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Hall KB, Immink MA, Martin DT, Bennett H, Crowther RG. Dose-Response Effect of an Inertia Flywheel Postactivation Performance Enhancement Protocol on Countermovement Jump Performance. J Appl Biomech 2024; 40:147-154. [PMID: 38176403 DOI: 10.1123/jab.2023-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
The purpose of this study was to investigate the dose-response effect of a high-load, 6-repetition, maximum effort inertial flywheel (IFw) squat postactivation performance enhancement (PAPE) protocol on countermovement jump (CMJ) performance metrics. Thirteen subjects completed 5 squat testing sessions: 1 session to determine back-squat 6-repetition maximum, 1 session to determine 6-repetition maximum IFw load, and 3 sessions to investigate the dose-response effect of an IFw PAPE protocol set at the load determined in the second session. In the IFw PAPE sessions, subjects completed either 1, 2, or 3 sets of IFw squats, then performed 5 CMJs over 12 minutes (1, 3, 6, 9, and 12 min post-IFw). All CMJ tests were conducted on a force platform where CMJ performance outcomes and impulse variables were calculated. There was no main time or volume effect for jump height, contact time, reactive strength index, peak force, or any of the impulse variables. A main time effect was identified for flight time (P = .006, effect size = 0.24) and peak power (P = .001, effect size = 0.28). The lack of change in jump height may indicate that too much fatigue was generated following this near-maximal IFw squat protocol, thereby reducing the PAPE effect.
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Affiliation(s)
- Keegan B Hall
- UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Maarten A Immink
- UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Sport, Health, Activity, Performance and Exercise Research Centre and College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David T Martin
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Hunter Bennett
- UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Robert G Crowther
- UniSA: Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Yuyun MF, Joseph J, Erqou SA, Kinlay S, Echouffo-Tcheugui JB, Peralta AO, Hoffmeister PS, Boden WE, Yarmohammadi H, Martin DT, Singh JP. Persistence of significant secondary mitral regurgitation post-cardiac resynchronization therapy and survival: a systematic review and meta-analysis : Mitral regurgitation and mortality post-CRT. Heart Fail Rev 2024; 29:165-178. [PMID: 37855988 DOI: 10.1007/s10741-023-10359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
Cardiac resynchronization therapy (CRT) significantly reduces secondary mitral regurgitation (MR) in patients with severe left ventricular systolic dysfunction. However, uncertainty remains as to whether improvement in secondary MR correlates with improvement with mortality seen in CRT. We conducted a meta-analysis to determine the association of persistent unimproved significant secondary MR (defined as moderate or moderate-to-severe or severe MR) compared to improved MR (no MR or mild MR) post-CRT with all-cause mortality, cardiovascular mortality, and heart failure hospitalization. A systematic search of PubMed, EMBASE, and Cochrane Library databases till July 31, 2022 identified studies reporting clinical outcomes by post-CRT secondary MR status. In 12 prospective studies of 4954 patients (weighted mean age 66.8 years, men 77.8%), the median duration of follow-up post-CRT at which patients were re-evaluated for significant secondary MR was 6 months and showed significant relative risk reduction of 30% compared to pre-CRT. The median duration of follow-up post-CRT for ascertainment of main clinical outcomes was 38 months. The random effects pooled hazard ratio (95% confidence interval) of all-cause mortality in patients with unimproved secondary MR compared to improved secondary MR was 2.00 (1.57-2.55); p < 0.001). There was insufficient data to evaluate secondary outcomes in a meta-analysis, but limited data that examined the relationship showed significant association of unimproved secondary MR with increased cardiovascular mortality and heart failure hospitalization. The findings of this meta-analysis suggest that lack of improvement in secondary MR post-CRT is associated with significantly elevated risk of all-cause mortality and possibly cardiovascular mortality and heart failure hospitalization. Future studies may investigate approaches to address persistent secondary MR post-CRT to help improved outcome in this population.
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Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA.
- Harvard Medical School, Boston, USA.
- Boston University School of Medicine, Boston, USA.
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA
- VA Providence Healthcare System, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Sebhat A Erqou
- VA Providence Healthcare System, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Scott Kinlay
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA
- Harvard Medical School, Boston, USA
- Boston University School of Medicine, Boston, USA
- Brigham and Women's Hospital, Boston, USA
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA
- Harvard Medical School, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA
- Harvard Medical School, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - William E Boden
- Cardiology and Vascular Medicine Service, VA , Boston Healthcare System, 1400 VFW Parkway, West Roxbury, Boston, MA 02132, USA
- Harvard Medical School, Boston, USA
- Boston University School of Medicine, Boston, USA
| | | | - David T Martin
- Harvard Medical School, Boston, USA
- Brigham and Women's Hospital, Boston, USA
| | - Jagmeet P Singh
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital, Boston, USA
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3
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Diaz JC, Sauer WH, Duque M, Koplan BA, Braunstein ED, Marín JE, Aristizabal J, Niño CD, Bastidas O, Martinez JM, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Kapur S, Tadros TM, Martin DT, Zei PC, Tedrow UB, Romero JE. Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization. JACC Clin Electrophysiol 2023; 9:1568-1581. [PMID: 37212761 DOI: 10.1016/j.jacep.2023.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Juan Manuel Martinez
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Romero JE, Diaz JC, Zei PC, Steiger NA, Koplan BA, Matos CD, Alviz I, Hoyos C, Marín JE, Duque M, Aristizabal J, Kapur S, Nyman CB, Niño CD, Bastidas O, Tadros TM, Martin DT, Tedrow UB, Sauer WH. Sustained Apnea for Epicardial Access With Right Ventriculography: The SAFER Epicardial Approach. JACC Clin Electrophysiol 2023; 9:1487-1499. [PMID: 37486280 DOI: 10.1016/j.jacep.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Epicardial access (EA) has emerged as an increasingly important approach for the treatment of ventricular arrhythmias and to perform other interventional cardiology procedures. EA is frequently underutilized because the current approach is challenging and carries a high risk of life-threatening complications. OBJECTIVE The purpose of this study was to determine the efficacy and safety of the SAFER (Sustained Apnea for Epicardial Access With Right Ventriculography) epicardial approach. METHODS Consecutive patients who underwent EA with the SAFER technique were included in this multicenter study. The primary efficacy outcome was the successful achievement of EA. The primary safety outcomes included right ventricular (RV) perforation, major hemorrhagic pericardial effusion (HPE), and bleeding requiring surgical intervention. Secondary outcomes included procedural characteristics and any complications. Our results were compared with those from previous studies describing other EA techniques to assess differences in outcomes. RESULTS A total of 105 patients undergoing EA with the SAFER approach from June 2021 to February 2023 were included. EA was used for ventricular tachycardia ablation in 98 patients (93.4%), left atrial appendage closure in 6 patients (5.7%), and phrenic nerve displacement in 1 patient (0.9%). EA was successful in all subjects (100%). The median time to EA was 7 minutes (IQR: 5-14 minutes). No cases of RV perforation, HPE, or need of surgical intervention were observed in this cohort. Comparing our results with previous studies about EA, the SAFER epicardial approach resulted in a significant reduction in major pericardial bleeding. CONCLUSIONS The SAFER epicardial approach is a simple, efficient, effective, and low-cost technique easily reproducible across multiple centers. It is associated with lower complication rates than previously reported techniques for EA.
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Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Juan C Diaz
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Paul C Zei
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Marín
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cesar D Niño
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ginder C, Li J, Halperin JL, Akar JG, Martin DT, Chattopadhyay I, Upadhyay GA. Predicting Malignant Ventricular Arrhythmias Using Real-Time Remote Monitoring. J Am Coll Cardiol 2023; 81:949-961. [PMID: 36889873 DOI: 10.1016/j.jacc.2022.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Although implantable cardioverter-defibrillator (ICD) therapies are associated with increased morbidity and mortality, the prediction of malignant ventricular arrhythmias has remained elusive. OBJECTIVES The purpose of this study was to evaluate whether daily remote-monitoring data may predict appropriate ICD therapies for ventricular tachycardia or ventricular fibrillation. METHODS This was a post hoc analysis of IMPACT (Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices), a multicenter, randomized, controlled trial of 2,718 patients evaluating atrial tachyarrhythmias and anticoagulation for patients with heart failure and ICD or cardiac resynchronization therapy with defibrillator devices. All device therapies were adjudicated as either appropriate (to treat ventricular tachycardia or ventricular fibrillation) or inappropriate (all others). Remote monitoring data in the 30 days before device therapy were utilized to develop separate multivariable logistic regression and neural network models to predict appropriate device therapies. RESULTS A total of 59,807 device transmissions were available for 2,413 patients (age 64 ± 11 years, 26% women, 64% ICD). Appropriate device therapies (141 shocks, 10 antitachycardia pacing) were delivered to 151 patients. Logistic regression identified shock lead impedance and ventricular ectopy as significantly associated with increased risk of appropriate device therapy (sensitivity 39%, specificity 91%, AUC: 0.72). Neural network modeling yielded significantly better (P < 0.01 for comparison) predictive performance (sensitivity 54%, specificity 96%, AUC: 0.90), and also identified patterns of change in atrial lead impedance, mean heart rate, and patient activity as predictors of appropriate therapies. CONCLUSIONS Daily remote monitoring data may be utilized to predict malignant ventricular arrhythmias in the 30 days before device therapies. Neural networks complement and enhance conventional approaches to risk stratification.
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Affiliation(s)
- Curtis Ginder
- Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jin Li
- Department of Computer Science, The University of Chicago, Chicago, Illinois, USA
| | - Jonathan L Halperin
- Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA
| | - Joseph G Akar
- Cardiac Electrophysiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ishanu Chattopadhyay
- Department of Hospital Medicine, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA. https://twitter.com/gauravaupadhyay
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Diaz JC, Cañas F, Duque M, Aristizabal J, Niño C, Bastidas O, Marin J, Rivera E, Hoyos C, Matos C, Peralta A, Martin DT, Romero J. Assisted reality device to guide cardiac implantable device programming in distant rural areas. J Cardiovasc Electrophysiol 2023; 34:497-501. [PMID: 36640437 DOI: 10.1111/jce.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIEDs) living in rural areas have difficulty obtaining follow-up visits for device interrogation and programming in specialized healthcare facilities. OBJECTIVE To describe the use of an assisted reality device designed to provide front-line workers with real-time online support from a remotely located specialist (Realwear HTM-1; Realwear) during CIED assistance in distant rural areas. METHODS This is a prospective study of patients requiring CIED interrogation using the Realwear HMT-1 in a remote rural population in Colombia between April 2021 and June 2022. CIED interrogation and device programming were performed by a general practitioner and guided by a cardiac electrophysiologist. Non-CIED-related medical interventions were allowed and analyzed. The primary objective was to determine the incidence of clinically significant CIED alerts. Secondary objectives were the changes medical interventions used to treat the events found in the device interrogations regarding non-CIED related conditions. RESULTS A total of 205 CIED interrogations were performed on 139 patients (age 69 ± 14 years; 54% female). Clinically significant CIED alerts were reported in 42% of CIED interrogations, consisting of the detection of significant arrhythmias (35%), lead malfunction (3%), and device in elective replacement interval (3.9%). Oral anticoagulation was initiated in 8% of patients and general medical/cardiac interventions unrelated to the CIED were performed in 52% of CIED encounters. CONCLUSION Remote assistance using a commercially available assisted reality device has the potential to provide specialized healthcare to patients in difficult-to-reach areas, overcoming current difficulties associated with RM, including the inability to change device programming. Additionally, these interactions provided care beyond CIED-related interventions, thus delivering significant social and clinical impact to remote rural populations.
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Affiliation(s)
- Juan C Diaz
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Felipe Cañas
- Universidad CES School of Medicine, Medellin, Colombia
| | | | - Julian Aristizabal
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Cesar Niño
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Oriana Bastidas
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Clinica Las Vegas Grupo Quiron Salud, Universidad CES, Medellin, Colombia
| | - Jorge Marin
- Universidad CES School of Medicine, Medellin, Colombia
| | - Estefania Rivera
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Matos
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adelqui Peralta
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Romero
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kiefer AW, Martin DT. Phenomics in sport: Can emerging methodology drive advanced insights? Front Netw Physiol 2022; 2:1060858. [PMID: 36926080 PMCID: PMC10012997 DOI: 10.3389/fnetp.2022.1060858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
Methodologies in applied sport science have predominantly driven a reductionist grounding to component-specific mechanisms to drive athlete training and care. While linear mechanistic approaches provide useful insights, they have impeded progress in the development of more complex network physiology models that consider the temporal and spatial interactions of multiple factors within and across systems and subsystems. For this, a more sophisticated approach is needed and the development of such a methodological framework can be considered a Sport Grand Challenge. Specifically, a transdisciplinary phenomics-based scientific and modeling framework has merit. Phenomics is a relatively new area in human precision medicine, but it is also a developed area of research in the plant and evolutionary biology sciences. The convergence of innovative precision medicine, portable non-destructive measurement technologies, and advancements in modeling complex human behavior are central for the integration of phenomics into sport science. The approach enables application of concepts such as phenotypic fitness, plasticity, dose-response dynamics, critical windows, and multi-dimensional network models of behavior. In addition, profiles are grounded in indices of change, and models consider the athlete's performance or recovery trajectory as a function of their dynamic environment. This new framework is introduced across several example sport science domains for potential integration. Specific factors of emphasis are provided as potential candidate fitness variables and example profiles provide a generalizable modeling approach for precision training and care. Finally, considerations for the future are discussed, including scaling from individual athletes to teams and additional factors necessary for the successful implementation of phenomics.
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Affiliation(s)
- Adam W. Kiefer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - David T. Martin
- Apeiron Life, Menlo Park, CA, United States
- School of Behavioral and Health Sciences, Australia Catholic University, Melbourne, NSW, Australia
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Abraham S, Nohria A, Neilan TG, Asnani A, Saji AM, Shah J, Lech T, Grossman J, Abraham GM, McQuillen DP, Martin DT, Sax PE, Dani SS, Ganatra S. Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 80:1912-1924. [PMID: 36243540 PMCID: PMC9580069 DOI: 10.1016/j.jacc.2022.08.800] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving NMVr. Ritonavir, the pharmaceutical enhancer used in NMVr, is an inhibitor of the enzymes of CYP450 pathway, particularly CYP3A4 and to a lesser degree CYP2D6, and affects the P-glycoprotein pump. Co-administration of NMVr with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects. It is crucial to be aware of such interactions and take appropriate measures to avoid them. In this review, we discuss potential drug-drug interactions between NMVr and commonly used cardiovascular medications based on their pharmacokinetics and pharmacodynamic properties.
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Affiliation(s)
- Sonu Abraham
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aarti Asnani
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anu Mariam Saji
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Jui Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Tara Lech
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Jason Grossman
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - George M Abraham
- Division of Infectious Disease, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Daniel P McQuillen
- Division of Infectious Disease, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - David T Martin
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
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9
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McLean BD, Strack DS, Martin DT. 'Avoidance Preening', Displacement Behavior and Co-Dependency in Professional Team Sport: When Wants Become More Important Than Needs. Int J Sports Phys Ther 2022; 17:945-949. [PMID: 35949384 PMCID: PMC9340827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/04/2022] [Indexed: 10/29/2022] Open
Abstract
An athlete's body plays an important role in their performance and well-being. However, game-relevant skills are better determinants of success, compared with physical fitness, in technically-driven team sports. In the professional era, over utilization of resources, in pursuit of physical optimization, can detract from time spent on priorities. Athletes' non-strategic, time-demanding focus on physical preparation/treatments resembles avian 'avoidance preening', whereby stressful situations trigger birds to excessively preen in place of more productive activities. The purpose of this commentary is to explore the behaviors of resource-rich professional teams and the roles of staff dedicated to optimizing physical performance, including circumstances that foster avoidance behavior and create the potential for practitioners to encourage co-dependent relationships with athletes. To cultivate healthy/productive environments, the following is recommended: I) recognition of non-productive avoidance behaviors; II) eschewing unjustified, fear promoting, pathoanatomical language; III) fostering collaborative approaches; IV) encouraging utilization of psychology services; V) recognizing that optimal physical function and feeling good is rarely the primary goal in professional team sports. Level of Evidence 5.
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Affiliation(s)
- Blake D McLean
- University of Technology Sydney, School of Sport, Exercise and Rehabilitation, Faculty of Health; Oklahoma City Thunder, Human & Player Performance
| | | | - David T Martin
- School of Behavioural and Health Sciences, Australian Catholic University; APEIRON Life
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10
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Wu CC, Martin DT, Bauman BD, Amateau SK, Azeem N, Harmon JV. Video-assisted retroperitoneal debridement for infected pancreatic necrosis: A single center series. Int J Surg Case Rep 2022. [PMCID: PMC9168180 DOI: 10.1016/j.ijscr.2022.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion VARD is a first option when surgery is required for infected necrotizing pancreatic necrosis. The VARD procedure requires placement of percutaneous CT guided retroperitoneal flank drains. Complications of the VARD procedure include bleeding, bowel injury, and pancreatic fistula.
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11
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Whitaker J, Kreidieh O, Bredfeldt J, Thurber CJ, Steiger N, Chang D, Sharma E, Batnyam U, Martin DT, Kapur S, Tadros TM, Koplan BA, Mak R, Martin N, Tedrow UB, Zei PC, Sauer WH. PO-632-06 REAL-TIME EX-VIVO RADIOTHERAPY IMPACTS ON PACEMAKER FUNCTION ARE MINIMAL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Sharma E, Kreidieh O, Batnyam U, Chang D, Thurber CJ, Whitaker J, Steiger N, Martin DT, Tadros TM, Kapur S, Tedrow UB, Koplan BA, Zei PC, Sauer WH. PO-715-02 POST ABLATION QT INTERVAL AND HEART RATE INCREASES ARE ASSOCIATED WITH IMPROVED OUTCOMES AFTER PULMONARY VEIN ISOLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Sauer K, Chang D, Kreidieh O, Miller AL, Tedrow UB, Zei PC, Tadros TM, Kapur S, Maytin M, Batnyam U, Sharma E, Thurber CJ, Whitaker J, Shea JB, Steiger N, Comeiro K, Rousseau LA, Andrade T, Martin DT, Romero J, Harris L, Hoskins P, Sauer WH, Koplan BA. PO-706-01 A WIDENING DIGITAL DIVIDE: UTILIZATION OF VIRTUAL VISITS IS REDUCED OVER TIME FOR BLACK AND HISPANIC COMMUNITIES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Andrade T, Kapur S, Sauer WH, Miller AL, Koplan BA, Tedrow UB, McClennen S, Tadros TM, Maytin M, Zei PC, Martin DT, Rousseau LA, Sifrig LA, Bourque N, Brady ME, Taylor LM, Hoskins P, Turner M. PO-644-07 IMPLANTABLE LOOP RECORDER UTILIZATION IN PATIENTS WITH BREAST AUGMENTATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Steiger N, Khambhati J, Kreidieh O, Whitaker J, Thurber CJ, Sharma E, Chang D, Batnyam U, Kapur S, Martin DT, Tadros TM, Zei PC, Sauer WH, Koplan BA, Tedrow UB. PO-672-03 TWO FOR THE PRICE OF ONE: BIDIRECTIONAL VENTRICULAR TACHYCARDIA FROM THE ANTEROLATERAL PAPILLARY MUSCLE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Koplan BA, Sauer K, Miller AL, Chang D, Sharma E, Batnyam U, Kapur S, Tadros TM, Tedrow UB, Martin DT, Zei PC, Antman E, Sauer WH. PO-661-08 VIRTUAL CARE IN CARDIAC ELECTROPHYSIOLOGY HAS LASTING IMPACT AND IS USED MORE OFTEN COMPARED TO OTHER CARDIOVASCULAR SUBSPECIALTIES. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Abstract
This cross-sectional study examines characteristics and outcomes of estimated discharges for Chagas heart disease in the United States from 2002 to 2017.
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Affiliation(s)
- Neiberg de Alcantara Lima
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
- Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit, Michigan
| | - David T. Martin
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ricardo Lessa de Castro
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Adam Ladzinski
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Anya Ring
- Department of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Duncan Vos
- Department of Statistics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
| | - Thomas A. Melgar
- Department of Pediatrics, Adolescent and Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo
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18
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Miyazawa K, Pastori D, Martin DT, Choucair WK, Halperin JL, Lip GYH. Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices. Europace 2021; 24:375-383. [PMID: 34426836 PMCID: PMC8892042 DOI: 10.1093/europace/euab186] [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] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied. Methods and results This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24–3.65, P = 0.006). Conclusion Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age.
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Affiliation(s)
- Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba 260-8677, Japan
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, Rome 5 00185, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
| | - David T Martin
- Department of Medicine, Brigham and Women's Hospital, Boston, 41 Mall Road Burlington, MA 01805, USA
| | - Wassim K Choucair
- Heart and Rhythm Institute of South Texas, 8122 Datapoint Dr, San Antonio, TX 78229, USA
| | - Jonathan L Halperin
- Department of Cardiovascular Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, Mount Sinai Heart, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 7K, Aalborg Øst 9220, Denmark
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19
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Sifrig LA, Taylor LM, Rousseau LA, Rubins DM, Miller AL, Martin DT, Kapur S, Tadros TM, Hoskins P, Antonellis M, Bourque N, Andrade T, Turner M. B-PO03-005 AUTOMATING AND EXPEDITING IDENTIFICATION OF CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Thurber CJ, Whitaker J, Steiger N, Kreidieh O, Dherange PA, Halawa A, Zei PC, Tadros TM, Koplan BA, Martin DT, Sauer WH, Tedrow UB, Kapur S. B-PO02-213 INTRACARDIAC ECHO MAY FACILITATE EPICARDIAL SUBSTRATE CHARACTERIZATION AFTER NORMAL BIPOLAR AND UNIPOLAR ENDOCARDIAL VOLTAGE MAPS IN VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Whitaker, BCH J, Williams SE, Tzou WS, Kreidieh O, Thurber CJ, Halawa A, Dherange PA, Martin DT, Kapur S, Tadros TM, Zei PC, Koplan BA, Tedrow UB, Sauer WH. B-PO02-175 ENDOCARDIAL UNIPOLAR VOLTAGE UNDERESTIMATES INTRAMYOCARDIAL AND EPICARDIAL SCAR IN PATIENTS WITH CARDIAC SARCOIDOSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Whitaker J, Steiger N, Thurber CJ, Kreidieh O, Dherange PA, Halawa A, Martin DT, Tadros TM, Kapur S, Koplan BA, Zei PC, Sauer WH, Tedrow UB. B-PO03-181 LVOT DILATATION IS ASSOCIATED WITH REDUCED PERI-AORTIC BIPOLAR VOLTAGE IN PATIENTS UNDERGOING VT ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Kreidieh O, Thurber CJ, Whitaker J, Amit M, Goldberg S, Harel O, Yungher D, Steiger N, Halawa A, Dherange PA, Sauer WH, Tadros TM, Kapur S, Koplan BA, Martin DT, Tedrow UB, Zei PC. B-PO03-110 ANATOMIC LESION LOCATION DURING PULMONARY VEIN ISOLATION IMPACTS ABLATION PARAMETERS AND INDEPENDENTLY PREDICTS IMPEDANCE CHANGE AND REGIONAL FIRST PASS ISOLATION: AN ANALYSIS OF 8395 LESIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Thurber CJ, Whitaker J, Kreidieh O, Halawa A, Dherange PA, Steiger N, Amit M, Goldberg S, Harel O, Yungher D, Amos Y, Koplan BA, Tadros TM, Martin DT, Kapur S, Tedrow UB, Sauer WH, Zei PC. B-PO03-101 ABLATION DELIVERY PARAMETERS PREDICT IMPEDANCE DECREASE DURING ATRIAL FIBRILLATION ABLATION VIA A CLOUD ARTIFICIAL INTELLIGENCE SYSTEM ANALYSIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Dherange PA, Thurber C, Halawa A, Kreidieh O, Whitaker J, Steiger N, Martin DT, Zei P, Koplan B, Tadros TM, Kapur S, Tedrow UB, Sauer WH. B-PO02-012 USE OF STORED DEFIBRILLATOR ELECTROGRAMS AND EXTRA STIMULUS MAPPING FOR IDENTIFICATION OF VENTRICULAR ECTOPY TRIGGERING VENTRICULAR FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Steiger N, Foley G, Qian PC, Thurber CJ, Whitaker J, Dherange PA, Halawa A, Kreidieh O, Zei PC, Tedrow UB, Kapur S, Koplan BA, Martin DT, Tadros TM, Sauer WH. B-PO03-109 ACIDIC IRRIGANT INCREASES SURFACE AREA OF RADIOFREQUENCY ABLATION LESIONS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Whitaker J, Kreidieh O, Thurber CJ, Amit M, Goldberg S, Harel O, Don Yungher YA, Steiger N, Dherange PA, Halawa A, Tadros TM, Kapur S, Koplan BA, Martin DT, Tedrow UB, Sauer WH, Zei PC. B-PO03-105 CLOUD-BASED LESION ANALYSIS WITH CARTONET IDENTIFIES CATHETER STABILITY AS A KEY FACTOR PROMOTING ACUTE FIRST PASS PULMONARY VEIN SEGMENT ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Steiger N, Foley G, Qian PC, Kreidieh O, Halawa A, Dherange PA, Whitaker J, Thurber CJ, Kapur S, Tadros TM, Koplan BA, Zei PC, Martin DT, Tedrow UB, Sauer WH. B-AB12-01 THE PRESENCE OF UNINSULATED METALLIC ELECTRODES ON AN ESOPHAGEAL TEMPERATURE PROBE IS ASSOCIATED WITH INCREASED TEMPERATURES WHEN EXPOSED TO NEARBY RADIOFREQUENCY ELECTRICAL CURRENT. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Kantharia BK, Lip GYH, Martin DT. Alterations in atrial electrogram amplitude as steady sinus rhythm transitions to paroxysmal atrial fibrillation during continuous monitoring in patients with implantable cardiac devices: Insights from the IMPACT study. J Cardiovasc Electrophysiol 2021; 32:1357-1363. [PMID: 33709486 DOI: 10.1111/jce.14997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to evaluate whether device measured amplitudes of atrial electrogram (AEGM) would change when measured in sinus rhythm (SR) transitioning to paroxysmal atrial fibrillation (AF) from previous steady SR, and significance of such change. METHODS From the IMPACT trial's database we selected two groups; (A) those who developed AF (n = 164), and (B) propensity-matched control (n = 459) who stayed in SR during continuous Home Monitoring (HM) to compare AEGMs amplitudes at baseline SR and transition phase. RESULTS During 420.0 ± 349.2 days (mean ± SD) from first postenrollment HM transmission to AF event transmission in Group A, and corresponding 515.3 ± 407.0 days in Group B, baseline and transition AEGM amplitude were 2.88 ± 1.146 and 2.74 ± 1.186 mV, respectively, for Group A (p = .1), and 2.88 ± 1.155 and 2.79 ± 1.145, respectively, for Group B (p < .005). Comparison of differences of AEGM amplitude, 0.14 ± 1.072 mV in Group A and 0.09 ± 0.893 mV in Group B were insignificant (p = .3). Age, sex, and hypertension identified as confounders had no association to AEGM changes (p = NS). CONCLUSIONS Independent of age, sex, and hypertension, AEGMs amplitudes decline over a long period of time in patients with defibrillators and substrate for AF. The significance of such change remains unclear as it occurs whether patients develop AF or not, but raises a possibility of progressive atrial myopathy that patients with substrate for AF may be predisposed to.
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Affiliation(s)
- Bharat K Kantharia
- Cardiovascular and Heart Rhythm Consultants, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregory Y H Lip
- University of Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - David T Martin
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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30
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Windt J, MacDonald K, Taylor D, Zumbo BD, Sporer BC, Martin DT. "To Tech or Not to Tech?" A Critical Decision-Making Framework for Implementing Technology in Sport. J Athl Train 2021; 55:902-910. [PMID: 32991702 DOI: 10.4085/1062-6050-0540.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The current technological age has created exponential growth in the availability of technology and data in every industry, including sport. It is tempting to get caught up in the excitement of purchasing and implementing technology, but technology has a potential dark side that warrants consideration. Before investing in technology, it is imperative to consider the potential roadblocks, including its limitations and the contextual challenges that compromise implementation in a specific environment. A thoughtful approach is therefore necessary when deciding whether to implement any given technology into practice. In this article, we review the vision and pitfalls behind technology's potential in sport science and medicine applications and then present a critical decision-making framework of 4 simple questions to help practitioners decide whether to purchase and implement a given technology.
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Affiliation(s)
- Johann Windt
- Vancouver Whitecaps FC, BC, Canada.,University of British Columbia, Vancouver, Canada
| | | | - David Taylor
- United States Olympic and Paralympic Committee, Colorado Springs, CO
| | | | - Ben C Sporer
- Vancouver Whitecaps FC, BC, Canada.,University of British Columbia, Vancouver, Canada
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31
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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo-Tcheugui JB, Martin DT, Joseph J, Singh JP. Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2021; 14:e009139. [PMID: 33554611 DOI: 10.1161/circep.120.009139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Matthew F Yuyun
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Sebhat A Erqou
- Brown University (S.A.E.), RI.,Providence VA Medical Center (S.A.E.), RI
| | - Adelqui O Peralta
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Peter S Hoffmeister
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Boston University School of Medicine (M.F.Y., A.O.P., P.S.H.), MA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York (H.Y.)
| | | | - David T Martin
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jacob Joseph
- VA Boston Healthcare System (M.F.Y., A.O.P., P.S.H., J.J.), MA.,Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Brigham and Women's Hospital (D.T.M., J.J.), Boston
| | - Jagmeet P Singh
- Harvard Medical School (M.F.Y., A.O.P., P.S.H., D.T.M., J.J., J.P.S.), MA.,Massachusetts General Hospital (J.P.S.), Boston
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Yuyun MF, Erqou SA, Peralta AO, Hoffmeister PS, Yarmohammadi H, Echouffo Tcheugui JB, Martin DT, Joseph J, Singh JP. Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis. Europace 2021; 23:1262-1274. [PMID: 33496319 DOI: 10.1093/europace/euaa414] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.
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Affiliation(s)
- Matthew F Yuyun
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sebhat A Erqou
- Department of Medicine, Brown University, Providence, RI, USA.,Division of Cardiology, Providence VA Medical Center, Providence, RI, USA
| | - Adelqui O Peralta
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Peter S Hoffmeister
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | | | - David T Martin
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacob Joseph
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jagmeet P Singh
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, MA, USA.,Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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Varshney AS, Madias C, Kakkar R, Martin DT. Watching for Disease: the Changing Paradigm of Disease Screening in the Age of Consumer Health Devices. J Gen Intern Med 2020; 35:2173-2175. [PMID: 31942673 PMCID: PMC7352046 DOI: 10.1007/s11606-019-05626-y] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/05/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
There has been a recent proliferation of consumer health devices (CHDs) that enable user-initiated screening for a variety of diseases. These devices represent a paradigm shift in the deployment of disease screening, a process that has historically been led by clinicians following the guidance of professional bodies. The detection of AF via CHDs is a contemporary example of this phenomenon and highlights several important implications of the shift of disease screening from clinicians to CHD users. These include responsibility for patient data and outcomes, healthcare costs and access, and an evolution of the patient-provider relationship. However, as CHD technologies mature and become more affordable, they have the potential to detect actionable subclinical disease and improve health. Rather than allow CHDs to enter the marketplace organically with the potential for unintended negative consequences, it is critical that clinical, research, and industry communities proactively collaborate and establish best practices for their use.
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Affiliation(s)
- Anubodh S Varshney
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Rahul Kakkar
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - David T Martin
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Ganatra S, Sharma A, Shah S, Chaudhry GM, Martin DT, Neilan TG, Mahmood SS, Barac A, Groarke JD, Hayek SS, Dani S, Venesy D, Patten R, Nohria A. Ibrutinib-Associated Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:1491-1500. [PMID: 30573111 DOI: 10.1016/j.jacep.2018.06.004] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Abstract
Ibrutinib, a novel and potent Bruton tyrosine kinase inhibitor, is an effective and well-tolerated treatment for a variety of B-cell lymphomas. However, its use is associated with an increased incidence of atrial fibrillation (AF), ranging from 4% to 16%. We reviewed the original clinical trials that led to the approval of ibrutinib, as well as several other prospective and retrospective studies, to better appreciate the incidence of ibrutinib-associated AF. Based on 16 studies included in our analysis, the incidence of ibrutinib-associated AF was 5.77 per 100 person-years, which is much higher than rates previously reported with ibrutinib and compared with the general adult population. New onset AF in cancer patients is associated with a significantly higher risk of heart failure and thromboembolism, even after adjusting for known risk factors. In addition, ibrutinib poses unique challenges due to its interactions with many medications that are commonly used to manage AF. Ibrutinib also inhibits platelet activation and decisions regarding anticoagulation have to be carefully weighed against this increased risk of bleeding. Ibrutinib's interaction with calcium channel blockers, digoxin, amiodarone, and direct oral anticoagulants can result in either ibrutinib or other drug-related toxicity and careful selection and dose adjustment may be needed. Ibrutinib-associated AF can be a therapy-limiting side effect and physicians should be familiar with the special management considerations imposed by this agent. We review the potential mechanisms and incidence of ibrutinib-associated AF and propose an algorithm for its management.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - Ajay Sharma
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Sachin Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Ghulam M Chaudhry
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David T Martin
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Syed Saad Mahmood
- Division of Cardiovascular Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Ana Barac
- Cardio-Oncology Program, Division of Cardiology, Medstar Washington Hospital Center, Washington, DC
| | - John D Groarke
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cardio-Oncology Program, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Salim S Hayek
- Division of Cardiology, Emory University, Atlanta, Georgia
| | - Saurbha Dani
- Division of Cardiovascular Medicine, Eastern Maine Medical Center, Bangor, Maine
| | - David Venesy
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Richard Patten
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Anju Nohria
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cardio-Oncology Program, Dana-Farber Cancer Institute, Boston, Massachusetts
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35
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Dunican IC, Martin DT, Halson SL, Reale RJ, Dawson BT, Caldwell JA, Jones MJ, Eastwood PR. The Effects of the Removal of Electronic Devices for 48 Hours on Sleep in Elite Judo Athletes. J Strength Cond Res 2018; 31:2832-2839. [PMID: 28081034 DOI: 10.1519/jsc.0000000000001697] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the effects of evening use of electronic devices (i.e., smartphones, etc.) on sleep quality and next-day athletic and cognitive performance in elite judo athletes. Over 6 consecutive days and nights, 23 elite Australian judo athletes were monitored while attending a camp at the Australian Institute of Sport (AIS). In 14 athletes, all electronic devices were removed on days 3 and 4 (i.e., for 48 hours: the "device-restricted group"), whereas 9 were permitted to use their devices throughout the camp (the "control group"). All athletes wore an activity monitor (Readiband) continuously to provide measures of sleep quantity and quality. Other self-reported (diary) measures included time in bed, electronic device use, and rate of perceived exertion during training periods. Cognitive performance (Cogstate) and physical performance (single leg triple hop test) were also measured. When considering night 2 as a "baseline" for each group, removal of electronic devices on nights 3 and 4 (device-restricted group) resulted in no significant differences in any sleep-related measure between the groups. When comparing actigraphy-based measures of sleep to subjective measures, all athletes significantly overestimated sleep duration by 58 ± 85 minutes (p = 0.001) per night and underestimated time of sleep onset by 37 ± 72 minutes (p = 0.001) per night. No differences in physical or cognitive function were observed between the groups. CONCLUSION This study has shown that the removal of electronic devices for a period of two nights (48 hours) during a judo camp does not affect sleep quality or quantity or influence athletic or cognitive performance.
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Affiliation(s)
- Ian C Dunican
- 1Center for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Australia; 2University of Sunshine Coast, Sippy Downs, Queensland, Australia; 3School of Sports Science Exercise and Health, The University of Western Australia, Perth, Australia; 4Combat Sports Center, The Australian Institute of Sport, Canberra, Australian Capital Territory, Australia; and 5Coastal Performance Consulting, Key West, Florida
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Sood N, Martin DT, Lampert R, Curtis JP, Parzynski C, Clancy J. Incidence and Predictors of Perioperative Complications With Transvenous Lead Extractions. Circ Arrhythm Electrophysiol 2018; 11:e004768. [DOI: 10.1161/circep.116.004768] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Nitesh Sood
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - David T. Martin
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Rachel Lampert
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jeptha P. Curtis
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Craig Parzynski
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
| | - Jude Clancy
- From the Cardiac Arrhythmia Services, Southcoast Health System, Fall River, MA (N.S.); Cardiac Arrhythmia Service, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center Burlington, MA (D.T.M.); and Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.P.C., C.P., J.C.)
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Maloney MA, Renshaw I, Headrick J, Martin DT, Farrow D. Taekwondo Fighting in Training Does Not Simulate the Affective and Cognitive Demands of Competition: Implications for Behavior and Transfer. Front Psychol 2018; 9:25. [PMID: 29445348 PMCID: PMC5797738 DOI: 10.3389/fpsyg.2018.00025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/09/2018] [Indexed: 11/13/2022] Open
Abstract
Enhancing practice design is critical to facilitate transfer of learning. Considerable research has focused on the role of perceptual information in practice simulation, yet has neglected how affect and cognition are shaped by practice environments and whether this influences the fidelity of behavior (Headrick et al., 2015). This study filled this gap by examining the fidelity of individual (cognition, affect, and actions) and interpersonal behavior of 10 highly skilled Australian Taekwondo athletes fighting in training compared to competition. Interpersonal behavior was assessed by tracking location coordinates to analyze distance-time coordination tendencies of the fighter-fighter system. Individual actions were assessed through notational analysis and approximate entropy calculations of coordinate data to quantify the (un)predictability of movement displacement. Affect and cognition were assessed with mixed-methods that included perceptual scales measuring anxiety, arousal, and mental effort, and post-fight video-facilitated confrontational interviews to explore how affect and cognitions might differ. Quantitative differences were assessed with mixed models and dependent t-tests. Results reveal that individual and interpersonal behavior differed between training and competition. In training, individuals attacked less (d = 0.81, p < 0.05), initiated attacks from further away (d = -0.20, p < 0.05) and displayed more predictable movement trajectories (d = 0.84, p < 0.05). In training, fighters had lower anxiety (d = -1.26, p < 0.05), arousal (d = -1.07, p < 0.05), and mental effort (d = -0.77, p < 0.05). These results were accompanied by changes in interpersonal behavior, with larger interpersonal distances generated by the fighter-fighter system in training (d = 0.80, p < 0.05). Qualitative data revealed the emergence of cognitions and affect specific to the training environment, such as reductions in pressure, arousal, and mental challenge. Findings highlight the specificity of performer-environment interactions. Fighting in training affords reduced affective and cognitive demands and a decrease in action fidelity compared to competition. In addition to sampling information, representative practice needs to consider modeling the cognitions and affect of competition to enhance transfer.
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Affiliation(s)
- Michael A Maloney
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia.,Movement Science Department, Australian Institute of Sport, Canberra, ACT, Australia
| | - Ian Renshaw
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jonathon Headrick
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | | | - Damian Farrow
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia.,Movement Science Department, Australian Institute of Sport, Canberra, ACT, Australia
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Dunn EC, Humberstone CE, Iredale KF, Martin DT, Blazevich AJ. Human behaviours associated with dominance in elite amateur boxing bouts: A comparison of winners and losers under the Ten Point Must System. PLoS One 2017; 12:e0188675. [PMID: 29287064 PMCID: PMC5747423 DOI: 10.1371/journal.pone.0188675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/11/2017] [Indexed: 11/24/2022] Open
Abstract
Humans commonly ascertain physical dominance through non-lethal fighting by participating in combat sports. However, the behaviours that achieve fight dominance are not fully understood. Amateur boxing competition, which is judged using the subjective “Ten Point Must-System”, provides insight into fight dominance behaviours. Notational analysis was performed on 26 elite male competitors in a national boxing championship. Behavioural (guard-drop time; movement style [stepping/bouncing time]; clinch-time; interaction-time) and technical (total punches; punches landed [%Hit]; air punches [%Air]; defence) measures were recorded. Participants reported effort required (0–100%) and perceived effect of fatigue on their own performance (5-point Likert scale) following bouts. Differences between winners and losers, and changes across the duration of the bout were examined. Winners punched more accurately than losers (greater %Hit [33% vs. 23%] and lower %Air [17% vs. 27%]) but total punches, defence and interaction-time were similar. From rounds 1–2, clinch-time and guard drops increased whilst bouncing decreased. Perceived effect of fatigue increased throughout the bout while perceived effort increased only from rounds 2–3. %Hit and movement index together in regression analysis correctly classified 85% of bout outcomes, indicating that judges (subjectively) chose winning (dominant) boxers according to punch accuracy and style, rather than assertiveness (more punches thrown). Boxers appear to use tactical strategies throughout the bout to pace their effort and minimise fatigue (increased guard drops, reduced bouncing), but these did not influence perceived dominance or bout outcome. These results show that judges use several performance indicators not including the total number of successful punches thrown to assess fight dominance and superiority between fighters. These results provide valuable information as to how experienced fight observers subjectively rate superiority and dominance during one-on-one human fighting.
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Affiliation(s)
- Emily C. Dunn
- Centre for Exercise and Sport Science Research, School of Medical and Health Science. Edith Cowan University, Joondalup, WA, Australia
- Australian Institute of Sport, Combat Centre, Canberra, ACT, Australia
- * E-mail:
| | | | - K. Fiona Iredale
- Centre for Exercise and Sport Science Research, School of Medical and Health Science. Edith Cowan University, Joondalup, WA, Australia
| | - David T. Martin
- Australian Institute of Sport, Combat Centre, Canberra, ACT, Australia
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Li DG, Wong GX, Martin DT, Tybor DJ, Kim J, Lasker J, Mitty R, Salem D. Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 2017; 7:e017251. [PMID: 28765138 PMCID: PMC5642791 DOI: 10.1136/bmjopen-2017-017251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. DESIGN In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. SETTING Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. PARTICIPANTS 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. MAIN OUTCOMES AND MEASURES Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. RESULTS A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p<0.001) were more likely to favour the equitable option compared with medical students. Moreover, female responders across all three cohorts favoured the more equitable screening test to a greater degree than did male responders (OR 1.70, CI 1.29 to 2.24; p<0.001). CONCLUSIONS Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.
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Affiliation(s)
- David G Li
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gordon X Wong
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David T Martin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - David J Tybor
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer Kim
- Stanford Medical Center, Palo Alto, California, USA
| | - Jeffrey Lasker
- New England Quality Care Alliance, Boston, Massachusetts, USA
| | - Roger Mitty
- St. Elizabeth's Medical Center, Brighton, Massachusetts, USA
| | - Deeb Salem
- Tufts Medical Center, Boston, Massachusetts, USA
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Dominguez DA, Martin DT, Velotta JB. A case of video-assisted thoracoscopic resection of malignant transformation of pulmonary recurrent respiratory papillomatosis. J Thorac Dis 2017; 9:E364-E366. [PMID: 28523179 DOI: 10.21037/jtd.2017.03.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) is a disease of the respiratory tract caused by infection with the human papillomavirus (HPV) and is characterized by multiple recurring papillomas throughout the respiratory tract. Although rare, extra laryngeal involvement carries the risk of malignant transformation in 3-7% of adults. We report the case of a patient with unmonitored juvenile onset RRP with pulmonary involvement found to have malignant transformation to squamous cell carcinoma (SCC). Incidentally found on chest radiography for mild chest wall trauma, she was found to have a large left lower lobe mass with pathology consistent with SCC. The patient underwent surgical management with thoracoscopic left lower lobectomy and mediastinal lymph node dissection followed by adjuvant chemoradiation for pathologic stage IIIA SCC. Surveillance imaging at 6 months shows no evidence of disease progression.
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Affiliation(s)
| | - David T Martin
- UCSF-East Bay Department of Surgery, San Francisco, CA, USA
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Halperin I, Williams KJ, Martin DT, Chapman DW. The Effects of Attentional Focusing Instructions on Force Production During the Isometric Midthigh Pull. J Strength Cond Res 2016; 30:919-23. [PMID: 27003451 DOI: 10.1519/jsc.0000000000001194] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Verbal instructions play a key role in motor learning and performance. Whereas directing one's attention toward bodily movements or muscles (internal focus) tends to hinder performance, instructing persons to focus on the movement outcome, or an external object related to the performed task (external focus) enhances performance. The study's purpose was to examine whether focus of attention affects maximal force production during an isometric midthigh pull (IMTP) among 18 trained athletes (8F & 10M). Athletes performed 3 IMTP trials a day for 3 consecutive days. The first day was a familiarization session in which athlete's received only control instructions. The following 2 days athletes received either control, internal, or external focus of attention instructions in a randomized, within-subject design. Compared to performance with an internal focus of attention, athletes applied 9% greater force when using an external focus of attention (p < 0.001, effect size [ES] = 0.33) and 5% greater force with control instructions (p = 0.001, ES = 0.28). A small positive 3% advantage was observed between performances with an external focus of attention compared with control instructions (p = 0.03, ES = 0.13). Focusing internally on body parts and/or muscle groups during a movement task that requires maximal force hinders performance, whereas focusing on an object external to the self leads to enhanced force production, even when using a simple multijoint static task such as the IMTP.
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Affiliation(s)
- Israel Halperin
- 1Physiology Discipline, Australian Institute of Sport, Leverrier Crescent, Bruce, Australia;2Centre for Exercise and Sport Science Research, School of Exercise & Health Science, Edith Cowan University, Joondalup, Australia; and3Strength and Conditioning, Australian Institute of Sport, Leverrier Crescent, Bruce, Australia
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Lip GY, Waldo AL, Ip J, Martin DT, Bersohn MM, Choucair WK, Akar JG, Wathen M, Halperin JL. Determinants of Time in Therapeutic Range in Patients Receiving Oral Anticoagulants (A Substudy of IMPACT). Am J Cardiol 2016; 118:1680-1684. [PMID: 27665206 DOI: 10.1016/j.amjcard.2016.08.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
Implanted cardiac arrhythmia devices can detect atrial tachyarrhythmias (atrial high-rate episodes [AHREs]) that are considered to correlate with atrial fibrillation and risk of stroke. In the IMPACT trial, oral anticoagulation was initiated when AHREs were detected by implanted cardioverter-defibrillators and withdrawn when they abated, according to a protocol accounting both for AHRE duration as detected by remote device monitoring and stroke risk assessment. In this analysis, we ascertained determinants of time in therapeutic range (TTR) among protocol-determined vitamin K antagonist-treated patients during the trial. We enrolled 2,718 patients with at least 1 additional stroke risk factor (CHADS2 score ≥1) at 104 arrhythmia centers. The sex, age <60, medical history, treatments interacting with VKA, tobacco use (2 points) and race (2 points for non-Caucasian) (SAMe-TT2R2) score is a simple clinical-derived score designed to aid decision-making on whether a patient is likely to achieve good anticoagulation control on vitamin K antagonist (e.g., warfarin), which was calculated and related to TTR achieved using the Rosendaal method. We analyzed 229 patients (mean age 66.7 years; mean CHADS2 score 2.85 [SD 1.1]) with mean TTR of 0.536 (SD 0.23) overall. Univariate analysis identified 5 variables associated with differences in mean TTR. Mean TTR was lower in those who were women (p = 0.031), of black race (p = 0.005) and in New York Heart Association class IV (p = 0.014), whereas hemoglobin >13.5 g/dl (p = 0.010) and New York Heart Association class I (p = 0.037) were associated with higher mean TTR. There was a significant difference in mean TTR value between US and non-US sites (Canada and Germany) (mean TTR for US: 0.513 vs non-US: 0.686; p <0.0001). Mean TTR was significantly lower (Δ = 0.1382, 95% CI 0.0382 to 0.2382) for patients with SAMe-TT2R2 scores of 4 (p = 0.007) and higher (Δ = 0.0612, 95% CI 0.0005 to 0.1219) for patients with SAMe-TT2R2 scores of 1 (p = 0.048). Linear regression confirmed a significant association between lower SAMe-TT2R2 score and improved anticoagulation control (p = 0.0021) with a 1-unit decrease in SAMe-TT2R2 score associated with an increase in TTR of 0.0404 (95% CI 0.0149 to 0.0659). In conclusion, clinical, geographical, and demographic factors were associated with the quality of anticoagulation control as reflected by TTR. Although overall TTR in this population was poor, lower SAMe-TT2R2 scores were associated with better TTR.
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Halperin I, Chapman DW, Martin DT, Abbiss C. The effects of attentional focus instructions on punching velocity and impact forces among trained combat athletes. J Sports Sci 2016; 35:500-507. [DOI: 10.1080/02640414.2016.1175651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Townsend NE, Gore CJ, Ebert TR, Martin DT, Hahn AG, Chow CM. Ventilatory acclimatisation is beneficial for high-intensity exercise at altitude in elite cyclists. Eur J Sport Sci 2016; 16:895-902. [PMID: 26894371 DOI: 10.1080/17461391.2016.1139190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM The aim of this study was to examine the relationship between ventilatory adaptation and performance during altitude training at 2700 m. METHODS Seven elite cyclists (age: 21.2 ± 1.1 yr, body mass: 69.9 ± 5.6 kg, height 176.3 ± 4.9 cm) participated in this study. A hypoxic ventilatory response (HVR) test and a submaximal exercise test were performed at sea level prior to the training camp and again after 15 d at altitude (ALT15). Ventilation (VE), end-tidal carbon-dioxide partial pressure (PETCO2) and oxyhaemoglobin saturation via pulse oximetry (SpO2) were measured at rest and during submaximal cycling at 250 W. A hill climb (HC) performance test was conducted at sea level and after 14 d at altitude (ALT14) using a road of similar length (5.5-6 km) and gradient (4.8-5.3%). Power output was measured using SRM cranks. Average HC power at ALT14 was normalised to sea level power (HC%). Multiple regression was used to identify significant predictors of performance at altitude. RESULTS At ALT15, there was a significant increase in resting VE (10.3 ± 1.9 vs. 12.2 ± 2.4 L·min(-1)) and HVR (0.34 ± 0.24 vs. 0.71 ± 0.49 L·min(-1)·%(-1)), while PETCO2 (38.4 ± 2.3 vs. 32.1 ± 3.3 mmHg) and SpO2 (97.9 ± 0.7 vs. 94.0 ± 1.7%) were reduced (P < .05). Multiple regression revealed ΔHVR and exercise VE at altitude as significant predictors of HC% (adjusted r(2) = 0.913; P = 0.003). CONCLUSIONS Ventilatory acclimatisation occurred during a 2 wk altitude training camp in elite cyclists and a higher HVR was associated with better performance at altitude, relative to sea level. These results suggest that ventilatory acclimatisation is beneficial for cycling performance at altitude.
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Affiliation(s)
- Nathan E Townsend
- a Athlete Health and Performance Research Centre , Aspetar Orthopaedic and Sports Medicine Hospital , Doha , Qatar.,b School of Exercise and Nutrition Sciences, Deakin University , Burwood , Australia
| | - Christopher J Gore
- c Department of Physiology , Australian Institute of Sport , Canberra , Australia
| | - Tammie R Ebert
- c Department of Physiology , Australian Institute of Sport , Canberra , Australia
| | - David T Martin
- c Department of Physiology , Australian Institute of Sport , Canberra , Australia
| | - Allan G Hahn
- c Department of Physiology , Australian Institute of Sport , Canberra , Australia
| | - Chin-Moi Chow
- d School of Exercise and Sport Science, University of Sydney , Lidcombe , Australia
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Garvican-Lewis LA, Clark B, Martin DT, Schumacher YO, McDonald W, Stephens B, Ma F, Thompson KG, Gore CJ, Menaspà P. Impact of Altitude on Power Output during Cycling Stage Racing. PLoS One 2015; 10:e0143028. [PMID: 26629912 PMCID: PMC4668098 DOI: 10.1371/journal.pone.0143028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/29/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to quantify the effects of moderate-high altitude on power output, cadence, speed and heart rate during a multi-day cycling tour. METHODS Power output, heart rate, speed and cadence were collected from elite male road cyclists during maximal efforts of 5, 15, 30, 60, 240 and 600 s. The efforts were completed in a laboratory power-profile assessment, and spontaneously during a cycling race simulation near sea-level and an international cycling race at moderate-high altitude. Matched data from the laboratory power-profile and the highest maximal mean power output (MMP) and corresponding speed and heart rate recorded during the cycling race simulation and cycling race at moderate-high altitude were compared using paired t-tests. Additionally, all MMP and corresponding speeds and heart rates were binned per 1000 m (<1000 m, 1000-2000, 2000-3000 and >3000 m) according to the average altitude of each ride. Mixed linear modelling was used to compare cycling performance data from each altitude bin. RESULTS Power output was similar between the laboratory power-profile and the race simulation, however MMPs for 5-600 s and 15, 60, 240 and 600 s were lower (p ≤ 0.005) during the race at altitude compared with the laboratory power-profile and race simulation, respectively. Furthermore, peak power output and all MMPs were lower (≥ 11.7%, p ≤ 0.001) while racing >3000 m compared with rides completed near sea-level. However, speed associated with MMP 60 and 240 s was greater (p < 0.001) during racing at moderate-high altitude compared with the race simulation near sea-level. CONCLUSION A reduction in oxygen availability as altitude increases leads to attenuation of cycling power output during competition. Decrement in cycling power output at altitude does not seem to affect speed which tended to be greater at higher altitudes.
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Affiliation(s)
- Laura A Garvican-Lewis
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
- Physiology, Australian Institute of Sport, Canberra, Australia
- * E-mail:
| | - Bradley Clark
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
- Physiology, Australian Institute of Sport, Canberra, Australia
| | - David T. Martin
- Physiology, Australian Institute of Sport, Canberra, Australia
| | | | | | | | - Fuhai Ma
- Qinghai Institute of Sport Science, Duoba, China
| | - Kevin G. Thompson
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Christopher J. Gore
- Physiology, Australian Institute of Sport, Canberra, Australia
- Exercise Physiology Laboratory, Flinders University, Adelaide, Australia
| | - Paolo Menaspà
- Physiology, Australian Institute of Sport, Canberra, Australia
- Edith Cowan University, Perth, Australia
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Lastella M, Roach GD, Halson SL, Martin DT, West NP, Sargent C. The impact of a simulated grand tour on sleep, mood, and well-being of competitive cyclists. J Sports Med Phys Fitness 2015; 55:1555-1564. [PMID: 25286890] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Professional cycling is considered one of the most demanding of all endurance sports. The three major professional cycling stages races (i.e. Tour de France, Giro d'Italia and Vuelta a España) require cyclists to compete daily covering between ~150-200 km for three consecutive weeks. Anecdotal evidence indicates that such an event has a significant effect on the sleep, mood, and general well-being of cyclists, particularly during the latter stages of the event. The primary aim of this study was to simulate a grand tour and determine the impact a grand tour has on the sleep, mood, and general well-being of competitive cyclists. METHODS Twenty-one male cyclists (M±SD, age 22.2±2.7 years) were examined for 39 days across three phases (i.e. baseline, simulated grand tour, and recovery). Sleep was assessed using sleep diaries and wrist activity monitors. Mood and general well-being were assessed using the Brunel Mood Scale (BRUMS) and Visual Analogue Scales (VAS). RESULTS The amount and quality of sleep as assessed by the wrist activity monitors declined during the simulated grand tour. In contrast, self-reported sleep quality improved throughout the study. Cyclists' mood and general well-being as indicated by vigour, motivation, physical and mental state declined during the simulated tour. CONCLUSION Future investigations should examine sleep, mood and well-being during an actual grand tour. Such data could prove instrumental toward understanding the sleep and psychological changes that occur during a grand tour.
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Affiliation(s)
- M Lastella
- Appleton Institute for Behavioural Science, Central Queensland University, SA, Australia -
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Haakonssen EC, Barras M, Burke LM, Jenkins DG, Martin DT. Body composition of female road and track endurance cyclists: Normative values and typical changes. Eur J Sport Sci 2015; 16:645-53. [PMID: 26366462 DOI: 10.1080/17461391.2015.1084538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aims of this study were to describe normative values and seasonal variation of body composition in female cyclists comparing female road and track endurance cyclists, and to validate the use of anthropometry to monitor lean mass changes. Anthropometric profiles (seven site skinfolds) were measured over 16 years from 126 female cyclists. Lean mass index (LMI) was calculated as body weight × skinfolds(-x). The exponent (x) was calculated as the slope of the natural logarithm of body weight and skinfolds. Percentage changes in LMI were compared to lean mass changes measured using dual-energy X-ray absorptiometry (DXA) in a subset of 25 road cyclists. Compared to sub-elite and elite cyclists, world class cyclists were (mean [95% CI]) 1.18 kg [0.46, 1.90] and 0.60 kg [0.05, 1.15] lighter and had skinfolds that were 7.4 mm [3.8, 11.0] and 4.6 mm [1.8, 7.4] lower, respectively. Body weight (0.41 kg [0.04, 0.77]) and skinfolds (4.0 mm [2.1, 6.0]) were higher in the off-season compared to the early-season. World class female road cyclists had lower body weight (6.04 kg [2.73, 9.35]) and skinfolds (11.5 mm [1.1, 21.9]) than track endurance cyclists. LMI (mean exponent 0.15 [0.13, 0.18]) explained 87% of the variance in DXA lean mass. In conclusion, higher performing female cyclists were lighter and leaner than their less successful peers, road cyclists were lighter and leaner than track endurance cyclists, and weight and skinfolds were lowest early in the season. LMI appears to be a reasonably valid tool for monitoring lean mass changes.
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Affiliation(s)
- Eric C Haakonssen
- a Physiology , Australian Institute of Sport , Belconnen , ACT , Australia.,b High Performance Unit , Cycling Australia , Enfield Plaza , SA , Australia.,c Human Movement and Nutrition Sciences , University of Queensland , St Lucia , QLD , Australia
| | - Martin Barras
- b High Performance Unit , Cycling Australia , Enfield Plaza , SA , Australia
| | - Louise M Burke
- d Sports Nutrition , Australian Institute of Sport , Belconnen , ACT , Australia.,e School of Exercise Science , Australian Catholic University , Melbourne , VIC , Australia
| | - David G Jenkins
- c Human Movement and Nutrition Sciences , University of Queensland , St Lucia , QLD , Australia
| | - David T Martin
- a Physiology , Australian Institute of Sport , Belconnen , ACT , Australia
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Abstract
The aim of this study was to quantify the demands of road competitions ending with sprints in male professional cycling. 17 races finished with top-5 results from 6 male road professional cyclists (age, 27.0±3.8 years; height, 1.76±0.03 m; weight, 71.7±1.1 kg) were analysed. SRM power meters were used to monitor power output, cadence and speed. Data were averaged over the entire race, different durations prior to the sprint (60, 10, 5 and 1 min) and during the actual sprint. Variations in power during the final 10 min of the race were quantified using exposure variation analysis. This observational study was conducted in the field to maximize the ecological validity of the results. Power, cadence and speed were statistically different between various phases of the race (p<0.001), increasing from 316±43 W, 95±4 rpm and 50.5±3.3 km·h(-1) in the last 10 min, to 487±58 W, 102±6 rpm and 55.4±4.7 km·h(-1) in the last min prior to the sprint. Peak power during the sprint was 17.4±1.7 W·kg(-1). Exposure variation analysis revealed a significantly greater number of short-duration high-intensity efforts in the final 5 min of the race, compared with the penultimate 5 min (p=0.010). These findings quantify the power output requirements associated with high-level sprinting in men's professional road cycling and highlight the need for both aerobic and anaerobic fitness.
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Affiliation(s)
- P Menaspà
- School of Exercise and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - M Quod
- Sport Science, GreenEDGE Cycling, Melbourne, Australia
| | - D T Martin
- Physiology, Australian Institute of Sport, Belconnen, Australia
| | - J J Peiffer
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - C R Abbiss
- Biomedical and Health Sciences, School of Exercise, Edith Cowan University, Perth, Australia
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Martin DT, Smith RK, Velu RB. Delayed pseudoaneurysm after below-knee amputation. J Vasc Surg 2015. [PMID: 26211380 DOI: 10.1016/j.jvs.2014.07.011] [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] [Indexed: 10/23/2022]
Affiliation(s)
- David T Martin
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
| | - Ross K Smith
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Ramesh B Velu
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
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Menaspà P, Martin DT, Victor J, Abbiss CR. Maximal Sprint Power in Road Cyclists After Variable and Nonvariable High-Intensity Exercise. J Strength Cond Res 2015; 29:3156-61. [PMID: 25932988 DOI: 10.1519/jsc.0000000000000972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study compared the sprint performance of professional cyclists after 10 minutes of variable (VAR) or nonvariable (N-VAR) high-intensity cycling with sprint performance in a rested state. Ten internationally competitive male cyclists (mean ± SD: age, 20.1 ± 1.3 years; stature, 1.81 ± 0.07 m; body weight, 69.5 ± 4.9 kg; and V[Combining Dot Above]O2peak, 72.5 ± 4.4 ml·kg·min) performed a 12-second maximal sprint in 3 conditions: (a) a rested state, (b) after 10 minutes of N-VAR cycling, and (c) after 10 minutes of VAR cycling. The intensity during the 10-minute efforts gradually increased to replicate power output observed in the final section of cycling road races. During the VAR cycling, participants performed short (2 seconds) accelerations at 80% of their sprint peak power, every 30 seconds. Average power output, cadence, and maximal heart rate (HR) during the 10-minute efforts were similar between conditions (5.3 ± 0.2 W·kg, 102 ± 1 rpm, and 93 ± 3% HRmax). Postexercise blood lactate concentration and sessional perceived exertion were also similar (8.3 ± 1.6 mmol·L, 15.4 ± 1.3 [6-20 scale]). Peak and average power output and cadence during the subsequent maximal sprint were not different between the 3 experimental conditions (p > 0.05). In conclusion, this study showed that neither the VAR nor the N-VAR 10-minute efforts ridden in this study impaired sprint performance in elite competitive cyclists.
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Affiliation(s)
- Paolo Menaspà
- 1Centre for Exercise and Sports Science Research, School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia; 2Department of Physiology, Sports Science and Sports Medicine, Australian Institute of Sport, Canberra, Australia; and 3High Performance Unit, Cycling Australia, Adelaide, Australia
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