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Della Rocca DG, Magnocavallo M, Gianni C, Mohanty S, Zou F, Tarantino N, Vetta G, Lin AN, Mariani MV, Lavalle C, Anannab A, Zhang X, Bassiouny MA, Gallinghouse GJ, Burkhardt JD, Al-Ahmad A, Horton RP, Di Biase L, Natale A. PO-696-07 LEFT ATRIAL APPENDAGE ANATOMICAL CHANGES FOLLOWING RADIOFREQUENCY-BASED OSTIAL ISOLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.998] [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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Gianni C, Anannab A, Della Rocca DG, Salwan A, MacDonald B, Quintero Mayedo A, Mohanty S, Trivedi C, Di Biase L, Natale A. Recurrent Atrial Fibrillation with Isolated Pulmonary Veins: What to Do. Card Electrophysiol Clin 2021; 12:209-217. [PMID: 32451105 DOI: 10.1016/j.ccep.2020.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Moreover, in those with non-paroxysmal atrial fibrillation or a known higher prevalence of non-pulmonary vein triggers, empirical isolation of the superior vena cava, coronary sinus, and/or left atrial appendage might be performed. In this review, we will focus on ablation of non-pulmonary vein triggers, summarizing our current approach for their mapping and ablation.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Electrophysiology Unit, Department of Cardiovascular Interventions, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | | | - Anu Salwan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; HCA National Medical Director of Cardiac Electrophysiology, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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3
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Della Rocca DG, Horton RP, Di Biase L, Gianni C, Trivedi C, Mohanty S, Anannab A, Magnocavallo M, Chen Q, Tarantino N, Bassiouny M, Lavalle C, Natale VN, Forleo GB, Del Prete A, Van Niekerk CJ, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Lakkireddy D, Gibson DN, Natale A. Incidence of Device-Related Thrombosis in Watchman Patients Undergoing a Genotype-Guided Antithrombotic Strategy. JACC Clin Electrophysiol 2021; 7:1533-1543. [PMID: 34217665 DOI: 10.1016/j.jacep.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to report the incidence of device-related thrombosis (DRT) and thromboembolic (TE) events when an alternative to clopidogrel is prescribed in loss-of-function (LOF) allele carriers of the cytochrome P450 2C19 (CYP2C19) gene. BACKGROUND LOF polymorphisms of the CYP2C19 gene are associated with reduced hepatic bioactivation of clopidogrel. METHODS One thousand two Watchman patients were included. Six hundred forty-five patients underwent CYP2C19 genetic testing; among patients with clopidogrel resistance, clopidogrel was replaced by either prasugrel (pilot cohort) or half dose direct oral anticoagulant ((DOAC)/Group 1), both in combination with aspirin. We compared the incidence of DRT/TE events among genotyped patients and a control group which received standard dual antiplatelet therapy (DAPT) (Group 2; n = 357). All reported events occurred during a timeframe between 45- and 180-day follow-up transesophageal echocardiograms, when the 2 different antithrombotic strategies (genotype-guided vs standard DAPT) were adopted. RESULTS In the pilot cohort (n = 244), bleeding events occurred in 10.2% of patients who received aspirin plus prasugrel, leading to early discontinuation of the prasugrel-based protocol. DOAC Group 1 patients (n = 401), 25.7% were reduced metabolizers, and clopidogrel was replaced by half dose direct oral anticoagulant. DRT was documented in 1 (0.2%) patient of Group 1 and 7 (1.96%) patients of Group 2 (log-rank P value = 0.021). The composite endpoint of DRT/TE events was significantly lower among patients receiving a genotype-guided antithrombotic strategy (0.75% vs 3.1%; log-rank P value = 0.017). CONCLUSIONS In Watchman patients, a genotype-based antithrombotic strategy with aspirin plus half dose DOAC in reduced clopidogrel metabolizers was superior to standard DAPT with respect to DRT/TE events.
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Affiliation(s)
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Nicola Tarantino
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Veronica N Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Giovanni B Forleo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco," Milan, Italy
| | | | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
| | - Douglas N Gibson
- Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, California, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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4
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Chimparlee N, Prechawat S, Khongphatthanayothin A, Mauleekoonphairoj J, Lekchuensakul S, Wongcharoen W, Makarawate P, Sahasatas D, Krittayaphong R, Amnueypol M, Anannab A, Ngarmukos T, Vardhanabhuti S, Sutjaporn B, Wandee P, Veerakul G, Bezzina CR, Poovorawan Y, Nademanee K. Clinical Characteristics of SCN5A p.R965C Carriers: A Common Founder Variant Predisposing to Brugada Syndrome in Thailand. Circ Genom Precis Med 2021; 14:e003229. [PMID: 34092119 DOI: 10.1161/circgen.120.003229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nitinan Chimparlee
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand
| | - Somchai Prechawat
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand
| | - Apichai Khongphatthanayothin
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine (A.K., S.L., Y.P.), Chulalongkorn University, Bangkok, Thailand.,Bangkok Heart Hospital, Bangkok General Hospital, Thailand (A.K., G.V.)
| | - John Mauleekoonphairoj
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand
| | - Sarin Lekchuensakul
- Department of Pediatrics, Faculty of Medicine (A.K., S.L., Y.P.), Chulalongkorn University, Bangkok, Thailand
| | | | - Pattarapong Makarawate
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand (P.M., D.S.)
| | - Dujdao Sahasatas
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand (P.M., D.S.)
| | - Rungroj Krittayaphong
- Department of Medicine, Faculty of Medicine at Siriraj Hospital (R.K.), Mahidol University, Bangkok
| | - Montawatt Amnueypol
- Department of Medicine, Faculty of Medicine at Ramathibodi Hospital (M.A., T.N.), Mahidol University, Bangkok
| | - Alisara Anannab
- Department of Cardiovascular and Intervention, Central Chest Institute of Thailand, Nonthaburi (A.A.)
| | - Tachapong Ngarmukos
- Department of Medicine, Faculty of Medicine at Ramathibodi Hospital (M.A., T.N.), Mahidol University, Bangkok
| | | | - Boosamas Sutjaporn
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand
| | - Pharawee Wandee
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand
| | | | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, the Netherlands (C.R.B.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (C.R.B.)
| | - Yong Poovorawan
- Department of Pediatrics, Faculty of Medicine (A.K., S.L., Y.P.), Chulalongkorn University, Bangkok, Thailand
| | - Koonlawee Nademanee
- Department of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University (N.C., S.P., A.K., J.M., B.S., P.W., K.N.), Chulalongkorn University, Bangkok, Thailand.,Pacific Rim Electrophysiology Research Institute, Bumrungrad Hospital, Bangkok, Thailand (K.N.)
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5
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Mohanty S, Trivedi C, Della Rocca DG, Baqai FM, Anannab A, Gianni C, MacDonald B, Quintero Mayedo A, Bassiouny M, Gallinghouse GJ, Burkhardt JD, Horton R, Al-Ahmad A, Di Biase L, Natale A. Thromboembolic Risk in Atrial Fibrillation Patients With Left Atrial Scar Post-Extensive Ablation: A Single-Center Experience. JACC Clin Electrophysiol 2020; 7:308-318. [PMID: 33736751 DOI: 10.1016/j.jacep.2020.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation. BACKGROUND Late gadolinium enhancement-cardiac magnetic resonance studies have reported a direct association between pre-ablation left atrial scar and thromboembolic events in patients with AF. METHODS Consecutive patients with AF were classified into 2 groups based on the type of ablation performed at the first procedure. Group 1 involved limited ablation (isolation of pulmonary veins, left atrial posterior wall, and superior vena cava); and group 2 involved extensive ablation (limited ablation + ablation of nonpulmonary vein triggers from all sites except left atrial appendage). During the repeat procedure, post-ablation scar (region with bipolar voltage amplitude <0.5 mV) was identified by using 3-dimensional voltage mapping. RESULTS A total of 6,297 patients were included: group 1, n = 1,713; group 2, n = 4,584. Group 2 patients were significantly older and had more nonparoxysmal AF. Nineteen (0.3%) thromboembolic events were reported after the first ablation procedure: 9 (1.02%) in group 1 and 10 (0.61%) in group 2 (p = 0.26). At the time of the event, all 19 patients were experiencing arrhythmia. Median time to stroke was 14 (interquartile range: 9 to 20) months in group 1 and 14.5 (interquartile range: 8 to 18) months in group 2. Post-ablation scar data were derived from 2,414 patients undergoing repeat ablation. Mean scar area was detected as 67.1 ± 4.6% in group 2 and 34.9 ± 8.8% in group 1 at the redo procedure (p < 0.001). CONCLUSIONS Differently from the cardiac magnetic resonance-detected pre-ablation scar, scar resulting from extensive ablation was not associated with increased risk of stroke compared with that from the limited ablation.
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Affiliation(s)
| | | | | | | | | | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | | | | | | | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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6
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Della Rocca DG, Horton RP, Tarantino N, Van Niekerk CJ, Trivedi C, Chen Q, Mohanty S, Anannab A, Murtaza G, Akella K, Gianni C, Bassiouny M, Ahmadian-Tehrani A, Al-Ahmad A, Burkhardt JD, Natale VN, Price M, Gallinghouse GJ, Gibson DN, Lakkireddy D, Di Biase L, Natale A. Use of a Novel Septal Occluder Device for Left Atrial Appendage Closure in Patients With Postsurgical and Postlariat Leaks or Anatomies Unsuitable for Conventional Percutaneous Occlusion. Circ Cardiovasc Interv 2020; 13:e009227. [DOI: 10.1161/circinterventions.120.009227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Interventional therapies aiming at excluding the left atrial appendage (LAA) from systemic circulation have been established as a valid alternative to oral anticoagulation in patients at high thromboembolic risk. However, their efficacy on stroke prophylaxis may be compromised owing to incomplete LAA closure. Additionally, the need for an alternative thromboembolic prevention may remain unmet in patients with contraindications to oral anticoagulation whose appendage anatomy is unsuitable for some conventional devices commercially available. We aimed at evaluating the feasibility of LAA closure with the novel Gore Cardioform Septal Occluder in patients with incomplete appendage ligation or anatomic features which do not meet the manufacturer’s requirements for Watchman deployment.
Methods:
Twenty-one consecutive patients (mean age: 72±6 years; 85.7% males; CHA
2
DS
2
-VASc: 4.5±1.4; HAS-BLED: 3.6±1.0) were included. Transesophageal echocardiography was performed within 2 months to assess for residual LAA patency.
Results:
Fourteen patients had incomplete LAA closure following surgical (n=6) or Lariat ligation (n=8). In 7 patients with an appendage anatomy unsuitable for Watchman deployment, the mean maximal landing zone size and LAA depth were 14.4±1.3 and 18.6±2.8 mm. Successful Cardioform Septal Occluder deployment was achieved in all patients. No peri-procedural complications were documented. Procedure and fluoroscopy times were 46±13 and 14±5 minutes. Follow-up transesophageal echocardiography after 58±9 days revealed complete LAA closure in all patients.
Conclusions:
Transcatheter LAA closure via a Cardioform Septal Occluder device might be a valid alternative in patients with residual leaks following failed appendage ligation or whose LAA anatomy does not meet the minimal anatomic criteria to accommodate a Watchman device.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- Domenico G. Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Rodney P. Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Department of Biomedical Engineering, Cockrell School of Engineering (R.P.H.), University of Texas, Austin
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (N.T., L.D.B.)
| | | | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Department of Cardiopulmonary Function Test, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, China (Q.C.)
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi (A.A.)
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute at HCA Midwest Health (G.M., K.A., D.L.)
| | - Krishna Akella
- Kansas City Heart Rhythm Institute at HCA Midwest Health (G.M., K.A., D.L.)
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Ashkan Ahmadian-Tehrani
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Division of Internal Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio (A.A.-T.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Veronica N. Natale
- Department of Pediatrics, Charlotte R. Bloomberg Children’s Center, Johns Hopkins University, Baltimore, MD (V.N.N.)
| | - Matthew Price
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (C.J.V.N., M.P., D.N.G., A.N.)
| | - G. Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
| | - Douglas N. Gibson
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (C.J.V.N., M.P., D.N.G., A.N.)
| | | | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Department of Internal Medicine, Dell Medical School (L.D.B.), University of Texas, Austin
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (N.T., L.D.B.)
- Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B., A.N.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (D.G.D.R., R.P.H., C.T., Q.C., S.M., A.A., C.G., M.B., A.A.-A., J.D.B., G.J.G., L.D.B., A.N.)
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA (C.J.V.N., M.P., D.N.G., A.N.)
- Department of Clinical and Experimental Medicine, University of Foggia, Italy (L.D.B., A.N.)
- Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)
- Division of Cardiology, Stanford University, CA (A.N.)
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7
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Tarantino N, Della Rocca DG, Faggioni M, Zhang XD, Mohanty S, Anannab A, Canpolat U, Ayhan H, Bassiouny M, Sahore A, Aytemir K, Sarcon A, Forleo GB, Lavalle C, Horton RP, Trivedi C, Al-Ahmad A, Romero J, Burkhardt DJ, Gallinghouse JG, Di Biase L, Natale A. Epicardial Ablation Complications. Card Electrophysiol Clin 2020; 12:409-418. [PMID: 32771194 DOI: 10.1016/j.ccep.2020.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The percutaneous epicardial approach has become an adjunctive tool for electrophysiologists to treat disparate cardiac arrhythmias, including accessory pathways, atrial tachycardia, and particularly ventricular tachycardia. This novel technique prompted a strong impulse to perform epicardial access as an alternative strategy for pacing and defibrillation, left atrial appendage exclusion, heart failure with preserved ejection fraction, and genetically engineered tissue delivery. However, because of the incremental risk of major complications compared with stand-alone endocardial ablation, it is still practiced in a limited number of highly experienced centers across the world.
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Affiliation(s)
- Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 110 East 210th Street, Bronx, NY 10467, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA.
| | - Michela Faggioni
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Xiao-Dong Zhang
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 110 East 210th Street, Bronx, NY 10467, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Ugur Canpolat
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA; Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Huseyin Ayhan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA; Department of Cardiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Anu Sahore
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara 06100, Turkey
| | - Annahita Sarcon
- Division of Electrophysiology, University of California San Francisco, San Francisco, CA, USA
| | - Giovanni B Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco", Milano, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Policlinico Street, Roma 155-00161, Italy
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 110 East 210th Street, Bronx, NY 10467, USA
| | - David J Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Joseph G Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Luigi Di Biase
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 110 East 210th Street, Bronx, NY 10467, USA; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 919 East 32nd Street, Austin, TX 78705, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA
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8
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Della Rocca DG, Tarantino N, Trivedi C, Mohanty S, Anannab A, Salwan AS, Gianni C, Bassiouny M, Al‐Ahmad A, Romero J, Briceño DF, Burkhardt JD, Gallinghouse GJ, Horton RP, Di Biase L, Natale A. Non‐pulmonary vein triggers in nonparoxysmal atrial fibrillation: Implications of pathophysiology for catheter ablation. J Cardiovasc Electrophysiol 2020; 31:2154-2167. [DOI: 10.1111/jce.14638] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | | | - Alisara Anannab
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Department of Cardiovascular InterventionCentral Chest Institute of ThailandNonthaburi Thailand
| | - Anu S. Salwan
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Carola Gianni
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Amin Al‐Ahmad
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - David F. Briceño
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | | | - Rodney P. Horton
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Arrhythmia Services, Department of Medicine, Montefiore Medical CenterAlbert Einstein College of MedicineBronx New York
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggia Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia InstituteSt. David's Medical CenterAustin Texas
- Interventional ElectrophysiologyScripps ClinicLa Jolla California
- Department of Cardiology, MetroHealth Medical CenterCase Western Reserve University School of MedicineCleveland Ohio
- Division of CardiologyStanford UniversityStanford California
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9
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Gianni C, Canby RC, Anannab A, Della Rocca DG, Natale A, Al-Ahmad A. The Subtle Journey of a Right Atrial Lead. JACC Case Rep 2020; 2:902-906. [PMID: 34317378 PMCID: PMC8302113 DOI: 10.1016/j.jaccas.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/26/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Abstract
We report an unusual case of subacute right atrial perforation by a screw-in pacemaker lead that migrated into the right lung causing hemopneumothorax 2 weeks after the procedure. After transvenous simple manual traction and minithoracotomy repair of the right atrial wall, the lead was repositioned without any complications. (Level of Difficulty: Beginner.)
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10
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Gianni C, Anannab A, Sahore Salwan A, Della Rocca DG, Natale A, Horton RP. Closure of the left atrial appendage using percutaneous transcatheter occlusion devices. J Cardiovasc Electrophysiol 2020; 31:2179-2186. [PMID: 32249473 DOI: 10.1111/jce.14471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/21/2020] [Indexed: 12/28/2022]
Abstract
Closure of the left atrial appendage (LAA) using percutaneous transcatheter occlusion devices is used for stroke prevention as an alternative for patients with a high risk and contraindications for long-term oral anticoagulation use. In this manuscript, we will discuss the practical aspects of four among the available devices that provide percutaneous intravascular closure of the LAA: Watchman, Amulet, WaveCrest, and LAmbre.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Electrophysiology Unit, Department of Cardiovascular Interventions, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Anu Sahore Salwan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,HCA National Medical Director of Cardiac Electrophysiology, USA.,Scripps Clinic, La Jolla, California.,MetroHealth Medical Center, Cleveland, Ohio
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Biomedical Engineering, Austin, Texas
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11
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Anannab A, Gianni C, Della Rocca DG, Sahore Salwan A, Natale A, Al-Ahmad A. Catheter ablation is preferred over surgery for persistent atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2168-2171. [PMID: 32293063 DOI: 10.1111/jce.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022]
Abstract
There are important limitations that can hinder outcomes of surgical ablation in nonparoxysmal patients with atrial fibrillation (AF), which is the typical AF population undergoing concomitant cardiac surgery for valve or ischemic heart disease. Incomplete lesions with recovered conduction or gaps as well as arrhythmias originating from areas not targeted by surgical ablation are commonly seen at the time of recurrence. Therefore, while it might be reasonable to perform AF surgery in this cohort, it is important to know these limitations and establish adequate postoperative rhythm monitoring to detect recurrences, which can be effectively addressed by catheter ablation.
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Affiliation(s)
- Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Electrophysiology Unit, Department of Cardiovascular Interventions, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Anu Sahore Salwan
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,HCA National Medical Director of Cardiac Electrophysiology, USA.,Interventional Electrophysiology, Scripps Clinic, La Jolla, California.,MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
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12
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Mohanty S, Trivedi C, Rocca DD, Gianni C, Bassiouny M, Salwan A, Anannab A, Macdonald B, Mayedo A, Burkhardt J, Gallinghouse G, Al-Ahmad A, Horton R, Di Biase L, Natale A. STROKE RISK IN PATIENTS WITH PAROXYSMAL AND PERSISTENT ATRIAL FIBRILLATION TREATED WITH ANTI-ARRHYTHMIC DRUGS VS. CATHETER ABLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Sahore A, Della Rocca DG, Anannab A, Mohanty S, Akella K, Murtaza G, Trivedi C, Gianni C, Chen Q, Bassiouny M, Ahmadian-Tehrani A, Macdonald B, Al-Ahmad A, Tarantino N, Cirone D, Horton RP, Romero J, Lakkireddy D, Di Biase L, Natale A. Clinical Implications and Management Strategies for Left Atrial Appendage Leaks. Card Electrophysiol Clin 2020; 12:89-96. [PMID: 32067651 DOI: 10.1016/j.ccep.2019.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Left atrial appendage (LAA) is the dominant source of systemic thromboembolic (TE) events in patients with nonvalvular atrial fibrillation (AF). In patients with significant bleeding risk, various LAA exclusion strategies have been developed as an alternative to pharmacologic TE prophylaxis. Nevertheless, in a relatively small percentage of patients, incomplete LAA closure can be documented, either at the time of procedure or during follow-up. This persistent patency can potentially jeopardize an effective stroke prophylaxis. Hereby, we report an update on the current clinical implications of LAA leaks and how to manage them.
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Affiliation(s)
- Anu Sahore
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Alisara Anannab
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Cardiovascular Intervention, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Krishna Akella
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Qiong Chen
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Ashkan Ahmadian-Tehrani
- Department of Medicine, Division of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bryan Macdonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Nicola Tarantino
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Jorge Romero
- Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA
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