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Preisendörfer S, Singla V, Bhonsale A, Kancharla K, Thoma F, Mulukutla S, Voigt A, Shalaby A, Estes NAM, Jain S, Saba S. Heart Rate at Rest and Incident Atrial Fibrillation in Patients With Diastolic Dysfunction. Am J Cardiol 2024; 218:72-76. [PMID: 38461926 DOI: 10.1016/j.amjcard.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Diastolic dysfunction (DD) is associated with incident atrial fibrillation (AF). The influence of heart rate at rest (RHR) on incident AF in patients with DD has not been investigated. The goal of this study is to assess the influence of RHR on incident AF in patients with DD. Patients from a large health system with no previous history of AF, a left ventricular ejection fraction ≥50%, and documented DD on echocardiography were divided into quartiles (<66, 66 to 76, 77 to 91, >91 beats per minute) based on RHR. Incident AF was estimated using AF hospitalization during follow-up. Hazard ratios (HR) for AF hospitalization and all-cause death were calculated with a Cox proportional hazards model. A total of 19,046 patients were analyzed. Over a median follow-up of 42.2 months, 742 (3.9%) patients were hospitalized for AF. Both slower and faster RHR were associated with increased risk of AF hospitalization (HR 1.40, confidence interval [CI] 1.14 to 1.71, p = 0.001, HR 1.23, CI 0.99 to 1.53, p = 0.06 and HR 1.72, CI 1.38 to 2.14, p <0.001, for quartiles 1, 2, and 4, respectively), suggesting a J-shaped relation. Progressive increase in all-cause death was noted with faster RHR (HR1.19 per quartile increase, CI 1.16 to 1.22, p <0.001). These results persisted after adjustment for age, cardiovascular co-morbidities, grade of DD, and β-blocker use. In conclusion, this large, real-world analysis indicates increased risk of incident AF with slower and faster RHR in patients with DD. Randomized trials are needed to evaluate the potential of RHR modification to mitigate the risk of incident AF.
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Affiliation(s)
- Stefan Preisendörfer
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Virginia Singla
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Voigt
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alaa Shalaby
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N A Mark Estes
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep Jain
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Mark Estes NA. Concise guidelines on catheter ablation of atrial fibrillation from the European Cardiac Arrhythmias Society. J Cardiovasc Electrophysiol 2024. [PMID: 38634164 DOI: 10.1111/jce.16278] [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: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Affiliation(s)
- N A Mark Estes
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Dhande M, Barakat A, Canterbury A, Thoma F, Mulukutla S, Sezer A, Aronis KN, Bhonsale A, Kancharla K, Voigt AH, Wang NC, Shalaby A, Mark Estes NA, Saba S, Jain SK. Cardiovascular Hospitalizations and Resource Use Following Atrial Fibrillation Ablation. J Am Heart Assoc 2023; 12:e028609. [PMID: 37681551 PMCID: PMC10547277 DOI: 10.1161/jaha.122.028609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/06/2023] [Indexed: 09/09/2023]
Abstract
Background Over the next few years, atrial fibrillation (AF)-related morbidity and costs will increase significantly. Thus, it is prudent to examine the impact of AF treatment on health care resource use. This study examined the impact of AF ablation on hospitalization, length of stay, and resource use for patients undergoing AF ablation in a multihospital system. Methods and Results In an observational analysis, outcomes of total, cardiovascular, and AF hospitalizations, emergency department visits, and length of stay were compared for 3417 patients between 12 months before and 24 months following AF ablation. Use of electrical cardioversions and antiarrhythmic use were also compared 1 year before to 2 years after AF ablation. There were fewer total (0.7±1.3 versus 0.3±0.7; P<0.001), cardiovascular (0.7±1.2 versus 0.2±0.6; P<0.001), and AF (0.6±1.1 versus 0.1±0.3; P<0.001) hospitalizations and emergency department visits (0.8±2.1 versus 0.4±0.9; P<0.001) per patient-year for the 2 years following AF ablation compared with 1 year before. Average length of stay per patient-year (1.4±7.9 versus 3.6±5.3 days; P<0.0001), the percentage of patients on antiarrhythmic therapy (21.2% versus 58.5%; P<0.0001), and those undergoing electrical cardioversions (16.1% versus 28.1%; P<0.0001) were lower 2 years following AF ablation versus 1 year before. Conclusions We noted a decrease in total, cardiovascular, and AF hospitalizations and health care resource use during the 2-year period after index AF ablation, compared with the 1 year before. AF ablation may portend a decline in patient morbidity and health care costs.
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Affiliation(s)
- Mehak Dhande
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Amr Barakat
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Ann Canterbury
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Floyd Thoma
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Suresh Mulukutla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Ahmet Sezer
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Konstantinos N. Aronis
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Aditya Bhonsale
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Krishna Kancharla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Andrew H. Voigt
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Norman C. Wang
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Alaa Shalaby
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - N. A. Mark Estes
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Samir Saba
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Sandeep K. Jain
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
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Maron BJ, Estes NAM. Commotio Cordis Returns…When We Least Expected It: Cardiac Arrest in A Professional Football Player. Am J Cardiol 2023; 202:229-232. [PMID: 37495440 DOI: 10.1016/j.amjcard.2023.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
For the first time in 52 years, an American professional football player (Damar Hamlin) collapsed in cardiac arrest during a game, viewed in real-time on national television. The cause of this profound event was commotio cordis, that is, blunt non-penetrating chest blow-initiated ventricular fibrillation triggered by physical contact not considered unusual for football. The athlete survived because of timely cardiopulmonary resuscitation and defibrillation provided by first responders organized by the National Football League. Commotio cordis, albeit rare, was most prominently identified initially in competitive and also recreational sports participants. More recently it became apparent that similar events could occur in almost any circumstance involving a chest blow, such as during everyday activities around the home and with innocent play. The determinant of a commotio cordis event is a blow over the heart in a narrow vulnerable electrical window during dispersion of repolarization. Survival from these events has increased substantially to >60% due to enhanced recognition and prompt resuscitation/defibrillation. In conclusion, in this commentary, we take a timely opportunity to describe in detail the relevant demographics, mechanism/pathophysiology, and clinical course of commotio cordis.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, Pennsylvania
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Saba S, Mulukutla S, Thoma F, Aronis KN, Bhonsale A, Kancharla K, Voigt A, Shalaby AA, Estes NAM, Jain S. Impact of Diastolic Dysfunction on the Risk of Sudden Cardiac Arrest. Circ Arrhythm Electrophysiol 2023; 16:475-477. [PMID: 37485680 DOI: 10.1161/circep.123.012089] [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] [Indexed: 07/25/2023]
Affiliation(s)
- Samir Saba
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Suresh Mulukutla
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Floyd Thoma
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Konstantinos N Aronis
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Aditya Bhonsale
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Krishna Kancharla
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Andrew Voigt
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Alaa A Shalaby
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - N A Mark Estes
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Sandeep Jain
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
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Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2023; 82:353-373. [PMID: 37468191 DOI: 10.1016/j.jacc.2023.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom.
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Affiliation(s)
- Barry J Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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Lampert R, Ackerman MJ, Marino BS, Burg M, Ainsworth B, Salberg L, Tome Esteban MT, Ho CY, Abraham R, Balaji S, Barth C, Berul CI, Bos M, Cannom D, Choudhury L, Concannon M, Cooper R, Czosek RJ, Dubin AM, Dziura J, Eidem B, Emery MS, Estes NAM, Etheridge SP, Geske JB, Gray B, Hall K, Harmon KG, James CA, Lal AK, Law IH, Li F, Link MS, McKenna WJ, Molossi S, Olshansky B, Ommen SR, Saarel EV, Saberi S, Simone L, Tomaselli G, Ware JS, Zipes DP, Day SM. Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy. JAMA Cardiol 2023; 8:595-605. [PMID: 37195701 PMCID: PMC10193262 DOI: 10.1001/jamacardio.2023.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 05/18/2023]
Abstract
Importance Whether vigorous intensity exercise is associated with an increase in risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM) is unknown. Objective To determine whether engagement in vigorous exercise is associated with increased risk for ventricular arrhythmias and/or mortality in individuals with HCM. The a priori hypothesis was that participants engaging in vigorous activity were not more likely to have an arrhythmic event or die than those who reported nonvigorous activity. Design, Setting, and Participants This was an investigator-initiated, prospective cohort study. Participants were enrolled from May 18, 2015, to April 25, 2019, with completion in February 28, 2022. Participants were categorized according to self-reported levels of physical activity: sedentary, moderate, or vigorous-intensity exercise. This was a multicenter, observational registry with recruitment at 42 high-volume HCM centers in the US and internationally; patients could also self-enroll through the central site. Individuals aged 8 to 60 years diagnosed with HCM or genotype positive without left ventricular hypertrophy (phenotype negative) without conditions precluding exercise were enrolled. Exposures Amount and intensity of physical activity. Main Outcomes and Measures The primary prespecified composite end point included death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator. All outcome events were adjudicated by an events committee blinded to the patient's exercise category. Results Among the 1660 total participants (mean [SD] age, 39 [15] years; 996 male [60%]), 252 (15%) were classified as sedentary, and 709 (43%) participated in moderate exercise. Among the 699 individuals (42%) who participated in vigorous-intensity exercise, 259 (37%) participated competitively. A total of 77 individuals (4.6%) reached the composite end point. These individuals included 44 (4.6%) of those classified as nonvigorous and 33 (4.7%) of those classified as vigorous, with corresponding rates of 15.3 and 15.9 per 1000 person-years, respectively. In multivariate Cox regression analysis of the primary composite end point, individuals engaging in vigorous exercise did not experience a higher rate of events compared with the nonvigorous group with an adjusted hazard ratio of 1.01. The upper 95% 1-sided confidence level was 1.48, which was below the prespecified boundary of 1.5 for noninferiority. Conclusions and Relevance Results of this cohort study suggest that among individuals with HCM or those who are genotype positive/phenotype negative and are treated in experienced centers, those exercising vigorously did not experience a higher rate of death or life-threatening arrhythmias than those exercising moderately or those who were sedentary. These data may inform discussion between the patient and their expert clinician around exercise participation.
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Affiliation(s)
- Rachel Lampert
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Michael J. Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Lurie Children’s Hospital, Chicago, Illinois
| | - Matthew Burg
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Lisa Salberg
- Hypertrophic Cardiomyopathy Association, Denville, New Jersey
| | | | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Roselle Abraham
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland
| | - Cheryl Barth
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Charles I. Berul
- Division of Cardiology, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Martijn Bos
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - David Cannom
- Division of Cardiology, PIH Health Good Samaritan Hospital, Los Angeles, California
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Robert Cooper
- Department of Cardiology, Liverpool Heart and Chest Hospital/Liverpool John Moores University, Liverpool, United Kingdom
| | - Richard J. Czosek
- Department of Pediatrics, Heart Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Anne M. Dubin
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin Eidem
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Michael S. Emery
- Department of Cardiovascular Medicine, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - N. A. Mark Estes
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan P. Etheridge
- Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah
| | - Jeffrey B. Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Belinda Gray
- Faculty of Medicine and Health, Royal Prince Alfred Hospital/Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Hall
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Cynthia A. James
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ashwin K. Lal
- Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah
| | - Ian H. Law
- Department of Pediatrics, University of Iowa, Iowa City
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Mark S. Link
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Department of Internal Medicine, University of Texas, Southwestern, Dallas
| | - William J. McKenna
- Institute of Cardiovascular Medicine, University College London, London, United Kingdom
| | - Silvana Molossi
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston
| | - Brian Olshansky
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Steven R. Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth V. Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio
- Department of Pediatric Cardiology, St Luke’s Health System, Boise, Idaho
| | - Sara Saberi
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Laura Simone
- Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Gordon Tomaselli
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - James S. Ware
- National Heart and Lung Institute & MRC London Institute of Medical Sciences, Imperial College London/ Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust
| | - Douglas P. Zipes
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sharlene M. Day
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Reddy VY, Exner DV, Doshi R, Tomassoni G, Bunch TJ, Friedman P, Estes NAM, Neužil P, de la Concha JF, Cantillon DJ. 1-Year Outcomes of a Leadless Ventricular Pacemaker: The LEADLESS II (Phase 2) Trial. JACC Clin Electrophysiol 2023:S2405-500X(23)00089-0. [PMID: 36951813 DOI: 10.1016/j.jacep.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
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Dhande M, Aronis KN, Thoma F, Mulukutla S, Bhonsale A, Kancharla K, Shalaby A, Voigt A, Mark Estes NA, Jain SK, Saba S. Ventricular conduction abnormality in patients with mild to moderate cardiomyopathy. Clin Cardiol 2023; 46:543-548. [PMID: 36883012 DOI: 10.1002/clc.24001] [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: 09/21/2022] [Revised: 01/21/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In mild-to-moderate cardiomyopathy, cardiac resynchronization therapy (CRT) is indicated in patients with high burden of right ventricular pacing but not in those with intrinsic ventricular conduction abnormalities. HYPOTHESIS We hypothesized that CRT positively impacts outcomes of patients with intrinsic ventricular conduction delay and left ventricular ejection fraction (LVEF) of 36%-50%. METHODS Of 18 003 patients with LVEF ≤ 50%, 5966 (33%) patients had mild-to-moderate cardiomyopathy, of whom 1741 (29%) have a QRS duration ≥120 ms. Patients were followed to the endpoints of death and heart failure (HF) hospitalization. Outcomes were compared between patients with narrow versus wide QRS. RESULTS Of the 1741 patients with mild-to-moderate cardiomyopathy and wide QRS duration, only 68 (4%) were implanted with a CRT device. Over a median follow-up of 3.35 years, 849 (51%) died and 1004 (58%) had a HF hospitalization. The adjusted risk of death (hazard ratio (HR) = 1.11, p = 0.046) and of death or HF hospitalization (HR = 1.10, p = 0.037) were significantly higher in patients with wide versus narrow QRS duration. In patients with wide QRS complex, CRT was associated with reduction in the adjusted risk of death (HR = 0.47, p = 0.020) and of death or HF hospitalization (HR = 0.58, p = 0.008). CONCLUSIONS Patients with mild-to-moderate cardiomyopathy and wide QRS duration are rarely implanted with CRT devices and have worse outcomes compared to those with narrow QRS. Randomized trials are needed to examine if CRT has salutary effects in this population.
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Affiliation(s)
- Mehak Dhande
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Konstantinos N Aronis
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suresh Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alaa Shalaby
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Mark Estes NA, Jain S, Saba S. Coronary Vasospasm With Pulse Field Ablation: Primum Non Nocere. Circulation 2022; 146:1820-1822. [PMID: 36508497 DOI: 10.1161/circulationaha.122.062319] [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] [Indexed: 12/15/2022]
Affiliation(s)
- N A Mark Estes
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, The University of Pittsburgh School of Medicine, PA
| | - Sandeep Jain
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, The University of Pittsburgh School of Medicine, PA
| | - Samir Saba
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, The University of Pittsburgh School of Medicine, PA
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Estes NAM. EP News: Clinical. Heart Rhythm 2022; 19:1924. [PMID: 37850599 DOI: 10.1016/j.hrthm.2022.09.001] [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: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- N A Mark Estes
- UPMC Heart and Vascular Institute, Pittsburgh, Pennsylvania.
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Zacharia EM, Istvanic F, Mulukutla S, Thoma F, Aronis KN, Bhonsale A, Kancharla K, Voigt A, Shalaby A, Estes NAM, Jain SK, Saba S. Predictors of Hospital Admissions for Ventricular Arrhythmia or Cardiac Arrest in Patients With Cardiomyopathy. Am J Cardiol 2022; 171:127-131. [PMID: 35292146 DOI: 10.1016/j.amjcard.2022.01.056] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/19/2022]
Abstract
Although ventricular dysfunction is associated with the occurrence of ventricular arrhythmia (VA), most patients with cardiomyopathy do not experience VA. We therefore investigated other predictors of VA in a large contemporary cohort of patients with cardiomyopathy. All patients at a large academic medical system with left ventricular ejection fraction (LVEF) ≤50% were enrolled at the time of first documented low LVEF. Predictors of hospital admission for VA were examined using multivariable Cox models. The incidence of implantable defibrillator (ICD) placement was also examined. A total of 18,003 patients were enrolled. Over a median follow-up of 3.35 years, 389 patients (2.2%) were admitted for VA (304 of 12,037 [2.5%] among patients with LVEF ≤35% vs 85 of 5,966 [1.4%] among those with LVEF 36% to 50%). Predictors of VA hospitalization included lower LVEF (hazard ratio (HR) = 1.43 per 10% decrease, p <0.001), the presence of an ICD at baseline (HR = 1.63, p = 0.010), higher blood glucose (HR = 1.02 per 10 mg/100 ml increase, p = 0.050), the presence of end-stage renal disease (HR = 3.59, p <0.001), and the presence of liver cirrhosis (HR = 1.93, p = 0.013). During follow-up, 626 patients were implanted with a new ICD. In addition to being admitted with VA, a lower LVEF and a history of coronary artery disease or heart failure were the main predictors of ICD therapy in this population. In conclusion, in addition to more severe cardiomyopathy and the presence of an implanted ICD, metabolic derangements on initial contact are independent predictors of hospital admissions for VA in patients with cardiomyopathy. Noncardiac co-morbidities play an important role in stratifying patients with cardiomyopathy for their risk of VA or cardiac arrest.
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Affiliation(s)
- Effimia M Zacharia
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Filip Istvanic
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos N Aronis
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Voigt
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alaa Shalaby
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N A Mark Estes
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Cardiology Division of the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Thalappillil A, Johnson A, Althouse A, Thoma F, Lee J, Estes NAM, Jain S, Lee J, Saba S. Impact of an Automated Best Practice Alert on Sex and Race Disparities in Implantable Cardioverter-Defibrillator Therapy. J Am Heart Assoc 2022; 11:e023669. [PMID: 35301858 PMCID: PMC9075484 DOI: 10.1161/jaha.121.023669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Implantable cardioverter‐defibrillators (ICDs) are indicated in patients with severe left ventricular dysfunction, but many eligible patients do not receive them, especially women and Black patients. Our group had previously demonstrated that a best practice alert (BPA) improves overall rates of electrophysiology referrals and ICD implantations. This study examined the impact of a BPA by sex and race. Methods and Results This is a cluster randomized trial of cardiology (n=106) and primary care (n=89) providers who were randomized to receive (BPA, n=93) or not receive (No BPA, n=102) the alert and managed 1856 patients meeting primary prevention criteria for ICD implantation (965 BPA and 891 No BPA). After a median follow up of 34 months, 630 (34%) patients were referred to electrophysiology, and 522 (28%) patients received an ICD. Compared with the No BPA arm, patients in the BPA arm saw a modest differential increase in the rate of electrophysiology referrals at 18 months in men (+4%) compared with women (+7%) but a profound increase in Black patients (+16%) compared with White patients (+2%), thus closing the sex and race gaps. Similar trends were noted for rates of ICD implantation. Conclusions Use of a BPA improves rates of electrophysiology referrals and ICD implantations in all comers with severe cardiomyopathy and no prior ventricular arrhythmias but has a more pronounced impact in women and Black patients. The use of a BPA at the point of care is an effective tool in the fight against sex and race inequities in health care.
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Affiliation(s)
- Alvin Thalappillil
- Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Amber Johnson
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Andrew Althouse
- Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Floyd Thoma
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Jae Lee
- Department of Cardiology Inova Heart and Vascular Institute Falls Church VA
| | - N A Mark Estes
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Sandeep Jain
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Joon Lee
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Samir Saba
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
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Estes NAM, Saba S. Atrial resynchronization therapy: An emerging potential to advance physiologic pacing? Heart Rhythm 2021; 19:495-496. [PMID: 34839045 DOI: 10.1016/j.hrthm.2021.11.029] [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: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- N A Mark Estes
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Samir Saba
- The Heart and Vascular Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Reddy VY, Exner DV, Doshi R, Tomassoni G, Bunch TJ, Estes NAM, Neužil P, Paulin FL, Garcia Guerrero JJ, Cantillon DJ. Primary Results on Safety and Efficacy From the LEADLESS II-Phase 2 Worldwide Clinical Trial. JACC Clin Electrophysiol 2021; 8:115-117. [PMID: 34863657 DOI: 10.1016/j.jacep.2021.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/19/2022]
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Rangavajla G, Mulukutla S, Thoma F, Kancharla K, Bhonsale A, Estes NAM, Jain SK, Saba S. Ventricular pacing and myocardial function in patient with congenital heart block. J Cardiovasc Electrophysiol 2021; 32:2684-2689. [PMID: 34409682 DOI: 10.1111/jce.15207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Pacing-induced cardiomyopathy (PICM) is a potential complication of chronic right ventricular (RV) pacing, but its characterization in adult patients is often complicated by pre-existing cardiomyopathy. This study investigated the incidence of PICM in patients with congenital heart block (cHB) who have conduction disease from birth without confounding pre-existing cardiac conditions. METHODS AND RESULTS This retrospective cohort analysis included 42 patients with cHB and baseline left ventricular ejection fraction (LVEF) ≥50%. Kaplan-Meier analysis was used to assess freedom from cardiomyopathy (defined as LVEF <50%) between paced and nonpaced patients. Patients were 26 ± 3 years old at first presentation, 64% were women and baseline LVEF was 60.0 ± 0.2%. Median follow-up from birth was 35 (interquartile range [IQR]: 20-42) years with a median of 6.7 years (IQR: 3.6-9.2) at our institution. Thirty-two patients received pacing at mean age 21 ± 3 years. Patients receiving a pacemaker (PM) were significantly more likely to develop a cardiomyopathy (p = .021) and no patient developed a cardiomyopathy in the absence of a PM. Four patients who developed a new cardiomyopathy were upgraded to biventricular pacing, leading to stabilization or improvement of LVEF. CONCLUSION In a relatively young and healthy cHB cohort, RV pacing is associated with a higher risk of developing a cardiomyopathy. These data confirm the deleterious effects of RV pacing on myocardial function in patients without pre-existing structural cardiac disease and has clinical implications to the management of patients with cHB.
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Affiliation(s)
- Gautam Rangavajla
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Suresh Mulukutla
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Floyd Thoma
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Krishna Kancharla
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aditya Bhonsale
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - N A Mark Estes
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sandeep K Jain
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samir Saba
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Cao DX, Maiton K, Nasir JM, Estes NAM, Shah SA. Energy Drink-Associated Electrophysiological and Ischemic Abnormalities: A Narrative Review. Front Cardiovasc Med 2021; 8:679105. [PMID: 34277730 PMCID: PMC8280314 DOI: 10.3389/fcvm.2021.679105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022] Open
Abstract
An increasing number of cardiovascular adverse effects, emergency room visits, and deaths have been linked to energy drinks. In this review, we summarized available published literature assessing electrophysiological and ischemic adverse effects associated with energy drink consumption. Overall, 32 case reports and 19 clinical trials are included in this review. Ventricular arrhythmia, supraventricular arrhythmia, and myocardial ischemia were amongst the most commonly reported in case reports with 3 having a fatal outcome. Although serious ischemic changes, arrhythmias, or death were not observed in clinical trials, significant electrophysiological changes, such as PR/PQ interval shortening/prolongation, QT/QTc shortening/prolongation, and ST-T changes, were noted. QT/QTc interval prolongation appears to be the most significant finding in clinical trials, and there appears to be a dose-response relationship between energy drink consumption and QTc prolongation. The exact mechanisms and the particular combination of ingredients behind energy drink-induced cardiac abnormalities require further evaluation. Until more information is available, energy drink use should be considered as part of the differential diagnosis in appropriate patients presenting with electrocardiographic changes. Further, certain patient populations should exercise caution and limit their energy drink consumption.
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Affiliation(s)
- Diana X Cao
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, Fullerton, CA, United States
| | - Kimberly Maiton
- Department of Pharmacy Practice, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA, United States
| | - Javed M Nasir
- David Grant USAF Medical Center, Fairfield, CA, United States
| | - N A Mark Estes
- Heart and Vascular Institute, UPMC Presbyterian, Pittsburgh, PA, United States
| | - Sachin A Shah
- Department of Pharmacy Practice, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA, United States.,David Grant USAF Medical Center, Fairfield, CA, United States
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Alyesh D, Gambhir A, Waase M, Remo B, Singh A, Green J, Kittleson M, Estes NAM, Heist EK. Response by Alyesh et al to Letter Regarding Article, "A Blueprint for Productive Maintenance of Certification, but Is the American Board of Internal Medicine up to the Challenge?". Circ Cardiovasc Qual Outcomes 2021; 14:e007961. [PMID: 34078096 DOI: 10.1161/circoutcomes.121.007961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Alyesh
- South Denver Cardiology Associates, Littleton, Colorado (D.A.)
| | - Alok Gambhir
- The Heart Center of Northeast Georgia Medical Center, Gainesville (A.G.)
| | - Marc Waase
- Columbia University Medical Center, New York, NY (M.W.)
| | - Benjamin Remo
- University of Maryland Medical Center, Baltimore (B.R.)
| | | | | | - Michelle Kittleson
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.K.)
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Affiliation(s)
- N A Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, PA
| | - Samir Saba
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, PA
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Brazile T, Mulukutla S, Thoma F, Estes NAM, Jain S, Saba S. Inverse association of mortality and body mass index in patients with left ventricular systolic dysfunction of both ischemic and non-ischemic etiologies. Clin Cardiol 2021; 44:495-500. [PMID: 33675050 PMCID: PMC8027570 DOI: 10.1002/clc.23556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases. HYPOTHESIS We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all-cause mortality as the primary endpoint and hospitalization as the secondary endpoint. METHODS We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): <20%, 20-35%, and 35-50%. RESULTS Over a median follow-up of 2.28 years, higher BMI (mean 28.9 ± 6.8) was associated with better survival for the overall cohort and within LVEF strata (p < .0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and prior myocardial infarction are independent predictors of death. CONCLUSIONS Our results support the existence of an obesity paradox impacting all-cause mortality in patients with LVSD of ischemic and non-ischemic etiologies even after adjusting for LVEF and comorbidities. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of LVSD is established.
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Affiliation(s)
- Tiffany Brazile
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Suresh Mulukutla
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Floyd Thoma
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - N. A. Mark Estes
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Sandeep Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgPennsylvaniaUSA
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Heidenreich PA, Estes NAM, Fonarow GC, Jurgens CY, Kittleson MM, Marine JE, McManus DD, McNamara RL. 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2021; 77:326-341. [PMID: 33303319 DOI: 10.1016/j.jacc.2020.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- N A Mark Estes
- From the University of Pittsburgh Medical Center Heart and Vascular Institute University of Pittsburgh School of Medicine Pittsburgh PA
| | - Timothy C Wong
- From the University of Pittsburgh Medical Center Heart and Vascular Institute University of Pittsburgh School of Medicine Pittsburgh PA
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy: Executive summary. Heart Rhythm 2020; 16:e373-e407. [PMID: 31676023 DOI: 10.1016/j.hrthm.2019.09.019] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Indexed: 01/14/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Heidenreich PA, Estes NAM, Fonarow GC, Jurgens CY, Kittleson MM, Marine JE, McManus DD, McNamara RL. 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2020; 14:e000100. [PMID: 33284642 DOI: 10.1161/hcq.0000000000000100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Estes NAM, Jain SK. Risk Factor Modification for Atrial Fibrillation: An Ounce of Prevention. JACC Clin Electrophysiol 2020; 6:1288-1290. [PMID: 33092756 DOI: 10.1016/j.jacep.2020.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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33
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Affiliation(s)
- N A Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samir Saba
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Wang NC, Jain SK, Estes NAM, Barrington WW, Bazaz R, Bhonsale A, Kancharla K, Shalaby AA, Voigt AH, Saba S. Priority plan for invasive cardiac electrophysiology procedures during the coronavirus disease 2019 (COVID-19) pandemic. J Cardiovasc Electrophysiol 2020; 31:1255-1258. [PMID: 32323382 PMCID: PMC7264655 DOI: 10.1111/jce.14478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William W Barrington
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raveen Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alaa A Shalaby
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew H Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Estes NAM. Improving Outcomes in Patients With Atrial Fibrillation and Hypertension. JAMA 2020; 323:221-222. [PMID: 31961401 DOI: 10.1001/jama.2019.20144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- N A Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Wingerter R, Steiger N, Burrows A, Estes NAM. Impact of Lifestyle Modification on Atrial Fibrillation. Am J Cardiol 2020; 125:289-297. [PMID: 31761147 DOI: 10.1016/j.amjcard.2019.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Atrial Fibrillation (AF) is the most common arrhythmia in adults, and the rapid increase in AF prevalence has been classified by experts as an epidemic. The mechanisms of AF are complex and incompletely understood. While many aspects of management are now based on high quality evidence, other clinical decisions are based on experience and judgment. This article provides an up to date review relating to lifestyle modification and its effect on AF to inform clinical treatment. This comprehensive review used PubMed and Google Scholar to perform keyword searches of articles published between 1998 and the present, with the exception of the 1978 "Holiday Heart" article. Robust data has emerged identifying multiple risk factors for development of AF, including age, sex, hypertension, diabetes mellitus, obesity, alcohol consumption, exercise, and obstructive sleep apnea. Recent evidence indicates that lifestyle modification has a significant role in mitigating the risk and burden of AF. In conclusion, based on the available evidence, an interdisciplinary approach to lifestyle modification will likely reduce risk and/or symptom burden of AF.
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Affiliation(s)
- Rebecca Wingerter
- College of Medicine at University of Central Florida, Orlando, Florida
| | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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37
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Barakat AF, Asif A, Inashvili A, Szeto L, Noor A, Thalappillil A, Adhikari S, Fatima S, Pasupula DK, Ahmad S, Mathew D, Bhonsale A, Kancharla K, Wang NC, Jain S, Mark Estes NA, Saba S. Documentation of shared decision making around primary prevention defibrillator implantations. Pacing Clin Electrophysiol 2020; 43:100-109. [DOI: 10.1111/pace.13846] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Amr F. Barakat
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Anum Asif
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ana Inashvili
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Libby Szeto
- School of MedicineUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Ahmed Noor
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Alvin Thalappillil
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shubash Adhikari
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shumail Fatima
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Deepak Kumar Pasupula
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Shahzad Ahmad
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Don Mathew
- Department of MedicineUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Norman C. Wang
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Sandeep Jain
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - N. A. Mark Estes
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Samir Saba
- Heart and Vascular InstituteUniversity of Pittsburgh Medical Center Pittsburgh Pennsylvania
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38
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Li JZ, Bhonsale A, Estes NAM, Jain SK, Kancharla K, Mezu-Chukwu U, Saba S, Shalaby AA, Voigt AH, Wang NC. Trends and Implications of DF-4 Implantable Cardioverter-Defibrillator Lead Adoption in the United States of America. Circ Arrhythm Electrophysiol 2019; 12:e007134. [PMID: 30841723 DOI: 10.1161/circep.118.007134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jack Z Li
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Sandeep K Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Ure Mezu-Chukwu
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Samir Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Alaa A Shalaby
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Andrew H Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
| | - Norman C Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA
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Abstract
Sudden cardiac death (SCD) secondary to sudden cardiac arrest (SCA) is a leading cause of death in the United States, claiming over a quarter million lives annually, and is directly responsible for 50% of all cardiovascular mortality. Brugada Syndrome (BrS) is an arrhythmogenic cardiovascular channelopathy that predisposes asymptomatic patients who have no identified disease to a high-risk of SCD/SCA as their first cardiac event/disease manifestation. Limited progress has been made in risk prediction of SCA and SCD, with the greatest challenge being the ability to identify the small high-risk subgroups concealed within the larger general population. In conclusion, accurate identification of high-risk asymptomatic BrS patients (through multiparametric risk scores composed of reliable and validated unambiguous clinical variables and biomarkers) may hold utility in improving current SCD prediction algorithms, and the appropriate primary prevention therapy may prove valuable in reducing risk of sudden death for this patient population. This systematic review aims to comprehensively summarize qualitative evidence that explore proposed clinical, electrocardiographic, electrophysiological, and genetic markers for risk stratification of patients with BrS phenotype, and to discuss the best available contemporary evidence regarding therapeutic approach.
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Affiliation(s)
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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40
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Morin DP, Bernard ML, Madias C, Rogers PA, Thihalolipavan S, Estes NAM. In reply-Atrial Fibrillation and Morbidity and Mortality in Stress-Induced Cardiomyopathy. Mayo Clin Proc 2019; 94:2148-2149. [PMID: 31585590 DOI: 10.1016/j.mayocp.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel P Morin
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | - Michael L Bernard
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | | | - Paul A Rogers
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
| | - Sudarone Thihalolipavan
- Ochsner Medical Center and Ochsner Clinical School - University of Queensland School of Medicine, New Orleans, LA
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41
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm 2019; 16:e301-e372. [PMID: 31078652 DOI: 10.1016/j.hrthm.2019.05.007] [Citation(s) in RCA: 406] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 02/08/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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42
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Estes NAM, Weinstock J. MY APPROACH to Commotio Cordis. Trends Cardiovasc Med 2018; 29:248. [PMID: 30878295 DOI: 10.1016/j.tcm.2018.10.015] [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: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- N A Mark Estes
- Tufts University School of Medicine; Director, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA, United States.
| | - Jonathan Weinstock
- Tufts University School of Medicine; Director, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA, United States.
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43
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Rowin EJ, Hausvater A, Link MS, Abt P, Gionfriddo W, Wang W, Rastegar H, Estes NAM, Maron MS, Maron BJ. Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation 2017; 136:2420-2436. [DOI: 10.1161/circulationaha.117.029267] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved.
Methods:
Records of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8±3.4 years (from 2004 to 2014) were accessed.
Results:
Of the 1558 patients with HCM, 304 (20%) had episodes of AF, of which 226 (74%) were confined to symptomatic paroxysmal AF (average, 5±5; range, 1 to >20), whereas 78 (26%) developed permanent AF, preceded by 7±6 paroxysmal AF episodes. At last evaluation, 277 patients (91%) are alive at 62±13 years of age, including 89% in New York Heart Association class I or II. No difference was found in outcome measures for patients with AF and age- and sex-matched patients with HCM without AF. Four percent of patients with AF died of HCM-related causes (n=11), with annual mortality 0.7%; mortality directly attributable to AF (thromboembolism without prophylactic anticoagulation) was 0.1% per year (n=2 patients). Patients were treated with antiarrhythmic drugs (most commonly amiodarone [n=103] or sotalol [n=78]) and AF catheter ablation (n=49) or the Maze procedure at surgical myectomy (n=72). Freedom from AF recurrence at 1 year was 44% for ablation patients and 75% with the Maze procedure (
P
<0.001). Embolic events were less common with anticoagulation prophylaxis (4/233, 2%) than without (9/66, 14%) (
P
<0.001).
Conclusions:
Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
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Affiliation(s)
- Ethan J. Rowin
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Anais Hausvater
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Mark S. Link
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Patrick Abt
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - William Gionfriddo
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Wendy Wang
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Hassan Rastegar
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - N. A. Mark Estes
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Martin S. Maron
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Barry J. Maron
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
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Abstract
Sudden death is a major problem, with significant impact on public health. Many conditions predispose to sudden cardiac death and sudden cardiac arrest (SCA), foremost among them coronary artery disease, and an effective therapy exists in the form of the implantable cardioverter defibrillator. Risk stratification for SCA remains imperfect, especially for patients with nonischemic cardiomyopathy. Ongoing trials may make it easier to identify those at high risk, and potentially those at very low risk, in the future.
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Affiliation(s)
- Daniel P Morin
- Ochsner Medical Center, Ochsner Clinical School, University of Queensland Medical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Munther K Homoud
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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45
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Shenasa M, Estes NAM, Tomaselli GF. Sudden Cardiac Death: Contemporary Challenges. Card Electrophysiol Clin 2017; 9:xvii-xviii. [PMID: 29173420 DOI: 10.1016/j.ccep.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mohammad Shenasa
- Heart and Rhythm Medical Group, Department of Cardiovascular Services, O'Connor Hospital, San Jose, CA 95128, USA.
| | - N A Mark Estes
- Tufts University School of Medicine, New England Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA 02111, USA.
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46
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Morin DP, Bernard ML, Madias C, Rogers PA, Thihalolipavan S, Estes NAM. In Reply-Atrial Fibrillation: Interatrial Block May Be an Underdiagnosed and Easily Recognizable Risk Factor. Mayo Clin Proc 2017; 92:682. [PMID: 28385203 DOI: 10.1016/j.mayocp.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/13/2017] [Indexed: 11/15/2022]
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47
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Morin DP, Bernard ML, Madias C, Rogers PA, Thihalolipavan S, Estes NAM. The State of the Art: Atrial Fibrillation Epidemiology, Prevention, and Treatment. Mayo Clin Proc 2016; 91:1778-1810. [PMID: 27825618 DOI: 10.1016/j.mayocp.2016.08.022] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/04/2016] [Accepted: 08/17/2016] [Indexed: 12/16/2022]
Abstract
As the most common sustained arrhythmia in adults, atrial fibrillation (AF) is an established and growing epidemic. To provide optimal patient care, it is important for clinicians to be aware of AF's epidemiological trends, methods of risk reduction, and the various available treatment modalities. Our understanding of AF's pathophysiology has advanced, and with this new understanding has come advancements in prevention strategies as well as pharmacological and nonpharmacological treatment options. Following PubMed and MEDLINE searches for AF risk factors, epidemiology, and therapies, we reviewed relevant articles (and bibliographies of those articles) published from 2000 to 2016. This "state-of-the-art" review provides a comprehensive update on the understanding of AF in the world today, contemporary therapeutic options, and directions of ongoing and future study.
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Affiliation(s)
- Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA; Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.
| | | | - Christopher Madias
- Electrophysiology, Arrhythmia and Pacemaker Program, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL
| | - Paul A Rogers
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA
| | | | - N A Mark Estes
- Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA
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48
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Affiliation(s)
- N A Mark Estes
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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49
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Wilkoff BL, Fauchier L, Stiles MK, Morillo CA, Al-Khatib SM, Almendral J, Aguinaga L, Berger RD, Cuesta A, Daubert JP, Dubner S, Ellenbogen KA, Mark Estes NA, Fenelon G, Garcia FC, Gasparini M, Haines DE, Healey JS, Hurtwitz JL, Keegan R, Kolb C, Kuck KH, Marinskis G, Martinelli M, McGuire M, Molina LG, Okumura K, Proclemer A, Russo AM, Singh JP, Swerdlow CD, Teo WS, Uribe W, Viskin S, Wang CC, Zhang S. Erratum to '2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing' [Journal of Arrhythmia 32/1 (2016) 1-28]. J Arrhythm 2016; 32:441-442. [PMID: 27761170 PMCID: PMC5063272 DOI: 10.1016/j.joa.2016.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Carlos A Morillo
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | - Jesœs Almendral
- Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | | | | | - Alejandro Cuesta
- Servicio de Arritmias, Instituto de Cardiologia Infantil, Montevideo, Uruguay
| | | | - Sergio Dubner
- Clinica y Maternidad Suizo Argentina; De Los Arcos Sanatorio, Buenos Aires, Argentina
| | | | | | | | - Fermin C Garcia
- Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | | | - David E Haines
- William Beaumont Hospital Division of Cardiology, Royal Oak, MI, United States
| | - Jeff S Healey
- Department of Medicine, Cardiology Division, McMaster University-Population Health Research Institute, Hamilton, Canada
| | | | | | | | | | | | | | | | - Luis G Molina
- Mexico's National University, Mexico's General Hospital, Mexico City, Mexico
| | - Ken Okumura
- Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Alessandro Proclemer
- Azienda Ospedaliero Universitaria S. Maria della Misericordia- Udine, Udine, Italy
| | | | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Wee Siong Teo
- National Heart Centre Singapore, Singapore, Singapore
| | - William Uribe
- CES Cardiología and Centros Especializados San Vicente Fundación, Medellín y Rionegro, Colombia
| | - Sami Viskin
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shu Zhang
- National Center for Cardiovascular Disease and Beijing Fu Wai Hospital, Peking Union Medical College and China Academy of Medical Sciences, Beijing, China
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50
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Ruff CT, Ansell JE, Becker RC, Benjamin EJ, Deicicchi DJ, Mark Estes NA, Ezekowitz MD, Fanikos J, Fareed J, Garcia D, Giugliano RP, Goldhaber SZ, Granger C, Healey JS, Hull R, Hylek EM, Libby P, Lopes RD, Mahaffey KW, Mega J, Piazza G, Sasahara AA, Sorond FA, Spyropoulos AC, Walenga JM, Weitz JI. North American Thrombosis Forum, AF Action Initiative Consensus Document. Am J Med 2016; 129:S1-S29. [PMID: 27126598 DOI: 10.1016/j.amjmed.2016.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The North American Thrombosis Forum Atrial Fibrillation Action Initiative consensus document is a comprehensive yet practical briefing document focusing on stroke and bleeding risk assessment in patients with atrial fibrillation, as well as recommendations regarding anticoagulation options and management. Despite the breadth of clinical trial data and guideline recommendation updates, many clinicians continue to struggle to synthesize the disparate information available. This problem slows the uptake and utilization of updated risk prediction tools and adoption of new oral anticoagulants. This document serves as a practical and educational reference for the entire medical community involved in the care of patients with atrial fibrillation.
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Affiliation(s)
- Christian T Ruff
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Jack E Ansell
- Hofstra North Shore/LIJ School of Medicine, Hempstead, NY
| | - Richard C Becker
- University of Cincinnati College of Medicine, University of Cincinnati Medical Center, Ohio
| | - Emelia J Benjamin
- Boston University School of Medicine and Public Health, Boston Medical Center, Boston, Mass
| | | | - N A Mark Estes
- Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | - Michael D Ezekowitz
- Lankenau Medical Center, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - John Fanikos
- Massachusetts College of Pharmacy, Brigham and Women's Hospital, Northeastern University School of Pharmacy, Boston, Mass
| | - Jawed Fareed
- Loyola University Medical Center, Loyola University Chicago Stritch School of Medicine, Ill
| | - David Garcia
- University of Washington Medical Center, University of Washington School of Medicine, Seattle, Wash
| | - Robert P Giugliano
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Samuel Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Christopher Granger
- Duke University Medical Center, Duke University School of Medicine, Durham, NC
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Russell Hull
- Foothills Medical Center, University of Calgary, Alberta, Canada
| | - Elaine M Hylek
- Boston University School of Medicine and Public Health, Boston Medical Center, Boston, Mass
| | - Peter Libby
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Renato D Lopes
- Duke University Medical Center, Duke University School of Medicine, Durham, NC
| | - Kenneth W Mahaffey
- Stanford University Medical Center, Stanford University School of Medicine, Calif
| | - Jessica Mega
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Arthur A Sasahara
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Farzaneh A Sorond
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Jeanine M Walenga
- Loyola University Medical Center, Loyola University Chicago Stritch School of Medicine, Ill
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
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