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Gasperetti A, James C, Chen L, Compagnucci P, Casella M, Dello Russo A, Tondo C, Platonov P, Jensen H, Schenker N, Shibu M, Kany S, Calkins H, Duru F, Saguner A. First-in-world assessment of outcomes of catheter ablation for atrial arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically inherited disease characterized by fibro-fatty infiltrations (FFI). FFI in ARVC patients usually originates in the ventricles, but recent imaging studies showed FFI at the atrial level as well. Effectiveness of catheter ablation (CA) for atrial arrhythmias (AA) in this subset of patients is currently unknown.
Purpose
Aim of our study is to describe acute and long-term effectiveness of CA for AA in ARVC patients.
Methods
Nine ARVC registries from Europe, US, and China were retrospectively searched for ARVC patients undergoing CA for AA (namely: atrial fibrillation (AF), atrial tachycardia (AT), and cavo-tricuspid dependent atrial flutter (CTI-FL)). Baseline, procedural, and long-term outcome data were collected.
Results
Thirty-five pts (86% male, median CHA2DS2-VASc 1 [1–2], HAS-BLED 1 [0–2], and EHRA scores 2 [2–3]) were enrolled, in which a total of 45 CA procedures for AA were performed (left atrial CA: n=19 AF, n=10 AT; right atrial CA: n=16 CTI). Mean age at AA CA was 48.2±14.8 y.o. At baseline, 63% of pts were on oral anticoagulants (OAC) (n=9 warfarin; n=13 NOAC). Catheter ablation was successful and sinus rhythm obtained at the end of the procedure in all patients, with 2 (6%) AF patients requiring electrical cardioversion. Over a median follow-up of 36 [14–74] months, 12 (27%) pts experienced arrhythmia recurrence (left atrial group: n=6 AF recurrences, n=3 AT recurrences; CTI-FL group: n=1 CTI-FL recurrence; n=1 new AF with previous CTI-dependent flutter ablation), with a 1-year follow-up resulting comparable to what has been reported in the literature for the general population. [Figure 1 and 2]. 61% pts were on OAC at last follow-up.
Conclusion
Age at the time of CA for AA is about 10 years younger in patients with ARVC as compared to the general population. CA for AA in ARVC pts is safe and effective; surprisingly, long-term CA outcomes for AF and left AT result comparable to those reported in the general population, whereas recurrence rates of CTI-dependent flutter seem to be higher.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Gasperetti
- University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - C.A James
- Johns Hopkins University, Baltimore, United States of America
| | - L Chen
- Fuwai Hospital, Beijing, China
| | - P Compagnucci
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - M Casella
- Marche Polytechnic University of Ancona, Department of clinical, special, and dental sciences, Ancona, Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - C Tondo
- Centro Cardiologico Monzino, IRCCS, Heart Rhythm Center, Milan, Italy
| | | | - H.K Jensen
- Aarhus University Hospital, Aarhus, Denmark
| | - N Schenker
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - M Shibu
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - S Kany
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - H Calkins
- Johns Hopkins University, Baltimore, United States of America
| | - F Duru
- University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, University Heart Center, Zurich, Switzerland
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Schenker N, Hashiguchi N, Maurer T, Lemes C, Rottner L, Reissmann B, Rillig A, Kuck KH, Ouyang F, Mathew S. P1361Impact of radiation/chemotherapy for breast cancer on the electroanatomic features in patients receiving catheter ablation for left atrial arrhythmia. Europace 2020. [DOI: 10.1093/europace/euaa162.177] [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] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common cardiac arrhythmia and catheter ablation a viable treatment option for patients with AF. Extensive left atrial (LA) scars, frequently seen in patients with persistent AF, can limit its efficacy. Radiation for breast cancer treatment is known to have serious long-term effects (e.g. fibrosis) on the targeted tissue. At the same time, chemotherapy often leads to organ dysfunction. We sought to examine the effects of radiation and chemotherapy on the electroanatomic features of the LA in patients who received catheter ablation for left atrial arrhythmias with prior breast cancer treatment.
Methods and Results
We compared 38 patients (mean age 68.4 ± 7.1 years) who underwent catheter ablation for LA arrhythmia and had a previous diagnosis of breast cancer with 38 patients (mean age 65.4 ± 7.3 years) without breast cancer who formed our control group. LA scar area, as well as its distribution was measured during the electrophysiology (EP) study and graded according to the Utah classification.
The existence of LA scarring did not differ significantly between both groups (71.1% vs. 76.3%, p = 0.602). LA scar area (excluding PVs) was 107.5cm2 ± 19.0cm2 in the breast cancer group compared to 110.1cm2 ± 18.5cm2 in the control group (p = 0.536). The distribution of the scar area revealed no significant difference between both groups, however an involvement of the anterior wall was common (65.8% vs. 73.7%; p = 0.454). We further investigated whether the location of breast cancer had an impact on the LA scar development of the patients in our study cohort. Here, we found no significant difference in the amount of LA scarring when comparing patients with left-sided breast cancer to patients with right-sided breast cancer (66.7% vs. 73.9%). In a sub-analysis patients with breast cancer and persistent AF showed a non-significant trend towards greater LA scar areas (17.4cm2 vs. 6.8cm2) in comparison to patients of the control group with similar LA volumes.
The patient’s age (>65 years) was the only independent predictor for greater LA scarring we could identify. Neither former radiotherapy, nor chemotherapy showed a positive correlation with greater LA scarring.
Conclusion
There is no change in the distribution as well as an increase of the extent of LA scars after thoracic irradiation and/or chemotherapy. A trend towards greater LA scar areas was seen in patients with breast cancer and persistent AF. The patient’s age was identified as an independent predictor for LA scar development.
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Affiliation(s)
- N Schenker
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - T Maurer
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - L Rottner
- University Heart Center Hamburg, Hamburg, Germany
| | - B Reissmann
- University Heart Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart Center Hamburg, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - F Ouyang
- Fuwai Hospital, CAMS and PUMC, Beijing, China
| | - S Mathew
- Justus-Liebig University of Giessen, Giessen, Germany
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Schenker N, van der Schalk H, Bohné M, Hahn J, Waddell D, Moschner A, Alexy H, Willems S, Kivelitz D, Bahlmann E. Hirninfarkt als Erstsymptom – seltene kardiogene Ursache. Med Klin Intensivmed Notfmed 2020; 115:343-347. [DOI: 10.1007/s00063-020-00666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 11/24/2022]
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Saguner AM, Mathew S, Schenker N, Metzner A, Santoro F, Reissmann B, Yashuiro Y, Maurer T, Lemes C, Heeger CH, Riedl J, Sohns C, Kuck KH, Ouyang F. P482Catheter ablation of ventricular tachycardia in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia - the hamburg sequential approach. Europace 2017. [DOI: 10.1093/ehjci/eux141.205] [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: 11/14/2022] Open
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Meier JJ, Pennartz C, Schenker N, Menge BA, Schmidt WE, Heise T, Kapitza C, Veldhuis JD. Hyperglycaemia is associated with impaired pulsatile insulin secretion: effect of basal insulin therapy. Diabetes Obes Metab 2013; 15:258-63. [PMID: 23039360 DOI: 10.1111/dom.12022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 08/17/2012] [Accepted: 10/01/2012] [Indexed: 01/09/2023]
Abstract
AIM Postprandial insulin pulsatility is impaired in patients with type 2 diabetes, but the effects of exogenous insulin therapy on pulsatile insulin secretion are not known. We addressed, whether pulsatile insulin secretion is related to glycaemic control, whether basal insulin supplementation increases postprandial insulin secretion, and if so, is this accomplished by a specific improvement in pulsatile insulin secretion? METHODS Fourteen patients with type 2 diabetes underwent a mixed meal test before and after an 8-week treatment period with insulin glargine. Glucose, insulin and C-peptide levels were measured, and insulin pulsatility was determined by deconvolution analysis. RESULTS Insulin treatment lowered fasting glycaemia from 179.6 ± 7.5 mg/dl to 117.6 ± 6.5 mg/dl (p < 0.001). Postprandial insulin and C-peptide levels increased significantly after the treatment period (p < 0.0001). The total calculated insulin secretion rate increased with insulin treatment (p = 0.0039), with non-significant increases in both pulsatile and non-pulsatile insulin secretion. Insulin pulse frequency was unchanged by the intervention. There was an inverse relationship between fasting and postprandial glycaemia and insulin pulse mass (r(2) = 0.51 and 0.56, respectively), whereas non-pulsatile insulin secretion was unrelated to either fasting or postprandial glucose concentrations (r(2) = 0.0073 and 0.031). CONCLUSIONS Hyperglycaemia in type 2 diabetes is associated with a reduction in postprandial insulin secretion, specifically through a reduction in insulin pulsatility. Reducing chronic hyperglycaemia by basal insulin therapy enhances endogenous β-cell function in the postprandial state. These data support the use of basal insulin regimens in the pharmacotherapy of overtly hyperglycaemic patients with type 2 diabetes.
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Affiliation(s)
- J J Meier
- Diabetes Division, Department of Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
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Buxhoeveden DP, Semendeferi K, Buckwalter J, Schenker N, Switzer R, Courchesne E. Reduced minicolumns in the frontal cortex of patients with autism. Neuropathol Appl Neurobiol 2006; 32:483-91. [PMID: 16972882 DOI: 10.1111/j.1365-2990.2006.00745.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cell minicolumns were shown to be narrower in frontal regions in brains of autistic patients compared with controls. This was not found in primary visual cortex. Within the frontal cortex, dorsal and orbital regions displayed the greatest differences while the mesial region showed the least change. We also found that minicolumns in the brain of a 3-year-old autistic child were indistinguishable from those of the autistic adult in two of three frontal regions, in contrast to the control brains. This may have been due to the small size of the columns in the adult autistic brain rather than to an accelerated development. The presence of narrower minicolumns supports the theory that there is an abnormal increase in the number of ontogenetic column units produced in some regions of the autistic brain during corticoneurogenesis.
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Affiliation(s)
- D P Buxhoeveden
- Department of Anthropology, University of South Carolina, Columbia, SC, USA.
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Abstract
OBJECTIVE To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as "injuries".) DESIGN The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported. MAIN OUTCOME MEASURES An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors. RESULTS The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3--6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6--13) than in earlier weeks (weeks 1--5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar. CONCLUSIONS The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.
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Affiliation(s)
- M Warner
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA.
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Schenker N, Treiman DJ, Weidman L. Analyses of public use decennial census data with multiply imputed industry and occupation codes. J R Stat Soc Ser C Appl Stat 2002; 42:545-56. [PMID: 12157990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"This paper gives a brief introduction to multiple imputation for handling non-response in surveys. We then describe a recently completed project in which multiple imputation was used to recalibrate industry and occupation codes in 1970 U.S. census public use samples to the 1980 standard. Using analyses of data from the project, we examine the utility of analysing a large data set having imputed values compared with analysing a small data set having true values, and we provide examples of the amount by which variability is underestimated by using just one imputation rather than multiple imputations."
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Abstract
Some of the outstanding cognitive capabilities of humans are commonly attributed to a disproportionate enlargement of the human frontal lobe during evolution. This claim is based primarily on comparisons between the brains of humans and of other primates, to the exclusion of most great apes. We compared the relative size of the frontal cortices in living specimens of several primate species, including all extant hominoids, using magnetic resonance imaging. Human frontal cortices were not disproportionately large in comparison to those of the great apes. We suggest that the special cognitive abilities attributed to a frontal advantage may be due to differences in individual cortical areas and to a richer interconnectivity, none of which required an increase in the overall relative size of the frontal lobe during hominid evolution.
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Affiliation(s)
- K Semendeferi
- Department of Anthropology, University of California at San Diego, La Jolla, California 92093, USA.
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Abstract
We present a case study in the analysis of the prognostic effects of anaemia and other covariates on the local recurrence of head and neck cancer in patients who have been treated with radiation therapy. Because it is believed that a large fraction of the patients are cured by the therapy, we use a failure time mixture model for the outcomes, which simultaneously models both the relationship of the covariates to cure and the relationship of the covariates to local recurrence times for subjects who are not cured. A problematic feature of the data is that two covariates of interest having missing values, so that only 75 per cent of the subjects have complete data. We handle the missing-data problem by jointly modelling the covariates and the outcomes, and then fitting the model to all of the data, including the incomplete cases. We compare our approach to two traditional methods for handling missingness, that is, complete-case analysis and the use of an indicator variable for missingness. The comparison with complete-case analysis demonstrates gains in efficiency for joint modelling as well as sensitivity of some results to the method used to handle missing data. The use of an indicator variable yields results that are very similar to those from joint modelling for our data. We also compare the results obtained for the mixture model with results obtained for a standard (non-mixture) survival model. It is seen that the mixture model separates out effects in a way that is not possible with a standard survival model. In particular, conditional on other covariates, we find strong evidence of an association between anaemia and cure, whereas the evidence of an association between anaemia and time to local recurrence for patients who are not cured is weaker.
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Abstract
Data obtained from studies in the health sciences often have incompletely observed covariates as well as censored outcomes. In this paper, we present methods for fitting the log-F accelerated failure time model with incomplete continuous and/or categorical time-independent covariates using the Gibbs sampler. A general location model that allows different covariance structures across cells is specified for the covariates, and ignorable missingness of the covariates is assumed. Techniques that accommodate standard assumptions of ignorable censoring as well as certain types of nonignorable censoring are developed. We compare our approach to traditional complete-case analysis in an application to data obtained from a study of melanoma. The comparison indicates that substantial gains in efficiency are possible with our approach.
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Affiliation(s)
- M Cho
- Department of Clinical Biostatistics and Research Data Systems, Merck Research Laboratories, Merck & Co., Inc., Rahway, New Jersey 07065, USA
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Abstract
Medical statistics often involve measurements of the time when a variable crosses a threshold value. The time to threshold crossing may be the outcome variable in a survival analysis, or a time-dependent covariate in the analysis of a subsequent event. This paper presents new methods for analysing threshold-crossing data that are interval censored in that the time of threshold crossing is known only within a specified interval. Such data typically arise in event-history studies when the threshold is crossed at some time between data-collection points, such as visits to a clinic. We propose methods based on multiple imputation of the threshold-crossing time with use of models that take into account values recorded at the times of visits. We apply the methods to two real data sets, one involving hip replacements and the other on the prostate specific antigen (PSA) assay for prostate cancer. In addition, we compare our methods with the common practice of imputing the threshold-crossing time as the right endpoint of the interval. The two examples require different imputation models, but both lead to simple analyses of the multiply imputed data that automatically take into account variability due to imputation.
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Affiliation(s)
- F J Dorey
- Division of Orthopaedic Surgery, UCLA School of Medicine 90024
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Abstract
Multiple imputation for non-response replaces each missing value by two or more plausible values. The values can be chosen to represent both uncertainty about the reasons for non-response and uncertainty about which values to impute assuming the reasons for non-response are known. This paper provides an overview of methods for creating and analysing multiply-imputed data sets, and illustrates the dramatic improvements possible when using multiple rather than single imputation. A major application of multiple imputation to public-use files from the 1970 census is discussed, and several exploratory studies related to health care that have used multiple imputation are described.
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Affiliation(s)
- D B Rubin
- Department of Statistics, Harvard University, Cambridge, MA 02138
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Schenker N. Handling missing data in coverage estimation, with application to the 1986 Test of Adjustment Related Operations. Surv Methodol 1988; 14:87-104. [PMID: 12315619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
"This paper discusses methods used to handle missing data in post-enumeration surveys for estimating census coverage error, as illustrated for the 1986 Test of Adjustment Related Operations (Diffendal 1988). The methods include imputation schemes based on hot-deck and logistic regression models as well as weighting adjustments. The sensivity of undercount estimates from the 1986 test to variations in the imputation models is also explored." The test was carried out in Central Los Angeles County, California.
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