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Remote monitoring of cardiac implantable electronic devices (CIEDs) has become routine practice as a result of the advances in biomedical engineering, the advent of interconnectivity between the devices through the Internet, and the demonstrated improvement in patient outcomes, survival, and hospitalizations. However, this increased dependency on the Internet of Things comes with risks in the form of cybersecurity lapses and possible attacks. Although no cyberattack leading to patient harm has been reported to date, the threat is real and has been demonstrated in research laboratory scenarios and echoed in patient concerns. The CIED universe comprises a complex interplay of devices, connectivity protocols, and sensitive information flow between the devices and the central cloud server. Various manufacturers use proprietary software and black-box connectivity protocols that are susceptible to hacking. Here we discuss the fundamentals of the CIED ecosystem, the potential security vulnerabilities, a historical overview of such vulnerabilities reported in the literature, and recommendations for improving the security of the CIED ecosystem and patient safety.

OBJECTIVES The purpose of this study was to evaluate the transfemoral venous approach for electrophysiologic interventions in patients with inferior vena cava filters. BACKGROUND Reports have detailed complications associated with obtaining central venous access in patients with inferior vena cava filters. Accordingly, electrophysiologic interventions have been modified or deferred altogether in such patients. METHODS Patients requiring interventions with a transfemoral approach who were at least 3 months post filter insertion underwent fluoroscopically guided insertion and withdrawal of electrode catheters with appropriate follow-up. RESULTS Five patients underwent successful pacing, electrophysiologic study, or radiofrequency ablation using one to three catheters, with no complications attributable to filter placement. CONCLUSIONS Transfemoral electrophysiologic interventions can be safely undertaken across vena cava filters provided appropriate precautions are taken.

adiofrequency catheter ablation of accessory pathways has ecome a well-established therapy with a high rate of success. ntracardiac electrophysiologic study, mapping, and ablation of he pathway are typically performed either in sinus rhythm or uring AV reentrant tachycardia. However, atrial fibrillation ccurs commonly in these patients (11.5%–39%). It may be he presenting arrhythmia and can occur during the electrohysiologic study. Atrial fibrillation during electrophysiologic tudy makes mapping and catheter ablation difficult. Previous eports have described ablation of AV accessory pathways uring atrial fibrillation using an accessory pathway potential r earliest ventricular activation as a guide. Pathway potenial localization can be used to guide ablation of an atriofasicular (Mahaim) pathway during atrial fibrillation. However, ocalization of these potentials is different compared with AV athways, as illustrated in the following case.

We report the case of a 47-year-old white man who presented with 1-year history of palpitations while swallowing. Event monitor confirmed the episodes were atrial tachycardia. Medical management with a calcium channel blocker did not alleviate the patient's symptoms. Gastrointestinal endoscopy did not reveal any abnormality. Electrophysiologic study was performed to identify and map the tachycardia. Swallowing during the procedure was used to repeatedly induce the tachycardia. A focal right atrial tachycardia that was mapped to the lower posterior right atrium was successfully ablated. Follow-up at 6 months and 1 year showed complete resolution of symptoms. An in-depth review of the literature and all published case reports of swallowing-induced atrial tachycardia is presented, and possible mechanisms of this rare form of tachycardia are discussed.