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Leelaviwat N, Kewcharoen J, Trongtorsak A, Thangjui S, Del Rio-Pertuz G, Abdelnabi M, Navaravong L. Association between periodontal disease and heart failure: a systematic review and meta-analysis. Acta Cardiol 2024; 79:405-409. [PMID: 37768121 DOI: 10.1080/00015385.2023.2259192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Natnicha Leelaviwat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sittinun Thangjui
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | | | - Mahmoud Abdelnabi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT, USA
- Intermountain Heart Institute - Utah Valley, Provo, UT, USA
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2
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Waitayangkoon P, Leesutipornchai T, Techasatian W, Aiumtrakul N, Tanariyakul M, Arayangkool C, Kanthajan T, Nagamine T, Kewcharoen J. Urate-lowering therapy is associated with a reduced risk of arrhythmias: a systematic review and meta-analysis. J Rheum Dis 2024; 31:108-115. [PMID: 38559794 PMCID: PMC10973354 DOI: 10.4078/jrd.2023.0059] [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: 09/18/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 04/04/2024]
Abstract
Objective While urate-lowering therapy (ULT) is linked to increased cardioprotective benefits on primary prevention of cardiovascular events such myocardial infarction or heart failure, little is known regarding their effects on arrhythmia risk. The purpose of this study was to investigate the relationship between incident arrhythmias and ULT. Methods We searched MEDLINE and Embase from inception to May 2023. Included studies were randomized controlled trials and cohort studies that compared the risk of cardiac arrhythmias among ULT users with non-ULT users. Results A total of 12,420 patients from five studies were analyzed, comprising 7,359 subjects in the ULT group and 5,061 subjects in the non-ULT group. Our results showed that ULT users had significant reductions in the risk of arrhythmias (pooled relative risk [RR] 0.82, 95% confidence interval [CI] 0.74~0.92, p<0.001, I2=0.0%) compared to non-ULT users. Subgroup analysis did not show that ULT users had a significant reduced risk of atrial fibrillation (pooled RR 0.76, 95% CI 0.54~1.05, p=0.096 with I2=15.4%) compared to non-ULT users. Conclusion ULT is associated with lower risk of overall arrhythmias. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Palapun Waitayangkoon
- Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
| | | | - Witina Techasatian
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | | | | | | | | | - Todd Nagamine
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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Jaroonpipatkul S, Trongtorsak A, Kewcharoen J, Thangjui S, Pokawattana A, Navaravong L. Clarifying the association between high-sensitivity C-reactive protein and atrial fibrillation recurrence: A comprehensive response. J Arrhythm 2024; 40:391-392. [PMID: 38586834 PMCID: PMC10995582 DOI: 10.1002/joa3.13016] [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] [Received: 01/15/2024] [Accepted: 02/21/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Surachat Jaroonpipatkul
- Division of CardiologyCollege of Medicine, Rajavithi Hospital, Rangsit UniversityBangkokThailand
| | - Angkawipa Trongtorsak
- Division of Cardiovascular MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Jakrin Kewcharoen
- Division of Cardiovascular MedicineLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Sittinun Thangjui
- West Virginia University Heart and Vascular InstituteMorgantownWest VirginiaUSA
| | - Apichai Pokawattana
- Division of CardiologyCollege of Medicine, Rajavithi Hospital, Rangsit UniversityBangkokThailand
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Kewcharoen J, Shah K, Bhardwaj R, Turagam MK, Contractor T, Mandapati R, Lakkireddy D, Garg J. Catheter-related and clinical complications associated with contact force-sensing irrigated ablation catheter. Heart Rhythm 2024:S1547-5271(24)02258-6. [PMID: 38548124 DOI: 10.1016/j.hrthm.2024.03.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, Iowa
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California.
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5
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. New-generation electronic appliances and cardiac implantable electronic devices: a systematic literature review of mechanisms and in vivo studies. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01777-z. [PMID: 38443707 DOI: 10.1007/s10840-024-01777-z] [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: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) functions are susceptible to electromagnetic interference (EMI) from electromagnetic fields (EMF). Data on EMI risks from new-generation electronic appliances (EA) are limited. OBJECTIVE We performed a systematic literature review on the mechanisms of EMI, current evidence, and recently published trials evaluating the effect of EMF on CIEDs from electric vehicles (EV), smartphone, and smartwatch technology and summarize its safety data. METHODS Electronic databases, including PubMed and EMBASE, were searched for in vivo studies evaluating EMF strength and incidence between CIEDs and commercial EVs, new-generation smartphones, and new-generation smartwatches. RESULTS A total of ten studies (three on EVs, five on smartphones, one on smartphones, one on smartphones and smartwatches) were included in our systematic review. There was no report of EMI incidence associated with EVs or smartwatches. Magnet-containing smartphones (iPhone 12) can cause EMI when placed directly over CIEDs - thereby triggering the magnet mode; otherwise, no report of EMI was observed with other positions or smartphone models. CONCLUSION Current evidence suggests CIED recipients are safe from general interaction with EVs/HEVs, smartphones, and smartwatches. Strictly, results may only be applied to commercial brands or models tested in the published studies. There is limited data on EMI risk from EVs wireless charging and smartphones with MagSafe technology.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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6
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Minhas AMK, Kewcharoen J, Hall ME, Warraich HJ, Greene SJ, Shapiro MD, Michos ED, Sauer AJ, Abramov D. Temporal Trends in Substance Use and Cardiovascular Disease-Related Mortality in the United States. J Am Heart Assoc 2024; 13:e030969. [PMID: 38197601 PMCID: PMC10926834 DOI: 10.1161/jaha.123.030969] [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: 06/19/2023] [Accepted: 10/25/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND There are limited data on substance use (SU) and cardiovascular disease (CVD)-related mortality trends in the United States. We aimed to evaluate SU+CVD-related deaths in the United States using the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research database. METHODS AND RESULTS The Multiple Cause-of-Death Public Use record death certificates were used to identify deaths related to both SU and CVD. Crude, age-adjusted mortality rates, annual percent change, and average annual percent changes with a 95% CI were analyzed. Between 1999 and 2019, there were 636 572 SU+CVD-related deaths (75.6% men, 70.6% non-Hispanic White individuals, 65% related to alcohol). Age-adjusted mortality rates per 100 000 population were pronounced in men (22.5 [95% CI, 22.6-22.6]), American Indian or Alaska Native individuals (37.7 [95% CI, 37.0-38.4]), nonmetropolitan/rural areas (15.2 [95% CI, 15.1-15.3]), and alcohol-related death (9.09 [95% CI, 9.07 to 9.12]). The overall SU+CVD-related age-adjusted mortality rates increased from 9.9 (95% CI, 9.8-10.1) in 1999 to 21.4 (95% CI, 21.2-21.6) in 2019 with an average annual percent change of 4.0 (95% CI, 3.7-4.3). Increases in SU+CVD-related average annual percent change were noted across all subgroups and were pronounced among women (4.8% [95% CI, 4.5-5.1]), American Indian or Alaska Native individuals, younger individuals, nonmetropolitan areas, and cannabis and psychostimulant users. CONCLUSIONS There was a prominent increase in SU+CVD-related mortality in the United States between 1999 and 2019. Women, non-Hispanic American Indian or Alaska Native individuals, younger individuals, nonmetropolitan area residents, and users of cannabis and psychostimulants had pronounced increases in SU+CVD mortality.
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Affiliation(s)
| | - Jakrin Kewcharoen
- Division of CardiologyLoma Linda University Medical CenterLoma LindaCA
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | | | | | - Michael D. Shapiro
- Cardiovascular MedicineWake Forest University School of MedicineWinston SalemNC
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | | | - Dmitry Abramov
- Division of CardiologyLoma Linda University Medical CenterLoma LindaCA
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Garg J, Kewcharoen J, Contractor T, Mandapati R, Bhardwaj R. Intracardiac Echocardiogram from Persistent Left Superior Vena Cava. Am J Cardiol 2024; 210:225-228. [PMID: 38682714 DOI: 10.1016/j.amjcard.2023.10.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 05/01/2024]
Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California.
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
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Kewcharoen J, Shah K, Mandapati R, Bhardwaj R, Turagam M, Contractor T, Lakkireddy D, Garg J. Safety of oral anticoagulants in patients undergoing left ventricular arrhythmia ablation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01731-5. [PMID: 38158513 DOI: 10.1007/s10840-023-01731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St., Loma Linda, CA, 92354, USA
| | - Kuldeep Shah
- Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, IA, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St., Loma Linda, CA, 92354, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St., Loma Linda, CA, 92354, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St., Loma Linda, CA, 92354, USA
| | | | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, 11234 Anderson St., Loma Linda, CA, 92354, USA.
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Leelaviwat N, Kewcharoen J, Poomprakobsri K, Trongtorsak A, Del Rio‐Pertuz G, Abdelnabi M, Benjanuwattra J, Navaravong L. Periodontal disease and risk of atrial fibrillation or atrial flutter: A systematic review and meta-analysis. J Arrhythm 2023; 39:992-996. [PMID: 38045467 PMCID: PMC10692853 DOI: 10.1002/joa3.12921] [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: 06/12/2023] [Revised: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 12/05/2023] Open
Abstract
Background We conducted a study to evaluate the risk of atrial fibrillation (AF) and atrial flutter (AFL) in periodontal disease (PD) patients. Methods Cohort studies that evaluate the risk of AF or AFL in PD patients were included. The risk was expressed in the pooled odd ratio (OR) with 95% confidence interval (CI). Results A total of four cohort studies were included. We found that patients with PD have a significantly higher risk of AF/AFL compared to those without PD with the pooled OR of 1.33 (95% CI 1.29-1.38; p = 0.357, I 2 = 3.0%). Conclusions PD increases the risk of AF and AFL.
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Affiliation(s)
- Natnicha Leelaviwat
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | - Jakrin Kewcharoen
- Division of CardiologyLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Kiddee Poomprakobsri
- Advanced Education Program in Implant DentistryLoma Linda University School of DentistryLoma LindaCaliforniaUSA
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Mahmoud Abdelnabi
- Department of Internal MedicineTexas Tech University Health Sciences CenterLubbockTexasUSA
| | | | - Leenhapong Navaravong
- Division of Cardiovascular MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
- Intermountain Heart Institute—Utah ValleyProvoUtahUSA
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Kewcharoen J, Basharat SA, Fobb-Mitchell I, Chatta P, Diep B, Ramsingh D, Bhardwaj R, Contractor T, Mandapati R, Garg J. Racial and Ethnic Disparities in Patients Who Underwent Leadless Pacemaker Implantation. Am J Cardiol 2023; 208:153-155. [PMID: 37839459 DOI: 10.1016/j.amjcard.2023.09.072] [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: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
Evidence regarding racial disparities in leadless pacemaker (LP) utilization and outcomes is limited. We aimed to explore ethnicity-based disparities in LP utilization and clinical outcomes of patients who underwent LP implantation. All consecutive patients who underwent LP between January 2019 and January 2023 at our institution were included. Charts were reviewed for baseline characteristics and clinical outcomes. The primary outcomes were procedure-related complications, cardiac rehospitalization, worsening heart failure (HF) or HF hospitalization, and all-cause mortality. All statistical analyses were performed using SPSS Statistics 22 (IBM Corp., Armonk, NY). The p <0.05 was considered statistically significant. A total of 196 adult patients underwent LP implantation during the study period (48% Caucasians, 36.2% Hispanic, 8.2% Asians, and 7.7% African-American). The groups were balanced with respect to baseline demographics, clinical characteristics, and procedure-related complications. During the median follow-up of 104 days (interquartile range 24 to 382), no statistically significant differences were observed in worsening HF or HF hospitalization or all-cause mortality among the ethnic groups. After multivariable logistic regression, Asian individuals had higher odds of cardiac readmissions (odds ratio 4.1, 95% confidence interval 1.4 to 12.3, p = 0.01). Patients from racial and ethnic minorities face significant inequities in arrhythmia care, including patients who have undergone LP implantation. Awareness and a system-based approach (understanding cultural preferences, effective application of evidence-based guidelines, and population-based policies) are crucial to lessen disparities in health care among minorities.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Sohaib A Basharat
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Ingrid Fobb-Mitchell
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Payush Chatta
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Brian Diep
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Health, Loma Linda, California
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California.
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Gozun M, Nishimura Y, Techasatian W, Pham A, Benavente K, Kewcharoen J. The risk of new heart failure associated with protease inhibitor: Systematic scoping review. Int J STD AIDS 2023; 34:1053-1061. [PMID: 37608625 DOI: 10.1177/09564624231196599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Protease inhibitors (PIs) have contributed to the long-term survival of persons with human immunodeficiency virus (PHIV). While there is a concern linking protease inhibitors to an increased risk of heart failure (HF), the evidence linking protease inhibitors and heart failure has been uncertain. METHODS Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for peer-reviewed articles using keywords including "protease inhibitor," "heart failure," and "human immunodeficiency virus" from their inception to December 21, 2022. RESULTS Five articles, including three observational studies and two randomized controlled trials, were included in the review. While protease inhibitors seem to be associated with atherosclerotic cardiovascular disease through their effects on metabolic markers, there is scarce evidence suggesting a direct association between protease inhibitors and heart failure. Although one study showed a possible correlation between protease inhibitor use and lower left ventricular ejection fraction and increased heart failure admission, the results were subject to confounders, and participants had poor medication adherence. CONCLUSION Although current data are conflicting, there could be an association between PIs and HF in PHIV. Future prospective studies are warranted to evaluate the incidence of heart failure stratified on the generation of PIs and with adjustment for other metabolic risk factors.
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Affiliation(s)
- Maan Gozun
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Witina Techasatian
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Andrew Pham
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kevin Benavente
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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Techasatian W, Nishimura Y, Tanariyakul M, Morihara C, Arayangkool C, Settle A, Aiumtrakul N, Kewcharoen J. Intravenous Iron for Heart Failure: Updated Systematic Review and Meta-Analysis. Angiology 2023:33197231213181. [PMID: 37916421 DOI: 10.1177/00033197231213181] [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: 11/03/2023]
Abstract
While the administration of intravenous (IV) iron to those with heart failure has been implicated to be associated with a possible reduction in hospitalizations and improvement in symptoms, a recent large multicenter trial only showed modest benefits in reducing hospitalization, necessitating the updated systematic review. We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE database until January 9, 2023. Outcomes included total heart failure hospitalizations, first heart failure hospitalization, six-minute walk test (6MWT) distance, and incidence of infection. There were 13 studies with 3410 participants (1,790 with IV iron). Pooled analysis that reported the incidence of cardiovascular death showed that patients with IV iron did not have significantly lower odds of cardiovascular death or first heart failure hospitalization. In contrast, those who received IV iron had significantly lower total heart failure hospitalization (pooled odds ratio (OR) 0.63, 95% confidence interval (CI) 0.44-0.90, I2 59.0%, P = .017) and a composite of cardiovascular death and first heart failure hospitalization (pooled OR 0.55, 95% CI 0.47-0.64, I2 0%, P = .656). While the efficacy is modest, IV iron therapy could be associated with reduced hospitalization for heart failure without significant adverse events.
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Affiliation(s)
- Witina Techasatian
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Manasawee Tanariyakul
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Clarke Morihara
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Chinnawat Arayangkool
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Alexander Settle
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Noppawit Aiumtrakul
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
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Benjanuwattra J, Kewcharoen J, Phinyo P, Swusdinaruenart S, Abdelnabi M, Del Rio-Pertuz G, Leelaviwat N, Navaravong L. High-risk phenotypes of arrhythmic mitral valve prolapse: a systematic review and meta-analysis. Acta Cardiol 2023; 78:1012-1019. [PMID: 37358248 DOI: 10.1080/00015385.2023.2227487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/01/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is associated with aggravated risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden cardiac death (SCD). There is a lack of specific guideline recommendation regarding risk stratification and management, despite multiple proposed high-risk phenotypes. We performed systematic review and meta-analysis to evaluate high-risk phenotypes for malignant arrhythmias in patients with MVP. METHODS We comprehensively searched the databases of MEDLINE, SCOPUS, and EMBASE from inception to April 2023. Included studies were cohort and case-control comparing between MVP patients with and without VT, VF, cardiac arrest, ICD placement, or SCD. Data from each study were combined using the random-effects. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS Nine studies from 1985 to 2023 were included involving 2,279 patients with MVP. We found that T-wave inversion (OR 2.52; 95% CI: 1.90-3.33; p < 0.001), bileaflet involvement (OR 2.28; 95% CI: 1.69-3.09; p < 0.001), late gadolinium enhancement (OR 17.05; 95% CI: 3.41-85.22; p < 0.001), mitral annular disjunction (OR 3.71; 95% CI: 1.63-8.41; p < 0.002), and history of syncope (OR 6.96; 95% CI: 1.05-46.01; p = 0.044), but not female (OR 0.96; 95% CI: 0.46-2.01; p = 0.911), redundant leaflets (OR 4.30; 95% CI: 0.81-22.84; p = 0.087), or moderate-to-severe mitral regurgitation (OR 1.24; 95% CI: 0.65-2.37; p = 0.505), were associated with those events. CONCLUSION Bileaflet prolapse, T-wave inversion, mitral annular disjunction, late gadolinium enhancement, and history of syncope are high-risk phenotypes among population with MVP. Further research is needed to validate the risk stratification model and justify the role of primary prophylaxis against malignant arrhythmias.
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Affiliation(s)
- Juthipong Benjanuwattra
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Thailand
| | | | - Mahmoud Abdelnabi
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gaspar Del Rio-Pertuz
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Natnicha Leelaviwat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, UT, USA
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14
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. Adverse events associated with amplatzer left atrial appendage occlusion delivery system: A Food and Drug Administration MAUDE database study. J Cardiovasc Electrophysiol 2023; 34:2382-2385. [PMID: 37679961 DOI: 10.1111/jce.16053] [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: 05/11/2023] [Revised: 08/04/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Dual occlusive closure mechanism (disc and lobe type), Amulet device (Abbott; a second-generation device that has replaced Amplatzer Cardiac Plug) was approved by the Food and Drug Administration (FDA) in August 2021 for percutaneous left atrial appendage occlusion (LAAO). However, real-world safety data on the delivery system (Amplatzer Cardiac Plug and Amplatzer Amulet device) are lacking. OBJECTIVE We sought to assess the type of adverse events associated with the Amplatzer LAAO delivery system using the FDA Manufacturer and User Facility Device Experience (MAUDE) database. METHODS A MAUDE database search was conducted on March 31, 2023, for reports received between February 2013 and March 2023 to capture all adverse events. RESULTS A total of 59 adverse events were reported, of which 58 were sheath-related events, and one was a wire-related event. The most commonly encountered issue was air embolism (19%, 11 events), followed by sheath thrombosis (13.8%, eight events, two of which were also associated with device thrombosis), kinked sheath (10.3%, six events), and sheath deformation (8.6%, five events). Patient-related adverse events included pericardial effusion requiring pericardiocentesis (22.4%, 13 events), vascular complications (20.7%, 12 events), and device dislodgement (5.2%, three events). CONCLUSION LAAO-related adverse events are increasingly being reported using the Amplatzer LAAO delivery sheath. It is anticipated that improvements in device technology, the advent of steerable sheaths, and operator experience will minimize these complications.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Division of Cardiology, Cardiac Arrhythmia Service, MercyOne Siouxland Heart and Vascular Center, Sioux City, Iowa, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Mohit K Turagam
- Division of Cardiology, Cardiac Arrhythmia Service, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
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15
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Kewcharoen J, Bhardwaj R, Garg J. The missing vector - TactiFlex sensor enabled ablation catheter. Pacing Clin Electrophysiol 2023. [PMID: 37885380 DOI: 10.1111/pace.14861] [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: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
New ablation catheters have continuously developed to improve the safety and efficacy of ablation procedures. The TactiFlex Ablation Catheter Sensor Enabled (Abbott, Minneapolis, MN) is a novel open-irrigation radiofrequency ablation catheter that has contact force-sensing technology and flexible tip, allowing real-time contact force assessment with directionality. This case report reported a loss of contact force vector and directionality with the TactiFlex SE ablation catheter during de novo atrial fibrillation (AF) ablation.
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Affiliation(s)
- Jakrin Kewcharoen
- Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Rahul Bhardwaj
- Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
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16
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Rattanawong P, Mattanapojanat N, Mead-Harvey C, Van Der Walt C, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Putthapiban P, Chintanavilas K, Sahasthas D, Ngarmukos T, Thakkinstian A, Sorajja D, Makarawate P, Shen WK. Predicting arrhythmic event score in Brugada syndrome: Worldwide pooled analysis with internal and external validation. Heart Rhythm 2023; 20:1358-1367. [PMID: 37355026 DOI: 10.1016/j.hrthm.2023.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). Risk predictive scores were previously developed with various performances. OBJECTIVE The purpose of this study was to create a novel score-Predicting Arrhythmic evenT (PAT)-with internal and external validation. METHODS A systematic review was performed to identify risk factors for MAE. The odds ratios (ORs) of each factor were pooled across studies. The PAT scoring scheme was developed based on pooled ORs. The PAT score was internally validated with published 105 Asian patients (follow-up 8.0 ± 4.1 [SD] years) and externally validated with unpublished 164 multiracial patients (82.3% White, 14.6% Asian, 3.2% Black; mean follow-up 8.0 ± 6.9 years) with Brugada syndrome. Performances were assessed and compared with previous scores using receiver operating characteristic curve (ROC) analysis. RESULTS Sixty-seven studies published between 2002 and 2022 from 26 countries (7358 patients) were included. Pooled ORs were estimated, indicating that 15 of 23 risk factors were significant. The PAT score was then developed accordingly. The PAT score had significantly better discrimination (ROC 0.9671) than the BRUGADA-RISK score (ROC 0.7210; P = .006), Shanghai Score System (ROC 0.7079; P = .003), and Sieira et al score (ROC 0.8174; P = .026) in an external validation cohort. PAT score ≥ 10 predicted the first MAE with 95.5% sensitivity and 89.1% specificity (ROC 0.9460) and the recurrent MAE (ROC 0.7061) with 15.4% sensitivity and 93.3% specificity. CONCLUSION The PAT score was shown to be useful in predicting MAE for primary prevention in patients with Brugada syndrome.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Carolyn Mead-Harvey
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - Jakrin Kewcharoen
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Prapaipan Putthapiban
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Kumpol Chintanavilas
- Cardiology Department, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Tachapong Ngarmukos
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
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17
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Jaroonpipatkul S, Trongtorsak A, Kewcharoen J, Thangjui S, Pokawattana A, Navaravong L. High sensitivity C reactive protein levels and atrial fibrillation recurrence after catheter ablation for atrial fibrillation: A systematic review and meta-analysis. J Arrhythm 2023; 39:515-522. [PMID: 37560294 PMCID: PMC10407178 DOI: 10.1002/joa3.12895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/24/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) recurrence after AF ablation is not uncommon. High sensitivity C reactive protein (hs-CRP) is a widely used inflammatory marker with a potential property to predict AF recurrence. We conducted a systematic review and a meta-analysis to find an association between hs-CRP levels and AF recurrence after ablation. METHODS We searched PubMed, Embase, and Wiley-Cochrane Library from inception to January 2022 for studies that reported hs-CRP levels in patients who underwent AF ablation. Weighted mean difference (WMD) was used to evaluate the difference between hs-CRP levels in post-ablation AF recurrent and non-recurrent group. Also, the difference between hs-CRP levels in pre- and post-ablation was determined. RESULTS We identified 10 studies, and a total of 789 patients were included (299 recurrent vs. 490 non-recurrent patients). The mean age was 57.7 years (76.4% male). There was no difference in baseline hs-CRP levels between AF recurrent and non-recurrent group (WMD = 0.05, 95% CI = -0.04 to 0.15, p = 0.045). However, higher hs-CRP levels post-ablation were found in AF recurrent group (WMD = 0.09, 95% CI = 0.03-0.15, p < 0.001). CONCLUSION There is no significant difference in baseline hs-CRP levels between AF recurrent and non-recurrent patients after AF ablation. However, higher post-ablation hs-CRP level was found in AF recurrent group. High Sensitivity C reactive protein may play a role as a predictor of AF recurrence.
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Affiliation(s)
- Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi HospitalCollage of Medicine Rangsit UniversityBangkokThailand
| | - Angkawipa Trongtorsak
- Department of Cardiovascular MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jakrin Kewcharoen
- Division of Cardiovascular MedicineLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Sittinun Thangjui
- Internal Medicine Residency Program, Bassett Healthcare NetworkCooperstownNew YorkUSA
| | - Apichai Pokawattana
- Division of Cardiology, Rajavithi HospitalCollage of Medicine Rangsit UniversityBangkokThailand
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18
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Kewcharoen J, Basharat S, Bhardwaj R, Shah S, Shu R, Krishnan R, Lan H. Swallowing-induced atrial tachycardia: A rare demonstration on fluoroscopic esophagram. J Cardiovasc Electrophysiol 2023; 34:1761-1763. [PMID: 37354447 DOI: 10.1111/jce.15973] [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: 04/10/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Swallowing-associated arrhythmias are rare and most commonly present as atrial tachycardias. METHODS We present a case of a 45-year-old female who experienced frequent episodes of palpitations and dyspnea occurring immediately after swallowing solid food. She was noted to have atrial tachycardia with deglutition that was recorded on the 12-lead electrocardiogram. She underwent fluoroscopic esophagram that demonstrated atrial tachycardia as the barium passed through the distal esophagus and gastroesophageal junction. CONCLUSION Swallowing induced arrhythmias occur rarely and can be confirmed by EKG obtained during deglutition. Gastroesophageal evaluation is required to rule out primary esophageal disorders. Treatment of such arrhythmias is required if symptoms are intractable and can include pharmacotherapy and radiofrequency ablation.
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Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Sohaib Basharat
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Shivang Shah
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Richard Shu
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Rajagopal Krishnan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
| | - Howard Lan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
- Division of Cardiology, Riverside University Health Systems, Moreno Valley, California, USA
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Thangjui S, Thyagaturu H, Trongtorsak A, Yodsuwan R, Fayaz M, Kewcharoen J, Navaravong L. Reply to Letter to the Editor: 'Diabetes mellitus as a protective factor in Takotsubo Cardiomyopathy'. Anatol J Cardiol 2023; 27:371. [PMID: 37257012 DOI: 10.14744/anatoljcardiol.2023.3101] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Sittinun Thangjui
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Harshith Thyagaturu
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, IL, USA
| | - Ratdanai Yodsuwan
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Muhammad Fayaz
- Department of Internal Medicine, Bassett Healthcare Network, Cooperstown, NY, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Leenhapong Navaravong
- Section of Clinical Cardiac, Electrophysiology, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
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20
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Kewcharoen J, Contractor T, Kotak K, Prasad V. Management of an Inadvertently Placed Transarterial Pacemaker Lead in the Left Ventricle: A Step-by-step Approach. J Innov Card Rhythm Manag 2023; 14:5482-5487. [PMID: 37388424 PMCID: PMC10306246 DOI: 10.19102/icrm.2023.14064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 07/01/2023] Open
Abstract
Inadvertent lead misplacement in the left ventricle can lead to thromboembolic events, valvular damage, and endocarditis. We present a case of an inadvertently placed transarterial pacemaker lead in the left ventricle in a patient who underwent percutaneous lead removal. After a multidisciplinary team discussion involving cardiac electrophysiology and interventional cardiology as well as a discussion of treatment options with the patient, it was decided to proceed with pacemaker lead removal with the Sentinel™ Cerebral Protection System (Boston Scientific, Marlborough, MA, USA) to prevent thromboembolic events. The patient tolerated the procedure well without post-procedural complications and was discharged the next day on oral anticoagulation. We also present a step-by-step approach to perform lead removal with the use of Sentinel™, emphasizing mitigating the stroke and bleeding risks in this patient setting.
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Affiliation(s)
- Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Tahmeed Contractor
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kamal Kotak
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Vinoy Prasad
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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McCabe MD, Cervantes R, Kewcharoen J, Sran J, Garg J. Quelling the Storm: A Review of the Management of Electrical Storm. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00338-5. [PMID: 37296026 DOI: 10.1053/j.jvca.2023.05.029] [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: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
Heightened sympathetic input to the myocardium potentiates cardiac electrical instability and may herald an electrical storm. An electrical storm is characterized by 3 or more episodes of ventricular tachycardia, ventricular fibrillation, or appropriate internal cardiac defibrillator shocks within 24 hours. Management of electrical storms is resource-intensive and inevitably requires careful coordination between multiple subspecialties. Anesthesiologists have an important role in acute, subacute, and long-term management. Identifying the phase of an electrical storm and understanding the characteristics of each morphology may help the anesthesiologist anticipate the management approach. In the acute phase, management of an electrical storm is aimed at providing advanced cardiac life support and identifying reversible causes. After initial stabilization, subacute management focuses on dampening the sympathetic surge with sedation, thoracic epidural, or stellate ganglion blockade. Definitive long-term management with surgical sympathectomy or catheter ablation also may be warranted. Our objective is to provide an overview of electrical storms and the anesthesiologist's role in management.
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Affiliation(s)
- Melissa D McCabe
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California.
| | - Richard Cervantes
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jakrin Kewcharoen
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
| | - Jasmine Sran
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
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22
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Trongtorsak A, Thangjui S, Adhikari P, Shrestha B, Kewcharoen J, Navaravong L, Kanjanauthai S, Attanasio S, Saudye HA. Gender Disparities after Transcatheter Aortic Valve Replacement with Newer Generation Transcatheter Heart Valves: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2023; 11:medsci11020033. [PMID: 37218985 DOI: 10.3390/medsci11020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Previous studies have demonstrated gender disparities in mortality and vascular complications after transcatheter aortic valve replacement (TAVR) with early generation transcatheter heart valves (THVs). It is unclear, however, whether gender-related differences persist with the newer generation THVs. We aim to assess gender disparities after TAVR with newer generation THVs. The MEDLINE and Embase databases were thoroughly searched from inception to April 2023 to identify studies that reported gender-specific outcomes after TAVR with newer generation THVs (Sapien 3, Corevalve Evolut R, and Evolut Pro). The outcomes of interest included 30-day mortality, 1-year mortality, and vascular complications. In total, 5 studies (4 databases) with a total of 47,933 patients (21,073 females and 26,860 males) were included. Ninety-six percent received TAVR via the transfemoral approach. The females had higher 30-day mortality rates (odds ratio (OR) = 1.53, 95% confidence interval (CI) 1.31-1.79, p-value (p) < 0.001) and vascular complications (OR = 1.43, 95% CI 1.23-1.65, p < 0.001). However, one-year mortality was similar between the two groups (OR = 0.78, 95% CI 0.61-1.00, p = 0.28). The female gender continues to be associated with higher 30-day mortality rates and vascular complications after TAVR with newer generation transcatheter heart valves, while there was no difference in 1-year mortality between the genders. More data is needed to explore the causes and whether we can improve TAVR outcomes in females.
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Affiliation(s)
- Angkawipa Trongtorsak
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Sittinun Thangjui
- Bassett Healthcare Network, Internal Medicine Residency Program, New York, NY 13326, USA
| | - Pabitra Adhikari
- Ascension Saint Francis Hospital, Internal Medicine Residency Program, Evanston, IL 60202, USA
| | - Biraj Shrestha
- Reading Hospital-Tower Health, Internal Medicine Residency Program, West Reading, PA 19611, USA
| | - Jakrin Kewcharoen
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, CA 92350, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Steve Attanasio
- Rush University Medical Center, Division of Cardiovascular Medicine, Chicago, IL 60612, USA
| | - Hammad A Saudye
- Ascension Saint Francis Hospital, Division of Cardiovascular Medicine, Evanston, IL 60202, USA
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23
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Kewcharoen J, Ali S, Stoelk R, Lafian H, Abramov D, Prasad V. Left Ventricular Outflow Obstruction From Mechanical Circulatory Support in Critical Aortic Stenosis: A Cautionary Tale. JACC Case Rep 2023; 13:101659. [PMID: 37153476 PMCID: PMC10157102 DOI: 10.1016/j.jaccas.2022.09.025] [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: 06/19/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 05/09/2023]
Abstract
We submit a cautionary tale of a patient with critical aortic stenosis presenting with acute myocardial infarction and cardiogenic shock, who underwent balloon aortic valvuloplasty, insertion of a transvalvular left percutaneous ventricular assist device and high-risk percutaneous coronary intervention, with a post-operative course complicated by outflow obstruction from the device itself. (Level of Difficulty: Intermediate.).
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Affiliation(s)
| | | | | | | | | | - Vinoy Prasad
- Address for correspondence: Dr Vinoy Prasad, Loma Linda University Medical Center, Department of Cardiology, 11234 Anderson Street, Room 2422, Loma Linda, California 92354, USA. @VinoyPrasadMD
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Tokavanich N, Prasitlumkum N, Kewcharoen J, Chokesuwattanaskul R, Phannajit J, Cheungpasitporn W, Akoum N, Ranjan R, Bunch TJ, Navaravong L. Network meta-analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:869-879. [PMID: 36691892 DOI: 10.1111/jce.15831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) atrial fibrillation (AF) ablation with a power of 40-50 W was proved to be safe and effective. Very high-power short-duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation. METHODS A literature search for studies that reported AF ablation outcomes, including short-term freedom from atrial arrhythmia, first-pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random-effects model of network meta-analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes. RESULTS A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2-1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78-2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5-8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61-8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques. CONCLUSION vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.
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Affiliation(s)
- Nithi Tokavanich
- Sparrow Hospital, Michigan State University, East Lansing, Michigan, USA
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California, USA
| | - Jakrin Kewcharoen
- Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jeerath Phannajit
- Division of Clinical Epidemiology and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Nazem Akoum
- Cardiology Department, University of Washington Medical Center, Seattle, Washington, USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Techasatian W, Kewcharoen J, Kuniyoshi J, Leesutipornchai T, Tanariyakul M, Nagamine T, Wongcharoen W. PROPHYLACTIC PULMONARY VEIN ISOLATION IN PATIENTS WITH TYPICAL ATRIAL FLUTTER UNDERGOING CAVOTRICUPID ISTHMUS ABLATION: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Assawamasbunlue N, Lorlowhakarn K, Kewcharoen J, Laisathit P, Shotelersuk V, Ariyachaipanich A. CHARACTERISTICS AND OUTCOMES OF OCTOGENARIAN WITH ACUTE HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01144-0] [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: 03/06/2023]
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Chaikijurajai T, Worapongsatitaya P, Kewcharoen J, Ponvilawan B, Charoenngam N, Mutirangura P, Dhole AK, Ergando T, Ungprasert P. HYPOCHLOREMIA ON ADMISSION AND MORTALITY RISK IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Leelaviwat N, Benjanuwattra J, Vutthikraivit W, Kewcharoen J, Trongtorsak A, Abdelnabi M, Del Rio-Pertuz G, Mekraksakit P, Thangjui S, Sethi P. GENOTYPIC OVERLAP BETWEEN BRUGADA SYNDROME AND HYPERTROPHIC CARDIOMYOPATHY OR BRUGADA PHENOCOPY? J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04314-0] [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: 03/06/2023]
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Leelaviwat N, Paz P, Abdelnabi M, Benjanuwattra J, Del Rio-Pertuz G, Trongtorsak A, Vutthikraivit W, Kewcharoen J, Sethi P. ASPIRATION THROMBECTOMY: A POSSIBLE PROMISING THERAPY FOR INFERIOR VENA CAVA AND RIGHT ATRIUM THROMBUS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kewcharoen J, Contractor T, Kotak K, Prasad VS. MANAGEMENT OF INADVERTENTLY PLACED TRANS-ARTERIAL PACEMAKER LEAD IN THE LEFT VENTRICLE: A STEP-BY-STEP APPROACH. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03246-1] [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: 03/06/2023]
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Leesutipornchai T, Waitayangkoon P, Techasatian W, Aiumtrakul N, Tanariyakul M, Arayangkool C, Nagamine T, Kewcharoen J. URATE-LOWERING THERAPY IS ASSOCIATED WITH A REDUCED RISK OF ARRHYTHMIAS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00529-6] [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: 03/06/2023]
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Trongtorsak A, Kewcharoen J, Thangjui S, Leelaviwat N, Li S, Luo S, Navaravong L, Marinescu K, Rao A, Volgman AS, Suboc TM. SEX AND OUTCOME DIFFERENCES AFTER CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICE IMPLANTATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00995-6] [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: 03/07/2023]
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Mekraksakit P, Leelaviwat N, Benjanuwattra J, Duangkham S, Del Rio-Pertuz G, Thongprayoon C, Kewcharoen J, Boonpheng B, Pena C, Cheungpasitporn W. A Systematic Review and Meta-Analysis of Posttransplant Anemia With Overall Mortality and Cardiovascular Outcomes Among Kidney Transplant Recipients. Prog Transplant 2023; 33:78-89. [PMID: 36591924 DOI: 10.1177/15269248221145046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Posttransplant anemia is a common finding after kidney transplantation. A previous meta-analysis reported an association between anemia and graft loss. However, data on cardiovascular outcomes have not yet been reported. Objective: We conducted an updated meta-analysis to examine the association between posttransplant anemia and outcomes after transplantation including cardiovascular mortality in adult kidney transplant recipients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2021. Data from each study were combined using the random-effects model. Generic inverse variance method of DerSimonian and Laird was employed to calculate the risk ratios and 95% CIs. Results: Seventeen studies from August 2006 to April 2019 were included (16 463 kidney transplantation recipients). Posttransplant anemia was associated with overall mortality (pooled risk ratio = 1.72 [1.39, 2.13], I2 = 56%), graft loss (pooled risk ratio = 2.28 [1.77, 2.93], I2 = 94%), cardiovascular death (pooled risk ratio = 2.06 [1.35, 3.16], I2 = 0%), and cardiovascular events (pooled risk ratio = 1.33 [1.10, 1.61], I2 = 0%). Early anemia (≤6 months), compared with late anemia (>6 months), has higher risk of overall mortality and graft loss with a pooled risk ratio of 2.63 (95% CI 1.79-3.86; I2 = 0%) and 2.96 (95% CI 2.29-3.82; I2 = 0%), respectively. Discussion: In addition to increased risk of graft loss, our updated meta-analysis demonstrated that posttransplant anemia was significantly associated with poor outcomes after kidney transplantation including overall mortality, graft loss, cardiovascular death, and cardiovascular events. Future studies are required to assess the effects of treatment strategies for posttransplant anemia on posttransplant outcomes including cardiovascular mortality.
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Affiliation(s)
- Poemlarp Mekraksakit
- Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Division of Nephrology and Hypertension, Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Natnicha Leelaviwat
- Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Juthipong Benjanuwattra
- Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Samapon Duangkham
- Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gaspar Del Rio-Pertuz
- Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, 23331Loma Linda University Health, Loma Linda, CA, USA
| | - Boonphiphop Boonpheng
- Division of Nephrology, Department of Medicine, 205280University of Washington School of Medicine, Seattle, WA, USA
| | - Camilo Pena
- Division of Nephrology, Department of Internal Medicine, 12343Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, 6915Mayo Clinic, Rochester, MN, USA
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Leelaviwat N, Mekraksakit P, Trongtorsak A, Vutthikraivit W, Kewcharoen J, Abdelnabi M, Del Rio-Pertuz G, Benjanuwattra J, Thangjui S, Navaravong L. AMULET VERSUS WATCHMAN DEVICE FOR LEFT ATRIAL APPENDAGE CLOSURE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND PROPENSITY-SCORE-MATCHED STUDIES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00550-8] [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: 03/06/2023]
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Kewcharoen J, Giri P, Amini MR, Tan L, Moretta D, Barrett E, Walters EL, Abramov D. Heart failure alters diagnostic yield for pulmonary embolism in patients undergoing computed tomography pulmonary angiogram. Am J Emerg Med 2023; 64:8-11. [PMID: 36427385 DOI: 10.1016/j.ajem.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is limited evidence regarding the effects of a pre-existing heart failure (HF) on the diagnostic yield of pulmonary embolism (PE) evaluation in the Emergency Department (ED). METHODS Electronic medical record of consecutive adults who underwent a computed tomography pulmonary angiogram (CTPA) in the ED at Loma Linda University Medical Center between June 1, 2019 and March 25, 2022 were reviewed. Repeat studies for the same patient and patients with unspecified HF diagnoses or isolated right ventricular HF were excluded. Key demographics, lab values and vital signs, relevant medications were collected. Primary outcome was the incidence of PE on CTPA compared between patients with and without pre-existing HF. RESULTS A total of 2846 patients were included in the study (602 patients with HF and 2244 without). In total cohort, 11.7% (n = 334) of patients had PE found on CTPA. The incidence of PE on CTPA was lower among patients with a history of HF than patients without a history of HF (12.5% vs 9%). A history of pre-existing HF was associated with a lower odds ratio for a positive PE study (OR 0.13, 95%CI: 0.03-0.57) in multivariable analyses. CONCLUSIONS In this study, we observed that the incidence of PE among patients who undergo CTPA was lower among patients with pre-existing HF compared to those without. Further studies should determine if HF is an important mitigating factor when risk stratifying patients for PE.
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Affiliation(s)
- Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Paresh Giri
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - M Reza Amini
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Laren Tan
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dafne Moretta
- Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Emily Barrett
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - E Lea Walters
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA..
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam MK, Mandapati R, Lakkireddy D, Garg J. Electromagnetic Field-Induced Interactions Among Electric Vehicles, New-Generation Electronic Devices, and Cardiovascular Implantable Electronic Devices. JACC Clin Electrophysiol 2023; 9:257-259. [PMID: 36858694 DOI: 10.1016/j.jacep.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
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Leelaviwat N, Mekraksakit P, Kewcharoen J, Thangjui S, Abdelnabi M, Del Rio Pertuz G, Benjanuwattra J, Trongtorsak A. CRT-300.09 Amulet Versus Watchman Device for Left Atrial Appendage Closure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.169] [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: 02/22/2023]
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Rattanawong P, Kewcharoen J, Yinadsawaphan T, Fatunde OA, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Chung EH, Shen W. Type of syncope and outcome in Brugada syndrome: A systematic review and meta‐analysis. J Arrhythm 2023; 39:111-120. [PMID: 37021016 PMCID: PMC10068940 DOI: 10.1002/joa3.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). The importance of primary prevention of sudden cardiac death (SCD) in Brugada syndrome is well recognized; however, ventricular arrhythmia risk stratification remains challenging and controversial. We aimed to assess the association of type of syncope with MAE via systematic review and meta-analysis. Methods We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2021. Included studies were cohort (prospective or retrospective) studies that reported the types of syncope (cardiac, unexplained, vasovagal, and undifferentiated) and MAE. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the odds ratio (OR) and 95% confidence intervals (CIs). Results Seventeen studies from 2005 to 2019 were included in this meta-analysis involving 4355 Brugada syndrome patients. Overall, syncope was significantly associated with an increased risk of MAE in Brugada syndrome (OR = 3.90, 95% CI: 2.22-6.85, p < .001, I 2 = 76.0%). By syncope type, cardiac (OR = 4.48, 95% CI: 2.87-7.01, p < .001, I 2 = 0.0%) and unexplained (OR = 4.71, 95% CI: 1.34-16.57, p = .016, I 2 = 37.3%) syncope was significantly associated with increased risk of MAE in Brugada syndrome. Vasovagal (OR = 2.90, 95% CI: 0.09-98.45, p = .554, I 2 = 70.9%) and undifferentiated syncope (OR = 2.01, 95% CI: 1.00-4.03, p = .050, I 2 = 64.6%, respectively) were not. Conclusion Our study demonstrated that cardiac and unexplained syncope was associated with MAE risk in Brugada syndrome populations but not in vasovagal syncope and undifferentiated syncope. Unexplained syncope is associated with a similar increased risk of MAE compared to cardiac syncope.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service Loma Linda University Health Loma Linda California USA
| | - Thanaboon Yinadsawaphan
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
- Department of Cardiology Central Chest Institute of Thailand Nonthaburi Thailand
| | | | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine, Department of Internal Medicine University of Iowa Iowa City Iowa USA
| | - Narut Prasitlumkum
- Department of Cardiology University of California Riverside Riverside California USA
| | - Eugene H. Chung
- Department of Internal Medicine, Michigan Medicine University of Michigan Ann Arbor Michigan USA
| | - Win‐Kuang Shen
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona USA
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Chang AK, Kewcharoen J, Henkel DM, Parwani P, Abramov D. Myocardial Contraction Fraction is not a Predictor of Clinical Outcomes in Acute Systolic Heart Failure: A Brief Report. J Cardiovasc Echogr 2023; 33:27-29. [PMID: 37426719 PMCID: PMC10328125 DOI: 10.4103/jcecho.jcecho_53_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 07/11/2023] Open
Abstract
Introduction The utility of myocardial contraction fraction (MCF), a volumetric measure of myocardial shortening, has not been well evaluated in patients with systolic heart failure (SHF). Materials and Methods A single-center, retrospective cohort study of all adults admitted with acute SHF from 2013 to 2018 at an academic medical center. A chart review was performed to identify key echocardiographic transthoracic echocardiogram (TTE), laboratory, and demographic characteristics. MCF was calculated based on M-mode measurements of estimated stroke volume and myocardial volume based on admission TTE. The primary outcome was 30-day combined all-cause readmission/mortality and 365-day all-cause mortality. Results A total of 1282 patients were analyzed. The 30-day composite outcome occurred in 310 patients (24.2%), and all-cause death at 365 days occurred in 375 patients (29.3%). There was a weak correlation between the visually estimated ejection fraction (EF) and MCF (r = 0.356, P < 0.001). Neither MCF nor EF was associated with either component of the primary outcome. Other parameters on TTE that were associated with higher risk of primary outcome were higher tricuspid regurgitation (TR) velocity, larger left atrial (LA) diameter, and moderate or greater TR and mitral regurgitation (MR). Conclusion Echocardiographic predictors of postdischarge adverse events among patients hospitalized with acute SHF include higher TR velocity, larger LA diameter, and at least moderate MR or TR. MCF does not correlate well with visually assessed EF among patients with acute SHF, and neither MCF nor EF provides prognostic information in this population.
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Affiliation(s)
- Andrew K. Chang
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Danielle M. Henkel
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Purvi Parwani
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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Garg J, Kewcharoen J, Shah K, Turagam M, Bhardwaj R, Contractor T, Mandapati R, Lakkireddy D. Clinical outcomes of radiofrequency catheter ablation of ventricular tachycardia in patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:219-224. [PMID: 36335616 PMCID: PMC10100142 DOI: 10.1111/jce.15739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/27/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population. OBJECTIVES We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients. METHODS A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality. RESULTS This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%-95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1-3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%-86.2%), while after the last ablation was 82.8% (95% CI: 57%-99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%-5.8%). CONCLUSION The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence-findings comparable to previously published reports in other disease substrates.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
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Bhardwaj R, Kewcharoen J, Contractor T, Nayak S, Ai S, Kim U, Mandapati R, Garg J. Echocardiogram-Guided Leadless Pacemaker Implantation. JACC Clin Electrophysiol 2022; 8:1581-1582. [PMID: 36543510 DOI: 10.1016/j.jacep.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/18/2023]
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Lorlowhakarn K, Arayakarnkul S, Trongtorsak A, Leesutipornchai T, Kewcharoen J, Sinphurmsukskul S, Siwamogsatham S, Puwanant S, Ariyachaipanich A. Outcomes and predictors of one-year mortality in patients hospitalized with Acute Heart Failure. Int J Cardiol Heart Vasc 2022; 43:101159. [PMID: 36467463 PMCID: PMC9713267 DOI: 10.1016/j.ijcha.2022.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/06/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Registries of patients hospitalized with acute heart failure (AHF) provided useful description of characteristics and outcomes. However, a contemporary registry which provides sufficient evidence on outcomes after discharge is needed. OBJECTIVE The study aims to identify 1-year clinical outcomes and prognostic predictors of patients hospitalized with AHF. METHOD This is a retrospective registry which enrolled patients who were hospitalized due to a principal diagnosis of AHF in a tertiary care center in Thailand between July 2017 and June 2019. Baseline characteristics and hospital courses between the deceased patients and the survivors at 1 year were compared. Prognostic predictors for 1-year mortality were analyzed using Cox regression model. RESULTS A total of 759 patients were enrolled (mean age of 68.9 ± 15 years, 49.8% men, mean ejection fraction of 47.1 ± 19.2%, 55.7% heart failure reduced ejection fraction (HFrEF)). Among these, 40.7% had no history of heart failure. The in-hospital and 1-year mortality was 5.8% and 21.5%, respectively. Patients with HFrEF had lower 1-year mortality compared to those without (HR = 0.57, p = 0.04). Age ≥ 70 years, the history of heart failure, prior heart failure hospitalization, cerebrovascular accident (CVA), reactive airway disease, cancer, length of stay > 10 days and NT-proBNP ≥ 10,000 pg/mL were associated with higher 1-year mortality (p < 0.05). The multivariate analysis showed age, CVA and NT-proBNP were independent predictors. CONCLUSION Patients with AHF had high mortality after discharge. Patients with poor prognostic predictors, such as elderly, may benefit from continuous care. The study is the most recent registry of patients with AHF in Thailand.
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Affiliation(s)
- Koravich Lorlowhakarn
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suchapa Arayakarnkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Angkawipa Trongtorsak
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Jakrin Kewcharoen
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supanee Sinphurmsukskul
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sarawut Siwamogsatham
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Chula Clinical Research Center (ChulaCRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sarinya Puwanant
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Pathum Wan, Bangkok, Thailand
| | - Aekarach Ariyachaipanich
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand,Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Corresponding author at: King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok 10330, Thailand.
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Garg J, Kewcharoen J, Bhardwaj R, Contractor T, Jain S, Mandapati R. Intracardiac echocardiography from coronary sinus. J Cardiovasc Electrophysiol 2022; 33:2382-2388. [PMID: 36153661 PMCID: PMC9828028 DOI: 10.1111/jce.15687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/28/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures. Intracardiac echocardiography offers real-time, high-quality, near-field evaluation of cardiac anatomy. Standard ICE imaging includes placing the catheter in the right atrium (RA), right ventricle (RV), or left atrium (LA, via the transeptal approach). Coronary sinus echocardiography (CSE) is another alternative, where the ICE catheter is positioned in the coronary sinus (CS). This approach offers better catheter stability and allows operators to visualize cardiac structure with particularly excellent views of the LA, LAA, left ventricle (LV), and mitral annulus. Additionally, CSE is an attractive alternative in cases with unfavorable interatrial septum or fossa ovalis anatomical features that could lead to difficulty advancing ICE catheter in left atrium. In this article focusing on CSE, we provide illustration-based guidance to help operators identify critical cardiac structures from CSE.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Sarika Jain
- Division of Cardiothoracic SurgeryLoma Linda University HealthLoma LindaCaliforniaUSA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia ServiceLoma Linda University HealthLoma LindaCaliforniaUSA
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Rattanawong P, Kanitsoraphan C, Kewcharoen J, Sriramoju A, Shanbhag A, Ko Ko NL, Barry T, Vutthikraivit W, Shen WK. Surgical versus catheter ablation in atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials. J Cardiovasc Electrophysiol 2022; 33:2152-2163. [PMID: 35771487 DOI: 10.1111/jce.15617] [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: 12/08/2021] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia with a high stroke and mortality rate. The video-assisted thoracoscopic radiofrequency pulmonary vein ablation is a treatment option for patients who fail catheter ablation. Randomized data comparing surgical versus catheter ablation are limited. We performed a meta-analysis of randomized control trials to explore the outcome efficacy between surgical and catheter radiofrequency pulmonary vein ablation in patients with AF. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to December 2020. Included studies were published randomized control trials that compared video-assisted thoracoscopic and catheter radiofrequency pulmonary vein ablation. Data from each study were combined using the fixed-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios and 95% confidence intervals. RESULTS Six studies from November 2013 to 2020 were included in this meta-analysis involving 511 AF patients (79% paroxysmal) with 263 catheter ablation (mean age 56±3 years) and 248 surgical ablations (mean age 52 ±4 years). Catheter ablation was associated with increased atrial arrhythmias recurrence when compared to surgical ablation (pooled relative risk=1.85, 95 % confidence interval: 1.44-2.39, p<0.001, I2 =0.0%) but associated with less total major adverse events (pooled relative risk=0.29, 95 % confidence interval: 0.16-0.53, p<0.001, I2 =0.0%). In subgroup analysis, catheter ablation was associated with increased AF recurrence in refractory paroxysmal AF when compared to surgical ablation (pooled relative risk=2.47, 95 % confidence interval: 1.31-4.65, p=0.005, I2 =0.0%) but not in persistent AF (relative risk=1.09, 95 % confidence interval: 0.60-2.0, p=0.773). CONCLUSION Catheter ablation was associated with higher atrial arrhythmia recurrence when compared with surgical ablation. However, our study suggests that the benefit of surgical ablation in patients with persistent AF is unclear. More studies and alternative ablation strategies investigation in persistent AF are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jakrin Kewcharoen
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anil Sriramoju
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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Kewcharoen J, Shah K, Bhardwaj R, Contractor T, Turagam M, Mandapati R, Lakkireddy D, Garg J. Left atrial appendage occlusion in patients with blood cell dyscrasia. Pacing Clin Electrophysiol 2022; 45:1316-1319. [PMID: 35696197 DOI: 10.1111/pace.14550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jakrin Kewcharoen
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Rahul Bhardwaj
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Tahmeed Contractor
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ravi Mandapati
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, California, USA
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Prasitlumkum N, Tokavanich N, Trongtorsak A, Cheungpasitporn W, Kewcharoen J, Chokesuwattanaskul R, Akoum N, Jared Bunch T, Navaravong L. Catheter Ablation for Atrial Fibrillation in the Elderly > 75 Years old: Systematic Review and Meta-Analysis. J Cardiovasc Electrophysiol 2022; 33:1435-1449. [PMID: 35589557 DOI: 10.1111/jce.15549] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) ablation is increasingly performed worldwide. As comfort with AF ablation increases, the procedure is increasingly used in patients that are older and in those with more comorbidities. However, it is not well established whether AF ablation in the elderly, especially those >75 years old, has comparable safety and efficacy to younger populations. OBJECTIVE To compare the efficacy and safety profiles in patients older than 75years undergoing AF ablation with younger patients. METHODS Databases from EMBASE, Medline, PubMed and Cochrane, were searched from inception through September 2021. Studies that compared the success rates in AF catheter ablation and all complications rates between patients who were older vs under 75 years were included. Effect estimates from the individual studies were extracted and combined using random effect, generic inverse variance method of DerSimonian and Laird. RESULTS Twenty-seven observational studies were included in the analysis consisting of 363,542 patients who underwent AF ablation. Comparing patients older than 75 years old to younger patients, there was no difference in the success of ablation rates between elderly and younger patients (pooled OR 0.85: 95% CI:0.69 - 1.05, p=0.131). On the other hand, AF ablation in the elderly was associated with higher complication rates (pooled OR 1.43: 95% CI:1.21 - 1.68, p<0.001) CONCLUSION: As AF ablation is expanded to elderly populations, our study found that AF ablation success rates were similar in both elderly and younger patients. However, older patients experience higher rates of complications that should be considered when offering the procedure and as a means to improve outcomes with future innovations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
| | - Nithi Tokavanich
- Department of Cardiovascular Medicine, Vajira Hospital, Bangkok, Thailand
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, IL, USA
| | | | - Jakrin Kewcharoen
- Department of Cardiovascular Medicine, Loma Linda University, Loma Linda, CA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nazem Akoum
- Department of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leenhapong Navaravong
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Mongkonsritragoon W, Prueksapraoprong C, Kewcharoen J, Tokavanich N, Prasitlumkum N, Huang J, Poowuttikul P. Prevalence and risk associated with asthma in children hospitalized with SARS-CoV-2: a meta-analysis and systematic review. J Allergy Clin Immunol Pract 2022; 10:1382-1384.e1. [PMID: 35123100 PMCID: PMC8808430 DOI: 10.1016/j.jaip.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Jakrin Kewcharoen
- Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, Calif
| | - Jenny Huang
- Division of Allergy/Immunology and Rheumatology, Children's Hospital of Michigan, Central Michigan University, Detroit, Mich
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology and Rheumatology, Children's Hospital of Michigan, Central Michigan University, Detroit, Mich
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Prasitlumkum N, Kewcharoen J, Bhardwaj R, Mandapati R, Lakkireddy DR, Garg J. PO-665-01 THE BLIP SIDES OF ADVISOR HD GRID MAPPING CATHETER - MAUDE DATABASE ANALYSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.360] [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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Shah KB, Kewcharoen J, Turagam MK, Bhardwaj R, Contractor T, Mandapati R, Lakkireddy DR, Garg J. PO-695-07 ADVERSE EVENTS ASSOCIATED WITH ORION BASKET ARRAY MAPPING CATHETER - MAUDE DATABASE ANALYSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Contractor T, Bhardwaj R, Shah K, Kewcharoen J, Mandapati R, Lakkireddy DR, Garg J. PO-682-01 OUTCOME OF CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA IN POST-MYOCARDITIS PATIENTS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.516] [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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