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Jomaa N, Nasreddine W, Hmeimess G, Beaini S, Beydoun A, Hotait M, Wazne J, Beydoun A. Risk of recurrence in patients with an unprovoked tonic-clonic seizure and generalized epileptiform discharges on EEG. Epilepsia 2023; 64:2153-2161. [PMID: 37264785 DOI: 10.1111/epi.17671] [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: 04/08/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The decision to initiate treatment in patients with a first unprovoked seizure remains controversial. Studies have reported a recurrence rate ranging from 21%-50%, but most have included patients with different etiologies, electroencephalography (EEG) findings, and seizure types. This study aimed to determine the risk of recurrence in patients with a first unprovoked generalized tonic-clonic (GTC) seizure with evidence of generalized spike-wave discharges (GSWDs) on EEG and compare the efficacy of antiseizure medications (ASMs) in preventing recurrence. METHODS This prospective study included consecutive patients who presented with a single GTC seizure, evidence of GSWDs on EEG, and a follow-up period of at least 1 year. All patients underwent extensive evaluation, including a 3-hour sleep-deprived video-EEG recording and an epilepsy protocol brain magnetic resonance imaging (MRI). Treatment with ASMs was recommended for all patients. The decision regarding the specific ASM to be used was left to the treating physician's discretion. RESULTS A total of 57 patients with a median age of 19 years were included. A total of 41 patients agreed to be started on an ASM while 16 declined. Seizure recurred in 6 of 41 patients (14.6%) in the treated group compared to 11 of 16 (68.8%) in the untreated group (p = .00006). Valproate was significantly more efficacious than levetiracetam or lamotrigine (p = .04). Of the 15 patients who discontinued ASM treatment after remaining seizure-free for an average of 30 months, 6 (40%) experienced a seizure recurrence. SIGNIFICANCE Patients with a first unprovoked GTC seizure and evidence of GSWDs on EEG have a high risk of recurrence if left untreated. Valproate is the most efficacious ASM for preventing recurrence in this population. A sizeable proportion of patients can be successfully tapered off medication after a period of seizure freedom. This study provides valuable information for guiding treatment decisions in this patient population.
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Affiliation(s)
- Najo Jomaa
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ghassan Hmeimess
- St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | | | - Ayman Beydoun
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Mostafa Hotait
- Louisiana State University Health Sciences Center Shreveport, Louisiana, USA
| | - Jaafar Wazne
- Rafic Hariri University Hospital, Beirut, Lebanon
| | - Ahmad Beydoun
- American University of Beirut Medical Center, Beirut, Lebanon
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Aboseria M, Hotait M, Greenbaum N, Horng S, Berkowitz S. Abstract No. 530 A Machine Learning Approach to Reducing Radiation Exposure to the Hands of the Interventionalist. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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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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Hotait M, Ismail HH, Saab GE, Salameh JS. An open label pilot study of the safety and tolerability of perampanel in amyotrophic lateral sclerosis. Muscle Nerve 2021; 64:504-508. [PMID: 34322897 DOI: 10.1002/mus.27385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Perampanel, a selective noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) antagonist, is capable of slowing the progression of the amyotrophic lateral sclerosis (ALS) phenotype and increasing the number of anterior horn cells in transgenic mice. Trials of perampanel in epilepsy showed a favorable tolerability profile. In this study we aimed to determine the tolerability and safety of perampanel in patients with ALS. METHODS Enrolled subjects were started on 2 mg/day of perampanel and the dose was increased by 2 mg/day every week to a maximum dose of 8 mg/day. Our primary outcome measure was tolerability, which was evaluated by monitoring adverse events. The secondary outcome measure was clinical progression, assessed using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) and spirometry. RESULTS Six participants were enrolled. All had adverse events, mostly behavioral. Two completed the trial and the other four withdrew due to adverse events. All participants reported resolution of these events after discontinuation of the drug. The trial was halted due to the large number of adverse events. DISCUSSION The use of perampanel in this study of ALS was limited by its poor tolerability.
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Affiliation(s)
- Mostafa Hotait
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Helen H Ismail
- Department of Neurology, American University of Beirut medical Center, Beirut, Lebanon
| | - Georges E Saab
- Department of Neurology, American University of Beirut medical Center, Beirut, Lebanon
| | - Johnny S Salameh
- Department of Neurology, American University of Beirut medical Center, Beirut, Lebanon
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El Halabi T, Dirani M, Hotait M, Nasreddine W, Beydoun A. A novel possible familial cause of epilepsy of infancy with migrating focal seizures related to SZT2 gene variant. Epilepsia Open 2021; 6:73-78. [PMID: 33681650 PMCID: PMC7918305 DOI: 10.1002/epi4.12451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/10/2020] [Accepted: 11/22/2020] [Indexed: 12/31/2022] Open
Abstract
Seizure threshold-2 (SZT2) gene variants have been associated with a decrease in seizure threshold resulting in variable phenotypic expressions ranging from mild-moderate intellectual disabilities without seizures, to an early-onset epileptic encephalopathy with severe cognitive impairment. In addition, hypotonia and distinctive facial dysmorphism, including a high forehead and to a lesser extent ptosis and down-slanting palpebral fissures, were present in the majority. We herein report a novel SZT2 variant in one of two siblings both diagnosed with epilepsy of infancy with migrating focal seizures (EIMFS). This report is the fourth to document a possible familial case in EIMFS, a condition that was not previously associated with SZT2 variant. This report expands the phenotypic expression of SZT2, corroborates the importance of genetic counseling in some cases of EIMFS, and highlights the efficacy of potassium bromide in controlling the seizures associated with this condition.
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Affiliation(s)
- Tarek El Halabi
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Maya Dirani
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Mostafa Hotait
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Wassim Nasreddine
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
| | - Ahmad Beydoun
- Neurology DepartmentAmerican University of Beirut Medical CenterBeirutLebanon
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Hotait M, Dirani M, El Halabi T, Beydoun A. Case Report: Distinctive EEG Patterns in SCARB-2 Related Progressive Myoclonus Epilepsy. Front Genet 2020; 11:581253. [PMID: 33343627 PMCID: PMC7744754 DOI: 10.3389/fgene.2020.581253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Action myoclonus-renal failure syndrome (AMRF) is a rare, recessively inherited form of progressive myoclonus epilepsy (PME) caused by mutations in the SCARB2 gene and associated with end-stage renal failure. In addition to severe progressive myoclonus, the neurological manifestations of this syndrome are characterized by progressive ataxia and dysarthria with preserved intellectual capacity. Since its original description, an increasing number of "AMRF-like" cases without renal failure have been reported. We describe the case of a 29-year-old woman with progressive disabling myoclonus associated with dysarthria and ataxia who was found to have a novel homozygous frameshift mutation in the SCARB2 gene. In addition, this report emphasizes the presence of two EEG patterns, fixation-off phenomenon, and bursts of parasagittal spikes exclusively seen during REM sleep that appear to be characteristic of this condition.
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Affiliation(s)
- Mostafa Hotait
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Dirani
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tarek El Halabi
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Hotait M, Nasreddine W, El-Khoury R, Dirani M, Nawfal O, Beydoun A. FARS2 Mutations: More Than Two Phenotypes? A Case Report. Front Genet 2020; 11:787. [PMID: 32774346 PMCID: PMC7387725 DOI: 10.3389/fgene.2020.00787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 12/04/2022] Open
Abstract
FARS2, a nuclear gene, encodes the mitochondrial phenylalanyl-tRNA synthetase (mtPheRS). Previous reports have described two distinct phenotypes linked to FARS2 gene mutation: an early onset epileptic encephalopathy and spastic paraplegia. This report describes a distinctive phenotype of FARS2-linked, juvenile onset refractory epilepsy, caused by a hemizygous mutation in a compound heterozygous state (p.V197M and exon 2 microdeletion). A 17-year- old woman with normal development presented with a super refractory focal motor status epilepticus. Only an emergency life-saving surgery aborted her status after all therapeutic interventions, including anesthesia, failed to control her seizures. Pathological and biochemical activities on muscle biopsy showed mitochondrial proliferation with enhanced isolated activities of complexes II and IV, suggestive of a compensatory mechanism for the bioenergetic deficiency. Postoperatively, the patient started experiencing focal aware motor seizures originating from the contralateral hemisphere after being seizure free for a few months. This report suggests a third phenotypic manifestation of FARS2 gene mutation.
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Affiliation(s)
- Mostafa Hotait
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Riyad El-Khoury
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Dirani
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Omar Nawfal
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
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Refaat MM, Hassanieh S, Ballout JA, Zakka P, Hotait M, Khalil A, Bitar F, Arabi M, Arnaout S, Skouri H, Abchee A, Abi-Saleh B, Khoury M, Massouras A, Nemer G. Non-familial cardiomyopathies in Lebanon: exome sequencing results for five idiopathic cases. BMC Med Genomics 2019; 12:33. [PMID: 30764827 PMCID: PMC6375196 DOI: 10.1186/s12920-019-0478-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Cardiomyopathies affect more than 0.5% of the general population. They are associated with high risk of sudden cardiac death, which can result from either heart failure or electrical abnormalities. Although different mechanisms underlie the various types of cardiomyopathies, a principal pathology is common to all and is usually at the level of the cardiac muscle. With a relatively high incidence rate in most countries, and a subsequent major health burden on both the families and governments, cardiomyopathies are gaining more attention by researchers and pharmaceutical companies as well as health government bodies. In Lebanon, there is no official data about the spectrum of the diseases in terms of their respective prevalence, clinical, or genetic profiles. Methods We used exome sequencing to unravel the genetic basis of idiopathic cases of cardiomyopathies in Lebanon, a relatively small country with high rates of consanguineous marriages. Results Five cases were diagnosed with different forms of cardiomyopathies, and exome sequencing revealed the presence of already documented or novel mutations in known genes in three cases: LMNA for an Emery Dreifuss Muscular Dystrophy case, PKP2 for an arrhythmogenic right ventricle dysplasia case, and MYPN for a dilated cardiomyopathy case. Interestingly two brothers with hypertrophic cardiomyopathy have a novel missense variation in NPR1, the gene encoding the natriuretic peptides receptor type I, not reported previously to be causing cardiomyopathies. Conclusion Our results unravel novel mutations in known genes implicated in cardiomyopathies in Lebanon. Changes in clinical management however, require genetic profiling of a larger cohort of patients. Electronic supplementary material The online version of this article (10.1186/s12920-019-0478-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marwan M Refaat
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon. .,Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - Sylvana Hassanieh
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Jad A Ballout
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Patrick Zakka
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Mostafa Hotait
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Athar Khalil
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Samir Arnaout
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Hadi Skouri
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Antoine Abchee
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Bernard Abi-Saleh
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Maurice Khoury
- Department of Internal Medicine, Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | | | - Georges Nemer
- Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center (AUBMC), Phase I, 8th floor, Room C-823, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
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Refaat MM, Ballout JA, Zakka P, Hotait M, Al Feghali KA, Gheida IA, Saade C, Hourani M, Geara F, Tabbal M, Sfeir P, Jalbout W, Al-Jaroudi W, Jurjus A, Youssef B. Swine Atrioventricular Node Ablation Using Stereotactic Radiosurgery: Methods and In Vivo Feasibility Investigation for Catheter-Free Ablation of Cardiac Arrhythmias. J Am Heart Assoc 2017; 6:JAHA.117.007193. [PMID: 29079566 PMCID: PMC5721791 DOI: 10.1161/jaha.117.007193] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Linear accelerator–based stereotactic radiosurgery delivered to cardiac arrhythmogenic foci could be a promising catheter‐free ablation modality. We tested the feasibility of in vivo atrioventricular (AV) node ablation in swine using stereotactic radiosurgery. Methods and Results Five Large White breed swine (weight 40–75 kg; 4 females) were studied. Single‐chamber St Jude pacemakers were implanted in each pig. The pigs were placed under general anesthesia, and coronary/cardiac computed tomography simulation scans were performed to localize the AV node. Cone beam computed tomography was used for target positioning. Stereotactic radiosurgery doses ranging from 35 to 40 Gy were delivered by a linear accelerator to the AV node, and the pigs were followed up with weekly pacemaker interrogations to observe for potential electrocardiographic changes. Once changes were observed, the pigs were euthanized, and pathology specimens of various tissues, including the AV node and tissues surrounding the AV node, were taken to study the effects of radiation. All 5 pigs had disturbances of AV conduction with progressive transition into complete heart block. Macroscopic inspection did not reveal damage to the myocardium, and pigs had preserved systolic function on echocardiography. Immunostaining revealed fibrosis in the target region of the AV node, whereas no fibrosis was detected in the nontargeted regions. Conclusions Catheter‐free radioablation using linear accelerator–based stereotactic radiosurgery is feasible in an intact swine model.
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Affiliation(s)
- Marwan M Refaat
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Lebanon .,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Jad A Ballout
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Patrick Zakka
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Mostafa Hotait
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | - Karine A Al Feghali
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Ibrahim Abu Gheida
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Charbel Saade
- Department of Radiology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Mukbil Hourani
- Department of Radiology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Malek Tabbal
- Department of Physics, Faculty of Arts and Sciences, American University of Beirut, Lebanon
| | - Pierre Sfeir
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Lebanon
| | - Wassim Jalbout
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut, Lebanon
| | - Wael Al-Jaroudi
- Division of Cardiology, Clemenceau Medical Center, Beirut, Lebanon
| | - Abdo Jurjus
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Lebanon
| | - Bassem Youssef
- Department of Radiation Oncology, Faculty of Medicine, American University of Beirut, Lebanon
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Zakka P, Hotait M, Arnaout S, Isma'eel H, Taher A, Refaat M. PP-052 [AJC » Peripheral arterial diseases] Digital Thermography and Vascular Involvement in Thalassemia Intermedia. Am J Cardiol 2017. [DOI: 10.1016/j.amjcard.2017.03.183] [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: 11/25/2022]
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Zakka P, Mansour S, Chami H, Hotait M, Noureddin S, Wood K, Abi Saleh B, Khoury M, Refaat M. PP-136 [AJC » Arrhythmias and antiarrhythmic therapy] Arrhythmia and Impact on Patient's Life. Am J Cardiol 2017. [DOI: 10.1016/j.amjcard.2017.03.177] [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: 10/19/2022]
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Abstract
Hypertrophic cardiomyopathy (HCM) is a familial cardiac disease manifested in a wide phenotype and diverse genotype and, thus, presenting unpredictable risks mainly on young adults. Extensive studies are being conducted to categorize patients and link phenotype with genotype for a better management and control of the disease with all its complications. Because the full mechanisms behind HCM are still not revealed, therapeutics are not definitive. Further research is to be conducted for the generation of a complete picture and directed therapy for HCM.
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Affiliation(s)
- Marwan M Refaat
- Cardiac Electrophysiology, Cardiology, Department of Internal Medicine, American University of Beirut Faculty of Medicine and Medical Center, PO Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon; 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; Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
| | - Akl C Fahed
- Department of Genetics, Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sylvana Hassanieh
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Mostafa Hotait
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Hadi Skouri
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA, USA; Division of Cardiology, Howard Hughes Medical Institute, Brigham and Women's Hospital, Boston, MA, USA
| | - Fadi F Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Georges Nemer
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
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Abstract
Brugada syndrome might stay undetected in patients until surviving cardiac arrest. Despite the prominent advances in exploring the disease in the past 2 decades, many questions remain unanswered and the controversies continue. Despite all mutations identified to be associated with the disease, two-thirds of cases have a negative genetic test. Future studies should be more directed on modulating factors and their impact on patients' risk for sudden death to help physicians in risk stratifying their patients and optimally implementing an implantable cardioverter defibrillator to prevent sudden cardiac death.
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Affiliation(s)
- Marwan M Refaat
- Cardiac Electrophysiology, Cardiology, Department of Internal Medicine, American University of Beirut Faculty of Medicine and Medical Center, 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USA; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USA; Department of Biochemistry and Molecular Genetics, American University of Beirut Medical Center, Beirut, Lebanon; Cardiology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Mostafa Hotait
- Cardiology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Melvin Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco Medical Center, San Francisco, CA, USA
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Refaat MM, El Hage L, Steffensen AB, Hotait M, Schmitt N, Scheinman M, Badhwar N. Iron Overload Leading to Torsades de Pointes in β-Thalassemia and Long QT Syndrome. Card Electrophysiol Clin 2016; 8:247-256. [PMID: 26920202 DOI: 10.1016/j.ccep.2015.10.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors present a unique case of torsades de pointes in a β-thalassemia patient with early iron overload in the absence of any structural abnormalities as seen in hemochromatosis. Genetic testing showed a novel KCNQ1 gene mutation 1591C>T [Gln531Ter(X)]. Testing of the gene mutation in Xenopus laevis oocytes showed loss of function of the IKs current. The authors hypothesize that iron overload combined with the KCNQ1 gene mutation leads to prolongation of QTc and torsades de pointes.
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Affiliation(s)
- Marwan M Refaat
- Cardiology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biochemistry and Molecular Genetics, American University of Beirut Medical Center, Beirut, Lebanon; Cardiac Electrophysiology, Cardiology, Department of Internal Medicine, American University of Beirut Faculty of Medicine and Medical Center, 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USA; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine and Medical Center, 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USA
| | - Lea El Hage
- Division of Cardiology, Department of Medicine, University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE-431, San Francisco, CA 94143-1354, USA
| | - Annette Buur Steffensen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Danish National Research Foundation Centre for Cardiac Arrhythmia, University of Copenhagen, Copenhagen, Denmark
| | - Mostafa Hotait
- Cardiology Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nicole Schmitt
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Danish National Research Foundation Centre for Cardiac Arrhythmia, University of Copenhagen, Copenhagen, Denmark
| | - Melvin Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE-431, San Francisco, CA 94143-1354, USA
| | - Nitish Badhwar
- Division of Cardiology, Department of Medicine, University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE-431, San Francisco, CA 94143-1354, USA.
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15
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Abstract
BACKGROUND Sudden cardiac death (SCD) remains a major public health problem. Current established criteria identifying those at risk of sudden arrhythmic death, and likely to benefit from implantable cardioverter defibrillators (ICDs), are neither sensitive nor specific. Exercise electrocardiogram (ECG) testing was traditionally used for information concerning patients' symptoms, exercise capacity, cardiovascular function, myocardial ischemia detection, and hemodynamic responses during activity in patients with hypertrophic cardiomyopathy. METHODS We conducted a systematic review of MEDLINE on the utility of exercise ECG testing in SCD risk stratification. RESULTS Exercise testing can unmask suspected primary electrical diseases in certain patients (catecholaminergic polymorphic ventricular tachycardia or concealed long QT syndrome) and can be effectively utilized to risk stratify patients at an increased (such as early repolarization syndrome and Brugada syndrome) or decreased risk of SCD, such as the loss of preexcitation on exercise testing in asymptomatic Wolff-Parkinson-White syndrome. CONCLUSIONS Exercise ECG testing helps in SCD risk stratification in patients with and without arrhythmogenic hereditary syndromes.
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Affiliation(s)
- Marwan M Refaat
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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Refaat M, Hotait M, Winston B. Homozygous factor V Leiden mutation in type IV Ehlers-Danlos patient. World J Clin Cases 2014; 2:75-77. [PMID: 24653990 PMCID: PMC3955805 DOI: 10.12998/wjcc.v2.i3.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/02/2014] [Accepted: 02/20/2014] [Indexed: 02/05/2023] Open
Abstract
Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders caused by collagen synthesis defects. Several hemostatic abnormalities have been described in EDS patients that increase the bleeding tendencies of these patients. This case report illustrates a patient with an unusual presentation of a patient with type IV EDS, platelet δ-storage pool disease and factor V Leiden mutation. Young woman having previous bilateral deep vein thrombosis and pulmonary emboli coexisting with ruptured splenic aneurysm and multiple other aneurysms now presented with myocardial infarction. Presence of factor V Leiden mutation raises the possibility that the infarct was due to acute coronary thrombosis, although coronary artery aneurysm and dissection with myocardial infarction is known to occur in vascular type EDS. This is the first report in the medical literature of factor V Leiden mutation in an EDS patient which made the management of our patient challenging with propensity to both bleeding and clotting.
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Hotait M, Sawaya R. Spontaneous Bilateral Vertebral Artery Dissection Secondary to PAI-1, MTHFR C677T and ACE Gene Mutations in a Young Man. Cerebrovasc Dis 2013; 35:182-3. [DOI: 10.1159/000346103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Duca S, Bala O, Hotait M, Barbonta C, Ban A. Primary actinomycosis of the urinary bladder. Case report and review of the literature. Acta Chir Belg 1996; 96:295-7. [PMID: 9008774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The case of a female patient, aged 37, with signs of partial intestinal obstruction, repeated cystitis and a tumoral mass in the hypogastrium is reported. Preoperative examinations could not establish the nature of the tumour. Colonoscopy as well as barium enema stopped at a sharp angulation of the sigmoid. Laparotomy evidenced an inflammatory tumour, with departure point in the urinary bladder, which involved the sigmoid and the uterus. After adhesiotomy a partial cystectomy was performed. The macroscopic aspect of the bladder was pseudopolypoid, while the microscopic one was typical for actinomycosis. The patient was discharged cured and was prescribed a penicillin course for 4 weeks.
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Affiliation(s)
- S Duca
- Surgical Clinic No. 3, University of Medicine and Pharmacy, Cluj, Romania
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