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Kaul R, Yang F, Shokr M, Jankelson L, Knotts RJ, Holmes D, Aizer A, Chinitz LA, Barbhaiya CR. Caudal tilt ultrasound-guided axillary venous access for transvenous pacing lead implant. Heart Rhythm 2024; 21:662-667. [PMID: 38266750 DOI: 10.1016/j.hrthm.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/04/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Risheek Kaul
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Felix Yang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University School of Medicine, NYU Langone Health, New York, New York.
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Zhang H, Tarabanis C, Jethani N, Goldstein M, Smith S, Chinitz L, Ranganath R, Aphinyanaphongs Y, Jankelson L. QTNet: Predicting Drug-Induced QT Prolongation With Artificial Intelligence-Enabled Electrocardiograms. JACC Clin Electrophysiol 2024:S2405-500X(24)00166-X. [PMID: 38703162 DOI: 10.1016/j.jacep.2024.01.022] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Prediction of drug-induced long QT syndrome (diLQTS) is of critical importance given its association with torsades de pointes. There is no reliable method for the outpatient prediction of diLQTS. OBJECTIVES This study sought to evaluate the use of a convolutional neural network (CNN) applied to electrocardiograms (ECGs) to predict diLQTS in an outpatient population. METHODS We identified all adult outpatients newly prescribed a QT-prolonging medication between January 1, 2003, and March 31, 2022, who had a 12-lead sinus ECG in the preceding 6 months. Using risk factor data and the ECG signal as inputs, the CNN QTNet was implemented in TensorFlow to predict diLQTS. RESULTS Models were evaluated in a held-out test dataset of 44,386 patients (57% female) with a median age of 62 years. Compared with 3 other models relying on risk factors or ECG signal or baseline QTc alone, QTNet achieved the best (P < 0.001) performance with a mean area under the curve of 0.802 (95% CI: 0.786-0.818). In a survival analysis, QTNet also had the highest inverse probability of censorship-weighted area under the receiver-operating characteristic curve at day 2 (0.875; 95% CI: 0.848-0.904) and up to 6 months. In a subgroup analysis, QTNet performed best among males and patients ≤50 years or with baseline QTc <450 ms. In an external validation cohort of solely suburban outpatient practices, QTNet similarly maintained the highest predictive performance. CONCLUSIONS An ECG-based CNN can accurately predict diLQTS in the outpatient setting while maintaining its predictive performance over time. In the outpatient setting, our model could identify higher-risk individuals who would benefit from closer monitoring.
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Affiliation(s)
- Hao Zhang
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Neil Jethani
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Mark Goldstein
- Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Silas Smith
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Rajesh Ranganath
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Yindalon Aphinyanaphongs
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
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Dai M, Peterson C, Chorin U, Leiva O, Katz M, Sliman H, Aizer A, Barbhaiya C, Bernstein S, Holmes D, Knotts R, Park D, Spinelli M, Chinitz L, Jankelson L. Risk of malignant ventricular arrhythmias in patients with mildly to moderately reduced ejection fraction after permanent pacemaker implantation. Heart Rhythm 2024:S1547-5271(24)00271-6. [PMID: 38490597 DOI: 10.1016/j.hrthm.2024.03.026] [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: 01/08/2024] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Many patients with mildly to moderately reduced left ventricular ejection fraction (LVEF) who require permanent pacemaker (PPM) implantation do not have a concurrent indication for implantable cardioverter-defibrillator (ICD) therapy. However, the risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in this population is unknown. OBJECTIVE The aim of this study was to describe the risk of VT/VF after PPM implantation in patients with mildly to moderately reduced LVEF. METHODS Retrospective analysis was performed of 243 patients with LVEF between 35% and 49% who underwent PPM placement and did not meet indications for an ICD. The primary end point was occurrence of sustained VT/VF. Competing risks regression was performed to calculate subhazard ratios for the primary end point. RESULTS Median follow-up was 27 months; 73% of patients were male, average age was 79 ± 10 years, average LVEF was 42% ± 4%, and 70% were New York Heart Association class II or above. Most PPMs were implanted for sick sinus syndrome (34%) or atrioventricular block (50%). Of 243 total patients, 11 (4.5%) met the primary end point of VT/VF. Multivessel coronary artery disease (CAD) was associated with significantly higher rates of VT/VF, with a subhazard ratio of 5.4 (95% CI, 1.5-20.1; P = .01). Of patients with multivessel CAD, 8 of 82 (9.8%) patients met the primary end point for an annualized risk of 4.3% per year. CONCLUSION Patients with mildly to moderately reduced LVEF and multivessel CAD undergoing PPM implantation are at increased risk for the development of malignant ventricular arrhythmias. Patients in this population may benefit from additional risk stratification for VT/VF and consideration for upfront ICD implantation.
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Affiliation(s)
- Matthew Dai
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Udi Chorin
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orly Leiva
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Moshe Katz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Hend Sliman
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - David Park
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.
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Zahid S, Malik T, Peterson C, Tarabanis C, Dai M, Katz M, Bernstein SA, Barbhaiya C, Park DS, Knotts RJ, Holmes DS, Kushnir A, Aizer A, Chinitz LA, Jankelson L. Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:203-210. [PMID: 36952090 DOI: 10.1007/s10840-023-01533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. METHODS We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. RESULTS There were no differences in baseline demographics, atrial size, or valvular disease between HCM and control patients. Patients with HCM had significantly reduced atrial conduction velocity compared to controls (0.44 ± 0.17 vs 0.56 ± 0.10 m/s, p = 0.01), despite no significant differences in bipolar voltage amplitude (1.23 ± 0.38 vs 1.20 ± 0.41 mV, p = 0.76). There was a statistically significant reduction in conduction velocity in the posterior left atrium in HCM patients relative to controls (0.43 ± 0.18 vs 0.58 ± 0.10 m/s, p = 0.003), but not in the anterior left atrium (0.46 ± 0.17 vs 0.55 ± 0.10 m/s, p = 0.05). There was a significant association between conduction velocity and interventricular septal thickness (slope = -0.013, R2 = 0.13, p = 0.03). CONCLUSIONS Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
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Affiliation(s)
- Sohail Zahid
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
| | - Tahir Malik
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Moshe Katz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Douglas S Holmes
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Department of Internal Medicine, NYU Langone Health, 550 1st Ave., New York, NY, 10016, USA.
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Tarabanis C, Segev M, Weiss S, Chinitz L, Jankelson L. Novel algorithm for fully automated rapid and accurate high definition electrogram acquisition for electroanatomical mapping. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01669-8. [PMID: 37853261 DOI: 10.1007/s10840-023-01669-8] [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: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, 560 1st Avenue, New York, NY, 10016, USA
| | | | | | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, 560 1st Avenue, New York, NY, 10016, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, 560 1st Avenue, New York, NY, 10016, USA.
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Tarabanis C, Kalampokis E, Khalil M, Alviar CL, Chinitz LA, Jankelson L. Explainable SHAP-XGBoost models for in-hospital mortality after myocardial infarction. Cardiovasc Digit Health J 2023; 4:126-132. [PMID: 37600443 PMCID: PMC10435947 DOI: 10.1016/j.cvdhj.2023.06.001] [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] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background A lack of explainability in published machine learning (ML) models limits clinicians' understanding of how predictions are made, in turn undermining uptake of the models into clinical practice. Objective The purpose of this study was to develop explainable ML models to predict in-hospital mortality in patients hospitalized for myocardial infarction (MI). Methods Adult patients hospitalized for an MI were identified in the National Inpatient Sample between January 1, 2012, and September 30, 2015. The resulting cohort comprised 457,096 patients described by 64 predictor variables relating to demographic/comorbidity characteristics and in-hospital complications. The gradient boosting algorithm eXtreme Gradient Boosting (XGBoost) was used to develop explainable models for in-hospital mortality prediction in the overall cohort and patient subgroups based on MI type and/or sex. Results The resulting models exhibited an area under the receiver operating characteristic curve (AUC) ranging from 0.876 to 0.942, specificity 82% to 87%, and sensitivity 75% to 87%. All models exhibited high negative predictive value ≥0.974. The SHapley Additive exPlanation (SHAP) framework was applied to explain the models. The top predictor variables of increasing and decreasing mortality were age and undergoing percutaneous coronary intervention, respectively. Other notable findings included a decreased mortality risk associated with certain patient subpopulations with hyperlipidemia and a comparatively greater risk of death among women below age 55 years. Conclusion The literature lacks explainable ML models predicting in-hospital mortality after an MI. In a national registry, explainable ML models performed best in ruling out in-hospital death post-MI, and their explanation illustrated their potential for guiding hypothesis generation and future study design.
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Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University School of Medicine, New York, New York
| | | | - Mahmoud Khalil
- Department of Internal Medicine, Lincoln Medical Centre, Bronx New York
| | - Carlos L. Alviar
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University School of Medicine, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University School of Medicine, New York, New York
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Shashar M, Schwartz D, Zubkov A, Hoffman S, Jankelson L, Shapira S, Merimsky B, Berman J, Chernichovski T, Amitai O, Raz MA, Hershkovitz R, Grupper A, Weinstein T, Arber N, Schwartz IF. Renal Tubular CD24 Upregulation Aggravates Folic Acid Induced Acute Kidney Injury: A Possible Role for T Regulatory Cells Inhibition in Mice. J Pers Med 2023; 13:1134. [PMID: 37511747 PMCID: PMC10381775 DOI: 10.3390/jpm13071134] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Acute kidney injury (AKI) is characterized by cell death and inflammation. CD24 is a protein induced during tissue damage and is not expressed in mature renal tissue. We explored the role of CD24 in the pathogenesis of folic acid-induced AKI (FA-AKI) in mice. A single Intraperitoneal (IP) injection of folic acid induced AKI in WT and CD24-/- mice. Renal function tests, histological analysis, immunohistochemistry, Western blot analysis, and ELISA were performed to assess the severity of renal damage and the intensity of the inflammatory response. FA-AKI induced CD24 in the distal tubular epithelial cells. Compared to WT mice, FA-AKI CD24-/- mice exhibited an attenuated reduction in renal function and histological injury, lower serum IL-10 and interferon γ, and decreased expression of renal TNFα. In contrast, renal and systemic IL-33 upregulation were augmented. CD24-/- FA-AKI animals exhibited increased splenic margination and renal infiltration of regulatory T cells (Tregs). At day 7, FA-AKI CD24-/- mice exhibited increased expression of tubular pro-apoptotic and decreased anti-apoptotic proteins compared to WT animals. Anti-CD24 antibody administration to FA-AKI mice attenuated the decrease in renal function as well as the histological injury. Renal biopsies from patients with ATN stained strongly for CD24 in the distal tubules. In conclusion, during AKI, upregulation of CD24 promotes renal inflammation through inhibition of Treg infiltration and diversion of cell death towards necrosis rather than apoptosis. Neutralization of CD24 may prove a target for future therapies in AKI.
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Affiliation(s)
- Moshe Shashar
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Laniado Hospital, Netanya 4244916, Israel
| | - Doron Schwartz
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Asia Zubkov
- Pathology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Sarit Hoffman
- Pathology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Lior Jankelson
- Internal Medicine "T", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Shiran Shapira
- The Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Barak Merimsky
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Julia Berman
- Internal Medicine "T", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Tamara Chernichovski
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Oeren Amitai
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Michal Ariela Raz
- Internal Medicine "T", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Rami Hershkovitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
- Internal Medicine "T", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Ayelet Grupper
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Talia Weinstein
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Nadir Arber
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- The Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Idit F Schwartz
- Departments of Nephrology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
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Cheng A, Qiu J, Barbhaiya C, Garber L, Holmes D, Jankelson L, Kushnir A, Knotts R, Bernstein S, Park D, Spinelli M, Chinitz L, Aizer A. Outcomes and atrial substrate analysis in patients with HIV undergoing atrial fibrillation ablation. J Cardiovasc Electrophysiol 2023; 34:575-582. [PMID: 36511474 DOI: 10.1111/jce.15774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patients with HIV infection have increased risk of atrial fibrillation, but the pathophysiologic mechanisms and the utility of catheter ablation in this population are not well-studied. We aimed to characterize outcomes of atrial fibrillation ablation and left atrial substrate in patients with HIV. METHODS The study was a retrospective propensity score-matched analysis of patients with and without HIV undergoing atrial fibrillation ablation. A search was performed in the electronic medical record for all patients with HIV who received initial atrial fibrillation ablation from 2011 to 2020. After calculating propensity scores for HIV, matching was performed with patients without HIV by using nearest-neighbor matching without replacement in a 1:2 ratio. The primary outcome was freedom from atrial arrhythmia and secondary outcomes were freedom from atrial fibrillation, freedom from atrial tachycardia, and freedom from repeat ablation, compared by log-rank analysis. The procedures of patients with HIV who underwent repeat ablation at our institution were further analyzed for etiology of recurrence. To further characterize the left atrial substrate, a subsequent case-control analysis was then performed for a set of randomly chosen 10 patients with HIV matched with 10 without HIV to compare minimum and maximum voltage at nine pre-specified regions of the left atrium. RESULTS Twenty-seven patients with HIV were identified. All were prescribed antiretroviral therapy at time of ablation. These patients were matched with 54 patients without HIV by propensity score. 86.4% of patients with HIV and 76.9% of controls were free of atrial fibrillation or atrial tachycardia at 1 year (p = .509). Log-rank analysis showed no difference in freedom from atrial arrhythmia (p value .971), atrial fibrillation (p-value .346), atrial tachycardia (p value .306), or repeat ablation (p value .401) after initial atrial fibrillation ablation in patients with HIV compared to patients without HIV. In patients with HIV with recurrent atrial fibrillation, the majority had pulmonary vein reconnection (67%). There were no significant differences in minimum or maximum voltage at any of the nine left atrial regions between the matched patients with and without HIV. CONCLUSIONS Ablation to treat atrial fibrillation in patients with HIV, but without overt AIDS is frequently successful therapy. The majority of patients with recurrence of atrial fibrillation had pulmonary vein reconnection, suggesting infrequent nonpulmonary vein substrate. In this population, the left atrial voltage in patients with HIV is similar to that of patients without HIV. These findings suggest that the pulmonary veins remain a critical component to the initiation and maintenance of atrial fibrillation in patients with HIV.
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Affiliation(s)
- Austin Cheng
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jessica Qiu
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leonid Garber
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
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Khan H, Bonvissuto MR, Rosinski E, Shokr M, Metcalf K, Jankelson L, Kushnir A, Park DS, Bernstein SA, Spinelli MA, Aizer A, Holmes D, Chinitz LA, Barbhaiya CR. Comparison of combined substrate-based mapping techniques to identify critical sites for ventricular tachycardia ablation. Heart Rhythm 2023; 20:808-814. [PMID: 36863636 DOI: 10.1016/j.hrthm.2023.02.023] [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: 10/19/2022] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Established electroanatomic mapping techniques for substrate mapping for ventricular tachycardia (VT) ablation includes voltage mapping, isochronal late activation mapping (ILAM), and fractionation mapping. Omnipolar mapping (Abbott Medical, Inc.) is a novel optimized bipolar electrogram creation technique with integrated local conduction velocity annotation. The relative utilities of these mapping techniques are unknown. OBJECTIVE The purpose of this study was to evaluate the relative utility of various substrate mapping techniques for the identification of critical sites for VT ablation. METHODS Electroanatomic substrate maps were created and retrospectively analyzed in 27 patients in whom 33 VT critical sites were identified. RESULTS Both abnormal bipolar voltage and omnipolar voltage encompassed all critical sites and were observed over a median of 66 cm2 (interquartile range [IQR] 41.3-86 cm2) and 52 cm2 (IQR 37.7-65.5 cm2), respectively. ILAM deceleration zones were observed over a median of 9 cm2 (IQR 5.0-11.1 cm2) and encompassed 22 critical sites (67%), while abnormal omnipolar conduction velocity (CV <1 mm/ms) was observed over 10 cm2 (IQR 5.3-16.6 cm2) and identified 22 critical sites (67%), and fractionation mapping was observed over a median of 4 cm2 (IQR 1.5-7.6 cm2) and encompassed 20 critical sites (61%). The mapping yield was the highest for fractionation + CV (2.1 critical sites/cm2) and least for bipolar voltage mapping (0.5 critical sites/cm2). CV identified 100% of critical sites in areas with a local point density of >50 points/cm2. CONCLUSION ILAM, fractionation, and CV mapping each identified distinct critical sites and provided a smaller area of interest than did voltage mapping alone. The sensitivity of novel mapping modalities improved with greater local point density.
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Affiliation(s)
- Hassan Khan
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | | | | | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | | | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - David S Park
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Michael A Spinelli
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York.
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Panday P, Holmes D, Park DS, Jankelson L, Bernstein SA, Knotts R, Kushnir A, Aizer A, Chinitz LA, Barbhaiya CR. Catheter ablation of atrioventricular nodal reentrant tachycardia with an irrigated contact-force sensing radiofrequency ablation catheter. J Cardiovasc Electrophysiol 2023; 34:942-946. [PMID: 36738141 DOI: 10.1111/jce.15849] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/23/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) slow pathway modification for catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is traditionally performed using a 4-mm nonirrigated (NI) RF ablation catheter. Slow pathway modification using irrigated, contact-force sensing (ICFS) RFA catheters has been described in case reports, but the outcomes have not been systematically evaluated. METHODS Acute procedural outcomes of 200 consecutive patients undergoing slow pathway modification for AVNRT were analyzed. A 3.5-mm ICFS RFA catheter (ThermoCool SmartTouch STSF, Biosense Webster, Inc.) was utilized in 134 patients, and a 4-mm NI RFA catheter (EZ Steer, Biosense Webster, Inc.) was utilized in 66 patients. Electroanatomic maps were retrospectively analyzed in a blinded fashion to determine the proximity of ablation lesions to the His region. RESULTS The baseline characteristics of patients in both groups were similar. Total RF time was significantly lower in the ICFS group compared to the NI group (5.53 ± 4.6 vs. 6.24 ± 4.9 min, p = 0.03). Median procedure time was similar in both groups (ICFS, 108.0 (87.5-131.5) min vs. NI, 100.0 (85.0-125.0) min; p = 0.2). Ablation was required in closer proximity to the His region in the NI group compared to the ICFS group (14.4 ± 5.9 vs. 16.7 ± 6.4 mm, respectively, p = 0.01). AVNRT was rendered noninducible in all patients, and there was no arrhythmia recurrence during follow-up in both groups. Catheter ablation was complicated by AV block in one patient in the NI group. CONCLUSION Slow pathway modification for catheter ablation of AVNRT using an ICFS RFA catheter is feasible, safe, and may facilitate shorter duration ablation while avoiding ablation in close proximity to the His region.
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Affiliation(s)
- Priya Panday
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York University Langone Health. New York, NY, USA
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Kushnir A, Barbhaiya CR, Aizer A, Jankelson L, Holmes D, Knotts R, Park D, Spinelli M, Bernstein S, Chinitz LA. Temporal trends in atrial fibrillation ablation procedures at an academic medical center: 2011-2021. J Cardiovasc Electrophysiol 2023; 34:800-807. [PMID: 36738147 DOI: 10.1111/jce.15839] [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: 09/09/2022] [Revised: 01/03/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Radiofrequency ablation technology for treating atrial fibrillation (AF) has evolved rapidly over the past decade. We investigated the impact of technological and procedural advances on procedure times and ablation outcomes at a major academic medical center over a 10-year period. METHODS Clinical data was collected from patients who presented to NYU Langone Health between 2011 and 2021 for a first-time AF ablation. Time to redo AF ablation or direct current cardioversion (DCCV) for recurrent AF during a 3-year follow-up period was determined and correlated with ablation technology and practices, antiarrhythmic medications, and patient comorbid conditions. RESULTS From 2011 to 2021, the cardiac electrophysiology lab adopted irrigated-contact force ablation catheters, high-power short duration ablation lesions, steady-pacing, jet ventilation, and eliminated stepwise linear ablation for AF ablation. During this time the number of first time AF ablations increased from 403 to 1074, the percentage of patients requiring repeat AF-related intervention within 3-years of the index procedure dropped from 22% to 14%, mean procedure time decreased from 271 ± 65 to 135 ± 36 min, and mean annual major adverse event rate remained constant at 1.1 ± 0.5%. Patient comorbid conditions increased during this time period and antiarrhythmic use was unchanged. CONCLUSION Rates of redo-AF ablation or DCCV following an initial AF ablation at a single center decreased 36% over a 10-year period. Procedural and technological changes likely contributed to this improvement, despite increased AF related comorbidities.
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Affiliation(s)
- Alexander Kushnir
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, USA
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Tarabanis C, Ronan R, Shokr M, Chinitz L, Jankelson L. Development of an AI-Driven QT Correction Algorithm for Patients in Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:246-254. [PMID: 36858692 DOI: 10.1016/j.jacep.2022.09.021] [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] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 09/17/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Prolongation of the QTc interval is associated with the risk of torsades de pointes. Determination of the QTc interval is therefore of critical importance. There is no reliable method for measuring or correcting the QT interval in atrial fibrillation (AF). OBJECTIVES The authors sought to evaluate the use of a convolutional neural network (CNN) applied to AF electrocardiograms (ECGs) for accurately estimating the QTc interval and ruling out prolongation of the QTc interval. METHODS The authors identified patients with a 12-lead ECG in AF within 10 days of a sinus ECG, with similar (±10 ms) QRS durations, between October 23, 2001, and November 5, 2021. A multilayered deep CNN was implemented in TensorFlow 2.5 (Google) to predict the MUSE (GE Healthcare) software-generated sinus QTc value from an AF ECG waveform, demographic characteristics, and software-generated features. RESULTS The study identified 6,432 patients (44% female) with an average age of 71 years. The CNN predicted sinus QTc values with a mean absolute error of 22.2 ms and root mean squared error of 30.6 ms, similar to the intrinsic variability of the sinus QTc interval. Approximately 84% and 97% of the model's predictions were contained within 1 SD (±30.6 ms) and 2 SD (±61.2 ms) from the sinus QTc interval. The model outperformed the AFQTc method, exhibiting narrower error ranges (mean absolute error comparison P < 0.0001). The model performed best for ruling out QTc prolongation (negative predictive value 0.82 male, 0.92 female; specificity 0.92 male, 0.97 female). CONCLUSIONS A CNN model applied to AF ECGs accurately predicted the sinus QTc interval, outperforming current alternatives and exhibiting a high negative predictive value.
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Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Robert Ronan
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
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Vamos M, Saghy L, Jankelson L, Garber L, Pap R. Inability to perform 'en bloc' pulmonary vein isolation requiring ablation of the intervenous carina increases recurrence of atrial fibrillation: A meta-analysis. Pacing Clin Electrophysiol 2022; 45:1415-1418. [PMID: 36272168 DOI: 10.1111/pace.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/19/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Failure to isolate ipsilateral pulmonary veins (PV) "en bloc" by wide-area circumferential ablation (WACA) may necessitate ablation at the intervenous carina. It is unknown how this scenario impacts rates of atrial fibrillation (AF) recurrence. METHODS A standard random-effect meta-analysis of randomized or observational studies were performed, where the outcome of first-time AF ablation was reported in patients with "en bloc" isolation of PVs by WACA as compared with those in whom ablation at the intervenous carina was needed after WACA to achieve complete isolation. RESULTS A total of five single-center, observational studies (N = 1185) and one, multi-center randomized trial (N = 234) were enrolled. PV isolation could be achieved by WACA "en bloc" in 902/1419 (63.6%) cases. The rest required additional ablation at one or both of the left and right intervenous carinas to achieve isolation. The follow-up time after ablation ranged from 1 to 2 years in the included trials. The incidence of AF recurrence proved to be significantly lower in patients with successful "en bloc" isolation compared to those requiring carina ablation(s) to achieve complete bilateral PV isolation (MH-OR 1.89, 95% CI 1.42-2.53, p < .01) CONCLUSION: This present meta-analysis demonstrates a lower arrhythmia recurrence rate in patients with bilateral "en bloc" isolation, as compared to those who needed additional carina ablation for complete PVI. Therefore, it is imperative that every effort be made to isolate ipsilateral PVs "en bloc" during PVI.
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Affiliation(s)
- Mate Vamos
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
| | - Laszlo Saghy
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Leonid Garber
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Robert Pap
- Department of Internal Medicine, Cardiac Electrophysiology Division, University of Szeged, Szeged, Hungary
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Tarabanis C, Klapholz J, Zahid S, Jankelson L. A systematic review of the use of 3D printing in left atrial appendage occlusion procedures. J Cardiovasc Electrophysiol 2022; 33:2367-2374. [PMID: 35989544 DOI: 10.1111/jce.15658] [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: 02/18/2022] [Revised: 08/09/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
The placement of a left atrial appendage occlusion (LAAO) device can be a technically challenging transcatheter-based procedure. Key challenges include accurate pre-procedural device sizing and proper device positioning at the LAA ostium to ensure sufficient device anchoring and avoid peri-device leaks. To address these challenges, 3D printing (3DP) of LAA models has recently emerged in the literature, first being described in 2015. We present a review of the benefits and drawbacks of employing this technology for LAAO procedures. Pre-procedurally the use of 3DP can consistently and accurately determine LAAO device size over standard of care approaches. Intra-procedurally 3DP's impact entailed a statistically significant decrease in the number of devices used per procedure, as well as in the fluoroscopic time and dose. Post-procedurally, there is some evidence that 3DP could reduce the rate of peri-device leaks, with limited data on its effect on complication rates. Based on existing evidence, we recommend the focused application of 3DP to cases of complex LAA anatomy and for the training of proceduralists. Lastly, we address the emergence of next generation LAAO devices and AR/VR systems that could limit even this narrow window of clinical benefit afforded by 3DP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Constantine Tarabanis
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Jonah Klapholz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sohail Zahid
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York, NY, United States
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Yaacov O, Chinitz LA, Chakravarti A, Jankelson L. HF-566-01 INTERACTION OF ARRHYTHMIA AND CARDIOMYOPATHY WITH GENETIC VARIANT GROUPS IN THE UK BIOBANK POPULATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Barbhaiya CR, Barbee D, Wang H, Chen T, Axel L, Jankelson L, Aizer A, Chinitz LA, Yuan Y. PO-687-03 TRANSIENT DYSFUNCTION OF CARDIAC RESYNCHRONIZATION THERAPY DEFIBRILLATOR SYSTEM FOLLOWING CARDIAC RADIATION ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maidman SD, Jankelson L, Holmes D, Park DS, Bernstein SA, Knotts R, Kushnir A, Aizer A, Chinitz LA, Barbhaiya CR. PO-637-01 ATRIAL FIBRILLATION ABLATION IN PATIENTS WITH SEVERELY REDUCED EJECTION FRACTION PRIOR TO CONSIDERATION OF PRIMARY PREVENTION ICD IMPLANTATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dai MS, Peterson C, Katz M, Aizer A, Barbhaiya CR, Bernstein SA, Holmes D, Knotts R, Park DS, Spinelli MA, Chinitz LA, Jankelson L. PO-688-06 RISK OF ADVERSE CARDIAC EVENTS IN PATIENTS WITH MODERATELY REDUCED EJECTION FRACTION FOLLOWING PERMANENT PACEMAKER IMPLANT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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KHAN HASSAN, Bonvissuto MR, Rosinski E, Shokr M, Metcalf K, Jankelson L, Kushnir A, Park DS, Bernstein SA, Spinelli MA, Aizer A, Holmes D, Chinitz LA, Barbhaiya CR. PO-622-06 RELATIVE UTILITY OF OMNIPOLAR SUBSTRATE MAPPING FOR VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.848] [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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20
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Barbhaiya CR, Shokr M, Jankelson L, Knotts R, Spinelli MA, Kushnir A, Park DS, Bernstein SA, Holmes D, Aizer A, Chinitz LA. PO-693-02 CAUDAL-TILT ULTRASOUND GUIDED AXILLARY VENOUS ACCESS FOR TRANSVENOUS PACING LEAD IMPLANT. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Malik T, Garber L, Aizer A, Barbhaiya CR, Bernstein SA, Holmes D, Knotts R, Park DS, Spinelli MA, Cerrone M, Chinitz LA, Jankelson L. PO-656-05 CLINICAL FEATURES AND MANAGEMENT OF SHORT-COUPLED PVC IDIOPATHIC VENTRICULAR FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.284] [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: 11/27/2022]
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22
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Rzucidlo J, Panday P, Lombardo M, H Shulman E, S Park D, A Bernstein S, Jankelson L, Holmes D, Aizer A, A Chinitz L, R Barbhaiya C. Elevated Left Atrial Volume Index Predicts Incident Atrial Fibrillation After Typical Right Atrial Flutter Ablation. J Atr Fibrillation 2021; 14:20200485. [PMID: 34950364 DOI: 10.4022/jafib.20200485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/27/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022]
Abstract
Purpose Incident atrial fibrillation (AF) is common after cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation. Risk factors for the development of AF post ablation are not well understood. The purpose of this study was to identify patients undergoing CTI ablation for AFL most likely to develop AF. Methods Retrospective chart review identified 114 consecutive patients without a history of AF or prior cardiac surgery who underwent typical CTI dependent AFL ablation between December 2013 to November 2018, who also had a complete preoperative transthoracic echocardiogram, and at least 1 year of follow-up at our medical center. We evaluated baseline characteristics, electrophysiology study (EPS) data and echocardiographic data for incidence of AF within 3 years. Results Incident AF was identified in 46 patients (40%) during 600 + 405 days follow-up. Left atrial volume index (LAVI) was significantly greater in patients who developed AF compared to those that did not (37 ± 12.2 ml/m2 vs 30 ± 13.4 ml/m2, p=.004), with an area under the receiver operator characteristic curve based on the LAVI of 0.7 (p = 0.004). Kaplan-Meier estimated incidence of AF was significantly greater in patients with LAVI ≥ 30 ml/m2 than LAVI < 30 ml/m2 (66% vs 27%, p=0.004). Risk of incident AF in patients with LAVI > 40 mL/m2 was similar to that of LAVI 30-40 ml/m2 (67% vs 63%, respectively, p=0.97). In multivariable analysis LAVI remained the sole independent predictor of incidence AF after CTI AFL ablation. Conclusions LAVI ≥ 30 ml/m2 is associated with significantly increased risk of incident AF following CTI ablation for typical AFL. HATCH <2 was notably not an independent predictor of AF after AFL ablation.
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Affiliation(s)
- Justyna Rzucidlo
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Priya Panday
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Marissa Lombardo
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Eric H Shulman
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Scott A Bernstein
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
| | - Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology. New York University Langone Health. New York, NY, USA
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Jankelson L, Garber L, Shulman E, Cohen RB, Peterson C, Wadhwani L, Nadeau-Routhier C, Xia Y, Barbhaiya C, Holmes D, Knotts R, Bernstein S, Kushnir A, Spinelli M, Park D, Aizer A, Chinitz L. Outcomes of posterior wall isolation with pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2021; 33:209-217. [PMID: 34911157 DOI: 10.1111/jce.15325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/22/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prior studies have shown that addition of posterior wall isolation (PWI) may reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation. No data on PWI in paroxysmal AF (pAF) patients with normal left atrial voltage is available, to date. OBJECTIVE This study sought to evaluate the efficacy of PWI in addition to pulmonary vein isolation (PVI) in patients presenting with pAF and normal left atrial voltage. METHODS Consecutive patient registry analysis was performed on all patients with pAF and normal left atrial voltage undergoing initial radiofrequency ablation from November 1, 2018 to November 15, 2019. Primary endpoint was recurrence of atrial arrhythmia including AF, atrial tachycardia (AT), or atrial flutter (AFL). RESULTS A total of 321 patients were studied, 214 in the PVI group and 107 in the PWI + PVI group. Recurrence of any atrial arrhythmia occurred in 18.2% of patients in the PVI group and 16.8% in the PVI + PWI cohort (p = 0.58). At 1 year, recurrence was 14.0% in the PVI group and 15.0% in the PWI + PVI group (p = 0.96). There was a lower AT/AFL recurrence in the PVI + PWI group, not reaching significance (3.7% in the PWI + PVI group vs. 7.9% in PVI group, p = 0.31). Need for carina lesions predicted recurrence in the PVI-only group. CONCLUSIONS Addition of PWI to PVI in pAF patients undergoing their first ablation did not reduce the frequency of atrial arrhythmia recurrence. This warrants further study in a prospective trial.
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Affiliation(s)
- Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Leonid Garber
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Eric Shulman
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Roi Bar Cohen
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lalit Wadhwani
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Charles Nadeau-Routhier
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Yuhe Xia
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexander Kushnir
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York, USA
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Siskin M, Cerrone M, Shokr M, Aizer A, Barbhaiya C, Dai M, Bernstein S, Holmes D, Knotts R, Park DS, Spinelli M, Chinitz LA, Jankelson L. ICD shocks and complications in patients with inherited arrhythmia syndromes. Int J Cardiol Heart Vasc 2021; 37:100908. [PMID: 34765721 PMCID: PMC8569698 DOI: 10.1016/j.ijcha.2021.100908] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Background There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. Methods Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. Results 123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. Conclusion The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.
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Affiliation(s)
- Matthew Siskin
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Marina Cerrone
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
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Wadhwani L, Occhipinti K, Selim A, Manmadhan A, Kushnir A, Barbhaiya C, Jankelson L, Holmes D, Bernstein S, Spinelli M, Knotts R, Park DS, Chinitz LA, Aizer A. Time to diagnosis of acute complications after cardiovascular implantable electronic device insertion and optimal timing of discharge within the first 24 hours. Heart Rhythm 2021; 18:2110-2114. [PMID: 34517119 DOI: 10.1016/j.hrthm.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 3 million cardiovascular implantable electronic devices (CIEDs) are implanted annually. There are minimal data regarding the timing of diagnosis of acute complications after implantation. It remains unclear whether patients can be safely discharged less than 24 hours postimplantation. OBJECTIVE The purpose of this study was to determine the precise timing of acute complication diagnosis after CIED implantation and optimal timing for same-day discharge. METHODS A retrospective cohort analysis of adults 18 years or older who underwent CIED implantation at a large urban quaternary care medical center between June 1, 2015, and March 30, 2020, was performed. Standard of care included overnight observation and chest radiography 6 and 24 hours postprocedure. Medical records were reviewed for the timing of diagnosis of acute complications. Acute complications included pneumothorax, hemothorax, pericardial effusion, lead dislodgment, and implant site hematoma requiring surgical intervention. RESULTS A total of 2421 patients underwent implantation. Pericardial effusion or cardiac tamponade was diagnosed in 13 patients (0.53%), pneumothorax or hemothorax in 19 patients (0.78%), lead dislodgment in 11 patients (0.45%), and hematomas requiring surgical intervention in 5 patients (0.2%). Of the 48 acute complications, 43 (90%) occurred either within 6 hours or more than 24 hours after the procedure. Only 3 acute complications identified between 6 and 24 hours required intervention during the index hospitalization (0.12% of all cases). CONCLUSION Most acute complications are diagnosed either within the first 6 hours or more than 24 hours after implantation. With rare exception, patients can be considered for discharge after 6 hours of appropriate monitoring.
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Affiliation(s)
- Lalit Wadhwani
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Karen Occhipinti
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Ahmed Selim
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Arun Manmadhan
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Alexander Kushnir
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Chirag Barbhaiya
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Lior Jankelson
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Douglas Holmes
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Scott Bernstein
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Michael Spinelli
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Robert Knotts
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - David S Park
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Larry A Chinitz
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York
| | - Anthony Aizer
- NYU Cardiac Electrophysiology Service, NYU Division of Cardiology, NYU Department of Internal Medicine, NYU Grossman School of Medicine, NYU Langone Medical Center, NYU Langeone Health, New York, New York.
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Khan H, Shokr M, Occhipinti KM, Jankelson L, Kushnir A, Knotts R, Bernstein SA, Barbhaiya CR, Holmes D, Aizer A, Chinitz LA. B-PO05-203 RISK FACTORS FOR POSTOPERATIVE URINARY RETENTION IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Garber L, Jankelson L, Shulman EH, Bar-Cohen R, Peterson C, Nadeau-Routhier C, Wadhwani L, Xia Y, Barbhaiya CR, Bernstein SA, Holmes D, Knotts R, Kushnir A, Park DS, Spinelli MA, Aizer A, Chinitz LA. B-PO02-077 OUTCOMES OF LEFT ATRIAL POSTERIOR WALL ISOLATION IN CONJUNCTION WITH PULMONARY VEIN ISOLATION FOR PAROXYSMAL ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbhaiya CR, Kushnir A, Jankelson L, Knotts R, Holmes D, Aizer A, Linton P, Oneill D, Chinitz LA. B-PO05-067 SAFETY AND OUTCOMES OF VENOUS BLOOD-GAS GUIDED HIGH-FREQUENCY JET VENTILATION FOR ATRIAL FIBRILLATION ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spinelli MA, Selim AMA, Aizer A, Holmes D, Jankelson L, Knotts R, Kushnir A, Park DS, Bernstein SA, Germano JJ, Barbhaiya CR, Chinitz LA. B-PO04-030 REAL WORLD UTILIZATION AND OUTCOMES OF THE MICRA AV PACING SYSTEM. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.726] [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: 11/25/2022]
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Qiu J, Cheng AV, Barbhaiya CR, Jankelson L, Holmes D, Kushnir A, Knotts R, Bernstein SA, Park DS, Chinitz LA, Aizer A. B-PO04-102 INCREASING BSA PREDICTS RESIDUAL PULMONARY VEIN CONNECTION AFTER FIRST PASS WIDE AREA CIRCUMFERENTIAL ABLATION UTILIZING STANDARDIZED ABLATION INDEX TARGETS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Siskin M, Cerrone M, Shokr M, Shijie Dai M, Barbhaiya CR, Bernstein SA, Holmes D, Knotts R, Kushnir A, Park DS, Spinelli MA, Chinitz LA, Jankelson L. B-PO05-058 LONG-TERM ICD RELATED OUTCOMES IN PATIENTS WITH INHERITED ARRHYTHMIC SYNDROMES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jethani N, Zhang H, Chinitz LA, Aphinyanaphongs Y, Ranganath R, Jankelson L. B-PO03-175 QTNET: PREDICTING DRUG-INDUCED QT PROLONGATION WITH DEEP NEURAL NETWORKS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cohen RB, Dai M, Aizer A, Barbhaiya C, Peterson C, Bernstein S, Park DS, Spinelli M, Chinitz LA, Jankelson L. QT interval dynamics and triggers for QT prolongation immediately following cardiac arrest. Resuscitation 2021; 162:171-179. [PMID: 33652119 DOI: 10.1016/j.resuscitation.2021.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prolongation in QT interval typically observed following cardiac arrest is considered to be multifactorial and induced by external triggers such as hypothermia therapy and exposure to antiarrhythmic medications. OBJECTIVE To evaluate the corrected QT interval (QTc) dynamics in the first 10 days following cardiac arrest with respect to the etiology of arrest, hypothermia and QT prolonging medications. METHODS We enrolled 104 adult survivors of cardiac arrest, where daily ECG was available for at least 3 days. We followed their QT and QRS intervals for the first 10 days of hospitalization. We used both Bazett and Fridericia formulas to correct for heart rate. For patients with QRS < 120 we analyzed the QTc interval (n = 90) and for patients with QRS > 120 ms we analyzed the JTc (n = 104) vs. including only the narrow QRS samples (n = 89). We stratified patients by 3 groups: (1) presence of ischemic heart disease (IHD) (2) treatment with hypothermia protocol, and (3) treatment with QTc prolonging medications. Additionally, genetic information obtained during hospitalization was analyzed. RESULTS QTc and JTc intervals were significantly prolonged in the first 6 days. Maximal QTc/JTc prolongation was observed in day 2 (QTcB = 497 ± 55). There were no differences in daily QTc/JTc and QRS intervals in the first 2 days post arrest between patients with or without hypothermia induction but such difference was found with QT prolonging medications. All subgroups demonstrated significantly prolonged QTc/JTc interval regardless of the presence of IHD, hypothermia protocol or QTc prolonging medication exposure. Our results were consistent for both Bazetts' and Frediricia correction and for any QRS duration. Prolongation of the JTcB beyond 382 ms after day 3 predicted sustained QTc/JTc prolongation beyond day 6 with an ROC of 0.78. CONCLUSIONS QTc/JTc interval is significantly and independently prolonged post SCA, regardless of known QT prolonging triggers. Normalization of the QTc post cardiac arrest should be expected only after day 6 of hospitalization. Assessment of the QTc for adjudication of the etiology of arrest or for monitoring the effect of QT prolonging medications may be unreliable.
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Affiliation(s)
- Roi Bar Cohen
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Connor Peterson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, NY, USA.
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Chorin E, Dai M, Kogan E, Wadhwani L, Shulman E, Nadeau-Routhier C, Knotts R, Bar-Cohen R, Barbhaiya C, Aizer A, Holmes D, Bernstein S, Spinelli M, Park D, Chinitz L, Jankelson L. Electrocardiographic Risk Stratification in COVID-19 Patients. Front Cardiovasc Med 2021; 8:636073. [PMID: 33604358 PMCID: PMC7884321 DOI: 10.3389/fcvm.2021.636073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality. Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion. Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05-1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality. Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.
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Affiliation(s)
- Ehud Chorin
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Edward Kogan
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Lalit Wadhwani
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Eric Shulman
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Charles Nadeau-Routhier
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Roi Bar-Cohen
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - David Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York City, NY, United States
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Jankelson L, Dai M, Aizer A, Bernstein S, Park DS, Holmes D, Chinitz LA, Barbhaiya C. Lesion Sequence and Catheter Spatial Stability Affect Lesion Quality Markers in Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2021; 7:367-377. [PMID: 33516716 DOI: 10.1016/j.jacep.2020.09.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to analyze high-frequency catheter excursion in relation to lesion quality markers in 20 consecutive patients undergoing first-time radiofrequency (RF) ablation for paroxysmal atrial fibrillation (AF). BACKGROUND Ablation therapy for AF requires the delivery of durable lesions. The extent to which lesion sequence, catheter spatial stability, and anatomic location influence lesion formation during RF ablation of AF is not well understood. METHODS Three-dimensional spatial excursion of the ablation catheter sampled at 60 Hz during pre-specified pairs of RF lesions was extracted from the CARTO3 System (Biosense Webster Inc., Irvine, California) and analyzed by using custom-developed MATLAB software (MathWorks, Natick, Massachusetts) to define precise catheter spatial stability during RF ablation. Ablation parameters including bipolar electrogram amplitude reduction, impedance decline and transmurality-associated unipolar electrogram (TUE) as evidence of lesion transmurality during lesion placement were recorded and analyzed. RESULTS We collected 437,760 position data points during lesion placement. Ablation catheter spatial stability and lesion formation parameters varied considerably by anatomic location. Lesions placed immediately had similar bipolar electrogram amplitude reduction, smaller impedance decline, but higher likelihood of achieving TUE compared to delayed lesions. Greater catheter spatial stability correlated with lesser impedance decline. CONCLUSIONS Lesion sequence, ablation catheter spatial stability, and anatomic location are important modifiers of RF lesion formation. Lesions placed immediately are more likely to exhibit TUE. Greater ablation catheter stability is associated with lesser impedance decline but greater likelihood of TUE.
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Affiliation(s)
- Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA.
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, New York, USA
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Barbhaiya CR, Knotts RJ, Beccarino N, Vargas-Pelaez AF, Jankelson L, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Multiple procedure outcomes for nonparoxysmal atrial fibrillation: Left atrial posterior wall isolation versus stepwise ablation. J Cardiovasc Electrophysiol 2020; 31:3117-3123. [PMID: 33022816 DOI: 10.1111/jce.14771] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare multiple-procedure catheter ablation outcomes of a stepwise approach versus left atrial posterior wall isolation (LA PWI) in patients undergoing nonparoxysmal atrial fibrillation (NPAF) ablation. BACKGROUND Unfavorable outcomes for stepwise ablation of NPAF in large clinical trials may be attributable to proarrhythmic effects of incomplete ablation lines. It is unknown if a more extensive initial ablation strategy results in improved outcomes following multiple ablation procedures. METHODS Two hundred twenty two consecutive patients with NPAF underwent first-time ablation using a contact-force sensing ablation catheter utilizing either a stepwise (Group 1, n = 111) or LA PWI (Group 2, n = 111) approach. The duration of follow-up was 36 months. The primary endpoint was freedom from atrial arrhythmia >30 s. Secondary endpoints were freedom from persistent arrhythmia, repeat ablation, and recurrent arrhythmia after repeat ablation. RESULTS There was similar freedom from atrial arrhythmias after index ablation for both stepwise and LA PWI groups at 36 months (60% vs. 69%, p = .1). The stepwise group was more likely to present with persistent recurrent arrhythmia (29% vs. 14%, p = .005) and more likely to undergo second catheter ablation (32% vs. 12%, p < .001) compared to LA PWI patients. Recurrent arrhythmia after repeat ablation was more likely in the stepwise group compared to the LA PWI group (15% vs. 4%, p = .003). CONCLUSIONS Compared to a stepwise approach, LA PWI for patients with NPAF resulted in a similar incidence of any atrial arrhythmia, lower incidence of persistent arrhythmia, and fewer repeat ablations. Results for repeat ablation were not improved with a more extensive initial approach.
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Affiliation(s)
- Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Robert J Knotts
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Nicholas Beccarino
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Alvaro F Vargas-Pelaez
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
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Dai M, Barbhaiya C, Aizer A, Hyde J, Kogan E, Holmes D, Bernstein S, Spinelli M, S Park D, A Chinitz L, Jankelson L. Ablation in Atrial Fibrillation with Ventricular Pacing Results in Similar Spatial Catheter Stability as Compared to Ablation in Sinus Rhythm with Atrial Pacing. J Atr Fibrillation 2020; 13:2373. [PMID: 34950311 DOI: 10.4022/jafib.2373] [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] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 11/10/2022]
Abstract
Background Improved catheter stability is associated with decreased arrhythmia recurrence after atrial fibrillation (AF) ablation. Recently, atrial voltage mapping in AF was demonstrated to correlate better with scar as compared to mapping in sinus rhythm (SR). However, it is unknown whether ablation of persistent AF in sinus rhythm with atrial pacing or in atrial fibrillation with ventricular pacing results in differences in catheter stability or arrhythmia recurrence. Methods We analyzed 53 consecutive patients undergoing first-time persistent AF ablation with pulmonary vein and posterior wall isolation: 27 were cardioverted, mapped, and ablated in sinus rhythm with atrial pacing, and 26 were mapped and ablated in AF with ventricular pacing. Ablation data was extracted from the mapping system and analyzed using custom MATLAB software to determine high-frequency (60Hz) catheter excursion as a novel metric for catheter spatial stability. Results There was no difference in catheter stability as assessed by maximal catheter excursion, mean catheter excursion, or contact force variability between the atrial-paced and ventricular-paced patients. Ventricular-paced patients had significantly greater mean contact force as compared to atrial-paced patients. Contact-force variability demonstrated poor correlation with catheter excursion. One year arrhythmia-free survival was similar between the atrial paced and ventricular paced patients. Conclusions For patients with persistent AF, ablation in AF with ventricular pacing results in similar catheter stability and arrhythmia recurrence as compared to cardioversion and ablation in sinus rhythm with atrial pacing. Given the improved fidelity of mapping in AF, mapping and ablating during AF with ventricular pacing may be preferred.
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Affiliation(s)
- Matthew Dai
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Jonathan Hyde
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Edward Kogan
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, NY, USA
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Barbhaiya CR, Moskowitz C, Duraiswami H, Jankelson L, Knotts RJ, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Reply: Electrical Weapons and Electrophysiology. JACC Case Rep 2020; 2:2049. [PMID: 34317106 PMCID: PMC8299239 DOI: 10.1016/j.jaccas.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chirag R. Barbhaiya
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 1st Avenue, New York, New York 10016
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Grewal S, Jankelson L, van den Broek MPH, Cour M, Bachmann G, Kostis JB, Misra K. QTc Prolongation Risk Evaluation in Female COVID-19 Patients Undergoing Chloroquine and Hydroxychloroquine With/Without Azithromycin Treatment. Front Cardiovasc Med 2020; 7:152. [PMID: 33102533 PMCID: PMC7498717 DOI: 10.3389/fcvm.2020.00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022] Open
Abstract
Women have higher risk for developing TdP in response to ventricular repolarization prolonging drugs. Hundreds of trials are administering chloroquine and hydroxychloroquine with/without azithromycin to COVID-19 patients. While an overall prolonged QTc has been reported in COVID-19 patients undergoing these treatments, the question on even higher QTc elevation risk in thousands of female COVID-19 patients undergoing these treatments remains unanswered. We therefore explore data reported and shared with us to evaluate safety and efficacy of antimalaria pharmacotherapies in female COVID-19 patients. Although we observed longer mean QTc intervals in female patients in 2 of the 3 cohorts reviewed, the sex disproportionality in COVID-19 hospitalizations precludes a clear sex mediated QTc interval elevation risk association in the female COVID-19 patients undergoing acute treatment regimens. Adoption of study designs that include observation of sex mediated differential triggering of cardiac electrical activity by these drugs is warranted.
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Affiliation(s)
- Sarah Grewal
- Pharmacovigilance, ContraRx, NJ, United States Edison, NJ, United States
| | - Lior Jankelson
- NYU Langone Health, New York University School of Medicine, New York, NY, United States
| | | | - Martin Cour
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine—Intensive Réanimation, Lyon, France
| | - Gloria Bachmann
- Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - John B. Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Kamana Misra
- Pharmacovigilance, ContraRx, NJ, United States Edison, NJ, United States
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Chorin E, Wadhwani L, Magnani S, Dai M, Shulman E, Nadeau-Routhier C, Knotts R, Bar-Cohen R, Kogan E, Barbhaiya C, Aizer A, Holmes D, Bernstein S, Spinelli M, Park DS, Stefano C, Chinitz LA, Jankelson L. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm 2020; 17:1425-1433. [PMID: 32407884 PMCID: PMC7214283 DOI: 10.1016/j.hrthm.2020.05.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background There is no known effective therapy for patients with coronavirus disease 2019 (COVID-19). Initial reports suggesting the potential benefit of hydroxychloroquine/azithromycin (HY/AZ) have resulted in massive adoption of this combination worldwide. However, while the true efficacy of this regimen is unknown, initial reports have raised concerns about the potential risk of QT interval prolongation and induction of torsade de pointes (TdP). Objective The purpose of this study was to assess the change in corrected QT (QTc) interval and arrhythmic events in patients with COVID-19 treated with HY/AZ. Methods This is a retrospective study of 251 patients from 2 centers who were diagnosed with COVID-19 and treated with HY/AZ. We reviewed electrocardiographic tracings from baseline and until 3 days after the completion of therapy to determine the progression of QTc interval and the incidence of arrhythmia and mortality. Results The QTc interval prolonged in parallel with increasing drug exposure and incompletely shortened after its completion. Extreme new QTc interval prolongation to >500 ms, a known marker of high risk of TdP, had developed in 23% of patients. One patient developed polymorphic ventricular tachycardia suspected as TdP, requiring emergent cardioversion. Seven patients required premature termination of therapy. The baseline QTc interval of patients exhibiting extreme QTc interval prolongation was normal. Conclusion The combination of HY/AZ significantly prolongs the QTc interval in patients with COVID-19. This prolongation may be responsible for life-threatening arrhythmia in the form of TdP. This risk mandates careful consideration of HY/AZ therapy in light of its unproven efficacy. Strict QTc interval monitoring should be performed if the regimen is given.
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Affiliation(s)
- Ehud Chorin
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Lalit Wadhwani
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Silvia Magnani
- Division of Cardiology, Department of Health Science, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Eric Shulman
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Charles Nadeau-Routhier
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Roi Bar-Cohen
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Edward Kogan
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - David S Park
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Carugo Stefano
- Division of Cardiology, Department of Health Science, San Paolo Hospital, University of Milan, Milan, Italy
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University Grossman School of Medicine, New York, New York.
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Barbhaiya CR, Niazi O, Jankelson L, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Response to: Do not yet abandon cephalic vein access for multiple leads in ICD implantation. J Cardiovasc Electrophysiol 2020; 31:2789-2790. [PMID: 32789905 DOI: 10.1111/jce.14701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Chirag R Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Osama Niazi
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - David Park
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
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Pinnelas R, Friedman J, Gidea C, Yuriditsky E, Chinitz L, Cerrone M, Jankelson L. The case for quinidine: Management of electrical storm in refractory ventricular fibrillation. HeartRhythm Case Rep 2020; 6:375-377. [PMID: 32695580 PMCID: PMC7360984 DOI: 10.1016/j.hrcr.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/04/2023] Open
Affiliation(s)
- Rebecca Pinnelas
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Julie Friedman
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Claudia Gidea
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Larry Chinitz
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Marina Cerrone
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
| | - Lior Jankelson
- Heart Rhythm Center, Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York
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Barbhaiya CR, Moskowitz C, Duraiswami H, Jankelson L, Knotts RJ, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Inappropriate ICD Shock as a Result of TASER Discharge. JACC Case Rep 2020; 2:1166-1169. [PMID: 34317440 PMCID: PMC8311712 DOI: 10.1016/j.jaccas.2020.04.057] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022]
Abstract
Conducted energy weapon (commonly known as TASER) discharge in patients with implantable cardioverter-defibrillators is known to cause electromagnetic interference and inappropriate ventricular fibrillation sensing without delivery of implantable cardioverter-defibrillators therapy during conducted energy weapon application. We report the first known case of conducted energy weapon discharge resulting in inappropriate implantable cardioverter-defibrillators therapy. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Chirag R Barbhaiya
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Craig Moskowitz
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Harish Duraiswami
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Lior Jankelson
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Robert J Knotts
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Scott Bernstein
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - David Park
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Douglas Holmes
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Anthony Aizer
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
| | - Larry A Chinitz
- Leon H. Charney Heart Rhythm Center at NYU Langone Health, New York, New York
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Barbhaiya CR, Niazi O, Bostrom J, Patil S, Jankelson L, Bernstein S, Park D, Holmes D, Aizer A, Chinitz LA. Early ICD lead failure in defibrillator systems with multiple leads via cephalic access. J Cardiovasc Electrophysiol 2020; 31:1462-1469. [DOI: 10.1111/jce.14523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/12/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Chirag R. Barbhaiya
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Osama Niazi
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Jack Bostrom
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Sachi Patil
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - David Park
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
| | - Larry A. Chinitz
- Leon H. Charney Division of Cardiology, New York University Langone HealthNew York NY
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Jankelson L, Karam G, Becker ML, Chinitz LA, Tsai MC. QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review. Heart Rhythm 2020; 17:1472-1479. [PMID: 32438018 PMCID: PMC7211688 DOI: 10.1016/j.hrthm.2020.05.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chloroquine and hydroxychloroquine are now being widely used for treatment of COVID-19. Both medications prolong the QT interval and accordingly may put patients at increased risk for torsades de pointes and sudden death. Published guidance documents vary in their recommendations for monitoring and managing these potential adverse effects. Accordingly, we set out to conduct a systematic review of the arrhythmogenic effect of short courses of chloroquine or hydroxychloroquine. We searched on MEDLINE and Embase, as well as in the gray literature up to April 17, 2020, for the risk of QT prolongation, torsades, ventricular arrhythmia, and sudden death with short-term chloroquine and hydroxychloroquine usage. This search resulted in 390 unique records, of which 41 were ultimately selected for qualitative synthesis and which included data on 1515 COVID-19 patients. Approximately 10% of COVID-19 patients treated with these drugs developed QT prolongation. We found evidence of ventricular arrhythmia in 2 COVID-19 patients from a group of 28 treated with high-dose chloroquine. Limitations of these results are unclear follow-up and possible publication/reporting bias, but there is compelling evidence that chloroquine and hydroxychloroquine induce significant QT-interval prolongation and potentially increase the risk of arrhythmia. Daily electrocardiographic monitoring and other risk mitigation strategies should be considered in order to prevent possible harms from what is currently an unproven therapy.
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Affiliation(s)
- Lior Jankelson
- NYU Langone Health, NYU School of Medicine, New York, New York.
| | - Giorgio Karam
- Dalhousie University, College of Pharmacy, Halifax, Nova Scotia, Canada.
| | - Matthijs L Becker
- Pharmacy Foundation of Haarlem Hospitals, Haarlem, The Netherlands; Spaarne Gasthuis, Haarlem, The Netherlands
| | - Larry A Chinitz
- Cardiac Electrophysiology and Heart Rhythm Center at NYU Langone Health, NYU School of Medicine, New York, New York
| | - Meng-Chiao Tsai
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada
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Barbhaiya CR, Kogan EV, Jankelson L, Knotts RJ, Spinelli M, Bernstein S, Park D, Aizer A, Chinitz LA, Holmes D. Esophageal temperature dynamics during high-power short-duration posterior wall ablation. Heart Rhythm 2020; 17:721-727. [DOI: 10.1016/j.hrthm.2020.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
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Aizer A, Qiu JK, Cheng AV, Wu PB, Barbhaiya CR, Jankelson L, Linton P, Bernstein SA, Park DS, Holmes DS, Chinitz LA. Rapid pacing and high-frequency jet ventilation additively improve catheter stability during atrial fibrillation ablation. J Cardiovasc Electrophysiol 2020; 31:1678-1686. [PMID: 32314841 DOI: 10.1111/jce.14507] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Catheter stability during atrial fibrillation ablation is associated with higher ablation success rates. Rapid cardiac pacing and high-frequency jet ventilation (HFJV) independently improve catheter stability. Simultaneous modulation of cardiac and respiratory motion has not been previously studied. The objective of this study was to determine the effect of simultaneous heart rate and respiratory rate modulation on catheter stability. METHODS Forty patients undergoing paroxysmal atrial fibrillation ablation received ablation lesions at 15 prespecified locations (12 left atria, 3 right atria). Patients were randomly assigned to undergo rapid atrial pacing for either the first or the second half of each lesion. Within each group, half of the patients received HFJV and the other half standard ventilation. Contact force and ablation data for all lesions were compared among the study groups. Standard deviation of contact force was the primary endpoint defined to examine contact force variability. RESULTS Lesions with no pacing and standard ventilation had the greatest contact force standard deviation (5.86 ± 3.08 g), compared to lesions with pacing and standard ventilation (5.45 ± 3.28 g; P < .01) or to lesions with no pacing and HFJV (4.92 ± 3.00 g; P < .01). Lesions with both pacing and HFJV had the greatest reduction in contact force standard deviation (4.35 ± 2.81 g; P < .01), confirming an additive benefit of each maneuver. Pacing and HFJV together was also associated with a reduction in the proportion of lesions with excessive maximum contact force (P < .001). DISCUSSION Rapid pacing and HFJV additively improve catheter stability. Simultaneous pacing with HFJV further improves catheter stability over pacing or HFJV alone to optimize ablation lesions.
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Affiliation(s)
- Anthony Aizer
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Jessica K Qiu
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Austin V Cheng
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Patrick B Wu
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Chirag R Barbhaiya
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Lior Jankelson
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Patrick Linton
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Scott A Bernstein
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - David S Park
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Douglas S Holmes
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
| | - Larry A Chinitz
- The New York University Cardiac Electrophysiology Service, New York University School of Medicine, New York University Langone Health, New York, New York
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Barbhaiya CR, Guandalini GS, Jankelson L, Park D, Bernstein S, Holmes D, Aizer A, Chinitz L. Direct autotransfusion following emergency pericardiocentesis in patients undergoing cardiac electrophysiology procedures. J Cardiovasc Electrophysiol 2020; 31:1379-1384. [PMID: 32243641 DOI: 10.1111/jce.14462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/05/2020] [Accepted: 03/19/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute hemopericardium during cardiac electrophysiology (EP) procedures may result in significant blood loss and is the most common cause of procedure-related death. Matched allogeneic blood is often not immediately available. The feasibility and safety of direct autotransfusion in cardiac electrophysiology patients requiring emergency pericardiocentesis is unknown. METHODS We retrospectively analyzed records of patients undergoing EP procedures at a single, tertiary care medical center who had procedure-related acute hemopericardium requiring emergency pericardiocentesis during a 3-year period. Procedure details, transfusion volumes, and clinical outcomes of patients who received direct autotransfusion of aspirated pericardial blood via a femoral venous sheath were compared to those of patients who did not receive direct autotransfusion. RESULTS During the study period, 10 patients received direct autotransfusion (group 1) and outcomes were compared with those of 14 control patients who did not receive direct autotransfusion (group 2). The volume of aspirated pericardial blood was similar in groups 1 and 2 (1.6 ± 0.7 L vs 1.3 ± 1.0 L, respectively; P = .52). Amongst patients with aspirated volumes <1 L, group 1 patients (n = 4) were less likely than group 2 patients (n = 8) to require allotransfusion (0% vs 75%, P = .02). Amongst patients with aspirated volume ≥1 L, group 1 patients (n = 6) required fewer units of red cell allotransfusion than group 2 patients (n = 6) (1.5 ± 0.8 units vs 4.3 ± 2.0 units, P = .01). No procedural complications related to direct autotransfusion occurred. CONCLUSIONS Direct autotransfusion following emergency pericardiocentesis during electrophysiology procedures requiring systemic anticoagulation is feasible and safe. The utilization of direct autotransfusion may eliminate or reduce the need for allotransfusion.
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Affiliation(s)
| | | | - Lior Jankelson
- Internal Medicine, NYU Langone Health, New York, New York
| | - David Park
- Internal Medicine, NYU Langone Health, New York, New York
| | | | - Douglas Holmes
- Internal Medicine, NYU Langone Health, New York, New York
| | - Anthony Aizer
- Internal Medicine, NYU Langone Health, New York, New York
| | - Larry Chinitz
- Electrophysiology, New York University Langone Medical Center, New York, New York
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Jankelson L, Dai M, Bernstein S, Park D, Holmes D, Aizer A, Chinitz L, Barbhaiya C. Quantitative analysis of ablation technique predicts arrhythmia recurrence following atrial fibrillation ablation. Am Heart J 2020; 220:176-183. [PMID: 31835167 DOI: 10.1016/j.ahj.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Optimal ablation technique, including catheter-tissue contact during atrial fibrillation (AF) radiofrequency (RF) ablation, is associated with improved procedural outcomes. We used a custom developed software to analyze high-frequency catheter position data to study the interaction between catheter excursion during lesion placement, lesion-set sequentiality, and arrhythmia recurrence. METHODS A total of 100 consecutive patients undergoing first-time RF ablation for paroxysmal AF were analyzed. Spatial positioning of the ablation catheter sampled at 60 Hz during RF application was extracted from the CARTO3 system (Biosense Webster Inc, USA) and analyzed using custom-developed MATLAB software to determine precise catheter spatial 3D excursion during RF ablation. The primary end point was freedom from atrial arrhythmia lasting longer than 30 seconds after a single ablation procedure. RESULTS At 1 year, 86% of patients were free from recurrent arrhythmia. There was no significant difference in clinical, echocardiographic, or ablation characteristics between patients with and without recurrent arrhythmia. Analyzing 15,356,998 position data points revealed that lesion-set sequentiality and mean lesion catheter excursion were predictors of arrhythmia recurrence. Analyzing arrhythmia recurrence by mean single-lesion catheter excursion (excursion >2.81 mm) and by sequentiality (using 46% of lesions with interlesion distance >6 mm as cutoff) revealed significantly increased arrhythmia recurrence in the higher excursion group (23% vs 6%, P = .03) and in the less sequential group (24% vs 4%, P = .02). CONCLUSIONS Ablation lesion sequentiality measured by catheter interlesion distance and catheter stability measured by catheter excursion during lesion placement are potentially modifiable factors affecting arrhythmia recurrence after RF ablation for AF.
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Jankelson L, Zimmermann H, Fowler S, Borneman L, Conner B, Wu S, Karam R, Chinitz L, Cerrone M. Impact of RNA testing on cardiac variant interpretation and patient management. HeartRhythm Case Rep 2019; 5:402-406. [PMID: 31453089 PMCID: PMC6700669 DOI: 10.1016/j.hrcr.2019.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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