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Karikalan S, Tan MC, Zhang N, El-Masry H, Killu AM, DeSimone CV, Deshmukh AJ, McLeod CJ, Sorajja D, Srivathsan K, Scott L, Cha YM, Lee JZ. Electrical storm after left ventricular assist device (LVAD) implantation. J Cardiovasc Electrophysiol 2024. [PMID: 38590268 DOI: 10.1111/jce.16275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Ventricular tachycardia storm or electrical storm (ES) is a common complication following left ventricular assist device (LVAD) implantation. The factors contributing to ES and outcomes are less studied. The study aimed to determine the factors associated with ES and the probability of survival in patients undergoing LVAD in three tertiary centers over a span of 15 years. METHODS We performed a retrospective cohort study on all patients who underwent LVAD implantation at the Mayo Clinic (Rochester, Phoenix, and Jacksonville) from January 1, 2006 to December 31, 2020. ES was defined as ≥3 episodes of sustained ventricular tachycardia over a period of 24 h with no identifiable reversible cause. Detailed chart reviews of the electronic health records within the Mayo Clinic and outside medical records were performed. RESULTS A total of 883 patients who underwent LVAD implantation were included in our study. ES occurred in 7% (n = 61) of patients with a median of 13 days (interquartile range [IQR]: 5-297 days) following surgery. We found 57% of patients (n = 35) developed ES within 30 days, while 43% (n = 26) patients developed ES at a median of 545 (IQR 152-1032) days after surgery. Following ES, 26% of patients died within 1 year. Patients with ES had a significant association with a history of ventricular arrhythmias and implantable cardioverter defibrillator (ICD) shocks before the procedure. ES was significantly associated with reduced survival compared to patients without ES (hazards ratio [HR]: 1.92, 95% CI: 1.39-2.64, p < .001). CONCLUSION Following LVAD implantation, the rate of ES was 7% with majority of ES occurring within 30 days of LVAD. Risk factors for ES included pre-implant history of ventricular arrhythmias and ICD shock. ES was significantly associated with reduced survival compared to patients without ES.
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Affiliation(s)
- Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Hicham El-Masry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Sykora D, Rosenbaum AN, Churchill RA, Kim BM, Elwazir MY, Bois JP, Giudicessi JR, Bratcher M, Young KA, Ryan SM, Sugrue AM, Killu AM, Chareonthaitawee P, Kapa S, Deshmukh AJ, Abou Ezzeddine OF, Cooper LT, Siontis KC. Arrhythmic manifestations and outcomes of definite and probable cardiac sarcoidosis. Heart Rhythm 2024:S1547-5271(24)02326-9. [PMID: 38588996 DOI: 10.1016/j.hrthm.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The 2014 Heart Rhythm Society consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes. OBJECTIVE The purpose of this study was to evaluate the electrophysiological/arrhythmic phenotype and outcomes of patients with definite and probable CS. METHODS We analyzed the arrhythmic/electrophysiological phenotype in a single-center North American cohort of 388 patients (median age 56 years; 39% female, n = 151) diagnosed with definite (n = 58) or probable (n = 330) CS (2000-2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) event or sudden cardiac death. Key secondary outcomes were also assessed. RESULTS At index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At a median follow-up of 3.1 years, the primary outcome occurred in 22 patients with definite CS (38%) and 127 patients with probable CS (38%) (log-rank, P = .55). In multivariable analysis, only a higher ratio of the 18F-fluorodeoxyglucose maximum standardized uptake value of the myocardium to the maximum standardized uptake value of the blood pool (hazard ratio 1.09; 95% confidence interval 1.03-1.15; P = .003, per 1 unit increase) was associated with the primary outcome. During follow-up, patients with definite CS had a higher burden of device-treated VT/VF events (mean 2.86 events per patient-year vs 1.56 events per patient-year) and a higher rate of progression to heart transplant/left ventricular assist device implantation but no difference in all-cause mortality compared with patients with probable CS. CONCLUSION Patients with definite and probable CS had similarly high risks of first sustained VT/VF/sudden cardiac death and all-cause mortality, though patients with definite CS had a higher overall arrhythmia burden. Both CS diagnostic groups as defined by the 2014 Heart Rhythm Society criteria require an aggressive approach to prevent arrhythmic complications.
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Affiliation(s)
- Daniel Sykora
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - B Michelle Kim
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamed Y Elwazir
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melanie Bratcher
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sami M Ryan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan M Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
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Howick JF, Saric P, Elwazir M, Newman DB, Pellikka PA, Howick AS, O'Horo JC, Cooper LT, Deshmukh AJ, Ganesh R, Hurt R, Gersh B, Bois JP. A Pragmatic Study of Cardiovascular Disease During Long-Term COVID-19. Am J Med 2024:S0002-9343(24)00162-1. [PMID: 38548213 DOI: 10.1016/j.amjmed.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Many patients diagnosed with COVID-19 have persistent cardiovascular symptoms, but whether this represents a true cardiac process is unclear. This study assessed whether symptoms associated with long COVID among patients referred for cardiovascular evaluation are associated with objective abnormalities on cardiac testing to explain their clinical presentation. METHODS A retrospective cohort study of 40,462 unique patients diagnosed with COVID-19 at our tertiary referral was conducted and identified 363 patients with persistent cardiovascular symptoms a minimum of 4 weeks after polymerase chain reaction confirmed COVID-19 infection. Patients had no cardiovascular symptoms prior to COVID-19 infection. Each patient was referred for cardiovascular evaluation at a tertiary referral center. The incidence and etiology of abnormalities on cardiovascular testing among patients with long COVID symptoms are reported here. The cohort was subsequently divided into 3 categories based on the dominant circulating severe acute respiratory syndrome coronavirus 2 variant at the time of initial infection for further analysis. RESULTS Among 40,462 unique patients diagnosed with COVID-19 at our tertiary referral center from April 2020 to March 2022, 363 (0.9%) patients with long COVID were evaluated by Cardiology for possible cardiac sequelae from COVID and formed the main study cohort. Of these, 229 (63%) were vaccinated and 47 (12.9%) had severe initial infection, receiving inpatient treatment for COVID prior to developing long COVID symptoms. Symptoms were associated with a cardiac cause in 85 (23.4%), of which 52 (14.3%) were attributed to COVID; 39 (10.7%) with new cardiac disease from COVID, and 13 (3.6%) to worsening of pre-existing cardiac disease after COVID infection. The median troponin change in 45 patients with troponin measurements within 4 weeks of acute infection was +4 ng/dL (9 to 13 ng/dL). Among the total cohort with long COVID, 83.7% were diagnosed during the pre-Delta phase, 13.2% during the Delta phase, and 3.1% during the Omicron phase of the pandemic. There were 6 cases of myocarditis, 11 rhythm disorders, 8 cases of pericarditis, 5 suspected cases of endothelial dysfunction, and 33 cases of autonomic dysfunction. CONCLUSION This pragmatic retrospective cohort study suggests that patients with long COVID referred for cardiovascular evaluation infrequently have new, objective cardiovascular disease to explain their clinical presentation. A multidisciplinary, patient-centered approach is warranted for symptom management along with conservative use of diagnostic testing.
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Affiliation(s)
| | | | | | | | | | | | - John C O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine; Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minn
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Fla
| | | | | | - Ryan Hurt
- Division of General Internal Medicine
| | | | - John P Bois
- Department of Cardiovascular Medicine; Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minn
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Bhalla JS, Majmundar M, Patel KN, Deshmukh AJ, Connolly HM, Chirac A, Egbe AC, Miranda WR, Madhavan M. Trends in cardiac implantable electronic device utilization in adults with congenital heart disease: a US nationwide analysis. J Interv Card Electrophysiol 2024; 67:319-328. [PMID: 37392273 DOI: 10.1007/s10840-023-01601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) have increased risk of arrhythmias warranting implantation of cardiac implantable electronic devices (CIEDs), which may parallel the observed increase in survival of ACHD patients over the past few decades. We sought to characterize the trends and outcomes of CIED implantation in the inpatient ACHD population across US from 2005 to 2019. METHODS A retrospective analysis of the Nationwide Inpatient Sample (NIS) identified 1,599,519 unique inpatient ACHD admissions (stratified as simple (85.1%), moderate (11.5%), and complex (3.4%)) using the International Classification of Diseases 9/10-CM codes. Hospitalizations for CIED implantation (pacemaker, ICD, CRT-p/CRT-d) were identified and the trends analyzed using regression analysis (2-tailed p < 0.05 was considered significant). RESULTS A significant decrease in the hospitalizations for CIED implantation across the study period [3.3 (2.9-3.8)% in 2005 vs 2.4 (2.1-2.6)% in 2019, p < 0.001] was observed across all types of devices and CHD severities. Pacemaker implantation increased with each age decade, whereas ICD implantation rates decreased over 70 years of age. Complex ACHD patients receiving CIED were younger with a lower prevalence of age-related comorbidities, however, had a greater prevalence of atrial/ventricular tachyarrhythmias and complete heart block. The observed inpatient mortality rate was 1.2%. CONCLUSIONS In a nationwide analysis, we report a significant decline in CIED implantation between 2005 and 2019 in ACHD patients. This may either be due to a greater proportion of hospitalizations resulting from other complications of ACHD or reflect a declining need for CIED due to advances in medical/surgical therapies. Future prospective studies are needed to elucidate this trend further.
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Affiliation(s)
- Jaideep Singh Bhalla
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Monil Majmundar
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kunal N Patel
- Department of Cardiovascular Medicine, West Virginia University Hospital, Morgantown, WV, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Anca Chirac
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander C Egbe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Kowlgi GN, Vaidya V, Dai MY, Futela P, Mishra R, Hodge DO, Deshmukh AJ, Mulpuru SK, Friedman PA, Cha YM. Trends in the 30-year span of noninfectious cardiovascular implantable electronic device complications in Olmsted County. Heart Rhythm O2 2024; 5:158-167. [PMID: 38560372 PMCID: PMC10980926 DOI: 10.1016/j.hroo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background Cardiac implantable electronic devices (CIEDs), such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices, alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends. Objectives We sought to describe trends in noninfectious CIED complications over the past 3 decades in Olmsted County. Methods The Rochester Epidemiology Project is a medical records linkage system comprising records of over 500,000 residents of Olmsted County from 1966 to present. CIED implantations between 1988 and 2018 were determined. Trends in noninfectious complications within 30 days of implantation were analyzed. Results A total of 157 (6.2%) of 2536 patients who received CIED experienced device complications. A total of 2.7% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.8%), followed by hematoma (1.7%). Complications went up from 1988 to 2005, and then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (P < .01). Those with complications were more likely to have prosthetic valves. Obesity appeared to have a protective effect in a multivariate regression model. The mean Charlson comorbidity index has trended up over the 30 years. Conclusion Our study describes a real-world trend of CIED complications over 3 decades. Lead dislodgements and hematomas were the most common complications. Complications have declined over the last decade due to safer practices and a better understanding of anticoagulant management.
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Affiliation(s)
| | - Vaibhav Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pragyat Futela
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rahul Mishra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | | | - Siva K. Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Chen J, Ezzeddine FM, Liu X, Vaidya V, McLeod CJ, Valverde AM, Del-Carpio Munoz F, Deshmukh AJ, Madhavan M, Killu AM, Mulpuru SK, Friedman PA, Cha YM. Left bundle branch pacing vs ventricular septal pacing for cardiac resynchronization therapy. Heart Rhythm O2 2024; 5:150-157. [PMID: 38560374 PMCID: PMC10980924 DOI: 10.1016/j.hroo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background The outcomes of left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) in patients with heart failure remain to be learned. Objective The objective of this study was to assess the echocardiographic and clinical outcomes of LBBP, LVSP, and deep septal pacing (DSP). Methods This retrospective study included patients who met the criteria for cardiac resynchronization therapy (CRT) and underwent attempted LBBP in 5 Mayo centers. Clinical, electrocardiographic, and echocardiographic data were collected at baseline and follow-up. Results A total of 91 consecutive patients were included in the study. A total of 52 patients had LBBP, 25 had LVSP, and 14 had DSP. The median follow-up duration was 307 (interquartile range 208, 508) days. There was significant left ventricular ejection fraction (LVEF) improvement in the LBBP and LVSP groups (from 35.9 ± 8.5% to 46.9 ± 10.0%, P < .001 in the LBBP group; from 33.1 ± 7.5% to 41.8 ± 10.8%, P < .001 in the LVSP group) but not in the DSP group. A unipolar paced right bundle branch block morphology during the procedure in lead V1 was associated with higher odds of CRT response. There was no significant difference in heart failure hospitalization and all-cause deaths between the LBBP and LVSP groups. The rate of heart failure hospitalization and all-cause deaths were increased in the DSP group compared with the LBBP group (hazard ratio 5.10, 95% confidence interval 1.14-22.78, P = .033; and hazard ratio 7.83, 95% confidence interval 1.38-44.32, P = .020, respectively). Conclusion In patients undergoing CRT, LVSP had comparable CRT outcomes compared with LBBP.
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Affiliation(s)
- Jingjing Chen
- Department of Cardiovascular Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Xiaoke Liu
- Department of Cardiovascular Medicine, Mayo Clinic, La Crosse, Wisconsin
| | - Vaibhav Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Eau Claire, Wisconsin
| | | | | | | | | | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ammar M. Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva K. Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Tan NY, Adedinsewo D, El Sabbagh A, Sayed Ahmed AF, Carolina Morales-Lara A, Wieczorek M, Madhavan M, Mulpuru SK, Deshmukh AJ, Asirvatham SJ, Eleid MF, Friedman PA, Cha YM, Killu AM. Incidence and Outcomes of New-Onset Right Bundle Branch Block Following Transcatheter Aortic Valve Replacement. Circ Arrhythm Electrophysiol 2024; 17:e012377. [PMID: 38288627 DOI: 10.1161/circep.123.012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The incidence and prognosis of right bundle branch block (RBBB) following transcatheter aortic valve replacement (TAVR) are unknown. Hence, we sought to characterize the incidence of post-TAVR RBBB and determine associated risks of permanent pacemaker (PPM) implantation and mortality. METHODS All patients 18 years and above without preexisting RBBB or PPM who underwent TAVR at US Mayo Clinic sites and Mayo Clinic Health Systems from June 2010 to May 2021 were evaluated. Post-TAVR RBBB was defined as new-onset RBBB in the postimplantation period. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. The risks of PPM implantation (within 90 days) and mortality following TAVR were compared for patients with and without post-TAVR RBBB using Kaplan-Meier analysis and Cox proportional hazards modeling. RESULTS Of 1992 patients, 15 (0.75%) experienced new RBBB post-TAVR. There was a higher degree of valve oversizing among patients with new RBBB post-TAVR versus those without (17.9% versus 10.0%; P=0.034). Ten patients (66.7%) with post-TAVR RBBB experienced high-grade atrioventricular block and underwent PPM implantation (median 1 day; Q1, 0.2 and Q3, 4), compared with 268/1977 (13.6%) without RBBB. Following propensity score adjustment for covariates (age, sex, balloon-expandable valve, annulus diameter, and valve oversizing), post-TAVR RBBB was significantly associated with PPM implantation (hazard ratio, 8.36 [95% CI, 4.19-16.7]; P<0.001). No statistically significant increase in mortality was seen with post-TAVR RBBB (hazard ratio, 0.83 [95% CI, 0.33-2.11]; P=0.69), adjusting for age and sex. CONCLUSIONS Although infrequent, post-TAVR RBBB was associated with elevated PPM implantation risk. The mechanisms for its development and its clinical prognosis require further study.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | | | | | | | | | - Mikolaj Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL (M.W.)
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (N.Y.T., M.M., S.K.M., A.J.D., S.J.A., M.F.E., P.A.F., Y.-M.C., A.M.K.)
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8
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Tan MC, Yeo YH, Ibrahim R, Tan MX, Lee JZ, Deshmukh AJ, Guha A. Trends and Disparities in Cardiovascular Death in Non-Hodgkin Lymphoma. Am J Cardiol 2024; 210:276-278. [PMID: 37945468 DOI: 10.1016/j.amjcard.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, Michigan
| | - Ramzi Ibrahim
- Department of Internal Medicine, University of Arizona-Banner University Medical Center, Tucson, Arizona
| | - Min Xuan Tan
- Department of Pharmacy, Monash University, Melbourne, Victoria, Australia
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Avirup Guha
- Cardio-Oncology Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia; Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
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Kashou AH, LoCoco S, Gardner MR, Webb J, Jentzer JC, Noseworthy PA, DeSimone CV, Deshmukh AJ, Asirvatham SJ, May AM. Mayo Clinic VT calculator: A practical tool for accurate wide complex tachycardia differentiation. Ann Noninvasive Electrocardiol 2023; 28:e13085. [PMID: 37670480 PMCID: PMC10646384 DOI: 10.1111/anec.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open
Abstract
The discrimination of ventricular tachycardia (VT) versus supraventricular wide complex tachycardia (SWCT) via 12-lead electrocardiogram (ECG) is crucial for achieving appropriate, high-quality, and cost-effective care in patients presenting with wide QRS complex tachycardia (WCT). Decades of rigorous research have brought forth an expanding arsenal of applicable manual algorithm methods for differentiating WCTs. However, these algorithms are limited by their heavy reliance on the ECG interpreter for their proper execution. Herein, we introduce the Mayo Clinic ventricular tachycardia calculator (MC-VTcalc) as a novel generalizable, accurate, and easy-to-use means to estimate VT probability independent of ECG interpreter competency. The MC-VTcalc, through the use of web-based and mobile device platforms, only requires the entry of computerized measurements (i.e., QRS duration, QRS axis, and T-wave axis) that are routinely displayed on standard 12-lead ECG recordings.
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Affiliation(s)
- Anthony H. Kashou
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | - Sarah LoCoco
- Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Jocelyn Webb
- Mayo Clinic Center for Digital HealthMayo ClinicRochesterMinnesotaUSA
| | - Jacob C. Jentzer
- Department of Cardiovascular MedicineMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Adam M. May
- Cardiovascular DivisionWashington University School of MedicineSt. LouisMissouriUSA
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Ezzeddine FM, Haq IU, Heinrich CK, Jain V, Enger NJ, Schultz ZC, Deshmukh AJ, Del-Carpio Munoz F, Asirvatham SJ, Kapa S, Bowen JM. Mitral annular disjunction and arrhythmias in Marfan syndrome. Heart Rhythm 2023; 20:1461-1462. [PMID: 37406872 DOI: 10.1016/j.hrthm.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ikram U Haq
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Vaibhav Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nicholas J Enger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachary C Schultz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Juan M Bowen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.
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11
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Raina A, van Zyl M, Henrich M, Deshmukh AJ, Kowlgi GN. Reply: Proarrhythmic Effect of Intrinsic Antitachycardia Pacing: Is Only the Pacing Algorithm to be Blamed? JACC Clin Electrophysiol 2023; 9:2171. [PMID: 37879801 DOI: 10.1016/j.jacep.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 10/27/2023]
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12
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Burczak DR, Scott CG, Julakanti RR, Kara Balla A, Swain WH, Ismail K, Geske JB, Killu AM, Deshmukh AJ, MacIntyre CJ, Ommen SR, Nkomo VT, Gersh BJ, Noseworthy PA, Siontis KC. Persistence of left atrial thrombus in patients with hypertrophic cardiomyopathy and atrial fibrillation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01642-5. [PMID: 37715077 DOI: 10.1007/s10840-023-01642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND We recently demonstrated that patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM) have an increased risk of left atrial (LA) thrombus. In this study, we aimed to evaluate thrombus management, thrombus persistence, and thromboembolic events for HCM and non-HCM patients with AF and LA thrombus. METHODS From a cohort of 2,155 AF patients undergoing transesophageal echocardiography (TEE) for any indication, this study included 122 patients with LA thrombus (64 HCM patients and 58 non-HCM controls). RESULTS There was no difference in mean CHA2DS2-VASc scores between HCM and control patients (3.9 ± 2.2 vs 3.8 ± 2.0, p = 0.88). Ten (16%) and 4 (7%) patients in the HCM and control groups, respectively, were in sinus rhythm at the time of TEE identifying the LA thrombus (p = 0.13). In all patients, the anticoagulation strategy was modified after the LA thrombus diagnosis. A total of 36 (56%) HCM patients and 34 (59%) control patients had follow-up TEE at median 90 and 62 days, respectively, after index TEE. The HCM group had significantly higher 90-day rates of persistent LA thrombus compared to the control group (88% vs 29%; p < 0.001). In adjusted models, HCM was independently associated with LA thrombus persistence. Among patients with LA thrombus, the 5-year cumulative incidence of thromboembolic events was 11% and 2% in HCM and control groups, respectively (p = 0.22). CONCLUSIONS Among patients with AF with LA thrombus identified by TEE, those with HCM appear to have a higher risk of LA thrombus persistence than non-HCM patients despite anticoagulation.
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Affiliation(s)
- Daniel R Burczak
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Raghav R Julakanti
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abdalla Kara Balla
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - William H Swain
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Khaled Ismail
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ciorsti J MacIntyre
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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13
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Ezzeddine FM, Killu AM, Deshmukh AJ, Munoz FDC. Inappropriate shocks due to P-wave oversensing in a patient with a subcutaneous implantable cardioverter-defibrillator. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01625-6. [PMID: 37670065 DOI: 10.1007/s10840-023-01625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA.
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
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14
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Egbe AC, Miranda WR, Madhavan M, Abozied O, Younis AK, Ahmed MH, Connolly HM, Deshmukh AJ. Right atrial dysfunction is associated with atrial arrhythmias in adults with repaired tetralogy of fallot. Am Heart J 2023; 263:141-150. [PMID: 37271358 DOI: 10.1016/j.ahj.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adults with repaired tetralogy of Fallot (TOF) have right atrial (RA) remodeling and dysfunction, and RA function can be measured using speckle tracking echocardiography. There are limited data about the role of RA strain imaging for risk stratification in this population. We hypothesized that RA reservoir strain can identify TOF patients at risk of developing atrial arrhythmia. To test this hypothesis, we assessed the relationship between RA reservoir strain and atrial arrhythmias in adults with repaired TOF. METHOD Retrospective cohort study of adults with repaired TOF, and no prior history of atrial arrhythmias. Atrial arrhythmia was defined as atrial fibrillation, atrial flutter/atrial tachycardia, and categorized as new-onset versus recurrent atrial arrhythmias. RESULTS We identified 426 patients (age 33 ± 12 years; males 208 (49%)) that met the inclusion criteria. The mean RA reservoir strain, conduit strain, and booster strain were 34 ± 11%, 20 ± 9%, and 15 ± 12%, respectively. Of 426 patients, 73 (17%) developed new-onset atrial arrhythmias (atrial flutter/tachycardia n = 42; atrial fibrillation n = 31); annual incidence 1.9%. RA reservoir strain was associated with new-onset atrial arrhythmias (adjusted HR 0.95, 95% CI 0.93-0.97) after multivariable adjustment. Of 73 patients with new-onset atrial arrhythmia, 41 (56%) had recurrent atrial arrhythmia (atrial flutter/tachycardia n = 18; atrial fibrillation n = 23); annual incidence 11.2%. Similarly, RA reservoir strain was associated with recurrent atrial arrhythmias (adjusted HR 0.92, 95% CI 0.88-0.96) after multivariable adjustment. CONCLUSIONS RA strain indices can identify patients at risk for atrial arrhythmias, and this can in turn, be used to guide the type/intensity of therapy in such patients.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN.
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Ahmed K Younis
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN
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15
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Ezzeddine FM, Agboola KM, Hassett LC, Killu AM, Del-Carpio Munoz F, DeSimone CV, Kowlgi GN, Deshmukh AJ, Siontis KC. Catheter ablation of atrial fibrillation in patients with and without hypertrophic cardiomyopathy: systematic review and meta-analysis. Europace 2023; 25:euad256. [PMID: 37595138 PMCID: PMC10498139 DOI: 10.1093/europace/euad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). There is limited data regarding the outcomes of AF catheter ablation in HCM patients. In this study, we aimed to synthesize all available evidence on the effectiveness of ablation of AF in patients with HCM compared to those without HCM. METHODS AND RESULTS We systematically reviewed bibliographic databases to identify studies published through February 2023. We included cohort studies with available quantitative information on rates of recurrent atrial arrhythmias, anti-arrhythmic drug (AAD) therapy, and repeat ablation procedures after initial AF ablation in patients with vs without HCM. Estimates were combined using random-effects meta-analysis models and reported as risk ratios (RR) and 95% confidence intervals (CI). Eight studies were included in quantitative synthesis (262 HCM and 642 non-HCM patients). During median follow-up 13-54 months across studies, AF recurrence rates ranged from 13.3% to 92.9% in HCM and 7.6% to 58.8% in non-HCM patients. The pooled RR for recurrent atrial arrhythmia after the first AF ablation in HCM patients compared to non-HCM controls was 1.498 (95% CI = 1.305-1.720; P < 0.001). During follow-up, HCM patients more often required AAD therapy (RR = 2.844; 95% CI = 1.713-4.856; P < 0.001) and repeat AF ablation (RR = 1.544; 95% CI = 1.070-2.228; P = 0.02). The pooled RR for recurrent atrial arrhythmias after the last AF ablation was higher in patients with HCM than those without HCM (RR = 1.607; 95% CI = 1.235-2.090; P < 0.001). CONCLUSIONS Compared to non-HCM patients, those with HCM had higher rates of recurrent atrial arrhythmias, AAD use, and need for repeat AF ablation after initial ablation of AF.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Kolade M Agboola
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 59905, USA
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16
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Tryon DN, Deshmukh AJ, Kowlgi GN. When to sear, when to burn, and when to chop: The art of substrate modification. HeartRhythm Case Rep 2023; 9:576-580. [PMID: 37614382 PMCID: PMC10444547 DOI: 10.1016/j.hrcr.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- David N. Tryon
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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17
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Hu TY, Janga C, Amin M, Tan NY, Hodge DO, Mehta RA, McLeod CJ, Chiriac A, Miranda WR, Connolly HM, Asirvatham SJ, Deshmukh AJ, Egbe AC, Madhavan M. Catheter Ablation of Atrial Fibrillation in Adult Congenital Heart Disease: Procedural Characteristics and Outcomes. Circ Arrhythm Electrophysiol 2023; 16:437-446. [PMID: 37485717 DOI: 10.1161/circep.122.011392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/27/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The outcomes of catheter ablation for atrial fibrillation in adults with congenital heart disease are not well described. METHODS In a retrospective study of adult patients with congenital heart disease who underwent catheter ablation for atrial fibrillation between 2000 and 2020 at Mayo Clinic, procedural characteristics and outcomes were collected. The primary outcomes were atrial arrhythmia (AA) recurrence following a 3-month blanking period and repeat ablation. An arrhythmia clinical severity score was assessed pre- and post-ablation based on the duration of arrhythmia episodes, symptoms, cardioversion frequency, and antiarrhythmic drug use. RESULTS One hundred forty-five patients (age, 57±12 years; 28% female; 63% paroxysmal atrial fibrillation) underwent 198 ablations with a median follow-up of 26 months (interquartile range, 14-69). One hundred ten, 26, and 9 patients had simple, moderate, and complex congenital heart disease, respectively. All patients underwent pulmonary vein isolation, and non-pulmonary vein targets were ablated in 79 (54%). AA recurrence at 12 months was 37% (95% CI, 29%-45%). On univariate analysis, increasing left atrial volume index was associated with higher odds of AA recurrence (odds ratio, 1.03 [1.00-1.06] per 1 mL/m2 increment; P=0.05). Noninducibility of atrial flutter was predictive of decreased odds of AA recurrence (odds ratio, 0.43 [0.21-0.90]; P=0.03). A second ablation was performed in 43 patients after a median of 20 (interquartile range, 8-37) months. Arrhythmia clinical severity scores improved following ablation, reflecting a decrease in symptoms, cardioversions, and antiarrhythmic drugs. CONCLUSIONS Catheter ablation of atrial fibrillation is feasible and effective in patients with adult congenital heart disease and reduces symptoms. Recurrence of AA frequently requires repeat ablation.
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Affiliation(s)
- Tiffany Y Hu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Chaitra Janga
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Mustapha Amin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH (M.A.)
| | - Nicholas Y Tan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo College of Medicine, Jacksonville, FL (D.O.H.)
| | - Ramila A Mehta
- Department of Quantitative Health Sciences, Mayo College of Medicine, Rochester, MN (R.A.M.)
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic in Jacksonville, FL (C.J.M., A.C.)
| | - Anca Chiriac
- Department of Cardiovascular Diseases, Mayo Clinic in Jacksonville, FL (C.J.M., A.C.)
| | - William R Miranda
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Alexander C Egbe
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (T.Y.H., C.J., N.Y.T., W.R.M., H.M.C., S.J.A., A.J.D., A.C.E., M.M.)
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18
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Kowlgi GN, Vaidya V, Dai MY, Mishra R, Hodge DO, Deshmukh AJ, Mulpuru SK, Friedman PA, Cha YM. Trends in the 30-year span of Noninfectious Cardiovascular Implantable Electronic Device Complications in Olmsted County. medRxiv 2023:2023.05.09.23289751. [PMID: 37214896 PMCID: PMC10197787 DOI: 10.1101/2023.05.09.23289751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background Cardiovascular implantable electronic devices (CIEDs) such as permanent pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices alleviate morbidity and mortality in various diseases. There is a paucity of real-world data on CIED complications and trends. Objectives Describe trends in noninfectious CIED complications over the past three decades in Olmsted County. Methods The Rochester Epidemiology Project is a medical records linkage system comprising records of over 500,000 residents of Olmsted County from 1966-current. CIED implants between 1988-2018 were determined. Trends in noninfectious complications within 30 days of implant were analyzed. Results 175 out of 2536 (6.9%) patients who received CIED experienced device complications. 3.8% of the implants had major complications requiring intervention. Lead dislodgement was the most common (2.9%), followed by hematoma (2.1%). Complications went up from 1988 to 2005, then showed a downtrend until 2018, driven by a decline in hematomas in the last decade (p<0.01). Those with complications were more likely to have prosthetic valves. Obesity appeared to have a protective effect in a multivariate regression model. The mean Charlson comorbidity score has trended up over the 30 years. Conclusions Our study describes a real-world trend of CIED complications over three decades. Lead dislodgements and hematomas were the most common complications. Complications have declined over the last decade due to safer practices and a better understanding of anticoagulant management.
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Affiliation(s)
- Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Vaibhav Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Rahul Mishra
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - David O Hodge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Jacksonville, FL 32224, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Jacksonville, FL 32224, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Jacksonville, FL 32224, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
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19
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Gupta AR, Deshmukh AJ, Del-Carpio Munoz F. A Tale of Two Parallel Rhythms. Circulation 2023; 147:1463-1466. [PMID: 37155590 DOI: 10.1161/circulationaha.123.064492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Anshul R Gupta
- Department of Internal Medicine (A.R.G.), Mayo Clinic, Rochester, MN
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine (A.J.D., F.D.-C.M.), Mayo Clinic, Rochester, MN
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20
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Raina A, van Zyl M, Henrich M, Deshmukh AJ, Kowlgi GN. Failure of Intrinsic Antitachycardia Pacing to Terminate Ventricular Tachycardia and Potential Proarrhythmic Effects. JACC Clin Electrophysiol 2023; 9:697-700. [PMID: 37204352 DOI: 10.1016/j.jacep.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/14/2023] [Accepted: 03/01/2023] [Indexed: 05/20/2023]
Abstract
Intrinsic antitachycardia pacing (iATP) is a novel, automated antitachycardia pacing (ATP) algorithm that provides individualized therapy to terminate ventricular tachycardia (VT). If the first ATP attempt is unsuccessful, the algorithm analyzes the tachycardia cycle length and the postpacing interval and adjusts the subsequent sequence to successfully terminate VT. This algorithm was effective in a single clinical study without a comparator arm. However, iATP failure has not been well-documented in the literature. This publication represents the first case series with episode analysis of iATP failure, including a demonstration of its proarrhythmic effect.
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Affiliation(s)
- Anvi Raina
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Mark Henrich
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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21
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Tan MC, Rattanawong P, Karikalan S, Deshmukh AJ, Srivathsan K, Scott L, McLeod CJ, Asirvatham SJ, Noseworthy PA, Mulpuru SK, Cha YM, Munger TM, Lee JZ. Causes of Early Mortality After Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2023; 16:e011365. [PMID: 37082954 DOI: 10.1161/circep.122.011365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Recognition of the causes of early mortality after atrial fibrillation (AF) catheter ablation is essential for the improvement of patient safety. This study sought to determine the causes of early mortality (≤90 days) after AF ablation. METHODS We performed a retrospective analysis of AF ablation from January 1, 2013, to December 1, 2021 at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). Causes of death were identified through a comprehensive chart review of the electronic health record from within the Mayo Clinic system and outside records when available. RESULTS A total of 6723 patients were included in the study. The 90-day all-cause mortality rate was 0.22% (n=15). Among all 90-day deaths, majority of the deaths (73.3%) did not have a direct relationship with the procedure. Sudden death was the most common cause of early death (20%), followed by peri-procedural stroke (13%), respiratory failure (13%), atrioesophageal fistula (13%), infection (7%), heart failure (7%), and traumatic brain injury (7%). The 90-day mortality rate directly due to AF ablation procedural complications was 0.06% (n=4). CONCLUSIONS AF ablation procedure has a 90-day mortality of 0.22%, and the most common cause of early mortality was sudden death. The majority (73.3%) of early mortality was not directly associated with a procedural complication, and the mortality rate due to complications associated with the AF ablation procedure was low at 0.06%. Further studies are required to investigate causes and risk factors associated with sudden death in this patient population.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Komandoor Srivathsan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
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22
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Ma YD, Watson RE, Olson NE, Birgersdotter-Green U, Patel K, Mulpuru SK, Madhavan M, Deshmukh AJ, Killu AM, Friedman PA, Cha YM. Safety of Magnetic Resonance Imaging in Patients with Surgically Implanted Permanent Epicardial Leads. Heart Rhythm 2023:S1547-5271(23)02102-1. [PMID: 37075957 DOI: 10.1016/j.hrthm.2023.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/28/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) safety in patients with an epicardial cardiac implantable electronic device (CIED) is uncertain. OBJECTIVE To assess the safety and adverse effects of MRI in patients who had surgically implanted epicardial CIED. METHODS Patients with surgically implanted CIEDs who underwent MRI with an appropriate Cardiology-Radiology collaborative protocol between January 2008 and January 2021 were prospectively studied in two clinical centers. All patients underwent close cardiac monitoring through MRI procedures. Outcomes were compared between the epicardial CIED group and matched the non-MRI-conditional transvenous CIED group. RESULTS Twenty-nine consecutive patients with epicardial CIED (male 41.4%, mean age of 43 years) underwent 52 MRIs in the 57 anatomic regions. Sixteen patients had pacemakers, 9 had cardiac defibrillators or cardiac resynchronization therapy defibrillators, and 4 had no device generators. There were no significant adverse events in epicardial or transvenous CIED groups. The battery life, pacing, sensing thresholds, lead impedance and cardiac biomarkers were not significantly changed, except one patient had a transient decrease in atrial lead sensing function. CONCLUSION MRI of CIEDs with epicardially implanted leads does not represent a greater risk than the transvenous CIEDs when performed with a multidisciplinary collaborative protocol centered on patient safety.
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Affiliation(s)
- Yue-Dong Ma
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, China
| | | | - Nora E Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ulrika Birgersdotter-Green
- Department of Cardiovascular Medicine, University of California, San Diego Health System, 200 West Arbor Drive, San Diego, California
| | - Kavisha Patel
- Department of Cardiovascular Medicine, University of California, San Diego Health System, 200 West Arbor Drive, San Diego, California
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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23
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van Zyl M, Deshmukh AJ, Asirvatham SJ, DeSimone CV. Isolation of the Right Superior Pulmonary Vein Requiring Superior Limbus Ablation From the Right Atrium. JACC Clin Electrophysiol 2023; 9:603-606. [PMID: 37100539 DOI: 10.1016/j.jacep.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Martin van Zyl
- Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Egbe AC, Abozied O, Miranda WR, Connolly HM, Deshmukh AJ. Relationship between left atrial myopathy and atrial fibrillation in adults with coarctation of aorta. Am Heart J Plus 2023; 27:100284. [PMID: 38511091 PMCID: PMC10945908 DOI: 10.1016/j.ahjo.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/22/2024]
Abstract
Background Although patients with coarctation of aorta (COA) have clinical risk factors for atrial fibrillation (AF), there are limited data about AF prevalence, and role of left atrial (LA) indices for risk stratification in this population. We hypothesized that LA indices (LA reservoir strain and LA volume index) were associated with AF, and would identify patients at risk for AF progression. Methods We analyzed electrocardiograms/Holters, and echocardiograms of adult COA patients at Mayo Clinic (2000-2018). Results Of 776 patients, 726(94 %), 46(5.9 %) and 4(0.5 %) had no history of AF, paroxysmal AF, and persistent AF respectively; yielding AF prevalence of 6.4 %. LA reservoir strain (AUC 0.782 [0.751-0.808]) had more robust association with AF as compared to LA volume index (AUC difference -0.115, p < 0.001).Among 726 patients without prior AF, 25(3.4 %) had new-onset AF during follow-up. LA reservoir strain <25 % and LA volume index >34 ml/m2 were independent predictors of new-onset AF (HR 1.81 [1.15-3.85], and HR 1.41 [1.03-4.78], respectively). Of 46 patients with paroxysmal AF, 22(48 %) had recurrent AF, and LA reservoir strain <25 % was an independent predictor of recurrent AF (HR 1.94 [1.41-4.17]). LV pressure overload and stiffness indices were associated with progressive LA dysfunction and new-onset AF. Conclusions Collectively, these data suggest that LA strain can potentially be used for AF risk stratification. Further studies are required to determine whether LA strain can proactively identify patients that will respond favorably to different antiarrhythmic therapies, and whether interventions to reduce LV pressure overload will improve LA function and reduce AF progression.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Omar Abozied
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
| | - Abhishek J. Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America
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25
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Tan NY, Deshmukh AJ. The scenic route: dilated left superior intercostal vein following acute left brachiocephalic venous obstruction. Europace 2023; 25:39. [PMID: 36106678 PMCID: PMC10103551 DOI: 10.1093/europace/euac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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26
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Agboola KM, Dietrich M, Karki R, Lodhi F, McGill T, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Single-Dose Intraprocedural Steroid Administration Does Not Impact Early Atrial Fibrillation Recurrence. Cardiovasc Drugs Ther 2023; 37:151-157. [PMID: 34581901 DOI: 10.1007/s10557-021-07271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the effect of single-dose intravenous dexamethasone on atrial fibrillation (AF) recurrence following radiofrequency catheter ablation. METHODS A cohort of 84 adult patients (> 18 years) underwent catheter ablation at Mayo Clinic Rochester from January to March 2019. Only first-time ablation patients were included, with all re-do ablations excluded to minimize heterogeneity. Administration of intraoperative dexamethasone 4 mg or 8 mg was determined by chart review from the procedure. At our institution, intraoperative intravenous steroids are administered for postoperative nausea and vomiting (PONV) prophylaxis at the discretion of the anesthesiologist. AF recurrence was determined by ECG or cardiac monitoring within 3 months or between 3 and 12 months post-ablation with an in-person follow-up visit. RESULTS A total of 31 (36.9%) patients received intravenous dexamethasone compared to 54 (63.1%) who did not (approximating a 2:1 comparison group). The incidence of documented AF or atrial flutter, lasting greater than 30 s, within the first 3 months post-ablation was 29.0% in the dexamethasone group versus 24.5% in the non-dexamethasone group (p value 0.80). AF or atrial flutter recurrence at 3-12 months post-ablation was 3.2% in the dexamethasone group compared to 9.4% in the non-dexamethasone group (p value 0.41). CONCLUSION These data suggest that intraoperative intravenous dexamethasone administered during AF ablation for postoperative nausea and vomiting prophylaxis may not have a significant effect on AF recurrence rates.
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Affiliation(s)
- Kolade M Agboola
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael Dietrich
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Roshan Karki
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Fahad Lodhi
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Trevon McGill
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abhishek J Deshmukh
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christopher V DeSimone
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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27
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Patel D, Rao A, Friedman PA, Deshmukh AJ, Lande J, Murphy JA, Brown ML, Lexcen DR, Wilkoff BL. New atrial arrhythmia occurrence in single chamber implantable cardioverter defibrillator patients: A real-world investigation. J Cardiovasc Electrophysiol 2023; 34:438-444. [PMID: 36579406 PMCID: PMC10108104 DOI: 10.1111/jce.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION A current limitation of single chamber implantable cardioverter defibrillators (ICDs) is the lack of an atrial lead to reliably detect atrial fibrillation (AF) episodes. A novel ventricular based atrial fibrillation (VBAF) detection algorithm was created for single chamber ICDs to assess R-R variability for detection of AF. METHODS Patients implanted with Visia AF™ ICDs were prospectively enrolled in the Medtronic Product Surveillance Registry from December 15, 2015 to January 23, 2019 and followed with at least 30 days of monitoring with the algorithm. Time to device-detected daily burden of AF ≥ 6 min, ≥6 h, and ≥23 h were reported. Clinical actions after device-detected AF were recorded. RESULTS A total of 291 patients were enrolled with a mean follow-up of 22.5 ± 7.9 months. Of these, 212 (73%) had no prior history of AF at device implant. However, 38% of these individuals had AF detected with the VBAF algorithm with daily burden of ≥6 min within two years of implant. In these 80 patients with newly detected AF by their ICD, 23 (29%) had a confirmed clinical diagnosis of AF by their provider. Of patients with a clinical diagnosis of AF, nine (39%) were newly placed on anticoagulation, including five of five (100%) patients having a burden >23 h. CONCLUSIONS Continuous AF monitoring with the new VBAF algorithm permits early identification and actionable treatment for patients with undiagnosed AF that may improve patient outcomes.
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Affiliation(s)
- Divyang Patel
- Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia, USA
| | - Archana Rao
- Institute of Cardiovascular Medicine and Science at Liverpool Heart and Chest Hospital Liverpool, Liverpool, UK
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeff Lande
- Medtronic Inc, Mounds View, Minnesota, USA
| | | | | | | | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute Cleveland Clinic, Cleveland, Ohio, USA
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28
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Tarabochia AD, Tan NY, Lewis BR, Slusser JP, Hayes SN, Best PJM, Gulati R, Deshmukh AJ, Tweet MS. Association of Spontaneous Coronary Artery Dissection With Atrial Arrhythmias. Am J Cardiol 2023; 186:203-208. [PMID: 36328832 PMCID: PMC10403149 DOI: 10.1016/j.amjcard.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/01/2022]
Abstract
The co-morbidities and long-term complications of spontaneous coronary artery dissection (SCAD) are incompletely understood. This study investigated the association of atrial arrhythmias (AA), defined as atrial fibrillation and atrial flutter, with SCAD in a patient registry and population-based cohort. This observational study was performed in 2 parts. The first was a retrospective study reviewing patients diagnosed with AA in the Mayo Clinic SCAD Registry. The second was a population-based, case-control study to assess AA in patients with SCAD compared with age- and gender-matched controls. Of 1,214 patients in the Mayo Clinic SCAD Registry, 45 patients (3.7%) with SCAD were identified with an AA. A total of 8 of those patients (17.8%) had a pre-SCAD AA; 20 (44.4%) had a peri-SCAD AA; and 17 (37.8%) had a post-SCAD AA. The univariate analysis did not reveal significant associations with traditional cardiovascular risk factors. In the population-based cohort, 5 patients with SCAD (4%) and 4 controls (1%) developed an AA before the date of SCAD for each patient (odds ratio 4.5, 95% confidence interval [CI] 1.05 to 19.0, p = 0.04). A total of 5 patients with SCAD (4%) and 3 controls (1%) developed an AA in the 10 years after SCAD (hazard ratio 6.3, 95% CI 1.2 to 32.8, p = 0.03). A subgroup of patients with SCAD experienced AA before and after SCAD. Patients with a history of SCAD were more likely to develop AA in the next 10 years than were age- and gender-matched healthy controls.
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Affiliation(s)
- Alex D Tarabochia
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Bradley R Lewis
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Joshua P Slusser
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Patricia J M Best
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
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29
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Lee JZ, Tan MC, Karikalan S, Deshmukh AJ, Sorajja D, Valverde A, Srivathsan K, Scott L, Kusumoto FM, Friedman PA, Asirvatham SJ, Mulpuru SK, Cha YM. Causes of Early Mortality After Transvenous Lead Removal. JACC Clin Electrophysiol 2022; 8:1566-1575. [PMID: 36543507 DOI: 10.1016/j.jacep.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. OBJECTIVES This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. METHODS A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. RESULTS A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. CONCLUSIONS The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Fred M Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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30
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Ward RC, Deshmukh AJ. Cardiac magnetic resonance imaging is a promising modality for left atrial appendage occlusion planning. J Cardiovasc Electrophysiol 2022; 33:2651-2652. [PMID: 36300697 DOI: 10.1111/jce.15721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Robert C Ward
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
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31
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Haq IU, Akhiyat N, Anan AR, Alzubi H, Kowlgi GN, Lee HC, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Mediastinal radiation therapy for breast cancer in female patients is an independent risk factor for atrial fibrillation recurrence post-catheter ablation. J Interv Card Electrophysiol 2022; 65:751-756. [PMID: 35963910 DOI: 10.1007/s10840-022-01341-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to assess the safety, efficacy, and predictors of outcomes for atrial fibrillation (AF) ablation in patients with a history of breast cancer. METHODS Consecutive patients with a history of breast cancer undergoing AF ablation from January 2010 to December 2021 were propensity matched in a 1:1 ratio to patients without a history of any cancer. The primary outcome was procedural efficacy, defined by clinical AF recurrence and repeat catheter ablation. The secondary outcome was an assessment of safety looking at eight peri-procedural events. RESULTS Our cohort was comprised of 82 female patients, 41 patients with a history of breast cancer (mean age, 74.6 ± 7.4 years), and 41 patients with no history of cancer (76.7 ± 8.1 years). Both groups had similar echocardiographic, baseline, and arrhythmia characteristics. Breast cancer patients were at an increased risk of AF recurrence post-ablation compared to non-cancer patients (OR 2.68, 95% CI 1.05-6.86, p = 0.04). Multivariate analysis found prior mediastinal radiotherapy (OR 4.79, 95% CI 1.34-17.1) and AF diagnosis to ablation time (OR 1.2, 95% CI 1.03-1.29) were both independent predictors of AF recurrence post-ablation. CONCLUSION Our study suggests that female patients with a history of breast cancer are at a higher risk of developing AF recurrence after catheter ablation. Multivariate analysis showed that patients with a history of prior mediastinal radiation therapy and AF diagnosis to time to ablation were both independent risk factors.
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Affiliation(s)
- Ikram U Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nadia Akhiyat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Abu Rmilah Anan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hossam Alzubi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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32
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Kashou AH, LoCoco S, Shaikh PA, Katbamna BB, Sehrawat O, Cooper DH, Sodhi SS, Cuculich PS, Gleva MJ, Deych E, Zhou R, Liu L, Deshmukh AJ, Asirvatham SJ, Noseworthy PA, DeSimone CV, May AM. Computerized electrocardiogram data transformation enables effective algorithmic differentiation of wide QRS complex tachycardias. Ann Noninvasive Electrocardiol 2022; 28:e13018. [PMID: 36409204 PMCID: PMC9833371 DOI: 10.1111/anec.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Accurate automated wide QRS complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) can be accomplished using calculations derived from computerized electrocardiogram (ECG) data of paired WCT and baseline ECGs. OBJECTIVE Develop and trial novel WCT differentiation approaches for patients with and without a corresponding baseline ECG. METHODS We developed and trialed WCT differentiation models comprised of novel and previously described parameters derived from WCT and baseline ECG data. In Part 1, a derivation cohort was used to evaluate five different classification models: logistic regression (LR), artificial neural network (ANN), Random Forests [RF], support vector machine (SVM), and ensemble learning (EL). In Part 2, a separate validation cohort was used to prospectively evaluate the performance of two LR models using parameters generated from the WCT ECG alone (Solo Model) and paired WCT and baseline ECGs (Paired Model). RESULTS Of the 421 patients of the derivation cohort (Part 1), a favorable area under the receiver operating characteristic curve (AUC) by all modeling subtypes: LR (0.96), ANN (0.96), RF (0.96), SVM (0.96), and EL (0.97). Of the 235 patients of the validation cohort (Part 2), the Solo Model and Paired Model achieved a favorable AUC for 103 patients with (Solo Model 0.87; Paired Model 0.95) and 132 patients without (Solo Model 0.84; Paired Model 0.95) a corroborating electrophysiology procedure or intracardiac device recording. CONCLUSION Accurate WCT differentiation may be accomplished using computerized data of (i) the WCT ECG alone and (ii) paired WCT and baseline ECGs.
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Affiliation(s)
- Anthony H. Kashou
- Department of Cardiovascular MedicineMayo ClinicMinnesotaRochesterUSA
| | - Sarah LoCoco
- Department of MedicineWashington University School of MedicineMissouriSt. LouisUSA
| | - Preet A. Shaikh
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
| | - Bhavesh B. Katbamna
- Department of MedicineWashington University School of MedicineMissouriSt. LouisUSA
| | - Ojasav Sehrawat
- Department of Cardiovascular MedicineMayo ClinicMinnesotaRochesterUSA
| | - Daniel H. Cooper
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
| | - Sandeep S. Sodhi
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
| | - Phillip S. Cuculich
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
| | - Marye J. Gleva
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
| | - Elena Deych
- Division of BiostatisticsWashington University School of MedicineMissouriSt. LouisUSA
| | - Ruiwen Zhou
- Division of BiostatisticsWashington University School of MedicineMissouriSt. LouisUSA
| | - Lei Liu
- Division of BiostatisticsWashington University School of MedicineMissouriSt. LouisUSA
| | | | | | | | | | - Adam M. May
- Department of Medicine, Division of Cardiovascular DiseasesWashington University School of MedicineMissouriSt. LouisUSA
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Egbe AC, Miranda WR, Anderson JH, DeSimone CV, Andi K, Goda AY, Stephens EH, Dearani JA, Crestanello J, Connolly HM, Deshmukh AJ. Outcome of New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery in Adults With Congenital Heart Disease. JACC Clin Electrophysiol 2022; 8:1407-1416. [PMID: 36424678 PMCID: PMC9991111 DOI: 10.1016/j.jacep.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. POAF is associated with a longer hospital stay, higher healthcare resource utilization, and higher risk of morbidity and mortality. As a result, the American and European guidelines recommend the use of beta-blockers and amiodarone for the prevention of POAF, and in turn, avoid the complications associated with POAF. OBJECTIVES The purpose of this study was to determine the incidence, risk factors, and prognostic implications of new-onset POAF after cardiac surgery in adults with congenital heart disease (CHD). METHODS A retrospective study was conducted among adults with CHD who underwent cardiac surgery (2003-2019). POAF and late-onset atrial fibrillation (AF) were defined as AF occurring within and after 30 days postoperatively, respectively. RESULTS Of 1,598 patients (mean age 39 ± 13 years, 51% men), 335 (21%) developed POAF. Risk factors associated with POAF were older age, hypertension, left atrial (LA) reservoir strain and right atrial (RA) dysfunction, and nonsystemic atrioventricular valve regurgitation. Of 1,291 patients (81%) with follow-up ≥12 months, the annual incidence of late-onset AF was 1.5% and was higher in patients with POAF compared with those without POAF (5.9% vs 0.4%; P < 0.001). Risk factors associated with late-onset AF were POAF, older age, severe CHD, and LA and RA dysfunction. Of the 1,291 patients, 63 (5%) died during follow-up, and the risk factors associated with all-cause mortality were older age, severe CHD, hypertension, left ventricular systolic dysfunction, and LA and RA dysfunction. POAF was not associated with all-cause mortality. CONCLUSIONS POAF was common in adults with CHD and was associated with late-onset AF but not all-cause mortality. Atrial dysfunction was independently associated with POAF, late-onset AF, and all-cause mortality. These risk factors can be used to identify patients at risk for POAF and provide a foundation for prospective studies assessing the efficacy of prophylactic therapies in this population.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kartik Andi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Y Goda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lee JZ, Tan MC, Karikalan S, Deshmukh AJ, Srivathsan K, Shen WK, El-Masry H, Scott L, Asirvatham SJ, Cha YM, McLeod CJ, Mulpuru SK. Causes of Early Mortality After Ventricular Tachycardia Ablation in Patients with Reduced Ejection Fraction. JACC Clin Electrophysiol 2022:S2405-500X(22)00938-0. [DOI: 10.1016/j.jacep.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022]
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Ezzeddine FM, Siontis KC, Giudicessi J, Ackerman MJ, Killu AM, Deshmukh AJ, Madhavan M, van Zyl M, Vaidya VR, Karki R, Tseng A, Munger TM, McLeod CJ, Asirvatham SJ, Del-Carpio Munoz F. Substrate Characterization and Outcomes of Catheter Ablation of Ventricular Arrhythmias in Patients With Mitral Annular Disjunction. Circ Arrhythm Electrophysiol 2022; 15:e011088. [PMID: 36074649 DOI: 10.1161/circep.122.011088] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral annular disjunction (MAD) has recently been recognized as an arrhythmogenic entity. Data on the electrophysiological substrate as well as the outcomes of catheter ablation of ventricular arrhythmias in patients with MAD is limited. METHODS Forty patients with MAD (mean age 47±15 years; 70% female) underwent catheter ablation for ventricular arrhythmias. Detailed clinical, electrocardiographic, cardiac imaging, and procedural data were collected. Clinical outcomes were compared between patients who had substrate modification in the MAD area and those who did not. RESULTS Twenty-three (57.5%) patients had ablation for premature ventricular contractions, 10 (25%) patients for sustained ventricular tachycardia, and 7 (17.5%) patients for premature ventricular contraction-triggered ventricular fibrillation ablation. Mean end-systolic MAD length was 10.58±3.49 mm on transthoracic echocardiography. Seventeen (42.5%) patients had preprocedural cardiac magnetic resonance imaging, and 5 (29%) patients had late gadolinium enhancement. Among the 18 (45%) patients who had abnormal local electrograms (low voltage, long-duration, fractionated, isolated mid-diastolic potentials) during electroanatomical mapping, 10 (25%) patients had abnormal electrograms in the anterolateral mitral annulus or MAD area. Substrate modification was performed in 10 (25%) patients. Catheter ablation was acutely successful in 36 (90%) patients (elimination of premature ventricular contraction or noninducibility of ventricular tachycardia). After a median follow-up duration of 54.08 (interquartile range, 10.67-89.79) months, premature ventricular contraction burden decreased from a median of 9.75% (interquartile range, 3.25-14) before the ablation to a median of 4% (interquartile range, 1-7.75) after the ablation (P=0.03 [95% CI, 0.055-6.5]). Eight (20.5%) patients had repeat ablation for ventricular arrhythmias. Substrate modification of the MAD was associated with a trend toward lower rates of repeat ablation (0% versus 26.7%; P=0.16). CONCLUSIONS Patients with MAD have a complex arrhythmogenic substrate, and catheter ablation is effective in reducing recurrence of ventricular arrhythmias. Substrate mapping and ablation may be considered in these patients.
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Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Konstantinos C Siontis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - John Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Roshan Karki
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Andrew Tseng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.).,Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.A.)
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (F.M.E., K.C.S., J.G., M.J.A., A.M.K., A.J.D., M.M., M.v.Z., V.R.V., R.K., A.T., T.M.M., S.J.A., F.D.-C.M.)
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Deshmukh AJ, Harrell C, Hicks J, Killu AM, Mulpuru SK, Asirvatham SJ, Friedman PA, Cha YM, Madhavan M. Physical Activity in Cardiac Implantable Electronic Device Recipients During the COVID-19 Pandemic. Mayo Clin Proc 2022; 97:1493-1500. [PMID: 35933135 PMCID: PMC8808717 DOI: 10.1016/j.mayocp.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/26/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize the physical activity (PA) level in patients with a cardiac implantable electronic device (CIED) during the coronavirus disease 2019 (COVID-19) pandemic and compare PA level during the pandemic in 2020 with the year 2019. METHODS We performed a retrospective analysis of PA activity in individuals implanted with a CIED enrolled in the BIOTRONIK CERTITUDE Registry. Mean daily and weekly PA from January to August 2020 was compared with 2019. RESULTS A total of 21,660 individuals met eligibility criteria, with mean age of 72.6±11.6 years, and 12,411 (57.3)% were males. A significant decline in daily PA was noted following the pandemic declaration in 2020, with a maximum mean reduction of -24.5±36.3 minutes (P<.0001) observed in April 2020 compared with 2019. PA in 2020 increased from April to May (120.6±67.4 to 129.2±70.9 min/d). PA was lower for all months in 2020 compared with 2019. The decrease in PA was observed in all prespecified groups based on age, sex, type of device, and region of the country. CONCLUSION After the declaration of the coronavirus disease 2019 pandemic, a significant decline in daily PA was observed in individuals with a CIED. Future investigation to establish the impact of this reduction on short and long-term cardiovascular outcomes is required.
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Affiliation(s)
| | | | | | - Ammar M Killu
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Yong Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Shabtaie SA, Sehrawat O, Lee JZ, Cha Y, Mulpuru SK, Kowlgi NG, Siontis KC, Rosenbaum AN, Bois JP, AbouEzzeddine OF, Noseworthy PA, Asirvatham SJ, DeSimone CV, Deshmukh AJ. Cardiac Resynchronization Therapy Response in Cardiac Sarcoidosis. J Cardiovasc Electrophysiol 2022; 33:2072-2080. [DOI: 10.1111/jce.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Samuel A. Shabtaie
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Ojasav Sehrawat
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Yong‐Mei Cha
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Siva K. Mulpuru
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Narayan G. Kowlgi
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | | | - Andrew N. Rosenbaum
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - John P. Bois
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Omar F. AbouEzzeddine
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Peter A. Noseworthy
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | - Samuel J. Asirvatham
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
| | | | - Abhishek J. Deshmukh
- Department of Cardiovascular MedicineMayo Clinic200 First Street SWRochesterMN55905USA
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Deshmukh AJ, DeSimone CV. Reduction of ventricular arrhythmias with synchronized LV pacing-fact, fiction, or fortuitous. J Interv Card Electrophysiol 2022; 65:263-265. [PMID: 35821154 DOI: 10.1007/s10840-022-01295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
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Thotamgari SR, Sheth A, Thakkar S, Patel HP, Deshmukh AJ, DeSimone CV. PO-685-06 LIVER CIRRHOSIS IS ASSOCIATED WITH AN INCREASE IN BLEEDING AND MORTALITY IN PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION: INSIGHTS FROM A NATIONWIDE COHORT ANALYSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Challa A, Pistiolis S, Ward RC, DeSimone CV, DeSimone D, Deshmukh AJ. PO-648-07 OUTCOMES OF INFECTION IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS WITH END STAGE RENAL DISEASE ON HEMODIALYSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Voruganti D, Subash Shantha GP, Bolton A, Alotaibi B, Shah SD, Shravan Turaga NS, Devabhaktuni S, Deshmukh AJ, Paydak H, Mounsey JP. PO-685-08 INCIDENCE OF LIFE-THREATENING EVENTS IN ADULTS WITH PRE-EXCITATION SYNDROME: NATIONAL DATABASE ANALYSIS 2016-2019. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deshmukh AJ, Horner C, Moineau B, Chaves G, Alizadeh-Meghrazi M, Dugan J, Attia ZI, Friedman PA. PO-661-01 SMART CLOTHING FOR THE DETECTION OF CARDIAC ELECTRICAL ACTIVITY AND ARRHYTHMIAS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abu Rmilah AA, Al-Zu’bi H, Haq IU, Yagmour AH, Jaber SA, Alkurashi AK, Qaisi I, Kowlgi GN, Cha YM, Mulpuru S, DeSimone CV, Deshmukh AJ. Predicting Permanent Pacemaker Implantation following Trans-catheter Aortic Valve Replacement: A Contemporary Meta-Analysis of 981,168 patients. Heart Rhythm O2 2022; 3:385-392. [PMID: 36097458 PMCID: PMC9463692 DOI: 10.1016/j.hroo.2022.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heart block requiring permanent pacemaker (PPM) implantation is a relatively frequent complication of transcatheter aortic valve replacement (TAVR). Objective The purpose of this study was to perform a contemporary meta-analysis to provide an updated assessment of clinically useful predictors of PPM implantation post-TAVR. Methods Medline and EMBASE searches were performed to include all studies reporting PPM post-TAVR between 2015 and 2020. Pertinent data were extracted from the studies for further analysis. RevMan was used to create forest plots and calculate risk ratios (RRs). Results We evaluated 41 variables from 239 studies with a total of 981,168 patients. From this cohort, 17.4% received a PPM following TAVR. Strong predictors for PPM implant were right bundle branch block (RBBB) (RR 3.12; P <.001) and bifascicular block (RR 2.40; P = .002). Intermediate factors were chronic kidney disease (CKD) (RR 1.53; P <.0001) and first-degree atrioventricular block (FDAVB) (RR 1.44; P <.001). Weak factors (RR 1–1.50; P <.05) were male gender, age ≥80 years, body mass index ≥25, diabetes mellitus (DM), atrial fibrillation (AF), and left anterior fascicular block (LAFB). These factors along with increased left ventricular outflow tract (LVOT) area (>435 mm2) and/or aortic annulus diameter (>24.4 mm) were incorporated to propose a new scoring system to stratify patients into high- and low-risk groups. Conclusion Male gender, age ≥80 years, FDAVB, RBBB, AF, DM, CKD, Medtronic CoreValve, transfemoral TAVR, increased LVOT, and aortic annulus diameter were significant predictors of post-TAVR PPM implantation. Preprocedural assessment should consider these factors to guide clinical decision-making before TAVR. Validation of our scoring system is warranted.
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Affiliation(s)
- Anan A. Abu Rmilah
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hossam Al-Zu’bi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ikram-Ul Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suhaib A. Jaber
- Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi Arabia
| | - Adham K. Alkurashi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ibraheem Qaisi
- An-Najah National University School of Medicine, Palestine
| | | | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Abhishek J. Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr Abhishek J. Deshmukh, Department of Cardiovascular Disease, Mayo Clinic, 200 First St SW, Rochester, MN 55902.
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Pistiolis S, Challa A, Ward RC, DeSimone CV, Deshmukh AJ, Cha YM. PO-707-04 ANALYSIS OF PATIENT PREDICTORS AND OUTCOMES IN ICD SHOCK THERAPY EXPERIENCED DURING HEMODIALYSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haddadin F, Majmundar M, Jabri A, Pecha L, Scott C, Daher M, Kumar A, Kalra A, Fram R, Haddadin F, Almahameed S, DeSimone CV, Cha YM, Mulpuru SK, Ellenbogen KA, Saeed M, Chelu MG, Deshmukh AJ. Clinical outcomes and predictors of complications in patients undergoing leadless pacemaker implantation. Heart Rhythm 2022; 19:1289-1296. [PMID: 35490710 DOI: 10.1016/j.hrthm.2022.03.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leadless pacemakers have emerged as a viable alternative for traditional transvenous pacemakers to reduce the risk of device-related complications. OBJECTIVE The purpose of this study was to examine the real-world clinical outcomes and complications associated with the implantation of leadless pacemaker devices. METHODS Using the National Readmission Database (NRD), we examined patient demographics, and in-hospital and 30-day procedural outcomes after leadless pacemaker implantation from 2016-2018. Our cohort comprised adults (≥18 years) with an ICD-10 procedural code for leadless pacemaker implantation. RESULTS Our cohort included a total of 7821 patients who underwent leadless pacemaker implantation. Overall immediate procedure-related complications, as defined broadly in this study, occurred in 7.5% of patients. Pericardial effusion without the need for pericardiocentesis occurred in 1.9% of patients, with pericardiocentesis performed in 1.0%. Vascular complications occurred in 2.3% of patients; 0.33% required repair, and device dislodgment occurred in 0.51%. The most significant predictor for procedural complications was end-stage renal disease (odds ratio [OR] 1.65; 95% confidence interval [CI] 1.17-2.32; P = .004), congestive heart failure (OR 1.28; 95% CI 1.01-1.62; P = .04), and coagulopathy (OR 1.77; 95% CI 1.34-2.34; P <.001). All-cause readmission occurred in 17.9% of patients within 30 days from device implant, with 1.36% of readmissions being procedure related. At 30 days postimplant and after discharge, 0.25% of patients needed a new pacemaker, and 0.18% had pericardial complications. CONCLUSION In our large real-life cohort, we found the rate of serious complications after leadless pacemaker implantation to be relatively low and comparable to prior studies in a high-risk population with multiple comorbid conditions.
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Affiliation(s)
- Faris Haddadin
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Monil Majmundar
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic, Akron, Ohio
| | - Ahmad Jabri
- Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Ohio
| | - Luke Pecha
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Claire Scott
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Marilyne Daher
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Ankur Kalra
- Department of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic, Cleveland, Ohio
| | - Rand Fram
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Farah Haddadin
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Soufian Almahameed
- Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Ohio
| | - Christopher V DeSimone
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Siva K Mulpuru
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohammad Saeed
- Department of Cardiology, Texas Heart Institute, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mihail G Chelu
- Department of Cardiology, Texas Heart Institute, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Abhishek J Deshmukh
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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Kashou AH, Mulpuru SK, Deshmukh AJ, Ko WY, Attia ZI, Carter RE, Friedman PA, Noseworthy PA. An artificial intelligence-enabled ECG algorithm for comprehensive ECG interpretation: Can it pass the 'Turing test'? Cardiovasc Digit Health J 2022; 2:164-170. [PMID: 35265905 PMCID: PMC8890338 DOI: 10.1016/j.cvdhj.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an artificial intelligence (AI)–enabled electrocardiogram (ECG) algorithm capable of comprehensive, human-like ECG interpretation and compare its diagnostic performance against conventional ECG interpretation methods. Methods We developed a novel AI-enabled ECG (AI-ECG) algorithm capable of complete 12-lead ECG interpretation. It was trained on nearly 2.5 million standard 12-lead ECGs from over 720,000 adult patients obtained at the Mayo Clinic ECG laboratory between 2007 and 2017. We then compared the need for human over-reading edits of the reports generated by the Marquette 12SL automated computer program, AI-ECG algorithm, and final clinical interpretations on 500 randomly selected ECGs from 500 patients. In a blinded fashion, 3 cardiac electrophysiologists adjudicated each interpretation as (1) ideal (ie, no changes needed), (2) acceptable (ie, minor edits needed), or (3) unacceptable (ie, major edits needed). Results Cardiologists determined that on average 202 (13.5%), 123 (8.2%), and 90 (6.0%) of the interpretations required major edits from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. They considered 958 (63.9%), 1058 (70.5%), and 1118 (74.5%) interpretations as ideal from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. They considered 340 (22.7%), 319 (21.3%), and 292 (19.5%) interpretations as acceptable from the computer program, AI-ECG algorithm, and final clinical interpretations, respectively. Conclusion An AI-ECG algorithm outperforms an existing standard automated computer program and better approximates expert over-read for comprehensive 12-lead ECG interpretation.
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Affiliation(s)
- Anthony H. Kashou
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Address reprint requests and correspondence: Dr Anthony H. Kashou, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Siva K. Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Wei-Yin Ko
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Haq IU, Lodhi FK, Anan AR, Alzu’bi H, Agboola KM, Lee HC, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Safety and Efficacy Outcomes of Atrial Fibrillation Ablation in Patients with Rheumatoid Arthritis. Heart Rhythm O2 2022; 3:261-268. [PMID: 35734296 PMCID: PMC9207736 DOI: 10.1016/j.hroo.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease associated with atrial fibrillation (AF) and stroke. Objective The purpose of this study was to evaluate the safety and efficacy of AF ablation in patients with RA. Methods All patients with RA undergoing AF ablation at our institution from 2010 to 2021 were propensity matched to patients without RA using 9 baseline characteristics. The primary outcome was procedural efficacy defined by clinical AF recurrence, the need for antiarrhythmic drugs (AADs), and repeat catheter ablation. Secondary outcome was safety. Results A total of 45 patients with RA (age 66.3 ± 7.7 years) were matched to 45 patients without a history of RA (age 68.0 ± 7.3 years). Both groups had similar procedural and periprocedural characteristics. Before ablation, RA patients had statistically higher C-reactive protein (CRP) levels (P ≤.01) and erythrocyte sedimentation rates (ESRs) (P <.05) compared to non-RA patients. After ablation, RA patients had statistically significant higher rates of AF recurrence (P = .006), were more likely to be taking AADs (P <.05), and more likely to undergo repeat ablations (P <.05). The use of immunosuppression or corticosteroids at the time of ablation did not influence the primary endpoint of AF recurrence, AADs, or repeat ablation. Multivariate regression analysis showed CRP and ESR were independent predictors of AF recurrence. CRP was an independent predictor of repeat ablation. Conclusion Patients with RA are at higher risk of clinical AF recurrence, and are more likely to be taking AADs and require repeat ablation. Preablation CRP and ESR are independent predictors of AF recurrence, and CRP is an independent predictor of repeat catheter ablation.
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Kowlgi GN, Tseng AS, Tempel ND, Henrich MJ, Venkatachalam KL, Scott L, Shen WK, Deshmukh AJ, Mbbs MM, Lee HC, Asirvatham SJ, Friedman PA, Cha YM, Mulpuru SK. A Real-world Experience of Atrioventricular Synchronous Pacing with Leadless Ventricular Pacemakers. J Cardiovasc Electrophysiol 2022; 33:982-993. [PMID: 35233867 DOI: 10.1111/jce.15430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
AIMS The MicraTM transcatheter pacing system (TPS) (Medtronic) is the only leadless pacemaker that promotes atrioventricular (AV) synchrony via accelerometer-based atrial sensing. Data regarding the real-world experience with this novel system are scarce. We sought to characterize patients undergoing MicraTM -AV implants, describe percentage AV synchrony achieved, and analyze the causes for suboptimal AV synchrony. METHODS In this retrospective cohort study, electronic medical records from 56 consecutive patients undergoing MicraTM -AV implants at the Mayo Clinic sites in Minnesota, Florida, and Arizona with a minimum follow-up of 3 months were reviewed. Demographic data, comorbidities, echocardiographic data, and clinical outcomes were compared among patients with and without atrial synchronous-ventricular pacing (AsVP) ≥70%. RESULTS Sixty-five percent of patients achieved AsVP ≥70%. Patients with adequate AsVP had smaller body mass indices, a lower proportion of congestive heart failure, and prior cardiac surgery. Echocardiographic parameters and procedural characteristics were similar across the two groups. Active device troubleshooting was associated with higher AsVP. The likely reasons for low AsVP were small A4-wave amplitude, high ventricular pacing burden, and inadequate device reprogramming. Importantly, in patients with low AsVP, subjective clinical worsening was not noted during follow-up. CONCLUSION With the increasing popularity of leadless PM, it is paramount for device implanting teams to be familiar with common predictors of AV synchrony and troubleshooting with MicraTM -AV devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Andrew S Tseng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathan D Tempel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark J Henrich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Sanborn D, Sugrue A, Amin M, Mehta R, Farwati M, Deshmukh AJ, Sridhar H, Ahmed A, Asirvatham SJ, Ou NN, Noseworthy PA, Killu AM, Mulpuru SK, Madhavan M. Outcomes of Direct Oral Anticoagulants Co-Prescribed with Common Interacting Medications. Am J Cardiol 2022; 162:80-85. [PMID: 34756422 PMCID: PMC8678337 DOI: 10.1016/j.amjcard.2021.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
Direct oral anticoagulants (DOACs) can potentially interact with multiple prescription medications. We examined the prevalence of co-prescription of DOACs with interacting medications and its impact on outcomes in patients with atrial fibrillation (AF). Patients with AF treated with a DOAC from 2010 to 2017 at the Mayo Clinic and co-prescribed medications that are inhibitors or inducers of the P-glycoprotein and/or Cytochrome P450 3A4 pathways were identified. The outcomes of stroke, transient ischemic attack, or systemic embolism, major bleeding, and minor bleeds were compared between patients with and without an enzyme inducer. Cox proportional hazards model was used to assess the association between interacting medications and outcomes. Of 8,576 patients with AF (mean age 70 ± 12 years, 35% female) prescribed a DOAC (38.6% apixaban, 35.8% rivaroxaban, 25.6% dabigatran), 2,610 (30.4%) were on at least 1 interacting agent: the majority were on an enzyme inhibitor (n = 2,592). Prescribed medications included non-dihydropyridine calcium channel blocker (n = 1,412; 16.5%), antiarrhythmic medication (n = 790; 9.2%), antidepressant (n = 659; 7.7%), antibiotic/antifungal (n = 77; 0.90%), antiepileptics (n = 17; 0.2%) and immunosuppressant medications (n = 19; 0.2%). Patients on an interacting medication were more likely to receive a lower dose of DOAC than indicated by the manufacturer's labeling (15.0% vs 11.4%, p <0.0001). In multivariable analysis, co-prescription of an enzyme inhibitor was not associated with risk of any bleeding (hazard ratio 0.87 [0.71 to 1.05], p = 0.15) or stroke, transient ischemic attack, or systemic embolism (hazard ratio 0.82 [0.51 to 1.31], p = 0.39). In conclusion, DOACs are co-prescribed with medications with potential interactions in 30.4% of patients with AF. Co-prescription of DOACs and these drugs are not associated with increased risk of adverse embolic or bleeding outcomes in our cohort.
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Affiliation(s)
- David Sanborn
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan Sugrue
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Mustapha Amin
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Ramila Mehta
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Medhat Farwati
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | | | - Haarini Sridhar
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Azza Ahmed
- Department of Internal Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin
| | | | - Narith N Ou
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | | | - Ammar M Killu
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Siva K Mulpuru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Malini Madhavan
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
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Kashou AH, Noseworthy PA, Jentzer JC, Rafie N, Roy AR, Abraham HM, Sang PD, Kronzer EK, Inglis SS, Rezkalla JA, Julakanti RR, Saric P, Asirvatham SJ, Deshmukh AJ, DeSimone CV, May AM. Wide complex tachycardia discrimination tool improves physicians' diagnostic accuracy. J Electrocardiol 2022; 74:32-39. [PMID: 35933848 PMCID: PMC9799284 DOI: 10.1016/j.jelectrocard.2022.07.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Timely and accurate discrimination of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critically important. Previously we developed and validated an automated VT Prediction Model that provides a VT probability estimate using the paired WCT and baseline 12-lead ECGs. Whether this model improves physicians' diagnostic accuracy has not been evaluated. OBJECTIVE We sought to determine whether the VT Prediction Model improves physicians' WCT differentiation accuracy. METHODS Over four consecutive days, nine physicians independently interpreted fifty WCT ECGs (25 VTs and 25 SWCTs confirmed by electrophysiological study) as either VT or SWCT. Day 1 used the WCT ECG only, Day 2 used the WCT and baseline ECG, Day 3 used the WCT ECG and the VT Prediction Model's estimation of VT probability, and Day 4 used the WCT ECG, baseline ECG, and the VT Prediction Model's estimation of VT probability. RESULTS Inclusion of the VT Prediction Model data increased diagnostic accuracy versus the WCT ECG alone (Day 3: 84.2% vs. Day 1: 68.7%, p 0.009) and WCT and baseline ECGs together (Day 3: 84.2% vs. Day 2: 76.4%, p 0.003). There was no further improvement of accuracy with addition of the baseline ECG comparison to the VT Prediction Model (Day 3: 84.2% vs. Day 4: 84.0%, p 0.928). Overall sensitivity (Day 3: 78.2% vs. Day 1: 67.6%, p 0.005) and specificity (Day 3: 90.2% vs. Day 1: 69.8%, p 0.016) for VT were superior after the addition of the VT Prediction Model. CONCLUSION The VT Prediction Model improves physician ECG diagnostic accuracy for discriminating WCTs.
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Affiliation(s)
- Anthony H. Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Jacob C. Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nikita Rafie
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Philip D. Sang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ellen K. Kronzer
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sara S. Inglis
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joshua A. Rezkalla
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Petar Saric
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Adam M. May
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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