Volume 21 - Issue 5 - May, 2009

Current Procedural Terminology Coding in Electrophysiology: Focus on 2009 Updates

Manish Undavia, MD

From the Mount Sinai Medical Center, New York, New York.
The author reports no conflicts of interest regarding the content herein.
Address for correspondence: Manish Undavia, MD, 242 Merrick Road, Suite 402, Rockville Center, NY 11570.

ABSTRACT: This article highlights the major changes in the current procedural terminology codes (CPT codes) that were announced by the American Medical Association in January 2009. These new CPT codes were developed to more accurately reflect current cardiac device monitoring capabilities, long-distance telemetry and remote interrogation as well as follow-up practices. Some of these new code sets are structured differently than the CPT codes that they replace. Specifically, the new codes for remote monitoring do not have separate professional (-26) and technical components (-TC) applied to an ...

Advances in Atrial Fibrillation Ablation

Alicia Darge, RPA-C, *Matthew R. Reynolds, MD, MSc, Joseph J. Germano, DO

From Winthrop-University Hospital, Mineola, New York, and *Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Disclosure: Dr. Reynolds is a consultant to Biosense Webster; Dr. Germano has received speaker honnoraria from Boston Scientific Corp., Medtronic, Inc., and St. Jude Medical.
Address for correspondence: Joseph Germano, DO, Assistant Professor of Medicine, Health Science Center, SUNY Stony Brook, Winthrop-University Hospital, 120 Mineola Blvd, Suite 500, Mineola, NY 11501.

Atrial fibrillation (AF) is an increasingly common and costly medical problem.1–3 Given the disappointing efficacy and side effects associated with pharmacological therapy for AF, new treatment options are needed. Over the last decade, advances in our understanding of the mechanisms of AF, coupled with iterative improvements in catheter ablation techniques, have spurred the evolution of catheter ablation for AF from an experimental procedure to an increasingly important treatment option.4 This paper will review recent advances in the approaches and outcomes of AF ablation.

Mechanisms o...

Metastatic Renal Cell Carcinoma Masquerading as ST-Segment Elevation Myocardial Infarction

Danai Kitkungvan, MD, *Sandeep Sharma, MD, *Luigi Pacifico, DO, *David H. Spodick, MD, DSc

From the Department of Medicine, and the *Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted December 16, 2008, provisional acceptance given February 5, 2009, and final version accepted February 11, 2009.
Address for correspondence: Danai Kitkungvan, MD, Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608. E-mail: [email protected]

Case Presentation. A 60-year-old male presented to the emergency department with exertional dyspnea. His past medical history was significant for hypertension and renal cell carcinoma (RCC), which had been diagnosed 2 years previously. He underwent a left nephrectomy followed by combination chemotherapy. However, the cancer was resistant to the chemotherapy and had progressed. His case had been followed by an oncologist from outside the hospital. Therefore, the full details of his medical record were not available to us upon his arrival.

In the emergency department, his electrocardiogram (E...

Letter to the Editor



Fever after BioSTAR® Implantation: Is It a Systemic Reaction to the Collagen Matrix?

“The BioSTAR® septal repair implant for patent foramen ovale (PFO) closure is an exciting development, as it uses a bioabsorbable collagen matrix layer, which is thought to induce low host immune response and is absorbed and replaced by healthy host tissue. In the BEST study (first human trial with the implant), no major adverse events were reported and no evidence of a systematic inflammatory response was recorded.

We report 2 patients who developed fever within 24-hours of receiving a ...

Intravascular Ultrasound Guidance of Multiple Drug-Eluting Stent Implantation in Lesions Associated with Coronary Aneurysms

Godfrey Aleong, MD, Camino Bañuelos, MD, Fernando Alfonso, MD, PhD

From the Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 8, 2008 provisional acceptance given January 13, 2009, and final version accepted February 9, 2009.

Address for correspondence: Fernando Alfonso, MD, Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico “San Carlos”, Ciudad Universitaria, Plaza Cristo Rey, Madrid 28040, Spain. E-mail: [email protected]...

Feasibility and Safety of Ad Hoc Percutaneous Coronary Intervention in the Modern Era

Christopher W. Good, DO, James C. Blankenship, MD, Thomas D. Scott, DO, Kimberly A. Skelding, MD, Peter B. Berger, MD, *G. Craig Wood

From the Department of Cardiology, and the *Center for Health Research, Geisinger Medical Center, Danville, Pennsylvania.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted November 18, 2008, provisional acceptance given December 30, 2008, final version accepted February 9, 2009.
Address for correspondence: James Blankenship, MD, Department of Cardiology 21-60, Geisinger Medical Center, 100 North Academy Drive, Danville, PA 17822. E-mail: [email protected]

ABSTRACT: Background. The frequency of ad hoc percutaneous coronary intervention (PCI) varies among institutions and regions of the country. It is unclear what factors limit use of the ad hoc strategy. Objective. To define factors which limit the use of the ad hoc strategy. Methods. All patients who underwent PCI at our center in 2004 were reviewed. Patients who had emergent PCI for ST-elevation myocardial infarction (n = 188), those who had undergone diagnostic coronary angiography at a referring facility (n = 54), and those who had a repeat PCI after a previous ad hoc PCI (n = 19) were exclu...

Conservative Approach for Perforation and Early Pseudoaneurysm of Left Anterior Descending Artery during Overlapped Stenting

Mohammad Alidoosti, MD, Abbas Soleimani, MD, *Ali Abbasi, MD

From the Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran, and the *Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 5, 2008, provisional acceptance given January 13, 2009, and final version accepted February 9. 2009.

Address for correspondence: Abbas Soleimani, MD, North Kargar Street, Tehran Heart Center, Postal code 1411713138, Tehran, Iran.,Tehran Heart Center...

Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events (full title below)

Daniel L. Jurewitz, MD, Antonio Pessegueiro, MD, Raymond Zimmer, MD, Ravi Bhatia, MD, Jonathan Tobis, MD, Michael S. Lee, MD

From the David Geffen School of Medicine at University of California, Los Angeles (Division of Cardiology), Los Angeles, California.
Michael S. Lee is on the speaker’s bureau for Boston Scientific Corporation, Bristol Myer Squibb, and Schering-Plough; Jonathan Tobis is on the speaker’s bureau for Boston Scientific Corporation.
Manuscript submitted December 15, provisional acceptance given February 9, 2009, manuscript accepted February 25, 2009.
Address for correspondence: Michael S. Lee, MD, UCLA Medical Center, Adult Cardiac Catheterization Laboratory, 10833 Le Conte Avenue, Room BL-394 CHS, Los Angeles, CA 90095. E-mail: [email protected]

Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents

ABSTRACT: Background. Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES). Methods. Our retrospecti...

Percutaneous Revascularization of Chronic Total Occlusion of Left Anterior Descending Artery (full title below)

*Akio Kawamura, MD, §Masahiro Jinzaki, MD, §Sachio Kuribayashi, MD

Percutaneous Revascularization of Chronic Total Occlusion of Left Anterior Descending Artery Using Contralateral Injection via
Isolated Conus Artery

From the *Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, and the §Division of Radiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 15, 2008, and accepted January 5, 2009.

Address for correspondence: Akio Kawamura, MD, Division of Cardi...

Pre-PCI White Blood Cell Count: Should We Care?

David Lao, MD and Yerem Yeghiazarians, MD

From the University of California San Francisco, Division of Cardiology, San Francisco, California.
Address for correspondence: David Lao, MD, University of California San Francisco, Division of Cardiology, 505 Parnassus Avenue, Box 0103, San Francisco, CA 94143-0103. E-mail: [email protected]

Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events.1 While a causal mechanism has yet to be determined, the relationship remains consistent, temporal and dose-dependent in a wide array of patients, ranging from those free of coronary heart disease to those presenting with acute myocardial infarction (MI).2 In the era of percutaneous coronary intervention (PCI), an elevated preprocedural white blood cell (WBC) count has been associated with worse clinical outcomes in patients undergoing angioplasty with or without b...

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