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Markman TM, Frankel DS. To Stim and Then Map, or Map and Then Stim, That is the Question. Circ Arrhythm Electrophysiol 2023; 16:e011794. [PMID: 36716172 DOI: 10.1161/circep.123.011794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Markman TM, Gugger D, Arkles J, Riley MP, Dixit S, Guandalini GS, Frankel DS, Epstein AE, Callans DJ, Singhal S, Marchlinski FE, Nazarian S. Neuromodulation for the Treatment of Refractory Ventricular Arrhythmias. JACC Clin Electrophysiol 2023; 9:161-169. [PMID: 36858681 DOI: 10.1016/j.jacep.2022.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neuromodulation is increasingly recognized as a therapeutic strategy for patients with refractory ventricular arrhythmias (VAs). Percutaneous stellate ganglion blockade (SGB), transcutaneous magnetic stimulation (TcMS), and surgical cardiac sympathetic denervation (CSD) have all been utilized in this setting. OBJECTIVES This study sought to characterize contemporary use and outcomes of these neuromodulation techniques for patients with refractory VA. METHODS This retrospective cohort study included all patients at the Hospital of the University of Pennsylvania with antiarrhythmic drug (AAD)-refractory VA from 2019 to 2021 who were treated with SGB, TcMS, or CSD. RESULTS A total of 34 patients (age 61 ± 14 years, 15 polymorphic VAs [44%], refractory to 1.8 ± 0.8 AADs) met inclusion criteria. SGB was performed on 11 patients (32%), TcMS on 19 (56%), and CSD on 7 (21%). Neuromodulation was associated with a reduction in the number of episodes of sustained VAs from 7 [IQR: 4-12] episodes in the 24 hours before the initial neuromodulation strategy to 0 [IQR: 0-1] episodes in the subsequent 24 hours (P < 0.001). During 1.2 ± 1.1 years of follow-up, 21 (62%) experienced recurrent VAs, and among those patients, the median time to recurrence was 3 [IQR: 1-25] days. Outcomes were similar among patients with monomorphic and polymorphic VAs. Among patients who had an acute myocardial infarction within 30 days before neuromodulation, the burden of VAs decreased from 11 [IQR: 7-12] episodes to 0 episodes in the 24 hours after treatment. CONCLUSIONS Autonomic neuromodulation with SGB, TcMS, or CSD in patients with AAD-refractory VAs is safe and results in substantial acute reduction of VA although recurrent arrhythmias are common, and not all patients experience a reduction in arrhythmia burden.
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Blandino A, Bianchi F, Frankel DS, Liang JJ, Mazzanti A, D'Ascenzo F, Masi AS, Grossi S, Musumeci G. Safety and efficacy of catheter ablation for ventricular tachycardia in elderly patients with structural heart disease: a systematic review and meta-analysis. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:179-192. [PMID: 34436722 DOI: 10.1007/s10840-021-01007-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Data regarding the age-specific outcomes of VT ablation in patients with structural heart disease (SHD) are scarce. We performed a systematic review and meta-analysis to evaluate the outcomes of VT ablation in elderly vs. younger patients with SHD. METHODS MEDLINE/PubMed, Cochrane, and Google Scholar and references comparing VT ablation in elderly vs. younger patients were screened and studies included if matching inclusion and exclusion criteria. RESULTS Five retrospective studies enrolling 2778 SHD patients (868 elderly vs. 1910 younger) were included. Compared to younger subjects, the elderly showed similar results in terms of acute ablation success (OR 0.78, 95% CI 0.54-1.13, p = 0.189) and minor complications (OR 1.74, 95% CI 0.74-4.09, p = 0.205), a trend toward a higher risk of major complications (OR 2.30, 95% CI 0.83-6.40, p = 0.110) and significantly higher rates of all complications (OR 2.67, 95% CI 1.51-4.71, p = 0.001) and periprocedural mortality (OR 1.93, 95% CI 1.24-3.01, p = 0.004). At a mean follow-up of 18 months, elderly patients showed similar long-term VT recurrence rate (OR 1.02, 95% CI 0.85-1.22, p = 0.861) and higher all-cause mortality (OR 2.00, 95% CI 1.40-2.86, p < 0.001). In elderly patients, urgent VT ablation is associated with higher risk of major complications (beta = 0.06, p < 0.001) and periprocedural mortality (beta = 0.03, p = 0.029), while advanced age is associated with higher risk of major complications (beta = 0.29 with p = 0.009) and all complications + periprocedural mortality (beta = 0.17 with p = 0.037). CONCLUSIONS Compared to younger patients, VT ablation in elderly showed similar results in terms of acute ablation success and long-term VT recurrence rate with a significantly higher risk of all complications, periprocedural mortality, and long-term mortality, especially when the procedure is performed urgently and in the most aged patients. Large prospective multicenter randomized trials are required to confirm these findings.
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Tschabrunn CM, Frankel DS. Diving beneath the surface to maximize ablation lesion size. J Interv Card Electrophysiol 2023; 66:133-134. [PMID: 35913581 DOI: 10.1007/s10840-022-01320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
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Cerantola M, Frankel DS, Callans DJ, Santangeli P, Schaller RD. Left bundle branch area pacing for the treatment of painful left bundle branch block syndrome. HeartRhythm Case Rep 2022; 9:121-125. [PMID: 36860742 PMCID: PMC9968912 DOI: 10.1016/j.hrcr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Markman TM, Jarrah AA, Tian Y, Mustin E, Guandalini GS, Lin D, Epstein AE, Hyman MC, Deo R, Supple GE, Arkles JS, Dixit S, Schaller RD, Santangeli P, Nazarian S, Riley M, Callans DJ, Marchlinski FE, Frankel DS. Safety of Pill-in-the-Pocket Class 1C Antiarrhythmic Drugs for Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:1515-1520. [PMID: 36543501 DOI: 10.1016/j.jacep.2022.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Guidelines recommend that initial trial of a "pill-in-the-pocket" (PIP) Class 1C antiarrhythmic drug (AAD) for cardioversion of atrial fibrillation (AF) be performed in a monitored setting because of the potential for adverse reactions. OBJECTIVES This study sought to characterize real-world, contemporary use of the PIP approach, including the setting of initiation and incidence of adverse events. METHODS This retrospective cohort study included all patients at the Hospital of the University of Pennsylvania treated with a PIP approach for AF between 2007 and 2020. RESULTS A total of 273 patients (age 56 ± 13 years; 182 [67%] male; CHA2DS2VASc score 1.1 ± 1.2) took a first dose of PIP AAD. Flecainide was used in 151 (55%) and propafenone in 122 (45%). The first dose of PIP AAD was taken in a monitored setting in 167 (62%). Significant adverse events occurred in 7 patients (3%), 2 of whom had taken the dose in a monitored setting. Significant adverse events included unexplained syncope (1 of 7), symptomatic bradycardia/hypotension (4 of 7), and 1:1 atrial flutter (2 of 7). All occurred in patients taking 300 mg of flecainide (n = 4) or 600 mg of propafenone (n = 3). Electrical cardioversion was performed in 29 (11%) patients because of failure of the AAD to terminate AF. One patient required intravenous fluids and vasopressors for 2 hours because of persistent hypotension and bradycardia. Two patients required permanent pacemakers for bradycardia. The remaining patients required no intervention. CONCLUSIONS Our data support the current recommendation to initiate PIP AAD in a monitored setting because of rare significant adverse reactions that can require urgent intervention.
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Markman TM, Epstein AE, Frankel DS. Reply: Pill-in-the-Pocket Therapy for Atrial Fibrillation: Is There More to Say? JACC Clin Electrophysiol 2022; 8:1586. [PMID: 36543513 DOI: 10.1016/j.jacep.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
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Chee J, Lin AN, Julien H, Lin D, Schaller RD, Frankel DS, Supple GE, Santangeli P, Riley MP, Nazarian S, Deo R, Arkles J, Kumareswaran R, Hyman MC, Guandalini G, Epstein AE, Zado ES, Callans DJ, Marchlinski FE, Dixit S. Impact of Left Ventricular Papillary Muscle Ventricular Arrhythmia Ablation on Mitral Valve Function. JACC Clin Electrophysiol 2022; 8:1475-1483. [PMID: 36543496 DOI: 10.1016/j.jacep.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although efficacious, catheter ablation (CA) of ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs) has the potential to affect mitral valve (MV) function. OBJECTIVES The aim of this study was to determine whether lesions delivered during CA of VAs from LV PAPs affected MV function. METHODS Consecutive patients undergoing CA of LV PAP VAs from January 2015 to December 2020 in whom both preprocedural and postprocedural transthoracic echocardiography was performed were included. Radiofrequency ablation was performed with an irrigated-tip catheter with or without contact force sensing and intracardiac echocardiographic guidance. The PAPs were delineated into segments: tip, body, and base. Pre- and post-CA transthoracic echocardiograms were reviewed to assess MV regurgitation, which was graded 0 (none), 1 (mild), 2 (moderate), or 3 (severe). A change of ≥2 grades from baseline was considered significant. RESULTS A total of 103 patients (mean age 63 ± 15 years, 78% men) were included. VAs were ablated from the anterolateral PAP in 35% (n = 36), posteromedial PAP in 55% (n = 57), and both PAPs in 10% (n = 10). Lesion distribution was as follows: PAP tip in 52 (50%), PAP base in 34 (33%), PAP body in 13 (13%), and entire PAP in 4 (4%). The mean number of lesions delivered was 16 ± 13 (median 14). Of 103 patients, 102 (99%) showed no change in MV function. CONCLUSIONS Using intracardiac echocardiographic guidance, lesions can be safely delivered on various aspects of this structure without adverse impact on MV function.
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Piccini JP, Russo AM, Sharma PS, Kron J, Tzou W, Sauer W, Park DS, Birgersdotter-Green U, Frankel DS, Healey JS, Hummel J, Koruth J, Linz D, Mittal S, Nair DG, Nattel S, Noseworthy PA, Steinberg BA, Trayanova NA, Wan EY, Wissner E, Zeitler EP, Wang PJ. Advances in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2022; 15:e009911. [DOI: 10.1161/circep.121.009911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite the global COVID-19 pandemic, during the past 2 years, there have been numerous advances in our understanding of arrhythmia mechanisms and diagnosis and in new therapies. We increased our understanding of risk factors and mechanisms of atrial arrhythmias, the prediction of atrial arrhythmias, response to treatment, and outcomes using machine learning and artificial intelligence. There have been new technologies and techniques for atrial fibrillation ablation, including pulsed field ablation. There have been new randomized trials in atrial fibrillation ablation, giving insight about rhythm control, and long-term outcomes. There have been advances in our understanding of treatment of inherited disorders such as catecholaminergic polymorphic ventricular tachycardia. We have gained new insights into the recurrence of ventricular arrhythmias in the setting of various conditions such as myocarditis and inherited cardiomyopathic disorders. Novel computational approaches may help predict occurrence of ventricular arrhythmias and localize arrhythmias to guide ablation. There are further advances in our understanding of noninvasive radiotherapy. We have increased our understanding of the role of His bundle pacing and left bundle branch area pacing to maintain synchronous ventricular activation. There have also been significant advances in the defibrillators, cardiac resynchronization therapy, remote monitoring, and infection prevention. There have been advances in our understanding of the pathways and mechanisms involved in atrial and ventricular arrhythmogenesis.
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Murashige D, Jung JW, Neinast MD, Levin MG, Chu Q, Lambert JP, Garbincius JF, Kim B, Hoshino A, Marti-Pamies I, McDaid KS, Shewale SV, Flam E, Yang S, Roberts E, Li L, Morley MP, Bedi KC, Hyman MC, Frankel DS, Margulies KB, Assoian RK, Elrod JW, Jang C, Rabinowitz JD, Arany Z. Extra-cardiac BCAA catabolism lowers blood pressure and protects from heart failure. Cell Metab 2022; 34:1749-1764.e7. [PMID: 36223763 PMCID: PMC9633425 DOI: 10.1016/j.cmet.2022.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 06/09/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023]
Abstract
Pharmacologic activation of branched-chain amino acid (BCAA) catabolism is protective in models of heart failure (HF). How protection occurs remains unclear, although a causative block in cardiac BCAA oxidation is widely assumed. Here, we use in vivo isotope infusions to show that cardiac BCAA oxidation in fact increases, rather than decreases, in HF. Moreover, cardiac-specific activation of BCAA oxidation does not protect from HF even though systemic activation does. Lowering plasma and cardiac BCAAs also fails to confer significant protection, suggesting alternative mechanisms of protection. Surprisingly, activation of BCAA catabolism lowers blood pressure (BP), a known cardioprotective mechanism. BP lowering occurred independently of nitric oxide and reflected vascular resistance to adrenergic constriction. Mendelian randomization studies revealed that elevated plasma BCAAs portend higher BP in humans. Together, these data indicate that BCAA oxidation lowers vascular resistance, perhaps in part explaining cardioprotection in HF that is not mediated directly in cardiomyocytes.
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Griffiths JR, Nussinovitch U, Liang JJ, Sims R, Yoneda ZT, Bernstein HM, Viswanathan MN, Khairy P, Srivatsa UN, Frankel DS, Marciniak FE, Sandhu A, Shoemaker MB, Mohanty S, Burkhardt JD, Natale A, Lakkireddy D, De Groot NMS, Gerstenfeld EP, Moore JP, Avila P, Ernst S, Nguyen DT. Catheter Ablation for Atrial Fibrillation in Adult Congenital Heart Disease: An International Multicenter Registry Study. Circ Arrhythm Electrophysiol 2022; 15:e010954. [PMID: 36074954 DOI: 10.1161/circep.122.010954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes. METHODS A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using 2014 PACES/HRS guidelines. Clinical data were collected. One-year complete procedural success was defined as freedom from atrial tachycardia or AF in the absence of antiarrhythmic drugs or including previously failed antiarrhythmic drugs (partial success). RESULTS Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate, and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had trialed at least one antiarrhythmic drug. Forty-six patients (22.1%) had reduced systemic ventricular ejection fraction <50%, and mean left atrial diameter was 44.1±0.7 mm. Pulmonary vein isolation was performed in 227 patients (94.6%); additional ablation included left atrial linear ablations (25.4%), complex fractionated atrial electrogram (19.2%), and cavotricuspid isthmus ablation (40.8%). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications. CONCLUSIONS AF ablation in CHD was safe and resulted in AF control in a majority of patients, regardless of complexity. Future work should address the most appropriate ablation targets in this challenging population.
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Amankwah NA, Pothineni NVK, Guandalini G, Santangeli P, Schaller R, Supple GE, Deo R, Nazarian S, Lin D, Epstein AE, Dixit S, Callans DJ, Marchlinski FE, Frankel DS. Impact of atrial fibrillation recurrences during the blanking period following catheter ablation on long-term arrhythmia-free survival: a prospective study with continuous monitoring. J Interv Card Electrophysiol 2022; 65:519-525. [PMID: 35794440 DOI: 10.1007/s10840-022-01291-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The significance of atrial fibrillation (AF) recurrences during the 90-day blanking period following catheter ablation is controversial. Studies to date examining the impact of AF recurrences during the blanking period have been limited by intermittent monitoring. We sought to test whether AF recurrences during the blanking period are associated with long-term recurrences using continuous monitoring. METHODS Patients undergoing AF ablation by a single operator at an academic medical center between 2015 and 2019, who either already had a cardiac implantable electronic device (CIED) with an atrial lead or received an insertable cardiac monitor (ICM), were followed for long-term AF recurrence. Recurrence was defined as > 30 s by CIED and > 2 min by ICM. All device-reported AF episodes were adjudicated by a physician. RESULTS Of 196 consecutive patients, 51 (26%) had AF recurrence in the blanking period and 145 (74%) did not. Over the year following ablation, those who had an AF recurrence in the blanking period were significantly more likely to have long-term AF recurrences than those without AF in the blanking period (log rank p < 0.001). The higher the burden of AF recurrences during the blanking period, the more likely AF was to recur long-term (hazard ratio 1.04 [CI 1.01-1.06] per 1% increase in burden, p = 0.002). CONCLUSION Using continuous monitoring of a sizable population, we confirmed that AF recurrences in the blanking period following ablation are in fact associated with long-term AF recurrences. The higher the burden of recurrence, the more likely AF is to recur long-term.
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Kalluri AG, Sugrue A, Frankel DS. An Important Cause of Wide Complex Tachycardia. JAMA Intern Med 2022; 182:670-671. [PMID: 35404427 DOI: 10.1001/jamainternmed.2022.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Markman TM, Folse E, Yang L, Groeneveld PW, Frankel DS. Trends in Opioid Use after Cardiac Implantable Electronic Device Procedures in the United States Between 2004 and 2020. Circulation 2022; 145:1499-1501. [PMID: 35491872 DOI: 10.1161/circulationaha.121.058610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bode WD, Gonzalez KA, Muser D, Nazarian S, Garcia FC, Supple GE, Schaller RD, Frankel DS, Arkles J, Hyman MC, Kumareswaran R, Guandalini GS, Lin D, Dixit S, Callans DJ, Marchlinski FE, Santangeli P. BS-400-19 INTRAMURAL EXTENSION OF THE POST-INFARCTION SUBSTRATE IN PATIENTS UNDERGOING CATHETER ABLATION OF VENTRICULAR TACHYCARDIA: PREVALENCE AND PROGNOSTIC IMPLICATIONS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Alsalem A, Judy R, Zado ES, Guandalini GS, Deo R, Arkles J, Schaller RD, Santangeli P, Nazarian S, Frankel DS, Riley MP, Dixit S, Garcia FC, Epstein AE, Callans DJ, Marchlinski FE, Damrauer S, Hyman MC. HF-566-03 EMD MISSENSE VARIANTS ARE ASSOCIATED WITH A DILATED CARDIOMYOPATHY AND CONDUCTION SYSTEM DISEASE/ATL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arceluz MR, Bravo P, Vanard Bush KN, Krishna Chand Pothineni NV, Cherian TS, Garcia FC, Santangeli P, Guandalini GS, Callans DJ, Frankel DS, Nazarian S, Supple GE, Schaller RD, Riley MP, Deo R, Hyman MC, Kumareswaran R, Dixit S, Lin D, Marchlinski FE. PO-700-06 ROLE OF SINUS RHYTHM QRS AMPLITUDE, FRACTIONATION AND DURATION TO IDENTIFY CLINICAL RESPONSE TO MEDICAL TREATMENT IN PATIENTS WITH CARDIAC SARCOIDOSIS AND FDG-PET UPTAKE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magnani S, Muser D, Nucifora G, Enriquez A, Castro SA, Liuba I, Dechyapirom Bode W, Arkles J, Zado ES, Schaller RD, Deo R, Garcia FC, Frankel DS, Callans DJ, Ricardo Arceluz M, Lin D, Tschabrunn CM, Frankel DS, Marchlinski FE, Santangeli P. CE-544-03 INCIDENCE AND PREDICTORS OF ACQUIRED LV DYSFUNCTION IN PATIENTS WITH ASYMPTOMATIC FREQUENT PREMATURE VENTRICULAR COMPLEXES: A LONGITUDINAL CMR STUDY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arceluz MR, Hambach B, Garcia FC, Callans DJ, Supple GE, Schaller RD, Frankel DS, Arkles J, Hyman MC, Kumareswaran R, Guandalini GS, Lin D, Dixit S, Nazarian S, Muser D, Marchlinski FE, Santangeli P. PO-681-01 SEPTAL SUBSTRATE ABLATION GUIDED BY DELAYED TRANSMURAL CONDUCTION TIMES: A NOVEL ABLATION APPROACH TO TARGET INTRAMURAL SUBSTRATES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Markman T, Hyman MC, Deo R, Epstein AE, Frankel DS, Guandalini GS, Dixit S, Riley MP, Callans DJ, Marchlinski FE, Nazarian S. PO-698-06 NEUROMODULATION FOR THE TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Muser D, Nucifora G, Casella M, Tritto M, Magnani S, Compagnucci P, Zagari D, Enriquez A, Liuba I, Chahal AA, Arceluz MR, Castro SA, Bode WD, Arkles J, Lin D, Tschabrunn CM, Zado ES, Schaller RD, Deo R, Garcia FC, Frankel DS, Russo AD, Callans DJ, Pieroni M, Marchlinski FE, Santangeli P. PO-715-06 RINGLIKE LEFT VENTRICULAR CARDIOMYOPATHY: A DISTINCT FAMILIAL FORM OF ARRHYTHMOGENIC CARDIOMYOPATHY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bode WD, Gonzalez KA, Muser D, Nazarian S, Garcia FC, Supple GE, Schaller RD, Frankel DS, Arkles J, Hyman MC, Kumareswaran R, Guandalini GS, Lin D, Dixit S, Callans DJ, Marchlinski FE, Santangeli P. PO-623-03 INTRAMURAL EXTENSION OF THE POST-INFARCTION SUBSTRATE IN PATIENTS UNDERGOING CATHETER ABLATION OF VENTRICULAR TACHYCARDIA: PREVALENCE AND PROGNOSTIC IMPLICATIONS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pothineni NVK, Cherian T, Patel N, Smietana J, Frankel DS, Deo R, Epstein AE, Marchlinski FE, Schaller RD. Subcutaneous Implantable Cardioverter-defibrillator Explantation-A Single Tertiary Center Experience. J Innov Card Rhythm Manag 2022; 13:4947-4953. [PMID: 35474857 PMCID: PMC9023024 DOI: 10.19102/icrm.2022.130407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. The objective of this study was to assess the incidence and indications for S-ICD explantation at a large tertiary referral center. We conducted a retrospective study of all S-ICD explantations performed from 2014–2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation were collected. A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution, of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7 ± 20.1 months. The mean age of the patients at explantation was 44.8 ± 15.3 years, and 42% (n = 27) were women. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of patients, respectively. The most common reason for explantation was infection (32.8%), followed by abnormal sensing (25%) and the need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7 ± 13.6 vs. 42.3 ± 14.6 years, P = 0.005) with a wider QRS duration (111 ± 19 vs. 98 ± 19 ms, P = 0.03) at device implantation compared to patients who underwent explantation for other indications. The incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for one-third of the explantations, a significant number of explantations were due to sensing abnormalities and the need for pacing. These data may have implications for patient selection for S-ICD implantation.
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Frankel DS, Dechert-Crooks BE, Campbell K, DeSimone CV, Etheridge S, Harvey M, Lampert R, Nayak HM, Saliba WI, Shea J, Thomas J, Zado E, Daubert JP. 2021 HRS Educational Framework for Clinical Cardiac Electrophysiology. Heart Rhythm O2 2022; 3:120-132. [PMID: 35496459 PMCID: PMC9043382 DOI: 10.1016/j.hroo.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Garg L, Daubert T, Lin A, Dhakal B, Santangeli P, Schaller R, Hyman MC, Kumareswaran R, Arkles J, Nazarian S, Lin D, Riley MP, Supple GE, Frankel DS, Zado E, Callans DJ, Marchlinski FE, Dixit S. Utility of Prolonged Duration Endocardial Ablation for Ventricular Arrhythmias Originating From the Left Ventricular Summit. JACC Clin Electrophysiol 2022; 8:465-476. [PMID: 35450601 DOI: 10.1016/j.jacep.2021.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to explore whether prolonged duration (PD) radiofrequency ablation (RFA) from adjacent endocardial locations can improve catheter ablation (CA) outcomes of left ventricular summit (LVS) ventricular arrhythmias (Vas). BACKGROUND CA of VAs originating from the LVS region can be challenging. METHODS Patients undergoing CA of LVS VAs from January 1, 2015, to December 31, 2019, were included. Standard RFA approach involved incremental power titration (20-45 W) over 60-120 seconds with irrigated tip catheter to achieve 10%-12% impedance drop. Prolonged duration RFA involved similar power titration; however, lesion application was extended beyond 120 seconds (maximum 5 minutes). Lesions were confined to lowest aspect of aortic cusps and/or subvalvular LV outflow tract region (≤0.5 cm from the valve). Procedural success was defined as suppression of VA ≥30 minutes postablation and clinical success as no arrhythmia symptoms on follow-up and >80% reduction of VA burden on postprocedure monitor. RESULTS This study included 102 patients (60±14 years old, 62% male): standard RFA in 80 and PD RFA in 38. Procedural success was achieved in 54 patients with standard and 32 patients with PD RFA (68% vs 84%; P = 0.05). Short-term clinical success was achieved in 48 patients (60%) with standard and 30 patients (79%) with PD RFA (P = 0.04). Two pericardial effusions occurred (1 in each group) and no steam pops were noted. Patients in whom standard RFA was successful were more likely to have R/S ratio >1 or absence of qS in lead I (odds ratio: 3.35; 95% CI: 1.20-9.35; P = 0.03). CONCLUSIONS Prolonged duration RFA from adjacent endocardial locations is a safe and effective technique for successfully targeting challenging LVS VAs that fail standard RFA.
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