathy) with high risk of ventricular tachycardia (VT). However, the natural history of VT amongst patients with cardiolaminopathy is incompletely understood. Objective To describe the longitudinal burden and progression of VT, including change in tachycardia cycle length (TCL), response to anti-tachycardia pacing (ATP), and prognostic significance of high-burden VT (> 5 episodes of VT at any device interrogation) in cardiolaminopathy patients. Methods Patients with cardiolaminopathy and an implantable cardioverter defibrillator (ICD) were identified from a single center database. Serial device interrogations and the medical record were used to collect VT burden, TCL and response to ATP. Results Cardiolaminopathy patients with primary (n=27) or secondary prevention (n=16) ICDs were followed for 2 (IQR 1,5) years. VT burden was substantially higher in patients receiving secondary prevention ICDs (28±40.9 vs. 3.6±7.3 episodes per 100 patient years, p less then 0.001). ATP was highly effective (94%) at terminating VT except in short TCL ( less then 250 ms) where ATP failed in 60%. Amongst patients with recurrent VT, the TCL increased by 112±93.6 ms during follow up. Inappropriate shocks were rare (0.4% of all therapies). Median time to transplantation, ventricular assist device or death was 18 months (IQR 0.7, 27.1) in patients with high-burden VT. Conclusion In cardiolaminopathy, VT is recurrent and highly responsive to ATP which supports the use of transvenous ICDs iteratively programmed to manage VT of various TCLs. The onset of high-burden VT indicates poor prognosis and should warrant referral to a heart failure specialist.Background 12-lead electrocardiogram (ECG) criteria have been developed to identify idiopathic ventricular arrhythmias (VAs) from the left ventricular (LV) papillary muscles (PAPs), but accurate localization remains a challenge. Objective To develop ECG criteria for accurate localization of LV PAP VAs utilizing lead V1 exclusively. Methods Consecutive patients undergoing mapping and ablation of VAs from the LV PAPs guided by intracardiac echocardiography from 2007-2018 were reviewed (study group). The QRS morphology in V1 was compared to patients with VAs with a "RBBB" morphology from other LV locations (reference group). Patients with structural heart disease were excluded. Results 111 patients with LV PAP VAs (age 54±16, male 59%) including 64 (55%) from the posteromedial PAP and 47 (42%) from the anterolateral PAP. The reference group included patients with VAs from the following LV locations fascicles (n=21), outflow tract (n=36), ostium (n=37), inferobasal segment (n=12), and apex (5). PAP VAs showed 3 distinct QRS morphologies in V1 93% of the time Rr (53%), R with a slurred downslope (29%), and RR (11%). Sensitivity, specificity, and positive and negative predictive values for the 3 morphologies combined are 93%, 98%, 98%, and 93%, respectively. The intrinsicoid deflection of the PAP VAs in V1 were shorter than the reference group (63±13 ms versus 79±24 ms; p less then 0.001). An intrinsicoid deflection time less than 74 ms best differentiated the two groups (sensitivity, 79%; specificity, 87%). Conclusion VAs originating from the LV PAPs manifest unique QRS morphologies in lead V1, which can aid in rapid and accurate localization.Background The Micra leadless pacemaker (MLP) has proven to be an effective alternative to a traditional transvenous pacemaker (TVP). However, there has been concern about using the MLP in frail elderly patients because of the size of the implant sheath and perceived risk of perforation. Objectives The objectives of this study were to report the safety of the MLP and compare MPLs with TVPs in the very elderly. Methods All patients 85 years and older who received an MLP or a single-chamber TVP across 6 hospitals in the Northwell Health system from December 2015 to November 2019 were included. Demographic characteristics, procedural details, and procedure-related complications were reviewed. Results Over 4 years, 564 patients underwent MLP implantation. During this time, 183 MLPs and 119 TVPs were implanted in patients 85 years and older. The mean age was 89.7 ± 3.4 years, and 47.4% were men. CDK inhibitor MLP implantation was successful in all but 3 patients (98.4% success rate). There was no difference in procedure-related complications (3.3% vs 5.9%; P = .276). Complications included 5 access site hematomas in the MLP group, 3 in the TVP group, 1 pericardial effusion in each group, and 3 acute lead dislodgments ( less then 24 hours) in the TVP group. MLP implantation resulted in a significantly shorter mean procedure time (35.7 ± 23.0 minutes vs 62.3 ± 31.5 minutes, P less then .001). Conclusion In a large multicenter study of patients 85 years and older, MLP implantation (1) was successful in 98.4% of patients, (2) was safe with no difference in procedure-related complications compared to the TVP group, and (3) resulted in significantly shorter procedure times.Background Gain-of-function variants in the SCN5A-encoded Nav1.5 sodium channel cause type 3 long QT syndrome (LQT3) and multifocal ectopic Purkinje-related premature contractions (MEPPC). Although the Purkinje system is uniquely sensitive to the action potential prolonging effects of LQT3-causative variants, the existence of additional Purkinje phenotype(s) in LQT3 is unknown. Objective To determine the prevalence and clinical implications of frequent fascicular/Purkinje-related premature ventricular contractions (PVCs) and short-coupled ventricular arrhythmias (VAs), suggestive of Purkinje system hyperexcitability (PSH), in a single-center LQT3 cohort. Methods Retrospective analysis of 177 SCN5A-positive patients was performed to identify individuals with a LQT3 phenotype. Available electrocardiographic, electrophysiology (EP) study, device, and genetic data from 91 LQT3 individuals were reviewed for evidence of presumed fascicular PVCs and short-coupled VAs. The relationship between PSH and ventricular fibrillation (VF) events was assessed by Kaplan-Meier and Cox regression analyses.