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Fatunde OA, Rattanawong P, Maleszewski J, Murray D, Shen WK, Pereira NL. Brugada Syndrome in a Transplanted Heart: Implications for Organ Transplant Screening Process. Circ Genom Precis Med 2024:e004533. [PMID: 38651350 DOI: 10.1161/circgen.123.004533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Olubadewa A Fatunde
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix (O.A.F., P.R., W.-K.S.)
| | - Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix (O.A.F., P.R., W.-K.S.)
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston (P.R., N.L.P.)
| | - Joseph Maleszewski
- Department of Laboratory Medicine and Pathology, Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN (J.M.)
| | - David Murray
- Department of Medicine, University of Wisconsin, Madison (D.M.)
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix (O.A.F., P.R., W.-K.S.)
| | - Naveen L Pereira
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston (P.R., N.L.P.)
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Rattanawong P, Mattanapojanat N, Mead-Harvey C, Van Der Walt C, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Putthapiban P, Chintanavilas K, Sahasthas D, Ngarmukos T, Thakkinstian A, Sorajja D, Makarawate P, Shen WK. Predicting arrhythmic event score in Brugada syndrome: Worldwide pooled analysis with internal and external validation. Heart Rhythm 2023; 20:1358-1367. [PMID: 37355026 DOI: 10.1016/j.hrthm.2023.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/04/2022] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). Risk predictive scores were previously developed with various performances. OBJECTIVE The purpose of this study was to create a novel score-Predicting Arrhythmic evenT (PAT)-with internal and external validation. METHODS A systematic review was performed to identify risk factors for MAE. The odds ratios (ORs) of each factor were pooled across studies. The PAT scoring scheme was developed based on pooled ORs. The PAT score was internally validated with published 105 Asian patients (follow-up 8.0 ± 4.1 [SD] years) and externally validated with unpublished 164 multiracial patients (82.3% White, 14.6% Asian, 3.2% Black; mean follow-up 8.0 ± 6.9 years) with Brugada syndrome. Performances were assessed and compared with previous scores using receiver operating characteristic curve (ROC) analysis. RESULTS Sixty-seven studies published between 2002 and 2022 from 26 countries (7358 patients) were included. Pooled ORs were estimated, indicating that 15 of 23 risk factors were significant. The PAT score was then developed accordingly. The PAT score had significantly better discrimination (ROC 0.9671) than the BRUGADA-RISK score (ROC 0.7210; P = .006), Shanghai Score System (ROC 0.7079; P = .003), and Sieira et al score (ROC 0.8174; P = .026) in an external validation cohort. PAT score ≥ 10 predicted the first MAE with 95.5% sensitivity and 89.1% specificity (ROC 0.9460) and the recurrent MAE (ROC 0.7061) with 15.4% sensitivity and 93.3% specificity. CONCLUSION The PAT score was shown to be useful in predicting MAE for primary prevention in patients with Brugada syndrome.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Carolyn Mead-Harvey
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - Jakrin Kewcharoen
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Prapaipan Putthapiban
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Kumpol Chintanavilas
- Cardiology Department, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Tachapong Ngarmukos
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
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Talaei F, Tan MC, Trongtorsak A, Lee JZ, Rattanawong P. Heart failure is associated with increased risk of all-cause mortality after transvenous lead extraction: A systematic review and meta-analysis. J Arrhythm 2023; 39:596-606. [PMID: 37560268 PMCID: PMC10407184 DOI: 10.1002/joa3.12880] [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: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is increasingly considered in cardiac implantable electronic device management. Heart failure (HF) might be associated with mortality risks after the TLE procedure. This study aims to assess mortality risk in HF patients undergoing TLE. METHOD We searched MEDLINE and Embase databases from inception to June 2022 to identify articles that included patients with and without HF who underwent TLE, which reported mortality in both groups. The pooled effect size was calculated with a random-effects model and 95% CI to compare post-TLE mortality between the two groups. RESULTS Eleven studies were included in the analysis. Each left ventricular ejection fraction (LVEF) increased by 1% was associated with reduced mortality by 2% (HR = 0.98, 95% CI: 0.97-0.99, I 2 = 74.9%, p < .01). The presence of HF compared to those without HF was associated with higher mortality rates (OR: 3.04, 95% CI: 2.56-3.61, I 2 = 0.0%, p < .531). There was a significant increase in the mortality rates in patients with New York Heart Association (NYHA) function class III (OR: 2.29, 95% CI: 1.29-4.06, I 2 = 0.0%, p = .498) and NYHA IV (OR: 8.5, 95% CI: 2.98-24.3, I 2 = 0.0%, p = .997). CONCLUSIONS Our study found that post-TLE mortality decreases by 2% as LVEF increases by 1%, also mortality is higher in patients with NYHA III and IV.
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Affiliation(s)
- Fahimeh Talaei
- Department of Internal MedicineMcLaren Flint HospitalFlintMichiganUSA
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
| | - Min C. Tan
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Justin Z. Lee
- Department of Cardiovascular DiseasesMayo ClinicPhoenixArizonaUSA
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac ArrhythmiasMassachusetts General Hospital Harvard Medical SchoolBostonMassachusettsUSA
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Tan MC, Yeo YH, Ang QX, Tan BE, Rattanawong P, Tan JL, Lee JZ. Impact of obesity on catheter ablation of ventricular tachycardia: In-hospital and 30-day outcomes. J Arrhythm 2023; 39:672-675. [PMID: 37560290 PMCID: PMC10407173 DOI: 10.1002/joa3.12892] [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: 03/30/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Evidence on the impact of obesity on catheter ablation for ventricular tachycardia (VT) is scarce. METHOD AND RESULTS We queried the Nationwide Readmissions Database to determine the hospital outcomes and procedural complications of VT ablation among the obese and nonobese populations. Obesity was associated with a more prolonged length of stay (p < .01), higher cost of hospitalization (p < .01), and higher rates of pericardial effusion or hemopericardium (p = .05) and vascular complications (p = .05). There was no significant difference in early mortality, 30-day readmissions, and other procedural complications. CONCLUSION VT ablation could be performed relatively safely among patients with obesity.
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Affiliation(s)
- Min Choon Tan
- Division of Cardiovascular MedicineMayo ClinicPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Yong Hao Yeo
- Department of Internal Medicine/PediatricsBeaumont HealthRoyal OakMichiganUSA
| | - Qi Xuan Ang
- Department of Internal MedicineSparrow Health System and Michigan State UniversityEast LansingMichiganUSA
| | - Bryan E‐Xin Tan
- Section of Cardiology, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Pattara Rattanawong
- Division of Cardiovascular MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Jian Liang Tan
- Division of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Justin Z. Lee
- Division of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
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Hakimjavadi R, DiRienzo L, Rattanawong P, Ayoub C, Visintini SM, Small GR, Chow B. Prognostic Value of Coronary Computed Tomography Angiography in Coronary Artery Bypass Graft Patients Systematic Review and Meta-Analysis. Am J Cardiol 2023; 201:107-115. [PMID: 37354866 DOI: 10.1016/j.amjcard.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/28/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
We sought to assess the prognostic value of coronary computed tomographic angiography (CCTA) in patients with coronary artery bypass graft (CABG) by meta-analysis. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched for relevant original articles published up to July 2021. CCTA prognostic studies enrolling patients with CABG were screened and included if outcomes included all-cause mortality or major adverse cardiac events. Maximally adjusted hazard ratios (HRs) were extracted for CCTA-derived prognostic factors. HRs were log-transformed and pooled across studies using the DerSimonian-Laird random-effects model and statistical heterogeneity was assessed using the I2 statistic. Of 1,576 screened articles, 4 retrospective studies fulfilled all inclusion criteria. Collectively, a total of 1,809 patients with CABG underwent CCTA (mean [SD] age 67.0 [8.5] years across 3 studies, 81.5% male across 4 studies). Coronary artery disease severity and revascularization were categorized using 2 models: unprotected coronary territories and coronary artery protection score. The pooled HRs from the random-effects models using the most highly adjusted study estimate were 3.64 (95% confidence interval 2.48 to 5.34, I2 = 57.8%, p <0.001; 4 studies) and 4.85 (95% confidence interval 3.17 to 7.43, I2 = 39.9%, p <0.001; 2 studies) for unprotected coronary territories and coronary artery protection score, respectively. In conclusion, in a limited number of studies, CCTA is an independent predictor of adverse events in patients with CABG. Larger studies using uniform models and endpoints are needed.
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Affiliation(s)
| | - Lucas DiRienzo
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | | | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Sarah M Visintini
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Gary R Small
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Benjamin Chow
- Division of Cardiology, University of Ottawa Heart Institute, Canada; Department of Radiology, University of Ottawa, Canada.
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Tan MC, Rattanawong P, Karikalan S, Deshmukh AJ, Srivathsan K, Scott L, McLeod CJ, Asirvatham SJ, Noseworthy PA, Mulpuru SK, Cha YM, Munger TM, Lee JZ. Causes of Early Mortality After Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2023; 16:e011365. [PMID: 37082954 DOI: 10.1161/circep.122.011365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Recognition of the causes of early mortality after atrial fibrillation (AF) catheter ablation is essential for the improvement of patient safety. This study sought to determine the causes of early mortality (≤90 days) after AF ablation. METHODS We performed a retrospective analysis of AF ablation from January 1, 2013, to December 1, 2021 at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). Causes of death were identified through a comprehensive chart review of the electronic health record from within the Mayo Clinic system and outside records when available. RESULTS A total of 6723 patients were included in the study. The 90-day all-cause mortality rate was 0.22% (n=15). Among all 90-day deaths, majority of the deaths (73.3%) did not have a direct relationship with the procedure. Sudden death was the most common cause of early death (20%), followed by peri-procedural stroke (13%), respiratory failure (13%), atrioesophageal fistula (13%), infection (7%), heart failure (7%), and traumatic brain injury (7%). The 90-day mortality rate directly due to AF ablation procedural complications was 0.06% (n=4). CONCLUSIONS AF ablation procedure has a 90-day mortality of 0.22%, and the most common cause of early mortality was sudden death. The majority (73.3%) of early mortality was not directly associated with a procedural complication, and the mortality rate due to complications associated with the AF ablation procedure was low at 0.06%. Further studies are required to investigate causes and risk factors associated with sudden death in this patient population.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Suganya Karikalan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Komandoor Srivathsan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | | | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (A.J.D., S.J.A., P.A.N., S.K.M., Y.-M.C.)
| | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ (M.C.T., P.R., S.K., K.S., L.S., T.M.M., J.Z.L.)
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Talaei F, Tan MC, Trongtorsak A, Lee JZE, Rattanawong P. HEART FAILURE IS ASSOCIATED WITH INCREASED ALL-CAUSE MORTALITY IN TRANSVENOUS LEAD EXTRACTION: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Rattanawong P, Chao CJ, Sriramoju A, Tagle-Cornell MCA, Farina J, Beirne E, Fatunde OA, Koepke LM, Ko NLK, Shanbhag A, Barry T, Shen WK. SYNCOPE AND ALL-CAUSE MORTALITY IN HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Agasthi P, Sridhara S, Rattanawong P, Venepally N, Chao CJ, Ashraf H, Pujari SH, Allam M, Almader-Douglas D, Alla Y, Kumar A, Mookadam F, Packer DL, Holmes DR, Hagler DJ, Fortuin FD, Arsanjani R. Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis. World J Cardiol 2023; 15:64-75. [PMID: 36911751 PMCID: PMC9993931 DOI: 10.4330/wjc.v15.i2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI).
AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.
METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity.
RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I2 = 0.0%).
CONCLUSION Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Srilekha Sridhara
- Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States
| | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Nithin Venepally
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | | | - Yamini Alla
- Department of Medicine, Bronx Lebanon Hospital, Bronx, NY 10457, United States
| | - Amit Kumar
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - David R Holmes Jr
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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Rattanawong P, Kewcharoen J, Yinadsawaphan T, Fatunde OA, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Chung EH, Shen W. Type of syncope and outcome in Brugada syndrome: A systematic review and meta‐analysis. J Arrhythm 2023; 39:111-120. [PMID: 37021016 PMCID: PMC10068940 DOI: 10.1002/joa3.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). The importance of primary prevention of sudden cardiac death (SCD) in Brugada syndrome is well recognized; however, ventricular arrhythmia risk stratification remains challenging and controversial. We aimed to assess the association of type of syncope with MAE via systematic review and meta-analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2021. Included studies were cohort (prospective or retrospective) studies that reported the types of syncope (cardiac, unexplained, vasovagal, and undifferentiated) and MAE. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the odds ratio (OR) and 95% confidence intervals (CIs). Results Seventeen studies from 2005 to 2019 were included in this meta-analysis involving 4355 Brugada syndrome patients. Overall, syncope was significantly associated with an increased risk of MAE in Brugada syndrome (OR = 3.90, 95% CI: 2.22-6.85, p < .001, I 2 = 76.0%). By syncope type, cardiac (OR = 4.48, 95% CI: 2.87-7.01, p < .001, I 2 = 0.0%) and unexplained (OR = 4.71, 95% CI: 1.34-16.57, p = .016, I 2 = 37.3%) syncope was significantly associated with increased risk of MAE in Brugada syndrome. Vasovagal (OR = 2.90, 95% CI: 0.09-98.45, p = .554, I 2 = 70.9%) and undifferentiated syncope (OR = 2.01, 95% CI: 1.00-4.03, p = .050, I 2 = 64.6%, respectively) were not. Conclusion Our study demonstrated that cardiac and unexplained syncope was associated with MAE risk in Brugada syndrome populations but not in vasovagal syncope and undifferentiated syncope. Unexplained syncope is associated with a similar increased risk of MAE compared to cardiac syncope.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service Loma Linda University Health Loma Linda California USA
| | - Thanaboon Yinadsawaphan
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
- Department of Cardiology Central Chest Institute of Thailand Nonthaburi Thailand
| | | | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine, Department of Internal Medicine University of Iowa Iowa City Iowa USA
| | - Narut Prasitlumkum
- Department of Cardiology University of California Riverside Riverside California USA
| | - Eugene H. Chung
- Department of Internal Medicine, Michigan Medicine University of Michigan Ann Arbor Michigan USA
| | - Win‐Kuang Shen
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
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Tan MC, Talaei F, Trongtorsak A, Lee JZ, Rattanawong P. Chronic kidney disease is associated with increased all-cause mortality in transvenous lead extraction: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2023; 46:66-72. [PMID: 36441922 DOI: 10.1111/pace.14631] [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: 08/12/2022] [Revised: 10/23/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on patients receiving transvenous lead extraction (TLE) is not well-established. We performed a systematic review and meta-analysis to explore the association between CKD and all-cause mortality in TLE. METHODS We searched the databases of PubMed and EMBASE from inception to April 2022. Included studies were published TLE studies that compared the risk of mortality in CKD patients compared to control patients. Data from each study were combined using the random-effects model. RESULTS Eight studies (5,013 patients) were included. Compared with controls, CKD patients had a significantly higher risk of overall all-cause mortality (hazard ratio [HR] = 2.14, 95% confidence interval [CI]: 1.65-2.77, I2 = 51.1%, p < .001). The risk of overall all-cause mortality increased with the severity of CKD for nonspecific CKD (HR = 2.01, 95% CI: 1.49-2.69, I2 = 53.4, p < .001) and ESRD (HR = 2.79, 95% CI: 1.85-4.23, I2 = 0%, p < .001). The risk of all-cause mortality in CKD is double at follow-up ≤1 year (HR = 1.99, 95% CI: 1.29-3.09, I2 = 50.9%, p = .002) and higher at follow-up >1 year (HR = 2.36, 95% CI: 1.63-3.42, I2 = 59.7%, p < .001). CONCLUSIONS Our meta-analysis demonstrates a significantly increased risk of overall all-cause mortality in patients with CKD who underwent TLE compared to controls.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.,Department of Internal Medicine, McLaren Flint Hospital, Flint, Michigan, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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Prasitlumkum N, Navaravong L, Desai A, Desai D, Cheungpasitporn W, Rattanawong P, Bunch TJ, Jongnarangsin K, Chokesuwattanaskul R. Impact of early ventricular tachycardia ablation in patients with an implantable cardioverter-defibrillator: An updated systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2022; 19:2054-2061. [PMID: 35820619 DOI: 10.1016/j.hrthm.2022.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/17/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited information on whether early catheter ablation (CA) for ventricular tachycardia (VT) is associated with better outcomes compared with alternative strategies in patients with implantable cardioverter-defibrillator (ICD). OBJECTIVE The purpose of this article was to assess the efficacy of early VT CA in patients with ICD. METHODS EMBASE, PubMed, and Cochrane were searched from inception to April 2022. Randomized controlled trials comparing the efficacy of early VT CA with control groups, both in patients with ICD, were included in the analysis. Data on effect estimates in individual studies were extracted and combined via random effects meta-analysis using the DerSimonian and Laird method, a generic inverse variance strategy. RESULTS Nine randomized controlled trials with 1106 patients (n = 1018, 92.1% with ischemic cardiomyopathy and n = 88, 7.9% with nonischemic cardiomyopathy) were evaluated. VT CA was associated with reduced VT recurrences (odds ratio [OR] 0.64; P = .007), appropriate ICD shocks (OR 0.53; P = .002), ICD therapies (OR 0.54; P = .002), and cardiovascular hospitalization (OR 0.67; P = .004). However, no significant differences were observed in terms of mortality rate, heart failure hospitalization, and quality of life between the early VT CA and control groups. CONCLUSION Early CA was beneficial in reducing VT burden and ICD therapies. However, it did not affect mortality rate and quality of life. Since most patients in the included studies presented with ischemic cardiomyopathy, further studies on nonischemic cardiomyopathy should be conducted to validate if early CA has similar outcomes.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Aditya Desai
- Department of Internal Medicine, University of California Riverside, Riverside, California
| | - Darshi Desai
- Department of Internal Medicine, University of California Riverside, Riverside, California
| | | | | | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, Michigan
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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13
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Rattanawong P, Kanitsoraphan C, Kewcharoen J, Sriramoju A, Shanbhag A, Ko Ko NL, Barry T, Vutthikraivit W, Shen WK. Surgical versus catheter ablation in atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Electrophysiol 2022; 33:2152-2163. [PMID: 35771487 DOI: 10.1111/jce.15617] [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: 12/08/2021] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video-assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta-analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals. RESULTS Six studies from November 2013 to 2020 were included in this meta-analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56±3 years) and 248 surgical ablations (mean age 52 ±4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk=1.85, 95 % confidence interval: 1.44-2.39, p<0.001, I2 =0.0%) but associated with less total major adverse events (pooled relative risk=0.29, 95 % confidence interval: 0.16-0.53, p<0.001, I2 =0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk=2.47, 95 % confidence interval: 1.31-4.65, p=0.005, I2 =0.0%) but not in persistent AF (relative risk=1.09, 95 % confidence interval: 0.60-2.0, p=0.773). CONCLUSION Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anil Sriramoju
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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14
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Seri A, Rattanawong P, Firouzbakht T, Sorajja D. Vaping tetrahydrocannabinol unmasks Brugada pattern and induces ventricular fibrillation in Brugada syndrome: a case report. Eur Heart J Case Rep 2022; 6:ytac200. [PMID: 35693027 PMCID: PMC9178961 DOI: 10.1093/ehjcr/ytac200] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022]
Abstract
Background Fever, alcohol, and sodium channel blockers can unmask Brugada pattern and may also induce arrhythmias in Brugada syndrome. We report a case of unmasked Type-1 Brugada pattern presenting with ventricular fibrillation that was induced by a tetrahydrocannabinol vaping. Case summary A 48-year-old male with a past medical history of hypertension treated with hydrochlorothiazide and back pain controlled with tetrahydrocannabinol vaping presented with sudden cardiac arrest from ventricular fibrillation, which was terminated with defibrillation. Electrocardiogram after resuscitation showed a new Type-1 Brugada pattern compared to a previous normal baseline electrocardiogram. Echocardiography and coronary angiogram were unremarkable. Complete blood count and chemistries were unremarkable except for mild hypokalaemia (K = 3.3 mmol/L). After correction of the hypokalaemia, the Type-1 Brugada pattern persisted. Urine drug screen was positive for tetrahydrocannabinol (60 ng/mL). Genetic testing was negative for inherited arrhythmic disease and cardiomyopathy gene panels. Discussion The patient’s type-1 Brugada pattern and ventricular fibrillation were likely induced by vaping tetrahydrocannabinol. He underwent secondary prevention with an implantable cardioverter-defibrillator. He abstains from cannabis and Type-1 Brugada pattern is normalized. There was no arrhythmic event at his 18-month follow-up appointment with abstinence from tetrahydrocannabinol.
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Affiliation(s)
- Amith Seri
- Department of Cardiology, Mayo Clinic , 5777 East Mayo Boulevard, Phoenix, AZ 85054 , USA
- Department of Internal Medicine, McLaren Regional Medical Center , Flint, MI , USA
| | - Pattara Rattanawong
- Department of Cardiology, Mayo Clinic , 5777 East Mayo Boulevard, Phoenix, AZ 85054 , USA
| | - Tina Firouzbakht
- Department of Cardiology, Mayo Clinic , 5777 East Mayo Boulevard, Phoenix, AZ 85054 , USA
| | - Dan Sorajja
- Department of Cardiology, Mayo Clinic , 5777 East Mayo Boulevard, Phoenix, AZ 85054 , USA
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15
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Rattanawong P, Fatunde O, Ko Ko N, Shen W, Sorajja D. The prevalence of Type-1 Brugada pattern in African American: a large population study from the United States. Europace 2022. [DOI: 10.1093/europace/euac053.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The prevalence of Type-1 Brugada pattern in Caucasians and Asians have been estimated to be 20 and 180 per 100,000. However, the prevalence of Type-1 Brugada pattern in African Americans has never been studied.
Purpose
This study aims to identify the prevalence of Type-1 Brugada pattern in African Americans.
Methods
Medical records of African American patients ages 18 years old or older with at least one 12-lead electrocardiogram (ECG) performed at 16 hospitals from 5 states in a single healthcare system between January 1, 2011 to December 31, 2020 were included. The search engine software was used to identify patients with keywords (Brugada pattern, Brugada ECG, Brugada Type-1, or Brugada syndrome) documented in the electronic medical record. The 12-lead ECGs were retrospectively analyzed by 2 cardiologists. Any inconsistencies were reviewed by a third cardiac electrophysiologist. Type-1 Brugada pattern was diagnosed according to the recent Heart Rhythm Society Expert Consensus Statement.
Results
Among 43,116 African American patients, (46.9% males), 6 patients (mean age 44.8±13.9 years, 100% males) had Type-1 Brugada pattern documented on at least one 12-lead ECG. The prevalence of Type-1 Brugada pattern in this large patient population of African American was 13.9 per 100,000. None of the patients had major arrhythmic event at 6.7±4.7 years follow-up.
Conclusions
The prevalence of Type-1 Brugada pattern in African American is lower than Caucasian and Asian populations. The risk of major arrhythmic event of Type-1 Brugada pattern in African American appears to be low; however longer follow-up data is needed.
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Affiliation(s)
- P Rattanawong
- Mayo Clinic Arizona, Phoenix, United States of America
| | - O Fatunde
- Mayo Clinic Arizona, Phoenix, United States of America
| | - N Ko Ko
- Mayo Clinic Arizona, Phoenix, United States of America
| | - W Shen
- Mayo Clinic Arizona, Phoenix, United States of America
| | - D Sorajja
- Mayo Clinic Arizona, Phoenix, United States of America
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16
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Rattanawong P, Fatunde O, Le Ko Ko N, Sorajja D. CE-544-02 THE PREVALENCE OF TYPE-1 BRUGADA PATTERN AT MAYO CLINIC: A LARGE POPULATION STUDY FROM THE UNITED STATES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Rattanawong P, Sorajja D. PO-642-06 A PULMONARY VEIN ISOLATION WITH WIDE AREA CIRCUMFERENTIAL ABLATION AND BILATERAL CARINAL LINE ABLATION VIA TRANSHEPATIC APPROACH. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Kanitsoraphan C, Rattanawong P, Techorueangwiwat C, Kewcharoen J, Mekritthikrai R, Prasitlumkum N, Shah P, El Masry H. The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and
meta‐analysis
of randomized controlled trials. J Arrhythm 2022; 38:275-286. [PMID: 35785381 PMCID: PMC9237313 DOI: 10.1002/joa3.12698] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation. Objective To assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long‐term follow‐ups when compared to conventional methods. Methods We conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI). Results Eight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88–1.05, I2 = 31.6%, p‐value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81–0.96, I2 = 48.2%, p‐value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80–0.98, I2 = 65.2%, p‐value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74–0.95, I2 0.00%, p‐value .008). Conclusion Our study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population.
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Affiliation(s)
| | | | | | - Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology Loma Linda University Medical Center Loma Linda California USA
| | | | - Narut Prasitlumkum
- Department of cardiology University of California Riverside Riverside California USA
| | - Parthav Shah
- University of Hawaii Internal Medicine Residency Program Honolulu Hawaii USA
| | - Hicham El Masry
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
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19
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Elshaer A, Naqvi TZ, Rattanawong P. MIDVENTRICULAR VARIANT STRESS-INDUCED CARDIOMYOPATHY IN PATIENT WITH UNDERLYING CORONARY ARTERY DISEASE: A CHALLENGING DIAGNOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03653-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Rattanawong P, Fatunde OA, Rayfield C, Sorajja D. BRUGADA PHENOCOPY IN COVID-19 PATIENT WITH FEVER AND HYPERKALEMIA. J Am Coll Cardiol 2022. [PMCID: PMC8972389 DOI: 10.1016/s0735-1097(22)03352-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Kanitsoraphan C, Thangjui S, Techorueangwiwat C, Kewcharoen J, Rattanawong P, Nagamine T, Kanjanauthai S. Gender difference in outcomes of patients undergoing MitraClip therapy: A systematic review and meta-analysis. Cardiovasc Revasc Med 2021; 40:20-25. [PMID: 34799289 DOI: 10.1016/j.carrev.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Transcatheter edge-to-edge repair (TEER) of the mitral valve with MitraClip therapy is an emerging treatment in selected patients with severe mitral regurgitation. Identifying the patient with increased risk of poorer outcomes, including mortality, is crucial in these patients. Recent studies suggested conflicting data regarding the effects of gender on outcome in this patient population. We evaluate the impact of gender on the outcome of patients undergoing MitraClip therapy by systematic review and meta-analysis. METHODS The authors comprehensively searched the databases of EMBASE and MEDLINE from inception to April 2021. Included studies were published cohorts reporting univariate or multivariate analysis of the effects of gender on in-hospital and overall mortality among patients undergoing MitraClip therapy. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonioan and Laird. RESULTS A total of nine studies were included in this meta-analysis, including 9062 patients. Male gender is associated with higher in-hospital mortality with pooled OR 1.81 (95% confidence interval 1.01-3.22, p-value 0.045) and overall mortality with pooled OR 1.19 (95% CI 1.06-1.33, p-value 0.003). CONCLUSIONS According to our meta-analysis, the male gender increases the risk of in-hospital mortality up to 1.81 folds and overall mortality up to 1.19 folds.
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Affiliation(s)
| | - Sittinun Thangjui
- Internal Medicine Residency Program, Bassett Healthcare Network, NY, USA
| | | | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Todd Nagamine
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
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22
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Vutthikraivit W, Rattanawong P, Putthapiban P, Kewcharoen J. TCT-177 Direct Oral Anticoagulants Versus Vitamin K Antagonist After Transcatheter Aortic Valve Replacement in Patients With Concomitant Indication for Oral Anticoagulation: A Meta-Analysis. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1030] [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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23
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Rattanawong P, Senthong V. Hyponatremia induced Brugada syndrome mimicking ST segment elevation myocardial infarction. J Arrhythm 2021; 37:1377-1379. [PMID: 34621444 PMCID: PMC8485814 DOI: 10.1002/joa3.12617] [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: 05/16/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Abstract
Seventy-three year-old male with history of diabetes, hypertension, and chronic kidney disease stage 3 presented with epigastric pain and hyponatremia. ECG showed new ST segment elevation at precordial leads consistent with Cove-type Brugada ECG pattern. Cardiac catheterization revealed non-significant coronary artery stenosis. He experienced pre-syncope and palpitations a year prior to admission with family history sudden cardiac death. Brugada syndrome was diagnosed. Cove-type Brugada ECG pattern and palpitations resolved with corrected sodium to 135.
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Affiliation(s)
| | - Vichai Senthong
- Cardiovascular Unit Faculty of Medicine Khon Kaen University Khon Kaen Thailand
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24
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Kanitsoraphan C, Techorueangwiwat C, Rattanawong P, Kewcharoen J, Ayinapudi K, Bunch TJ, Groh C, Navaravong L. Zero fluoroscopy approach versus fluoroscopy approach for cardiac arrhythmia ablations: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 32:2761-2776. [PMID: 34427955 DOI: 10.1111/jce.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation for cardiac arrhythmias has traditionally been guided by fluoroscopy. Fluoroscopy exposes the patient, operator, and staff to ionizing radiation which has no safe dose void of stochastic and deterministic biologic risks. Zero fluoroscopy (ZF) approaches for catheter ablation have been advocated to eliminate these risks. We conducted a meta-analysis comparing acute procedure success, recurrence-free survival, complications, and procedure times between the approaches. METHODS We conducted a literature search from inception through December 2020 in the databases of EMBASE and MEDLINE. We included randomized controlled trials and cohorts that compared the outcomes of interest in ZF and conventional/low fluoroscopy (CF/LF) approaches. The outcomes sought were acute procedure success, recurrence-free survival, complications, and procedure times. Effect estimates were combined, using the random-effects, generic inverse variance method of DerSimonian and Laird. RESULTS Sixteen studies from 2013 to 2020, including 6052 patients (2219 ZF, 3833 CF/LF) were included. There were no significant differences in acute procedure success rate (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.75-1.59), recurrence-free survival (OR: 1.08, 95% CI: 0.78-1.49), periprocedural complication rate (OR: 0.72, 95% CI: 0.45-1.16), or total procedure time (weighted mean difference 2.32 min, 95% CI: -2.85-7.50) between ZF and CF/LF approaches, respectively. Overall, only 1.26% of patients crossed over from ZF to CF/LF arm. CONCLUSIONS Periprocedural and postprocedural outcomes with a ZF approach compared favorably with traditional fluoroscopic guidance without increasing procedural times. As comfort with ZF grows, coupled with evolving mapping technologies, this method has potential to become the standard approach for catheter ablation.
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Affiliation(s)
- Chanavuth Kanitsoraphan
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Chol Techorueangwiwat
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | | | - Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Karnika Ayinapudi
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher Groh
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Rattanawong P, Kewcharoen J, Prapaipan Putthapiban WV, Narut Prasitlumkum CK, Hooke PS, Dujdao Sahasatas KC, Makarawate P, Ngarmukos T, Thakkinstian A, Shen WK. B-PO03-167 PREDICTING ARRHYTHMIC EVENT FOR ICD THERAPY IN BRUGADA SYNDROME: A PREDICTIVE SCORE FROM WORLDWIDE POOLED ANALYSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.640] [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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Rattanawong P, Ladia V, Minaskeian N, Sorajja D, Shen WK, Srivathsan KS. Empirical Ablation to Prevent Sequential Purkinje System Recruitment: A Novel Therapy for Idiopathic Ventricular Fibrillation. JACC Case Rep 2021; 3:517-522. [PMID: 34317571 PMCID: PMC8311030 DOI: 10.1016/j.jaccas.2021.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022]
Abstract
We report 3 cases (mean age 48.3 ± 11.6 years) of idiopathic ventricular fibrillation (IVF), in which a triggering premature ventricular complex leading to IVF could not be identified. All patients underwent posterior fascicle transection with empirical linear ablation of the mid-Purkinje potentials identified along the left ventricular interventricular inferior septum, and no ventricular fibrillation recurrence was documented in any of the patients. (Level of Difficulty: Advanced.)
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Affiliation(s)
| | - Vatsal Ladia
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Nareg Minaskeian
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
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Ashraf H, Agasthi P, Shanbhag A, Mehta RA, Rattanawong P, Allam M, Pujari SH, Mookadam F, Freeman WK, Srivathsan K, Sorajja D, Shen WK, Noseworthy PA, Yang EH, Masry HZE, Yao X, Mulpuru SK, Beohar N, Holmes DR, Arsanjani R. Long-Term Clinical Outcomes of Underdosed Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Atrial Flutter. Am J Med 2021; 134:788-796. [PMID: 33444586 DOI: 10.1016/j.amjmed.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/09/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF. METHODS We conducted a study of subjects with AF who had a clinical indication for stroke prophylaxis (with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 47 years, sex category [CHA2DS2-VASc] of 2 or greater) and were prescribed 1 of the 4 clinically approved DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban). We compared all-cause mortality, composite of stroke and systemic embolism, composite of myocardial infarction (MI), acute coronary syndromes (ACS), and coronary revascularization, and major bleeding between patients appropriately dosed and inappropriately underdosed. RESULTS A total of 8125 patients met inclusion criteria, with a mean follow up of 2.2 ± 2 years. Of those, 1724 patients (21.2%) were inappropriately dosed. After adjusting for baseline variables, there was no difference in all-cause mortality, risk of stroke or systemic embolism, International Society on Thrombosis and Haemostasis (ISTH) major bleeding, or composite of myocardial infarction, acute coronary syndromes, or coronary revascularization between patients appropriately dosed and inappropriately underdosed. In subgroup analysis, only apixaban demonstrated an increased incidence all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.03-1.49) with inappropriate underdosing. There was no difference in the remaining clinical outcomes noted on subgroup analysis. CONCLUSION Underdosing of DOACs did not minimize risk of bleeding, systemic embolization or all-cause mortality in patients with AF. Inappropriate underdosing with apixaban in particular was associated with increased all-cause mortality.
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Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz.
| | | | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Ramila A Mehta
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | | | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Xiaoxi Yao
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minn
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Nirat Beohar
- Division of Cardiology, Mount Sinai Medical Center, Miami, Fla
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Barry T, Shanbhag A, Ko Ko NL, Vutthikraivit W, Home M, Agasthi P, Ashraf H, Shimizu W, Shen WK. Does the Age of Sudden Cardiac Death in Family Members Matter in Brugada Syndrome? J Am Heart Assoc 2021; 10:e019788. [PMID: 34013737 PMCID: PMC8483509 DOI: 10.1161/jaha.120.019788] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Brugada syndrome is an inherited cardiac channelopathy associated with major arrhythmic events (MAEs). The presence of a positive family history of sudden cardiac death (SCD) as a risk predictor of MAE remains controversial. We aimed to examine the association between family history of SCD and MAEs stratified by age of SCD with a systematic review and meta-analysis. Methods and Results We searched the databases of MEDLINE and EMBASE from January 1992 to January 2020. Data from each study were combined using the random-effects model. Fitted metaregression was performed to evaluate the association between the age of SCD in families and the risk of MAE. Twenty-two studies from 2004 to 2019 were included in this meta-analysis involving 3386 patients with Brugada syndrome. The overall family history of SCD was not associated with increased risk of MAE in Brugada syndrome (pooled odds ratio [OR], 1.11; 95% CI, 0.82-1.51; P=0.489, I2=45.0%). However, a history of SCD in family members of age younger than 40 years of age did increase the risk of MAE by ≈2-fold (pooled OR, 2.03; 95% CI, 1.11-3.73; P=0.022, I2=0.0%). When stratified by the age of cut point at 50, 45, 40, and 35 years old, a history of SCD in younger family member was significantly associated with a higher risk of MAE (pooled OR, 0.49, 1.30, 1.51, and 2.97, respectively; P=0.046). Conclusions A history of SCD among family members of age younger than 40 years was associated with a higher risk of MAE.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ.,Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program Honolulu HI
| | | | - Timothy Barry
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa IA
| | | | | | - Hasan Ashraf
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Graduate School of Medicine Nippon Medical School Tokyo Japan
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
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Vutthikraivit W, Rattanawong P, Putthapiban P, Pachariyanon P, Bedanie G, Parmar K, Hanna E. DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENT WITH ATRIAL FIBRILLATION: A META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Rattanawong P, Firouzbakht T, Sorajja D. VAPING CARBOXY-TETRAHYDROCANNABINOL UNMASKS BRUGADA PATTERN AND INDUCES VENTRICULAR FIBRILLATION IN BRUGADA SYNDROME. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03422-7] [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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31
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Kanitsoraphan C, Techorueangwiwat C, Kewcharoen J, Rattanawong P, Banerjee D. GENDER-RELATED OUTCOMES IN PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Vutthikraivit W, Rattanawong P, Putthapiban P, Pachariyanon P, Bedanie G, Parmar K, Hanna E. DRUG-COATED BALLOON VERSUS DRUG-ELUTING STENT IN SMALL VESSEL CORONARY ARTERY DISEASE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02409-8] [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: 10/21/2022]
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33
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Kanitsoraphan C, Techorueangwiwat C, Kewcharoen J, Rattanawong P, Bunch T, Navaravong L. ZERO FLUOROSCOPY APPROACH VERSUS CONVENTIONAL FLUOROSCOPY APPROACH FOR CARDIAC ARRHYTHMIA ABLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Barat M, Chung E, Shen WK. TYPES OF SYNCOPE AND OUTCOMES IN BRUGADA SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01668-5] [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: 10/21/2022]
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35
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Kewcharoen J, Tachorueangwiwat C, Kanitsoraphan C, Saowapa S, Nitinai N, Vutthikraivit W, Rattanawong P, Banerjee D. Association between depression and increased risk of readmission in patients with heart failure: a systematic review and meta-analysis. Minerva Cardiol Angiol 2020; 69:389-397. [PMID: 32996309 DOI: 10.23736/s2724-5683.20.05346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Heart failure (HF) is one of the world leading causes of admission and readmission. Recent studies have shown that the presence of depression is associated with hospital readmission in patients after an index admission for heart failure (HF). However, there is disagreement between published studies regarding this finding. We performed a systematic review and meta-analysis to evaluate the effect of depression on readmission rates in HF patients. EVIDENCE ACQUISITION We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published study evaluating readmission rate of HF patients, with and without depression. Data from each study were combined using a random-effects model, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. EVIDENCE SYNTHESIS Ten studies were included in the meta-analysis with a total of 53,165 patients (6194 patients with depression). The presence of depression was associated with an increased risk of readmission in patients with HF (pooled HR=1.54, 95% CI: 1.22-1.94, P<0.001, I2=55.4%). In a subgroup analysis, depression was associated with an increased risk of readmission in patients with HF in both short-term (≤90 days) follow-up (pooled HR=1.75, 95% CI: 1.07-2.85, P=0.025, I2=76.0%) and long-term (>90 days) follow-up (pooled HR=1.58, 95% CI: 1.32-1.90, P<0.001, I2=0.0%). CONCLUSIONS Our meta-analysis demonstrated that depression is associated with an increased risk of hospital readmission in patients with HF.
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Affiliation(s)
- Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA -
| | | | | | - Sakditad Saowapa
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattapat Nitinai
- Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pattara Rattanawong
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Dipanjan Banerjee
- Queens Heart Physician Practice, Queen's Medical Center, Honolulu, HI, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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36
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Kewcharoen J, Tachorueangwiwat C, Kanitsoraphan C, Saowapa S, Nitinai N, Vutthikraivit W, Rattanawong P, Banerjee D. Association between depression and increased risk of readmission in patients with heart failure: a systematic review and meta-analysis. Minerva Cardiol Angiol 2020. [PMID: 32996309 DOI: 10.23736/s0026-4725.20.05346-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Heart failure (HF) is one of the world leading causes of admission and readmission. Recent studies have shown that the presence of depression is associated with hospital readmission in patients after an index admission for heart failure (HF). However, there is disagreement between published studies regarding this finding. We performed a systematic review and meta-analysis to evaluate the effect of depression on readmission rates in HF patients. EVIDENCE ACQUISITION We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published study evaluating readmission rate of HF patients, with and without depression. Data from each study were combined using a random-effects model, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. EVIDENCE SYNTHESIS Ten studies were included in the meta-analysis with a total of 53,165 patients (6194 patients with depression). The presence of depression was associated with an increased risk of readmission in patients with HF (pooled HR=1.54, 95% CI: 1.22-1.94, P<0.001, I2=55.4%). In a subgroup analysis, depression was associated with an increased risk of readmission in patients with HF in both short-term (≤90 days) follow-up (pooled HR=1.75, 95% CI: 1.07-2.85, P=0.025, I2=76.0%) and long-term (>90 days) follow-up (pooled HR=1.58, 95% CI: 1.32-1.90, P<0.001, I2=0.0%). CONCLUSIONS Our meta-analysis demonstrated that depression is associated with an increased risk of hospital readmission in patients with HF.
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Affiliation(s)
- Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA -
| | | | | | - Sakditad Saowapa
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattapat Nitinai
- Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pattara Rattanawong
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Dipanjan Banerjee
- Queens Heart Physician Practice, Queen's Medical Center, Honolulu, HI, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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37
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Kewcharoen J, Prasitlumkum N, Titichoatrattana S, Wittayalikit C, Trongtorsak A, Kanitsoraphan C, Putthapiban P, Poonsombudlert K, Rattanawong P, Chung EH. Factors associated with recurrent postinfarction ventricular tachycardia following ablation. Minerva Cardiol Angiol 2020. [PMID: 32989960 DOI: 10.23736/s0026-4725.20.05128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Ablation of ventricular tachycardia is the main therapy for patients with drug-refractory ventricular tachycardia (VT). Although evidence suggests that VT ablation could lower the incidence of recurrent VT, many cases still develop VT in follow-up. In this study, we performed a systematic review and meta-analysis to examine risk factors for recurrent VT in patients with postinfarction VT who underwent VT ablation. EVIDENCE ACQUISITION We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, experimental trials, or randomized controlled trials that evaluate the risk of recurrent VT in postinfarction VT patients who underwent VT ablation. Data from each study were combined using random-effects. EVIDENCE SYNTHESIS Thirteen studies involving 1803 postinfarction patients who underwent VT ablation were included. Inducibility after the procedure (pooled HR=1.71, P<0.001), lower baseline left ventricular ejection fraction (LVEF) (pooled HR=0.98, P<0.001) and higher baseline New York Heart Association (NYHA) classification (pooled HR=1.34, P=0.003) were significantly associated with VT recurrence during the follow-up. There was no significant association between age, gender or diabetes mellitus and VT recurrence. CONCLUSIONS Our meta-analysis demonstrated that inducibility after the procedure, lower baseline LVEF and higher baseline NYHA classification were associated with an increased risk of VT recurrence in postinfarction VT patients who underwent VT ablation.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA -
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | | | | | | | | | | | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Eugene H Chung
- Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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38
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Kewcharoen J, Prasitlumkum N, Titichoatrattana S, Wittayalikit C, Trongtorsak A, Kanitsoraphan C, Putthapiban P, Poonsombudlert K, Rattanawong P, Chung EH. Factors associated with recurrent postinfarction ventricular tachycardia following ablation. Minerva Cardiol Angiol 2020; 69:50-60. [PMID: 32989960 DOI: 10.23736/s2724-5683.20.05128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Ablation of ventricular tachycardia is the main therapy for patients with drug-refractory ventricular tachycardia (VT). Although evidence suggests that VT ablation could lower the incidence of recurrent VT, many cases still develop VT in follow-up. In this study, we performed a systematic review and meta-analysis to examine risk factors for recurrent VT in patients with postinfarction VT who underwent VT ablation. EVIDENCE ACQUISITION We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, experimental trials, or randomized controlled trials that evaluate the risk of recurrent VT in postinfarction VT patients who underwent VT ablation. Data from each study were combined using random-effects. EVIDENCE SYNTHESIS Thirteen studies involving 1803 postinfarction patients who underwent VT ablation were included. Inducibility after the procedure (pooled HR=1.71, P<0.001), lower baseline left ventricular ejection fraction (LVEF) (pooled HR=0.98, P<0.001) and higher baseline New York Heart Association (NYHA) classification (pooled HR=1.34, P=0.003) were significantly associated with VT recurrence during the follow-up. There was no significant association between age, gender or diabetes mellitus and VT recurrence. CONCLUSIONS Our meta-analysis demonstrated that inducibility after the procedure, lower baseline LVEF and higher baseline NYHA classification were associated with an increased risk of VT recurrence in postinfarction VT patients who underwent VT ablation.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA -
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | | | | | | | | | | | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Eugene H Chung
- Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Kittipibul V, Vutthikraivit W, Kewcharoen J, Rattanawong P, Tantrachoti P, Putthapiban P, Nair N. Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis. Int J Artif Organs 2020; 44:215-220. [PMID: 32842844 DOI: 10.1177/0391398820951811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22-0.56, I2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19-1.07, I2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.
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Affiliation(s)
- Veraprapas Kittipibul
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Pakpoom Tantrachoti
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Nandini Nair
- Department of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Kewcharoen J, Trongtorsak A, Kittipibul V, Prasitlumkum N, Kanitsoraphan C, Putthapiban P, Mekraksakit P, Pattison RJ, Rattanawong P. Fragmented QRS predicts reperfusion failure and in-hospital mortality in ST-Elevation myocardial infarction: a systematic review and meta-analysis. Acta Cardiol 2020; 75:298-311. [PMID: 31021694 DOI: 10.1080/00015385.2019.1584696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: Recent studies have shown that fragmented QRS (fQRS) is associated with unfavourable outcomes in STEMI patients. However, there is controversy amongst studies. We performed a systematic review and meta-analysis to explore the effect of fQRS on reperfusion failure and in-hospital mortality among this population.Methods: We searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort studies of STEMI patients that underwent primary percutaneous coronary intervention (pPCI) and thrombolysis. Data from each study were combined using the random-effects model.Results: Ten studies from January 2011 to October 2018 (2753 patients, 1075 patients with fQRS), were included. The fQRS was associated with higher risk of reperfusion failure in pPCI when defined by ST-segment resolution (OR = 3.08, 95% CI = 1.27-7.46, p-value = .013) but not when defined by TIMI flow grade (pooled OR = 1.45, 95% CI = 0.83-2.54, p-value = .192). In thrombolysis, fQRS was associated with higher risk of reperfusion failure when defined by both ST-segment resolution (pooled OR = 4.35, 95% CI = 1.80-10.49, p-value = .001) and TIMI flow grade (OR = 3.70, 95% CI = 2.10-6.53, p-value < .001). The fQRS was also associated with an increased risk of in-hospital mortality in both pPCI (pooled OR = 4.41, 95% CI = 1.60-12.16, p-value = .004) and thrombolysis (pooled OR = 2.38, 95% CI = 1.06-5.35, p-value = .036).Conclusions: Our meta-analysis demonstrated that fQRS in STEMI patients was associated with reperfusion failure as well as in-hospital mortality.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | | | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | | | | | - Robert J. Pattison
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Putthapiban P, Prasitlumkum N, Mekraksakit P, Mekritthikrai R, Chung EH. The utility of drug challenge testing in Brugada syndrome: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2474-2483. [DOI: 10.1111/jce.14631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/25/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Jakrin Kewcharoen
- Internal Medicine Residency Program University of Hawaii Honolulu Hawaii
| | | | - Wasawat Vutthikraivit
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | | | - Narut Prasitlumkum
- Internal Medicine Residency Program University of Hawaii Honolulu Hawaii
| | - Poemlarp Mekraksakit
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | | | - Eugene H. Chung
- Department of Internal Medicine, Frankel Cardiovascular Center, Michigan Medicine University of Michigan Ann Arbor Michigan
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Rattanawong P, Kewcharoen J, S Srivathsan K, Shen WK. Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. J Atr Fibrillation 2020; 13:2410. [PMID: 33024510 DOI: 10.4022/jafib.2410] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/27/2020] [Accepted: 03/28/2020] [Indexed: 12/13/2022]
Abstract
Objective The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "vagal", "vagal nerve", "vagus", "vagus nerve", and "atrial fibrillation". Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Results A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models. Conclusions Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results.
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Affiliation(s)
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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Abstract
Atrial fibrillation is a common clinical manifestation in hospitalized patients with coronavirus disease 2019 (COVID‐19). Medications used to treat atrial fibrillation, such as antiarrhythmic drugs and anticoagulants, may have significant drug interactions with emerging COVID‐19 treatments. Common unintended nontherapeutic target effects of COVID‐19 treatment include potassium channel blockade, cytochrome P 450 isoenzyme inhibition or activation, and P‐glycoprotein inhibition. Drug‐drug interactions with antiarrhythmic drugs and anticoagulants in these patients may lead to significant bradycardia, ventricular arrhythmias, or severe bleeding. It is important for clinicians to be aware of these interactions, drug metabolism changes, and clinical consequences when choosing antiarrhythmic drugs and anticoagulants for COVID‐19 patients with atrial fibrillation. The objective of this review is to provide a practical guide for clinicians who are managing COVID‐19 patients with concomitant atrial fibrillation.
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Affiliation(s)
- Pattara Rattanawong
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Win Shen
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Hicham El Masry
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Dan Sorajja
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Komandoor Srivathsan
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Arturo Valverde
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
| | - Luis R Scott
- Division of Heart Rhythm Services Department of Cardiovascular Diseases Mayo Clinic Arizona Phoenix AZ
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Rattanawong P, Kewcharoen J, Vutthikraivit W, Kanitsoraphan C, Ko NLK, Shanbhag A, Shen WK. ELECTROPHYSIOLOGY STUDY AND THE RISK OF MAJOR ARRHYTHMIC EVENTS IN BRUGADA SYNDROME: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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45
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Elmassry M, Vutthikraivit W, El-Nawaa S, Rattanawong P, Tantrachoti P, Mazek H, Paz P, Rahman MR, Mantilla B, Abdelmalek J, Sethi P. IMPACT OF HIS BUNDLE PACING ON LEFT VENTRICULAR FUNCTION COMPARED TO RIGHT VENTRICULAR APICAL PACING: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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46
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Shanbhag A, Barry T, Ko NLK, Taweesedt P, Shen WK. SURGICAL VERSUS CATHETER ABLATION IN ATRIAL FIBRILLATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31087-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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47
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Kewcharoen J, Trivedi N, Techorueangwiwat C, Kanitsoraphan C, Prasitlumkum N, Rattanawong P, Vutthikraivit W. BASELINE TRICUSPID REGURGITATION IS ASSOCIATED WITH WORSE OUTCOME IN PATIENTS UNDERGOING MITRACLIP THERAPY: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Techorueangwiwat C, Kanitsoraphan C, Rattanawong P, Kewcharoen J. IMPACT OF RESIDUAL MITRAL REGURGITATION ON MORTALITY AFTER ACUTE SUCCESSFUL MITRACLIP IMPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31842-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kewcharoen J, Techorueangwiwat C, Kittipibul V, Kanitsoraphan C, Leesutipornchai T, Thangjui S, Vutthikraivit W, Rattanawong P, Banerjee D. BASELINE RENAL DYSFUNCTION IS ASSOCIATED WITH INCREASED MORTALITY IN PATIENTS UNDERGOING PERCUTANEOUS MITRAL VALVE REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vutthikraivit W, Kewcharoen J, Prasitlumkum N, Putthapiban P, Ajmal R, Klomjit S, Rahman MR, Mantilla B, Rattanawong P. 5-YEAR OUTCOME OF PERCUTANEOUS CORONARY INTERVENTION VS. CORONARY ARTERY BYPASS SURGERY FOR PATIENTS PRESENTING WITH UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND PROPENSITY SCORE ADJUSTED STUDIES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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