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Dankar R, Wehbi J, Atasi MM, Alam S, Refaat MM. Coronary microvascular dysfunction, arrythmias, and sudden cardiac death: A literature review. Am Heart J Plus 2024; 41:100389. [PMID: 38584700 PMCID: PMC10998042 DOI: 10.1016/j.ahjo.2024.100389] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
The coronary vascular system has a unique structure and function that is adaptive to myocardial demand. It is composed of a continuous network of vessels receding in size from epicardial arteries to the microvascular circulation. Failure to meet myocardial demand results in ischemia, angina, and adverse myocardial outcomes. It is evident that 50 % of patients with angina have a non-obstructive coronary disease and 66 % of these patients have coronary microvascular dysfunction (CMD). The impact of CMD on the atria and ventricles is exhibited through its association with atrial fibrillation and distortion of ventricular repolarization. Ultimately, this influence increases the risk of mortality, morbidity, and sudden cardiac arrest. CMD serves as an independent risk for atrial fibrillation, increases ventricular electrical inhomogeneity, and contributes to the progression of cardiac disease. The underlying pathogenesis may be attributed to oxidative stress evident through reactive oxygen species, impaired vasoactive function, and structural disorders such as fibrotic changes. Myocardial ischemia, brought about by a demand-supply mismatch in CMD, may create a milieu for ventricular arrythmia and sudden cardiac arrest through distortion of ventricular repolarization parameters such as QT dispersion and corrected QT dispersion.
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Affiliation(s)
- Razan Dankar
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Wehbi
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Montaser Atasi
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samir Alam
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Dankar R, Wehbi J, Refaat MM. Tailoring Treatment in Cardiovascular Diseases: The Role of Targeted Therapies. Pharmaceutics 2024; 16:461. [PMID: 38675122 PMCID: PMC11054164 DOI: 10.3390/pharmaceutics16040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality around the globe. To address this public health burden, innovative therapeutic agents are being developed to specifically target molecular and genetic markers. Various therapeutic modalities have been implemented, including vaccines, monoclonal or bispecific antibodies, and gene-based therapies. Such drugs precisely target the underlying disease pathophysiology, aiming at notable molecules such as lipid metabolism regulators, proinflammatory cytokines, and growth factors. This review focuses on the latest advancements in different targeted therapies. It provides an insightful overview of the current landscape of targeted cardiovascular therapies, highlighting promising strategies with potential to transform the treatment of CVDs into an era of precision medicine.
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Affiliation(s)
- Razan Dankar
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon; (R.D.); (J.W.)
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Jad Wehbi
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon; (R.D.); (J.W.)
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Marwan M. Refaat
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon; (R.D.); (J.W.)
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut P.O. Box 11-0236, Lebanon
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Ghazal R, Garabedian H, Sawaya F, Refaat MM. Post-TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management. J Cardiovasc Electrophysiol 2024; 35:488-497. [PMID: 38254339 DOI: 10.1111/jce.16185] [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: 08/22/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta-analyses identified preexisting right bundle branch block (RBBB), LAHB, and new-onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self-expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post-TAVR, highlighting the need for further research and standardized treatment strategies.
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Affiliation(s)
- Rachad Ghazal
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Fadi Sawaya
- Structural Heart and Valve Division, American University of Beirut Medical Center, Beirut, Lebanon
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
- Cardiac Electrophysiology Division, American University of Beirut Medical Center, Beirut, Lebanon
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Jain S, Bakolitsa C, Brenner SE, Radivojac P, Moult J, Repo S, Hoskins RA, Andreoletti G, Barsky D, Chellapan A, Chu H, Dabbiru N, Kollipara NK, Ly M, Neumann AJ, Pal LR, Odell E, Pandey G, Peters-Petrulewicz RC, Srinivasan R, Yee SF, Yeleswarapu SJ, Zuhl M, Adebali O, Patra A, Beer MA, Hosur R, Peng J, Bernard BM, Berry M, Dong S, Boyle AP, Adhikari A, Chen J, Hu Z, Wang R, Wang Y, Miller M, Wang Y, Bromberg Y, Turina P, Capriotti E, Han JJ, Ozturk K, Carter H, Babbi G, Bovo S, Di Lena P, Martelli PL, Savojardo C, Casadio R, Cline MS, De Baets G, Bonache S, Díez O, Gutiérrez-Enríquez S, Fernández A, Montalban G, Ootes L, Özkan S, Padilla N, Riera C, De la Cruz X, Diekhans M, Huwe PJ, Wei Q, Xu Q, Dunbrack RL, Gotea V, Elnitski L, Margolin G, Fariselli P, Kulakovskiy IV, Makeev VJ, Penzar DD, Vorontsov IE, Favorov AV, Forman JR, Hasenahuer M, Fornasari MS, Parisi G, Avsec Z, Çelik MH, Nguyen TYD, Gagneur J, Shi FY, Edwards MD, Guo Y, Tian K, Zeng H, Gifford DK, Göke J, Zaucha J, Gough J, Ritchie GRS, Frankish A, Mudge JM, Harrow J, Young EL, Yu Y, Huff CD, Murakami K, Nagai Y, Imanishi T, Mungall CJ, Jacobsen JOB, Kim D, Jeong CS, Jones DT, Li MJ, Guthrie VB, Bhattacharya R, Chen YC, Douville C, Fan J, Kim D, Masica D, Niknafs N, Sengupta S, Tokheim C, Turner TN, Yeo HTG, Karchin R, Shin S, Welch R, Keles S, Li Y, Kellis M, Corbi-Verge C, Strokach AV, Kim PM, Klein TE, Mohan R, Sinnott-Armstrong NA, Wainberg M, Kundaje A, Gonzaludo N, Mak ACY, Chhibber A, Lam HYK, Dahary D, Fishilevich S, Lancet D, Lee I, Bachman B, Katsonis P, Lua RC, Wilson SJ, Lichtarge O, Bhat RR, Sundaram L, Viswanath V, Bellazzi R, Nicora G, Rizzo E, Limongelli I, Mezlini AM, Chang R, Kim S, Lai C, O’Connor R, Topper S, van den Akker J, Zhou AY, Zimmer AD, Mishne G, Bergquist TR, Breese MR, Guerrero RF, Jiang Y, Kiga N, Li B, Mort M, Pagel KA, Pejaver V, Stamboulian MH, Thusberg J, Mooney SD, Teerakulkittipong N, Cao C, Kundu K, Yin Y, Yu CH, Kleyman M, Lin CF, Stackpole M, Mount SM, Eraslan G, Mueller NS, Naito T, Rao AR, Azaria JR, Brodie A, Ofran Y, Garg A, Pal D, Hawkins-Hooker A, Kenlay H, Reid J, Mucaki EJ, Rogan PK, Schwarz JM, Searls DB, Lee GR, Seok C, Krämer A, Shah S, Huang CV, Kirsch JF, Shatsky M, Cao Y, Chen H, Karimi M, Moronfoye O, Sun Y, Shen Y, Shigeta R, Ford CT, Nodzak C, Uppal A, Shi X, Joseph T, Kotte S, Rana S, Rao A, Saipradeep VG, Sivadasan N, Sunderam U, Stanke M, Su A, Adzhubey I, Jordan DM, Sunyaev S, Rousseau F, Schymkowitz J, Van Durme J, Tavtigian SV, Carraro M, Giollo M, Tosatto SCE, Adato O, Carmel L, Cohen NE, Fenesh T, Holtzer T, Juven-Gershon T, Unger R, Niroula A, Olatubosun A, Väliaho J, Yang Y, Vihinen M, Wahl ME, Chang B, Chong KC, Hu I, Sun R, Wu WKK, Xia X, Zee BC, Wang MH, Wang M, Wu C, Lu Y, Chen K, Yang Y, Yates CM, Kreimer A, Yan Z, Yosef N, Zhao H, Wei Z, Yao Z, Zhou F, Folkman L, Zhou Y, Daneshjou R, Altman RB, Inoue F, Ahituv N, Arkin AP, Lovisa F, Bonvini P, Bowdin S, Gianni S, Mantuano E, Minicozzi V, Novak L, Pasquo A, Pastore A, Petrosino M, Puglisi R, Toto A, Veneziano L, Chiaraluce R, Ball MP, Bobe JR, Church GM, Consalvi V, Cooper DN, Buckley BA, Sheridan MB, Cutting GR, Scaini MC, Cygan KJ, Fredericks AM, Glidden DT, Neil C, Rhine CL, Fairbrother WG, Alontaga AY, Fenton AW, Matreyek KA, Starita LM, Fowler DM, Löscher BS, Franke A, Adamson SI, Graveley BR, Gray JW, Malloy MJ, Kane JP, Kousi M, Katsanis N, Schubach M, Kircher M, Mak ACY, Tang PLF, Kwok PY, Lathrop RH, Clark WT, Yu GK, LeBowitz JH, Benedicenti F, Bettella E, Bigoni S, Cesca F, Mammi I, Marino-Buslje C, Milani D, Peron A, Polli R, Sartori S, Stanzial F, Toldo I, Turolla L, Aspromonte MC, Bellini M, Leonardi E, Liu X, Marshall C, McCombie WR, Elefanti L, Menin C, Meyn MS, Murgia A, Nadeau KCY, Neuhausen SL, Nussbaum RL, Pirooznia M, Potash JB, Dimster-Denk DF, Rine JD, Sanford JR, Snyder M, Cote AG, Sun S, Verby MW, Weile J, Roth FP, Tewhey R, Sabeti PC, Campagna J, Refaat MM, Wojciak J, Grubb S, Schmitt N, Shendure J, Spurdle AB, Stavropoulos DJ, Walton NA, Zandi PP, Ziv E, Burke W, Chen F, Carr LR, Martinez S, Paik J, Harris-Wai J, Yarborough M, Fullerton SM, Koenig BA, McInnes G, Shigaki D, Chandonia JM, Furutsuki M, Kasak L, Yu C, Chen R, Friedberg I, Getz GA, Cong Q, Kinch LN, Zhang J, Grishin NV, Voskanian A, Kann MG, Tran E, Ioannidis NM, Hunter JM, Udani R, Cai B, Morgan AA, Sokolov A, Stuart JM, Minervini G, Monzon AM, Batzoglou S, Butte AJ, Greenblatt MS, Hart RK, Hernandez R, Hubbard TJP, Kahn S, O’Donnell-Luria A, Ng PC, Shon J, Veltman J, Zook JM. CAGI, the Critical Assessment of Genome Interpretation, establishes progress and prospects for computational genetic variant interpretation methods. Genome Biol 2024; 25:53. [PMID: 38389099 PMCID: PMC10882881 DOI: 10.1186/s13059-023-03113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/17/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The Critical Assessment of Genome Interpretation (CAGI) aims to advance the state-of-the-art for computational prediction of genetic variant impact, particularly where relevant to disease. The five complete editions of the CAGI community experiment comprised 50 challenges, in which participants made blind predictions of phenotypes from genetic data, and these were evaluated by independent assessors. RESULTS Performance was particularly strong for clinical pathogenic variants, including some difficult-to-diagnose cases, and extends to interpretation of cancer-related variants. Missense variant interpretation methods were able to estimate biochemical effects with increasing accuracy. Assessment of methods for regulatory variants and complex trait disease risk was less definitive and indicates performance potentially suitable for auxiliary use in the clinic. CONCLUSIONS Results show that while current methods are imperfect, they have major utility for research and clinical applications. Emerging methods and increasingly large, robust datasets for training and assessment promise further progress ahead.
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Dankar R, Wehbi J, Refaat MM. The clinical and economic impact of extended battery longevity of the extravascular implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2024; 35:238-239. [PMID: 38180150 DOI: 10.1111/jce.16174] [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: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Razan Dankar
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jad Wehbi
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Dankar R, Refaat MM. Quality of life and acceptance of the extravascular implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol 2024; 35:247-248. [PMID: 38178582 DOI: 10.1111/jce.16177] [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: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Razan Dankar
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Lakkiss B, Refaat MM. β 1 and α 2C-Adrenergic Receptor Polymorphisms Are Associated With Lower Incident Ventricular Fibrillation in Patients With ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2023; 12:e029102. [PMID: 36927047 PMCID: PMC10111538 DOI: 10.1161/jaha.123.029102] [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] [Indexed: 03/18/2023]
Affiliation(s)
- Bachir Lakkiss
- Division of Cardiology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Lakkiss B, Refaat MM. Pulmonary vein isolation-induced vagal nerve injury and gastric motility disorders. J Cardiovasc Electrophysiol 2023; 34:1318-1319. [PMID: 36740367 DOI: 10.1111/jce.15844] [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: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Bachir Lakkiss
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Rizkallah DH, Refaat MM. Safety and effect on length of stay of intravenous sotalol initiation for arrhythmia management. J Cardiovasc Electrophysiol 2023; 34:1324-1325. [PMID: 36738140 DOI: 10.1111/jce.15852] [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: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Diane H Rizkallah
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Lakkis B, Refaat MM. Is esophageal temperature management needed during cryoballoon ablation for atrial fibrillation? J Cardiovasc Electrophysiol 2022; 33:2567-2568. [PMID: 36317451 DOI: 10.1111/jce.15725] [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: 10/20/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Bachir Lakkis
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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El Khoury W, Al Aaraj J, Gebran A, Hajjar M, Abbas R, Daoud H, Khoury M, Abi-Saleh B, Oweis GF, Refaat MM. Establishing Safe Working Parameters for Radiofrequency Ablation In Vitro Using Acoustic Sensing, Probability Mapping, and Catheter Contact Angle. J Innov Card Rhythm Manag 2022; 13:5087-5099. [PMID: 35949646 PMCID: PMC9359427 DOI: 10.19102/icrm.2022.130703] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
Surgical quality and safety in radiofrequency catheter ablation (RFA) are critical in arrhythmia procedures. Steam pops, in particular, are potentially catastrophic events that must be avoided; otherwise, they may cause significant damage to the myocardium. This study aimed to evaluate the effect of applied RFA inclination angle and tissue contact parameters on the ablated volume and “steam pop” formation. An ex vivo model consisting of a viable ovine myocardium, an ablation catheter, and a circulating warmed 0.9% NaCl saline solution was used. RFA was conducted while controlling for contact force, electrical power, ablation time, flow rate, irrigation, and catheter tip angle. Irrigation was delivered to the catheter tip manually when indicated. Acoustic transducers were included in the setup to detect preliminary acoustic signals. A total dataset of 567 measurements was taken. Benign precursory signals (hissing and lower-intensity “pops”) were detected by acoustic sensors preceding the occurrence of “steam pops.” Furthermore, a Pearson coefficient of r = 0.809 with P < .01 was shown to exist between the acoustic intensity of a “steam pop” and the ablated lesion volume. RFA powers of 25 and 30 W with a duration of 20 s induced more “steam pops” than ablation powers of ≤20 W with a duration of ≥30 s. There was also an increased probability of “steam pop” formation with the use of a non-irrigated catheter tip, as compared to an irrigated catheter tip. A more acute catheter angle increased the lesion size at powers of 20 and 25 W (r = −0.568 and r = −0.653, both P < .05, respectively). There is a potential benefit of using acoustic sensing as a warning before the occurrence of “steam pops.” Varying power, duration, and catheter tip angle will generate different ablation sizes and need to be tailored to individual needs and procedures.
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Affiliation(s)
- Wadih El Khoury
- Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, Beirut, Lebanon,Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Joseph Al Aaraj
- Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, Beirut, Lebanon
| | - Anthony Gebran
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Marwan Hajjar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rawad Abbas
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussein Daoud
- Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, Beirut, Lebanon
| | - Maurice Khoury
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon,Department of Internal Medicine/Cardiology Division, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bernard Abi-Saleh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon,Department of Internal Medicine/Cardiology Division, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghanem F. Oweis
- Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, Beirut, Lebanon,Address correspondence to: Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FRCP, Cardiovascular Fellowship Program, Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. . Ghanem F. Oweis, PhD, Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Marwan M. Refaat
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon,Department of Internal Medicine/Cardiology Division, Faculty of Medicine, American University of Beirut, Beirut, Lebanon,Address correspondence to: Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FRCP, Cardiovascular Fellowship Program, Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. . Ghanem F. Oweis, PhD, Department of Mechanical Engineering, Faculty of Engineering, American University of Beirut, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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Higuchi S, Ito H, Gerstenfeld EP, Lee AC, Lee BK, Marcus GM, Hsia HH, Moss JD, Lee RJ, Dewland TA, Vedantham V, Tseng ZH, Patel AR, Tanel RE, Badhwar N, Pellegrini CN, Kawamura M, Shoda M, Hwang C, Refaat MM, Scheinman MM. EN-571-01 THE VALUE OF PROGRAMMED VENTRICULAR EXTRASTIMULI FROM THE RIGHT VENTRICULAR BASAL SEPTUM DURING SUPRAVENTRICULAR TACHYCARDIA. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nayfeh M, Refaat MM. Is there a need for a novel algorithm for accessory pathways localization? J Cardiovasc Electrophysiol 2022; 33:962-965. [PMID: 35175658 DOI: 10.1111/jce.15414] [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: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
Wolff Parkinson White Syndrome (WPW) affects between 0.1% and 0.2% of the population, causes morbidity due to supraventricular tachycardia (SVT) and can lead to sudden cardiac arrest [1-3]. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Malek Nayfeh
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Daou D, Chakhtoura M, El-Yazbi A, Mukherji D, Sbaity E, Refaat MM, Nabulsi M. Teaching critical appraisal to large classes of undergraduate medical students using team-based learning versus group discussions: a randomized controlled trial. BMC Med Educ 2022; 22:77. [PMID: 35120498 PMCID: PMC8815246 DOI: 10.1186/s12909-022-03145-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/27/2022] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evidence on the effectiveness of team-based learning in teaching critical appraisal to large classes of preclinical medical students is scarce. This study investigated whether team-based learning is effective in teaching critical appraisal to large classes of preclinical medical students. METHODS Between April 2018 and May 2019, 107 first-year medical students were randomly allocated to receive instruction in critical appraisal using team-based learning or traditional group discussions as teaching methods. The primary outcome was students' performance on the Berlin Questionnaire administered at the end of second year. RESULTS Students' mean (SD) age was 22.0 (0.7) years. Baseline characteristics of the two groups were similar (all p values > 0.05). The mean (SD) Berlin scores of both groups were 80.4 (11.6) and 80.1 (12.1) for team-based learning and group discussions, respectively. Multivariate stepwise linear regression analysis revealed that the student's academic achievement in medical school was the sole predictor of performance on the Berlin Questionnaire (ß = 1.079, p < 0.001), adjusting for gender, Medical College Admission Test score, student's self-reported preferred teaching method, rank upon admission to medical school, score on the Epidemiology and Biostatistics course, and teaching method (team-based learning versus group discussions). CONCLUSIONS Team-based learning and group discussions were equally effective instructional strategies to teach critical appraisal to large classes of undergraduate medical students. Replication of our findings is needed in other educational settings. TRIAL REGISTRATION Current Controlled Trials ISRCTN15430424 , retrospectively registered on December 30, 2021.
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Affiliation(s)
- Dayane Daou
- Department of Anesthesiology, American University of Beirut, Beirut, Lebanon
| | - Marlene Chakhtoura
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmed El-Yazbi
- Department of Pharmacology, American University of Beirut, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Eman Sbaity
- Department of Surgery, American University of Beirut, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon.
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15
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Hughey AB, Muthappan P, Badin A, Baman T, Baig-Ansari N, Jawed F, Khan AB, Jiang Q, Hughey KL, Toruño RJ, Machado C, Refaat MM, Zakka P, Hotait M, Eagle KA, Crawford TC. Patients' and Family Members' Views on Pacemaker Reuse: an International Survey. J Cardiovasc Electrophysiol 2022; 33:473-480. [PMID: 35040526 DOI: 10.1111/jce.15367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice. METHODS AND RESULTS A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients' family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua - 100; Pakistan - 493; Ecuador - 252; Lebanon - 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P<0.001). CONCLUSIONS Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Andrew B Hughey
- Michigan Heart, Saint Joseph Mercy Health System, Ypsilanti, MI, USA
| | - Palaniappan Muthappan
- Wright State University Boonshoft School of Medicine, Internal Medicine, Dayton, OH, USA
| | - Auroa Badin
- University of Texas Health Science Center at San Antonio, Internal Medicine, San Antonio, Texas, USA
| | | | - Naila Baig-Ansari
- The Indus Hospital, Indus Hospital Research Center, Karachi, Pakistan
| | | | - Abdul B Khan
- Indus Hospital, Indus Hospital Research Center, Karachi, Pakistan
| | - Qingmei Jiang
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
| | - Katherine L Hughey
- University of Michigan, Michigan Medicine, Family Medicine Ann Arbor, MI, USA
| | | | - Christian Machado
- Providence Hospital and Medical Center, Cardiology/Electrophysiology, Southfield, Michigan, USA.,Wayne State University, Internal Medicine, Detroit, Michigan, USA
| | - Marwan M Refaat
- Department of Internal Medicine, Cardiovascular Medicine Division, American University of Beirut Medical Center, Lebanon
| | - Patrick Zakka
- Emory University School of Medicine, Internal Medicine, Atlanta, Georgia, USA
| | - Mostafa Hotait
- Department of Internal Medicine, Cardiovascular Medicine Division, American University of Beirut Medical Center, Lebanon
| | - Kim A Eagle
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
| | - Thomas C Crawford
- University of Michigan, Michigan Medicine, Internal Medicine, Ann Arbor, MI, USA
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16
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Refaat MM, Gharios C, Moorthy MV, Abdulhai F, Blumenthal RS, Jaffa MA, Mora S. Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals. J Am Coll Cardiol 2021; 78:2267-2277. [PMID: 34857087 DOI: 10.1016/j.jacc.2021.09.1366] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. OBJECTIVES This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. METHODS A cohort of 5,486 asymptomatic individuals who took part in the Lipid Research Clinics prospective cohort had baseline interview, physical examination, blood tests, and underwent Bruce protocol treadmill testing. Adjusted Cox survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent (>10 per minute), multifocal, R-on-T type, or ≥2 PVCs in a row) with all-cause and cardiovascular mortality. RESULTS Mean baseline age was 45.4 ± 10.8 years; 42% were women. During a mean follow-up of 20.2 ± 3.9 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (hazard ratio [HR]: 1.82; 95% CI: 1.19-2.79; P = 0.006), which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST-segment depression (HR: 1.68; 95% CI: 1.09-2.60; P = 0.020). Results were similar by clinical subgroups. High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination beyond clinical variables. CONCLUSIONS High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.
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Affiliation(s)
- Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Charbel Gharios
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - M Vinayaga Moorthy
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Farah Abdulhai
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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17
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Gharios C, Leblebjian M, Mora S, Blumenthal RS, Jaffa MA, Refaat MM. The association of cardiovascular mortality with a first-degree family member history of different cardiovascular diseases. J Geriatr Cardiol 2021; 18:816-824. [PMID: 34754293 PMCID: PMC8558742 DOI: 10.11909/j.issn.1671-5411.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To investigate which history of cardiovascular disease [coronary heart disease (CHD), stroke, or peripheral arterial disease] in a first-degree family member predicts cardiovascular mortality. METHODS We studied a prospective cohort (the Lipid Research Clinics Prevalence Study) from ten primary care centers across North America. The primary outcome was cardiovascular mortality, assessed using Cox survival models. RESULTS There were 8,646 participants (mean age: 47.4 ± 12.1 years, 46% women, 52% of participants with hyperlipidemia) who were followed up for a mean duration of 19.4 ± 4.9 years. There were 1,851 deaths (21%), including 852 cardiovascular deaths. A paternal, maternal or sibling history of premature CHD (before 60 years) was present in 26% of participants, of stroke in 27% of participants, and of peripheral arterial disease in 24% of participants. After adjusting for risk factors (age, sex, systolic blood pressure, diastolic blood pressure, body mass index, smoking, fasting glucose, low-density lipoprotein cholesterol and triglycerides), only a paternal history of premature or any CHD, a maternal history of diabetes mellitus or premature or any CHD, and a sibling history of premature CHD, hypertension, or hyperlipidemia were individually predictive of cardiovascular mortality. After adjusting for risk factors and the mentioned familial factors, only paternal and maternal histories of CHD, especially before 60 years, remained predictive of cardiovascular mortality, with a somewhat higher association for a maternal history [adjusted hazard ratio (aHR) = 1.99, 95% CI: 1.36-2.92,P < 0.001 for maternal history of premature CHD; aHR = 1.52, 95% CI: 1.10-2.10, P = 0.011 for paternal history of premature CHD]. Family history of stroke or peripheral arterial disease did not predict cardiovascular mortality. Parental history of premature CHD predicted cardiovascular mortality independently of baseline age (< 60 years and ≥ 60 years), hypertension, or hyperlipidemia and carried more important prognostic value in men rather than women. CONCLUSIONS In this study, a parental history of CHD, especially before 60 years, best predicted cardiovascular mortality. This finding could help more accurately identify high-risk patients who would benefit from preventive strategies.
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Affiliation(s)
- Charbel Gharios
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mireille Leblebjian
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Miran A. Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marwan M. Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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18
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Beydoun N, Gharios C, Refaat MM. Toward better risk stratification of asymptomatic Brugada syndrome patients? J Cardiovasc Electrophysiol 2021; 32:3008-3009. [PMID: 34596930 DOI: 10.1111/jce.15261] [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: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Najla Beydoun
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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19
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El Moheb M, Refaat MM. Taiwan Atrial Fibrillation Score: A New Clinical Tool for Predicting New Onset Atrial Fibrillation in Asian Populations. J Am Heart Assoc 2021; 10:e022621. [PMID: 34459228 PMCID: PMC8649283 DOI: 10.1161/jaha.121.022621] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamad El Moheb
- Division of Trauma Emergency Surgery and Surgical Critical Care Massachusetts General Hospital Boston MA
| | - Marwan M Refaat
- Division of Cardiology Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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20
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Abdulhai F, Fares S, Mekary W, Habeichi NJ, Massoud GP, Refaat MM, Zouein FA. Abstract P264: Protective Effects Of Angiotensin II Inhibitors In Lebanese SARS-COV2 Hospitalized Patients. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p264] [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] [Indexed: 11/16/2022]
Abstract
Introduction:
SARS-CoV2 leads to increased Angiotensin II resulting in worsened cardiovascular disease (CVD) outcome and prognosis. ACEIs and ARBs prescribed drugs could be a crucial player in SARS-COV2 prognosis, owing that ACE2 is one SARS-CoV2 binding site and that ACE2 expression in the cardiovascular system is markedly elevated following the treatment with ACEIs and ARBs.
Hypothesis:
We hypothesized that hospitalized SARS-COV2 Lebanese patients with varying stages of heart failure (A through C) taking ACEIs or ARBs will exhibit an overall better cardiovascular prognosis than control patients with comparable demographics but on other cardiovascular medications.
Method:
Lebanese patients (N=66) classified as heart failure A-C and admitted to AUBMC for SARS-CoV2 infection were recruited as a part of an ongoing clinical study. Patients were assigned to the control group (No ACEIs or ARBs) or the study sample group (on ACEIs or ARBs). Baseline characteristics including cardiovascular, inflammatory, respiratory and overall outcomes were collected from the patients’ medical charts and analyzed. Unadjusted associations on recruited patients are presented here. Adjusted analyses will be performed when a total of 200 patients is reached.
Results:
The average age of patients was 69±12.42. The total average weight was 84.24±15.59 Kg and significantly higher in ACEIs/ARBs group (p=0.032). Most patients were males (48 of 66) and patients on ACEIs/ARBs medication were 38 of 66. Heart failure stage, systolic and diastolic blood pressures and heart rate were comparable on presentation between patients on ACEIs/ARBs and controls. Unadjusted analysis showed a significantly higher percentage of death (p=0.024), mechanical ventilation (p=0.05), and elevated troponin (p=0.03) in the control group. A trend towards higher percentage of elevated NT-ProBNP and high levels of peak IL-6 were observed in the control group (p = 0.088 and p=0.076 respectively). All patients had elevated CRP on admission. SARS-CoV2 treatments were comparable between the two groups.
Conclusion:
Higher mortality and worsened prognosis were observed in the control groups when compared to the ACEIs/ARBs group. Ongoing recruitment is currently underway to perform adjusted analyses.
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Affiliation(s)
| | - Souha Fares
- American Univ of Beirut Med Cntr, beirut, Lebanon
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21
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Hoteit A, Refaat MM. Brugada syndrome masked by complete left bundle branch block. J Cardiovasc Electrophysiol 2021; 32:2791-2792. [PMID: 34411361 DOI: 10.1111/jce.15214] [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: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Abbas Hoteit
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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22
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Hoteit A, Refaat MM. Electrogram-guided endomyocardial biopsy yield in patients with suspected cardiac sarcoidosis. J Cardiovasc Electrophysiol 2021; 32:2496-2497. [PMID: 34314558 DOI: 10.1111/jce.15185] [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: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Abbas Hoteit
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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23
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Gebran A, Refaat MM. Long-term evaluation of a novel extravascular implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2021; 32:2379-2380. [PMID: 34314084 DOI: 10.1111/jce.15184] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Anthony Gebran
- Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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24
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Al Tannir AH, Refaat MM. Impact of pre-ablation weight loss on the success of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:2105-2106. [PMID: 34216054 DOI: 10.1111/jce.15145] [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: 06/17/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Abdul Hafiz Al Tannir
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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25
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Torp-Pedersen C, Goette A, Nielsen PB, Potpara T, Fauchier L, John Camm A, Arbelo E, Boriani G, Skjoeth F, Rumsfeld J, Masoudi F, Guo Y, Joung B, Refaat MM, Kim YH, Albert CM, Piccini J, Avezum A, Lip GYH. 'Real-world' observational studies in arrhythmia research: data sources, methodology, and interpretation. A position document from European Heart Rhythm Association (EHRA), endorsed by Heart Rhythm Society (HRS), Asia-Pacific HRS (APHRS), and Latin America HRS (LAHRS). Europace 2021; 22:831-832. [PMID: 31725156 DOI: 10.1093/europace/euz210] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023] Open
Abstract
The field of observational studies or "real world studies" is in rapid development with many new techniques introduced and increased understanding of traditional methods. For this reason the current paper provides an overview of current methods with focus on new techniques. Some highlights can be emphasized: We provide an overview of sources of data for observational studies. There is an overview of sources of bias and confounding. Next There is an overview of causal inference techniques that are increasingly used. The most commonly used techniques for statistical modelling are reviewed with focus on the important distinction of risk versus prediction. The final section provides examples of common problems with reporting observational data.
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Affiliation(s)
| | | | | | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia.,Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine, Tours, France
| | - Alan John Camm
- St. George's, University of London, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Flemming Skjoeth
- Aalborg University, Health Science and Technology, Aalborg, Denmark
| | - John Rumsfeld
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Frederick Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yutao Guo
- Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Boyoung Joung
- Cardiology Department, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Marwan M Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Young-Hoon Kim
- Cardiology Department, Korea University Medical Center, Seoul, Republic of Korea
| | | | - Jonathan Piccini
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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26
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Gharios C, Refaat MM, Abdulhai F, Blumenthal R, Jaffa MA, Mora S. EXERCISE-INDUCED VENTRICULAR ECTOPY AND FUTURE CARDIOVASCULAR DEATH IN ASYMPTOMATIC INDIVIDUALS: A 20-YEAR FOLLOW-UP OF THE LIPID RESEARCH CLINICS PREVALENCE STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01617-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24785. [PMID: 33725833 PMCID: PMC7969328 DOI: 10.1097/md.0000000000024785] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient. METHODS Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias. RESULTS A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients. CONCLUSION Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
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Affiliation(s)
| | | | - Ghulam Murtaza
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Timir K. Paul
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Marwan M. Refaat
- Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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28
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Tannous C, Booz GW, Altara R, Muhieddine DH, Mericskay M, Refaat MM, Zouein FA. Nicotinamide adenine dinucleotide: Biosynthesis, consumption and therapeutic role in cardiac diseases. Acta Physiol (Oxf) 2021; 231:e13551. [PMID: 32853469 DOI: 10.1111/apha.13551] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/24/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
Nicotinamide adenine dinucleotide (NAD) is an abundant cofactor that plays crucial roles in several cellular processes. NAD can be synthesized de novo starting with tryptophan, or from salvage pathways starting with NAD precursors like nicotinic acid (NA), nicotinamide (NAM) or nicotinamide riboside (NR), referred to as niacin/B3 vitamins, arising from dietary supply or from cellular NAD catabolism. Given the interconversion between its oxidized (NAD+ ) and reduced form (NADH), NAD participates in a wide range of reactions: regulation of cellular redox status, energy metabolism and mitochondrial biogenesis. Plus, NAD acts as a signalling molecule, being a cosubstrate for several enzymes such as sirtuins, poly-ADP-ribose-polymerases (PARPs) and some ectoenzymes like CD38, regulating critical biological processes like gene expression, DNA repair, calcium signalling and circadian rhythms. Given the large number of mitochondria present in cardiac tissue, the heart has the highest NAD levels and is one of the most metabolically demanding organs. In several models of heart failure, myocardial NAD levels are depressed and this depression is caused by mitochondrial dysfunction, metabolic remodelling and inflammation. Emerging evidence suggests that regulating NAD homeostasis by NAD precursor supplementation has therapeutic efficiency in improving myocardial bioenergetics and function. This review provides an overview of the latest understanding of the different NAD biosynthesis pathways, as well as its role as a signalling molecule particularly in cardiac tissue. We highlight the significance of preserving NAD equilibrium in various models of heart diseases and shed light on the potential pharmacological interventions aiming to use NAD boosters as therapeutic agents.
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Affiliation(s)
- Cynthia Tannous
- Department of Pharmacology and Toxicology Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
| | - George W. Booz
- Department of Pharmacology and Toxicology University of Mississippi Medical Center Jackson MS USA
| | - Raffaele Altara
- Department of Pathology School of Medicine University of Mississippi Medical Center Jackson MS USA
- Institute for Experimental Medical Research Oslo University Hospital and University of Oslo Oslo Norway
- KG Jebsen Center for Cardiac Research University of Oslo Oslo Norway
| | - Dina H. Muhieddine
- Department of Pharmacology and Toxicology Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Mathias Mericskay
- INSERM Department of Signalling and Cardiovascular Pathophysiology UMR‐S 1180 Université Paris‐Saclay Châtenay‐Malabry France
| | - Marwan M. Refaat
- Department of Internal Medicine Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
- Department of Biochemistry and Molecular Genetics Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Fouad A. Zouein
- Department of Pharmacology and Toxicology Faculty of Medicine American University of Beirut Medical Center Beirut Lebanon
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29
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Nahlawi A, Refaat MM. Arrhythmia-induced cardiomyopathy: What are predictors of myocardial recovery? J Cardiovasc Electrophysiol 2021; 32:1093-1094. [PMID: 33625774 DOI: 10.1111/jce.14962] [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: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Acile Nahlawi
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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30
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Itani HA, Jaffa MA, Elias J, Sabra M, Zakka P, Ballout J, Bekdash A, Ibrahim R, Al Hariri M, Ghemrawi M, Abi-Saleh B, Khoury M, Alam S, Mahfouz R, Jaffa AA, Azar ST, Refaat MM. Genomic and Proteomic Study of the Inflammatory Pathway in Patients With Atrial Fibrillation and Cardiometabolic Syndrome. Front Cardiovasc Med 2020; 7:613271. [PMID: 33344519 PMCID: PMC7738559 DOI: 10.3389/fcvm.2020.613271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/10/2020] [Indexed: 01/26/2023] Open
Abstract
Atrial fibrillation (AF) and cardiometabolic syndrome (CMS) have been linked to inflammation and fibrosis. However, it is still unknown which inflammatory cytokines contribute to the pathogenesis of AF. Furthermore, cardiometabolic syndrome (CMS) risk factors such as obesity, hypertension, insulin resistance/glucose intolerance are also associated with inflammation and increased level of cytokines and adipokines. We hypothesized that the inflammatory immune response is exacerbated in patients with both AF and CMS compared to either AF or CMS alone. We investigated inflammatory cytokines and fibrotic markers as well as cytokine genetic profiles in patients with lone AF and CMS. CMS, lone AF patients, patients with both lone AF and CMS, and control patients were recruited. Genetic polymorphisms in inflammatory and fibrotic markers were assessed. Serum levels of connective tissue growth factor (CTGF) were tested along with other inflammatory markers including platelet-to-lymphocyte ratio (PLR), monocyte-to-HDL ratio (MHR) in three groups of AF+CMS, AF, and CMS patients. There was a trend in the CTGF levels for statistical significance between the AF and AF+CMS group (P = 0.084). Genotyping showed high percentages of patients in all groups with high secretor genotypes of Interleukin-6 (IL-6) (P = 0.037). Genotyping of IFN-γ and IL-10 at high level showed an increase in expression in the AF + CMS group compared to AF and CMS alone suggesting an imbalance between the inflammatory and anti-inflammatory cytokines which is exacerbated by AF. Serum cytokine inflammatory cytokine levels showed that IL-4, IL-5, IL-10, IL-17F, and IL-22 were significant between the AF, AF+CMS, and CMS patients. Combination of both CMS and AF may be associated with a higher degree of inflammation than what is seen in either CMS or AF alone. Thus, the identification of a biomarker capable of identifying metabolic syndrome associated with disease will help in identification of a therapeutic target in treating this devastating disease.
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Affiliation(s)
- Hana A Itani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Medicine, Clinical pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Miran A Jaffa
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joseph Elias
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Mohammad Sabra
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Patrick Zakka
- Department of Internal Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Jad Ballout
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Amira Bekdash
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rand Ibrahim
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Moustafa Al Hariri
- Department of Emergency Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Mirna Ghemrawi
- Department of Pathology and Laboratory Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Bernard Abi-Saleh
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Maurice Khoury
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Samir Alam
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Ayad A Jaffa
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Sami T Azar
- Department of Internal Medicine, Endocrinology Diabetes and Metabolism Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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31
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Lakkis B, Refaat MM. Optimal location of the QT interval evaluation in patients with drug‐induced QT prolongation and torsades de pointes: Limb leads, chest leads, or both? J Cardiovasc Electrophysiol 2020; 31:2702-2703. [DOI: 10.1111/jce.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Bachir Lakkis
- Division of Cardiology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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32
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Ibrahim R, Refaat MM. Risk factors for recurrent ventricular arrhythmias in patients with idiopathic ventricular fibrillation. J Cardiovasc Electrophysiol 2020; 31:2687-2688. [DOI: 10.1111/jce.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rand Ibrahim
- Department of Internal Medicine, Division of Cardiology American University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Department of Internal Medicine, Division of Cardiology American University of Beirut Medical Center Beirut Lebanon
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33
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El Baba M, Sabayon D, Refaat MM. Radiofrequency Catheter Ablation: How to Manage and Prevent Collateral Damage? J Innov Card Rhythm Manag 2020; 11:4234-4240. [PMID: 32983592 PMCID: PMC7510472 DOI: 10.19102/icrm.2020.110901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Radiofrequency catheter ablation has become the standard of care for the management of various arrhythmias and, in fact, the first-line therapy for many tachyarrhythmias. It entails creating scar tissue in the heart in regions where abnormal impulses form or propagate to restore normal cardiac conduction. As the heart is a complex organ and is surrounded by and related to many other anatomical structures, it is important to avoid the collateral damage that can happen from radiofrequency (RF) ablation on the endocardium as well as on the epicardium. This review explores methods for mitigating or limiting collateral damage during catheter ablation.
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Affiliation(s)
- Mohammad El Baba
- Electrophysiology Section, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Dean Sabayon
- Electrophysiology Section, Emory University Hospital, Atlanta, GA, USA
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology/Electrophysiology Section, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
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34
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Ramadan M, Refaat MM. Cardiac resynchronization therapy in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2403-2404. [DOI: 10.1111/jce.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Ramadan
- Department of Internal Medicine, Division of Cardiology, Faculty of Medicine and Medical Center American University of Beirut Beirut Lebanon
| | - Marwan M. Refaat
- Department of Internal Medicine, Division of Cardiology, Faculty of Medicine and Medical Center American University of Beirut Beirut Lebanon
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical Center American University of Beirut Beirut Lebanon
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35
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Sabeh MK, Refaat MM. Are all non‐sustained ventricular tachycardia the same in hypertrophic cardiomyopathy risk stratification for sudden cardiac death? J Cardiovasc Electrophysiol 2020; 31:2099-2100. [DOI: 10.1111/jce.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad Khaled Sabeh
- Department of Internal Medicine, Cardiac Arrhythmia ServiceMassachusetts General Hospital Boston Massachusetts
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
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36
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Khaled Sabeh M, Refaat MM. Transseptal puncture for atrial fibrillation ablation under electroanatomic guidance: Is it feasible? J Cardiovasc Electrophysiol 2020; 31:2614-2615. [PMID: 32700441 DOI: 10.1111/jce.14686] [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: 07/16/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mohamad Khaled Sabeh
- Department of Internal Medicine, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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37
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El Moheb MN, Refaat MM. Idiopathic right ventricular arrhythmias with changes in the QRS morphology after ablation. J Cardiovasc Electrophysiol 2020; 31:2665-2667. [PMID: 32639594 DOI: 10.1111/jce.14656] [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: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Mohamad N El Moheb
- Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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38
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Jalloul Y, Refaat MM. Catheter ablation of atrial tachycardias after mitral valve surgery. J Cardiovasc Electrophysiol 2020; 31:2642-2644. [PMID: 32652602 DOI: 10.1111/jce.14667] [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: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Youssef Jalloul
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
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39
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Azar RR, Refaat MM. Anti-inflammatory Therapy in Rheumatoid Arthritis to Improve Cardiovascular Outcome. Can J Cardiol 2020; 36:1700-1702. [PMID: 32619444 DOI: 10.1016/j.cjca.2020.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Rabih R Azar
- Division of Cardiology, Hotel Dieu de France Hospital the St Joseph University, Beirut, Lebanon.
| | - Marwan M Refaat
- Division of Cardiology, American University Hospital and American University of Beirut, Beirut, Lebanon
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40
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Abdulhai F, Refaat MM. Pulmonary vein isolation and QT prolongation in paroxysmal atrial fibrillation: What have we learned? J Cardiovasc Electrophysiol 2020; 31:2380-2381. [PMID: 32557959 DOI: 10.1111/jce.14622] [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: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Farah Abdulhai
- Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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41
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El Moheb MN, Refaat MM. A cardiac sodium channel mutation associated with epinephrine-induced marked QT-prolongation. J Cardiovasc Electrophysiol 2020; 31:2116-2117. [PMID: 32437005 DOI: 10.1111/jce.14572] [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: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad N El Moheb
- Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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42
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El Moheb MN, Refaat MM. Protecting the esophagus during catheter ablation: Evaluation of a novel vacuum suction-based retractor. J Cardiovasc Electrophysiol 2020; 31:1670-1671. [PMID: 32369252 DOI: 10.1111/jce.14530] [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: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad N El Moheb
- Division of Trauma Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Marwan M Refaat
- Division of Cardiology Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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43
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Jalloul Y, Refaat MM. Patients' experience after cryoballoon ablation under moderate sedation and general anesthesia. J Cardiovasc Electrophysiol 2020; 31:1585-1586. [PMID: 32406144 DOI: 10.1111/jce.14545] [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: 05/01/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Youssef Jalloul
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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44
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Charafeddine F, Refaat MM. Approach to induce infrequent premature ventricular complexes. Pacing Clin Electrophysiol 2020; 43:435-436. [DOI: 10.1111/pace.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Fatme Charafeddine
- Department of Pediatrics, Division of Pediatric CardiologyAmerican University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Department of Internal Medicine, Division of CardiologyAmerican University of Beirut Medical Center Beirut Lebanon
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45
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El Moheb M, Nicolas J, Khamis A, Akl EA, Refaat MM. Cochrane corner: implantable cardiac defibrillators for patients with non-ischaemic cardiomyopathy. Heart 2020; 106:636-638. [DOI: 10.1136/heartjnl-2019-315341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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46
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Jalloul Y, Refaat MM. Brugada syndrome and chest pain. Pacing Clin Electrophysiol 2020; 43:364. [DOI: 10.1111/pace.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Youssef Jalloul
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
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47
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Jalloul Y, Refaat MM. Flecainide increased capture threshold in permanent His‐bundle pacing. Pacing Clin Electrophysiol 2020; 43:357-359. [DOI: 10.1111/pace.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Youssef Jalloul
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
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48
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Jalloul Y, Refaat MM. Left ventricular apical thinning. J Cardiovasc Electrophysiol 2020; 31:921-923. [DOI: 10.1111/jce.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Youssef Jalloul
- Division of Cardiology, Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical CenterAmerican University of Beirut Beirut Lebanon
| | - Marwan M. Refaat
- Division of Cardiology, Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical CenterAmerican University of Beirut Beirut Lebanon
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49
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Jalloul Y, Refaat MM. Novel variants in TECRL cause catecholaminergic polymorphic ventricular tachycardia. J Cardiovasc Electrophysiol 2020; 31:1536-1538. [PMID: 32173953 DOI: 10.1111/jce.14443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Youssef Jalloul
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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50
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El Moheb M, Refaat MM. FIRM-guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection: Lessons learned. J Cardiovasc Electrophysiol 2020; 31:1038-1039. [PMID: 32115789 DOI: 10.1111/jce.14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohamad El Moheb
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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