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Saluja D, Huang Z, Majumder J, Zeldin L, Yarmohammadi H, Biviano A, Wan EY, Ciaccio EJ, Hendon CP, Garan H. Automated prediction of isthmus areas in scar-related atrial tachycardias using artificial intelligence. J Cardiovasc Electrophysiol 2024. [PMID: 38738814 DOI: 10.1111/jce.16299] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Ablation of scar-related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well-suited to analyze the irregularly-structured data obtained in mapping procedures and may be used to identify potential isthmuses. METHODS Electroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off-line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas. RESULTS A total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group. CONCLUSION A GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets.
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Affiliation(s)
- Deepak Saluja
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ziyi Huang
- Department of Electrical Engineering, Fu Foundation School of Engineering and Applied Science (SEAS), Columbia University, New York, New York, USA
| | - Jonah Majumder
- Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science (SEAS), Columbia University, New York, New York, USA
| | - Lawrence Zeldin
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Angelo Biviano
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine Y Wan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Edward J Ciaccio
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Christine P Hendon
- Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science (SEAS), Columbia University, New York, New York, USA
| | - Hasan Garan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Shehadeh M, Wan EY, Biviano A, Mollazadeh R, Garan H, Yarmohammadi H. Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation. J Interv Card Electrophysiol 2024; 67:409-424. [PMID: 38038816 DOI: 10.1007/s10840-023-01708-4] [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: 10/28/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Esophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication. METHODS We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review. RESULTS A total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5-40%, cryoballoon 3-25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention. CONCLUSIONS Esophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.
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Affiliation(s)
- Malik Shehadeh
- Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami, FL, USA
| | - Elaine Y Wan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Angelo Biviano
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Reza Mollazadeh
- Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Garan
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, Irving Medical Center, New York, NY, USA.
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Redel-Traub G, Elnabawi YA, Gurel K, Sudesh S, Rosenbaum HR, Dizon J, Biviano A, Rubin GA, Wan EY, Garan H, Yarmohammadi H. Predictors of Transthoracic Impedance in Patients Who Underwent Elective Electrical Cardioversion. Am J Cardiol 2024; 213:146-150. [PMID: 38008349 DOI: 10.1016/j.amjcard.2023.11.040] [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: 08/29/2023] [Revised: 10/30/2023] [Accepted: 11/11/2023] [Indexed: 11/28/2023]
Abstract
Successful synchronized direct current cardioversion (DCCV) requires adequate current delivery to the heart. However, adequate current for successful DCCV has not yet been established. Transmyocardial current depends on 2 factors: input energy and transthoracic impedance (TTI). Although factors affecting TTI have been studied in animal models, factors affecting TTI in humans have not been well established. Herein, we explored the potential factors that affect TTI in humans. A retrospective review of patients who underwent DCCV at a large quaternary medical center between October 2019 and August 2021 was conducted. Pertinent clinical information, including demographics, echocardiography findings, laboratory findings, and body characteristics, was collected. Cardioversion details, including joules delivered and TTI, were recorded by the defibrillator for each patient's first shock. Predictors of thoracic impedance were assessed using regression analysis. A total of 220 patients (29% women) were included in the analysis; 143 of the patients (65%) underwent DCCV for atrial fibrillation and 77 (35%) underwent DCCV for atrial flutter. The mean impedance in our population was 73 ± 18 Ω. In a regression model with high impedance defined as the upper quartile of our cohort, body mass index (BMI), female sex, obstructive sleep apnea, and chronic kidney disease (all p values <0.05) were significantly associated with high impedance. According to a receiver operating characteristic analysis, BMI has a high predictive value for high impedance, with an area under the curve of 0.76. In conclusion, our study reveals that elevated BMI, female sex, sleep apnea, and chronic kidney disease were predictors of higher TTI. These factors may help determine the appropriate initial shock energy in patients who underwent DCCV for atrial fibrillation and flutter.
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Affiliation(s)
| | | | - Kursat Gurel
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Saurabh Sudesh
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Jou S, Liu Q, Gulsen MR, Biviano A, Wan EY, Dizon J, Saluja D, Garan H, Yarmohammadi H. Catheter ablation of typical atrial flutter improves cardiac chamber size and function. J Cardiovasc Electrophysiol 2024; 35:130-135. [PMID: 37975539 DOI: 10.1111/jce.16134] [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: 07/31/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) is one of the most common atrial arrhythmias involving the right atrium (RA) for which radiofrequency catheter ablation has been widely used as a therapy of choice. However, there is limited data on the effect of this intervention on cardiac size and function. METHODS A retrospective study was conducted on 468 patients who underwent ablation for CTI dependent typical AFL at a single institution between 2010 and 2019. After excluding patients with congenital or rheumatic heart disease, heart transplant recipients, or those without baseline echocardiogram, a total of 130 patients were included in the analysis. Echocardiographic data were analyzed at baseline before ablation, and at early follow-up within 1-year postablation. Follow-up echocardiographic data was available for 55 patients. RESULTS Of the 55 patients with CTI-AFL, the mean age was 64.2 ± 14.8 years old with 14.5% (n = 8) female. The average left ventricular ejection fraction (LVEF) significantly improved on follow-up echo (40.2 ± 16.9 to 50.4 ± 14.9%, p < .0001), of which 50% of patients had an improvement in LVEF of at least 10%. There was a significant reduction in left atrial volume index (82.74 ± 28.5 to 72.96 ± 28 mL/m2 , p = .008) and RA volume index (70.62 ± 25.6 to 64.15 ± 31 mL/m2 , p = .046), and a significant improvement in left atrial reservoir strain (13.04 ± 6.8 to 19.10 ± 7.7, p < .0001). CONCLUSIONS Patients who underwent CTI dependent AFL ablation showed an improvement in cardiac size and function at follow-up evaluation. While long-term results are still unknown, these findings indicate that restoration of sinus rhythm in patients with typical AFL is associated with improvement in atrial size and left ventricular function.
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Affiliation(s)
- Stephanie Jou
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Qi Liu
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mert R Gulsen
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jose Dizon
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deepak Saluja
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Abstract
BACKGROUND The current COVID-19 pandemic has led to many studies examining its arrhythmogenic effects. However, there are many other viruses that are capable of inducing arrhythmias that have not received as much attention. The objective of this study was to review common viruses and identify studies highlighting their arrhythmogenic effects. METHODS AND RESULTS In this review, we examined 15 viruses and the literature regarding their arrhythmogenic effects. The common mechanisms of action appear to be direct invasion of myocytes leading to immune mediated damage, infection of vascular endothelium, and alteration of cardiac ion channels. CONCLUSIONS This review highlights the growing evidence that supports the involvement of other viral infections in the development of arrhythmia. Physicians should be aware of these potentially life-threatening effects when caring for patients with these viruses, some of which are very common. Additional studies are required to better understand the complex mechanism and risk factors of cardiac arrhythmias in patients suffered from viral infections to determine whether the processes can be reversed or even prevented.
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Affiliation(s)
- Paul Y Lee
- Department of Medicine, Rutgers University, Newark, NJ, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brian E Scully
- Department of Medicine, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Cardiology and Cardiac Electrophysiology, Columbia University, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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DeFilippis EM, Batra J, Donald E, Rubin G, Jou S, Razzaq A, Wan EY, Garan H, Takeda K, Sayer G, Uriel N, Topkara VK, Biviano A, Yarmohammadi H. Long-Term Outcomes of Permanent Pacemaker Implantation in Bicaval Heart Transplant Recipients. JACC Clin Electrophysiol 2023; 9:1964-1971. [PMID: 37480861 DOI: 10.1016/j.jacep.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Permanent pacemakers (PPMs) may be necessary in up to 10% of patients after heart transplantation (HT). OBJECTIVES The purpose of this study was to evaluate long-term outcomes and clinical courses of heart transplant recipients who received PPM. METHODS All patients who required PPM after bicaval HT at Columbia University between January 2005 and December 2021 were included. Cases were compared to matched heart transplant recipients by age, sex, and year of transplantation. Patient and device characteristics including complications and device interrogations were reviewed. Outcomes of re-transplantation or graft failure/death were compared between groups. RESULTS Of 1,082 heart transplant recipients, 41 (3.8%) received PPMs. The median time from transplantation to PPM was 118 days (IQR: 18-920 days). The most common indications were sinus node dysfunction (60%, n = 25) and atrioventricular (AV) nodal disease (41.5%, n = 17). Post-implantation complications included pocket hematoma (n = 3), lead under-sensing (n = 2), and pocket infection requiring explant (n = 1). Rates of death and re-transplantation at 10 years post-HT were similar between groups. In multivariable analysis, after adjustment for mechanical circulatory support, pretransplantation amiodarone use, donor ischemic time and age, only older donor age was associated with increased risk of PPM implantation (P = 0.03). There was a significant decrease in PPM placement after 2018 (1.2% vs 4.4%, P = 0.02), largely driven by a decline in early PPM placement. There were no differences in mortality or need for re-transplantation between groups. CONCLUSIONS PPMs are implanted after HT for sinus and atrioventricular node dysfunctions with low incidence of device-related complications. Our study shows a decrease in PPM implantation after 2018, likely attributable to expectant management in the early postoperative period.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elena Donald
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephanie Jou
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ansa Razzaq
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
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Girvin ZP, Sweat AO, Kochav SM, Maurer MS, Dizon J, Wan EY, Biviano A, Garan H, Yarmohammadi H. Tafamidis and Incidence of Atrial Fibrillation in Transthyretin Amyloid Cardiomyopathy. JACC Clin Electrophysiol 2023; 9:586-587. [PMID: 36752478 DOI: 10.1016/j.jacep.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/06/2022] [Accepted: 11/09/2022] [Indexed: 01/20/2023]
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Koleck TA, Mitha S, Biviano A, Caceres BA, Corwin EJ, Goldenthal I, Creber RM, Turchioe MR, Hickey KT, Bakken S. Response to Mental Health of Cardiac Procedure Patients Should Be a Priority for All Healthcare Providers. J Cardiovasc Nurs 2023; 38:118-119. [PMID: 36752762 PMCID: PMC10042584 DOI: 10.1097/jcn.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | | | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, ColuAcmbia University Irving Medical Center
| | | | | | | | | | | | - Kathleen T. Hickey
- School of Nursing, Columbia University
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, ColuAcmbia University Irving Medical Center
| | - Suzanne Bakken
- School of Nursing, Columbia University
- Department of Biomedical Informatics, Columbia University
- Data Science Institute, Columbia University
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Yarmohammadi H, Wan EY, Biviano A, Garan H, Koehler JL, Stadler RW. Prolonged PR Interval and Incidence of Atrial Fibrillation, Heart Failure Admissions and Mortality in Patients with Implanted Cardiac Devices: A Real-World Survey. Heart Rhythm O2 2022; 4:171-179. [PMID: 36993911 PMCID: PMC10041089 DOI: 10.1016/j.hroo.2022.12.009] [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: 12/24/2022] Open
Abstract
Background Prolongation of the PR interval has long been considered a benign condition, particularly in the setting of nonstructural heart disease. Objective The purpose of this study was to investigate the effect of PR interval on various well-adjudicated cardiovascular outcomes using a large real-world population data of patients with implanted dual-chamber permanent pacemakers or implantable cardioverter-defibrillators. Methods PR intervals were measured during remote transmissions in patients with implanted permanent pacemakers or implantable cardioverter-defibrillators. Study endpoints (time to the first occurrence of AF, heart failure hospitalization [HFH], or death) were obtained between January 2007 and June 2019 from the deidentified Optum de-identified Electronic Health Record dataset. Results A total of 25,752 patients (age 69.3 ± 13.9 years; 58% male) were evaluated. The average intrinsic PR interval was 185 ± 55 ms. In the subset of 16,730 patients with available long-term device diagnostic data, a total of 2555 (15.3%) individuals developed AF during 2.59 ± 2.18 years of follow-up. The incidence of AF was significantly higher (up to 30%) in patients with a longer PR interval (ie, PR interval ≥270 ms; P < .05). Time-to-event survival analysis and multivariable analysis showed that PR interval ≥190 ms was significantly associated with higher incidence of AF, HFH, or HFH or death when compared with shorter PR intervals (P < .05 for all 3 parameters). Conclusion In a large real-world population of patients with implanted devices, PR interval prolongation was significantly associated with increased incidence of AF, HFH, or death.
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Tovia-Brodie O, Rav Acha M, Belhassen B, Gasperetti A, Schiavone M, Forleo GB, Guevara-Valdivia ME, Ruiz DV, Lellouche N, Hamon D, Castagno D, Bellettini M, De Ferrari GM, Laredo M, Carvès JB, Ignatiuk B, Pasquetto G, De Filippo P, Malanchini G, Pavri BB, Raphael C, Rivetti L, Mantovan R, Chinitz J, Harding M, Boriani G, Casali E, Wan EY, Biviano A, Macias C, Havranek S, Lazzerini PE, Canu AM, Zardini M, Conte G, Cano Ó, Casella M, Rudic B, Omelchenko A, Mathuria N, Upadhyay GA, Danon A, Schwartz AL, Maury P, Nakahara S, Goldenberg G, Schaerli N, Bereza S, Auricchio A, Glikson M, Michowitz Y. Implantation of cardiac electronic devices in active COVID-19 patients: Results from an international survey. Heart Rhythm 2022; 19:206-216. [PMID: 34710561 PMCID: PMC8547796 DOI: 10.1016/j.hrthm.2021.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) implantation rates as well as the clinical and procedural characteristics and outcomes in patients with known active coronavirus disease 2019 (COVID-19) are unknown. OBJECTIVE The purpose of this study was to gather information regarding CIED procedures during active COVID-19, performed with personal protective equipment, based on an international survey. METHODS Fifty-three centers from 13 countries across 4 continents provided information on 166 patients with known active COVID-19 who underwent a CIED procedure. RESULTS The CIED procedure rate in 133,655 hospitalized COVID-19 patients ranged from 0 to 16.2 per 1000 patients (P <.001). Most devices were implanted due to high-degree/complete atrioventricular block (112 [67.5%]) or sick sinus syndrome (31 [18.7%]). Of the 166 patients in the study survey, the 30-day complication rate was 13.9% and the 180-day mortality rate was 9.6%. One patient had a fatal outcome as a direct result of the procedure. Differences in patient and procedural characteristics and outcomes were found between Europe and North America. An older population (76.6 vs 66 years; P <.001) with a nonsignificant higher complication rate (16.5% vs 7.7%; P = .2) was observed in Europe vs North America, whereas higher rates of critically ill patients (33.3% vs 3.3%; P <.001) and mortality (26.9% vs 5%; P = .002) were observed in North America vs Europe. CONCLUSION CIED procedure rates during known active COVID-19 disease varied greatly, from 0 to 16.2 per 1000 hospitalized COVID-19 patients worldwide. Patients with active COVID-19 infection who underwent CIED implantation had high complication and mortality rates. Operators should take these risks into consideration before proceeding with CIED implantation in active COVID-19 patients.
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Affiliation(s)
- Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Bernard Belhassen
- Heart Institute, Hadassah University Hospital, Jerusalem, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alessio Gasperetti
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | | | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - David Valdeolivar Ruiz
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza IMSS, CDMX, Mexico City, México
| | - Nicolas Lellouche
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - David Hamon
- Henri Mondor University Hospital Cardiology Unit Creteil, Paris, France
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Matteo Bellettini
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città della Salute della Scienza" Hospital, University of Turin, Turin, Italy
| | - Mikael Laredo
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Baptiste Carvès
- AP. HP-Sorbonne Université, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Barbara Ignatiuk
- Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", Monselice, Italy
| | | | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Giovanni Malanchini
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo (BG), Italy
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Craig Raphael
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Luigi Rivetti
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Roberto Mantovan
- Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano (TV), Italy
| | - Jason Chinitz
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Melissa Harding
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, New York
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Carlos Macias
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
| | - Stepan Havranek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy, and Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio M Canu
- Azienda Ospedaliero-Universitaria Pisana, Cardiothoracic and Vascular Department, Cardiovascular Unit II, Pisa, Italy
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore", Parma, Italy
| | - Giulio Conte
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Óscar Cano
- Arrhythmia Section, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Valencia, Spain
| | - Michela Casella
- Clinic of Cardiology and Arrhythmology, University Hospital "Ospedali Riuniti", Department of Clinical, Special and Dental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Boris Rudic
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Germany, and German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Nilesh Mathuria
- Division of Cardiac Electrophysiology, Houston Methodist DeBakey Cardiology Associates, Houston, Texas
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Division of Cardiology, Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Asaf Danon
- Electrophysiology Unit, Cardiology Department, Carmel Medical Center, Haifa, Israel
| | - Arie Lorin Schwartz
- Cardiology Department, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Gustavo Goldenberg
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicolas Schaerli
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sergiy Bereza
- Cardiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Angelo Auricchio
- Electrophysiology Unit, Department of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
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11
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Batra J, Biviano A, Yarmohammadi H. Dancing Bundles With Stable Sinus Rhythm. Circulation 2022; 145:84-86. [PMID: 34965165 DOI: 10.1161/circulationaha.121.058218] [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)
- Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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12
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Grubb CS, Melki L, Wang DY, Peacock J, Dizon J, Iyer V, Sorbera C, Biviano A, Rubin DA, Morrow JP, Saluja D, Tieu A, Nauleau P, Weber R, Chaudhary S, Khurram I, Waase M, Garan H, Konofagou EE, Wan EY. Noninvasive localization of cardiac arrhythmias using electromechanical wave imaging. Sci Transl Med 2021; 12:12/536/eaax6111. [PMID: 32213631 DOI: 10.1126/scitranslmed.aax6111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/21/2020] [Indexed: 12/13/2022]
Abstract
Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high-frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.
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Affiliation(s)
- Christopher S Grubb
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Daniel Y Wang
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - James Peacock
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jose Dizon
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Vivek Iyer
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Carmine Sorbera
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - David A Rubin
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - John P Morrow
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Andrew Tieu
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Pierre Nauleau
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Salma Chaudhary
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Irfan Khurram
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Marc Waase
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA. .,Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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13
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Lee J, Turchioe MR, Creber RM, Biviano A, Hickey K, Bakken S. Phenotypes of engagement with mobile health technology for heart rhythm monitoring. JAMIA Open 2021; 4:ooab043. [PMID: 34131638 PMCID: PMC8200132 DOI: 10.1093/jamiaopen/ooab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Guided by the concept of digital phenotypes, the objective of this study was to identify engagement phenotypes among individuals with atrial fibrillation (AF) using mobile health (mHealth) technology for 6 months. Materials and Methods We conducted a secondary analysis of mHealth data, surveys, and clinical records collected by participants using mHealth in a clinical trial. Patterns of participants’ weekly use over 6 months were analyzed to identify engagement phenotypes via latent growth mixture model (LGMM). Multinomial logistic regression models were fitted to compute the effects of predictors on LGMM classes. Results One hundred twenty-eight participants (mean age 61.9 years, 75.8% male) were included in the analysis. Application of LGMM identified 4 distinct engagement phenotypes: “High-High,” “Moderate-Moderate,” “High-Low,” and “Moderate-Low.” In multinomial models, older age, less frequent afternoon mHealth use, shorter intervals between mHealth use, more AF episodes measured directly with mHealth, and lower left ventricular ejection fraction were more strongly associated with the High-High phenotype compared to the Moderate-Low phenotype (reference). Older age, more palpitations, and a history of stroke or transient ischemic attack were more strongly associated with the Moderate-Moderate phenotype compared to the reference. Discussion Engagement phenotypes provide a nuanced characterization of how individuals engage with mHealth over time, and which individuals are more likely to be highly engaged users. Conclusion This study demonstrates that engagement phenotypes are valuable in understanding and possibly intervening upon engagement within a population, and also suggests that engagement is an important variable to be considered in digital phenotyping work more broadly.
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Affiliation(s)
- Jihui Lee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Angelo Biviano
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathleen Hickey
- Columbia University School of Nursing, New York, New York, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
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14
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Mannina C, Jin Z, Matsumoto K, Ito K, Biviano A, Elkind MSV, Rundek T, Homma S, Sacco RL, Di Tullio MR. Frequency of cardiac arrhythmias in older adults: Findings from the Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. Int J Cardiol 2021; 337:64-70. [PMID: 33965468 DOI: 10.1016/j.ijcard.2021.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/07/2021] [Revised: 04/21/2021] [Accepted: 05/03/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Prolonged monitoring of cardiac rhythm has been used to screen for subclinical atrial fibrillation (AF); little is known about other arrhythmias in the general population, especially in the elderly, who are at higher risk of arrhythmias. METHODS We evaluated the frequency of arrhythmias in the tri-ethnic (white, Black, Hispanic), community-based Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study using a patch-based recorder for up to 14 days in 527 participants free of AF, congestive heart failure (CHF) or history of stroke. Differences according to gender, age, ethnicity and presence of hypertension, diabetes and pertinent ECG and echocardiographic variables were examined. RESULTS Mean age was 77.2 ± 6.8 years (37.2% men, 62.8% women). AF was present in 10 participants (1.9%), only 2 of them symptomatic. Supraventricular tachycardia (SVT) and ventricular tachycardia (VT) episodes were observed in 84.4% and 25.0% but only 13.5% and 10.6% of participants reported symptoms, respectively. Severe bradycardia (<40 bpm) was present in 12.5%. Sinus pauses and high-degree atrioventricular blocks were infrequent (2.1% and 1.5%, respectively). Most arrhythmias were more frequent in participants > 75 years; ventricular arrhythmias and severe bradycardia were more common in men. Whites had significantly more episodes of AF than Hispanics, SVT than Blacks and VT ≥ 10 beats than Hispanics and Blacks. Hypertensives had more episodes of severe bradycardia. LV hypertrophy or LVEF <55% were associated with more frequent ventricular and supraventricular arrhythmias. CONCLUSIONS Prolonged cardiac rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing arrhythmias. Ventricular arrhythmias were relatively frequent, whereas severe bradyarrhythmias were infrequent.
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Affiliation(s)
- Carlo Mannina
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Department of Internal Medicine, University of Palermo, Italy
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Kenji Matsumoto
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Kazato Ito
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Angelo Biviano
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL, United States of America; Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL, United States of America
| | - Shunichi Homma
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL, United States of America; Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL, United States of America; Clinical and Translational Science Institute, Miller School of Medicine, University of Miami, FL, United States of America
| | - Marco R Di Tullio
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America.
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15
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Masterson Creber RM, Reading Turchioe M, Biviano A, Caceres B, Garan H, Goldenthal I, Koleck T, Mitha S, Hickey K, Bakken S. Cardiac symptom burden and arrhythmia recurrence drives digital health use: results from the iHEART randomized controlled trial. Eur J Cardiovasc Nurs 2021; 21:107-115. [PMID: 34009326 PMCID: PMC8560656 DOI: 10.1093/eurjcn/zvab009] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/05/2020] [Accepted: 01/27/2021] [Indexed: 12/26/2022]
Abstract
Aims Digital health can transform the management of atrial fibrillation (AF) and enable patients to take a central role in detecting symptoms and self-managing AF. There is a gap in understanding factors that support sustained use of digital health tools for patients with AF. This study identified predictors of Alivecor® KardiaMobile ECG monitor usage among patients with AF enrolled in the iPhone®Helping Evaluate Atrial fibrillation Rhythm through Technology (iHEART) randomized controlled trial. Methods and results We analysed data from 105 English and Spanish-speaking adults with AF enrolled in the intervention arm of the iHEART trial. The iHEART intervention included smartphone-based electrocardiogram self-monitoring with Alivecor® KardiaMobile and triweekly text messages for 6 months. The primary outcome was use of Alivecor® categorized as: infrequent (≤5 times/week), moderate (>5 times and ≤11 times/week), and frequent (>11 times/week). We applied multinomial logistic regression modelling to characterize frequency and predictors of use. Of the 105 participants, 25% were female, 75% were White, and 45% were ≥65 years of age. Premature atrial contractions (PACs) [adjusted odds ratio (OR): 1.23, 1.08–1.40, P = 0.002] predicted frequent as compared to infrequent use. PACs (adjusted OR: 1.17, 95% confidence interval 1.06–1.30, P = 0.003), lower symptom burden (adjusted OR: 1.06, 1.01–1.11, P = 0.02), and less treatment concern (adjusted OR: 0.96, 0.93–0.99, P = 0.02) predicted moderate as compared to infrequent use. Conclusions Frequent use of AliveCor® is associated with AF symptoms and potentially symptomatic cardiac events. Symptom burden and frequency should be measured and incorporated into analyses of future digital health trials for AF management.
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Affiliation(s)
- Ruth M Masterson Creber
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065, USA
| | - Meghan Reading Turchioe
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medical College, 425 East 61st Street, Suite 301, New York, NY 10065, USA
| | - Angelo Biviano
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Billy Caceres
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Hasan Garan
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Isaac Goldenthal
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Theresa Koleck
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shazia Mitha
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kathleen Hickey
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, NY 10032, USA.,School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, USA.,Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, USA
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16
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Rubin GA, Desai AD, Chai Z, Wang A, Chen Q, Wang AS, Kemal C, Baksh H, Biviano A, Dizon JM, Yarmohammadi H, Ehlert F, Saluja D, Rubin DA, Morrow JP, Avula UMR, Berman JP, Kushnir A, Abrams MP, Hennessey JA, Elias P, Poterucha TJ, Uriel N, Kubin CJ, LaSota E, Zucker J, Sobieszczyk ME, Schwartz A, Garan H, Waase MP, Wan EY. Cardiac Corrected QT Interval Changes Among Patients Treated for COVID-19 Infection During the Early Phase of the Pandemic. JAMA Netw Open 2021; 4:e216842. [PMID: 33890991 PMCID: PMC8065381 DOI: 10.1001/jamanetworkopen.2021.6842] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 12/15/2022] Open
Abstract
IMPORTANCE Critical illness, a marked inflammatory response, and viruses such as SARS-CoV-2 may prolong corrected QT interval (QTc). OBJECTIVE To evaluate baseline QTc interval on 12-lead electrocardiograms (ECGs) and ensuing changes among patients with and without COVID-19. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 3050 patients aged 18 years and older who underwent SARS-CoV-2 testing and had ECGs at Columbia University Irving Medical Center from March 1 through May 1, 2020. Patients were analyzed by treatment group over 5 days, as follows: hydroxychloroquine with azithromycin, hydroxychloroquine alone, azithromycin alone, and neither hydroxychloroquine nor azithromycin. ECGs were manually analyzed by electrophysiologists masked to COVID-19 status. Multivariable modeling evaluated clinical associations with QTc prolongation from baseline. EXPOSURES COVID-19, hydroxychloroquine, azithromycin. MAIN OUTCOMES AND MEASURES Mean QTc prolongation, percentage of patients with QTc of 500 milliseconds or greater. RESULTS A total of 965 patients had more than 2 ECGs and were included in the study, with 561 (58.1%) men, 198 (26.2%) Black patients, and 191 (19.8%) aged 80 years and older. There were 733 patients (76.0%) with COVID-19 and 232 patients (24.0%) without COVID-19. COVID-19 infection was associated with significant mean QTc prolongation from baseline by both 5-day and 2-day multivariable models (5-day, patients with COVID-19: 20.81 [95% CI, 15.29 to 26.33] milliseconds; P < .001; patients without COVID-19: -2.01 [95% CI, -17.31 to 21.32] milliseconds; P = .93; 2-day, patients with COVID-19: 17.40 [95% CI, 12.65 to 22.16] milliseconds; P < .001; patients without COVID-19: 0.11 [95% CI, -12.60 to 12.81] milliseconds; P = .99). COVID-19 infection was independently associated with a modeled mean 27.32 (95% CI, 4.63-43.21) millisecond increase in QTc at 5 days compared with COVID-19-negative status (mean QTc, with COVID-19: 450.45 [95% CI, 441.6 to 459.3] milliseconds; without COVID-19: 423.13 [95% CI, 403.25 to 443.01] milliseconds; P = .01). More patients with COVID-19 not receiving hydroxychloroquine and azithromycin had QTc of 500 milliseconds or greater compared with patients without COVID-19 (34 of 136 [25.0%] vs 17 of 158 [10.8%], P = .002). Multivariable analysis revealed that age 80 years and older compared with those younger than 50 years (mean difference in QTc, 11.91 [SE, 4.69; 95% CI, 2.73 to 21.09]; P = .01), severe chronic kidney disease compared with no chronic kidney disease (mean difference in QTc, 12.20 [SE, 5.26; 95% CI, 1.89 to 22.51; P = .02]), elevated high-sensitivity troponin levels (mean difference in QTc, 5.05 [SE, 1.19; 95% CI, 2.72 to 7.38]; P < .001), and elevated lactate dehydrogenase levels (mean difference in QTc, 5.31 [SE, 2.68; 95% CI, 0.06 to 10.57]; P = .04) were associated with QTc prolongation. Torsades de pointes occurred in 1 patient (0.1%) with COVID-19. CONCLUSIONS AND RELEVANCE In this cohort study, COVID-19 infection was independently associated with significant mean QTc prolongation at days 5 and 2 of hospitalization compared with day 0. More patients with COVID-19 had QTc of 500 milliseconds or greater compared with patients without COVID-19.
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Affiliation(s)
- Geoffrey A. Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Amar D. Desai
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Zilan Chai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Aijin Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Amy S. Wang
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cameron Kemal
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Haajra Baksh
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jose M. Dizon
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Frederick Ehlert
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A. Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - John P. Morrow
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Uma Mahesh R. Avula
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jeremy P. Berman
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander Kushnir
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mark P. Abrams
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jessica A. Hennessey
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Pierre Elias
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Timothy J. Poterucha
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christine J. Kubin
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elijah LaSota
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jason Zucker
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Magdalena E. Sobieszczyk
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc P. Waase
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y. Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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17
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Melki L, Wang DY, Grubb CS, Weber R, Biviano A, Wan EY, Garan H, Konofagou EE. Cardiac Resynchronization Therapy Response Assessment with Electromechanical Activation Mapping within 24 Hours of Device Implantation: A Pilot Study. J Am Soc Echocardiogr 2021; 34:757-766.e8. [PMID: 33675941 DOI: 10.1016/j.echo.2021.02.012] [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: 07/30/2020] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) response assessment relies on the QRS complex narrowing criterion. Yet one third of patients do not improve despite narrowed QRS after implantation. Electromechanical wave imaging (EWI) is a quantitative echocardiography-based technique capable of noninvasively mapping cardiac electromechanical activation in three dimensions. The aim of this exploratory study was to investigate the EWI technique, sensitive to ventricular dyssynchrony, for informing CRT response on the day of implantation. METHODS Forty-four patients with heart failure with left bundle branch block or right ventricular (RV) paced rhythm and decreased left ventricular ejection fraction (LVEF; mean, 25.3 ± 9.6%) underwent EWI without and with CRT within 24 hours of device implantation. Of those, 16 were also scanned while in left ventricular (LV) pacing. Improvement in LVEF at 3-, 6-, or 9-month follow-up defined (1) super-responders (ΔLVEF ≥ 20%), (2) responders (10% ≤ ΔLVEF < 20%), and (3) nonresponders (ΔLVEF ≤ 5%). Three-dimensionally rendered electromechanical maps were obtained under RV, LV, and biventricular CRT pacing conditions. Mean RV free wall and LV lateral wall activation times were computed. The percentage of resynchronized myocardium was measured by quantifying the percentage of the left ventricle activated within 120 msec of QRS onset. Correlations between percentage of resynchronized myocardium and type of CRT response were assessed. RESULTS LV lateral wall activation time was significantly different (P ≤ .05) among all three pacing conditions in the 16 patients: LV lateral wall activation time with CRT in biventricular pacing (73.1 ± 17.6 msec) was lower compared with LV pacing (89.5 ± 21.5 msec) and RV pacing (120.3 ± 17.8 msec). Retrospective analysis showed that the percentage of resynchronized myocardium with CRT was a reliable response predictor within 24 hours of implantation for significantly (P ≤ .05) identifying super-responders (n = 7; 97.7 ± 1.9%) from nonresponders (n = 17; 89.9 ± 9.9%). CONCLUSION Electromechanical activation mapping constitutes a valuable three-dimensional visualization tool within 24 hours of implantation and could potentially aid in the timely assessment of CRT response rates, including during implantation for adjustment of lead placement and pacing outcomes.
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Affiliation(s)
- Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Daniel Y Wang
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christopher S Grubb
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York; Department of Radiology, Columbia University Irving Medical Center, New York, New York.
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18
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Saluja D, Rubin GA, Abrams MP, Berman JP, Wan EY, Biviano A, Garan H. High-density Grid Technology Aids in the Visualization of Purkinje Potentials in Fascicular Ventricular Tachycardia. J Innov Card Rhythm Manag 2021; 12:56-59. [PMID: 33604126 PMCID: PMC7885965 DOI: 10.19102/icrm.2021.120121s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Deepak Saluja
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey A Rubin
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mark P Abrams
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeremy P Berman
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hasan Garan
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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19
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Berman JP, Wan EY, Saluja D, Garan H, Biviano A. High-density Grid Mapping of Micro- and Macro-reentrant Left Atrial Arrhythmias. J Innov Card Rhythm Manag 2021; 12:28-30. [PMID: 33604114 PMCID: PMC7885948 DOI: 10.19102/icrm.2021.120105s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jeremy P Berman
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Deepak Saluja
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hasan Garan
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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20
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Coromilas EJ, Kochav S, Goldenthal I, Biviano A, Garan H, Goldbarg S, Kim JH, Yeo I, Tracy C, Ayanian S, Akar J, Singh A, Jain S, Zimerman L, Pimentel M, Osswald S, Twerenbold R, Schaerli N, Crotti L, Fabbri D, Parati G, Li Y, Atienza F, Zatarain E, Tse G, Leung KSK, Guevara-Valdivia ME, Rivera-Santiago CA, Soejima K, De Filippo P, Ferrari P, Malanchini G, Kanagaratnam P, Khawaja S, Mikhail GW, Scanavacca M, Abrahão Hajjar L, Rizerio B, Sacilotto L, Mollazadeh R, Eslami M, Laleh Far V, Mattioli AV, Boriani G, Migliore F, Cipriani A, Donato F, Compagnucci P, Casella M, Dello Russo A, Coromilas J, Aboyme A, O'Brien CG, Rodriguez F, Wang PJ, Naniwadekar A, Moey M, Kow CS, Cheah WK, Auricchio A, Conte G, Hwang J, Han S, Lazzerini PE, Franchi F, Santoro A, Capecchi PL, Joglar JA, Rosenblatt AG, Zardini M, Bricoli S, Bonura R, Echarte-Morales J, Benito-González T, Minguito-Carazo C, Fernández-Vázquez F, Wan EY. Worldwide Survey of COVID-19-Associated Arrhythmias. Circ Arrhythm Electrophysiol 2021; 14:e009458. [PMID: 33554620 PMCID: PMC7982128 DOI: 10.1161/circep.120.009458] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [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: 02/01/2023]
Abstract
Supplemental Digital Content is available in the text. Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic.
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Affiliation(s)
- Ellie J Coromilas
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Stephanie Kochav
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Isaac Goldenthal
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
| | - Seth Goldbarg
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Joon-Hyuk Kim
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Ilhwan Yeo
- New York Presbyterian Queens, Weill Medical College (S.G., J.-H.K., I.Y.)
| | - Cynthia Tracy
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Shant Ayanian
- The George Washington University School of Medicine & Health Sciences, The GW Medical Faculty Associates, Washington, DC (C.T., S.A.)
| | - Joseph Akar
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Avinainder Singh
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Shashank Jain
- Section of Cardiovascular Disease, Yale University School of Medicine, New Haven, CT (J.A., A. Singh, S.J.)
| | - Leandro Zimerman
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Maurício Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil (L.Z., M.P.)
| | - Stefan Osswald
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Raphael Twerenbold
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Nicolas Schaerli
- Department of Cardiology & Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland (S.O., R.T., N.S.)
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Daniele Fabbri
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C., D.F., G.P.).,Department of Medicine & Surgery, University of Milano-Bicocca, Milan, Italy (L.C., D.F., G.P.)
| | - Yi Li
- Wuhan Asia General Hospital, China (Y.L.)
| | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Eduardo Zatarain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) (F.A., E.Z.).,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (F.A., E.Z.)
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, China (G.T.).,School of Life Sciences. The Hospital Authority of Hong Kong, Hong Kong, China (G.T.).,Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China (G.T.)
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, United Kingdom (K.C.K.L.)
| | - Milton E Guevara-Valdivia
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Carlos A Rivera-Santiago
- UMAE Hospital de Especialidades Dr. Antonio Fraga Mouret CMN La Raza IMSS, CDMX, Mexico (M.E.G.-V., C.A.R.-S.)
| | - Kyoko Soejima
- Kyorin University School of Medicine, Tokyo, Japan (K.S.)
| | - Paolo De Filippo
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Paola Ferrari
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Giovanni Malanchini
- Electrophysiology & Cardiac Pacing Unit, Cardiology Department, ASST Papa Giovanni XXIII, Bergamo, Italy (P.D.F., P.F., G.M.)
| | - Prapa Kanagaratnam
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Saud Khawaja
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Ghada W Mikhail
- Imperial College Healthcare NHS Trust, London, United Kingdom (P.K., S. Khawaja, G.W.M.)
| | - Mauricio Scanavacca
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Ludhmila Abrahão Hajjar
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Brenno Rizerio
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Luciana Sacilotto
- Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (M.S., A.H., B.R., L.S.)
| | - Reza Mollazadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Masoud Eslami
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | - Vahideh Laleh Far
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran (R.M., M.E., V.L.f.)
| | | | - Giuseppe Boriani
- University of Modena & Reggio Emilia, Modena, Italy (V.M., G.B.)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Filippo Donato
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.C., F.D.)
| | - Paolo Compagnucci
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Michela Casella
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - Antonio Dello Russo
- Cardiology & Arrhythmology Clinic, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy (P.C., M.C., A.D.R.)
| | - James Coromilas
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Andrew Aboyme
- Division of Cardiovascular Disease & Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.C., A. Aboyme)
| | - Connor Galen O'Brien
- Department of Medicine, Division of Cardiology, University of California San Francisco School of Medicine (C.G.O.)
| | | | - Paul J Wang
- Division of Cardiology, Stanford University, CA (F.R., P.J.W.)
| | | | - Melissa Moey
- East Carolina University, Greenville, NC (A.N., M.M.)
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur (C.S.K.)
| | - Wee Kooi Cheah
- Department of Medicine & Clinical Research Center, Taiping Hospital, Perak, Malaysia (W.K.C.)
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland (A. Auricchio, G.C.)
| | - Jongmin Hwang
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (J.H., S.H.)
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Federico Franchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Amato Santoro
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery & Neurosciences, University of Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.).,Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy (P.E.L., F.F., A. Santoro, P.L.C.)
| | - Jose A Joglar
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Anna G Rosenblatt
- University of Texas Southwestern Medical Center, Dallas (J.A.G., A.G.R.)
| | - Marco Zardini
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Serena Bricoli
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Rosario Bonura
- Division of Cardiology, University Hospital "Ospedale Maggiore," Parma, Italy (M.Z., S.B., R.B.)
| | - Julio Echarte-Morales
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Tomás Benito-González
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Carlos Minguito-Carazo
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Felipe Fernández-Vázquez
- Department of Cardiology, University Hospital of Leon, Spain (J.E.-M., T.B.-G., C.M.-C., F.F.-V.)
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians & Surgeons (E.J.C., S. Kochav, I.G., A.B., H.G., E.Y.W.)
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21
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Mannina C, Jin Z, Matsumoto K, Ito K, Biviano A, Elkind M, Rundek T, Homma S, Sacco R, Di Tullio M. Frequency of cardiac arrhythmias in older adults: findings from the subclinical atrial fibrillation and risk of ischemic stroke (SAFARIS) study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Prolonged monitoring of cardiac rhythm has been used in patients with symptomatic arrhythmias and to assess for atrial fibrillation (AF) after cryptogenic stroke, but not in the general population and especially in older adults.
Purpose
To evaluate the frequency of arrhythmias in a community-based cohort of older adults through 14-days continuous cardiac monitoring using a patch-based device.
Methods
Cardiac rhythm was analyzed in 533 participants free of AF and congestive heart failure (CHF) from the tri-ethnic (white, black, Hispanic) Subclinical Atrial Fibrillation and Risk of Ischemic Stroke (SAFARIS) study. AF, supraventricular tachycardia (SVT, defined as 4 beats or more), premature atrial (PACs) and ventricular (PVCs) contractions, ventricular tachycardia (VT, defined as 4 beats or more), sinus pauses (SP) and atrio-ventricular blocks (AVB) were analyzed. Gender, age and race-ethnic differences were examined.
Results
Mean age was 77.2±6.8 years (198 men, 335 women). Recording duration was over 10 days in 91%, and over 13 days in 84%. AF was present in 10 participants (1.9%), atrial flutter in 1 (0.2%). Other arrhythmias are reported in the Table. SP (1.9%) and high-degree AVB (Mobitz II: 0.6%; 3rd degree: 0.9%) were rare. No significant race-ethnic differences were observed.
Conclusion
In older adults without history of stroke or CHF, prolonged rhythm monitoring revealed moderate frequency of AF, but higher than expected frequencies of AF-predisposing conditions such as SVT and frequent PACs. VT episodes were relatively frequent, whereas SP and AVB were less frequent than commonly believed. Most arrhythmias were more frequent in the oldest; ventricular arrhythmias were more common in men than in women.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NINDS R01 NS083874
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Affiliation(s)
- C Mannina
- University of Palermo, Palermo, Italy
| | - Z Jin
- Columbia University, New York, United States of America
| | - K Matsumoto
- Columbia University, New York, United States of America
| | - K Ito
- Columbia University, New York, United States of America
| | - A Biviano
- Columbia University, New York, United States of America
| | - M Elkind
- Columbia University, New York, United States of America
| | - T Rundek
- University of Miami Leonard M. Miller School of Medicine, Miami, United States of America
| | - S Homma
- Columbia University, New York, United States of America
| | - R Sacco
- University of Miami Leonard M. Miller School of Medicine, Miami, United States of America
| | - M Di Tullio
- Columbia University, New York, United States of America
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22
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Berman JP, Abrams MP, Kushnir A, Rubin GA, Ehlert F, Biviano A, Morrow JP, Dizon J, Wan EY, Yarmohammadi H, Waase MP, Rubin DA, Garan H, Saluja D. Cardiac electrophysiology consultative experience at the epicenter of the COVID-19 pandemic in the United States. Indian Pacing Electrophysiol J 2020; 20:250-256. [PMID: 32861812 PMCID: PMC7450949 DOI: 10.1016/j.ipej.2020.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/21/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has greatly altered the practice of cardiac electrophysiology around the world for the foreseeable future. Professional organizations have provided guidance for practitioners, but real-world examples of the consults and responsibilities cardiac electrophysiologists face during a surge of COVID-19 patients is lacking. METHODS In this observational case series we report on 29 consecutive inpatient electrophysiology consultations at a major academic medical center in New York City, the epicenter of the pandemic in the United States, during a 2 week period from March 30-April 12, 2020, when 80% of hospital beds were occupied by COVID-19 patients, and the New York City metropolitan area accounted for 10% of COVID-19 cases worldwide. RESULTS Reasons for consultation included: Atrial tachyarrhythmia (31%), cardiac implantable electronic device management (28%), bradycardia (14%), QTc prolongation (10%), ventricular arrhythmia (7%), post-transcatheter aortic valve replacement conduction abnormality (3.5%), ventricular pre-excitation (3.5%), and paroxysmal supraventricular tachycardia (3.5%). Twenty-four patients (86%) were positive for COVID-19 by nasopharyngeal swab. All elective procedures were canceled, and only one urgent device implantation was performed. Thirteen patients (45%) required in-person evaluation and the remainder were managed remotely. CONCLUSION Our experience shows that the application of a massive alteration in workflow and personnel forced by the pandemic allowed our team to efficiently address the intersection of COVID-19 with a range of electrophysiology issues. This experience will prove useful as guidance for emerging hot spots or areas affected by future waves of the pandemic.
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Affiliation(s)
- Jeremy P Berman
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Mark P Abrams
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Alexander Kushnir
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey A Rubin
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Frederick Ehlert
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Angelo Biviano
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - John P Morrow
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jose Dizon
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elaine Y Wan
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hirad Yarmohammadi
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marc P Waase
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - David A Rubin
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hasan Garan
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Deepak Saluja
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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23
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Abrams MP, Wan EY, Waase MP, Morrow JP, Dizon JM, Yarmohammadi H, Berman JP, Rubin GA, Kushnir A, Poterucha TJ, Elias PA, Rubin DA, Ehlert F, Biviano A, Uriel N, Garan H, Saluja D. Clinical and cardiac characteristics of COVID-19 mortalities in a diverse New York City Cohort. J Cardiovasc Electrophysiol 2020; 31:3086-3096. [PMID: 33022765 PMCID: PMC7675758 DOI: 10.1111/jce.14772] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/14/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
Introduction Electrocardiographic characteristics in COVID‐19‐related mortality have not yet been reported, particularly in racial/ethnic minorities. Methods and Results We reviewed demographics, laboratory and cardiac tests, medications, and cardiac rhythm proximate to death or initiation of comfort care for patients hospitalized with a positive SARS‐CoV‐2 reverse‐transcriptase polymerase chain reaction in three New York City hospitals between March 1 and April 3, 2020 who died. We described clinical characteristics and compared factors contributing toward arrhythmic versus nonarrhythmic death. Of 1258 patients screened, 133 died and were enrolled. Of these, 55.6% (74/133) were male, 69.9% (93/133) were racial/ethnic minorities, and 88.0% (117/133) had cardiovascular disease. The last cardiac rhythm recorded was VT or fibrillation in 5.3% (7/133), pulseless electrical activity in 7.5% (10/133), unspecified bradycardia in 0.8% (1/133), and asystole in 26.3% (35/133). Most 74.4% (99/133) died receiving comfort measures only. The most common abnormalities on admission electrocardiogram included abnormal QRS axis (25.8%), atrial fibrillation/flutter (14.3%), atrial ectopy (12.0%), and right bundle branch block (11.9%). During hospitalization, an additional 17.6% developed atrial ectopy, 14.7% ventricular ectopy, 10.1% atrial fibrillation/flutter, and 7.8% a right ventricular abnormality. Arrhythmic death was confirmed or suspected in 8.3% (11/133) associated with age, coronary artery disease, asthma, vasopressor use, longer admission corrected QT interval, and left bundle branch block (LBBB). Conclusions Conduction, rhythm, and electrocardiographic abnormalities were common during COVID‐19‐related hospitalization. Arrhythmic death was associated with age, coronary artery disease, asthma, longer admission corrected QT interval, LBBB, ventricular ectopy, and usage of vasopressors. Most died receiving comfort measures.
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Affiliation(s)
- Mark P Abrams
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Marc P Waase
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - John P Morrow
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Jose M Dizon
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Jeremy P Berman
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey A Rubin
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander Kushnir
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Timothy J Poterucha
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Pierre A Elias
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - David A Rubin
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Frederick Ehlert
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Deepak Saluja
- Department of Medicine, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
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24
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Shahim B, Malaisrie SC, George I, Thourani V, Russo M, Biviano A, Mack M, Brown DL, Babaliaros V, Guyton R, Kodali S, Nazif T, Genereux P, Makkar R, Williams M, McCabe J, Webb J, Lu M, Yu X, Leon M, Kosmidou I. TCT CONNECT-468 Postoperative Atrial Fibrillation or Flutter Following Transcatheter or Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Patients at Low Surgical Risk: An Analysis From the PARTNER 3 Trial. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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25
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DeFilippis EM, Rubin G, Farr MA, Biviano A, Wan EY, Takeda K, Garan H, Topkara VK, Yarmohammadi H. Cardiac Implantable Electronic Devices Following Heart Transplantation. JACC Clin Electrophysiol 2020; 6:1028-1042. [PMID: 32819520 DOI: 10.1016/j.jacep.2020.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022]
Abstract
Permanent pacemaker (PPM) implantation is required in a subset of patients (∼10%) for sinus node dysfunction or atrioventricular block both early and late after heart transplantation. The incidence of PPM implantation has decreased to <5% with the advent of bicaval anastamosis transplantation surgery. Pacing dependence upon follow-up has been variably reported. An even smaller percentage of transplantation recipients (1.5% to 3.4%) undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous data are lacking for the use of ICDs in the transplantation population and is largely derived from cohort studies and case series. Sudden cardiac death occurs in approximately 10% of transplantation recipients, but multiple nonarrhythmic factors are believed to be responsible, including acute rejection, late graft failure with electromechanical dissociation, and ischemia due to cardiac allograft vasculopathy. This review provides a comprehensive analysis of the existing data regarding the role for PPMs and ICDs in this population, including leadless PPMs and subcutaneous ICDs, special considerations, and future directions.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
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26
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Chung CJ, Nazif TM, Wolbinski M, Hakemi E, Lebehn M, Brandwein R, Rezende CP, Doolittle J, Rabbani L, Uriel N, Schwartz A, Biviano A, Wan E, Hathaway L, Hahn R, Khalique O, Hamid N, Ng V, Patel A, Vahl T, Kirtane A, Bapat V, George I, Leon MB, Kodali SK. Restructuring Structural Heart Disease Practice During the COVID-19 Pandemic: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:2974-2983. [PMID: 32278716 PMCID: PMC7146690 DOI: 10.1016/j.jacc.2020.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
Patients with structural heart disease are at increased risk of adverse outcomes from the coronavirus disease-2019 (COVID-19) due to advanced age and comorbidity. In the midst of a global pandemic of a novel infectious disease, reality-based considerations comprise an important starting point for formulating clinical management pathways. The aims of these "crisis-driven" recommendations are: 1) to ensure appropriate and timely treatment of structural heart disease patients; 2) to minimize the risk of COVID-19 exposure to patients and health care workers; and 3) to limit resource utilization under conditions of constraint. Although the degree of disruption to usual practice will vary across the United States and elsewhere, we hope that early experiences from a heart team operating in the current global epicenter of COVID-19 may prove useful for others adapting their practice in advance of local surges of COVID-19.
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Affiliation(s)
- Christine J Chung
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mariusz Wolbinski
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Emad Hakemi
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mark Lebehn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Russell Brandwein
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Carolina Pinheiro Rezende
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - James Doolittle
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Leroy Rabbani
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Elaine Wan
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lisa Hathaway
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Rebecca Hahn
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Omar Khalique
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nadira Hamid
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vivian Ng
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Amisha Patel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Torsten Vahl
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Ajay Kirtane
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vinayak Bapat
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Isaac George
- Division of Adult Cardiac Surgery, Department of Surgery, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
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27
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Rubin GA, Biviano A, Dizon J, Yarmohammadi H, Ehlert F, Saluja D, Rubin DA, Morrow JP, Waase M, Berman J, Kushnir A, Abrams MP, Garan H, Wan EY. Performance of electrophysiology procedures at an academic medical center amidst the 2020 coronavirus (COVID-19) pandemic. J Cardiovasc Electrophysiol 2020; 31:1249-1254. [PMID: 32281214 PMCID: PMC7262273 DOI: 10.1111/jce.14493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022]
Abstract
A global coronavirus (COVID-19) pandemic occurred at the start of 2020 and is already responsible for more than 74 000 deaths worldwide, just over 100 years after the influenza pandemic of 1918. At the center of the crisis is the highly infectious and deadly SARS-CoV-2, which has altered everything from individual daily lives to the global economy and our collective consciousness. Aside from the pulmonary manifestations of disease, there are likely to be several electrophysiologic (EP) sequelae of COVID-19 infection and its treatment, due to consequences of myocarditis and the use of QT-prolonging drugs. Most crucially, the surge in COVID-19 positive patients that have already overwhelmed the New York City hospital system requires conservation of hospital resources including personal protective equipment (PPE), reassignment of personnel, and reorganization of institutions, including the EP laboratory. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID-19 pandemic, including performance of only urgent/emergent procedures, after hours/7-day per week laboratory operation, single attending-only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow-up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. We discuss also discuss how we perform EP procedures on presumed COVID positive and COVID tested positive patients to highlight issues that others in the EP community may soon face in their own institution as the virus continues to spread nationally and internationally.
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Affiliation(s)
- Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Frederick Ehlert
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - John P Morrow
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc Waase
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jeremy Berman
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander Kushnir
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mark P Abrams
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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28
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Kosmidou I, Liu Y, Alu MC, Liu M, Madhavan M, Chakravarty T, Makkar R, Thourani VH, Biviano A, Kodali S, Leon MB. Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation. JACC Cardiovasc Interv 2019; 12:1580-1589. [PMID: 31439338 DOI: 10.1016/j.jcin.2019.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The study sought to determine the patterns of antithrombotic therapy and association with clinical outcomes in patients with atrial fibrillation (AF) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score ≥2 following transcatheter aortic valve replacement (TAVR). BACKGROUND The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown. METHODS In the randomized PARTNER II (Placement of Aortic Transcatheter Valve II) trial and associated registries, 1,621 patients with prior AF and CHA2DS2-VASc score ≥2 comprised the study cohort. Outcomes were analyzed according to antithrombotic therapy. RESULTS During the 5-year enrollment period, 933 (57.6%) patients were discharged on oral anticoagulant therapy (OAC). Uninterrupted antiplatelet therapy (APT) for at least 6 months or until an endpoint event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of patients not on OAC. At 2 years, patients on OAC had a similar rate of stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT. Following adjustment, OAC with APT and APT alone were both associated with reduced rates of stroke compared with no OAC or APT (hazard ratio for OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p = 0.002), while OAC alone was not. CONCLUSIONS Among patients with prior AF undergoing TAVR, antiplatelet with or without anticoagulant therapy was associated with a reduced risk of stroke at 2 years, implicating multifactorial stroke mechanisms in this population.
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Affiliation(s)
- Ioanna Kosmidou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York.
| | - Yangbo Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Maria C Alu
- Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Mahesh Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Tarun Chakravarty
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj Makkar
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute/Georgetown University, Washington, DC
| | - Angelo Biviano
- Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Susheel Kodali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
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29
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Moore SKL, Chau KH, Chaudhary S, Rubin G, Bayne J, Avula UMR, Wang DY, Sorbera C, Dizon J, Biviano A, Waase M, Iyer V, George I, Kodali SK, Nazif TM, Garan H, Wan EY. Leadless pacemaker implantation: A feasible and reasonable option in transcatheter heart valve replacement patients. Pacing Clin Electrophysiol 2019; 42:542-547. [PMID: 30829416 DOI: 10.1111/pace.13648] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/08/2019] [Accepted: 02/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR. METHODS This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only. RESULTS LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. CONCLUSIONS In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications.
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Affiliation(s)
- Sarah K L Moore
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Katherine H Chau
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Salma Chaudhary
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph Bayne
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Uma Mahesh R Avula
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Daniel Y Wang
- Division of Cardiology, Montefiore-White Plains Hospital, White Plains, New York
| | - Carmine Sorbera
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc Waase
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Vivek Iyer
- Division of Cardiology, Department of Medicine, Marin General Hospital, Greenbrae, California
| | - Isaac George
- Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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Kosmidou I, Madhavan M, Liu Y, Alu M, Biviano A, Chakravarty T, Makkar R, Thourani V, Kodali S, Leon M. ANTITHROMBOTIC THERAPY AND CARDIOVASCULAR RISK IN PATIENTS WITH ATRIAL FIBRILLATION AT HIGH RISK FOR THROMBOEMBOLIC EVENTS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: FROM THE PARTNER 2 TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Grubb CS, Lewis M, Whang W, Biviano A, Hickey K, Rosenbaum M, Garan H. Catheter Ablation for Atrial Tachycardia in Adults With Congenital Heart Disease: Electrophysiological Predictors of Acute Procedural Success and Post-Procedure Atrial Tachycardia Recurrence. JACC Clin Electrophysiol 2019; 5:438-447. [PMID: 31000097 DOI: 10.1016/j.jacep.2018.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 09/07/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to determine the electrophysiological predictors of acute procedural success and of post-ablation recurrence of atrial tachyarrhythmias (ATs) in our adult congenital heart disease (ACHD) population undergoing catheter ablation for treatment of AT. BACKGROUND Catheter ablation is frequently performed to treat persistent AT in ACHD. The predictors of post-ablation AT recurrence have not been well studied in the ACHD population. METHODS The authors performed a retrospective study of all catheter ablations for treatment of AT performed in ACHD patients between December 1, 2005, and July 20, 2017, at Columbia University Medical Center. Pre-specified clinical and procedural data of interest and the time from ablation to recurrence were determined by chart and procedure report review. RESULTS A total of 140 patients (mean age: 45 years) underwent catheter ablation for 182 AT. Of the AT, 179 (93%) were intra-atrial macro-re-entrant tachycardia, and 12 (7%) had a focal origin. The presence of a single mechanism was a predictor of acute procedural success that could be achieved in 89% of the patients. At a median of 49.9 months, 62 patients (44%) had recurrent AT. Time to recurrence was significantly shorter (12.5 months) for recurrent AT in 13 of the 20 patients with previous Fontan procedure. By multivariable analysis, acute procedural success was a positive predictor and prior surgical maze procedure was a negative predictor of AT-free survival. Of the 62 patients with recurrent AT, 42 (68%) had a second catheter ablation procedure, and in 22 of these, the AT mechanism was different than previously observed. CONCLUSIONS Catheter ablation for AT in ACHD patients is an effective method of arrhythmia control. More than 1 AT mechanism per patient is common. Acute procedural success is a predictor of freedom from AT recurrence. The majority of patients achieve multiple arrhythmia-free years.
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Affiliation(s)
- Christopher S Grubb
- Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Matthew Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
| | - William Whang
- Helmsley Center for Electrophysiology, Division of Cardiology, Mount Sinai Health System, New York, New York
| | - Angelo Biviano
- Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Kathleen Hickey
- Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
| | - Hasan Garan
- Cardiac Electrophysiology Unit, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
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Lewis M, Whang W, Biviano A, Hickey K, Garan H, Rosenbaum M. Predictors and rates of recurrence of atrial arrhythmias following catheter ablation in adults with congenital heart disease. CONGENIT HEART DIS 2018; 14:207-212. [PMID: 30451375 DOI: 10.1111/chd.12695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation is commonly performed to treat atrial arrhythmias in adult congenital heart disease (ACHD). Despite the frequency of ablations in the ACHD population, predictors of recurrence remain poorly defined. OBJECTIVE We sought to determine predictors of arrhythmia recurrence in ACHD patients following catheter ablation for atrial arrhythmias. METHODS We performed a retrospective study of all catheter ablations for atrial arrhythmias performed in ACHD patients between January 12, 2005 and February 11, 2015 at our institution. Prespecified exposures of interest and time from ablation to recurrence were determined via chart review. RESULTS Among 124 patients (mean age: 45 years) who underwent catheter ablation, 96 (77%) were treated for macro-reentrant atrial tachycardia, 10 (7%) for focal atrial tachycardia, 9 (7%) for atrial fibrillation, 7 (6%) for atrioventricular nodal reentrant tachycardia, and 2 (2%) for atrioventricular reentrant tachycardia. 15 (12%) required transseptal/transbaffle puncture. Fifty-one percent of patients recurred with a median time to recurrence of 1639 days. By univariate and multivariable analysis, body mass index (BMI) and Fontan status were the only variables associated with recurrence. Dose-dependent effect was observed with overweight (HR = 2.37, P = .012), obese (HR = 2.67, P = .009), and morbidly obese (HR = 4.23, P = .003) patients demonstrating an increasing risk for arrhythmia recurrence postablation. There was no significant different in recurrence rates by gender, age, non-Fontan diagnosis, or need for transseptal puncture. CONCLUSIONS In our cohort of ACHD patients, BMI was a significant risk factor for arrhythmia recurrence postablation, independent of Fontan status. These findings may help guide treatment decisions for persistent arrhythmias in the ACHD population.
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Affiliation(s)
- Matthew Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
| | - William Whang
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Kathleen Hickey
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
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Abstract
Atrial fibrillation (AF) is a known complication of many cardiac procedures, including those undergoing surgical aortic valve replacement (SAVR). In the transcatheter aortic valve replacement (TAVR) era, AF has been noted not only to be present in these patients but also associated with morbidity and mortality. In this article, we first outline the significance of AF in general and then more specifically in patients undergoing cardiac surgery. We then compare and contrast specific clinical issues related to AF in patients with aortic stenosis undergoing aortic valve replacement, traditionally with SAVR, but now increasingly more common with TAVR.
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Affiliation(s)
- Kinjan Parikh
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Avenue, Milstein 5-435, New York, NY 10032, USA.
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Dizon JM, Nazif T, Biviano A, Garan H, Kodali SK, Smith CR, Lowry A, Blackstone E, Thourani VH, Svensson L, Mack MJ, Leon MB. NEW PACEMAKER IMPLANTATION AFTER SURGICAL AORTIC VALVE REPLACEMENT IN THE PARTNER TRIALS: RATES, RISK FACTORS, AND CLINICAL OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Biviano A, Nazif T, Dizon J, Garan H, Crowley A, Malaisrie S, Makkar R, Thourani V, Mack M, Szeto WY, Fearon W, Leon M, Kodali S. TCT-106 Atrial Fibrillation is Associated with Increased Mortality in Intermediate-Risk Patients Undergoing TAVR or SAVR: Insights From the PARTNER 2A and PARTNER 2 S3i Trials. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.162] [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: 10/18/2022]
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Willey JZ, Biviano A. Letter from Willey and Biviano Regarding Article, "Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial". Circulation 2016; 134:e181-2. [PMID: 27601561 DOI: 10.1161/circulationaha.116.023261] [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)
- Joshua Z Willey
- From Department of Neurology, Columbia University, New York, NY (J.Z.W.); and Division of Cardiology, Cardiac Electrophysiology Service, Department of Medicine, Columbia University, New York, NY (A.B.)
| | - Angelo Biviano
- From Department of Neurology, Columbia University, New York, NY (J.Z.W.); and Division of Cardiology, Cardiac Electrophysiology Service, Department of Medicine, Columbia University, New York, NY (A.B.)
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Dizon JM, Nazif TM, Hess PL, Biviano A, Garan H, Douglas PS, Kapadia S, Babaliaros V, Herrmann HC, Szeto WY, Jilaihawi H, Fearon WF, Tuzcu EM, Pichard AD, Makkar R, Williams M, Hahn RT, Xu K, Smith CR, Leon MB, Kodali SK. Chronic pacing and adverse outcomes after transcatheter aortic valve implantation. Heart 2015; 101:1665-71. [DOI: 10.1136/heartjnl-2015-307666] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/14/2015] [Indexed: 11/04/2022] Open
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Merten J, Meneghetti M, Postman M, Umetsu K, Zitrin A, Medezinski E, Nonino M, Koekemoer A, Melchior P, Gruen D, Moustakas LA, Bartelmann M, Host O, Donahue M, Coe D, Molino A, Jouvel S, Monna A, Seitz S, Czakon N, Lemze D, Sayers J, Balestra I, Rosati P, Benítez N, Biviano A, Bouwens R, Bradley L, Broadhurst T, Carrasco M, Ford H, Grillo C, Infante L, Kelson D, Lahav O, Massey R, Moustakas J, Rasia E, Rhodes J, Vega J, Zheng W. CLASH: THE CONCENTRATION-MASS RELATION OF GALAXY CLUSTERS. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/1/4] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grillo C, Suyu SH, Rosati P, Mercurio A, Balestra I, Munari E, Nonino M, Caminha GB, Lombardi M, De Lucia G, Borgani S, Gobat R, Biviano A, Girardi M, Umetsu K, Coe D, Koekemoer AM, Postman M, Zitrin A, Halkola A, Broadhurst T, Sartoris B, Presotto V, Annunziatella M, Maier C, Fritz A, Vanzella E, Frye B. CLASH-VLT: INSIGHTS ON THE MASS SUBSTRUCTURES IN THE FRONTIER FIELDS CLUSTER MACS J0416.1–2403 THROUGH ACCURATE STRONG LENS MODELING. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/800/1/38] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meneghetti M, Rasia E, Vega J, Merten J, Postman M, Yepes G, Sembolini F, Donahue M, Ettori S, Umetsu K, Balestra I, Bartelmann M, Benítez N, Biviano A, Bouwens R, Bradley L, Broadhurst T, Coe D, Czakon N, De Petris M, Ford H, Giocoli C, Gottlöber S, Grillo C, Infante L, Jouvel S, Kelson D, Koekemoer A, Lahav O, Lemze D, Medezinski E, Melchior P, Mercurio A, Molino A, Moscardini L, Monna A, Moustakas J, Moustakas LA, Nonino M, Rhodes J, Rosati P, Sayers J, Seitz S, Zheng W, Zitrin A. THE MUSIC OF CLASH: PREDICTIONS ON THE CONCENTRATION-MASS RELATION. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/797/1/34] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Biviano A, Dizon J, Nazif T, Kapadia S, Babaliaros V, Xu K, Rodes-Cabau J, Szeto W, Fearon W, Dvir D, Dewey T, Williams M, Mack M, Webb J, Miller DC, Smith C, Leon M, Kodali S. ATRIAL FIBRILLATION IS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS UNDERGOING TAVR: INSIGHTS FROM THE PARTNER TRIAL. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61689-2] [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: 10/25/2022]
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Dizon J, Nazif T, Biviano A, Kapadia S, Babaliaros V, Herrmann H, Szeto W, Jilaihawi H, Fearon W, Tuzcu EM, Pichard A, Makkar R, Williams M, Hahn R, Xu K, Smith C, Leon M, Kodali S. THE PRESENCE OF A PACEMAKER IS ASSOCIATED WITH INCREASED 1 YEAR MORTALITY AND REHOSPITALIZATION IN THE PARTNER TRIAL. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.
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Affiliation(s)
- Thomas Bartel
- Division of Cardiology, Department of Internal Medicine III, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
- Corresponding author. Tel: +43 512 50481992, Fax: +43 512 50423379,
| | - Silvana Müller
- Division of Cardiology, Department of Internal Medicine III, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Angelo Biviano
- Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, USA
| | - Rebecca T. Hahn
- Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, USA
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Dizon JM, Brener SJ, Maehara A, Witzenbichler B, Biviano A, Godlewski J, Parise H, Dambrink JH, Mehran R, Gibson CM, Stone GW. Relationship between ST-segment resolution and anterior infarct size after primary percutaneous coronary intervention: analysis from the INFUSE-AMI trial. Eur Heart J Acute Cardiovasc Care 2013; 3:78-83. [PMID: 24562806 DOI: 10.1177/2048872613508658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS ST-segment resolution (STR) after reperfusion therapy has been shown to correlate with prognosis in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether acute ECG measurements also correlate with ultimate infarct size. METHODS AND RESULTS The INFUSE-AMI trial randomized 452 patients with anterior STEMI to intracoronary bolus abciximab vs. no abciximab, and to thrombus aspiration vs. no aspiration. Infarct size as percentage of total LV mass was calculated by cardiac magnetic resonance imaging (MRI) 30 days post intervention. Five ECG methods were analysed for their ability to predict MRI infarct mass: (1) summed STR across all infarct-related ECG leads (ΣSTR); (2) STR in the single lead with maximum baseline ST-segment elevation (maxSTR); (3) summed residual ST-segment elevation across all infarct-related leads at 60 min post intervention (ΣST residual); (4) maximum residual ST-segment elevation in the worst single lead at 60 min post intervention (maxST residual); (5) number of new significant Q-waves (Qwave) at 60 min. All ECG methods strongly correlated with 30-day MRI infarct mass (all p<0.003). Simpler ECG measurements such as maxSTresidual and Qwave were as predictive as more complex measurements. A subset analysis of 158 patients who had microvascular obstruction (MVO) determined by MRI 5 days post intervention also showed strong correlations of MVO with the ECG measures. CONCLUSIONS ST-segment and Q-wave changes after primary PCI in anterior STEMI strongly correlated with 30-day infarct size by MRI. In particular, maxST residual and Qwave at 60 min are simple ECG parameters that offer rapid analysis for prognostication.
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Hickey KT, Reiffel J, Sciacca RR, Whang W, Biviano A, Baumeister M, Castillo C, Talathothi J, Garan H. Correlating perceived arrhythmia symptoms and quality of life in an older population with heart failure: a prospective, single centre, urban clinic study. J Clin Nurs 2013; 22:434-44. [PMID: 23301579 PMCID: PMC3748605 DOI: 10.1111/j.1365-2702.2012.04307.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. BACKGROUND While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. DESIGN Prospective, cross-sectional single-centre study. METHODS A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2(™) and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express(®) ) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. RESULTS Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. CONCLUSION Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. RELEVANCE TO CLINICAL PRACTICE The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life.
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Abstract
Cardiac arrhythmias are important contributors to morbidity and mortality in patients with pulmonary arterial hypertension (PAH). Such patients manifest a substrate resulting from altered autonomics, repolarization abnormalities, and ischemia. Supraventricular arrhythmias such as atrial fibrillation and flutter are associated with worsened outcomes, and maintenance of sinus rhythm is a goal. Sudden death is a relatively common issue, though the contribution of malignant ventricular arrhythmias versus bradyarrhythmias differs from non-PAH patients. Congenital heart disease patients with PAH benefit from catheter ablation of medically refractory arrhythmias. Clinical studies of defibrillator/pacemaker therapy for primary prevention against sudden death in PAH patients are lacking.
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Affiliation(s)
- Archana Rajdev
- Department of Medicine, Section of Cardiology, Danbury Hospital, Danbury, CT, USA
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Biviano A, Goa C, Hanon S, Reiffel J. The Use of Ranolazine in the Management of Recurrent Atrial Fibrillation After Percutaneous Radiofrequency Ablation. J Atr Fibrillation 2012; 5:562. [PMID: 28496762 PMCID: PMC5153125 DOI: 10.4022/jafib.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/20/2012] [Accepted: 04/26/2012] [Indexed: 06/07/2023]
Abstract
Long-term medical treatment options for atrial fibrillation (AF) include rate-control as well as rhythm-control therapy with various antiarrhythmics. However, because of the limited efficacy and potential side effects of these medications, percutaneous and surgical ablations in AF patients have evolved as alternative or additional approaches to achieve rhythm-control. Nonetheless, arrhythmia recurrences may also occur after these procedures. Thus, the search for complementary treatment options continues.Ranolazine possesses antiarrhythmic effects in atrial myocytes via blockade of sodium channels. These properties facilitate AF suppression in animal models and human subjects. We report a patient with persistent AF that was refractory to medical management and percutaneous catheter ablation. She has remained in sinus rhythm for at least 18 months after the initiation of ranolazine.
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Affiliation(s)
- Angelo Biviano
- Drs. Biviano and Reiffel Division of Cardiology of New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Cristobal Goa
- Dr. Goa Department of Internal Medicine of New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Sam Hanon
- Dr. Hanon Division of Cardiology of Beth Israel Medical Center, University Hospital and Manhattan Campus for the Albert Einstein College of Medicine, New York, NY
| | - James Reiffel
- Drs. Biviano and Reiffel Division of Cardiology of New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
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Hickey KT, Johnson MP, Biviano A, Aboelela S, Thomas T, Bakken S, Garan H, Zimmerman JL, Whang W. Cardiac e-Learning: Development of a Web-Based Implantable Cardioverter Defibrillator Educational System. Telemed J E Health 2011; 17:196-200. [DOI: 10.1089/tmj.2010.0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kathleen T. Hickey
- School of Nursing, Columbia University, New York, New York
- College of Physicians & Surgeons, Columbia University, New York, New York
| | | | - Angelo Biviano
- College of Physicians & Surgeons, Columbia University, New York, New York
| | - Sally Aboelela
- School of Nursing, Columbia University, New York, New York
| | - Tami Thomas
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York
- College of Physicians & Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- College of Physicians & Surgeons, Columbia University, New York, New York
| | - John L. Zimmerman
- College of Physicians & Surgeons, Columbia University, New York, New York
- College of Dental Medicine, Columbia University, New York, New York
- College of Physicians & Surgeons, Columbia University, New York, New York
| | - William Whang
- College of Physicians & Surgeons, Columbia University, New York, New York
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Dizon J, Biviano A, Whang W, Ehlert F, Garan H. Changes in low right atrial conduction times during pulmonary vein isolation for atrial fibrillation: correlation with inducibility of typical right atrial flutter. Europace 2011; 13:942-8. [PMID: 21427089 DOI: 10.1093/europace/eur033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Isthmus-dependent right atrial flutter (RAFL) is a common sequela of pulmonary vein isolation (PVI). It is unclear as to whether RAFL is a result of PVI or a concealed phenomenon unmasked by the elimination of atrial fibrillation (AF). We measured low right atrial conduction times (LRACTs) before and after PVI and examined their relationship to the inducibility of RAFL. METHODS AND RESULTS Twenty consecutive patients with paroxysmal AF but no history of RAFL were studied during the initial PVI procedure by radiofrequency ablation. Antiarrhythmic agents were discontinued for at least five half-lives. The clockwise and counterclockwise LRACTs were measured before and after PVI by pacing the proximal coronary sinus or low-lateral RA. Programmed atrial stimulation was performed post-PVI. Right atrial flutter, if inducible, was confirmed by entrainment mapping. Right atrial flutter was induced in six patients (Group A). No arrhythmias or only AF was induced in the remaining 14 patients (Group B). The average change in the clockwise LRACT was 19.8±17.5 ms in Group A vs. 0.3±10.7 ms in Group B (P<0.05). The average change in the counterclockwise LRACT was 25.7±30.4 ms in Group A vs. 0.0±6.7 ms in Group B (P<0.05). There were no significant differences between the groups in absolute LRACT or number of ablation lesions around the right pulmonary veins. CONCLUSION Right atrial flutter post-PVI is associated with prolongation of LRACTs. Ablation over the septal left atrium near the posterior right atrium during isolation of the right pulmonary veins may cause conduction delays that can lead to RAFL.
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Affiliation(s)
- José Dizon
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, Columbia University, 630 West. 168th Street, New York, NY 10032, USA.
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