Padgettdempsey4967

001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access. CONCLUSIONS Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium. OBJECTIVES The aim of this study was to assess the incidence of unfavorable coronary access after transcatheter aortic valve replacement (TAVR) using post-implantation computed tomography (CT). BACKGROUND Real-world data regarding coronary access after TAVR assessed using post-implantation CT are scarce. METHODS Post-TAVR CT of 66 patients treated with Evolut R or Evolut PRO valves and 345 patients treated with SAPIEN 3 valves were analyzed. The distance from inflow of the transcatheter heart valve (THV) to the coronary ostia and the overlap between THV commissures and the coronary ostia were assessed. Coronary access was defined as unfavorable if the coronary ostium was below the skirt or in front of the THV commissural posts above the skirt in each coronary artery. RESULTS CT-identified features of unfavorable coronary access were observed in 34.8% (n = 23) for the left coronary artery and 25.8% (n = 17) for the right coronary artery in the Evolut R/Evolut PRO group, while those percentages were 15.7% (n = SOLVE]; NCT02318342). INTRODUCTION Obtaining tumor-free margins during breast conservative surgery (BCS) is essential to avoid local recurrence and frequently requires reoperation. Radiofrequency ablation (RFA) of surgical margins after lumpectomy seems to be a helpful tool to avoid reoperations, but evidence is insufficient. This study analyzes the efficacy and safety of RFA after BCS to obtain free surgical margins. METHODS Non-randomized experimental study performed in an intervention group of 40 patients assigned to receive RFA after lumpectomy and successive resection of surgical margins, and a historical control group of 40 patients treated with BCS alone. In the intervention group, the RFA effect on tumor cell viability in the surgical margins was analyzed. Also, reoperation rate, complications and cosmetic results were compared in both groups. RESULTS A total of 240 excised margins were analyzed after RFA, obtaining a high number of tumor-free margins. Compared to the control group, the reoperation rate decreased significantly (0% vs 12%; P=.02), without differences in terms of postoperative complications (10% vs 5%; P=.67) or cosmetic results (excellent or good 92.5% vs 95%; P=.3). CONCLUSIONS RFA after lumpectomy is a reliable, safe and successful procedure to obtain tumor-free surgical margins and to decrease the reoperation rate without affecting complications or compromising cosmetic results. OBJECTIVES This study sought to determine whether sex-specific differences in management and outcomes of syncope patients exist. BACKGROUND Syncope is a common presentation to the emergency department (ED) and reason for hospital admission. METHODS Patients ≥18 years of age, presenting to the ED with a primary diagnosis of syncope in Alberta, Canada, from January 1, 2007 to December 12, 2015 were included. ED records were linked to hospital records to identify patients admitted versus discharged from the ED. Outcomes included 30-day and 1-year all-cause mortality. Multivariable mixed-effect logistic regression assessed the association between sex and outcomes. RESULTS Of the 63,274 ED syncope patients, 33,986 (53.7%) were women and 29,288 (46.3%) were men (p  less then  0.01). Compared with men, women were younger (51.6 ± 23.8 years for women vs. 55.1 ± 20.9 years for men; p  less then  0.001), less likely to arrive by ambulance (48.4% women vs. 51.7% men; p  less then  0.001), and had fewer comorbidities (67.9% women vs. 61.8% men with Charlson comorbidity score = 0; p  less then  0.001). Overall, 12.6% women and 16.8% men were admitted to hospital (p  less then  0.001). Regardless of discharge status, women had lower mortality rates (30-day admitted 2.9% women and 4.4% men; p  less then  0.001; discharged 0.2% women and 0.4% men; p  less then  0.001; and 1-year admitted 12.6% women and 16.1% men; p  less then  0.001; discharged 2.4% women and 3.7% men; p  less then  0.001). After adjusting for confounders, men were associated with 1.4-fold higher odds of death at 1 year. This was unchanged regardless of discharge status. CONCLUSIONS Although women are more likely than men to present to the ED with syncope, they are less likely to be admitted to hospital. Mortality rates are lower for women, regardless of discharge status. OBJECTIVES This study sought to examine the adverse prognosis associated with ventricular arrhythmia clusters that falls outside the current electrical storm definition. BACKGROUND Electrical storm is most frequently defined as a cluster of ≥3 episodes of ventricular arrhythmia (VA) in a 24-h period. This definition has been associated with adverse cardiovascular outcomes and mortality, but the effect of lesser and greater clustering of arrhythmias has not been described. METHODS Among all patients in the Resynchronization in Ambulatory Heart Failure trial, 14,515 implantable cardioverter-defibrillator-detected events with data available were rigorously adjudicated in blinded fashion. Arrhythmia incidence was examined for clustering, defined as 2 or more VA events occurring within 3 months. The prognostic importance of clustering was analyzed by varying the cluster length and number of events used to define a cluster. Mortality rates of groups with clustered arrhythmias were compared to patients with no arrhyassociated with still higher mortality risk. CONCLUSIONS Significant adverse prognostic association of clustered VAs is observable with even 2 VA events within 3 months and increases with higher cluster density. OBJECTIVES This study aimed to evaluate the feasibility and accuracy of using a novel grid mapping catheter during scar-related ventricular tachycardia (VT) ablation. BACKGROUND Ultra-high-density (UHD) mapping improves identification of local abnormal ventricular activities (LAVAs) and characterization of scar substrates. METHODS Consecutive patients underwent endocardial and/or epicardial ablation guided by a HD grid mapping catheter. A linear duodecapolar catheter was used in the initial cases for systematic correlation. Isochronal late activation mapping was performed during sinus rhythm to identify deceleration zones, and activation mapping of VT was performed when tolerated. RESULTS In 38 patients, 51 electroanatomic maps (left ventricle 26, epicardium 21, right ventricle 4) were created using a grid catheter. LAVAs were identified in 98% of cases and deceleration zones were observed in 86%. High-frequency electrograms with diastolic activation were identified during 44 sustained monomorphic VTs, and the critical isthmus was colocalized to deceleration zones during sinus rhythm in 96% of cases. In 17 cases that underwent sequential mapping with both grid and linear catheters, the low voltage area detected using the grid (HD wave) was significantly smaller, with ratios of 0.61 ( less then 0.5 mV) and 0.81 ( less then 1.5 mV) relative to the duodecapolar catheter. CONCLUSIONS VT ablation guided by a novel HD grid catheter is safe and feasible for clinical use in human scar-related VT via both endocardial and epicardial approaches. Automated selection of larger bipolar amplitudes among orthogonal pairs consistently displayed smaller low voltage areas than a previously validated linear catheter. OBJECTIVES This study investigated the performance of Temporary Pacing via an Externalized Active-Fixation (TPEAF) lead. BACKGROUND The incidence of cardiac implantable electronic device infections is increasing, which necessitates the need for transvenous lead extraction (TLE). Pacemaker-dependent patients require temporary pacing during the guideline-recommended waiting period before reimplantation. Data regarding safety and efficacy of TPEAF leads are very limited. METHODS We evaluated patients implanted with TPEAF leads post-TLE at our center between April 2004 and December 2017. RESULTS TPEAF leads were placed in 158 patients. The mean age was 74 ± 11 years. The median duration of the temporary lead was 6 days (range 1 to 29). There were 4 procedural complications (2.5% incidence) 1 patient had cardiac arrest from hyperkalemia, 2 developed cardiac tamponade, and 1 had profuse bleeding from the entry point of the leads. There were 13 complications post-implantation (8.2% incidence) 8 lead dislodgments, 1 elevated pacing threshold, 2 vegetations on the temporary lead, 1 pneumothorax, and 1 loss of capture due to the generator "safety switch." All dislodgements occurred within 24 h, except 1 on day 3. Sixteen patients died during the hospital stay 10 due to septic shock, 2 due to hyperkalemic cardiac arrest, 3 due to ventricular tachycardia, and 1 due to a massive cerebrovascular accident. CONCLUSIONS The use of TPEAF leads is safe and efficacious in pacemaker-dependent patients post-TLE. Dislodgement can occur within the first 24 h. The presence of persistent fever and positive blood cultures should raise concern for vegetation on the temporary lead. OBJECTIVES The aim of this study was to develop and validate a risk prediction model for high-grade atrioventricular block requiring cardiac implantable electronic device (CIED) implantation after transcatheter aortic valve replacement (TAVR). BACKGROUND High-grade atrioventricular block requiring CIED remains a significant sequelae following TAVR. Although several pre-operative characteristics have been associated with the risk of post-operative CIED implantation, an accurate and validated risk prediction model is not established yet. METHODS This was a single center, retrospective study of consecutive patients who underwent TAVR from March 10, 2011, to October 8, 2018. This cohort sample was randomly divided into a derivation cohort (group A) and a validation cohort (group B). A scoring system for risk prediction of post-TAVR CIED implantation was devised using logistic regression estimates in group A and the calibration and validation were done in group B. RESULTS A total of 1,071 patients underwent TAVR during the study period. After excluding pre-existing CIED, a total of 888 cases were analyzed (group A 507 and group B 381). Independent predictive variables were as follows self-expanding valve (1 point), hypertension (1 point), pre-existing first-degree atrioventricular block (1 point), and right bundle branch block (2 points). The resulting score was calculated from the total points. The internal validation in group B showed an ideal linear relationship in calibration plot (R2 = 0.933) and a good predictive accuracy (area under the curve 0.693; 95% confidence interval 0.627 to 0.759). CONCLUSIONS This prediction model accurately predicts post-operative risk of CIED implantation with simple pre-operative parameters. OBJECTIVES This study was a sham-controlled, double-blind, randomized clinical trial to examine the effect of chronic low level tragus stimulation (LLTS) in patients with paroxysmal AF. BACKGROUND Low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve at the tragus (LLTS) acutely suppresses atrial fibrillation (AF) in humans, but the chronic effect remains unknown. METHODS LLTS (20 Hz, 1 mA below the discomfort threshold) was delivered using an ear clip attached to the tragus (active arm) (n = 26) or the ear lobe (sham control arm) (n = 27) for 1 h daily over 6 months. AF burden over 2-week periods was assessed by noninvasive continuous electrocardiogram monitoring at baseline, 3 months, and 6 months. Five-minute electrocardiography and serum were obtained at each visit to measure heart rate variability and inflammatory cytokines, respectively. RESULTS Baseline characteristics were balanced between the 2 groups. Adherence to the stimulation protocol (≤4 sessions lost per month) was 75% in the active arm and 83% in the control arm (p > 0.