Cardiac Electrophysiology Review 

About: Cardiac Electrophysiology Review is an academic journal. The journal publishes majorly in the area(s): Atrial fibrillation & Sinus rhythm. It has an ISSN identifier of 1385-2264. Over the lifetime, 523 publications have been published receiving 5367 citations.

DEFibrillators In Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE).

Abstract: The DEFibrillators In Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) was a multi-center, randomized, investigator-initiated trial. Patients enrolled in the trial had non-ischemic cardiomyopathy (LVEF 10 PVCs/hr or non-sustained ventricular tachycardia defined as 3 to 15 beats at a rate of >120 bpm) on Holter monitor or telemetry within the past 6 months. All patients received standard oral medical therapy for heart failure including angiotensin converting enzyme inhibitors and beta-blockers. Patients were randomized to implantable cardioverter defibrillator (ICD) versus no ICD. Patients were followed for 2 to 3 years. The primary endpoint was total mortality. Quality of life and pharmacoeconomics analysis was also performed. A registry tracked patients who met basic inclusion criteria but were not randomized. We estimated an annual total mortality of 15% at 2 years in the treatment arm that did not receive an ICD. The ICD was expected to reduce mortality by 50%. Approximately 229 patients were required in each treatment group. Forty-five centers were included in this trial that was designed to last an estimated 4 years. Enrollment was projected to occur over 2 1/2 years with a post enrollment follow-up of 1 1/2 years.

Clinical implications of present physiological understanding of HRV components.

Abstract: Time and frequency domain analysis of heart rate variability (HRV) is a non invasive techniquecapable of providing information on autonomic modulation of the sinus node and of stratifying risk aftermyocardial infarction and in heart failure. One of the basic assumptions used to explain the negative predictivevalue of reduced HRV was the concept that overall HRV was largely dependent on vagal mechanisms and that areduction in HRV could reflect an increased sympathetic and a reduced vagal modulation of sinus node; i.e.,an autonomic imbalance favouring cardiac electrical instability. This initial interpretation was challenged byseveral findings indicating a greater complexity of the relationship between neural input and sinus noderesponsiveness as well as the possible interference with non neural mechanisms.

Evaluation of pulmonary vein stenosis after catheter ablation of atrial fibrillation.

Abstract: Pulmonary vein (PV) stenosis has emerged recently as an important issue in patients who received radiofrequency (RF) ablation of atrial fibrillation (AF). Serial pathophysiological responses, including thrombosis, metaplasia, proliferation and neovascularization, may lead to PV stenosis after RF energy application around or inside the PV ostia. The clinical manifestations of PV stenosis consist of chest pain, dyspnea, cough, hemoptysis, recurrent lung infection and pulmonary hypertension. Although PV stenosis can be asymptomatic, its severity may be related to the numbers of stenotic PVs, the degree and chronicity of PV stenosis. The incidence of PV stenosis (defined as luminal diameter reduction >50%) detected by spiral computer tomography scan or three dimensional magnetic resonance angiography was from 0 to 7% per PV after isolation of PVs from left atria. Furthermore, some patients may show late progression of PV stenosis during follow-up. The first choice of treatment for symptomatic PV stenosis is PV angioplasty with stenting; however, restenosis were reported occasionally. Several studies have analyzed the predictors of PV stenosis, and the results are controversial. However, the consensus for prevention of PV stenosis should include less energy application and the ablation site more close to the atrial site.

Willem Einthoven and the birth of clinical electrocardiography a hundred years ago.

Abstract: The first electrocardiogram (ECG) from the intact human heart was recorded with a mercury capillary electrometer by Augustus Waller in May 1887 at St. Mary's Hospital, London. The tracings were poor and exhibited only 2 distorted deflections. Willem Einthoven (1860-1927) who was professor of physiology at the University of Leiden, The Netherlands, began his studies of the ECG with the mercury capillary electrometer, and improved its distortion mathematically so that he was finally able to register a good representation of the ECG before the beginning of the twentieth century. He later further improved ECG recordings with the introduction of a string galvanometer of his design. Einthoven published his first article about the string galvanometer in 1901, followed by a more detailed description in 1903 which included a report of ECGs taken with the new instrument. The year 2002 marks the centennial of Willem Einthoven's first recording of the ECG in a clinically applicable fashion with the string galvanometer. The clinical use of Einthoven's immobile equipment required transtelephonic transmission of the ECG from the physiology laboratory to the clinic at the Academic Hospital about a mile away as documented in the 1906 paper on the "telecardiogramme". This report contained a wealth of ECG patterns and arrhythmias. Einthoven developed a system of electrocardiographic standardization that continues to be used all over the world and introduced the triaxial bipolar system with 3 limb leads and thus established uniformity of the recording process. Einthoven also conceived the famous equilateral triangle with leads I, II, and III at its sides and the calculation of the electrical axis (in the frontal plane) depicted as a single vector with an arrow at the center of the triangle. Einthoven recognized the great potential importance of the ECG as a diagnostic and investigative tool and his achievements made him the founder of modern electrocardiography. He was awarded the Nobel Prize in 1924 (2 years after Waller's death) in physiology and medicine, "for the discovery of the mechanism of the electrocardiogram."