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Alnajar A, Benck KN, Dar T, Hirji SA, Ibrahim W, Detweiler B, Vuddanda V, Balise R, Rao JS, Lu M, Lamelas J. Predictors of outcomes in patients with obesity following mitral valve surgery. JTCVS Open 2023; 15:127-150. [PMID: 37808032 PMCID: PMC10556846 DOI: 10.1016/j.xjon.2023.03.017] [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] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 10/10/2023]
Abstract
Objective Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care. Methods A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable. Results Of the 48,775 patients with obesity, 34% had morbid obesity (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Kelley N. Benck
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Tawseef Dar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Sameer A. Hirji
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Walid Ibrahim
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Brian Detweiler
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Venkat Vuddanda
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Raymond Balise
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - J. Sunil Rao
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Min Lu
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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Litwinowicz R, Natorska J, Zabczyk M, Kapelak B, Lakkireddy D, Vuddanda V, Bartus K. Changes in fibrinolytic activity and coagulation factors after epicardial left atrial appendage closure in patients with atrial fibrillation. J Thorac Dis 2022; 14:4226-4235. [PMID: 36524072 PMCID: PMC9745526 DOI: 10.21037/jtd-21-1093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/19/2022] [Indexed: 10/29/2023]
Abstract
BACKGROUND The left atrial appendage (LAA) is known to be the primary source of thrombus formation in atrial fibrillation (AF). We investigate whether epicardial LAA occlusion (LAAO) from the cardiovascular system has an effect on coagulation and prothrombotic status in AF. METHODS Twenty-two patients with nonvalvular AF, who were not currently receiving oral anticoagulation (OAC) therapy, participated in a single-center prospective study. We measured fibrinogen and plasminogen levels along with plasma fibrin clot permeability, clot lysis time (CLT) and endogenous thrombin potential (ETP) before the LAAO procedure, at discharge and 1 month afterward. RESULTS One month after the LAAO procedure, plasma fibrin clot permeability improved by 39.3% as measured by clots prepared from peripheral blood (P=0.019) and also after adjustment for fibrinogen (P=0.027). Higher plasma fibrin clot permeability was associated with improved clot susceptibility to lysis (r=-0.67, P=0.013). CLT was reduced by 10.3% (P=0.0020), plasminogen activator inhibitor-1 antigen levels were reduced by 52% (P=0.023) and plasminogen activity was increased by 8.9% (P=0.0077). A trend toward decreased thrombin generation, reflected by a decreased ETP and peak thrombin generated was also observed 1 month after LAAO procedure (P=0.072 and P=0.087, respectively). No differences were observed in tissue-type plasminogen activator and thrombin-activatable fibrinolysis inhibitor plasma levels (both P>0.05). CONCLUSIONS Obtained results seem to confirm that LAA plays a key role in thrombogenesis. Elimination of LAA from the circulatory system may improve fibrin clot permeability and susceptibility to fibrinolysis in peripheral blood.
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Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Zabczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, USA
| | | | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Dar T, Murtaza G, Yarlagadda B, Madoukh B, Bravin L, Vuddanda V, Parikh V, Reddy M, Lakkireddy D. Dofetilide Initiation and Implications of Deviation From the Standard Protocol - A Real World Experience. J Atr Fibrillation 2020; 12:2265. [PMID: 32435348 DOI: 10.4022/jafib.2265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 11/10/2022]
Abstract
Background Manufacturer/federal drug administration (FDA) recommends inpatient initiation of dofetilide with the manufacturer providing an initiation algorithm. The outcomes of algorithm deviation have not been reported outside of clinical trials. Objective We sought to perform a chart review of all the patients admitted for inpatient initiation of dofetilide to report on the incidence of protocol deviations and their implications. Methods We performed a retrospective review of all patients over a 15-month periodwho were initiated on dofetilide for the very first time or reinitiated on dofetilide after a break of three months or more at our institution. We assessed data about patients who were given dofetilide without adherence to the protocol (i.e. protocol deviation). Results A total of 189 patients were included in the study with a median age of 66 ± 9 years. Mean baseline QTc interval was 436 ± 32 msec, and 61% (116/189) were in atrial fibrillation (AF) at the time of dofetilide initiation. In 9% (17/189) of patients, the drug was discontinued due to intolerance or inefficacy. Therapy in 49% (93/189) of patients was noted to deviate from manufacturer recommended protocol with deviations more than once in some patients during the same hospitalization. Baseline QTc exceeding 440 msec(>500msec in conduction abnormalities) was the most frequent deviation (25%; 47/189).Ventricular tachyarrhythmia occurred in 4% (7/189) of patients, did not differ between patients, and occurred with and without protocol deviations (5% vs 2%; p = 0.27). Conclusions In our retrospective study, there were frequent deviations from the manufacturer-recommended algorithm guidelines for dofetilideinitation, primarily due to prolonged baseline QTc interval. The impact of these protocol deviations on drug discontinuation was uncertain; however, significant adverse events were higher in the deviation group compared to the group that fully adhered to the protocol. Further multicenter studies are warranted to clarify our findings.
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Affiliation(s)
- Tawseef Dar
- Department of Nuclear Cardiology, Massachusetts General Hospital, Boston, MA
| | - Ghulam Murtaza
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | | | - Bader Madoukh
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Lesley Bravin
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Venkat Vuddanda
- Department of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Valay Parikh
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Madhu Reddy
- Division of Cardiovascular Diseases, University of Kansas Hospital and Medical Center, Kansas City, KS
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Mohammed M, Rali AS, Buechler T, Vuddanda V, Arshi J, Hosseini Dehkordi SH, Chandler J, Weidling R, Abicht T, Haglund N, Sauer A, Shah Z. In-Hospital Outcomes and Trends of Tricuspid Valve Surgery in Heart Transplant Patients. Biomed Hub 2020; 5:247-256. [PMID: 32775331 DOI: 10.1159/000507179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/12/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Aniket S Rali
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Tyler Buechler
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Venkat Vuddanda
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juwairiya Arshi
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | | | - Jonathan Chandler
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Robert Weidling
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Travis Abicht
- Department of Cardiothoracic Surgery, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Nicholas Haglund
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Andrew Sauer
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
| | - Zubair Shah
- Department of Cardiovascular Diseases, The University of Kansas Health System, Kansas City, Missouri, USA
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Murtaza G, Vuddanda V, Akella K, Della Rocca DG, Sharma S, Li L, Kutty S, Turagam M, Kar S, Holmes D, Lakkireddy D. Impact of left atrial appendage occlusion on left atrial function-The LAFIT Watchman study. J Interv Card Electrophysiol 2019; 58:163-167. [PMID: 31823234 DOI: 10.1007/s10840-019-00674-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/19/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left atrial (LA) strain and strain rate (SR) analysis by two-dimensional speckle tracking echocardiography is a novel way of LA function assessment. From prior study, we know that LA appendage closure with LARIAT appears to improve LA function. OBJECTIVE The purpose of this study was to assess the impact of LAA closure via Watchman device on LA function via strain and volumetric analyses using two-dimensional speckle tracking echocardiography (2D-STE). METHODS Twenty-five patients who underwent Watchman device implantation (WDI) were included. LA function parameters (volumetric, strain indices) were calculated from apical four chamber views with the reference point set at QRS using 2D-STE before and after WDI. LA expansion index, strain and strain rate during ventricular systole represent LA reservoir function. Passive emptying fraction, strain and strain rate during early ventricular diastole represent LA conduit function. RESULTS Mean age was 76 ± 6.9 years with 60% males. There was significant improvement in conduit function (LA passive emptying fraction; post 28.6 (21.9-35.9) vs pre 21.0 (13.8-34.7), p = 0.032), reservoir function (LA expansion index; post 75.3 (52.3-98.0) vs pre 58.1 (37.8-85.2), p = 0.026), and booster function (LA active emptying fraction; post 13.3 (9.7-29.9) vs pre 12.6 (8.8-25.5), p = 0.04) by volumetric indices. No significant improvement was noted with strain indices in conduit function (SRe; post - 0.56 (0.43-0.93) vs pre - 0.58 (0.46-0.87); p = 0.518) and reservoir function (SRs; post + 0.58 (0.28-0.40) vs pre + 0.52 (0.35-0.86); p = 0.851). CONCLUSIONS WDI resulted in discrepancy of volumetric and strain indices in LA function assessment.
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Affiliation(s)
- Ghulam Murtaza
- The Kansas City Heart Rhythm Institute & Research Foundation, 5100 W 110th St Second Floor, Overland Park, KS, 66211, USA
| | - Venkat Vuddanda
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Krishna Akella
- The Kansas City Heart Rhythm Institute & Research Foundation, 5100 W 110th St Second Floor, Overland Park, KS, 66211, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N Interstate Hwy 35, Austin, TX, 78705, USA
| | - Sharan Sharma
- The Kansas City Heart Rhythm Institute & Research Foundation, 5100 W 110th St Second Floor, Overland Park, KS, 66211, USA
| | - Ling Li
- Division of Pediatric Cardiology, Johns Hopkins Medical Center, 600 N Wolfe St, Baltimore, MD, 21205, USA
| | - Shelby Kutty
- Division of Pediatric Cardiology, Johns Hopkins Medical Center, 600 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohit Turagam
- Mt. Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA
| | | | | | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute & Research Foundation, 5100 W 110th St Second Floor, Overland Park, KS, 66211, USA.
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Turagam MK, Vuddanda V, Verberkmoes N, Ohtsuka T, Akca F, Atkins D, Bommana S, Emmert MY, Gopinathannair R, Dunnington G, Rasekh A, Cheng J, Salzberg S, Natale A, Cox J, Lakkireddy DR. Epicardial Left Atrial Appendage Exclusion Reduces Blood Pressure in Patients With Atrial Fibrillation and Hypertension. J Am Coll Cardiol 2019; 72:1346-1353. [PMID: 30213326 DOI: 10.1016/j.jacc.2018.06.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 06/11/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Percutaneous left atrial appendage exclusion (LAAE) has evolved as an alternative strategy for stroke prevention in atrial fibrillation (AF). Recent observational data have suggested that epicardial LAAE can have substantial impact on arrhythmia burden and hemodynamic profile. OBJECTIVES The authors aimed to study the impact of epicardial versus endocardial LAAE on systemic blood pressure in hypertensive AF patients. METHODS This was a prospective, nonrandomized study comparing 247 patients who underwent epicardial LAAE with 124 patients with endocardial exclusion. Clinical outcomes were measured at 3 months and 1 year. Primary outcome was improvement in systolic blood pressure (SBP) between both groups compared with baseline. Secondary outcome included changes in diastolic pressures (DBP), serum electrolytes, and creatinine. RESULTS There was no significant difference in baseline SBP between epicardial and endocardial groups. SBP was significantly lower in the epicardial group both at 3 months (122 ± 11.8 mm Hg vs. 129.7 ± 8.2 mm Hg; p < 0.001) and 1 year (123 ± 11.6 mm Hg vs. 132.2 ± 8.8 mm Hg; p < 0.001) compared with the endocardial group. An adjusted multivariate linear mixed effects model demonstrated that epicardial LAAE significantly decreased SBP by 7.4 mm Hg at 3 months and by 8.9 mm Hg at 1 year (p < 0.0001). There was a trend toward lower DBP with epicardial LAAE at 3 months by 1.3 mm Hg (p = 0.2) and at 1 year by 1.8 mm Hg (p = 0.09). There was no significant difference in serum electrolytes and creatinine between both groups. CONCLUSIONS In hypertensive AF patients, epicardial LAAE significantly decreases SBP both at 3 and 12 months compared with endocardial exclusion.
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Affiliation(s)
- Mohit K Turagam
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Toshiya Ohtsuka
- Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Ferdi Akca
- Heart Center, Catharina Hospital, Eindhoven, the Netherlands
| | - Donita Atkins
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas
| | - Sudharani Bommana
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, Kansas
| | | | | | | | | | - Jie Cheng
- Texas Heart Institute, Houston, Texas
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas. https://twitter.com/andreanatalemd
| | - James Cox
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Shah Z, Mohammed M, Vuddanda V, Ansari MW, Masoomi R, Gupta K. National Trends, Gender, Management, and Outcomes of Patients Hospitalized for Myocarditis. Am J Cardiol 2019; 124:131-136. [PMID: 31060730 DOI: 10.1016/j.amjcard.2019.03.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022]
Abstract
Myocarditis is a major cause of acute and chronic cardiomyopathy. Data on patient characteristics utilization of healthcare, and outcomes of myocarditis-related hospitalizations are limited. We sought to analyze the outcomes of patients hospitalized with myocarditis from a large diverse, multicentric, nationwide cohort using Nationwide Inpatient Sample database. A total of 27,129 hospitalizations involving adult patients (age ≥ 18 years) with the primary discharge diagnosis of myocarditis from years 2007 through 2014 were included and patients who had diagnosis of myocardial infarction or coronary syndromes (including unstable angina) during the same hospitalization were excluded. More men were hospitalized compared with women (66% vs 34%, p <0.05). Patients hospitalized were young with a mean age of 37.3 ± 18.8 years with women being older compared with men (45.2 ± 20.9 vs 33.2 ± 16.2, p <0.001). In-hospital complications of cardiogenic shock and ventricular fibrillation/cardiac arrest occurred in 6.5% and 2.5% of hospitalizations, respectively, with females being affected significantly more than males (10.2% vs 4.6%; 3.6% vs 2%, respectively, p <0.001 for both comparisons). A total of 640 (2.4%) patients died during index hospitalization. Mortality was significantly higher in females compared with males (3.5% vs 1.8%; p <0.001). Multiple logistic regression analysis demonstrated female gender as an independent predictor of in-hospital mortality (odds ratio: 1.69, 95% confidence interval: 1.1 to 2.6; p = 0.007). In conclusion, myocarditis-related hospitalizations have increased during the study years and mostly affect young population with no significant co-morbidities. Female gender remains at high risk for myocarditis-related complications and in-hospital mortality.
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Litwinowicz R, Filip G, Bryndza M, Bartus M, Sadowski J, Kapelak B, Mazur P, Vuddanda V, Lakkireddy D, Bartus K. Outcomes of emergency coronary angiography after cardiac surgery. Eur J Prev Cardiol 2019; 27:1339-1342. [PMID: 31238714 DOI: 10.1177/2047487319859972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Bryndza
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Magdalena Bartus
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | | | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute, Overland Park Regional Hospital, University of Kansas, USA
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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Litwinowicz R, Bartus M, Burysz M, Brzeziński M, Suwalski P, Kapelak B, Vuddanda V, Lakkireddy D, Lee RJ, Trabka R, Bartus K. Long term outcomes after left atrial appendage closure with the LARIAT device-Stroke risk reduction over five years follow-up. PLoS One 2018; 13:e0208710. [PMID: 30566961 PMCID: PMC6300408 DOI: 10.1371/journal.pone.0208710] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Left atrial appendage closure (LAAC) with LARIAT offers an alternative to oral anticoagulation (OAC) for patients with atrial fibrillation. The aim of this study was to present long-term clinical outcomes of LAAC in these patients (AF). Material and methods A prospective, single-center study was performed in 139 patients undergoing LAAC with Lariat. Thromboembolic events, severe bleeding and mortality rate were recorded. The reduction in risk of thromboembolism and bleeding after LAAC was calculated. Results The mean CHADS2-score was 1.8 ± 1.0, mean CHA2DS2-VASc score was 2.9 ± 1.6 and HAS-BLED score was 3.1 ± 1.1. After 428.4 patient-years of follow-up (mean 4.2±1.0 years), the thromboembolism rate was 0.6% with a calculated thromboembolism risk reduction of 81%. The severe bleeding rate was 0.8%; calculated bleeding risk reduction was 78%. The overall mortality rate was 1.6%. Conclusions Long-term outcomes show that LAAC with Lariat is a safe and effective treatment for stroke prevention and bleeding risk reduction in AF patients with a high level of underlying risk.
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Affiliation(s)
- Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
- * E-mail:
| | - Magdalena Bartus
- Departament of Pharmacology, Jagiellonian University, Krakow, Poland
| | - Marian Burysz
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziadz, Poland
| | - Maciej Brzeziński
- Department of Cardiac and Vacsular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of Ministry of Interior, Warsaw, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Venkat Vuddanda
- Warren Alpert School of Medicine, Brown University, Harvard Medical School, Boston MA, United States of America
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas, Kansas City, KS, United States of America
| | - Randall J. Lee
- Department of Medicine, Division of Cardiac Electrophysiology, University of California San Francisco, San Francisco, CA, United States of America
- Cardiovascular Research Institute, Institute for Regeneration Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Rafal Trabka
- Departament of Rehabilitation, Jagiellonian University, Krakow, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
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Turagam MK, Vuddanda V, Atkins D, Venkata R, Yarlagadda B, Korra H, Pitchika J, Bommana S, Lakkireddy DR. Assessment of DNA Damage After Ionizing Radiation Exposure in Patients Undergoing Cardiac Resynchronization Therapy Device Implantation or Atrial Fibrillation Ablation (The RADAR Study). J Atr Fibrillation 2018; 11:2094. [PMID: 30505385 DOI: 10.4022/jafib.2094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022]
Abstract
Background There is limited data regarding effect of prolonged radiation exposure during electrophysiological (EP) procedures on direct DNA damage. Comet test has shown to assess DNA damage following radiation exposure. Methods We performed a single-center prospective observational study assessing direct DNA damage using the quantitative comet assay in patients undergoing cardiac resynchronization (CRT) and atrial fibrillation (AF) catheter ablation procedures. Venous comet assay was performed pre, immediately post procedure and at 3-month duration in twenty-two (N=22) patients who underwent catheter ablation for symptomatic AF and fourteen (N=14) patients who underwent CRT implantation. Results The median [interquartile range (IQR)] fluoroscopy time, radiation dose and dose area product (DAP) were 34.3 (27.97 - 45.48) minutes, 853.07 (611.36 - 1334.76) mGy and 16,994.10 (9,023.65 - 58,845.00) UGym2 in the ablation group and 30.05 (18.75 - 37.33) minutes, 345.00 (165.09 - 924.79) mGy and 11,837.20 [7182.67 - 35567.75] UGym2 in the CRT group. When compared with pre-procedure, there was a statistically significant increase in median (IQR) DNA migration on comet assay in the ablation group immediately post procedure [+6.55 µm (0.78, 10.25, p=0.02)] that subsequently decreased at 3 months [-1.00 µm (-2.20, 0.78), p=0.03] but not in the CRT group. Conclusion There was a significant increase in DNA damage as detected by comet assay immediately post procedure that normalized at 3 months in patients undergoing AF ablation. Further large prospective studies are warranted to evaluate the impact of this prolonged radiation exposure and DNA damage on long-term follow up.
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Affiliation(s)
| | - Venkat Vuddanda
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | | | - Rakesh Venkata
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Bhavya Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Himabindu Korra
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
| | - Jaya Pitchika
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS
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Shah Z, Vuddanda V, Rali A, Pamulapati H, Masoomi R, Gupta K. National Trends and Procedural Complications from Endomyocardial Biopsy: Results from the National Inpatient Sample, 2007–2014. Cardiology 2018; 141:125-131. [DOI: 10.1159/000493786] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/12/2018] [Indexed: 11/19/2022]
Abstract
Aim: The aim of this study is to report recent trends in the performance of endomyocardial biopsy (EMB) and its in-hospital complications (and their predictors) in the United States (US). Method: We analyzed Nationwide Inpatient Sample (NIS) database from years 2007 through 2014 to identify patients who underwent EMB. Once identified, the patients were subdivided into those with no history of heart transplant (HT) (cohort 1) and those with history of HT (cohort 2). We then studied the major complication of pericardial effusion, hemopericardium or/and cardiac tamponade that required a pericardiocentesis or a pericardial window (CTRPD) following the EMB procedure. Results: We observed a steady increase in the in-patient EMB procedures, with more EMB procedures being performed in males and in Caucasians. In cohort 1, the CTRPD was higher (0.70%) as compared to cohort 2 (0.19; p = 0.01). CTRPD in women was higher compared to men (0.94 vs. 0.53% p = 0.022). Most of the EMB procedures are performed in teaching hospitals. The CTRPD rate was significantly higher in the nonteaching hospitals when compared to teaching hospitals in both cohort 1 and cohort 2 (3.4 vs. 0.53% and 1 vs.0.18%, respectively; p = 0.01 and < 0.001, respectively). The overall mortality in cohort 1 was 4.3% as compared to 2.5% in cohort 2; p = 0.01. In cohort 1, the mortality was significantly higher in the group that had EMB-related complications versus the group without the complications (20 vs. 2.5%; p < 0.001). Conclusion: There has been an increase in the number of EMB procedures in the US in recent years. Though the overall risk of CTRPD is very low, the risk is significantly higher in cohort 1, women, and in nonteaching hospitals. The study results provide data benchmarks for assessing EMB outcomes in the US.
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Turagam MK, Vuddanda V, Koerber S, Garg J, Yarlagadda B, Dar T, Aryana A, Di Biase L, Natale A, Lakkireddy D. Percutaneous ventricular assist device in ventricular tachycardia ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2018; 55:197-205. [PMID: 30377926 DOI: 10.1007/s10840-018-0477-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a lack of compelling data regarding the benefit of percutaneous ventricular assist devices (PVAD) in patients undergoing ventricular tachycardia (VT) ablation. The study aims to conduct a meta-analysis comparing the safety and efficacy of PVAD versus no-PVAD (N-PVAD) during VT ablation. METHODS Studies meeting criteria were systematically reviewed. Baseline characteristics and clinical outcomes were extracted and analyzed. A meta-analysis was performed using random-effects model to calculate risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI). RESULTS The meta-analysis included five retrospective, observational studies consisting of 2026 patients (PVAD group-284 patients versus N-PVAD group-1742 patients). The PVAD group was sicker with significantly higher VT storm, lower LVEF and greater proportion of NYHA class ≥ III than N-PVAD (p < 0.050). The acute procedural success [RR 0.95, 95% CI, (0.89-1.00), p = 0.070], VT recurrence [RR 0.94, 95% CI, (0.66-1.34), p = 0.740] and mortality [RR 1.28, 95% CI, (0.43-3.83), p = 0.660] were similar on follow-up between PVAD versus N-PVAD. PVAD group also had significantly higher complications [RR 1.83, 95% CI (1.21-2.76), p = 0.004] and longer fluoroscopy [MD + 7.31 min, 95% CI (0.91-13.71), p = 0.030] and procedure time [MD + 71.41 min, 95% CI (31.67-111.14), p < 0.001] than N-PVAD. CONCLUSION Patients receiving PVAD support during VT ablation were sicker with no significant difference in acute procedural success, VT recurrence, and mortality compared with N-PVAD. PVAD support was also associated with higher complications and longer fluoroscopy and procedure time. A prospective randomized controlled trial will identify if using PVAD support in unstable patients undergoing VT ablation will impact clinical outcomes.
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Affiliation(s)
| | | | - Scott Koerber
- Medical University of South Carolina, Charleston, SC, USA
| | - Jalaj Garg
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bharath Yarlagadda
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA
| | - Tawseef Dar
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA
| | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | | | | | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS, 66221, USA.
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13
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Parikh V, Swarup V, Hantla J, Vuddanda V, Dar T, Yarlagadda B, Di Biase L, Al-Ahmad A, Natale A, Lakkireddy D. Feasibility, safety, and efficacy of a novel preshaped nitinol esophageal deviator to successfully deflect the esophagus and ablate left atrium without esophageal temperature rise during atrial fibrillation ablation: The DEFLECT GUT study. Heart Rhythm 2018; 15:1321-1327. [DOI: 10.1016/j.hrthm.2018.04.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 11/24/2022]
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Atti V, Vuddanda V, Turagam MK, Vemula P, Shah Z, Nagam H, Yandrapalli S, Jazayeri MA, Koerber S, Gonzalez JV, Natale A, Di Biase L, Lakkireddy DR. Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2018; 53:207-215. [PMID: 29680972 DOI: 10.1007/s10840-018-0376-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/11/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality. METHODS We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications. RESULTS Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups. CONCLUSION These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.
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Affiliation(s)
- Varunsiri Atti
- Department of Internal Medicine, Michigan State University, East Lansing, MI, USA.
| | - Venkat Vuddanda
- Department of Cardiovascular Disease, Harvard Medical School, Boston, MA, USA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Praveen Vemula
- Department of Internal Medicine, Sparrow Hospital, Lansing, MI, USA
| | - Zubair Shah
- Department of Cardiovascular Diseases, University of Utah, Salt Lake City, UT, USA
| | | | - Srikanth Yandrapalli
- Department of Cardiovascular Diseases, New York Medical College, Valhalla, NY, USA
| | | | - Scott Koerber
- Department of Cardiac Electrophysiology, Medical University of South Carolina, Columbia, SC, USA
| | - Juan Viles Gonzalez
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Luigi Di Biase
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA
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Shah Z, Vuddanda V, Yin M, Wever-Pinzon O, Nativi-Nicolau J, Drakos S, Kfoury A, Fang J, Stehlik J. Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant versus Left Ventricular Assist Device: Analysis of a Multicenter, Nationwide Database. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rali A, Vuddanda V, Shah Z, Masoomi R, Gupta B, Haglund N, Abicht T, Sauer A. LEFT VENTRICULAR ASSIST DEVICES (LVADS) RE-HOSPITALIZATION DEMOGRAPHICS AND TRENDS IN 2014. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Yarlagadda B, Vuddanda V, Dar T, Jazayeri MA, Parikh V, Turagam MK, Lavu M, Avula SR, Atkins D, Bommana S, Gopinathannair R, Yeruva MR, Lakkireddy D. Safety and Efficacy of Inpatient Initiation of Dofetilide versus Sotalol for atrial fibrillation. J Atr Fibrillation 2017; 10:1805. [PMID: 29487686 DOI: 10.4022/jafib.1805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/11/2017] [Revised: 11/19/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022]
Abstract
Background We sought to investigate and compare the safety and efficacy of two commonly used antiarrhythmic drugs, Dofetilide (DF) and Sotalol (SL), during inpatient drug initiation in patients with symptomatic atrial fibrillation (AF). Methods We performed a single center retrospective study of consecutive patients, admitted for initiation of either DF or SL, for AF between 2012 and 2015. Rates of successful cardioversion, QT interval prolongation, adverse events and drug discontinuations were calculated and compared. A two-tailed p value less than 0.05 was considered statistically significant. Results Of 378 patients, 298 (78.8%) received DF and 80 (21.2%) SL, mean age was 64 ± 11 years, 90% were Caucasians and 66% were males. Among the patients who remained in AF upon admission (DF: 215/298 (72%) vs. SL: 48/80 (60%)), no significant differences were noted in pharmacological cardioversion rates (DF: 125/215(58%) vs. SL: 30/48 (62.5%); p = 0.58). Baseline QTc was similar between the groups, with higher dose dependent QTc prolongation with DF (472.25± 31.3 vs. 458± 27.03; p = 0.008). There were no significant differences in the rates of adverse events such as bradycardia (7.4% vs. 11.3%; p = 0.26), Torsades de pointes (1.3% vs. 1.2%; p = 1.00), and drug discontinuation (9.0% vs. 5.0%; p = 0.47) between the two groups.
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Affiliation(s)
- Bharath Yarlagadda
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Venkat Vuddanda
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Tawseef Dar
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | | | - Valay Parikh
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Mohit K Turagam
- Division of Electrophysiology, Icahn School of Medicine, New York, NY
| | - Madhav Lavu
- Western Kentucky Heart and Lung Institute, Bowling Green, KY
| | | | - Donita Atkins
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | - Sudharani Bommana
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
| | | | - Madhu Reddy Yeruva
- Cardiovascular research institute, The Kansas University Hospital, Kansas City, KS
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18
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Turagam MK, Vuddanda V, Atkins D, Santangeli P, Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou W, Mathuria N, Nakahara S, Dickfeld TM, Bunch TJ, Weiss P, Di Biase L, Tholakanahalli V, Vakil K, Tedrow UB, Stevenson WG, Della Bella P, Shivkumar K, Marchlinski FE, Callans DJ, Natale A, Reddy M, Lakkireddy D. Hemodynamic Support in Ventricular Tachycardia Ablation: An International VT Ablation Center Collaborative Group Study. JACC Clin Electrophysiol 2017; 3:1534-1543. [PMID: 29759835 DOI: 10.1016/j.jacep.2017.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 03/02/2017] [Revised: 06/23/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to evaluate the clinical outcomes of patients receiving hemodynamic support (HS) during ventricular tacchycardia (VT) ablation. BACKGROUND There are limited real-world data evaluating its effect of HS in ablation outcomes. METHODS An analysis of 1,655 patients from the International VT Ablation Center Collaborative group was performed. A total of 105 patients received HS with percutaneous ventricular assist device. RESULTS Patients in the HS group had lower left ventricular ejection fraction (LVEF), higher New York Heart Association (NYHA) functional class, and more implantable cardioverter-defibrillator (ICD) shocks, VT storm, and antiarrhythmic drug use (all p < 0.05). The HS group also required significantly longer fluoroscopy, procedure, and total lesion time. Acute procedural success (71.8% vs. 73.7%; p = 0.04) was significantly lower and complications (12.5% vs. 6.5%; p = 0.03) and 1-year mortality (34.7% vs. 9.3%; p < 0.001) were significantly higher in the HS group. Multivariate Cox regression analysis demonstrated HS as an independent predictor of mortality (hazard ratio: 5.01; 95% confidence interval: 3.44 to 7.20; p < 0.001). There was no significant difference in VT recurrence between groups. In a subgroup analysis including LVEF ≤20% and NYHA functional class III to IV patients, acute procedural success (74.0% vs. 70.5%; p = 0.8), complications (15.6% vs. 7.8%; p = 0.2), VT recurrence (30.2% vs. 38.1%; p = 0.44), and 1-year mortality (40.0% vs. 28.8%; p = 0.2) were no different between the HS and no-HS groups. CONCLUSIONS Patients requiring HS were sicker with multiple comorbidities and, as expected, had a significantly higher 1-year mortality than did those patients in the no-HS group. In patients with LVEF ≤20% and NYHA functional class III to IV, there was also no significant difference in clinical outcomes when compared with no HS. Further studies are needed to systematically evaluate patients undergoing VT ablation receiving HS.
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Affiliation(s)
- Mohit K Turagam
- Division of Cardiovascular Medicine, University of Missouri Hospital and Clinics, Columbia, Missouri
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roderick Tung
- Pritzker School of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | | | - Wendy Tzou
- University of Colorado, Aurora, Colorado
| | - Nilesh Mathuria
- St. Luke's Health System/Texas Heart Institute and University of Texas Health Science Center, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | | | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York
| | - Venkat Tholakanahalli
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Kairav Vakil
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | | | | | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Francis E Marchlinski
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas.
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Jazayeri MA, Vuddanda V, Turagam MK, Parikh V, Lavu M, Atkins D, Earnest M, Di Biase L, Natale A, Wilber D, Reddy YM, Lakkireddy DR. Safety profiles of percutaneous left atrial appendage closure devices: An analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database from 2009 to 2016. J Cardiovasc Electrophysiol 2017; 29:5-13. [DOI: 10.1111/jce.13362] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 06/15/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Mohammad-Ali Jazayeri
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Mohit K. Turagam
- Division of Cardiovascular Disease; University of Missouri Hospital & Clinics; Columbia MO USA
| | - Valay Parikh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Matthew Earnest
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Luigi Di Biase
- Electrophysiology Section; Albert Einstein College of Medicine at Montefiore Medical Center; Bronx NY USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin TX USA
| | - David Wilber
- Division of Cardiovascular Medicine; Loyola University Medical Center; Chicago IL
| | - Yeruva Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
| | - Dhanunjaya R. Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute; University of Kansas Hospital & Medical Center; Kansas City KS USA
- Mid-America Cardiology, Bloch Heart Rhythm Center; University of Kansas Hospital & Medical Center; Kansas City KS USA
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Vuddanda V, Jazayeri MA, Turagam MK, Lavu M, Parikh V, Atkins D, Bommana S, Yeruva MR, Di Biase L, Cheng J, Swarup V, Gopinathannair R, Olyaee M, Ivaturi V, Natale A, Lakkireddy D. Systemic Octreotide Therapy in Prevention of Gastrointestinal Bleeds Related to Arteriovenous Malformations and Obscure Etiology in Atrial Fibrillation. JACC Clin Electrophysiol 2017; 3:1390-1399. [PMID: 29759670 DOI: 10.1016/j.jacep.2017.04.022] [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] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. BACKGROUND AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs. METHODS In a multicenter, observational study, 38 AF patients with contraindications to OAC because of AVM-related GI bleeding were started on 100 μg of subcutaneous OCT twice daily. OAC was resumed in all patients within 48 h. Incidence of recurrent GI bleeds was calculated, and hemoglobin levels were recorded at enrollment and at 3 and 6 months' follow-up. RESULTS After a median follow-up of 8 months, 36 patients (mean age 69 ± 8.0 years; mean CHA2DS2-VASc score 3 ± 1 and mean HAS-BLED score 3 ± 1) were available for analysis. All were able to successfully resume OAC, and 28 of 36 (78%) remained on OAC at the conclusion of the study, whereas 8 underwent left atrial appendage closure with subsequent OAC discontinuation. No systemic thromboembolic events occurred in follow-up. Of the 28 patients who continued receiving OAC, 19 (68%) were free of recurrent GI bleed, 4 had minor GI bleeds, 4 required transfusion, and 1 required colectomy for GI bleeding. Mean hemoglobin levels in all patients receiving OAC were significantly higher at 3- and 6-month follow-up than at baseline (p < 0.001). CONCLUSIONS Subcutaneous OCT therapy is an attractive option in AF patients receiving OAC who have AVM-related GI bleeds. It allows successful reinitiation of OAC as a bridge to left atrial appendage exclusion or short-term relief from bleeding.
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Affiliation(s)
- Venkat Vuddanda
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Mohammad-Ali Jazayeri
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Mohit K Turagam
- Division of Cardiology, University of Missouri, Columbia, Missouri
| | - Madhav Lavu
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Valay Parikh
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Donita Atkins
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Sudharani Bommana
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Madhu Reddy Yeruva
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Jie Cheng
- Texas Heart Institute, St. Luke's Hospital, Houston, Texas
| | | | | | - Mojtaba Olyaee
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas
| | - Vijay Ivaturi
- Department of Pharmacy Practice and Science University of Maryland, Baltimore
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Dhanunjaya Lakkireddy
- Cardiovascular Research Institute, University of Kansas Hospital, Kansas City, Kansas.
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Jazayeri MA, Vanga SR, Vuddanda V, Turagam M, Parikh V, Lavu M, Bommana S, Atkins D, Nath J, Rosamond T, Vacek J, Madhu Reddy Y, Lakkireddy D. Impact of Radiofrequency Ablation of Atrial Fibrillation on Pulmonary Vein Cross Sectional Area: Implications for the Diagnosis of Pulmonary Vein Stenosis. J Atr Fibrillation 2017; 10:1531. [PMID: 29250220 DOI: 10.4022/jafib.1531] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/19/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022]
Abstract
Introduction Restoration of normal sinus rhythm by radiofrequency ablation (RFA) in atrial fibrillation (AF) patients can result in a reduction of left atrial (LA) volume and pulmonary vein (PV) dimensions. It is not clear if this PV size reduction represents a secondary effect of overall LA volume reduction or true PV stenosis. We assessed the relationship between LA volume reduction and PV orifice area pre- and post-RFA. Methods A retrospective cohort study was conducted at a tertiary care academic hospital. Pre- and post-RFA cardiac computed tomography (CT) studies of 100 consecutive AF patients were reviewed. Studies identifying obvious segmental PV narrowing were excluded. Left atrial volumes and PV orifice cross-sectional areas (PVOCA) were measured using proprietary software from the CT scanner vendor (GE Healthcare, Waukesha, WI). Results The cohort had a mean age of 60 ± 8 years, 73% were male, and 90% were Caucasian. Non-paroxysmal AF was present in 76% of patients with a mean duration from diagnosis to RFA of 55 ± 54 months. Mean procedural time was 244 ± 70 min. AF recurred in 27% at 3 month follow-up. Pre-RFA LA volumes were 132 ± 60 ml and mean PVOCA was 2.89 ± 2.32 cm2. In patients with successful ablation, mean LA volume decreased by 10% and PVOCA decreased by 21%. PVOCA was significantly reduced in patients with successful RFA compared to those who had recurrence (2.18 ± 1.12 vs. 2.8 ± 1.9 cm2, p = 0.04) but reduction in LA volume between groups was not significant (118 ± 42 vs. 133 ± 54 ml, p=0.15). Conclusions The study demonstrates that both PV orifice dimensions and LA volume are reduced after successful AF ablation. These data warrant a reassessment of criteria for diagnosing PV stenosis based on changes in PV caliber alone, ideally incorporating LA volume changes.
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Affiliation(s)
- Mohammad-Ali Jazayeri
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Subba Reddy Vanga
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Mohit Turagam
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Valay Parikh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Sudharani Bommana
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Jayant Nath
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Thomas Rosamond
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - James Vacek
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Y Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital & Medical Center, Kansas City, KS, USA
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Reddy M, Vuddanda V, Jazayeri MA, Lavu M, Turagam M, Yarlagadda B, Korra H, Venkata R, Reddy V, Emert M, Pimentel R, Dendi R, Sheldon S, Bommana S, Atkins D, Berenbom L, Lakkireddy D. REAL WORLD BATTERY LONGEVITY OF ST. JUDE MEDICAL IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS INCLUDED IN THE ADVISORY FOR PREMATURE BATTERY DEPLETION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Turagam M, Velagapudi P, Vuddanda V, Lavu M, Jazayeri MA, Parikh V, Tarun T, Atkins D, Aggarwal K, Bommana S, Di Biase L, Natale A, Reddy M. META-ANALYSIS ON THE EFFICACY AND SAFETY OF NEW ORAL ANTICOAGULANTS COMPARED WITH VITAMIN K ANTAGONISTS IN PATIENTS UNDERGOING CARDIOVERSION FOR ATRIAL FIBRILLATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Turagam M, Vuddanda V, Velagapudi P, Pillarisetti J, Jazayeri MA, Lavu M, Parikh V, Atkins D, Bommana S, Aggarwal K, Di Biase L, Natale A, Reddy M, Lakkireddy D. UNINTERRUPTED NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS VERSUS WARFARIN IN PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A META-ANALYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33750-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Turagam M, Velagapudi P, Vuddanda V, Parikh V, Jazayeri MA, Lavu M, Tarun T, Aggarwal K, Atkins D, Bommana S, Di Biase L, Natale A, Lakkireddy D, Reddy M. IMPLANTABLE CARDIOVERTER DEFIBRILLATOR FOR THE PREVENTION OF MORTALITY IN NON-ISCHEMIC CARDIOMYOPATHY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33749-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jazayeri MA, Vuddanda V, Parikh V, Lavu M, Atkins D, Reddy YM, Nath J, Lakkireddy DR. Five years of keeping a watch on the left atrial appendage-how has the WATCHMAN fared? J Thorac Dis 2017; 8:E1726-E1733. [PMID: 28149625 DOI: 10.21037/jtd.2016.12.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Left atrial appendage closure (LAAC) is a promising site-directed therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF) who are ineligible or contraindicated for long-term oral anticoagulation. A variety of LAAC modalities are available, including percutaneous endocardial occluder devices such as WATCHMANTM (Boston Scientific Corp., Marlborough, MA, USA), and an ever-increasing body of evidence is helping to define the optimal use of each technique. Similarly increased experience with LAAC has revealed challenges such as device-related thrombi and peri-device leaks for which the long-term significance and appropriate management are areas of active investigation. We review the evolution and long-term outcomes with the WATCHMANTM device with particular emphasis on the nuances of its use and its role in the broader landscape of appendageology.
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Affiliation(s)
- Mohammad-Ali Jazayeri
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Venkat Vuddanda
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Valay Parikh
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Donita Atkins
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Y Madhu Reddy
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Jayant Nath
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
| | - Dhanunjaya R Lakkireddy
- Division of Cardiovascular Diseases, Center for Excellence in Atrial Fibrillation & EP Research, Bloch Heart Rhythm Center, Cardiovascular Research Institute, University of Kansas Medical Center, Mid America Cardiology, University of Kansas Hospitals, Kansas City, KS, USA
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Paul N, Vuddanda V, Mujib M, Aronow WS. Advances in our understanding of the influence of gender on patient outcomes with peripheral arterial disease co-occurring with diabetes. Expert Rev Endocrinol Metab 2016; 11:271-279. [PMID: 30058932 DOI: 10.1080/17446651.2016.1175936] [Citation(s) in RCA: 3] [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: 10/22/2022]
Abstract
Peripheral arterial disease is an important predictor of cardiovascular morbidity and mortality. Patients with peripheral arterial disease are at a higher risk of myocardial infarction and stroke. The well-known coronary artery disease risk factors such as diabetes, hypertension, smoking and dyslipidemia are also risk factors for peripheral arterial disease. Hyperglycemia is an important mediator in the pathogenesis of this disease in diabetics, more so in women. The morbidity and poor outcomes associated with peripheral arterial disease in women are emerging. Women are more likely to present at an older age are often asymptomatic and have poorer outcomes with revascularization. Women experience specific sex-related challenges in the various diagnostic methods which could lead to a delay in diagnosis. This is a group which needs close attention and aggressive risk factor modification.
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Affiliation(s)
- Neha Paul
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Venkat Vuddanda
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Marjan Mujib
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Wilbert S Aronow
- b Division of Cardiology , New York Medical College , Valhalla , NY , USA
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Vuddanda V, Goyal A, Mujib M, Khera S, Kolte D, Aronow W, Sule S, Frishman W, Cooper H, Panza J. LOW PLATELET COUNT AND FATAL MYOCARDIAL INFARCTION: A POPULATION BASED ANALYSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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