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Farwati M, Braghieri L, Abdulhai FA, Dabbagh M, Alkhalaileh FA, Younis A, Tabaja C, Farwati A, Amin M, Santangeli P, Nakagawa H, Saliba WI, Kanj M, Callahan TD, Bhargava M, Baranowski B, Rickard J, Sroubek J, Lee J, Tchou PJ, Wazni OM, Hussein AA. Cryoballoon pulmonary vein isolation versus radiofrequency ablation of the pulmonary veins and left atrial posterior wall: Patient-reported outcomes. Pacing Clin Electrophysiol 2024; 47:595-602. [PMID: 38523591 DOI: 10.1111/pace.14943] [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: 08/08/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Data are lacking on patient-reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO-PVI-ONLY) versus RFA with PVI and posterior wall isolation (RF-PVI+PWI) in a large prospective PRO registry. METHODS Patients who underwent AF ablation (2013-2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO-PVI-ONLY patients were matched (1:1) with RF-PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1-year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient-reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). RESULTS A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO-PVI-ONLY and RF-PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO-PVI-ONLY) vs. 92.8% (RF-PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO-PVI-ONLY group (39.7%) compared to RF-PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. CONCLUSION CRYO-PVI-ONLY and RF-PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF-PVI+PWI being more effective at reducing recurrences.
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Affiliation(s)
- Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Farah A Abdulhai
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marwan Dabbagh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Firas A Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Burke BJ, El Assaad I, Liu W, Kanj M, Wazni OM, Callahan TD, Baranowski B, Saarel EV, Heilbronner A, Aziz PF. Underestimated recurrence rates after ablation for Wolff-Parkinson-White syndrome and impact on follow-up practices. Heart Rhythm 2024:S1547-5271(24)02498-6. [PMID: 38663786 DOI: 10.1016/j.hrthm.2024.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Brendan J Burke
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Iqbal El Assaad
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Thomas D Callahan
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bryan Baranowski
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Peter F Aziz
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio.
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Hayashi K, Callahan T, Rickard J, Younis A, Baranowski B, Martin D, Nakhla S, Tabaja C, Wilkoff BL. Extraction outcomes of implantable cardioverter-defibrillator leads vary by manufacturer and model family. Europace 2023; 25:euad345. [PMID: 38000893 PMCID: PMC10751850 DOI: 10.1093/europace/euad345] [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: 09/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) of implantable cardioverter-defibrillator (ICD) leads is considered challenging. The structure of each ICD leads is variable between manufacturer and model families. The net impact of lead family on the safety and effectiveness of TLE is poorly characterized. We assessed the safety and efficacy of ICD TLE and the impact of manufacturer ICD model family on the outcomes. METHODS AND RESULTS The study cohort included all consecutive patients with ICD who underwent TLE between 2013 and 2022 and are enrolled in the Cleveland Clinic Prospective TLE Registry. A total of 885 ICD leads (median implant duration 8 years) in 810 patients were included. Complete ICD TLE success was achieved in 97.2% of the leads (n = 860) and in 98.0% of the patients (n = 794). Major complications occurred in 22 patients (2.7%). Complete procedural success rate varied by manufacturer and lead family; Medtronic 98.9%, Abbott 95.9%, Boston Scientific 95.0%, Biotronik 91.2%, P = 0.03, and Linox family leads had the lowest, 89.7% P = 0.02. Multivariable predictors of incomplete ICD lead removal included ICD lead age > 10 years and Linox family lead. Multivariable predictors of major complications included ICD lead age > 15 years and longer lead extraction time, and predictors of all-cause mortality within 30 days included lead extraction for infection, end-stage renal disease, and higher New York Heart Association functional class. CONCLUSION Complete and safe ICD lead removal rate by TLE is extremely high but varied by manufacturer and lead family. Linox family lead and >10 years lead age were independent predictors of incomplete lead removal.
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Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - David Martin
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Chadi Tabaja
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue Desk J2-2, Cleveland, OH 44195, USA
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM, Mendes LA, Arrighi JA, Breinholt JP, Day J, Dec GW, Denktas AE, Drajpuch D, Faza N, Francis SA, Hahn RT, Housholder-Hughes SD, Khan SS, Kondapaneni MD, Lee KS, Lin CH, Hussain Mahar J, McConnaughey S, Niazi K, Pearson DD, Punnoose LR, Reejhsinghani RS, Ryan T, Silvestry FE, Solomon MA, Spicer RL, Weissman G, Werns SW. 2023 ACC/AHA/SCAI advanced training statement on interventional cardiology (coronary, peripheral vascular, and structural heart interventions): A report of the ACC Competency Management Committee. J Thorac Cardiovasc Surg 2023; 166:e73-e123. [PMID: 37269254 DOI: 10.1016/j.jtcvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Alkhalaileh F, Wazni OM, Kiang A, Parker J, Ellis S, Kanj M, Farwati M, Menon V, Callahan T, Baranowski B, Nakhla S, Taigen T, Santangeli P, Kewan T, Cantillon D, Sroubek J, Rickard J, Zmaili M, Bhargava M, Saliba WI, Nakagawa H, Hussein AA. Ischemic or Coronary Evaluations in Patients With Monomorphic VT Electrical Storm Undergoing VT Ablation. JACC Clin Electrophysiol 2023; 9:1890-1899. [PMID: 37542488 DOI: 10.1016/j.jacep.2023.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Monomorphic ventricular tachycardia (VT) electrical storm (ES) in patients with coronary artery disease is dependent on scarred myocardium. The role of routine ischemic or coronary evaluations before ablation in patients presenting with monomorphic VT storm, without acute coronary syndrome (ACS), remains unknown. OBJECTIVES This study sought to assess the impact of ischemic or coronary evaluations on procedural outcomes and post-ablation mortality in monomorphic VT storm patients. METHODS All patients undergoing VT ablation at the Cleveland Clinic from 2014 to 2020 after presenting with monomorphic VT storm were enrolled in a prospectively maintained registry. The associations among ischemic or coronary evaluations and short-term procedural efficacy, acute outcomes, and mortality during follow-up were assessed. RESULTS A total of 97 consecutive patients with monomorphic VT storm in the absence of ACS underwent VT ablations. This cohort was characterized by severe LV systolic dysfunction (mean left ventricular ejection fraction 30.3%, 67% with known ischemic cardiomyopathy) with moderately severe heart failure (median NYHA functional class II); 45% of patients underwent ischemic or coronary evaluations via coronary angiography (10%), noninvasive myocardial perfusion (26%), or both (9%). The yield of these evaluations was low: No acute coronary occlusions were identified. There was no association between ischemic evaluation and acute ablation outcomes or mortality during follow-up. Similarly, in a secondary analysis, the yield of ischemic or coronary evaluations in patients with monomorphic VT storm and known coronary disease (regardless of ablation status) was found to be low. CONCLUSIONS Ischemic evaluations in patients with monomorphic VT storm without ACS may not improve procedural outcomes or mortality after ablation.
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Affiliation(s)
- Feras Alkhalaileh
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alan Kiang
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Parker
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Ellis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Venugopal Menon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tariq Kewan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Cantillon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohammad Zmaili
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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6
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Tabaja C, Younis A, Santageli P, Farwati M, Braghieri L, Nakagawa H, Saliba WI, Madden R, Bouscher P, Kanj M, Callahan TD, Martin D, Bhargava M, Chung M, Baranowski B, Nakhla S, Sroubek J, Lee J, Taigen T, Wazni OM, Hussein AA. Impact of obesity on catheter ablation of atrial fibrillation: Patient characteristics, procedural complications, outcomes, and quality of life. J Cardiovasc Electrophysiol 2023; 34:1648-1657. [PMID: 37493505 PMCID: PMC11078572 DOI: 10.1111/jce.15987] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Obesity is a well-known risk factor for atrial fibrillation (AF). We aim to evaluate the effect of baseline obesity on procedural complications, AF recurrence, and symptoms following catheter ablation (CA). METHODS All consecutive patients undergoing AF ablation (2013-2021) at our center were enrolled in a prospective registry. The study included all consecutive patients with available data on body mass index (BMI). Primary endpoint was AF recurrence based on electrocardiographic documentation. Patients were categorized into five groups according to their baseline BMI. Patients survey at baseline and at follow-up were used to calculate AF symptom severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous and 9 frequencies/durations in between). Patients were scheduled for follow-up visits with 12-lead electrocardiogram at 3, 6, and 12 months after ablation, and every 6 months thereafter. RESULTS A total of 5841 patients were included (17% normal weight, 34% overweight, 27% Class I, 13% Class II, and 9% Class III obesity). Major procedural complications were low (1.5%) among all BMI subgroups. At 3 years AF recurrence was the highest in Class III obesity patients (48%) followed by Class II (43%), whereas Class I, normal, and overweight had similar results with lower recurrence (35%). In multivariable analyses, Class III obesity (BMI ≥ 40) was independently associated with increased risk for AF recurrence (hazard ratio, 1.30; confidence interval, 1.06-1.60; p = .01), whereas other groups had similar risk in comparison to normal weight. Baseline AFSS was lowest in normal weight, and highest in Obesity-III, median (interquartile range) 10 (5-16) versus 15 (10-21). In all groups, CA resulted in a significant improvement in their AFSS with a similar magnitude among the groups. At follow-up, AF burden was minimal and did not differ significantly between the groups. CONCLUSION AF ablation is safe with a low complication rate across all BMI groups. Morbid obesity (BMI ≥ 40) was significantly associated with reduced AF ablation success. However, ablation resulted in improvement in QoL including reduction of the AFSS, and AF burden regardless of BMI.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santageli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Bouscher
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Justin Lee
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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7
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Johnson BM, Wazni OM, Farwati M, Saliba WI, Santangeli P, Madden R, Bouscher P, Chung M, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Sroubek J, Nakagawa H, Hussein AA. Atrial Fibrillation Ablation in Young Adults: Measuring Quality of Life Using Patient-Reported Outcomes Over 5 Years. Circ Arrhythm Electrophysiol 2023; 16:e011565. [PMID: 37183675 PMCID: PMC11093280 DOI: 10.1161/circep.122.011565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 04/07/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Ablation is used for both rhythm control and improved quality of life (QoL) in atrial fibrillation (AF). It has been suggested that young adults may experience high recurrence rates after ablation and data remain lacking regarding QoL benefits. We aimed to investigate AF ablation outcomes and QoL benefits in young adults undergoing AF ablation using a large prospectively maintained registry and automated patient-reported outcomes (PRO). METHODS All patients undergoing AF ablation (2013-2016) at our center were prospectively enrolled. Patients aged 50 years or younger were included. For PROs, QoL measures and symptoms were assessed at baseline, 3 months after ablation, and every 6 months thereafter. The AF severity score served as the main assessment of QoL. RESULTS A total of 241 young adults (age, 16-50 years) were included (17% female, 40.3% persistent AF). In all, 77.2% of patients remained arrhythmia-free during the first year of follow-up (80% in nonstructural AF and 66% in structural AF). Using PROs, 90% of patients reported improvement in QoL throughout all survey time points up to 5 years postablation (P<0.0001). The baseline median AF severity score was 14 and improved to between 2 and 4 on all follow-up after ablation (P<0.0001). Patients also reported fewer and shorter AF episodes, fewer emergency room visits secondary to AF, and fewer hospitalizations (P<0.0001). CONCLUSIONS Ablation remains an effective rhythm-control strategy in young adults with AF. Young adults also experience significant improvement in QoL with reduction of the frequency and duration of AF episodes and AF-related healthcare utilization.
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Affiliation(s)
- Brett M Johnson
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Patricia Bouscher
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Mina Chung
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | | | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. JACC Cardiovasc Interv 2023; 16:1239-1291. [PMID: 37115166 DOI: 10.1016/j.jcin.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Lin CH, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2023; 81:1386-1438. [PMID: 36801119 DOI: 10.1016/j.jacc.2022.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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10
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Bass TA, Abbott JD, Mahmud E, Parikh SA, Aboulhosn J, Ashwath ML, Baranowski B, Bergersen L, Chaudry HI, Coylewright M, Denktas AE, Gupta K, Gutierrez JA, Haft J, Hawkins BM, Herrmann HC, Kapur NK, Kilic S, Lesser J, Huie LC, Mendirichaga R, Nkomo VT, Park LG, Phoubandith DR, Quader N, Rich MW, Rosenfield K, Sabri SS, Shames ML, Shernan SK, Skelding KA, Tamis-Holland J, Thourani VH, Tremmel JA, Uretsky S, Wageman J, Welt F, Whisenant BK, White CJ, Yong CM. 2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee. Circ Cardiovasc Interv 2023; 16:e000088. [PMID: 36795800 DOI: 10.1161/hcv.0000000000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Hayashi K, Younis A, Callahan T, Baranowski B, Martin DO, Nakhla S, Wilkoff BL. Clinical Predictors of Incomplete CS Lead Removal during Transvenous Lead Extraction in the Patients with Cardiac Resynchronization Therapy. Heart Rhythm 2023; 20:872-878. [PMID: 36933853 DOI: 10.1016/j.hrthm.2023.03.015] [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: 01/16/2023] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Reports of coronary sinus (CS) lead removal include small studies with short implant durations. Procedural outcomes for mature CS leads removed with long duration implantation are unavailable. OBJECTIVE To examine the safety, efficacy, and clinical predictors for incomplete CS lead removal by Transvenous Lead Extraction (TLE) in a large, long implant duration cardiac resynchronization therapy (CRT) patient cohort. METHODS Consecutive patients with CRT devices in the Cleveland Clinic Prospective TLE Registry who had TLE between 2013 and 2022. RESULTS CS leads, n=231, implant duration = 6.1±4.0 years, removed from 226 patients were included, employing powered sheaths for 137 leads (59.3%). Complete CS lead success was achieved in 95.2% of leads (n=220) and in 95.6% of patients (n=216). Major complications occurred in 5 patients (2.2%). Patients who had the CS lead extracted 1st had significantly higher incomplete removal rates than when the other leads were 1st removed. Multivariable analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent predictors of incomplete CS lead removal. CONCLUSION Complete and safe lead removal rate of long implant duration CS leads by TLE was 95%. However, CS lead age and the order that leads were extracted were the independent predictors of incomplete CS lead removal. Therefore, before the CS lead is extracted, physicians should first extract the leads from the other chambers and employ powered sheaths.
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Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - David O Martin
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
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12
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Wang TKM, Liao BYW, Chan N, Cremer P, Baranowski B, Kanj MH, Saliba WI, Wazni OM, Jaber WA. IMPACT AND ASSOCIATED FACTORS ON MITRAL REGURGITATION SEVERITY IN ATRIAL FIBRILLATION PATIENTS AFTER CATHETER PULMONARY VEIN ISOLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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13
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Wang TKM, Chan N, Arockiam AD, Cremer PC, Kanj M, Baranowski B, Saliba W, Hussein A, Wazni OM, Jaber WA. Anticoagulation after pulmonary vein isolation for atrial fibrillation: Associations with CHA₂DS₂-VASc score, sex, and rhythm. J Cardiovasc Electrophysiol 2023; 34:765-768. [PMID: 36738138 DOI: 10.1111/jce.15848] [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: 07/19/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Guidelines recommend using the CHA₂DS₂-VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription rates patterns in AF patients 1 year PVI at our institution. Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA₂DS₂-VASc score, sex, and heart rhythm status at 1 year. Amongst 4596 patients undergoing PVI, mean age was 64.2 ± 10.0 years, 1328 (28.9%) were female, and based on CHA₂DS₂-VASc score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%), and 2541 (55.3%) patients, respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation was continued in over half of AF patients without classic CHA₂DS₂-VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men. In a large real world cohort of patients after PVI, anticoagulation prescription is not solely depending on the CHA₂DS₂-VASc score and sex, but also heart rhythm status and other clinical or imaging factors.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aro D Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid Saliba
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman Hussein
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Farwati M, Amin M, Saliba WI, Nakagawa H, Tarakji KG, Diab M, Scandinaro A, Madden R, Bouscher P, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Sroubek J, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Wazni OM, Hussein AA. Impact of redo ablation for atrial fibrillation on patient-reported outcomes and quality of life. J Cardiovasc Electrophysiol 2023; 34:54-61. [PMID: 36259719 DOI: 10.1111/jce.15710] [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: 05/18/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry. METHODS All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations. RESULTS A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p < .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to <8% across all time points during follow-up (p < .0001). AF burden was significantly reduced (including frequency and duration of episodes; p < .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p < .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p < .0001 for all variables). CONCLUSION Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.
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Affiliation(s)
- Medhat Farwati
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mustapha Amin
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mohamed Diab
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna Scandinaro
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Madden
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patricia Bouscher
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shunsuke Kuroda
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas J Dresing
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Patrick J Tchou
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Aguilera J, Hutt E, Kaur S, Saliba WI, Tarakji KG, Baranowski B, Bhargava M, Kanj M, Cantillon DJ, Rickard J, Sroubek J, Nakagawa H, Wazni OM, Hussein AA. Outcomes of atrial fibrillation ablation in patients with or without silent pulmonary veins from prior ablation procedure. J Cardiovasc Electrophysiol 2022; 33:1994-2000. [PMID: 35689504 DOI: 10.1111/jce.15592] [Citation(s) in RCA: 2] [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: 02/03/2022] [Revised: 03/15/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pulmonary venous (PV) electrical recovery underlies most arrhythmia recurrences after atrial fibrillation (AF) ablation. Little is known about procedural profiles and outcomes of patients with electrically silent PVs upon redo ablation for AF. METHODS In a prospectively maintained registry, we enrolled 838 consecutive patients (2013-2016) undergoing redo ablation procedures. Ablation procedures targeted the PVs, the PV antra, and non-PV sites at operators' discretion. Procedural profiles and clinical outcomes were assessed. The primary outcome was freedom from AF after a 3-month blanking period. The secondary outcome was improvement in quality of life. RESULTS Most patients undergoing redo AF ablation (n = 684, 82%) had PV reconnection while the remaining 154 (18%) had electrically silent PVs. Patients with recurrent AF and electrically silent PVs were older (66 vs. 64 years, p = .02), had more prior ablation procedures (median 2 IQR 1-3 vs 1 IQR 1-2 p = .001), were more likely to have non-paroxysmal AF (62% vs. 49%, p = .004) and atrial flutter (48% vs. 29%, p = .001) and had significantly larger left atrial volumes (89 vs. 81 ml, p = .003). Patients with silent PVs underwent a more extensive non-PV ablation strategies with antral extension of prior ablation sets in addition to ablation of the roof, appendage, inferior to the right PVs, peri-mitral flutter lines, cavotricuspid isthmus lines and ablation in the coronary sinus. Upon one year of follow-up, patients with electrically silent PVs were less likely to remain free from recurrent atrial arrhythmias (64% vs. 76%, p = .008). Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. CONCLUSION Rhythm control with extensive ablation allowed maintenance of sinus rhythm in about two thirds of patients with silent PVs during redo AF ablation procedures. Regardless of PV reconnection status, redo ablation resulted in improvement in quality of life. This remains a challenging group of patients, highlighting the need to better understand non-PV mediated AF.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erika Hutt
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Simrat Kaur
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, Ohio, USA
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16
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Aguilera J, Cantillon DJ, Kiang A, Hutt E, Madden RA, Bouscher P, Kanj M, Saliba WI, Rickard J, Callahan TD, Chung MK, Baranowski B, Dresing TJ, Nakhla S, Wazni OM, Hussein AA, Taigen TL. PO-649-07 SAFETY OF SAME-DAY DISCHARGE AFTER PULMONARY VEIN ISOLATION: CONTEMPORARY SINGLE CENTER EXPERIENCE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Farwati M, Amin M, Nakagawa H, Saliba WI, Tarakji KG, Diab M, Zmaili M, alkhalaileh F, Madden RA, Bouscher P, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Wazni OM, Hussein AA. PO-650-07 CRYOBALLOON VERSUS RADIOFREQUENCY ABLATION FOR ATRIAL FIBRILLATION: ASSESSMENT OF QUALITY OF LIFE AND CLINICAL OUTCOMES USING PATIENT-REPORTED OUTCOMES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Higuchi K, Higuchi S, Baranowski B, Wazni O, Scheinman MM, Tchou P. A Case Series of Very Slow Atrioventricular Nodal Reentrant Tachycardia Resembling Junctional Tachycardia. J Cardiovasc Electrophysiol 2022; 33:1177-1182. [PMID: 35348267 PMCID: PMC9324822 DOI: 10.1111/jce.15465] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Introduction The surface electrocardiography of typical atrioventricular nodal reentrant tachycardia (AVNRT) shows simultaneous ventricular‐atrial (RP) activation with pseudo R′ in V1 and typical heart rates ranging from 150 to 220/min. Slower rates are suspicious for junctional tachycardia (JT). However, occasionally we encounter typical AVNRT with slow ventricular rates. We describe a series of typical AVNRT cases with heart rates under 110/min. Methods A total of 1972 patients with AVNRT who underwent slow pathway ablation were analyzed. Typical AVNRT was diagnosed when; (1) evidence of dual atrioventricular nodal conduction, (2) tachycardia initiation by atrial drive train with atrial‐His‐atrial response, (3) short septal ventriculoatrial time, and (4) ventricular‐atrial‐ventricular (V‐A‐V) response to ventricular overdrive (VOD) pacing with corrected post pacing interval‐tachycardia cycle length (cPPI‐TCL) > 110 ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing. Results We found 11 patients (age 20−78 years old, six female) who met the above‐mentioned criteria. The TCL ranged from 560 to 782 ms. Except for one patient showing tachycardia termination, all patients demonstrated a V‐A‐V response and cPPI‐TCL over 110 ms with VOD. AES or AOD pacing successfully excluded JT by either advancing the tachycardia in 10 patients or by tachycardia termination in one patient. Slow pathway was successfully ablated, and tachycardia was not inducible in all patients. Conclusions This case series describes patients with typical AVNRT with slow ventricular rate (less than 110/min) who may mimic JT. We emphasize the importance of using pacing maneuvers to exclude JT.
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Affiliation(s)
- Koji Higuchi
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Satoshi Higuchi
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Oussama Wazni
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Melvin M. Scheinman
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Patrick Tchou
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
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Wang TKM, Chan N, Cremer PC, Kanj M, Baranowski B, Saliba W, Wazni OM, Jaber WA. Associations and outcomes of cardiovascular calcifications by computed tomography in atrial fibrillation patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0184] [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: 11/14/2022] Open
Abstract
Abstract
Background
Coronary (CAC), mitral annular (MAC), aortic valve (AVC) and thoracic aortic (TAC) calcifications are known imaging biomarkers for cardiovascular risk in the general population. Despite this, their prognostic value are not well established in atrial fibrillation (AF) patients who have elevated risk for cardiovascular events.
Purpose
We assessed the associated factors and outcomes of cardiovascular calcifications detected by computed tomography (CT) in AF patients undergoing pulmonary vein isolation (PVI).
Methods
Consecutive AF patients enrolled in a prospective PVI registry during 2014–2018 with CT performed within 1-year of their procedure were reviewed for the presence of cardiovascular calcifications on CT. Risk factors and outcomes for each type of cardiovascular calcifications were analyzed in univariable and multivariable regression models.
Results
Amongst 3604 AF patients, there were 2238 (62.1%), 308 (8.6%), 572 (15.9%) and 1048 (29.1%) patients with CAC, MAC, AVC and TAC respectively. Factors independently associated with these cardiovascular calcifications are listed in Table 1. During mean follow-up of 2.8±1.6 years, there were 97 (2.7%) all-cause deaths, and 158 (4.4%) major adverse cardiovascular events (MACE). Forest plots of unadjusted and adjusted hazards ratios of cardiovascular calcifications at predicting these outcomes are shown in Figure 1.
Conclusion
Cardiovascular calcifications especially CAC are prevalent in AF patients, and share common risk factors with cardiovascular events, except for female being protective for CAC and AVC but having higher risk of MAC and TAC. Although all cardiovascular calcifications were associated with death and MACE in unadjusted analyses, only CAC remained so for both outcomes in adjusted analyses.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand Table 1Figure 1
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Affiliation(s)
- T K M Wang
- Cleveland Clinic, Cleveland, United States of America
| | - N Chan
- Cleveland Clinic, Cleveland, United States of America
| | - P C Cremer
- Cleveland Clinic, Cleveland, United States of America
| | - M Kanj
- Cleveland Clinic, Cleveland, United States of America
| | - B Baranowski
- Cleveland Clinic, Cleveland, United States of America
| | - W Saliba
- Cleveland Clinic, Cleveland, United States of America
| | - O M Wazni
- Cleveland Clinic, Cleveland, United States of America
| | - W A Jaber
- Cleveland Clinic, Cleveland, United States of America
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20
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Patel D, Kumar A, Moennich LA, Trulock K, Nemer DM, Donnellan E, Il'Giovine ZJ, Martyn T, Callahan TD, Hussein AA, Tarakji KG, Kanj M, Cantillon DJ, Baranowski B, Starling RC, Tang WHW, Wazni OM, Varma N, Wilkoff BL, Rickard J. Cardiac resynchronisation therapy in anthracycline-induced cardiomyopathy. Heart 2021; 108:274-278. [PMID: 34489312 DOI: 10.1136/heartjnl-2020-318333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood. METHODS We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM). RESULTS A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival. CONCLUSIONS Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
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Affiliation(s)
- Divyang Patel
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Kevin Trulock
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David M Nemer
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Eoin Donnellan
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Trejeeve Martyn
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Thomas D Callahan
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Randall C Starling
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - W H Wilson Tang
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Niraj Varma
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bruce L Wilkoff
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - John Rickard
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Bansal A, Cantillon DJ, Nakhla S, Rickard J, Baranowski B, Hussein AA, Wazni OM, Louis Taigen T. B-PO05-180 MACHINE LEARNING PREDICTION OF PULMONARY VEIN STENOSIS IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Kuroda S, Wazni OM, Saliba WI, Tarakji KG, Baranowski B, Tchou PJ, Dresing TJ, Bhargava M, Cantillon DJ, Taigen TL, Sroubek J, Chung MK, Varma N, Callahan TD, Rickard J, Nakagawa H, Anter E, Hussein AA. B-PO04-082 ELECTROPHYSIOLOGICAL FINDINGS UNDERLYING RECURRENT ATRIAL TACHYARRHYTHMIAS AFTER SURGICAL ATRIAL FIBRILLATION ABLATION IN THE ERA OF HIGH DENSITY MAPPING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Kochar AS, Donnellan E, Vincenzo LD, Wazni OM, Tanaka-Esposito C, Saliba WI, Baranowski B, Dresing TJ, Tchou PJ, Chung R. B-PO05-050 OUTCOMES OF HIS BUNDLE VS LEFT BUNDLE BRANCH PACING FOLLOWING AV NODE ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Kuroda S, Wazni OM, Saliba WI, Tarakji KG, Baranowski B, Tchou PJ, Dresing TJ, Bhargava M, Cantillon DJ, Taigen TL, Sroubek J, Chung MK, Varma N, Callahan TD, Rickard J, Nakagawa H, Anter E, Hussein A. B-PO02-107 INDICES OF CONTACT FORCE GUIDED CATHETER ABLATION AND PULMONARY VEIN RECONNECTION DURING REPEAT ATRIAL FIBRILLATION ABLATION PROCEDURES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Anter E, Yavin H, Biton D, Bubar Z, Higuchi K, Sroubek J, Wazni OM, Baranowski B, Nakagawa H, Kanj M, Tchou PJ. B-PO04-123 INCREASING LESION DIMENSIONS OF BIPOLAR RADIOFREQUENCY ABLATION BY MODULATING THE SURFACE AREA OF THE GROUNDING CATHETER. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Farwati M, Wazni OM, Tarakji KG, Diab M, Scandinaro A, Amin M, Zmaili M, Bazarbashi N, Dikilitas O, Nakagawa H, Kuroda S, Kanj M, Dresing TJ, Callahan TD, Bhargava M, Baranowski B, Rickard J, Cantillon DJ, Tchou PJ, Saliba WI, Hussein AA. Super and Nonresponders to Catheter Ablation for Atrial Fibrillation: A Quality-of-Life Assessment Using Patient Reported Outcomes. Circ Arrhythm Electrophysiol 2021; 14:e009938. [PMID: 34279998 DOI: 10.1161/circep.121.009938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Medhat Farwati
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Oussama M Wazni
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mohamed Diab
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Anna Scandinaro
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mustapha Amin
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Mohammad Zmaili
- Department of Internal Medicine (M.F., A.S., M.A., M.Z.), Cleveland Clinic, OH
| | - Najdat Bazarbashi
- Department of Internal Medicine, University of Maryland, Baltimore (N.B.)
| | - Ozan Dikilitas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (O.D.)
| | - Hiroshi Nakagawa
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Shunsuke Kuroda
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | | | - Thomas J Dresing
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Thomas D Callahan
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Mandeep Bhargava
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Bryan Baranowski
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - John Rickard
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Daniel J Cantillon
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Patrick J Tchou
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Walid I Saliba
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
| | - Ayman A Hussein
- Heart and Vascular Institute (O.M.W., K.G.T., M.D., H.N., S.K., M.K., T.J.D., T.D.C., M.B., B.B., J.R., D.J.C., P.J.T., W.I.S., A.A.H.), Cleveland Clinic, OH
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Wang T, Chan N, Cremer P, Kanj M, Baranowski B, Saliba W, Wazni O, Jaber W. Associations And Outcomes Of Cardiovascular Calcifications By Computed Tomography In Atrial Fibrillation Patients. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Donnellan E, Wazni O, Kanj M, Elshazly MB, Hussein A, Baranowski B, Hanna M, Patel D, Trulock K, Martyn M, Menon V, Saliba W, Jaber WA. Atrial fibrillation ablation in patients with transthyretin cardiac amyloidosis. Europace 2021; 22:259-264. [PMID: 32031230 DOI: 10.1093/europace/euz314] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) occurs in as many as 70% of patients with transthyretin cardiac amyloidosis (ATTR CA). The aim of our study was to investigate the impact of AF ablation on freedom from recurrent arrhythmia, hospitalization for AF or heart failure (HF), and mortality. METHODS AND RESULTS This was a retrospective observational cohort study of 72 patients with ATTR CA and AF, of whom 24 underwent AF ablation and were matched in a 2:1 manner based on age, gender, ATTR CA stage, New York Heart Association functional class, ejection fraction, and date of AF diagnosis with 48 patients with ATTR CA and AF undergoing medical management. During a mean follow-up of 39 ± 26 months, 10 (42%) patients remained free of recurrent arrhythmia following ablation. Ablation was significantly more effective in those with Stage I or II ATTR CA, with 9/14 (64%) patients with Stage I or II ATTR CA remaining free of recurrent arrhythmia compared to only 1/10 (10%) patients with Stage III disease (P = 0.005). Death occurred in 7 (29%) patients in the ablation group compared to 36 (75%) in the non-ablation arm (P = 0.01). Rates of ischaemic stroke were similar in both groups. Ablation was associated with a significant reduction in the frequency of hospitalization for HF/arrhythmia (1.7 ± 2.4 hospitalizations vs. 4 ± 3.5, P = 0.005). On Cox proportional hazards analyses, ablation was associated with improved survival (hazard ratio 0.38, 95% confidence intervals 0.17-0.86; P = 0.02). CONCLUSION Atrial fibrillation ablation is associated with reduced mortality in ATTR CA and is most effective when performed earlier during the disease process.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Michael Martyn
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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29
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Kuroda S, Wazni OM, Saliba WI, Hilow H, Baranowski B, Tarakji KG, Higuchi K, Tchou P, Dresing T, Lopez JO, Bhargava M, Cantillon DJ, Callahan T, Rickard J, Nakagawa H, Anter E, Hussein AA. The utility of a novel mapping algorithm utilizing vectors and global pattern of propagation for scar-related atrial tachycardias. J Cardiovasc Electrophysiol 2021; 32:1909-1917. [PMID: 33955116 DOI: 10.1111/jce.15074] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/15/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Activation maps of scar-related atrial tachycardias (AT) can be challenging to interpret due to difficulty in inaccurate annotation of electrograms, and an arbitrarily predefined mapping window. A novel mapping software integrating vector data and applying an algorithmic solution taking into consideration global activation pattern has been recently described (Coherent™, Biosense Webster "Investigational"). OBJECTIVE We aimed to assess the investigational algorithm to determine the mechanism of AT compared with the standard algorithm. METHODS This study included patients who underwent ablation of scar-related AT using the Carto 3 and the standard activation algorithm. The mapping data were analyzed retrospectively using the investigational algorithm, and the mechanisms were evaluated by two independent electrophysiologists. RESULTS A total of 77 scar-related AT activation maps were analyzed (89.6% left atrium, median tachycardia cycle length of 273 ms). Of those, 67 cases with a confirmed mechanism of arrhythmia were used to compare the activation software. The actual mechanism of the arrhythmia was more likely to be identified with the investigational algorithm (67.2% vs. 44.8%, p = .009). In five patients with dual-loop circuits, 3/5 (60%) were correctly identified by the investigational algorithm compared to 0/5 (0%) with the standard software. The reduced atrial voltage was prone to lead to less capable identification of mechanism (p for trend: .05). The investigational algorithm showed higher inter-reviewer agreement (Cohen's kappa .62 vs. .47). CONCLUSIONS In patients with scar-related ATs, activation mapping algorithms integrating vector data and "best-fit" propagation solution may help in identifying the mechanism and the successful site of termination.
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Affiliation(s)
- Shunsuke Kuroda
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Henry Hilow
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaldoun G Tarakji
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Tchou
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John O Lopez
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J Cantillon
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Callahan
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elad Anter
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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30
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Wang TKM, Chan N, Cremer P, Kanj M, Baranowski B, Saliba W, Wazni O, Jaber W. INCORPORATING CORONARY CALCIFICATION BY COMPUTED TOMOGRAPHY INTO CHA2DS2-VASC SCORE AND ASSOCIATIONS WITH CARDIOVASCULAR OUTCOMES IN ATRIAL FIBRILLATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Wang TKM, Chan N, Cremer PC, Kanj M, Baranowski B, Saliba W, Wazni OM, Jaber WA. Incorporating coronary calcification by computed tomography into CHA2DS2-VASc score: impact on cardiovascular outcomes in patients with atrial fibrillation. Europace 2021; 23:1211-1218. [PMID: 33585883 DOI: 10.1093/europace/euab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS CHA2DS2-VASc score is widely utilized for risk stratification and guiding anticoagulation in patients with atrial fibrillation (AF). Cardiac computed tomography (CCT) routinely performed for pulmonary vein isolation (PVI) can also identify coronary artery calcifications (CAC). We evaluated the frequency and outcomes of incorporating CAC into the CHA2DS2-VASc score in AF patients undergoing PVI. METHODS AND RESULTS Consecutive patients in a prospective PVI registry during 2014-18 having CCT within 1 year of PVI were studied. Reclassification of CHA2DS2-VASc score and associations between CAC as a binary variable detected on CCT with clinical characteristics, stroke as primary endpoint, death, myocardial infarction, and major adverse cardiovascular events (MACE) were analysed. Amongst 3604 AF patients, 2238 (62.1%) had CAC detected on CCT and was associated with most traditional cardiovascular risk factors. Coronary artery calcification was independently associated with all pre-specified endpoints adjusting for clinical parameters in multivariable analysis. Adjusting for CHA2DS2-VASc score, CAC was associated with stroke (hazards ratio 3.64, 95% confidence interval 1.25-10.6, P = 0.018), death (2.26, 1.29-3.98, P = 0.006), and MACE (2.08, 1.36-3.16, P = 0.001) during 2.8 ± 1.6-year follow-up. Incorporating CAC as a vascular disease parameter of CHA2DS2-VASc score, anticoagulation decision-making would be revised in 723 (20.1%) patients, including an additional 488 (13.5%) patients where anticoagulation would be now indicated. CONCLUSION Coronary artery calcification is prevalent in AF patients undergoing PVI and independently associated stroke, death and MACE even when adjusted for traditional CHA2DS2-VASc score. Adding CAC as vascular component to the CHA2DS2-VASc score requires further research as it potentially modified the anticoagulation management in 20% of our AF cohort.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Nicholas Chan
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Walid Saliba
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Oussama M Wazni
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland,OH, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, 9500 Euclid Avenue, Main Campus J1-5, Cleveland Clinic, Cleveland,OH 44195, USA
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32
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Donnellan E, Elshazly MB, Vakamudi S, Wazni OM, Cohen JA, Kanj M, Hanna M, Baranowski B, Saliba W, Jaber W. No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. JACC Clin Electrophysiol 2020; 5:1473-1474. [PMID: 31857048 DOI: 10.1016/j.jacep.2019.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
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Donnellan E, Wazni OM, Kanj M, Baranowski B, Cremer P, Harb S, McCarthy CP, McEvoy JW, Elshazly MB, Aagaard P, Tarakji KG, Jaber WA, Schauer PR, Saliba WI. Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation. Europace 2020; 21:1476-1483. [PMID: 31304532 DOI: 10.1093/europace/euz183] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 04/11/2019] [Accepted: 06/04/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. METHODS AND RESULTS In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05-0.39; P = 0.002). CONCLUSION Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Cian P McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - John W McEvoy
- National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip Aagaard
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Philip R Schauer
- Department of Bariatric Surgery, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH, USA
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Mandsager KT, Phelan DM, Diab M, Baranowski B, Saliba WI, Tarakji KG, Jaber WA, Kanj M, Tchou P, Lindsay BD, Wazni OM, Hussein AA. Outcomes of Pulmonary Vein Isolation in Athletes. JACC Clin Electrophysiol 2020; 6:1265-1274. [DOI: 10.1016/j.jacep.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022]
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Higuchi K, Baranowski B, Tchou P. Ventricular premature pacing to reveal slow pathway conduction: A case of dual ventricular response with ventriculoatrial block. HeartRhythm Case Rep 2020; 6:765-769. [PMID: 33101951 PMCID: PMC7573365 DOI: 10.1016/j.hrcr.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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36
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Donnellan E, Wazni OM, Hanna M, Elshazly MB, Puri R, Saliba W, Kanj M, Vakamudi S, Patel DR, Baranowski B, Cantillon D, Dresing T, Jaber WA. Atrial Fibrillation in Transthyretin Cardiac Amyloidosis. JACC Clin Electrophysiol 2020; 6:1118-1127. [DOI: 10.1016/j.jacep.2020.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 01/02/2023]
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37
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Diab M, Wazni OM, Saliba WI, Tarakji KG, Ballout JA, Hutt E, Rickard J, Baranowski B, Tchou P, Bhargava M, Chung M, Varma N, Martin DO, Dresing T, Callahan T, Cantillon D, Kanj M, Hussein AA. Ablation of Atrial Fibrillation Without Left Atrial Appendage Imaging in Patients Treated With Direct Oral Anticoagulants. Circ Arrhythm Electrophysiol 2020; 13:e008301. [DOI: 10.1161/circep.119.008301] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background:
Many centers continue to routinely perform transesophageal echocardiograms before atrial fibrillation (AF) ablation procedures in patients treated with direct oral anticoagulants (DOACs). One study suggested that the procedures could be done without transesophageal echocardiogram but used intracardiac echocardiography imaging of the appendage from the right ventricular outflow. This study aimed to assess the safety of ablation for AF without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage in DOAC compliant patients.
Methods:
All patients undergoing AF ablation at the Cleveland Clinic (2011–2018) were enrolled in a prospectively maintained data registry. All consecutive patients presenting with AF or atrial flutter on DOAC were included. Periprocedural thromboembolic complications were assessed.
Results:
A total of 900 patients were included. Their median CHA
2
DS
2
-VASc score was 2 (interquartile range 1–3). All were on DOACs (333 rivaroxaban, 285 dabigatran, 281 apixaban, and 1 edoxaban). Thromboembolic complications occurred in 4 patients (0.3%): 2 ischemic strokes, 1 transient ischemic attack without residual deficit, and 1 splenic infarct; all with no further complications. Bleeding complications occurred in 5 patients (0.4%): 2 pericardial effusions (1 intraoperative, 1 after 30 days, both drained), 3 groin hematomas (1 of them due to needing heparin for venous thrombosis, none required interventions). No patients required emergent surgeries.
Conclusions:
In DOAC compliant patients who present for ablation in AF/atrial flutter, the procedures could be performed without transesophageal echocardiogram screening or intracardiac echocardiography imaging of the appendage; with low risk of complications.
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Affiliation(s)
- Mohamed Diab
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Oussama M. Wazni
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Walid I. Saliba
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Khaldoun G. Tarakji
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Jad A. Ballout
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Erika Hutt
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - John Rickard
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bryan Baranowski
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Patrick Tchou
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mandeep Bhargava
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mina Chung
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Niraj Varma
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - David O. Martin
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Dresing
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Callahan
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Daniel Cantillon
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Kanj
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ayman A. Hussein
- Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, OH
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Donnellan E, Cotter TG, Wazni OM, Elshazly MB, Kochar A, Wilner B, Patel D, Kanj M, Hussein A, Baranowski B, Cantillon D, Griffin B, Jaber W, Saliba WI. Impact of Nonalcoholic Fatty Liver Disease on Arrhythmia Recurrence Following Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:1278-1287. [PMID: 33092755 DOI: 10.1016/j.jacep.2020.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study sought to investigate the association between nonalcoholic fatty liver disease (NAFLD) and arrhythmia recurrence following atrial fibrillation ablation; and to examine the impact of NAFLD stage on outcomes. BACKGROUND Metabolic derangements, including obesity and diabetes, are associated with incident and recurrent atrial fibrillation (AF), in addition to the development of NAFLD. METHODS This was a retrospective study of 267 consecutive patients undergoing AF ablation, 89 of whom were diagnosed with NAFLD prior to ablation and matched in a 2:1 manner based on age, sex, body mass index, ejection fraction, and AF type with 178 patients without NAFLD. Patients were monitored for arrhythmia recurrence during a mean follow-up of 29 months. RESULTS Recurrent arrhythmia was observed in 50 (56%) patients with NAFLD compared with 37 (21%) without NAFLD. Epicardial fat volume was measured on computed tomography and was significantly higher among those with NAFLD (248 ± 125 ml vs. 223 ± 97 ml; p = 0.01). On multivariable models adjusting for sleep apnea, body mass index, heart failure, AF type, and left atrial size, NAFLD was independently associated with increased rates of arrhythmia recurrence (hazard ratio: 3.010; 95% confidence interval: 1.980 to 4.680; p < 0.0001). CONCLUSIONS NAFLD is associated with significantly increased arrhythmia recurrence rates following AF ablation. Identification and reversal, where possible, may result in improved arrhythmia-free survival.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas G Cotter
- Department of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed B Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arshneel Kochar
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Wilner
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Cantillon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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39
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Chahine J, Baranowski B, Tarakji K, Gad MM, Saliba W, Rickard J, Cantillon DJ, Diab M, Kanj M, Callahan T, Dresing T, Bhargava M, Chung M, Niebauer MJ, Varma N, Tchou P, Wilkoff BL, Wazni O, Hussein AA. Cardiac venous injuries: Procedural profiles and outcomes during left ventricular lead placement for cardiac resynchronization therapy. Heart Rhythm 2020; 17:1298-1303. [DOI: 10.1016/j.hrthm.2020.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
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40
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Donnellan E, Wazni OM, Kanj M, Elshazly M, Hussein AA, Patel DR, Trulock K, Wilner B, Baranowski B, Cantillon DJ, Varma N, Jaber W, Saliba WI. Impact of risk-factor modification on arrhythmia recurrence among morbidly obese patients undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:1979-1986. [PMID: 32510749 DOI: 10.1111/jce.14607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Morbid obesity is associated with prohibitively high arrhythmia recurrence rates following atrial fibrillation (AF) ablation. DESIGN This was a single-center study comprising 239 patients with morbid obesity and symptomatic paroxysmal or persistent AF undergoing AF ablation compared to 239 patients with a body mass index less than 30 kg/m2 matched based on age, sex, ejection fraction, AF type, presence and type of heart failure, and left atrial volume index. METHODS Our primary outcome of interest was arrhythmia recurrence. RESULTS During a mean follow-up of 29 months, arrhythmia recurrence was observed in 65% of the morbidly obese cohort compared to 27% of the control group (P < .0001). Among those with morbid obesity, sleep apnea screening, and treatment (91% vs 40%; P < .0001), blood pressure control (62% vs 53%; P = .001), glycemic control (85% vs 56%; P = .004), and weight loss more than equal to 5% (33% vs 57% in those who lost less than 5% and 83% in those who gained weight, P < .0001) were associated with lower arrhythmia recurrence. Recurrent arrhythmia was observed in one (4%) patient who accomplished all four goals, compared to 36% who achieved 3 of 4, 85% who modified 2 of 4%, and 97% of those who modified zero or one risk-factor. Risk-factor modification (RFM) was also associated with substantial reductions in the need for repeat ablation or direct-current cardioversion and arrhythmia-related hospitalization (P < .0001). CONCLUSION RFM through pragmatic noninvasive means such as blood pressure and glycemic control, sleep apnea screening and treatment, and weight loss is associated with substantially lower rates of recurrent arrhythmia among morbidly obese patients undergoing AF ablation.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Elshazly
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Divyang R Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Wilner
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Daniel J Cantillon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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41
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Koene RJ, Menon V, Cantillon DJ, Dresing TJ, Martin DO, Kanj M, Saliba WI, Tarakji KG, Baranowski B, Hussein AA, Tchou PJ, Bhargava M, Callahan TD, Rickard JW, Niebauer MJ, Chung MK, Varma N, Wilkoff BL, Lindsay BD, Wazni OM. Clinical Outcomes and Characteristics With Dofetilide in Atrial Fibrillation Patients Considered for Implantable Cardioverter-Defibrillator. Circ Arrhythm Electrophysiol 2020; 13:e008168. [PMID: 32538135 DOI: 10.1161/circep.119.008168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dofetilide is one of the only anti-arrhythmic agents approved for atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF). However, postapproval data and safety outcomes are limited. In this study, we assessed the incidence and predictors of LVEF improvement, safety, and outcomes in patients with AF with LVEF ≤35% without prior implantable cardioverter defibrillator, cardiac resynchronization therapy, or AF ablation. METHODS An analysis of 168 consecutive patients from 2007 to 2016 was performed. Incidences of adverse events, drug continuation, implantable cardioverter defibrillator and cardiac resynchronization therapy implantation, LVEF improvement (>35%) and recovery (≥50%), AF recurrence, and AF ablation were determined. Multivariable regression analysis to identify predictors of LVEF improvement/recovery was performed. RESULTS The mean age was 64±12 years. Dofetilide was discontinued before hospital discharge in 46 (27%) because of QT prolongation (14%), torsades de pointe or polymorphic ventricular tachycardia/fibrillation (6% [sustained 3%, nonsustained 3%]), ineffectiveness (5%), or other causes (3%). At 1 year, 43% remained on dofetilide. Freedom from AF was 42% at 1 year, and 40% underwent future AF ablation. LVEF recovered (≥50%) in 45% and improved to >35% in 73%. Predictors of LVEF improvement included presence of AF during echocardiogram (odds ratio, 4.22 [95% CI, 1.71-10.4], P=0.002), coronary artery disease (odds ratio, 0.35 [95% CI, 0.16-0.79], P=0.01), left atrial diameter (odds ratio, 0.52 per 1 cm increase [95% CI, 0.30-0.90], P=0.01), and LVEF (odds ratio, per 1% increase, 1.09 [95% CI, 1.02-1.16], P=0.006). The C statistic was 0.78. CONCLUSIONS In patients with LVEF ≤35%, who are potential implantable cardioverter defibrillator candidates, treated with dofetilide as an initial anti-arrhythmic strategy for AF, drug discontinuation rates were high, and many underwent future AF ablation. However, most patients had improvement in LVEF, obviating the need for primary prevention implantable cardioverter defibrillator.
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Affiliation(s)
- Ryan J Koene
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Vivek Menon
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Daniel J Cantillon
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Thomas J Dresing
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - David O Martin
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Walid I Saliba
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Patrick J Tchou
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mandeep Bhargava
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Thomas D Callahan
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - John W Rickard
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mark J Niebauer
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Mina K Chung
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Niraj Varma
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Bruce D Lindsay
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic, OH
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Hu PT, Hilow H, Patel D, Eppich M, Cantillon D, Tchou P, Bhargava M, Kanj M, Baranowski B, Hussein A, Callahan T, Saliba W, Dresing T, Wilkoff BL, Rasmussen PA, Wazni O, Tarakji KG. Use of virtual visits for the care of the arrhythmia patient. Heart Rhythm 2020; 17:1779-1783. [PMID: 32438016 DOI: 10.1016/j.hrthm.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Virtual visits (VVs) are a modality for delivering health care services remotely through videoconferencing tools. Data about patient and physician experience in using VVs are limited. OBJECTIVE The purpose of this study was to assess patient and physician experience with the use of VVs in cardiac electrophysiology. METHODS We performed a prospective survey of cardiac electrophysiology patients and physicians who participated in an outpatient VV from December 2018 to July 2019. RESULTS One-hundred consecutive VVs were included. Sixty-four patients elected to complete a survey. Patients rated their experience as either excellent/very good in scheduling a VV (87%), seeing their physician of choice (100%), transmitting arrhythmia data (88%), rating their physician's ability to communicate (98%), asking all questions (98%), rating the level of care received (98%), paying for the cost of a VV (67%), and rating their overall level of satisfaction (98%). Thirty-eight of 64 patients (59.4%) preferred a VV for their next visit, 12 of 64 (18.8%) preferred an in-office visit, 13 of 64 (20.3%) responded that their decision for a virtual or office visit depended on indication, and 1 of 64 (1.6%) had no preference. A total of 14 cardiac electrophysiologists participated in 100 VVs. Nine visits were not included due to technical difficulty. Physician responses to survey questions were rated as excellent/very good in the ability to communicate (92%), accessing monitoring data (95%), and overall level of satisfaction (98%). CONCLUSION In our small study population, most patients and physicians prefer VVs. Convenience, cost, and reason for follow-up were important determinants that affected both patient and physician preference.
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Affiliation(s)
- Peter T Hu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Henry Hilow
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Divyang Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Megan Eppich
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter A Rasmussen
- Department of Neurosurgery and Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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43
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Ballout JA, Wazni OM, Tarakji KG, Saliba WI, Kanj M, Diab M, Bhargava M, Baranowski B, Dresing TJ, Callahan TD, Cantillon DJ, Rickard J, Martin DO, Varma N, Niebauer MJ, Chung MK, Tchou PJ, Lindsay BD, Hussein AA. Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2020; 13:e007669. [PMID: 32281407 DOI: 10.1161/circep.119.007669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. METHODS Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010-2017). RESULTS All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction-induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. CONCLUSIONS Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.
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Affiliation(s)
- Jad A Ballout
- Department of Internal Medicine (J.A.B.), Cleveland Clinic, OH
| | - Oussama M Wazni
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Khaldoun G Tarakji
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Walid I Saliba
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Mohamed Kanj
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Mohamed Diab
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Mandeep Bhargava
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Bryan Baranowski
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Thomas J Dresing
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Thomas D Callahan
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Daniel J Cantillon
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - John Rickard
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - David O Martin
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Niraj Varma
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Mark J Niebauer
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Mina K Chung
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Patrick J Tchou
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Bruce D Lindsay
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
| | - Ayman A Hussein
- Cardiovascular Medicine (O.M.W., K.G.T., W.I.S., M.K., M.D., M.B., B.B., T.J.D., T.D.C., D.J.C., J.R., D.O.M., N.V., M.J.N., M.K.C., P.J.T., B.D.L., A.A.H.), Cleveland Clinic, OH
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44
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Patel D, Trulock KM, Moennich LA, Kiehl EL, Kumar A, Toro S, Donnellan E, Grimaldi A, Baranowski B, Hussein AA, Tarakji KG, Cantillon DJ, Niebauer M, Wazni OM, Varma N, Wilkoff BL, Rickard JW. Predictors of long‐term outcomes greater than 10 years after cardiac resynchronization therapy implantation. J Cardiovasc Electrophysiol 2020; 31:1182-1186. [DOI: 10.1111/jce.14425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/17/2020] [Accepted: 02/05/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Divyang Patel
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Kevin M. Trulock
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Laurie Ann Moennich
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Erich L. Kiehl
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Anirudh Kumar
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Saleem Toro
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Eoin Donnellan
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Adam Grimaldi
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Bryan Baranowski
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Ayman A. Hussein
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Khaldoun G. Tarakji
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Daniel J. Cantillon
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Mark Niebauer
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Niraj Varma
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - Bruce L. Wilkoff
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
| | - John W. Rickard
- Department of Cardiovascular Medicine Heart and Vascular InstituteCleveland Clinic Foundation Cleveland Ohio
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45
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Donnellan E, Wazni O, Kanj M, Cantillon D, Patel D, Trulock K, Elshazly M, Kochar A, Cohen J, Hussein A, Baranowski B, Griffin BP, Jaber WA, Saliba WI. IMPACT OF NONALCOHOLIC FATTY LIVER DISEASE ON ARRHYTHMIA RECURRENCE FOLLOWING ATRIAL FIBRILLATION ABLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Donnellan E, Wazni OM, Elshazly M, Kanj M, Hussein AA, Baranowski B, Kochar A, Trulock K, Aminian A, Schauer P, Jaber W, Saliba WI. Impact of Bariatric Surgery on Atrial Fibrillation Type. Circ Arrhythm Electrophysiol 2020; 13:e007626. [DOI: 10.1161/circep.119.007626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Obesity is an independent risk factor for atrial fibrillation (AF) and is associated with a higher AF burden. Recently, weight loss has been found to be associated with a significant reversal in AF type. Bariatric surgery (BS) is associated with reductions in inflammation, left atrial and ventricular remodeling, sleep apnea, blood pressure, and improved glycemic control, all of which may reduce AF burden. In this study, we sought to determine the impact of BS on AF type.
Methods:
We studied AF type before and after BS in 220 morbidly obese patients (body mass index, ≥40 kg/m
2
). All patients underwent extended outpatient cardiac rhythm monitoring within 12 months of BS and at least 1 year after BS.
Results:
There was a significant reduction in body mass index following BS from 49.7±9 to 37.2±9 kg/m
2
. Weight loss was the greatest in the gastric bypass group with a mean percentage weight loss of 25% compared with 19% in patients who underwent sleeve gastrectomy and 16% following gastric banding (
P
<0.0001). Significant reductions in CRP (C-reactive protein), NT-proBNP (N-terminal pro-B-type natriuretic peptide), HbA1C (glycated hemoglobin), and systolic blood pressure were observed in all 3 groups. Reversal of AF type occurred in 71% of patients following gastric bypass, 56% of patients who underwent sleeve gastrectomy, and 50% of patients following gastric banding (
P
=0.004). On Cox proportional hazards analyses, percentage weight loss was significantly associated with AF reversal (
P
=0.0002).
Conclusions:
BS is associated with significant reductions in weight, inflammatory markers, blood pressure, and AF type, and the beneficial effects appear to be the greatest in those undergoing gastric bypass surgery. This study further exemplifies the importance of weight loss and risk factor modification in AF management.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | | | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
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47
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Patel D, Hu P, Hilow H, Lambert CT, Moufawad M, Poe S, Hussein AA, Baranowski B, Bhargava M, Rickard JW, Cantillon DJ, Saliba W, Wilkoff BL, Wazni O, Tarakji KG. The gap between what patients know and desire to learn about their cardiac implantable electronic devices. Pacing Clin Electrophysiol 2019; 43:118-122. [PMID: 31782195 DOI: 10.1111/pace.13850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advancement of digital technology now allows patients to have access to data from their cardiac implantable electronic devices (CIEDs). However, patients' understanding regarding CIED data and perceived personal usability remain unclear. The present study is a prospective survey to examine patients' understanding of their CIEDs and their perception of what is important. METHODS We screened 400 patients between July and December 2018 who presented to our outpatient clinic for a CIED interrogation. Patients received a one-page questionnaire asking baseline demographics, their perception about their own knowledge about their device, and multiple-choice questions in seven basic categories: type of CIED, original indication, functionality, manufacturer, number of active leads, estimated battery life, and number of shocks received. We compared these answers to their interrogation reports to assess accuracy. We also asked participants what they would like to be aware of regarding their CIED. RESULTS From this cohort, 344 of 400 (86%) (62.9 ± 12.8 years and 64 % males) agreed to take the survey and were included in the analysis. At baseline, 63.2% agreed or strongly agreed that they were knowledgeable about their devices. The overwhelming majority of patients demonstrated CIED knowledge deficits in at least one content area (n = 294, 86%), or more than two content areas (n = 176, 51%). Patients agreed or strongly agreed that they had a desire to have information regarding each of the following: battery life (84%), activity level (79%), heart rate trend (75%), and ventricular arrhythmias (74%). CONCLUSION There is a large discrepancy in patients' level of knowledge regarding their CIEDs and their wish to know more details. Future technologies should satisfy providers' goals to educate their patients with basic information and fulfill patients' desire to obtain more data from their CIEDs.
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Affiliation(s)
- Divyang Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Peter Hu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Henry Hilow
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Cameron T Lambert
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Michelle Moufawad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Stacy Poe
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Bryan Baranowski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Mandeep Bhargava
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - John W Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Daniel J Cantillon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Bruce L Wilkoff
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Cleveland, Cleveland, Ohio
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48
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Donnellan E, Wazni O, Kanj M, Hussein A, Baranowski B, Lindsay B, Aminian A, Jaber W, Schauer P, Saliba W. Outcomes of Atrial Fibrillation Ablation in Morbidly Obese Patients Following Bariatric Surgery Compared With a Nonobese Cohort. Circ Arrhythm Electrophysiol 2019; 12:e007598. [DOI: 10.1161/circep.119.007598] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 11/16/2022]
Abstract
Background:
Morbid obesity is associated with unacceptable high recurrence rates following atrial fibrillation ablation. The role of risk-factor modification including weight loss and improved glycemic control in reducing arrhythmia recurrence following ablation has been highlighted in recent years. In this study, we compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients following atrial fibrillation ablation in addition to morbidly obese patients who did not undergo BS.
Methods:
This was a single-center observational cohort study. We matched 51 morbidly obese patients [body mass index ≥40 kg/m
2
] who had undergone prior BS in a 2:1 manner with 102 nonobese patients and 102 morbidly obese patients without prior BS on the basis of age, sex, and timing of atrial fibrillation ablation. Our primary outcome of interest was arrhythmia recurrence.
Results:
From the time of BS to ablation, BS was associated with a significant reduction in body mass index (47.6±9.3 to 36.7±7;
P
<0.0001), glycated hemoglobin (6.7±1.5 to 5.8±0.6;
P
<0.0001), and systolic blood pressure (145±13 to 118±11;
P
<0.0001). During a mean follow-up of 29±13 months following ablation, recurrent arrhythmia occurred in 10/51 (20%) patients in the BS group compared with 25/102 (24.5%) patients in the nonobese group and 56 (55%) patients in the non-BS morbidly obese group (
P
<0.0001). No procedural complications were observed in the BS group.
Conclusions:
Bariatric surgery is associated with a reduction in arrhythmia recurrence following atrial fibrillation ablation in morbidly obese patients to those of nonobese patients. Morbidly obese patients should be considered for BS before atrial fibrillation ablation.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | - Bruce Lindsay
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
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49
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Donnellan E, Wazni OM, Saliba WI, Baranowski B, Hanna M, Martyn M, Patel D, Trulock K, Menon V, Hussein A, Aagaard P, Jaber W, Kanj M. Cardiac devices in patients with transthyretin amyloidosis: Impact on functional class, left ventricular function, mitral regurgitation, and mortality. J Cardiovasc Electrophysiol 2019; 30:2427-2432. [DOI: 10.1111/jce.14180] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/05/2019] [Accepted: 09/07/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Walid I. Saliba
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Bryan Baranowski
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Mazen Hanna
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Michael Martyn
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Divyang Patel
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Kevin Trulock
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Ayman Hussein
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Philip Aagaard
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Wael Jaber
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
| | - Mohamed Kanj
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland Ohio
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50
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Raeisi-Giglou P, Wazni OM, Saliba WI, Barakat A, Tarakji KG, Rickard J, Cantillon D, Baranowski B, Tchou PJ, Bhargava M, Dresing TJ, Callahan TD, Kanj M, Lindsay BD, Hussein AA. Outcomes and Management of Patients With Severe Pulmonary Vein Stenosis From Prior Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2019; 11:e006001. [PMID: 29752377 DOI: 10.1161/circep.117.006001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein (PV) stenosis remains a feared complication of atrial fibrillation ablation. Little is known about outcomes in patients with severe PV stenosis, especially about repeat ablations. METHODS In 10 368 patients undergoing atrial fibrillation ablation (2000-2015), computed tomography scans were obtained 3 to 6 months after ablation. The clinical outcomes in severe PV stenosis were determined. RESULTS Severe PV stenosis was diagnosed in 52 patients (0.5%). This involved mostly the left superior PV (51% of severely stenosed veins). Percutaneous interventions were performed in 43 patients, and complications occurred in 5: 3 PV ruptures, 1 stroke, and 1 phrenic injury. Over a median follow-up of 25 months, 41 (79%) patients remained arrhythmia free. Repeat ablation was performed in 15 patients (7 from the main series and 8 from prior ablation at other institutions); of whom 10 had PV stents in place. Conduction recovery was noted in all but 2 of the stenosed or stented PVs, and areas with recovery were targeted with antral ablation. Lasso entrapment within stents occurred in 2 patients but eventually freed without complications. After redo ablation, preplanned stenting was performed in 3 patients and computed tomographic scans showed progression of concomitant stenoses in 1 patient (moderate to severe). No procedure-related deaths occurred. CONCLUSIONS The incidence of severe PV stenosis is low but remains associated with significant morbidity. In patients with recurrent arrhythmia, conduction recovery at the stenosed or stented veins is common. Care must be taken to ablate antrally to avoid stenosis progression. In patients with prior PV stents, we suggest to avoid using Lasso.
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Affiliation(s)
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Amr Barakat
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | | | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Daniel Cantillon
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Bryan Baranowski
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Patrick J Tchou
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Thomas D Callahan
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Bruce D Lindsay
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, OH.
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