Happy New Year! With the advent of 2007, we bring you several new reader questions, as well as keep the discussion going on many other topics. Let us know if you can help provide any answers for these readers. If you would like to respond, please email us at eplabdigest@hotmail.com or visit us on the Web at www.eplabdigest.com (click on the email discussion group link). Remember, when posting or responding to the discussion group, please let me know if you would like your name, location, and/or email address listed as well. We hope to hear from you soon!

The University College of London Hospital’s (UCLH) Heart Hospital is a leader in catheter-based management of atrial fibrillation (AF), generally performing two to three AF ablations each day. The frequency of these complex arrhythmia cases has helped in the development of the electrophysiology (EP) lab staff so that they are experienced in the use of the most advanced navigation, visualization and ablation techniques and technologies available today. In addition to the use of these tools for the most complex cases, they have also proven to be highly beneficial in facilitating treatment of other supraventricular tachycardias (SVTs).

The Arrhythmia Alliance is a heart rhythm organization in the United Kingdom that aims to provide better understanding and treatment for those living with a cardiac arrhythmia. Continue reading to learn more about the extensive services they offer.

As with any type of regulated environment, one thing is for sure: challenges and changes are inevitable. As a practicing electrophysiologist, this is true not only for me, but also for my patients. That being said, I continue to believe the benefits of implanted device therapy far outweigh the risk. By now many of you have had the opportunity to review the Recommendations from the Heart Rhythm Society (HRS) Task Force on Device Performance Policies and Guidelines released September 28, 2006.¹ These recommendations are and will become more and more important in the future of device therapy.

Pacemaker and implantable cardioverter defibrillator (ICD) device implantation can be a life-saving procedure for many patients. Approximately two million people worldwide have pacemakers, and about 500,000 ICDs are implanted annually. As the popularity and clinical use of these devices continues to grow, so does the incidence of complication, including malfunction, infection and subclavian vein (SVC) occlusion. Pacemaker pocket and infective endocarditis (IE) are a rare but potentially lethal complication of these procedures. The incidence of infective endocarditis within this patient population ranges from 1–7%. Cardiac device (CD) patients with IE have a mortality rate as high as 35%.

ABSTRACT: Endovascular lead infection is an uncommon but serious problem. Transesophageal echocardiography (TEE) is a useful tool for identification of pacemaker lead vegetations. Additionally, incidental echogenic masses are occasionally identified by TEE. The prognosis and optimal treatment of either suspected lead infection or an incidental mass is poorly understood. Objective. The purpose of this study was to examine the incidence and clinical course of pacemaker lead masses. Methods. A total of 1,569 sequential TEE examinations performed from January 2002 to January 2005 were reviewed. Retrospective chart analysis of patients with a pacing lead-associated mass was performed to review the indication for TEE as well as clinical management. Telephone follow up was also performed. Results. During 125 TEE examinations, pacemaker leads were visualized in the right-sided chambers. Fifteen studies demonstrated an echogenic mass associated with the lead. In 9 of these