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Gupta S, Khakh P, Miranda-Arboleda AF, Romero JE, Berni AC, Marquez MF, Pozzer L, Hardy C, Enriquez A, Kashou A, Baranchuk A. Pattern Recognition and Inductive-Deductive Reasoning: Two Cornerstones of Electrocardiogram Teaching. Can J Cardiol 2024:S0828-282X(24)00300-3. [PMID: 38604335 DOI: 10.1016/j.cjca.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Abstract
Almost half of physicians report being uncomfortable with ECG interpretation, underscoring the need for high-quality ECG training. There are two major strategies for teaching ECG interpretation. Pattern recognition involves reading ECGs solely as graphic images, after being taught the underlying pathophysiology behind the ECG patterns. Inductive-deductive reasoning requires logical thought mechanisms, using clinical context and algorithms, to reach a correct diagnosis. It is important for ECG educators to choose between these teaching strategies, depending on the clinical scenario. Hopefully, consistency around teaching strategies will help learners to become more comfortable in ECG interpretation, and ultimately correctly interpret ECGs more frequently.
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Affiliation(s)
- Shyla Gupta
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Parm Khakh
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana C Berni
- Department of Cardiology, Laboratorio de Arritmias, Hospital Ángeles Pedregal, Ciudad de México, México
| | - Manlio F Marquez
- Electrophysiology Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Leo Pozzer
- Section of Cardiac Electrophysiology, Buenos Aires Cardiovascular Institute (ICBA), Buenos Aires, Argentina
| | - Carina Hardy
- Arrhythmia Unit-Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil
| | - Andres Enriquez
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Adrian Baranchuk
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
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Diaz JC, Duque M, Miranda-Arboleda AF, Koplan BA, Marín JE, Aristizabal JM, Niño CD, Bastidas O, Hincapie D, Hoyos C, Matos CD, Lopez-Cabanillas N, Jaraba E, Moreno S, Caceres M, Ruiz LM, Sauer WH, Romero JE. Single-/dual-chamber vs cardiac resynchronization pacemakers for cardiac resynchronization. Heart Rhythm 2024; 21:499-501. [PMID: 38181988 DOI: 10.1016/j.hrthm.2023.12.024] [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: 11/23/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Juan C Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia.
| | - Mauricio Duque
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andres F Miranda-Arboleda
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Julian M Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Cesar D Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Antioquia, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Daniela Hincapie
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Carlos D Matos
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | | | - Elmer Jaraba
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | | | | | | | - William H Sauer
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Romero
- Cardiac Arrhythmia and Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
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Steiger N, McClennen L, Bilenker J, Elst LV, Matos C, Gracia E, Nauffal V, Zei PC, Romero JE, Sauer WH. Relative contribution of contact force to lesion depth using high-power short-duration radiofrequency applications. Heart Rhythm 2024:S1547-5271(24)00288-1. [PMID: 38518952 DOI: 10.1016/j.hrthm.2024.03.042] [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: 11/18/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Nathaniel Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Logan McClennen
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Justin Bilenker
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lucas Vander Elst
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carlos Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ely Gracia
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Victor Nauffal
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Wang X, Ge B, Miao C, Lee C, Romero JE, Li P, Wang F, Xu D, Chen M, Li D, Li D, Li M, Xu F, Li Y, Gong C, Taub CC, Yao J. Beyond conduction impairment: Unveiling the profound myocardial injury in left bundle branch block. Heart Rhythm 2024:S1547-5271(24)00256-X. [PMID: 38490601 DOI: 10.1016/j.hrthm.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Left bundle branch block (LBBB) represents a frequently encountered conduction system disorder. Despite its widespread occurrence, a continual dilemma persists regarding its intricate association with underlying cardiomyopathy and its pivotal role in the initiation of dilated cardiomyopathy. The pathologic alterations linked to LBBB-induced cardiomyopathy (LBBB-CM) have remained elusive. OBJECTIVE This study sought to investigate the chronologic dynamics of LBBB to left ventricular dysfunction and the pathologic mechanism of LBBB-CM. METHODS LBBB model was established through main left bundle branch trunk ablation in 14 canines. All LBBB dogs underwent transesophageal echocardiography and electrocardiography before ablation and at 1 month, 3 months, 6 months, and 12 months after LBBB induction. Single-photon emission computed tomography imaging was performed at 12 months. We then harvested the heart from all LBBB dogs and 14 healthy adult dogs as normal controls for anatomic observation, Purkinje fiber staining, histologic staining, and connexin43 protein expression quantitation. RESULTS LBBB induction caused significant fibrotic changes in the endocardium and mid-myocardium. Purkinje fibers exhibited fatty degeneration, vacuolization, and fibrosis along with downregulated connexin43 protein expression. During a 12-month follow-up, left ventricular dysfunction progressively worsened, peaking at the end of the observation period. The association between myocardial dysfunction, hypoperfusion, and fibrosis was observed in the LBBB-afflicted canines. CONCLUSION LBBB may lead to profound myocardial injury beyond its conduction impairment effects. The temporal progression of left ventricular dysfunction and the pathologic alterations observed shed light on the complex relationship between LBBB and cardiomyopathy. These findings offer insights into potential mechanisms and clinical implications of LBBB-CM.
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Affiliation(s)
- Xiaoxian Wang
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Beibei Ge
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Changqing Miao
- Department of Cardiology, Jiangyin People's Hospital, Jiangyin, People's Republic of China
| | - Christopher Lee
- Department of Cardiology, University of California, San Francisco, California
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Di Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dong Li
- Harbor-UCLA Medical Center, Torrance, California
| | - Mingxia Li
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Fang Xu
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Chanjuan Gong
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Cynthia C Taub
- Department of Medicine, Upstate Medical University, Norton College of Medicine, Syracuse, New York
| | - Jing Yao
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China; Medical Imaging Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China.
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Diaz JC, Tedrow UB, Duque M, Aristizabal J, Braunstein ED, Marin J, Niño C, Bastidas O, Lopez Cabanillas N, Koplan BA, Hoyos C, Matos CD, Hincapie D, Velasco A, Steiger NA, Kapur S, Tadros TM, Zei PC, Sauer WH, Romero JE. Left Bundle Branch Pacing vs Left Ventricular Septal Pacing vs Biventricular Pacing for Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2024; 10:295-305. [PMID: 38127008 DOI: 10.1016/j.jacep.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are considered to be acceptable as LBBAP strategies. Differences in clinical outcomes between LBBP and LVSP are yet to be determined. OBJECTIVES The purpose of this study was to compare the outcomes of LBBP vs LVSP vs BIVP for CRT. METHODS In this prospective multicenter observational study, LBBP was compared with LVSP and BIVP in patients undergoing CRT. The primary composite outcome was freedom from heart failure (HF)-related hospitalization and all-cause mortality. Secondary outcomes included individual components of the primary outcome, postprocedural NYHA functional class, and electrocardiographic and echocardiographic parameters. RESULTS A total of 415 patients were included (LBBP: n = 141; LVSP: n = 31; BIVP: n = 243), with a median follow-up of 399 days (Q1-Q3: 249.5-554.8 days). Freedom from the primary composite outcomes was 76.6% in the LBBP group and 48.4% in the LVSP group (HR: 1.37; 95% CI: 1.143-1.649; P = 0.001), driven by a 31.4% absolute increase in freedom from HF-related hospitalizations (83% vs 51.6%; HR: 3.55; 95% CI: 1.856-6.791; P < 0.001) without differences in all-cause mortality. LBBP was also associated with a higher freedom from the primary composite outcome compared with BIVP (HR: 1.43; 95% CI: 1.175-1.730; P < 0.001), with no difference between LVSP and BIVP. CONCLUSIONS In patients undergoing CRT, LBBP was associated with improved outcomes compared with LVSP and BIVP, while outcomes between BIVP and LVSP are similar.
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Affiliation(s)
- Juan C Diaz
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón Uribe, Medellin, Colombia
| | | | - Bruce A Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Diaz JC, Bastidas O, Duque M, Marín JE, Aristizabal J, Niño CD, Hoyos C, Matos CD, Gabr M, Steiger NA, Kapur S, Sauer WH, Romero JE. Impact of intracardiac echocardiography versus transesophageal echocardiography guidance on left atrial appendage occlusion procedures: A meta-analysis. J Cardiovasc Electrophysiol 2024; 35:44-57. [PMID: 37927196 DOI: 10.1111/jce.16118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is increasingly used during left atrial appendage occlusion (LAAO) as an alternative to transesophageal echocardiography (TEE). The objective of this study is to evaluate the impact of ICE versus TEE guidance during LAAO on procedural characteristics and acute outcomes, as well the presence of peri-device leaks and residual septal defects during follow-up. METHODS All studies comparing ICE-guided versus TEE-guided LAAO were identified. The primary outcomes were procedural efficacy and occurrence of procedure-related complications. Secondary outcomes included lab efficiency (defined as a reduction in in-room time), procedural time, fluoroscopy time, and presence of peri-device leaks and residual interatrial septal defects (IASD) during follow-up. RESULTS Twelve studies (n = 5637) were included. There were no differences in procedural success (98.3% vs. 97.8%; OR 0.73, 95% CI 0.42-1.27, p = .27; I2 = 0%) or adverse events (4.5% vs. 4.4%; OR 0.81 95% CI 0.56-1.16, p = .25; I2 = 0%) between the ICE-guided and TEE-guided groups. ICE guidance reduced in in-room time (mean-weighted 28.6-min reduction in in-room time) without differences in procedural time or fluoroscopy time. There were no differences in peri-device leak (OR 0.93, 95% CI 0.68-1.27, p = 0.64); however, an increased prevalence of residual IASD was observed with ICE-guided versus TEE-guided LAAO (46.3% vs. 34.2%; OR 2.23, 95% CI 1.05-4.75, p = 0.04). CONCLUSION ICE guidance is associated with similar procedural efficacy and safety, but could result in improved lab efficiency (as established by a significant reduction in in-room time). No differences in the rate of periprocedural leaks were found. A higher prevalence of residual interatrial septal defects was observed with ICE guidance.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Universidad CES Medical School, Division of Cardiology, Clinica Las Vegas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge E Marín
- Department of Medicine, Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Americas, Medellin, colombia, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Cesar D Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Diaz JC, Duque M, Aristizabal J, Marin J, Niño C, Bastidas O, Ruiz LM, Matos CD, Hoyos C, Hincapie D, Velasco A, Romero JE. The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy. Arrhythm Electrophysiol Rev 2023; 12:e29. [PMID: 38173800 PMCID: PMC10762674 DOI: 10.15420/aer.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/04/2023] [Indexed: 01/05/2024] Open
Abstract
Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical SchoolMedellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Jorge Marin
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las AmericasMedellin, Colombia
| | - Cesar Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobón UribeMedellin, Colombia
| | | | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Daniela Hincapie
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
| | - Alejandro Velasco
- Electrophysiology Section, University of Texas Health Sciences CentreSan Antonio, TX, US
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, US
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Diaz JC, Braunstein ED, Cañas F, Duque M, Marín JE, Aristizabal J, Niño CD, Bastidas O, Hoyos C, Steiger NA, Matos CD, Sauer WH, Romero JE. Chlorhexidine gluconate pocket lavage to prevent cardiac implantable electronic device infection in high-risk procedures. Heart Rhythm 2023; 20:1674-1681. [PMID: 37598986 DOI: 10.1016/j.hrthm.2023.08.015] [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: 06/22/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Infection is the most dreaded complication of cardiac implantable electronic devices (CIEDs), particularly in patients undergoing high-risk procedures (eg, generator change, device upgrade, lead/pocket revision). OBJECTIVE The purpose of this study was to describe the impact of chlorhexidine gluconate (CHG) pocket lavage in high-risk procedures. METHODS Patients from a prospective multicenter registry undergoing high-risk procedures were included. CHG lavage was performed by irrigating the generator pocket with 20 cc of 2% CHG without alcohol followed by and normal saline (NS) irrigation. Only NS irrigation was performed in the comparison group. The primary efficacy outcome was CIED-related infection at 12 months. The primary safety outcome was any CHG-associated adverse event. The secondary outcome was CIED infection during long-term follow-up. Propensity score matching (PSM) analysis was performed for the primary efficacy outcome. RESULTS A total of 1504 patients were included. At 12-month follow-up, the primary efficacy outcome occurred in 4 of 904 CHG (0.4%) and 14 of 600 NS (2.3%) subjects (log-rank P = .005). On multivariate analysis, the use of CHG irrigation was associated with a lower risk of infection at 1-year follow-up (Cox proportional hazard ratio [HR] 0.138; 95% confidence interval [CI] 0.04-0.45; P = .001). This effect persisted during long-term follow-up. PSM demonstrated a significant reduction in CIED-related infection for the CHG group (0.2% vs 2.5%; Cox proportional HR 0.08; 95% CI 0.01-0.59; P = .014). No adverse events were associated with the use of CHG. CONCLUSION CHG lavage during high-risk procedures was associated with a reduction in CIED-related infections without any adverse events reported. The benefits of CHG lavage were observed even during long-term follow up and in PSM analysis.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia.
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
| | - Felipe Cañas
- Universidad CES School of Medicine, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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9
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, Romero JE. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:2573-2583. [PMID: 37804258 DOI: 10.1016/j.jacep.2023.08.005] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. OBJECTIVES This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. METHODS Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. RESULTS A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. CONCLUSIONS There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
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Affiliation(s)
- Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA; Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Te
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Benjamin D'Souza
- Cardiac Arrythmia Program, Cardiology Service, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Mohit Rastogi
- Electrophysiology Department, Heart and Vascular Service, University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | | | - Laura C Ibanez
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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10
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Batnyam U, Zei PC, Romero JE, Kapur S, Steiger N, Tadros T, Sharma E, Tedrow U, Koplan BA, Sauer WH. Reduction and elimination of operator exposure to radiation during endocardial ventricular arrhythmia ablation procedures over time. Heart Rhythm O2 2023; 4:733-737. [PMID: 38034893 PMCID: PMC10685160 DOI: 10.1016/j.hroo.2023.09.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Affiliation(s)
- Uyanga Batnyam
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C. Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E. Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas Tadros
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Esseim Sharma
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bruce A. Koplan
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H. Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Diaz JC, Sauer WH, Duque M, Koplan BA, Braunstein ED, Marín JE, Aristizabal J, Niño CD, Bastidas O, Martinez JM, Hoyos C, Matos CD, Lopez-Cabanillas N, Steiger NA, Kapur S, Tadros TM, Martin DT, Zei PC, Tedrow UB, Romero JE. Left Bundle Branch Area Pacing Versus Biventricular Pacing as Initial Strategy for Cardiac Resynchronization. JACC Clin Electrophysiol 2023; 9:1568-1581. [PMID: 37212761 DOI: 10.1016/j.jacep.2023.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) for cardiac resynchronization therapy (CRT) is an alternative to biventricular pacing (BiVp). OBJECTIVES The purpose of this study was to compare the outcomes between LBBAP and BiVp as an initial implant strategy for CRT. METHODS In this prospective multicenter, observational, nonrandomized study, first-time CRT implant recipients with LBBAP or BiVp were included. The primary efficacy outcome was a composite of heart failure (HF)-related hospitalization and all-cause mortality. The primary safety outcomes were acute and long-term complications. Secondary outcomes included postprocedural New York Heart Association functional class and electrocardiographic and echocardiographic parameters. RESULTS A total of 371 patients (median follow-up of 340 days [IQR: 206-477 days]) were included. The primary efficacy outcome occurred in 24.2% in the LBBAP vs 42.4% in the BiVp (HR: 0.621 [95% CI: 0.415-0.93]; P = 0.021) group, driven by a reduction in HF-related hospitalizations (22.6% vs 39.5%; HR: 0.607 [95% CI: 0.397-0.927]; P = 0.021) without significant difference in all-cause mortality (5.5% vs 11.9%; P = 0.19) or differences in long-term complications (LBBAP: 9.4% vs BiVp: 15.2%; P = 0.146). LBBAP resulted in shorter procedural (95 minutes [IQR: 65-120 minutes] vs 129 minutes [IQR: 103-162 minutes]; P < 0.001) and fluoroscopy times (12 minutes [IQR: 7.4-21.1 minutes] vs 21.7 minutes [IQR: 14.3-30 minutes]; P < 0.001), shorter QRS duration (123.7 ± 18 milliseconds vs 149.3 ± 29.1 milliseconds; P < 0.001), and higher postprocedural left ventricular ejection fraction (34.1% ± 12.5% vs 31.4% ± 10.8%; P = 0.041). CONCLUSIONS LBBAP as an initial CRT strategy resulted in a lower risk of HF-related hospitalizations compared to BiVp. A reduction in procedural and fluoroscopy times, shorter paced QRS duration, and improvements in left ventricular ejection fraction compared with BiVp were observed.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Duque
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California, USA
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Juan Manuel Martinez
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Las Americas Cardiovascular Institute, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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12
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Romero JE, Diaz JC, Zei PC, Steiger NA, Koplan BA, Matos CD, Alviz I, Hoyos C, Marín JE, Duque M, Aristizabal J, Kapur S, Nyman CB, Niño CD, Bastidas O, Tadros TM, Martin DT, Tedrow UB, Sauer WH. Sustained Apnea for Epicardial Access With Right Ventriculography: The SAFER Epicardial Approach. JACC Clin Electrophysiol 2023; 9:1487-1499. [PMID: 37486280 DOI: 10.1016/j.jacep.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Epicardial access (EA) has emerged as an increasingly important approach for the treatment of ventricular arrhythmias and to perform other interventional cardiology procedures. EA is frequently underutilized because the current approach is challenging and carries a high risk of life-threatening complications. OBJECTIVE The purpose of this study was to determine the efficacy and safety of the SAFER (Sustained Apnea for Epicardial Access With Right Ventriculography) epicardial approach. METHODS Consecutive patients who underwent EA with the SAFER technique were included in this multicenter study. The primary efficacy outcome was the successful achievement of EA. The primary safety outcomes included right ventricular (RV) perforation, major hemorrhagic pericardial effusion (HPE), and bleeding requiring surgical intervention. Secondary outcomes included procedural characteristics and any complications. Our results were compared with those from previous studies describing other EA techniques to assess differences in outcomes. RESULTS A total of 105 patients undergoing EA with the SAFER approach from June 2021 to February 2023 were included. EA was used for ventricular tachycardia ablation in 98 patients (93.4%), left atrial appendage closure in 6 patients (5.7%), and phrenic nerve displacement in 1 patient (0.9%). EA was successful in all subjects (100%). The median time to EA was 7 minutes (IQR: 5-14 minutes). No cases of RV perforation, HPE, or need of surgical intervention were observed in this cohort. Comparing our results with previous studies about EA, the SAFER epicardial approach resulted in a significant reduction in major pericardial bleeding. CONCLUSIONS The SAFER epicardial approach is a simple, efficient, effective, and low-cost technique easily reproducible across multiple centers. It is associated with lower complication rates than previously reported techniques for EA.
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Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Juan C Diaz
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Paul C Zei
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bruce A Koplan
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Isabella Alviz
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Marín
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Sunil Kapur
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cesar D Niño
- Cardiac Arrhythmia Institute, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Thomas M Tadros
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David T Martin
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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13
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Osorio J, Zei PC, Díaz JC, Varley AL, Morales GX, Silverstein JR, Oza SR, D'Souza B, Singh D, Moretta A, Metzl MD, Hoyos C, Matos CD, Rivera E, Magnano A, Salam T, Nazari J, Thorne C, Costea A, Thosani A, Rajendra A, Romero JE. High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:1543-1554. [PMID: 37294263 DOI: 10.1016/j.jacep.2023.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined. OBJECTIVES This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF). METHODS In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months. RESULTS A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications. CONCLUSIONS HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times.
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Affiliation(s)
- Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan C Díaz
- Cardiac Arrhythmia Center, Division of Cardiology, Clinica Las Vegas, Universidad CES, Medellín, Colombia
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Saumil R Oza
- Ascension Medical Group, St Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - David Singh
- The Queens Medical Center, Honolulu, Hawaii, USA
| | | | - Mark D Metzl
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefania Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tariq Salam
- MultiCare Pulse Heart Institute, Tacoma, Washington, USA
| | - Jose Nazari
- Cardiovascular Institute, NorthShore University Health System, Northbrook, Illinois, USA
| | | | - Alexandru Costea
- Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, UC Heart, Lung, and Vascular Institute, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amit Thosani
- Cardiovascular Institute, Allegheny Health Network, Baden, Pennsylvania, USA
| | - Anil Rajendra
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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14
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Rajendra A, Osorio J, Diaz JC, Hoyos C, Rivera E, Matos CD, Costea A, Varley AL, Thorne C, Hoskins M, Goyal S, Oza S, Magnano A, D'Souza B, Silverstein J, Metzl M, Zei PC, Romero JE. Performance of the REAL-AF Same-Day Discharge Protocol in Patients Undergoing Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1515-1526. [PMID: 37204358 DOI: 10.1016/j.jacep.2023.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Same-day discharge (SDD) after catheter ablation of atrial fibrillation (AF) has been widely adopted. Nevertheless, planned SDD has been performed by using subjective criteria rather than standardized protocols. OBJECTIVES The goal of this study was to determine the efficacy and safety of the previously described SDD protocol in a prospective multicenter study. METHODS Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation) SDD protocol eligibility criteria (stable anticoagulation, no bleeding history, left ventricular ejection fraction >40%, no pulmonary disease, no procedures within 60 days, and body mass index <35 kg/m2), operators prospectively determined whether patients undergoing ablation of AF were candidates for SDD (SDD vs non-SDD groups). Successful SDD was achieved if the patient met the protocol discharge criteria. The primary efficacy endpoint was the success rate of SDD. The primary safety endpoints were readmission rates as well as acute and subacute complications. The secondary endpoints included procedural characteristics and freedom from all-atrial arrhythmias. RESULTS A total of 2,332 patients were included. The REAL-AF SDD protocol identified 1,982 (85%) patients as potential candidates for SDD. The primary efficacy endpoint was achieved in 1,707 (86.1%) patients. The readmission rate for SDD vs non-SDD group was similar (0.8% vs 0.9%; P = 0.924). The SDD group had a lower acute complication rate than the non-SDD group (0.8% vs 2.9%; P < 0.001), and there was no difference in the subacute complication rate between groups (P = 0.513). Freedom from all-atrial arrhythmias was comparable between groups (P = 0.212). CONCLUSIONS In this large, multicenter prospective registry, the use of a standardized protocol showed the safety of SDD after catheter ablation of paroxysmal and persistent AF. (Real-world Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation [REAL-AF]; NCT04088071).
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Affiliation(s)
- Anil Rajendra
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Grandview Medical Center, Birmingham, Alabama, USA
| | - Juan C Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Clinica Las Vegas, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Estefanía Rivera
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandru Costea
- Heart & Vascular Institute, The Christ Hospital Medical Center, Liberty Township, Ohio, USA
| | - Allyson L Varley
- Heart Rhythm Clinical and Research Solutions, Birmingham, Alabama, USA
| | | | | | - Sandeep Goyal
- Piedmont Heart Institute Buckhead, Atlanta, Georgia, USA
| | - Saumil Oza
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Anthony Magnano
- Ascension Medical Group, St. Vincent's Cardiology, Jacksonville, Florida, USA
| | - Benjamin D'Souza
- Penn Heart and Vascular Center Cherry Hill, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Joshua Silverstein
- Electrophysiology Service, AHN Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark Metzl
- NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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15
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Cui Z, Castagna F, Hanif W, Apple SJ, Zhang L, Tauras JM, Braunschweig I, Kaur G, Janakiram M, Wang Y, Fang Y, Diaz JC, Hoyos C, Marin J, Pellikka PA, Romero JE, Garcia MJ, Verma AK, Shah N, Slipczuk L. Global Longitudinal Strain Is Associated with Mortality in Patients with Multiple Myeloma. J Clin Med 2023; 12:2595. [PMID: 37048679 PMCID: PMC10095531 DOI: 10.3390/jcm12072595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with multiple myeloma (MM) are at a high risk for developing cardiovascular complications. Global longitudinal strain (GLS) can detect early functional impairment before structural abnormalities develop. It remains unknown if reduced GLS is associated with reduced survival in patients with MM. We conducted a retrospective cohort analysis of patients diagnosed with MM between 1 January 2000 and 31 December 2017 at our institution. Patients with a 2D transthoracic echocardiogram completed within 1 year of MM diagnosis, left ventricular ejection fraction (LVEF) greater than 40%, and no history of myocardial infarction prior to MM diagnosis were included. GLS was measured using an artificial-intelligence-powered software (EchoGo Core), with reduced GLS defined as an absolute value of <18%. The primary outcome of interest was overall survival since myeloma diagnosis. Our cohort included 242 patients with a median follow up of 4.28 years. Fifty-two (21.5%) patients had reduced average GLS. Patients with reduced GLS were more likely to have an IVSd ≥ 1.2cm, E/E' > 9.6, LVEF/GLS > 4.1, higher LV mass index, and low-voltage ECG. A Total of 126 (52.1%) deaths occurred during follow-up. Overall survival was lower among patients with reduced GLS (adjusted HR: 1.81, CI: 1.07-3.05).
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Affiliation(s)
- Zhu Cui
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Waqas Hanif
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Samuel J. Apple
- Department of Internal Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - James M. Tauras
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ira Braunschweig
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Gurbakhash Kaur
- Hematology Oncology Division, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Murali Janakiram
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55812, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yanan Fang
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Carolina Hoyos
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jorge Marin
- Clínica Las Americas, Medellin 50025, Colombia
| | | | - Jorge E. Romero
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mario J. Garcia
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Amit K. Verma
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nishi Shah
- Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Rodriguez D, Thurber CJ, Romero JE, Sauer WH, Kapur S, Tadros TM, Koplan BA. Device Pocket Antibiotic Irrigation Provides No CIED-Pocket Infection Prophylaxis Advantage Compared to Normal Saline. JACC Clin Electrophysiol 2022; 8:1319-1320. [DOI: 10.1016/j.jacep.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
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17
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Romero JE, Goldhaber SZ. Uninterrupted Oral Anticoagulation During Catheter Ablation of Ventricular Tachycardia: Is the Riskier Option the Safest? JACC Clin Electrophysiol 2022; 8:749-753. [PMID: 35738851 DOI: 10.1016/j.jacep.2022.04.007] [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] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Samuel Z Goldhaber
- Thrombosis Research Group and Section of Vascular Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Gianni C, Sanchez JE, Chen Q, Della Rocca DG, Mohanty S, Trivedi C, Al-Ahmad A, Bassiouny MA, Burkhardt JD, Gallinghouse GJ, Horton RP, Hranitzky PM, Romero JE, Di Biase L, Garcia MJ, Natale A. Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications. Circ Arrhythm Electrophysiol 2022; 15:e010975. [PMID: 35617267 DOI: 10.1161/circep.122.010975] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. METHODS One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. RESULTS Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%-89%]). CONCLUSIONS Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, China (Q.C.)
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Mohamed A Bassiouny
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Department of Biomedical Engineering, University of Texas, Austin (R.P.H.)
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.)
| | - Jorge E Romero
- Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B.)
| | - Mario J Garcia
- Division of Cardiology (M.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin (C.G., J.E.S., Q.C., D.G.D., S.M., C.T., A.A.-A., M.A.B., J.D.B., G.J.G., R.P.H., P.M.H., L.D.B., A.N.).,Electrophysiology (J.E.R., L.D.B., A.N.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.,HCA Healthcare, Nashville, TN (A.N.).,Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (A.N.).,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
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19
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Steiger NA, Romero JE. Pulsed-Field Ablation: What Are the Unknowns and When Will They Cease to Concern Us? J Cardiovasc Electrophysiol 2022; 33:1489-1493. [PMID: 35510406 DOI: 10.1111/jce.15521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Catheter ablation (CA) is the mainstay therapy for the maintenance of sinus rhythm in patients with paroxysmal and persistent atrial fibrillation (AF). This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nathaniel A Steiger
- Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jorge E Romero
- Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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20
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Laidi C, Hajek T, Spaniel F, Kolenic M, d'Albis MA, Sarrazin S, Mangin JF, Duchesnay E, Brambilla P, Wessa M, Linke J, Polosan M, Favre P, Versace AL, Phillips ML, Manjon JV, Romero JE, Hozer F, Leboyer M, Coupe P, Houenou J. Cerebellar parcellation in schizophrenia and bipolar disorder. Acta Psychiatr Scand 2019; 140:468-476. [PMID: 31418816 DOI: 10.1111/acps.13087] [Citation(s) in RCA: 19] [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] [Accepted: 08/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The cerebellum is involved in cognitive processing and emotion control. Cerebellar alterations could explain symptoms of schizophrenia spectrum disorder (SZ) and bipolar disorder (BD). In addition, literature suggests that lithium might influence cerebellar anatomy. Our aim was to study cerebellar anatomy in SZ and BD, and investigate the effect of lithium. METHODS Participants from 7 centers worldwide underwent a 3T MRI. We included 182 patients with SZ, 144 patients with BD, and 322 controls. We automatically segmented the cerebellum using the CERES pipeline. All outputs were visually inspected. RESULTS Patients with SZ showed a smaller global cerebellar gray matter volume compared to controls, with most of the changes located to the cognitive part of the cerebellum (Crus II and lobule VIIb). This decrease was present in the subgroup of patients with recent-onset SZ. We did not find any alterations in the cerebellum in patients with BD. However, patients medicated with lithium had a larger size of the anterior cerebellum, compared to patients not treated with lithium. CONCLUSION Our multicenter study supports a distinct pattern of cerebellar alterations in SZ and BD.
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Affiliation(s)
- C Laidi
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - T Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | - F Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - M Kolenic
- National Institute of Mental Health, Klecany, Czech Republic
| | - M-A d'Albis
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - S Sarrazin
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - J-F Mangin
- NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - E Duchesnay
- NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Wessa
- Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg-University, Mainz, Germany
| | - J Linke
- Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg-University, Mainz, Germany
| | - M Polosan
- Grenoble Institute of Neuroscience, INSERM U1216, Hôpital Grenoble Alpes, Grenoble Alpes University, Grenoble, France
| | - P Favre
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - A L Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - M L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA
| | - J V Manjon
- Instituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, España
| | - J E Romero
- Instituto Universitario de Tecnologías de la Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, España
| | - F Hozer
- Department of Psychiatry, Assistance Publique-Hôpitaux de Paris (AP-HP) - Hôpital Corentin Celton, Paris Descartes University, Près Sorbonne Paris Cité, Issy-les- Moulineaux, France
| | - M Leboyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - P Coupe
- Pictura Research Group, Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR 5800), Laboratoire Bordelais de Recherche en Informatique, Centre National de la Recherche Scientifique, Talence, France.,Pictura Research Group, Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR 5800), Laboratoire Bordelais de Recherche en Informatique, University Bordeaux, Talence, France
| | - J Houenou
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955 - Translational Psychiatry, Institut Mondor de Recherche Biomédicale, Psychiatrie, Créteil, France.,Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris (AP-HP), Faculté de Médecine de Créteil, DHU PePsy, Hôpitaux Universitaires Mondor, Créteil, France.,Fondation Fondamental, Créteil, France.,NeuroSpin, CEA, Paris Saclay University, Gif-sur-Yvette, France
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Romero JE, Cepeda J, Quinn P, Underwood SC. Prisoner rehabilitation through animal-assisted activities in Argentina: the Huellas de Esperanza Prison Dog Programme. REV SCI TECH OIE 2018; 37:171-180. [PMID: 30209419 DOI: 10.20506/rst.37.1.2750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
One of the most traumatic events that a person can ever experience in their lifetime is being detained. The prison dog programmes are the most successful prison rehabilitation programmes in the United States of America and consist of detainees training service dogs for other people to assist with different types of disability. It is a typical win-win system: inmates win as they connect with their deepest feelings of affection and solidarity while acquiring a concrete skill for their future release; people with disabilities win because they receive a dog to support their day-to-day activities; the dogs win (especially adopted street dogs) because their lot in life is improved; institutions win because they are enabled to meet their objective more fully; and society wins because they gain a concrete tool to aid the social rehabilitation of detainees. This article describes the operation and achievements of Huellas de Esperanza (Traces of Hope), the Argentine prison dog programme, which has been implemented by the Federal Penitentiary Service since 2010 using State resources. A total of 85 inmates have participated in the programme, which has delivered more than a dozen assistance dogs to people with disabilities and many more dogs to elderly people to provide them with affection and companionship. The article also describes the programme methodology and the way it has decreased prison unrest and led to a low reoffending rate among programme participants.
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22
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Stankey JA, Akbulut C, Romero JE, Govindasamy-Lucey S. Evaluation of X-ray fluorescence spectroscopy as a method for the rapid and direct determination of sodium in cheese. J Dairy Sci 2015; 98:5040-51. [PMID: 26051319 DOI: 10.3168/jds.2014-9055] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Abstract
Cheese manufacturers indirectly determine Na in cheese by analysis of Cl using the Volhard method, assuming that all Cl came from NaCl. This method overestimates the actual Na content in cheeses when Na replacers (e.g., KCl) are used. A direct and rapid method for Na detection is needed. X-ray fluorescence spectroscopy (XRF), a mineral analysis technique used in the mining industry, was investigated as an alternative method of Na detection in cheese. An XRF method for the detection of Na in cheese was developed and compared with inductively coupled plasma optical emission spectroscopy (ICP-OES; the reference method for Na in cheese) and Cl analyzer. Sodium quantification was performed by multi-point calibration with cheese standards spiked with NaCl ranging from 0 to 4% Na (wt/wt). The Na concentration of each of the cheese standards (discs: 30mm×7mm) was quantified by the 3 methods. A single laboratory method validation was performed; linearity, precision, limit of detection, and limit of quantification were determined. An additional calibration graph was created using cheese standards made from natural or process cheeses manufactured with different ratios of Na:K. Both Na and K calibration curves were linear for the cheese standards. Sodium was quantified in a variety of commercial cheese samples. The Na data obtained by XRF were in agreement with those from ICP-OES and Cl analyzer for most commercial natural cheeses. The XRF method did not accurately determine Na concentration for several process cheese samples, compared with ICP-OES, likely due to the use of unknown types of Na-based emulsifying salts (ES). When a calibration curve was created for process cheese with the specific types of ES used for this cheese, Na content was successfully predicted in the samples. For natural cheeses, the limit of detection and limit of quantification for Na that can be determined with an acceptable level of repeatability, precision, and trueness was 82 and 246mg/100g of cheese, respectively. Calibration graphs should be created with standards that reflect the concentration range, ratio, and salt type present in the cheeses. This XRF method can be successfully used for the rapid and direct measurement of Na content in a wide variety of natural cheeses. Commercial process cheese manufacturers use proprietary blends of ES. We did find that the XRF technique worked for process cheese when the calibration graphs were created with the specific types of ES actually used.
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Affiliation(s)
- J A Stankey
- Wisconsin Center for Dairy Research, University of Wisconsin, Madison 53706
| | - C Akbulut
- Wisconsin Center for Dairy Research, University of Wisconsin, Madison 53706
| | - J E Romero
- Wisconsin Center for Dairy Research, University of Wisconsin, Madison 53706
| | - S Govindasamy-Lucey
- Wisconsin Center for Dairy Research, University of Wisconsin, Madison 53706.
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23
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Eslava DJ, Cordova JP, Korniyenko A, Nadkarni GN, Alviar CL, Romero JE, Chorzempa A, Fridman V, Wysoczanski M, Cianci C, Kearney K, Kantrowitz N, Fox J, Hong M, Tamis-Holland JE. Abstract P80: Lack of English Comprehension is Associated with Delays in Hospital Presentation in Patients with ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Prior studies have demonstrated an association between ethnicity and symptom onset to presentation time (S2PT) among patients presenting with ST elevation MI (STEMI) in the USA, with a shorter S2PT among Caucasians when compared with other ethnicities. However, little is known regarding whether or not a patient's ability to comprehend English impacts the S2PT.
Methods:
Consecutive patients presenting to 4 hospitals in NYC with STEMI referred for primary angioplasty were included in the analysis. S2PT was recorded on the day of the infarct based on the patient's account of the onset of symptoms. We assessed a patient's ability to comprehend English through telephone interviews conducted during routine follow-up.
Results:
Among 210 patients, 83.8% (176 of 210) had either some English comprehension or were fluent in English (E) and 16.2% (34 of 210) reported no English comprehension (non-E). Of the non-E patients, 65% (22 of 34) spoke Spanish, 6% (2 of 34) spoke Russian, 6% (2 of 34) spoke Chinese and 23% (8 of 34) spoke another language. The baseline variables and mean S2PT are depicted in the table. Non-E patients had a significantly higher S2PT compared to E patients even after adjusting for differences in baseline variables. Increased odds were also observed among non-E patients with a longer S2PT (adjusted odds ratio for S2PT > 120 minutes 2.17; 95% CI 01.03-4.54; p=0.04). This association remained constant even after adjusting for confounders like age, sex, ethnicity, level of education and comorbidities (diabetes, previous history of MI and PCI).
Conclusions:
S2PT is strongly influenced by a patient's ability to comprehend English. This information emphasizes the need for more aggressive “multi-lingual” educational outreach and the use of multi-lingual emergency lines in an effort to decrease total ischemic time during STEMI.
English Comprehension Fair or Good (N=176)
No English Comprehension (N=34)
P
Age Mean (SD)
62 (14.2)
65 (11)
0.22
Male sex n (%)
129 (73)
26 (76)
0.70
Diabetes n (%)
25 (14)
9 (27)
0.09
Hypertension n (%)
107 (66)
20 (62.5)
0.70
Prior MI n (%)
21 (12)
2 (6)
0.284
Prior PCI or CABG n (%)
12 (6.8)
2 (6)
0.960
Education: n (%)
40 (23)
12 (35)
0.09
Less than HS
62 (35)
8 (23)
HS Diploma
8 (4)
0 (0)
College Diploma Unknown
66 (38)
14 (42)
Mean S2P time (SD)
225 (315)
387 (820.6)
0.05
S2P time > 120 minutes n (%)
70 (40)
20 (62.5)
0.04
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - John Fox
- Beth Israel Med Cntr, New York City, NY
| | - Mun Hong
- St Luke's-Roosevelt Hosp, New York City, NY
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24
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McKusick BC, Thomas DL, Romero JE, Marnet PG. Effect of weaning system on milk composition and distribution of milk fat within the udder of East Friesian dairy ewes. J Dairy Sci 2002; 85:2521-8. [PMID: 12416804 DOI: 10.3168/jds.s0022-0302(02)74335-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We investigated whether the inhibition of milk ejection during and/or between machine milkings is responsible for the low milk fat observed in commercial milk obtained from dairy ewes managed with a mixed system (MIX) of partial daily suckling (10 h) and once daily machine milking (after 14 h of udder filling). East Friesian crossbred dairy ewes were randomly allocated postpartum to the MIX system (n = 9) or to exclusive twice-daily machine milking (DY1, n = 8). Following wk 4, MIX ewes were permanently weaned from their lambs and milked twice daily. All ewes were injected with saline, oxytocin, or an oxytocin-receptor antagonist prior to three morning milkings during wk 2,4, and 6 of lactation to study cisternal and alveolar milk distribution. Overall milk yield (cisternal + alveolar) for MIX ewes was 42% greater than for DY1 ewes during wk 2 and 4, which demonstrates the beneficial effect of lamb suckling on milk production of dairy ewes. However, during normal machine milking, only the cisternal fraction was obtained from MIX ewes, confirming that milk ejection did not occur for as long as these ewes remained in partial daily contact with their lambs. Although the volume of milk stored within the cistern, and its concentration of milk protein was similar for the two weaning systems, milk of MIX ewes was significantly inferior in cisternal milk fat concentration and yield compared to DY1 ewes. This provides evidence that not only is there inhibition of milk ejection during machine milking of MIX ewes, there is additional inhibition of transfer of milk fat, but not milk protein, from the alveoli to the cistern during the evening when MIX ewes a reseparated from their lambs. Following weaning of MIX ewes, the majority of lactation traits studied were similar compared to DY1 ewes.
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25
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Romero AL, Romero JE, Galaviz S, Fernandez ML. Cookies enriched with psyllium or oat bran lower plasma LDL cholesterol in normal and hypercholesterolemic men from Northern Mexico. J Am Coll Nutr 1998; 17:601-8. [PMID: 9853540 DOI: 10.1080/07315724.1998.10718809] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Psyllium and oat bran have been shown to lower plasma LDL cholesterol levels in different populations. Hypercholesterolemia is prevalent in the Northern part of Mexico and might be associated to dietary habits and sedentary lifestyle. METHODS Sedentary normal (cholesterol<200 mg/dL) (n=36) and hypercholesterolemic (cholesterol>220 mg/dL) (n=30) men from the Northern part of Mexico aged 20 to 45 years of age participated in an 8-week study to determine the effects of dietary soluble fiber, either psyllium or oat bran, in lowering plasma LDL cholesterol in this population. Fiber was administered by feeding the subjects an amount of cookies (100 g) equivalent to 1.3 or 2.6 g/day of soluble fiber from psyllium or oat bran, respectively. Subjects were randomly allocated to three groups: a control group consuming cookies with wheat bran, a known source of fiber with no cholesterol lowering effects, psyllium, or oat bran. RESULTS Food frequency questionnaires indicated that subjects from the three groups had similar intakes of foods classified as hypercholesterolemic (p>0.05). Plasma LDL cholesterol concentrations were reduced by an average of 22.6 and 26% in the psyllium and oat bran groups (p<0.001) while a non-significant reduction of 8.4% was observed in the hypercholesterolemic individuals from the control group. No effects on plasma HDL or triglycerides levels were observed among the three dietary treatments except for hypercholesterolemic individuals supplemented with oat bran where a 28% reduction in plasma triglycerides was observed after 8 weeks (p<0.01). CONCLUSION These results indicate that psyllium and oat bran are efficacious in lowering plasma LDL cholesterol in both normal and hypercholesterolemic individuals from this population.
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Affiliation(s)
- A L Romero
- Centro de Investigacion y Postgrado, Universidad de Sonora, Hermosillo, Mexico
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