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202. When and how to replicate systematic reviews

Author

Karunananthan, Sathya, primary, Maxwell, Lara J, additional, Welch, Vivian, additional, Petkovic, Jennifer, additional, Pardo Pardo, Jordi, additional, Rader, Tamara, additional, Avey, Marc T, additional, Baptiste-Ngobi, John, additional, Batista, Ricardo, additional, Curran, Janet A, additional, Tanjong Ghogomu, Elizabeth, additional, Graham, Ian D, additional, Grimshaw, Jeremy M, additional, Ioannidis, John PA, additional, Jordan, Zoe, additional, Jull, Janet, additional, Lyddiatt, Anne, additional, Moher, David, additional, Petticrew, Mark, additional, Pottie, Kevin, additional, Rada, Gabriel, additional, Shamseer, Larissa, additional, Shea, Beverley, additional, Siontis, Konstantinos, additional, Tschirhart, Naomi, additional, Vachon, Brigitte, additional, Wells, George A, additional, White, Howard, additional, and Tugwell, Peter, additional

Published
2020
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203. Detection of Hypertrophic Cardiomyopathy Using a Convolutional Neural Network-Enabled Electrocardiogram

Author

Ko, Wei-Yin, primary, Siontis, Konstantinos C., additional, Attia, Zachi I., additional, Carter, Rickey E., additional, Kapa, Suraj, additional, Ommen, Steve R., additional, Demuth, Steven J., additional, Ackerman, Michael J., additional, Gersh, Bernard J., additional, Arruda-Olson, Adelaide M., additional, Geske, Jeffrey B., additional, Asirvatham, Samuel J., additional, Lopez-Jimenez, Francisco, additional, Nishimura, Rick A., additional, Friedman, Paul A., additional, and Noseworthy, Peter A., additional

Published
2020
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206. Catheter ablation of ventricular tachycardia in patients with postinfarction left ventricular aneurysm.

Author

Amin, Mustapha, Farwati, Medhat, Hilaire, Emilie, Siontis, Konstantinos C., Madhavan, Malini, Kapa, Suraj, Mulpuru, Siva K., Deshmukh, Abhishek J., Cha, Yong‐Mei, Friedman, Paul A., Munger, Thomas, Asirvatham, Samuel J., and Killu, Ammar M.

Subjects
MYOCARDIAL infarction complications, ANEURYSMS, VENTRICULAR ejection fraction, CATHETER ablation, PERICARDIUM paracentesis, VENTRICULAR tachycardia, TREATMENT effectiveness, CARDIAC tamponade, CORONARY thrombosis, DISEASE relapse, DESCRIPTIVE statistics
Abstract

Background: While ventricular tachycardia (VT) in the setting of postmyocardial infarction left ventricular aneurysms (LVA) is not uncommonly encountered, there is a scarcity of data regarding the safety, efficacy, and outcomes of ablation of VT in this subset of patients. Methods: Our study included consecutive patients aged 18 years or older with postmyocardial infarction LVA who presented to Mayo Clinic for catheter ablation of VT between 2002 and 2018. Results: Of 34 patients, the mean age was 70.4 ± 9.1 years; 91% were male. Mean LVEF was 29 ± 9.7% and left ventricular end‐diastolic dimension was 64.9 ± 6.6 mm. The site of the LVA was apical in 21 patients (62%). Fifteen patients (44%) presented with electrical storm or incessant VT. Nine patients (26%) had a history of intracardiac thrombus. All except for one patient had at least one VT originating from the aneurysm. The mean number of VTs was 2.9 ± 1.7. All patients underwent ablation at the site of the aneurysm. Ablation outside the aneurysm was performed in 13 patients (38%). Low‐voltage fractionated potentials and/or late potentials at the aneurysmal site were present in all cases. Complete elimination of all VTs was achieved in 18 (53%), while the elimination of the clinical VT with continued inducibility of nonclinical VTs was achieved in a further 11 patients (32%). Two patients developed cardiac tamponade requiring pericardiocentesis. During a mean follow‐up period of 2.3 ± 2.4 years, 11 patients (32%) experienced VT recurrence. Freedom from all‐cause mortality at 1‐year follow‐up was 94%. Conclusion: Radiofrequency catheter ablation targeting the aneurysmal site is a feasible and reasonably effective management strategy for clinical VTs in patients with postinfarction LVA. [ABSTRACT FROM AUTHOR]

Published
2021
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207. Endpoints for Successful Slow Pathway Catheter Ablation in Typical and Atypical Atrioventricular Nodal Re-Entrant Tachycardia A Contemporary, Multicenter Study

Author

Katritsis, Demosthenes G. Zografos, Theodoros Siontis, Konstantinos C. Giannopoulos, George Muthalaly, Rahul G. and Liu, Qiang Latchamsetty, Rakesh Varga, Zoltan Deftereos, Spyridon Swerdlow, Charles Callans, David J. Miller, John M. and Morady, Fred John, Roy M. Stevenson, William G.

Abstract

OBJECTIVES This study sought to investigate markers of success following slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND Published data are conflicting. METHODS The authors studied 1,007 patients with typical AVNRT and 77 patients with atypical AVNRT. RESULTS Following ablation, tachycardia was rendered not inducible in all patients. One case of transient (0.09%) and 1 of permanent (0.09%) atrioventricular (AV) block were encountered. At a 3-month follow-up, arrhythmia recurrence was noted in 21 (2.10%) patients in the typical and 3 (3.90%) patients in the atypical group (odds ratio: 0.525; 95% confidence interval [CI]: 0.153 to 1.802; p = 0.298). To predict absence of recurrence in 3 months, the induction of junctional rhythm (95.70% in typical and 96.10% in atypical groups) had sensitivity of 95.9% (95% CI: 94.6% to 97.0%) and specificity of 4.20% (95% CI: 0.11% to 21.10%), while the absence of dual AV nodal conduction post-ablation had sensitivity of 65.2% (95% CI: 62.2% to 68.1%) and specificity of 33.30% (95% CI: 15.60% to 55.30%). Neither junctional rhythm nor residual dual AV nodal pathway conduction were predictive of arrhythmia recurrence by univariate analysis. In long-term follow-up data available for 239 patients, arrhythmia-free survival was not associated with the induction of junctional rhythm or the absence of residual dual AV nodal conduction (log-rank test, p = 0.819 and p = 0.226, respectively). CONCLUSIONS Induction of a junctional rhythm during ablation is a sensitive but not a specific marker of success. Residual dual AV nodal conduction is not predictive of recurrence. Noninducibility of the arrhythmia, usually after ablation-induced junctional rhythm, and despite isoproterenol challenge, is the most credible endpoint for success. (C) 2019 by the American College of Cardiology Foundation.

Published
2019

209. Outcomes and Resource Utilization Associated With Readmissions After Atrial Fibrillation Hospitalizations

Author

Tripathi, Byomesh, primary, Atti, Varunsiri, additional, Kumar, Varun, additional, Naraparaju, Vamsidhar, additional, Sharma, Purnima, additional, Arora, Shilpkumar, additional, Wojtaszek, Ewelina, additional, Gopalan, Radha, additional, Siontis, Konstantinos C., additional, Gersh, Bernard J., additional, and Deshmukh, Abhishek, additional

Published
2019
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211. Role of diabetes and insulin use in the risk of stroke and acute myocardial infarction in patients with atrial fibrillation: A Medicare analysis

Author

Mentias, Amgad, primary, Shantha, Ghanshyam, additional, Adeola, Oluwaseun, additional, Barnes, Geoffrey D, additional, Narasimhan, Bharat, additional, Siontis, Konstantinos C., additional, Levine, Deborah A., additional, Sah, Rajan, additional, Giudici, Michael C., additional, and Vaughan Sarrazin, Mary, additional

Published
2019
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214. Abstract 11: Comparative Effectiveness and Safety of Oral Anticoagulants across Baseline Kidney Function

Author

Yao, Xiaoxi, primary, Inselman, Jonathan W, additional, Shah, Nilay D, additional, Ross, Joseph S, additional, Izem, Rima, additional, Graham, David, additional, Martin, David, additional, Thompson, Aliza, additional, Southworth, Mary R, additional, Siontis, Konstantinos C, additional, Ngufor, Che G, additional, Nath, Karl, additional, Desai, Nihar R, additional, Nallamothu, Brahmajee, additional, Saran, Rajiv, additional, and Noseworthy, Peter A, additional

Published
2019
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217. Detection of Hypertrophic Cardiomyopathy Using a Convolutional Neural Network-Enabled 12-Lead Electrocardiogram

Author

Siontis, Konstantinos

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden cardiac death in adolescents and young adults. We aimed to develop an artificial intelligence (AI) approach for the detection of HCM based on the 12-lead ECG.Methods: We trained and validated a convolutional neural network (CNN) using digital 12-lead ECGs from 2,448 patients with verified HCM diagnosis and 51,153 non-HCM age- and sex-matched control subjects. The ability of the CNN to detect HCM was then tested on a different dataset of 612 HCM and 12,788 non-HCM subjects. The ECG data is interpreted as a 2-dimensional matrix with voltage over time and the leads representing the dimensions. The CNN is built with 11 2-dimensitional convolutional layers with downsampling via maxpooling. The pooling is only performed on the voltage over time dimension in order to keep the features from the leads separate. Prior to classification, an average pooling layer is applied in order to account for relevant low-level features in each convolutional filter. The model is built in Keras with TensorFlow backend.Results: In the combined datasets, mean age was 54.8u00b115.9 years for the HCM group and 57.5u00b115.5 years for the control group. After training and validation, the area under the curve (AUC) of the CNN in the validation dataset was 0.95 (95% CI 0.94-0.97) at the optimal probability threshold of 11% for having HCM. When applying this probability threshold in the testing dataset, the CNNu2019s AUC was 0.96 (95% CI 0.95-0.96) with sensitivity 87% and specificity 91%. In subgroup analyses, the AUC for detecting HCM among patients with LVH by ECG criteria was 0.95 (95% CI 0.94-0.97) and the model performed particularly well in younger age groups (diagnostic OR 236.4 [55.9-1000] in women and 163.92 [58.3-461] in men under age 40 years compared to OR 64.56 [50.6-82.5] in the overall population).Conclusions: ECG-based detection of HCM by an AI algorithm can be achieved with high diagnostic performance. The model may enable effective and relatively inexpensive screening for HCM using the 12-lead ECG.

Published
2017

218. Impact of Intramural Scar on Mapping and Ablation of Premature Ventricular Complexes

Author

Ghannam, Michael, Liang, Jackson J., Dabbagh, Ghaith Sharaf, Siontis, Konstantinos C., Attili, Anil, Cochet, Hubert, Jais, Pierre, Juhoor, Mehdi, Latchamsetty, Rakesh, Jongnarangsin, Krit, Morady, Fred, and Bogun, Frank

Abstract

This study sought to determine intramural scar characteristics associated with successful premature ventricular complex (PVC) ablations.

Published
2021
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219. Generalizability of the CASTLE-AF trial: Catheter ablation for patients with atrial fibrillation and heart failure in routine practice.

Author

Noseworthy, Peter A., Van Houten, Holly K., Gersh, Bernard J., Packer, Douglas L., Friedman, Paul A., Shah, Nilay D., Dunlay, Shannon M., Siontis, Konstantinos C., Piccini, Jonathan P., and Yao, Xiaoxi

Abstract

Background: In the Catheter Ablation for Atrial Fibrillation with Heart Failure (CASTLE-AF) trial, catheter ablation reduced the risk of death and heart failure (HF) hospitalization in patients with atrial fibrillation and HF by 40%.Objectives: The study aimed to assess the generalizability of CASTLE-AF to routine clinical practice.Methods: Using a large US administrative database, we identified 289,831 patients with atrial fibrillation and HF treated with ablation (n = 7465) or medical therapy alone (n = 282,366) from January 1, 2008, through August 31, 2018. Patients were divided into 3 groups on the basis of trial eligibility: (1) eligible for CASTLE-AF, (2) failing to meet the inclusion criteria, and (3) meeting at least 1 of the exclusion criteria. Propensity score overlap weighting was used to balance ablated and drug-treated patients on 90 baseline characteristics. Cox proportional hazards regression was used to compare ablation with medical therapy for the primary outcome of a composite end point of all-cause mortality and HF hospitalization.Results: Only 7.8% of patients would have been eligible for the trial; 91.0% failed to meet the trial inclusion criteria; and 15.5% met the exclusion criteria. Ablation was associated with a lower risk of the primary outcome in the overall cohort (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.76-0.87; P < .001), in the trial-eligible cohort (HR 0.82; 95% CI 0.70-0.96; P = .01), and in patients who failed to meet inclusion criteria (HR 0.79; 95% CI 0.73-0.86; P < .001) but not in patients who met the exclusion criteria (HR 0.97; 95% CI 0.81-1.17). The relative risk reduction was consistent regardless of whether patients had HF with reduced left ventricular ejection fraction.Conclusion: The benefit associated with ablation appears to be more modest in practice than that reported in the CASTLE-AF trial. [ABSTRACT FROM AUTHOR]

Published
2020
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221. Value of mapping and ablation of ventricular tachycardia targets within the coronary venous system in patients with nonischemic cardiomyopathy.

Author

Ghannam, Michael, Siontis, Konstantinos C., Cochet, Hubert, Jais, Pierre, Eng, Mehdi Juhoor, Latchamsetty, Rakesh, Jongnarangsin, Krit, Dabbagh, Ghaith Sharaf, Yokokawa, Miki, Morady, Fred, Bogun, Frank, and Dabbagh, Rakesh Sharaf

Abstract

Background: Patients with nonischemic cardiomyopathy (NICM) often require epicardial ventricular tachycardia (VT) ablation procedures via subxiphoid access. The coronary venous system (CVS) provides limited access to the epicardial space.Objective: The purpose of this study was to determine the value of an approach targeting the CVS in these patients.Methods: In a series of 41 consecutive patients (mean age 59.7 ± 11.5 years; 36 men [88%]; ejection fraction 34.5% ± 13.1%; 269 inducible VTs [6.6 ± 5.0 VTs per patient]) with NICM and VT, mapping and ablation were performed sequentially at the endocardium, then within the CVS, and finally within the pericardial space if required.Results: VT target sites were identified within the CVS in 15 patients and by subxiphoid access to the pericardial space in 8 patients. Ablation within the CVS eliminated VT inducibility in 9 patients without the need for epicardial ablation. Cardiac magnetic resonance imaging demonstrated that the CVS was closer to a scarred area in patients with CVS-related VT target sites than in other patients (mean 3.5 ± 3.9 mm vs 14.3 ± 8.3 mm; P < .001). A cutoff distance of ≤9 mm from the scar (area under the curve 0.91; 95% confidence interval 0.82-0.99; sensitivity 0.78; specificity 0.93) identified patients with vs patients without VT target sites within the CVS.Conclusion: A stepwise approach with mapping/ablation in the endocardium followed by ablation within the CVS can reduce the need for subxiphoid epicardial access in some patients with NICM. Proximity of the scar to the CVS detected by cardiac magnetic resonance imaging can identify the patients most likely to benefit from this approach. [ABSTRACT FROM AUTHOR]

Published
2020
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222. Risk stratification in patients with frequent premature ventricular complexes in the absence of known heart disease.

Author

Ghannam, Michael, Siontis, Konstantinos C., Kim, Myra Hyungjin, Cochet, Hubert, Jais, Pierre, Eng, Mehdi Juhoor, Attili, Anil, Sharaf-Dabbagh, Ghaith, Latchamsetty, Rakesh, Jongnarangsin, Krit, Morady, Fred, and Bogun, Frank

Abstract

Background: Frequent premature ventricular complexes (PVCs) can be an indicator of structural heart disease.Objective: The purpose of this study was to determine the prevalence of scarring detected by delayed enhancement cardiac magnetic resonance (DE-CMR) imaging in patients with frequent PVCs without apparent structural heart disease and to determine the value of programmed ventricular stimulation (PVS) for risk stratification in patients with frequent PVCs and myocardial scarring.Methods: DE-CMR imaging was performed in patients without apparent heart disease who had frequent PVCs and were referred for ablation. In the presence of scarring, scar volume was measured and correlated with outcome variables. All patients underwent PVS and were monitored for the occurrence of ventricular arrhythmias. Logistic regression was used to compare imaging and procedural findings with long-term outcomes, with adjustment for postablation ejection fraction (EF).Results: The study consisted of 272 patients (135 men; mean age 52 ± 15 years; EF 52% ± 12%). DE-CMR scar was found in 67 patients (25%), and 7 (3%) were found to have inducible ventricular tachycardia (VT). The presence and amount of DE-CMR were related to the risk of long-term VT independent of EF (hazard ratio 18.8 [95% confidence interval] [2.0-176.6], P = .01; and hazard ratio 1.4 [1.1-1.7] per cm3 scar, P <.001, respectively). The positive predictive value and negative predictive value of PVS for VT during long-term follow-up were 71% and 100%, respectively.Conclusion: Preprocedural cardiac DE-CMR and PVS can be used to identify patients with frequent PVCs without apparent heart disease who are at risk for VT. [ABSTRACT FROM AUTHOR]

Published
2020
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224. Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States

Author

Siontis, Konstantinos C., primary, Zhang, Xiaosong, additional, Eckard, Ashley, additional, Bhave, Nicole, additional, Schaubel, Douglas E., additional, He, Kevin, additional, Tilea, Anca, additional, Stack, Austin G., additional, Balkrishnan, Rajesh, additional, Yao, Xiaoxi, additional, Noseworthy, Peter A., additional, Shah, Nilay D., additional, Saran, Rajiv, additional, and Nallamothu, Brahmajee K., additional

Published
2018
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226. EFFECT OF MAINTENANCE OF SINUS RHYTHM AFTER CATHETER ABLATION ON BODY WEIGHT IN PATIENTS WITH ATRIAL FIBRILLATION

Author

Sunkara, Bipin, primary, Li, Yumeng, additional, Siontis, Konstantinos, additional, Yokokawa, Miki, additional, Latchamsetty, Rakesh, additional, Ghanbari, Hamid, additional, Crawford, Thomas C., additional, Jongnarangsin, Krit, additional, Pelosi, Frank, additional, Chugh, Aman, additional, Morady, Fred, additional, and Oral, Hakan, additional

Published
2018
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230. Artificial intelligence–enabled electrocardiograms for identification of patients with low ejection fraction: a pragmatic, randomized clinical trial

Author

Yao, Xiaoxi, Rushlow, David R., Inselman, Jonathan W., McCoy, Rozalina G., Thacher, Thomas D., Behnken, Emma M., Bernard, Matthew E., Rosas, Steven L., Akfaly, Abdulla, Misra, Artika, Molling, Paul E., Krien, Joseph S., Foss, Randy M., Barry, Barbara A., Siontis, Konstantinos C., Kapa, Suraj, Pellikka, Patricia A., Lopez-Jimenez, Francisco, Attia, Zachi I., Shah, Nilay D., Friedman, Paul A., and Noseworthy, Peter A.

Abstract

We have conducted a pragmatic clinical trial aimed to assess whether an electrocardiogram (ECG)-based, artificial intelligence (AI)-powered clinical decision support tool enables early diagnosis of low ejection fraction (EF), a condition that is underdiagnosed but treatable. In this trial (NCT04000087), 120 primary care teams from 45 clinics or hospitals were cluster-randomized to either the intervention arm (access to AI results; 181 clinicians) or the control arm (usual care; 177 clinicians). ECGs were obtained as part of routine care from a total of 22,641 adults (N= 11,573 intervention; N= 11,068 control) without prior heart failure. The primary outcome was a new diagnosis of low EF (≤50%) within 90 days of the ECG. The trial met the prespecified primary endpoint, demonstrating that the intervention increased the diagnosis of low EF in the overall cohort (1.6% in the control arm versus 2.1% in the intervention arm, odds ratio (OR) 1.32 (1.01–1.61), P= 0.007) and among those who were identified as having a high likelihood of low EF (that is, positive AI-ECG, 6% of the overall cohort) (14.5% in the control arm versus 19.5% in the intervention arm, OR 1.43 (1.08–1.91), P= 0.01). In the overall cohort, echocardiogram utilization was similar between the two arms (18.2% control versus 19.2% intervention, P= 0.17); for patients with positive AI-ECGs, more echocardiograms were obtained in the intervention compared to the control arm (38.1% control versus 49.6% intervention, P< 0.001). These results indicate that use of an AI algorithm based on ECGs can enable the early diagnosis of low EF in patients in the setting of routine primary care.

Published
2021
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231. List of Contributors

Author

Al-Ahmad, Amin, Andrade, Jason G., Anter, Elad, Arora, Rishi, Asirvatham, Samuel J., Banchs, Javier E., Bassiouny, Mohamed, Baykaner, Tina, Bessière, Francis, Bhakta, Deepak, Bogun, Frank, Brodt, Chad, Buch, Eric, Burkhardt, J. David, Callans, David J., Chen, Jien-Jiun, Choi, Jong-Il, Crawford, Thomas C., Dandamudi, Gopi, Das, Mithilesh K., Daubert, James P., Dawood, Farah Z., Di Biase, Luigi, Dixit, Sanjay, Dubuc, Marc, Dukkipati, Srinivas R., Ellims, Andris, Feld, Gregory K., Friadi, Doni, Gianni, Carola, Gonzalez, Mario D., Gula, Lorne J., Haines, David E., Haqqani, Haris M., Ho, Gordon, Hoffmayer, Kurt, Horton, Rodney P., Hranitzky, Patrick M., Hsu, Jonathan, Stephen Huang, Shoei K., Hutchinson, Mathew D., Ikeda, Atsushi, Jackman, Warren M., Jain, Rahul, Kalman, Jonathan M., Kanj, Mohamed H., Kay, G. Neal, Khairy, Paul, Khakpour, Houman, Kim, Young-Hoon, Kim, Yun Gi, Kiser, Andy C., Kistler, Peter M., Klein, George J., Koruth, Jacob S., Kowalewski, Christopher A.B., Krummen, David E., Lee, Kwang-No, Leong-Sit, Peter, Lerman, Bruce B., Liang, Jackson J., Lin, Jiunn-Lee, Lin, Lian-Yu, Lin, Ting-Tse, Lockwood, Deborah, Markowitz, Steven M., Michaud, Gregory F., Miller, John M., Miller, Marc A., Montgomery, Jay A., Moukabary, Talal, Mounsey, J. Paul, Nademanee, Koonlawee, Nakagawa, Hiroshi, Naksuk, Niyada, Narayan, Sanjiv M., Natale, Andrea, Nogami, Akihiko, Oh, Suk-Kyu, Oral, Hakan, Padala, Santosh K., Padmanabhan, Deepak, Park, Hee-Soon, Pathik, Bhupesh, Paul, Thomas, Petrellis, Basilios, Reddy, Vivek Y., Ringwala, Sukit, Rivera, Jaime, Roberts, Jason, Rodrigo, Miguel, Sakamoto, Yuichiro, Sanchez, Javier E., Santangeli, Pasquale, Sauer, William H., Saul, J. Philip, Shepard, Richard K., Shim, Jaemin, Shivkumar, Kalyanam, Siontis, Konstantinos, Skanes, Allan C., Su, Wilber W., Sze, Edward, Tada, Hiroshi, Taneja, Taresh, Tchou, Patrick J., Triedman, John K., Tung, Roderick, Turagam, Mohit K., Tzou, Wendy S., Viswanathan, Mohan N., Walters, Tomos E., Wang, Paul J., Whang, William, Yamada, Takumi, Yee, Raymond, and Zaman, Junaid A.B.

Published
2020
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233. Factors predictive for delayed enhancement in cardiac resonance imaging in patients undergoing catheter ablation of premature ventricular complexes

Author

Ghannam, Michael, Siontis, Konstantinos C., Kim, Hyungjin Myra, Cochet, Hubert, Jais, Pierre, Eng, Mehdi Juhoor, Attili, Anil, Sharaf-Dabbagh, Ghaith, Latchamsetty, Rakesh, Jongnarangsin, Krit, Morady, Fred, and Bogun, Frank

Abstract

Patients undergoing ablation of premature ventricular complexes (PVCs) can have cardiac scar. Risk factors for the presence of scar are not well defined.

Published
2021
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234. Artificial intelligence-enhanced electrocardiography in cardiovascular disease management

Author

Siontis, Konstantinos C., Noseworthy, Peter A., Attia, Zachi I., and Friedman, Paul A.

Abstract

The application of artificial intelligence (AI) to the electrocardiogram (ECG), a ubiquitous and standardized test, is an example of the ongoing transformative effect of AI on cardiovascular medicine. Although the ECG has long offered valuable insights into cardiac and non-cardiac health and disease, its interpretation requires considerable human expertise. Advanced AI methods, such as deep-learning convolutional neural networks, have enabled rapid, human-like interpretation of the ECG, while signals and patterns largely unrecognizable to human interpreters can be detected by multilayer AI networks with precision, making the ECG a powerful, non-invasive biomarker. Large sets of digital ECGs linked to rich clinical data have been used to develop AI models for the detection of left ventricular dysfunction, silent (previously undocumented and asymptomatic) atrial fibrillation and hypertrophic cardiomyopathy, as well as the determination of a person’s age, sex and race, among other phenotypes. The clinical and population-level implications of AI-based ECG phenotyping continue to emerge, particularly with the rapid rise in the availability of mobile and wearable ECG technologies. In this Review, we summarize the current and future state of the AI-enhanced ECG in the detection of cardiovascular disease in at-risk populations, discuss its implications for clinical decision-making in patients with cardiovascular disease and critically appraise potential limitations and unknowns.

Published
2021
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235. Value of cardiac magnetic resonance imaging and programmed ventricular stimulation in patients with frequent premature ventricular complexes undergoing radiofrequency ablation

Author

Yokokawa, Miki, primary, Siontis, Konstantinos C., additional, Kim, Hyungjin Myra, additional, Stojanovska, Jadranka, additional, Latchamsetty, Rakesh, additional, Crawford, Thomas, additional, Jongnarangsin, Krit, additional, Ghanbari, Hamid, additional, Cunnane, Ryan, additional, Chugh, Aman, additional, Pelosi, Frank, additional, Oral, Hakan, additional, Morady, Fred, additional, and Bogun, Frank, additional

Published
2017
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238. Women with hypertrophic cardiomyopathy have worse survival

Author

Geske, Jeffrey B, primary, Ong, Kevin C, additional, Siontis, Konstantinos C, additional, Hebl, Virginia B, additional, Ackerman, Michael J, additional, Hodge, David O, additional, Miller, Virginia M, additional, Nishimura, Rick A, additional, Oh, Jae K, additional, Schaff, Hartzell V, additional, Gersh, Bernard J, additional, and Ommen, Steve R, additional

Published
2017
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246. Prognostic Impact of the Timing of Recurrence of Infarct-Related Ventricular Tachycardia After Catheter Ablation

Author

Siontis, Konstantinos C., primary, Kim, Hyungjin Myra, additional, Stevenson, William G., additional, Fujii, Akira, additional, Della Bella, Paolo, additional, Vergara, Pasquale, additional, Shivkumar, Kalyanam, additional, Tung, Roderick, additional, Do, Duc H., additional, Daoud, Emile G., additional, Okabe, Toshimasa, additional, Zeppenfeld, Katja, additional, de Riva Silva, Marta, additional, Hindricks, Gerhard, additional, Arya, Arash, additional, Weber, Alexander, additional, Kuck, Karl-Heinz, additional, Metzner, Andreas, additional, Mathew, Shibu, additional, Riedl, Johannes, additional, Yokokawa, Miki, additional, Jongnarangsin, Krit, additional, Latchamsetty, Rakesh, additional, Morady, Fred, additional, and Bogun, Frank M., additional

Published
2016
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247. Electroanatomical Voltage Mapping to Distinguish Right-Sided Cardiac Sarcoidosis From Arrhythmogenic Right Ventricular Cardiomyopathy

Author

Hoogendoorn, Jarieke C., Sramko, Marek, Venlet, Jeroen, Siontis, Konstantinos C., Kumar, Saurabh, Singh, Robin, Nakajima, Ikutaro, Piers, Sebastiaan R.D., de Riva Silva, Marta, Glashan, Claire A., Crawford, Thomas, Tedrow, Usha B., Stevenson, William G., Bogun, Frank, and Zeppenfeld, Katja

Abstract

This study sought to investigate the value of electroanatomical voltage mapping (EAVM) to distinguish cardiac sarcoidosis (CS) from arrhythmogenic right ventricular cardiomyopathy (ARVC) in patients with ventricular tachycardia from the right ventricle (RV).

Published
2020
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248. Stepwise Approach for Ventricular Tachycardia Ablation in Patients With Predominantly Intramural Scar

Author

Ghannam, Michael, Siontis, Konstantinos C., Kim, Hyungjin Myra, Cochet, Hubert, Jais, Pierre, Juhoor, Mehdi, Latchamsetty, Rakesh, Jongnarangsin, Krit, Attili, Anil, Sharaf Dabbagh, Ghaith, Yokokawa, Miki, Morady, Fred, and Bogun, Frank

Abstract

The goal of this study was to assess the value of a stepwise, image-guided ablation approach in patients with cardiomyopathy and predominantly intramural scar.

Published
2020
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249. Significance of clinical ventricular tachycardias induced by antitachycardia pacing in patients with prior myocardial infarction.

Author

Sharaf-Dabbagh, Ghaith, Siontis, Konstantinos C., Latchamsetty, Rakesh, Jongnarangsin, Krit, Yokokawa, Miki, Lathkar-Pradhan, Sangeeta, Morady, Fred, and Bogun, Frank

Abstract

Background: In patients with implantable cardioverter-defibrillator (ICD), ventricular tachycardia (VT) can occur spontaneously or as a result of antitachycardia pacing (ATP) that changes, rather than terminates, a spontaneous VT to a different VT. The relevance of ATP-induced VTs is uncertain.Objective: The purpose of this study was to assess the clinical relevance of ATP-mediated VTs in patients undergoing VT ablation procedures.Methods: Stored ICD electrograms of 162 consecutive patients with prior myocardial infarction referred for VT ablation (mean age 67.5 ± 9.2 years; 150 men; median ejection fraction 25% [IQR 20%-35%]) were reviewed. Clinical VTs were classified as spontaneous or ATP-induced. All VTs were targeted during the ablation procedures.Results: Of 554 ICD-recorded clinical VTs, 157 (28%) were ATP-induced (63 patients) and 397 (72%) were spontaneous. ATP-induced VTs were faster (cycle length 316 ± 62 ms vs 369 ± 83 ms; P < .001), less commonly inducible with invasive programmed stimulation (35% vs 52%; P < .001), and less commonly had identifiable target sites (21% vs 40%; P < .001) than were spontaneous VTs. During a median follow-up of 368 days [IQR: 68-1106] postablation, 71 VTs recurred (39 patients), none of which was a previously documented ATP-induced VT. A history of ATP-induced VT was associated with an increase in VT recurrence.Conclusion: ATP-induced VTs occur frequently in patients with prior myocardial infarction presenting for VT ablation procedures. The presence of ATP-induced VT is associated with a higher VT recurrence rate postablation. None of the ATP-induced VTs recorded before the ablation procedure recurred postablation, and therefore ATP-induced VTs represent a marker rather than the cause of VT recurrence. [ABSTRACT FROM AUTHOR]

Published
2019
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