Quality improvement (QI) is based on a methodology of baseline measurement, intervention, and remeasurement/analysis, with iterative improvement cycles along the way. The accuracy of the data used for measuring and remeasuring quality is therefore paramount, which leads to the question: What if the data are not accurate?

General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related…

Arrhythmogenic sudden cardiac arrest (SCA) is a rare but feared complication of hypertrophic cardiomyopathy (HCM). Modern practice is to predict the risk of SCA for patients with HCM and recommend implantable cardiac defibrillators (ICD) for those with specific high risk features.1,2 Largely due to primary prevention ICDs, the mortality of HCM has plummeted over the past few decades, now…

Marcus and colleagues (N Engl J Med. 2023;388(12):1092-1100 PMID: 36947466)

Cardiac pathologists and electrophysiologists have studied the atrioventricular (AV) node since 1906, when Tawara1 described its inferior extensions in the human heart. One century later, this important cardiac structure still carries the reputation of a profound enigma, invoked as the riddle of Sphinx, by means of its electrophysiological properties during both normal conduction and reentrant…

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent regular tachycardia in humans. In this review, we describe the most recent discoveries regarding the anatomical, physiological, and molecular biological features of the atrioventricular junction that could underlie the typical slow-fast AVNRT mechanisms, as these insights could lead to the proposal of a new theory…

Topaz et al (J Am Col Cardiol 2023;81:119, PMID 36631206) developed a technique for treating pocket infections in patients with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators who were deemed too high risk for lead and device extraction because of age, comorbidities, or frailty. The developed technique is a way to deliver continuous,…

Kistler et al (JAMA 2023;329:127, PMID 36625809) compared pulmonary vein isolation (PVI) with posterior wall isolation (PWI) vs PVI alone in symptomatic patients with persistent AF undergoing first-time catheter ablation in a prospective randomized trial. The PVI with PWI group (n = 170) underwent wide antral PVI and PWI. The PVI alone group (n = 168) underwent wide antral PVI alone. The primary…

We thank Kaba et al1 for their interest in our study. The MAUDE (Manufacturer and User Facility Device Experience) database represents a collection of adverse events reported by multiple individuals, including physicians and industry representatives working in the field. This provides us with a fair idea of the real-world problems that can be expected with any particular device. While the…