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Objectives This study aimed to compare permanent pacemaker implantation (PPMI) rates among patients undergoing Trans-catheter Aortic Valve Implantation (TAVI) with first generation (G1) versus second generation (G2) valves and the impact of PPMI on long-term mortality. Background PPMI is a known adverse event after TAVI. Recently, two novel iterations of valve designs of both the balloon expandable valves (BEV) and self-expanding valves (SEV) were introduced as a second generation valves. Methods All patients included in the Israeli multicenter TAVI registry were grouped according to valve type (BEV vs. SEV) and generation (G1 vs. G2). A comparison was made for clinical and outcome indices of patients undergoing TAVI with G1 and G2 in each of the valve systems. Results A total of 1377 patients were included. The incidence of PPMI did not differ between G1-BEV versus G2-BEV (15.3% vs. 17.4%; p = 0.598) nor between G1-SEV versus G2-SEV (23.4% vs. 20.3%; p = 0.302). Depth of implantation and complete right bundle branch block were independently associated with PPMI post-TAVI in both valve systems. PPMI was not associated with an increased risk for 2-year mortality. Conclusions The incidence of PPMI remains a relevant adverse event post-TAVI even when the newer generation valves are used. Since the predictors for PPMI are well established, a standardized approach for the management of conduction disorders is much needed.

BACKGROUND There are limited data available regarding the relationship between atrial fibrillation (AF) clinical type, oral anticoagulation (OAC) treatment, and clinical outcome after transcatheter aortic valve replacement (TAVR). The study was designed to evaluate this relationship. METHODS We analyzed data from the Rabin Medical Center TAVR registry, including 319 consecutive patients who underwent TAVR from 2008 to 2014. Patients were divided into three groups based on their history of AF: sinus rhythm (SR), paroxysmal AF (PAF), or nonparoxysmal AF (NPAF). RESULTS There were 211 (66%), 56 (18%), and 52 (16%) patients in the SR, PAF, and NPAF groups, respectively. The cumulative risk for stroke or death at 2 years was highest among patients with NPAF (38%), but similarly low in PAF (15%) and SR patients (16%, P < 0.001). By multivariate analysis, patients with NPAF demonstrated a significantly higher risk of stroke or death (HR = 2.76, 95% CI 1.63-4.66, P < 0.001), as compared with SR. In contrast, patients with PAF had a similar risk of stroke or death compared with SR (HR = 0.80, P = 0.508). Patients with NPAF not treated with OAC demonstrated an 8.3-fold (P < 0.001) increased risk of stroke or death, whereas patients with PAF not treated with OAC had a similar risk of stroke or death compared with the SR group (HR = 1.25, P = 0.569). CONCLUSION History of NPAF, but not PAF, is associated with a significant increased risk of stroke or death compared with sinus rhythm in patients undergoing TAVR.

Aim: Many publications in recent decades have reported a temporal link between medical events and environmental physical activity. The aim of this study was to analyze the time of occurrence of electrical heart storms against levels of cosmological parameters. Methods: The sample included 82 patients (71 male) with ischemic cardiomyopathy treated with an implantable cardioverter defibrillator at a tertiary medical center in 1999‐2012 (5,114 days). The time of occurrence of all electrical heart storms, defined as three or more events of ventricular tachycardia or ventricular fibrillation daily, was recorded from the defibrillator devices. Findings were analyzed against data on solar, geomagnetic, and cosmic ray (neutron) activity for the same time period obtained from space institutions in the United States and Russia. Results: Electrical storms occurred in all months of the year, with a slight decrease in July, August, and September. Most events took place on days with lower-than-average levels of solar and geomagnetic activity and higher-than-average levels of cosmic ray (neutron) activity. There was a significant difference in mean daily cosmic ray activity between the whole observation period and the days of electrical storm activity (P = 0.0001). Conclusion: These data extend earlier findings on the association of the timing of cardiac events and space weather parameters to the most dangerous form of cardiac arrhythmia-electric storms. Further studies are needed to delineate the pathogenetic mechanism underlying this association. (PACE 2014; 37:1067‐1070)

Environmental Physical Activity. Background: Studies by our group have shown an inverse relationship between sudden death and cardiac rhythm disturbances and environmental levels of geomagnetic activity (GMA). The aim of this study was to use the precise data provided by automatic implantable cardioverter defibrillators (ICDs) regarding the onset of ventricular fibrillation and ventricular tachycardia to link these events to GMA level. Patients and Methods: The study group included 25 patients (22 men; 22 with ischemic cardiomyopathy) aged 28-81 years in whom an ICD had been implanted between 1995 and 2004. Patients were referred to the cardiac intensive care unit after each event that induced one or more discharges. The number of events and the day on which they occurred were recorded. Data on GMA and other cosmophysical parameters were obtained from the U.S. National Geophysical and Space Service Centers and the Russian Academy of Sciences. GMA levels, graded from I (quiet) to IV (stormy) in the middle latitutes, were recorded for 1974-2003 (10,954 days) and for each day on which an ICD discharge occurred. Results: A total of 402 discharges were recorded on 137 days during the study period. Forty-six percent of the discharges took place on days of GMA I, compared with 38% - II, 13% - III, and 3% - IV. The daily distribution of GMA was as follows: level I - 35.2%, II - 37.3%, III - 21.86%, IV - 5.61%. Comparison of ICD discharge days and actual multiyear levels of GMA (in percent) yielded a ratio of 1.326 for GMA I, 1.076 - II, 0.459 - III, 0.390 - IV. There was a significant inverse correlation between GMA level and number of discharges (r = -0.97, P = 0.03) and days of treatment (r = -0.96, P = 0.039), and a significant difference between ICD discharges on days of GMA I and GMA II-IV (Χ 2 = 5.05, P = 0.02). Conclusion: The higher number of ICD discharges on days of lowest GMA maybe explained by a possible antiarrhythmic effect of GMA. Environmental arrhythmogenic factors that act inversely to GMA may be activated at times of low GMA.

Atrial Signal Amplitude Measurements in VDD Systems According to Body Position. Single lead VDD pacing is an established therapy in patients with AV block. Body position may influence the amplitude of the atrial signal recorded through the floating atrial electrode. This study analyzed the degree of posture related variation in the signal amplitude of floating atrial electrodes in 63 patients (mean age 72 ′ 21 years) implanted with a VDD system. The average atrial amplitude in the supine position was 1.59 ′ 1.15 mV and decreased significantly in the sitting position (1.37 ′ 1.08, P < 0.014), right decubitus (1.33 ′ 0.83, P < 0.007), and the abdominal position (1.24 ′ 0.86, P < 0.001). The left side decubitus showed a nonsignificant increase in atrial amplitude (1.66 ′ 1.02, P < 0.64). Body position significantly affects P wave amplitude and may be the cause of intermittent atrial undersensing. P wave amplitude measurement in different body postures should be performed in cases where suspected atrial undersensing occurs.