1 and the 2011 percutaneous coronary intervention (PCI) guidelines recommend (Class IC) that PCIs should be performed by operators with an annual volume (>75 procedures) at high-volume centers (>400 procedures) with on-site cardiac surgery. 2 The last decade has observed a decline in number of PCIs performed, and many interventional cardiologists have experienced a drop in procedural volume. 3,4 As a result, the Background-The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. Methods and Results-Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9 th Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457 498 PCIs were identified representing a total of 2 243 209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. ]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). Conclusions-Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization. 5 These recommendations, however, are based on expert opinion derived from the interpretation of data from multiple sources with inherent limitations. Some of these data were derived from state registries and are dated. 5-24The purpose of this study was to determine the association of annual PCI operator and institutional volume with in-hospital mortality, peri-procedural complications, length of hospital stay, and cost of hospitalization using the nation's largest available all-payer insurance inpatient database in a recent era (2005)(2006)(2007)(2008)(2009)) during which procedural techniques and practices have remained relatively stable. Methods Data SourceWe analyzed 5-year data from the 2005 to 2009 from National Inpatient Sample (NIS) database. The NIS is a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is the largest publicly available all-payer inpatient care database in the United States; including data on approximately 7 to 8 million discharges per year, it is stratified to sample approximately 20% sample of US community (nonfederal, short-term, general, a...

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The growing indications for permanent pacemaker and implantable cardioverter defibrillator (ICD) implantation have increased the number of patients with these cardiac rhythm management devices (CRMDs). Cardiac rhythm management devices occasionally perform inappropriately in response to electromagnetic interference (e.g. surgical electrocautery) or lead noise over-sensing (e.g. lead fracture). Temporary reprogramming of the CRMDs using device programmers can prevent these untoward device responses. However, these programmers are device manufacturer specific and require technically qualified personnel to operate. This could cause delayed patient care and increased use of resources in certain clinical situations. Alternatively, clinical magnets, when appropriately positioned over the device site, can change the pacing to an asynchronous mode in pacemakers and suspend tachycardia therapies in ICDs. Although readily available, clinical magnets have not been widely used for this purpose, perhaps due to the unfamiliarity with the variable responses of CRMDs to magnet application. This article provides a comprehensive overview of the current literature on the mechanism of action and the specific responses of various CRMDs to clinical magnets.

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