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8. Direct Oral Anticoagulants in Special Patient Populations.

Author

Kessler, Asa, Kolben, Yotam, Puris, Gal, Ellis, Martin, Alperin, Mordechai, Simovich, Vered, Lerman Shivek, Hila, Muszkat, Mordechai, Maaravi, Yoram, and Biton, Yitschak

Subjects
ORAL medication, OLDER patients, FRAIL elderly, ATRIAL fibrillation, CHRONIC kidney failure
Abstract

Anticoagulants are a cornerstone of treatment in atrial fibrillation. Nowadays, direct oral anticoagulants (DOACs) are extensively used for this condition in developed countries. However, DOAC treatment may be inappropriate in certain patient populations, such as: patients with chronic kidney disease in whom DOAC concentrations may be dangerously elevated; frail elderly patients with an increased risk of falls; patients with significant drug–drug interactions (DDI) affecting either DOAC concentration or effect; patients at the extremes of body mass in whom an "abnormal" volume of distribution may result in inappropriate drug concentrations; patients with recurrent stroke reflecting an unusually high thromboembolic tendency; and, lastly, patients who experience major hemorrhage on an anticoagulant and in whom continued anticoagulation is deemed necessary. Herein we provide a fictional case-based approach to review the recommendations for the use of DOACs in these special patient populations. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Utilization and Complications of Catheter Ablation for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Author

Rozen, Guy, primary, Elbaz‐Greener, Gabby, additional, Marai, Ibrahim, additional, Andria, Nizar, additional, Hosseini, Seyed Mohammadreza, additional, Biton, Yitschak, additional, Heist, E. Kevin, additional, Ruskin, Jeremy N., additional, Gavrilov, Yulia, additional, Carasso, Shemy, additional, Ghanim, Diab, additional, and Amir, Offer, additional

Published
2020
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26. Clinical presentation at first heart failure hospitalization does not predict recurrent heart failure admission

Author

Kosztin, Annamaria, Costa, Jason, Moss, Arthur J., Biton, Yitschak, Nagy, Vivien Klaudia, Solomon, Scott D., Geller, Laszlo, McNitt, Scott, Polonsky, Bronislava, Merkely, Bela, and Kutyifa, Valentina

Subjects
Heart Failure, Male, Cardiac resynchronization therapy, Heart failure hospitalization, Prognosis, Patient Readmission, Risk Assessment, United States, Hospitalization, Survival Rate, Recurrence, Risk Factors, Original Research Articles, Humans, Female, Original Research Article, Recurrent hospitalization, Prospective Studies, Aged
Abstract

Aims There are limited data on whether clinical presentation at first heart failure (HF) hospitalization predicts recurrent HF events. We aimed to assess predictors of recurrent HF hospitalizations in mild HF patients with an implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Methods and results Data on HF hospitalizations were prospectively collected for patients enrolled in MADIT‐CRT. Predictors of recurrent HF hospitalization (HF2) after the first HF hospitalization were assessed using Cox proportional hazards regression models including baseline covariates and clinical presentation or management at first HF hospitalization. There were 193 patients with first HF hospitalization, and 156 patients with recurrent HF events. Recurrent HF rate after the first HF hospitalization was 43% at 1 year, 52% at 2 years, and 55% at 2.5 years. Clinical signs and symptoms, medical treatment, or clinical management of HF at first HF admission was not predictive for HF2. Baseline covariates predicting recurrent HF hospitalization included prior HF hospitalization (HR = 1.59, 95% CI: 1.15–2.20, P = 0.005), digitalis therapy (HR = 1.58, 95% CI: 1.13–2.20, P = 0.008), and left ventricular end‐diastolic volume >240 mL (HR = 1.62, 95% CI: 1.17–2.25, P = 0.004). Conclusions Recurrent HF events are frequent following the first HF hospitalization in patients with implanted implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Neither clinical presentation nor clinical management during first HF admission was predictive of recurrent HF. Prior HF hospitalization, digitalis therapy, and left ventricular end‐diastolic volume at enrolment predicted recurrent HF hospitalization, and these covariates could be used as surrogate markers for identifying a high‐risk cohort.

Published
2017

28. Abstract 16953: Prospective Negative Microvolt T-Wave Alternans Testing is a Marker for Lower Risk of Cardiovascular Death and Appropriate Shock Therapy

Author

Biton, Yitschak, primary, Baman, Jayson R, additional, Mansour, Moussa, additional, Heist, E K, additional, Ruskin, Jeremy N, additional, Costantini, Ottorino, additional, Danilowicz-Szymanowicz, Ludmila, additional, Salerno-Uriarte, Jorge A, additional, Caravati, Fabrizio, additional, Pedretti, Robert, additional, Molon, Giulio, additional, Calo, Leonardo, additional, Ikeda, Takanori, additional, Erciyes, Demet, additional, Zecchin, Massimo, additional, Piancastelli, Maurizio, additional, Maury, Philippe, additional, Marangoni, Daniele, additional, Merchant, Faisal, additional, and Armoundas, Antonis, additional

Published
2018
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29. Reply: The Benefit of Cardiac Resynchronization Therapy Is Not Hindered by the Number of Comorbidities

Author

Zeitler, Emily P., Friedman, Daniel J., Daubert, James P., Al-Khatib, Sana M., Solomon, Scott D., Biton, Yitschak, McNitt, Scott, Zareba, Wojciech, Moss, Arthur J., and Kutyifa, Valentina

Subjects
Heart Failure, Male, Cardiac Resynchronization Therapy, Echocardiography, Humans, Female, Cardiac Resynchronization Therapy Devices, Comorbidity, Middle Aged, Article, United States, Retrospective Studies, Defibrillators, Implantable
Abstract

Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited.This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone.We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group.There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1).During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone.

Published
2017

36. Reply

Author

Zeitler, Emily P., primary, Friedman, Daniel J., additional, Daubert, James P., additional, Al-Khatib, Sana M., additional, Solomon, Scott D., additional, Biton, Yitschak, additional, McNitt, Scott, additional, Zareba, Wojciech, additional, Moss, Arthur J., additional, and Kutyifa, Valentina, additional

Published
2017
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37. Admission blood glucose and 10-year mortality among patients with or without pre-existing diabetes mellitus hospitalized with heart failure

Author

Itzhaki Ben Zadok, Osnat, primary, Kornowski, Ran, additional, Goldenberg, Ilan, additional, Klempfner, Robert, additional, Toledano, Yoel, additional, Biton, Yitschak, additional, Fisman, Enrique Z., additional, Tenenbaum, Alexander, additional, Golovchiner, Gregory, additional, Kadmon, Ehud, additional, Omelchenko, Alexander, additional, Gal, Tuvia Ben, additional, and Barsheshet, Alon, additional

Published
2017
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40. Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey

Author

Koifman, Edward, primary, Beigel, Roy, additional, Iakobishvili, Zaza, additional, Shlomo, Nir, additional, Biton, Yitschak, additional, Sabbag, Avi, additional, Asher, Elad, additional, Atar, Shaul, additional, Gottlieb, Shmuel, additional, Alcalai, Ronny, additional, Zahger, Doron, additional, Segev, Amit, additional, Goldenberg, Ilan, additional, Strugo, Rafael, additional, and Matetzky, Shlomi, additional

Published
2017
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41. Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients.

Author

Biton, Yitschak, Rosero, Spencer, Moss, Arthur J, Goldenberg, Ilan, Kutyifa, Valentina, McNitt, Scott, Polonsky, Bronislava, Baman, Jayson R, and Zareba, Wojciech

Abstract

Aims: Prospective data regarding the role of implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death in patients with long QT syndrome (LQTS) is scarce. Herein, we explore the prospective Rochester LQTS ICD registry to assess the risk for appropriate shock in primary prevention in a real-world setting.Methods and Results: We studied 212 LQTS patients that had ICD implantation for primary prevention. Best-subsets proportional-hazards regression analysis was used to identify clinical variables that were associated with the first appropriate shock. Conditional models of Prentice, Williams, and Peterson were utilized for the analysis of recurrent appropriate shocks. During a median follow-up of 9.2 ± 4.9 years, there were 42 patients who experienced at least one appropriate shock and the cumulative probability of appropriate shock at 8 years was 22%. QTc ≥ 550 ms [hazard ratio (HR) 3.94, confidence interval (CI) 2.08-7.46; P < 0.001) and prior syncope on β-blockers (HR 1.92, CI 1.01-3.65; P = 0.047) were associated with increased risk of appropriate shock. History of syncope while on β-blocker treatment (HR 1.87, CI 1.28-2.72; P = 0.001), QTc 500-549 ms (HR 1.68, CI 1.10-2.81; P = 0.048), and QTc ≥ 550 ms (HR 3.66, CI 2.34-5.72; P < 0.001) were associated with increased risk for recurrent appropriate shocks, while β-blockers were not protective (HR 1.03, CI 0.63-1.68, P = 0.917). LQT2 (HR 2.10, CI 1.22-3.61; P = 0.008) and multiple mutations (HR 2.87, CI 1.49-5.53; P = 0.002) were associated with higher risk for recurrent shocks as compared with LQT1.Conclusion: In this prospective ICD registry, we identified clinical and genetic variables that were associated appropriate shock risk. These data can be used for risk stratification in high-risk patients evaluated for primary prevention with ICD. [ABSTRACT FROM AUTHOR]

Published
2019
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42. Effect of cardiac resynchronization therapy on the risk of ventricular tachyarrhythmias in patients with chronic kidney disease

Author

Daimee, Usama A., primary, Biton, Yitschak, additional, Moss, Arthur J., additional, Zareba, Wojciech, additional, Cannom, David, additional, Klein, Helmut, additional, Solomon, Scott, additional, Ruwald, Martin H., additional, McNitt, Scott, additional, Polonsky, Bronislava, additional, Wang, Paul J., additional, Goldenberg, Ilan, additional, and Kutyifa, Valentina, additional

Published
2016
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43. Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Author

Husaini, Mustafa, primary, Biton, Yitschak, additional, Stair, Brad, additional, Moss, Arthur J., additional, Biering-Sørensen, Tor, additional, Solomon, Scott, additional, McNitt, Scott, additional, Polonsky, Bronislava, additional, Zareba, Wojciech, additional, Barsheshet, Alon, additional, and Kutyifa, Valentina, additional

Published
2016
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49. FUNCTIONAL EFFECTS OF SCN5A CHANNEL MUTATIONS AND THE RISK OF LIFE-THREATENING EVENTS IN TYPE 3 LONG QT SYNDROME

Author

Biton, Yitschak, primary, Otani, Neils, additional, Goldenberg, Ilan, additional, Ronzier, Elsa, additional, Baman, Jayson, additional, McNitt, Scott, additional, Polonsky, Bronislava, additional, Benhorin, Jesaia, additional, Wilde, Arthur A.M., additional, Schwartz, Peter, additional, Ackerman, Michael, additional, Wataru, Shimuzu, additional, Kaufman, Elizabeth, additional, Zareba, Wojciech, additional, Moss, Arthur, additional, and Lopes, Coeli, additional

Published
2016
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50. Relationship between age and inappropriate implantable cardioverter-defibrillator therapy in MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy)

Author

Biton, Yitschak, primary, Huang, David T., additional, Goldenberg, Ilan, additional, Rosero, Spencer, additional, Moss, Arthur J., additional, Kutyifa, Valentina, additional, McNitt, Scott, additional, Strasberg, Boris, additional, Zareba, Wojciech, additional, and Barsheshet, Alon, additional

Published
2016
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