ICD treatment has been shown to be more effective than antiarrhythmic drugs in the prevention of sudden cardiac death, due to malignant ventricular arrhythmias.1 Despite recent advances in device technology, inappropriate therapy (antitachycardia pacing or shock) still remains an unsolved problem. Electromagnetic interference is a cause of inappropriate therapy and EGMs stored by the devices usually show a pattern of electrical noise.

Readers, thank you for your emails. This month, we are including a reader’s question about EP/cath lab requirements. We have had a great number of you send in questions; now we just need more of you to send in the answers! In addition, please review last month’s questions still under discussion. If you have information that would be helpful for our readers, email us at eplabdigest@hotmail.com or go to www.eplabdigest.com and click on the email discussion group link.

Disclosure: Dr. Machado serves on the scientific advisory board for Guidant Corporation, and is a consultant for Medtronic, Guidant and Biotronik.

The May 20th issue of the New England Journal of Medicine featured two articles that continue to feed the dialogue regarding devices and heart failure. The results of the COMPANION study and the DEFINITE study were both published, and a review of these studies and implications for practice follows.

Syncope is defined as the sudden loss of consciousness associated with the absence of postural tone, and is usually followed by a complete and rapid recovery. It is a very common clinical problem. The overall incidence of this first report of syncope is that it occurs in 6.2 per 1,000 patients; the incidence rate increases with age, especially after age 70.¹ The estimated 10-year cumulative incidence of syncope is 6%, and up to 22% of patients experience recurrent syncope.

Description: A 60-year-old female presented to the Emergency Department with a tachycardia (see 12-lead ECG obtained during tachycardia). She complained of being light-headed, breathless, and was slightly diaphoretic. Upon questioning, for many years she has felt the same way when she would get in an argument with someone. This is her first visit to the Emergency Department.

The Heart Rhythm Society held its annual meeting in San Francisco, California on May 19–22. Couldn’t attend? Here are some of the news items you missed.

This month we cover such topics as CRT, syncope, and MRI-safe devices.

Lenox Hill Hospital, located in New York, is home to one of the best cardiovascular care programs in the United States. In this article, Dr. Steven Zweibel describes what it is like to work in their busy and technologically advanced EP lab.