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210. Independent mapping methods reveal rotational activation near pulmonary veins where atrial fibrillation terminates before pulmonary vein isolation

Author

Navara, Rachita, primary, Leef, George, additional, Shenasa, Fatemah, additional, Kowalewski, Christopher, additional, Rogers, Albert J., additional, Meckler, Gabriela, additional, Zaman, Junaid A. B., additional, Baykaner, Tina, additional, Park, Shirley, additional, Turakhia, Mintu P., additional, Zei, Paul, additional, Viswanathan, Mohan, additional, Wang, Paul J., additional, and Narayan, Sanjiv M., additional

Published
2018
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211. Geographic and racial representation and reported success rates of studies of catheter ablation for atrial fibrillation: Findings from the SMASH-AF meta-analysis study cohort

Author

Leef, George C., primary, Perino, Alexander C., additional, Cluckey, Andrew, additional, Yunus, Fahd N., additional, Askari, Mariam, additional, Heidenreich, Paul A., additional, Narayan, Sanjiv M., additional, Wang, Paul J., additional, and Turakhia, Mintu P., additional

Published
2018
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213. Screening for Atrial Fibrillation:A Report of the AF-SCREEN International Collaboration

Author

Freedman, Ben, Camm, John, Calkins, Hugh, Healey, Jeffrey S, Rosenqvist, Mårten, Wang, Jiguang, Albert, Christine M, Anderson, Craig S, Antoniou, Sotiris, Benjamin, Emelia J, Boriani, Giuseppe, Brachmann, Johannes, Brandes, Axel, Chao, Tze-Fan, Conen, David, Engdahl, Johan, Fauchier, Laurent, Fitzmaurice, David A, Friberg, Leif, Gersh, Bernard J, Gladstone, David J, Glotzer, Taya V, Gwynne, Kylie, Hankey, Graeme J, Harbison, Joseph, Hillis, Graham S, Hills, Mellanie T, Kamel, Hooman, Kirchhof, Paulus, Kowey, Peter R, Krieger, Derk, Lee, Vivian W Y, Levin, Lars-Åke, Lip, Gregory Y H, Lobban, Trudie, Lowres, Nicole, Mairesse, Georges H, Martinez, Carlos, Neubeck, Lis, Orchard, Jessica, Piccini, Jonathan P, Poppe, Katrina, Potpara, Tatjana S, Puererfellner, Helmut, Rienstra, Michiel, Sandhu, Roopinder K, Schnabel, Renate B, Siu, Chung-Wah, Steinhubl, Steven, Svendsen, Jesper H, Svennberg, Emma, Themistoclakis, Sakis, Tieleman, Robert G, Turakhia, Mintu P, Tveit, Arnljot, Uittenbogaart, Steven B, Van Gelder, Isabelle C, Verma, Atul, Wachter, Rolf, Yan, Bryan P, Freedman, Ben, Camm, John, Calkins, Hugh, Healey, Jeffrey S, Rosenqvist, Mårten, Wang, Jiguang, Albert, Christine M, Anderson, Craig S, Antoniou, Sotiris, Benjamin, Emelia J, Boriani, Giuseppe, Brachmann, Johannes, Brandes, Axel, Chao, Tze-Fan, Conen, David, Engdahl, Johan, Fauchier, Laurent, Fitzmaurice, David A, Friberg, Leif, Gersh, Bernard J, Gladstone, David J, Glotzer, Taya V, Gwynne, Kylie, Hankey, Graeme J, Harbison, Joseph, Hillis, Graham S, Hills, Mellanie T, Kamel, Hooman, Kirchhof, Paulus, Kowey, Peter R, Krieger, Derk, Lee, Vivian W Y, Levin, Lars-Åke, Lip, Gregory Y H, Lobban, Trudie, Lowres, Nicole, Mairesse, Georges H, Martinez, Carlos, Neubeck, Lis, Orchard, Jessica, Piccini, Jonathan P, Poppe, Katrina, Potpara, Tatjana S, Puererfellner, Helmut, Rienstra, Michiel, Sandhu, Roopinder K, Schnabel, Renate B, Siu, Chung-Wah, Steinhubl, Steven, Svendsen, Jesper H, Svennberg, Emma, Themistoclakis, Sakis, Tieleman, Robert G, Turakhia, Mintu P, Tveit, Arnljot, Uittenbogaart, Steven B, Van Gelder, Isabelle C, Verma, Atul, Wachter, Rolf, and Yan, Bryan P

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country- and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen

Published
2017

214. Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration

Author

Freedman, Ben, Camm, John, Calkins, Hugh, Healey, Jeffrey S., Rosenqvist, Marten, Wang, Jiguang, Albert, Christine M., Anderson, Craig S., Antoniou, Sotiris, Benjamin, Emelia J., Boriani, Giuseppe, Brachmann, Johannes, Brandes, Axel, Chao, Tze-Fan, Conen, David, Engdahl, Johan, Fauchier, Laurent, Fitzmaurice, David A., Friberg, Leif, Gersh, Bernard J., Gladstone, David J., Glotzer, Taya V., Gwynne, Kylie, Hankey, Graeme J., Harbison, Joseph, Hillis, Graham S., Hills, Mellanie T., Kamel, Hooman, Kirchhof, Paulus, Kowey, Peter R., Krieger, Derk, Lee, Vivian W. Y., Levin, Lars-Åke, Lip, Gregory Y. H., Lobban, Trudie, Lowres, Nicole, Mairesse, Georges H., Martinez, Carlos, Neubeck, Lis, Orchard, Jessica, Piccini, Jonathan P., Poppe, Katrina, Potpara, Tatjana S., Puererfellner, Helmut, Rienstra, Michiel, Sandhu, Roopinder K., Schnabel, Renate B., Siu, Chung-Wah, Steinhubl, Steven, Svendsen, Jesper H., Svennberg, Emma, Themistoclakis, Sakis, Tieleman, Robert G., Turakhia, Mintu P., Tveit, Arnljot, Uittenbogaart, Steven B., Van Gelder, Isabelle C., Verma, Atul, Wachter, Rolf, Yan, Bryan P., Freedman, Ben, Camm, John, Calkins, Hugh, Healey, Jeffrey S., Rosenqvist, Marten, Wang, Jiguang, Albert, Christine M., Anderson, Craig S., Antoniou, Sotiris, Benjamin, Emelia J., Boriani, Giuseppe, Brachmann, Johannes, Brandes, Axel, Chao, Tze-Fan, Conen, David, Engdahl, Johan, Fauchier, Laurent, Fitzmaurice, David A., Friberg, Leif, Gersh, Bernard J., Gladstone, David J., Glotzer, Taya V., Gwynne, Kylie, Hankey, Graeme J., Harbison, Joseph, Hillis, Graham S., Hills, Mellanie T., Kamel, Hooman, Kirchhof, Paulus, Kowey, Peter R., Krieger, Derk, Lee, Vivian W. Y., Levin, Lars-Åke, Lip, Gregory Y. H., Lobban, Trudie, Lowres, Nicole, Mairesse, Georges H., Martinez, Carlos, Neubeck, Lis, Orchard, Jessica, Piccini, Jonathan P., Poppe, Katrina, Potpara, Tatjana S., Puererfellner, Helmut, Rienstra, Michiel, Sandhu, Roopinder K., Schnabel, Renate B., Siu, Chung-Wah, Steinhubl, Steven, Svendsen, Jesper H., Svennberg, Emma, Themistoclakis, Sakis, Tieleman, Robert G., Turakhia, Mintu P., Tveit, Arnljot, Uittenbogaart, Steven B., Van Gelder, Isabelle C., Verma, Atul, Wachter, Rolf, and Yan, Bryan P.

Abstract

Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the, Funding Agencies|Bayer HealthCare; Bristol-Myers Squibb/Pfizer; Daiichi Sankyo; Medtronic; C-SPIN (Canadian Stroke Prevention Intervention Network); Zenicor; iRhythm

Published
2017
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215. Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

Author

Ullal, Aditya J., Kaiser, Daniel W., Fan, Jun, Schmitt, Susan, Than, Claire T., Winkelmayer, Wolfgang C., Heidenreich, Paul A., Piccini, Jonathon P., Perez, Marco V., Wang, Paul J., and Turakhia, Mintu P.

Subjects
Adult, Male, Time Factors, Adolescent, Databases, Factual, Comorbidity, Kaplan-Meier Estimate, Patient Readmission, Article, Disease-Free Survival, Young Adult, Recurrence, Risk Factors, Atrial Fibrillation, Humans, Renal Insufficiency, Chronic, Aged, Proportional Hazards Models, Aged, 80 and over, Heart Failure, Incidence, Middle Aged, United States, Treatment Outcome, Chronic Disease, Multivariate Analysis, Catheter Ablation, Female
Abstract

Data regarding catheter ablation of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) is limited. We therefore assessed the association of CKD with common safety and clinical outcomes in a nationwide sample of ablation recipients.Using MarketScanOf 21,091 patients included, 1,593 (7.6%) had CKD. Patients with CKD were older (64 years vs. 59 years, P0.001) with higher CHAAmong patients selected for AF ablation, those with and without CKD had similar rates of postprocedural complications although they were more likely to be re-admitted for heart failure. CKD was not independently associated with AF hospitalization, cardioversion, and repeat ablation. These findings can inform clinical decision-making in patients with AF and CKD.

Published
2016

216. Oral Anticoagulant Therapy Prescription in Patients With Atrial Fibrillation Across the Spectrum of Stroke Risk: Insights From the NCDR PINNACLE Registry

Author

Marzec, Lucas N., Katz, David F., Marcus, Gregory M., Turakhia, Mintu P., Gehi, Anil K., Lubitz, Steven A., Hsu, Jonathan C., Kennedy, Kevin F., and Maddox, Thomas M.

Abstract

IMPORTANCE: Patients with atrial fibrillation (AF) are at a proportionally higher risk of stroke based on accumulation of well-defined risk factors. OBJECTIVE: To examine the extent to which prescription of an oral anticoagulant (OAC) in US cardiology practices increases as the number of stroke risk factors increases. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional registry study of outpatients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's PINNACLE (Practice Innovation and Clinical Excellence) Registry between January 1, 2008, and December 30, 2012. As a measure of stroke risk, we calculated the CHADS2 score and the CHA2DS2-VASc score for all patients. Using multinomial logistic regression models adjusted for patient, physician, and practice characteristics, we examined the association between increased stroke risk score and prescription of an OAC. MAIN OUTCOMES AND MEASURES: The primary outcome was prescription of an OAC with warfarin sodium or a non-vitamin K antagonist OAC. RESULTS: The study cohort comprised 429 417 outpatients with AF. Their mean (SD) age was 71.3 (12.9) years, and 55.8% were male. Prescribed treatment consisted of an OAC (192 600 [44.9%]), aspirin only (111 134 [25.9%]), aspirin plus a thienopyridine (23 454 [5.5%]), or no antithrombotic therapy (102 229 [23.8%]). Each 1-point increase in risk score was associated with increased odds of OAC prescription compared with aspirin-only prescription using the CHADS2 score (adjusted odds ratio, 1.158; 95% CI, 1.144-1.172; P

Published
2016
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217. 2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Author

Varma, Niraj, Cygankiewicz, Iwona, Turakhia, Mintu P., Heidbuchel, Hein, Hu, Yufeng, Chen, Lin Yee, Couderc, Jean-Philippe, Cronin, Edmond M., Estep, Jerry D., Grieten, Lars, Lane, Deirdre A., Mehra, Reena, Page, Alex, Passman, Rod, Piccini, Jonathan P., Piotrowicz, Ewa, Piotrowicz, Ryszard, Platonov, Pyotr G., Ribeiro, Antonio Luiz, Rich, Robert E., Russo, Andrea M., Slotwiner, David, Steinberg, Jonathan S., and Svennberg, Emma

Abstract

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

Published
2021
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218. Integration of novel monitoring devices with machine learning technology for scalable cardiovascular management

Author

Krittanawong, Chayakrit, Rogers, Albert J., Johnson, Kipp W., Wang, Zhen, Turakhia, Mintu P., Halperin, Jonathan L., and Narayan, Sanjiv M.

Abstract

Ambulatory monitoring is increasingly important for cardiovascular care but is often limited by the unpredictability of cardiovascular events, the intermittent nature of ambulatory monitors and the variable clinical significance of recorded data in patients. Technological advances in computing have led to the introduction of novel physiological biosignals that can increase the frequency at which abnormalities in cardiovascular parameters can be detected, making expert-level, automated diagnosis a reality. However, use of these biosignals for diagnosis also raises numerous concerns related to accuracy and actionability within clinical guidelines, in addition to medico-legal and ethical issues. Analytical methods such as machine learning can potentially increase the accuracy and improve the actionability of device-based diagnoses. Coupled with interoperability of data to widen access to all stakeholders, seamless connectivity (an internet of things) and maintenance of anonymity, this approach could ultimately facilitate near-real-time diagnosis and therapy. These tools are increasingly recognized by regulatory agencies and professional medical societies, but several technical and ethical issues remain. In this Review, we describe the current state of cardiovascular monitoring along the continuum from biosignal acquisition to the identification of novel biosensors and the development of analytical techniques and ultimately to regulatory and ethical issues. Furthermore, we outline new paradigms for cardiovascular monitoring.

Published
2021
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219. Smart wearable devices in cardiovascular care: where we are and how to move forward

Author

Bayoumy, Karim, Gaber, Mohammed, Elshafeey, Abdallah, Mhaimeed, Omar, Dineen, Elizabeth H., Marvel, Francoise A., Martin, Seth S., Muse, Evan D., Turakhia, Mintu P., Tarakji, Khaldoun G., and Elshazly, Mohamed B.

Abstract

Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical ‘ABCD’ guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.

Published
2021
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220. Chronic kidney disease and arrhythmias : Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Turakhia, Mintu P, Blankestijn, Peter J, Carrero, Juan-Jesus, Clase, Catherine M, Deo, Rajat, Herzog, Charles A, Kasner, Scott E, Passman, Rod S, Pecoits-Filho, Roberto, Reinecke, Holger, Shroff, Gautam R, Zareba, Wojciech, Cheung, Michael, Wheeler, David C, Wanner, Christoph, Winkelmayer, Wolfgang C, Conference Participants, Amann, Kerstin, Banerjee, Debasish, Bansal, Nisha, Boriani, Giuseppe, Bunch, Jared, Chan, Christopher T, Charytan, David M, Conen, David, Friedman, Allon N, Genovesi, Simonetta, Holden, Rachel M, House, Andrew A, Jadoul, Michel, Jardine, Alan G, Johnson, David W, Jun, Min, Labriola, Laura, Mark, Patrick B, McCullough, Peter A, Nolin, Thomas D, Potpara, Tatjana S, Pun, Patrick H, Ribeiro, Antonio L P, Rossignol, Patrick, Shen, Jenny I, Sood, Manish M, Tsukamoto, Yusuke, Wang, Angela Yee-Moon, Weir, Matthew R, Wetmore, James B, Wranicz, Jerzy K, Yamasaki, Hiro, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Turakhia, M, Blankestijn, P, Carrero, J, Clase, C, Deo, R, Herzog, C, Kasner, S, Passman, R, Pecoits-Filho, R, Reinecke, H, Shroff, G, Zareba, W, Cheung, M, Wheeler, D, Winkelmayer, W, Wanner, C, and Genovesi, S

Subjects
Nephrology, Heart rhythm disorders, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, urologic and male genital diseases, Kidney, law.invention, Sudden cardiac death, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, atrial fibrillation, Arrhythmia/Electrophysiology, Treatment options, Atrial fibrillation, stroke, Defibrillators, Implantable, Current Opinion, cardiovascular system, Hemodialysis, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Hypokalemia, arrhythmia, Sudden death, sudden cardiac death, End stage renal disease, 03 medical and health sciences, Renal Dialysis, Internal medicine, Chronic kidney disease, end stage renal disease, arrhythmias, atrial fibrillation, sudden death, medicine, Humans, In patient, cardiovascular diseases, Renal Insufficiency, Chronic, Intensive care medicine, Inflammation, business.industry, Arrhythmias, Cardiac, medicine.disease, Oxidative Stress, Death, Sudden, Cardiac, Potassium, Hyperkalemia, Kidney Failure, Chronic, business, Atrial flutter, chronic kidney disease, 030217 neurology & neurosurgery, Kidney disease
Abstract

Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease (ESKD) have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies,1 although this situation is changing.2 Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders.3–7 To identify key issues relevant to the optimal prevention, management, and treatment of arrhythmias and their complications in patients with kidney disease, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference in Berlin, Germany, titled CKD and Arrhythmias in October 2016. The conference agenda and discussion questions are available on the KDIGO website (http://kdigo.org/conferences/ckd-arrhythmias/; 13 February 2018).

Published
2018

222. Reply

Author

Perino, Alexander C., primary and Turakhia, Mintu P., additional

Published
2017
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224. Adherence and outcomes to direct oral anticoagulants among patients with atrial fibrillation: findings from the veterans health administration

Author

Borne, Ryan T., primary, O’Donnell, Colin, additional, Turakhia, Mintu P., additional, Varosy, Paul D., additional, Jackevicius, Cynthia A., additional, Marzec, Lucas N., additional, Masoudi, Frederick A., additional, Hess, Paul L., additional, Maddox, Thomas M., additional, and Ho, P. Michael, additional

Published
2017
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226. Reply

Author

Ladapo, Joseph A., primary, Turakhia, Mintu P., additional, Ryan, Michael P., additional, Mollenkopf, Sarah A., additional, and Reynolds, Matthew R., additional

Published
2017
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228. Response by Vaidya et al to Letter Regarding Article, “Burden of Arrhythmia in Pregnancy”

Author

Vaidya, Vaibhav R., primary, Arora, Shilpkumar, additional, Patel, Nileshkumar, additional, Badheka, Apurva, additional, Patel, Nilay, additional, Agnihotri, Kanishk, additional, Billimoria, Zeenia, additional, Turakhia, Mintu P., additional, Friedman, Paul A., additional, Madhavan, Malini, additional, Kapa, Suraj, additional, Noseworthy, Peter A., additional, Cha, Yong-Mei, additional, Gersh, Bernard, additional, Asirvatham, Samuel J., additional, and Deshmukh, Abhishek J., additional

Published
2017
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229. Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Author

Perino, Alexander C., primary, Fan, Jun, additional, Schmitt, Susan K., additional, Askari, Mariam, additional, Kaiser, Daniel W., additional, Deshmukh, Abhishek, additional, Heidenreich, Paul A., additional, Swan, Christopher, additional, Narayan, Sanjiv M., additional, Wang, Paul J., additional, and Turakhia, Mintu P., additional

Published
2017
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230. Screening for Atrial Fibrillation

Author

Freedman, Ben, primary, Camm, John, additional, Calkins, Hugh, additional, Healey, Jeffrey S., additional, Rosenqvist, Mårten, additional, Wang, Jiguang, additional, Albert, Christine M., additional, Anderson, Craig S., additional, Antoniou, Sotiris, additional, Benjamin, Emelia J., additional, Boriani, Giuseppe, additional, Brachmann, Johannes, additional, Brandes, Axel, additional, Chao, Tze-Fan, additional, Conen, David, additional, Engdahl, Johan, additional, Fauchier, Laurent, additional, Fitzmaurice, David A., additional, Friberg, Leif, additional, Gersh, Bernard J., additional, Gladstone, David J., additional, Glotzer, Taya V., additional, Gwynne, Kylie, additional, Hankey, Graeme J., additional, Harbison, Joseph, additional, Hillis, Graham S., additional, Hills, Mellanie T., additional, Kamel, Hooman, additional, Kirchhof, Paulus, additional, Kowey, Peter R., additional, Krieger, Derk, additional, Lee, Vivian W. Y., additional, Levin, Lars-Åke, additional, Lip, Gregory Y. H., additional, Lobban, Trudie, additional, Lowres, Nicole, additional, Mairesse, Georges H., additional, Martinez, Carlos, additional, Neubeck, Lis, additional, Orchard, Jessica, additional, Piccini, Jonathan P., additional, Poppe, Katrina, additional, Potpara, Tatjana S., additional, Puererfellner, Helmut, additional, Rienstra, Michiel, additional, Sandhu, Roopinder K., additional, Schnabel, Renate B., additional, Siu, Chung-Wah, additional, Steinhubl, Steven, additional, Svendsen, Jesper H., additional, Svennberg, Emma, additional, Themistoclakis, Sakis, additional, Tieleman, Robert G., additional, Turakhia, Mintu P., additional, Tveit, Arnljot, additional, Uittenbogaart, Steven B., additional, Van Gelder, Isabelle C., additional, Verma, Atul, additional, Wachter, Rolf, additional, Yan, Bryan P., additional, Al Awwad, A, additional, Al-Kalili, F, additional, Berge, T, additional, Breithardt, G, additional, Bury, G, additional, Caorsi, WR, additional, Chan, NY, additional, Chen, SA, additional, Christophersen, I, additional, Connolly, S, additional, Crijns, H, additional, Davis, S, additional, Dixen, U, additional, Doughty, R, additional, Du, X, additional, Ezekowitz, M, additional, Fay, M, additional, Frykman, V, additional, Geanta, M, additional, Gray, H, additional, Grubb, N, additional, Guerra, A, additional, Halcox, J, additional, Hatala, R, additional, Heidbuchel, H, additional, Jackson, R, additional, Johnson, L, additional, Kaab, S, additional, Keane, K, additional, Kim, YH, additional, Kollios, G, additional, Løchen, ML, additional, Ma, C, additional, Mant, J, additional, Martinek, M, additional, Marzona, I, additional, Matsumoto, K, additional, McManus, D, additional, Moran, P, additional, Naik, N, additional, Ngarmukos, T, additional, Prabhakaran, D, additional, Reidpath, D, additional, Ribeiro, A, additional, Rudd, A, additional, Savalieva, I, additional, Schilling, R, additional, Sinner, M, additional, Stewart, S, additional, Suwanwela, N, additional, Takahashi, N, additional, Topol, E, additional, Ushiyama, S, additional, Verbiest van Gurp, N, additional, Walker, N, additional, and Wijeratne, T, additional

Published
2017
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233. Long-term electrocardiographic safety monitoring in clinical drug development: A report from the Cardiac Safety Research Consortium

Author

Piccini, Jonathan P., primary, Clark, Richard L., additional, Kowey, Peter R., additional, Mittal, Suneet, additional, Dunnmon, Preston, additional, Stockbridge, Norman, additional, Reiffel, James A., additional, Turakhia, Mintu P., additional, Ziegler, Paul D., additional, Kleiman, Robert B., additional, Ismat, Fraz, additional, and Sager, Philip, additional

Published
2017
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234. Burden of Arrhythmia in Pregnancy

Author

Vaidya, Vaibhav R., primary, Arora, Shilpkumar, additional, Patel, Nileshkumar, additional, Badheka, Apurva O., additional, Patel, Nilay, additional, Agnihotri, Kanishk, additional, Billimoria, Zeenia, additional, Turakhia, Mintu P., additional, Friedman, Paul A., additional, Madhavan, Malini, additional, Kapa, Suraj, additional, Noseworthy, Peter A., additional, Cha, Yong-Mei, additional, Gersh, Bernard, additional, Asirvatham, Samuel J., additional, and Deshmukh, Abhishek J., additional

Published
2017
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237. Impact of Baseline Stroke Risk and Bleeding Risk on Warfarin International Normalized Ratio Control in Atrial Fibrillation (from the TREAT-AF Study)

Author

Hellyer, Jessica A., primary, Azarbal, Farnaz, additional, Than, Claire T., additional, Fan, Jun, additional, Schmitt, Susan K., additional, Yang, Felix, additional, Frayne, Susan M., additional, Phibbs, Ciaran S., additional, Yong, Celina, additional, Heidenreich, Paul A., additional, and Turakhia, Mintu P., additional

Published
2017
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238. Survival After Secondary Prevention Implantable Cardioverter-Defibrillator Placement

Author

Katz, David F., primary, Peterson, Pamela, additional, Borne, Ryan T., additional, Betz, Jarrod, additional, Al-Khatib, Sana M., additional, Varosy, Paul D., additional, Wang, Yongfei, additional, Hsu, Jonathan C., additional, Hoffmayer, Kurt S., additional, Kipp, Ryan T., additional, Hansen, Carolina Malta, additional, Turakhia, Mintu P., additional, and Masoudi, Frederick A., additional

Published
2017
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241. Survey of current perspectives on consumer-available digital health devices for detecting atrial fibrillation

Author

Ding, Eric Y., Svennberg, Emma, Wurster, Christina, Duncker, David, Manninger, Martin, Lubitz, Steven A., Dickson, Emily, Fitzgibbons, Timothy P., Akoum, Nazem, Al-Khatib, Sana M., Attia, Zachi I., Ghanbari, Hamid, Marrouche, Nassir F., Mendenhall, G. Stuart, Peters, Nicholas S., Tarakji, Khaldoun G., Turakhia, Mintu, Wan, Elaine Y., and McManus, David D.

Abstract

Many digital health technologies capable of atrial fibrillation (AF) detection are directly available to patients. However, adaptation into clinical practice by heart rhythm healthcare practitioners (HCPs) is unclear.

Published
2020
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242. Venous Vascular Closure System Versus Manual Compression Following Multiple Access Electrophysiology Procedures

Author

Natale, Andrea, Mohanty, Sanghamitra, Liu, P.Y., Mittal, Suneet, Al-Ahmad, Amin, De Lurgio, David B., Horton, Rodney, Spear, William, Bailey, Shane, Bunch, Jared, Musat, Dan, O’Neill, Padraig, Compton, Steven, Turakhia, Mintu P., Natale, Andrea, Al-Ahmad, Amin M., Horton, Rodney Paul, Bailey, Shane M., Cardinal, Deborah S., Compton, Steven, Balaban, Krzysztof W., Rambur, Deidre, Mittal, Suneet, Preminger, Mark W., Musat, Dan Laurentiu, Sichrovsky, Tina Claudia, Bhatt, Advay G., Michel, Kimberly, DeLurgio, David B., Shah, Anand D., Kavtaradze, Nino, O'Neill, Padraig Gearoid, Allen, Shelley, Spear, William H., Duggal, Manoj, Braun, Diane, Han, Frederick T., Marrouche, Nassir F., Chelu, Mihail G., Rivera, Andrew M., Bunch, T. Jared, Weiss, Jonathan Peter, Day, John D., Crandall, Brian G., Cutler, Michael J., Allen, Meredith, Tung, Roderick, Beaser, Andrew D., Sarrafi, Shahram, Shah, Manish Hasmukh, Lee, Sung W., Fischer, Margaret Bell, Thomaides, Athanasios, Durrani, Sarfraz A.K., Strouse, David Abraham, Eldadah, Zayd A., Kim, Shine, Bashian, Gregory G., Borek, Przemyslaw Peter, Darby, James, Dukkipati, Srinivas Rao, Whang, William, Koruth, Jacob Sam, Miller, Marc A., Reddy, Vivek Y., Biondo, Felicia, Viswanathan, Mohan N., and Magee, Sarah

Abstract

This study compared the efficacy and safety of the VASCADE MVP Venous Vascular Closure System (VVCS) device (Cardiva Medical, Santa Clara, California) to manual compression (MC) for closing multiple access sites after catheter-based electrophysiology procedures.

Published
2020
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243. Technology-Enabled Clinical Trials: Transforming Medical Evidence Generation.

Author

Marquis-Gravel, Guillaume, Roe, Matthew T., Turakhia, Mintu P., Boden, William, Temple, Robert, Sharma, Abhinav, Hirshberg, Boaz, Slater, Paul, Craft, Noah, Stockbridge, Norman, McDowell, Bryan, Waldstreicher, Joanne, Bourla, Ariel, Bansilal, Sameer, Wong, Jennifer L., Meunier, Claire, Kassahun, Helina, Coran, Philip, Bataille, Lauren, and Patrick-Lake, Bray

Published
2019
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244. Transparent sharing of digital health data: A call to action.

Author

Turakhia, Mintu P., Schaeffer, Jill, Mendenhall, G. Stuart, Hindricks, Gerhard, Narayan, Sanjiv M., Davenport, Elizabeth E., Marrouche, Nassir F., Slotwiner, David J., Tarakji, Khaldoun G., Al-Khatib, Sana M., Passman, Rod S., Saxon, Leslie A., Peters, Nicholas S., and McCall, Debbe

Published
2019
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245. Wavefront Field Mapping Reveals a Physiologic Network Between Drivers Where Ablation Terminates Atrial Fibrillation.

Author

Leef, George, Shenasa, Fatemah, Bhatia, Neal K., Rogers, Albert J., Sauer, William, Miller, John M., Swerdlow, Mark, Tamboli, Mallika, Alhusseini, Mahmood I., Armenia, Erin, Baykaner, Tina, Brachmann, Johannes, Turakhia, Mintu P., Atienza, Felipe, Rappel, Wouter-Jan, Wang, Paul J., and Narayan, Sanjiv M.

Abstract

Background: Localized drivers are proposed mechanisms for persistent atrial fibrillation (AF) from optical mapping of human atria and clinical studies of AF, yet are controversial because drivers fluctuate and ablating them may not terminate AF. We used wavefront field mapping to test the hypothesis that AF drivers, if concurrent, may interact to produce fluctuating areas of control to explain their appearance/disappearance and acute impact of ablation.Methods: We recruited 54 patients from an international registry in whom persistent AF terminated by targeted ablation. Unipolar AF electrograms were analyzed from 64-pole baskets to reconstruct activation times, map propagation vectors each 20 ms, and create nonproprietary phase maps.Results: Each patient (63.6±8.5 years, 29.6% women) showed 4.0±2.1 spatially anchored rotational or focal sites in AF in 3 patterns. First, a single (type I; n=7) or, second, paired chiral-antichiral (type II; n=5) rotational drivers controlled most of the atrial area. Ablation of 1 to 2 large drivers terminated all cases of types I or II AF. Third, interaction of 3 to 5 drivers (type III; n=42) with changing areas of control. Targeted ablation at driver centers terminated AF and required more ablation in types III versus I (P=0.02 in left atrium).Conclusions: Wavefront field mapping of persistent AF reveals a pathophysiologic network of a small number of spatially anchored rotational and focal sites, which interact, fluctuate, and control varying areas. Future work should define whether AF drivers that control larger atrial areas are attractive targets for ablation. [ABSTRACT FROM AUTHOR]

Published
2019
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246. Site Variation and Outcomes for Antithrombotic Therapy in Atrial Fibrillation Patients After Percutaneous Coronary Intervention: Findings From the Veterans Health Administration.

Author

Olivier, Christoph B., Fan, Jun, Askari, Mariam, Mahaffey, Kenneth W., Heidenreich, Paul A., Perino, Alexander C., Leef, George C., Ho, P. Michael, Harrington, Robert A., and Turakhia, Mintu P.

Abstract

BACKGROUND: Patients with atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI) require multiple antithrombotic therapies. The optimal strategy is debated suggesting increased treatment variation. This study sought to characterize site-level variation in antithrombotic therapies in AF patients after PCI and determine the association with outcomes. METHODS: Using the retrospective TREAT-AF study (The Retrospective Evaluation and Assessment of Therapies in AF) from the Veterans Health Administration, patients with newly diagnosed, nonvalvular AF between 2004 and 2015 followed by a PCI with a P2Y12-antagonist prescription were identified. Patients were grouped according to the therapy dispensed 7 days before until 30 days after the PCI: oral anticoagulation plus platelet inhibition (OAC+PI) or platelet inhibition only. A combined outcome of death, myocardial infarction, stroke, or major bleeding was assessed 1 year after PCI and Cox regression was performed to estimate hazard ratios. RESULTS: Of 230 762 patients with newly diagnosed AF, 4042 (1.8%) underwent PCI and received a P2Y12-antagonist during the observation period (age, 67±9 years; CHA2DS2-VASc, 2.7±1.7; HAS-BLED, 2.6±1.2). Among these, 47% were prescribed OAC+PI, and 53% platelet inhibition only 7 days before until 30 days after the PCI. Across 63 sites, the use of OAC+PI ranged from 19% to 66%. Prescription of OAC+PI was independently associated with a reduction in the combined outcome of death, myocardial infarction, stroke, or major bleeding compared with platelet inhibition only (adjusted hazard ratio, 0.85; 95% CI, 0.73-0.99; P=0.033). CONCLUSIONS: In patients with established AF undergoing PCI, the use of OAC+PI varied substantially across sites in the 30 days post-PCI. Anticoagulation appeared to be underutilized but was associated with improved outcomes. Strategies to promote OAC+PI and minimize site variation may be useful, particularly in light of recent randomized trials. [ABSTRACT FROM AUTHOR]

Published
2019
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248. Comparison of Patient-Reported Care Satisfaction, Quality of Warfarin Therapy, and Outcomes of Atrial Fibrillation: Findings From the ORBIT - AF Registry.

Author

Perino, Alexander C., Shrader, Peter, Turakhia, Mintu P., Ansell, Jack E., Gersh, Bernard J., Fonarow, Gregg C., Go, Alan S., Kaiser, Daniel W., Hylek, Elaine M., Kowey, Peter R., Singer, Daniel E., Thomas, Laine, Steinberg, Benjamin A., Peterson, Eric D., Piccini, Jonathan P., and Mahaffey, Kenneth W.

Published
2019
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249. A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using "dual-chamber entrainment" for improved supraventricular tachycardia discrimination.

Author

Kaiser, Daniel W., Nasir, Javed M., Liem, L. Bing, Brodt, Chad, Motonaga, Kara S., Ceresnak, Scott R., Turakhia, Mintu P., and Dubin, Anne M.

Abstract

Background: The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI-TCL challenging.Objective: The purpose of this study was to investigate a novel maneuver to confirm the PPI-TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias.Methods: We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI-TCL, the AH-corrected PPI-TCL, and estimated the PPI-TCL using "dual-chamber entrainment" calculated as [PPIV - TCL = Stim(A→V) + Stim(V→A) - PPIA].Results: The PPI-TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI-TCL (R2 = 0.79 and 0.96, respectively; P <.001]. A dual-chamber entrainment PPI-TCL value of 80 ms correctly differentiated all AVNRT from septal ORT cases, whereas the standard PPI-TCL and AH-corrected PPI-TCL methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation, including 4 pathways with significant (>10 ms) decrement.Conclusion: Dual-chamber entrainment estimates the PPI-TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI-TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI-TCL value in challenging cases. [ABSTRACT FROM AUTHOR]

Published
2019
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250. Wolff-Parkinson-White syndrome: where is the pathway?

Author

Turakhia, Mintu P, Turakhia, Mintu P, Scheinman, Melvin, Badhwar, Nitish, Turakhia, Mintu P, Turakhia, Mintu P, Scheinman, Melvin, and Badhwar, Nitish

Abstract

A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

Published
2009

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