Cardiac Rhythm Management
Articles Articles 2014 December

Letter from the Editor in Chief

DOI: 10.19102/icrm.2014.051201

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Dear Readers,

This issue of the Journal contains many interesting publications. I would like to highlight the article by Dr. Aryana and his colleagues entitled “Three-Dimensional Electroanatomical Mapping to Guide Endocardial Occlusion of Stenotic Left Atrial Appendage”. The authors describe a novel technique for the occlusion of the left atrial appendage in the setting of stenotic neck. Accessing the appendage in the presence of a narrow neck can be challenging using fluoroscopy. The novel technique illustrated in this article involves the use of electroanatomical mapping and image integration to facilitate the localization and instrumentation of the neck of the appendage. This is the second innovative technique described by this group in the area of left appendage closure. In previous articles, they described the use of Ampltazer ASD closure device to occlude partially-ligated appendages. Incomplete occlusion of the left atrial appendage after surgical ligation is not uncommon. It is sometimes encountered after ligation using prolene sutures, a practice that is being replaced in many centers by surgical excision or clipping. It has been reported that patients with atrial fibrillation and incomplete closure continue to be at risk for stroke, thus presenting a challenging clinical scenario. The technique presented in this article may provide a solution for some of these patients.

This issue of the Journal also marks the end of 2014, a very productive year for the field of clinical cardiac electrophysiology. Contact force sensing received FDA approval in 2014 after favorable results from the SMART AF and TOCCASTAR studies. The quest for elucidating the mechanism of persistent atrial fibrillation continued in 2014 with more studies showing potential roles for rotor mapping and scar delineation by MRI. Other studies revealed lack of benefit with CFAE ablation. Leadless pacing also became available this year, commercially in Europe and in clinical trials in the US. This method of pacing has the potential of revolutionizing the field of device implantation by eliminating decades-old history of lead complications. On the pharmacology front, we witnessed this year a substantial increase in the use of novel anticoagulants which have been shown to be superior to Warfarin in many aspects and provided further options for stroke prevention in patients with atrial fibrillation. In contrast to all those positive developments, there were some unfortunate changes in 2014 relating to reimbursement. The bundling of procedure codes that started two years ago lead to reduction of payments in 2014 and exerted significant economical pressure on electrophysiologists. Physicians, nurses, and administrators are constantly asked to reduce cost which is creating significant stress for all health care providers in this field.

On a personal level 2014 marked my first year as the Editor-in-Chief of the Journal of Innovations in Cardiac Rhythm Management. The satisfaction I derive from this job exceeds all my expectations. Reviewing manuscripts from talented investigators and working with members of the editorial board and administrative staff has been extremely fulfilling.

Finally I would like to use this occasion to wish you and your loved ones happy Holidays and a healthy and prosperous New Year.

Warm regards,

Moussa Mansour, MD, FHRS, FACC
The Journal of Innovations in Cardiac Rhythm Management
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital
Boston, MA