1
|
Phan F, Sanghai S, Sandhu U, Verdick C, Krebsbach A, Bhamidipati CM, Tibayan FA, Jessel P, Henrikson CA. Out with the old: Single center experience with transvenous extraction of leads older than 15 years. Pacing Clin Electrophysiol 2024. [PMID: 38641950 DOI: 10.1111/pace.14989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Lead dwell time is the single strongest predictor of failure and complications in transvenous lead extraction. OBJECTIVES To report the success rate and complications of transvenous lead extractions with implant dwell time of at least 15 years. METHODS Procedural and patient data were prospectively collected into a database. The excimer laser was the primary method for lead extraction with the use of mechanical rotational sheaths and femoral snares at operator discretion. RESULTS A total of 442 patients between 2011 and 2020 underwent lead extraction (705 leads) primarily for infection or device failure at our high-volume center. Forty-one patients with 71 leads > 15 years old were included in this cohort. Mean patient age was 53.5 ± 18.5 years, 67.5% were male. Mean lead dwell time was 19.6 ± 4.4 years. Thirty-six of 41 (88%) patients had successful extraction of all leads compared to 96% in the remaining 401 patients, p value.004. Of the five patients without fully successful extractions two of these patients had abandoned leads (three total) that were clinically significant. There were two (4.9%) major complications in the very old lead group and six (1.5%) in the other group. In the very old lead group, one patient experienced right atrial appendage perforation requiring surgical repair and recovered well. One patient experienced new complete heart block requiring 2 min of CPR but did well thereafter. There was no procedure-related mortality. CONCLUSIONS Despite challenges posed by older leads, very old leads can be safely and effectively extracted with low complication rates.
Collapse
Affiliation(s)
- Francis Phan
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Saket Sanghai
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Uday Sandhu
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Chris Verdick
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Angela Krebsbach
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Castigliano M Bhamidipati
- Division of Cardiac Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Frederick A Tibayan
- Division of Cardiac Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Peter Jessel
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Division of Cardiology, Knight Cardiovascular Insitute, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
2
|
Altibi AM, Hashem A, Ghanem F, Sanghai S, Nazer B, Stecker EC, Henrikson CA. Impact of COVID-19 pandemic on the volume, cost, and outcomes of cardiac electrophysiology procedures in the United States. Heart Rhythm 2024:S1547-5271(24)00219-4. [PMID: 38417597 DOI: 10.1016/j.hrthm.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, professional societies recommended deferral of elective procedures for optimal resource utilization. OBJECTIVE We sought to assess changes in procedural trends and outcomes of electrophysiology (EP) procedures during the pandemic. METHODS National Inpatient Sample databases were used to identify all EP procedures performed in the United States (2016-2020) by International Classification of Diseases, Tenth Revision codes. We evaluated trends in utilization, cost/revenue, and outcomes from EP procedures performed. RESULTS An estimated 1.35 million EP procedures (82% devices and 18% catheter ablations) were performed (2016-2020) with significant yearly uptrend. During the pandemic, there was a substantial decline in EP procedure utilization from a 5-year peak of 298 cases/million population in the second quarter of 2019 to a nadir of 220 cases in the second quarter of 2020. In 2020, the pandemic was associated with the loss of 50,233 projected EP procedures (39,337 devices and 10,896 ablations) with subsequent revenue loss of $7.06 billion. This deficit was driven by revenue deficit from dual-chamber permanent pacemaker (PPM) utilization ($2.88 billion, 49.3% of lost cases), ablation procedures ($1.84 billion, 21.7% of lost cases), and implantable cardioverter-defibrillator implantation ($1.36 billion, 12.0% of lost cases). To the contrary, there was a 9.4% increase in the utilization of leadless PPM. EP device implantation during the pandemic was associated with higher adverse in-hospital events (9.4% vs 8.0%; P < .001). CONCLUSION In the United States, the significant decline in EP procedures during the pandemic was primarily driven by the reduction in dual-chamber PPM utilization, followed by arrhythmia ablation and implantable cardioverter-defibrillator implantation. There was a substantial increase in leadless PPM utilization during the pandemic.
Collapse
Affiliation(s)
- Ahmed M Altibi
- Section of Cardiac Electrophysiology, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Anas Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Fares Ghanem
- Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Saket Sanghai
- Section of Cardiac Electrophysiology, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Division of Cardiovascular Medicine, University of Washington Medical Center, Seattle, Washington
| | - Eric C Stecker
- Section of Cardiac Electrophysiology, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A Henrikson
- Section of Cardiac Electrophysiology, Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
3
|
Sanghai S, Henrikson CA. ABCs: A Better Chance to Improve Outcomes in Atrial Fibrillation. JACC Asia 2023; 3:592-594. [PMID: 37614547 PMCID: PMC10442875 DOI: 10.1016/j.jacasi.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Saket Sanghai
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles A. Henrikson
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
4
|
Prasad P, Howell S, Sanghai S, Stecker E, Henrikson CA, Masri A, Nazer B. Targeted Screening for Transthyretin Amyloid Cardiomyopathy in Patients With Atrial Fibrillation. Circulation 2022; 146:1730-1732. [PMID: 36441818 DOI: 10.1161/circulationaha.122.060596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pooja Prasad
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| | - Stacey Howell
- University of California, San Francisco Cardiac Electrophysiology and Arrhythmia Service (S.H.)
| | - Saket Sanghai
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| | - Eric Stecker
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| | - Charles A Henrikson
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| | - Ahmad Masri
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| | - Babak Nazer
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (P.P., S.S., E.S., C.A.H., A.M., B.N.)
| |
Collapse
|
5
|
Li S, Simpson T, Sanghai S, Henrikson C, Golwala H. TCT-395 Nationwide Incidence and Trends of Left Atrial Occlusion Device Implantation Among Medicare Patients in the United States. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
6
|
Sanghai S, Henrikson CA. Radiofrequency ablation-to insure or not to insure is the question. J Cardiovasc Electrophysiol 2022; 33:1513-1514. [PMID: 35437896 DOI: 10.1111/jce.15499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Saket Sanghai
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| |
Collapse
|
7
|
Kheiri B, Sanghai S, Alhamoud H, Osman M, Stecker E, Henrikson CA, Nazer B. Meta-Analysis of Implantable Loop Recorder for Atrial Fibrillation Detection in Patients With Ischemic Stroke. Am J Cardiol 2021; 161:115-116. [PMID: 34794608 DOI: 10.1016/j.amjcard.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Saket Sanghai
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Hani Alhamoud
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Eric Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
8
|
Sanghai S, Sandhu U, Verdick C, Krebsbach A, Glover A, Beitinjaneh B, Golwala H, Henrikson CA. Figure-of-Eight Sutures in Fully Anticoagulated Patients After Left Atrial Appendage Occlusion May Obviate Need for Anticoagulation Reversal: Vascular Management After LAAO. Circ Arrhythm Electrophysiol 2021; 14:e010268. [PMID: 34565167 DOI: 10.1161/circep.121.010268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saket Sanghai
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Uday Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Christopher Verdick
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Angela Krebsbach
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Anne Glover
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Bassel Beitinjaneh
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Harsh Golwala
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| | - Charles A Henrikson
- Division of Cardiovascular Medicine, Department of Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland OR
| |
Collapse
|
9
|
Sanghai S, Kelly J, Ganje G, Nazer B, Balaji S. B-PO03-140 “ATRAUMATIC” HIGH-DENSITY ELECTROANATOMIC MAPPING OF ATRIO-FASCICULAR ACCESSORY PATHWAYS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.614] [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]
|
10
|
Sanghai S, Sandhu U, Verdick C, Golwala H, Henrikson CA. B-PO02-154 FIGURE OF EIGHT SUTURES IN FULLY ANTICOAGULATED PATIENTS AFTER LEFT ATRIAL APPENDAGE OCCLUSION MAY OBVIATE NEED FOR ANTICOAGULATION REVERSAL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.407] [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]
|
11
|
Sanghai S, Chen H, Ivie R, Gonzalez-Sotomayor J, Nazer B. Reply: A Bedside Intervention to Treat Ventricular Arrhythmias: Procedural Advances and Safety Considerations. JACC Clin Electrophysiol 2021; 7:540-541. [PMID: 33888274 DOI: 10.1016/j.jacep.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
|
12
|
Kumar K, Merrill M, Przybylowicz R, Sanghai S, MacMurdy K, Masri A, Davidson B, Zarraga IG. MULTIPLE MORPHING MORPHOLOGIES OF MONOMORPHIC TACHYCARDIA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03457-4] [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: 10/21/2022]
|
13
|
Sanghai S, Abbott NJ, Dewland TA, Henrikson CA, Elman MR, Wollenberg M, Ivie R, Gonzalez-Sotomayor J, Nazer B. Stellate Ganglion Blockade With Continuous Infusion Versus Single Injection for Treatment of Ventricular Arrhythmia Storm. JACC Clin Electrophysiol 2020; 7:452-460. [PMID: 33358672 DOI: 10.1016/j.jacep.2020.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/07/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to compare the efficacy and safety of single-injection stellate ganglion block (SGB) with a novel continuous-infusion SGB procedure. BACKGROUND SGB for ventricular arrhythmia (VA) storm is typically performed with a single injection of local anesthetic agents. METHODS Eighteen patients underwent left-sided SGB (9 single injection and 9 continuous infusion). The number of implantable cardioverter-defibrillator therapies and sustained VAs/24 h were compared between the pre-SGB and post-SGB periods. Adverse effects of SGB and in-hospital outcomes were also compared. RESULTS The mean age was 61.1 ± 13.7 years. The presenting arrhythmia was ventricular tachycardia in 13 (72%) patients, ventricular fibrillation in 4 (22%), and both in 1 (6%). Single-injection SGB reduced VA/24 h by a median of 0.3 (interquartile range: 0.2 to 0.9), which was a 45% reduction (p = 0.008), resulting in 5 of 9 patients with no recurrent VA. Continuous-infusion SGB reduced VA/24 h by a median of 2.0 (interquartile range: 1.3 to 3.0), which was a 94% reduction (p = 0.004), resulting in 7 of 9 patients with no recurrent VA (p = 0.006 for comparison with single injection). Transient left arm weakness and voice hoarseness were each noted in 1 patient in both groups. Repeat SGB was required in 4 (44%) patients in the single-injection group. In-hospital outcomes were similar between the groups. CONCLUSIONS In patients with VA storm, SGB performed via both continuous-infusion and single-injection approaches provided significant reductions in VA burden. Compared to single-injection SGB, continuous-infusion was associated with a greater reduction in VA burden and similar adverse events, without the need for repeat procedures.
Collapse
Affiliation(s)
- Saket Sanghai
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Nicholas J Abbott
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Miriam R Elman
- Biostatistics and Design Program, Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Michael Wollenberg
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Ryan Ivie
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Julio Gonzalez-Sotomayor
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
| |
Collapse
|
14
|
Sanghai S, Wong C, Wang Z, Clive P, Tran W, Waring M, Goldberg R, Hayward R, Saczynski JS, McManus DD. Rates of Potentially Inappropriate Dosing of Direct-Acting Oral Anticoagulants and Associations With Geriatric Conditions Among Older Patients With Atrial Fibrillation: The SAGE-AF Study. J Am Heart Assoc 2020; 9:e014108. [PMID: 32146898 PMCID: PMC7335533 DOI: 10.1161/jaha.119.014108] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Direct‐acting oral anticoagulant (DOAC) dosing guidelines for atrial fibrillation recommend dose alteration based on age, renal function, body weight, and drug‐drug interactions. There is paucity of data describing the frequency and factors associated with prescription of potentially inappropriate doses. Methods and Results In the ongoing SAGE‐AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, we performed geriatric assessments (frailty, cognitive impairment, sensory impairments, social isolation, and depression) for participants with atrial fibrillation (age ≥65 years, CHA2DS2VASc ≥2, no anticoagulant contraindications). We developed an algorithm to analyze DOAC dose appropriateness accounting for drug‐drug interactions, age, renal function, and body weight. We also examined whether geriatric impairments were related to inappropriate dosing. Of 1064 patients prescribed anticoagulants, 460 received a DOAC. Participants were aged 74±7 years, 49% were women, and 82% were white. A quarter (23%; n=105) of participants received inappropriate DOAC dose, of whom 82 (78%) were underdosed and 23 (22%) were overdosed. Among participants receiving an inappropriate dose, 12 (11%) were identified using the drug‐drug interactions criteria and would have otherwise been misclassified. In multivariable regression analyses, older age, higher CHA2DS2VASc score, and history of renal failure were associated with inappropriate DOAC dosing (P<0.05). Geriatric conditions were not associated with inappropriate dosing. Conclusions In this cohort, over 20% of older patients with atrial fibrillation treated with DOACs were prescribed an inappropriate dose, with most being underdosed. Drug‐drug interactions were common. Factors that influence prescription of guideline‐nonadherent doses may be perception of higher bleeding risk or presence of renal failure in addition to lack of familiarity with dosing guidelines.
Collapse
Affiliation(s)
- Saket Sanghai
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandOR
| | - Cecillia Wong
- Cardiology DivisionDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Ziyue Wang
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Pia Clive
- Department of PharmacyUniversity of Massachusetts Memorial Medical CenterWorcesterMA
| | - Wenisa Tran
- Department of PharmacyUniversity of Massachusetts Memorial Medical CenterWorcesterMA
| | - Molly Waring
- Department of Allied Health SciencesUniversity of ConnecticutStorrsCT
| | - Robert Goldberg
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Robert Hayward
- Kaiser Permanente Santa Clara Medical CenterSanta ClaraCA
| | - Jane S. Saczynski
- Department of Pharmacy and Health System SciencesNortheastern UniversityBostonMA
| | - David D. McManus
- Cardiology DivisionDepartment of MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterMA
| |
Collapse
|
15
|
Simpson T, Coonse K, Kumar K, Sanghai S, Masri AM, Nazer B, Divanji P. A DISJOINTED CAUSE OF SUDDEN ARRHYTHMIC DEATH. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Tran KV, Majka J, Sanghai S, Sardana M, Lessard D, Milstone Z, Tanriverdi K, Freedman JE, Fitzgibbons TP, McManus D. Micro-RNAs Are Related to Epicardial Adipose Tissue in Participants With Atrial Fibrillation: Data From the MiRhythm Study. Front Cardiovasc Med 2019; 6:115. [PMID: 31475159 PMCID: PMC6702296 DOI: 10.3389/fcvm.2019.00115] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/26/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction: Epicardial adipose tissue (EAT) has been linked to incidence and recurrence of atrial fibrillation (AF), but the underlying mechanisms that mediate this association remain unclear. Circulating microRNAs (miRNAs) contribute to the regulation of gene expression in cardiovascular diseases, including AF. Thus, we sought to test the hypothesis that circulating miRNAs relate to burden of EAT. Methods: We examined the plasma miRNA profiles of 91 participants from the miRhythm study, an ongoing study examining associations between miRNA and AF. We quantified plasma expression of 86 unique miRNAs commonly expressed in cardiomyocytes using quantitative reverse transcriptase polymerase chain reaction (qPCR). From computed tomography, we used validated methods to quantify the EAT area surrounding the left atrium (LA) and indexed it to body surface area (BSA) to calculate indexed LA EAT (iLAEAT). Participants were divided into tertiles of iLAEAT to identify associations with unique miRNAs. We performed logistic regression analyses adjusting for factors associated with AF to examine relations between iLAEAT and miRNA. We performed further bioinformatics analysis of miRNA predicted target genes to identify potential molecular pathways are regulated by the miRNAs. Results: The mean age of the participants was 59 ± 9, 35% were women, and 97% were Caucasian. Participants in the highest tertile of iLAEAT were more likely to have hypertension, heart failure, and thick posterior walls. In regression analyses, we found that miRNAs 155-5p (p < 0.001) and 302a-3p (p < 0.001) were significantly associated with iLAEAT in patients with AF. The predicted targets of the miRNAs identified were implicated in the regulation of cardiac hypertrophy, adipogenesis, interleukin-8 (IL-8), and nerve growth factor (NGF) signaling. Conclusion: miRNA as well as EAT have previously been linked to AF. Our finding that iLAEAT and miRNAs 155-5p and 302a-3p are associated suggest a possible direct link to between these entities in the development and maintenance of AF. Further research is needed to study causal relationships between these biomarkers.
Collapse
Affiliation(s)
- Khanh-Van Tran
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jordan Majka
- Department of Biochemistry and Molecular Biology, Clark University, Worcester, MA, United States
| | - Saket Sanghai
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mayank Sardana
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Zachary Milstone
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kahraman Tanriverdi
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jane E Freedman
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - David McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
17
|
Soni A, Karna S, Fahey N, Sanghai S, Patel H, Raithatha S, Thanvi S, Nimbalkar S, Freedman B, Allison J, McManus DD. Age-and-sex stratified prevalence of atrial fibrillation in rural Western India: Results of SMART-India, a population-based screening study. Int J Cardiol 2019; 280:84-88. [PMID: 30551905 PMCID: PMC6378127 DOI: 10.1016/j.ijcard.2018.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early detection of Atrial Fibrillation (AF) is a public health priority across the globe because AF-related strokes are preventable. Despite an ongoing stroke epidemic in India, a public health strategy for AF screening and treatment is missing because the epidemiology of AF in India remains poorly defined. METHODS This population-based study used mobile technology to derive age and sex-stratified AF prevalence by screening 7 participants in each of six age and sex strata (age 40-55, 56-65, 65+, and male and female) from 50 villages (2100 participants). A health worker from each village used a handheld digital electrocardiogram (iECG) device (Kardia) to screen for AF on 3 separate days, and administered a questionnaire. All abnormal (AF or unclassified) iECGs were reviewed by the Indian cardiologist and AF determination confirmed by a US-based cardiac electrophysiologist. RESULTS Of the 2100 individuals enrolled, iECGs were collected from 2074 participants (98.8%) and 1947 (92.7%) participants responded to the questionnaire. AF was identified in 33 participants (1.6%), two-thirds on the first iECG. AF prevalence was higher among males (2.3% vs 1.0%, p = 0.03) and in older people (0.6%, 0.9%, 2.1%, 5.6%; p < 0.01). CONCLUSIONS The prevalence of AF observed in our population-based sample is comparable to rates found in studies from North America and Western Europe and increases similarly with age. AF screening using village health workers in rural India is feasible and presents an opportunity for a strategy to address the stroke epidemic in India through primary prevention.
Collapse
Affiliation(s)
- Apurv Soni
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Sunil Karna
- Cardiovascular Center, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Nisha Fahey
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Saket Sanghai
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Harshil Patel
- Central Research Services, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Shyamsundar Raithatha
- Department of Extensions Programme, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Sunil Thanvi
- Cardiovascular Center, Pramukhswami Medical College, Karamsad, Gujarat, India
| | | | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney and Concord Hospital, Dept of Cardiology, Australia
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
18
|
Aldrugh S, Sanghai S, Waring M, Kiefe C, Goldberg R, Gurwitz J, Lessard D, Parish D, Helm R, Sogade F, Hayward R, Mailhot T, Barton B, Saczynski J, McManus D. GERIATRIC ELEMENTS AND PRESCRIPTION OF WARFARIN VERSUS DIRECT ORAL ANTICOAGULANTS AMONG OLDER PATIENTS WITH AF: THE SAGE-AF STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Sanghai S, Aldrugh S, Waring M, Kiefe C, Goldberg R, Gurwitz J, Lessard D, Parish DC, Awad HH, Sogade F, Helm R, Hayward R, McManus D, Saczynski J. ASSOCIATION BETWEEN GERIATRIC ELEMENTS AND ORAL ANTICOAGULANT PRESCRIBING AMONG OLDER ADULTS WITH ATRIAL FIBRILLATION: DATA FROM THE SAGE-AF STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31013-7] [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: 10/27/2022]
|
20
|
Sanghai S, Wang V, Rose A, Yu H, Liu W, Cho K, Driver J, Orkaby A, Saczynski J, McManus D. EXAMINING THE ASSOCIATION BETWEEN FRAILTY AND ORAL ANTICOAGULANT USE FOR ATRIAL FIBRILLATION: DATA FROM A CONTEMPORARY AMBULATORY VA COHORT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Taleb A, Sanghai S, Tighe D, Alonso A. ACUTE INJURY PATTERN ON ELECTROCARDIOGRAM FOLLOWING INTERRUPTION OF EPOPROSTENOL INFUSION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32987-5] [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: 10/17/2022]
|
22
|
Abstract
Stochastic processes that involve the creation of objects and relations over time are widespread, but relatively poorly studied. For example, accurate fault diagnosis in factory assembly processes requires inferring the probabilities of erroneous assembly operations, but doing this efficiently and accurately is difficult. Modeled as dynamic Bayesian networks, these processes have discrete variables with very large domains and extremely high dimensionality. In this paper, we introduce relational dynamic Bayesian networks (RDBNs), which are an extension of dynamic Bayesian networks (DBNs) to first-order logic. RDBNs are a generalization of dynamic probabilistic relational models (DPRMs), which we had proposed in our previous work to model dynamic uncertain domains. We first extend the Rao-Blackwellised particle filtering described in our earlier work to RDBNs. Next, we lift the assumptions associated with Rao-Blackwellization in RDBNs and propose two new forms of particle filtering. The first one uses abstraction hierarchies over the predicates to smooth the particle filter's estimates. The second employs kernel density estimation with a kernel function specifically designed for relational domains. Experiments show these two methods greatly outperform standard particle filtering on the task of assembly plan execution monitoring.
Collapse
|