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McIntyre WF, Benz AP, Becher N, Healey JS, Granger CB, Rivard L, Camm AJ, Goette A, Zapf A, Alings M, Connolly SJ, Kirchhof P, Lopes RD. Direct Oral Anticoagulants for Stroke Prevention in Patients With Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials. Circulation 2024; 149:981-988. [PMID: 37952187 DOI: 10.1161/circulationaha.123.067512] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 10/06/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Device-detected atrial fibrillation (also known as subclinical atrial fibrillation or atrial high-rate episodes) is a common finding in patients with an implanted cardiac rhythm device and is associated with an increased risk of ischemic stroke. Whether oral anticoagulation is effective and safe in this patient population is unclear. METHODS We performed a systematic review of MEDLINE and Embase for randomized trials comparing oral anticoagulation with antiplatelet or no antithrombotic therapy in adults with device-detected atrial fibrillation recorded by a pacemaker, implantable cardioverter defibrillator, cardiac resynchronization therapy device, or implanted cardiac monitor. We used random-effects models for meta-analysis and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework (GRADE). The review was preregistered (PROSPERO CRD42023463212). RESULTS From 785 citations, we identified 2 randomized trials with relevant clinical outcome data: NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes; 2536 participants) evaluated edoxaban, and ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; 4012 participants) evaluated apixaban. Meta-analysis demonstrated that oral anticoagulation with these agents reduced ischemic stroke (relative risk [RR], 0.68 [95% CI, 0.50-0.92]; high-quality evidence). The results from the 2 trials were consistent (I2 statistic for heterogeneity=0%). Oral anticoagulation also reduced a composite of cardiovascular death, all-cause stroke, peripheral arterial embolism, myocardial infarction, or pulmonary embolism (RR, 0.85 [95% CI, 0.73-0.99]; I2=0%; moderate-quality evidence). There was no reduction in cardiovascular death (RR, 0.95 [95% CI, 0.76-1.17]; I2=0%; moderate-quality evidence) or all-cause mortality (RR, 1.08 [95% CI, 0.96-1.21]; I2=0%; moderate-quality evidence). Oral anticoagulation increased major bleeding (RR, 1.62 [95% CI, 1.05-2.50]; I²=61%; high-quality evidence). CONCLUSIONS The results of the NOAH-AFNET 6 and ARTESiA trials are consistent with each other. Meta-analysis of these 2 large randomized trials provides high-quality evidence that oral anticoagulation with edoxaban or apixaban reduces the risk of stroke in patients with device-detected atrial fibrillation and increases the risk of major bleeding.
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Affiliation(s)
- William F McIntyre
- McMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.)
| | - Alexander P Benz
- McMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.)
| | - Nina Becher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (N.B., P.K.)
| | - Jeffrey S Healey
- McMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.)
| | | | | | - A John Camm
- St George's University of London and Imperial College London, United Kingdom (A.J.C.)
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St Vincenz Hospital Paderborn, Germany (A.G.)
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (A.Z.)
| | | | - Stuart J Connolly
- McMaster University and Population Health Research Institute, Hamilton, Canada (W.F.M., A.P.B., J.S.H., S.J.C.)
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (N.B., P.K.)
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Durham, NC (C.B.G., R.D.L.)
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Healey JS, Lopes RD, Granger CB, Alings M, Rivard L, McIntyre WF, Atar D, Birnie DH, Boriani G, Camm AJ, Conen D, Erath JW, Gold MR, Hohnloser SH, Ip J, Kautzner J, Kutyifa V, Linde C, Mabo P, Mairesse G, Benezet Mazuecos J, Cosedis Nielsen J, Philippon F, Proietti M, Sticherling C, Wong JA, Wright DJ, Zarraga IG, Coutts SB, Kaplan A, Pombo M, Ayala-Paredes F, Xu L, Simek K, Nevills S, Mian R, Connolly SJ. Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. N Engl J Med 2024; 390:107-117. [PMID: 37952132 DOI: 10.1056/nejmoa2310234] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. METHODS We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). RESULTS We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P = 0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P = 0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. CONCLUSIONS Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.).
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Affiliation(s)
- Jeff S Healey
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Renato D Lopes
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Christopher B Granger
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marco Alings
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Lena Rivard
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - William F McIntyre
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Dan Atar
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David H Birnie
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Giuseppe Boriani
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - A John Camm
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David Conen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Julia W Erath
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Michael R Gold
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Stefan H Hohnloser
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - John Ip
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Josef Kautzner
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Valentina Kutyifa
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Cecilia Linde
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Philippe Mabo
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Georges Mairesse
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Juan Benezet Mazuecos
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Jens Cosedis Nielsen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Francois Philippon
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marco Proietti
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Christian Sticherling
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Jorge A Wong
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David J Wright
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Ignatius G Zarraga
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Shelagh B Coutts
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Andrew Kaplan
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marta Pombo
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Felix Ayala-Paredes
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Lizhen Xu
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Kim Simek
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Sandra Nevills
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Rajibul Mian
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Stuart J Connolly
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
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Rivard L, Nault I, Krahn AD, Daneault B, Roux JF, Natarajan M, Healey JS, Quadros K, Sandhu RK, Kouz R, Greiss I, Leong-Sit P, Gourraud JB, Ben Ali W, Asgar A, Aguilar M, Bonan R, Cadrin-Tourigny J, Cartier R, Dorval JF, Dubuc M, Dürrleman N, Dyrda K, Guerra P, Ibrahim M, Ibrahim R, Macle L, Mondesert B, Moss E, Raymond-Paquin A, Roy D, Tadros R, Thibault B, Talajic M, Nozza A, Guertin MC, Khairy P. Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block. CJC Open 2023; 5:611-618. [PMID: 37720184 PMCID: PMC10502429 DOI: 10.1016/j.cjco.2023.05.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/22/2023] [Indexed: 09/19/2023] Open
Abstract
Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the Comparison of a Clinical Monitoring Strategy Versus Electrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After TAVI (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring. In the EPS-guided approach, patients with a His to ventricle (HV) interval ≥ 65 ms undergo permanent pacemaker implantation. Patients randomized to noninvasive monitoring receive a wearable continuous electrocardiographic recording and transmitting device for 30 days. Follow-up will be performed at 3, 6, and 12 months. The primary endpoint is a composite outcome designed to capture net clinical benefit. The endpoint incorporates major consequences of both strategies in patients with new-onset LBBB after TAVI, as follows: (i) sudden cardiac death; (ii) syncope; (iii) atrioventricular conduction disorder requiring a pacemaker (for a class I or IIa indication); and (iv) complications related to the pacemaker or EPS. The trial incorporates a Bayesian design with a noninformative prior, outcome-adaptive randomization (initially 1:1), and 2 prespecified interim analyses once 25% and 50% of the anticipated number of primary endpoints are reached. The trial is event-driven, with an anticipated upper limit of 452 patients required to reach 77 primary outcome events over 12 months of follow-up. In summary, the aim of this Bayesian multicentre randomized trial is to compare 2 management strategies in patients with new-onset LBBB post-TAVI-an EPS-guided approach vs noninvasive 30-day monitoring. Trial registration number: NCT03303612.
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Affiliation(s)
- Lena Rivard
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Nault
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benoit Daneault
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Francois Roux
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Madhu Natarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Quadros
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K. Sandhu
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Remi Kouz
- Department of Cardiology, Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Isabelle Greiss
- Department of Cardiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Peter Leong-Sit
- Department of Cardiology, Western University, London, Ontario, Canada
| | | | - Walid Ben Ali
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raoul Bonan
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Dubuc
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Dürrleman
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter Guerra
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marina Ibrahim
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Moss
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Raymond-Paquin
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Lehoux P, Rivard L, de Oliveira RR, Mörch CM, Alami H. Tools to foster responsibility in digital solutions that operate with or without artificial intelligence: A scoping review for health and innovation policymakers. Int J Med Inform 2023; 170:104933. [PMID: 36521423 DOI: 10.1016/j.ijmedinf.2022.104933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Digital health solutions that operate with or without artificial intelligence (D/AI) raise several responsibility challenges. Though many frameworks and tools have been developed, determining what principles should be translated into practice remains under debate. This scoping review aims to provide policymakers with a rigorous body of knowledge by asking: 1) what kinds of practice-oriented tools are available?; 2) on what principles do they predominantly rely?; and 3) what are their limitations? METHODS We searched six academic and three grey literature databases for practice-oriented tools, defined as frameworks and/or sets of principles with clear operational explanations, published in English or French from 2015 to 2021. Characteristics of the tools were qualitatively coded and variations across the dataset identified through descriptive statistics and a network analysis. FINDINGS A total of 56 tools met our inclusion criteria: 19 health-specific tools (33.9%) and 37 generic tools (66.1%). They adopt a normative (57.1%), reflective (35.7%), operational (3.6%), or mixed approach (3.6%) to guide developers (14.3%), managers (16.1%), end users (10.7%), policymakers (5.4%) or multiple groups (53.6%). The frequency of 40 principles varies greatly across tools (from 0% for 'environmental sustainability' to 83.8% for 'transparency'). While 50% or more of the generic tools promote up to 19 principles, 50% or more of the health-specific tools promote 10 principles, and 50% or more of all tools disregard 21 principles. In contrast to the scattered network of principles proposed by academia, the business sector emphasizes closely connected principles. Few tools rely on a formal methodology (17.9%). CONCLUSION Despite a lack of consensus, there is a solid knowledge-basis for policymakers to anchor their role in such a dynamic field. Because several tools lack rigour and ignore key social, economic, and environmental issues, an integrated and methodologically sound approach to responsibility in D/AI solutions is warranted.
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Affiliation(s)
- P Lehoux
- Department of Health Management, Evaluation and Policy, Université de Montréal, Center for Public Health Research (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 Av du Parc, Montréal, Québec H3N 1X9, Canada.
| | - L Rivard
- Center for Public Health Research (CReSP), Université de Montréal, Canada.
| | | | - C M Mörch
- FARI - AI for the Common Good Institute, Université Libre de Bruxelles, 10-12, Cantersteen, 1000 Brussels, Belgium.
| | - H Alami
- Interdisciplinary Research in Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom.
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Gasperetti A, Carrick RT, Costa S, Compagnucci P, Bosman LP, Chivulescu M, Tichnell C, Murray B, Tandri H, Tadros R, Rivard L, van den Berg MP, Zeppenfeld K, Wilde AA, Pompilio G, Carbucicchio C, Dello Russo A, Casella M, Svensson A, Brunckhorst CB, van Tintelen JP, Platonov PG, Haugaa KH, Duru F, te Riele AS, Khairy P, Tondo C, Calkins H, James CA, Saguner AM, Cadrin-Tourigny J. Programmed Ventricular Stimulation as an Additional Primary Prevention Risk Stratification Tool in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Study. Circulation 2022; 146:1434-1443. [PMID: 36205131 PMCID: PMC9640278 DOI: 10.1161/circulationaha.122.060866] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND A novel risk calculator based on clinical characteristics and noninvasive tests that predicts the onset of clinical sustained ventricular arrhythmias (VA) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been proposed and validated by recent studies. It remains unknown whether programmed ventricular stimulation (PVS) provides additional prognostic value. METHODS All patients with a definite ARVC diagnosis, no history of sustained VAs at diagnosis, and PVS performed at baseline were extracted from 6 international ARVC registries. The calculator-predicted risk for sustained VA (sustained or implantable cardioverter defibrillator treated ventricular tachycardia [VT] or fibrillation, [aborted] sudden cardiac arrest) was assessed in all patients. Independent and combined performance of the risk calculator and PVS on sustained VA were assessed during a 5-year follow-up period. RESULTS Two hundred eighty-eight patients (41.0±14.5 years, 55.9% male, right ventricular ejection fraction 42.5±11.1%) were enrolled. At PVS, 137 (47.6%) patients had inducible ventricular tachycardia. During a median of 5.31 [2.89-10.17] years of follow-up, 83 (60.6%) patients with a positive PVS and 37 (24.5%) with a negative PVS experienced sustained VA (P<0.001). Inducible ventricular tachycardia predicted clinical sustained VA during the 5-year follow-up and remained an independent predictor after accounting for the calculator-predicted risk (HR, 2.52 [1.58-4.02]; P<0.001). Compared with ARVC risk calculator predictions in isolation (C-statistic 0.72), addition of PVS inducibility showed improved prediction of VA events (C-statistic 0.75; log-likelihood ratio for nested models, P<0.001). PVS inducibility had a 76% [67-84] sensitivity and 68% [61-74] specificity, corresponding to log-likelihood ratios of 2.3 and 0.36 for inducible (likelihood ratio+) and noninducible (likelihood ratio-) patients, respectively. In patients with a ARVC risk calculator-predicted risk of clinical VA events <25% during 5 years (ie, low/intermediate subgroup), PVS had a 92.6% negative predictive value. CONCLUSIONS PVS significantly improved risk stratification above and beyond the calculator-predicted risk of VA in a primary prevention cohort of patients with ARVC, mainly for patients considered to be at low and intermediate risk by the clinical risk calculator.
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Affiliation(s)
- Alessio Gasperetti
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Sarah Costa
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Laurens P. Bosman
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Rafik Tadros
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Lena Rivard
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Maarten P. van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen‚ The Netherlands (M.P.v.d.B.)
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, The Netherlands (K.Z.)
| | - Arthur A.M. Wilde
- Amsterdam UMC location University of Amsterdam‚ Department of Cardiology‚ Amsterdam‚ The Netherlands (A.A.M.W.)
| | | | - Corrado Carbucicchio
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo)
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, Ancona, Italy (P.C., A.D.R., M. Casella)
| | - Anneli Svensson
- Department of Cardiology and Department of Health‚ Medicine and Caring Sciences‚ Linköping University‚ Sweden (A.S.)
| | - Corinna B. Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - J. Peter van Tintelen
- Department of Genetics (J.P.v.T.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Sweden (P.G.P.)
| | - Kristina H. Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo (M. Chivulescu, K.H.H.)
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Anneline S.J.M. te Riele
- Department of Cardiology (L.P.B., A.S.J.M.t.R.), University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Paul Khairy
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
| | - Claudio Tondo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Department of Clinical Electrophisiology and Cardiac Pacing, Milan, Italy (C.C., C. Tondo).,Department Biomedical, Surgical and Dental Sciences, University of Milan, Italy (C. Tondo)
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Cynthia A. James
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (A.G., R.T.C., C. Tichnell, B.M., H.T., H.C., C.A.J.)
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich‚ Switzerland (S.C., C.B.B., F.D., A.M.S.)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Canada (R.T., L.R., P.K., J.C.-T.)
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Sanchez-Somonte P, Dryda K, Nault I, Rivard L, Verma A. Evaluation of Saline-Enhanced Radiofrequency Needle-Tip Ablation for Ventricular Tachycardia (SERF VT CANADA Trial). Can J Cardiol 2022; 38:1277-1285. [PMID: 35714882 DOI: 10.1016/j.cjca.2022.06.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/21/2022] [Accepted: 06/09/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endocardial catheter ablation for ventricular tachycardia (VT) may fail owing to the inability to deliver transmural lesions. Saline-enhanced radiofrequency (SERF) ablation uses a needle-tip catheter that is placed at varying depths into the myocardial tissue and heated saline solution is injected along with radiofrequency power (RF), creating fully transmural lesions. We report the first in-human SERF ablation for VT in Canada. METHODS Twenty-five patients with ischemic and nonischemic cardiomyopathy, with recurrent monomorphic drug-refractory VT who had failed a prior catheter ablation underwent SERF ablation in 3 different centres in Canada. After a voltage map, the mapping catheter was replaced with the needle-tipped ablation catheter, which was located perpendicular to the myocardium and extended either 6 or 8 mm into the tissue. Sterile saline solution was infused at a flow rate of 10 mL/min and at 60 °C, and 20-50 W RF was used. RESULTS Baseline left ventricular ejection fraction was 33.3 ± 8.6%, mean age was 69.5 ± 6.4 years; 92% were male. From 43 clinical VTs induced, 42 were ablated and 266 SERF lesions were delivered (10.6 ± 4.9 per patient). Of the 42 treated clinical VTs, 41 VTs (98%) were noninducible and 24 patients (96%) had their VT eliminated. At 6 months' follow-up, 42% of patients were free from VT and there was a 73% reduction in shocks. CONCLUSIONS SERF ablation is feasible and permits control of symptomatic monomorphic VT in drug-refractory patients with a prior failed ablation.
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Affiliation(s)
| | - Katia Dryda
- Montréal Heart Institute, Montréal, Québec, Canada
| | - Isabelle Nault
- Laval University Heart and Lung Institute, Québec City, Québec, Canada
| | - Lena Rivard
- Montréal Heart Institute, Montréal, Québec, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada.
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7
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Schnabel RB, Marinelli EA, Arbelo E, Boriani G, Boveda S, Buckley CM, Camm AJ, Casadei B, Chua W, Dagres N, de Melis M, Desteghe L, Diederichsen SZ, Duncker D, Eckardt L, Eisert C, Engler D, Fabritz L, Freedman B, Gillet L, Goette A, Guasch E, Svendsen JH, Hatem SN, Haeusler KG, Healey JS, Heidbuchel H, Hindricks G, Hobbs FDR, Hübner T, Kotecha D, Krekler M, Leclercq C, Lewalter T, Lin H, Linz D, Lip GYH, Løchen ML, Lucassen W, Malaczynska-Rajpold K, Massberg S, Merino JL, Meyer R, Mont L, Myers MC, Neubeck L, Niiranen T, Oeff M, Oldgren J, Potpara TS, Psaroudakis G, Pürerfellner H, Ravens U, Rienstra M, Rivard L, Scherr D, Schotten U, Shah D, Sinner MF, Smolnik R, Steinbeck G, Steven D, Svennberg E, Thomas D, True Hills M, van Gelder IC, Vardar B, Palà E, Wakili R, Wegscheider K, Wieloch M, Willems S, Witt H, Ziegler A, Daniel Zink M, Kirchhof P. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. Europace 2022; 25:6-27. [PMID: 35894842 PMCID: PMC9907557 DOI: 10.1093/europace/euac062] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [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: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Despite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy. This document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework. Implementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.
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Affiliation(s)
- Renate B Schnabel
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Serge Boveda
- Cardiology—Heart Rhythm Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France,Universiteit Ziekenhuis, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - A John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Barbara Casadei
- RDM, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mirko de Melis
- Medtronic Bakken Research Center, Maastricht, The Netherlands
| | - Lien Desteghe
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Eckardt
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Division of Electrophysiology, Department of Cardiology and Angiology, Münster, Germany
| | | | - Daniel Engler
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK,University Center of Cardiovascular Science Hamburg, Hamburg, Germany
| | - Ben Freedman
- Heart Research Institute, The University of Sydney, Sydney, Australia
| | | | - Andreas Goette
- Atrial Fibrillation Network (AFNET), Muenster, Germany,St Vincenz Hospital, Paderborn, Germany
| | - Eduard Guasch
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Karl Georg Haeusler
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jeff S Healey
- Population Health Research Institute, McMaster University Hamilton, ON, Canada
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Gerhard Hindricks
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Dipak Kotecha
- University of Birmingham & University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Thorsten Lewalter
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Hospital Munich South, Department of Cardiology, Munich, Germany,Department of Cardiology, University of Bonn, Bonn, Germany
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maja Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Wim Lucassen
- Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands
| | | | - Steffen Massberg
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Jose L Merino
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | | | - Lluıs Mont
- Arrhythmia Section, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain,IDIBAPS, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain,CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | | | - Lis Neubeck
- Arrhythmia & Robotic EP Unit, La Paz University Hospital, IDIPAZ, Madrid, Spain
| | - Teemu Niiranen
- Medtronic, Dublin, Ireland,Centre for Cardiovascular Health Edinburgh Napier University, Edinburgh, UK
| | - Michael Oeff
- Atrial Fibrillation Network (AFNET), Muenster, Germany
| | - Jonas Oldgren
- University of Turku and Turku University Hospital, Turku, Finland
| | | | - George Psaroudakis
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helmut Pürerfellner
- School of Medicine, Belgrade University, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ursula Ravens
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Bayer AG, Leverkusen, Germany
| | - Michiel Rienstra
- Ordensklinikum Linz, Elisabethinen, Cardiological Department, Linz, Austria
| | - Lena Rivard
- Institute of Experimental Cardiovascular Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Daniel Scherr
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ulrich Schotten
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - Dipen Shah
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Moritz F Sinner
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Amsterdam UMC (location AMC), Department General Practice, Amsterdam, The Netherlands,Royal Brompton Hospital, London, UK
| | | | - Gerhard Steinbeck
- Atrial Fibrillation Network (AFNET), Muenster, Germany,MUMC+, Maastricht, The Netherlands
| | - Daniel Steven
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital of Geneva, Cardiac Electrophysiology Unit, Geneva, Switzerland
| | - Emma Svennberg
- Center for Cardiology at Clinic Starnberg, Starnberg, Germany
| | - Dierk Thomas
- Atrial Fibrillation Network (AFNET), Muenster, Germany,University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany,Karolinska Institutet, Department of Medicine Huddinge, Karolinska University Hospital, Stockholm, Sweden,Department of Cardiology, Medical University Hospital, Heidelberg, Germany
| | - Mellanie True Hills
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Isabelle C van Gelder
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Burcu Vardar
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elena Palà
- StopAfib.org, American Foundation for Women’s Health, Decatur, TX, USA
| | - Reza Wakili
- Atrial Fibrillation Network (AFNET), Muenster, Germany,Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Karl Wegscheider
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Mattias Wieloch
- Department of Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Stephan Willems
- Atrial Fibrillation Network (AFNET), Muenster, Germany,German Centre for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany,Department of Coagulation Disorders, Skane University Hospital, Lund University, Malmö, Sweden
| | | | | | - Matthias Daniel Zink
- Asklepios Hospital St Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Corresponding author. Tel: +49 40 7410 52438; Fax: +49 40 7410 55862. E-mail address:
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Petzl A, Dyrda K, Rivard L, Martinek M, Purerfellner H, Aguilar M. PO-667-04 PATIENT-SPECIFIC QUANTIFICATION OF CARDIO-RESPIRATORY MOTION FOR CARDIAC RADIO-ABLATION TREATMENT PLANNING. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.381] [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: 11/15/2022]
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9
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Gasperetti A, Carrick RT, Tundo F, Compagnucci P, Bosman LP, Tundo F, Tichnell C, Murray BA, Tandri H, Tadros R, Rivard L, Van Der Bergh P, Zeppenfeld K, Wilde AA, Tundo F, Carbucicchio C, Russo AD, Casella M, Svensson A, Brunckhorst CB, van Tintelen P, Platonov PG, Haugaa KH, Duru F, Riele AT, Khairy P, Tondo C, Calkins H, James CA, Saguner A, CADRIN-TOURIGNY JULIA. PE-565-01 PROGRAMMED VENTRICULAR STIMULATION AS AN ADDITIONAL PRIMARY PREVENTION RISK STRATIFICATION TOOL IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY: A MULTINATIONAL STUDY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.677] [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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10
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NOEL A, Rémillard W, Samuel M, Ben Ali W, Khairy P, Macle L, Mondesert B, Dyrda K, Tadros R, Guerra P, Thibault B, CADRIN-TOURIGNY JULIA, Aguilar M, Dubuc M, Raymond-Paquin A, Asgar A, Ibrahim R, Dorval JF, DURRLEMAN N, Ibrahim M, Roy D, Rivard L. PO-648-05 PREDICTORS FOR TEMPORARY PACEMAKER USE IN PATIENTS WITH NEW LEFT BUNDLE BRANCH BLOCK AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.212] [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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11
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Somonte PS, Dyrda K, Nault I, Rivard L, Verma A. CA-531-04 CANADIAN EXPERIENCE WITH SALINE ENHANCED RADIOFREQUENCY NEEDLE TIP ABLATION FOR VENTRICULAR TACHYCARDIA (SERF VT CANADA TRIAL). Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.630] [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: 11/15/2022]
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2022; 43:e1-e9. [PMID: 35441664 PMCID: PMC9392651 DOI: 10.1093/eurheartj/ehac180] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/16/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients. METHODS AND RESULTS Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 ± 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.3% reduction of ICD placements with the same proportion of protected patients (P < 0.001). CONCLUSION Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).
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Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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13
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Parkash R, Wells GA, Rouleau J, Talajic M, Essebag V, Skanes A, Wilton SB, Verma A, Healey JS, Sterns L, Bennett M, Roux JF, Rivard L, Leong-Sit P, Jensen-Urstad M, Jolly U, Philippon F, Sapp JL, Tang ASL. Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients with Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial. Circulation 2022; 145:1693-1704. [PMID: 35313733 DOI: 10.1161/circulationaha.121.057095] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and can be challenging to treat. Pharmacologic based rhythm-control of AF has not proven to be superior to rate-control. Ablation-based rhythm-control was compared to rate-control to evaluate if clinical outcomes in patients with HF and AF could be improved. Methods: This was a multicenter, open-label trial with blinded outcome evaluation using a central adjudication committee. Patients with high burden paroxysmal (>4 episodes in six months) or persistent (duration < three years) AF, New York Heart Association class II-III HF, and elevated NT-proBNP were randomized to ablation-based rhythm-control or rate-control. The primary outcome was a composite of all-cause mortality and all HF events, with a minimum follow up of two years. Secondary outcomes included left ventricular ejection fraction (LVEF), six-minute walk test and NT-proBNP. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the AF Effect on quality of life (AFEQT). The primary analysis was time-to-event using Cox proportional hazards modeling. The trial was stopped early due to a determination of apparent futility by the Data Safety Monitoring Committee. Results: From December 1, 2011, to January 20, 2018, 411 patients were randomized to ablation-based rhythm-control (n=214) or rate-control (n=197). The primary outcome occurred in 50 (23.4%) patients in the ablation-based rhythm-control group and 64 (32.5%) patients in the rate-control group (hazard ratio 0.71 95% CI (0.49, 1.03), p=0.066). LVEF increased in the ablation-based group (10.1±1.2% vs 3.8±1.2%, p=0.017); six-minute walk distance improved (44.9±9.1 meters 27.5±9.7 meters, p=0.025) and NT-proBNP demonstrated a decrease (mean change -77.1% vs -39.2%, p<0.0001). MLHFQ demonstrated greater improvement in the ablation-based rhythm-control group (LSMD of -5.4, 95%CI (-10.5, -0.3), p=0.0036), as did the AFEQT score (LSMD of 6.2, 95%CI (1.7, 10.7), p=0.0005). Serious adverse events were observed in 50% of patients in both treatment groups. Conclusions: In patients with high burden AF and HF, there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm-control versus rate-control, however, there was a non-significant trend for improved outcomes with ablation-based rhythm control over rate-control.
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Affiliation(s)
- Ratika Parkash
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - George A Wells
- University of Ottawa Cardiovascular Research Methods Centre, Ottawa, ON, Canada
| | - Jean Rouleau
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Vidal Essebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Allan Skanes
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen B Wilton
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Atul Verma
- Southlake Regional Health Centre, ON, Canada
| | | | - Laurence Sterns
- Royal Jubilee Hospital, Island Health Authority, Victoria, BC, Canada
| | - Matthew Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Lena Rivard
- Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Peter Leong-Sit
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Umjeet Jolly
- St. Mary's General Hospital, Kitchener, ON, Canada
| | - François Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, QC, Canada
| | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anthony S L Tang
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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14
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Parkash R, Andrade JG, Rivard L, Tang AS, Healey JS. In Memoriam: George Wyse (1941-2022). Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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15
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Grondin S, Davies B, Cadrin-Tourigny J, Steinberg C, Cheung CC, Jorda P, Healey JS, Green MS, Sanatani S, Alqarawi W, Angaran P, Arbour L, Antiperovitch P, Khan H, Leather R, Guerra PG, Rivard L, Simpson CS, Gardner M, MacIntyre C, Seifer C, Fournier A, Joza J, Gollob MH, Lettre G, Talajic M, Laksman ZW, Roberts JD, Krahn AD, Tadros R. OUP accepted manuscript. Eur Heart J 2022; 43:3071-3081. [PMID: 35352813 PMCID: PMC9392649 DOI: 10.1093/eurheartj/ehac145] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Aims Genetic testing is recommended in specific inherited heart diseases but its role remains unclear and it is not currently recommended in unexplained cardiac arrest (UCA). We sought to assess the yield and clinical utility of genetic testing in UCA using whole-exome sequencing (WES). Methods and results Survivors of UCA requiring external defibrillation were included from the Cardiac Arrest Survivor with Preserved Ejection fraction Registry. Whole-exome sequencing was performed, followed by assessment of rare variants in previously reported cardiovascular disease genes. A total of 228 UCA survivors (mean age at arrest 39 ± 13 years) were included. The majority were males (66%) and of European ancestry (81%). Following advanced clinical testing at baseline, the likely aetiology of cardiac arrest was determined in 21/228 (9%) cases. Whole-exome sequencing identified a pathogenic or likely pathogenic (P/LP) variant in 23/228 (10%) of UCA survivors overall, increasing the proportion of ‘explained’ cases from 9% only following phenotyping to 18% when combining phenotyping with WES. Notably, 13 (57%) of the 23 P/LP variants identified were located in genes associated with cardiomyopathy, in the absence of a diagnosis of cardiomyopathy at the time of arrest. Conclusions Genetic testing identifies a disease-causing variant in 10% of apparent UCA survivors. The majority of disease-causing variants was located in cardiomyopathy-associated genes, highlighting the arrhythmogenic potential of such variants in the absence of an overt cardiomyopathy diagnosis. The present study supports the use of genetic testing including assessment of arrhythmia and cardiomyopathy genes in survivors of UCA.
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Affiliation(s)
- Steffany Grondin
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec City, QC, Canada
| | - Christopher C Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paloma Jorda
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shubhayan Sanatani
- Division of Pediatric Cardiology, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Wael Alqarawi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Angaran
- Cardiac Arrhythmia Service, St Michael’s Hospital, Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Pavel Antiperovitch
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Habib Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Richard Leather
- Division of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Peter G Guerra
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Ste-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Michael H Gollob
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Guillaume Lettre
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Zachary W Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rafik Tadros
- Corresponding author. Tel: +1 514 376 3330, Fax: +1 514 593 2158, , Twitter: @rafik_tadros
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Samuel M, Rivard L, Nault I, Gula L, Essebag V, Parkash R, Sterns LD, Khairy P, Sapp JL. Comparative effectiveness of ventricular tachycardia ablation vs. escalated antiarrhythmic drug therapy by location of myocardial infarction: a sub-study of the VANISH trial. Europace 2021; 24:948-958. [PMID: 34964475 PMCID: PMC9282915 DOI: 10.1093/europace/euab298] [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: 08/31/2021] [Accepted: 11/16/2021] [Indexed: 12/31/2022] Open
Abstract
AIMS Complexity of the ventricular tachycardia (VT) substrate and the size and thickness of infarction area border zones differ based on location of myocardial infarctions (MIs). These differences may translate into heterogeneity in the effectiveness of treatments. This study aims to examine the influence of infarct location on the effectiveness of VT ablation in comparison with escalated pharmacological therapy in patients with prior MI and antiarrhythmic drug (AAD)-refractory VT. METHODS AND RESULTS VANISH trial participants were categorized based on the presence or absence of an inferior MI scar. Inverse probability of treatment weighted Cox models were calculated for each subgroup. Of 259 randomized patients (median age 69.8 years, 7.0% women), 135 had an inferior MI and 124 had a non-inferior MI. Among patients with an inferior MI, no statistically significant difference in the composite primary outcome of all-cause mortality, appropriate implantable cardioverter-defibrillator (ICD) shock, and VT storm was detected between treatment arms [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.51-1.20]. In contrast, patients with non-inferior MIs had a statistically significant reduction in the incidence of the primary outcome with ablation (aHR 0.48, 95% CI 0.27-0.86). In a sensitivity analysis of anterior MI patients (n = 83), a trend towards a reduction in the primary outcome with ablation was detected (aHR 0.50, 95% CI 0.23-1.09). CONCLUSION The effectiveness of VT ablation versus escalated AADs varies based on the location of the MI. Patients with MI scars located only in non-inferior regions of the ventricles derive greater benefit from VT ablation in comparison to escalation of AADs in reducing VT-related events.
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Affiliation(s)
- Michelle Samuel
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Nault
- Department of Medicine, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Lorne Gula
- Department of Medicine, Western University, London, Ontario, Canada
| | - Vidal Essebag
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ratika Parkash
- Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Room 2501B Halifax Infirmary, 1796 Summer St, Halifax, Nova Scotia B3H 3A7, Canada
| | - Laurence D Sterns
- Department of Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - John L Sapp
- Corresponding author. Tel: +1 902 473 4272; fax: +1 902 473 3158. E-mail address:
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17
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Rivard L, Samuel M, Fortier A, Guertin MC, Khairy P, Roy D, Talajic M, Tardif JC. Effect of Perindopril on Atrial Fibrillation Recurrence and Burden: Results of the Canadian Trial of Atrial Fibrillation (CTAF)-2. CJC Open 2021; 3:1100-1107. [PMID: 34712936 PMCID: PMC8531231 DOI: 10.1016/j.cjco.2021.04.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension is a risk factor for the development and exacerbation of atrial fibrillation (AF). Angiotensin-converting enzyme inhibitors are a standard-of-care treatment option for patients with hypertension; however, there is conflicting evidence about their effects on AF recurrence. Therefore, our objective was to assess the efficacy of perindopril, compared with placebo, to reduce AF recurrence in patients with hypertension and AF. Methods In a multicenter, double-blind, placebo-controlled trial, patients with hypertension and symptomatic AF were randomly assigned (1:1) to perindopril or placebo based on a stratification factor of antiarrhythmic drug use. Patients with terminated AF were followed up from 30 days after randomization to 7 to 13 months. The primary endpoint was AF recurrence. Secondary endpoints included AF hospitalization, cardioversion, and blood pressure control. Recurrent events, AF burden, and safety endpoints were also investigated. Results A total of 315 patients were randomly assigned, and 301 patients were included in the modified intent-to-treat analysis (155 vs 146 patients in the perindopril and placebo groups, respectively). The mean follow-up was 336 ± 70 days, and 91.1% of patients were compliant to the treatment medication throughout the study. After adjustment for baseline antiarrhythmic drugs, there was no statistically significant difference in the hazards of AF recurrence (hazard ratio, 1.22; 95% confidence interval, 0.92-1.61), with similar blood pressure. The incidence of secondary endpoints and adverse events also did not differ between treatment arms. Conclusions Perindopril does not reduce recurrence or the number of AF episodes in patients with hypertension and AF.
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Affiliation(s)
- Lena Rivard
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Michelle Samuel
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- Corresponding author: Dr Jean-Claude Tardif, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada. Tel.: 514 376-3330; Fax: 514 376-1355.
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18
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Weng W, Choudhury R, Sapp J, Tang A, Healey JS, Nault I, Rivard L, Greiss I, Bernick J, Parkash R. The role of brain natriuretic peptide in atrial fibrillation: a substudy of the Substrate Modification with Aggressive Blood Pressure Control for Atrial Fibrillation (SMAC-AF) trial. BMC Cardiovasc Disord 2021; 21:445. [PMID: 34530738 PMCID: PMC8447763 DOI: 10.1186/s12872-021-02254-5] [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: 03/29/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter ablation is an established therapy for atrial fibrillation but is limited by recurrence; efforts have been made to identify biomarkers that predict recurrence. We investigated the effect of baseline NT-proBNP on AF recurrence following catheter ablation in patients randomized to aggressive (< 120/80 mmHg) or standard blood pressure management (< 140/90 mmHg) in the Substrate Modification with Aggressive Blood Pressure Control trial (SMAC-AF). METHODS The SMAC-AF study included 173 patients resistant or intolerant to at least one class I or III antiarrhythmic drug. We studied the effect of baseline NT-proBNP on the primary outcome of AF recurrence > 3 months post-ablation. RESULTS Of the 173 patients, 88 were randomized to the aggressive cohort, and 85 into the standard group. The primary outcome occurred in 61.4% of those in the aggressive arm, versus 61.2% in the standard arm. In the aggressive group, logNT-proBNP predicted recurrence (HR 1.28, p = 0.04, adjusted HR 1.43, p = 0.03), while in the standard cohort, it did not (HR 0.94, p = 0.62, adjusted HR 0.83, p = 0.22). NT-proBNP ≥ 280 pg/mL also predicted occurrence in the aggressive (HR 1.98, p = 0.02) but not the standard cohort (HR 1.00, p = 1.00). CONCLUSION We conclude that pre-ablation NT-proBNP may be useful in predicting recurrence in hypertensive patients and identifying patients who benefit from aggressive blood control and upstream therapies. TRIAL REGISTRATION NCT00438113, registered February 21, 2007.
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Affiliation(s)
- Willy Weng
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rajin Choudhury
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada
| | | | | | | | - Lena Rivard
- Montreal Heart Institute, Montreal, QC, Canada
| | - Isabelle Greiss
- Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Jordan Bernick
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ratika Parkash
- Dalhousie University, 1796 Summer Street, Rm 2501-D, Halifax Infirmary, Halifax, NS, B3H 3A7, Canada.
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19
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Aldred MP, Elhaj B, Zeng YH, Couture EJ, Rivard L, Lamarche Y, Denault AY. Right Ventricular Epicardial Pacing Postcardiac Surgery Can Cause Dynamic Right Ventricular Outflow Tract Obstruction: A Case Report. A A Pract 2021; 14:e01346. [PMID: 33295744 DOI: 10.1213/xaa.0000000000001346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dynamic right ventricular outflow tract obstruction is rare in the cardiac surgical population. Significant obstruction developing in the perioperative period can contribute to systemic hemodynamic instability. We describe 2 cases of dynamic right ventricular outflow tract obstruction that developed immediately after separation from cardiopulmonary bypass, due to temporary right ventricular epicardial pacing. Both patients had systemic hypotension which improved once ventricular pacing was discontinued. We discuss the recognition of right ventricular outflow tract obstruction as a contributing factor to hemodynamic instability, as well as the importance of identifying the underlying cause such as to institute appropriate management in these patients.
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Affiliation(s)
- Matthew P Aldred
- From the Department of Anesthesiology, Université de Montréal, Montreal, Quebec, Canada
| | - Bilel Elhaj
- Department of Anesthesiology, Valais-Sion Hospital, Sion, Switzerland
| | - Yu Hao Zeng
- From the Department of Anesthesiology, Université de Montréal, Montreal, Quebec, Canada
| | - Etienne J Couture
- Division of Intensive Care Medicine, Department of Anesthesiology and Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, Quebec, Canada
| | - Lena Rivard
- Department of Cardiology and Electrophysiology Division and
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; and.,Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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20
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Samuel M, Rivard L, Nault I, Gula L, Essebag V, Parkash R, Sterns LD, Khairy P, Sapp JL. Comparative effectiveness of ventricular tachycardia ablation versus escalated antiarrhythmic drug therapy by location of myocardial infarction: A sub-study of the VANISH trial. Europace 2021. [DOI: 10.1093/europace/euab116.073] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Fonds de recherché du Québec-Santé (FRQS) [post doctoral award for Dr. Samuel)
BACKGROUND
Complexity of ventricular tachycardia (VT) substrate, efficiency of lesion formation, and the size and thickness of infarction area border zones differ based on location of myocardial infarctions (MI). These differences may translate into heterogeneity in risk of events and effectiveness of treatments for VT. Small observational studies suggest that VT from inferior infarctions have higher risk of early recurrence despite smaller infarct areas. However, differential effectiveness of VT treatments based on location of MI not been definitively established.
PURPOSE
The objective of this sub-study of the Ventricular tachycardia AblatioN versus escalated antiarrhythmic drug therapy in ISchemic Heart disease (VANISH) randomized trial was to compare the effectiveness of VT ablation by location of MI in reducing the composite endpoint of all-cause mortality, VT storm, or appropriate ICD therapy when compared to escalated pharmacological therapy in VT patients with a prior MI.
METHODS
VANISH participants were categorized into 3 subgroups based on MI location: 1. Inferior (may also have MI in other locations); 2. Non-inferior (no inferior MI, all patients not in group 1); and 3. Anterior (may also have MI in other locations). Inverse probability of treatment weighting was used to balance baseline characteristics (ie. age, sex, comorbidities, medications, and the location of additional infarctions) between patients randomized to ablation or escalated therapy within each subgroup. Weighted Cox proportional hazards models were calculated separately for each subgroup.
RESULTS
Of 259 patients enrolled in the VANISH trial [median age 69.8 (IQR 63.0-74.2) years, 7.0% women], 135 had an inferior MI, 124 a non-inferior MI, and 83 an anterior MI. Among patients with an inferior MI, no statistically significant difference in the primary outcome was detected between patients randomized to ablation or escalated therapy [aHR 0.78 (95% CI 0.51-1.20)]. In contrast, patients with non-inferior MIs had a statistically significant reduction in the incidence of the primary outcome with ablation [aHR 0.48 (95% CI 0.27-0.86)]; which was of greater magnitude than the reduction observed in the overall results of the VANISH trial [HR 0.72 (95% CI 0.53-0.98)]. In addition, a trend towards a reduction in the primary outcome with ablation was detected in patients with anterior MIs [aHR 0.50 (95% CI 0.23-1.09)].
CONCLUSION
The effectiveness of VT ablation versus escalated pharmacological therapy varies based on the location of the MI. Patients with MI scars located only in non-inferior regions of the ventricles derive greater benefit from VT ablation in reducing VT-related events. Further studies are required to explore reasons for this finding and to assess the impact of VT treatment strategies based on MI location in optimizing outcomes.
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Affiliation(s)
- M Samuel
- Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - L Rivard
- Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - I Nault
- Quebec Heart and Lung Institute, Quebec, Canada
| | - L Gula
- Western University, London, Canada
| | - V Essebag
- McGill University Health Centre, Cardiology, Montreal, Canada
| | - R Parkash
- QE II Health Sciences Center, Halifax, Canada
| | - LD Sterns
- Royal Jubilee Hospital, Victoria, Canada
| | - P Khairy
- Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - JL Sapp
- QE II Health Sciences Center, Halifax, Canada
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21
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Camden C, Campbell W, Missiuna C, Berbari J, Héguy L, Gauvin C, Dostie R, Ianni L, Rivard L, Anaby D. Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders' Perceptions. Can J Occup Ther 2021; 88:71-82. [PMID: 33834889 PMCID: PMC8041449 DOI: 10.1177/0008417421994368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background. The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. Purpose. This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. Method. A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. Findings. Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. Implications. Lessons learned may be helpful for others implementing P4C in their own contexts.
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Affiliation(s)
| | | | | | | | | | | | - Rosalie Dostie
- Rosalie Dostie, Université de Sherbrooke, 2500 Boulevard de l’Université, Sherbrooke, Québec J1K 2R1, Canada. Lina Ianni, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, Québec H3G 1Y5, Canada.
| | - Lina Ianni
- Rosalie Dostie, Université de Sherbrooke, 2500 Boulevard de l’Université, Sherbrooke, Québec J1K 2R1, Canada. Lina Ianni, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montréal, Québec H3G 1Y5, Canada.
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22
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Cadrin-Tourigny J, Bosman LP, Wang W, Tadros R, Bhonsale A, Bourfiss M, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, Van der Heijden JF, Tandri H, Jongbloed JDH, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. Sudden Cardiac Death Prediction in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Collaboration. Circ Arrhythm Electrophysiol 2020; 14:e008509. [PMID: 33296238 PMCID: PMC7834666 DOI: 10.1161/circep.120.008509] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [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] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with ventricular arrhythmias (VA) and sudden cardiac death (SCD). A model was recently developed to predict incident sustained VA in patients with ARVC. However, since this outcome may overestimate the risk for SCD, we aimed to specifically predict life-threatening VA (LTVA) as a closer surrogate for SCD.
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Affiliation(s)
- Julia Cadrin-Tourigny
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Laurens P Bosman
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Weijia Wang
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Aditya Bhonsale
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Mimount Bourfiss
- Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Øyvind H Lie
- Department of Cardiology and Research group for Cardiogenetics and Sudden Cardiac Death, Oslo University Hospital, Rikshospitalet, Norway (Ø.H.L., K.H.H.)
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Switzerland (A.M.S., F.D.)
| | - Anneli Svensson
- Department of Cardiology and Department of Medical & Health Sciences, Linköping University, Swede (A.S.)
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Brittney Murray
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (K.Z.)
| | - Maarten P van den Berg
- Department of Cardiology (M.P.v.d.B.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Institute of Cardiovascular Science & Institute of Health Informatics, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center (A.A.M.W.).,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.M.W.)
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada (J.C.-T., R.T., A.A., M.T., L.R., P.K.)
| | - Stephen Chelko
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD.,Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee (S.C.)
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science (S.L.Z., I.R.K.), Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science (S.L.Z., I.R.K.), Johns Hopkins Hospital, Baltimore, MD
| | - Jane E Crosson
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus Medical Center, Rotterdam (S.-C.Y.)
| | - Jeroen F Van der Heijden
- Department of Cardiology (L.P.B., M.B., F.W.A., J.F.V.d.H., A.S.J.M.t.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Jan D H Jongbloed
- Department of Genetics (J.D.H.J.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - J Peter van Tintelen
- Netherlands Heart Institute (L.P.B., F.W.A., J.P.v.T., R.N.W.H., A.S.J.M.t.R.).,Department of Genetics (J.P.v.T.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, the Netherlands (J.P.v.T.)
| | - Pyotr G Platonov
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Firat Duru
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Kristina H Haugaa
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Paul Khairy
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Richard N W Hauer
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
| | - Cynthia A James
- Department of Medicine, Division of Cardiology (J.C.-T., W.W., A.B., C.T., B.M., S.C., J.E.C., D.P.J., H.T., H.C., C.A.J.), Johns Hopkins Hospital, Baltimore, MD
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Samuel M, Khairy P, Mongeon FP, Andrade JG, Gomes S, Galvan Z, Weerasooriya R, Novak P, Nault I, Arentz T, Deisenhofer I, Veenhuyzen GD, Jaïs P, Parkash R, Verma A, Menon S, Puererfellner H, Scavée C, Talajic M, Guerra PG, Rivard L, Dubuc M, Dyrda K, Thibault B, Mondesert B, Tadros R, Cadrin-Tourigny J, Aguilar M, Tardif JC, Levesque S, Roy D, Nattel S, Macle L. Pulmonary Vein Stenosis After Atrial Fibrillation Ablation: Insights From the ADVICE Trial. Can J Cardiol 2020; 36:1965-1974. [PMID: 33157186 DOI: 10.1016/j.cjca.2020.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pulmonary vein (PV) stenosis is a complication of atrial fibrillation (AF) ablation. The incidence of PV stenosis after routine post-ablation imaging remains unclear and is limited to single-centre studies. Our objective was to determine the incidence and predictors of PV stenosis following circumferential radiofrequency ablation in the multicentre Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination (ADVICE) trial. METHODS Patients with symptomatic AF underwent circumferential radiofrequency ablation in one of 13 trial centres. Computed tomographic (CTA) or magnetic resonance (MRA) angiography was performed before ablation and 90 days after ablation. Two blinded reviewers measured PV diameters and areas. PVs with stenosis were classified as severe (> 70%), moderate (50%-70%), or mild (< 50%). Predictors of PV stenosis were identified by means of multivariable logistic regression. RESULTS A total of 197 patients (median age 59.5 years, 29.4% women) were included in this substudy. PV stenosis was identified in 41 patients (20.8%) and 47 (8.2%) of 573 ablated PVs. PV stenosis was classified as mild in 42 PVs (7.3%) and moderate in 5 PVs (0.9%). No PVs had severe stenosis. Both cross-sectional area and diameter yielded similar classifications for severity of PV stenosis. Diabetes was associated with a statistically significant increased risk of PV stenosis (OR 4.91, 95% CI 1.45-16.66). CONCLUSIONS In the first systematic multicentre evaluation of post-ablation PV stenosis, no patient acquired severe PV stenosis. Although the results are encouraging for the safety of AF ablation, 20.8% of patients had mild or moderate PV stenosis, in which the long-term effects are unknown.
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Affiliation(s)
- Michelle Samuel
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Paul Khairy
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | | | - Jason G Andrade
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophie Gomes
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Zurine Galvan
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Rukshen Weerasooriya
- University of Western Australia and Hollywood Private Hospital, Perth, Western Australia, Australia
| | - Paul Novak
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec, Canada
| | | | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, France
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Canada
| | | | | | | | - Mario Talajic
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Peter G Guerra
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Lena Rivard
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Marc Dubuc
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Katia Dyrda
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Bernard Thibault
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Blandine Mondesert
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Rafik Tadros
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | | | - Martin Aguilar
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Jean-Claude Tardif
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Sylvie Levesque
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Denis Roy
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Stanley Nattel
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada
| | - Laurent Macle
- Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada.
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Rivard L, Pester J, McMahon K, Balakrishnan V, Check R, Kelly B, Jeanmonod D, Jeanmonod R. 368 Efficacy of Continuous Use Disposable N95 Masks in Clinical Practice in the Emergency Department. Ann Emerg Med 2020. [PMCID: PMC7598380 DOI: 10.1016/j.annemergmed.2020.09.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A, Bourfiss M, Fortier A, Lie ØH, Saguner AM, Svensson A, Andorin A, Tichnell C, Murray B, Zeppenfeld K, van den Berg MP, Asselbergs FW, Wilde AAM, Krahn AD, Talajic M, Rivard L, Chelko S, Zimmerman SL, Kamel IR, Crosson JE, Judge DP, Yap SC, van der Heijden JF, Tandri H, Jongbloed JDH, Guertin MC, van Tintelen JP, Platonov PG, Duru F, Haugaa KH, Khairy P, Hauer RNW, Calkins H, Te Riele ASJM, James CA. A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2020; 40:1850-1858. [PMID: 30915475 PMCID: PMC6568197 DOI: 10.1093/eurheartj/ehz103] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/21/2018] [Accepted: 03/01/2019] [Indexed: 12/23/2022] Open
Affiliation(s)
- Julia Cadrin-Tourigny
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA.,Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Laurens P Bosman
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - Øyvind H Lie
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Anneli Svensson
- Department of Cardiology, University Hosptial of Linköping, S-581 85 Linköping, Sweden
| | - Antoine Andorin
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Asselbergs
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands.,Faculty of Population Health Sciences, Institute of Cardiovascular Science, Institute of Health Informatics, University College London, 69-75 Chenies Mews, London, UK
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, AZ, Amsterdam, The Netherlands
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia 211 - 1033 Davie Street, Vancouver, BC, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Stephen Chelko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD, USA
| | - Jane E Crosson
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Sing-Chien Yap
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Dr. Molewaterplein 40, GD, Rotterdam, The Netherlands
| | - Jeroen F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Université de Montréal, 4100 Molson St, Suite 400, Montréal, Canada
| | - J Peter van Tintelen
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, DD Amsterdam, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University Hosptial, Lund, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Postboks 4950 Nydalen, Oslo, Norway.,University of Oslo, Postboks 1171, Blindern Oslo, Norway
| | - Paul Khairy
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, 5000 Bélanger St, Montréal, Canada
| | - Richard N W Hauer
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
| | - Anneline S J M Te Riele
- Netherlands Heart Institute, 3501 DG, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, CX Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Carnegie 568D, 600 N. Wolfe St. Baltimore, MD, USA
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Grondin S, Wazirian AC, Jorda P, Terrone DG, Gagnon J, Robb L, Amyot J, Rivard L, Pagé S, Talajic M, Cadrin-Tourigny J, Tadros R. Missense variants in the spectrin repeat domain of DSP are associated with arrhythmogenic cardiomyopathy: A family report and systematic review. Am J Med Genet A 2020; 182:2359-2368. [PMID: 32808748 DOI: 10.1002/ajmg.a.61799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/16/2020] [Accepted: 07/11/2020] [Indexed: 11/08/2022]
Abstract
Rare loss of function variants in DSP, which codes for the desmosomal protein desmoplakin, have been implicated in dilated and arrhythmogenic right ventricular cardiomyopathies. We present a family with arrhythmogenic cardiomyopathy associated with a novel missense variant in DSP (NM_004415.4): c.877G>A, p.(Glu293Lys). The phenotype is characterized by predominant involvement of the left ventricle with systolic dysfunction, fibrosis, and life-threatening arrhythmias. We performed a systematic review of literature collecting all cardiomyopathy cases with rare missense variants in DSP. We demonstrate that the distribution of missense variants across the protein domains in cardiomyopathy cases differs from that in gnomAD (p = .04), with a case enrichment of rare missense variants in the spectrin repeat domain (36/78 [46%] in cases vs. 449/1495 [30%] in gnomAD; p = .004). Our findings highlight the predominance of cardiac arrhythmia and left ventricular involvement in desmoplakin cardiomyopathy and pinpoint to a potential mutation hotspot in DSP thereby facilitating missense variant interpretation in the diagnostic setting.
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Affiliation(s)
- Steffany Grondin
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Avedis-Christ Wazirian
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Paloma Jorda
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Department of Cardiology, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain.,Universitat de Barcelona, Institut d'Investigacions Biomèdiques, Barcelona, Spain
| | - Donato G Terrone
- Department of Radiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Johannie Gagnon
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Laura Robb
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Amyot
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Sylvain Pagé
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Medor MC, Spence S, Nery PB, Beanlands R, Promislow S, Juneau D, de Kemp R, Ha AC, Rivard L, Gula L, Birnie DH. Treatment with corticosteroids is associated with an increase in ventricular arrhythmia burden in patients with clinically manifest cardiac sarcoidosis: Insights from implantable cardioverter-defibrillator diagnostics. J Cardiovasc Electrophysiol 2020; 31:2751-2758. [PMID: 32713090 DOI: 10.1111/jce.14689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/21/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We sought to explore the relationship between ventricular tachycardia (VT) and premature ventricular complex (PVC) burden (from implantable cardioverter-defibrillator diagnostics), before and during corticosteroid use in patients with newly diagnosed clinically manifest cardiac sarcoidosis (CS). METHODS A single-centre, prospective cohort study was performed in consecutive patients who met all of the following criteria: (1) presentation with clinically manifest CS, (2) abnormal myocardial fluoro-deoxyglucose (FDG) uptake on positron emission tomography scan, (3) plan for implantation with implantable cardioverter-defibrillator device that reports accurate PVC count, (4) plan to initiate corticosteroids after the device healing period. Data were collected during each device interrogation visit for all patients in the study. For each inter-visit period the total number of episodes of VT-sustained and nonsustained, and the number of PVCs was obtained. Each inter-visit period was classified into one of the following three periods: (1) New diagnosis of treatment-naive active disease without corticosteroids during the period. (2) Known treatment-naive active disease with corticosteroids initiated during the inter-visit period. (3) On corticosteroid therapy during the entire period. RESULTS A total of 20 patients with a mean age of 59.7 ± 7.7 years were recruited and 82 inter-visit periods were analyzed. All patients were corticosteroid responders based on FDG uptake. The maximum left ventricular standardized uptake value was 11.14 ± 5.19 before corticosteroid initiation and 4.07 ± 0.88 after (p < .001). Patients with active untreated CS had an average of 496.4 ± 879.1 PVCs per day. After treatment with corticosteroids, the average PVC count increased to 1332.4 ± 1865.7/day during Period 2 (p = .036) and to 1590.1 ± 2362.2 per day during Period 3 (p = .008). There was also a statistically significant increase in episodes of nonsustained ventricular tachycardia (NSVT) before and after treatment with corticosteroids (p = .017). There were too few episodes of sustained ventricular arrhythmia to analyze. Overall, 18 out of 20 patients (90%) had an increase in PVC burden after corticosteroid initiation. CONCLUSION This study demonstrated, on average, a threefold increase in daily PVC count in clinically manifest CS patients during treatment with corticosteroids compared to pretreatment. There was also a significant increase in episodes of NSVT. Clinicians and patients with active manifest CS should be aware that corticosteroids are unlikely to lead to a reduction in the burdens of PVC and NSVT.
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Affiliation(s)
- Maria C Medor
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stewart Spence
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Steven Promislow
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Juneau
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rob de Kemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew C Ha
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lena Rivard
- Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Lorne Gula
- Department of Medicine, Western University, London, Ontario, Canada
| | - David H Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Thibault B, Richer LP, Relan J, Mcspadden L, Ryu K, Rivard L, Dyrda K, Dubuc M, Mondesert B, Cadrin-Tourigny J, Tadros R, Macle L, Khairy P, Gregoire J, Harel F. 668Principal component analysis can identify ventricular regions with highest variability in the arrhythmogenic substrate of ventricular tachycardia patients. Europace 2020. [DOI: 10.1093/europace/euaa162.233] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left ventricle (LV) substrate can be characterized by imaging modalities providing physiological variables (tissue perfusion, ischemia, etc.) grouped in a complex dataset. Principal Component Analysis (PCA) can identify the dataset variables that best explain its variance. Variables linked to substrate arrhythmogenicity will lead PCA to identify LV regions most influenced by the variables on a LV 3D geometry.
Purpose
To evaluate whether regions identified by PCA correspond to regions targeted by physicians in a ventricular tachycardia (VT) ablation procedure.
Methods
Ischemic VT subjects underwent SPECT/CT perfusion imaging (rest and stress) prior to LV voltage mapping with the cardiac mapping system. Co-registration allowed projection of ablation sites onto SPECT/CT geometries. PCA retrospectively analyzed the following dataset: tissue perfusion (rest and stress), tissue ischemia and the local (1cm2 sub-regions) stress-rest difference for: 1) standard deviation (STD) and 2) skewness (Skew). PCA components (PCAc) explaining ≥85% of the total variance were plotted on the LV 3D geometry to display regions highly influenced by the dataset variables (see figure below).
Results
Ten subjects (9 males, 66 ± 8 years old, LVEF 37 ± 11%) underwent co-registration. In 7/10 subjects, tissue perfusion (in PCAc#1) and ischemia (in PCAc#2) were most influential on LV regions variance. Ischemia and low perfusion (≤40%) areas equaled 32 ± 19 % of the LV with 21 ± 23% of these areas highly involved in the arrhythmogenic substrate (≥75% of explained LV variance). The location of 63 ± 18% of ablation sites were <1 cm from areas explaining ≥50% of LV variance.
Conclusion
Preliminary results showed that PCA can synthesize the influence of different perfusion derived variables, like tissue perfusion and ischemia, used in SPECT/CT imaging of the LV. Further analysis is needed to confirm whether this could be used to select VT ablation targets.
Abstract Figure.
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Affiliation(s)
- B Thibault
- Montreal Heart Institute, Montreal, Canada
| | - L P Richer
- Abbott Medical, Sylmar, United States of America
| | - J Relan
- Abbott Medical, Sylmar, United States of America
| | - L Mcspadden
- Abbott Medical, Sylmar, United States of America
| | - K Ryu
- Abbott Medical, Sylmar, United States of America
| | - L Rivard
- Montreal Heart Institute, Montreal, Canada
| | - K Dyrda
- Montreal Heart Institute, Montreal, Canada
| | - M Dubuc
- Montreal Heart Institute, Montreal, Canada
| | | | | | - R Tadros
- Montreal Heart Institute, Montreal, Canada
| | - L Macle
- Montreal Heart Institute, Montreal, Canada
| | - P Khairy
- Montreal Heart Institute, Montreal, Canada
| | - J Gregoire
- Montreal Heart Institute, Montreal, Canada
| | - F Harel
- Montreal Heart Institute, Montreal, Canada
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29
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Deyell MW, AbdelWahab A, Angaran P, Essebag V, Glover B, Gula LJ, Khoo C, Lane C, Nault I, Nery PB, Rivard L, Slawnych MP, Tulloch HL, Sapp JL. 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Position Statement on the Management of Ventricular Tachycardia and Fibrillation in Patients With Structural Heart Disease. Can J Cardiol 2020; 36:822-836. [DOI: 10.1016/j.cjca.2020.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/29/2020] [Accepted: 04/05/2020] [Indexed: 10/24/2022] Open
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Khairy TF, Lupien MA, Nava S, Baez FV, Ovalle FS, Ochoa NEL, Mendoza GS, Carrazco CA, Villemaire C, Cartier R, Roy D, Talajic M, Dubuc M, Thibault B, Guerra PG, Rivard L, Dyrda K, Mondésert B, Tadros R, Cadrin-Tourigny J, Macle L, Khairy P. Infections Associated with Resterilized Pacemakers and Defibrillators. N Engl J Med 2020; 382:1823-1831. [PMID: 32374963 DOI: 10.1056/nejmoa1813876] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Access to pacemakers and defibrillators is problematic in places with limited resources. Resterilization and reuse of implantable cardiac devices obtained post mortem from patients in wealthier nations have been undertaken, but uncertainty around the risk of infection is a concern. METHODS A multinational program was initiated in 1983 to provide tested and resterilized pacemakers and defibrillators to underserved nations; a prospective registry was established in 2003. Patients who received reused devices in this program were matched in a 1:3 ratio with control patients who received new devices implanted in Canada. The primary outcome was infection or device-related death, with mortality from other causes modeled as a competing risk. RESULTS Resterilized devices were implanted in 1051 patients (mean [±SD] age, 63.2±18.5 years; 43.6% women) in Mexico (36.0%), the Dominican Republic (28.1%), Guatemala (26.6%), and Honduras (9.3%). Overall, 85% received pacemakers and 15% received defibrillators, with one (55.5%), two (38.8%), or three (5.7%) leads. Baseline characteristics did not differ between these patients and the 3153 matched control patients. At 2 years of follow-up, infections had occurred in 21 patients (2.0%) with reused devices and in 38 (1.2%) with new devices (hazard ratio, 1.66; 95% confidence interval, 0.97 to 2.83; P = 0.06); there were no device-related deaths. The most common implicated pathogens were Staphylococcus aureus and S. epidermidis. CONCLUSIONS Among patients in underserved countries who received a resterilized and reused pacemaker or defibrillator, the incidence of infection or device-related death at 2 years was 2.0%, an incidence that did not differ significantly from that seen among matched control patients with new devices in Canada.
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Affiliation(s)
- Thomas F Khairy
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Marie-Andrée Lupien
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Santiago Nava
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Frank Valdez Baez
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Fernando Solares Ovalle
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Nery E Linarez Ochoa
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Gerardo Sosa Mendoza
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Cesar A Carrazco
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Christine Villemaire
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Richard Cartier
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Denis Roy
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Mario Talajic
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Marc Dubuc
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Bernard Thibault
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Peter G Guerra
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Lena Rivard
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Katia Dyrda
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Blandine Mondésert
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Rafik Tadros
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Julia Cadrin-Tourigny
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Laurent Macle
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
| | - Paul Khairy
- From the Montreal Heart Institute, Université de Montréal, Montreal (T.F.K., M.-A.L., C.V., R.C., D.R., M.T., M.D., B.T., P.G.G., L.R., K.D., B.M., R.T., J.C.-T., L.M., P.K.); Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (S.N.); the Dominican Institute of Cardiology, Santo Domingo, Dominican Republic (F.V.B.); Clínicas Médicas las Américas, Guatemala City, Guatemala (F.S.O.); and Cardiología Hospital General del Sur, Choluteca (N.E.L.O.), and Instituto Nacional Cardiopulmonar (G.S.M.) and Medicina Interna-Programación de Marcapaso Definitivo, Instituto Nacional Cardiopulmonar, Tegucigalpa (C.A.C.) - all in Honduras
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Birnie D, Beanlands RSB, Nery P, Aaron SD, Culver DA, DeKemp RA, Gula L, Ha A, Healey JS, Inoue Y, Judson MA, Juneau D, Kusano K, Quinn R, Rivard L, Toma M, Varnava A, Wells G, Wickremasinghe M, Kron J. Cardiac Sarcoidosis multi-center randomized controlled trial (CHASM CS- RCT). Am Heart J 2020; 220:246-252. [PMID: 31911261 DOI: 10.1016/j.ahj.2019.10.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/06/2019] [Indexed: 12/23/2022]
Abstract
Approximately 5% of patients with sarcoidosis have clinically manifest cardiac involvement. Clinical features of Cardiac Sarcoidosis are dependent on the location, extent, and activity of the disease. First line therapy is usually with prednisone and this is recommended based on clinician experience, expert opinion and small observational cohorts. There are no published clinical trials in cardiac sarcoidosis and multiple experts in the field have called for randomized clinical trials to answer important patient care questions. Corticosteroid are associated with multiple adverse effects including hypertension, diabetes, weight gain, osteoporosis, and increased risk of infections. In contrast Methotrexate is generally well tolerated and is increasingly used in other forms of sarcoidosis. OBJECTIVES The Cardiac Sarcoidosis Multi-Center Randomized Controlled Trial (CHASM CS-RCT; NCT03593759) is a multicenter randomized controlled trial designed to evaluate the optimal initial treatment strategy for patients with active cardiac sarcoidosis. We hypothesize that (1) a low dose prednisone/methotrexate combination will have non-inferior efficacy to standard dose prednisone and that (2) the low dose prednisone/ methotrexate combination will result in significantly better quality of life than standard dose prednisone, as a result of reduced burden of side effects. METHODS/DESIGN Eligible study subjects will have active clinically manifest cardiac sarcoidosis presenting with one or more of the following clinical findings: advanced conduction system disease, significant sinus node dysfunction, non-sustained or sustained ventricular arrhythmia, left ventricular dysfunction or right ventricular dysfunction. Subjects will be randomized in a 1:1 ratio to prednisone 0.5 mg/kg/day for 6 months (maximum dose 30 mg daily) OR to prednisone 20 mg daily for 1 month, then 10 mg daily for 1 month, then 5 mg daily for one month then stop AND methotrexate 15-20 mg once weekly for 6 months. The primary endpoint is summed perfusion rest score on 6-month PET (blinded core-lab review). The summed perfusion rest score is measure of myocardial fibrosis/scar. The design is non-inferiority with a sample size of 97 per group. DISCUSSION Given the multiorgan system potential adverse side effects of prednisone, proving noninferiority of an alternate regimen would be sufficient to make the alternative compare favorably to standard dose steroids. This is the first ever clinical trial in cardiac sarcoidosis and thus in addition to the listed goals of the trial, we will also establish a multi-center, multinational cardiac sarcoidosis clinical trials network. Such a collaborative infrastructure will enable a new era of high quality data to guide physicians when treating cardiac sarcoidosis patients.
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Affiliation(s)
- David Birnie
- University of Ottawa Heart Institute, ON, Canada.
| | | | - Pablo Nery
- University of Ottawa Heart Institute, ON, Canada
| | | | | | | | - Lorne Gula
- London Health Sciences Centre, On, Canada
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | | | - Yuko Inoue
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Daniel Juneau
- Centre Hospitalier de l'Université de Montréal, Department of Radiology and Nuclear Medicine, Montréal, QC, Canada
| | - Kengo Kusano
- National Cerebral and Cardiovascular Center, Suita, Japan; Libin Cardiovascular Institute of Alberta, Alberta, Canada
| | | | - Lena Rivard
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Mustafa Toma
- Imperial College Healthcare NHS Trust, London, UK
| | | | - George Wells
- University of Ottawa Heart Institute, ON, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, VA, USA
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Weng W, Choudhury R, Sapp J, Tang A, Healey J, Nault I, Rivard L, Greiss I, Parkash R. NT-PROBNP PREDICTS RECURRENCE AFTER CATHETER ABLATION IN A HYPERTENSIVE POPULATION UNDERGOING AGGRESSIVE BLOOD PRESSURE MANAGEMENT: A SUB-STUDY OF SMAC-AF. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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33
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Ortmans S, Daval C, Aguilar M, Compagno P, Cadrin-Tourigny J, Dyrda K, Rivard L, Tadros R. Pharmacotherapy in inherited and acquired ventricular arrhythmia in structurally normal adult hearts. Expert Opin Pharmacother 2019; 20:2101-2114. [DOI: 10.1080/14656566.2019.1669561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Staniel Ortmans
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charline Daval
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Compagno
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Katia Dyrda
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafik Tadros
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Physiology and Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Cadrin-Tourigny J, Bosman LP, Tadros R, Talajic M, Rivard L, James CA, Khairy P. Risk stratification for ventricular arrhythmias and sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy: an update. Expert Rev Cardiovasc Ther 2019; 17:645-651. [PMID: 31422711 DOI: 10.1080/14779072.2019.1657831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined disease associated with a significant risk of ventricular arrhythmias and sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) are the only effective preventive measure. Over the past 30 years, much effort has been invested in determining predictors of adverse arrhythmic events in these patients. Areas covered: This review summarizes available evidence on risk stratification for ARVC, with an emphasis on recent research findings. While efforts are ongoing to define risk predictors, several recent publications have synthetized and built on this knowledge base. A recently published meta-analysis has clarified the strongest predictors of ventricular arrhythmias in ARVC, which vary depending on the population included. Three management guidelines/expert consensus documents have integrated the previously described risk predictors into proposed ICD recommendations. Furthermore, a risk prediction model has allowed the integration of multiple risk factors to provide individualized risk prediction and to inform shared-decision making regarding ICD implantation. Expert opinion: Over the past few years, knowledge of risk prediction in ARVC has been consolidated and refined. Further improvements may be made by the considering additional predictors such as exercise and by targeting more specific surrogate outcomes for SCD.
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Affiliation(s)
| | - Laurens P Bosman
- Department of Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Rafik Tadros
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Mario Talajic
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Lena Rivard
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
| | - Cynthia A James
- Division of Cardiology, Johns Hopkins University , Baltimore , MD , USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute , Montreal , Quebec , Canada
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Parkash R, Nault I, Rivard L, Gula L, Essebag V, Nery P, Tung S, Raymond JM, Sterns L, Doucette S, Wells G, Tang ASL, Stevenson WG, Sapp JL. Effect of Baseline Antiarrhythmic Drug on Outcomes With Ablation in Ischemic Ventricular Tachycardia: A VANISH Substudy (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease). Circ Arrhythm Electrophysiol 2019; 11:e005663. [PMID: 29305400 DOI: 10.1161/circep.117.005663] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/19/2017] [Accepted: 11/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) compared the effectiveness of escalated antiarrhythmic drug therapy to catheter ablation in patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia (VT). The effectiveness of these interventions in patients on sotalol versus amiodarone was compared. METHODS AND RESULTS Analysis was conducted based on whether patients had recurrent VT, despite amiodarone (amio-refractory) or nonamiodarone drugs (sotalol-refractory). Outcomes included death, VT storm, appropriate implantable cardioverter defibrillator shock, and any ventricular arrhythmia. At baseline, 169 (65.2%) were amio-refractory, and 90 (34.7%) were sotalol-refractory (1 patient on procainamide rather than sotalol). Amio-refractory patients had more renal insufficiency (23.7% versus 10%; P=0.0008), worse New York Heart Association class (82.3% II/III versus 65.5%; P=0.0003), and lower ejection fraction (29±9.7% versus 35.2±11%; P<0.0001). Within the amio-refractory group, ablation resulted in reduction of any ventricular arrhythmia compared with escalated drug therapy (hazard ratio, 0.53; 95% confidence interval, 0.31-0.9), P=0.020). Sotalol-refractory patients had trends toward higher mortality and VT storm with ablation, with no effect on implantable cardioverter defibrillator shocks. Within the escalated drug therapy arm, amio-refractory patients had a higher rate of the composite outcome (hazard ratio, 1.94; 95% confidence interval, 1.14-3.29; P=0.0144) and a trend to higher mortality (hazard ratio, 2.40; 95% confidence interval, 0.93-6.22; P=0.07), whereas mortality was not different between amio- and sotalol-refractory patients within the ablation treatment group. CONCLUSIONS Patients with amio-refractory VT have a higher rate of ventricular arrhythmia and mortality than those with sotalol-refractory VT and derive greater benefit of catheter ablation than for patients with sotalol-refractory VT who are switched to amiodarone. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT00905853.
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Affiliation(s)
- Ratika Parkash
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - Isabelle Nault
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Lena Rivard
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Lorne Gula
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Vidal Essebag
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Pablo Nery
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Stanley Tung
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Jean-Marc Raymond
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Laurence Sterns
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Steve Doucette
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - George Wells
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - Anthony S L Tang
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - William G Stevenson
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
| | - John L Sapp
- From the QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, Canada (I.N.); Montreal Heart Institute, Quebec, Canada (L.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); McGill University Health Center, Montreal, Quebec, Canada (V.E.); Hôpital Sacré-Coeur de Montréal, Quebec, Canada (V.E.); University of Ottawa Heart Institute, Ontario, Canada (P.N., G.W.); Royal Columbian Hospital, Vancouver, British Columbia, Canada (S.T.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (J.-M.R.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada (S.D.); and Brigham and Women's Hospital, Boston, MA (W.G.S.)
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Russo JJ, Nery PB, Ha AC, Healey JS, Juneau D, Rivard L, Friedrich MG, Gula L, Wisenberg G, deKemp R, Chakrabarti S, Hruczkowski TW, Quinn R, Ramirez FD, Dwivedi G, Beanlands RSB, Birnie DH. Sensitivity and specificity of chest imaging for sarcoidosis screening in patients with cardiac presentations. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:18-24. [PMID: 32476932 DOI: 10.36141/svdld.v36i1.6865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/19/2018] [Indexed: 11/02/2022]
Abstract
Background Patients with sarcoidosis can present with cardiac symptoms as the first manifestation of disease in any organ. In these patients, the use of chest imaging modalities may serve as an initial screening tool towards the diagnosis of sarcoidosis through identification of pulmonary/mediastinal involvement; however, the use of chest imaging for this purpose has not been well studied. We assessed the utility of different chest imaging modalities for initial screening for cardiac sarcoidosis (CS). Methods and Results All patients were investigated with chest x-ray, chest computed tomography (CT) and/or cardiac/thorax magnetic resonance imaging (MRI). We then used the final diagnosis (CS versus no CS) and adjudicated imaging reports (normal versus abnormal) to calculate the sensitivity and specificity of individual and combinations of chest imaging modalities. We identified 44 patients (mean age 54 (±8) years, 35.4% female) and a diagnosis of CS was made in 18/44 patients (41%). The sensitivity and specificity for screening for sarcoidosis were 35% and 85% for chest x-ray, respectively (AUC 0.60; 95%CI 0.42-0.78; p value=0.27); 94% and 86% for chest CT (AUC 0.90; 95%CI 0.80-1.00; p value <0.001); 100% and 50% for cardiac/thorax MRI (AUC 0.75; 95%CI 0.56-0.94; p value=0.04). Conclusions During the initial diagnostic workup of patients with suspected CS, chest x-ray was suboptimal as a screening test. In contrast CT chest and cardiac/thorax MRI had excellent sensitivity. Chest CT has the highest specificity among imaging modalities. Cardiac/thorax MRI or chest CT could be used as an initial screening test, depending on local availability.
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Affiliation(s)
- Juan J Russo
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - Andrew C Ha
- Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, ON
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON
| | - Daniel Juneau
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | | | | | - Lorne Gula
- Department of Medicine, Western University, London, ON
| | - Gerald Wisenberg
- Department of Medicine, Western University, London, ON.,Division of Imaging, Lawson Research Institute, London, ON
| | - Robert deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - Santabhanu Chakrabarti
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC
| | | | - Russell Quinn
- Libin Cardiovascular Institute of Alberta, Calgary, AB
| | - F Daniel Ramirez
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - Girish Dwivedi
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - Rob S B Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
| | - David H Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON
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Gourraud JB, Khairy P, Abadir S, Tadros R, Cadrin-Tourigny J, Macle L, Dyrda K, Mondesert B, Dubuc M, Guerra PG, Thibault B, Roy D, Talajic M, Rivard L. Atrial fibrillation in young patients. Expert Rev Cardiovasc Ther 2018; 16:489-500. [DOI: 10.1080/14779072.2018.1490644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Sylvia Abadir
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Rafik Tadros
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Blandine Mondesert
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Peter G. Guerra
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Lena Rivard
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
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Essebag V, Joza J, Nery PB, Doucette S, Nault I, Rivard L, Gula L, Deyell M, Raymond JM, Lane C, Sapp JL. Prognostic Value of Noninducibility on Outcomes of Ventricular Tachycardia Ablation: A VANISH Substudy. JACC Clin Electrophysiol 2018; 4:911-919. [PMID: 30025692 DOI: 10.1016/j.jacep.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to evaluate the predictive value of noninducibility on long-term outcomes. BACKGROUND The traditional endpoint for catheter ablation of ventricular tachycardia (VT) is noninducibility of VT by programmed stimulation; however, the definition of inducibility remains variable and its prognostic value limited by nonstandardized periprocedural antiarrhythmic drug therapy and implantable cardioverter-defibrillator programming in prior observational studies. The VANISH trial randomized patients with prior myocardial infarction and VT to ablation (with an endpoint of noninducibility of VT ≥300 ms after ablation) versus antiarrhythmic drug escalation. METHODS Patients enrolled in the VANISH study randomized to catheter ablation were included. The relationship between post-ablation inducibility and the primary composite endpoint (death, VT storm >30 days, or appropriate implantable cardioverter-defibrillator shock >30 days) was assessed using a time-to-event analysis, adjusting for other clinical and procedural characteristics. RESULTS A total of 129 patients from the ablation arm were included in the primary analysis, of which 51 were noninducible post-ablation compared with 78 who had inducible VT or in whom inducibility testing was not performed. There were no significant baseline characteristic or procedural differences except for increased implantable cardioverter-defibrillator shocks before randomization in the noninducible group. In multivariate analysis, inducibility significantly increased the risk of death, appropriate shock, or VT storm after 30 days (HR: 1.87; p = 0.017). CONCLUSIONS Inducibility of any VT post-ablation was associated with an increased risk of the composite endpoint in the VANISH trial. A randomized trial is required to confirm whether more aggressive ablation targeting faster induced VTs (<300 ms) can improve outcomes.
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Affiliation(s)
- Vidal Essebag
- McGill University Health Centre Research Institute, Montreal, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Canada.
| | - Jacqueline Joza
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Pablo B Nery
- Research Methods Unit, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Isabelle Nault
- Institute Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada
| | | | | | | | | | - Chris Lane
- Royal Jubilee Hospital, Victoria, Canada
| | - John L Sapp
- Department of Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Canada
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Gélinas R, El Khoury N, Chaix MA, Beauchamp C, Alikashani A, Ethier N, Boucher G, Villeneuve L, Robb L, Latour F, Mondesert B, Rivard L, Goyette P, Talajic M, Fiset C, Rioux JD. Characterization of a Human Induced Pluripotent Stem Cell-Derived Cardiomyocyte Model for the Study of Variant Pathogenicity: Validation of a KCNJ2 Mutation. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001755. [PMID: 29021306 DOI: 10.1161/circgenetics.117.001755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Long-QT syndrome is a potentially fatal condition for which 30% of patients are without a genetically confirmed diagnosis. Rapid identification of causal mutations is thus a priority to avoid at-risk situations that can lead to fatal cardiac events. Massively parallel sequencing technologies are useful for the identification of sequence variants; however, electrophysiological testing of newly identified variants is crucial to demonstrate causality. Long-QT syndrome could, therefore, benefit from having a standardized platform for functional characterization of candidate variants in the physiological context of human cardiomyocytes. METHODS AND RESULTS Using a variant in Kir2.1 (Gly52Val) revealed by whole-exome sequencing in a patient presenting with symptoms of long-QT syndrome as a proof of principle, we demonstrated that commercially available human induced pluripotent stem cell-derived cardiomyocytes are a powerful model for screening variants involved in genetic cardiac diseases. Immunohistochemistry experiments and whole-cell current recordings in human embryonic kidney cells expressing the wild-type or the mutant Kir2.1 demonstrated that Kir2.1-52V alters channel cellular trafficking and fails to form a functional channel. Using human induced pluripotent stem cell-derived cardiomyocytes, we not only confirmed these results but also further demonstrated that Kir2.1-52V is associated with a dramatic prolongation of action potential duration with evidence of arrhythmic activity, parameters which could not have been studied using human embryonic kidney cells. CONCLUSIONS Our study confirms the pathogenicity of Kir2.1-52V in 1 patient with long-QT syndrome and also supports the use of isogenic human induced pluripotent stem cell-derived cardiomyocytes as a physiologically relevant model for the screening of variants of unknown function.
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Affiliation(s)
- Roselle Gélinas
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Nabil El Khoury
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Marie-A Chaix
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Claudine Beauchamp
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Azadeh Alikashani
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Nathalie Ethier
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Gabrielle Boucher
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Louis Villeneuve
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Laura Robb
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Frédéric Latour
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Blandine Mondesert
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Lena Rivard
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Philippe Goyette
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Mario Talajic
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Céline Fiset
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada.
| | - John David Rioux
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada.
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Bessière F, Zikry C, Rivard L, Dyrda K, Khairy P. Contact force with magnetic-guided catheter ablation. Europace 2018; 20:ii1-ii4. [DOI: 10.1093/europace/euy006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Francis Bessière
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada
| | - Christopher Zikry
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada
- Department of Biomedical Engineering, McGill University, 3775 University, Montreal, QC, H3A 2B4, Canada
| | - Lena Rivard
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada
| | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montreal, QC H1T 1C8, Canada
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41
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Dagres N, Chao TF, Fenelon G, Aguinaga L, Benhayon D, Benjamin EJ, Bunch TJ, Chen LY, Chen SA, Darrieux F, de Paola A, Fauchier L, Goette A, Kalman J, Kalra L, Kim YH, Lane DA, Lip GYH, Lubitz SA, Márquez MF, Potpara T, Pozzer DL, Ruskin JN, Savelieva I, Teo WS, Tse HF, Verma A, Zhang S, Chung MK, Bautista-Vargas WF, Chiang CE, Cuesta A, Dan GA, Frankel DS, Guo Y, Hatala R, Lee YS, Murakawa Y, Pellegrini CN, Pinho C, Milan DJ, Morin DP, Nadalin E, Ntaios G, Prabhu MA, Proietti M, Rivard L, Valentino M, Shantsila A. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice? J Arrhythm 2018; 34:99-123. [PMID: 29657586 PMCID: PMC5891416 DOI: 10.1002/joa3.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nikolaos Dagres
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany
| | | | | | | | - Daniel Benhayon
- Cardiac and Vascular Institute Memorial Health Hollywood FL USA
| | - Emelia J Benjamin
- Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA
| | | | - Lin Yee Chen
- Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA
| | | | | | - Angelo de Paola
- Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil
| | - Laurent Fauchier
- Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France
| | - Andreas Goette
- Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany
| | - Jonathan Kalman
- Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia
| | | | | | - Deirdre A Lane
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark
| | | | - Manlio F Márquez
- Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico
| | - Tatjana Potpara
- School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia
| | | | | | - Irina Savelieva
- Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK
| | | | - Hung-Fat Tse
- Department of Medicine The University of Hong Kong Hong Kong China
| | - Atul Verma
- Southlake Regional Health Centre Newmarket ON Canada
| | - Shu Zhang
- Beijing Fuwai Hospital Beijing China
| | | | - William-Fernando Bautista-Vargas
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Chern-En Chiang
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alejandro Cuesta
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Gheorghe-Andrei Dan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David S Frankel
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yutao Guo
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Robert Hatala
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Young Soo Lee
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Yuji Murakawa
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Cara N Pellegrini
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Claudio Pinho
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - David J Milan
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Daniel P Morin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Elenir Nadalin
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - George Ntaios
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mukund A Prabhu
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Marco Proietti
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Lena Rivard
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Mariana Valentino
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
| | - Alena Shantsila
- Department of Electrophysiology Heart Center Leipzig Leipzig Germany.,Taipei Veterans General Hospital Taipei Taiwan.,Hospital Israelita Albert Einstein São Paulo Brazil.,Centro Privado de Cardiología Tucumán Argentina.,Cardiac and Vascular Institute Memorial Health Hollywood FL USA.,Boston University Schools of Medicine and Public Health Framingham Heart Study Boston MA USA.,Intermountain Medical Center Murray UT USA.,Cardiovascular Division Department of Medicine University of Minnesota Minneapolis MN USA.,University of Sao Paulo Medical School Sao Paulo Brazil.,Escola Paulista de Medicina Universidade Federal de São Paulo São Paulo Brazil.,Service de Cardiologie Centre Hospitalier Universitaire Trousseau Université François Rabelais Tours France.,Department of Cardiology and Intensive Care Medicine St. Vincenz-Hospital Paderborn Working Group: Molecular Electrophysiology, University Hospital Magdeburg Magdeburg Germany.,Royal Melbourne Hospita lUniversity of Melbourne Melbourne Vic.Australia.,King's College London London UK.,Korea University Medical Center Seoul Korea.,Institute of Cardiovascular Sciences University of Birmingham Birmingham UK.,Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark.,Massachusetts General Hospital Boston MA USA.,Departmen of Electrocardiography Instituto Nacional De Cardiologia Mexico City Mexico.,School of Medicine Belgrade University Belgrade Serbia.,Cardiology Clinic Clinical Center of Serbia Belgrade Serbia.,Instituto de Cardiología de CorrientesCorrientesArgentina.,Cardiology Clinical Academic Group Molecular and Clinical Sciences Research Institute St. George's University of London London UK.,National Heart Centre Singapore City Singapore.,Department of Medicine The University of Hong Kong Hong Kong China.,Southlake Regional Health Centre Newmarket ON Canada.,Beijing Fuwai Hospital Beijing China.,Cleveland Clinic Cleveland OH USA
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42
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Thibault B, Richer LP, Mcspadden LC, Ryu K, Mondesert B, Rivard L, Dyrda K, Dubuc M, Macle L, Guerra PG, Khairy P, Tadros R, Finnerty V, Gregoire J, Harel F. P775Extra-cardiac and intra-cardiac landmarks used in combination can increase registration accuracy between nuclear imaging and electro-anatomical 3D geometries. Europace 2018. [DOI: 10.1093/europace/euy015.379] [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: 11/12/2022] Open
Affiliation(s)
- B Thibault
- Montreal Heart Institute, Montreal, Canada
| | - L P Richer
- Abbott, Sylmar, United States of America
| | | | - K Ryu
- Abbott, Sylmar, United States of America
| | | | - L Rivard
- Montreal Heart Institute, Montreal, Canada
| | - K Dyrda
- Montreal Heart Institute, Montreal, Canada
| | - M Dubuc
- Montreal Heart Institute, Montreal, Canada
| | - L Macle
- Montreal Heart Institute, Montreal, Canada
| | - P G Guerra
- Montreal Heart Institute, Montreal, Canada
| | - P Khairy
- Montreal Heart Institute, Montreal, Canada
| | - R Tadros
- Montreal Heart Institute, Montreal, Canada
| | - V Finnerty
- Montreal Heart Institute, Montreal, Canada
| | - J Gregoire
- Montreal Heart Institute, Montreal, Canada
| | - F Harel
- Montreal Heart Institute, Montreal, Canada
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43
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Deyell MW, Steinberg C, Doucette S, Parkash R, Nault I, Gray C, Essebag V, Gardner M, Sterns LD, Healey JS, Hruczkowski T, Rivard L, Leong-Sit P, Nery PB, Sapp JL. Mexiletine or catheter ablation after amiodarone failure in the VANISH trial. J Cardiovasc Electrophysiol 2018; 29:603-608. [DOI: 10.1111/jce.13431] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Marc W. Deyell
- Heart Rhythm Services, Division of Cardiology, Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec; Universite Laval; Quebec City Quebec Canada
| | - Steve Doucette
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - Ratika Parkash
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et Pneumologie de Québec; Universite Laval; Quebec City Quebec Canada
| | - Chris Gray
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | - Vidal Essebag
- McGill University Health Centre and Hôpital Sacré-Coeur de Montréal; Montreal Quebec Canada
| | - Martin Gardner
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
| | | | - Jeff S. Healey
- Population Health Research Institute; Hamilton Ontario Canada
| | - Tomasz Hruczkowski
- Mazankowski Alberta Heart Institute; University of Alberta; Edmonton Alberta Canada
| | - Lena Rivard
- Institut de Cardiologie de Montréal; Montreal Quebec Canada
| | - Peter Leong-Sit
- Heart Rhythm Service, University Hospital; Western University; London Ontario Canada
| | - Pablo B. Nery
- University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - John L. Sapp
- Department of Medicine; QEII Health Sciences Centre and Dalhousie University; Halifax Nova Scotia Canada
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44
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Labombarda F, Hamilton R, Shohoudi A, Aboulhosn J, Broberg C, Cohen S, Cook S, Dore A, Fernandes S, Fournier A, Kay J, Macle L, Mondésert B, Mongeon F, Opotowsky A, Proietti A, Rivard L, Ting J, Zaidi A, Khairy P. Increasing prevalence of atrial fibrillation and permanent atrial tachyarrhythmias in the aging population with congenital heart disease: A multicenter study. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Parkash R, Nault I, Rivard L, Gula L, Essebag V, Nery P, Tung S, Raymond J, Sterns L, Doucette S, Wells G, Tang A, Stevenson W, Sapp J. EFFECT OF BASELINE ANTIARRHYTHMIC DRUG ON OUTCOMES WITH ABLATION IN ISCHEMIC VENTRICULAR TACHYCARDIA: A VANISH SUBSTUDY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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46
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Essebag V, Joza J, Doucette S, Raymond J, Sapp J, Rivard L. PROGNOSTIC VALUE OF NON-INDUCIBILITY ON OUTCOMES OF VENTRICULAR TACHYCARDIA ABLATION: A VENTRICULAR TACHYCARDIA ABLATION VS. ENHANCED DRUG THERAPY IN STRUCTURAL HEART DISEASE (VANISH) SUBSTUDY. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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47
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Veldhuizen S, Rivard L, Cairney J. Relative age effects in the Movement Assessment Battery for Children-2: age banding and scoring errors. Child Care Health Dev 2017; 43:752-757. [PMID: 28295480 DOI: 10.1111/cch.12459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 02/26/2017] [Indexed: 11/28/2022]
Abstract
AIM The Movement Assessment Battery for Children-2 (MABC-2) uses age-grouped scoring, which will result in relative motor functioning being overestimated for some children and underestimated for others. In this paper, we measure these errors and discuss their consequences. METHOD We pool data from two validation studies to obtain a sample of 278 children assessed with the MABC-2 (mean (SD) age: 5 years, 0 months (9.6 months); 142 female). We used regression to measure the association between standard score and relative age, and used these results to estimate misclassification rates at the MABC-2's recommended thresholds. RESULTS Movement Assessment Battery for Children-2 scores were distributed as expected (mean (SD) = 10.4 (2.8)). We estimated that the standard score varied by 2.76 units (0.92 SDs) per year of relative age. Depending on threshold and age bandwidth, this implies overall misclassification rates from 9% to 23%. INTERPRETATION Relative age differences in MABC-2 scores led to substantial systematic error for young children. These errors can affect MABC-2 validity, longitudinal stability and agreement with other tools, which may reduce the appropriateness of care offered to children. Scoring approaches that may reduce or eliminate these errors are outlined.
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Affiliation(s)
- S Veldhuizen
- Infant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - L Rivard
- CanChild Centre for Studies in Childhood Disability, McMaster University, Hamilton, Canada
| | - J Cairney
- Infant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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48
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Labombarda F, Hamilton R, Shohoudi A, Aboulhosn J, Broberg CS, Chaix MA, Cohen S, Cook S, Dore A, Fernandes SM, Fournier A, Kay J, Macle L, Mondésert B, Mongeon FP, Opotowsky AR, Proietti A, Rivard L, Ting J, Thibault B, Zaidi A, Khairy P. Increasing Prevalence of Atrial Fibrillation and Permanent Atrial Arrhythmias in Congenital Heart Disease. J Am Coll Cardiol 2017; 70:857-865. [DOI: 10.1016/j.jacc.2017.06.034] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022]
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49
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Roberts JD, Krahn AD, Ackerman MJ, Rohatgi RK, Moss AJ, Nazer B, Tadros R, Gerull B, Sanatani S, Wijeyeratne YD, Baruteau AE, Muir AR, Pang B, Cadrin-Tourigny J, Talajic M, Rivard L, Tester DJ, Liu T, Whitman IR, Wojciak J, Conacher S, Gula LJ, Leong-Sit P, Manlucu J, Green MS, Hamilton R, Healey JS, Lopes CM, Behr ER, Wilde AA, Gollob MH, Scheinman MM. Loss-of-Function
KCNE2
Variants. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005282. [DOI: 10.1161/circep.117.005282] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 01/09/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Babak Nazer
- For author affiliations, please see the Appendix
| | - Rafik Tadros
- For author affiliations, please see the Appendix
| | | | | | | | | | | | | | | | | | - Lena Rivard
- For author affiliations, please see the Appendix
| | | | - Taylor Liu
- For author affiliations, please see the Appendix
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50
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Rivard L, Roy D, Talajic M, Nattel S, Mondesert B, Guerra P, Thibault B, Dubuc M, Dyrda K, Black S, Dorian P, Healey J, Lanthier S, Khairy P. P4625Association between pattern of atrial fibrillation and neurocognitive function in patients at low risk of stroke. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4625] [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: 11/13/2022] Open
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