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  • The mean follow up period was months ICD discharges and

    2019-06-28

    The mean follow-up period was 12 months. ICD discharges and ventricular tachycardia (VT) events were recorded by reviewing Holter, exercise ECG tracings, ICD interrogation reports, and clinic visit notes. Sustained VT was considered as VT with a rate of >100 beats per minute and duration of >30s or VT that resulted in an ICD shock or anti-tachycardia pacing. Appropriate ICD therapies were all confirmed by an electrophysiologist and resulted from ventricular tachyarrhythmias, not arrhythmias, such as atrial flutter or fibrillation associated with a rapid ventricular response or device/lead malfunction.
    Results We studied 112 patients (mean age 49±15 years); 73 (65%) were male. Majority of the patients were classified as New York Heart Association (NYHA) class I or II (Table 1). Angina and pre-syncope were present in 36 (32%) and 15 (13%) patients, respectively; a significant proportion of patients (27%) had ventricular arrhythmias, consisting of non-sustained VT (n=17) and sustained VT (n=13).
    Discussion
    Conclusion
    Conflict of interest
    Acknowledgments This study was supported by a grant from the John Taylor Babbit Foundation. We are grateful to Dr. Marc Halushka for providing histopathology images and Dr. Nestor Enrique Vasquez for assistance with manuscript preparation.
    Introduction Paroxysmal atrioventricular block (P-AVB) is a well-known cause of syncope. However, it is probably underreported because of poor recognition, limited information in medical literature, its unpredictability, and the lack of a clear marker for AV conduction disease between culprit episodes [1]. In addition, the underlying mechanism of P-AVB is difficult to determine. Identifying the etiology of P-AVB is important because cases of vagally mediated P-AVB are usually benign and do not necessarily require cardiac pacemaker Bax channel blocker [2]. Although ECG findings are reported to be important for predicting the mechanism of P-AVB [1,2], no clinically useful ECG scoring system for P-AVB is currently available. This study aimed to evaluate a new ECG index, the “vagal score (VS),” for determining the mechanism of P-AVB.
    Material and methods
    Results
    Discussion
    Conclusions
    Conflict of interest
    Introduction The implantable cardioverter-defibrillator (ICD) has become a standard therapy for the prevention of sudden cardiac death in patients with lethal ventricular arrhythmias [1,2]. It has been reported that ICD can also reduce the mortality in patients at risk of such arrhythmias [1–4]. Therefore, ICD implantation continues to be commonly performed. Inappropriate ICD shocks, most frequently caused by supraventricular tachyarrhythmias [5,6], are not rare [5–8], despite effective device-related discrimination methods such as dual-chamber ICDs [9,10] and the stability/sudden-onset detection [11,12]. Since inappropriate shocks could result in poorer quality of life [13,14], proarrhythmia [15–17], and increased mortality, [5,7] improvements in tachyarrhythmia detection algorithms in ICD devices are required. Wavelet™ (Medtronic Inc., MN, USA) is one of the morphology-based algorithms that prevent inappropriate ICD therapy due to supraventricular tachycardia (SVT) [18]. It was reported that the Wavelet algorithm effectively distinguishes SVT from ventricular tachycardia (VT) [18,19]. However, since Wavelet is a morphology-based algorithm, its accuracy of discrimination depends on the quality of electrogram (EGM). The EGM source of the Wavelet algorithm is nominally programmed with the Can-RV coil configuration. It uses a far-field EGM, which is superior to near-field EGM in VT detection [20,21]. In addition, it was reported that the morphology of the Can-RV coil EGM was stable across different body positions, thereby maintaining the high percent-match score on the Wavelet algorithm [22–24]. On the other hand, the far-field EGM obtained by the Can-RV coil configuration may be influenced by myopotential interference.