Some of the new topics under discussion this month include patient support groups and reps in the EP lab. Readers, let us know if you can help provide any input. 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 look forward to hearing from you!

There are currently about five million people with diagnosed heart failure in the United States, and each year 500,000 new cases are found. The five-year mortality rate for heart failure victims is about 50%. It is estimated that for each heart failure admission, a hospital will lose about $1,000.^{1/SUP> The implantation of bi-ventricular pacing devices has impacted quality of life for many of these patients. The benefits of cardiac resynchronization therapy (CRT) have been reported in the literature.2,3 However, a 2003 report stated that 30% of those with bi-ventricular devices implanted did not improve with CRT.4 In the original CRT trials, AV and VV optimization were performed at discharge and at ~ six-month intervals, as changes due to remodeling of the heart took place. This optimization was an attempt to ensure that paced timing events maximized cardiac hemodynamics. However, the 2003 report found that only 10% of patients were undergoing measured optimization post}

The results of the DAVID trial indicated that for patients undergoing ICD implants, DDDR 70-130 programming was associated with greater risk of heart failure hospitalization and total mortality compared with VVI-40 programming. The investigators speculated that excess right ventricular (RV) pacing in the DDDR arm may have explained the outcomes. DAVID raised questions regarding the safety of dual-chamber programming and the potential harm of right ventricular pacing.

Twenty-year-old Anthony Bates was on his way home when he suffered sudden cardiac arrest (SCA) in his truck. He had just completed a light workout at the Kansas State weight room. Emergency hospital physicians worked for three hours to revive Anthony to no avail. The accident didn’t kill him — SCA did. His cause of death was determined to be undetected hypertrophic cardiomyopathy (HCM).

In the October 9, 2006 issue of the Archives of Internal Medicine, Dr. Susmita Parashar et al published “Time Course of Depression and Outcome of Myocardial Infarction.” In their research, they evaluated the importance of transient, new, or persistent depression on outcomes at six months post myocardial infarction (MI). They found that patients who experienced symptoms of depression after a heart attack were associated with worse outcomes. Susmita Parashar, MD, MPH, MS is Assistant Professor at Emory University in Atlanta, Georgia.

At Platte Valley Medical Group in Kearney, Nebraska, I am responsible for obtaining pacemaker data for more than 700 patients. My goal is to ensure all patients are getting the follow-up they need and not falling through the cracks. However, when I am the only staff member checking more than 700 patients, it can be extremely challenging.

Electrocautery is commonly employed during surgical implantation and explantation of pacemakers and implantable cardioverter-defibrillators (ICDs). Four cases of electrocautery-induced ventricular tachyarrhythmias including ventricular tachycardia (VT) or ventricular fibrillation (VF) during device implantation or explantation are described. Methods. The incidence of electrocautery-induced VT or VF at Winthrop University Hospital was analyzed over a 5-year period (November 2000 to March 2006). Specific devices, indications for device implantation or explantation, electrocautery configuration, and grounding patch placement were analyzed. Results. Between November 2000 to March 2006, 4,698 devices were implanted and/or explanted at Winthrop University Hospital, of which 4 patients developed electrocautery-induced ventricular tachyarrhythmias. The patients had a mean age of 64 ± 16 years, and mean left ventricular ejection fraction of 34 ± 9 percent. Three patients (75%) had