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Noubiap JJ, Tang JJ, Dewland TA, Marcus GM. Contemporary trends in incident ischemic stroke, intracranial hemorrhage, and mortality in individuals with atrial fibrillation. Eur Heart J Qual Care Clin Outcomes 2024:qcae022. [PMID: 38592955 DOI: 10.1093/ehjqcco/qcae022] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND The prognosis for atrial fibrillation (AF) patients is based on data that is decades old. Given evolving standards of clinical practice, we sought to evaluate temporal trends in clinically important outcomes among patients with AF. METHODS California's Department of Health Care Access and Information databases were used to identify adults aged ≥ 18 years with AF receiving hospital-based care in California. We compared 3 time-periods: 2005-2009, 2010-2014, and 2015-2019. ICD codes were used to identify chronic diseases and acute events. The outcomes were incident ischemic stroke, intracranial hemorrhage, and overall mortality. RESULTS We included 2 009 832 patients with AF (52.7% males, 70.7% Whites, and mean age of 75.0 years), divided in 3 cohorts: 2005-2009 (n = 738 954), 2010-2014 (n = 609 447), and 2015-2019 (n = 661 431). Each outcome became substantially less common with time: compared to 2005-2009, AF patients diagnosed in 2015-2019 experienced a 34% (adjusted hazard ratio [HR] 0.66, 95% CI 0.64-0.69), 22% (HR 0.78, 0.75-0.82), and 24% (HR 0.76, 0.75-0.77) reduction in risk of incident ischemic stroke, intracranial hemorrhage, and mortality, respectively. Between 2005-2009 and 2015-2019, patients aged ≥ 65 years experienced more reductions in each outcome compared to younger patients (p < 0.001 for all), and declines in each outcome were significantly lower for Hispanics and Blacks compared to white patients. CONCLUSION The risks of stroke, intracranial hemorrhage, and death have significantly declined among AF patients, although differences in the magnitude of improvement of these outcomes by demographic groups were observed. Commonly described estimates of the prognosis for AF patients should be updated to reflect contemporary care.
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Affiliation(s)
- Jean Jacques Noubiap
- From the Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Janet J Tang
- From the Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Thomas A Dewland
- From the Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- From the Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
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Cabulong AP, Tang JJ, Teraoka JT, Dewland TA, Marcus GM. Systemic infarcts among patients with atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00245-5. [PMID: 38461923 DOI: 10.1016/j.hrthm.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The epidemiology of atrial fibrillation (AF)-associated thromboembolic complications outside of ischemic strokes has not been thoroughly elucidated. OBJECTIVE The aim of this study was to describe the epidemiology of AF-associated systemic infarcts and relevant interactions by sex and race/ethnicity. METHODS Using the Office of Statewide Health Planning and Development, we performed a longitudinal analysis of patients aged ≥18 years who received ambulatory surgery, emergency, or inpatient medical care in California between 2005 and 2015. We determined the distribution of infarct locations and risks of systemic infarcts for patients with AF. Interaction analyses by sex and race/ethnicity were conducted. RESULTS Of 1,321,694 patients with AF, the average annual rate of systemic infarct was 2.1% ± 0.18% compared with 0.56% ± 0.06% in the 22,944,488 patients without AF. The increased frequency of these infarcts was observed for every body area investigated. After adjustment for potential confounders and mediators, patients with AF experienced a 45% increased risk of a systemic infarct (hazard ratio, 1.45; 95% confidence interval, 1.44-1.47; P < .001). Women, Asians, Blacks, and Hispanics each exhibited a statistically significant heightened relative risk of systemic infarcts in the presence of AF. CONCLUSION AF increases the risk of infarcts throughout the body. Susceptibility to these systemic infarcts varies by sex and race/ethnicity in patterns similar to differential risks for stroke. The presence of a systemic infarct in the absence of a clear cause should raise suspicion for AF, and the potential benefits of AF prevention and anticoagulation should be considered beyond only infarcts to the brain.
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Affiliation(s)
- Alexander P Cabulong
- Division of Epidemiology and Biostatistics, University of California, Berkeley, California
| | - Janet J Tang
- Division of Cardiology, University of California, San Francisco, California
| | - Justin T Teraoka
- Division of Cardiology, University of California, San Francisco, California
| | - Thomas A Dewland
- Division of Cardiology, University of California, San Francisco, California
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, California.
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Siontis KC, Abreau S, Attia ZI, Barrios JP, Dewland TA, Agarwal P, Balasubramanyam A, Li Y, Lester SJ, Masri A, Wang A, Sehnert AJ, Edelberg JM, Abraham TP, Friedman PA, Olgin JE, Noseworthy PA, Tison GH. Patient-Level Artificial Intelligence-Enhanced Electrocardiography in Hypertrophic Cardiomyopathy: Longitudinal Treatment and Clinical Biomarker Correlations. JACC Adv 2023; 2:100582. [PMID: 38076758 PMCID: PMC10702858 DOI: 10.1016/j.jacadv.2023.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Artificial intelligence (AI) applied to 12-lead electrocardiographs (ECGs) can detect hypertrophic cardiomyopathy (HCM). OBJECTIVES The purpose of this study was to determine if AI-enhanced ECG (AI-ECG) can track longitudinal therapeutic response and changes in cardiac structure, function, or hemodynamics in obstructive HCM during mavacamten treatment. METHODS We applied 2 independently developed AI-ECG algorithms (University of California-San Francisco and Mayo Clinic) to serial ECGs (n = 216) from the phase 2 PIONEER-OLE trial of mavacamten for symptomatic obstructive HCM (n = 13 patients, mean age 57.8 years, 69.2% male). Control ECGs from 2,600 age- and sex-matched individuals without HCM were obtained. AI-ECG output was correlated longitudinally to echocardiographic and laboratory metrics of mavacamten treatment response. RESULTS In the validation cohorts, both algorithms exhibited similar performance for HCM diagnosis, and exhibited mean HCM score decreases during mavacamten treatment: patient-level score reduction ranged from approximately 0.80 to 0.45 for Mayo and 0.70 to 0.35 for USCF algorithms; 11 of 13 patients demonstrated absolute score reduction from start to end of follow-up for both algorithms. HCM scores were significantly associated with other HCM-relevant parameters, including left ventricular outflow tract gradient at rest, postexercise, and with Valsalva, and NT-proBNP level, independent of age and sex (all P < 0.01). For both algorithms, the strongest longitudinal correlation was between AI-ECG HCM score and left ventricular outflow tract gradient postexercise (slope estimate: University of California-San Francisco 0.70 [95% CI: 0.45-0.96], P < 0.0001; Mayo 0.40 [95% CI: 0.11-0.68], P = 0.007). CONCLUSIONS AI-ECG analysis longitudinally correlated with changes in echocardiographic and laboratory markers during mavacamten treatment in obstructive HCM. These results provide early evidence for a potential paradigm for monitoring HCM therapeutic response.
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Affiliation(s)
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Zachi I. Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua P. Barrios
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Thomas A. Dewland
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Priyanka Agarwal
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Aarthi Balasubramanyam
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Yunfan Li
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Steven J. Lester
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Ahmad Masri
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew Wang
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy J. Sehnert
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Jay M. Edelberg
- MyoKardia Inc, a Wholly Owned Subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Theodore P. Abraham
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
- Cardiovascular Research Institute, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California-San Francisco, San Francisco, California, USA
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Verma A, Feld GK, Cox JL, Dewland TA, Babkin A, De Potter T, Raju N, Haissaguerre M. Combined pulsed field ablation with ultra-low temperature cryoablation: A preclinical experience. J Cardiovasc Electrophysiol 2023; 34:2124-2133. [PMID: 36218014 DOI: 10.1111/jce.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Combining pulsed field ablation (PFA) with ultra-low temperature cryoablation (ULTC) represents a novel energy source which may create more transmural cardiac lesions. We sought to assess the feasibility of lesions created by combined cryoablation and pulsed field ablation (PFCA) versus PFA alone. METHODS Ablations were performed using a custom PFA generator, ULTC console, and an ablation catheter with insertable stylets. PFA was delivered in a biphasic, bipolar train. PFCA precooled the tissue for 30 s followed by a concurrent PFA train. Benchtop testing using Schlieren imaging and microbubble volume assessment were used to compare PFA and PFCA. PFA and PFCA lesions using pre-optimized and optimized ablation protocols were studied in 6 swine. Pre and post-ECGs were recorded for each ablation and a gross necropsy was performed at 14 days. RESULTS Consistent with benchtop comparisons of heat and microbubble generation, PFA deliveries in the animals were accompanied by muscle contractions and significant microbubbles (Grade 2-3) visible on intracardiac echo while neither occurred during PFCA at higher voltage levels. Both PFA and PFCA acutely eliminated or highly attenuated (>80%) local atrial electrograms. Histology of PFA and PFCA lesions indicated depth up to 6-7 mm and nearly all lesions were transmural. Optimized PFCA produced wider cavotricuspid isthmus lesions with evidence of tissue selectivity. CONCLUSION A novel technology combining PFA and ULTC into one energy source demonstrated in-vivo feasibility for PFCA ablation. PFCA had a more favorable thermal profile and did not produce muscle contraction or microbubbles while extending lesion depth beyond cryoablation.
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Affiliation(s)
- Atul Verma
- McGill University Health Centre, Division of Cardiology, Montreal, Quebec, Canada
| | - Gregory K Feld
- Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - James L Cox
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Thomas A Dewland
- Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | | | - Tom De Potter
- Division of Cardiology, Cardiovascular Center, OLV Aalst, Aalst, Belgium
| | - Narayan Raju
- Pathology Research Laboratory, San Francisco, California, USA
| | - Michel Haissaguerre
- Division of Cardiology, Centre Hospitalier Universitaire Bordeaux, Pessac, France
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Dewland TA, Scheinman MM, Marcus MG, Marcus GM. Back to the basics: A case of atrial flutter? Heart Rhythm 2023; 20:773-774. [PMID: 37120287 DOI: 10.1016/j.hrthm.2022.06.014] [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: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 05/01/2023]
Affiliation(s)
- Thomas A Dewland
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Melvin M Scheinman
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Maurice G Marcus
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California.
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Affiliation(s)
- Thomas A. Dewland
- Section of Electrophysiology, Division of Cardiology, Department of Internal MedicineUniversity of CaliforniaSan FranciscoCAUSA
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Lee AC, Voskoboinik A, Cheung CC, Yogi S, Tseng ZH, Moss JD, Dewland TA, Lee BK, Lee RJ, Hsia HH, Marcus GM, Vedantham V, Chieng D, Kistler PM, Dillon W, Vittinghoff E, Gerstenfeld EP. A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation. JACC Clin Electrophysiol 2023. [PMID: 37495318 DOI: 10.1016/j.jacep.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND High-power, short duration (HPSD) radiofrequency ablation (RFA) is a commonly used strategy for pulmonary vein isolation (PVI). OBJECTIVES This study sought to compare HPSD with standard power, standard duration (SPSD) RFA in patients undergoing PVI. METHODS Patients with paroxysmal or persistent (<1 year) atrial fibrillation (AF) were randomized to HPSD (50 W) or SPSD (25-30 W) RFA to achieve PVI. Outcomes assessed included time to achieve PVI (primary), left atrial dwell time, total procedure time, first-pass isolation, PV reconnection with adenosine, procedure complications including asymptomatic cerebral emboli (ACE), and freedom from atrial arrhythmias. RESULTS Sixty patients (median age 66 years; 75% male) with paroxysmal (57%) or persistent (43%) AF were randomized to HPSD (n = 29) or SPSD (n = 31). Median time to achieve PVI was shorter with HPSD vs SPSD (87 minutes vs 126 minutes; P = 0.003), as was left atrial dwell time (157 minutes vs 180 minutes; P = 0.04). There were no differences in first-pass isolation (79% vs 76%; P = 0.65) or PV reconnection with adenosine (12% vs 20%; P = 0.26) between groups. At 12 months, recurrent atrial arrhythmias occurred less in the HPSD group compared with the SPSD group (n = 3 of 29 [10%] vs n = 11 of 31 [35%]; HR: 0.26; P = 0.027). There was a trend toward more ACE with HPSD RFA (40% HPSD vs 17% SPSD; P = 0.053). CONCLUSIONS In patients undergoing AF ablation, HPSD compared with SPSD RFA results in shorter time to achieve PVI, greater freedom from AF at 12 months, and a trend toward increased ACE.
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Lin AL, Nah G, Tang JJ, Vittinghoff E, Dewland TA, Marcus GM. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation. Eur Heart J 2022; 43:4933-4942. [PMID: 36257330 DOI: 10.1093/eurheartj/ehac558] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. METHODS AND RESULTS Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81-1.92], 1.61 (95% CI 1.55-1.68), 1.74 (95% CI 1.62-1.87), and 1.35 (95% CI 1.30-1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. CONCLUSION Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.
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Affiliation(s)
- Anthony L Lin
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janet J Tang
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas A Dewland
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Higuchi S, Ito H, Gerstenfeld EP, Lee AC, Lee BK, Marcus GM, Hsia HH, Moss JD, Lee RJ, Dewland TA, Vedantham V, Tseng ZH, Patel AR, Tanel RE, Badhwar N, Pellegrini CN, Kawamura M, Shoda M, Hwang C, Refaat MM, Scheinman MM. EN-571-01 THE VALUE OF PROGRAMMED VENTRICULAR EXTRASTIMULI FROM THE RIGHT VENTRICULAR BASAL SEPTUM DURING SUPRAVENTRICULAR TACHYCARDIA. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.778] [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: 11/16/2022]
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Dewland TA, Whitman IR, Win S, Sanchez JM, Olgin JE, Pletcher MJ, Santhosh L, Kumar U, Joyce S, Yang V, Hwang J, Ogomori K, Peyser N, Horner C, Wen D, Butcher X, Marcus GM. Prospective arrhythmia surveillance after a COVID-19 diagnosis. Open Heart 2022; 9:openhrt-2021-001758. [PMID: 35058344 PMCID: PMC8783964 DOI: 10.1136/openhrt-2021-001758] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiac arrhythmias have been observed among patients hospitalised with acute COVID-19 infection, and palpitations remain a common symptom among the much larger outpatient population of COVID-19 survivors in the convalescent stage of the disease. Objective To determine arrhythmia prevalence among outpatients after a COVID-19 diagnosis. Methods Adults with a positive COVID-19 test and without a history of arrhythmia were prospectively evaluated with 14-day ambulatory electrocardiographic monitoring. Participants were instructed to trigger the monitor for palpitations. Results A total of 51 individuals (mean age 42±11 years, 65% women) underwent monitoring at a median 75 (IQR 34–126) days after a positive COVID-19 test. Median monitoring duration was 13.2 (IQR 10.5–13.8) days. No participant demonstrated atrial fibrillation, atrial flutter, sustained supraventricular tachycardia (SVT), sustained ventricular tachycardia or infranodal atrioventricular block. Nearly all participants (96%) had an ectopic burden of <1%; one participant had a 2.8% supraventricular ectopic burden and one had a 15.4% ventricular ectopic burden. While 47 (92%) participants triggered their monitor for palpitation symptoms, 78% of these triggers were for either sinus rhythm or sinus tachycardia. Conclusions We did not find evidence of malignant or sustained arrhythmias in outpatients after a positive COVID-19 diagnosis. While palpitations were common, symptoms frequently corresponded to sinus rhythm/sinus tachycardia or non-malignant arrhythmias such as isolated ectopy or non-sustained SVT. While these findings cannot exclude the possibility of serious arrhythmias in select individuals, they do not support a strong or widespread proarrhythmic effect of COVID-19 infection after resolution of acute illness.
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Affiliation(s)
- Thomas A Dewland
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Isaac R Whitman
- Department of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sithu Win
- Department of Medicine, ZSFGH, San Francisco, California, USA
| | - Jose M Sanchez
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Jeffrey E Olgin
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | | | - Uday Kumar
- Element Science, Inc, San Francisco, California, USA
| | - Sean Joyce
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Vivian Yang
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Janet Hwang
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Kelsey Ogomori
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Noah Peyser
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Cathy Horner
- Department of Medicine, UCSF, San Francisco, California, USA
| | - David Wen
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Xochitl Butcher
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Limpitikul WB, Dewland TA, Vittinghoff E, Soliman E, Nah G, Fang C, Siscovick DS, Psaty BM, Sotoodehnia N, Heckbert S, Stein PK, Gottdiener J, Hu X, Hempfling R, Marcus GM. Premature ventricular complexes and development of heart failure in a community-based population. Heart 2022; 108:105-110. [PMID: 34493549 PMCID: PMC8702448 DOI: 10.1136/heartjnl-2021-319473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE A higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias. This study aims to identify PVC characteristics associated with incident CHF in a community-based setting. METHODS The Cardiovascular Health Study is a cohort of community-dwelling individuals who underwent prospective evaluation and follow-up. We analysed 24-hour Holter data to assess PVC characteristics and used multivariable logistic and Cox proportional hazards models to identify predictors of a left ventricular ejection fraction (LVEF) decline and incident CHF, respectively. RESULTS Of 871 analysed participants, 316 participants exhibited at least 10 PVCs during the 24-hour recording. For participants with PVCs, the average age was 72±5 years, 41% were women and 93% were white. Over a median follow-up of 11 years, 34% developed CHF. After adjusting for demographics, cardiovascular comorbidities, antiarrhythmic drug use and PVC frequency, a greater heterogeneity of the PVC coupling interval was associated with an increased risk of LVEF decline and incident CHF. Of note, neither PVC duration nor coupling interval duration exhibited a statistically significant relationship with either outcome. CONCLUSIONS In this first community-based study to identify Holter-based features of PVCs that are associated with LVEF reduction and incident CHF, the fact that coupling interval heterogeneity was an independent risk factor suggests that the mechanism of PVC generation may influence the risk of heart failure.
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Affiliation(s)
- Worawan B Limpitikul
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas A Dewland
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Elsayed Soliman
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory Nah
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | - Christina Fang
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
| | | | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Nona Sotoodehnia
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Susan Heckbert
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington, USA
| | - Phyllis K Stein
- Cardiovascular Division, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - John Gottdiener
- Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiao Hu
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA
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Higuchi S, Tchou PJ, Voskoboinik A, Goldberger JJ, Nazer B, Dewland TA, Danon A, Belhassen B, Scheinman MM. Reply: Multiform Ventricular Tachycardia With Conduction System Participation: Is There a Fourth-Limb of the His. JACC Clin Electrophysiol 2021; 7:1626-1627. [PMID: 34949432 DOI: 10.1016/j.jacep.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
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Rosenthal DG, Fang CD, Groh CA, Nah G, Vittinghoff E, Dewland TA, Marcus GM. Association Between Sarcoidosis and Atrial Fibrillation Among Californians Using Medical Care. JACC Clin Electrophysiol 2021; 7:1620-1622. [PMID: 34844907 DOI: 10.1016/j.jacep.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
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Higuchi S, Voskoboinik A, Goldberger JJ, Nazer B, Dewland TA, Danon A, Belhassen B, Tchou PJ, Scheinman MM. B-PO01-085 ARRHYTHMIAS UTILIZING VENTRICULAR-NODAL OR VENTRICULAR-HISIAN PATHWAYS: A STRUCTURED APPROACH TO DIAGNOSIS AND MANAGEMENT. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.230] [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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15
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Verma A, Feld GK, Haissaguerre M, Cox JL, Dewland TA, Sharma A, Babkin A, Rupp K, Raju N, Ahmed F, De Potter T. B-PO03-095 COMBINED PULSED FIELD ABLATION WITH CRYOABLATION (PFCA): PRE-CLINICAL EXPERIENCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.569] [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: 11/16/2022]
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16
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Haq KT, Rogovoy NM, Thomas JA, Hamilton C, Lutz KJ, Wirth A, Bender AB, German DM, Przybylowicz R, van Dam P, Dewland TA, Dalouk K, Stecker E, Nazer B, Jessel PM, MacMurdy KS, Zarraga IGE, Beitinjaneh B, Henrikson CA, Raitt M, Fuss C, Ferencik M, Tereshchenko LG. Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): A randomized controlled trial. Heart Rhythm O2 2021; 2:374-381. [PMID: 34430943 PMCID: PMC8369305 DOI: 10.1016/j.hroo.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT, but the mechanisms are unclear. OBJECTIVE Compare effects of aCRT and conventional CRT on electrical dyssynchrony. METHODS A prospective, double-blind, 1:1 parallel-group assignment randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrode body surface mapping. The primary outcome was change in electrical dyssynchrony measured on the epicardial surface using noninvasive electrocardiographic imaging before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. RESULTS We randomized 27 participants (aged 64 ± 12 years; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28% ± 8%; QRS duration 155 ± 21 ms; typical left bundle branch block [LBBB] in 13%) to conventional CRT (n = 15) vs aCRT (n = 12). In atypical LBBB (n = 11; 41%) with S waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in strict LBBB. As compared to baseline, VEU reduced post-CRT in the aCRT (median reduction 18.9 [interquartile range 4.3-29.2 ms; P = .034]), but not in the conventional CRT (21.4 [-30.0 to 49.9 ms; P = .525]) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. CONCLUSION The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar, but only aCRT harmoniously reduced interventricular dyssynchrony by reducing RV uncoupling.
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Affiliation(s)
- Kazi T. Haq
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Nichole M. Rogovoy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jason A. Thomas
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of Washington, Seattle, Washington
| | - Christopher Hamilton
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Katherine J. Lutz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ashley Wirth
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aron B. Bender
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California Los Angeles, Los Angeles, California
| | - David M. German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ryle Przybylowicz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Thomas A. Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California San Francisco, San Francisco, California
| | - Khidir Dalouk
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Eric Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Peter M. Jessel
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Karen S. MacMurdy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Ignatius Gerardo E. Zarraga
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Bassel Beitinjaneh
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A. Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Merritt Raitt
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Cristina Fuss
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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Higuchi S, Voskoboinik A, Goldberger JJ, Nazer B, Dewland TA, Danon A, Belhassen B, Tchou PJ, Scheinman MM. Arrhythmias Utilizing Concealed Nodoventricular or His-Ventricular Pathways: A Structured Approach to Diagnosis and Management. JACC Clin Electrophysiol 2021; 7:1588-1599. [PMID: 34332874 DOI: 10.1016/j.jacep.2021.05.010] [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] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to describe the electrophysiologic characteristics, diagnostic maneuvers, and treatment of a series of arrhythmias using concealed nodoventricular (cNV) or His-ventricular (cHV) pathways. BACKGROUND Confirming the presence and participation of cNV or cHV pathways in tachyarrhythmias is challenging. METHODS We present 4 cases of tachycardias with a participatory cNV or cHV pathway. RESULTS The first patient had a narrow complex tachycardia with ventriculoatrial dissociation. Findings of an entrainment pacing from the right ventricle and fused premature ventricular complexes suggested cNV pathway involvement. The second patient had nonsustained narrow complex tachycardia with more ventricular than atrial complexes. The tachycardia exhibited an anterograde His-right bundle (RB) activation sequence and normal His-ventricular (HV) interval and consistently terminated with fused ventricular extra stimuli, suggesting cNV pathway participation. The third patient had a wide complex tachycardia (WCT) with either a right or left bundle branch block pattern. The WCT showed an eccentric His-RB activation sequence and short HV interval and terminated with fused premature ventricular complexes, suggesting a cHV (or concealed fasciculoventricular) pathway involvement. The fourth patient had a WCT with alternating bundle branch block morphologies with a short HV interval. Entrainment from the basal right ventricle demonstrated fusion and a short postpacing interval, suggesting cHV (or fasciculoventricular) pathway involvement. Ablation at the proximal RB rendered the tachycardia noninducible. CONCLUSIONS A structured approach can help diagnose and treat cNV or cHV pathways. We emphasize the importance of evaluating both the His-RB activation pattern and HV interval during sinus rhythm and tachycardia as well as the ventricular pacing study.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | | | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas A Dewland
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Asaf Danon
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Patrick J Tchou
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melvin M Scheinman
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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Dewland TA, Marcus GM. Can a Drink a Day Keep the Electrophysiologist Away? JACC Clin Electrophysiol 2021; 7:1570-1572. [PMID: 34330670 DOI: 10.1016/j.jacep.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas A Dewland
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California, USA.
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Semaan S, Dewland TA, Tison GH, Nah G, Vittinghoff E, Pletcher MJ, Olgin JE, Marcus GM. Physical activity and atrial fibrillation: Data from wearable fitness trackers. Heart Rhythm 2021; 17:842-846. [PMID: 32354448 DOI: 10.1016/j.hrthm.2020.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/02/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regular physical activity is an important determinant of cardiovascular health and quality of life. Previous investigations examining the association between exercise and atrial fibrillation (AF) have been limited by self-reported, retrospectively collected activity data. OBJECTIVE The purpose of this study was to objectively quantify differences in daily physical activity among individuals with and those without AF using electronic wearable activity trackers. METHODS Daily exercise data were directly obtained from wrist-worn activity trackers (Fitbit, San Francisco, CA) among participants in the Health eHeart (HeH) study. Average daily step count was compared between individuals with and those without AF both before and after adjusting for comorbidities. AF severity was quantified using the Atrial Fibrillation Effect on QualiTy of Life (AFEQT) survey. RESULTS Among 171,284 HeH study participants, 3333 individuals (234 with AF [7%]) submitted activity data. In unadjusted analysis, AF participants ambulated an average of 723 fewer steps per day (95% confidence interval [CI] 292-1154; P = .001) compared to individuals without AF. After adjustment for demographics and comorbid diseases, participants with AF demonstrated 591 fewer steps per day (95% CI 149-1033; P = .009). Among AF patients, AF severity was associated with less physical activity. For each single point decrease in AFEQT score (corresponding to more symptomatic AF), physical activity decreased by a mean 24 steps per day (95% CI 1-46; P = .04). CONCLUSION Objective, automatically collected step count data demonstrate that individuals with AF engage in significantly less average daily physical activity. In addition, worsening AF symptom severity is associated with reduced daily exercise.
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Affiliation(s)
- Sarah Semaan
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Geoffrey H Tison
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Gregory Nah
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jeffrey E Olgin
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California
| | - Gregory M Marcus
- Department of Medicine, Division of Cardiology, Electrophysiology Section, University of California, San Francisco, San Francisco, California.
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Abstract
BACKGROUND American Indian individuals experience a relatively high risk for cardiovascular disease and have exhibited a higher risk of stroke compared with other racial and ethnic minorities. Although this population has the highest incidence of atrial fibrillation (AF) compared with other groups, the relationship between AF and nonhemorrhagic stroke among American Indian individuals compared with other groups has not been thoroughly studied. METHODS and RESULTS We used the Healthcare Cost and Utilization Project to evaluate risk of nonhemorrhagic stroke among American Indian individuals, with comparisons to White, Black, Hispanic, and Asian individuals, among all adult California residents receiving care in an emergency department, inpatient hospital unit, or ambulatory surgery setting from 2005 to 2011. Of 16 951 579 patients followed for a median 4.1 years, 105 822 (0.6%) were American Indian. After adjusting for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, cardiac surgery, valvular heart disease, chronic kidney disease, smoking, obstructive sleep apnea, pulmonary disease, and alcohol use, American Indian individuals with AF exhibited the highest risk of nonhemorrhagic stroke when compared with either non‐American Indian individuals with AF (hazard ratio, 1.38; 95% CI, 1.23–1.55; P<0.0001) or to each race and ethnicity with AF. American Indian individuals also experienced the highest overall risk for stroke, with no evidence that AF disproportionately heightened that risk in interaction analyses. CONCLUSIONS American Indian individuals experienced the highest risk of nonhemorrhagic stroke, whether in the presence or absence of AF. Our findings likely suggest an opportunity to further study, if not immediately address, guideline‐adherent anticoagulation prescribing patterns among American Indian individuals with AF.
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Affiliation(s)
- José M Sanchez
- Section of Cardiac Electrophysiology Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | - Stacey E Jolly
- The Department of General Internal Medicine Cleveland Clinic OH
| | - Thomas A Dewland
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Zian H Tseng
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Gregory Nah
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
| | - Eric Vittinghoff
- The Department of Epidemiology and Biostatistics University of California San Francisco CA
| | - Gregory M Marcus
- The Section of Cardiac Electrophysiology Division of Cardiology University of California San Francisco CA
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21
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Rosenthal DG, Fang CD, Groh CA, Nah G, Vittinghoff E, Dewland TA, Vedantham V, Marcus GM. Heart Failure, Atrioventricular Block, and Ventricular Tachycardia in Sarcoidosis. J Am Heart Assoc 2021; 10:e017692. [PMID: 33599141 PMCID: PMC8174291 DOI: 10.1161/jaha.120.017692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7-11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3-134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2-28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%-26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.
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Affiliation(s)
- David G Rosenthal
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christina D Fang
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christopher A Groh
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory Nah
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics University of California, San Francisco CA
| | - Thomas A Dewland
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Vasanth Vedantham
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
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22
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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.
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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.
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Kerola T, Dewland TA, Vittinghoff E, Heckbert SR, Stein PK, Marcus GM. Predictors of atrial ectopy and their relationship to atrial fibrillation risk. Europace 2020; 21:864-870. [PMID: 30843034 DOI: 10.1093/europace/euz008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Premature atrial contractions (PACs) are known to trigger and predict atrial fibrillation (AF). We sought to identify the determinants of PACs and the degree to which PACs mediate the effects of established risk factors for AF. METHODS AND RESULTS Predictors of baseline PAC frequency were examined using a Holter Study among 1392 participants in the Cardiovascular Health Study, a community-based cohort of individuals aged ≥65 years. Participants were then followed for their first diagnosis of AF. Independent predictors of PACs were identified, and the extent to which PACs might mediate the relationship between those predictors and AF was determined. The median hourly frequency of PACs was 2.7 (interquartile range 0.8-12.1). After multivariable adjustment, increasing age, increasing height, decreasing body mass index, and a history of myocardial infarction were each associated with more PACs. Regarding modifiable predictors, participants using beta-blockers had 21% less [95% confidence interval (95% CI) 9-30%, P = 0.001] and those performing at least moderate intensity exercise vs. lower intensity exercisers had 10% less (95% CI 1-18%, P = 0.03) PACs. Higher PAC frequency explained 34% (95% CI 22-57%, P < 0.0001) of the relationship between increasing age and AF risk and 27% (95% CI 10-75%, P = 0.004) of the relationship between taller height and AF risk. CONCLUSION Enhancing physical activity and use of beta-blockers may represent fruitful strategies to mitigate PAC frequency. A substantial proportion of the excess risk of AF due to increasing age and taller height may be explained by an increase in PAC frequency.
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Affiliation(s)
- Tuomas Kerola
- Division of Cardiology, Electrophysiology Section, University of California, San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA, USA
| | - Thomas A Dewland
- The Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA, USA
| | - Phyllis K Stein
- School of Medicine, Washington University, HRV Lab, 660 South Euclid Avenue, Campus Box 8215, St. Louis, MO, USA
| | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section, University of California, San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, CA, USA
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Miller JD, Dewland TA, Henrikson CA, Reiss J, Patel A, Nazer B. Point density exclusion electroanatomic mapping for ventricular arrhythmias arising from endocavitary structures. Heart Rhythm O2 2020; 1:394-398. [PMID: 34113896 PMCID: PMC8183858 DOI: 10.1016/j.hroo.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jared D Miller
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - James Reiss
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Ashit Patel
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
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25
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Dewland TA, Wong AC, Gerstenfeld EP. Noninvasive ventricular tachycardia ablation: Should we apply the accelerator or the brake? Heart Rhythm 2020; 17:1249-1250. [DOI: 10.1016/j.hrthm.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
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Stecker EC, Nazer B, Dewland TA. Primary Prevention ICDs in Nonischemic Cardiomyopathy: Time to Put the Toothpaste Back in the Tube? J Am Coll Cardiol 2020; 76:416-418. [PMID: 32703512 DOI: 10.1016/j.jacc.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Eric C Stecker
- Electrophysiology Section, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - Babak Nazer
- Electrophysiology Section, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Thomas A Dewland
- Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of San Francisco, San Francisco, California
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Whitman IR, Vittinghoff E, DeFilippi CR, Gottdiener JS, Alonso A, Psaty BM, Heckbert SR, Hoogeveen RC, Arking DE, Selvin E, Chen LY, Dewland TA, Marcus GM. NT -pro BNP as a Mediator of the Racial Difference in Incident Atrial Fibrillation and Heart Failure. J Am Heart Assoc 2020; 8:e010868. [PMID: 30912456 PMCID: PMC6509704 DOI: 10.1161/jaha.118.010868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Blacks harbor more cardiovascular risk factors than whites, but experience less atrial fibrillation (AF). Conversely, whites may have a lower risk of heart failure (CHF). N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels are higher in whites, predict incident AF, and have diuretic effects in the setting of increased ventricular diastolic pressures, potentially providing a unifying explanation for these racial differences. Methods and Results We used data from the CHS (Cardiovascular Health Study) to determine the degree to which baseline NT‐proBNP levels mediate the relationships between race and incident AF and CHF by comparing beta estimates between models with and without NT‐proBNP. The ARIC (Atherosclerosis Risk in Communities) study was used to assess reproducibility. Among 4731 CHS (770 black) and 12 418 ARIC (3091 black) participants, there were 1277 and 1253 incident AF events, respectively. Whites had higher baseline NT‐proBNP (CHS: 40% higher than blacks; 95% CI, 29–53; ARIC: 39% higher; 95% CI, 33–46) and had a greater risk of incident AF compared with blacks (CHS: adjusted hazard ratio, 1.60; 95% CI, 1.31–1.93; ARIC: hazard ratio, 1.93; 95% CI, 1.57–2.27). NT‐proBNP levels explained a significant proportion of the racial difference in AF risk (CHS: 36.2%; 95% CI, 23.2–69.2%; ARIC: 24.6%; 95% CI, 14.8–39.6%). Contrary to our hypothesis, given an increased risk of CHF among whites in CHS (adjusted hazard ratio, 1.20; 95% CI, 1.05–1.47) and the absence of a significant association between race and CHF in ARIC (adjusted hazard ratio, 1.07; 95% CI, 0.94–1.23), CHF‐related mediation analyses were not performed. Conclusions A substantial portion of the relationship between race and AF was statistically explained by baseline NT‐proBNP levels. No consistent relationship between race and CHF was observed. See Editorial by Richards
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Affiliation(s)
- Isaac R Whitman
- 1 Section of Cardiac Electrophysiology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Eric Vittinghoff
- 2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco California USA
| | | | - John S Gottdiener
- 3 Division of Cardiology University of Maryland Baltimore Maryland USA
| | - Alvaro Alonso
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia USA
| | - Bruce M Psaty
- 5 Cardiovascular Health Research Unit Departments of Medicine, Epidemiology, and Health Services University of Washington Seattle Washington USA.,6 Kaiser Permanente Washington Health Research Institute Seattle Washington USA
| | - Susan R Heckbert
- 7 Department of Epidemiology University of Washington, School of Public Health Seattle Washington USA
| | - Ron C Hoogeveen
- 8 Division of Atherosclerosis and Vascular Medicine Baylor College of Medicine Houston Texas USA
| | - Dan E Arking
- 9 McKusick-Nathans Institute of Genetic Medicine Johns Hopkins University Baltimore Maryland USA
| | - Elizabeth Selvin
- 10 Division of Cardiovascular and Clinical Epidemiology Johns Hopkins University Baltimore Maryland USA
| | - Lin Y Chen
- 11 Cardiovascular Division University of Minnesota Minneapolis and Saint Paul, Minnesota USA
| | - Thomas A Dewland
- 12 Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Gregory M Marcus
- 13 Division of Cardiac Electrophysiology University of California, San Francisco San Francisco California USA
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Sardana M, Hsue PY, Tseng ZH, Vittinghoff E, Nah G, Dewland TA, Marcus GM. Human Immunodeficiency Virus Infection and Incident Atrial Fibrillation. J Am Coll Cardiol 2020; 74:1512-1514. [PMID: 31514955 DOI: 10.1016/j.jacc.2019.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/07/2019] [Indexed: 11/25/2022]
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Jessel PM, Yadava M, Nazer B, Dewland TA, Miller J, Stecker EC, Bhamidipati CM, Song HK, Henrikson CA. Transvenous management of cardiac implantable electronic device late lead perforation. J Cardiovasc Electrophysiol 2020; 31:521-528. [DOI: 10.1111/jce.14331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/23/2019] [Revised: 11/28/2019] [Accepted: 12/07/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Peter M. Jessel
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
- Division of CardiologyVA Portland Health Care System Portland Oregon
| | - Mrinal Yadava
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Babak Nazer
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Thomas A. Dewland
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Jared Miller
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Eric C. Stecker
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | | | - Howard K. Song
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
| | - Charles A. Henrikson
- Knight Cardiovascular InstituteOregon Health & Science University Hospital Portland Oregon
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Abstract
Background Premature ventricular contractions (PVCs) predict heart failure and death. Data regarding modifiable risk factors for PVCs are scarce. Methods and Results We studied 1424 Cardiovascular Health Study participants randomly assigned to 24‐hour Holter monitoring. Demographics, comorbidities, habits, and echocardiographic measurements were examined as predictors of PVC frequency and, among 845 participants, change in PVC frequency 5 years later. Participants exhibited a median of 0.6 (interquartile range, 0.1–7.1) PVCs per hour. Of the more directly modifiable characteristics and after multivariable adjustment, every SD increase in systolic blood pressure was associated with 9% more PVCs (95% confidence interval [CI], 2%–17%; P=0.01), regularly performing no or low‐intensity exercise compared with more physical activity was associated with ≈15% more PVCs (95% CI, 3–25%; P=0.02), and those with a history of smoking exhibited an average of 18% more PVCs (95% CI, 3–36%; P=0.02) than did never smokers. After 5 years, PVC frequency increased from a median of 0.5 (IQR, 0.1–4.7) to 1.2 (IQR, 0.1–13.8) per hour (P<0.0001). Directly modifiable predictors of 5‐year increase in PVCs, described as the odds per each quintile increase in PVCs, included increased diastolic blood pressure (odds ratio per SD increase, 1.16; 95% CI, 1.02–1.31; P=0.02) and a history of smoking (OR, 1.31; 95% CI, 1.02–1.68; P=0.04). Conclusions Enhancing physical activity, smoking cessation, and aggressive control of blood pressure may represent fruitful strategies to mitigate PVC frequency and PVC‐associated adverse outcomes.
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Affiliation(s)
- Tuomas Kerola
- 1 Division of Cardiology, Electrophysiology Section University of California San Francisco CA
| | - Thomas A Dewland
- 3 Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Eric Vittinghoff
- 2 Department of Epidemiology and Biostatistics University of California San Francisco CA
| | - Susan R Heckbert
- 4 Cardiovascular Health Research Unit and Department of Epidemiology University of Washington Seattle WA
| | - Phyllis K Stein
- 5 HRV Lab School of Medicine Washington University Saint Louis MO
| | - Gregory M Marcus
- 1 Division of Cardiology, Electrophysiology Section University of California San Francisco CA
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Affiliation(s)
- José M. Sanchez
- Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco
| | - Stacey E. Jolly
- Department of General Internal Medicine, Cleveland Clinic, OH (S.E.J.)
| | - Thomas A. Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (T.A.D.)
| | - Zian H. Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco
| | - Gregory Nah
- Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics (E.V.), University of California, San Francisco
| | - Gregory M. Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco
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Nazer B, Walters TE, Dewland TA, Naniwadekar A, Koruth JS, Najeeb Osman M, Intini A, Chen M, Biermann J, Steinfurt J, Kalman JM, Tanel RE, Lee BK, Badhwar N, Gerstenfeld EP, Scheinman MM. Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers. Circ Arrhythm Electrophysiol 2019; 12:e007337. [PMID: 31505948 DOI: 10.1161/circep.119.007337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/22/2022]
Abstract
BACKGROUND Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways. METHODS Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4). RESULTS NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT. CONCLUSIONS Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.
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Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Tomos E Walters
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Aditi Naniwadekar
- Division of Cardiology, East Carolina University; Greenville, NC (A.N.)
| | - Jacob S Koruth
- Cardiology Division, Mount Sinai Medical Center; New York (J.S.K.)
| | - Mohammed Najeeb Osman
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Anselma Intini
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (M.C.)
| | - Jurgen Biermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Johannes Steinfurt
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia (J.M.K.)
| | - Ronn E Tanel
- Pediatric Cardiology Division (R.E.T.), University of California San Francisco
| | - Byron K Lee
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | | | - Edward P Gerstenfeld
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Melvin M Scheinman
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
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Stecker EC, Dewland TA. A Game of the Long Season. J Am Coll Cardiol 2019; 73:3267-3270. [PMID: 31248547 DOI: 10.1016/j.jacc.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Eric C Stecker
- Electrophysiology Section of the Knight Cardiovascular Institute, Oregon Heath & Science University, Portland, Oregon.
| | - Thomas A Dewland
- Electrophysiology Section of the Knight Cardiovascular Institute, Oregon Heath & Science University, Portland, Oregon
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Delling FN, Vittinghoff E, Dewland TA, Pletcher MJ, Olgin JE, Nah G, Aschbacher K, Fang CD, Lee ES, Fan SM, Kazi DS, Marcus GM. Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA. BMJ Open 2019; 9:e027432. [PMID: 31092662 PMCID: PMC6530411 DOI: 10.1136/bmjopen-2018-027432] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 01/01/2023] Open
Abstract
OBJECTIVE To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). DESIGN We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. SETTING Population-based, inpatient. PARTICIPANTS HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states. MAIN OUTCOME MEASURES We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. RESULTS In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). CONCLUSIONS Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.
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Affiliation(s)
- Francesca N Delling
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Eric Vittinghoff
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Thomas A Dewland
- Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark J Pletcher
- Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jeffrey E Olgin
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Gregory Nah
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Kirstin Aschbacher
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Christina D Fang
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Emily S Lee
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Shannon M Fan
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Dhruv S Kazi
- Medicine (Cardiology), University of California, San Francisco, California, USA
| | - Gregory M Marcus
- Medicine (Cardiology), University of California, San Francisco, California, USA
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Schulman PM, Treggiari MM, Yanez ND, Henrikson CA, Jessel PM, Dewland TA, Merkel MJ, Sera V, Harukuni I, Anderson RB, Kahl E, Bingham A, Alkayed N, Stecker EC. Electromagnetic Interference with Protocolized Electrosurgery Dispersive Electrode Positioning in Patients with Implantable Cardioverter Defibrillators. Anesthesiology 2019; 130:530-540. [DOI: 10.1097/aln.0000000000002571] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
The goal of this study was to determine the occurrence of intraoperative electromagnetic interference from monopolar electrosurgery in patients with an implantable cardioverter defibrillator undergoing surgery. A protocolized approach was used to position the dispersive electrode.
Methods
This was a prospective cohort study including 144 patients with implantable cardioverter defibrillators undergoing surgery between May 2012 and September 2016 at an academic medical center. The primary objectives were to determine the occurrences of electromagnetic interference and clinically meaningful electromagnetic interference (interference that would have resulted in delivery of inappropriate antitachycardia therapy had the antitachycardia therapy not been programmed off) in noncardiac surgeries above the umbilicus, noncardiac surgeries at or below the umbilicus, and cardiac surgeries with the use of an underbody dispersive electrode.
Results
The risks of electromagnetic interference and clinically meaningful electromagnetic interference were 14 of 70 (20%) and 5 of 70 (7%) in above-the-umbilicus surgery, 1 of 40 (2.5%) and 0 of 40 (0%) in below-the-umbilicus surgery, and 23 of 34 (68%) and 10 of 34 (29%) in cardiac surgery. Had conservative programming strategies intended to reduce the risk of inappropriate antitachycardia therapy been employed, the occurrence of clinically meaningful electromagnetic interference would have been 2 of 70 (2.9%) in above-the-umbilicus surgery and 3 of 34 (8.8%) in cardiac surgery.
Conclusions
Despite protocolized dispersive electrode positioning, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with surgery above the umbilicus were high, supporting published recommendations to suspend antitachycardia therapy whenever monopolar electrosurgery is used above the umbilicus. For surgery below the umbilicus, these risks were negligible, implying that suspending antitachycardia therapy is likely unnecessary in these patients. For cardiac surgery, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with an underbody dispersive electrode were high. Conservative programming strategies would not have eliminated the risk of clinically meaningful electromagnetic interference in either noncardiac surgery above the umbilicus or cardiac surgery.
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Affiliation(s)
- Peter M. Schulman
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Miriam M. Treggiari
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - N. David Yanez
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Charles A. Henrikson
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Peter M. Jessel
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Thomas A. Dewland
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Matthias J. Merkel
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Valerie Sera
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Izumi Harukuni
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ryan B. Anderson
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ed Kahl
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Ann Bingham
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Nabil Alkayed
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
| | - Eric C. Stecker
- From the Department of Anesthesiology and Perioperative Medicine (P.M.S., M.M.T., M.J.M., V.S., I.H., R.B.A., A.B., N.A.) and the Knight Cardiovascular Institute (C.A.H., P.M.J., T.A.D., E.C.S.), Oregon Health and Science University, Portland, Oregon; the School of Public Health, Oregon Health and Science University and Portland State University, Portland, Oregon (N.D.Y.); and Department of Anest
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Roberts JD, Hu D, Heckbert SR, Alonso A, Dewland TA, Vittinghoff E, Liu Y, Psaty BM, Olgin JE, Magnani JW, Huntsman S, Burchard EG, Arking DE, Bibbins-Domingo K, Harris TB, Perez MV, Ziv E, Marcus GM. Genetic Investigation Into the Differential Risk of Atrial Fibrillation Among Black and White Individuals. JAMA Cardiol 2018; 1:442-50. [PMID: 27438321 DOI: 10.1001/jamacardio.2016.1185] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE White persons have a higher risk of atrial fibrillation (AF) compared with black individuals despite a lower prevalence of risk factors. This difference may be due, at least in part, to genetic factors. OBJECTIVES To determine whether 9 single-nucleotide polymorphisms (SNPs) associated with AF account for this paradoxical differential racial risk for AF and to use admixture mapping to search genome-wide for loci that may account for this phenomenon. DESIGN, SETTING, AND PARTICIPANTS Genome-wide admixture analysis and candidate SNP study involving 3 population-based cohort studies that were initiated between 1987 and 1997, including the Cardiovascular Health Study (CHS) (n = 4173), the Atherosclerosis Risk in Communities (ARIC) (n = 12 341) study, and the Health, Aging, and Body Composition (Health ABC) (n = 1015) study. In all 3 studies, race was self-identified. Cox proportional hazards regression models and the proportion of treatment effect method were used to determine the impact of 9 AF-risk SNPs among participants from CHS and the ARIC study. The present study began July 1, 2012, and was completed in 2015. MAIN OUTCOMES AND MEASURES Incident AF systematically ascertained using clinic visit electrocardiograms, hospital discharge diagnosis codes, death certificates, and Medicare claims data. RESULTS A single SNP, rs10824026 (chromosome 10: position 73661450), was found to significantly mediate the higher risk for AF in white participants compared with black participants in CHS (11.4%; 95% CI, 2.9%-29.9%) and ARIC (31.7%; 95% CI, 16.0%-53.0%). Admixture mapping was performed in a meta-analysis of black participants within CHS (n = 811), ARIC (n = 3112), and Health ABC (n = 1015). No loci that reached the prespecified statistical threshold for genome-wide significance were identified. CONCLUSIONS AND RELEVANCE The rs10824026 SNP on chromosome 10q22 mediates a modest proportion of the increased risk of AF among white individuals compared with black individuals, potentially through an effect on gene expression levels of MYOZ1. No additional genetic variants accounting for a significant portion of the differential racial risk of AF were identified with genome-wide admixture mapping, suggesting that additional genetic or environmental influences beyond single SNPs in isolation may account for the paradoxical racial risk of AF among white individuals and black individuals.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Donglei Hu
- Institute of Human Genetics and Department of Medicine, University of California, San Francisco
| | | | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Thomas A Dewland
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bruce M Psaty
- Department of Epidemiology, University of Washington, Seattle7Cardiovascular Health Research Unit, University of Washington, Seattle8Departments of Medicine and Health Services, University of Washington, Seattle9Group Health Research Institute, Group Heal
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jared W Magnani
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Scott Huntsman
- Institute of Human Genetics and Department of Medicine, University of California, San Francisco
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco 12Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, US National Institutes of Health, Bethesda, Maryland
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Elad Ziv
- Institute of Human Genetics and Department of Medicine, University of California, San Francisco
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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Christensen MA, Dixit S, Dewland TA, Whitman IR, Nah G, Vittinghoff E, Mukamal KJ, Redline S, Robbins JA, Newman AB, Patel SR, Magnani JW, Psaty BM, Olgin JE, Pletcher MJ, Heckbert SR, Marcus GM. Sleep characteristics that predict atrial fibrillation. Heart Rhythm 2018; 15:1289-1295. [PMID: 29958805 DOI: 10.1016/j.hrthm.2018.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown. OBJECTIVE The purpose of this study was to determine whether poor sleep itself is a risk factor for AF. METHODS We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005-2009 data from the California Healthcare Cost and Utilization Project. RESULTS Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14-1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17-1.51; P <.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00-1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30-1.42; P <.001). CONCLUSION Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.
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Affiliation(s)
- Matthew A Christensen
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California; Department of Internal Medicine, University of Utah Medical School, Salt Lake City, Utah
| | - Shalini Dixit
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Isaac R Whitman
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Gregory Nah
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics University of California, San Francisco, California
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Susan Redline
- Division of Cardiovascular Medicine and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
| | - John A Robbins
- Department of Medicine, University of California, Davis, Sacramento, California
| | - Anne B Newman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington
| | - Jeffrey E Olgin
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics University of California, San Francisco, California
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
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Hsu JC, Varosy PD, Bao H, Dewland TA, Curtis JP, Marcus GM. Coronary Venous Dissection from Left Ventricular Lead Placement During Cardiac Resynchronization Therapy With Defibrillator Implantation and Associated in-Hospital Adverse Events (from the NCDR ICD Registry). Am J Cardiol 2018; 121:55-61. [PMID: 29102348 DOI: 10.1016/j.amjcard.2017.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
Coronary venous dissection is a known complication of left ventricular lead placement during implantation of a cardiac resynchronization with defibrillator (CRT-D) system. A large-scale evaluation of the prevalence of coronary venous dissection and associated in-hospital clinical outcomes has not been performed. We sought to identify predictors of coronary venous dissection and evaluate subsequent in-hospital adverse events in those with the complication. We studied 140,991 first-time CRT-D recipients in the implantable cardioverter-defibrillator (ICD) Registry implanted between 2006 and 2011. Using hierarchical multivariable logistic regression adjusting for patient, implanting physician, and hospital characteristics, we examined predictors of coronary venous dissection and its association with other major complications, length of hospital stay, and in-hospital mortality. Coronary venous dissection occurred in 392 patients (0.28%). After multivariable adjustment, female gender and left bundle branch block were associated with greater odds of coronary venous dissection. Conversely, atrial fibrillation, previous coronary artery bypass graft, and higher implanter procedure volume were associated with lower odds of coronary venous dissection (all p values <0.05). After multivariable adjustment, CRT-D recipients with coronary venous dissection had greater odds of major complications (odds ratio [OR] 10.47, 95% confidence interval [CI] 6.75 to 16.24, p <0.0001), postprocedural hospital stays >3 days (OR 1.71, 95% CI 1.29 to 2.29, p <0.0001), but not in-hospital death (OR 0.78, 95% CI 0.12 to 5.25, p = 0.8012). In conclusion, in a large population of first-time CRT-D recipients, specific patient and implanter characteristics predicted coronary venous dissection risk. Coronary venous dissection was associated with major in-hospital complications and prolonged hospitalization, but not death.
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Dewland TA, Soliman EZ, Yamal JM, Davis BR, Alonso A, Albert CM, Simpson LM, Haywood LJ, Marcus GM. Pharmacologic Prevention of Incident Atrial Fibrillation: Long-Term Results From the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005463. [PMID: 29212812 DOI: 10.1161/circep.117.005463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/19/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. METHODS AND RESULTS We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95% confidence interval, 0.94-1.15; P=0.46) or amlodipine (hazard ratio, 0.93; 95% confidence interval, 0.84-1.03; P=0.16) was not associated with a significant reduction in incident AF/AFL. CONCLUSIONS Compared with chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Thomas A Dewland
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Elsayed Z Soliman
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Jose-Miguel Yamal
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Barry R Davis
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Alvaro Alonso
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Christine M Albert
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Lara M Simpson
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - L Julian Haywood
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - Gregory M Marcus
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland (T.A.D.); Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.); University of Texas School of Public Health, Houston (J.-M.Y., B.R.D., L.M.S.); Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.); Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.M.A.); Keck School of Medicine, University of Southern California, Los Angeles (L.J.H.); and Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.).
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Nguyen KT, Vittinghoff E, Dewland TA, Dukes JW, Soliman EZ, Stein PK, Gottdiener JS, Alonso A, Chen LY, Psaty BM, Heckbert SR, Marcus GM. Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community. J Am Heart Assoc 2017; 6:JAHA.117.006028. [PMID: 28775064 PMCID: PMC5586444 DOI: 10.1161/jaha.117.006028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality. METHODS AND RESULTS We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P<0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC. CONCLUSIONS Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.
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Affiliation(s)
- Kaylin T Nguyen
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
| | - Jonathan W Dukes
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Phyllis K Stein
- Division of Cardiology, Washington University School of Medicine, St Louis, MO
| | - John S Gottdiener
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Susan R Heckbert
- Department of Epidemiology and Cardiovascular Health Research Unit, University of Washington, Seattle, WA.,Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA
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Dewland TA, Stecker EC. Riskier Business. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.003801. [DOI: 10.1161/circoutcomes.117.003801] [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: 11/16/2022]
Affiliation(s)
- Thomas A. Dewland
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Eric C. Stecker
- From the Knight Cardiovascular Institute, Oregon Health & Science University, Portland
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Affiliation(s)
| | | | - Charles A. Henrikson
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
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Dewland TA, Henrikson CA. Catheter ablation and the left atrial appendage: Should we embrace isolation? Heart Rhythm 2016; 14:320-321. [PMID: 27890734 DOI: 10.1016/j.hrthm.2016.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Nguyen KT, Vittinghoff E, Dewland TA, Mandyam MC, Stein PK, Soliman EZ, Heckbert SR, Marcus GM. Electrocardiographic Predictors of Incident Atrial Fibrillation. Am J Cardiol 2016; 118:714-9. [PMID: 27448684 DOI: 10.1016/j.amjcard.2016.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is likely secondary to multiple different pathophysiological mechanisms that are increasingly but incompletely understood. Motivated by the hypothesis that 3 previously described electrocardiographic predictors of AF identify distinct AF mechanisms, we sought to determine if these electrocardiographic findings independently predict incident disease. Among Cardiovascular Health Study participants without prevalent AF, we determined whether left anterior fascicular block (LAFB), a prolonged QTC, and atrial premature complexes (APCs) each predicted AF after adjusting for each other. We then calculated the attributable risk in the exposed for each electrocardiographic marker. LAFB and QTC intervals were assessed on baseline 12-lead electrocardiogram (n = 4,696). APC count was determined using 24-hour Holter recordings obtained in a random subsample (n = 1,234). After adjusting for potential confounders and each electrocardiographic marker, LAFB (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.1 to 3.9, p = 0.023), a prolonged QTC (HR 2.5, 95% CI 1.4 to 4.3, p = 0.002), and every doubling of APC count (HR 1.2, 95% CI 1.1 to 1.3, p <0.001) each remained independently predictive of incident AF. The attributable risk of AF in the exposed was 35% (95% CI 13% to 52%) for LAFB, 25% (95% CI 0.6% to 44%) for a prolonged QTC, and 34% (95% CI 26% to 42%) for APCs. In conclusion, in a community-based cohort, 3 previously established electrocardiogram-derived AF predictors were each independently associated with incident AF, suggesting that they may represent distinct mechanisms underlying the disease.
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Affiliation(s)
- Kaylin T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Mala C Mandyam
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Phyllis K Stein
- Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Elsayed Z Soliman
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, Washington
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California.
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Roberts JD, Yang J, Gladstone RA, Longoria J, Whitman IR, Dewland TA, Miller C, Robles A, Poon A, Seiler B, Laframboise WA, Olgin JE, Kwok PY, Marcus GM. Atrial Fibrillation Associated Genetic Variants and Left Atrial Histology: Evaluation for Molecular Sub-Phenotypes. J Cardiovasc Electrophysiol 2016; 27:1264-1270. [PMID: 27574037 DOI: 10.1111/jce.13083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Genome wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with atrial fibrillation (AF), but the mechanisms underlying these relationships have not yet been elucidated. Inflammation and fibrosis have been posited as important mechanisms responsible for AF. We sought to investigate the impact of SNP carrier status on inflammation and fibrosis in left atrial appendage tissue. METHODS AND RESULTS Carrier status of 10 AF-associated SNPs was evaluated on DNA extracted from left atrial appendage tissue in 176 individuals (120 with AF). The presence of inflammation was evaluated through visual quantification of leukocyte infiltration following hematoxylin and eosin staining, while fibrosis was quantified using picrosirius red with fast green staining. Unadjusted and adjusted linear and logistic regression models were utilized to evaluate for an association between SNP carrier status and inflammation and fibrosis. On adjusted logistic regression analysis, the rs7164883 SNP (intronic within HCN4) was associated with a reduced odds of inflammation (odds ratio: 0.42; 95% CI: 0.22-0.81, P = 0.01), and was not associated with fibrosis on adjusted linear regression analysis (β-coefficient: -0.31; 95% CI: -1.03-0.40, P = 0.40). None of the remaining SNPs exhibited significant associations with left atrial inflammation or fibrosis. CONCLUSIONS Among 10 AF-associated SNPs, a single genetic variant was associated with reduced left atrial inflammation, while no histologic differences were observed in the remaining 9. The known AF-associated SNPs do not appear to predispose to the development of pro-inflammatory or pro-fibrotic AF sub-phenotypes.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jingkun Yang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rachel A Gladstone
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - James Longoria
- Division of Cardiovascular Surgery, Sutter Health, Sacramento, California, USA
| | - Isaac R Whitman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas A Dewland
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Caroline Miller
- Gladstone Institute of Cardiovascular Disease, San Francisco, California, USA
| | - Anatalia Robles
- Gladstone Institute of Cardiovascular Disease, San Francisco, California, USA
| | - Annie Poon
- Cardiovascular, Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Beverly Seiler
- Division of Cardiovascular Surgery, Sutter Health, Sacramento, California, USA
| | - William A Laframboise
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Pui-Yan Kwok
- Cardiovascular, Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Dewland TA, Soliman EZ, Davis BR, Magnani JW, Yamal JM, Piller LB, Haywood LJ, Alonso A, Albert CM, Marcus GM. Effect of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) on Conduction System Disease. JAMA Intern Med 2016; 176:1085-92. [PMID: 27367818 DOI: 10.1001/jamainternmed.2016.2502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/14/2022]
Abstract
IMPORTANCE Cardiac conduction abnormalities are associated with an increased risk for morbidity and mortality, and understanding factors that accelerate or delay conduction system disease could help to identify preventive and therapeutic strategies. Antifibrotic and anti-inflammatory properties of angiotensin-converting enzyme inhibitors and treatment for hyperlipidemia may reduce the risk for incident conduction system disease. OBJECTIVE To identify the effect of pharmacologic therapy randomization and clinical risk factors on the incidence of conduction system disease. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) investigation acquired data from 623 North American centers. A total of 21 004 ambulatory individuals 55 years or older with hypertension and at least 1 other cardiac risk factor were included in the analysis. INTERVENTIONS Participants were randomly assigned to receive amlodipine besylate, lisinopril, or chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin sodium vs usual care. MAIN OUTCOMES AND MEASURES An electrocardiogram (ECG) was obtained at study enrollment and every 2 years of follow-up. The development of incident first-degree atrioventricular block, left anterior fascicular block, incomplete left bundle branch block (LBBB), LBBB, incomplete right bundle branch block (RBBB), RBBB, or intraventricular conduction delay was assessed by serial ECGs. RESULTS The 21 004 participants (11 758 men [56.0%]; 9246 women [44.0%]; mean [SD] age, 66.5 [7.3] years) underwent a mean (SD) follow-up of 5.0 (1.2) years. Among the 1114 participants who developed any conduction defect, 389 developed LBBB, 570 developed RBBB, and 155 developed intraventricular conduction delay. Compared with chlorthalidone, randomization to lisinopril was associated with a significant 19% reduction in conduction abnormalities (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .01). Treatment with amlodipine, however, was not associated with a significant difference in conduction outcome events (HR, 0.94; 95% CI, 0.81-1.09; P = .42). Similarly, pravastatin treatment was not associated with a reduced adjusted risk for incident disease compared with usual hyperlipidemia treatment (HR, 1.13; 95% CI, 0.95-1.35; P = .18). Increased age (HR, 1.47; 95% CI, 1.34-1.63; P < .001), male sex (HR, 0.59; 95% CI, 0.50-0.73; P < .001), white race (HR, 0.59; 95% CI, 0.50-0.70; P < .001), diabetes (HR, 1.23; 95% CI, 1.07-1.42; P = .003), and left ventricular hypertrophy (HR, 3.20; 95% CI, 2.61-3.94; P < .001) were also independently associated with increased risk for conduction system disease. CONCLUSIONS AND RELEVANCE Incident conduction system disease is significantly reduced by lisinopril therapy and is independently associated with multiple clinical factors. Further studies are warranted to determine whether pharmacologic treatment affects conduction abnormality outcomes, including pacemaker implantation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000542.
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Affiliation(s)
- Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina3Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barry R Davis
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jared W Magnani
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jose-Miguel Yamal
- Department of Biostatistics, University of Texas School of Public Health, Houston
| | - Linda B Piller
- Department of Biostatistics, University of Texas School of Public Health, Houston
| | - L Julian Haywood
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory M Marcus
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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Dukes JW, Dewland TA, Vittinghoff E, Olgin JE, Pletcher MJ, Hahn JA, Gladstone RA, Marcus GM. Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws. BMJ 2016; 353:i2714. [PMID: 27301557 PMCID: PMC4908314 DOI: 10.1136/bmj.i2714] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the relation between alcohol consumption and heart disease by using differences in county level alcohol sales laws as a natural experiment. DESIGN Observational cohort study using differences in alcohol sales laws. SETTING Hospital based healthcare encounters in Texas, USA. POPULATION 1 106 968 patients aged 21 or older who were residents of "wet" (no alcohol restrictions) and "dry" (complete prohibition of alcohol sales) counties and admitted to hospital between 2005 and 2010, identified using the Texas Inpatient Research Data File. OUTCOME MEASURES Prevalent and incident alcohol misuse and alcoholic liver disease were used for validation analyses. The main cardiovascular outcomes were atrial fibrillation, acute myocardial infarction, and congestive heart failure. RESULTS Residents of wet counties had a greater prevalence and incidence of alcohol misuse and alcoholic liver disease. After multivariable adjustment, wet county residents had a greater prevalence (odds ratio 1.05, 95% confidence interval 1.01 to 1.09; P=0.007) and incidence (hazard ratio 1.07, 1.01 to 1.13; P=0.014) of atrial fibrillation, a lower prevalence (odds ratio 0.83, 0.79 to 0.87; P<0.001) and incidence (hazard ratio 0.91, 0.87 to 0.99; P=0.019) of myocardial infarction, and a lower prevalence (odds ratio 0.87, 0.84 to 0.90; P<0.001) of congestive heart failure. Conversion of counties from dry to wet resulted in statistically significantly higher rates of alcohol misuse, alcoholic liver disease, atrial fibrillation, and congestive heart failure, with no detectable difference in myocardial infarction. CONCLUSIONS Greater access to alcohol was associated with more atrial fibrillation and less myocardial infarction and congestive heart failure, although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.
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Affiliation(s)
- Jonathan W Dukes
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Mark J Pletcher
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Rachel A Gladstone
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Ave, M-1180B, Box 0124, San Francisco, CA 94143-0124, USA
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Roberts JD, Dewland TA, Glidden DV, Hoffmann TJ, Arking DE, Chen LY, Psaty BM, Olgin JE, Alonso A, Heckbert SR, Marcus GM. Impact of genetic variants on the upstream efficacy of renin-angiotensin system inhibitors for the prevention of atrial fibrillation. Am Heart J 2016; 175:9-17. [PMID: 27179719 DOI: 10.1016/j.ahj.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renin-angiotensin system (RAS) inhibition via angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers may reduce the risk of developing atrial fibrillation (AF) in certain populations, but the evidence is conflicting. Recent genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with AF, potentially identifying clinically relevant subtypes of the disease. We sought to investigate the impact of carrier status of 9 AF-associated SNPs on the efficacy of RAS inhibition for the primary prevention of AF. METHODS We performed SNP-RAS inhibitor interaction testing with unadjusted and adjusted Cox proportional hazards models using a discovery (Cardiovascular Health Study) and a replication (Atherosclerosis Risk in Communities) cohort. Additive genetic models were used for the SNP analyses, and 2-tailed P values <.05 were considered statistically significant. RESULTS Among 2,796 Cardiovascular Health Study participants, none of the 9 a priori identified candidate SNPs exhibited a significant SNP-drug interaction. Two of the 9 SNPs, rs2106261 (16q22) and rs6666258 (1q21), revealed interaction relationships that neared statistical significance (with point estimates in the same direction for angiotensin-converting enzyme inhibitor only and angiotensin II receptor blocker only analyses), but neither association could be replicated among 8,604 participants in Atherosclerosis Risk in Communities. CONCLUSIONS Our study failed to identify AF-associated SNP genetic subtypes of AF that derive increased benefit from upstream RAS inhibition for AF prevention. Future studies should continue to investigate the impact of genotype on the response to AF treatment strategies in an effort to develop personalized approaches to therapy and prevention.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Thomas A Dewland
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - David V Glidden
- Departments of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Thomas J Hoffmann
- Departments of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lin Y Chen
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA; Departments of Medicine and Health Services, University of Washington, Seattle, WA; Group Health Research Institute, Group Health, Seattle, WA
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA; Group Health Research Institute, Group Health, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
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Dewland TA, Bibbins-Domingo K, Lin F, Vittinghoff E, Foster E, Ogunyankin KO, Lima JA, Jacobs DR, Hu D, Burchard EG, Marcus GM. Racial Differences in Left Atrial Size: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. PLoS One 2016; 11:e0151559. [PMID: 26985672 PMCID: PMC4795666 DOI: 10.1371/journal.pone.0151559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/01/2016] [Indexed: 01/19/2023] Open
Abstract
Whites have an increased risk of atrial fibrillation (AF) compared to Blacks. The mechanism underlying this association is unknown. Left atrial (LA) size is an important AF risk factor, and studies in older adults suggest Whites have larger LA diameters. However, because AF itself causes LA dilation, LA size differences may be due to greater subclinical AF among older Whites. We therefore assessed for racial differences in LA size among young adults at low AF risk. The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled White and Black participants between 18 and 30 years of age. LA diameter was measured in a subset of participants using echocardiography at Year 5 (n = 4,201) and Year 25 (n = 3,373) of follow up. LA volume was also assessed at Year 5 (n = 2,489). Multivariate linear regression models were used to determine the adjusted association between race and LA size. In unadjusted analyses, mean LA diameter was significantly larger among Blacks compared to Whites both at Year 5 (35.5 ± 4.8 mm versus 35.1 ± 4.5 mm, p = 0.01) and Year 25 (37.4 ± 5.1 mm versus 36.8 ± 4.9 mm, p = 0.002). After adjusting for demographics, comorbidities, and echocardiographic parameters, Whites demonstrated an increased LA diameter (0.7 mm larger at Year 5, 95% CI 0.3-1.1, p<0.001; 0.6 mm larger at Year 25, 95% CI 0.3-1.0, p<0.001). There was no significant association between race and adjusted Year 5 LA volume. In conclusion, in a young, well-characterized cohort, the larger adjusted LA diameter among White participants suggests inherent differences in atrial structure may partially explain the higher risk of AF in Whites. The incongruent associations between race, LA diameter, and LA volume suggest that LA geometry, rather than size alone, may have implications for AF risk.
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Affiliation(s)
- Thomas A. Dewland
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Elyse Foster
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | - Joao A. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, United States of America
| | - David R. Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Donglei Hu
- Department of Medicine, Institute for Human Genetics, University of California San Francisco, San Francisco, California, United States of America
| | - Esteban G. Burchard
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Abstract
Background Premature cardiac contractions are associated with increased morbidity and mortality. Though experts associate premature atrial contractions (PACs) and premature ventricular contractions (PVCs) with caffeine, there are no data to support this relationship in the general population. As certain caffeinated products may have cardiovascular benefits, recommendations against them may be detrimental. Methods and Results We studied Cardiovascular Health Study participants with a baseline food frequency assessment, 24‐hour ambulatory electrocardiography (Holter) monitoring, and without persistent atrial fibrillation. Frequencies of habitual coffee, tea, and chocolate consumption were assessed using a picture‐sort food frequency survey. The main outcomes were PACs/h and PVCs/hour. Among 1388 participants (46% male, mean age 72 years), 840 (61%) consumed ≥1 caffeinated product per day. The median numbers of PACs and PVCs/h and interquartile ranges were 3 (1–12) and 1 (0–7), respectively. There were no differences in the number of PACs or PVCs/h across levels of coffee, tea, and chocolate consumption. After adjustment for potential confounders, more frequent consumption of these products was not associated with ectopy. In examining combined dietary intake of coffee, tea, and chocolate as a continuous measure, no relationships were observed after multivariable adjustment: 0.48% fewer PACs/h (95% CI −4.60 to 3.64) and 2.87% fewer PVCs/h (95% CI −8.18 to 2.43) per 1‐serving/week increase in consumption. Conclusions In the largest study to evaluate dietary patterns and quantify cardiac ectopy using 24‐hour Holter monitoring, we found no relationship between chronic consumption of caffeinated products and ectopy.
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Affiliation(s)
- Shalini Dixit
- University of California, San Francisco, San Francisco, CA (S.D., J.W.D., E.V., G.M.M.)
| | - Phyllis K Stein
- Washington University School of Medicine, St. Louis, MO (P.K.S.)
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (T.A.D.)
| | - Jonathan W Dukes
- University of California, San Francisco, San Francisco, CA (S.D., J.W.D., E.V., G.M.M.)
| | - Eric Vittinghoff
- University of California, San Francisco, San Francisco, CA (S.D., J.W.D., E.V., G.M.M.)
| | - Susan R Heckbert
- University of Washington and Group Health Research Institute, Seattle, WA (S.R.H.)
| | - Gregory M Marcus
- University of California, San Francisco, San Francisco, CA (S.D., J.W.D., E.V., G.M.M.)
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