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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Ling LH, Voskoboinik A, Sugumar H, Lee G, Morton J, Kalman J, Kistler P. Development and validation of the HARMS2-AF lifestyle risk score to predict incident AF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lifestyle risk factors (RFs) are a modifiable target in atrial fibrillation (AF) management. However, the relative contribution of individual lifestyle RFs to AF incidence has not been described.
Purpose
Development and validation of a novel AF-lifestyle risk score to determine AF risk in the general population.
Methods
The UK Biobank (UKB) is a large prospective cohort with outcomes measured >10 years. In the UKB, we performed regression analysis of AF lifestyle RFs which were then evaluated in a multivariable model and a weighted score was developed. Next, the risk score was externally validated in the Framingham Heart Study (FHS) population. Kaplan-Meier estimates ascertained the 10-year risk of AF development.
Results
In the UKB, AF incidence was 5.3% among 302,926 participants, with a median time to AF 7.3 years (IQR 4.3–9.8). Hypertension, sleep apnoea, male sex, age, obesity (BMI>30 kg/m2), alcohol and smoking were predictive variables (all p<0.001); physical inactivity (OR 1.02,95% CI 0.97–1.10, p=0.3), diabetes (OR 0.98,95% CI 0.91–1.06, p=0.2) and BMI 27–30 kg/m2 (OR 1.02, 95% CI 0.97–1.07, p=0.424) were not significant. The HARMS2-AF score (Figure 1) had similar predictive performance (AUC=0.782, LogLoss 0.178, Brier Score 0.046) to the unweighted regression model (AUC 0.808) in the UKB. Validation in the FHS (AF incidence 6.7% of 7206 participants) maintained excellent predictive performance with an AUC of 0.747 (95% CI 0.724–0.769, Figure 2). A higher HARMS2-AF score (>5 points) was associated with a heightened 10-year AF risk (score 5–9: OR 9.35, score 10–14: OR 33.34).
Conclusions
The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF and assists in general population screening.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Segan
- The Alfred Hospital , Melbourne , Australia
| | - R Canovas
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | | | - D Chieng
- The Alfred Hospital , Melbourne , Australia
| | - S Prabhu
- The Alfred Hospital , Melbourne , Australia
| | - L H Ling
- The Alfred Hospital , Melbourne , Australia
| | | | - H Sugumar
- The Alfred Hospital , Melbourne , Australia
| | - G Lee
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Morton
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Kalman
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - P Kistler
- The Alfred Hospital , Melbourne , Australia
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Chieng D, Sugumar H, Segan L, Al-Kaisey A, Hawson J, Prabhu S, Voskoboinik A, Morton JB, Lee G, Mariani J, La Gerche A, Kistler PM, Kalman JM, Kaye DM, Ling LH. Catheter ablation in atrial fibrillation and heart failure with preserved ejection fraction improves peak pulmonary capillary wedge pressure, exercise capacity and quality of life: RCT STALL HFpEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) frequently accompanies heart failure with preserved ejection fraction (HFpEF). AF exacerbates HFpEF through adverse haemodynamic effects. In turn, HFpEF promotes AF through adverse left atrial remodelling. Observational data suggest sinus rhythm restoration improves outcomes in patients with AF and HFpEF. However, there are no randomised data examining the effects of rhythm control with catheter-based AF ablation on HFpEF outcomes.
Purpose
To compare the effects of AF ablation versus usual medical therapy on markers of HFpEF severity, including exercise haemodynamics, natriuretic peptide levels and patient symptoms.
Methods
Patients with symptomatic AF and HFpEF underwent exercise right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET). HFpEF diagnosis was based on left ventricular ejection fraction (LVEF) ≥50%, elevated natriuretic peptide and echocardiographic diastolic impairment. HFpEF was confirmed on exercise RHC based on peak exercise pulmonary capillary wedge pressure (PCWP) of ≥25mmHg. Patients were randomised to AF ablation versus medical therapy, with investigations repeated at 6 months. The primary outcome was change in PCWP on follow-up.
Results
31 patients aged 66.1±7.5 years were randomized to AF ablation (16) versus medical therapy (15), with 51.6% female and 80.6% persistent AF. Baseline characteristics were comparable across groups. Paired analyses of ablation cohort showed significant reductions in peak PCWP (29.6±3.7 vs 25.9±4.6 mmHg, p<0.01), PCWP indexed for workload (39.0±57.9 vs 33.0±50.5 mmHg/W/kg, p<0.01), and BNP (146.2±80.5 vs 82.2±75.4 pg/mL, p=0.01); and increased resting cardiac output (4.6±0.9 vs 5.6±1.2 L/min, p=0.01), peak cardiac output (9.6±4.2 vs 10.4±3.7 L/min, p=0.02), peak (30s averaged) VO2 (1875.1±759.2 vs 2193.7±878.1 mL/min, p<0.01), peak absolute VO2 (1937.3±739.3 vs 2216.3±861.9 mL/min, p<0.01), peak (30s averaged) relative VO2 (19.4±5.9 vs 22.9±7.4 ml/kg/min) and peak workload (162.0±81.1 vs 184.4±83.4 W, p<0.01). Quality of life scores improved: AFEQT (45.3±20.9 vs 75±20.7, p<0.01) and MLHF (53±23.3 vs 17.5±22.8, p<0.01). Reversal of HFpEF by PCWP criteria occurred in 31.2% following AF ablation, and 50% among those free from arrhythmia recurrence. In the medical arm, there were no significant differences in RHC, CPET, and natriuretic peptide outcomes on follow-up versus baseline. Repeated measures mixed ANOVA testing showed significant time-randomisation interaction on peak VO2, absolute peak VO2, peak relative VO2, AFEQT/ MLHF scores, suggesting that significant improvements in these parameters were related to AF ablation.
Conclusion
In patients with concomitant AF and HFpEF, AF ablation improves invasive exercise haemodynamic parameters, increases exercise capacity, and enhances quality of life. Successful AF ablation may reverse the clinical syndrome of HFpEF in a subset of cases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Chieng
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - H Sugumar
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - L Segan
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Al-Kaisey
- Royal Melbourne Hospital, Cardiology , Melbourne , Australia
| | - J Hawson
- Royal Melbourne Hospital, Cardiology , Melbourne , Australia
| | - S Prabhu
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Voskoboinik
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - J B Morton
- Royal Melbourne Hospital, Cardiology , Melbourne , Australia
| | - G Lee
- Royal Melbourne Hospital, Cardiology , Melbourne , Australia
| | - J Mariani
- The Alfred Hospital , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - P M Kistler
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - J M Kalman
- Royal Melbourne Hospital, Cardiology , Melbourne , Australia
| | - D M Kaye
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - L H Ling
- Baker Heart and Diabetes Institute , Melbourne , Australia
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Segan L, Nanayakkara S, Spear E, Shirwaiker A, Chieng D, Sugumar H, Ling LH, Prabhu S, Lee G, Morton J, Kalman J, Voskoboinik A, Kistler P. Clinical risk prediction for left atrial appendage thrombus among patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Exclusion of left atrial appendage thrombus (LAAT) by transoesophageal echocardiography (TOE) is recommended in patients with inadequate anticoagulation prior to direct cardioversion (DCR) or catheter ablation for atrial fibrillation/flutter (AF/AFL). LAAT risk factors in this population remain poorly defined.
Purpose
Determine LAAT predictors in AF/AFL patients undergoing pre-procedural TOE.
Methods
We evaluated available clinical and transthoracic echocardiographic (TTE) parameters in AF/AFL patients undergoing TOE between 1999–2022 in our institution in Melbourne, Australia. Regression analysis identified predictors of LAAT, which were applied to a weighted score developed in the derivation cohort (70%) and validated in the remaining 30%.
Results
Of 627 patients (age 62±12 years, 27% female, AF 84%,AFL 16%, left ventricular ejection fraction (LVEF) 44±20%), 24% had LAAT and 13.8% dense spontaneous echo contrast precluding DCR. Anticoagulation was NOAC 56.5%, warfarin 32.1% and none in 11.4%. In the LAAT cohort, thrombus resolution occurred in 39% on serial transoesophageal imaging with a median time to resolution of 131 days (IQR 54–398).
Diabetes (p=0.004), prior stroke (p=0.009), coronary disease (p=0.015), renal impairment (p<0.001) and CHADS2VASc >2 (73% vs. 55%, p<0.001) were higher in the LAAT cohort. Age (p=0.093), gender (p=0.689), BMI (p=0.828), anticoagulant type (p=0.316) and diabetes (p=0.107) were not univariate predictors, whereas anticoagulation duration (<30 days), creatinine and TTE markers of remodeling (LVEF, LAVI, RVSP and TAPSE) were independent predictors on univariate and multivariate regression; CHADS2VASc was not significant after adjustment (p=0.090). The weighted risk model included continuous (age, creatinine, LVEF, LAVI, TAPSE and RVSP) and categorical (anticoagulation duration) variables with excellent predictive performance: AUC 0.872 (95% CI 0.798–0.946), PPV 91%, NPV 70% and accuracy 80%.
Conclusion
A novel LAAT risk model comprising clinical and echocardiographic parameters enhances risk prediction over CHADS2VASc in AF/AFL and may guide the need for pre-procedural TOE imaging.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Segan
- The Alfred Hospital , Melbourne , Australia
| | | | - E Spear
- Monash Health, General Medicine , Melbourne , Australia
| | | | - D Chieng
- The Alfred Hospital , Melbourne , Australia
| | - H Sugumar
- The Alfred Hospital , Melbourne , Australia
| | - L H Ling
- The Alfred Hospital , Melbourne , Australia
| | - S Prabhu
- The Alfred Hospital , Melbourne , Australia
| | - G Lee
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Morton
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | - J Kalman
- Royal Melbourne Hospital, Department of Cardiology , Melbourne , Australia
| | | | - P Kistler
- The Alfred Hospital , Melbourne , Australia
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Hawson J, Van Nieuwenhuyse E, Van Den Abeele R, Al-Kaisey A, Anderson RD, Chieng D, Segan L, Watts T, Campbell T, Hendrickx S, Morton J, McLellan A, Kistler P, Lee A, Gerstenfeld EP, Hsia HH, Voskoboinik A, Pathik B, Kumar S, Kalman J, Lee G, Vandersickel N. Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques. JACC Clin Electrophysiol 2022:S2405-500X(22)00723-X. [PMID: 36752465 DOI: 10.1016/j.jacep.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit. OBJECTIVES This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool. METHODS Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus. RESULTS Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases. CONCLUSIONS DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re-annotated VT maps.
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Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - David Chieng
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Segan
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Timothy Campbell
- Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sander Hendrickx
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexander McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adam Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Henry H Hsia
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Bhupesh Pathik
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
| | - Nele Vandersickel
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
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Koh Y, Voskoboinik A, Neil C. Arrhythmias and Their Electrophysiological Mechanisms in Takotsubo Syndrome: A Narrative Review. Heart Lung Circ 2022; 31:1075-1084. [PMID: 35562239 DOI: 10.1016/j.hlc.2022.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS), an acute and usually reversible condition, is associated with both tachy- and bradyarrhythmias. Such arrhythmias can be life-threatening, e.g. ventricular tachycardia and fibrillation, and associated with cardiac arrest. Others, such as atrioventricular block, persist and require long-term device therapy. In this narrative review, we aim to provide a summary of the current literature on arrhythmias in TTS and their clinical sequelae. METHODS PubMed and Medline databases were searched with various permutations of TTS, arrhythmias and beta-adrenoceptors. After application of exclusion criteria and review, 84 articles were included. RESULTS Although there are no specific electrocardiograph (ECG) findings in TTS to differentiate it from ST-elevation myocardial infarction, suggestive patterns include small QRS amplitude, ST segment elevation without reciprocal ST depression and prolonged QT interval. Atrial tachyarrhythmias (incidence of 5-15%) are associated with a more unwell patient cohort. Ventricular arrhythmias (incidence 4-14%) are often associated with prolonged QT interval and are a cause of sudden death in TTS. Bradyarrhythmias are less common (incidence 1.3-2.5%), but have been reported with TTS, and usually persist beyond the acute phase. CONCLUSIONS Takotsubo syndrome, though considered primarily a disease of the myocardium, carries multiple arrhythmic manifestations that affect short- and long-term prognosis. The management of such arrhythmias represents a constantly evolving area of research.
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Affiliation(s)
- Y Koh
- Department of Cardiology, Western Health, Melbourne, Vic, Australia.
| | - A Voskoboinik
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
| | - C Neil
- Department of Cardiology, Western Health, Melbourne, Vic, Australia
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Hawson J, Anderson RD, Al-Kaisey A, Chieng D, Segan L, Watts T, Campbell T, Morton J, McLellan A, Kistler P, Voskoboinik A, Pathik B, Kumar S, Kalman J, Lee G. Functional Assessment of Ventricular Tachycardia Circuits and Their Underlying Substrate Using Automated Conduction Velocity Mapping. JACC Clin Electrophysiol 2022; 8:480-494. [PMID: 35450603 DOI: 10.1016/j.jacep.2021.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/03/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to describe the utility of automated conduction velocity mapping (ACVM) in ventricular tachycardia (VT) ablation. BACKGROUND Identification of areas of slowed conduction velocity (CV) is critical to our understanding of VT circuits and their underlying substrate. Recently, an ACVM called Coherent Mapping (Biosense Webster Inc) has been developed for atrial mapping. However, its utility in VT mapping has not been described. METHODS Patients with paired high-density VT activation and substrate maps were included. ACVM was applied to paired VT activation and substrate maps to assess regional CV and activation patterns. A combination of ACVM, traditional local activation time maps, electrogram analysis, and off-line calculated CV using triangulation were used to characterize zones of slowed conduction during VT and in substrate mapping. RESULTS Fifteen patients were included in the study. In all cases, ACVM identified slow CV within the putative VT isthmus, which colocalized to the VT isthmus identified with entrainment. The dimensions of the VT isthmus with local activation time mapping were 37.8 ± 13.7 mm long and 8.7 ± 4.2 mm wide. In comparison, ACVM produced an isthmus that was shorter (length: 25.1 ± 10.6 mm; mean difference: 12.8; 95% CI: 7.5-18.0; P < 0.01) and wider (width: 18.8 ± 8.1 mm; mean difference: 10.1; 95% CI: 6.1-14.2; P < 0.01). In VT, the CV using triangulation at the entrance (8.0 ± 3.6 cm/s) and midisthmus (8.1 ± 4.3 cm/s) was not significantly different (P = 0.92) but was significantly faster at the exit (16.2 ± 9.7 cm/s; P < 0.01). In the paired substrate analysis, traditional local activation time isochronal mapping identified 6.3 ± 2.0 deceleration zones. In contrast, ACVM identified a median of 0 deceleration zones (IQR: 0-1; P < 0.01). CONCLUSIONS ACVM is a novel complementary tool that can be used to accurately resolve complex VT circuits and identify slow conduction zones in VT but has limited accuracy in identifying slowed conduction during substrate-based mapping.
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Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - David Chieng
- Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Louise Segan
- Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Timothy Campbell
- Faculty of Medicine and Health, Western Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alexander McLellan
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Aleksander Voskoboinik
- Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bhupesh Pathik
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Faculty of Medicine and Health, Western Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
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Chieng D, Sugumar H, Segan L, Al-Kaisey A, Moore BM, Nam MCY, Prabhu S, Voskoboinik A, Ling LH, Kalman JM, Kistler PM. High power short duration (HPSD) versus lower power longer duration (LPLD) atrial fibrillation ablation: a multi-centre randomised controlled trial (HiLo-HEAT study). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Lower power (25W) longer duration (LPLD) radiofrequency (RF) ablation has conventionally been used on the posterior wall during pulmonary vein isolation (PVI) for atrial fibrillation (AF), to attenuate the risk of esophageal thermal injury (ETI). High power (40-50 W) short duration (HPSD) RF ablation results in shorter procedural times with no increase in ETI. However evidence had been limited by non-randomised studies.
Purpose
To compare HPSD versus LPLD ablation and the effects on esophageal thermal injury (ETI) and procedural outcomes.
Methods
In this multi-centre, prospective, randomised control trial, 88 patients with paroxysmal/persistent AF undergoing their first RF ablation procedure were randomised 1:1 to HPSD or LPLD ablation. Anterior wall ablation was done in both arms using 40-50 W, with ablation target of AI 500-500/ LSI 5-5.5. Posterior wall ablation was done using 40-50W (HPSD group) versus 25 W (LPLD group), with target AI 400/ LSI 4. Ablation involves wide antral circumferential PVI using contact force sensing ablation catheters, with additional ablation lines as per operator discretion. Circa multi-sensor esophageal temperature monitoring (ETM) probe was utilized. Endoscopy was performed within 24 hours to assess for ETI. The primary outcome was incidence of ETI, with secondary outcomes including acute procedural endpoints.
Results
Mean age of the cohort was 61+/-9 years, with 31% females. 36 (41%) had PAF. PVI was achieved in 100% of patients, with posterior wall isolation (PWI) added in 19 PsAF patients (21.6%). There were more hypertensive patients in HPSD (p = 0.02). Significant esophageal luminal temperature rises (≥ 38 c) were seen in 93.2% of patients, with no difference between groups (p = 0.69). First pass isolation rates for left and right PVs were 85% and 61% respectively, with similar rates in both groups (p = 0.37, p = 0.65 respectively). HPSD group had shorter RF time (1613 vs 2303 secs, p <0.04), and fluoroscopy times (11.4 vs 13.1 mins, p = 0.05). Procedural times were lower in HPSD, although not significant (133.7 vs 150.8 mins, p = 0.10). Post ablation endoscopy showed 4 cases of ETI (4.5%), with equal occurrence in HPSD and LPLD (p = 1.0). All ETIs were class 2a (superficial ulcer), and treated with PPI therapy. Esophageal injuries not attributable to RF ablation occurred in 9 (10%), with no difference between groups (p = 0.29). There was no difference in AF recurrence between the 2 groups (post 3 months blanking period) after a mean follow up of 6.3 months (p = 0.71).
Conclusion
HPSD ablation was associated with lower RF ablation and fluoroscopy times compared to LPSD, with comparably low rates of ETI on post ablation endoscopy. Our findings suggest that HPSD ablation is a safe and efficacious approach to PVI. However clinicians should be cognisant of the potential injury risk related to esophageal instrumentation from transesophageal echo/ ETM probes.
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Affiliation(s)
- D Chieng
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - H Sugumar
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L Segan
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Al-Kaisey
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - B M Moore
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - M C Y Nam
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - S Prabhu
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A Voskoboinik
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L H Ling
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J M Kalman
- Royal Melbourne Hospital, Cardiology, Melbourne, Australia
| | - P M Kistler
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Al-Kaisey A, Parameswaran R, Anderson R, Chieng D, Hawson J, Voskoboinik A, Sugumar H, Wong G, West D, Azzopardi S, Joseph S, McLellan A, Ling L, Bryant C, Finch S, Sanders P, Lee G, Kistler P, Kalman J. Randomised Evaluation of the Impact of Catheter Ablation on Cognitive Function in Atrial Fibrillation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Segan L, Chieng D, Lee G, Sugumar H, Voskoboinik A, Ling L, Morton J, Kalman J, Kistler P, Prabhu S. The Impact of Atrial Scarring on AF Recurrence and LV Recovery in AF-Mediated Cardiomyopathy. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Chieng D, Segan L, Sugumar H, Al-Kaisey A, Hawson J, Moore B, Nam M, Voskoboinik A, Prabhu S, Ling L, Ng J, Brown G, Lee G, Morton J, Debinski H, Kalman J, Kistler P. High Power Short Duration (HPSD) is Safe and Improves Outcomes for Atrial Fibrillation Ablation vs Lower Power Longer Duration (LPLD): A Prospective Multi-Centre Randomised Controlled Study (Hi-Lo HEAT trial). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Jumaah H, Kistler P, Mariani J, Patel H, Hare J, Kaye D, Taylor A, Voskoboinik A. Cardiac MRI Findings in Patients presenting With Advanced Conduction System Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Chieng D, Canovas R, Segan L, Sugumar H, Voskoboinik A, Prabhu S, Ling L, Lee G, Morton J, Kaye D, Kalman J, Kistler P. Effects of Habitual Coffee Consumption on Incident Cardiovascular Disease, Arrhythmia, and Mortality: Long Term Outcomes From the UK Biobank. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chieng D, Kistler P, Canovas R, Kaye D, Morton J, Lee G, Ling L, Prabhu S, Voskoboinik A, Sugumar H, Segan L, Kalman J. Regular Coffee Intake Is Safe and Associated With Improved Mortality in Prevalent Cardiovascular Disease and /or Arrhythmia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Sugumar H, Voskoboinik A, Ling L, Morton J, Lee G, Kalman J, Kistler P. Development and Validation of the HARMS2-AF Lifestyle Risk Score to Predict Incident AF. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chieng D, Sugumar H, Segan L, Tan C, Vizi D, Al-Kaisey A, Hawson J, Prabhu S, Voskoboinik A, Morton J, Lee G, Mariani J, Le Gerche A, Kistler P, Kalman J, Kaye D, Ling L. Catheter Ablation in Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction Improves Peak Pulmonary Capillary Wedge Pressure, Exercise Capacity and Quality of Life. A Prospective Randomised Controlled Trial (RCT-STALL HFpEF). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Ling L, Voskoboinik A, Sugumar H, Lee G, Morton J, Kalman J, Kistler P. Development of an AF Lifestyle Score for Risk Prediction in Incident AF. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shirwaiker A, William J, Mariani J, Kistler P, Patel H, Voskoboinik A. Long-term implications of pacemaker insertion in younger adults: a single centre experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The long-term implications of pacemaker insertion in younger adults are poorly described in the literature.
Methods
We performed a retrospective analysis of consecutive younger adult patients (18–50 years) undergoing pacemaker implantation at a quaternary hospital between 1986–2020. Defibrillators and cardiac resynchronisation therapy devices were excluded. All clinical records, pacemaker checks and echocardiograms were reviewed.
Results
81 patients (39.5±9.6 years, 53% male) underwent pacemaker implantation. Indications were complete heart block (41%), sinus node dysfunction (33%), high grade AV block (11%) and tachycardia-bradycardia syndrome (7%). During a median 7.6 (IQR=0.6–14.8) years follow-up, 9 patients (11%) developed 13 late device-related complications (generator or lead malfunction requiring reoperation (n=11), device infection (n=1) and pocket revision (n=1)). Five of these patients were <40 years old at time of pacemaker insertion. At long-term follow-up, a further 9 patients (11%) experienced significant symptoms from inadequate lead performance managed with device reprogramming. Sustained ventricular tachycardia was detected in 2 patients (2%). Deterioration in ventricular function (LVEF decline >10%) was observed in 14 patients (17%) and 7 of these patients required subsequent biventricular upgrade. Furthermore, 4 patients (5%) developed new tricuspid regurgitation (≥ moderate-severe). Of 69 patients with available long-term pacing data, minimal pacemaker utilisation (pacing <5% at all checks) was observed in 13 (19%) patients.
Conclusions
Pacemaker insertion in younger adults has significant long-term implications. Clinicians should carefully consider pacemaker insertion in this cohort given risk of device-related complications, potential for device under-utilisation and issues related to lead longevity. In addition, patients require close follow-up for development of structural abnormalities and arrhythmias.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shirwaiker
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - J William
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - J Mariani
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - P Kistler
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - H Patel
- The Alfred Hospital, Heart Centre, Melbourne, Australia
| | - A Voskoboinik
- The Alfred Hospital, Heart Centre, Melbourne, Australia
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Block T, Paratz E, La Gerche A, Stub D, Strathmore N, Mond H, Kistler P, Kalman J, Burke M, Voskoboinik A. Unearthing the evidence: post-mortem interrogation of cardiac implantable electronic devices. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnostic yield of post-mortem interrogation of cardiac implantable electronic devices (CIEDs) including pacemakers, defibrillators and implantable loop recorders has not been well described.
Methods
We reviewed all post-mortem CIED interrogations performed by our statewide Institute of Forensic Medicine between 2005–2020 for investigation of sudden or unexplained death.
Results
260 patients (68.8% male, median age 72.8 years [IQR 62.7–82.2]) underwent post-mortem CIED interrogation (202 pacemakers, 56 defibrillators and 2 loop recorders). CIEDs were implanted for a median of 2.0 [IQR 0.75–5] years, with 19 devices requiring replacement (and 5 end of life). Post-mortem interrogation was successful in 256 (98.5%) cases. Potential CIED malfunction was identified in 21 (8.1%) cases: untreated ventricular arrhythmias (n=13), lead failures (n=3) and battery depletion (n=5). CIED interrogation directly informed cause of death in 130 (50.0%) cases, with fatal ventricular arrhythmias identified in 121 patients (46.5%). In retrospect, 72 (27.7%) patients had abnormalities recorded by their device in the 30 days preceding death: non-sustained ventricular tachycardia (n=26), rapid atrial fibrillation (n=17), longevity concerns (n=22), intrathoracic impedance alarms (n=3), lead issues (n=3) or therapy delivered (n=1). In 6 cases where the patient was found deceased after a prolonged time, CIED interrogation accurately determined time of death. In one case, CIED interrogation was the primary method of patient identification.
Conclusion
Post-mortem CIED interrogation frequently contributes important information regarding critical device malfunction, pre-mortem abnormalities, cause and time of death or patient identity. Device interrogation should be considered for select patients with CIEDs undergoing autopsy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Block
- Austin Hospital, Melbourne, Australia
| | - E Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - D Stub
- The Alfred Hospital, Melbourne, Australia
| | | | - H Mond
- Royal Melbourne Hospital, Melbourne, Australia
| | - P Kistler
- The Alfred Hospital, Melbourne, Australia
| | - J Kalman
- Royal Melbourne Hospital, Melbourne, Australia
| | - M Burke
- Victorian Institute of Forensic Medicine, Melbourne, Australia
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Xiao X, Joseph S, Mariani J, Kalman J, Kistler P, Voskoboinik A. Predictors of Subsequent Pacemaker Requirement in Patients with Loop Recorders Inserted for Syncope. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Koh Y, Kwok C, Voskoboinik A, Wong M. Selective Serotonin/Noradrenaline Inhibitors and Atrial Fibrillation on Cardiac Devices: The SAF-Device Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Block T, Paratz E, La Gerche A, Stub D, Strathmore N, Mond H, Kistler P, Kalman J, Burke M, Voskoboinik A. Unearthing the Evidence: Post-Mortem Interrogation of Cardiac Implantable Electronic Devices. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Kistler P, Chieng D, Tonchev I, Sugumar H, McLellan A, Prabhu S, Voskoboinik A, Schwartz L, Parameswaran R, Anderson R, Al-Kaisey A, Ling L, Lee G, Kalman J. P-wave Morphology in Focal Atrial Tachycardia: An Updated 2021 Algorithm to Predict Site of Origin. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Shirwaiker A, William J, Mariani J, Kistler P, Patel H, Voskoboinik A. Long-term Implications of Pacemaker Insertion in Younger Adults: A Single Centre Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Chieng D, Sugumar H, Kaye D, Azzopardi S, Vizi D, Rossi E, Voskoboinik A, Prabhu S, Ling L, Lee G, Kalman J, Kistler P. Prone and Supine 12 Lead Electrocardiography Comparisons: Utility of the Prone ECG for the Detection of Cardiac Conditions in Patients Requiring Prone Ventilation with COVID-19. Heart Lung Circ 2021. [PMCID: PMC8324102 DOI: 10.1016/j.hlc.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Nalliah C, Wong G, Lee G, Voskoboinik A, Kee K, Goldin J, Watts T, Linz D, Parameswaren R, Sugumar H, Prabhu S, McLellan A, Ling H, Joseph S, Morton J, Kistler P, Sanders P, Kalman J. 005 Impact of Continuous Positive Airway Pressure on the Atrial Substrate in Patients With Obstructive Sleep Apnoea and Atrial Fibrillation: The SLEEP-AF Substrate Sub-Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kistler P, Chieng D, Sugumar H, Prabhu S, Voskoboinik A, McLellan A, Ling H, Lee G, Kalman J. 241 P Wave Morphology in Focal Atrial Tachycardia: An Updated 2020 Algorithm to Predict site of Origin. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong G, Nalliah C, Lee G, Voskoboinik A, Prabhu S, Parameswaran R, Sugumar H, Anderson R, Al-Kaisey A, McLellan A, Ling L, Sanders P, Kistler P, Kalman J. 029 Gender Differences in Atrial Remodelling in Atrial Fibrillation: Relationship to Ablation Outcomes. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong G, Nalliah C, Lee G, Voskoboinik A, Prabhu S, Parameswaran R, Sugumar H, Al-Kaisey A, Anderson R, McLellan A, Ling L, Morris G, Sanders P, Kistler P, Kalman J. 255 Sinus Node Remodelling in Atrial Fibrillation: Insights from High Density Mapping. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Voskoboinik A, Kalman J, Nicholls T, Nanayakkara S, Wong G, Prabhu S, Nalliah C, Sugumar H, Stub D, Kaye D, Wong M, Kotschet E, Taylor A, Kistler P. Alcohol Abstinence in Moderate Drinkers with Atrial Fibrillation: Results from the Alcohol-AF Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong G, Nalliah C, Voskoboinik A, Lee G, Prabhu S, Sugumar H, Parameswaran R, Anderson R, McLellan A, Ling L, Morton J, Johnson R, Kistler P, Fatkin D, Kalman J. Genetic Susceptibility to Atrial Fibrillation at the chr 4q25 Locus is Associated with Left Atrial Electrical Remodelling. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Anderson R, Kumar S, Parameswaran R, Wong G, Voskoboinik A, Sugumar H, Watts T, Sparks P, Morton J, McLellan A, Kistler P, Kalman J, Lee G. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias – A Review of “Classical” ECG Signatures and Prediction Algorithms. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Costello BT, Voskoboinik A, Qadri AM, La Gerche AM, Hare J, Rudman M, Thompson M, Kistler P, Taylor AJ. P875Atrial stasis measured by cardiac magnetic resonance 4D flow particle tracing is present during sinus rhythm in patients with paroxysmal atrial fibrillation and is associated with higher stroke risk. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B T Costello
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Voskoboinik
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A M Qadri
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A M La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J Hare
- The Alfred Hospital, Melbourne, Australia
| | - M Rudman
- Monash University, Melbourne, Australia
| | | | - P Kistler
- The Alfred Hospital, Melbourne, Australia
| | - A J Taylor
- The Alfred Hospital, Melbourne, Australia
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Anderson R, Ling L, Lee G, Morton J, Kistler P, Kalman J. Gender-Based Differences in High-Density Electroanatomic Mapping: More Advanced Atrial Remodelling in Females with Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Costello B, Voskoboinik A, Qadri M, Hare J, La Gerche A, Thompson M, Rudman M, Kistler P, Taylor A. Atrial Stasis Measured by Cardiac Magnetic Resonance 4D Flow Particle Tracing is Present During Sinus Rhythm in Patients with Paroxysmal Atrial Fibrillation, and is Associated with Higher Cardio-Embolic Risk. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Anderson R, Ling L, Lee G, Morton J, Kistler P, Sanders P, Kalman J. Greater Regional Left Atrial Complex Fractionated Potentials in Obese Patients with Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wong G, Nalliah C, Voskoboinik A, Parameswaran R, Prabhu S, Pathik B, Sugumar H, Ling L, Anderson R, Lee G, Morton J, Kistler P, Kalman J. Incremental Pacing Identifies Target Atrial Substrate in Paroxysmal and Persistent Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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37
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Voskoboinik A, Costello B, Kalman E, Prabhu S, Sugumar H, Ling L, Wong G, Nalliah C, Mclellan A, Laerche A G, Taylor A, Kalman J, Kistler P. Regular Alcohol Consumption is Associated with Impaired Atrial Mechanical Function in the Atrial Fibrillation Population: A Prospective Magnetic Resonance Imaging-Based Study. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Nalliah C, Wong G, Parameswaran R, Voskoboinik A, Wirth D, Pathik B, Prabhu S, Morton J, Goldin J, Lee G, Kee K, Ling H, McLellan A, Joseph S, Kistler P, Sanders P, Kalman J. High-Density Mapping of the Substrate for Atrial Fibrillation in Obstructive Sleep Apnoea: Implications for the Crista Terminalis and Posterior Right Atrium. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nalliah C, Wong G, Parameswaran R, Voskoboinik A, Pathik B, Prabhu S, Morton J, Lee G, Joseph S, Ling H, McLellan A, Kistler P, Sanders P, Kalman J. The Crista Terminalis: A Site of Localised Re-Entry in Persistent Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nalliah C, Wong G, Parameswaran R, Voskoboinik A, Pathik B, Prabhu S, Wirth D, Morton J, Goldin J, Lee G, Kee K, Ling H, McLellan A, Kistler P, Sanders P, Kalman J. High-Density Mapping of the Substrate for Atrial Fibrillation in Obstructive Sleep Apnoea: Relationship with Atrial Fibrillation Phenotype. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Nalliah C, Wirth D, Wong G, Voskoboinik A, Prabhu S, Pathik B, Morton J, Lee G, Joseph S, Ling H, Goldin J, Kee K, McLellan A, Kistler P, Sanders P, Kalman J. Prevalence of Obstructive Sleep Aponea in Atrial Fibrillation Ablation Patients: Relationship with the Atrial Fibrillation Phenotype. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Voskoboinik A, Moskovitch J, Plunkett G, Prabhu S, Wong G, Bloom J, Nalliah C, Sugumar H, Parameswaran R, Mclellan A, Ling L, Goh C, Noaman S, Fernando H, Wong M, Taylor A, Kalman J, Kistler P. Hand-Held Paddles More Effective than Adhesive Patches for Cardioversion of Atrial Fibrillation in Obese Patients: Results from the DCR-BMI Multicenter Randomised Controlled Trial. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Moskovitch J, Voskoboinik A, Kistler P. Predictors of Failed Elective Direct Current Cardioversion. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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44
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Sugumar H, Voskoboinik A, Morton J, Kalman J, Kistler P. Recurrent Atrial Fibrillation in the Presence of Enduring Pulmonary Vein Isolation is Associated with Poorer Outcomes Compared with Pulmonary Vein Reconnection at Repeat Catheter Ablation: Long-Term Multi–Procedural Outcomes for Persistent Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Voskoboinik A, Kalman E, Wong G, Nalliah C, Prabhu S, Ling L, Kistler P. Modest Alcohol Consumption is Associated with Significant Left Atrial Conduction Slowing. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Wirth D, Nalliah C, Wong G, Voskoboinik A, Pathik B, Prabhu S, Morton J, Lee G, Joseph S, Ling H, Goldin J, Kee K, Kistler P, Sanders P, Kalman J. Obstructive Sleep Apnoea in Patients Having Atrial Fibrillation Ablation: Prevalence, Severity and Association with Arrhythmia Phenotype. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Prabhu S, Costello B, Voskoboinik A, Mclellan A, Peck K, Pathik B, Nalliah C, Wong G, Azzopardi S, Lee G, Gutman S, Mariani J, Ling L, Taylor A, Kalman J, Kistler P. Ventricular Fibrosis Improves Following AF Ablation in Patients with Persistent AF and Heart Failure. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Toner L, Voskoboinik A, Spencer R, Ord M, Teh A, Liam H, O’Donnell D. Heart Failure with Preserved Ejection Fraction–Association of Diastolic Dysfunction and Left Bundle Branch Block. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Prabhu S, McLellan A, Voskoboinik A, Peck K, Pathik B, Nalliah C, Wong G, Mariani J, Lee G, Ling L, Taylor A, Kalman J, Kistler P. Pulmonary Vein Activity in Systolic Heart Failure and Persistent Atrial Fibrillation. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Voskoboinik A, Kalman E, Costello B, La Gerche A, Springer F, Prabhu S, Wong G, Nalliah C, Taylor A, Kistler P. Modest Alcohol Consumption is Associated with Atrial Myopathy: A Prospective MRI-Based Study. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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