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Tabaja C, Younis A, Santangeli P, Madden R, Taigen T, Farwati M, Hayashi K, Braghieri L, Rickard J, Klein BM, Paul A, Dresing TJ, Martin DO, Bhargava M, Kanj M, Sroubek J, Nakagawa H, Saliba WI, Wazni OM, Hussein AA. Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01659-w. [PMID: 37848806 DOI: 10.1007/s10840-023-01659-w] [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: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. METHODS All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculate quality of life (QoL) metrics: the AF severity score as well as the AF burden. RESULTS A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. CONCLUSION Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.
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Affiliation(s)
- Chadi Tabaja
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Arwa Younis
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ruth Madden
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Tyler Taigen
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Medhat Farwati
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Katsuhide Hayashi
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Lorenzo Braghieri
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Benjamin M Klein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Aritra Paul
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Thomas J Dresing
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - David O Martin
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mandeep Bhargava
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Mohamed Kanj
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Hiroshi Nakagawa
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Walid I Saliba
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Oussama M Wazni
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA
| | - Ayman A Hussein
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J2-2, Cleveland, OH, 44195, USA.
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2
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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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3
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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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4
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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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5
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Callahan TD, Martin DO. Quantifying risk after transvenous lead extraction. J Cardiovasc Electrophysiol 2020; 31:1163-1165. [DOI: 10.1111/jce.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas D. Callahan
- Department of Cardiovascular MedicineCleveland ClinicCleveland Ohio
- Department of MedicineCleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityCleveland Ohio
| | - David O. Martin
- Department of Cardiovascular MedicineCleveland ClinicCleveland Ohio
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6
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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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7
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Barakat AF, Zmaili MA, Tarakji KG, Shah S, Abdur Rehman K, Martin DO, Brunner MP, Saliba WI, Kanj M, Ballout J, Baranowski B, Cantillon D, Niebauer M, Callahan T, Dresing T, Rickard J, Lindsay BD, Wilkoff BL, Wazni OM, Hussein AA. Transvenous Lead Extraction in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2019; 5:665-670. [PMID: 31221352 DOI: 10.1016/j.jacep.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness and safety of transvenous lead extraction (TLE) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). BACKGROUND ARVC is an increasingly diagnosed cardiomyopathy that often requires device implantation to prevent sudden death. Little is known about TLE in this setting, which has potential challenges and risks, primarily due to right ventricular (RV) wall thinning and fragility. METHODS All consecutive patients with ARVC who underwent TLE at our institution between 1996 and 2016 were included. When extraction tools were used, sheaths were advanced to the RV with countertraction at the lead tip. Success and complications were defined in concordance with Heart Rhythm Society guidelines. RESULTS Twenty-two TLE procedures in patients with ARVC involved extraction of 27 leads (22 defibrillators and 5 pacemakers). TLEs were performed due to evidence of lead malfunction (n = 17; 77%) or device infection (n = 5; 23%). Twenty-four leads (89%) were RV, and 3 leads (11%) were right atrial. The median age of the oldest extracted lead was 1,691 days (interquartile range [IQR]: 1,168 to 2,726 days). Specialized extraction tools were required in 20 procedures (91%). None required the use of a snare or a femoral workstation. The median procedural and fluoroscopic times were 152 min (IQR: 129 to 185 min) and 11 min (IQR: 6 to 18 min), respectively. Complete procedural success with removal of all leads was achieved in all cases. There were no major complications. CONCLUSIONS In a high-volume center, TLE in patients with ARVC was associated with a high success rate and a low rate of complications when guideline-established techniques and tools were used.
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Affiliation(s)
- Amr F Barakat
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Khaldoun G Tarakji
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shailee Shah
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - David O Martin
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Brunner
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jad Ballout
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mark Niebauer
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ayman A Hussein
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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8
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Gasparini M, Birnie D, Lemke B, Aonuma K, Lee KLF, Gorcsan J, Landolina M, Klepfer R, Meloni S, Cicconelli M, Grammatico A, Martin DO. Adaptive Cardiac Resynchronization Therapy Reduces Atrial Fibrillation Incidence in Heart Failure Patients With Prolonged AV Conduction. Circ Arrhythm Electrophysiol 2019; 12:e007260. [DOI: 10.1161/circep.119.007260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maurizio Gasparini
- Electrophysiology and Pacing Unit, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Italy (M.G.)
| | - David Birnie
- University of Ottawa Heart Institute, ON, Canada (D.B.)
| | - Bernd Lemke
- Lüdenscheid Clinic, Lüdenscheid, Germany (B.L.)
| | | | | | - John Gorcsan
- The University of Pittsburgh Medical Centre, PA (J.G.)
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9
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Tarakji KG, Saliba W, Markabawi D, Rodriguez ER, Krauthammer Y, Brunner MP, Hussein AA, Baranowski B, Cantillon DJ, Kanj M, Niebauer M, Rickard J, Callahan T, Shao M, Martin DO, Wazni OM, Wilkoff BL, Tan CD. Unrecognized venous injuries after cardiac implantable electronic device transvenous lead extraction. Heart Rhythm 2018; 15:318-325. [DOI: 10.1016/j.hrthm.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Indexed: 11/28/2022]
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10
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Barakat AF, Wazni OM, Tarakji KG, Callahan T, Nimri N, Saliba WI, Shah S, Abdur Rehman K, Rickard J, Brunner MP, Martin DO, Kanj M, Baranowski B, Cantillon D, Niebauer M, Dresing T, Lindsay BD, Wilkoff BL, Hussein AA. Transvenous Lead Extraction in Chronic Kidney Disease and Dialysis Patients With Infected Cardiac Devices. Circ Arrhythm Electrophysiol 2018; 11:e005706. [DOI: 10.1161/circep.117.005706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/31/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Amr F. Barakat
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Oussama M. Wazni
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Khaldoun G. Tarakji
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Callahan
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Nayef Nimri
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Walid I. Saliba
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Shailee Shah
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Karim Abdur Rehman
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - John Rickard
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Michael P. Brunner
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - David O. Martin
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mohamed Kanj
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bryan Baranowski
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Daniel Cantillon
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Mark Niebauer
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Thomas Dresing
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce D. Lindsay
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Bruce L. Wilkoff
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
| | - Ayman A. Hussein
- From the Department of Medicine (A.F.B., N.N., S.S., K.A.R.) and Cardiac Pacing and Electrophysiology Section (O.M.W., K.G.T., T.C., W.I.S., J.R., M.P.B., D.O.M., M.K., B.B., D.C., M.N., T.D., B.D.L., B.L.W., A.A.H.), Heart and Vascular Institute, Cleveland Clinic, OH
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11
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Barakat AF, Wazni OM, Tarakji K, Saliba WI, Nimri N, Rickard J, Brunner M, Bhargava M, Kanj M, Baranowski B, Martin DO, Cantillon D, Callahan T, Dresing T, Niebauer M, Chung M, Lindsay BD, Wilkoff B, Hussein AA. Transvenous lead extraction at the time of cardiac implantable electronic device upgrade: Complexity, safety, and outcomes. Heart Rhythm 2017; 14:1807-1811. [DOI: 10.1016/j.hrthm.2017.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 10/19/2022]
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12
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Hussein AA, Tarakji KG, Martin DO, Gadre A, Fraser T, Kim A, Brunner MP, Barakat AF, Saliba WI, Kanj M, Baranowski B, Cantillon D, Niebauer M, Callahan T, Dresing T, Lindsay BD, Gordon S, Wilkoff BL, Wazni OM. Cardiac Implantable Electronic Device Infections: Added Complexity and Suboptimal Outcomes With Previously Abandoned Leads. JACC Clin Electrophysiol 2016; 3:1-9. [PMID: 29759687 DOI: 10.1016/j.jacep.2016.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to assess the impact of previously abandoned leads on the clinical management of cardiac device infections, notably transvenous lead extraction and subsequent clinical course. BACKGROUND The population of patients with cardiac implantable electronic devices continues to grow with a disproportionate increase in device infections, which are invariably life threatening. A potentially complicating issue is the widely practiced strategy of device lead abandonment at the time of system revision, change, or upgrade, which is affecting an increasing number of patients. METHODS The study assessed the impact of previously abandoned leads in a prospectively maintained registry of consecutive patients undergoing percutaneous extraction of infected cardiac devices at the Cleveland Clinic between August 1996 and September 2012. The primary clinical endpoint was complete procedural and clinical success defined as the successful removal of the device and all lead material from the vascular space, in the absence of a major complication. RESULTS Of 1,386 patients with infected cardiac devices, 323 (23.3%) had previously abandoned leads. Failure to achieve the primary endpoint occurred more frequently in patients with abandoned leads (13.0% vs. 3.7%; p < 0.0001). This was primarily due to retention of lead material (11.5% vs. 2.9%; p < 0.0001), which was associated with poor clinical outcomes including higher rates of 1-month mortality (7.4% vs. 3.5% in those without lead remnants). Lead extraction procedures in patients with previously abandoned leads were longer (p < 0.0001), with longer fluoroscopy times (p < 0.0001), and more likely to require specialized extraction tools (94.4% vs. 81.8%; p < 0.0001) or adjunctive rescue femoral workstations (14.9% vs. 2.9%; p < 0.0001). Procedural complications occurred more frequently in patients with previously abandoned leads (11.5% vs. 5.6%; p = 0.0003), which was true for both major (3.7% vs. 1.4%; p = 0.009) and minor complications (7.7% vs. 4.4%; p = 0.02). CONCLUSIONS Previously abandoned leads complicate the management of cardiac device infections, leading to worse clinical outcomes.
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Affiliation(s)
- Ayman A Hussein
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Khaldoun G Tarakji
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - David O Martin
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Abhishek Gadre
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Fraser
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Alice Kim
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Brunner
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Amr F Barakat
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Walid I Saliba
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Cantillon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Mark Niebauer
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Steven Gordon
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Oussama M Wazni
- Sections of Cardiac Electrophysiology and Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
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13
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Crossley GH, Sorrentino RA, Exner DV, Merliss AD, Tobias SM, Martin DO, Augostini R, Piccini JP, Schaerf R, Li S, Miller CT, Adler SW. Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads. Heart Rhythm 2016; 13:1253-9. [DOI: 10.1016/j.hrthm.2016.01.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 11/30/2022]
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14
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Hussein AA, Saliba WI, Barakat A, Bassiouny M, Chamsi-Pasha M, Al-Bawardy R, Hakim A, Tarakji K, Baranowski B, Cantillon D, Dresing T, Tchou P, Martin DO, Varma N, Bhargava M, Callahan T, Niebauer M, Kanj M, Chung M, Natale A, Lindsay BD, Wazni OM. Radiofrequency Ablation of Persistent Atrial Fibrillation: Diagnosis-to-Ablation Time, Markers of Pathways of Atrial Remodeling, and Outcomes. Circ Arrhythm Electrophysiol 2016; 9:e003669. [PMID: 26763227 DOI: 10.1161/circep.115.003669] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation-related atrial remodeling. METHODS AND RESULTS Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005-2012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th-75th percentiles 1-6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels (P=0.01), C-reactive protein levels (P<0.0001), and left atrial size (P=0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively (P(categorical)<0.0001). In Cox Proportional Hazard analyses, B-type natriuretic peptide levels, C-reactive protein levels, and left atrial size were associated with arrhythmia recurrence. The diagnosis-to-ablation time had the strongest association with the ablation outcomes which persisted in multivariable Cox analyzes (hazard ratio for recurrence per +1Log diagnosis-to-ablation time 1.27, 95% confidence interval 1.14-1.43; P<0.0001; hazard ratio fourth versus first quartile 2.44, 95% confidence interval 1.68-3.65; P(categorical)<0.0001). CONCLUSIONS In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.
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Affiliation(s)
- Ayman A Hussein
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Walid I Saliba
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Amr Barakat
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mohammed Bassiouny
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mohammed Chamsi-Pasha
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Rasha Al-Bawardy
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Ali Hakim
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Khaldoun Tarakji
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Bryan Baranowski
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Daniel Cantillon
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Thomas Dresing
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Patrick Tchou
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - David O Martin
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Niraj Varma
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mandeep Bhargava
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Thomas Callahan
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mark Niebauer
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mohamed Kanj
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Mina Chung
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Andrea Natale
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Bruce D Lindsay
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.)
| | - Oussama M Wazni
- From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David's Medical Center, Austin, TX (A.N.).
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Bassiouny M, Saliba W, Hussein A, Rickard J, Diab M, Aman W, Dresing T, Callahan, T, Bhargava M, Martin DO, Shao M, Baranowski B, Tarakji K, Tchou PJ, Hakim A, Kanj M, Lindsay B, Wazni O. Randomized Study of Persistent Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2016; 9:e003596. [DOI: 10.1161/circep.115.003596] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamed Bassiouny
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Walid Saliba
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Ayman Hussein
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - John Rickard
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mariam Diab
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Wahaj Aman
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Thomas Dresing
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Thomas Callahan,
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - David O. Martin
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mingyuan Shao
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Bryan Baranowski
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Khaldoun Tarakji
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Patrick J. Tchou
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Ali Hakim
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Mohamed Kanj
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Bruce Lindsay
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Oussama Wazni
- From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
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16
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Avila M, Dyment DA, Sagen JV, St-Onge J, Moog U, Chung BHY, Mo S, Mansour S, Albanese A, Garcia S, Martin DO, Lopez AA, Claudi T, König R, White SM, Sawyer SL, Bernstein JA, Slattery L, Jobling RK, Yoon G, Curry CJ, Merrer ML, Luyer BL, Héron D, Mathieu-Dramard M, Bitoun P, Odent S, Amiel J, Kuentz P, Thevenon J, Laville M, Reznik Y, Fagour C, Nunes ML, Delesalle D, Manouvrier S, Lascols O, Huet F, Binquet C, Faivre L, Rivière JB, Vigouroux C, Njølstad PR, Innes AM, Thauvin-Robinet C. Clinical reappraisal of SHORT syndrome with PIK3R1 mutations: toward recommendation for molecular testing and management. Clin Genet 2015; 89:501-506. [PMID: 26497935 DOI: 10.1111/cge.12688] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 08/03/2015] [Revised: 10/10/2015] [Accepted: 10/16/2015] [Indexed: 12/01/2022]
Abstract
SHORT syndrome has historically been defined by its acronym: short stature (S), hyperextensibility of joints and/or inguinal hernia (H), ocular depression (O), Rieger abnormality (R) and teething delay (T). More recently several research groups have identified PIK3R1 mutations as responsible for SHORT syndrome. Knowledge of the molecular etiology of SHORT syndrome has permitted a reassessment of the clinical phenotype. The detailed phenotypes of 32 individuals with SHORT syndrome and PIK3R1 mutation, including eight newly ascertained individuals, were studied to fully define the syndrome and the indications for PIK3R1 testing. The major features described in the SHORT acronym were not universally seen and only half (52%) had four or more of the classic features. The commonly observed clinical features of SHORT syndrome seen in the cohort included intrauterine growth restriction (IUGR) <10th percentile, postnatal growth restriction, lipoatrophy and the characteristic facial gestalt. Anterior chamber defects and insulin resistance or diabetes were also observed but were not as prevalent. The less specific, or minor features of SHORT syndrome include teething delay, thin wrinkled skin, speech delay, sensorineural deafness, hyperextensibility of joints and inguinal hernia. Given the high risk of diabetes mellitus, regular monitoring of glucose metabolism is warranted. An echocardiogram, ophthalmological and hearing assessments are also recommended.
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Affiliation(s)
- M Avila
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Service de Pédiatrie 1, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - D A Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J V Sagen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.,KJ Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J St-Onge
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,CHU Dijon, Laboratoire de Génétique Moléculaire, Dijon, France
| | - U Moog
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - B H Y Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - S Mo
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - S Mansour
- SW Thames Regional Genetics Service, St. George's Hospital Medical School, London, SW17 0RE, UK
| | - A Albanese
- Paediatric Endocrine Unit, St George's Hospital, London, UK
| | - S Garcia
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain.,Instituto de Salud Carlos III, Unit 753, Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - D O Martin
- Department of Ophthalmology, Hospital Central de la Cruz Roja San Jose y Santa Adela, Madrid, Spain
| | - A A Lopez
- Puerta de Hierro, University Hospital, Madrid, Spain
| | - T Claudi
- Department of Medicine, Bodø, Norway
| | - R König
- Department of Human Genetics, University of Frankfurt, Frankfurt, Germany
| | - S M White
- Victorian Clinical genetics Services, Murdoch Childrens Research institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - S L Sawyer
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J A Bernstein
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - L Slattery
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - R K Jobling
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - G Yoon
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - C J Curry
- Genetic Medicine/, University of California, San Francisco, CA, USA
| | - M L Merrer
- Département de Génétique, Hôpital Necker Enfants Malades, Paris, France
| | - B L Luyer
- Service de Pédiatrie, CH Le Havre, Le Havre, France
| | - D Héron
- Département de Génétique et Centre de Référence "Déficiences intellectuelles de causes rares", Paris, France
| | | | - P Bitoun
- Service de Pédiatrie, Bondy, France
| | - S Odent
- Service de Génétique clinique, Rennes, France.,UMR CNRS 6290 IGDR, Universitė Rennes, Rennes, France
| | - J Amiel
- Département de Génétique, Hôpital Necker Enfants Malades, Paris, France
| | - P Kuentz
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France
| | - J Thevenon
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
| | - M Laville
- Département d'Endocrinologie, Diabétologie et Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Institut National de la Santé et de la Recherche Médicale Unité 1060, Centre Européen pour la nutrition et la Santé, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Université Claude Bernard Lyon, Pierre-Bénite, France
| | - Y Reznik
- Service d'Endocrinologie, Centre Hospitalier Universitaire Côte-de-Nacre, Caen, France
| | - C Fagour
- Département d'Endocrinologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - M-L Nunes
- Département d'Endocrinologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - D Delesalle
- Service de pédiatrie, CH de Valencienne, Valencienne, France
| | - S Manouvrier
- Centre de Référence CLAD NdF - Service de génétique clinique Guy Fontaine, CHRU de Lille - Hôpital Jeanne de Flandre, Lille, France
| | - O Lascols
- INSERM, UMR_S938, Centre de Recherche Saint-Antoine, Paris, France.,UPMC Univ Paris 06, Paris, France.,ICAN, Institute of Cardiometabolism And Nutrition, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire Commun de Biologie et Génétique Moléculaires, Paris, France
| | - F Huet
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Service de Pédiatrie 1, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - C Binquet
- Centre d'Investigation Clinique-Epidémiologique Clinique/essais cliniques du CHU de Dijon, Dijon, France
| | - L Faivre
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
| | - J-B Rivière
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,CHU Dijon, Laboratoire de Génétique Moléculaire, Dijon, France
| | - C Vigouroux
- INSERM, UMR_S938, Centre de Recherche Saint-Antoine, Paris, France.,UPMC Univ Paris 06, Paris, France.,ICAN, Institute of Cardiometabolism And Nutrition, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire Commun de Biologie et Génétique Moléculaires, Paris, France
| | - P R Njølstad
- Department of Pediatrics, Haukeland, University Hospital, Bergen, Norway
| | - A M Innes
- Department of Medical Genetics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Canada
| | - C Thauvin-Robinet
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
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Lou X, Brunner MP, Wilkoff BL, Martin DO, Clair DG, Soltesz EG. Successful stent implantation for superior vena cava injury during transvenous lead extraction. HeartRhythm Case Rep 2015; 1:394-396. [PMID: 28491594 PMCID: PMC5419697 DOI: 10.1016/j.hrcr.2014.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Xiaoying Lou
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Cronin EM, Brunner MP, Tan CD, Rene Rodriguez E, Rickard J, Martin DO, Wazni OM, Tarakji KG, Wilkoff BL, Baranowski BJ. Incidence, management, and outcomes of the arteriovenous fistula complicating transvenous lead extraction. Heart Rhythm 2014; 11:404-11. [DOI: 10.1016/j.hrthm.2013.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Indexed: 11/24/2022]
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Rickard J, Tarakji K, Cheng A, Spragg D, Cantillon DJ, Martin DO, Baranowski B, Gordon SM, Tang WHW, Kanj M, Wazni O, Wilkoff BL. Survival of patients with biventricular devices after device infection, extraction, and reimplantation. JACC Heart Fail 2013; 1:508-13. [PMID: 24622003 DOI: 10.1016/j.jchf.2013.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare outcomes in patients with biventricular device infections who undergo successful treatment including extraction and reimplantation to patients with biventricular devices never known to become infected. BACKGROUND Infection of a cardiac implantable electronic device (CIED) is associated with substantial morbidity and mortality. Survival in patients with cardiac resynchronization therapy (CRT) device infections undergoing full system extraction is unknown. METHODS We extracted data on all patients undergoing extraction of a biventricular pacing device for an infectious indication at the Cleveland Clinic between February 16, 2000, and June 30, 2011. Survival of patients who presented with a CRT device infection, extraction, and successful reimplantation was compared to that of a large cohort of consecutive patients undergoing initial CRT implantation without a known history of subsequent device-related infection. In addition, long-term outcomes were compared between patients who were extracted and deemed to be cured with and without successful biventricular device reimplantation. RESULTS In all, 151 patients underwent biventricular device extraction for infection, of whom 81 were successfully reimplanted. The noninfected cohort consisted of 879 patients. In a multivariate Cox regression model controlling for sex, a history of ischemic cardiomyopathy, creatinine, hemoglobin, beta-blocker use, angiotensin-converting enzyme inhibitor use, and diuretic use, no significant association between subsequent infection with reimplantation and all-cause mortality was noted (p = 0.21). There was a trend toward worse outcomes for patients extracted, deemed cured, and not reimplanted compared to patients with successful CRT reimplantation. CONCLUSIONS Patients with a biventricular device infection who are successfully extracted, treated with antibiotics, and reimplanted with a biventricular device have outcomes similar to those of patients with biventricular devices not known to have become infected.
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Affiliation(s)
- John Rickard
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | | | - Alan Cheng
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - David Spragg
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - David O Martin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Steven M Gordon
- Division of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammed Kanj
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce L Wilkoff
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Cronin EM, Baranowski BJ, Martin DO. Failure of fluoroscopy to detect “inside-out” insulation failure and externalized conductors in a Riata ICD lead. Heart Rhythm 2013. [DOI: 10.1016/j.hrthm.2012.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brunner MP, Cronin EM, Jacob J, Duarte VE, Tarakji KG, Martin DO, Callahan T, Borek PP, Cantillon DJ, Niebauer MJ, Saliba WI, Kanj M, Wazni O, Baranowski B, Wilkoff BL. Transvenous extraction of implantable cardioverter-defibrillator leads under advisory—A comparison of Riata, Sprint Fidelis, and non-recalled implantable cardioverter-defibrillator leads. Heart Rhythm 2013; 10:1444-50. [DOI: 10.1016/j.hrthm.2013.06.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Indexed: 10/26/2022]
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Singh JP, Abraham WT, Chung ES, Rogers T, Sambelashvili A, Coles JA, Martin DO. Clinical response with adaptive CRT algorithm compared with CRT with echocardiography-optimized atrioventricular delay: a retrospective analysis of multicentre trials. Europace 2013; 15:1622-8. [PMID: 24014804 DOI: 10.1093/europace/eut107] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Adaptive cardiac resynchronization therapy (aCRT) is a novel algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular (LV) or bi-ventricular (BiV) pacing and optimization of atrioventricular (AV) and inter-ventricular (VV) delays based on periodic measurement of intrinsic conduction. We aimed to compare the clinical response between aCRT and standard CRT in historical trials. METHODS AND RESULTS The treatment arm of the aCRT trial was compared with a pooled historical control (HC) derived from the CRT arms of four clinical trials (MIRACLE, MIRACLE ICD, PROSPECT, and InSync III Marquis) with respect to the proportion of patients who had an improved clinical composite score (CCS) at the 6-month follow-up. Patients in the HC underwent echocardiography-guided AV optimization after the implant. A propensity score model was used to adjust for 22 potential baseline confounders of the effect of CRT. Patients were stratified into quintiles according to the propensity score and the adjusted absolute treatment effect was obtained by averaging estimates across these quintiles. The propensity score model included 751 patients (aCRT: 266, historical trials: 485). The adjusted absolute difference in percent improved in CCS between the aCRT and HC arms was 11.9% [95% confidence interval (CI): 2.7-19.2%] favouring aCRT. The patients in the aCRT group were significantly more likely to have an improved CCS than the patients in the HC (odds ratio = 1.65, 95% CI: 1.1-2.5). CONCLUSION The aCRT algorithm may be associated with additional improvement in clinical response compared with historical CRT with echocardiographic AV optimization.
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Affiliation(s)
- Jagmeet P Singh
- Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA
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Bassiouny M, Saliba W, Rickard J, Shao M, Sey A, Diab M, Martin DO, Hussein A, Khoury M, Abi-Saleh B, Alam S, Sengupta J, Borek PP, Baranowski B, Niebauer M, Callahan T, Varma N, Chung M, Tchou PJ, Kanj M, Dresing T, Lindsay BD, Wazni O. Response to Letter by May et al regarding article, "Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation" by Bassiouny et al. Circ Arrhythm Electrophysiol 2013; 6:e66. [PMID: 23962867 DOI: 10.1161/circep.113.000701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamed Bassiouny
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
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Birnie D, Lemke B, Aonuma K, Krum H, Lee KLF, Gasparini M, Starling RC, Milasinovic G, Gorcsan J, Houmsse M, Abeyratne A, Sambelashvili A, Martin DO. Clinical outcomes with synchronized left ventricular pacing: analysis of the adaptive CRT trial. Heart Rhythm 2013; 10:1368-74. [PMID: 23851059 DOI: 10.1016/j.hrthm.2013.07.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [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: 04/24/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Acute studies have suggested that left ventricular pacing (LVP) may have benefits over biventricular pacing (BVP). The adaptive cardiac resynchronization therapy (aCRT) algorithm provides LVP synchronized to produce fusion with the intrinsic activation when the intrinsic atrioventricular (AV) interval is normal. The randomized double-blind adaptive cardiac resynchronization therapy trial demonstrated noninferiority of the aCRT algorithm compared to echocardiography-optimized BVP (control). OBJECTIVE To examine whether synchronized LVP (sLVP) resulted in better clinical outcomes. METHODS First, stratification by percent sLVP (%sLVP) and multivariate Cox proportional hazards model was used to assess the relationship between %sLVP and clinical outcomes. Second, outcomes were compared between patients in the aCRT arm (n = 318) and control patients (n = 160) stratified by intrinsic AV interval at randomization. RESULTS In the aCRT arm, %sLVP ≥50% (n = 142) was independently associated with a decreased risk of death or heart failure hospitalization (hazard ratio 0.49; 95% confidence interval 0.28-0.85; P = .012) compared with %sLVP <50% (n = 172). A greater proportion of patients with %sLVP ≥50% improved in Packer's clinical composite score at 6-month (82% vs. 68%; P = .002) and 12-month (80% vs. 62%; P = .0006) follow-ups compared to controls. In the subgroup with normal AV (n = 241), there was a lower risk of death or heart failure hospitalization (hazard ratio 0.52; 95% confidence interval 0.27-0.98; P = .044) with the aCRT algorithm. A greater proportion of patients in the aCRT arm improved in the clinical composite score at 6-month (81% vs. 69%; P = .041) and 12-month (77% vs. 66%; P = .076) follow-ups compared to controls. CONCLUSIONS Higher %sLVP was independently associated with superior clinical outcomes. In patients with normal AV conduction, the aCRT algorithm provided mostly sLVP and demonstrated better clinical outcomes compared to echocardiography-optimized BVP.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Martin DO. Reply to the Editor— A Novel Algorithm for Synchronized Left Ventricular Pacing and Ambulatory Optimization of Cardiac Resynchronization Therapy. Heart Rhythm 2013; 10:e71. [DOI: 10.1016/j.hrthm.2013.03.042] [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] [Received: 03/21/2013] [Indexed: 10/27/2022]
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Bassiouny M, Saliba W, Rickard J, Shao M, Sey A, Diab M, Martin DO, Hussein A, Khoury M, Abi-Saleh B, Alam S, Sengupta J, Borek PP, Baranowski B, Niebauer M, Callahan T, Varma N, Chung M, Tchou PJ, Kanj M, Dresing T, Lindsay BD, Wazni O. Use of dabigatran for periprocedural anticoagulation in patients undergoing catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol 2013; 6:460-6. [PMID: 23553523 PMCID: PMC3688655 DOI: 10.1161/circep.113.000320] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [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: 04/25/2012] [Accepted: 02/21/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) for atrial fibrillation is associated with a transient increased risk of thromboembolic and hemorrhagic events. We hypothesized that dabigatran can be safely used as an alternative to continuous warfarin for the periprocedural anticoagulation in PVI. METHODS AND RESULTS A total of 999 consecutive patients undergoing PVI were included; 376 patients were on dabigatran (150 mg), and 623 patients were on warfarin with therapeutic international normalized ratio. [corrected] Dabigatran was held 1 to 2 doses before PVI and restarted at the conclusion of the procedure or as soon as patients were transferred to the nursing floor. Propensity score matching was applied to generate a cohort of 344 patients in each group with balanced baseline data. Total hemorrhagic and thromboembolic complications were similar in both groups, before (3.2% versus 3.9%; P=0.59) and after (3.2% versus 4.1%; P=0.53) matching. Major hemorrhage occurred in 1.1% versus 1.6% (P=0.48) before and 1.2% versus 1.5% (P=0.74) after matching in the dabigatran versus warfarin group, respectively. A single thromboembolic event occurred in each of the dabigatran and warfarin groups. Despite higher doses of intraprocedural heparin, the mean activated clotting time was significantly lower in patients who held dabigatran for 1 or 2 doses than those on warfarin. CONCLUSIONS Our study found no evidence to suggest a higher risk of thromboembolic or hemorrhagic complications with use of dabigatran for periprocedural anticoagulation in patients undergoing PVI compared with uninterrupted warfarin therapy.
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Affiliation(s)
- Mohamed Bassiouny
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Walid Saliba
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - John Rickard
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Mingyuan Shao
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Albert Sey
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Mariam Diab
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - David O. Martin
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Ayman Hussein
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Maurice Khoury
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Bernard Abi-Saleh
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Samir Alam
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - Jay Sengupta
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - P. Peter Borek
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Bryan Baranowski
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Mark Niebauer
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Thomas Callahan
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Niraj Varma
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Mina Chung
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Patrick J. Tchou
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Mohamed Kanj
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Thomas Dresing
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Bruce D. Lindsay
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Oussama Wazni
- Dept of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
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Brunner MP, Yu C, Hachamovitch R, Duarte V, Cronin EM, Baranowski B, Tarakji KG, Cantillon DJ, Martin DO, Wazni O, Wilkoff BL. A RISK SCORE TO PREDICT MAJOR ADVERSE EVENTS AND 30-DAY ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING TRANSVENOUS LEAD EXTRACTION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alema ON, Martin DO, Okello TR. Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda. Afr Health Sci 2012; 12:518-21. [PMID: 23515280 DOI: 10.4314/ahs.v12i4.19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. OBJECTIVE To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. METHODS The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. RESULTS A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB. CONCLUSIONS Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.
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Abstract
BACKGROUND Expanding indications for cardiovascular implantable electronic devices are accompanied by an increasing burden of device clinic follow-up. Remote monitoring (RM) may be less time-consuming compared to in-office follow-up; however, its effect on the device clinic workflow has not been clarified. OBJECTIVE To determine the impact of RM on device clinic workflow. METHODS Detailed workflow data were prospectively collected over a 2-week period in a busy device clinic. RESULTS Five hundred remote transmissions were received from 434 patients between March 1 and March 16, 2011--346 implantable cardioverter-defibrillator, 84 pacemaker, and 70 implantable loop recorder transmissions--on 4 RM platforms (CareLink 56.4%, Merlin.net 21.4%, LATITUDE 17.8%, and Home Monitoring 4.4%). The mean time spent per transmission was 11.5 ± 7.7 minutes, which was less than in-person interrogations (27.7 ± 9.9 minutes; P <.01). Of 500 transmissions, 135 (27.0%) demonstrated clinically important findings; however, only 41 (8.2%) were forwarded for physician review. Of 500 transmissions, 138 (27.6%) were unscheduled, and these were more likely to contain a clinically important event (56 of 138 [40.6%] vs 79 of 362 [21.8%]; P = .0001). A total of 5.8% of the transmissions were duplicate. Transmissions that revealed clinically important findings took longer to process than those that did not (21.0 ± 7.4 minutes vs 10.1 ± 2.1 minutes; P <.05). A total of 49.2% of the scheduled remote transmissions were missed because of patient noncompliance. Telephone follow-up of patients (mean 21 patients/d) who missed scheduled remote transmissions took a mean of 55.1 (range 20-98) min/d. CONCLUSIONS Analysis of RM transmissions has significant implications for the device clinic workflow. Nonactionable transmissions are rapidly processed, allowing clinicians to focus on clinically important findings. However, poor patient compliance complicates the workflow efficiency of currently available systems.
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Affiliation(s)
- Edmond M Cronin
- Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44106, USA.
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Martin DO, Lemke B, Birnie D, Krum H, Lee KLF, Aonuma K, Gasparini M, Starling RC, Milasinovic G, Rogers T, Sambelashvili A, Gorcsan J, Houmsse M. Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial. Heart Rhythm 2012; 9:1807-14. [PMID: 22796472 DOI: 10.1016/j.hrthm.2012.07.009] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND In patients with sinus rhythm and normal atrioventricular conduction, pacing only the left ventricle with appropriate atrioventricular delays can result in superior left ventricular and right ventricular function compared with standard biventricular (BiV) pacing. OBJECTIVE To evaluate a novel adaptive cardiac resynchronization therapy ((aCRT) algorithm for CRT pacing that provides automatic ambulatory selection between synchronized left ventricular or BiV pacing with dynamic optimization of atrioventricular and interventricular delays. METHODS Patients (n = 522) indicated for a CRT-defibrillator were randomized to aCRT vs echo-optimized BiV pacing (Echo) in a 2:1 ratio and followed at 1-, 3-, and 6-month postrandomization. RESULTS The study met all 3 noninferiority primary objectives: (1) the percentage of aCRT patients who improved in their clinical composite score at 6 months was at least as high in the aCRT arm as in the Echo arm (73.6% vs 72.5%, with a noninferiority margin of 12%; P = .0007); (2) aCRT and echo-optimized settings resulted in similar cardiac performance, as demonstrated by a high concordance correlation coefficient between aortic velocity time integrals at aCRT and Echo settings at randomization (concordance correlation coefficient = 0.93; 95% confidence interval 0.91-0.94) and at 6-month postrandomization (concordance correlation coefficient = 0.90; 95% confidence interval 0.87-0.92); and (3) aCRT did not result in inappropriate device settings. There were no significant differences between the arms with respect to heart failure events or ventricular arrhythmia episodes. Secondary end points showed similar benefit, and right-ventricular pacing was reduced by 44% in the aCRT arm. CONCLUSIONS The aCRT algorithm is safe and at least as effective as BiV pacing with comprehensive echocardiographic optimization.
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Affiliation(s)
- David O Martin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Sengupta J, Kendig AC, Goormastic M, Hwang ES, Ching EA, Chung R, Lindsay BD, Tchou PJ, Wilkoff BL, Niebauer MJ, Martin DO, Varma N, Wazni O, Saliba W, Kanj M, Bhargava M, Dresing T, Taigen T, Ingelmo C, Bassiouny M, Cronin EM, Wilsmore B, Rickard J, Chung MK. Implantable cardioverter-defibrillator FDA safety advisories: Impact on patient mortality and morbidity. Heart Rhythm 2012; 9:1619-26. [PMID: 22772136 DOI: 10.1016/j.hrthm.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A significant proportion of implantable cardioverter-defibrillators (ICDs) have been subject to Food and Drug Administration (FDA) advisories. The impact of device advisories on mortality or patient care is poorly understood. Although estimated risks of ICD generators under advisory are low, dependency on ICD therapies to prevent sudden death justifies the assessment of long-term mortality. OBJECTIVE To test the association of FDA advisory status with long-term mortality. METHODS The study was a retrospective, single-center review of clinical outcomes, including device malfunctions, in patients from implantation to either explant or death. Patients with ICDs first implanted at Cleveland Clinic between August 1996 and May 2004 who became subject to FDA advisories on ICD generators were identified. Mortality was determined by using the Social Security Death Index. RESULTS In 1644 consecutive patients receiving first ICD implants, 704 (43%) became subject to an FDA advisory, of which 172 (10.5%) were class I and 532 (32.3%) were class II. ICDs were explanted before advisory notifications in 14.0% of class I and 10.1% of class II advisories. Among ICDs under advisory, 28 (4.0%) advisory-related and 15 non-advisory- related malfunctions were documented. Over a median follow-up of 70 months, 814 patients died. Kaplan-Meier 5-year survival rate was 65.6% overall, and 64.2, 61.1, and 69.3% in patients with no, class I, and class II advisories, respectively (P = .17). CONCLUSIONS ICD advisories impacted 43% of the patients. Advisory-related malfunctions affected 4% within the combined advisory group. Based on a conservative management strategy, ICDs under advisory were not associated with increased mortality over a background of significant disease-related mortality.
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Affiliation(s)
- Jay Sengupta
- Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland,OH 44195, USA
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Baranowski B, Wazni O, Chung R, Martin DO, Rickard J, Tanaka-Esposito C, Bassiouny M, Wilkoff BL. Percutaneous extraction of stented device leads. Heart Rhythm 2012; 9:723-7. [DOI: 10.1016/j.hrthm.2011.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Indexed: 10/14/2022]
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Rickard J, Bassiouny M, Cronin EM, Martin DO, Varma N, Niebauer MJ, Tchou PJ, Tang WW, Wilkoff BL. Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology. Am J Cardiol 2011; 108:1576-80. [PMID: 21890086 DOI: 10.1016/j.amjcard.2011.07.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/06/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
Abstract
Patients with non-left bundle branch block (LBBB) morphologies are thought to derive less benefit from cardiac resynchronization therapy (CRT) than those with LBBB. However, some patients do exhibit improvement. The characteristics associated with a response to CRT in patients with non-LBBB morphologies are unknown. Clinical, electrocardiographic, and echocardiographic data were collected from 850 consecutive patients presenting for a new CRT device. For inclusion, all patients had a left ventricular ejection fraction of ≤35%, a QRS duration of ≥120 ms, and baseline and follow-up echocardiograms available. Patients with a paced rhythm or LBBB were excluded. The response was defined as an absolute decrease in left ventricular end-systolic volume of ≥10% from baseline. Multivariate models were constructed to identify variables significantly associated with the response and long-term outcomes. A total of 99 patients met the inclusion criteria. Of these 99 patients, 22 had right bundle branch block and 77 had nonspecific intraventricular conduction delay; 52.5% met the criteria for response. On multivariate analysis, the QRS duration was the only variable significantly associated with the response (odds ratio per 10-ms increase 1.23, 95% confidence interval 1.01 to 1.52, p = 0.048). During a mean follow-up of 5.4 ± 0.9 years, 65 patients died or underwent heart transplant or left ventricular assist device placement. On multivariate analysis, the QRS duration was inversely associated with poor long-term outcomes (hazard ratio per 10-ms increase 0.79, 95% confidence interval 0.66 to 0.94, p = 0.005). In patients with advanced heart failure and non-LBBB morphologies, a wider baseline QRS duration is an important determinant of enhanced reverse ventricular remodeling and improved long-term outcomes after CRT.
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Rickard J, Kumbhani DJ, Gorodeski EZ, Martin DO, Grimm RA, Tchou P, Lindsay BD, Tang WH, Wilkoff BL. Elevated Red Cell Distribution Width Is Associated With Impaired Reverse Ventricular Remodeling and Increased Mortality in Patients Undergoing Cardiac Resynchronization Therapy. ACTA ACUST UNITED AC 2011; 18:79-84. [DOI: 10.1111/j.1751-7133.2011.00267.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Rickard J, Brennan DM, Martin DO, Hsich E, Tang WHW, Lindsay BD, Starling RC, Wilkoff BL, Grimm RA. The impact of left ventricular size on response to cardiac resynchronization therapy. Am Heart J 2011; 162:646-53. [PMID: 21982656 DOI: 10.1016/j.ahj.2011.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 07/13/2011] [Indexed: 11/17/2022]
Abstract
UNLABELLED Patients with nondilated (NDCM) or severely dilated cardiomyopathies (SDCM) have been underrepresented in clinical trials of cardiac resynchronization therapy (CRT). We examined changes in left ventricular ejection fraction (LVEF) and survival in patients with NDCM or SDCM compared with those with traditionally studied moderately dilated cardiomyopathy. METHODS We evaluated 800 consecutive patients undergoing the original implantation of a biventricular pacemaker between January 2004 and August 2007. For inclusion, patients had a baseline and pre-CRT echocardiogram, an LVEF ≤40%, a US social security number, and New York Heart Association class II to IV symptoms on standard medical therapy. Patients with a follow-up echocardiogram >2 months after device implantation were included in an analysis of remodeling. Using multivariate models, the impact of baseline left ventricular end-diastolic diameter (LVEDD) on change in LVEF and all-cause mortality was assessed. RESULTS A total of 668 patients met inclusion criteria and were included in the assessment of mortality. Four hundred seventy-one had an appropriately timed follow-up echocardiogram and were included in the analysis of remodeling. Patients in all 3 groups realized improvements in LVEF (%) after CRT as follows: NDCM (n = 137; LVEDD ≤5.5 cm) 10.0 ± 12.7, P < .001; moderately dilated cardiomyopathy (n = 233; LVEDD 5.6-6.9 cm) 8.2 ± 11.3, P < .001; and SDCM (n = 101; LVEDD ≥7.0 cm) 5.4 ± 9.4, P < .001. In multivariate analysis, baseline LVEDD was inversely associated with change in LVEF (parameter estimate -3.13 ± 0.56, P < .001) and directly associated with increased all-cause mortality (hazard ratio 1.25 [1.05-1.47] P = .01). CONCLUSION Patients with NDCM and SDCM experience significant improvements in LVEF after CRT. The degree of baseline left ventricular dilatation before CRT is an important predictor of subsequent changes in LVEF and survival.
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Affiliation(s)
- John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH, USA.
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Rickard J, Zardkoohi O, Popovic Z, Verhaert D, Sraow D, Baranowski B, Martin DO, Grimm RA, Chung MK, Tchou P, Lindsay BA, Wilkoff BL. QRS fragmentation is not associated with poor response to cardiac resynchronization therapy. Ann Noninvasive Electrocardiol 2011; 16:165-71. [PMID: 21496167 DOI: 10.1111/j.1542-474x.2011.00424.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/30/2022] Open
Abstract
BACKGROUND QRS fragmentation (fQRS) has been shown to be a marker of scar in patients with left ventricular dysfunction. Whether fQRS is associated with progressive left ventricular remodeling and increased mortality in patients receiving cardiac resynchronization therapy (CRT) is unclear. METHODS We reviewed the preimplant and follow-up echocardiograms in 233 patients undergoing the new implantation of a CRT device between December 2001 and November 2006. Patients were included if they had a pre-CRT ECG with appropriate filter settings (filter 0.16-100 or 0.16-150 Hz, 25 mm/s, 10 mm/mV), a left ventricular ejection fraction (LVEF) ≤40%, and New York Heart Association class II-IV symptoms on standard medical therapy. The 12-lead electrocardiogram (ECG) was interpreted by two blinded reviewers for the presence of fQRS. Remodeling end points, including changes in LVEF and left ventricular end-diastolic (LVEDV) and systolic (LVESV) volumes, were compared between patients with and without contiguous fQRS, and an assessment of all-cause mortality was made. RESULTS Two hundred thirty-two patients met inclusion criteria, of which 50 demonstrated fQRS in contiguous leads. There was no difference in improvement in LVEF (%) (7.9 ± 12.9 vs 6.8 ± 11.0, P = 0.60) or reduction in LVEDV (mL) (-30.1 ± 57.2 vs -15.7 ± 47.6) or LVESV (mL) (-33.7 ± 58.1 vs -22.7 ± 50.6, P = 0.40) between patients with and without contiguous fQRS. At a mean follow-up of 4.4 ± 1.9 years, there were a total of 89 deaths, 22 (44.0%) in patients with contiguous fQRS and 67 (36.8%) without (log rank P = 0.31). CONCLUSIONS QRS fragmentation is not a predictor of progressive ventricular remodeling or mortality in heart failure patients undergoing CRT.
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Affiliation(s)
- John Rickard
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Rickard J, Ahmed S, Baruch M, Klocman B, Martin DO, Menon V. Utility of a novel watch-based pulse detection system to detect pulselessness in human subjects. Heart Rhythm 2011; 8:1895-9. [PMID: 21802393 DOI: 10.1016/j.hrthm.2011.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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] [Received: 05/08/2011] [Accepted: 07/24/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Wriskwatch is a novel, watch-based pulse detection device that detects the loss of a radial pulse via advanced pulse detection technology and immediately contacts emergency medical systems. OBJECTIVE The purpose of this first-in-man, prospective, single-blinded, phase 1 study was to evaluate the ability of this device to detect motionlessness and pulselessness in human subjects as a simulation of sudden cardiac death. METHODS The study cohort consisted of 34 patients: 24 hospitalized patients and 10 presenting for implantable cardioverter-defibrillator (ICD) testing. We simulated loss of pulse in our hospitalized patients via blood pressure cuff inflation to occlude the brachial arterial pulse at random times in 20 subjects with no inflations in 4 while the patients were instructed to keep perfectly still. Of the 10 patients undergoing ventricular fibrillation (VF) induction during ICD testing, the exact times of VF induction were recorded. A blinded reviewer determined if and when motion and pulse were lost in all patients using only data from the device. RESULTS Of the 34 patients, 2 had an unusable signal, 1 had device ejection during ICD testing, and 2 had too much motion artifact and were excluded (5/34 patients, or 14.7% of the total cohort). Of the 29 remaining subjects, 4 had no loss of pulse of which the device correctly identified 3. In the remaining 25 patients, the device correctly identified the time of pulselessness in 23 of 25 (16/17 hospitalized patients and 7/8 ICD patients). Overall, the Wriskwatch was worn for a total of 561.2 minutes. Pulselessness was present for 5.8 minutes. The sensitivity of the watch to detect pulse status (based on 15-second intervals) was 99.9%, and the specificity was 90.3%. CONCLUSION The Wriskwatch is a novel device that shows promise as a tool to hasten activation of emergency medical systems and facilitate early defibrillation in patients with cardiac arrest.
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Affiliation(s)
- John Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Hussein AA, Saliba WI, Martin DO, Bhargava M, Sherman M, Magnelli-Reyes C, Chamsi-Pasha M, John S, Williams-Adrews M, Baranowski B, Dresing T, Callahan T, Kanj M, Tchou P, Lindsay BD, Natale A, Wazni O. Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation. Circ Arrhythm Electrophysiol 2011; 4:271-8. [DOI: 10.1161/circep.111.962100] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF.
Methods and Results—
We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score ≤2, stroke incidence of 0.06% per year). The procedure-related complication rate was very low.
Conclusions—
Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF. It obviates the need for antiarrhythmic drugs, negative dromotropic agents, and anticoagulants in a substantial proportion of patients.
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Affiliation(s)
- Ayman A. Hussein
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Walid I. Saliba
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - David O. Martin
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Mandeep Bhargava
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Minerva Sherman
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | | | | | - Seby John
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | | | - Bryan Baranowski
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Thomas Dresing
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Thomas Callahan
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Mohamed Kanj
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Patrick Tchou
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Bruce D. Lindsay
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Andrea Natale
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
| | - Oussama Wazni
- From the Center for Atrial Fibrillation, the Cleveland Clinic, Cleveland, OH
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Rickard J, Yousefzai R, Martin DO, Grimm RA, Sraow D, Lindsay BA, Wilkoff BL, Chung MK, Tchou P. SURVIVAL IN OCTOGENARIANS UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY COMPARED TO THE GENERAL POPULATION. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rickard J, Ahmed S, Martin DO, Klocman B, Baruch M, Menon V. THE UTILITY OF A NOVEL WATCH-BASED PULSE DETECTION SYSTEM TO DETECT PULSELESSNESS IN HUMAN SUBJECTS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61005-x] [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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Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, Baranowski B, Martin DO, Lindsay BD, Grimm RA, Wilkoff BL, Tchou P. Characterization of super-response to cardiac resynchronization therapy. Heart Rhythm 2010; 7:885-9. [DOI: 10.1016/j.hrthm.2010.04.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 04/02/2010] [Indexed: 11/15/2022]
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Hussein AA, Wilkoff BL, Martin DO, Karim S, Kanj M, Callahan T, Baranowski B, Saliba WI, Wazni OM. Initial experience with the Evolution mechanical dilator sheath for lead extraction: Safety and efficacy. Heart Rhythm 2010; 7:870-3. [PMID: 20346418 DOI: 10.1016/j.hrthm.2010.03.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 03/10/2010] [Indexed: 11/19/2022]
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Rickard J, Gorodeski EZ, Baranowski B, Sraow D, Grimm R, Tang WH, Martin DO, Wilkoff BL, Hsich E. PRE-IMPLANT LEFT VENTRICULAR DILATION IS AN IMPORTANT PREDICTOR OF RESPONSE IN PATIENTS UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60033-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Khaykin Y, Skanes A, Champagne J, Themistoclakis S, Gula L, Rossillo A, Bonso A, Raviele A, Morillo CA, Verma A, Wulffhart Z, Martin DO, Natale A. A randomized controlled trial of the efficacy and safety of electroanatomic circumferential pulmonary vein ablation supplemented by ablation of complex fractionated atrial electrograms versus potential-guided pulmonary vein antrum isolation guided by intracardiac ultrasound. Circ Arrhythm Electrophysiol 2009; 2:481-7. [PMID: 19843915 DOI: 10.1161/circep.109.848978] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [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 The study was conducted to compare relative safety and efficacy of pulmonary vein antrum isolation (PVAI) using intracardiac echocardiographic guidance and circumferential pulmonary vein ablation (CPVA) for atrial fibrillation (AF) using radiofrequency energy. METHODS AND RESULTS Sixty patients (81% men; 81% paroxysmal; age, 56+/-8 years) failing 2+/-1 antiarrhythmic drugs were randomly assigned to undergo CPVA (n=30) or PVAI (n=30) at 5 centers between December 2004 and October 2007. CPVA patients had circular lesions placed at least 1 cm outside of the veins. Ipsilateral veins were ablated en block with the end point of disappearance of potentials within the circular lesion. Left atrial roof line and mitral isthmus line were ablated without verification of block. For patients in AF postablation or with AF induced with programmed stimulation, complex fractionated electrograms were mapped and ablated to the end point of AF termination or disappearance of complex fractionated electrograms. PVAI did not include complex fractionated electrogram ablation. Esophageal temperature was monitored and kept within 2 degrees C of baseline or under 39 degrees C. Success was defined as absence of atrial tachyarrhythmias (AF/AT) off antiarrhythmic drugs. There was no difference between CPVA and PVAI regarding to baseline variables, catheter used, duration of the procedure, or RF delivery. Fluoroscopy time was longer with PVAI (54+/-17 minutes versus 77+/-18 minutes, P=0.0001). No significant complications occurred in either arm. PVAI was more likely to achieve control of AF/AT off antiarrhythmic drugs (57% versus 27%, P=0.02) at 2+/-1 years of follow-up. CONCLUSIONS A single PVAI procedure is more likely to result in freedom from AF/AT off antiarrhythmic drugs than CPVA supplemented by complex fractionated electrogram ablation in select patients.
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Affiliation(s)
- Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada.
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Hussein AA, Martin DO, Saliba W, Patel D, Karim S, Batal O, Banna M, Williams-Andrews M, Sherman M, Kanj M, Bhargava M, Dresing T, Callahan T, Tchou P, Di Biase L, Beheiry S, Lindsay B, Natale A, Wazni O. Radiofrequency ablation of atrial fibrillation under therapeutic international normalized ratio: A safe and efficacious periprocedural anticoagulation strategy. Heart Rhythm 2009; 6:1425-9. [PMID: 19968920 DOI: 10.1016/j.hrthm.2009.07.007] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 07/06/2009] [Indexed: 11/27/2022]
Affiliation(s)
- Ayman A Hussein
- Center for Atrial Fibrillation, Cleveland Clinic, Cleveland, OH, USA
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Bhargava M, Di Biase L, Mohanty P, Prasad S, Martin DO, Williams-Andrews M, Wazni OM, Burkhardt JD, Cummings JE, Khaykin Y, Verma A, Hao S, Beheiry S, Hongo R, Rossillo A, Raviele A, Bonso A, Themistoclakis S, Stewart K, Saliba WI, Schweikert RA, Natale A. Impact of type of atrial fibrillation and repeat catheter ablation on long-term freedom from atrial fibrillation: Results from a multicenter study. Heart Rhythm 2009; 6:1403-12. [DOI: 10.1016/j.hrthm.2009.06.014] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 06/05/2009] [Indexed: 11/30/2022]
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Martin DO, Day JD, Kraus SM, Stolen KQ, Christman S. Cardiac Resynchronization, Not Atrial Support Pacing, Improves Quality of Life in Heart Failure Patients. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ching CK, Elayi CS, Di Biase L, Barrett CD, Martin DO, Saliba WI, Wazni O, Kanj M, Burkhardt DJ, Schweikert RA, Wilkoff BL. Transiliac ICD implantation: Defibrillation vector flexibility produces consistent success. Heart Rhythm 2009; 6:978-83. [DOI: 10.1016/j.hrthm.2009.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 03/18/2009] [Indexed: 11/25/2022]
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Gorodeski EZ, Cantillon DJ, Goel SS, Kaufman ES, Martin DO, Hsich EM, Blackstone EH, Lauer MS. Microvolt T-wave alternans, peak oxygen consumption, and outcome in patients with severely impaired left ventricular systolic function. J Heart Lung Transplant 2009; 28:689-96. [PMID: 19560697 DOI: 10.1016/j.healun.2009.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 02/22/2009] [Accepted: 04/07/2009] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Abnormal microvolt T-wave alternans (MTWA) and low peak oxygen consumption (VO2) both predict poor outcome in heart failure. However, their independent predictive properties have not been assessed in large-scale cohorts. METHODS This was an observational prospective cohort study of 303 consecutive patients referred for metabolic stress testing. All had an ejection fraction < or = 40% and were considered candidates for transplantation. The exercise laboratory did not collect MTWA data from patients with implanted pacemakers or defibrillators. The primary end point was a composite of all-cause death or United Network for Organ Sharing status 1 transplantation. RESULTS During a 2.8-year period, there were 34 deaths and 17 transplantations. Patients with abnormal MTWA had a higher event rate of 23% (31 of 136) vs 12% (20 of 167), with an unadjusted hazard ratio (HR) of 1.90 (95% confidence interval [CI], 1.90-3.33; p = 0.03). The association remained significant after adjustment for 3 clinical variables (HR, 1.89; 95% CI, 1.05-3.39; p = 0.03). After adding peak VO2 to the model, the association was no longer significant (adjusted HR, 1.18; 95% CI, 0.64-2.17, p = 0.60). After accounting for peak VO2 and 28 other confounders in a matched propensity analysis, MTWA was not predictive (propensity-matched HR, 0.79; 95% CI, 0.37-1.66; p = 0.53). CONCLUSIONS These results confirm the association of abnormal MTWA with poor outcome amongst patients with impaired left ventricular systolic function. However, this association is markedly attenuated after accounting for peak VO2.
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Affiliation(s)
- Eiran Z Gorodeski
- Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio 32610, USA
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Di Biase L, Elayi CS, Fahmy TS, Martin DO, Ching CK, Barrett C, Bai R, Patel D, Khaykin Y, Hongo R, Hao S, Beheiry S, Pelargonio G, Russo AD, Casella M, Santarelli P, Potenza D, Fanelli R, Massaro R, Wang P, Al-Ahmad A, Arruda M, Themistoclakis S, Bonso A, Rossillo A, Raviele A, Schweikert RA, Burkhardt DJ, Natale A. Atrial Fibrillation Ablation Strategies for Paroxysmal Patients. Circ Arrhythm Electrophysiol 2009; 2:113-9. [DOI: 10.1161/circep.108.798447] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Luigi Di Biase
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Claude S. Elayi
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Tamer S. Fahmy
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - David O. Martin
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Chi Keong Ching
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Conor Barrett
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Rong Bai
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Dimpi Patel
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Yaariv Khaykin
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Richard Hongo
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Steven Hao
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Salwa Beheiry
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Gemma Pelargonio
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Antonio Dello Russo
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Michela Casella
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Pietro Santarelli
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Domenico Potenza
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Raffaele Fanelli
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Raimondo Massaro
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Paul Wang
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Amin Al-Ahmad
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Mauricio Arruda
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Sakis Themistoclakis
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Aldo Bonso
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Antonio Rossillo
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Antonio Raviele
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Robert A. Schweikert
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - David J. Burkhardt
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
| | - Andrea Natale
- From the Texas Cardiac Arrhythmia Institute at St David’s Medical Center (L.D.B., D.P., D.J.B., A.N.), Austin, Tex; the Department of Cardiology (L.D.B.), University of Foggia, Foggia, Italy; the Division of Cardiovascular Medicine (C.S.E.), Gill Heart Institute, University of Kentucky, Lexington, Ky; the Cleveland Clinic (D.O.M.), Cleveland, Ohio; the Sutter Pacific Heart Centers (R.H., S.H., S.B.), San Francisco, Calif; the Southlake Regional Health Center (Y.K.), New Market, Ontario, Canada; the
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