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Khan MZ, Nguyen A, Khan MU, Sattar Y, Alruwaili W, Gonuguntla K, Sohaib Hayat HM, Mendez M, Nassar S, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Nguyen B, Fan D, Darden D, Munir MB. Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States. Heart Rhythm 2024:S1547-5271(24)02311-7. [PMID: 38574789 DOI: 10.1016/j.hrthm.2024.03.1816] [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: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited. OBJECTIVE The objective of this study was to evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations. METHODS National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with CKD and ESRD who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study end points assessed included inpatient complications, outcomes, and resource utilization of leadless pacemaker implantations. RESULTS A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n = 5245 [18.1%]) and ESRD (n = 3790 [13.1%]) were younger than patients without CKD and had higher prevalence of important comorbidities. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (CKD: adjusted odds ratio [aOR], 1.62 [95% CI, 1.40-1.86]; ESRD: aOR, 1.38 [95% CI, 1.18-1.63]) and prolonged length of stay (CKD: aOR, 1.55 [95% CI, 1.46-1.66]; ESRD: aOR, 1.81 [95% CI 1.67-1.96]). ESRD was also associated with higher hospitalization costs (aOR, 1.63; 95% CI, 1.50-1.77) and major complications (aOR, 1.33; 95% CI, 1.13-1.57) after leadless pacemaker implantation. CONCLUSION Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay and inpatient mortality.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Amanda Nguyen
- Department of Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Waleed Alruwaili
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Karthik Gonuguntla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Hafiz Muhammad Sohaib Hayat
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Melody Mendez
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Sameh Nassar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | | | - Siddharth Agarwal
- Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sameer Raina
- Division of Cardiology, Stanford University, Stanford, California
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Bao Nguyen
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Dali Fan
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California.
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Darden D, Bilal Munir M, Zimmerman S, Eskander M, Pothineni NVK, Gopinathannair R, Kabra R, Lakkireddy D, Duong T, Han FT, Freeman JV, Hsu JC. Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry. J Interv Card Electrophysiol 2024; 67:625-635. [PMID: 37858000 DOI: 10.1007/s10840-023-01662-1] [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: 07/22/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Frailty is associated with significant morbidity and mortality and may have clinical implications in an advanced age population with atrial fibrillation undergoing left atrial appendage occlusion (LAAO). We sought to develop a novel frailty scale to predict worse outcomes in patients undergoing LAAO. METHODS Patients in the NCDR LAAO Registry between 2016 and 2021 receiving percutaneous LAAO devices were categorized as non-frail (0 points), pre-frail (1-3 points), or frail (4-5 points) based on a 5-point scale representing multiple domains of frailty: hemoglobin <13.0 g/dL in male, <12.0 g/dL in female; creatinine ≥1.2 mg/dL; albumin <3.5 g/dL; body mass index <20 kg/m2; and increased risk of falls. RESULTS Of 57,728 patients, 44,360 (76.8%) were pre-frail and 7693 (13.3%) were frail. Compared to non-frail, pre-frail and frail patients were older, had a higher burden of co-morbidities, and more disability based on the Modified Rankin Scale. Compared to non-frail patients after adjustment, frail patients were at higher risk of in-hospital major complication (OR 1.29, 95% 1.02-1.62, p = 0.01), any complication (OR 1.29, 95% CI 1.09-1.52, p = 0.0005), and death (OR 5.79, 95% CI 1.75-19.17, p = 0.001), while no difference was observed in pre-frail patients. At 45-day follow-up, there was no difference in the risk of complications in frail patients as compared to non-frail, although mortality was significantly higher (OR 3.01, 95% CI 1.97-4.85, p < 0.0001). CONCLUSION A simple and practical frailty scale accurately predicts adverse events in patients undergoing LAAO. The 13% of patients considered frail were at significantly higher risk of in-hospital adverse events and 45-day mortality.
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Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA.
| | - M Bilal Munir
- Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
| | - Sarah Zimmerman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Thao Duong
- Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Khan MZ, Sattar Y, Alruwaili W, Nassar S, Alhajji M, Alyami B, Nguyen AT, Neely J, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Nguyen B, Fan D, Darden D, Munir MB. Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database. Heart Rhythm O2 2024; 5:217-223. [PMID: 38690142 PMCID: PMC11056447 DOI: 10.1016/j.hroo.2024.02.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation. Objective The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations. Methods The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed. Results Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation. Conclusion In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Waleed Alruwaili
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Sameh Nassar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Mohamed Alhajji
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Bandar Alyami
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Amanda T. Nguyen
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Joseph Neely
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | | | - Siddharth Agarwal
- Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sameer Raina
- Division of Cardiology, Stanford University, Stanford, California
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Bao Nguyen
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Dali Fan
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
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Darden D, Bilal Munir M, Zimmerman S, Eskander M, Pothineni NVK, Gopinathannair R, Kabra R, Lakkireddy D, Duong T, Han FT, Freeman JV, Hsu JC. Correction: Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry. J Interv Card Electrophysiol 2024; 67:637. [PMID: 38019421 DOI: 10.1007/s10840-023-01704-8] [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: 11/30/2023]
Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA.
| | - M Bilal Munir
- Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
| | - Sarah Zimmerman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Thao Duong
- Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Darden D, Lakkireddy D. Diving deeper: Essential role of advanced ventricular tachycardia ablation techniques in hypertrophic cardiomyopathy. Indian Pacing Electrophysiol J 2024; 24:14-15. [PMID: 38242287 PMCID: PMC10927976 DOI: 10.1016/j.ipej.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)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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Ahlers M, Darden D, Hoffmayer K, Feld GK, Krummen DE, Ho G. A perfect storm of ventricular fibrillation: Infarct, posterior fascicle, and the moderator band. HeartRhythm Case Rep 2023; 9:943-947. [PMID: 38204826 PMCID: PMC10774567 DOI: 10.1016/j.hrcr.2023.10.005] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Michael Ahlers
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Douglas Darden
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Kurt Hoffmayer
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gregory K. Feld
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - David E. Krummen
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
| | - Gordon Ho
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Diego, La Jolla, California
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Aldaas OM, Darden D, Mylavarapu PS, Aldaas AM, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Safety and efficacy of catheter ablation of atrial fibrillation in the very elderly (≥80 years old): Insights from the UC San Diego AF Ablation Registry. Clin Cardiol 2023; 46:1488-1494. [PMID: 37626475 PMCID: PMC10716336 DOI: 10.1002/clc.24137] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Catheter ablation improves outcomes in symptomatic atrial fibrillation (AF) patients. However, its safety and efficacy in the very elderly (≥80 years old) is not well described. HYPOTHESIS Ablation of AF in the very elderly is safe and effective. METHODS We performed a retrospective study of all patients who underwent catheter ablation enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AADs). RESULTS Of 847 patients, 42 (5.0%) were 80 years of age or greater with a median age of 81.5 (80-82.3) and 805 (95.0%) were less than 80 years of age with a median age of 64.4 (57.6-70.2). Among those who were ≥80 years old, 29 were undergoing de novo ablation (69.0%), whereas in the younger cohort, 518 (64.5%) were undergoing de novo ablation (p = .548). There were no statistically significant differences in fluoroscopy (p = .406) or total procedure times (p = .076), AAD use (p = .611), or procedural complications (p = .500) between groups. After multivariable adjustment, there were no statistically significant differences in recurrence of any atrial arrhythmias on or off AAD (adjusted hazard ratio [AHR]: 0.75; 95% confidence interval [CI]: 0.45-1.23; p = .252), all-cause hospitalizations (AHR: 0.86; 95% CI: 0.46-1.60; p = .626), or all-cause mortality (AHR: 4.48; 95% CI: 0.59-34.07; p = .147) between the very elderly and the younger cohort. CONCLUSION In this registry analysis, catheter ablation of AF appears similarly effective and safe in patients 80 years or older when compared to a younger cohort.
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Affiliation(s)
- Omar M. Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Douglas Darden
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Praneet S. Mylavarapu
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Amer M. Aldaas
- A. T. Still University School of Osteopathic MedicineMesaArizonaUSA
| | - Frederick T. Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Kurt S. Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Gregory K. Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
| | - Jonathan C. Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health SystemLa JollaCaliforniaUSA
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Ahmed A, Bawa D, Kabra R, Pothineni NVK, Darden D, Gopinathannair R, Lakkireddy D. Correction to: Left Atrial Appendage Closure with Watchman vs Amulet Devices: Similarities and Differences. Curr Cardiol Rep 2023; 25:1389. [PMID: 37668847 DOI: 10.1007/s11886-023-01958-8] [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] [Accepted: 09/02/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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Ahmed A, Bawa D, Kabra R, Pothineni NVK, Darden D, Gopinathannair R, Lakkireddy D. Left Atrial Appendage Closure with Watchman vs Amulet Devices: Similarities and Differences. Curr Cardiol Rep 2023; 25:909-915. [PMID: 37584874 DOI: 10.1007/s11886-023-01913-7] [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: 06/27/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW Left atrial appendage closure (LAAC) has shown to be non-inferior to oral anticoagulation (OAC) for non-valvular atrial fibrillation (AF). LAAC is now becoming a leading method for stroke prophylaxis in patients who have atrial fibrillation and are unable to tolerate OAC. There are currently two FDA-approved endocardial closure devices, namely, the Watchman FLX and Amplatzer Amulet. RECENT FINDINGS Current data highlights that both devices offer similar efficacy and safety for LAAC. While the two devices differ in terms of intraprocedural complication rates, they offer similar short- to long-term outcomes in regard to peri-device leaks, device-related thrombosis, and mortality. With similar risk and safety profiles, both devices are indicated for patients who are unable to tolerate OAC. Newer clinical studies are directed to establish the efficacy of both devices as the primary method for stroke prevention in AF as an alternate to OAC.
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Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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Bawa D, Darden D, Ahmed A, Garg J, Karst E, Kabra R, Pothineni K, Gopinathannair R, Mansour M, Winterfield J, Lakkireddy D. Lower-adherence direct oral anticoagulant use is associated with increased risk of thromboembolic events than warfarin. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01585-x. [PMID: 37556090 DOI: 10.1007/s10840-023-01585-x] [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: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Real-world data have suggested inconsistent adherence to oral anticoagulation for thromboembolic event (TE) prevention in patients with Non valvular atrial fibrillation (NVAF), yet it remains unclear if event risk is elevated during gaps of non-adherence. OBJECTIVE To compare difference in outcomes between direct oral anticoagulant (DOAC) and warfarin based on adherence to the therapy in patients with NVAF. METHODS Using the MarketScan claims data, patients receiving prescription of warfarin or a DOAC for NVAF from January 2015 to June 2016 were included. Outcomes included hospitalization for TE (ischemic stroke or systemic embolism), hemorrhagic stroke, stroke of any kind, and major bleeding. Event rates were reported for warfarin and DOACs at a higher-adherence proportion of days covered (PDC > 80%) and lower-adherence (PDC 40-80%). RESULTS The cohort included 83,168 patients prescribed warfarin (51% [n = 42,639]) or DOAC (49% [n = 40,529]). Lower adherence occurred in 36% (n = 15,330) of patients prescribed warfarin and 26% (n = 10,956) prescribed DOAC. As compared to higher-adherence warfarin after multivariable adjustment, the risk of TE was highest in lower-adherence DOAC (HR 1.26; 95% CI, 1.14-1.33), and lowest in higher-adherence DOAC (HR, 0.93; 95% CI, 0.88-0.99). There was a significantly higher risk of hemorrhagic stroke and stroke of any kind in the lower-adherence groups. Major bleeding was more common with lower-adherence DOAC (HR, 1.43, 95% CI, 1.35-1.52) and lower-adherence warfarin (HR, 1.32, 95% CI, 1.26-1.39). CONCLUSIONS In this large real-world study, low adherence DOAC was associated with higher risk of TE events as compared to high and low adherence warfarin.
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Affiliation(s)
- Danish Bawa
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Douglas Darden
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Adnan Ahmed
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Rajesh Kabra
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Krishna Pothineni
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA
| | | | - Jeffrey Winterfield
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute (KCHRI) @ HCA Midwest, the University of Missouri - Columbia, 12200, W 106Th Street, Overland Park Regional Medical Center, Overland Park, KS, 66215, USA.
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Zeitler EP, Kearing S, Coylewright M, Nair D, Hsu JC, Darden D, O'Malley AJ, Russo AM, Al-Khatib SM. Response by Zeitler et al to Letter Regarding Article, "Comparative Effectiveness of Left Atrial Appendage Occlusion Versus Oral Anticoagulation by Sex". Circulation 2023; 148:510-511. [PMID: 37549206 DOI: 10.1161/circulationaha.123.065359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Emily P Zeitler
- Dartmouth Health (E.P.Z., S.K.), Lebanon, NH
- The Dartmouth Institute (E.P.Z., A.J.O.), Lebanon, NH
| | | | | | - Devi Nair
- St Bernard's Heart and Vascular Center, Jonesboro, AR (D.N.)
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS (D.D.)
| | - A James O'Malley
- The Dartmouth Institute (E.P.Z., A.J.O.), Lebanon, NH
- Geisel School of Medicine at Dartmouth College, Hanover, NH (A.J.O.)
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (S.M.A.-K.)
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Aldaas OM, Darden D, Mylavarapu PS, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. Association of isoproterenol infusion during catheter ablation of atrial fibrillation with outcomes: insights from the UC San Diego AF Ablation Registry. J Interv Card Electrophysiol 2023; 66:1243-1252. [PMID: 36508065 PMCID: PMC10258224 DOI: 10.1007/s10840-022-01448-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND High-dose isoproterenol infusion is a useful provocative maneuver to elicit triggers of atrial fibrillation (AF) during ablation. We evaluated whether the use of isoproterenol infusion to elicit triggers of AF after ablation is associated with differential outcomes. METHODS We performed a retrospective study of all patients who underwent de novo radiofrequency catheter ablation of AF enrolled in the University of California, San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off antiarrhythmic drugs (AAD). RESULTS Of 314 patients undergoing AF ablation, 235 (74.8%) received isoproterenol while 79 (25.2%) did not. Among those who received isoproterenol, 11 (4.7%) had additional triggers identified. There were no statistically significant differences in procedure time (p = 0.432), antiarrhythmic drug use (p = 0.289), procedural complications (p = 0.279), recurrences of atrial arrhythmias on or off AAD [adjusted hazard ratio (AHR) 0.92 (95% CI 0.58-1.46); p = 0.714], all-cause hospitalizations [AHR 1.00 (95% CI 0.60-1.67); p = 0.986], or all-cause mortality [AHR 0.14 (95% CI 0.01-3.52); p = 0.229] between groups. CONCLUSIONS In this registry analysis, use of isoproterenol is safe but was not associated with a reduction in recurrence of atrial arrhythmias.
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Affiliation(s)
- Omar M Aldaas
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Douglas Darden
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Praneet S Mylavarapu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Diego Health System, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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13
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Khan MZ, Shatla I, Darden D, Neely J, Mir T, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Singh GD, Srivatsa U, Munir MB. Intracranial bleeding and associated outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion: Insights from National Inpatient Sample 2016-2020. Heart Rhythm O2 2023; 4:433-439. [PMID: 37520018 PMCID: PMC10373143 DOI: 10.1016/j.hroo.2023.06.002] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background Percutaneous left atrial appendage occlusion (LAAO) has proved to be a safer alternative for long-term anticoagulation; however, patients with a history of intracranial bleeding were excluded from large randomized clinical trials. Objective The purpose of this study was to determine outcomes in atrial fibrillation (AF) patients with a history of intracranial bleeding undergoing percutaneous LAAO. Methods National Inpatient Sample and International Classification of Diseases, Tenth Revision, codes were used to identify patients with AF who underwent LAAO during the years 2016-2020. Patients were stratified based on a history of intracranial bleeding vs not. The outcomes assessed in our study included complications, in-hospital mortality, and resource utilization. Result A total of 89,300 LAAO device implantations were studied. Approximately 565 implantations (0.6%) occurred in patients with a history of intracranial bleed. History of intracranial bleeding was associated with a higher prevalence of overall complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, intracranial bleeding was found to be independently associated with in-patient mortality (adjusted odds ratio [aOR] 4.27; 95% confidence interval [CI] 1.68-10.82); overall complications (aOR 1.74; 95% CI 1.36-2.24); prolonged length of stay (aOR 2.38; 95% CI 1.95-2.92); and increased cost of hospitalization (aOR 1.28; 95% CI 1.08-1.52) after percutaneous LAAO device implantation. Conclusion A history of intracranial bleeding was associated with adverse outcomes after percutaneous LAAO. These data, if proven in a large randomized study, can have important clinical consequences in terms of patient selection for LAAO devices.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Islam Shatla
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, Kansas
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Joseph Neely
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Tanveer Mir
- Department of Medicine, Wayne State University, Detroit, Michigan
| | - Zain Ul Abideen Asad
- Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Siddharth Agarwal
- Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sameer Raina
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Gagan D. Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Uma Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
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Ahmed A, Pothineni NVK, Singh V, Bawa D, Darden D, Kabra R, Singh A, Memon S, Romeya A, Van Meeteren J, Thambidorai S, Lakkireddy D, Gopinathannair R. Long-Term Imaging and Clinical Outcomes of Surgical Left Atrial Appendage Occlusion With AtriClip. Am J Cardiol 2023; 201:193-199. [PMID: 37385174 DOI: 10.1016/j.amjcard.2023.06.026] [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: 03/10/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
Surgical left atrial appendage (LAA) occlusion with an AtriClip (AtriCure, West Chester, Ohio) is frequently performed for stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a retrospective analysis of all patients with long-standing persistent AF who underwent hybrid convergent ablation and LAA clipping. Contrast-enhanced cardiac computed tomography was performed at 3 to 6 months after LAA clipping to assess the degree of complete closure and the residual LAA stump. A total of 78 patients (64 ± 10 years, 72% male) underwent LAA clipping as part of hybrid convergent AF ablation, from 2019 to 2020. Median size of AtriClip used was 45 mm. Mean LA size was 4.6 ± 1 cm. At 3-to-6 months follow-up computed tomography, 46.2% of patients (n = 36) had a residual stump proximal to the deployed LAA clip. Mean depth of residual stump was 3.95 ± 5.5 mm, with 19% of patients (n = 15) having a stump depth of ≥10 mm and 1 patient requiring more endocardial LAA closure owing to large stump depth. During 1-year follow-up, 3 patients developed stroke; device leak of 6 mm was noted in 1 patient; and none of the patients had a thrombus proximal to the clip. In conclusion, high incidence of residual LAA stump was observed with AtriClip. Larger studies with long-term follow-up are needed to better assess the thromboembolic implications of a residual stump after AtriClip placement.
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Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | - Vasvi Singh
- Midwest Heart and Vascular Specialists, HCA Midwest Health, Overland Park, Kansas
| | - Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Angad Singh
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Saira Memon
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Ahmed Romeya
- Kansas City Heart Rhythm Institute, Overland Park, Kansas
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15
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Bawa D, Kabra R, Ahmed A, Bansal S, Darden D, Pothineni NVK, Gopinathannair R, Lakkireddy D. Data deluge from remote monitoring of cardiac implantable electronic devices and importance of clinical stratification. Heart Rhythm O2 2023; 4:374-381. [PMID: 37361614 PMCID: PMC10288027 DOI: 10.1016/j.hroo.2023.04.005] [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: 06/28/2023] Open
Abstract
Background Remote monitoring (RM) has been accepted as a standard of care for follow-up of patients with cardiac implantable electronic devices (CIEDs). However, the resulting data deluge poses major challenge to device clinics. Objective This study aimed to quantify the data deluge from CIED and stratify these data based on clinical relevance. Methods The study included patients from 67 device clinics across the United States being remotely monitored by Octagos Health. The CIEDs included implantable loop recorders, pacemakers, implantable cardioverter-defibrillators, cardiac resynchronization therapy defibrillators, and cardiac resynchronization therapy pacemakers. Transmissions were either dismissed before reaching the clinical practice if they were repetitive or redundant or were forwarded if they were either clinically relevant or actionable transmission (alert). The alerts were further classified as level 1, 2, or 3 based on clinical urgency. Results A total of 32,721 patients with CIEDs were included. There were 14,465 (44.2%) patients with pacemakers, 8381 (25.6%) with implantable loop recorders, 5351 (16.4%) with implantable cardioverter-defibrillators, 3531 (10.8%) with cardiac resynchronization therapy defibrillators, and 993 (3%) with cardiac resynchronization therapy pacemakers. Over a period of 2 years of RM, 384,796 transmissions were received. Of these, 220,049 (57%) transmissions were dismissed, as they were either redundant or repetitive. Only 164,747 (43%) transmissions were transmitted to the clinicians, of which only 13% (n = 50,440) had clinical alerts, while 30.6% (n = 114,307) were routine transmissions. Conclusion Our study shows that data deluge from RM of CIEDs can be streamlined by utilization of appropriate screening strategies that will enhance efficiency of device clinics and provide better patient care.
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Affiliation(s)
- Danish Bawa
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Rajesh Kabra
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Adnan Ahmed
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Shanti Bansal
- Department of Electrophysiology, Houston Heart Rhythm and Octagos Health, Houston, Texas
| | - Douglas Darden
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | | | - Rakesh Gopinathannair
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Dhanunjaya Lakkireddy
- Department of Electrophysiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
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16
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Darden D, Aldaas O, Du C, Munir MB, Feld GK, Pothineni NVK, Gopinathannair R, Lakkireddy D, Curtis JP, Freeman JV, Akar JG, Hsu JC. In-hospital complications associated with pulmonary vein isolation with adjunctive lesions: the NCDR AFib Ablation Registry. Europace 2023; 25:euad124. [PMID: 37184436 PMCID: PMC10228609 DOI: 10.1093/europace/euad124] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
AIMS No prior study has been adequately powered to evaluate real-world safety outcomes in those receiving adjunctive ablation lesions beyond pulmonary vein isolation (PVI). We sought to evaluate characteristics and in-hospital complications among patients undergoing PVI with and without adjunctive lesions. METHODS AND RESULTS Patients in the National Cardiovascular Data Registry AFib Ablation Registry undergoing first-time atrial fibrillation (AF) ablation between 2016 and 2020 were identified and stratified into paroxysmal (PAF) and persistent AF, and separated into PVI only, PVI + cavotricuspid isthmus (CTI) ablation, and PVI + adjunctive (superior vena cava isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, other). Adjusted odds of adverse events were calculated using multivariable logistic regression. A total of 50 937 patients [PAF: 30 551 (60%), persistent AF: 20 386 (40%)] were included. Among those with PAF, there were no differences in the adjusted odds of complications between PVI + CTI or PVI + adjunctive when compared with PVI only. Among persistent AF, PVI + adjunctive was associated with a higher risk of any complication [3.0 vs. 4.5%, odds ratio (OR) 1.30, 95% confidence interval (CI) 1.07-1.58] and major complication (0.8 vs. 1.4%, OR 1.56, 95% CI 1.10-2.21), while no differences were observed in PVI + CTI compared with PVI only. Overall, there was high heterogeneity in adjunctive lesion type, and those receiving adjunctive lesions had a higher comorbidity burden. CONCLUSION Additional CTI ablation was common without an increased risk of complications. Adjunctive lesions other than CTI are commonly performed in those with more comorbidities and were associated with an increased risk of complications in persistent AF, although the current analysis is limited by high heterogeneity in adjunctive lesion set type.
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Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Omar Aldaas
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Joseph G Akar
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
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Messele LF, Khan MZ, Darden D, Agarwal S, Krishan S, Pasupula DK, Asad ZUA, Balla S, Singh GD, Srivatsa UN, Munir MB. Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk. Europace 2023; 25:1415-1422. [PMID: 36881781 PMCID: PMC10105852 DOI: 10.1093/europace/euad049] [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: 11/29/2022] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS To determine outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO) based on the underlying stroke risk (defined by the CHA2DS2-VASc score). METHODS AND RESULTS Data were extracted from the National Inpatient Sample for calendar years 2016-20. Left atrial appendage occlusion implantations were identified on the basis of the International Classification of Diseases, 10th Revision, Clinical Modification code of 02L73DK. The study sample was stratified on the basis of the CHA2DS2-VASc score into three groups (scores of 3, 4, and ≥5). The outcomes assessed in our study included complications and resource utilization. A total of 73 795 LAAO device implantations were studied. Approximately 63% of LAAO device implantations occurred in patients with CHA2DS2-VASc scores of 4 and ≥5. The crude prevalence of pericardial effusion requiring intervention was higher with increased CHA2DS2-VASc score (1.4% in patients with a score of ≥5 vs. 1.1% in patients with a score of 4 vs. 0.8% in patients with a score of 3, P < 0.01). In the multivariable model adjusted for potential confounders, CHA2DS2-VASc scores of 4 and ≥5 were found to be independently associated with overall complications [adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI) 1.18-1.35, and aOR 1.88, 95% CI 1.73-2.04, respectively] and prolonged length of stay (aOR 1.18, 95% CI 1.11-1.25, and aOR 1.54, 95% CI 1.44-1.66, respectively). CONCLUSION A higher CHA2DS2-VASc score was associated with an increased risk of peri-procedural complications and resource utilization after LAAO. These findings highlight the importance of patient selection for the LAAO procedure and need validation in future studies.
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Affiliation(s)
- Lydia Fekadu Messele
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deepak Kumar Pasupula
- Division of Cardiovascular Medicine, MercyOne North Iowa Medical Center, Mason City, IA, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
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Hsu JC, Darden D, Du C, Marine JE, Nichols S, Marcus GM, Natale A, Noseworthy PA, Selzman KA, Varosy P, Masoudi F, Freeman J, Curtis J, Akar J, Kowey PR. Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures. J Am Coll Cardiol 2023; 81:867-878. [PMID: 36858707 DOI: 10.1016/j.jacc.2022.11.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND The National Cardiovascular Data Registry (NCDR) AFib Ablation Registry was created to assess real-world prevalence, demographic characteristics, procedural management, and outcomes of patients undergoing atrial fibrillation (AF) ablation procedures. OBJECTIVES The goal of this study was to characterize the patient, hospital, and physician characteristics and in-hospital outcomes related to AF ablation in the first 5 years of the registry. METHODS This paper describes the AFib Ablation Registry structure and governance, outcome assessment processes, data quality, and data collection processes. The characteristics of the patient population, hospitals, and in-hospital outcomes are also described. RESULTS A total of 76,219 patients were included in the registry between January 2016 and December 2020 (mean age 65.5 ± 10.3 years, 65.2% male, 55.8% paroxysmal AF, mean CHA2DS2-VASc score 2.7 ± 1.6) treated by 708 physicians in 162 hospitals. Successful isolation of all pulmonary veins was achieved in 92.4% of patients. The prevalence of any complication during procedural admission was 2.50% and major complication was 0.9%, including significant bradycardia in 0.47%, heart failure in 0.47%, and pericardial effusion requiring intervention in 0.44%. Hospitalization >1 day occurred in 11.8% of patients, and in-hospital death was rare (n = 41 [0.05%]). CONCLUSIONS The NCDR AFib Ablation Registry is the largest multicenter, prospective cohort study of patients undergoing catheter ablation worldwide. Results in the first 5 years showed that successful pulmonary vein isolation is achieved in the majority of patients, with a low rate of complications. Future studies from the registry will assess practice trends, evaluate treatment patterns associated with different patient outcomes, and support development of evidence-based guidelines.
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Affiliation(s)
- Jonathan C Hsu
- University of California-San Diego, La Jolla, California, USA.
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Chengan Du
- Yale University, New Haven, Connecticut, USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gregory M Marcus
- University of California-San Francisco, San Francisco, California, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | | | | | | | | | | | - Joseph Akar
- Yale University, New Haven, Connecticut, USA
| | - Peter R Kowey
- Lankenau Heart Institute Center, Wynnewood, Pennsylvania, USA
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Bawa D, Ahmed A, Akash M, Kabra R, Gopinathannair R, Lakkireddy DR, Darden D. UTILIZING INFODEMOGRAPHICAL DATA FOR PLANNING STRATEGIES TO PREVENT SUDDEN CARDIAC DEATH AMONG ATHLETES AND GENERAL POPULATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02680-3] [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: 03/06/2023]
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20
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Bawa D, Ahmed A, Garg J, Shah KB, Darden D, Kabra R, Pothineni NVK, Gopinathannair R, Lakkireddy DR. IS CT SURGERY BACK UP NECESSARY FOR LEFT ATRIAL APPENDAGE OCCLUSION PROCEDURE? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00493-x] [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: 03/06/2023]
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21
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Bawa D, Ahmed A, Akash M, Darden D, Kabra R, Gopinathannair R, Lakkireddy DR. IMPACT OF CARDIOVASCULAR PROVIDER ACCESS ON CARDIOVASCULAR MORTALITY IN THE UNITED STATES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02296-9] [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: 03/06/2023]
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Ahmed A, Bawa D, Singh V, Kabra R, Pothineni NVK, Darden D, Koerber S, Gopinathannair R, Lakkireddy DR. LEGIONELLA MYOCARDITIS MASQUERADING AS DUAL CHAMBER CARDIAC ARRHYTHMIA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03257-6] [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: 03/06/2023]
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23
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Ahmed A, Bawa D, Darden D, Pothineni NVK, Garg J, Kabra R, Gopinathannair R, Koch ZW, Al-Ahmad A, Natale A, Lakkireddy DR. ROLE OF HIGH FREQUENCY ALGORITHM OF PURE EP FOR LOW AMPLITUDE SIGNAL DETECTION DURING CARDIAC ABLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00628-9] [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: 03/06/2023]
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Bawa D, Ahmed A, Kabra R, Darden D, Bansal S, Gopinathannair R, Lakkireddy DR. DATA DELUGE FROM REMOTE MONITORING OF CARDIAC IMPLANTABLE ELECTRONIC DEVICES AND THE IMPORTANCE OF CLINICAL STRATIFICATION- A RETROSPECTIVE MULTICENTER STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02590-1] [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: 03/06/2023]
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Ahmed A, Bawa D, Kabra R, Garg J, Pothineni NVK, Darden D, Gopinathannair R, Natale A, Lakkireddy DR. EFFICACY OF VENOUS CLOSURE METHODS AFTER ELECTROPHYSIOLOGICAL PROCEDURES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00591-0] [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: 03/06/2023]
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Zeitler EP, Kearing S, Coylewright M, Nair D, Hsu JC, Darden D, O'Malley AJ, Russo AM, Al-Khatib SM. Comparative Effectiveness of Left Atrial Appendage Occlusion Versus Oral Anticoagulation by Sex. Circulation 2023; 147:586-596. [PMID: 36780379 DOI: 10.1161/circulationaha.122.062765] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/06/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The comparative real-world outcomes of older patients with atrial fibrillation (AF) treated with anticoagulation compared with left atrial appendage occlusion (LAAO) may be different from those in clinical trials because of differences in anticoagulation strategies and patient demographics, including a greater proportion of women. We sought to compare real-world outcomes between older patients with AF treated with anticoagulation and those treated with LAAO by sex. METHODS Using Medicare claims data from 2015 to 2019, we identified LAAO-eligible beneficiaries and divided them into sex subgroups. Patients receiving LAAO were matched 1:1 to those receiving anticoagulation alone through propensity score matching. The risks of mortality, stroke or systemic embolism, and bleeding were compared between matched groups with adjustment for potential confounding characteristics in Cox proportional hazards models. RESULTS Among women, 4085 LAAO recipients were matched 1:1 to those receiving anticoagulation; among men, 5378 LAAO recipients were similarly matched. LAAO was associated with a significant reduction in the risk of mortality for women and men (hazard ratio [HR], 0.509 [95% CI, 0.447-0.580]; and HR, 0.541 [95% CI, 0.487-0.601], respectively; P<0.0001), with a similar finding for stroke or systemic embolism (HR, 0.655 [95% CI, 0.555-0.772]; and HR, 0.649 [95% CI, 0.552-0.762], respectively; P<0.0001). Bleeding risk was significantly greater in LAAO recipients early after implantation but lower after the 6-week periprocedural period for women and men (HR, 0.772 [95% CI, 0.676-0.882]; and HR, 0.881 [95% CI, 0.784-0.989], respectively; P<0.05). CONCLUSIONS In a real-world population of older Medicare beneficiaries with AF, compared with anticoagulation, LAAO was associated with a reduction in the risk of death, stroke, and long-term bleeding among women and men. These findings should be incorporated into shared decision-making with patients considering strategies for reduction in AF-related stroke.
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Affiliation(s)
- Emily P Zeitler
- Dartmouth Health (E.P.Z., S.K.), Lebanon, NH
- Dartmouth Institute, Lebanon, NH (E.P.Z., A.J.O.)
| | | | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, AR (D.N.)
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park (D.D.)
| | - A James O'Malley
- Dartmouth Institute, Lebanon, NH (E.P.Z., A.J.O.)
- Geisel School of Medicine at Dartmouth College, Hanover, NH (A.J.O.)
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (S.M.A.-K.)
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Lakkireddy D, Ahmed A, Atkins D, Bawa D, Garg J, Bush J, Charate R, Bommana S, Pothineni NVK, Kabra R, Darden D, Koreber S, Tummala R, Vasamreddy C, Park P, Mohanty S, Gopinathannair R, Seo BW, Natale A, Kennedy R. Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF). JACC Clin Electrophysiol 2023; 9:555-564. [PMID: 37014289 DOI: 10.1016/j.jacep.2022.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Inpatient initiation of sotalol is recommended owing to its proarrhythmic effects. The DASH-AF (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation) trial evaluates the safety and feasibility of intravenous (IV) sotalol, achieving a steady state with maximum QTc prolongation within 6 hours instead of the traditional 5-dose inpatient oral (PO) titration. METHODS DASH-AF is a prospective, nonrandomized, multicenter, open-label trial consisting of patients who underwent IV sotalol loading dose to initiate rapid oral therapy for atrial arrhythmias. IV dose was calculated based on the target oral dose as indicated by baseline QTc and renal function. Patients' QTc (in sinus) was measured via electrocardiography at 15-minute intervals and after IV loading completion. Patients were discharged 4 hours after first oral dose. All patients were monitored via mobile cardiac outpatient telemetry for 72 hours. The control group was composed of patients admitted for the traditional 5 PO doses. Safety outcomes were assessed in both groups. RESULTS One hundred twenty patients from 3 centers were enrolled from 2021 to 2022 in the IV loading group (compared with type of AF- and renal function-matched patients in the conventional PO loading cohort). This study demonstrated no significant change in ΔQTc in both groups, with a significantly lower number of patients requiring dose adjustment in the IV arm compared with the PO arm (4.1% vs 16.6%; P = 0.003). This led to potential cost savings of up to $3,500.68 per admission. CONCLUSIONS The DASH-AF trial shows that rapid IV sotalol loading in atrial fibrillation/flutter patients for rhythm control is feasible and safe compared with conventional oral loading with significant cost reduction. (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation [DASH-AF]; NCT04473807).
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Bawa D, Darden D, Ahmed A, Spence MJ, Lakner M, Lakkireddy D. Non-Sustained Premature Atrial Contraction Ablation Guided by Single-Beat Mapping Using Charge Density Mapping. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.02.003] [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] [Indexed: 02/16/2023] Open
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Ahmed A, Darden D, Pothineni NVK. All that is "red" is not "dead": role of epicardial connections in atrial fibrillation ablation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01484-1. [PMID: 36705873 DOI: 10.1007/s10840-023-01484-1] [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: 11/18/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
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Bawa D, Ahmed A, Darden D, Lakkireddy D. Residual leak following left atrial appendage occlusion with lariat closed with amplatzer pfo occluder device. Pacing Clin Electrophysiol 2023; 46:440-442. [PMID: 36704965 DOI: 10.1111/pace.14669] [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: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023]
Abstract
Leaks from incomplete ligation of the left atrial appendage (LAA) following closure with Lariat device are not uncommon and associated with higher stroke rate. This clinical vignette highlights a procedure of closure of residual leak following closure with Lariat device with Amplatzer Talisman PFO Occluder. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Danish Bawa
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Adnan Ahmed
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
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Birs AS, Darden D, Adler ED, Feld GK. Refractory coronary vasospasm and recurrent cardiac arrest. BMJ Case Rep 2023; 16:16/1/e253884. [PMID: 36631170 PMCID: PMC9835876 DOI: 10.1136/bcr-2022-253884] [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] [Indexed: 01/13/2023] Open
Abstract
We present a case of recurrent vasospasm as an uncommon cause of ventricular fibrillation in a young female patient who was found to have a genetic mutation of unknown significance in the desmoplakin (DSP) gene and ultimately required an implantable cardiac defibrillator and percutaneous coronary intervention. Refractory vasospasm as a cause of chest pain and cardiac arrest may be under-recognised. In this manuscript, we highlight the natural history of refractory vasospasm, treatment considerations including medical therapy, implantable cardiac defibrillator and percutaneous coronary intervention. Lastly, we explore the potential correlation between the DSP mutation and her clinical presentation and the growing importance of genetic testing in unexplained cardiac arrest.
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Affiliation(s)
- Antoinette S Birs
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Douglas Darden
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Eric D Adler
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
| | - Gregory K Feld
- Department of Cardiology, UC San Diego Health System, La Jolla, California, USA
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Agarwal S, Asad ZUA, Khan MZ, Messele LF, Darden D, Pasupula DK, Singh GD, Srivatsa UN, Zahid S, Balla S, DeSimone CV, Deshmukh A, Munir MB. Morbid obesity is associated with increased procedural complications and worse in-hospital outcomes after percutaneous left atrial appendage occlusion device implantation. Heart Rhythm 2022; 20:637-639. [PMID: 36581172 DOI: 10.1016/j.hrthm.2022.12.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Siddharth Agarwal
- Division of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Lydia Fekadu Messele
- Division of Internal Medicine, University of California Davis, Sacramento, California
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Deepak Kumar Pasupula
- Division of Cardiovascular Medicine, MercyOne North Iowa Medical Center, Mason City, Iowa
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Salman Zahid
- Division of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Christopher V DeSimone
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota
| | - Abhishek Deshmukh
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California.
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Darden D, Scheinman MM, Hoffmayer KS. Exercise-induced arrhythmogenic right ventricular cardiomyopathy: Reverse remodeling with detraining. HeartRhythm Case Rep 2022; 8:599-603. [PMID: 36147714 PMCID: PMC9485656 DOI: 10.1016/j.hrcr.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
- Address reprint requests and correspondence: Dr Douglas Darden, University of California, San Diego, 4592 Medical Center Dr, ACTRI Bldg, 3rd Floor, Room 3E-313, La Jolla, CA 92037.
| | - Melvin M. Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Kurt S. Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
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Darden D, Peterson PN, Xin X, Munir MB, Minges KE, Goldenberg I, Poole JE, Feld GK, Birgersdotter-Green U, Curtis JP, Hsu JC. Temporal trends and long-term outcomes among recipients of cardiac resynchronization therapy with defibrillator in the United States, 2011-2015: Insights from the National Cardiovascular Data Registry. Heart Rhythm O2 2022; 3:405-414. [PMID: 36097450 PMCID: PMC9463686 DOI: 10.1016/j.hroo.2022.03.004] [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: 11/30/2022] Open
Abstract
Background Contemporary data on national trends and outcomes in cardiac resynchronization therapy with defibrillator (CRT-D) recipients following the 2012 updated guidelines has not been studied. Objectives This study assessed the trends in long-term outcomes among CRT-D Medicare-aged recipients implanted in 2011-2015. Methods Patients aged ≥65 years undergoing de novo CRT-D implantation in the National Cardiovascular Data Implantable Cardiac Defibrillator Registry from 2011-2015 with follow-up through 2017 using Medicare data were included and stratified by year of implant. Patient characteristics, in-hospital outcomes, and outcomes up to 2 years following implant were evaluated. Results Among 53,174 patients (aged 75.6-6.4 years, 29.7% women) implanted with CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations (81.0% to 84.7%, P < .001). Compared to 2011, in-hospital procedural complications decreased in 2015 (3.9% vs 2.9%; adjusted odds ratio, 0.76, 95% confidence interval, 0.66-0.88, P < .001), driven in part by decreased lead dislodgement (1.4% vs 1.0%). After multivariable adjustment, there was a lower risk of all-cause hospitalization, cardiovascular hospitalization, and mortality at 2-year follow-up in 2015 as compared to 2011, while there were no differences in heart failure hospitalizations at follow-up. Conclusion Among Medicare beneficiaries receiving CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations. Furthermore, there has been a reduction in in-hospital complications and long-term outcomes, including cardiovascular hospitalization, all-cause hospitalization, and mortality; however, there has been no difference in the risk of heart failure hospitalization after adjustment.
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Affiliation(s)
- Douglas Darden
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Pamela N. Peterson
- Division of Cardiology, Denver Health Medical Center, Denver, Colorado
- University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Xin Xin
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Muhammad Bilal Munir
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Karl E. Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ilan Goldenberg
- Division of Cardiology, University of Rochester Medical Center, Rochester, New York
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York
| | - Jeanne E. Poole
- University of Washington School of Medicine, Seattle, Washington
| | - Gregory K. Feld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Ulrika Birgersdotter-Green
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan C. Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
- Address reprint requests and correspondence: Dr Jonathan C. Hsu, Associate Professor of Medicine, University of California San Diego, 9452 Medical Center Dr, MC7411, La Jolla, CA 92037.
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Munir MB, Khan MZ, Darden D, Asad ZUA, Choubdar PA, Din MTU, Osman M, Singh GD, Srivatsa UN, Balla S, Reeves R, Hsu JC. Association of advanced age with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the National Inpatient Sample of 36,065 procedures. J Interv Card Electrophysiol 2022; 65:219-226. [PMID: 35731328 PMCID: PMC9550678 DOI: 10.1007/s10840-022-01266-1] [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: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Background Age-stratified analyses of atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) are limited. The purpose of current study was to compare in-hospital outcomes in elderly AF patients (age > 80 years) to a relatively younger cohort (age £ 80 years) after LAAO. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. LAAO device implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 LAAO recipients were included in the final analysis, of which 34.6% (n=12,475) were performed on elderly AF patients. Elderly AF patients had a higher prevalence of major complications (6.7% vs. 5.7%, p < 0.01) and mortality (0.4% vs. 0.1%, p < 0.01) after LAAO device implantation in the crude analysis. After multivariate adjustment of potential confounders, age > 80 years was associated with increased risk of inpatient mortality (adjusted odds ratio [aOR] 4.439, 95% confidence interval [CI] 2.391–8.239) but not major complications (aOR 1.084, 95% CI 0.971–1.211), prolonged length of stay (aOR 0.943, 95% CI 0.88–1.101), or increased hospitalization costs (aOR 0.909, 95% CI 0.865–0.955). Conclusion Over 1 in 3 LAAO device implantations occurred in elderly AF patients. After adjusting for potential confounding variables, advanced age was associated with inpatient mortality, but not with other LAAO procedural–related outcomes including major complications, prolonged length of stay, or increased hospitalization costs.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Parnia Abolhassan Choubdar
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | | | - Mohammed Osman
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA.
- University of California San Diego, 9452 Medical Center Dr., MC7411, La Jolla, San Diego, CA, 92037, USA.
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Munir MB, Khan MZ, Darden D, Asad ZUA, Osman M, Singh GD, Srivatsa UN, Han FT, Reeves R, Hsu JC. Association of heart failure with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the national inpatient sample of 62 980 procedures. Europace 2022; 24:1451-1459. [PMID: 35613020 DOI: 10.1093/europace/euac043] [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: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To determine outcomes in atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) with concomitant heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS Data were extracted from National Inpatient Sample for calendar years 2015-2019. LAAO device implantations were identified on the basis of ICD-10-CM code of 02L73DK. The outcomes assessed in our study included complications, in-patient mortality, and resource utilization. A total of 62 980 LAAO device implantations were studied. HFpEF (14.4%, n = 9040) and HFrEF (11.2%, n = 7100) were associated with a higher prevalence of major complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, HFpEF and HFrEF were not associated with major complications [adjusted odds ratio (aOR) 1.04, 95% confidence interval (CI) 0.93-1.16 and aOR 1.07, 95% CI 0.95-1.21] or in-patient mortality (aOR 1.48, 95% CI 0.85-2.55 and aOR 1.26, 95% CI 0.67-2.38). HFpEF and HFrEF were associated with prolonged length of stay (LOS) > 1 day (aOR 1.41, 95% CI 1.31-1.53 and aOR 1.66, 95% CI 1.53-1.80) and increased hospitalization costs > median cost 24 752$ (aOR 1.26, 95% CI 1.19-1.34 and aOR 1.21, 95% CI 1.13-1.29). CONCLUSION The prevalence of HF in AF patients undergoing percutaneous LAAO was approximately 26%. HF was not independently associated with major complications and in-patient mortality but was associated with prolonged LOS and higher hospitalization costs.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Mohammed Osman
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Frederick T Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
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Birs A, Darden D, Eskander M, Pollema T, Ho G, Birgersdotter-Green U. Implantable loop recorder as a strategy following cardiovascular implantable electronic device extraction without reimplantation. Pacing Clin Electrophysiol 2022; 45:853-860. [PMID: 35587876 DOI: 10.1111/pace.14519] [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: 01/31/2022] [Revised: 03/29/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited data exists for outcomes in patients undergoing cardiovascular implantable electronic device (CIED) transvenous lead extraction (TLE) without clear indications for device reimplantation. The implantable loop recorder (ILR) may be an effective strategy for continuous monitoring in select individuals. OBJECTIVE This retrospective analysis aims to investigate patients who have undergone ILR implant following TLE without CIED reimplantation. METHODS Clinical data from consecutive patients who have undergone TLE with ILR implant and without CIED reimplantation from October 2016 to May 2020 at a single center were collected. RESULTS Among 380 patients undergoing TLE, 28 (7.7%) underwent ILR placement without CIED reimplantation. TLE indications were systemic infection (n = 13, 46.4%), pain at the site (n = 8, 28.6%), device/lead malfunction (n = 4, 14.2%), and other. Devices extracted included: dual-chamber and single-chamber pacemaker (n = 14, 50%; n = 4, 14.2%), dual-chamber implantable cardiac defibrillator (n = 10; 35.7%), and cardiac-resynchronization therapy with defibrillator (n = 1, 3.5%). Reasons for no reimplantation included no longer meeting CIED criteria (n = 14, 50%), patient preference (n = 9, 32.1%), and no clear or inappropriate indication for initial CIED implantation (n = 5, 18%). During an average of 12.3 ± 13.1 months of follow-up, there were no lethal arrhythmias, and 4 (13.3%) patients underwent permanent pacemaker reimplantation due to symptomatic sinus bradycardia and atrioventricular block with syncope as discovered on ILR. Three patients died due to unknown causes (n = 1), non-cardiac (n = 1), and acute coronary syndrome (n = 1). CONCLUSIONS In patients undergoing TLE without reimplantation, an ILR may be an effective monitoring strategy in patients at low risk for cardiac arrhythmia. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antoinette Birs
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Douglas Darden
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Michael Eskander
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Travis Pollema
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Gordon Ho
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiology, Department of Medicine, Cardiovascular Institute, University of California San Diego, La Jolla, CA, USA
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Hsu JC, Darden D, Glover BM, Colley BJ, Steinberg C, Thibault B, Jewell C, Bernard M, Tabereaux PB, Siddiqui U, Li J, Horvath EE, Cooper D, Lin D. Performance and acute procedural outcomes of the EnSite Precision™ cardiac mapping system for electrophysiology mapping and ablation procedures: results from the EnSite Precision™ observational study. J Interv Card Electrophysiol 2022; 65:141-151. [PMID: 35536500 PMCID: PMC9550718 DOI: 10.1007/s10840-022-01239-4] [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: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
Background The EnSite Precision™ cardiac mapping system (Abbott) is a catheter navigation and mapping system capable of displaying the three-dimensional (3D) position of conventional and sensor-enabled electrophysiology catheters, as well as displaying cardiac electrical activity as waveform traces and dynamic 3D maps of cardiac chambers. The EnSite Precision™ Observational Study (NCT-03260244) was designed to quantify and characterize the use of the EnSite Precision™ cardiac mapping system for mapping and ablation of cardiac arrhythmias in a real-world environment and evaluate procedural outcomes. Methods A total of 1065 patients were enrolled at 38 centers in the USA and Canada between 2017 and 2018 and were followed for 12 months post procedure for arrhythmia recurrence, medication use, and quality-of-life changes. Eligible subjects were adults undergoing a cardiac electrophysiology mapping and radiofrequency ablation procedure using the EnSite Precision™ System. Results A final cohort of 925 patients (64.3 years of age, 30.2% female) were analyzed. The primary procedural indication was atrial flutter in 48.1% (445/925), atrial fibrillation in 46.5% (430/925), and other arrhythmias in 5% (50/925). Electroanatomic mapping was performed in 81.5% (754/925) of patients. Mapping was stable throughout 79.8% (738/925) of procedures with initial mapping time of 8.6 min (IQR 4.7–15.0). Average mapping efficiency created with AutoMap or TurboMap was 164.9 ± 365.7 used points per minute. Median number of mapping points collected and used was 1752.5 and 811.0, respectively. Only 335/925 (36.2%) required editing and 66.0% (221/335) of these patients required editing of less than 10 points. Fluoroscopy was utilized in most cases (n = 811/925, 87.4%) with fluoroscopy time of 11.0 min (IQR 6.0–18.0). Overall median procedure time was 101.0 min (IQR 59.0–152.0). Acute procedural success was high for both atrial fibrillation (n = 422/430, 98.1%) and atrial flutter (n = 434/445, 97.5%). Conclusion In a real-world study analysis, use of the EnSite Precision™ mapping system was associated with high procedural stability, short mapping times, high point density requiring infrequent editing, low fluoroscopy time, and high prevalence of acute procedural success. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01239-4.
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Affiliation(s)
- Jonathan C Hsu
- University of California San Diego, 4952 Medical Center Dr, ACTRI Bldg, 3rd Floor, Room 3E-313, MC7411, La Jolla, CA, 92037, USA.
| | - Douglas Darden
- University of California San Diego, 4952 Medical Center Dr, ACTRI Bldg, 3rd Floor, Room 3E-313, MC7411, La Jolla, CA, 92037, USA
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie Et Pneumologie de Québec (IUCPQ-UL), Laval University, Quebec, Canada
| | | | - Coty Jewell
- Oklahoma Heart Hospital South, Oklahoma City, OK, USA
| | | | | | | | - Jingyun Li
- Abbott Laboratories, Zephyrhills, FL, USA
| | | | - Daniel Cooper
- Washington University School of Medicine, St. Louis, MO, USA
| | - David Lin
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Patel K, Munir MB, Darden D, Bhatia P, Jacobs K, Pollema T, Birgersdotter-Green UM. CI-563-03 GENDER-BASED DIFFERENCES IN LEAD PERFORATION RATES ON COMPUTED TOMOGRAPHY SCANS IN PATIENTS UNDERGOING TRANSVENOUS LEAD EXTRACTION: RESULTS FROM UC SAN DIEGO LEAD EXTRACTION DATABASE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.733] [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: 11/26/2022]
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40
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Choubdar PA, Darden D, Birgersdotter-Green U, Raissi F. INAPPROPRIATE S-ICD FIRING DUE TO AUTOMATICALLY DISABLED SMART PASS ALGORITHM RESULTING IN T-WAVE OVERSENSING. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04351-0] [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: 10/18/2022]
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41
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Darden D, Boateng BA, Tseng AS, Alshawabkeh L, Pollema T, Cha YM, Birgersdotter-Green U. Transvenous Laser Lead Extraction in Patients with Congenital Complete Heart Block. Heart Rhythm 2022; 19:1158-1164. [DOI: 10.1016/j.hrthm.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
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42
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Darden D, Freeman JV, Hsu JC. To Occlude or Not to Occlude the Left Atrial Appendage in Women-Reply. JAMA Cardiol 2022; 7:464-465. [PMID: 35171204 DOI: 10.1001/jamacardio.2021.5933] [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: 11/14/2022]
Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego
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Lin AY, Duran JM, Sykes A, Darden D, Urey M, Hsu JC, Adler ED, Birgersdotter-Green U. Association between implantable cardioverter-defibrillator and survival in patients awaiting heart transplantation: A meta-analysis and systematic review. Heart Rhythm O2 2022; 2:710-718. [PMID: 34988520 PMCID: PMC8710633 DOI: 10.1016/j.hroo.2021.09.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Patients with end-stage heart failure are at high risk for sudden cardiac death. However, implantable cardioverter-defibrillator (ICD) is not routinely implanted given the high competing risk of pump failure. A unique population worth separate consideration are patients with end-stage heart failure awaiting heart transplantation, as prolonged survival improves the chances of receiving transplant. Objective To compare clinical outcomes of heart failure patients with and without an ICD awaiting heart transplant. Methods We performed an extensive literature search and systematic review of studies that compared end-stage heart failure patients with and without an ICD awaiting heart transplantation. We separately assessed the rates of total mortality, sudden cardiac death, nonsudden cardiac death, and heart transplantation. Risk ratio (RR) and 95% confidence intervals were measured using the Mantel-Haenszel method. The random effects model was used owing to heterogeneity across study cohorts. Results Ten studies with a total of 36,112 patients were included. A total of 62.5% of patients had an ICD implanted. Patients with an ICD had decreased total mortality (RR 0.60, 95% CI 0.51–0.71, P < .00001) and sudden cardiac death (RR 0.27, 95% CI 0.11–0.66, P = .004) and increased rates of heart transplantation (RR 1.09, 95% CI 1.05–1.14, P < .0001). There was no difference in prevalence of nonsudden cardiac death (RR 0.68, 95% CI 0.44–1.04, P = .07). Conclusion ICD implantation is associated with improved outcomes in patients awaiting heart transplant, characterized by decreased total mortality and sudden cardiac death as well as higher rates of heart transplantation.
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Affiliation(s)
- Andrew Y Lin
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Jason M Duran
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Alexandra Sykes
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Douglas Darden
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Marcus Urey
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C Hsu
- Division of Cardiology, University of California San Diego, La Jolla, California
| | - Eric D Adler
- Division of Cardiology, University of California San Diego, La Jolla, California
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Munir MB, Khan MZ, Darden D, Nishimura M, Vanam S, Pasupula DK, Asad ZUA, Bhagat A, Zahid S, Osman M, Balla S, Han FT, Reeves R, Hsu JC. Association of chronic kidney disease and end-stage renal disease with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: Insights from the national inpatient sample of 36,065 procedures. Heart Rhythm O2 2021; 2:472-479. [PMID: 34667962 PMCID: PMC8505197 DOI: 10.1016/j.hroo.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/01/2022] Open
Abstract
Background Left atrial appendage occlusion (LAAO) has emerged as an alternative strategy to oral anticoagulation for mitigating ischemic stroke risk in selected patients with atrial fibrillation (AF), but safety data in patients with significant kidney disease are limited. Objective To determine the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes after LAAO in AF patients. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. Watchman implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 Watchman recipients were included in the final analysis. CKD (9.8%, n = 3545) and ESRD (3%, n = 1155) were associated with a higher prevalence of major complications and mortality in crude analysis compared to no CKD. After multivariate adjustment for potential confounders, CKD was associated with length of stay (LOS) >1 day (adjusted odds ratio [aOR] 1.355; 95% confidence interval [CI] 1.234–1.488), median cost >$24,663 (aOR 1.267; 95% CI 1.176–1.365), and acute kidney injury (aOR 4.134; 95% CI 3.536–4.833), while ESRD was associated with in-patient mortality (aOR 7.156; 95% CI 3.294–15.544). Conclusion The prevalence of CKD and ESRD was approximately 13% in AF patients undergoing Watchman LAAO implantations. CKD was independently associated with prolonged LOS, higher hospitalization costs, and acute kidney injury, while ESRD was independently associated with in-patient mortality.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Marin Nishimura
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Sai Vanam
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | | | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Abhishek Bhagat
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Mohammed Osman
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Frederick T. Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
- Address reprint requests and correspondence: Dr Jonathan C. Hsu, Associate Professor of Medicine, University of California San Diego, 9452 Medical Center Dr, MC7411, La Jolla, CA 92037.
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45
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Darden D, Ammirati E, Brambatti M, Lin A, Hsu JC, Shah P, Perna E, Cikes M, Gjesdal G, Potena L, Masetti M, Jakus N, Van De Heyning C, De Bock D, Brugts JJ, Russo CF, Veenis JF, Rega F, Cipriani M, Frigerio M, Liviu K, Hong KN, Adler E, Braun OÖ. Cardiovascular implantable electronic device therapy in patients with left ventricular assist devices: insights from TRAViATA. Int J Cardiol 2021; 340:26-33. [PMID: 34437934 DOI: 10.1016/j.ijcard.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/18/2021] [Revised: 08/01/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is conflicting observational data on the survival benefit cardiac implantable electronic devices (CIED) in patients with LVADs. METHODS Patients in whom an LVAD was implanted between January 2008 and April 2017 in the multinational Trans-Atlantic Registry on VAD and Transplant (TRAViATA) registry were separated into four groups based on the presence of CIED prior to LVAD implantation: none (n = 146), implantable cardiac defibrillator (ICD) (n = 239), cardiac resynchronization without defibrillator (CRT-P) (n = 28), and CRT with defibrillator (CRT-D) (n = 111). RESULTS A total of 524 patients (age 52 years ±12, 84.4% male) were followed for 354 (interquartile range: 166-701) days. After multivariable adjustment, there were no differences in survival across the groups. In comparison to no device, only CRT-D was associated with late right ventricular failure (RVF) (hazard ratio 2.85, 95% confidence interval [CI] 1.42-5.72, p = 0.003). There was no difference in risk of early RVF across the groups or risk of ICD shocks between those with ICD and CRT-D. CONCLUSION In a multinational registry of patients with LVADs, there were no differences in survival with respect to CIED subtype. However, patients with a pre-existing CRT-D had a higher likelihood of late RVF suggesting significant long-term morbidity in those with devices capable of LV‑lead pacing post LVAD implantation.
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrew Lin
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Palak Shah
- Heart Failure, Mechanical Circulatory Support, and Transplantation, Inova Heart and Vascular Institute, Falls Church, Washington, VA, USA
| | - Enrico Perna
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Maja Cikes
- Division of Cardiology, Department of Medicine, University Hospital, Zagreb, Croatia
| | - Grunde Gjesdal
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Luciano Potena
- Division of Cardiology, Department of Medicine, Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Marco Masetti
- Division of Cardiology, Department of Medicine, Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Nina Jakus
- Division of Cardiology, Department of Medicine, University Hospital, Zagreb, Croatia
| | | | - Dina De Bock
- Department of Cardiology and Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jasper J Brugts
- Division of Cardiology, Department of Medicine, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Claudio F Russo
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Jesse F Veenis
- Division of Cardiology, Department of Medicine, Erasmus MC, University Medical Center Rotterdam, Thoraxcenter, Rotterdam, Netherlands
| | - Filip Rega
- Division of Cardiology, Department of Medicine, University Hospital, Leuven, Belgium
| | - Manlio Cipriani
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Maria Frigerio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy
| | - Klein Liviu
- Division of Cardiology, Department of Medicine, University of California San Francisco, CA, USA
| | - Kimberly N Hong
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eric Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Oscar Ö Braun
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
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Darden D, Birgersdotter-Green U. To the Editor-Denominator neglect in meta-analysis: Electrical abnormalities in St. Jude/Abbott pacing leads. Heart Rhythm 2021; 18:2226. [PMID: 34563690 DOI: 10.1016/j.hrthm.2021.09.019] [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: 09/08/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Douglas Darden
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California.
| | - Ulrika Birgersdotter-Green
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California
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Darden D, Duong T, Du C, Munir MB, Han FT, Reeves R, Saw J, Zeitler EP, Al-Khatib SM, Russo AM, Minges KE, Curtis JP, Freeman JV, Hsu JC. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JAMA Cardiol 2021; 6:1275-1284. [PMID: 34379072 DOI: 10.1001/jamacardio.2021.3021] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Indexed: 12/26/2022]
Abstract
Importance Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for select patients with atrial fibrillation; however, women have been underrepresented in clinical trials of LAAO, and sex-specific subanalyses are limited. Objective To evaluate the sex differences in the baseline characteristics of patients undergoing LAAO implant and in the in-hospital outcomes after LAAO implant. Design, Setting, and Participants A total of 49 357 patients in the National Cardiovascular Data Registry LAAO Registry undergoing LAAO with the Watchman device between January 1, 2016, and June 30, 2019, were included in this study. Exposure Female or male sex. Main Outcomes and Measures The primary outcomes were aborted or canceled procedure, major adverse event, any adverse event, prolonged hospital stay longer than 1 day, and death. Unadjusted and multivariable adjusted logistic regression analyses were performed to assess sex differences in in-hospital adverse events. Results In this cohort study of 49 357 patients (mean [SD] age, 76.1 [8.0] years), 20 388 women (41.3%) and 28 969 (58.7%) men underwent LAAO. Compared with men, women were older and had a higher prevalence of paroxysmal atrial fibrillation, prior stroke, and uncontrolled hypertension but a lower prevalence of congestive heart failure, diabetes, and coronary artery disease. After multivariable adjustment, there were no differences in aborted or canceled procedures between women and men (613 [3.0%] vs 851 [2.9%]; odds ratio [OR] 1.01, 95% CI, 0.90-1.13). Women were more likely than men to experience any adverse event (1284 [6.3%] vs 1144 [3.9%]; P < .001; OR, 1.63; 95% CI, 1.49-1.77; P < .001) or major adverse event (827 [4.1%] vs 567 [2.0%]; P < .001; OR, 2.06; 95% CI, 1.82-2.34; P < .001) owing to pericardial effusion requiring drainage (241 [1.2%] vs 144 [0.5%]) or major bleeding (349 [1.7%] vs 244 [0.8%]). Women were also more likely than men to experience a hospital stay longer than 1 day (3272 [16.0%] vs 3355 [11.6%]; P < .001; adjusted OR, 1.46; 95% CI, 1.38-1.54; P < .001) or death (adjusted OR, 2.01; 95% CI, 1.31-3.09; P = .001), although death was rare and absolute differences were minimal (58 [0.3%] vs 37 [0.1%]; P < .001). Conclusions and Relevance This study suggests that, compared with men, women have a significantly higher risk of in-hospital adverse events after LAAO. Further research aimed at risk reduction, particularly strategies to reduce the risk of pericardial effusion and major bleeding, in women undergoing LAAO is warranted.
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Thao Duong
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Ryan Reeves
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily P Zeitler
- Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Andrea M Russo
- Cardiac Electrophysiology and Arrhythmia Services, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Karl E Minges
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.,Department of Health Administration and Policy, University of New Haven, West Haven, Connecticut
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla
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Aldaas OM, Darden D, Mylavarapu PS, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Feld GK, Hsu JC. B-PO05-104 UTILITY OF ISOPROTERENOL INFUSION DURING CATHETER ABLATION OF ATRIAL FIBRILLATION: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1023] [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: 10/20/2022]
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Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. B-PO03-156 PROCEDURAL COMPLICATIONS AND IN-HOSPITAL OUTCOMES FROM LEFT ATRIAL APPENDAGE OCCLUSION DEVICE IMPLANTATION IN PATIENTS WITH CHRONIC AND END STAGE RENAL DISEASE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.629] [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: 11/26/2022]
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Mylavarapu P, Mahmoud Aldaas O, Darden D, Han FT, Hoffmayer KS, Krummen DE, Ho G, Raissi F, Feld GK, Hsu JC. B-011-06 USING MACHINE LEARNING TO IDENTIFY PATIENTS LIKELY TO REQUIRE REPEAT CATHETER ABLATION FOR ATRIAL FIBRILLATION: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.07.019] [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: 11/25/2022]
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