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Weiss R, Osorio J, Nair D, Aguinaga L, Arabia L, Alcivar D, Al-Ahmad A, Tomassoni G, Kahaly O, Mehta R, Ward C, Holmes B, Patel D, Killu AM, Munger T, Essandoh M, Houmsse M, Rajendra A, Morales G, Hummel JD, Balasubramanian G, Daoud EG. EsophAguS Deviation During RadiofrequencY Ablation of Atrial Fibrillation: The EASY AF Trial. JACC Clin Electrophysiol 2024; 10:68-78. [PMID: 37897465 DOI: 10.1016/j.jacep.2023.09.004] [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: 07/05/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Injury to the esophagus has been reported in a high percentage of patients undergoing ablation of atrial fibrillation (AF). OBJECTIVES This study assessed the incidence of esophageal injury in patients undergoing ablation of AF with and without an esophageal deviating device. METHODS This prospective, randomized, multicenter, double-blinded, controlled Food and Drug Administration investigational device exemption trial compared the incidence of ablation-related esophageal lesions, as assessed by endoscopy, in patients undergoing AF ablation assigned to a control group (luminal esophageal temperature [LET] monitoring alone) compared with patients randomized to a deviation group (esophagus deviation device + LET). This novel deviating device uses vacuum suction and mechanical deflection to deviate a segment of the esophagus, including the trailing edge. RESULTS The data safety and monitoring board recommended stopping the study early after randomizing 120 patients due to deviating device efficacy. The primary study endpoint, ablation injury to the esophageal mucosa, was significantly less in the deviation group (5.7%) in comparison to the control group (35.4%; P < 0.0001). Control patients had a significantly higher severity and greater number of ablation lesions per patient. There was no adverse event assigned to the device. By multivariable analysis, the only feature associated with reduced esophageal lesions was randomization to deviating device (OR: 0.13; 95% CI: 0.04-0.46; P = 0.001). Among control subjects, there was no difference in esophageal lesions with high power/short duration (31.8%) vs other radiofrequency techniques (37.2%; P = 0.79). CONCLUSIONS The use of an esophageal deviating device resulted in a significant reduction in ablation-related esophageal lesions without any adverse events.
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Affiliation(s)
- Raul Weiss
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Jose Osorio
- Alabama Grandview Medical Center, Birmingham, Alabama, USA
| | - Devi Nair
- Arrhythmia Research Group, Jonesboro, Arkansas, USA
| | - Luis Aguinaga
- Centro Integral de Arritmias Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Luis Arabia
- Centro Integral de Arritmias Tucumán, San Miguel de Tucumán, Tucumán, Argentina
| | - Diego Alcivar
- Hattiesburg Clinic-Heart & Vascular, Hattiesburg, Missouri, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Research Foundation, St. David's Medical Center, Austin, Texas, USA
| | | | - Omar Kahaly
- ProMedica Toledo Hospital, Toledo, Ohio, USA
| | - Rohit Mehta
- Atrium Health, Sanger Heart & Vascular Center, Charlotte, North Carolina, USA
| | - Chad Ward
- Prisma Health, Greenville, South Carolina, USA
| | | | - Dilesh Patel
- TriHealth Heart Institute, Cincinnati, Ohio, USA
| | | | | | - Michael Essandoh
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - Anil Rajendra
- Alabama Grandview Medical Center, Birmingham, Alabama, USA
| | | | - John D Hummel
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | - Emile G Daoud
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
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Okabe T, Bhuta S, Afzal MR, Savona SJ, Kalbfleisch SJ, Houmsse M, Augostini RS, Daoud EG, Hummel JD. Delayed bipolar voltage changes in the left atrium after vein of Marshall ethanol infusion. Pacing Clin Electrophysiol 2023; 46:948-950. [PMID: 37436707 DOI: 10.1111/pace.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sapan Bhuta
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Salvatore J Savona
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bhuta S, Shaaban A, Binda NC, Antaki J, Augostini RS, Kalbfleisch SJ, Savona SJ, Okabe T, Houmsse M, Afzal MR, Daoud EG, Hummel JD. Direct current cardioversion practices following percutaneous left atrial appendage closure. J Cardiovasc Electrophysiol 2023; 34:1698-1705. [PMID: 37493499 DOI: 10.1111/jce.15999] [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] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Among patients with non-valvular atrial fibrillation (AF) and percutaneous left atrial appendage closure (LAAC) undergoing direct current cardioversion (DCCV), the need for and use of LAA imaging and oral anticoagulation (OAC) is unclear. OBJECTIVE The purpose of this study is to evaluate the real-world use of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) before DCCV and use of OAC pre- and post-DCCV in patients with AF status post percutaneous LAAC. METHODS This retrospective single center study included all patients who underwent DCCV after percutaneous LAAC from 2016 to 2022. Key measures were completion of TEE or CCTA pre-DCCV, OAC use pre- and post-DCCV, incidence of left atrial thrombus (LAT) or device-related thrombus (DRT), incidence of peri-device leak (PDL), and DCCV-related complications (stroke, systemic embolism, device embolization, major bleeding, or death) within 30 days. RESULTS A total of 76 patients with AF and LAAC underwent 122 cases of DCCV. LAAC consisted of 47 (62%), 28 (37%), and 1 (1%) case of Watchman 2.5, Watchman FLX, and Lariat, respectively. Among the 122 DCCV cases, 31 (25%) cases were identified as "non-guideline based" due to: (1) no OAC for 3 weeks and no LAA imaging within 48 h before DCCV in 12 (10%) cases, (2) no OAC for 4 weeks following DCCV in 16 (13%) cases, or (3) both in 3 (2%) cases. Among the 70 (57%) cases that underwent TEE or CCTA before DCCV, 16 (23%) cases had a PDL with a mean size of 3.0 ± 1.1 mm, and 4 (6%) cases had a LAT/DRT on TEE resulting in cancellation. There were no DCCV-related complications within 30 days. DISCUSSION There is a widely varied practice pattern of TEE, CCTA, and OAC use with DCCV after LAAC, with a 6% rate of LAT/DRT. LAA imaging before DCCV appears prudent in all cases, especially within 1 year of LAAC, to assess for device position, PDL, and LAT/DRT.
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Affiliation(s)
- Sapan Bhuta
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adnan Shaaban
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nkongho C Binda
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Antaki
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Salvatore J Savona
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Toshimasa Okabe
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bhuta S, Cao C, Pieper JA, Tong MS, Varghese J, Han Y, Harfi TT, Simonetti OP, Augostini RS, Kalbfleisch SJ, Savona SJ, Okabe T, Afzal MR, Hummel JD, Daoud EG, Houmsse M. Cardiac magnetic resonance imaging for left atrial appendage closure planning. Pacing Clin Electrophysiol 2023; 46:745-751. [PMID: 37221927 DOI: 10.1111/pace.14713] [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] [Received: 03/18/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Transesophageal echocardiography (TEE) and cardiac computed tomography angiography (CCTA) are currently utilized for left atrial appendage closure (LAAC) planning. During the recent global iodine contrast media shortage in 2022, cardiac magnetic resonance imaging (CMR) was utilized for the first time for LAAC planning. This study sought to assess the utility of CMR versus TEE for LAAC planning. METHODS This single center retrospective study consisted of all patients who underwent preoperative CMR for LAAC with Watchman FLX or Amplatzer Amulet. Key measures were accuracy of LAA thrombus exclusion, ostial diameter, depth, lobe count, morphology, accuracy of predicted device size, and devices deployed per case. Bland-Altman Analysis was used to compare CMR versus TEE measurements of LAA ostial diameter and depth. RESULTS 25 patients underwent preoperative CMR for LAAC planning. A total of 24 (96%) cases were successfully completed with 1.2 ± 0.5 devices deployed per case. Among the 18 patients who underwent intraoperative TEE, there was no significant difference between CMR versus TEE in LAA thrombus exclusion (CMR 83% vs. TEE 100% cases, p = .229), lobe count (CMR 1.7 ± 0.8 vs. TEE 1.4 ± 0.6, p = .177), morphology (p = .422), and accuracy of predicted device size (CMR 67% vs. TEE 72% cases, p = 1.000). When comparing the difference between CMR and TEE measurements, Bland-Altman analysis demonstrated no significant difference in LAA ostial diameter (CMR-TEE bias 0.7 mm, 95% CI [-1.1, 2.4], p = .420), but LAA depth was significantly larger with CMR versus TEE (CMR-TEE bias 7.4 mm, 95% CI [1.6, 13.2], p = .015). CONCLUSIONS CMR is a promising alternative for LAAC planning in cases where TEE or CCTA are contraindicated or unavailable.
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Affiliation(s)
- Sapan Bhuta
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carolyn Cao
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Justin A Pieper
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew S Tong
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Juliet Varghese
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Yuchi Han
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thura T Harfi
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Salvatore J Savona
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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5
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Li N, Hansen BJ, Kennelly J, Kalyanasundaram A, Kanaan A, Simonetti OP, Mohler PJ, Whitson B, Hummel JD, Zhao J, Fedorov VV. High-Resolution 3-Dimensional Multimodality Imaging to Resolve Intramural Human Sinoatrial Node Pacemakers and Epicardial-Endocardial Atrial Exit Sites. Circ Arrhythm Electrophysiol 2023; 16:e011528. [PMID: 36916270 PMCID: PMC10208092 DOI: 10.1161/circep.122.011528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Ning Li
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Brian J. Hansen
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - James Kennelly
- Auckland Bioengineering Institute, The University of Auckland; Auckland, New Zealand
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adel Kanaan
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Orlando P. Simonetti
- Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Radiology The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J. Mohler
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryan Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D. Hummel
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
- Division of Cardiovascular Medicine The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland; Auckland, New Zealand
| | - Vadim V. Fedorov
- Department of Physiology & Cell Biology The Ohio State University Wexner Medical Center, Columbus, OH
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center, Columbus, OH
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Wilbur JG, Bhuta S, Horbal P, Abdel-Rasoul M, Sirinvaravong N, Sleiman J, Lee J, Wallace G, Daoud EG, Augostini RS, Weiss R, Kalbfleisch SJ, Savona S, Houmsse M, Hummel JD, Okabe T, Afzal MR. VEIN OF MARSHALL ETHANOL INFUSION FOR ADJUNCTIVE ABLATION OF ATRIAL FIBRILLATION: SINGLE CENTER EXPERIENCE AND PROCEDURAL LEARNING CURVE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Horbal P, Bhuta S, Wilbur JG, Abdel-Rasoul M, Salmeron A, Lopez-Giraldo S, Drake L, Sirinvaravong N, Sleiman J, Lee J, Wallace G, Daoud EG, Augostini RS, Weiss R, Kalbfleisch SJ, Savona S, Houmsse M, Hummel JD, Afzal MR, Okabe T. ATTRITION OF PROCEDURAL SUCCESS OF VEIN OF MARSHALL ALCOHOL ABLATION FOR ATRIAL FIBRILLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bhuta S, Poliner M, Horbal P, Sirinvaravong N, Sleiman J, Lee J, Wallace G, Daoud EG, Augostini RS, Weiss R, Kalbfleisch SJ, Savona S, Houmsse M, Okabe T, Afzal MR, Hummel JD. INCIDENCE AND TEMPORAL EVOLUTION OF PERIDEVICE LEAK WITH WATCHMAN FLX LEFT ATRIAL APPENDAGE CLOSURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00488-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kalyanasundaram A, Li N, Augostini RS, Weiss R, Hummel JD, Fedorov VV. Three-dimensional functional anatomy of the human sinoatrial node for epicardial and endocardial mapping and ablation. Heart Rhythm 2023; 20:122-133. [PMID: 36113768 PMCID: PMC9897959 DOI: 10.1016/j.hrthm.2022.08.039] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023]
Abstract
The sinoatrial node (SAN) is the primary pacemaker of the human heart. It is a single, elongated, 3-dimensional (3D) intramural fibrotic structure located at the junction of the superior vena cava intercaval region bordering the crista terminalis (CT). SAN activation originates in the intranodal pacemakers and is conducted to the atria through 1 or more discrete sinoatrial conduction pathways. The complexity of the 3D SAN pacemaker structure and intramural conduction are underappreciated during clinical multielectrode mapping and ablation procedures of SAN and atrial arrhythmias. In fact, defining and targeting SAN is extremely challenging because, even during sinus rhythm, surface-only multielectrode mapping may not define the leading pacemaker sites in intramural SAN but instead misinterpret them as epicardial or endocardial exit sites through sinoatrial conduction pathways. These SAN exit sites may be distributed up to 50 mm along the CT beyond the ∼20-mm-long anatomic SAN structure. Moreover, because SAN reentrant tachycardia beats may exit through the same sinoatrial conduction pathway as during sinus rhythm, many SAN arrhythmias are underdiagnosed. Misinterpretation of arrhythmia sources and/or mechanisms (eg, enhanced automaticity, intranodal vs CT reentry) limits diagnosis and success of catheter ablation treatments for poorly understood SAN arrhythmias. The aim of this review is to provide a state-of-the-art overview of the 3D structure and function of the human SAN complex, mechanisms of SAN arrhythmias and available approaches for electrophysiological mapping, 3D structural imaging, pharmacologic interventions, and ablation to improve diagnosis and mechanistic treatment of SAN and atrial arrhythmias.
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Affiliation(s)
- Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ralph S Augostini
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raul Weiss
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio; Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Hummel JD, Kong MH, D'Arcy J, Perekrestenko D, Ruppersberg P. PO-640-03 ELECTROGRAPHIC FLOW ANGLE VARIABILITY ENABLES ATRIAL RHYTHM DISCRIMINATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.138] [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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Kalyanasundaram A, Mylavarapu U, Li N, Hansen B, Khambhampati S, Mohler PJ, Simonetti OP, Hummel JD, Fedorov VV. PO-646-08 HETEROGENEOUS TRANSMURAL FIBROSIS REMODELING CREATES ARRHYTHMOGENIC SUBSTRATES IN A CANINE MODEL OF PERSISTENT ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.197] [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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12
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Shah R, Danielson A, Atchison T, Schilling G, Okabe T, Houmsse M, Augostini RS, Daoud EG, Hummel JD, Afzal MR. PO-678-07 IMPACT OF SINGLE VS MULTIPLE DEPLOYMENT ATTEMPTS ON CARDIAC PERFORATION DURING IMPLANTATION OF LEADLESS PACEMAKERS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.482] [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: 11/27/2022]
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13
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Li N, Artiga E, Kalyanasundaram A, Hansen BJ, Webb A, Pietrzak M, Biesiadecki B, Whitson B, Mokadam NA, Janssen PML, Hummel JD, Mohler PJ, Dobrzynski H, Fedorov VV. Altered microRNA and mRNA profiles during heart failure in the human sinoatrial node. Sci Rep 2021; 11:19328. [PMID: 34588502 PMCID: PMC8481550 DOI: 10.1038/s41598-021-98580-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022] Open
Abstract
Heart failure (HF) is frequently accompanied with the sinoatrial node (SAN) dysfunction, which causes tachy-brady arrhythmias and increased mortality. MicroRNA (miR) alterations are associated with HF progression. However, the transcriptome of HF human SAN, and its role in HF-associated remodeling of ion channels, transporters, and receptors responsible for SAN automaticity and conduction impairments is unknown. We conducted comprehensive high-throughput transcriptomic analysis of pure human SAN primary pacemaker tissue and neighboring right atrial tissue from human transplanted HF hearts (n = 10) and non-failing (nHF) donor hearts (n = 9), using next-generation sequencing. Overall, 47 miRs and 832 mRNAs related to multiple signaling pathways, including cardiac diseases, tachy-brady arrhythmias and fibrosis, were significantly altered in HF SAN. Of the altered miRs, 27 are predicted to regulate mRNAs of major ion channels and neurotransmitter receptors which are involved in SAN automaticity (e.g. HCN1, HCN4, SLC8A1) and intranodal conduction (e.g. SCN5A, SCN8A) or both (e.g. KCNJ3, KCNJ5). Luciferase reporter assays were used to validate interactions of miRs with predicted mRNA targets. In conclusion, our study provides a profile of altered miRs in HF human SAN, and a novel transcriptome blueprint to identify molecular targets for SAN dysfunction and arrhythmia treatments in HF.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Esthela Artiga
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Amy Webb
- Biomedical Informatics Shared Resources, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Maciej Pietrzak
- Biomedical Informatics Shared Resources, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Brandon Biesiadecki
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Bryan Whitson
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Nahush A Mokadam
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, 43210-1218, USA. .,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart & Lung Research Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA.
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14
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Okabe T, Savona SJ, Matto F, Ward C, Singh P, Afzal MR, Kalbfleisch SJ, Weiss R, Houmsse M, Augostini RS, Hummel JD, Daoud EG. A 10 J shock impedance in sinus rhythm correlates with a 65 J defibrillation impedance during subcutaneous defibrillator implantation using an intermuscular technique. J Cardiovasc Electrophysiol 2021; 32:3027-3034. [PMID: 34554620 DOI: 10.1111/jce.15249] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Defibrillation testing (DT) is recommended during the subcutaneous defibrillator (S-ICD) placement. We sought to compare 10 J shock impedance in sinus rhythm (SR) with 65 J defibrillation impedance and evaluate device position on a postimplant chest X-ray (CXR) using an intermuscular (IM) technique. METHODS Consecutive S-ICD implantations between 12/2019 and 12/2020 at The Ohio State University were reviewed. All implantations were performed using a two-incision IM technique. Standard DT with 65 J shock and 10 J shock in SR were performed unless contraindicated. The PRAETORIAN score was calculated based on CXR. RESULTS A total of 37 patients (age: 47.2 ± 15.8 years old, male: n = 26 [70.3%], body mass index: 30.1 ± 6.7 kg/m2 ) underwent IM S-ICD implantation, and of those, 27 (73%) underwent both 65 J shock and 10 J shock in SR. The coefficient of determination (R2 ) between 10 J shock impedance and 65 J shock impedance was 0.84. The mean of an impedance difference was 1.6 ± 4.8 Ω (minimum - 11 and maximum 8). Postimplant CXR was available for 33 out of 37 patients (89.2%). The PRAETORIAN score was less than 90 in all patients and the mean score was 32.7 ± 8.8. CONCLUSION We demonstrated that 10 J shock impedance in SR correlated well with 65 J defibrillation impedance during IM S-ICD implantation. An IM implantation technique provides excellent generator location on postimplant CXR. The IM technique combined with 10 J shock in SR may be sufficient to predict and ensure the defibrillation efficacy of the S-ICD.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Salvatore J Savona
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Faisal Matto
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chad Ward
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Prabhpreet Singh
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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15
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Afzal MR, Gabriels JK, Jackson GG, Chen L, Buck B, Campbell S, Sabin DF, Goldner B, Ismail H, Liu CF, Patel A, Beldner S, Daoud EG, Hummel JD, Ellis CR. Temporal Changes and Clinical Implications of Delayed Peridevice Leak Following Left Atrial Appendage Closure. JACC Clin Electrophysiol 2021; 8:15-25. [PMID: 34454881 DOI: 10.1016/j.jacep.2021.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess temporal changes and clinical implications of peridevice leak (PDL) after left atrial appendage closure. BACKGROUND Endocardial left atrial appendage closure devices are alternatives to long-term oral anticoagulation (OAC) for patients with atrial fibrillation. PDL > 5 mm may prohibit discontinuation of OAC. METHODS Patients included in the study had: 1) successful Watchman device implantation without immediate PDL; 2) new PDL identified at 45 to 90 days using transesophageal echocardiography; 3) eligibility for OAC; and 4) 1 follow-up transesophageal echocardiographic study for PDL surveillance. Relevant clinical and imaging data were collected by chart review. The combined primary outcome included failure to stop OAC after 45 to 90 days, transient ischemic attack or stroke, device-related thrombi, and need for PDL closure. RESULTS Relevant data were reviewed for 1,039 successful Watchman device implantations. One hundred eight patients (10.5%) met the inclusion criteria. The average PDL at 45 to 90 days was 3.2 ± 1.6 mm. On the basis of a median PDL of 3 mm, patients were separated into ≤3 mm (n = 73) and >3 mm (n = 35) groups. In the ≤3 mm group, PDL regressed significantly (2.2 ± 0.8 mm vs 1.6 ± 1.4 mm; P = 0.002) after 275 ± 125 days. In the >3 mm group, there was no significant change in PDL (4.9 ± 1.4 mm vs 4.0 ± 3.0 mm; P = 0.12) after 208 ± 137 days. The primary outcome occurred more frequently (69% vs 34%; P = 0.002) in the >3 mm group. The incidence of transient ischemic attack or stroke in patients with PDL was significantly higher compared with patients without PDL, irrespective of PDL size. CONCLUSIONS New PDL detected by transesophageal echocardiography at 45 to 90 days occurred in a significant percentage of patients and was associated with worse clinical outcomes. PDL ≤ 3 mm tended to regress over time.
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Affiliation(s)
- Muhammad R Afzal
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James K Gabriels
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Lu Chen
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Benjamin Buck
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sandra Campbell
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dawn F Sabin
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce Goldner
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Haisam Ismail
- Northwell Health, Long Island Jewish Hospital, Division of Electrophysiology, Manhasset, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Apoor Patel
- Division of Electrophysiology, Northwell Health, North Shore University Hospital, Manhasset, New York, USA
| | - Stuart Beldner
- Division of Electrophysiology, Northwell Health, North Shore University Hospital, Manhasset, New York, USA
| | - Emile G Daoud
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Mikhailov A, Subr M, Mylavarapu U, Hoenie L, Nalar A, Kennelly J, Yen YL, Li N, Pan Y, Helfrich KM, Scott SS, Kalyanasundaram A, Wilson A, Joseph M, Buck BH, Hansen B, Bratazc A, Mohler PJ, Zhao J, Hummel JD, Simonetti OP, Fedorov VV. B-PO05-017 IN VIVO TO EX VIVO HIGH RESOLUTION OPTICAL MAPPING AND CONTRAST ENHANCED MAGNETIC RESONANCE IMAGING TO REVEAL ATRIAL FIBRILLATION DRIVERS AND IMPROVE IDENTIFICATION OF ARRHYTHMOGENIC STRUCTURAL SUBSTRATES IN PERSISTENT ATRIAL FIBRILLATION CANINE MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.937] [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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17
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Wallace GM, Harding Buck B, Nadkarni A, Sanchez R, Okabe T, Houmsse M, Weiss R, Augostini RS, Daoud EG, Kalbfleisch SJ, Hummel JD, Afzal. B-PO04-047 VENTRICULAR DYSSYNCHRONY ASSESSED WITH SPECKLE-TRACKING ECHOCARDIOGRAPHY IS LOWER IN LEADLESS PACEMAKERS COMPARED TO TRANSVENOUS PACEMAKERS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.743] [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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18
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Okabe T, McVay H, Heidenthal E, Afzal MR, Kalbfleisch SJ, Weiss R, Houmsse M, Daoud EG, Augostini RS, Hummel JD. B-PO04-107 INCIDENCE AND CHARACTERISTICS OF CARINAL ABLATION IN PULMONARY VEIN ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.801] [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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19
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Okabe T, Afzal MR, Houmsse M, Makary MS, Elliot ED, Daoud EG, Augostini RS, Hummel JD. Tine-Based Leadless Pacemaker: Strategies for Safe Implantation in Unconventional Clinical Scenarios. JACC Clin Electrophysiol 2021; 6:1318-1331. [PMID: 33092762 DOI: 10.1016/j.jacep.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
Leadless pacemakers (LPs) have emerged as a meaningful alternative to transvenous pacemakers for single-ventricular pacing. LPs eliminate many of lead- and pocket-associated complications observed with transvenous pacemakers. Owing to the lack of atrioventricular synchronous pacing until recently, the use of LP was generally reserved for those patients who either required minimal ventricular pacing or had permanent atrial fibrillation. The only commercially available LP is the Micra transcatheter pacing system (Micra-TPS, Medtronic Inc. Fridley, Minnesota), which requires insertion of a 27-F (outer diameter) introducer sheath in the femoral vein. The LP is delivered to the right ventricle using a 23-F delivery catheter. Owing to the need for a large-bore sheath, the pivotal studies for the Micra transcatheter pacing system excluded patients with indwelling inferior vena cava filters and included only a few patients with bioprosthetic or repaired tricuspid valve. Subsequent real-world experience has demonstrated the overall safety and feasibility of LP placement, and use in various unconventional clinical settings has been validated, albeit with specific precautions. Additionally, incorporation of adjunctive techniques and strategies can improve the safety of the procedure in routine clinical settings as well. The objective of this state-of-the-art review is to highlight the key procedural elements to facilitate safe and efficient implantation of LP in routine as well as in unique clinical settings.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric D Elliot
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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20
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Okabe T, Hummel JD, Bank AJ, Niazi IK, McGrew FA, Kindsvater S, Oza SR, Scherschel JA, Walsh MN, Singh JP. Leadless left ventricular stimulation with WiSE-CRT System - Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase). Heart Rhythm 2021; 19:22-29. [PMID: 34332966 DOI: 10.1016/j.hrthm.2021.06.1195] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resynchronization therapy (CRT). WiSE-CRT is a wireless LV endocardial pacing system, and delivers ultrasonic energy to an LV electrode. OBJECTIVE The purpose of this study was to present short-term outcomes with the WiSE-CRT system in centers with no prior implanting experience. METHODS Data were prospectively collected from 19 centers where WiSE-CRT systems were implanted during the roll-in phase of the SOLVE-CRT trial. Patients were followed at 1, 3, and 6 months, including transthoracic echo (TTE) at 6 months. RESULTS The WiSE-CRT was successfully implanted in all 31 attempted cases, and 30 patients completed the 6-month follow-up. One patient underwent heart transplantation 1 month after implantation, and was excluded. Fourteen (46.7%) patients demonstrated ≥1 NYHA class improvement. TTE data were available in 29 patients. LV ejection fraction, LV end-systolic volume, and LV end-diastolic volume improved from 28.3% ± 6.7% to 33.5% ± 6.9% (P < .001), 134.9 ± 51.3 mL to 111.1 ± 40.3 mL (P = .0004), and 185.4 ± 58.8 mL to 164.9 ± 50.6 mL (P = .0017), respectively. There were 3 (9.7%) device-related type 1 complications: 1 insufficient LV pacing, 1 embolization of an unanchored LV electrode, and 1 skin infection. CONCLUSIONS We demonstrated a high success rate of LV endocardial electrode placement in centers with no prior implanting experience. Favorable clinical responses in heart failure symptoms and significant LV reverse remodeling were noted.
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Affiliation(s)
- Toshimasa Okabe
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alan J Bank
- Minneapolis Heart Institute, Allina Health, St. Paul, Minnesota
| | | | | | | | - Saumil R Oza
- Ascension St. Vincent's Hospital, Jacksonville, Florida
| | | | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Afzal MR, Jamal SM, Son JH, Chung JH, Gabriels J, Okabe T, Hummel JD, Augostini RS. Tips and Tricks for Safe Retrieval of Tine-based Leadless Pacemakers. J Innov Card Rhythm Manag 2021; 12:4562-4568. [PMID: 34234991 PMCID: PMC8225307 DOI: 10.19102/icrm.2021.120606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
As leadless pacing (LP) use is expected to increase, it becomes increasingly essential that operators become familiar with the tools and techniques needed to retrieve an LP successfully. The purpose of this review is to describe a stepwise approach for the successful retrieval of tine-based LP devices, including ways to minimize complications.
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Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shakeel M Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Jae H Son
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, OH, USA
| | - Jae-Hoon Chung
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James Gabriels
- Department of Medicine, Division of Cardiology, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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22
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Okabe T, Afzal MR, Hummel JD, Daoud EG, Houmsse M, Kalbfleisch SJ, Augostini RS. Reply to "Misleading Title and Communication Regarding Brief Communication entitled: First clinical use of real-time remote programming in cardiac implantable electronic devices". J Cardiovasc Electrophysiol 2021; 32:1517. [PMID: 33650726 DOI: 10.1111/jce.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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23
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Afzal MR, Casmer A, Buck B, Houmsse M, Daoud EG, Kalbfleisch SJ, Augostini RS, Weiss R, Hummel JD, Okabe T. Incidence and Risk Factors for Early Explantation of Subcutaneous Cardiac Rhythm Monitors. JACC Clin Electrophysiol 2020; 6:1858-1860. [DOI: 10.1016/j.jacep.2020.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
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24
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Piccini JP, Stromberg K, Jackson KP, Kowal RC, Duray GZ, El-Chami MF, Crossley GH, Hummel JD, Narasimhan C, Omar R, Ritter P, Roberts PR, Soejima K, Reynolds D, Zhang S, Steinwender C, Chinitz L. Patient selection, pacing indications, and subsequent outcomes with de novo leadless single-chamber VVI pacing. Europace 2020; 21:1686-1693. [PMID: 31681964 DOI: 10.1093/europace/euz230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Patient selection is a key component of securing optimal patient outcomes with leadless pacing. We sought to describe and compare patient characteristics and outcomes of Micra patients with and without a primary pacing indication associated with atrial fibrillation (AF) in the Micra IDE trial. METHODS AND RESULTS The primary outcome (risk of cardiac failure, pacemaker syndrome, or syncope related to the Micra system or procedure) was compared between successfully implanted patients from the Micra IDE trial with a primary pacing indication associated with AF or history of AF (AF group) and those without (non-AF group). Among 720 patients successfully implanted with Micra, 228 (31.7%) were in the non-AF group. Reasons for selecting VVI pacing in non-AF patients included an expectation for infrequent pacing (66.2%) and advanced age (27.2%). More patients in the non-AF group had a condition that precluded the use of a transvenous pacemaker (9.6% vs. 4.7%, P = 0.013). Atrial fibrillation patients programmed to VVI received significantly more ventricular pacing compared to non-AF patients (median 67.8% vs. 12.6%; P < 0.001). The overall occurrence of the composite outcome at 24 months was 1.8% with no difference between the AF and non-AF groups (hazard ratio 1.36, 95% confidence interval 0.45-4.2; P = 0.59). CONCLUSION Nearly one-third of patients selected to receive Micra VVI therapy were for indications not associated with AF. Non-AF VVI patients required less frequent pacing compared to patients with AF. Risks associated with VVI therapy were low and did not differ in those with and without AF.
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Affiliation(s)
- Jonathan P Piccini
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin P Jackson
- Electrophysiology Section, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Gabor Z Duray
- Clinical Electrophysiology Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | | | | | | | | | - Razali Omar
- Electrophysiology and Pacing Unit, National Heart Institute, Kuala Lumpur, Malaysia
| | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | | | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences Center, OU Medical Center, Oklahoma City, OK, USA
| | | | - Clemens Steinwender
- Kepler University Hospital, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
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25
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Sanchez R, Nadkarni A, Buck B, Daoud G, Koppert T, Okabe T, Houmsse M, Weiss R, Augostini R, Hummel JD, Kalbfleisch S, Daoud EG, Afzal MR. Incidence of pacing-induced cardiomyopathy in pacemaker-dependent patients is lower with leadless pacemakers compared to transvenous pacemakers. J Cardiovasc Electrophysiol 2020; 32:477-483. [PMID: 33205561 PMCID: PMC7984287 DOI: 10.1111/jce.14814] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023]
Abstract
Introduction Frequent right AQ4ventricular pacing (≥40%) with a transvenous pacemaker (TVP) is associated with the risk of pacing‐induced cardiomyopathy (PICM). Leadless pacemakers (LPs) have distinct physical and mechanical differences from TVP. The risk of PICM with LP is not known. To identify incidence, predictors, and long‐term outcomes of PICM in LP and TVP patients. Methods The study comprised all pacemaker‐dependent patients with LP or TVP who had left ventricular ejection fraction (LVEF) of ≥50 from 2014 to 2019. The incidence of PICM (≥10% LVEF drop) was assessed with an echocardiogram. Predictors for PICM were identified using multivariate analysis. Long‐term outcomes after cardiac resynchronization (CRT) were assessed in both groups. Results A total of 131 patients with TVP and 67 with LP comprised the study. All patients in the TVP group and the majority in the LP group underwent atrioventricular node ablation. The mean follow‐up duration in TVP and LP groups was 592 ± 549 and 817 ± 600 days, respectively. A total of 18 (13.7%) patients in TVP and 2 (3%) in LP developed PICM after a median duration of 254 (interquartile range: 470) days. The incidence of PICM was significantly higher with TVP compared with LP (p = .02). TVP as pacing modality was a positive (odds ratio [OR]: 1.07) while age was negative (OR: 0.94) predictor for PICM on multivariable analysis. Both patients in LP and all except two in the TVP group responded to CRT. Conclusion Incidence of PICM is significantly lower with LP compared with TVP in pacemaker‐dependent patients. Age and TVP as pacing modality were predictors for PICM.
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Affiliation(s)
- Reynaldo Sanchez
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anish Nadkarni
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin Buck
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Georges Daoud
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tanner Koppert
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph Augostini
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven Kalbfleisch
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Mikhailov AV, Kalyanasundaram A, Li N, Scott SS, Artiga EJ, Subr MM, Zhao J, Hansen BJ, Hummel JD, Fedorov VV. Comprehensive evaluation of electrophysiological and 3D structural features of human atrial myocardium with insights on atrial fibrillation maintenance mechanisms. J Mol Cell Cardiol 2020; 151:56-71. [PMID: 33130148 DOI: 10.1016/j.yjmcc.2020.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
Atrial fibrillation (AF) occurrence and maintenance is associated with progressive remodeling of electrophysiological (repolarization and conduction) and 3D structural (fibrosis, fiber orientations, and wall thickness) features of the human atria. Significant diversity in AF etiology leads to heterogeneous arrhythmogenic electrophysiological and structural substrates within the 3D structure of the human atria. Since current clinical methods have yet to fully resolve the patient-specific arrhythmogenic substrates, mechanism-based AF treatments remain underdeveloped. Here, we review current knowledge from in-vivo, ex-vivo, and in-vitro human heart studies, and discuss how these studies may provide new insights on the synergy of atrial electrophysiological and 3D structural features in AF maintenance. In-vitro studies on surgically acquired human atrial samples provide a great opportunity to study a wide spectrum of AF pathology, including functional changes in single-cell action potentials, ion channels, and gene/protein expression. However, limited size of the samples prevents evaluation of heterogeneous AF substrates and reentrant mechanisms. In contrast, coronary-perfused ex-vivo human hearts can be studied with state-of-the-art functional and structural technologies, such as high-resolution near-infrared optical mapping and contrast-enhanced MRI. These imaging modalities can resolve atrial arrhythmogenic substrates and their role in reentrant mechanisms maintaining AF and validate clinical approaches. Nonetheless, longitudinal studies are not feasible in explanted human hearts. As no approach is perfect, we suggest that combining the strengths of direct human atrial studies with high fidelity approaches available in the laboratory and in realistic patient-specific computer models would elucidate deeper knowledge of AF mechanisms. We propose that a comprehensive translational pipeline from ex-vivo human heart studies to longitudinal clinically relevant AF animal studies and finally to clinical trials is necessary to identify patient-specific arrhythmogenic substrates and develop novel AF treatments.
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Affiliation(s)
- Aleksei V Mikhailov
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Arrhythmology Research Department, Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ning Li
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shane S Scott
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Esthela J Artiga
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Megan M Subr
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, Bob and Corrine Frick Center for Heart Failure and Arrhythmia, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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27
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Hansen BJ, Zhao J, Helfrich KM, Li N, Iancau A, Zolotarev AM, Zakharkin SO, Kalyanasundaram A, Subr M, Dastagir N, Sharma R, Artiga EJ, Salgia N, Houmsse MM, Kahaly O, Janssen PML, Mohler PJ, Mokadam NA, Whitson BA, Afzal MR, Simonetti OP, Hummel JD, Fedorov VV. Unmasking Arrhythmogenic Hubs of Reentry Driving Persistent Atrial Fibrillation for Patient-Specific Treatment. J Am Heart Assoc 2020; 9:e017789. [PMID: 33006292 PMCID: PMC7792422 DOI: 10.1161/jaha.120.017789] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Atrial fibrillation (AF) driver mechanisms are obscured to clinical multielectrode mapping approaches that provide partial, surface‐only visualization of unstable 3‐dimensional atrial conduction. We hypothesized that transient modulation of refractoriness by pharmacologic challenge during multielectrode mapping improves visualization of hidden paths of reentrant AF drivers for targeted ablation. Methods and Results Pharmacologic challenge with adenosine was tested in ex vivo human hearts with a history of AF and cardiac diseases by multielectrode and high‐resolution subsurface near‐infrared optical mapping, integrated with 3‐dimensional structural imaging and heart‐specific computational simulations. Adenosine challenge was also studied on acutely terminated AF drivers in 10 patients with persistent AF. Ex vivo, adenosine stabilized reentrant driver paths within arrhythmogenic fibrotic hubs and improved visualization of reentrant paths, previously seen as focal or unstable breakthrough activation pattern, for targeted AF ablation. Computational simulations suggested that shortening of atrial refractoriness by adenosine may (1) improve driver stability by annihilating spatially unstable functional blocks and tightening reentrant circuits around fibrotic substrates, thus unmasking the common reentrant path; and (2) destabilize already stable reentrant drivers along fibrotic substrates by accelerating competing fibrillatory wavelets or secondary drivers. In patients with persistent AF, adenosine challenge unmasked hidden common reentry paths (9/15 AF drivers, 41±26% to 68±25% visualization), but worsened visualization of previously visible reentry paths (6/15, 74±14% to 34±12%). AF driver ablation led to acute termination of AF. Conclusions Our ex vivo to in vivo human translational study suggests that transiently altering atrial refractoriness can stabilize reentrant paths and unmask arrhythmogenic hubs to guide targeted AF driver ablation treatment.
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Affiliation(s)
- Brian J Hansen
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | | | - Katelynn M Helfrich
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Ning Li
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Alexander Iancau
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Alexander M Zolotarev
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Skolkovo Institute of Science and Technology Moscow Russia
| | - Stanislav O Zakharkin
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Anuradha Kalyanasundaram
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Megan Subr
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | | | | | - Esthela J Artiga
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Nicholas Salgia
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Mustafa M Houmsse
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH
| | - Omar Kahaly
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Paul M L Janssen
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Peter J Mohler
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
| | - Nahush A Mokadam
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Division of Cardiac Surgery The Ohio State University Wexner Medical Center Columbus OH
| | - Bryan A Whitson
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Division of Cardiac Surgery The Ohio State University Wexner Medical Center Columbus OH
| | - Muhammad R Afzal
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Orlando P Simonetti
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Biomedical Engineering The Ohio State University Wexner Medical Center Columbus OH
| | - John D Hummel
- Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH.,Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology and Frick Center for Heart Failure and Arrhythmia The Ohio State University Wexner Medical Center Columbus OH.,Davis Heart & Lung Research InstituteThe Ohio State University Wexner Medical Center Columbus OH
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Zolotarev AM, Hansen BJ, Ivanova EA, Helfrich KM, Li N, Janssen PML, Mohler PJ, Mokadam NA, Whitson BA, Fedorov MV, Hummel JD, Dylov DV, Fedorov VV. Optical Mapping-Validated Machine Learning Improves Atrial Fibrillation Driver Detection by Multi-Electrode Mapping. Circ Arrhythm Electrophysiol 2020; 13:e008249. [PMID: 32921129 DOI: 10.1161/circep.119.008249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/13/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) can be maintained by localized intramural reentrant drivers. However, AF driver detection by clinical surface-only multielectrode mapping (MEM) has relied on subjective interpretation of activation maps. We hypothesized that application of machine learning to electrogram frequency spectra may accurately automate driver detection by MEM and add some objectivity to the interpretation of MEM findings. METHODS Temporally and spatially stable single AF drivers were mapped simultaneously in explanted human atria (n=11) by subsurface near-infrared optical mapping (NIOM; 0.3 mm2 resolution) and 64-electrode MEM (higher density or lower density with 3 and 9 mm2 resolution, respectively). Unipolar MEM and NIOM recordings were processed by Fourier transform analysis into 28 407 total Fourier spectra. Thirty-five features for machine learning were extracted from each Fourier spectrum. RESULTS Targeted driver ablation and NIOM activation maps efficiently defined the center and periphery of AF driver preferential tracks and provided validated annotations for driver versus nondriver electrodes in MEM arrays. Compared with analysis of single electrogram frequency features, averaging the features from each of the 8 neighboring electrodes, significantly improved classification of AF driver electrograms. The classification metrics increased when less strict annotation, including driver periphery electrodes, were added to driver center annotation. Notably, f1-score for the binary classification of higher-density catheter data set was significantly higher than that of lower-density catheter (0.81±0.02 versus 0.66±0.04, P<0.05). The trained algorithm correctly highlighted 86% of driver regions with higher density but only 80% with lower-density MEM arrays (81% for lower-density+higher-density arrays together). CONCLUSIONS The machine learning model pretrained on Fourier spectrum features allows efficient classification of electrograms recordings as AF driver or nondriver compared with the NIOM gold-standard. Future application of NIOM-validated machine learning approach may improve the accuracy of AF driver detection for targeted ablation treatment in patients.
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Affiliation(s)
- Alexander M Zolotarev
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Brian J Hansen
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ekaterina A Ivanova
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ning Li
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul M L Janssen
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nahush A Mokadam
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bryan A Whitson
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Maxim V Fedorov
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - John D Hummel
- Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Division of Cardiac Surgery (N.A.M., B.A.W., J.D.H.), The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Internal Medicine (J.D.H), The Ohio State University Wexner Medical Center, Columbus, OH
| | - Dmitry V Dylov
- Center of Computational and Data-Intensive Science and Engineering, Skolkovo Institute of Science and Technology, Moscow, Russia (A.M.Z., E.A.I., M.V.F., D.V.D.)
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology and Bob and Corrine Frick Center for Heart Failure and Arrhythmia (A.M.Z., B.J.H., K.M.H., N.L., P.M.L.J., P.J.M., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH.,Davis Heart and Lung Research Institute (N.L., P.M.L.J., P.J.M., N.A.M., B.A.W., J.D.H., V.V.F.), The Ohio State University Wexner Medical Center, Columbus, OH
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Okabe T, Afzal MR, Hummel JD, Daoud EG, Houmsse M, Kalbfleisch SJ, Augostini RS. First clinical use of real-time remote programming in cardiac implantable electronic devices. J Cardiovasc Electrophysiol 2020; 31:2759-2761. [PMID: 33462860 DOI: 10.1111/jce.14698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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30
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Affiliation(s)
- Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ralph S Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael K Essandoh
- Department of Anesthesiology, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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31
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Afzal MR, Ellis CR, Gabriels J, El-Chami M, Amin A, Fanari Z, Delurgio D, John RM, Patel A, Haldis TA, Goldstein JA, Yakubov S, Daoud EG, Hummel JD. Percutaneous approaches for retrieval of an embolized or malpositioned left atrial appendage closure device: A multicenter experience. Heart Rhythm 2020; 17:1545-1553. [PMID: 32464184 DOI: 10.1016/j.hrthm.2020.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/10/2020] [Revised: 03/25/2020] [Accepted: 04/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Experience with retrieval of a Watchman left atrial (LA) appendage (LAA) closure device (WD) is limited. An embolized or grossly malpositioned WD warrants retrieval to minimize the risk of thromboembolic complications and vascular occlusion. OBJECTIVE The purpose of this study was to report approaches for percutaneous retrieval of a WD from multicenter experience. METHODS Data on successful WD retrievals were obtained from high-volume operators. Data included clinical characteristics; structural characteristics of the LA and LAA; and procedural details of the deployment and retrieval procedure, type of retrieval (immediate: during the same procedure; delayed: during a separate procedure after the successful deployment), equipment used, complications, and postretrieval management. RESULTS Ten successful percutaneous and 1 surgical retrievals comprised this study. Seven patients had immediate retrieval, while 4 had delayed retrieval. The median duration before delayed retrieval was 45 days (range 1-45 days). The median LAA diameter and size of a successfully deployed WD was 16 mm (range 14-24 mm) and 21 mm (range 21-30 mm), respectively. A WD was retrieved from the LA (n = 1), LAA (n = 2), left ventricle (n = 2), and aorta (n = 6). The reason for retrieval from the LAA was inadequate deployment, resulting in a significant peri-device leak. Retrieval from the LA or LAA was successfully performed using snares (n = 2) and a Raptor grasping device (n = 1). Retrieval from the left ventricle was achieved with a snare (n = 1) and surgery (n = 1). Retrieval from the aorta required snares (n = 5) and retrieval forceps (n = 1). Five patients were successfully reimplanted with a larger size WD. The only complication during percutaneous retrieval was a pseudoaneurysm. CONCLUSION Retrieval of an embolized or malpositioned WD is feasible, and familiarity with snares and grasping tools can facilitate a successful removal.
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Affiliation(s)
| | | | - James Gabriels
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | | | - Anish Amin
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Zaher Fanari
- University of Kansas Medical Center, Wichita, Kansas
| | | | - Roy M John
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | - Apoor Patel
- Northwell Health, North Shore University Hospital, Manhasset, New York
| | | | | | - Steven Yakubov
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, Ohio
| | - Emile G Daoud
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
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32
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Okabe T, Buck B, A Hayes S, T Harfi T, R Afzal M, Tyler J, Houmsse M, J Kalbfleisch S, Weiss R, D Hummel J, S Augostini R, G Daoud E. Extreme Obesity is Associated with Low Success Rate of Atrial Fibrillation Catheter Ablation. J Atr Fibrillation 2020; 12:2242. [PMID: 33024484 PMCID: PMC7533126 DOI: 10.4022/jafib.2242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/22/2019] [Accepted: 11/30/2019] [Indexed: 08/26/2023]
Abstract
BACKGROUND Catheter ablation (CA) is an established treatment for patients with symptomatic atrial fibrillation (AF). The purpose of this study was to evaluate the safety and efficacy of single CA in AF patients with extreme obesity (body mass index [BMI] ≥ 40 kg/m2) and its long-term impact on body weight. METHODS Patients with BMI ≥40 kg/m2 who underwent CA at the Ohio State University between 2012 and 2016 were included. The primary efficacy endpoint was no atrial arrhythmia lasting > 30 seconds without anti-arrhythmic drugs during 1-year follow-up after a single procedure. RESULTS Out of 230 AF patients with BMI ≥ 40 kg/m2 undergoing CA, pulmonary vein isolation was achieved in 226 (98%) patients.Seventeen patients (7.4%) experienced acute major complications, including pericardial effusion, vascular complications and respiratory failure. Patient characteristics for 135 patients with complete 1-year follow-up were as follows: mean age 58.6 ± 9.6 years, mean BMI 44.5±4.7 kg/m2, female 63 (47%), non-paroxysmal AF 100 (74%), median CHA2DS2-VASc score 2 (IQR:1-3). In this cohort, the primary efficacy endpoint was achieved in 44 (33%) patients. Paroxysmal AF was associated with higher CA success compared to non-paroxysmal (51 vs. 26% [p < 0.01]).There was no significant weight change even in patients with successful AF CA. CONCLUSIONS Extreme obesity is associated with low AF CA success, particularly in those with non-paroxysmal AF. Successful AF CA was not associated with long-term weight reduction. A better treatment strategy is needed in this population of AF and extreme obesity.
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Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin Buck
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samuel A Hayes
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thura T Harfi
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Muhammad R Afzal
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH, USA
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Li N, Kalyanasundaram A, Hansen BJ, Artiga EJ, Sharma R, Abudulwahed SH, Helfrich KM, Rozenberg G, Wu PJ, Zakharkin S, Gyorke S, Janssen PM, Whitson BA, Mokadam NA, Biesiadecki BJ, Accornero F, Hummel JD, Mohler PJ, Dobrzynski H, Zhao J, Fedorov VV. Impaired neuronal sodium channels cause intranodal conduction failure and reentrant arrhythmias in human sinoatrial node. Nat Commun 2020; 11:512. [PMID: 31980605 PMCID: PMC6981137 DOI: 10.1038/s41467-019-14039-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023] Open
Abstract
Mechanisms for human sinoatrial node (SAN) dysfunction are poorly understood and whether human SAN excitability requires voltage-gated sodium channels (Nav) remains controversial. Here, we report that neuronal (n)Nav blockade and selective nNav1.6 blockade during high-resolution optical mapping in explanted human hearts depress intranodal SAN conduction, which worsens during autonomic stimulation and overdrive suppression to conduction failure. Partial cardiac (c)Nav blockade further impairs automaticity and intranodal conduction, leading to beat-to-beat variability and reentry. Multiple nNav transcripts are higher in SAN vs atria; heterogeneous alterations of several isoforms, specifically nNav1.6, are associated with heart failure and chronic alcohol consumption. In silico simulations of Nav distributions suggest that INa is essential for SAN conduction, especially in fibrotic failing hearts. Our results reveal that not only cNav but nNav are also integral for preventing disease-induced failure in human SAN intranodal conduction. Disease-impaired nNav may underlie patient-specific SAN dysfunctions and should be considered to treat arrhythmias. The role of of voltage-gated sodium channels (Nav) in pacemaking and conduction of the human sinoatrial node is unclear. Here, the authors investigate existence and function of neuronal and cardiac Nav in human sinoatrial nodes, and demonstrate their alterations in explanted human diseased hearts.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Esthela J Artiga
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Roshan Sharma
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Suhaib H Abudulwahed
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Galina Rozenberg
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pei-Jung Wu
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stanislav Zakharkin
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sandor Gyorke
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul Ml Janssen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nahush A Mokadam
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brandon J Biesiadecki
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Federica Accornero
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Halina Dobrzynski
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.,Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Bob and Corrine Frick Center for Heart Failure and Arrhythmia, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Okabe T, Miller A, Koppert T, Cavalcanti R, Alcivar-Franco D, Osei J, Kahaly O, Afzal MR, Tyler J, Kalbfleisch SJ, Weiss R, Houmsse M, Augostini RS, Daoud EG, Andritsos MJ, Bhandary S, Dimitrova G, Fiorini K, Elsayed-Awad H, Flores A, Gorelik L, Iyer MH, Saklayen S, Stein E, Turner K, Perez W, Hummel JD, Essandoh MK. Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy. J Interv Card Electrophysiol 2019; 57:311-318. [PMID: 31813098 DOI: 10.1007/s10840-019-00673-1] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the feasibility and safety of same-day discharge after S-ICD implantation by implementing a specific analgesia protocol and phone follow-up. METHODS Consecutive patients presenting for outpatient S-ICD implantation were enrolled between 1/1/2018 and 4/30/2019. An analgesia protocol included pre-operative acetaminophen and oxycodone, intraoperative local bupivacaine, and limited use of oxycodone-acetaminophen at discharge. The primary outcome was successful same-day discharge. Numerical Pain Rating Scale (NPRS) on postoperative day (POD) 1, 3, 14, and 30 and any unplanned health care visits during the 1-month follow-up period were assessed. RESULTS Out of 53 potentially eligible S-ICD patients, 49 patients (92.5%) were enrolled and successfully discharged on the same day. Mean age of these 49 patients was 47 ± 14 years. There were no acute procedural complications. Severe pain (NPRS ≥ 8) on POD 0, 1, and 3 was present in 14.3%, 14.3%, and 8.2% of patients, respectively. The total in-hospital stay was 534 ± 80 min. Four unplanned visits (8%) due to cardiac or device-related issues occurred during 1-month follow-up, including 2 patients with heart failure exacerbation, one patient with an incisional infection, and one patient with inappropriate shocks. CONCLUSIONS With the appropriate institutional protocol including specific analgesics and phone follow-up, same-day discharge after outpatient S-ICD implantation is feasible and appears safe for most patients.. Device-related pain can be severe in the first 3 days post-implantation and can be successfully treated with limited supply of narcotic medications.
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Affiliation(s)
- Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Adrianne Miller
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tanner Koppert
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rafael Cavalcanti
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Diego Alcivar-Franco
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jemina Osei
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar Kahaly
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Muhammad R Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven J Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael J Andritsos
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sujatha Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Galina Dimitrova
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kasey Fiorini
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hamdy Elsayed-Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Antolin Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leonid Gorelik
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samiya Saklayen
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica Stein
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katja Turner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William Perez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Afzal MR, Okabe T, Koppert T, Tyler J, Houmsse M, Augostini RS, Hummel JD, Kalbfleisch SJ, Iyer MH, Flores AS, Bhandary S, Dimitrova G, Elsayed‐Awad H, Fiorini K, Gorelik L, Perez W, Saklayen S, Stein E, Turner K, Franklin NP, Ryu JN, Bhatt A, Weiss R, Daoud EG, Essandoh M. Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care. Pacing Clin Electrophysiol 2019; 42:1552-1557. [DOI: 10.1111/pace.13838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Muhammad R. Afzal
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Toshimasa Okabe
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Tanner Koppert
- Division of Cardiovascular Medicine ElectrophysiologyDavis Heart and Lung Research Institute Columbus Ohio
| | - Jaret Tyler
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Ralph S. Augostini
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - John D. Hummel
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Steven J. Kalbfleisch
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Manoj H. Iyer
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Antolin S. Flores
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Sujatha Bhandary
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Galina Dimitrova
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Hamdy Elsayed‐Awad
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Kasey Fiorini
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Leonid Gorelik
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - William Perez
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Samiya Saklayen
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Erica Stein
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Katja Turner
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Nicholas P. Franklin
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Jasmine N. Ryu
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Amar Bhatt
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Emile G. Daoud
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Michael Essandoh
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
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Afzal MR, Daoud EG, Matre N, Shoben A, Burnside M, Gilliam C, Pinkhas D, Okabe T, Tyler J, Houmsse M, Kalbfleisch SS, Crestanello JA, Turner K, Weiss R, Hummel JD, Love CJ, Augostini RS. RIsk Stratification prior to lead Extraction and impact on major intraprocedural complications (RISE protocol). J Cardiovasc Electrophysiol 2019; 30:2453-2459. [DOI: 10.1111/jce.14151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/18/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Muhammad R. Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Emile G. Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Nancy Matre
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Abigail Shoben
- Department of Public Health, Division of Biostatistics, College of Public Health The Ohio State University Columbus Ohio
| | - Melissa Burnside
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Courtney Gilliam
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Daniel Pinkhas
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Steven S. Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | | | - Katja Turner
- Department of Internal Medicine, Electrophysiology Section, Division of Anesthesiology Ross Heart Hospital at the Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - John D. Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
| | - Charles J. Love
- Department of Internal Medicine, Division of Cardiovascular Medicine Johns Hopkins Hospital Baltimore Maryland
| | - Ralph S. Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine Wexner Medical Center at the Ohio State University Medical Center Columbus Ohio
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Afzal MR, Daoud EG, Hussain S, Lloyd MS, Ellis C, Nangia V, Cha YM, Sridhar AR, Lakkireddy D, Hummel JD. Multicenter Experience of Feasibility and Safety of Leadless Pacemakers Across Bioprosthetic and Repaired Tricuspid Valves. JACC Clin Electrophysiol 2019; 5:1093-1094. [PMID: 31537341 DOI: 10.1016/j.jacep.2019.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022]
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38
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Okabe T, Weiss R, Hummel JD, Kalbfleisch SJ. Marked T wave abnormality after accessory pathway ablation. J Cardiovasc Electrophysiol 2018; 30:622-623. [PMID: 30575200 DOI: 10.1111/jce.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Hansen BJ, Li N, Helfrich KM, Abudulwahed SH, Artiga E, Joseph M, Mohler PJ, Hummel JD, Fedorov VV. First In Vivo Use of High-Resolution Near-Infrared Optical Mapping to Assess Atrial Activation During Sinus Rhythm and Atrial Fibrillation in a Large Animal Model. Circ Arrhythm Electrophysiol 2018; 11:e006870. [PMID: 30562105 PMCID: PMC6300135 DOI: 10.1161/circep.118.006870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J. Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Katelynn M. Helfrich
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Suhaib H. Abudulwahed
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Esthela Artiga
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Matt Joseph
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Internal Medicine; The Ohio State University Wexner Medical Center, Columbus, OH
| | - John D. Hummel
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Internal Medicine; The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vadim V. Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Afzal MR, Horner S, Matre NB, Blake P, Dunham K, Pinkhas D, Okabe T, Tyler J, Houmsse M, Kalbfleisch SJ, Weiss R, Hummel JD, Daoud EG, Augostini RS. Comprehensive strategy to reduce the incidence of lead dislodgement for cardiac implantable electronic devices. Pacing Clin Electrophysiol 2018; 42:58-62. [PMID: 30414285 DOI: 10.1111/pace.13544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lead dislodgement (LD) is a well-recognized complication during implantation of cardiac implantable electronic devices (CIEDs). An intraprocedural protocol, referred to as reduction of LD protocol, was developed to reduce the risk of LD. METHODS The protocol involved (1) inserting a straight stylet down the right atrial lead and applying forward pressure while monitoring for fluoroscopic stability, (2) visualizing all leads during deep inspiration to determine if there is adequate lead redundancy, and (3) having the patient take a deep breath and cough while pacing just at capture threshold to assess for loss of capture in each lead. Any intraprocedural change in the parameters fulfilling the predefined criteria for inadequate lead implantation prompted lead repositioning. Data regarding demographic factors, clinical characteristics, and incidence of LD in the first 30 days after implant was obtained from intramural CIED database. The preintervention (control) group spanned 27 months and consisted of a total of 4,294 leads while the postintervention (intervention) group spanned 17 months and consisted of 2,361 leads implanted. RESULTS There was no significant difference in the demographic factors and clinical characteristics in the two groups. Protocol compliance was > 90%. There were 44 occurrences of LD (1.02%) before and 10 (0.4%) after implementation of the protocol. The protocol significantly reduced the incidence of LD during the 30 days after implant (P = 0.014). No clinical characteristic predicted the risk of LD. CONCLUSION Intraprocedural maneuvers performed to assess the adequacy of lead implantation results in reduced risk of LD.
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Affiliation(s)
- Muhammad R Afzal
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Sarah Horner
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Nancy B Matre
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Patricia Blake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Kari Dunham
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Daniel Pinkhas
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Steven J Kalbfleisch
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - John D Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section, Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center, Columbus, OH, USA
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Hansen BJ, Zhao J, Li N, Zolotarev A, Zakharkin S, Wang Y, Atwal J, Kalyanasundaram A, Abudulwahed SH, Helfrich KM, Bratasz A, Powell KA, Whitson B, Mohler PJ, Janssen PML, Simonetti OP, Hummel JD, Fedorov VV. Human Atrial Fibrillation Drivers Resolved With Integrated Functional and Structural Imaging to Benefit Clinical Mapping. JACC Clin Electrophysiol 2018; 4:1501-1515. [PMID: 30573112 DOI: 10.1016/j.jacep.2018.08.024] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study sought to improve atrial fibrillation (AF) driver identification by integrating clinical multielectrode mapping with driver fingerprints defined by high-resolution ex vivo 3-dimensional (3D) functional and structural imaging. BACKGROUND Clinical multielectrode mapping of AF drivers suffers from variable contact, signal processing, and structural complexity within the 3D human atrial wall, raising questions on the validity of such drivers. METHODS Sustained AF was mapped in coronary-perfused explanted human hearts (n = 11) with transmural near-infrared optical mapping (∼0.3 mm2 resolution). Simultaneously, custom FIRMap catheters (∼9 × 9 mm2 resolution) mapped endocardial and epicardial surfaces, which were analyzed by Focal Impulse and Rotor Mapping activation and Rotational Activity Profile (Abbott Labs, Chicago, Illinois). Functional maps were integrated with contrast-enhanced cardiac magnetic resonance imaging (∼0.1 mm3 resolution) analysis of 3D fibrosis architecture. RESULTS During sustained AF, near-infrared optical mapping identified 1 to 2 intramural, spatially stable re-entrant AF drivers per heart. Driver targeted ablation affecting 2.2 ± 1.1% of the atrial surface terminated and prevented AF. Driver regions had significantly higher phase singularity density and dominant frequency than neighboring nondriver regions. Focal Impulse and Rotor Mapping had 80% sensitivity to near-infrared optical mapping-defined driver locations (16 of 20), and matched 14 of 20 driver visualizations: 10 of 14 re-entries seen with Rotational Activity Profile; and 4 of 6 breakthrough/focal patterns. Focal Impulse and Rotor Mapping detected 1.1 ± 0.9 false-positive rotational activity profiles per recording, but these regions had lower intramural contrast-enhanced cardiac magnetic resonance imaging fibrosis than did driver regions (14.9 ± 7.9% vs. 23.2 ± 10.5%; p < 0.005). CONCLUSIONS The study revealed that both re-entrant and breakthrough/focal AF driver patterns visualized by surface-only clinical multielectrodes can represent projections of 3D intramural microanatomic re-entries. Integration of multielectrode mapping and 3D fibrosis analysis may enhance AF driver detection, thereby improving the efficacy of driver-targeted ablation.
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Affiliation(s)
- Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ning Li
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander Zolotarev
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Phystech School of Biological and Medical Physics, Moscow Institute of Physic and Technology, Dolgoprudny, Russian Federation
| | - Stanislav Zakharkin
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Josh Atwal
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Suhaib H Abudulwahed
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Katelynn M Helfrich
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anna Bratasz
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kimerly A Powell
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan Whitson
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J Mohler
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Orlando P Simonetti
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Biomedical Engineering, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John D Hummel
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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42
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Hansen BJ, Csepe TA, Zhao J, Ignozzi AJ, Hummel JD, Fedorov VV. Maintenance of Atrial Fibrillation: Are Reentrant Drivers With Spatial Stability the Key? Circ Arrhythm Electrophysiol 2018; 9:CIRCEP.116.004398. [PMID: 27729340 DOI: 10.1161/circep.116.004398] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J Hansen
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Thomas A Csepe
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Jichao Zhao
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Anthony J Ignozzi
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - John D Hummel
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.)
| | - Vadim V Fedorov
- From the Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus (B.J.H., T.A.C., A.J.I., J.D.H., V.V.F.); and Auckland Bioengineering Institute, The University of Auckland, New Zealand (J.Z.).
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43
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Amin A, Gold MR, Burke MC, Knight BP, Kalbfleisch SJ, Okabe T, Duffy E, Stahl WK, Husby M, Tyler J, Houmsse M, Daoud EG, Hummel JD, Augostini RS, Weiss R. P2930Subcutaneous implantable cardioverter defibrillator position determines success. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Amin
- OhioHealth Heart and Vascular, Cardiac Electrophysiology, Columbus, United States of America
| | - M R Gold
- Medical University of South Carolina, Charleston, United States of America
| | - M C Burke
- CorVita Science Foundation, Chicago, United States of America
| | - B P Knight
- Northwestern University, Chicago, United States of America
| | - S J Kalbfleisch
- The Ohio State University, Columbus, United States of America
| | - T Okabe
- The Ohio State University, Columbus, United States of America
| | - E Duffy
- Boston Scientific, Saint Paul, United States of America
| | - W K Stahl
- Boston Scientific, Saint Paul, United States of America
| | - M Husby
- Boston Scientific, Saint Paul, United States of America
| | - J Tyler
- The Ohio State University, Columbus, United States of America
| | - M Houmsse
- The Ohio State University, Columbus, United States of America
| | - E G Daoud
- The Ohio State University, Columbus, United States of America
| | - J D Hummel
- The Ohio State University, Columbus, United States of America
| | - R S Augostini
- The Ohio State University, Columbus, United States of America
| | - R Weiss
- The Ohio State University, Columbus, United States of America
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44
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Godara H, Jia KQ, Augostini RS, Houmsse M, Okabe T, Hummel JD, Weiss R, Kalbfleisch SJ, Afzal MR, Badin A, Cavalcanti R, Franco DA, Tyler J, Daoud EG. Feasibility of concomitant vacuum-assisted removal of lead-related vegetations and cardiac implantable electronic device extraction. J Cardiovasc Electrophysiol 2018; 29:1460-1466. [DOI: 10.1111/jce.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Hemant Godara
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Kelly Qi Jia
- Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Ralph S. Augostini
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - John D. Hummel
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Steven J. Kalbfleisch
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Muhammad R. Afzal
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Auroa Badin
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Rafael Cavalcanti
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Diego Alcivar Franco
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Jaret Tyler
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Emile G. Daoud
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
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45
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Afzal MR, Daoud EG, Cunnane R, Mulpuru SK, Koay A, Hussain A, Omar R, Wei KK, Amin A, Kidwell G, Patel N, Love C, Lloyd M, Sterliński M, Goldbarg S, Leal MA, Gabriels J, Patel A, Jadonath R, Grubman E, Crossley G, Pepper C, Lakkireddy D, Okabe T, Hummel JD, Augostini RS. Techniques for successful early retrieval of the Micra transcatheter pacing system: A worldwide experience. Heart Rhythm 2018; 15:841-846. [DOI: 10.1016/j.hrthm.2018.02.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Indexed: 11/16/2022]
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46
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Csepe TA, Zhao J, Sul LV, Wang Y, Hansen BJ, Li N, Ignozzi AJ, Bratasz A, Powell KA, Kilic A, Mohler PJ, Janssen PML, Hummel JD, Simonetti OP, Fedorov VV. Novel application of 3D contrast-enhanced CMR to define fibrotic structure of the human sinoatrial node in vivo. Eur Heart J Cardiovasc Imaging 2018; 18:862-869. [PMID: 28087602 DOI: 10.1093/ehjci/jew304] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/16/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The adult human sinoatrial node (SAN) has a specialized fibrotic intramural structure (35-55% fibrotic tissue) that provides mechanical and electrical protection from the surrounding atria. We hypothesize that late gadolinium-enhanced cardiovascular magnetic resonance (LGE-CMR) can be applied to define the fibrotic human SAN structure in vivo. Methods and results LGE-CMR atrial scans of healthy volunteers (n olu, 23-52 y.o.) using a 3 Tesla magnetic resonance imaging system with a spatial resolution of 1.0 mm3 or 0.625 × 0.625 × 1.25 mm3 were obtained and analysed. Percent fibrosis of total connective and cardiomyocyte tissue area in segmented atrial regions were measured based on signal intensity differences of fibrotic vs. non-fibrotic cardiomyocyte tissue. A distinct ellipsoidal fibrotic region (length: 23.6 ± 1.9 mm; width: 7.2 ± 0.9 mm; depth: 2.9 ± 0.4 mm) in all hearts was observed along the posterior junction of the crista terminalis and superior vena cava extending towards the interatrial septum, corresponding to the anatomical location of the human SAN. The SAN fibrotic region consisted of 41.9 ± 5.4% of LGE voxels above an average threshold of 2.7 SD (range 2-3 SD) from the non-fibrotic right atrial free wall tissue. Fibrosis quantification and SAN identification by in vivo LGE-CMR were validated in optically mapped explanted donor hearts ex vivo (n ivo, 19-65 y.o.) by contrast-enhanced CMR (9.4 Tesla; up to 90 µm3 resolution) correlated with serial histological sections of the SAN. Conclusion This is the first study to visualize the 3D human SAN fibrotic structure in vivo using LGE-CMR. Identification of the 3D SAN location and its high fibrotic content by LGE-CMR may provide a new tool to avoid or target SAN structure during ablation.
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Affiliation(s)
- Thomas A Csepe
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, 70 Symonds Street, Auckland 1142, New Zealand
| | - Lidiya V Sul
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Yufeng Wang
- Auckland Bioengineering Institute, The University of Auckland, 70 Symonds Street, Auckland 1142, New Zealand
| | - Brian J Hansen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Ning Li
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Anthony J Ignozzi
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA
| | - Anna Bratasz
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Kimerly A Powell
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
| | - Ahmet Kilic
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Avenue, Columbus, OH 43210, USA
| | - Peter J Mohler
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - Paul M L Janssen
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - John D Hummel
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210, USA
| | - Orlando P Simonetti
- Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA.,Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, USA
| | - Vadim V Fedorov
- Department of Physiology & Cell Biology, The Ohio State University Wexner Medical Center, 304 Hamilton Hall, 1645 Neil Avenue, Columbus, OH 43210, USA.,Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Avenue, Columbus, OH 43210, USA
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47
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Li N, Hansen BJ, Csepe TA, Zhao J, Ignozzi AJ, Sul LV, Zakharkin SO, Kalyanasundaram A, Davis JP, Biesiadecki BJ, Kilic A, Janssen PML, Mohler PJ, Weiss R, Hummel JD, Fedorov VV. Redundant and diverse intranodal pacemakers and conduction pathways protect the human sinoatrial node from failure. Sci Transl Med 2018; 9:9/400/eaam5607. [PMID: 28747516 DOI: 10.1126/scitranslmed.aam5607] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 06/16/2017] [Indexed: 11/02/2022]
Abstract
The human sinoatrial node (SAN) efficiently maintains heart rhythm even under adverse conditions. However, the specific mechanisms involved in the human SAN's ability to prevent rhythm failure, also referred to as its robustness, are unknown. Challenges exist because the three-dimensional (3D) intramural structure of the human SAN differs from well-studied animal models, and clinical electrode recordings are limited to only surface atrial activation. Hence, to innovate the translational study of human SAN structural and functional robustness, we integrated intramural optical mapping, 3D histology reconstruction, and molecular mapping of the ex vivo human heart. When challenged with adenosine or atrial pacing, redundant intranodal pacemakers within the human SAN maintained automaticity and delivered electrical impulses to the atria through sinoatrial conduction pathways (SACPs), thereby ensuring a fail-safe mechanism for robust maintenance of sinus rhythm. During adenosine perturbation, the primary central SAN pacemaker was suppressed, whereas previously inactive superior or inferior intranodal pacemakers took over automaticity maintenance. Sinus rhythm was also rescued by activation of another SACP when the preferential SACP was suppressed, suggesting two independent fail-safe mechanisms for automaticity and conduction. The fail-safe mechanism in response to adenosine challenge is orchestrated by heterogeneous differences in adenosine A1 receptors and downstream GIRK4 channel protein expressions across the SAN complex. Only failure of all pacemakers and/or SACPs resulted in SAN arrest or conduction block. Our results unmasked reserve mechanisms that protect the human SAN pacemaker and conduction complex from rhythm failure, which may contribute to treatment of SAN arrhythmias.
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Affiliation(s)
- Ning Li
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brian J Hansen
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Thomas A Csepe
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Anthony J Ignozzi
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lidiya V Sul
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stanislav O Zakharkin
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Anuradha Kalyanasundaram
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jonathan P Davis
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brandon J Biesiadecki
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ahmet Kilic
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Peter J Mohler
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Raul Weiss
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - John D Hummel
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Vadim V Fedorov
- Department of Physiology and Cell Biology, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA. .,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Okabe T, El-Chami MF, Lloyd MS, Buck B, Gornick CC, Moore JC, Augostini RS, Hummel JD. Leadless pacemaker implantation and concurrent atrioventricular junction ablation in patients with atrial fibrillation. Pacing Clin Electrophysiol 2018; 41:504-510. [DOI: 10.1111/pace.13312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/24/2017] [Accepted: 01/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Toshimasa Okabe
- Division of Cardiovascular Medicine, Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - Mikhael F. El-Chami
- Department of Medicine-Cardiology; Emory University Hospital; Atlanta GA USA
| | - Michael S. Lloyd
- Department of Medicine-Cardiology; Emory University Hospital; Atlanta GA USA
| | - Benjamin Buck
- Division of Cardiovascular Medicine, Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - Charles C. Gornick
- Department of Cardiac Electrophysiology; Minneapolis Heart Institute; Minneapolis MN USA
| | - JoEllyn C. Moore
- Department of Cardiac Electrophysiology; Minneapolis Heart Institute; Minneapolis MN USA
| | - Ralph S. Augostini
- Division of Cardiovascular Medicine, Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus OH USA
| | - John D. Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine; The Ohio State University Wexner Medical Center; Columbus OH USA
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49
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Afzal MR, Mehta D, Evenson C, Pinkhas D, Badin A, Patel D, Essandoh MK, Godara H, Tyler J, Houmsse M, Liu Z, Kalbfleisch SJ, Hummel JD, Augostini R, Weiss R, Daoud EG, Okabe T. Perioperative management of oral anticoagulation in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2018; 15:520-523. [DOI: 10.1016/j.hrthm.2017.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 01/31/2023]
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50
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Afzal MR, Kahaly O, Weiss R, Houmsse M, Daoud EG, Hummel JD. Adenosine triphosphate/adenosine guided pulmonary vein isolation does not improve the outcomes of ablation: a meta-analysis of randomized controlled trials. Expert Rev Cardiovasc Ther 2018; 16:313-318. [PMID: 29561176 DOI: 10.1080/14779072.2018.1455500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Successful pulmonary vein isolation (PVI) is the most reliable predictor of success after ablation in patients with atrial fibrillation (AF). Adenosine triphosphate (ATP) unmasks the dormant conduction and can be used to improve the effectiveness of PVI. The impact of ATP guided PVI on clinical outcomes is discordant in various randomized controlled trials (RCTs). OBJECTIVES To delineate the incremental benefit of ATP during PVI in patients with AF through a meta-analysis. METHODS AND RESULTS Database searches through January 2017 identified 5 RCTs (enrolling 2839 patients) comparing ATP guided PVI versus standard PVI (non-ATP). Four trials exclusively studied paroxysmal AF while one trial included both paroxysmal and non-paroxysmal AF patients. Baseline characteristics, dose of adenosine and ablation strategies were clearly identified among all the trials. The risk ratio (RR) for AF episodes lasting >30 s after 3-month blanking period was calculated with random effects meta-analysis and showed no difference at a median follow up of 12 months [RR: 1.02, 95 % Confidence interval (CI): 0.85 to 1.25; p = 0.82]. Similarly, the number of repeat ablation was similar in both groups [RR: 1.02, 95 % CI: 0.63, 1.56; p = 0.98]. CONCLUSIONS ATP guided PVI does not decrease the recurrence of AF or the need for repeat ablation at 12 months.
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Affiliation(s)
- Muhammad R Afzal
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
| | - Omar Kahaly
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
| | - Raul Weiss
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
| | - Mahmoud Houmsse
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
| | - Emile G Daoud
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
| | - John D Hummel
- a Division of Cardiovascular Medicine, Department of Internal Medicine, Electrophysiology Section , Ross Heart Hospital, The Wexner Medical Center at the Ohio State University Medical Center , Columbus , OH , USA
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