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(Circulation. 2008;118:2115-2116.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-Defibrillator Leads

 
Fractures of pace-sense electrodes in implantable cardioverter-defibrillator patients are a common cause of inappropriate shocks. These fractures result in high pacing impedance and oversensing of rapid, nonphysiological potentials. Despite automated, daily measurements of impedance to provide advance warning, their most common presentation is inappropriate shocks. We developed and tested an algorithm to enhance early identification of lead fractures and to reduce inappropriate shocks. This lead-integrity algorithm, which can be downloaded into presently implanted implantable cardioverter-defibrillators, alerts the patient and/or physician when triggered by either oversensing or abnormal impedance. Because oversensing associated with lead fracture typically is transient, we hypothesized that increasing the number of intervals to detect ventricular fibrillation reduces inappropriate shocks. Thus, the lead-integrity algorithm also increases the number of intervals to detect ventricular fibrillation when triggered. In a simulated retrospective analysis, the lead-integrity algorithm improved advance warning of lead fractures compared with present impedance monitoring. Its clinical value depends on rapid response to alerts by the patient and physician. This lead-integrity algorithm is the first downloadable RAMware developed to enhance the performance of nominally functioning implantable cardioverter-defibrillators and is the first implantable cardioverter-defibrillator monitoring feature that triggers real-time changes in ventricular fibrillation detection parameters to reduce inappropriate shocks. See p 2122.

	A Randomized Trial of On-Pump Beating Heart and Conventional Cardioplegic Arrest in Coronary Artery Bypass Surgery Patients With Impaired Left Ventricular Function Using Cardiac Magnetic Resonance Imaging and Biochemical Markers

 
Although the financial burden of heart failure is growing in the United States, surgical research in this area is limited by difficult patient demographics. Coronary artery bypass grafting (CABG) affects both mortality and morbidity in heart failure patients; however, the benefits are balanced heavily by high . . . [Full Text of this Article]

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