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Ahmad A, Doshi RN. Ventricular arrhythmias: It is the substrate that counts. Heart Rhythm 2024; 21:172-173. [PMID: 38000654 DOI: 10.1016/j.hrthm.2023.11.018] [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: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Amier Ahmad
- Department of Clinical Cardiac Electrophysiology, HonorHealth, Scottsdale, Arizona
| | - Rahul N Doshi
- Department of Clinical Cardiac Electrophysiology, HonorHealth, Scottsdale, Arizona.
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2
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Banker RS, Rippy MK, Cooper N, Neužil P, Exner DV, Nair DG, Booth DF, Ligon D, Badie N, Krans M, Ando K, Knops RE, Ip JE, Doshi RN, Rashtian M, Reddy VY. Retrieval of Chronically Implanted Dual-chamber Leadless Pacemakers in an Ovine Model. Circ Arrhythm Electrophysiol 2023; 16:e012232. [PMID: 37767710 DOI: 10.1161/circep.123.012232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The clinical utilization of leadless pacemakers (LPs) as an alternative to traditional transvenous pacemakers is likely to increase with the advent of dual-chamber LP systems. Since device retrieval to allow LP upgrade or replacement will become an important capability, the first such dual-chamber, helix-fixation LP system (Aveir DR; Abbott, Abbott Park, IL) was specifically designed to allow catheter-based retrieval. In this study, the preclinical performance and safety of retrieving chronically implanted dual-chamber LPs was evaluated. METHODS Atrial and ventricular LPs were implanted in the right atrial appendage and right ventricular apex of 9 healthy ovine subjects. After ≈2 years, the LPs were retrieved using a dedicated transvenous retrieval catheter (Aveir Retrieval Catheter; Abbott) by snaring, docking, and unscrewing from the myocardium. Comprehensive necropsy/histopathology studies were conducted to evaluate device- and procedure-related outcomes. RESULTS At a median of 1.9 years postimplant (range, 1.8-2.6), all 18 of 18 (100%) LPs were retrieved from 9 ovine subjects without complications. The median retrieval procedure duration for both LPs, from first-catheter-in to last-catheter-out, was 13.3 minutes (range, 2.5-36.4). Postretrieval, all right atrial, and right ventricular implant sites demonstrated minimal tissue disruption, with intact fibrous tissue limited to the distal device body. No significant device-related trauma, perforation, pericardial effusion, right heart or tricuspid valve injury, or chronic pulmonary thromboembolism were observed at necropsy. CONCLUSIONS This preclinical study demonstrated the safe and effective retrieval of chronically implanted, helix-fixation, dual-chamber LP systems, paving the way for clinical studies of LP retrieval.
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Affiliation(s)
| | | | | | - Petr Neužil
- Na Homolce Hospital, Prague, Czech Republic (P.N., V.Y.R.)
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, Calgary, Canada (D.V.E.)
| | - Devi G Nair
- St. Bernards Healthcare, Jonesboro, AR (D.G.N.)
| | | | - David Ligon
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Nima Badie
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Mark Krans
- Abbott, Sylmar, CA (N.C., D.F.B., D.L., N.B., M.K.)
| | - Kenji Ando
- Kokura Memorial Hospital, Kitakyushu, Japan (K.A.)
| | | | - James E Ip
- Weill Cornell Medical Center, NY (J.E.I.)
| | | | | | - Vivek Y Reddy
- Na Homolce Hospital, Prague, Czech Republic (P.N., V.Y.R.)
- Icahn School of Medicine at Mount Sinai Hospital, NY (V.Y.R.)
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3
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Doshi RN, Kleinhans AC. A broken tine as a possible explanation for rise in pacing threshold in a leadless pacemaker. HeartRhythm Case Rep 2023; 9:573-575. [PMID: 37614395 PMCID: PMC10444565 DOI: 10.1016/j.hrcr.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Rahul N. Doshi
- HonorHealth Cardiac Arrhythmia Group, Scottsdale, Arizona
- University of Arizona College of Medicine Phoenix, Phoenix, Arizona
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4
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Reddy VY, Neuzil P, Booth DF, Knops RE, Doshi RN, Rashtian M, Exner DV, Banker RS, Nair D, Hadadi CA, Badie N, Yang W, Ligon D, Ip JE. Dual-Chamber Leadless Pacing: Atrioventricular Synchrony in Preclinical Models of Normal or Blocked Atrioventricular Conduction. Heart Rhythm 2023:S1547-5271(23)02104-5. [PMID: 37075958 DOI: 10.1016/j.hrthm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Dual-chamber leadless pacemakers (LP) require robust communication between distinct right atrial (RA) and right ventricular (RV) LPs to achieve atrioventricular (AV) synchrony. OBJECTIVE This preclinical study evaluated a novel, continuous implant-to-implant (i2i™) communication methodology for maintaining AV-synchronous, dual-chamber DDD(R) pacing by the 2 LPs. METHODS RA and RV LPs were implanted and paired in 7 ovine subjects, 4 of 7 with induced complete heart block. AV synchrony (% AV intervals <300 ms) and i2i communication success (% successful i2i transmissions between LPs) were evaluated acutely and chronically. During acute testing, 12-lead ECG and LP diagnostic data were collected from 5-minute recordings, in 4 postures and 2 rhythms (AP-VP and AS-VP or AP-VS and AS-VS) per subject. Chronic i2i performance was evaluated through 23 weeks post-implant (final i2i evaluation period: week 16-23). RESULTS Acute AV synchrony and i2i communication success across multiple postures and rhythms were 100.0% [100.0-100.0] (median [interquartile range]) and 99.9% [99.9-99.9], respectively. AV synchrony and i2i success rates did not differ across postures (P=0.59, P=0.11) or rhythms (P=1.00, P=0.82). During the final i2i evaluation period, the overall i2i success was 98.9% [98.1-99.0]. CONCLUSION Successful AV-synchronous, dual-chamber DDD(R) leadless pacing using a novel, continuous, wireless communication modality was demonstrated across variations in posture and rhythm in a preclinical model.
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Affiliation(s)
- Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Na Homolce Hospital, Prague, Czech Republic.
| | | | | | | | - Rahul N Doshi
- HonorHealth Research Institute, Scottsdale, Arizona, USA
| | | | - Derek V Exner
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, Arkansas, USA
| | | | | | | | | | - James E Ip
- Weill Cornell Medical Center, New York, New York, USA
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Eldadah ZA, Al-Ahmad A, Bunch TJ, Delurgio DB, Doshi RN, Hook BG, Hranitzky PM, Joyner CA, Mittal S, Porterfield C, Sanchez JE, Thambidorai SK, Wazni OM, McElderry HT. Same-day discharge following catheter ablation and venous closure with VASCADE MVP: A postmarket registry. J Cardiovasc Electrophysiol 2023; 34:348-355. [PMID: 36448428 DOI: 10.1111/jce.15763] [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: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Early and safe ambulation can facilitate same-day discharge (SDD) following catheter ablation, which can reduce resource utilization and healthcare costs and improve patient satisfaction. This study evaluated procedure success and safety of the VASCADE MVP venous vascular closure system in patients with atrial fibrillation (AF). METHODS The AMBULATE SDD Registry is a two-stage series of postmarket studies in patients with paroxysmal or persistent AF undergoing catheter ablation followed by femoral venous access-site closure with VASCADE MVP. Efficacy endpoints included SDD success, defined as the proportion of patients discharged the same day who did not require next-day hospital intervention for procedure/access site-related complications, and access site sustained success within 15 days of the procedure. RESULTS Overall, 354 patients were included in the pooled study population, 151 (42.7%) treated for paroxysmal AF and 203 (57.3%) for persistent AF. SDD was achieved in 323 patients (91.2%) and, of these, 320 (99.1%) did not require subsequent hospital intervention based on all study performance outcomes. Nearly all patients (350 of 354; 98.9%) achieved total study success, with no subsequent hospital intervention required. No major access-site complications were recorded. Patients who had SDD were more likely to report procedure satisfaction than patients who stayed overnight. CONCLUSION In this study, 99.7% of patients achieving SDD required no additional hospital intervention for access site-related complications during follow-up. SDD appears feasible and safe for eligible patients after catheter ablation for paroxysmal or persistent AF in which the VASCADE MVP is used for venous access-site closure.
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Affiliation(s)
- Zayd A Eldadah
- Heart & Vascular Institute, MedStar Health, Columbia, Maryland, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Murray, Utah, USA
| | - David B Delurgio
- Department of Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Rahul N Doshi
- Cardiac Arrhythmia Group, HonorHealth Medical Group, Scottsdale, Arizona, USA
| | - Bruce G Hook
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | | | - Charles A Joyner
- Department of Cardiology, Levinson Heart Hospital at Chippenham and Johnston Willis Medical Center, Richmond, Virginia, USA
| | - Suneet Mittal
- Electrophysiology, Valley Health System, Ridgewood, New Jersey, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia, Medical City Dallas, Dallas, Texas, USA
| | | | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Thomas McElderry
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Gleva MJ, Sullivan J, Crawford TC, Walcott G, Birgersdotter-Green U, Branch KR, Doshi RN, Kivilaid K, Brennan K, Rowbotham RK, Gustavson LM, Poole JE. Defibrillation effectiveness and safety of the shock waveform used in a contemporary wearable cardioverter defibrillator: Results from animal and human studies. PLoS One 2023; 18:e0281340. [PMID: 36917566 PMCID: PMC10013906 DOI: 10.1371/journal.pone.0281340] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/17/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION The wearable cardioverter defibrillator (WCD) is used to protect patients at risk for sudden cardiac arrest. We examined defibrillation efficacy and safety of a biphasic truncated exponential waveform designed for use in a contemporary WCD in three animal studies and a human study. METHODS Animal (swine) studies: #1: Efficacy comparison of a 170J BTE waveform (SHOCK A) to a 150J BTE waveform (SHOCK B) that approximates another commercially available waveform. Primary endpoint first shock success rate. #2: Efficacy comparison of the two waveforms at attenuated charge voltages in swine at three prespecified impedances. Primary endpoint first shock success rate. #3: Safety comparison of SHOCK A and SHOCK B in swine. Primary endpoint cardiac biomarker level changes baseline to 6 and 24 hours post-shock. Human Study: Efficacy comparison of SHOCK A to prespecified goal and safety evaluation. Primary endpoint cumulative first and second shock success rate. Safety endpoint adverse events. RESULTS Animal Studies #1: 120 VF episodes in six swine. First shock success rates for SHOCK A and SHOCK B were 100%; SHOCK A non-inferior to SHOCK B (entire 95% CI of rate difference above -10% margin, p < .001). #2: 2,160 VF episodes in thirty-six swine. Attenuated SHOCK A was non-inferior to attenuated SHOCK B at each impedance (entire 95% CI of rate difference above -10% margin, p < .001). #3: Ten swine, five shocked five times each with SHOCK A, five shocked five times each with SHOCK B. No significant difference in troponin I (p = 0.658) or creatine phosphokinase (p = 0.855) changes from baseline between SHOCK A and SHOCK B. Human Study: Thirteen patients, 100% VF conversion rate. Mild skin irritation from adhesive defibrillation pads in three patients. CONCLUSIONS The BTE waveform effectively and safely terminated induced VF in swine and a small sample in humans. TRIAL REGISTRATION Human study clinical trial registration: URL: https://clinicaltrials.gov; Unique identifier: NCT04132466.
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Affiliation(s)
- Marye J. Gleva
- Division of Cardiology, Department of Medicine, Washington University in Saint Louis School of Medicine in Saint Louis, St. Louis, Missouri, United States of America
- * E-mail:
| | - Joseph Sullivan
- Kestra Medical Technologies, Inc., Redmond, Washington, United States of America
| | - Thomas C. Crawford
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Greg Walcott
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | | | - Kelley R. Branch
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | | | | | - Kelly Brennan
- Kestra Medical Technologies, Inc., Redmond, Washington, United States of America
| | - Ron K. Rowbotham
- Kestra Medical Technologies, Inc., Redmond, Washington, United States of America
| | - Laura M. Gustavson
- Kestra Medical Technologies, Inc., Redmond, Washington, United States of America
| | - Jeanne E. Poole
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
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Kleinhans A, Williams CL, Mattioni TA, Doshi RN. PO-693-04 STRATEGIES FOR THE TRANSITION TO REMOTE BASED DEVICE CLINICS CAN YIELD LOWER ATTRITION AND FINANCIAL SUSTAINABILITY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Knops R, Cantillon DJ, Neuzil P, Banker RS, Rashtian M, Doshi RN, Booth D, Yang W, Goil A, Badie N, Ligon D, Fishler MG. PO-621-03 DUAL-CHAMBER LEADLESS PACEMAKER ENABLES ROBUST ATRIOVENTRICULAR SYNCHRONY IN VARIOUS POSTURES AND PACING CONFIGURATIONS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Doshi RN, Wang A, Franke A, Bourge R. Treatment Of Ambulatory Pulmonary Artery Pressure May Reduce Atrial Arrhythmias In Symptomatic Heart Failure Patients. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Poole JE, Gleva MJ, Birgersdotter-Green U, Branch KRH, Doshi RN, Salam T, Crawford TC, Willcox ME, Sridhar AM, Mikdadi G, Beinart SC, Cha YM, Russo AM, Rowbotham RK, Sullivan J, Gustavson LM, Kivilaid K. A Wearable Cardioverter Defibrillator with a Low False Alarm Rate. J Cardiovasc Electrophysiol 2022; 33:831-842. [PMID: 35174572 PMCID: PMC9305432 DOI: 10.1111/jce.15417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce risk for sudden cardiac death. Challenges for patients wearing a WCD have been frequent false shock alarms primarily due to ECG noise and wear discomfort. OBJECTIVE To test a contemporary WCD designed for reduced false shock alarms and improved comfort. METHODS 130 patients with LVEF ≤ 40% and an active implantable cardioverter defibrillator (ICD) were fitted with the ASSURE WCD (Kestra Medical Technologies) and followed 30 days. WCD detection was enabled and shock alarm markers recorded, but shocks and shock alarms disabled. All WCD episodes and ICD VT/VF episodes were adjudicated. The primary endpoint was the false positive shock alarm rate with a performance goal of 1 every 3.4 days (0.29 per patient-day). RESULTS Of 163 WCD episodes, 4 were VT/VF and 159 non-VT/VF (121 rhythms with noise, 32 uncertain with noise, 6 atrial flutter without noise). Only 3 false positive shock alarm markers were recorded; 1 false positive shock alarm every 1,333 patient-days (0.00075 per patient-day, 95% CI: 0.00015-0.00361; p < 0.001). No ICD recorded VT/VF episodes meeting WCD detection criteria (≥ 170 bpm for ≥ 20 seconds) were missed by the WCD during 3,501 patient-days of use. Median wear was 31.0 days (IQR 2.0) and median daily use 23.0 hours (IQR 1.7). Adverse events were mostly mild: skin irritation (19.4%) and musculoskeletal discomfort (8.5%). CONCLUSION The ASSURE WCD demonstrated a low false positive shock alarm rate, low patient-reported discomfort, and no serious adverse events. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ghiath Mikdadi
- Heart Clinic of Hammond, Hammond, Louisiana, Center for Cardiac and Vascular Research
| | - Sean C Beinart
- Washington Adventist Healthcare White Oak Medical Center, Silver Spring, Maryland
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Affiliation(s)
- Mayank Sardana
- HonorHealth Cardiovascular Center of Excellence and Cardiac Arrhythmia Group, HonorHealth, Scottsdale, AZ, USA
| | - Rahul N Doshi
- HonorHealth Cardiovascular Center of Excellence and Cardiac Arrhythmia Group, HonorHealth, Scottsdale, AZ, USA
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Doshi RN, Kleinhans A. Oral Anticoagulants for Newly Detected Atrial Fibrillation in Cryptogenic Stroke Patients: Still a Bitter Pill to Swallow Quickly. J Innov Card Rhythm Manag 2021; 12:4818-4820. [PMID: 34970472 PMCID: PMC8711970 DOI: 10.19102/icrm.2021.121206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
| | - Amy Kleinhans
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
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13
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Doshi RN. Demonstration of left bundle capture: Timing is everything. Heart Rhythm 2021; 18:944-945. [PMID: 33781983 DOI: 10.1016/j.hrthm.2021.03.035] [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: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Rahul N Doshi
- Pillar Chief Complex Arrhythmia Management, HonorHealth Cardiovascular Center of Excellence, HonorHealth Cardiac Arrhythmia Group, HonorHealth Medical Group, Heart Group Shea, Scottsdale, Arizona.
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14
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Affiliation(s)
- Rahul N Doshi
- Cardiovascular Center of Excellence, HonorHealth, Cardiac Arrhythmia Group, HonorHealth Medical Group, Scottsdale, AZ 85251, USA
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15
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Lador A, Peterson LE, Swarup V, Schurmann PA, Makkar A, Doshi RN, DeLurgio D, Athill CA, Ellenbogen KA, Natale A, Koneru J, Dave AS, Giorgberidze I, Afshar H, Guthrie ML, Bunge R, Morillo CA, Kleiman NS, Valderrábano M. Determinants of outcome impact of vein of Marshall ethanol infusion when added to catheter ablation of persistent atrial fibrillation: A secondary analysis of the VENUS randomized clinical trial. Heart Rhythm 2021; 18:1045-1054. [PMID: 33482387 DOI: 10.1016/j.hrthm.2021.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/19/2020] [Revised: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial demonstrated that adding vein of Marshall (VOM) ethanol infusion to catheter ablation (CA) improves ablation outcomes in persistent atrial fibrillation (AF). There was significant heterogeneity in the impact of VOM ethanol infusion on rhythm control. OBJECTIVE The purpose of this study was to assess the association between outcomes and (1) achievement of bidirectional perimitral conduction block and (2) procedural volume. METHODS The VENUS trial randomized patients with persistent AF (N = 343) to CA combined with VOM ethanol or CA alone. The primary outcome (freedom from AF or atrial tachycardia [AT] lasting longer than 30 seconds after a single procedure) was analyzed by 2 categories: (1) successful vs no perimitral block and (2) high- (>20 patients enrolled) vs low-volume centers. RESULTS In patients with perimitral block, the primary outcome was reached 54.3% after VOM-CA and 37% after CA alone (P = .01). Among patients without perimitral block, freedom from AF/AT was 34.0% after VOM-CA and 37.0% after CA (P = .583). In high-volume centers, the primary outcome was reached in 56.4% after VOM-CA and 40.2% after CA (P = .01). In low-volume centers, freedom from AF/AT was 30.77% after VOM-CA and 32.61% after CA (P = .84). In patients with successful perimitral block from high-volume centers, the primary outcome was reached in 59% after VOM-CA and 39.1% after CA (P = .01). Tests for interaction were significant (P = .002 for perimitral block and P = .04 for center volume). CONCLUSION Adding VOM ethanol infusion to CA has a greater impact on outcomes when associated with perimitral block and performed in high-volume centers. Perimitral block should be part of the VOM procedure.
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Affiliation(s)
- Adi Lador
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Leif E Peterson
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Paul A Schurmann
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Rahul N Doshi
- Division of Cardiology, Keck-USC University Hospital, University of Southern California, Los Angeles, California
| | - David DeLurgio
- Division of Cardiology, Emory St. Joseph's Hospital, Emory University, Atlanta, Georgia
| | - Charles A Athill
- San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California
| | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas
| | - Jayanthi Koneru
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Amish S Dave
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle L Guthrie
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Raquel Bunge
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Carlos A Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas.
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Affiliation(s)
- Junaid Bhutto
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
| | - Rahul N. Doshi
- Cardiac Arrhythmia Group, Cardiovascular Center of Excellence, HonorHealth, Scottsdale, AZ, USA
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Valderrábano M, Peterson LE, Swarup V, Schurmann PA, Makkar A, Doshi RN, DeLurgio D, Athill CA, Ellenbogen KA, Natale A, Koneru J, Dave AS, Giorgberidze I, Afshar H, Guthrie ML, Bunge R, Morillo CA, Kleiman NS. Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation: The VENUS Randomized Clinical Trial. JAMA 2020; 324:1620-1628. [PMID: 33107945 PMCID: PMC7592031 DOI: 10.1001/jama.2020.16195] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [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] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Catheter ablation of persistent atrial fibrillation (AF) has limited success. Procedural strategies beyond pulmonary vein isolation have failed to consistently improve results. The vein of Marshall contains innervation and AF triggers that can be ablated by retrograde ethanol infusion. OBJECTIVE To determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation. DESIGN, SETTING, AND PARTICIPANTS The Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an investigator-initiated, National Institutes of Health-funded, randomized, single-blinded trial conducted in 12 centers in the United States. Patients (N = 350) with persistent AF referred for first ablation were enrolled from October 2013 through June 2018. Follow-up concluded in June 2019. INTERVENTIONS Patients were randomly assigned to catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures. MAIN OUTCOMES AND MEASURES The primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was blinded to randomization treatment. There were 12 secondary outcomes, including AF burden, freedom from AF after multiple procedures, perimitral block, and others. RESULTS Of the 343 randomized patients (mean [SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial. Vein of Marshall ethanol was successfully delivered in 155 of 185 patients. At 6 and 12 months, the proportion of patients with freedom from AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the catheter ablation combined with vein of Marshall ethanol infusion group compared with 38% (60/158) in the catheter ablation alone group (difference, 11.2% [95% CI, 0.8%-21.7%]; P = .04). Of the 12 secondary outcomes, 9 were not significantly different, but AF burden (zero burden in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P = .01), freedom from AF after multiple procedures (65.2% vs 53.8%; difference, 11.4% [95% CI, 0.6%-22.2%]; P = .04), and success achieving perimitral block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P < .001) were significantly improved in vein of Marshall-treated patients. Adverse events were similar between groups. CONCLUSIONS AND RELEVANCE Among patients with persistent AF, addition of vein of Marshall ethanol infusion to catheter ablation, compared with catheter ablation alone, increased the likelihood of remaining free of AF or atrial tachycardia at 6 and 12 months. Further research is needed to assess longer-term efficacy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01898221.
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Affiliation(s)
- Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Leif E. Peterson
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Paul A. Schurmann
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Rahul N. Doshi
- Keck-USC University Hospital, University of Southern California, Los Angeles
| | - David DeLurgio
- Emory St Joseph’s Hospital, Emory University, Atlanta, Georgia
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin
| | - Jayanthi Koneru
- Virginia Commonwealth University School of Medicine, Richmond
| | - Amish S. Dave
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | | | - Hamid Afshar
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michelle L. Guthrie
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Raquel Bunge
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Carlos A. Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
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Singh JP, Berger RD, Doshi RN, Lloyd M, Moore D, Stone J, Daoud EG. Targeted Left Ventricular Lead Implantation Strategy for Non-Left Bundle Branch Block Patients. JACC Clin Electrophysiol 2020; 6:1171-1181. [DOI: 10.1016/j.jacep.2020.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 10/23/2022]
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19
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Doshi RN, Carlson S, Agarwal R, Bharmi R, Adamson PB. Association between Arrhythmia and Pulmonary Artery Pressure in Heart Failure Patients Implanted with a Cardiac Defibrillator and Ambulatory Pulmonary Artery Pressure Sensor. J Innov Card Rhythm Manag 2020; 10:3815-3821. [PMID: 32477750 PMCID: PMC7252698 DOI: 10.19102/icrm.2019.100903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022] Open
Abstract
The association between ventricular arrhythmia (VA) burden or defibrillator therapy and pulmonary artery pressure (PAP) has not been characterized in an ambulatory setting; thus, we sought in the present research to determine the relationship between ambulatory PAP and VA burden. A retrospective cohort study involving patients with an implantable cardiac defibrillator and CardioMEMS™ PAP sensor (Abbott Laboratories, Chicago, IL, USA) both transmitting remotely into the Merlin.net™ patient care network (Abbott Laboratories, Chicago, IL, USA) was conducted. VA and therapy burden in the six months following sensor implant were stratified by the baseline mean PAP. Patients with PAPs of 25 mmHg to 35 mmHg and those with PAPs of 35 mmHg or more were compared with individuals with PAPs of less than 25 mmHg. The change in VA burden was reported using the averaged mean PAP reduction during the first three months. A total of 162 patients aged 69.4 years ± 10.9 years were included (74% male) with a baseline mean PAP of 36.2 mmHg ± 10.4 mmHg. Twenty patients with a baseline mean PAP of less than 25 mmHg had no VAs over six months. For 61 patients with a baseline mean PAP of between 25 mmHg and 35 mmHg, the annualized number of days with ventricular tachycardia (VT)/ventricular fibrillation (VF) was 1.65/patient-year (p < 0.001), with 8% of patients having VT/VF events. For 81 patients with a baseline mean PAP of 35 mmHg or more, 19% of patients had a VT/VF event and an annualized number of days with VT/VF events of 1.45/patient-year (p < 0.001). When analyzing the treatment effect, a reduction of 3 mmHg or more in mean PAP over three months reduced arrhythmia burden over the next three months as compared with in patients without such an improvement. In conclusion, it is indicated that VAs are associated with high PAPs, and a reduction in PAP may lead to a reduction in VAs in real-world ambulatory patients.
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Affiliation(s)
- Rahul N Doshi
- University of Southern California, Los Angeles, CA, USA
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20
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Doshi RN. Morphology discrimination and ICD programming: Can we do better? J Cardiovasc Electrophysiol 2020; 31:1507-1508. [DOI: 10.1111/jce.14519] [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: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rahul N. Doshi
- Electrophysiology and Complex Arrhythmia Management, Cardiovascular Center of Excellence, HonorHealth Scottsdale Arizona
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Do K, Doshi RN. Reply to the Editor— Strategy for revision of subcutaneous implantable cardioverter-defibrillator following inappropriate shock. HeartRhythm Case Rep 2019; 5:559. [PMID: 31890575 PMCID: PMC6926260 DOI: 10.1016/j.hrcr.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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22
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Huntsinger ME, Doshi RN. Nurse-directed Preventative Management of Atrial Fibrillation: Is it Feasible? J Innov Card Rhythm Manag 2019; 10:3836-3838. [PMID: 32479571 PMCID: PMC7252798 DOI: 10.19102/icrm.2019.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Mary E Huntsinger
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rahul N Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Doshi RN. Cardiac Monitoring: Then and Now. J Innov Card Rhythm Manag 2019; 10:3800-3801. [PMID: 32494424 PMCID: PMC7252858 DOI: 10.19102/icrm.2019.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Rusia A, Kita KY, Shah SD, Roy D, Zhang Y, Nattiv J, Doshi N, Tun H, Clavijo LC, Doshi RN. Anticoagulation Patterns in Patients with Atrial Fibrillation Following Percutaneous Coronary Intervention in an Academic Center. J Innov Card Rhythm Manag 2019; 10:3785-3789. [PMID: 32477745 PMCID: PMC7252683 DOI: 10.19102/icrm.2019.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022] Open
Abstract
A common dilemma facing physicians treating patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) is the management of oral anticoagulation (OAC) therapy, because there is also an indication for dual antiplatelet therapy in these patients. The purpose of this study was therefore to evaluate anticoagulation patterns in this patient population in an attempt to identify patterns of risk factors that may influence OAC prescribing habits. This retrospective study entailed a review of a total of 4,648 patients from two academic hospitals who underwent PCI between 2008 and 2016. We ultimately included 211 patients who had AF and an indication for OAC. Chart review revealed patients' risk factors, CHA2DS2-VASc and HAS-BLED scores, and antithrombotic regimens. Only 105 (49.8%) patients who met the indications for OAC were actually placed on OAC post-PCI. There was no significant relationship between discharge on OAC and HAS-BLED score (t = 0.14; p = 0.44) or CHA2DS2-VASc score (t = 0.76; p = 0.22). Patients younger than 65 years of age were prescribed more triple therapy (56% versus 33%; p < 0.01) or any OAC (69% versus 41%; p < 0.01) on discharge in comparison with patients 65 years of age or older. The older patient group had a significantly higher average CHA2DS2-VASc score (4.4 versus 3.2; p < 0.01) and a higher average HAS-BLED score (2.8 versus 2.4; p < 0.01). Ultimately, this study indicated that less than half of AF patients with an indication for OAC were placed on OAC post-PCI. There was no association between discharge on OAC and CHA2DS2-VASc score, HAS-BLED score, or any other individual risk factor, with the exception of age.
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Affiliation(s)
- Akash Rusia
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kenneth Y. Kita
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shawn D. Shah
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dipayon Roy
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Youning Zhang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Nattiv
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Natasha Doshi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Han Tun
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Leonardo C. Clavijo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rahul N. Doshi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Address correspondence to: Rahul N. Doshi, MD, Keck USC School of Medicine, 1510 San Pablo Street, Suite 320, Los Angeles, CA 90033, USA.
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25
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Do K, Lee CC, Kiankhooy A, Chang PM, Doshi RN. Substernal subcutaneous implantable cardioverter-defibrillator lead placement for the management of inappropriate shocks. HeartRhythm Case Rep 2019; 5:407-410. [PMID: 31453090 PMCID: PMC6701193 DOI: 10.1016/j.hrcr.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | - Rahul N. Doshi
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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26
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Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Rusia A, Doshi RN. Arrhythmias and Cognitive Function: What is the Best Practice? J Innov Card Rhythm Manag 2018; 9:3454-3456. [PMID: 32494481 PMCID: PMC7252848 DOI: 10.19102/icrm.2018.091207] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Akash Rusia
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Address correspondence to: Rahul N. Doshi, MD, FHRS, Division of Cardiology, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Singh JP, Berger RD, Doshi RN, Lloyd M, Moore D, Daoud EG. Rationale and design for ENHANCE CRT: QLV implant strategy for non-left bundle branch block patients. ESC Heart Fail 2018; 5:1184-1190. [PMID: 30264456 PMCID: PMC6300807 DOI: 10.1002/ehf2.12340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
AIMS Historically, cardiac resynchronization therapy (CRT) response in non-left bundle branch block (non-LBBB) patients has been suboptimal in comparison with that observed in left bundle branch block patients. The electrical activation pattern of the left ventricle (LV) is different between these two QRS morphologies. Small non-randomized studies have suggested that targeting the LV wall with greatest electrical delay may be superior to conventional anatomical pacing from the lateral wall in non-LBBB patients. This article outlines the design and rationale of a prospective, randomized, pilot study, which assesses the effect of a non-traditional LV lead implant strategy on the clinical composite score after 12 months of follow-up in a non-LBBB patient population. METHODS All patients will receive an Abbott quadripolar CRT-D system (Quartet 1458Q LV lead with Unify Quadra™, Quadra Assura™ CRT-D or any market-approved CRT-D device with quadripolar pacing capabilities). Patients will be randomized in a 2:1 ratio between a QLV-based implant strategy vs. standard of care. Up to 250 patients will be enrolled in the study. CONCLUSIONS If the primary endpoint is achieved, this study will provide important information about reducing the non-responder rate in non-LBBB patients and provide further evidence for the QLV-based implant strategy.
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Affiliation(s)
| | | | - Rahul N Doshi
- University of Southern California, Los Angeles, CA, USA
| | | | - Douglas Moore
- St John Hospital and Medical Center, Detroit, MI, USA
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- The Ohio State University, Columbus, OH, USA
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30
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Sarcon A, Roy D, Laughrun D, Huntsinger M, Schwartz J, Sohn J, Doshi RN. Left Atrial Appendage Occlusion Complicated by Appendage Perforation Rescued by Device Deployment. J Investig Med High Impact Case Rep 2018; 6:2324709618800108. [PMID: 30214906 PMCID: PMC6134491 DOI: 10.1177/2324709618800108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/05/2018] [Indexed: 12/13/2022] Open
Abstract
The Watchman device is a transcatheter left atrial appendage (LAA) occluding device used in patients with nonvalvular atrial fibrillation (NVAF) and a high CHADS2-VA2SC score who are poor long-term anticoagulation candidates. Pericardial effusion related to device deployment and perforation can be a life-threatening complication. While not common in hands of experienced operators, management may require surgical intervention. Here we present a rare case of LAA perforation, which was corrected by successful repositioning of the device foregoing the need for surgical management.
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Affiliation(s)
- Anna Sarcon
- University of Southern California, Los Angeles, CA, USA
| | - Dipayon Roy
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Jina Sohn
- University of Southern California, Los Angeles, CA, USA
| | - Rahul N Doshi
- University of Southern California, Los Angeles, CA, USA
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Doshi RN. Highlights from Heart Rhythm 2018: Atrial Fibrillation. J Innov Card Rhythm Manag 2018; 9:3317-3320. [PMID: 32477824 PMCID: PMC7252785 DOI: 10.19102/icrm.2018.090907] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Address correspondence to: Rahul N. Doshi, MD, FHRS, Division of Cardiology, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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Doshi RN. Posterior Wall Isolation for Atrial Fibrillation: Excessive or Necessary? J Innov Card Rhythm Manag 2018; 9:3195-3196. [PMID: 32494494 PMCID: PMC7252886 DOI: 10.19102/icrm.2018.090606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck USC School of Medicine, Los Angeles, CA, USA
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Doshi RN. Microelectrodes for Atrial Flutter: Bringing a Scalpel to a Gun Fight. J Innov Card Rhythm Manag 2018; 9:3204-3205. [PMID: 32494495 PMCID: PMC7252883 DOI: 10.19102/icrm.2018.090607] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiovascular Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
- Address correspondence to: Rahul N. Doshi, MD, FHRS, Division of Cardiovascular Medicine, Keck School of Medicine of USC, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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Doshi RN. Three-dimensional Mapping: More Than “Burn as You Learn”. J Innov Card Rhythm Manag 2018; 9:3133-3134. [PMID: 32494490 PMCID: PMC7255413 DOI: 10.19102/icrm.2018.090505] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck USC School of Medicine, Los Angeles, CA, USA
- Address correspondence to: Rahul N. Doshi, MD, FHRS, Keck USC School of Medicine, Division of Cardiology, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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35
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Doshi RN. Cardiac Sarcoidosis: What's Bad for the Ventricle is Bad for the Atria. J Innov Card Rhythm Manag 2018; 9:3022-3024. [PMID: 32479570 PMCID: PMC7252772 DOI: 10.19102/icrm.2018.090205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rahul N. Doshi
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Do K, Chang P, Konecny T, Carlson SK, Tun H, Huntsinger M, Doshi RN. Predictors of Elevated Defibrillation Threshold with the Subcutaneous Implantable Cardioverter-defibrillator. J Innov Card Rhythm Manag 2017; 8:2920-2929. [PMID: 32494435 PMCID: PMC7252865 DOI: 10.19102/icrm.2017.081203] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022] Open
Abstract
There are limited data regarding defibrillation thresholds (DFTs) for the subcutaneous implantable cardioverter-defibrillator (S-ICD), and factors associated with elevated DFTs remain incompletely understood. The objective of this study was to determine the factors associated with elevated DFTs in patients undergoing S-ICD implantation. A retrospective cross-sectional analysis of all patients undergoing S-ICD implantation at our institution between 2013 and 2016 who underwent step-down DFT testing was performed. Factors associated with a higher DFT were analyzed. In total, 56 patients (mean age: 49.3 ± 13.1 years, mean left ventricular ejection rate: 31.1% ± 13.7%) underwent S-ICD implantation in the study period. Full DFT testing was performed in 31 of the 56 patients (55%), with an average DFT of 46.4 joules (J) ± 25.9 J found among this cohort. The DFT was > 65 J in five of the 31 patients (16%). A high DFT was associated with increased body mass index (BMI) (37.7 kg/m2 versus 29.4 kg/m2; p = 0.02) and either increased septal or posterior wall thickness (1.5 cm versus 1.0 cm; p = 0.0003 and 1.4 cm versus 1.1 cm; p= 0.003, respectively). Patients with high DFTs also had higher failed shock impedance values (138 Ω versus 71 Ω; p = 0.005). Renal failure did not appear to affect DFT (51.4 J versus 51.7 J; p = 0.99). BMI, body surface area (BSA), and septal and posterior left ventricular wall thickness predicted elevated DFT on univariate analysis, although findings were not significant with multivariate analysis due to the small sample size. Thus, elevated S-ICD DFT appears to be associated with increased BMI, BSA, and septal or posterior wall thickness. In contrast, dialysis-dependent renal failure is not associated with elevated DFT. Further investigation is necessary in order to better characterize and predict which patients are at-risk for high DFTs.
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Affiliation(s)
- Khuyen Do
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Philip Chang
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Tomas Konecny
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Steven K Carlson
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Han Tun
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Mary Huntsinger
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rahul N Doshi
- Keck USC Medical Center and LAC-USC Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
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Doshi RN. Review on Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2958-2962. [PMID: 32494437 PMCID: PMC7252853 DOI: 10.19102/icrm.2017.081209] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rahul N. Doshi
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Address correspondence to: Rahul N. Doshi, MD, FACC, FHRS, Keck USC School of Medicine, 1510 San Pablo Street., Suite 322, Los Angeles, CA 90033, USA. E-mail:
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Doshi RN. Highlights from Heart Rhythm Society 2017: Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2817-2819. [PMID: 32477775 PMCID: PMC7252679 DOI: 10.19102/icrm.2017.080801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Harris JR, Carlson SK, Wolfson AM, Saxon LA, Doshi RN. Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia. HeartRhythm Case Rep 2017; 3:348-351. [PMID: 28748142 PMCID: PMC5511983 DOI: 10.1016/j.hrcr.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - Rahul N. Doshi
- Division of Cardiology EP Section, University of Southern California Keck School of Medicine, Los Angeles, California
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Affiliation(s)
- Philip M Chang
- Keck School of Medicine of University of Southern California (USC), Keck Medical Center of USC, Los Angeles, California
| | - Rahul N Doshi
- Keck School of Medicine of University of Southern California (USC), Keck Medical Center of USC, Los Angeles, California
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Kita K, Rusia A, Shah S, Zhang Y, Roy D, Nattiv J, Doshi N, Tun H, Clavijo L, Doshi RN. DOES STROKE RISK INFLUENCE THE DECISION TO ANTICOAGULATE POST PERCUTANEOUS CORONARY INTERVENTION PATIENTS WITH ATRIAL FIBRILLATION: A REVIEW OF 3850 PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Al-Asady NA, Dhillon AS, Burton KR, Toubat O, Schwartzman WS, Doshi RN, Matthews RV, Clavijo LC. CRT-800.43 Left Atrial Appendage Occlusion for Atrial Fibrillation: Eligibility in a Typical Oral Anticoagulation Clinic. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carlson SK, Doshi RN. Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke. HeartRhythm Case Rep 2017; 3:18-21. [PMID: 28491759 PMCID: PMC5420035 DOI: 10.1016/j.hrcr.2016.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Steven K Carlson
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rahul N Doshi
- Keck School of Medicine, University of Southern California, Los Angeles, California
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O'Brien DP, Wolfson AM, Fong MW, Doshi RN, Saxon LA, Grazette L, Shavelle DM. Hemodynamic Guided Therapy for Heart Failure: Initial Clinical Experience with the CardioMEMSTMHF System. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Mooney DM, Fung E, Doshi RN, Shavelle DM. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors. Front Physiol 2015; 6:271. [PMID: 26500556 PMCID: PMC4595778 DOI: 10.3389/fphys.2015.00271] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/14/2015] [Indexed: 01/03/2023] Open
Abstract
Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.
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Affiliation(s)
- Deirdre M Mooney
- Cardiovascular Institute, Maine Medical Center Portland, ME, USA ; Department of Medicine, Tufts University School of Medicine Boston, MA, USA
| | - Erik Fung
- Keck Medical Center of USC, University of Southern California Los Angeles, CA, USA ; Department of Medicine, Dartmouth College Hanover, NH, USA ; School of Public Health, Imperial College London London, UK
| | - Rahul N Doshi
- Keck Medical Center of USC, University of Southern California Los Angeles, CA, USA
| | - David M Shavelle
- Keck Medical Center of USC, University of Southern California Los Angeles, CA, USA
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Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
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Affiliation(s)
- Mary Eng Huntsinger
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Roselou Rabara
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Irene Peralta
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
| | - Rahul N. Doshi
- Mary Eng Huntsinger is Cardiac Electrophysiology Nurse Practitioner, Keck Hospital of USC, 1510 San Pablo Blvd, Suite 322, Los Angeles, CA 90033 . Roselou Rabara is Heart Failure Nurse Practitioner, Keck Hospital of USC, Los Angeles, California. Irene Peralta is Registered Nurse, Keck Hospital of USC, Los Angeles, California. Rahul N. Doshi is Director of Electrophysiology, University of Southern California Keck School of Medicine, Los Angeles
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Carlson SK, Doshi RN. Device therapy for acute systolic heart failure and atrial fibrillation. Card Electrophysiol Clin 2015; 7:469-77. [PMID: 26304527 DOI: 10.1016/j.ccep.2015.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with newly diagnosed cardiomyopathy require careful assessment of cause and initiation of treatment before the decision is made to implant an internal cardiac defibrillator. In patients with medicine-refractory atrial fibrillation and cardiomyopathy, atrioventricular node ablation and implantation of a biventricular pacemaker is the therapy of choice when tachycardia-induced cardiomyopathy is suspected and curative therapy is not possible.
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Affiliation(s)
- Steven K Carlson
- Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA
| | - Rahul N Doshi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA.
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Fung E, Järvelin MR, Doshi RN, Shinbane JS, Carlson SK, Grazette LP, Chang PM, Sangha RS, Huikuri HV, Peters NS. Electrocardiographic patch devices and contemporary wireless cardiac monitoring. Front Physiol 2015; 6:149. [PMID: 26074823 PMCID: PMC4444741 DOI: 10.3389/fphys.2015.00149] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/27/2015] [Indexed: 01/19/2023] Open
Abstract
Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable “on-body” ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.
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Affiliation(s)
- Erik Fung
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA ; Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, NH, USA ; Department of Epidemiology and Biostatistics, Medical Research Council Health Protection Agency Centre for Environment and Health, School of Public Health, Imperial College London London, UK ; Digital Health Kitchen, Institute for Digital Health London, UK
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Medical Research Council Health Protection Agency Centre for Environment and Health, School of Public Health, Imperial College London London, UK ; Faculty of Medicine, Center for Life Course Epidemiology, University of Oulu Oulu, Finland ; Biocenter Oulu, University of Oulu Oulu, Finland ; Unit of Primary Care, Oulu University Hospital Oulu, Finland
| | - Rahul N Doshi
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Jerold S Shinbane
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Steven K Carlson
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Luanda P Grazette
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA
| | - Philip M Chang
- Division of Cardiovascular Medicine, University of Southern California and Keck Medical Center of University of Southern California Los Angeles, CA, USA ; Division of Cardiology, Children's Hospital Los Angeles Los Angeles, CA, USA
| | - Rajbir S Sangha
- Department of Medicine, Geisel School of Medicine, Dartmouth College Hanover, NH, USA ; Section of Cardiology, Dartmouth-Hitchcock Medical Center Lebanon, NH, USA
| | - Heikki V Huikuri
- Medical Research Center Oulu, Institute of Clinical Medicine, Oulu University Hospital and University of Oulu Oulu, Finland
| | - Nicholas S Peters
- Digital Health Kitchen, Institute for Digital Health London, UK ; National Heart and Lung Institute, Imperial College London, St Mary's and Hammersmith Hospitals London, UK
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Haberman ZC, Jahn RT, Bose R, Tun H, Shinbane JS, Doshi RN, Chang PM, Saxon LA. Wireless Smartphone ECG Enables Large-Scale Screening in Diverse Populations. J Cardiovasc Electrophysiol 2015; 26:520-6. [PMID: 25651872 DOI: 10.1111/jce.12634] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [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] [Received: 10/09/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser. OBJECTIVE We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed. METHODS In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists. RESULTS Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities. CONCLUSION Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.
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Affiliation(s)
| | - Ryan T Jahn
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rupan Bose
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Han Tun
- Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Rahul N Doshi
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Philip M Chang
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Leslie A Saxon
- Keck School of Medicine of USC, Los Angeles, California, USA
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Doshi RN, Kalahasty G, Lobban JH, Giudici MC, Gold MR, Zhang G, Hayes K, Shome S, Ellenbogen KA. The Left Ventricular Evoked Response Signal in Bipolar LV Pacing Leads of Large Electrode Surface Area. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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