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Della Rocca DG, Magnocavallo M, Gianni C, Mohanty S, Al-Ahmad A, Bassiouny M, Denora M, La Fazia VM, Lavalle C, Gallinghouse GJ, Santangeli P, Polselli M, Sarkozy A, Vetta G, Ahmed A, Sanchez JE, Pannone L, Chierchia GB, Tschopp DR, de Asmundis C, Di Biase L, Lakkireddy D, Burkhardt DJ, Horton RP, Natale A. Three-dimensional intracardiac echocardiography for left atrial appendage sizing and percutaneous occlusion guidance. Europace 2023; 26:euae010. [PMID: 38225176 PMCID: PMC10823354 DOI: 10.1093/europace/euae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS Left atrial appendage (LAA) imaging is critical during percutaneous occlusion procedures. 3D-intracardiac echocardiography (ICE) features direct visualization of LAA from multiple cross-sectional planes at a time. We aimed at reporting procedural success of 3D-ICE-guided LAA occlusion and the correlation between pre-procedural transoesophageal echocardiography (TEE) and intraprocedural 3D-ICE for LAA sizing. METHODS AND RESULTS Among 274 patients undergoing left atrial appendage occlusion (LAAO) with a Watchman FLX, periprocedural ICE guidance was achieved via a commercially available 2D-ICE catheter (220 patients) or a novel (NUVISION™) 3D-ICE one (54 patients). Primary endpoint was a composite of procedural success and LAA sealing at follow-up TEE. Secondary endpoint was a composite of periprocedural device recapture/resizing plus presence of leaks ≥ 3 mm at follow-up TEE. 3D-ICE measurements of maximum landing zone correlated highly with pre-procedural TEE reference values [Pearson's: 0.94; P < 0.001; bias: -0.06 (-2.39, 2.27)]. The agreement between 3D-ICE-based device selection and final device size was 96.3% vs. 79.1% with 2D-ICE (P = 0.005). The incidence of the primary endpoint was 98.1% with 3D-ICE and 97.3% with 2D-ICE (P = 0.99). 2D-ICE patients had a trend towards a higher incidence of periprocedural device recapture/redeployment (31.5% vs. 44.5%; P = 0.09). The secondary endpoint occurred in 31.5% of 3D-ICE patients vs. 45.9% of 2D-ICE ones (P = 0.065). CONCLUSION Intracardiac echocardiography-guided LAAO showed a very high success, with no major adverse events. A very high level of agreement for LAA sizing was found between pre-procedural TEE and periprocedural 3D-ICE. 3D-ICE performed significantly better than 2D-ICE for FLX size selection and may provide better guidance during device deployment.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina—Gemelli Isola, Rome, Italy
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Marialessia Denora
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Gerald J Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli Isola Tiberina—Gemelli Isola, Rome, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Adnan Ahmed
- Kansas City Heart Rhythm Institute, 5100 W 110th St Second Floor, Overland Park, KS, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - David R Tschopp
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Av. du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St Second Floor, Overland Park, KS, USA
| | - David J Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, 3000 N Interstate Hwy 35 Suite 720, Austin, TX, USA
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA
- Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Sanchez JE, Noor S, Sun MS, Zimmerly J, Pasmay A, Sanchez JJ, Vanderwall AG, Haynes MK, Sklar LA, Escalona PR, Milligan ED. The FDA-approved compound, pramipexole and the clinical-stage investigational drug, dexpramipexole, reverse chronic allodynia from sciatic nerve damage in mice, and alter IL-1β and IL-10 expression from immune cell culture. Neurosci Lett 2023; 814:137419. [PMID: 37558176 PMCID: PMC10552878 DOI: 10.1016/j.neulet.2023.137419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
During the onset of neuropathic pain from a variety of etiologies, nociceptors become hypersensitized, releasing neurotransmitters and other factors from centrally-projecting nerve terminals within the dorsal spinal cord. Consequently, glial cells (astrocytes and microglia) in the spinal cord are activated and mediate the release of proinflammatory cytokines that act to enhance pain transmission and sensitize mechanical non-nociceptive fibers which ultimately results in light touch hypersensitivity, clinically observed as allodynia. Pramipexole, a D2/D3 preferring agonist, is FDA-approved for the treatment of Parkinson's disease and demonstrates efficacy in animal models of inflammatory pain. The clinical-stage investigational drug, R(+) enantiomer of pramipexole, dexpramipexole, is virtually devoid of D2/D3 agonist actions and is efficacious in animal models of inflammatory and neuropathic pain. The current experiments focus on the application of a mouse model of sciatic nerve neuropathy, chronic constriction injury (CCI), that leads to allodynia and is previously characterized to generate spinal glial activation with consequent release IL-1β. We hypothesized that both pramipexole and dexpramipexole reverse CCI-induced chronic neuropathy in mice, and in human monocyte cell culture studies (THP-1 cells), pramipexole prevents IL-1β production. Additionally, we hypothesized that in rat primary splenocyte culture, dexpramixole increases mRNA for the anti-inflammatory and pleiotropic cytokine, interleukin-10 (IL-10). Results show that following intravenous pramipexole or dexpramipexole, a profound decrease in allodynia was observed by 1 hr, with allodynia returning 24 hr post-injection. Pramipexole significantly blunted IL-1β protein production from stimulated human monocytes and dexpramipexole induced elevated IL-10 mRNA expression from rat splenocytes. The data support that clinically-approved compounds like pramipexole and dexpramipexole support their application as anti-inflammatory agents to mitigate chronic neuropathy, and provide a blueprint for future, multifaceted approaches for opioid-independent neuropathic pain treatment.
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Affiliation(s)
- J E Sanchez
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - S Noor
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - M S Sun
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - J Zimmerly
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - A Pasmay
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - J J Sanchez
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - A G Vanderwall
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - M K Haynes
- Center for Molecular Discovery (CMD) Innovation, Discovery and Training Complex (IDTC), University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - L A Sklar
- Center for Molecular Discovery (CMD) Innovation, Discovery and Training Complex (IDTC), University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - P R Escalona
- Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; New Mexico VA Health Care System, Albuquerque NM 87108, USA
| | - E D Milligan
- Department of Neurosciences, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
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Eldadah ZA, Al-Ahmad A, Bunch TJ, Delurgio DB, Doshi RN, Hook BG, Hranitzky PM, Joyner CA, Mittal S, Porterfield C, Sanchez JE, Thambidorai SK, Wazni OM, McElderry HT. Same-day discharge following catheter ablation and venous closure with VASCADE MVP: A postmarket registry. J Cardiovasc Electrophysiol 2023; 34:348-355. [PMID: 36448428 DOI: 10.1111/jce.15763] [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: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Early and safe ambulation can facilitate same-day discharge (SDD) following catheter ablation, which can reduce resource utilization and healthcare costs and improve patient satisfaction. This study evaluated procedure success and safety of the VASCADE MVP venous vascular closure system in patients with atrial fibrillation (AF). METHODS The AMBULATE SDD Registry is a two-stage series of postmarket studies in patients with paroxysmal or persistent AF undergoing catheter ablation followed by femoral venous access-site closure with VASCADE MVP. Efficacy endpoints included SDD success, defined as the proportion of patients discharged the same day who did not require next-day hospital intervention for procedure/access site-related complications, and access site sustained success within 15 days of the procedure. RESULTS Overall, 354 patients were included in the pooled study population, 151 (42.7%) treated for paroxysmal AF and 203 (57.3%) for persistent AF. SDD was achieved in 323 patients (91.2%) and, of these, 320 (99.1%) did not require subsequent hospital intervention based on all study performance outcomes. Nearly all patients (350 of 354; 98.9%) achieved total study success, with no subsequent hospital intervention required. No major access-site complications were recorded. Patients who had SDD were more likely to report procedure satisfaction than patients who stayed overnight. CONCLUSION In this study, 99.7% of patients achieving SDD required no additional hospital intervention for access site-related complications during follow-up. SDD appears feasible and safe for eligible patients after catheter ablation for paroxysmal or persistent AF in which the VASCADE MVP is used for venous access-site closure.
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Affiliation(s)
- Zayd A Eldadah
- Heart & Vascular Institute, MedStar Health, Columbia, Maryland, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Murray, Utah, USA
| | - David B Delurgio
- Department of Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Rahul N Doshi
- Cardiac Arrhythmia Group, HonorHealth Medical Group, Scottsdale, Arizona, USA
| | - Bruce G Hook
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | | | - Charles A Joyner
- Department of Cardiology, Levinson Heart Hospital at Chippenham and Johnston Willis Medical Center, Richmond, Virginia, USA
| | - Suneet Mittal
- Electrophysiology, Valley Health System, Ridgewood, New Jersey, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia, Medical City Dallas, Dallas, Texas, USA
| | | | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Thomas McElderry
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Gianni C, Della Rocca D, MacDonald BC, Quintero Mayedo A, Mohanty S, Bassiouny MA, Burkhardt JD, Horton RP, Gallinghouse GJ, Sanchez JE, Natale A, Al-Ahmad A. Risk Assessment and Management of Patients Undergoing Left Atrial Appendage Isolation. Curr Cardiovasc Risk Rep 2022. [DOI: 10.1007/s12170-022-00693-z] [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: 11/30/2022]
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Gianni C, Sanchez JE, Chen Q, Della Rocca DG, Mohanty S, Trivedi C, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Horton RP, Hranitzky PM, Romero JE, Di Biase L, Garcia MJ, Natale A. Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications. Circ Arrhythm Electrophysiol 2022; 15:e010975. [PMID: 35617267 DOI: 10.1161/circep.122.010975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. METHODS One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. RESULTS Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%-89%]). CONCLUSIONS Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (Q.C.)
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Biomedical Engineering, University of Texas, Austin (R.P.H.)
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Jorge E Romero
- Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B.)
| | - Mario J Garcia
- Division of Cardiology (M.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,HCA Healthcare, Nashville, TN (A.N.).,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (A.N.).,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
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Bailey SA, Horton RP, Thambidorai S, Sanchez JE, Natale A. PO-671-05 ATRIAL ARRHYTHMIAS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS HOSPITALIZED WITH COVID-19. Heart Rhythm 2022. [PMCID: PMC9049669 DOI: 10.1016/j.hrthm.2022.03.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gianni C, Horton RP, Della Rocca DG, MacDonald BC, Mayedo AQ, Mohanty S, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Sanchez JE, Natale A. PO-654-05 VISUALLY ESTIMATED LEFT ATRIAL APPENDAGE LANDING ZONE DIAMETER BY FLUOROSCOPY: A SIMPLE METHOD FOR WATCHMAN SIZING. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Magnocavallo M, Vetta G, Della Rocca DG, Gianni C, Mohanty S, Bassiouny M, Di Lullo L, Del Prete A, Cirone D, Lavalle C, Chimenti C, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Horton RP, Di Biase L, Natale A. Prevalence, Management, and Outcome of Atrial Fibrillation and Other Supraventricular Arrhythmias in COVID-19 Patients. Card Electrophysiol Clin 2022; 14:1-9. [PMID: 35221076 PMCID: PMC8783208 DOI: 10.1016/j.ccep.2021.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giampaolo Vetta
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Roma, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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9
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Magnocavallo M, Rocca DGD, Lavalle C, Chimenti C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A. 479 Safety and effectiveness of left atrial appendage occlusion in patients with chronic kidney disease. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.053] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Left atrial appendage occlusion (LAAO) might be particularly attractive in chronic kidney disease (CKD) patients, owing to a high thromboembolic risk and an even higher risk of bleeding. We sought to evaluate the safety and effectiveness of LAAO in CKD patients.
Methods and results
A total of 1238 patients undergoing LAAO at six centres were enrolled. On the basis of kidney function, as assessed via the CKD-EPI formula, patients were classified in two groups. Group1 had a GFR value ≤60 ml/min/1.73 m2 (CKD stages 3a-b, 4, and 5), whereas Group2 had a function >60 ml/min/1.73 m2 (CKD stages 1 and 2). Predicted annual rates of TE or major bleeding events were compared to the annualized observed risk of the two populations. Compared to Group 2 (n = 720, 47.5% males), patients in Group 1 (n = 518, 86.5% males) were older (mean age: 78 ± 8 vs. 75 ± 8, P < 0.001), and were at higher risk (CHA2DS2-VASc: 4.7 ± 1.4 vs. 4.4 ± 1.4; HAS-BLED: 3.8 ± 1.1 vs. 3.2 ± 1.0; P < 0.001 for both). Procedural complications (within 7 days) were observed in 3.1% of patients in Group1 and 4.6% of those in Group2 (P = 0.18); of them, major procedural adverse events occurred in 10 patients of Group1 [1.9%; four gastrointestinal (GI) bleedings, four tamponades, one myocardial infarction, one retroperitoneal hematoma] and in 15 (2.1%; seven pericardial tamponades, five retroperitoneal hematomas, two strokes, and one GI bleeding) of Group2 (P = 0.84). During a mean follow-up of 11.5 ± 7 months (1183 pt/years), 10 stroke/TIA (1.9%) and 25 major bleeding events (4.8%; 18 GI and 7 intracranial) were observed in Group1. Rate of TE events was not statistically different between groups (1.9% vs. 2.6%; P = 0.41); major bleedings had a significantly higher incidence in Group 1 (4.8% vs. 2.4%, P = 0.02). Based on the estimated annual TE risk according to the CHA2DS2-VASc score (4.76% in Group1 and 4.51% in Group 2), the % risk reduction after LAAO was 57.5% and 38.8%, respectively. Based on the estimated annual major bleeding risk based on the HAS-BLED score (7.31% in Group1 and 5.39% in Group2), the % bleeding risk reduction was 30.9% and 54.2%.
Conclusions
LAAO is a safe and effective approach in CKD patients. Given the increased risk of bleeding and contraindications to oral anticoagulation, CKD patients might be good candidates for LAA occlusion.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
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10
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Magnocavallo M, Rocca DGD, Lavalle C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A, Chimenti C. 478 Clinical outcomes of patients at very high stroke risk undergoing watchman implantation. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.052] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Left atrial appendage occlusion (LAAO) with the Watchman device is an effective alternative to oral anticoagulation in patients with non-valvular atrial fibrillation at high thromboembolic risk. We sought to evaluate the safety and effectiveness of LAAO for stroke and bleeding prevention in patients at very high stroke risk.
Methods and results
Data were extracted from a prospective database of 488 AF patients who underwent LAA closure with a Watchman device. Periprocedural complications, thromboembolic (TE), and bleeding event rates among patients with a CHA2DS2-VASc ≥ 5 were reported. Predicted annual rates of TE or major bleeding events were compared to the annualized observed risk of the population. Overall, 209 patients with a CHA2DS2-VASc ≥5 (CHA2DS2-VASc: 6.0 ± 1.0; HAS-BLED: 3.7 ± 1.1) were included in the study. The mean age was 78 ± 6 years and 52.2% (n = 109) were males. Watchman implantation was successful in all patients. Overall procedure-related complication rate was 3.3% (n = 7). Two major complications were observed (1.0%): one pericardial tamponade requiring surgery and one major bleeding event at 3 days post-procedure. The incidence of minor complications was 2.3% (n = 5). Specifically, two patients experienced a pericardial effusion that required drainage and three had a groin hematoma. During a mean follow-up duration of 12 ± 5 months (193 pt/years), six TE events (2.9%/annualized rate: 3.1%) were documented after a median of 6.3 months (IQR: 2.2–9.6). Based on the estimated annual TE risk according to the CHA2DS2-VASc score (8.5%), the % risk reduction after LAAO was 63.5%. Four major bleeding events [1.9% (median time to event: 2.1 months; IQR: 1.0–3.4)] and five minor bleeding events occurred (2.5%) during follow-up. Compared to the expected rate of bleeding events as assessed by the HAS-BLED of the population (8.03%), LAAO led to a 42% reduction of bleeding risk.
Conclusions
In a population at very high TE risk, LAAO with the Watchman device was a safe and effective approach, and led to a 63.5% of stroke risk.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Sa Mohanty
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Cristina Chimenti
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
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11
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Magnocavallo M, Rocca DGD, Lavalle C, Chimenti C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A. 471 Arrhythmia-free survival in early-persistent atrial fibrillation patients undergoing radiofrequency catheter ablation. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.049] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Despite advances in success rate of paroxysmal atrial fibrillation (PAF) ablation, outcomes of radiofrequency catheter ablation (RFCA) in patients with persistent AF are highly variable. Early persistent AF (EPsAF) is defined as AF that is sustained beyond 7 days but is less than 3 months in duration. Arrhythmia-free survival data after RFCA in this specific population are still limited. We sought to report the outcomes of RFCA in the subgroup of patients with EPsAF, compared to those with PAF and with ‘late’ persistent AF (LPsAF) lasting between 3 and 12 months.
Methods and results
Data from 1143 consecutive AF patients receiving their first RFCA were prospectively collected. Patients with EPsAF (n = 190) were compared with PAF (n = 531) and LPsAF (n = 422) patients. All patients received pulmonary vein antrum isolation + posterior wall and sustained non-pulmonary vein (PV) trigger ablation. Non-sustained non-PV triggers were ablated based on operator discretion. Non-PV triggers were defined as sites of firing leading to sustained (>30 s) or non-sustained arrhythmias (<30 s, including premature atrial contractions ≥10 beats/min) with earliest activation outside the PVs. Mean age of the population was 64 ± 11 years. Female patients were more in PAF group (39%) compared to EPsAF (26%) and LPsAF (28%) (P < 0.001). There was no difference in other clinical characteristics among populations. Non-PV triggers were detected more in EPsAF [127 (66.8%)], and LPsAF [296 (70.1%)] patients compared to PAF [185 (34.8%)] (P < 0.001).One-year arrhythmia-free survival rate after a single procedure was 75.0% (398), 74.2% (141), and 64.5% (272) in PAF, EPsAF, and LPsAF, respectively. Success rate was significantly higher in PAF {[HR: 0.67 (0.53, 0.84), P = 0.001] and EPsAF [HR: 0.67 (0.49, 0.93)], P = 0.015} compared to LPsAF.
Conclusions
In patients with EPsAF, RFCA may result in significantly better freedom from atrial arrhythmias, compared to LPsAF. In this cohort, ablation might be reasonable as first line approach to improve outcomes and prevent AF progression.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 000161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 000161 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 000161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Rodney P. Horton
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center Austin, TX 78705, USA
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12
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Magnocavallo M, Rocca DGD, Lavalle C, Chimenti C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A. 475 Is left atrial appendage device compression rate a predictor of incomplete occlusion in patients undergoing watchman device implantation? Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.051] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Transesophageal echocardiography (TEE) is a standard peri-procedural imaging modality in patients undergoing percutaneous left atrial appendage (LAA) occlusion. An accurate device sizing is pivotal to assess stability and achieve successful closure. In this prospective study, we sought to evaluate the correlation between Watchman device compression rates (DCRs) and risk of incomplete LAA occlusion at follow-up in patients undergoing Watchman device implantation.
Methods and results
Two-dimensional TEE via a commercially available transducer (Vivid, Philips) was performed during the procedure and within 3 months after the procedure. LAA size, morphology, and DCRs [(original device size—size after deployment)/original device size; %] were assessed in a mid-oesophageal view at 0°, 45°, 90° and 135°, according to company recommendations. Residual leaks ≥ 3 mm were classified as significant. Between 2016 and 2018, 116 patients underwent LAA occlusion with a Watchman device at our institution. The mean age was 74 ± 9 years and 60.4% (n = 70) were males. The average CHA2DS2-VASc and HAS-BLED scores were 4.7 ± 1.7 and 2.5 ± 1.1, respectively. The final device size was 21 mm in 11 (9.5%) patients, 24 mm in 28 (24.1), 27 mm in 27 (23.3%), 30 mm in 26 (22.4%), and 33 mm in 24 (20.7). At follow-up TEE, 16 (13.8%) patients were found to have a significant (≥3 mm) residual leak. The average DCRs measured at different angles in patients with and without leak were not significantly different (24 ± 8% vs. 26 ± 7% at 0°, P = 0.47; 23 ± 9% vs. 25 ± 7% at 45°, P = 0.58; 23 ± 8% vs. 23 ± 6% at 90°, P = 0.61; 22 ± 8% vs. 21 ± 7% at 135°, P = 0.61). At receiver operating characteristic (ROC) analysis, the areas under the curve to discriminate between patients with/without leak were 0.58, 0.57, 0.55, and 0.46 for DCRs measured at 0°, 45°, 90°, and 135° angles.
Conclusions
Peri-procedural assessment of DCRs does not appear to be an accurate method to predict LAA complete occlusion in patients undergoing Watchman device implantation.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascula Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascula Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascula Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
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13
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Magnocavallo M, Della Rocca DG, Lavalle C, Chimenti C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A. 473 Propensity-matched comparison of left atrial appendage occlusion and direct oral anticoagulation for thromboembolic prevention in octogenarians. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.050] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
A significant amount of atrial fibrillation patients does not receive appropriate anticoagulation, owing to contraindications and side effects. Octogenarians have higher competing comorbidities with a remarkable bleeding/thromboembolic (TE) risk. We aimed at analysing the clinical outcomes of LAAO compared with direct oral anticoagulation (DOAC) in octogenarians.
Methods and results
Data were extracted from two prospective databases including 488 LAAO and 825 DOAC patients. Patients aged 80 years or older accounted for 37.1% (n = 181) and 39.5% (n = 326). In order to attenuate the imbalance in covariates between the groups, a propensity score matching technique was used (covariates: age, sex, CHA2DS2-VASc, and HAS-BLED scores, follow-up duration; tolerance 0.02). This method resulted in matched populations with 108 octogenarian patients per group. The annual stroke/transient ischaemic attack (TIA) risk was estimated based on the CHA2DS2-VASc, and compared to the annualized observed risk, owing to calculate the % risk reduction associated with the two treatment strategies. A total of 216 octogenarians were included in the analysis (84 ± 3 years; CHA2DS2-VASc: 4.9 ± 1.4, HAS-BLED: 3.1 ± 0.9). A Watchman device was successfully deployed in all LAAO ≥ 80 patients; periprocedural adverse events were observed in 2.8% (n = 3) of LAAO patients. During a follow-up of 13 ± 4 months, 3 (2.8%) TE complications (1 stroke, 2 TIA) occurred in LAAO ≥ 80 pts and 4 (3.7%; 1 stroke, 3 TIA) in DOAC ≥ 80 pts (P = 0.99). The annualized risk of stroke/TIA was 2.5% in the first and 3.5% in the second group. Based on the estimated annual TE risk according to the CHA2DS2-VASc score, the % risk reduction after LAAO and DOAC was 54.5% and 36.4%, respectively. Major bleeding events were 3 [1 intracranial, 2 gastrointestinal (GI)] LAAO ≥ 80 pts, and 3 (2 intracranial, 1GI) in DOAC ≥ 80 pts (2.8% in both groups). Minor bleeding events were significantly higher in DOAC ≥ 80 pts [13.0% (n = 14) vs. 2.7% (n = 3); RR: 4.7, 95% CI: 1.4–15.7; P = 0.009].
Conclusions
LAAO was safe and similar to DOAC at preventing ischaemic/major bleeding events in a matched population of patients aged ≥80 years. A significantly higher incidence of minor bleeding events was observed in the DOAC group.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, ST. David’s Medical Center, Austin, TX 78705, USA
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14
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Magnocavallo M, Rocca DGD, Lavalle C, Chimenti C, Carola G, Mohanty S, Trivedi C, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Natale A. 482 Dressler’s syndrome following catheter ablation of atrial fibrillation: a case series. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.054] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Dressler’s syndrome is a secondary form of pleuro-pericarditis caused by an immune system response to heart damage. The onset of Dressler’s syndrome following catheter ablation has been previously described in rare case reports. We sought to report clinical manifestations, management, and outcomes of Dressler’s syndrome after atrial fibrillation (AF) catheter ablation.
Methods and results
Data from five AF patients who underwent radiofrequency ablation that was complicated by the development of Dressler’s syndrome were extracted from a prospective, single-centre database. Five out of 12 747 patients (0.04%) developed Dressler’s syndrome post AF ablation, 100% of which were females, with a mean age of 75.8 ± 3.4 years. All patients had persistent AF, and had pulmonary vein (PV) antrum, plus posterior wall isolation, plus non-PV trigger ablation. The mean procedure, fluoroscopy, and radiofrequency times were 183.20 ± 48.0, 50.3 ± 24.0, and 78.03 ± 27.9 min, respectively. All procedures were uncomplicated, and patients were discharged after overnight observation. Hospital re-admission was required in all after an average of 13.2 ± 5.2 days, due to worsening dyspnoea, pleuritic pain, and low-grade fever. At re-admission, all five patients had moderate-severe leucocytosis with neutrophilia, as well as bilateral rales and pericardial friction rub. Transthoracic echocardiography showed a mean pericardial circumferential effusion of 8 ± 2 mm, and chest X-ray was suggestive of bilateral mild pleural effusion in all. Corticosteroids were prescribed in three and NSAIDs plus colchicine in two patients. Pericardial drain placement was required in three patients after a median of 3 days, due to increasing pericardial effusion with hemodynamic impairment. The drainage tube was removed after a median of 2 days. All patients had complete resolution of symptoms and remained free from pericardial/pleural effusion within 1-month post-admission. Four of five patients had repeat ablation without recurrent Dressler’s syndrome.
Conclusions
Dressler’s syndrome occurred in older female patients, who underwent extensive ablation for AF. If promptly treated, its clinical course appears favourable with complete resolution of symptoms and pleuro-pericardial involvement.
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Affiliation(s)
- Michele Magnocavallo
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Gianni Carola
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - David J Burkhardt
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute, St. David’s Medical Center, Austin, TX 78705, USA
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15
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Della Rocca DG, Di Biase L, Mohanty S, Trivedi C, Gianni C, Romero J, Tarantino N, Magnocavallo M, Bassiouny M, Natale VN, Mayedo AQ, Macdonald B, Lavalle C, Murtaza G, Akella K, Forleo GB, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Horton RP, Viles-Gonzalez JF, Lakkireddy D, Natale A. Targeting non-pulmonary vein triggers in persistent atrial fibrillation: results from a prospective, multicentre, observational registry. Europace 2021; 23:1939-1949. [PMID: 34417816 DOI: 10.1093/europace/euab161] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 08/03/2020] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS We evaluated the efficacy of an ablation strategy empirically targeting pulmonary veins (PVs) and posterior wall (PW) and the prevalence and clinical impact of extrapulmonary trigger inducibility and ablation in a large cohort of patients with persistent atrial fibrillation (PerAF). METHODS AND RESULTS A total of 1803 PerAF patients were prospectively enrolled. All patients underwent pulmonary vein antrum isolation (PVAI) extended to the entire PW. A standardized protocol was performed to confirm persistent PVAI and elicit any triggers originating from non-PV sites. All non-PV triggers initiating sustained atrial tachyarrhythmias were ablated. Ablation of non-PV sites triggering non-sustained runs (<30 s) of atrial tachyarrhythmias or promoting frequent premature atrial complexes (≥10/min) was left to operator's discretion. Overall, 1319 (73.2%) patients had documented triggers from non-PV areas. After 17.4 ± 8.5 months of follow-up, the cumulative freedom from atrial tachyarrhythmias among patients without inducible non-PV triggers (n = 484) was 70.2%. Patients with ablation of induced non-PV triggers had a significantly higher arrhythmia control than those whose triggers were not ablated (67.9% vs. 39.4%, respectively; P < 0.001). After adjusting for clinically relevant variables, patients in whom non-PV triggers were documented but not ablated had an increased risk of arrhythmia relapse (hazard ratio: 2.39; 95% confidence interval: 2.01-2.83; P < 0.001). CONCLUSION Pulmonary vein antrum isolation extended to the entire PW might provide acceptable long-term arrhythmia-free survival in PerAF patients without inducible non-PV triggers. In our population of PerAF patients, non-PV triggers could be elicited in ∼70% of PerAF patients and their elimination significantly improved outcomes.
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Affiliation(s)
- Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.,Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA.,Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Veronica N Natale
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Angel Quintero Mayedo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Bryan Macdonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Ghulam Murtaza
- Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA
| | - Krishna Akella
- Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - John David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Gerald Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.,Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Stanford University, Stanford, CA, USA
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16
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Gianni C, Horton RP, Della Rocca DG, Mohanty S, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Sanchez JE, Natale A. Intracardiac echocardiography- versus transesophageal echocardiography-guided left atrial appendage occlusion with Watchman FLX. J Cardiovasc Electrophysiol 2021; 32:2781-2784. [PMID: 34411376 DOI: 10.1111/jce.15220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/04/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Watchman FLX has been recently approved for left atrial appendage occlusion (LAAO) in the US. Intracardiac echocardiography (ICE) - which is already commonly used to guide trans-septal access - can serve as an alternative to TEE, simplifying the procedure and reducing associated costs. Herein, we report our experience with ICE-guided LAAO with Watchman FLX. METHODS AND RESULTS This cohort study included the first 190 consecutive patients who underwent LAAO with Watchman FLX in our center. LAAO was successful in all patients without significant peri-procedural, device-related complications in either group. Compared to TEE, we observed a significant reduction in procedural times when using ICE. In addition, there was a potentially clinically relevant reduction in fluoroscopy dose, mainly secondary to fewer cine acquisition runs. At follow-up, no cases of device embolism were noted, whereas the rate of device-related thrombosis and peri-device leaks were comparable between groups. CONCLUSION ICE-guided LAAO with Watchman FLX is safe and feasible, with a significant reduction in procedural time and potential reduction in fluoroscopy dose when compared to TEE.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,HCA National Medical Director of Cardiac Electrophysiology, HCA Healthcare, Nashville, Tennessee, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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17
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Della Rocca DG, Di Biase L, Gianni C, Trivedi CG, Mohanty S, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Magnocavallo M, Lavalle C, Joseph Gallinghouse G, Tarantino N, Sanchez JE, Forleo G, Gopinathannair R, Horton RP, Lakkireddy DR, Natale A. B-AB17-04 ELECTROPHYSIOLOGICAL FINDINGS IN PATIENTS UNDERGOING LEFT ATRIAL APPENDAGE OCCLUSION FOLLOWING PREVIOUS ELECTRICAL ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.100] [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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18
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Della Rocca DG, Magnocavallo M, Di Biase L, Mohanty S, Trivedi CG, Tarantino N, Gianni C, Gopinathannair R, Lavalle C, van Niekerk CJ, Romero J, Briceno DF, Bassiouny MA, Al-Ahmad A, David Burkhardt J, Natale V, Joseph Gallinghouse G, Del Prete A, Forleo G, Sanchez JE, Lakkireddy DR, Horton RP, Gibson DN, Natale A. B-AB17-03 LONG-TERM HALF-DOSE NOVEL ORAL ANTICOAGULATION VERSUS STANDARD ANTITHROMBOTIC THERAPY AFTER LEFT ATRIAL APPENDAGE OCCLUSION WITH A WATCHMAN DEVICE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.099] [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: 11/17/2022]
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19
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Della Rocca DG, Murtaza G, Di Biase L, Akella K, Krishnan SC, Magnocavallo M, Tarantino N, Mohanty S, Gianni C, Trivedi CG, Lavalle C, Forleo G, Natale V, Gopinathannair R, Patel P, Bassiouny MA, Al-Ahmad A, David Burkhardt J, Joseph Gallinghouse G, Sanchez JE, Doshi SK, Horton RP, Lakkireddy DR, Natale A. B-AB04-03 RADIOFREQUENCY ENERGY APPLICATIONS TO TREAT INCOMPLETE LEFT ATRIAL APPENDAGE CLOSURE IN WATCHMAN PATIENTS WITH PERI- OR POST-PROCEDURAL EVIDENCE OF A SIGNIFICANT RESIDUAL LEAK. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Magnocavallo M, Della Rocca DG, Lavalle C, Natale V, Gianni C, Schiavone M, Gopinathannair R, Mohanty S, Trivedi CG, Forleo G, Tarantino N, Romero J, Zhang X, Bassiouny MA, Al-Ahmad A, David Burkhardt J, Joseph Gallinghouse G, Sanchez JE, Horton RP, Lakkireddy DR, Di Biase L, Natale A. B-PO03-083 CLINICAL PRESENTATION, DIAGNOSIS, AND TREATMENT OF ATRIOESOPHAGEAL FISTULA RESULTING FROM ATRIAL FIBRILLATION ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.557] [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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21
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Della Rocca DG, Murtaza G, Di Biase L, Akella K, Krishnan SC, Magnocavallo M, Mohanty S, Gianni C, Trivedi C, Lavalle C, Forleo GB, Natale VN, Tarantino N, Romero J, Gopinathannair R, Patel PJ, Bassiouny M, Del Prete A, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Doshi SK, Horton RP, Lakkireddy D, Natale A. Radiofrequency Energy Applications Targeting Significant Residual Leaks After Watchman Implantation: A Prospective, Multicenter Experience. JACC Clin Electrophysiol 2021; 7:1573-1584. [PMID: 34330671 DOI: 10.1016/j.jacep.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/09/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of radiofrequency (RF) energy applications targeting the atrial side of a significant residual leak in patients with acute and chronic evidence of incomplete percutaneous left atrial appendage (LAA) occlusion. BACKGROUND RF applications have been proved to prevent recanalization of intracranial aneurysms after coil embolization, thereby favoring complete sealing. From a mechanistic standpoint, in vitro and in vivo experiments have demonstrated that RF promotes collagen deposition and tissue retraction. METHODS Forty-three patients (mean age 75 ± 7 years mean CHA2DS2-VASc score 4.6 ± 1.4, mean HAS-BLED score 4.0 ± 1.1) with residual leaks ≥4 mm after Watchman implantation were enrolled. Procedural success was defined as complete LAA occlusion or presence of a mild or minimal (1- to 2-mm) peridevice leak on follow-up transesophageal echocardiography (TEE), which was performed approximately 45 days after the procedure. RESULTS RF-based leak closure was performed acutely after Watchman implantation in 19 patients (44.2%) or scheduled after evidence of significant leaks on follow-up TEE in 24 others (55.8%). The median leak size was 5 mm (range: 4-7 mm). On average, 18 ± 7 RF applications per patient (mean maximum contact force 16 ± 3 g, mean power 44 ± 2 W, mean RF time 5.1 ± 2.5 minutes) were performed targeting the atrial edge of the leak. Post-RF median leak size was 0 mm (range: 0-1 mm). A very low rate (2.3% [n = 1]) of major periprocedural complications was observed. Follow-up TEE revealed complete LAA sealing in 23 patients (53.5%) and negligible residual leaks in 15 (34.9%). CONCLUSIONS RF applications targeting the atrial edge of a significant peri-Watchman leak may promote LAA sealing via tissue remodeling, without increasing complications. (RF Applications for Residual LAA Leaks [REACT]; NCT04726943).
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Affiliation(s)
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Krishna Akella
- Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA
| | | | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni B Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco," Milan, Italy
| | - Veronica N Natale
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Philip J Patel
- Eisenhower Desert Cardiology Center, Rancho Mirage, California, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Shephal K Doshi
- Cardiology Division, Pacific Heart Institute, Santa Monica, California
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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22
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Della Rocca DG, Magnocavallo M, Natale VN, Gianni C, Mohanty S, Trivedi C, Lavalle C, Forleo GB, Tarantino N, Romero J, Zhang X, Bassiouny M, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Sanchez JE, Horton RP, Di Biase L, Natale A. Clinical presentation, diagnosis, and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation. J Cardiovasc Electrophysiol 2021; 32:2441-2450. [PMID: 34260115 DOI: 10.1111/jce.15168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/04/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioesophageal fistula (AEF) is a worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. METHODS The digital search retrieved 150 studies containing 257 cases, 238 (92.6%) of which with a confirmed diagnosis of AEF and 19 (7.4%) of pericardioesophageal fistula. RESULTS The median time from ablation to symptom onset was 21 days (interquartile range [IQR]: 11-28). Neurological abnormalities were documented in 75% of patients. Compared to patients seen by a specialist, those evaluated at a walk-in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission (median: 2.5 day [IQR: 1-8] vs. 1 day [IQR: 1-5); p = .03). Overall, 198 patients underwent a chest scan (computed tomography [CT]: 192 patients and magnetic resonance imaging [MRI]: 6 patients), 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan (p < .001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. CONCLUSIONS Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course, as well as an early contact with the treating electrophysiologist for a coordinated interdisciplinary medical effort, are pivotal to prevent diagnostic delays and reduce mortality.
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Affiliation(s)
| | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Veronica N Natale
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo Lavalle
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Giovanni B Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco", Milano, Italy
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiadong Zhang
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - David J Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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23
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Della Rocca DG, Horton RP, Di Biase L, Gianni C, Trivedi C, Mohanty S, Anannab A, Magnocavallo M, Chen Q, Tarantino N, Bassiouny M, Lavalle C, Natale VN, Forleo GB, Del Prete A, Van Niekerk CJ, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Lakkireddy D, Gibson DN, Natale A. Incidence of Device-Related Thrombosis in Watchman Patients Undergoing a Genotype-Guided Antithrombotic Strategy. JACC Clin Electrophysiol 2021; 7:1533-1543. [PMID: 34217665 DOI: 10.1016/j.jacep.2021.04.012] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to report the incidence of device-related thrombosis (DRT) and thromboembolic (TE) events when an alternative to clopidogrel is prescribed in loss-of-function (LOF) allele carriers of the cytochrome P450 2C19 (CYP2C19) gene. BACKGROUND LOF polymorphisms of the CYP2C19 gene are associated with reduced hepatic bioactivation of clopidogrel. METHODS One thousand two Watchman patients were included. Six hundred forty-five patients underwent CYP2C19 genetic testing; among patients with clopidogrel resistance, clopidogrel was replaced by either prasugrel (pilot cohort) or half dose direct oral anticoagulant ((DOAC)/Group 1), both in combination with aspirin. We compared the incidence of DRT/TE events among genotyped patients and a control group which received standard dual antiplatelet therapy (DAPT) (Group 2; n = 357). All reported events occurred during a timeframe between 45- and 180-day follow-up transesophageal echocardiograms, when the 2 different antithrombotic strategies (genotype-guided vs standard DAPT) were adopted. RESULTS In the pilot cohort (n = 244), bleeding events occurred in 10.2% of patients who received aspirin plus prasugrel, leading to early discontinuation of the prasugrel-based protocol. DOAC Group 1 patients (n = 401), 25.7% were reduced metabolizers, and clopidogrel was replaced by half dose direct oral anticoagulant. DRT was documented in 1 (0.2%) patient of Group 1 and 7 (1.96%) patients of Group 2 (log-rank P value = 0.021). The composite endpoint of DRT/TE events was significantly lower among patients receiving a genotype-guided antithrombotic strategy (0.75% vs 3.1%; log-rank P value = 0.017). CONCLUSIONS In Watchman patients, a genotype-based antithrombotic strategy with aspirin plus half dose DOAC in reduced clopidogrel metabolizers was superior to standard DAPT with respect to DRT/TE events.
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Affiliation(s)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Nicola Tarantino
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Veronica N Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Giovanni B Forleo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco," Milan, Italy
| | | | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Douglas N Gibson
- Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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24
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Gianni C, Sanchez JE, Della Rocca DG, Al-Ahmad A, Horton RP, Di Biase L, Natale A. Intracardiac Echocardiography to Guide Catheter Ablation of Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:303-311. [PMID: 33990269 DOI: 10.1016/j.ccep.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intracardiac echocardiography (ICE) is a valuable tool and should be standard of care in any modern electrophysiology laboratory. Through real-time imaging of cardiac anatomy, ICE is used to guide electrophysiology procedures and monitor for complications. This article is a short overview of the application of real-time ICE imaging during atrial fibrillation ablation procedures.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; HCA National Medical Director of Cardiac Electrophysiology, Nashville, TN, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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25
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Gianni C, Gallinghouse GJ, Al-Ahmad A, Horton RP, Bailey SM, Burkhardt JD, Bassiouny MA, MacDonald BC, Quintero Mayedo A, Della Rocca DG, Mohanty S, Trivedi C, Di Biase L, Hranitzky PM, Sanchez JE, Natale A. Half-normal saline versus normal saline for irrigation of open-irrigated radiofrequency catheters in atrial fibrillation ablation. J Cardiovasc Electrophysiol 2021; 32:973-981. [PMID: 33442937 DOI: 10.1111/jce.14885] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 09/03/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The creation of effective and permanent lesions is a crucial factor in determining the success rate of atrial fibrillation (AF) ablation. By increasing the efficacy of radiofrequency (RF) energy-mediated lesion formation, half-normal saline (HNS) as an irrigant for open-irrigated ablation catheters has the potential to reduce procedural times and improve acute and long-term outcomes. METHODS This is a double-blind randomized clinical trial of 99 patients undergoing first-time RF catheter ablation for AF. Patients enrolled were randomly assigned in a 1:1 fashion to perform ablation using HNS or normal saline (NS) as an irrigant for the ablation catheter. RESULTS The use of HNS is associated with shorter RF times (26 vs. 33 min; p = .02) with comparable procedure times (104 vs. 104 min). The rate of acute pulmonary vein reconnections (16% vs. 18%) was comparable, with a median of 1 vein reconnection in the HNS arm versus 2 in the NS arm. There was no difference in procedure-related complications, including the incidence of postprocedural hyponatremia when using HNS. Over the 1-year follow-up, there is no significant difference between the HNS and NS with respect to the recurrence of any atrial arrhythmia (off antiarrhythmic drugs [AAD]: 47% vs. 52%; hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 0.66-2.06; off/on AAD: 66% vs. 66%, HR: 1.06, 95% CI: 0.53-2.12), with a potential benefit of using HNS when considering the paroxysmal AF cohort (on/off AAD 73% vs. 62%, HR: 0.72, 95% CI: 0.19-2.70). CONCLUSIONS In a mixed cohort of patients undergoing first-time AF ablation, irrigation of open-irrigated RF ablation catheters with HNS is associated with shorter RF times, with a comparably low rate of procedure-related complications. In the long term, there is no significant difference with respect to the recurrence of any atrial arrhythmia. Larger studies with a more homogeneous population are necessary to determine whether HNS improves clinical outcomes.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas, Austin, Texas, USA
| | - Shane M Bailey
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Bryan C MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Dell Medical School, University of Texas, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,HCA National Medical Director of Cardiac Electrophysiology, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA.,MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Abstract
PURPOSE The kinematic sequence (KS) during a baseball pitch provides insight into an athlete's ability to efficiently transfer energy and develop segmental velocities, to assess the quality of body segment position and control. Study purposes were 1) to introduce the four-category Kinematic Sequence Classification System and 2) to compare elbow and shoulder torques and shoulder distraction force across the KS categories performed during the fastball pitch. METHODS Thirty baseball pitchers (20.0 ± 3.1 yr) underwent 3D biomechanical pitch analyses of 249 fastball pitches. Seventeen distinct KS patterns were identified and assigned into four categories: 1) The proximal-to-distal (PDS) group includes the KS closest to theoretical ideal order of the five body segments (pelvis → trunk → arm → forearm → hand). The other categories were defined based on the segment where the first out-of-sequence peak angular velocity occurred: 2) distal upper extremity (DUE), 3) proximal upper extremity, and 4) pelvis/trunk. Throwing limb shoulder distraction force and shoulder and elbow torques were calculated. Linear mixed model analyses compared variables across KS categories. RESULTS Average elbow valgus torques differed significantly across all categories, P = 0.023, and were greater for the DUE (73.99 ± 20.84 N·m) than the PDS (61.35 ± 16.79 N·m), P = 0.006. Shoulder external rotation torques were significantly different, P = 0.033, across categories. CONCLUSION The PDS group demonstrated less mechanical stresses on the throwing shoulder and elbow but was observed in only 12% of pitches. The DUE group was the most common and generated the greatest elbow valgus and shoulder external rotation torques. The KS can inform coaches and sports medicine clinicians where the greatest torques are incurred by a pitcher. A KS classification system may serve as a screening tool or target pitching instruction for injury avoidance.
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Affiliation(s)
| | - Shannon E Linderman
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
| | - Javier E Sanchez
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA
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27
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Gianni C, Sanchez JE, Mohanty S, Trivedi C, Della Rocca DG, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Horton RP, Di Biase L, Natale A. High-Dose Dobutamine for Inducibility of Atrial Arrhythmias During Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:1701-1710. [PMID: 33334450 DOI: 10.1016/j.jacep.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to compare the effect of high-dose dobutamine (DBT) with that of high-dose isoproterenol (IPN) in eliciting triggers during atrial fibrillation (AF) ablation. BACKGROUND High-dose IPN is commonly used to elicit triggers during AF ablation. However, it is not available worldwide and, in the United States, its cost per dose has significantly increased. DBT is a similarly nonselective β-agonist and, as such, is a potential alternative. METHODS This was a prospective, randomized 2×2 crossover study of patients undergoing AF ablation. Patients were assigned to receive IPN (20 to 30 μg/min for 10 min) followed by DBT (40 to 50 μg/kg/min for 10 min) or vice versa in a 1:1 fashion. The type, number, and location of triggers as well as heart rate, blood pressure, and side effects were noted. RESULTS Fifty patients were included in the study. Both drugs caused a significant increase in heart rate, with a consistently lower peak for DBT. Blood pressure significantly increased with DBT, while there was a significant reduction with IPN, despite phenylephrine support. Atrial arrhythmias induced during DBT were comparable to that induced during IPN. In patients with IPN-inducible outflow tract premature ventricular contractions, a similar effect was noted with DBT. No major complications occurred during either drug challenge. CONCLUSIONS High-dose DBT is safe and comparable to high-dose IPN in respect of eliciting AF triggers, with the advantage to maintain systemic pressure without the need of additional vasopressor support. This study supports the use of high-dose DBT in electrophysiology laboratories in which IPN is not readily available and for those patients in whom hypotension is a concern.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Dell Medical School, University of Texas, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Biomedical Engineering, University of Texas, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Biomedical Engineering, University of Texas, Austin, Texas, USA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; HCA National Medical Director of Cardiac Electrophysiology, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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28
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Di Biase L, Mohanty S, Trivedi C, Romero J, Natale V, Briceno D, Gadiyaram V, Couts L, Gianni C, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Horton R, Hranitzky PM, Sanchez JE, Natale A. Stroke Risk in Patients With Atrial Fibrillation Undergoing Electrical Isolation of the Left Atrial Appendage. J Am Coll Cardiol 2020; 74:1019-1028. [PMID: 31439209 DOI: 10.1016/j.jacc.2019.06.045] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 06/20/2018] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Loss of contractility leading to stasis of blood flow following left atrial appendage electrical isolation (LAAEI) could lead to thrombus formation. OBJECTIVES This study evaluated the incidence of thromboembolic events (TE) in post-LAAEI cases "on" and "off" oral anticoagulation (OAC). METHODS A total of 1,854 consecutive post-LAAEI patients with follow-up transesophageal echocardiography (TEE) performed in sinus rhythm at 6 months to assess left atrial appendage (LAA) function were included in this analysis. RESULTS The TEE at 6 months revealed preserved LAA velocity, contractility, and consistent A waves in 336 (18%) and abnormal parameters in the remaining 1,518 patients. In the post-ablation period, all 336 patients with preserved LAA function were off OAC. At long-term follow-up, patients with normal LAA function did not experience any stroke events. Of the 1,518 patients with abnormal LAA contractility, 1,086 remained on OAC, and the incidence of stroke/transient ischemic attack (TIA) in this population was 18 of 1,086 (1.7%), whereas the number of TE events in the off-OAC patients (n = 432) was 72 (16.7%); p < 0.001. Of the 90 patients with stroke, 84 received left atrial appendage occlusion (LAAO) devices. At median 12.4 months (interquartile range: 9.8 to 15.3 months) of device implantation, 2 (2.4%) patients were on OAC because of high stroke risk or personal preference, whereas 81 patients discontinued OAC after LAAO device implantation without any TE events. CONCLUSIONS LAAEI is associated with a significant risk of stroke that can be effectively reduced by optimal uninterrupted OAC or LAAO devices.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York. https://twitter.com/luigidibiasemd
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Jorge Romero
- Albert Einstein College of Medicine at Montefiore Hospital, New York, New York
| | - Veronica Natale
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - David Briceno
- Albert Einstein College of Medicine at Montefiore Hospital, New York, New York
| | - Varuna Gadiyaram
- Interventional Electrophysiology, Scripps Clinic, San Diego, California
| | - Linda Couts
- Interventional Electrophysiology, Scripps Clinic, San Diego, California
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Andrea Natale
- Interventional Electrophysiology, Scripps Clinic, San Diego, California; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California.
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29
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Canpolat U, Faggioni M, Della Rocca DG, Chen Q, Ayhan H, Vu AA, Mohanty S, Trivedi C, Gianni C, Bassiouny M, Al-Ahmad A, Burkhardt JD, Sanchez JE, Gallinghouse GJ, Natale A, Horton RP. State of Fluoroless Procedures in Cardiac Electrophysiology Practice. J Innov Card Rhythm Manag 2020; 11:4018-4029. [PMID: 32368376 PMCID: PMC7192123 DOI: 10.19102/icrm.2020.110305] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
In the past decade, the use of interventional electrophysiological (EP) procedures for the diagnosis and treatment of cardiac arrhythmias has exponentially increased. These procedures usually require fluoroscopy to guide the advancement and frequent repositioning of intracardiac catheters, resulting in both the patient and the operator being subjected to a considerable degree of radiation exposure. Although shielding options such as lead gowns, glasses, and pull-down shields are useful for protecting the operator, they do not lessen the patient’s level of exposure. Furthermore, the prolonged use of lead gowns can exponentiate the onset of orthopedic problems among operators. Recent advancements in three-dimensional cardiac mapping systems and the use of radiation-free imaging technologies such as magnetic resonance imaging and intracardiac ultrasound allow operators to perform EP procedures with minimal or even no fluoroscopy. In this review, we sought to describe the state of fluoroless procedures in EP practice.
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Affiliation(s)
- Ugur Canpolat
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | | | | | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Huseyin Ayhan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, Ankara Yildirim Beyazit, Ankara, Turkey
| | - Andrew A Vu
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Mohammed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve, University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Stanford University, Stanford, CA, USA.,Dell Medical School, University of Texas, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA.,Division of Cardiology, Department of Medicine, University of Texas Health Sciences Center, San Antonio, TX, USA
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30
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Chen Q, Xu J, Gianni C, Trivedi C, Della Rocca DG, Bassiouny M, Canpolat U, Tapia AC, Burkhardt JD, Sanchez JE, Hranitzky P, Gallinghouse GJ, Al-Ahmad A, Horton R, Di Biase L, Mohanty S, Natale A. Simple electrocardiographic criteria for rapid identification of wide QRS complex tachycardia: The new limb lead algorithm. Heart Rhythm 2020; 17:431-438. [PMID: 31546028 DOI: 10.1016/j.hrthm.2019.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 11/26/2022]
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31
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Della Rocca DG, Horton RP, Di Biase L, Bassiouny M, Al-Ahmad A, Mohanty S, Gasperetti A, Natale VN, Trivedi C, Gianni C, Burkhardt JD, Gallinghouse GJ, Hranitzky P, Sanchez JE, Natale A. First Experience of Transcatheter Leak Occlusion With Detachable Coils Following Left Atrial Appendage Closure. JACC Cardiovasc Interv 2020; 13:306-319. [DOI: 10.1016/j.jcin.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
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32
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Chen Q, Mohanty S, Trivedi C, Gianni C, Della Rocca DG, Canpolat U, Burkhardt JD, Sanchez JE, Hranitzky P, Gallinghouse GJ, Al-Ahmad A, Horton R, Di Biase L, Natale A. Association between prolonged P wave duration and left atrial scarring in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1811-1818. [PMID: 31310407 DOI: 10.1111/jce.14070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/12/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND We evaluated the association of P wave duration (PWD) with left atrial scar (LAS) in patients with paroxysmal atrial fibrillation (PAF). METHODS Consecutive patients with PAF undergoing their first catheter ablation were screened and only those in sinus rhythm at baseline were included in the analysis. A standard 12-lead electrocardiogram (ECG) was performed in all and three-dimensional voltage mapping of the left atrium was generated for identification of low-voltage areas (≤0.2 mV) before the procedure. RESULTS In total, 411 patients with PAF were included in this study of which 181 had LASs (scar group), while 230 had no scar (nonscar group). In the scar group, patients were older (65.5 ± 8.8 vs 59.7 ± 11.7 years; P < .001), the proportion of female was higher (47.5% vs 37.4%; P = .04) and left atrial (LA) diameter (4.1 ± 0.6 vs 3.9 ± 0.6 cm; P < .001) was larger compared with the nonscar group. There was no significant difference in terms of hypertension, sleep apnea, and diabetes between the two groups. When comparing ECG characteristics between the two groups, PWD was significantly longer in the scar group (122.9 ± 18.5 and 116.9 ± 28.0 ms; P = .01). A multivariate analysis was performed, after adjustment of age, sex, LA diameter, PWD ≥ 120 ms was found to be an independent predictor of LA scarring (OR: 1.69, p-value: 0.02). CONCLUSION In the current series, prolonged PWD was found to be independently associated with LA scarring in PAF, even after adjustment for age, sex, and LA diameter.
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Affiliation(s)
- Qiong Chen
- Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.,Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Sanghamitra Mohanty
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Internal Medicine, Dell Medical School, Austin, Texas
| | - Chintan Trivedi
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Carola Gianni
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Domenico G Della Rocca
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ugur Canpolat
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - John David Burkhardt
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Javier E Sanchez
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Patrick Hranitzky
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Gerald Joseph Gallinghouse
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Amin Al-Ahmad
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore Hospital, New York City, New York
| | - Andrea Natale
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Internal Medicine, Dell Medical School, Austin, Texas.,Division of Interventional Electrophysiology, Interventional Electrophysiology, Scripps Clinic, San Diego, California.,Department of Electrophysiology, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California
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Di Biase L, Romero J, Briceno D, Valderrabano M, Sanchez JE, Della Rocca DG, Mohanty P, Horton R, Gallinghouse GJ, Mohanty S, Trivedi C, Beheiry S, Gianni C, Elayi CS, Burkhardt JD, Natale A. Evidence of relevant electrical connection between the left atrial appendage and the great cardiac vein during catheter ablation of atrial fibrillation. Heart Rhythm 2019; 16:1039-1046. [DOI: 10.1016/j.hrthm.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Indexed: 11/28/2022]
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Di Biase L, Romero J, Zado ES, Diaz JC, Gianni C, Hranitzki PM, Sanchez JE, Mohanty S, Al-Ahmad A, Mohanty P, Trivedi C, Della Rocca D, Santangeli P, Burkhardt JD, Garcia FC, Marchlinski FE, Natale A. Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. Heart Rhythm 2019; 16:724-732. [DOI: 10.1016/j.hrthm.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Indexed: 10/27/2022]
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Gianni C, Sanchez JE, Mohanty S, Trivedi C, Della Rocca DG, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Horton RP, Di Biase L, Natale A. Isolation of the superior vena cava from the right atrial posterior wall: a novel ablation approach. Europace 2019; 20:e124-e132. [PMID: 29016788 DOI: 10.1093/europace/eux262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/10/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Superior vena cava (SVC) isolation might be difficult to achieve because of the vicinity of the phrenic nerve (PN) and sinus node. Based on its embryogenesis, we hypothesized the presence of preferential conduction from the right atrial (RA) posterior wall, making it possible to isolate the SVC antrally, sparing its anterior and lateral aspect. Methods and results This is a descriptive cohort study of 105 consecutive patients in which SVC isolation was obtained with radiofrequency ablation, starting in the septal aspect of the SVC-RA junction and continued posteriorly and inferiorly targeting sites of early activation until electrical isolation was obtained. Acute SVC isolation was achieved in 103 (98%) patients; the mean distance between the site of SVC isolation and the SVC-RA junction was 19.9 ± 5.3 (range 9.7-33.7) mm. During follow-up, 2 (2%) patients developed symptomatic diaphragmatic paralysis due to transient right PN injury; 13 patients underwent a repeat ablation: SVC reconnection was observed in 5 patients, and re-isolation was easily achieved by targeting the corresponding sites of early activation. Conclusion Superior vena cava isolation can be completed by targeting its septal segment and sites of early activation in the posterior SVC-RA junction and RA posterior wall; this is a feasible alternative ablation strategy in patients in which SVC isolation cannot be completed with the standard approach. The risk of sinus node injury or SVC stenosis are eliminated; PN injury is still possible but can easily be prevented with high-output pacing to exclude a true posterior course of the PN.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA.,Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA.,Department of Cardiology, University of Tor Vergata, Rome, Italy
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA.,Department of Biomedical Engineering, University of Texas, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA.,Department of Biomedical Engineering, University of Texas, Austin, TX, USA.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N IH-35, Suite 720, Austin, TX, USA.,Dell Medical School, University of Texas, Austin, TX, USA.,Department of Biomedical Engineering, University of Texas, Austin, TX, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.,Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Stanford University, Stanford, CA, USA.,Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA
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Gadiyaram VK, Mohanty S, Gianni C, Trivedi C, Al-Ahmad A, Burkhardt DJ, Gallinghouse JG, Hranitzky PM, Horton RP, Sanchez JE, Della Rocca DG, Di Biase L, Price MJ, Couts L, Gibson D, Natale A. Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage. J Cardiovasc Electrophysiol 2019; 30:511-516. [PMID: 30623500 DOI: 10.1111/jce.13838] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 12/30/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS2 -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy. We aimed to assess the rate of OAC discontinuation and thromboembolic (TE) events following percutaneous LAAO in patients who underwent LAA electrical isolation (LAAI). METHODS This is a retrospective two-center study of patients who underwent percutaneous LAAO following LAAI. Patients with at least 3-month follow-up were included in the study. The antithrombotic therapy and TE events at the time of the last follow-up were noted. RESULTS The LAA was successfully occluded in 162 (with Watchman device in 140 [86.4%] and Lariat in 22 [13.6%]). A total of 32 patients had leaks detected on the 45-day transesophageal echocardiogram (TEE); 21 (15%) Watchman and 11 (50%) Lariat cases (P = 0.0001). Two (one Watchman and one Lariat) of the 32 leaks were more than 5 mm. After the 45-day TEE, 150 (92.6%) patients were off-OAC. No TE events were reported in the 150 patients who stopped the anticoagulants. Four (2.47%) patients experienced stroke following the LAAO (three Watchman and one Lariat) procedure while on-OAC, two of which were fatal. At the median follow-up of 18.5 months, 159 (98.15%) patients were off-anticoagulant. CONCLUSION Up to 98% of patients with LAAI could safely discontinue OAC after undergoing the appendage closure procedure.
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Affiliation(s)
- Varuna K Gadiyaram
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Sanghamitra Mohanty
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas
| | - Carola Gianni
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Chintan Trivedi
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Amin Al-Ahmad
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - David J Burkhardt
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Joseph G Gallinghouse
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Patrick M Hranitzky
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Rodney P Horton
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Javier E Sanchez
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | | | - Luigi Di Biase
- Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Department of Internal Medicine and Cardiology, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Matthew J Price
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Linda Couts
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California
| | - Douglas Gibson
- Department of Cardiac Electrophysiology, Scripps Clinic, La Jolla, CA
| | - Andrea Natale
- Department of Interventional Electrophysiology, Scripps Clinic, La Jolla, California.,Department of Electrophysiology, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,Department of Electrophysiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California
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37
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Rocca DGD, Prete AD, Biase LD, Horton RP, Al-Ahmad A, Bassiouny M, Mohanty S, Trivedi C, Romero J, Gianni C, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Versaci F, Natale A. Current Endocardial Approaches for Left Atrial Appendage Closure. ACTA ACUST UNITED AC 2019. [DOI: 10.17925/ejae.2019.5.1.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mohanty S, Gianni C, Trivedi C, Metz T, Bai R, Al-Ahmad A, Bailey S, Burkhardt JD, Gallinghouse GJ, Horton R, Hranitzky PM, Sanchez JE, Di Biase L, Natale A. Impact of rotor ablation in non-paroxysmal AF patients: Findings from the per-protocol population of the OASIS trial at long-term follow-up. Am Heart J 2018; 205:145-148. [PMID: 30144981 DOI: 10.1016/j.ahj.2018.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/15/2018] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the long-term efficacy of FIRM ablation with PVAI vs PVAI plus posterior wall isolation (PWI) and non-PV trigger ablation in persistent (PeAF) and long-standing persistent AF (LSPAF) patients. The procedure time was recorded to be 180.6 ± 35.9 and 124.03 ± 45.4 minutes in the FIRM+PVI and PVI + PWI + non-PV trigger ablation group respectively. At 24-month follow-up, 24% (95% CI 8.7%-37.8%) in the FIRM-ablation group and 48% (95% CI 27.6-63.3%) in the non-PV trigger ablation group remained arrhythmia-free off-antiarrhythmic drugs after a single procedure. Clinical Trial Registration:ClinicalTrials.gov (Identifier: NCT02533843).
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Gedikli Ö, Mohanty S, Trivedi C, Gianni C, Chen Q, Della Rocca DG, Burkhardt JD, Sanchez JE, Hranitzky P, Gallinghouse GJ, Al-Ahmad A, Horton R, Di Biase L, Natale A. Impact of dense "smoke" detected on transesophageal echocardiography on stroke risk in patients with atrial fibrillation undergoing catheter ablation. Heart Rhythm 2018; 16:351-357. [PMID: 30312757 DOI: 10.1016/j.hrthm.2018.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous echocardiographic contrast ("smoke") within the left atrial cavity on transesophageal echocardiography (TEE) suggests low blood flow velocities in the heart that may lead to thromboembolic (TE) events. OBJECTIVE The purpose of this study was to evaluate the risk of TE events in the periprocedural period and at long-term follow-up in atrial fibrillation (AF) patients having dense smoke on preprocedural TEE. METHODS A total of 2511 patients undergoing AF ablation were included in this analysis. They were classified as group 1 (dense smoke detected on TEE at baseline; n = 234) and group 2 (no smoke on baseline TEE; n = 2277). Patients were followed up for TE events, which included both stroke and transient ischemic attacks (TIAs). In order to attenuate the observed imbalance in baseline covariates between the study groups, a propensity score matching technique was used (covariates were age, sex, AF type, diabetes, and CHADS2VASc score). RESULTS In the periprocedural period, no TE events were reported in group 1 and 3 events (0.13%) were reported in group 2. At follow-up of 6.62 ± 2.01 years, 6 (2.6%) TE complications (2 TIA, 4 stroke) occurred in group 1 and 16 (0.70%) TE complications (6 TIA, 10 stroke) in group 2 (P = .004). In the propensity-matched population, 6 (2.56%) TE complications occurred in group 1 and 1 (0.2%) in group 2 (P = .007). CONCLUSION In our study population, the presence of dense left atrial smoke did not show any correlation with periprocedural TE events in patients undergoing catheter ablation with uninterrupted anticoagulation. However, significant association was observed with late stroke/TIA, irrespective of CHA2DS2-VASc score.
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Affiliation(s)
- Ömer Gedikli
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Cardiology, Ondokuz Mayis University Medicine School, Samsun, Turkey
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, Austin, Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Henan Provincial People's Hospital, Zhengzhou, China
| | | | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Patrick Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, Austin, Texas; Interventional Electrophysiology, Scripps Clinic, San Diego, California; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California.
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Della Rocca DG, Mohanty S, Mohanty P, Trivedi C, Gianni C, Al‐Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky P, Sanchez JE, Horton RP, Di Biase L, Natale A. Long‐term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years. J Cardiovasc Electrophysiol 2018; 29:1607-1615. [DOI: 10.1111/jce.13721] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 04/12/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Domenico G. Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Department of Cardiovascular MedicineUniversity of Tor VergataRome Italy
| | | | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Amin Al‐Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | | | - Patrick Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Javier E. Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Rodney P. Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Arrhythmia Services, Department of MedicineMontefiore Medical Center, Albert Einstein College of MedicineBronx New York
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggia Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Interventional Electrophysiology, Scripps ClinicLa Jolla California
- Department of CardiologyMetroHealth Medical Center, Case Western Reserve University School of MedicineCleveland Ohio
- Division of Cardiology, Stanford UniversityStanford California
- Atrial Fibrillation and Arrhythmia Center, California Pacific Medical CenterSan Francisco California
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Della Rocca DG, Trivedi C, Mohanty S, Gianni C, Burkhardt JD, Sanchez JE, Horton R, Hranitzky PM, Gallinghouse GJ, Al-Ahmad A, Di Biase L, Natale A. P5760Long term outcomes of catheter ablation of atrial fibrillation in very young adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5760] [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: 11/13/2022] Open
Affiliation(s)
- D G Della Rocca
- St. David's Medical Center, Austin, United States of America
| | - C Trivedi
- St. David's Medical Center, Austin, United States of America
| | - S Mohanty
- St. David's Medical Center, Austin, United States of America
| | - C Gianni
- St. David's Medical Center, Austin, United States of America
| | - J D Burkhardt
- St. David's Medical Center, Austin, United States of America
| | - J E Sanchez
- St. David's Medical Center, Austin, United States of America
| | - R Horton
- St. David's Medical Center, Austin, United States of America
| | - P M Hranitzky
- St. David's Medical Center, Austin, United States of America
| | | | - A Al-Ahmad
- St. David's Medical Center, Austin, United States of America
| | - L Di Biase
- St. David's Medical Center, Austin, United States of America
| | - A Natale
- St. David's Medical Center, Austin, United States of America
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Watling JP, Sanchez JE, Heilbroner SP, Levine WN, Bigliani LU, Jobin CM. Glenoid component loosening associated with increased critical shoulder angle at midterm follow-up. J Shoulder Elbow Surg 2018; 27:449-454. [PMID: 29241661 DOI: 10.1016/j.jse.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/06/2016] [Revised: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid component loosening is a common failure mode of total shoulder arthroplasty (TSA). A larger critical shoulder angle (CSA) may cause superior glenoid component loading and more rapid component loosening. The purpose of this study was to define the relationship between the CSA and glenoid component loosening in midterm follow-up after TSA. METHODS We conducted a retrospective study of 61 primary TSAs for osteoarthritis with an average follow-up of 5.0 ± 2.2 years without surgical revision. Standard true anteroposterior radiographs postoperatively and at longest follow-up were graded in a blinded and repetitive nature for pegged glenoid radiolucent lines and measured for the CSA. An "at-risk" glenoid was defined as grade 3 or higher lucency. RESULTS The average CSA was 32° ± 5°, median midterm lucency grade was 2 (range, 0-5), and median progression of lucency grade was 1 (range, -1 to 4). At midterm follow-up, 20% of TSAs were grade 3 or higher mean glenoid lucency, with an average CSA of 36°. There was a statistically significant correlation between CSA and both glenoid lucency grade (odds ratio, 1.20 per degree CSA) and progression of lucency grade (odds ratio, 1.24). An increase in CSA of 10° was associated with a 6.2-fold increased odds of having an at-risk glenoid. CONCLUSION This study identifies the CSA as a risk factor for glenoid component loosening after TSA. Our findings suggest that the CSA may be a modifiable factor during surgery to improve glenoid component outcomes.
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Affiliation(s)
- Jonathan P Watling
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Javier E Sanchez
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Samuel P Heilbroner
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Louis U Bigliani
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Mohanty S, Mohanty P, Natale V, Trivedi C, Gianni C, Burkhardt JD, Sanchez JE, Horton R, Gallinghouse GJ, Hongo R, Beheiry S, Al-Ahmad A, Di Biase L, Natale A. Impact of weight loss on ablation outcome in obese patients with longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol 2017; 29:246-253. [DOI: 10.1111/jce.13394] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 09/05/2017] [Revised: 10/16/2017] [Accepted: 11/02/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Sanghamitra Mohanty
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Prasant Mohanty
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | | | - Chintan Trivedi
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Carola Gianni
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - J. David Burkhardt
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Javier E. Sanchez
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Rodney Horton
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | | | - Richard Hongo
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
| | - Salwa Beheiry
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
| | - Amin Al-Ahmad
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
| | - Luigi Di Biase
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
- Albert Einstein College of Medicine at Montefiore Hospital; Bronx New York USA
| | - Andrea Natale
- St. David's Medical Center; Texas Cardiac Arrhythmia Institute; Austin TX USA
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
- Metro Health Medical Center; Case Western Reserve University School of Medicine; Cleveland OH USA
- Division of Cardiology; Stanford University; Stanford CA USA
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Mohanty S, Trivedi C, Gianni C, Della Rocca DG, Morris EH, Burkhardt JD, Sanchez JE, Horton R, Gallinghouse GJ, Hongo R, Beheiry S, Al-Ahmad A, Di Biase L, Natale A. Procedural findings and ablation outcome in patients with atrial fibrillation referred after two or more failed catheter ablations. J Cardiovasc Electrophysiol 2017; 28:1379-1386. [DOI: 10.1111/jce.13329] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/15/2017] [Accepted: 08/22/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | | | - Eli Hamilton Morris
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | - Javier E. Sanchez
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | | | - Richard Hongo
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
| | - Salwa Beheiry
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
- Albert Einstein College of Medicine at Montefiore Hospital; New York USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
- Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco CA USA
- Metro Health Medical Center; Case Western Reserve University School of Medicine; Cleveland OH USA
- Division of Cardiology; Stanford University; Stanford CA USA
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Mohanty S, Mohanty P, Di Biase L, Trivedi C, Morris EH, Gianni C, Santangeli P, Bai R, Sanchez JE, Hranitzky P, Gallinghouse GJ, Al-Ahmad A, Horton RP, Hongo R, Beheiry S, Elayi CS, Lakkireddy D, Madhu Reddy Y, Viles Gonzalez JF, Burkhardt JD, Natale A. Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation. Europace 2016; 19:1790-1797. [DOI: 10.1093/europace/euw338] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/21/2016] [Indexed: 11/13/2022] Open
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Di Biase L, Burkhardt JD, Mohanty P, Mohanty S, Sanchez JE, Trivedi C, Güneş M, Gökoğlan Y, Gianni C, Horton RP, Themistoclakis S, Gallinghouse GJ, Bailey S, Zagrodzky JD, Hongo RH, Beheiry S, Santangeli P, Casella M, Dello Russo A, Al-Ahmad A, Hranitzky P, Lakkireddy D, Tondo C, Natale A. Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation. J Am Coll Cardiol 2016; 68:1929-1940. [DOI: 10.1016/j.jacc.2016.07.770] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/14/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022]
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Gianni C, Atoui M, Mohanty S, Trivedi C, Bai R, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky PM, Horton RP, Sanchez JE, Di Biase L, Lakkireddy DR, Natale A. Difference in thermodynamics between two types of esophageal temperature probes: Insights from an experimental study. Heart Rhythm 2016; 13:2195-2200. [DOI: 10.1016/j.hrthm.2016.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 10/21/2022]
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Mohanty S, Gianni C, Mohanty P, Halbfass P, Metz T, Trivedi C, Deneke T, Tomassoni G, Bai R, Al-Ahmad A, Bailey S, Burkhardt JD, Gallinghouse GJ, Horton R, Hranitzky PM, Sanchez JE, Di Biase L, Natale A. RETRACTED: Impact of Rotor Ablation in Nonparoxysmal Atrial Fibrillation Patients Results From the Randomized OASIS Trial [J Am Coll Cardiol 2016;68:274–82]. J Am Coll Cardiol 2016; 68:274-282. [DOI: 10.1016/j.jacc.2016.04.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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Di Biase L, Briceno DF, Trivedi C, Mohanty S, Gianni C, Burkhardt JD, Mohanty P, Bai R, Gunda S, Horton R, Bailey S, Sanchez JE, Al-Ahmad A, Hranitzky P, Gallinghouse GJ, Reddy YM, Zagrodzky J, Hongo R, Beheiry S, Lakkireddy D, Natale A. Is transesophageal echocardiogram mandatory in patients undergoing ablation of atrial fibrillation with uninterrupted novel oral anticoagulants? Results from a prospective multicenter registry. Heart Rhythm 2016; 13:1197-202. [DOI: 10.1016/j.hrthm.2016.03.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Indexed: 01/09/2023]
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Santangeli P, Di Biase L, Al-Ahmad A, Horton R, Burkhardt JD, Sanchez JE, Gallinghouse GJ, Zagrodzky J, Bai R, Pump A, Mohanty S, Lewis WR, Natale A. Ablation as First-Line Therapy for Atrial Fibrillation: Yes. Card Electrophysiol Clin 2016; 4:287-97. [PMID: 26939948 DOI: 10.1016/j.ccep.2012.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article addresses the use of catheter ablation (CA) as first-line therapy for atrial fibrillation (AF). CA increases long-term freedom from AF, reduces hospitalizations, and improves quality of life compared with antiarrhythmic drug (AAD) therapy in patients with symptomatic AF who have already failed one AAD. The role of CA as first-line therapy for AF, however, is still controversial. Evidence from randomized controlled trials shows that CA is definitely superior to AADs as first-line therapy for relatively young patients with paroxysmal AF, with comparable complication rates and results consistently reproducible across different institutions, operators, and types of ablation approaches.
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Affiliation(s)
- Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; University of Foggia, Foggia, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; University of Foggia, Foggia, Italy
| | - Amin Al-Ahmad
- Division of Cardiology, Stanford University, 300 Pasteur Drive, MC 5319 A260, Stanford, CA, USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - Rong Bai
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Tong-Ji Hospital, Tong-Ji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Agnes Pump
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Heart Institute, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA
| | - William R Lewis
- Heart and Vascular Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA; Division of Cardiology, Stanford University, 300 Pasteur Drive, MC 5319 A260, Stanford, CA, USA; Heart and Vascular Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; EP Services, California Pacific Medical Center, San Francisco, CA, USA
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