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Jiang R, Cheung CC, Garcia-Montero M, Davies B, Cao J, Redfearn D, Laksman ZM, Grondin S, Atallah J, Escudero CA, Cadrin-Tourigny J, Sanatani S, Steinberg C, Joza J, Avram R, Tadros R, Krahn AD. Deep Learning-Augmented ECG Analysis for Screening and Genotype Prediction of Congenital Long QT Syndrome. JAMA Cardiol 2024; 9:377-384. [PMID: 38446445 PMCID: PMC10918571 DOI: 10.1001/jamacardio.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
Importance Congenital long QT syndrome (LQTS) is associated with syncope, ventricular arrhythmias, and sudden death. Half of patients with LQTS have a normal or borderline-normal QT interval despite LQTS often being detected by QT prolongation on resting electrocardiography (ECG). Objective To develop a deep learning-based neural network for identification of LQTS and differentiation of genotypes (LQTS1 and LQTS2) using 12-lead ECG. Design, Setting, and Participants This diagnostic accuracy study used ECGs from patients with suspected inherited arrhythmia enrolled in the Hearts in Rhythm Organization Registry (HiRO) from August 2012 to December 2021. The internal dataset was derived at 2 sites and an external validation dataset at 4 sites within the HiRO Registry; an additional cross-sectional validation dataset was from the Montreal Heart Institute. The cohort with LQTS included probands and relatives with pathogenic or likely pathogenic variants in KCNQ1 or KCNH2 genes with normal or prolonged corrected QT (QTc) intervals. Exposures Convolutional neural network (CNN) discrimination between LQTS1, LQTS2, and negative genetic test results. Main Outcomes and Measures The main outcomes were area under the curve (AUC), F1 scores, and sensitivity for detecting LQTS and differentiating genotypes using a CNN method compared with QTc-based detection. Results A total of 4521 ECGs from 990 patients (mean [SD] age, 42 [18] years; 589 [59.5%] female) were analyzed. External validation within the national registry (101 patients) demonstrated the CNN's high diagnostic capacity for LQTS detection (AUC, 0.93; 95% CI, 0.89-0.96) and genotype differentiation (AUC, 0.91; 95% CI, 0.86-0.96). This surpassed expert-measured QTc intervals in detecting LQTS (F1 score, 0.84 [95% CI, 0.78-0.90] vs 0.22 [95% CI, 0.13-0.31]; sensitivity, 0.90 [95% CI, 0.86-0.94] vs 0.36 [95% CI, 0.23-0.47]), including in patients with normal or borderline QTc intervals (F1 score, 0.70 [95% CI, 0.40-1.00]; sensitivity, 0.78 [95% CI, 0.53-0.95]). In further validation in a cross-sectional cohort (406 patients) of high-risk patients and genotype-negative controls, the CNN detected LQTS with an AUC of 0.81 (95% CI, 0.80-0.85), which was better than QTc interval-based detection (AUC, 0.74; 95% CI, 0.69-0.78). Conclusions and Relevance The deep learning model improved detection of congenital LQTS from resting ECGs and allowed for differentiation between the 2 most common genetic subtypes. Broader validation over an unselected general population may support application of this model to patients with suspected LQTS.
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Affiliation(s)
- River Jiang
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Marta Garcia-Montero
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Cao
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Zachary M. Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steffany Grondin
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Julia Cadrin-Tourigny
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Shubhayan Sanatani
- Children’s Heart Centre, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Avram
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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El-Sherbini AH, Shah A, Cheng R, Elsebaie A, Harby AA, Redfearn D, El-Diasty M. Machine Learning for Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Scoping Review of Current Literature. Am J Cardiol 2023; 209:66-75. [PMID: 37871512 DOI: 10.1016/j.amjcard.2023.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
Postoperative atrial fibrillation (POAF) occurs in up to 20% to 55% of patients who underwent cardiac surgery. Machine learning (ML) has been increasingly employed in monitoring, screening, and identifying different cardiovascular clinical conditions. It was proposed that ML may be a useful tool for predicting POAF after cardiac surgery. An electronic database search was conducted on Medline, EMBASE, Cochrane, Google Scholar, and ClinicalTrials.gov to identify primary studies that investigated the role of ML in predicting POAF after cardiac surgery. A total of 5,955 citations were subjected to title and abstract screening, and ultimately 5 studies were included. The reported incidence of POAF ranged from 21.5% to 37.1%. The studied ML models included: deep learning, decision trees, logistic regression, support vector machines, gradient boosting decision tree, gradient-boosted machine, K-nearest neighbors, neural network, and random forest models. The sensitivity of the reported ML models ranged from 0.22 to 0.91, the specificity from 0.64 to 0.84, and the area under the receiver operating characteristic curve from 0.67 to 0.94. Age, gender, left atrial diameter, glomerular filtration rate, and duration of mechanical ventilation were significant clinical risk factors for POAF. Limited evidence suggest that machine learning models may play a role in predicting atrial fibrillation after cardiac surgery because of their ability to detect different patterns of correlations and the incorporation of several demographic and clinical variables. However, the heterogeneity of the included studies and the lack of external validation are the most important limitations against the routine incorporation of these models in routine practice. Artificial intelligence, cardiac surgery, decision tree, deep learning, gradient-boosted machine, gradient boosting decision tree, k-nearest neighbors, logistic regression, machine learning, neural network, postoperative atrial fibrillation, postoperative complications, random forest, risk scores, scoping review, support vector machine.
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Affiliation(s)
| | - Aryan Shah
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Richard Cheng
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Ahmed A Harby
- The School of Computing, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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3
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de Leon A, Hanson M, Alhammad N, Bakker D, Chacko S, Simpson C, Abdollah H, Baranchuk A, Redfearn D, Glover B, Enriquez A, Neira V. Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation. CJC Open 2023; 5:965-970. [PMID: 38204850 PMCID: PMC10774089 DOI: 10.1016/j.cjco.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024] Open
Abstract
Background Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation. Methods Sixty patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops, and recurrence of AFL during follow-up. Results Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5 ± 8.2 years, 20% were female, and 32% had atrial fibrillation before being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4 ± 4.4 minutes vs 7.6 ± 4.5 minutes, respectively; P = 0.15). There was a trend to less acute reconnection in the HNS group compared with NS (13.3% vs 26.6%; P = 0.46). Steam pops occurred in 4 patients using HNS vs none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS; P = 0.5). There was no difference in time to recurrence (7.6 ± 6.9 vs 4.9 ± 4.5 months; P = 0.6). Conclusions In this small pilot randomized controlled trial, there was no significant difference between HNS and NS for CTI ablation; however, HNS may increase the incidence of steam pops.
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Affiliation(s)
- Ana de Leon
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Nasser Alhammad
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - David Bakker
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | | | - Hoshiar Abdollah
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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4
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Han HC, Wang J, Birnie DH, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Healey JS, Redfearn D, Toal S, Becker G, DeGrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Gervais P, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Longtin Y, Krahn AD. Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality. JAMA Cardiol 2023; 8:484-491. [PMID: 37017943 PMCID: PMC10077129 DOI: 10.1001/jamacardio.2023.0467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/06/2023] [Indexed: 04/06/2023]
Abstract
Importance Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established. Objective To evaluate the association of the extent and timing of CIED infection with all-cause mortality. Design, Setting, and Participants This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023. Exposures Prospectively identified CIED infections. Main Outcomes and Measures Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections. Results Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001). Conclusions and Relevance Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.
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Affiliation(s)
- Hui-Chen Han
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David H. Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marco Alings
- Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research the Netherlands (WCN), Breda, the Netherlands
| | - François Philippon
- Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- Division of Cardiology, St Mary’s General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R. Aaron Low
- Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Carlos Morillo
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey S. Healey
- Division of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Satish Toal
- Division of Cardiology, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel DeGrâce
- Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Montreal, Quebec, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- Division of Cardiology, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Montreal, Quebec, Canada
| | - Philippe Gervais
- Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Leon Rioux
- Division of Cardiology, Centre Intégré de Sante et Service Sociaux du Bas-Laurent (CISSSBSL), Rimouski, Montreal, Quebec, Canada
| | - Martin E. W. Hemels
- Division of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
- Division of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leon H. R. Bouwels
- Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Derek V. Exner
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Enriquez A, Korogyi A, Bakker D, Chacko S, Neira V, Simpson C, Abdollah H, Baranchuk A, Redfearn D. Late, Slow, or Decremental: Elucidating the Ideal Surrogate for Ventricular Tachycardia Isthmus. JACC Clin Electrophysiol 2023; 9:280-282. [PMID: 36858702 DOI: 10.1016/j.jacep.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
| | - Adam Korogyi
- Abbott Laboratories, Mississauga, Ontario, Canada
| | - David Bakker
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Hoshiar Abdollah
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Nery PB, Wells GA, Verma A, Joza J, Nair GM, Veenhuyzen G, Andrade J, Nault I, Wong JA, Sikkel M, Essebag V, Macle L, Sapp J, Roux JF, Skanes A, Angaran P, Novak P, Redfearn D, Golian M, Redpath CJ, Sturmer M, Birnie D. Characterization of arrhythmia substrate to ablate persistent atrial fibrillation (COAST-AF): Randomized controlled trial design and rationale. Am Heart J 2022; 254:133-140. [PMID: 36030965 DOI: 10.1016/j.ahj.2022.08.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atrial low voltage area (LVA) catheter ablation has emerged as a promising strategy for ablation of persistent atrial fibrillation (AF). It is unclear if catheter ablation of atrial LVA increases treatment success rates in patients with persistent AF. OBJECTIVE The primary aim of this trial is to assess the potential benefit of adjunctive catheter ablation of atrial LVA in addition to pulmonary vein isolation (PVI) in patients with persistent AF, when compared to PVI alone. The secondary aims are to evaluate safety outcomes, the quality of life and the healthcare resource utilization. METHODS/DESIGN A multicenter, prospective, parallel-group, 2-arm, single-blinded randomized controlled trial is under way (NCT03347227). Patients who are candidates for catheter ablation for persistent AF will be randomly assigned (1:1) to either PVI alone or PVI + atrial LVA ablation. The primary outcome is 18-month documented event rate of atrial arrhythmia (AF, atrial tachycardia or atrial flutter) post catheter ablation. Secondary outcomes include procedure-related complications, freedom from atrial arrhythmia at 12 months, AF burden, need for emergency department visits/hospitalization, need for repeat ablation for atrial arrhythmia, quality of life at 12 and 18 months, ablation time, and procedure duration. DISCUSSION Characterization of Arrhythmia Mechanism to Ablate Atrial Fibrillation (COAST-AF) is a multicenter randomized trial evaluating ablation strategies for catheter ablation. We hypothesize that catheter ablation of atrial LVA in addition to PVI will result in higher procedural success rates when compared to PVI alone in patients with persistent AF.
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Affiliation(s)
- Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada..
| | - George A Wells
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Canada
| | - Atul Verma
- McGill University Health Center, Montreal, Quebec, Canada
| | | | - Girish M Nair
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - George Veenhuyzen
- Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Jason Andrade
- Vancouver General Hospital, University of British Columbia,Vancouver, Canada
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada
| | - Jorge A Wong
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Markus Sikkel
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada; Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada
| | | | - John Sapp
- Queen Elizabeth II Health Sciences, Halifax, Nova Scotia, Canada
| | | | - Allan Skanes
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Novak
- Victoria Cardiac Arrhythmia Trials, Victoria, British Columbia, Canada
| | | | - Mehrdad Golian
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Calum J Redpath
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - Marcio Sturmer
- Hôpital Sacré-Cœur, Université de Montréal, Montréal, Québec, Canada
| | - David Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
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7
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Alexander B, Foisy M, Abdollah H, Chacko S, Enriquez A, Redfearn D, Simpson C, Baranchuk A. DEACTIVATION OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS AT DISTANCE FOR THE DIGNITY OF DYING (THE 4D STUDY). Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.080] [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] Open
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8
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de Leon A, Neira V, Alhammad N, Hopman W, Hansom S, Chacko S, Simpson C, Redfearn D, Abdollah H, Arauz A, Baranchuk A, Enriquez A. Electrocardiographic predictors of atrial fibrillation in patients with cryptogenic stroke. Pacing Clin Electrophysiol 2021; 45:176-181. [PMID: 34862978 DOI: 10.1111/pace.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Empiric anticoagulation is not routinely indicated in patients with cryptogenic stroke without documentation of atrial fibrillation (AF). Therefore, identification of patients at increased risk of AF from this vulnerable group is vital. OBJECTIVES To identify electrocardiographic (ECG) predictors of AF in patients with cryptogenic stroke or transient ischemic attack (TIA) undergoing insertion of an implantable cardiac monitor (ICM). METHODS In this single-center study, 48 patients with cryptogenic stroke or TIA had an ICM implanted for detection of AF between January 2013 and September 2019. Patients with and without AF were compared in terms of p-wave duration and a novel index (MVP score). RESULTS During a mean follow-up of 16±14 months, AF was detected in 7 patients (15%). Diagnosis of AF was made after a mean of 10 ± 14 months, with time to first AF detection ranging between 1 and 40 months. Patients with AF had a longer p-wave duration (136±9 ms vs 116±10 ms; p = 0.0001) and a higher MVP score (4.5±1.2 vs 2.0±0.9, p = 0.0001) than those without AF. Advanced interatrial block was observed in 43% of patients with ICM evidence of AF and 0% of those without AF (p = 0.002). Age, LA size or LVEF were not predictors of AF. CONCLUSION An increased p-wave duration, advanced interatrial block and high MVP score are associated with AF occurrence in patients with cryptogenic stroke. Identifying patients with these markers may be helpful as they may benefit from more exhaustive and prolonged monitoring. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ana de Leon
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Nasser Alhammad
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Wilma Hopman
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Simon Hansom
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Chris Simpson
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Manuel Velasco Suarez, Mexico
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston Health Science Centre, Ontario, Canada
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Longtin Y, Gervais P, Birnie DH, Wang J, Alings M, Philippon F, Parkash R, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Rioux L, Hemels MEW, Bouwels LHR, Exner DV, Dorian P, Connolly SJ, Krahn AD. Impact of Choice of Prophylaxis on the Microbiology of Cardiac Implantable Electronic Device Infections: Insights From the Prevention of Arrhythmia Device Infection Trial (PADIT). Open Forum Infect Dis 2021; 8:ofab513. [PMID: 34859113 PMCID: PMC8632784 DOI: 10.1093/ofid/ofab513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background The Prevention of Arrhythmia Device Infection Trial (PADIT) investigated whether intensification of perioperative prophylaxis could prevent cardiac implantable electronic device (CIED) infections. Compared with a single dose of cefazolin, the perioperative administration of cefazolin, vancomycin, bacitracin, and cephalexin did not significantly decrease the risk of infection. Our objective was to compare the microbiology of infections between study arms in PADIT. Methods This was a post hoc analysis. Differences between study arms in the microbiology of infections were assessed at the level of individual patients and at the level of microorganisms using the Fisher exact test. Results Overall, 209 microorganisms were reported from 177 patients. The most common microorganisms were coagulase-negative staphylococci (CoNS; 82/209 [39.2%]) and S. aureus (75/209 [35.9%]). There was a significantly lower proportion of CoNS in the incremental arm compared with the standard arm (30.1% vs 46.6%; P = .04). However, there was no significant difference between study arms in the frequency of recovery of other microorganisms. In terms of antimicrobial susceptibility, 26.5% of microorganisms were resistant to cefazolin. CoNS were more likely to be cefazolin-resistant in the incremental arm (52.2% vs 26.8%, respectively; P = .05). However, there was no difference between study arms in terms of infections in which the main pathogen was sensitive to cefazolin (77.8% vs 64.3%; P = .10) or vancomycin (90.8% vs 90.2%; P = .90). Conclusions Intensification of the prophylaxis led to significant changes in the microbiology of infections, despite the absence of a decrease in the overall risk of infections. These findings provide important insight on the physiopathology of CIED infections. Trial registration NCT01002911.
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Affiliation(s)
- Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Philippe Gervais
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marco Alings
- Amphia Ziekenhuis & Working Group on Cardiovascular Research (WCN), Breda, the Netherlands
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Eugene Crystal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Leon Rioux
- Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Ziekenhuis Rijnstate, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
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Chu S, Aamar A, Hale S, Roxas A, Redfearn D. Letter in response to "Polypharmacy is a determinant of hospitalization in Parkinson's disease". Eur Rev Med Pharmacol Sci 2021; 25:5887-5888. [PMID: 34661246 DOI: 10.26355/eurrev_202110_26864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S Chu
- Guy's, King's, and St. Thomas' School of Medical Education, King's College London, UK.
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Hassan S, Paleczny S, Redfearn D, Glover B, Enriquez A, Bisleri G. SIMULTANEOUS HYBRID ABLATION WITH EPI-ENDOCARDIAL MAPPING FOR THE TREATMENT OF LONG STANDING PERSISTENT ATRIAL FIBRILLATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.112] [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] Open
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12
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Enriquez A, Liang J, Smietana J, Muser D, Salazar P, Shah R, Badhwar N, Bogun F, Marchlinski FE, Garcia F, Baranchuk A, Tung R, Redfearn D, Santangeli P. Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study. Circ Arrhythm Electrophysiol 2021; 14:e010006. [PMID: 34315225 DOI: 10.1161/circep.121.010006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Jackson Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Jeffrey Smietana
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Pablo Salazar
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, IL
| | - Rajan Shah
- Section of Cardiac Electrophysiology, Stanford Health Care, Palo Alto, CA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Stanford Health Care, Palo Alto, CA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Roderick Tung
- University of Chicago Pritzker School of Medicine, Center for Arrhythmia Care at the University of Chicago Medicine, Chicago, IL
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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13
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Wang CN, Yeung C, Enriquez A, Chacko S, Hanson S, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Long-term Outcomes in Treated Lyme Carditis. Curr Probl Cardiol 2021; 47:100939. [PMID: 34417033 DOI: 10.1016/j.cpcardiol.2021.100939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
Lyme disease is the most reported tick-borne illness in North America. Lyme carditis (LC) is an early-disseminated manifestation of Lyme disease, most commonly presenting as symptomatic high-degree atrioventricular block (AVB) which resolves with appropriate antibiotic therapy. However, long-term outcomes of treated LC have not previously been described. We present a series of 7 patients (median 28 years, 6 male) with serologically confirmed LC treated with a standard protocol developed at our center including antibiotics and pre-discharge stress test to assess AV node stability. At a mean follow-up of 20.8 months, all patients were asymptomatic, had resumed normal activities, and were free of conduction abnormalities. None required permanent pacing. Our study supports avoidance of permanent pacing for LC if conduction is stable at discharge.
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14
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Hua T, Vlahos A, Shariat MH, Payne D, Redfearn D. Predicting adverse cardiovascular outcomes in post-coronary artery bypass grafting patients using novel ECG frequency analysis of the QRS complex. Ann Noninvasive Electrocardiol 2021; 26:e12822. [PMID: 33754404 PMCID: PMC8293601 DOI: 10.1111/anec.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background A novel metric called Layered Symbolic Decomposition frequency (LSDf) has been shown to be an independent predictor of ventricular arrhythmia and mortality in patients receiving implantable cardioverter‐defibrillator (ICD) devices. This novel index studies the fragmentation of the QRS complex. However, its generalizability to predict cardiovascular events for other cardiac procedures is unknown. Herein, we investigated the applicability of LSDf as a predictive measure for major adverse cardiovascular events (MACE) in patients receiving coronary artery bypass grafting (CABG). Methods and Results One hundred ninety‐five patients had high‐resolution ECG recorded prior to CABG surgery in 2012/2013 and were followed for a mean duration of 7.32 ± 0.32 years for postoperative cardiovascular outcomes. These outcomes were described as a modified composite of MACE defined as hospitalization for heart failure, ventricular tachycardia, ventricular fibrillation, and cardiovascular death including stroke and cardiac arrest. One hundred seventy‐two patients were included for analysis and 18 patients experienced a postoperative cardiovascular outcome. These patients had significantly increased age (71.3 vs. 64.6 years, p = .007), prolonged QRS duration (113.22 vs. 97.35 ms, p = .003), reduced left ventricular ejection fraction (42.7% vs. 56.5%, p < .001), and lower LSDf percent (13.5% vs. 16.9%, p = .002). Patients with an LSDf below 13.25% were 4.8 (OR 1.7–13.5, p < .001) times more likely to experience a MACE and up to 19.4 (OR 4.2–90.3, p < .001) times more likely to experience a MACE when older than 70 years and an ejection fraction below 50%. Conclusion Layered Symbolic Decomposition frequency may be an applicable metric to predict long‐term cardiovascular outcomes in patients with ischemic heart disease.
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Affiliation(s)
- Thalia Hua
- Queen's University, Kingston, ON, Canada
| | | | | | - Darrin Payne
- Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Damian Redfearn
- Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
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15
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Crinion D, Neira V, Al Hamad N, de Leon A, Bakker D, Korogyi A, Abdollah H, Glover B, Simpson C, Baranchuk A, Chacko S, Enriquez A, Redfearn D. Close-coupled pacing to identify the "functional" substrate of ventricular tachycardia: Long-term outcomes of the paced electrogram feature analysis technique. Heart Rhythm 2020; 18:723-731. [PMID: 33378703 DOI: 10.1016/j.hrthm.2020.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The conduction delay and block that compose the critical isthmus of macroreentrant ventricular tachycardia (VT) is partly "functional" in that they only occur at faster cycle lengths. Close-coupled pacing stresses the myocardium's conduction capacity and may reveal late potentials (LPs) and fractionation. Interest has emerged in targeting this functional substrate. OBJECTIVE The purpose of this study was to assess the feasibility and efficacy of a functional substrate VT ablation strategy. METHODS Patients with scar-related VT undergoing their first ablation were recruited. A closely coupled extrastimulus (ventricular effective refractory period + 30 ms) was delivered at the right ventricular apex while mapping with a high-density catheter. Sites of functional impaired conduction exhibited increased electrogram duration due to LPs/fractionation. The time to last deflection was annotated on an electroanatomic map, readily identifying ablation targets. RESULTS A total of 40 patients were recruited (34 [85%] ischemic). Median procedure duration was 330 minutes (interquartile range [IQR] 300-369), and ablation time was 49.4 minutes (IQR 33.8-48.3). Median functional substrate area was 41.9 cm2 (IQR 22.1-73.9). It was similarly distributed across bipolar voltage zones. Noninducibility was achieved in 34 of 40 patients (85%). Median follow-up was 711 days (IQR 255.5-972.8), during which 35 of 39 patients (89.7%) did not have VT recurrence, and 3 of 39 (7.5%) died. Antiarrhythmic drugs were continued in 53.8% (21/39). CONCLUSION Functional substrate ablation resulted in high rates of noninducibility and freedom from VT. Mapping times were increased considerably. Our findings add to the encouraging trend reported by related techniques. Randomized multicenter trials are warranted to assess this next phase of VT ablation.
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Affiliation(s)
- Derek Crinion
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Victor Neira
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Nasser Al Hamad
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Ana de Leon
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - David Bakker
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | | | - Hoshiar Abdollah
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Ben Glover
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Christopher Simpson
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Sanoj Chacko
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Andres Enriquez
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Queen's University, Kingston Health Sciences, Ontario, Canada.
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Crinion D, Al-Turki M, Al Hammad N, Neira V, De Leon A, Abdollah H, Chacko S, Enriquez A, Simpson C, Baranchuk A, Johri A, Redfearn D. Right Atrial Collision Time (RACT): a novel marker of propensity for typical atrial flutter. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0391] [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 risk of typical atrial flutter (AFL) is increased by factors that increase right atrial (RA) size or cause scarring to reduce conduction velocity. These characteristics ensure the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics (being equal to distance divided by velocity), and may provide a superior marker of propensity to develop AFL.
Purpose
To investigate right atrial collision time (RACT) as a marker of typical AFL.
Methods
This single centre, prospective study recruited consecutive typical AFL ablation cases that were in sinus rhythm. Controls were consecutive cases other than atrial fibrillation and >50 years of age. Exclusion criteria for both groups were a prior ablation in the RA and class I and III antiarrhythmics. While pacing the coronary sinus ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral wall, excluding the RA appendage (Figure 1). This RACT approximates half a revolution.
Results
The AFL group's (n=34) mean RACT was 132.5±15.06 vs 98.7±12.23ms in the controls (n=40) (p<0.01). No significant difference was observed for age (mean 65.6 vs 62.6 (p=0.18)), male (68.8% vs 60% (p=0.59)), body surface area (mean 2.1 vs 2.03 m2 (p=0.24)). The RACT also proved to be a superior marker than the echocardiographic measurement of right atrial area in an apical four chamber view (mean 17.8 vs 16.3 cm2 (p=0.21).A ROC curve indicated an AUC of 0.97 (95% CI: 0.93–1.0, p<0.01). A RACT cut-off of 120 ms had a specificity of 99% and a sensitivity of 75%.
Conclusion
RACT is a novel and promising marker of propensity for typical AFL. The ability to predict AFL would be of significant clinical value given the risk of stroke and frequent need for ablation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Crinion
- Queen's University, Kingston, Canada
| | | | | | - V Neira
- Queen's University, Kingston, Canada
| | - A De Leon
- Queen's University, Kingston, Canada
| | | | - S Chacko
- Queen's University, Kingston, Canada
| | | | - C Simpson
- Queen's University, Kingston, Canada
| | | | - A Johri
- Queen's University, Kingston, Canada
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Wang C, Campbell D, Chacko S, Abdollah H, Enriquez A, Simpson C, Redfearn D, Baranchuk A. QUALITY ASSURANCE IN TEMPORARY PERMANENT PACEMAKERS - A SINGLE CENTER EXPERIENCE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.107] [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] Open
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Campbell D, Chacko S, Abdollah H, Eniquez A, Redfearn D, Wang C, Hazell M, Boose L, Murphy K, Stephens J, Bakker D, Joseph P, McQullian C, Baranchuk A. DEALING WITH TEMPORARY PERMANENT PACEMAKERS: OUR JOURNEY TO IMPROVE QUALITY ASSURANCE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.223] [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] Open
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Alexander B, Neira V, Campbell D, Crystal E, Simpson C, Enriquez A, Chacko S, Abdollah H, Redfearn D, Baranchuk A. Implantable Cardioverter-Defibrillator-Cybersecurity. Circ Arrhythm Electrophysiol 2020; 13:e008261. [PMID: 32078370 DOI: 10.1161/circep.119.008261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bryce Alexander
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Debra Campbell
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Eugene Crystal
- Sunnybrook Research Institute (E.C.), Toronto, ON, Canada
| | - Chris Simpson
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston (B.A., V.N., D.C., C.S., A.E., S.C., H.A., D.R.), Toronto, ON, Canada
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Hong K, Bullen M, Redfearn D, Glover B. THE USE OF HALF NORMAL SALINE TO SHORTEN TIME REQUIRED TO ACHIEVE BIDIRECTIONAL BLOCK FOR THE CATHETER ABLATION OF TYPICAL ATRIAL FLUTTER. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.081] [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: 10/25/2022] Open
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21
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Trussler A, Alexander B, Campbell D, Alhammad N, Enriquez A, Chacko S, Garrett T, Simpson C, Redfearn D, Abdollah H, Herx L, Baranchuk A. Deactivation of Implantable Cardioverter Defibrillator in Patients With Terminal Diagnoses. Am J Cardiol 2019; 124:1064-1068. [PMID: 31353003 DOI: 10.1016/j.amjcard.2019.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. However, in patients with terminal illnesses, these devices may disrupt the dying process. This study was undertaken to review our current strategies surrounding device deactivation. A retrospective chart review was performed at Kingston Health Sciences Centre of patients with an ICD who died from 2015 to 2018. Data collected included patient demographics, clinical details surrounding device implantation, patient co-morbidities leading to deactivation, time to deactivation, physical place of deactivation, and device programming information. Ethics approval was obtained from the Queen's University Health Sciences Research Ethics Board. A total of 49 patients were included for analysis. Mean age at the time of death was 77.5 years (range: 57 to 94 years) and 12.2% (6/49) were women. The indications for ICD implantation were primary prevention of sudden cardiac death in 69.4% (34/49) and secondary prevention in 30.6% (15/49). Deactivation as part of end-of-life care was performed in 32.7% of patients (16/49). Deactivations occurred in clinic in 6.1% (3/49) of patients, on hospital inpatient wards in 12.2% (6/49) of patients, and in critical care settings in 14.2% (7/49) of patients. The remaining 67.3% (33/49) of patients died with fully functioning devices in place. The most prevalent terminal diagnoses were metastatic cancer (22.4%) and end-stage congestive heart failure (20.4%). On average, patients had their devices deactivated 13 months (range: 0 to 62 months) after their terminal diagnosis was established. Once a patient was documented as Do Not Resuscitate (DNR), deactivation was discussed and carried out within a mean time of 38 days (range: 0 to 400 days). Seven patients had their device active for more than 1 month after being documented as DNR. Ten patients (20.4%) received ICD shocks after their terminal diagnosis, 9 received shocks in the month before death, and 2 received shocks after formal DNR orders were in place. Approximately one-third of patients with ICDs received deactivation of their cardioversion/defibrillation therapies as part of their end-of-life care plan. A relatively high proportion of patients (20%) received an ICD shock in the last month of life. In conclusion, addressing device programming needs, including deactivation of cardioversion/defibrillation therapies, should be considered in the context of a patient's goals of care in every patient with an ICD who has a co-existing life-limiting diagnosis.
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Affiliation(s)
- Alexander Trussler
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Bryce Alexander
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Nasser Alhammad
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Andrés Enriquez
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Timothy Garrett
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Leonie Herx
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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Affiliation(s)
- Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Bryce Alexander
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Ben Glover
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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Krahn AD, Longtin Y, Philippon F, Birnie DH, Manlucu J, Angaran P, Rinne C, Coutu B, Low RA, Essebag V, Morillo C, Redfearn D, Toal S, Becker G, Degrâce M, Thibault B, Crystal E, Tung S, LeMaitre J, Sultan O, Bennett M, Bashir J, Ayala-Paredes F, Gervais P, Rioux L, Hemels MEW, Bouwels LHR, van Vlies B, Wang J, Exner DV, Dorian P, Parkash R, Alings M, Connolly SJ. Prevention of Arrhythmia Device Infection Trial: The PADIT Trial. J Am Coll Cardiol 2019; 72:3098-3109. [PMID: 30545448 DOI: 10.1016/j.jacc.2018.09.068] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/09/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infection of implanted medical devices has catastrophic consequences. For cardiac rhythm devices, pre-procedural cefazolin is standard prophylaxis but does not protect against methicillin-resistant gram-positive organisms, which are common pathogens in device infections. OBJECTIVE This study tested the clinical effectiveness of incremental perioperative antibiotics to reduce device infection. METHODS The authors performed a cluster randomized crossover trial with 4 randomly assigned 6-month periods, during which centers used either conventional or incremental periprocedural antibiotics for all cardiac implantable electronic device procedures as standard procedure. Conventional treatment was pre-procedural cefazolin infusion. Incremental treatment was pre-procedural cefazolin plus vancomycin, intraprocedural bacitracin pocket wash, and 2-day post-procedural oral cephalexin. The primary outcome was 1-year hospitalization for device infection in the high-risk group, analyzed by hierarchical logistic regression modeling, adjusting for random cluster and cluster-period effects. RESULTS Device procedures were performed in 28 centers in 19,603 patients, of whom 12,842 were high risk. Infection occurred in 99 patients (1.03%) receiving conventional treatment, and in 78 (0.78%) receiving incremental treatment (odds ratio: 0.77; 95% confidence interval: 0.56 to 1.05; p = 0.10). In high-risk patients, hospitalization for infection occurred in 77 patients (1.23%) receiving conventional antibiotics and in 66 (1.01%) receiving incremental antibiotics (odds ratio: 0.82; 95% confidence interval: 0.59 to 1.15; p = 0.26). Subgroup analysis did not identify relevant patient or site characteristics with significant benefit from incremental therapy. CONCLUSIONS The cluster crossover design efficiently tested clinical effectiveness of incremental antibiotics to reduce device infection. Device infection rates were low. The observed difference in infection rates was not statistically significant. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot] [PADIT]; NCT01002911).
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Affiliation(s)
- Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Yves Longtin
- Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Canada
| | - François Philippon
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada
| | - Paul Angaran
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Claus Rinne
- Division of Cardiology, St. Mary's General Hospital, Kitchener, Ontario, Canada
| | - Benoit Coutu
- Division of Cardiology, Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - R Aaron Low
- Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Carlos Morillo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Satish Toal
- Horizon Health Network, Saint John, New Brunswick, Canada
| | - Giuliano Becker
- Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel Degrâce
- Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Quebec, Canada
| | - Bernard Thibault
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eugene Crystal
- Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stanley Tung
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John LeMaitre
- Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Omar Sultan
- Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Matthew Bennett
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamil Bashir
- Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Ayala-Paredes
- Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Philippe Gervais
- Division of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Leon Rioux
- Division of Cardiology, Centre de santé et de services sociaux de Rimouski-Neigette (CSSSRN), Rimouski, Quebec, Canada
| | - Martin E W Hemels
- Division of Cardiology, Rijnstate Hospital, Arnhem, and Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Leon H R Bouwels
- Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Bob van Vlies
- Division of Cardiology, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Jia Wang
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Derek V Exner
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Paul Dorian
- Division of Cardiology, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael Hospital, Toronto, Ontario, Canada
| | - Ratika Parkash
- Division of Cardiology, Queen Elizabeth II Health Science Center, Halifax, Nova Scotia, Canada
| | - Marco Alings
- Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research The Netherlands (WCN), Breda, the Netherlands
| | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Enriquez A, Neira V, Bakker D, Baley J, Bisleri G, Baranchuk A, Redfearn D. Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction. HeartRhythm Case Rep 2019; 5:436-439. [PMID: 31453098 PMCID: PMC6701005 DOI: 10.1016/j.hrcr.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Jason Baley
- Division of Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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25
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Yeung C, Crinion D, Hammond S, Chacko S, Enriquez A, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Ambulatory ECG predictors of atrial fibrillation are ineffective in severe sleep apnea. J Electrocardiol 2019; 55:120-122. [PMID: 31152994 DOI: 10.1016/j.jelectrocard.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/23/2019] [Revised: 04/19/2019] [Accepted: 05/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is strongly associated with atrial fibrillation (AF). Long-term ECG monitoring with implantable loop recorders facilitates the identification of undiagnosed AF in 20% of severe OSA cases. However, ambulatory ECG (AECG) monitoring is less resource intensive, and various parameters have been shown to predict AF. The aim of this study was to assess the efficacy of such AECG-based AF predictors in identifying patients with severe OSA most at risk. METHODS Prospective observational study including patients with severe OSA and no history of AF. Patients had two 24-h AECG recordings, and if no AF was detected, implanted with a loop recorder (maximum 3 years). RESULTS Of 25 patients implanted, AF ≥ 10 s was detected in 5 patients. None of the parameters from the AECG recordings were significantly different between patients who did and did not develop AF. CONCLUSIONS AECG-based parameters were not effective for the prediction of AF in this severe OSA cohort.
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Affiliation(s)
- Cynthia Yeung
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Derek Crinion
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Sharlene Hammond
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Sanoj Chacko
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Andres Enriquez
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Damian Redfearn
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Chris Simpson
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Hoshiar Abdollah
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Adrian Baranchuk
- Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada.
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Hassan SM, Hong K, Rosati F, Glover B, Redfearn D, Enriquez A, Bisleri G. Hybrid ablation for atrial fibrillation: the importance of achieving transmurality and lesion validation. Minerva Cardioangiol 2019; 67:115-120. [DOI: 10.23736/s0026-4725.19.04918-1] [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: 11/08/2022]
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27
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Hong KL, Bakker D, Baley J, Babiolakis C, Bullen M, Xue C, Saramago F, Redfearn D, Glover B. HALF NORMAL SALINE SHORTENS THE TIME TO ACHIEVE BIDIRECTIONAL BLOCK IN TYPICAL ATRIAL FLUTTER. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Yeung C, Drew D, Hammond S, Ewart G, Suarez-Fuster L, Redfearn D, Simpson C, Abdollah H, Glover B, Baranchuk A. Short Term Cardiac Monitoring of Patients with Severe Sleep Apnea does not Allow for the Prediction of Atrial Fibrillation. J Electrocardiol 2019. [DOI: 10.1016/j.jelectrocard.2019.01.024] [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: 10/27/2022]
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29
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Yeung C, Drew D, Hammond S, Ewart G, Redfearn D, Simpson C, Abdollah H, Glover B, Baranchuk A. Extended Cardiac Monitoring in Patients with Severe Sleep Apnea and no History of Atrial Fibrillation (The Reveal XT-SA Study). J Electrocardiol 2019. [DOI: 10.1016/j.jelectrocard.2019.01.023] [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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Glover B, Hong KL, Bakker D, Baley J, Babiolakis C, Xue C, Saramago F, Redfearn D. REASONS FOR INAPPROPRIATE EMERGENCY DEPARTMENT ATTENDANCES IN PATIENTS WITH A HISTORY OF ATRIAL FIBRILLATION: RESULTS FROM THE MULTICENTRE AF-ED TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Besant G, Wan D, Blakely C, Branscombe P, Suarez-Fuster L, Redfearn D, Simpson C, Abdollah H, Glover B, Baranchuk A. Lyme Carditis Presenting with High-degree Atrioventricular Block: A Systematic Review. J Electrocardiol 2019. [DOI: 10.1016/j.jelectrocard.2019.01.019] [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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Abstract
Half a decade ago, transmembrane protein fibronectin type III domain-containing protein 5 (FNDC5) was found to be cleaved as a novel myokine irisin, which burst into prominence for browning of white adipose tissue during exercise. However, FNDC5, the precursor of irisin, has been paid relatively little attention compared with irisin despite evidence that FNDC5 is associated with the metabolic syndrome, which accounts for one-fourth of the world's adult population and contributes to diabetes, cardiovascular disease and all-cause mortality. Besides N-terminal and C-terminal sequences, the FNDC5 protein contains an irisin domain and a short transmembrane region. FNDC5 has shown to be widely distribute in different tissues and is highly expressed in heart, brain, liver, and skeletal muscle. Clinical studies have demonstrated that FNDC5 is essential for maintaining metabolic homeostasis and dysregulation of FNDC5 will lead to systemic metabolism imbalance and the onset of metabolic disorders. Growing evidence has suggested that FNDC5 gene polymorphisms are related to health and disease in different human populations. Additionally, FNDC5 has been found relevant to the regulation of metabolism and metabolic syndrome through diverse upstream and downstream signaling pathways in experimental studies. The present review summarizes the characteristics, clinical significance, and molecular mechanisms of FNDC5 in metabolic syndrome and proposes a novel concept that FNDC5 is activated by forming a putative ligand-receptor complex. Knowledge about the role of FNDC5 may be translated into drug development and clinical applications for the treatment of metabolic disorders.
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Affiliation(s)
- Richard Y Cao
- Cardiac Rehabilitation Program, Shanghai Xuhui Central Hospital/Zhongshan-Xuhui Hospital, Fudan University/Shanghai Clinical Research Center, Chinese Academy of Sciences, 966 Middle Huaihai Road, Shanghai 200031, China.
| | - Hongchao Zheng
- Cardiac Rehabilitation Program, Shanghai Xuhui Central Hospital/Zhongshan-Xuhui Hospital, Fudan University/Shanghai Clinical Research Center, Chinese Academy of Sciences, 966 Middle Huaihai Road, Shanghai 200031, China
| | - Damian Redfearn
- Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Jian Yang
- Cardiac Rehabilitation Program, Shanghai Xuhui Central Hospital/Zhongshan-Xuhui Hospital, Fudan University/Shanghai Clinical Research Center, Chinese Academy of Sciences, 966 Middle Huaihai Road, Shanghai 200031, China.
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Yeung C, Drew D, Hammond S, Hopman WM, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Extended Cardiac Monitoring in Patients With Severe Sleep Apnea and No History of Atrial Fibrillation (The Reveal XT-SA Study). Am J Cardiol 2018; 122:1885-1889. [PMID: 30274768 DOI: 10.1016/j.amjcard.2018.08.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/07/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is a risk factor for ischemic stroke and reported to be associated with severe obstructive sleep apnea (OSA). The aim of this study was to determine the occurrence of newly detected AF in patients with severe OSA and no previous history of AF. Prospective observational study included patients with severe OSA (Apnea-Hypopnea Index [AHI] ≥ 30) and no history of AF. Primary outcome was detection of AF lasting ≥10 seconds. Patients were subjected to 2 24-hour Holter monitors, and if no AF was detected, implanted with a Medtronic Reveal XT implantable loop recorder. Follow-up was done every 6 months for a total of 3years. Implantable loop recorder was explanted if the primary outcome was detected (AF) or the battery was exhausted. Of the 31 patients enrolled, 6 withdrew participation in the study before implantation. Mean age was 57 ± 10years, mean body mass index was 35 ± 6; 52% male patients. Hypertension 56% and coronary artery disease 24%. Mean AHI was 55 ± 18. AF was detected in 5 patients (20%). AF mean duration was 4.8hours (range 20 seconds to 15.3 hours). Mean time to diagnosis was 11 ± 7 months. Male gender was predictive for AF detection (p = 0.04). Continuous positive airway pressure therapy was used by 96% of patients with 68% total adherence. Mean follow-up was 27 months. In conclusion, extended cardiac monitoring of patients with severe OSA may facilitate the identification of newly detected AF.
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Affiliation(s)
- Cynthia Yeung
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Doran Drew
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sharlene Hammond
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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Besant G, Wan D, Yeung C, Blakely C, Branscombe P, Suarez-Fuster L, Redfearn D, Simpson C, Abdollah H, Glover B, Baranchuk A. Suspicious index in Lyme carditis: Systematic review and proposed new risk score. Clin Cardiol 2018; 41:1611-1616. [PMID: 30350436 DOI: 10.1002/clc.23102] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/07/2018] [Accepted: 10/19/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high-degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder. HYPOTHESIS The likelihood that a patient's high-degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool. METHODS A systematic review of all published cases of LC with high-degree AVB, and five cases from the authors' experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review. RESULTS Of the 88 cases included, 51 (58%) were high-risk, 31 (35.2%) intermediate-risk, and 6 (6.8%) low-risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that reported on all SILC variables, 24 (75%) cases were classified as high-risk, 8 (25%) intermediate-risk, and 0 low-risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment. CONCLUSION The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high-degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.
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Affiliation(s)
- Georgia Besant
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Douglas Wan
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Cynthia Yeung
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Crystal Blakely
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Pamela Branscombe
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Laiden Suarez-Fuster
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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35
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Boles U, Gul EE, Enriquez A, Starr N, Haseeb S, Abdollah H, Simpson C, Baranchuk A, Redfearn D, Michael K, Hopman W, Glover B. Coronary Sinus Electrograms May Predict New-onset Atrial Fibrillation After Typical Atrial Flutter Radiofrequency Ablation (CSE-AF). J Atr Fibrillation 2018; 11:1809. [PMID: 30455831 DOI: 10.4022/jafib.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/11/2018] [Revised: 03/19/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022]
Abstract
Background Complex fractionated electrograms (EGMs) of the coronary sinus electrograms (CSEs) are employed as a target during radiofrequency ablations (RFA) of atrial fibrillation (AF). Anatomically, CSEs includes both of left atrium (LA), coronary sinus musculature and right atrium (RA) electrograms. Aim To determine the significance of fractionated CSE and delayed potentials as a predictor of new-onset AF after radiofrequency ablation (RFA) of isolated atrial flutter (AFL). Methods Consecutive patients underwent AFL ablation. Fractionated and/or continuous discrete activities were recorded from coronary sinus electrograms during sinus rhythm and during pacing. Earliest CSE to the S nadir or peak R in milliseconds was recorded and considered as propagation delay for EGMs. Results Forty patients were included during a mean follow-up period of 55.1± 15.8 months. Twenty patients (50 %) developed AF while the remaining 20 patients maintained sinus rhythm(SR) during the follow-up period. Proximal and mid CSEs were significantly fractionated in AF group compared to group with no AF development (65 % and 60% Vs. 35 % and 30 %, p = 0.03, respectively). However, during pacing from distal duo-decapolar catheter (pole 1-2), distal CSEs alone were significantly fractionated (p < 0.05) compared to SR group. Significant delayed propagation of proximal CSE during pacing and in sinus rhythm were observed in AF group (12.3 ± 9.2 ms vs 7.1 ± 3.6 ms, p = 0.03) and (7.2 ± 2.9 ms Vs 8.1 ± 4.6 ms, p= 0.02) in the same order. Conclusion Incidence of AF is associated with fractionated proximal and mid CSE in sinus rhythm and distal CSE during paced rhythm after isolated AFL ablation. Delayed proximal CSE propagation is correlated with AF incidence.
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Affiliation(s)
- Usama Boles
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.,Heart and Vascular centre, Cardiology department, Mater Private Hospital, Dublin, Ireland
| | - Enes Elvin Gul
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Neasa Starr
- Heart and Vascular centre, Cardiology department, Mater Private Hospital, Dublin, Ireland
| | - Sohaib Haseeb
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada
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Gül EE, Boles U, Haseeb S, Hopman WM, Chacko S, Simpson C, Abdollah H, Michael K, Baranchuk A, Redfearn D, Glover B. Gold-tip versus contact-sensing catheter for cavotricuspid isthmus ablation: A comparative study. Turk Kardiyol Dern Ars 2018; 46:464-470. [PMID: 30204137 DOI: 10.5543/tkda.2018.44025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Radiofrequency (RF) ablation is a highly successful procedure for the management of typical atrial flutter (AFL), an abnormal heart rhythm originating within the atria. There is no strong evidence that the use of contact force (CF) has any impact on procedural duration or acute success in the management of cavotricuspid isthmus (CTI)-dependent AFL. The aim of this study was to compare acute procedural parameters using a non-CF, 4-mm, gold-tip, irrigated catheter and a CF-sensing catheter in patients with AFL. METHODS This was a retrospective cohort study. Consecutive patients who underwent typical AFL catheter ablation with either a gold-tip or CF-sensing catheter were enrolled. The procedural parameters obtained were: time to achieve bidirectional block, time to terminate AFL, total duration of RF application, procedure duration, fluoroscopy time, acute reconnection within 20 minutes following the last RF application, and procedural complications. RESULTS Of the 40 patients screened, 37 were included in the study. The procedural endpoint of bidirectional isthmus block was achieved in all patients. The use of gold-tip catheters was associated with a shorter length of time to achieve bidirectional block (median time: 20.0 minutes [interquartile range {IQR}: 12.0-28.0 minutes]) compared with a median time of 36.0 minutes (IQR: 12.0-53.0 minutes; p=0.048) in the CF group. Furthermore, there was a trend toward reduced procedural duration in favor of the gold-tip catheter (median goldtip: 74.0 minutes [IQR: 57.0-84.0 minutes]; median CF: 85.0 minutes [IQR: 57.0-107.0 minutes]; p=0.171). A greater requirement for the use of long sheaths was observed in cases where the CF catheter was employed for the procedure (CF: 11, 57.9 %; non-CF: 1, 5.6%; p=0.005). CONCLUSION The time required to achieve bidirectional block, which is also reflected in the procedural time, was less when using a gold-tip catheter, and there was less need for the use of a long sheath. Further studies may be useful to evaluate this finding.
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Affiliation(s)
- Enes Elvin Gül
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
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Yeung C, Drew D, Hammond S, Ewart G, Redfearn D, Simpson C, Abdollah H, Glover B, Baranchuk A. Extended Cardiac Monitoring in Patients with Severe Sleep Apnea and no History of Atrial Fibrillation (The Reveal XT-SA Study). J Electrocardiol 2018. [DOI: 10.1016/j.jelectrocard.2018.10.021] [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: 11/28/2022]
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Burstein B, Barbosa RS, Samuel M, Kalfon E, Philippon F, Birnie D, Mangat I, Redfearn D, Sandhu R, Macle L, Sapp J, Verma A, Healey JS, Becker G, Chauhan V, Coutu B, Roux JF, Leong-Sit P, Andrade JG, Veenhuyzen GD, Joza J, Bernier M, Essebag V. Prevention of venous thrombosis after electrophysiology procedures: a survey of national practice. J Interv Card Electrophysiol 2018; 53:357-363. [PMID: 30298364 DOI: 10.1007/s10840-018-0461-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/25/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Femoral venous access is required for most electrophysiology procedures. Limited data are available regarding post-procedure venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE). Potential preventative strategies are unclear. We aimed to survey Canadian centers regarding incidence of VTE and strategies for prevention of VTE after procedures that do not require post-procedure anticoagulation. METHODS An online survey was distributed to electrophysiologists representing major Canadian EP centers. Participants responded regarding procedural volume, incidence of VTE post-procedure, and their practice regarding pharmacological and non-pharmacological peri-procedural VTE prophylaxis. RESULTS The survey included 17 centers that performed a total of 6062 procedures in 2016. Ten patients (0.16%) had VTE (including 9 DVTs and 6 PEs) after diagnostic electrophysiology studies and right-sided ablation procedures excluding atrial flutter. Five centers (41.6%) administered systemic intravenous heparin during both diagnostic electrophysiology studies and right-sided ablation procedures. For patients taking oral anticoagulants, 10 centers (58.8%) suspend therapy prior to the procedure. Two centers (11.8%) routinely prescribed post-procedure pharmacologic prophylaxis for VTE. Four centers (23.5%) used compression dressings post-procedure and all prescribed bed rest for a maximum of 6 h. Of the variables collected in the survey, none were found to be predictive of VTE. CONCLUSIONS VTE is not a common complication of EP procedures. There is significant variability in the strategies used to prevent VTE events. Future research is required to evaluate strategies to reduce the risk of VTE that may be incorporated into EP practice guidelines.
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Affiliation(s)
- Barry Burstein
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Rodrigo S Barbosa
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.,Hospital Albert Sabin, Rua Doutor Edgar Carlos Pereira, 600 - Santa Teresa, Juiz de Fora, MG, 36020-200, Brazil
| | - Michelle Samuel
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Eli Kalfon
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.,Galilee Medical Center, POB 21, 2210001, Nahariya, Israel
| | - François Philippon
- Institut universitaire de cardiologie et de pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC, G1V 4G5, Canada
| | - David Birnie
- University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada
| | - Iqwal Mangat
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Damian Redfearn
- Kingston Health Sciences Centre, 166 Brock Street, Kingston, ON, K7L 5G2, Canada
| | - Roopinder Sandhu
- University of Alberta Hospital, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada
| | - Laurent Macle
- Montreal Heart Institute, 5000 Rue Bélanger, Montréal, QC, H1T 1C8, Canada
| | - John Sapp
- QEII Health Sciences Centre, 1799 Robie St, Halifax, NS, B3H 3G1, Canada
| | - Atul Verma
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, L3Y 2P9, Canada
| | - Jeff S Healey
- Hamilton Health Sciences Centre, 237 Barton St. East, Hamilton, ON, L8L 2X2, Canada
| | - Giuliano Becker
- Hôpital Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Vijay Chauhan
- University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Benoit Coutu
- Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - Jean-François Roux
- Centre hospitalier universitaire de Sherbrooke (CHUS), 580 Rue Bowen S, Sherbrooke, QC, J1G 2E8, Canada
| | - Peter Leong-Sit
- London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Jason G Andrade
- Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - George D Veenhuyzen
- Libin Cardiovascular Institute of Alberta, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Jacqueline Joza
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Martin Bernier
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Vidal Essebag
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada. .,Hôpital Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada. .,McGill University Health Centre, 1650 Cedar Ave, E5-200, Montreal, QC, H3G 1A4, Canada.
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Besant G, Blakely C, Wan D, Redfearn D, Simpson C, Glover B, Abdollah H, Hopman W, Baranchuk A. SUSPICIOUS INDEX IN LYME CARDITIS (SILC) SCORE. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.129] [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] Open
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Hart D, Barber D, Shaw C, Simpson C, Baranchuk A, Glover B, Abdollah H, Redfearn D. STRATEGIES TO REDUCE EMERGENCY DEPARTMENT REPEAT VISITS AND STROKES ASSOCIATED WITH ATRIAL FIBRILLATION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.452] [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] Open
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Chacko S, Redfearn D. One Size Fits All? Ethnicity and Electrocardiographic Criteria for Cardiac Hypertrophy. Can J Cardiol 2018; 34:1104-1107. [PMID: 30170665 DOI: 10.1016/j.cjca.2018.07.005] [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] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sanoj Chacko
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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Gul EE, Boles U, Haseeb S, Hopman W, Michael KA, Simpson C, Abdollah H, Baranchuk A, Redfearn D, Glover B. Contact-Force Guided Pulmonary Vein Isolation does not Improve Success Rate in Persistent Atrial Fibrillation Patients and Severe Left Atrial Enlargement: A 12-month Follow-Up Study. J Atr Fibrillation 2018; 11:2060. [PMID: 30505381 DOI: 10.4022/jafib.2060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
Background Catheter ablation is a cornerstone treatment strategy in atrial fibrillation (AF). Left atrial (LA) size is one of the contributors in development of AF recurrences. The impact of contact-forced (CF) guided catheter ablation on the success rate of persistent AF patients with severe enlarged LA has not been investigated yet. Methods Sixty-six patients with diagnosis of longstanding persistent AF undergoing catheter ablation were enrolled. All patients underwent a standard transthoracic echocardiography according to the guidelines. LA size was considered severely enlarged when LA diameter was ≥ 50 mm. CF catheter ablation with a Tacticath Quartz catheter (St Jude Medical, St. Paul, MN, USA) was used in all patients. Results The mean age was 61.9 ± 9.9 years, and LAD 47.8 ± 11.6 mm. Among 66 patients with persistent AF, 32 (48%) patients were diagnosed with AF recurrences. Twenty-eight (42%) patients had severely enlarged LA. The recurrence of AF was comparable in patients with and without severe enlarged LA (47% vs. 42%, p=0.79). The recurrence of AF was lower in patients who underwent CF-guided ablation with a normal LA dimension (36 %, p=0.54). Procedure duration was longer in patients with severely enlarged LA. LA dimension was not significantly different between patients with and without AF recurrence (49.8 ± 7.9 mm vs. 45.9 ± 7.5 mm, p=0.15). LAD and was significantly correlated with the time to recurrence of AF (r:-0.60, p=0.02). Conclusion Our preliminary findings have demonstrated that CF guided ablation does not improve the success rate in longstanding persistent AF patients with severe LA enlargement.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Sohaib Haseeb
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Hajimolahoseini H, Hashemi J, Gazor S, Redfearn D. Inflection point analysis: A machine learning approach for extraction of IEGM active intervals during atrial fibrillation. Artif Intell Med 2018; 85:7-15. [PMID: 29503040 DOI: 10.1016/j.artmed.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/11/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In this paper, we propose a novel algorithm to extract the active intervals of intracardiac electrograms during atrial fibrillation. METHODS First, we show that the characteristics of the signal waveform at its inflection points are prominent features that are implicitly used by human annotators for distinguishing between active and inactive intervals of IEGMs. Then, we show that the natural logarithm of features corresponding to active and inactive intervals exhibits a mixture of two Gaussian distributions in three dimensional feature space. An Expectation Maximization algorithm for Gaussian mixtures is then applied for automatic clustering of the features into two categories. RESULTS The absolute error in onset and offset estimation of active intervals is 6.1ms and 10.7ms, respectively, guaranteeing a high resolution. The true positive rate for the proposed method is also 98.1%, proving the high reliability. CONCLUSION The proposed method can extract the active intervals of IEGMs during AF with a high accuracy and resolution close to manually annotated results. SIGNIFICANCE In contrast with some of the conventional methods, no windowing technique is required in our approach resulting in significantly higher resolution in estimating the onset and offset of active intervals. Furthermore, since the signal characteristics at inflection points are analyzed instead of signal samples, the computational time is significantly low, ensuring the real-time application of our algorithm. The proposed method is also robust to noise and baseline variations thanks to the Laplacian of Gaussian filter employed for extraction of inflection points.
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E Gul E, Boles U, Haseeb S, Flood J, Bansal A, Glover B, Redfearn D, Simpson C, Abdollah H, Baranchuk A, Michael KA. Left Atrial Appendage characteristics in patients with Persistent Atrial Fibrillation undergoing catheter ablation (LAAPAF Study). J Atr Fibrillation 2017; 9:1526. [PMID: 29250273 DOI: 10.4022/jafib.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 01/09/2017] [Accepted: 01/15/2017] [Indexed: 12/13/2022]
Abstract
Background Despite technological and scientific efforts, the recurrence rate of persistent atrial fibrillation (AF) remains high. Several studies have shown that in addition to pulmonary vein (PV) isolation other non-PV triggers, particularly left atrial appendage may be the source of initiation and maintenance of AF. There are few studies showing the role of left atrial appendage (LAA) isolation in order to obtain higher success rate in persistent AF patients. Objective We analyzed the LAA volume, volume index and shape relative to the LA in patients with persistent AF undergoing AF ablation. Methods Fifty-nine consecutive patients with persistent AF who underwent catheter ablation were enrolled. Computerized tomography (CT) was performed in order to assess left atrial and PV anatomy including the LAA. Digital subtraction software (GE Advantage Workstation 4.3) was used to separate the LAA from the LA and calculate: LA volume (LAV), LA volume index (LAV/body surface area), LAA volume (LAAV), LAA volume index (LAA volume/LA volume), and LAA morphology [chicken wing (CW) or non-chicken wing (NCW)]. Results The mean age was 64.6 ± 9.8 years, 44 % male, and LA diameter 47.6 ± 7.8 mm. Median follow-up (FU) was 13 months. All patients had antral isolation of PVs and ablation of complex fractionation ± linear ablation (roof line/superior coronary sinus/mitral line). Among 59 patients with persistent AF, 26 (44 %) patients were diagnosed with AF recurrences. Mean LAV was 145.0 ± 45.9 ml, LAVI 68.9 ± 20.0 ml/m2, LAAV 10.3 ± 4.0 ml, and LAAVI 7.3 ± 2.7 ml/m2. LAA shape was non-chicken wing (NCW) in the majority of patients (51 %). LAA parameters were not significantly different between patients with and without AF recurrence (LAAV 11.0 ± 4.3 ml vs. 9.7 ± 3.8 ml, p=0.26; LAAVI 7.5 ± 3.0 ml/m2 vs. 7.2 ± 2.5 ml/m2, p=0.71; LAA shape of NCW 50 % vs 52 %, p=0.75, respectively). LAV was significantly correlated with the LAAV (r: o.47, p=0.009). The incidence of NCW LAA was significantly higher in patients with previous stroke/TIA (80 % vs. 20 %, p=0.04). Conclusion The LAA anatomical characteristics (volume/volume index and the shape) were comparable in patients with/out AF recurrence post PVI. It remains to be determined if additional LAA isolation will impact outcomes in patients with persistent AF.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Sohaib Haseeb
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Justin Flood
- Department of Diagnostic Radiology, Queens University, Kingston, ON, Canada
| | - Ayuish Bansal
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospitaş, Queens University, Kingston, ON, Canada
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Hashemi J, Shariat MH, Redfearn D. Intracardiac electrogram envelope detection during atrial fibrillation using fast orthogonal search. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:3162-3165. [PMID: 29060569 DOI: 10.1109/embc.2017.8037528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The performance of any intracardiac electrogram processing method is limited by the accuracy of its activation detection approach. The most common activation detection approaches in the literature aim to find the highest peak in the activation envelope disregarding the start and end points. However, the duration of the activation can be used to extract useful information such as wave collisions. In this work, we propose a novel orthogonal based approach for fast and accurate estimation of the start and end of the activations (activation envelope) in intracardiac recordings during atrial fibrillation. Wavelet decomposition of the signals was used to create a pool of basis functions for the proposed modeling method. The database included 24 recordings of approximate length of 6s obtained from atrial endocardium of 5 patients who underwent catheter ablation therapy. The start and end of activations in each electrogram was manually annotated by an expert electrophysiologist and the annotations were used as a gold standard to calculate the performance of our envelope detection method. The results show promising performance and excellent robustness to training data for our proposed method with respect to envelope estimation error.
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Gula L, Leong-Sit P, Tang A, Parkash R, Sarrazin J, Thibault B, Essebag V, Deyell M, Lane C, Nery P, Veenhuyzen G, Redfearn D, Healey J, Roux J, Doucette S, Sapp J. QUALITY OF LIFE IN PATIENTS WITH ABLATION OR MEDICAL THERAPY FOR VENTRICULAR ARRHYTHMIAS: A SUBSTUDY OF VANISH. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.129] [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] Open
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Boles U, Gul EE, Fitzpatrick N, Enriquez A, Conroy J, Ghassemian A, David S, Baranchuk A, Simpson C, Redfearn D, Glover B, Abdollah H, Michael K. Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter. J Innov Card Rhythm Manag 2017; 8:2732-2738. [PMID: 32494452 PMCID: PMC7252914 DOI: 10.19102/icrm.2017.080603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/08/2017] [Indexed: 11/12/2022] Open
Abstract
The application of optimum contact force (CF) can be used to improve ablation procedure success and safety. The lesion size index (LSI) is a novel dimensionless contact force parameter that allows for an accurate estimation of lesion volume in real time by integrating contact force (grams), duration (seconds) and power (watts). The aim was to correlate LSI values with current contact force parameters to achieve successful and safe bidirectional block of the cavotricuspid isthmus (CTI) using a maximum voltage-guided (MVG) ablation strategy. Fifteen consecutive patients (age 69 ± 7.9 years, nine males) with symptomatic atrial flutter (AFL) were evaluated and compared with 23 control (age 66.3 ± 10.4 years, 16 males) non-contact force-guided ablation cases. Irrigated-tip force-sensing ablation catheters (TactiCath Quartz™, St. Jude Medical, St. Paul, MN, USA) were used in the CF group to achieve the primary endpoint of complete bidirectional block of the isthmus. In the CF group, a total of 233 radiofrequency (RF) applications were examined. A mean LSI of 6.4 ±1.0 correlated with a force-time integral (FTI) of 581.2 ±230.9 g/s and an average CF of 13.9 ±4.9 g concurrently. Intraprocedural, fluoroscopy time and RF time demonstrated lower trends in the CF group, but no significance with respect to these trends was observed. The secondary endpoint of no reconnection within 20 min after the procedure was equally attained in both groups, and, likewise, the level of safety was comparable. An LSI value of >5 represents a new effective parameter in MVG ablation for the cavotricuspid region that demonstrates a safe profile. Guidance of CTI ablation using LSI and other contact force parameters of CF 13.9 ±4.9 g and FTI 581.2 ±230.9 g/s demonstrated highly effective and safe outcomes.
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Affiliation(s)
- Usama Boles
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
- Department of Cardiology, Midland Regional Hospital and St. James Hospital, Trinity College, Dublin, Ireland
- Address correspondence to: Usama Boles, MD, 12 Colpe Park, Deepforde, Co. Meath, Ireland AA92ED0H. E-mail:
| | - Enes E. Gul
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Noel Fitzpatrick
- Department of Cardiology, Midland Regional Hospital and St. James Hospital, Trinity College, Dublin, Ireland
| | - Andres Enriquez
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - John Conroy
- Department of Cardiology, Midland Regional Hospital and St. James Hospital, Trinity College, Dublin, Ireland
| | - Arian Ghassemian
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Santhosh David
- Department of Cardiology, Letterkenny University Hospital, Donegal, Ireland
| | - Adrian Baranchuk
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Heart Rhythm Service, Queen’s University, Kingston, Ontario, Canada
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Boles U, Gul EE, Enriquez A, Lee H, Riegert D, Andres A, Baranchuk A, Redfearn D, Glover B, Simpson C, Abdollah H, Michael K. High Voltage Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2017; 9:1517. [PMID: 29250270 DOI: 10.4022/jafib.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/17/2016] [Revised: 12/19/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022]
Abstract
Background Ablation of the pulmonary vein (PV) antrum using an electroanatomic mapping system is standard of care for point-by-point pulmonary vein isolation (PVI). Focused ablation at critical areas is more likely to achieve intra-procedural PV isolation and decrease the likelihood for reconnection and recurrence of atrial fibrillation (AF). Therefore this prospective pilot study is to investigate the short-term outcome of a voltage-guided circumferential PV ablation (CPVA) strategy. Methods We recruited patients with a history of paroxysmal atrial fibrillation (AF). The EnSite NavX system (St. Jude Medical, St Paul, Minnesota, USA) was employed to construct a three-dimensional geometry of the left atrium (LA) and voltage map. CPVA was performed; with radiofrequency (RF) targeting sites of highest voltage first in a sequential clockwise fashion then followed by complete the gaps in circumferential ablation. Acute and short-term outcomes were compared to a control group undergoing conventional standard CPVA using the same 3D system. Follow-up was scheduled at 3, 6 and 12 months. Results Thirty-four paroxysmal AF patients with a mean age of 40 years were included. Fourteen patients (8 male) underwent voltage mapping and 20 patients underwent empirical, non-voltage guided standard CPVA. A mean of 54 ± 12 points per PV antrum were recorded. Mean voltage for right and left PVs antra were 1.7±0.1 mV and 1.9±0.2 mV, respectively. There was a trend towards reduced radiofrequency time (40.9±17.4 vs. 48.1±15.5 mins; p=0.22). Conclusion Voltage-guided CPVA is a promising strategy in targeting critical points for PV isolation with a lower trend of AF recurrence compared with a standard CPVA in short-term period. Extended studies to confirm these findings are warranted.
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Affiliation(s)
- Usama Boles
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Enes E Gul
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Howard Lee
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Dave Riegert
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | - Adrian Andres
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Chris Simpson
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Kevin Michael
- Division of Cardiology, Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
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Drewnoski E, Parsons J, Redfearn D, Blanco-Canqui H, MacDonald JC. 735 Can cover crops pull double duty: Conservation and profitable forage production? J Anim Sci 2017. [DOI: 10.2527/asasann.2017.735] [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: 11/13/2022] Open
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Gul EE, Pal R, Caldwell J, Boles U, Hopman W, Glover B, Michael KA, Redfearn D, Simpson C, Abdollah H, Baranchuk A. Interatrial block and interatrial septal thickness in patients with paroxysmal atrial fibrillation undergoing catheter ablation: Long-term follow-up study. Ann Noninvasive Electrocardiol 2016; 22. [PMID: 28019054 DOI: 10.1111/anec.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/17/2016] [Accepted: 11/26/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Interatrial block (IAB) is a strong predictor of recurrence of atrial fibrillation (AF). IAB is a conduction delay through the Bachman region, which is located in the upper region of the interatrial space. During IAB, the impulse travels from the right atrium to the interatrial septum (IAS) and coronary sinus to finally reach the left atrium in a caudocranial direction. No relation between the presence of IAB and IAS thickness has been established yet. OBJECTIVE To determine whether a correlation exists between the degree of IAB and the thickness of the IAS and to determine whether IAS thickness predicts AF recurrence. METHODS Sixty-two patients with diagnosis of paroxysmal AF undergoing catheter ablation were enrolled. IAB was defined as P-wave duration ≥120 ms. IAS thickness was measured by cardiac computed tomography. RESULTS Among 62 patients with paroxysmal AF, 45 patients (72%) were diagnosed with IAB. Advanced IAB was diagnosed in 24 patients (39%). Forty-seven patients were male. During a mean follow-up period of 49.8 ± 22 months (range 12-60 months), 32 patients (51%) developed AF recurrence. IAS thickness was similar in patients with and without IAB (4.5 ± 2.0 mm vs. 4.0 ± 1.4 mm; p = .45) and did not predict AF. Left atrial size was significantly enlarged in patients with IAB (40.9 ± 5.7 mm vs. 37.2 ± 4.0 mm; p = .03). Advanced IAB predicted AF recurrence after the ablation (OR: 3.34, CI: 1.12-9.93; p = .03). CONCLUSIONS IAS thickness was not significantly correlated to IAB and did not predict AF recurrence. IAB as previously demonstrated was an independent predictor of AF recurrence.
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Affiliation(s)
- Enes E Gul
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Raveen Pal
- Department of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Jane Caldwell
- Hull & East Yorkshire NHS Trust and Hull York Medical School, Hull, United Kingdom
| | - Usama Boles
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Damian Redfearn
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Chris Simpson
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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