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Diaz JC, Tedrow UB, Duque M, Aristizabal J, Braunstein ED, Marin J, Niño C, Bastidas O, Lopez Cabanillas N, Koplan BA, Hoyos C, Matos CD, Hincapie D, Velasco A, Steiger NA, Kapur S, Tadros TM, Zei PC, Sauer WH, Romero JE. Left Bundle Branch Pacing vs Left Ventricular Septal Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2024; 10:295-305. [PMID: 38127008 DOI: 10.1016/j.jacep.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined. OBJECTIVES The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT. METHODS In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters. RESULTS A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP. CONCLUSIONS In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.
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Affiliation(s)
- Juan C Diaz
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón Uribe, Medellin, Colombia
| | | | - Bruce A Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Steiger N, Qian PC, Foley G, Bomma T, Kreidieh O, Whitaker J, Thurber CJ, Koplan BA, Tadros TM, Kapur S, Zei PC, Tedrow UB, Romero J, Sauer WH. Measured temperatures using uninterrupted and interrupted sequences of radiofrequency applications in a phantom gel model: implications for esophageal injury. J Interv Card Electrophysiol 2023; 66:1925-1928. [PMID: 36114382 DOI: 10.1007/s10840-022-01373-z] [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: 08/17/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nathaniel Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Pierre C Qian
- Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Grace Foley
- University of Massachusetts, Lowell and Amherst, Amherst, MA, USA
| | - Tarun Bomma
- University of Massachusetts, Lowell and Amherst, Amherst, MA, USA
| | - Omar Kreidieh
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - John Whitaker
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Clinton J Thurber
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Jorge Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
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Diaz JC, Sauer WH, Duque M, Koplan BA, Braunstein ED, Marín JE, Aristizabal J, Niño CD, Bastidas O, Martinez JM, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Kapur S, Tadros TM, Martin DT, Zei PC, Tedrow UB, Romero JE. Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization. JACC Clin Electrophysiol 2023; 9:1568-1581. [PMID: 37212761 DOI: 10.1016/j.jacep.2023.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Juan Manuel Martinez
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Romero JE, Diaz JC, Zei PC, Steiger NA, Koplan BA, Matos CD, Alviz I, Hoyos C, Marín JE, Duque M, Aristizabal J, Kapur S, Nyman CB, Niño CD, Bastidas O, Tadros TM, Martin DT, Tedrow UB, Sauer WH. Sustained Apnea for Epicardial Access With Right Ventriculography: The SAFER Epicardial Approach. JACC Clin Electrophysiol 2023; 9:1487-1499. [PMID: 37486280 DOI: 10.1016/j.jacep.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Epicardial access (EA) has emerged as an increasingly important approach for the treatment of ventricular arrhythmias and to perform other interventional cardiology procedures. EA is frequently underutilized because the current approach is challenging and carries a high risk of life-threatening complications. OBJECTIVE The purpose of this study was to determine the efficacy and safety of the SAFER (Sustained Apnea for Epicardial Access With Right Ventriculography) epicardial approach. METHODS Consecutive patients who underwent EA with the SAFER technique were included in this multicenter study. The primary efficacy outcome was the successful achievement of EA. The primary safety outcomes included right ventricular (RV) perforation, major hemorrhagic pericardial effusion (HPE), and bleeding requiring surgical intervention. Secondary outcomes included procedural characteristics and any complications. Our results were compared with those from previous studies describing other EA techniques to assess differences in outcomes. RESULTS A total of 105 patients undergoing EA with the SAFER approach from June 2021 to February 2023 were included. EA was used for ventricular tachycardia ablation in 98 patients (93.4%), left atrial appendage closure in 6 patients (5.7%), and phrenic nerve displacement in 1 patient (0.9%). EA was successful in all subjects (100%). The median time to EA was 7 minutes (IQR: 5-14 minutes). No cases of RV perforation, HPE, or need of surgical intervention were observed in this cohort. Comparing our results with previous studies about EA, the SAFER epicardial approach resulted in a significant reduction in major pericardial bleeding. CONCLUSIONS The SAFER epicardial approach is a simple, efficient, effective, and low-cost technique easily reproducible across multiple centers. It is associated with lower complication rates than previously reported techniques for EA.
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Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Juan C Diaz
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Paul C Zei
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Marín
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cesar D Niño
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sharma E, Wang W, Tadros TM, Koplan BA, Zei PC, Maytin M, Romero J, Tedrow U, Sauer W, Kapur S. Effect of Extracellular Matrix Envelopes on Shock Impedance in Patients With Subcutaneous Implantable Cardiac Defibrillators. JACC Clin Electrophysiol 2022; 9:701-703. [DOI: 10.1016/j.jacep.2022.10.008] [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: 07/27/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022]
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Rodriguez D, Thurber CJ, Romero JE, Sauer WH, Kapur S, Tadros TM, Koplan BA. Device Pocket Antibiotic Irrigation Provides No CIED-Pocket Infection Prophylaxis Advantage Compared to Normal Saline. JACC Clin Electrophysiol 2022; 8:1319-1320. [DOI: 10.1016/j.jacep.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
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Kreidieh O, Thurber CJ, Whitaker J, Steiger N, Batnyam U, Chang D, Kapur S, Tadros TM, Koplan BA, Tedrow UB, Sauer WH, Zei PC. CA-530-01 USE THE FORCE: ADEQUATE CATHETER CONTACT FORCE IS CRITICAL FOR HIGH QUALITY LESIONS GUIDED BY ABLATION INDEX. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.602] [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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Shea JB, Sauer WH, Sauer K, Sharma E, Chang D, Batnyam U, Kapur S, Tadros TM, Tedrow UB, Zei PC, Piazza G, Fanikos J, Romero J, Antman E, Koplan BA. PO-644-08 VIRTUAL ATRIAL FIBRILLATION PATIENT EDUCATION LED BY ALLIED PROFESSIONALS IS PREFERRED BY PATIENTS AND LEADS TO HIGH PARTICIPATION RATES AND IMPROVED VIRTUAL CARE ACCEPTANCE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whitaker J, Kreidieh O, Bredfeldt J, Thurber CJ, Steiger N, Chang D, Sharma E, Batnyam U, Martin DT, Kapur S, Tadros TM, Koplan BA, Mak R, Martin N, Tedrow UB, Zei PC, Sauer WH. PO-632-06 REAL-TIME EX-VIVO RADIOTHERAPY IMPACTS ON PACEMAKER FUNCTION ARE MINIMAL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rousseau LA, Brady ME, Taylor LM, Andrade T, Bourque N, Ann Sifrig L, Hoskins P, Turner M, Batnyam U, Chang D, Sharma E, Kapur S, Tadros TM, Tedrow UB, Zei PC, Sauer WH, Bruce A. Koplan. AP-519-02 THERE’S NO PLACE LIKE HOME: PROTOCOLIZED SAME DAY DISCHARGE AFTER ATRIAL FIBRILLATION ABLATION OVERSEEN BY ALLIED HEALTH PROFESSIONALS IS ASSOCIATED WITH IMPROVED SUCCESS AND EFFICIENCY OVER TIME. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma E, Kreidieh O, Batnyam U, Chang D, Thurber CJ, Whitaker J, Steiger N, Martin DT, Tadros TM, Kapur S, Tedrow UB, Koplan BA, Zei PC, Sauer WH. PO-715-02 POST ABLATION QT INTERVAL AND HEART RATE INCREASES ARE ASSOCIATED WITH IMPROVED OUTCOMES AFTER PULMONARY VEIN ISOLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sauer K, Chang D, Kreidieh O, Miller AL, Tedrow UB, Zei PC, Tadros TM, Kapur S, Maytin M, Batnyam U, Sharma E, Thurber CJ, Whitaker J, Shea JB, Steiger N, Comeiro K, Rousseau LA, Andrade T, Martin DT, Romero J, Harris L, Hoskins P, Sauer WH, Koplan BA. PO-706-01 A WIDENING DIGITAL DIVIDE: UTILIZATION OF VIRTUAL VISITS IS REDUCED OVER TIME FOR BLACK AND HISPANIC COMMUNITIES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1081] [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: 11/15/2022]
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Batnyam U, Chang D, Sharma E, Whitaker J, Kreidieh O, Thurber CJ, Steiger N, Kapur S, Zei PC, Tadros TM. PO-635-05 VENTRICULAR ARRHYTHMIA ABLATION WITHOUT FLUOROSCOPIC UTILIZATION - A SINGLE CENTER EXPERIENCE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Andrade T, Kapur S, Sauer WH, Miller AL, Koplan BA, Tedrow UB, McClennen S, Tadros TM, Maytin M, Zei PC, Martin DT, Rousseau LA, Sifrig LA, Bourque N, Brady ME, Taylor LM, Hoskins P, Turner M. PO-644-07 IMPLANTABLE LOOP RECORDER UTILIZATION IN PATIENTS WITH BREAST AUGMENTATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Steiger N, Khambhati J, Kreidieh O, Whitaker J, Thurber CJ, Sharma E, Chang D, Batnyam U, Kapur S, Martin DT, Tadros TM, Zei PC, Sauer WH, Koplan BA, Tedrow UB. PO-672-03 TWO FOR THE PRICE OF ONE: BIDIRECTIONAL VENTRICULAR TACHYCARDIA FROM THE ANTEROLATERAL PAPILLARY MUSCLE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koplan BA, Sauer K, Miller AL, Chang D, Sharma E, Batnyam U, Kapur S, Tadros TM, Tedrow UB, Martin DT, Zei PC, Antman E, Sauer WH. PO-661-08 VIRTUAL CARE IN CARDIAC ELECTROPHYSIOLOGY HAS LASTING IMPACT AND IS USED MORE OFTEN COMPARED TO OTHER CARDIOVASCULAR SUBSPECIALTIES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kreidieh O, Whitaker J, Thurber CJ, Amit M, Tsoref L, Goldberg S, Yungher D, Steiger N, Tadros TM, Kapur S, Koplan BA, Tedrow UB, Sauer WH, Zei PC. Utility of a Cloud Based Lesion Data Collection Software to Record, Monitor, and Analyze an Ablation Strategy. Heart Rhythm O2 2022; 3:319-322. [PMID: 35734303 PMCID: PMC9207725 DOI: 10.1016/j.hroo.2022.03.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Omar Kreidieh
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Whitaker
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clinton J. Thurber
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mati Amit
- Biosense Webster Ltd., Haifa Technology Center, Haifa Israel
| | - Liat Tsoref
- Biosense Webster Ltd., Haifa Technology Center, Haifa Israel
| | | | - Don Yungher
- Biosense Webster Ltd., Haifa Technology Center, Haifa Israel
| | - Nathaniel Steiger
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas M. Tadros
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sunil Kapur
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce A. Koplan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha B. Tedrow
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H. Sauer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C. Zei
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Address reprint requests and correspondence: Dr Paul C. Zei, Cardiology Department, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115.
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Sifrig LA, Taylor LM, Rousseau LA, Rubins DM, Miller AL, Martin DT, Kapur S, Tadros TM, Hoskins P, Antonellis M, Bourque N, Andrade T, Turner M. B-PO03-005 AUTOMATING AND EXPEDITING IDENTIFICATION OF CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.481] [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: 11/29/2022]
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Thurber CJ, Whitaker J, Steiger N, Kreidieh O, Dherange PA, Halawa A, Zei PC, Tadros TM, Koplan BA, Martin DT, Sauer WH, Tedrow UB, Kapur S. B-PO02-213 INTRACARDIAC ECHO MAY FACILITATE EPICARDIAL SUBSTRATE CHARACTERIZATION AFTER NORMAL BIPOLAR AND UNIPOLAR ENDOCARDIAL VOLTAGE MAPS IN VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.465] [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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Whitaker, BCH J, Williams SE, Tzou WS, Kreidieh O, Thurber CJ, Halawa A, Dherange PA, Martin DT, Kapur S, Tadros TM, Zei PC, Koplan BA, Tedrow UB, Sauer WH. B-PO02-175 ENDOCARDIAL UNIPOLAR VOLTAGE UNDERESTIMATES INTRAMYOCARDIAL AND EPICARDIAL SCAR IN PATIENTS WITH CARDIAC SARCOIDOSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.428] [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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Halawa A, Qian PC, Steiger N, Kreidieh O, Dherange PA, Whitaker J, Thurber CJ, Tadros TM, Koplan B, Zei PC, Kapur S, Sauer WH, Vlassakov K, Janfaza D, Tedrow UB. B-PO05-168 BEDSIDE PERCUTANEOUS SYMPATHETIC BLOCK IS SAFE AND EFFECTIVE IN REFRACTORY ELECTRICAL STORM AS A BRIDGE TO ADVANCED THERAPIES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1087] [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: 11/29/2022]
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Kreidieh O, Sauer WH, Dherange PA, Halawa A, Steiger N, Thurber CJ, Whitaker J, Tadros TM, Kapur S, Tedrow UB, Zei PC, Antman EM, Koplan BA. B-PO02-085 OBESITY IS ASSOCIATED WITH INCREASED COMORBIDITIES, BUT NOT ADVERSE OUTCOMES IN PATIENTS UNDERGOING ABLATION FOR PERSISTENT AF. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whitaker J, Steiger N, Thurber CJ, Kreidieh O, Dherange PA, Halawa A, Martin DT, Tadros TM, Kapur S, Koplan BA, Zei PC, Sauer WH, Tedrow UB. B-PO03-181 LVOT DILATATION IS ASSOCIATED WITH REDUCED PERI-AORTIC BIPOLAR VOLTAGE IN PATIENTS UNDERGOING VT ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.654] [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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Kreidieh O, Thurber CJ, Whitaker J, Amit M, Goldberg S, Harel O, Yungher D, Steiger N, Halawa A, Dherange PA, Sauer WH, Tadros TM, Kapur S, Koplan BA, Martin DT, Tedrow UB, Zei PC. B-PO03-110 ANATOMIC LESION LOCATION DURING PULMONARY VEIN ISOLATION IMPACTS ABLATION PARAMETERS AND INDEPENDENTLY PREDICTS IMPEDANCE CHANGE AND REGIONAL FIRST PASS ISOLATION: AN ANALYSIS OF 8395 LESIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.584] [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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Halawa A, Dherange PA, Whitaker J, Steiger N, Thurber CJ, Kreidieh O, Tadros TM, Koplan BA, Sauer WH, Zei PC, Tedrow UB, Kapur S. B-PO02-210 INFERRED INTRAMURAL ACTIVATION FACILITATED BY EPICARDIAL AND ENDOCARDIAL ACTIVATION MAPPING DURING VENTRICULAR TACHYCARDIA IN LAMIN CARDIOMYOPATHY. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.462] [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: 11/29/2022]
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Thurber CJ, Whitaker J, Kreidieh O, Halawa A, Dherange PA, Steiger N, Amit M, Goldberg S, Harel O, Yungher D, Amos Y, Koplan BA, Tadros TM, Martin DT, Kapur S, Tedrow UB, Sauer WH, Zei PC. B-PO03-101 ABLATION DELIVERY PARAMETERS PREDICT IMPEDANCE DECREASE DURING ATRIAL FIBRILLATION ABLATION VIA A CLOUD ARTIFICIAL INTELLIGENCE SYSTEM ANALYSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dherange PA, Thurber C, Halawa A, Kreidieh O, Whitaker J, Steiger N, Martin DT, Zei P, Koplan B, Tadros TM, Kapur S, Tedrow UB, Sauer WH. B-PO02-012 USE OF STORED DEFIBRILLATOR ELECTROGRAMS AND EXTRA STIMULUS MAPPING FOR IDENTIFICATION OF VENTRICULAR ECTOPY TRIGGERING VENTRICULAR FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.269] [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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Steiger N, Foley G, Qian PC, Thurber CJ, Whitaker J, Dherange PA, Halawa A, Kreidieh O, Zei PC, Tedrow UB, Kapur S, Koplan BA, Martin DT, Tadros TM, Sauer WH. B-PO03-109 ACIDIC IRRIGANT INCREASES SURFACE AREA OF RADIOFREQUENCY ABLATION LESIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.583] [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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Whitaker J, Kreidieh O, Thurber CJ, Amit M, Goldberg S, Harel O, Don Yungher YA, Steiger N, Dherange PA, Halawa A, Tadros TM, Kapur S, Koplan BA, Martin DT, Tedrow UB, Sauer WH, Zei PC. B-PO03-105 CLOUD-BASED LESION ANALYSIS WITH CARTONET IDENTIFIES CATHETER STABILITY AS A KEY FACTOR PROMOTING ACUTE FIRST PASS PULMONARY VEIN SEGMENT ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.579] [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: 11/15/2022]
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Steiger N, Foley G, Qian PC, Kreidieh O, Halawa A, Dherange PA, Whitaker J, Thurber CJ, Kapur S, Tadros TM, Koplan BA, Zei PC, Martin DT, Tedrow UB, Sauer WH. B-AB12-01 THE PRESENCE OF UNINSULATED METALLIC ELECTRODES ON AN ESOPHAGEAL TEMPERATURE PROBE IS ASSOCIATED WITH INCREASED TEMPERATURES WHEN EXPOSED TO NEARBY RADIOFREQUENCY ELECTRICAL CURRENT. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.070] [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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Lubitz SA, Yin X, Rienstra M, Schnabel RB, Walkey AJ, Magnani JW, Rahman F, McManus DD, Tadros TM, Levy D, Vasan RS, Larson MG, Ellinor PT, Benjamin EJ. Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. Circulation 2015; 131:1648-55. [PMID: 25769640 DOI: 10.1161/circulationaha.114.014058] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [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] [Received: 08/15/2014] [Accepted: 03/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited. METHODS AND RESULTS In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]). CONCLUSIONS AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
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Affiliation(s)
- Steven A Lubitz
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA.
| | - Xiaoyan Yin
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Michiel Rienstra
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Renate B Schnabel
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Allan J Walkey
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Jared W Magnani
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Faisal Rahman
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - David D McManus
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Thomas M Tadros
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Daniel Levy
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Ramachandran S Vasan
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Martin G Larson
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Patrick T Ellinor
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
| | - Emelia J Benjamin
- From Cardiovascular Research Center (S.A.L., P.T.E.) and Cardiac Arrhythmia Service (S.A.L., P.T.E.), Massachusetts General Hospital, Boston; Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (X.Y., J.W.M., D.L., R.S.V., M.G.L., E.J.B.); Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands (M.R.); Department of General and Interventional Cardiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany (R.B.S.); Pulmonary Center and Section of Pulmonary and Critical Care Medicine (A.J.W.), Section of Cardiovascular Medicine (J.W.M., R.S.V., E.J.B.), and Section of Preventive Medicine (R.S.V., E.J.B.), Department of Medicine, Boston University School of Medicine, MA; Department of Medicine, Boston University Medical Center, MA (F.R.); Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester (D.D.M.); Sutter Medical Group, Sacramento, CA (T.M.T.); Population Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.); Department of Mathematics and Statistics, Boston University, MA (M.G.L.); and Departments of Biostatistics (M.G.L.) and Epidemiology (E.J.B., R.S.V.), Boston University School of Public Health, MA
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Nagashima K, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Tokuda M, Inada K, Reichlin TR, Ng JP, Barbhaiya CR, Nof E, Tadros TM, Stevenson WG. Reentrant Ventricular Tachycardia Originating From the Periaortic Region in the Absence of Overt Structural Heart Disease. Circ Arrhythm Electrophysiol 2014; 7:99-106. [DOI: 10.1161/circep.113.000870] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
Background—
In the absence of overt structural heart disease, most left ventricular outflow tract ventricular tachycardias (VTs) have a focal origin and are benign. We hypothesized that multiple morphologies (MMs) of inducible left ventricular outflow tract VT may indicate a scar-related VT that can mimic idiopathic VT.
Methods and Results—
Of 54 consecutive patients referred for ablation of sustained outflow tract VT without overt structural heart disease, 24 had left ventricular outflow tract VT, 10 had MM VT, and 14 had a single VT (SM). The MM group were older (70.3±4.3 versus 53.9±15.9 years;
P
=0.004), had more hypertension (100% versus 29%;
P
=0.0006), and had longer PR intervals and QRS durations compared with the SM group. In contrast to the SM group, the MM group VTs had features consistent with reentry, including induction by programmed stimulation without isoproterenol, entrainment in some, and abnormal electrograms in the periaortic area. Periaortic region voltages suggested scar in the MM group, but not in the SM group. MRI in 2 MM patients was consistent with scar, but not in 10 SM patients. Longer radiofrequency applications were required in the MM group than in the SM group. At a median follow-up of 9.7 (3.0–32.0) months, recurrences tended to be more frequent in the MM group than in the SM group (70% versus 22%;
P
=0.07).
Conclusions—
VTs from small regions of periaortic scar can mimic idiopathic VT but are suggested by multiple VT morphologies and are more difficult to ablate. Whether these patients are at greater risk, as feared for other scar-related VTs, warrants further study.
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Affiliation(s)
- Koichi Nagashima
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Usha B. Tedrow
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Bruce A. Koplan
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Roy M. John
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Laurence M. Epstein
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Michifumi Tokuda
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Keiichi Inada
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Tobias R. Reichlin
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Justin P. Ng
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Chirag R. Barbhaiya
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Eyal Nof
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Thomas M. Tadros
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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Reichlin T, Knecht S, Lane C, Kühne M, Nof E, Chopra N, Tadros TM, Reddy VY, Schaer B, John RM, Osswald S, Stevenson WG, Sticherling C, Michaud GF. Initial impedance decrease as an indicator of good catheter contact: insights from radiofrequency ablation with force sensing catheters. Heart Rhythm 2013; 11:194-201. [PMID: 24177370 DOI: 10.1016/j.hrthm.2013.10.048] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [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: 07/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Good catheter-tissue contact force (CF) is critical for transmural and durable lesion formation during radiofrequency (RF) ablation but is difficult to assess in clinical practice. Tissue heating during RF application results in an impedance decrease at the catheter tip. OBJECTIVE The purpose of this study was to correlate achieved CF and initial impedance decreases during atrial fibrillation (AF) ablation. METHODS We correlated achieved CF and initial impedance decreases in patients undergoing ablation for AF with two novel open-irrigated CF-sensing RF catheters (Biosense Webster SmartTouch, n = 647 RF applications; and Endosense TactiCath, n = 637 RF applications). We then compared those impedance decreases to 691 RF applications with a standard open-irrigated RF catheter (Biosense Webster ThermoCool). RESULTS When RF applications with the CF-sensing catheters were analyzed according to an achieved average CF <5 g, 5-10 g, 10-20 g, and >20 g, the initial impedance decreases during ablation were larger with greater CF. Corresponding median values at 20 seconds were 5 Ω (interquartile range [IQR] 2-7), 8 Ω (4-11), 10 Ω (7-16), and 14 Ω (10-19) with the SmartTouch and n/a, 4 Ω (0-10), 8 Ω (5-12), and 13 Ω (8-18) with the TactiCath (P <.001 between categories for both catheters). When RF applications with the SmartTouch (CF-sensing catheter, median achieved CF 12 g) and ThermoCool (standard catheter) were compared, the initial impedance decrease was significantly greater in the CF-sensing group with median decreases of 10 Ω (6-14 Ω) vs 5 Ω (2-10 Ω) at 20 seconds (P <.001 between catheters). CONCLUSION The initial impedance decrease during RF applications in AF ablations is larger when greater catheter contact is achieved. Monitoring of the initial impedance decrease is a widely available indicator of catheter contact and may help to improve formation of durable ablation lesions.
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Affiliation(s)
- Tobias Reichlin
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; University Hospital, Basel, Switzerland.
| | | | - Christopher Lane
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Eyal Nof
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Nagesh Chopra
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Thomas M Tadros
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, The Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | | | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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34
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Schnabel RB, Rienstra M, Sullivan LM, Sun JX, Moser CB, Levy D, Pencina MJ, Fontes JD, Magnani JW, McManus DD, Lubitz SA, Tadros TM, Wang TJ, Ellinor PT, Vasan RS, Benjamin EJ. Risk assessment for incident heart failure in individuals with atrial fibrillation. Eur J Heart Fail 2013; 15:843-9. [PMID: 23594831 DOI: 10.1093/eurjhf/hft041] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a strong risk factor for heart failure (HF); HF onset in patients with AF is associated with increased morbidity and mortality. Risk factors that predict HF in individuals with AF in the community are not well established. METHODS AND RESULTS We examined clinical variables related to the 10-year incidence of HF in 725 individuals (mean 73.3 years, 45% women) with documented AF in the Framingham Heart Study. Event rates for incident HF (n = 161, 48% in women) were comparable in women (4.30 per 100 person-years) and men (3.34 per 100 person-years). Age, body mass index, ECG LV hypertrophy, diabetes, significant murmur, and history of myocardial infarction were positively associated with incident HF in multivariable models (C-statistic 0.71; 95% confidence interval 0.67-0.75). We developed a risk algorithm for estimating absolute risk of HF in AF patients with good model fit and calibration (adjusted calibration χ2 statistic 7.29; P(χ2) = 0.61). Applying the algorithm, 47.6% of HF events occurred in the top tertile in men compared with 13.1% in the bottom tertile, and 58.4% in women in the upper tertile compared with 18.2% in the lowest category. For HF type, women had a non-significantly higher incidence of HF with preserved EF compared with men. CONCLUSIONS We describe advancing age, LV hypertrophy, body mass index, diabetes, significant heart murmur, and history of myocardial infarction as clinical predictors of incident HF in individuals with AF. A risk algorithm may help identify individuals with AF at high risk of developing HF.
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Affiliation(s)
- Renate B Schnabel
- NHLBI's and Boston University's Framingham Heart Study, Framingham, MA, USA.
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35
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Tadros TM, Massaro JM, Rosito GA, Hoffmann U, Vasan RS, Larson MG, Keaney JF, Lipinska I, Meigs JB, Kathiresan S, O'Donnell CJ, Fox CS, Benjamin EJ. Pericardial fat volume correlates with inflammatory markers: the Framingham Heart Study. Obesity (Silver Spring) 2010; 18:1039-45. [PMID: 19875999 PMCID: PMC3014610 DOI: 10.1038/oby.2009.343] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [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] [Indexed: 11/08/2022]
Abstract
The objective of this study was to determine whether systemic inflammatory and oxidative stress marker concentrations correlate with pericardial and intrathoracic fat volumes. Participants of the Framingham Offspring Study (n = 1,175, 53% women, mean age 59 +/- 9 years) had pericardial and intrathoracic fat volumes assessed by multidetector computed tomography (MDCT) scans, and provided fasting blood and urine samples to measure concentrations of 14 inflammatory markers: C-reactive protein (CRP), interleukin-6, monocyte chemoattractant protein-1 (MCP-1), CD40 ligand, fibrinogen, intracellular adhesion molecule-1, lipoprotein-associated phospholipase A(2) activity and mass, myeloperoxidase, osteoprotegerin, P-selectin, tumor necrosis factor-alpha, tumor necrosis factor receptor-2, and urinary isoprostanes. Multivariable linear regression models were used to determine the association of log-transformed inflammatory marker concentrations with fat volumes, using fat volume as the dependent variable. Due to smaller sample sizes, models were rerun after adding urinary isoprostanes (n = 961) and tumor necrosis factor-alpha (n = 813) to the marker panel. Upon backward elimination, four of the biomarkers correlated positively with each fat depot: CRP (P < 0.0001 for each fat depot), interleukin-6 (P < 0.05 for each fat depot), MCP-1 (P < 0.01 for each fat depot), and urinary isoprostanes (P < 0.01 for pericardial fat; P < 0.001 for intrathoracic fat). Even after adjusting for BMI, waist circumference (WC), and abdominal visceral fat, CRP (P = 0.0001) and urinary isoprostanes (P = 0.02) demonstrated significant positive associations with intrathoracic fat, but not with pericardial fat. Multiple markers of inflammation and oxidative stress correlated with pericardial and intrathoracic fat volumes, extending the known association between regional adiposity and inflammation and oxidative stress.
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Affiliation(s)
- Thomas M Tadros
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Boston, Massachusetts, USA
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36
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Tadros TM, Klein MD, Shapira OM. Ascending aortic dilatation associated with bicuspid aortic valve: pathophysiology, molecular biology, and clinical implications. Circulation 2009; 119:880-90. [PMID: 19221231 DOI: 10.1161/circulationaha.108.795401] [Citation(s) in RCA: 295] [Impact Index Per Article: 19.7] [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: 12/24/2022]
Affiliation(s)
- Thomas M Tadros
- Division of Cardiology, Department of Internal Medicine, Boston University Medical Center, Boston, MA 02118, USA
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37
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Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB, Newton-Cheh C, Yamamoto JF, Magnani JW, Tadros TM, Kannel WB, Wang TJ, Ellinor PT, Wolf PA, Vasan RS, Benjamin EJ. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009; 373:739-45. [PMID: 19249635 PMCID: PMC2764235 DOI: 10.1016/s0140-6736(09)60443-8] [Citation(s) in RCA: 775] [Impact Index Per Article: 51.7] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial fibrillation contributes to substantial increases in morbidity and mortality. We aimed to develop a risk score to predict individuals' absolute risk of developing the condition, and to provide a framework for researchers to assess new risk markers. METHODS We assessed 4764 participants in the Framingham Heart Study from 8044 examinations (55% women, 45-95 years of age) undertaken between June, 1968, and September, 1987. Thereafter, participants were monitored for the first event of atrial fibrillation for a maximum of 10 years. Multivariable Cox regression identified clinical risk factors associated with development of atrial fibrillation in 10 years. Secondary analyses incorporated routine echocardiographic measurements (5152 participants, 7156 examinations) to reclassify the risk of atrial fibrillation and to assess whether these measurements improved risk prediction. FINDINGS 457 (10%) of the 4764 participants developed atrial fibrillation. Age, sex, body-mass index, systolic blood pressure, treatment for hypertension, PR interval, clinically significant cardiac murmur, and heart failure were associated with atrial fibrillation and incorporated in a risk score (p<0.05, except body-mass index p=0.08), clinical model C statistic 0.78 (95% CI 0.76-0.80). Risk of atrial fibrillation in 10 years varied with age: more than 15% risk was recorded in 53 (1%) participants younger than 65 years, compared with 783 (27%) older than 65 years. Additional incorporation of echocardiographic measurements to enhance the risk prediction model only slightly improved the C statistic from 0.78 (95% CI 0.75-0.80) to 0.79 (0.77-0.82), p=0.005. Echocardiographic measurements did not improve risk reclassification (p=0.18). INTERPRETATION From clinical factors readily accessible in primary care, our risk score could help to identify risk of atrial fibrillation for individuals in the community, assess technologies or markers for improvement of risk prediction, and target high-risk individuals for preventive measures.
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Affiliation(s)
- Renate B. Schnabel
- NHLBI’s Framingham Study, Framingham, MA
- Department of Medicine II, Johannes Gutenberg-University, Mainz, Germany
| | - Lisa M. Sullivan
- Boston University School of Public Health Department of Biostatistics, School of Medicine, Boston, MA
| | - Daniel Levy
- NHLBI’s Framingham Study, Framingham, MA
- Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Michael J. Pencina
- NHLBI’s Framingham Study, Framingham, MA
- Boston University School of Public Health Department of Biostatistics, School of Medicine, Boston, MA
| | - Joseph M. Massaro
- Boston University School of Public Health Department of Biostatistics, School of Medicine, Boston, MA
| | - Ralph B. D’Agostino
- Boston University School of Public Health Department of Biostatistics, School of Medicine, Boston, MA
- Department of Mathematics and Statistics, School of Medicine, Boston, MA
| | - Christopher Newton-Cheh
- NHLBI’s Framingham Study, Framingham, MA
- Cardiology Division, Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA
| | - Jennifer F. Yamamoto
- NHLBI’s Framingham Study, Framingham, MA
- Boston University School of Public Health Department of Biostatistics, School of Medicine, Boston, MA
| | | | | | - William B. Kannel
- NHLBI’s Framingham Study, Framingham, MA
- Department of Epidemiology, School of Medicine, Boston, MA
| | - Thomas J. Wang
- NHLBI’s Framingham Study, Framingham, MA
- Cardiology Division, Harvard Medical School, Boston, MA
| | - Patrick T. Ellinor
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA
| | - Philip A Wolf
- NHLBI’s Framingham Study, Framingham, MA
- Neurology Department, School of Medicine, Boston, MA
| | - Ramachandran S. Vasan
- NHLBI’s Framingham Study, Framingham, MA
- Public Health School, Whitaker Cardiovascular Institute, School of Medicine, Boston, MA
- Evans Memorial Medicine Department, School of Medicine, Boston, MA
- Cardiology Department, School of Medicine, Boston, MA
- Preventive Medicine Department, School of Medicine, Boston, MA
| | - Emelia J. Benjamin
- NHLBI’s Framingham Study, Framingham, MA
- Department of Epidemiology, School of Medicine, Boston, MA
- Public Health School, Whitaker Cardiovascular Institute, School of Medicine, Boston, MA
- Evans Memorial Medicine Department, School of Medicine, Boston, MA
- Cardiology Department, School of Medicine, Boston, MA
- Preventive Medicine Department, School of Medicine, Boston, MA
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