292 results on '"Carola Gianni"'
Search Results
2. Bailout Deep Septal LV Pacing to Treat Inadvertent Complete AV Block During Complex Ablation Procedure
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Dmytro Volkov, MD, DMedSc, Dmytro Lopin, MD, Dmytro Skoriy, MD, Carola Gianni, MD, PhD, Vincenzo Mirko La Fazia, MD, G. Joseph Gallinghouse, MD, Rodney Horton, MD, John D. Burkhardt, MD, Sanghamitra Mohanty, MD, MS, and Andrea Natale, MD
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bipolar radiofrequency ablation ,complete atrioventricular block ,deep septal-left bundle branch-conduction system pacing ,heart failure ,premature ventricular contraction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We present a case of persistent complete atrioventricular block that occurred during the diagnostic portion of a premature ventricular contractions’ radiofrequency ablation in a complex heart failure patient. The case was managed by bailout deep left ventricular septal pacing after bipolar radiofrequency elimination of premature ventricular contractions.
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- 2024
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3. Impact of digital monitoring on compliance and outcome of lifestyle-change measures in patients with coexistent atrial fibrillation and obesity
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Sanghamitra Mohanty, MD, FHRS, Chintan Trivedi, MD, MPH, FHRS, Domenico Giovanni Della Rocca, MD, Carola Gianni, MD, Bryan MacDonald, MD, Angel Mayedo, MD, SaiShishir Shetty, DPharm, MHI, Eleanora Natale, HSGrad, John D. Burkhardt, MD, FHRS, Mohamed Bassiouny, MD, G. Joseph Gallinghouse, MD, Rodney Horton, MD, Amin Al-Ahmad, MD, FHRS, and Andrea Natale, MD, FACC, FHRS, FESC
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Digital monitoring ,App ,Lifestyle change ,Weight loss ,Atrial fibrillation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Medical technology ,R855-855.5 - Abstract
Introduction: Obesity, a known risk factor for atrial fibrillation (AF), is potentially reversible through lifestyle changes, including diet and physical activity. However, lack of compliance is a major obstacle in attaining sustained weight loss. We investigated the impact of patient engagement using a digital monitoring system on compliance for lifestyle-change measures and subsequent outcome. Methods: A total of 105 consecutive patients with coexistent AF and obesity (body mass index ≥28) were classified into 2 groups based on the monitoring method: group 1, use of digital platform (n = 20); group 2, conventional method (n = 85). Group 1 used the RFMx digital monitoring platform (smartphone app) that sets weekly goals for exercise and weight loss, tracks patient compliance data continuously, and sends regular text reminders. Conventional method included monitoring patients’ adherence to diet and change in weight during in-person clinic visits or monthly phone calls from staff. Results: Baseline characteristics of groups 1 and 2 were comparable. At 6 months of follow-up, 12 (60%) and 28 (33%) from group 1 and 2, respectively, were compliant with the physician instructions regarding diet and exercise (P = .025). Weight loss was observed in 9 of 12 (75%) from group 1 and 11 of 28 (39%) from group 2 (P = .038) and mean reduction in weight was 9.9 ± 8.9 lb and 4.0 ± 2.1 lb (P = .042). Conclusion: In this series, continuous digital monitoring was seen to be associated with significant improvement in compliance through better patient engagement, resulting in more weight loss compared to the conventional method.
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- 2022
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4. The Subtle Journey of a Right Atrial Lead
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Carola Gianni, MD, Robert C. Canby, MD, Alisara Anannab, MD, Domenico G. Della Rocca, MD, Andrea Natale, MD, and Amin Al-Ahmad, MD
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atrial lead ,cardiac pacemaker ,hemothorax ,perforation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We report an unusual case of subacute right atrial perforation by a screw-in pacemaker lead that migrated into the right lung causing hemopneumothorax 2 weeks after the procedure. After transvenous simple manual traction and minithoracotomy repair of the right atrial wall, the lead was repositioned without any complications. (Level of Difficulty: Beginner.)
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- 2020
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5. Provocation and ablation of non–pulmonary vein triggers in nonparoxysmal atrial fibrillation: Role of the coronary sinusTest your knowledge!
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Domenico G. Della Rocca, MD, Carola Gianni, MD, PhD, Omer Gedikli, MD, Qiong Chen, MD, Andrea Natale, MD, FHRS, and Amin Al-Ahmad, MD, FHRS
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Atrial fibrillation ,Catheter ablation ,Coronary sinus ,Esophagus ,Left atrial appendage ,Outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2020
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6. Catheter Ablation versus Medical Therapy of Atrial Fibrillation in Patients with Heart Failure: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Michele Magnocavallo, Antonio Parlavecchio, Giampaolo Vetta, Carola Gianni, Marco Polselli, Francesco De Vuono, Luigi Pannone, Sanghamitra Mohanty, Filippo Maria Cauti, Rodolfo Caminiti, Vincenzo Miraglia, Cinzia Monaco, Gian-Battista Chierchia, Pietro Rossi, Luigi Di Biase, Stefano Bianchi, Carlo de Asmundis, Andrea Natale, and Domenico Giovanni Della Rocca
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atrial fibrillation ,heart failure ,catheter ablation ,medical therapy ,randomized controlled trials ,recurrence ,Medicine - Abstract
Background: Atrial fibrillation (AF) and heart failure (HF) often coexist and synergistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF. Methods: Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) were measured using the Mantel–Haenszel method. Results: A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53–0.80); p < 0.0001), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51–0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54–0.82); p = 0.0001), AF recurrence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24–0.54); p < 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39–0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35–7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83–30.14); p < 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01–5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12–03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p < 0.0001). Conclusions: In HF patients, AF catheter ablation was superior to MT in reducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life.
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- 2022
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7. Natural History of Arrhythmia After Successful Isolation of Pulmonary Veins, Left Atrial Posterior Wall, and Superior Vena Cava in Patients With Paroxysmal Atrial Fibrillation: A Multi‐Center Experience
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Sanghamitra Mohanty, Chintan Trivedi, Pamela Horton, Domenico G. Della Rocca, Carola Gianni, Bryan MacDonald, Angel Mayedo, Javier Sanchez, G. Joseph Gallinghouse, Amin Al‐Ahmad, Rodney P. Horton, J. David Burkhardt, Antonio Dello Russo, Michela Casella, Claudio Tondo, Sakis Themistoclakis, Giovanni Forleo, Luigi Di Biase, and Andrea Natale
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catheter ablation ,late recurrence ,left atrial appendage ,paroxysmal atrial fibrillation ,pulmonary vein isolation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background We evaluated long‐term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities. Methods and Results A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia‐free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidities); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10 years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3–8.5) and 5.6 (IQI 3.8–8.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147/201 and 414/456 received left atrial appendage and coronary sinus isolation and 54/201 and 42/456 had left atrial lines and flutter ablation. At 2 years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage/coronary sinus isolation remained arrhythmia‐free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (P
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- 2021
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8. Impact of Oral Anticoagulation Therapy Versus Left Atrial Appendage Occlusion on Cognitive Function and Quality of Life in Patients With Atrial Fibrillation
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Sanghamitra Mohanty, Prasant Mohanty, Chintan Trivedi, Joanna Assadourian, Angel Quintero Mayedo, Bryan MacDonald, Domenico G. Della Rocca, Carola Gianni, Rodney Horton, Amin Al‐Ahmad, Mohamed Bassiouny, John D. Burkhardt, Luigi Di Biase, M. Edip Gurol, and Andrea Natale
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AFEQT ,atrial fibrillation (AF) ,cognition ,left atrial appendage occlusion (LAAO) ,MoCA ,oral anticoagulation (OAC) ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background We compared the cognitive status and quality of life in patients with atrial fibrillation undergoing left atrial appendage occlusion (LAAO) or remaining on oral anticoagulation (OAC) after atrial fibrillation ablation. Methods and Results Cognition was assessed by the Montreal Cognitive Assessment (MoCA) survey at baseline and follow‐up. Consecutive patients receiving LAAO or OAC after atrial fibrillation ablation were screened, and patients with a score of ≤17 were excluded from the study. Quality of life was measured at baseline and 1 year using the Atrial Fibrillation Effect on Quality of Life survey. A total of 50 patients (CHA2DS2‐VASc [congestive heart failure, hypertension, age≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65–74 years, sex category] score: 3.30±1.43) in the LAAO group and 48 (CHA2DS2‐VASc score 2.73±1.25) in the OAC group were included in this prospective study. Mean baseline MoCA score was 26.18 and 26.08 in the LAAO and OAC groups, respectively (P=0.846). At 1 year, scores were 26.94 and 23.38 in the respective groups. MoCA score decreased by an estimated −2.74 (95% CI, −3.61 to −1.87; P
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- 2021
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9. Longstanding Persistent Atrial Fibrillation Ablation: How Do You Perform It?
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Carola Gianni, Andrea Natale, and Amin Al-Ahmad
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Atrial fibrillation ,Radiofrequency ablation ,Catheter ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Longstanding-persistent atrial fibrillation is one of the most challenging arrhythmias to treat. While radiofrequency catheter ablation is highly effective in paroxysmal atrial fibrillation, pulmonary vein antral isolation (including posterior wall isolation) alone is not enough for nonparoxysmal atrial fibrillation, other targets should be sought in this population. In this case report, we will describe our approach in a typical patient presenting for a first-time ablation procedure for longstanding persistent atrial fibrillation.
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- 2020
10. Long-term Outcome of Pulmonary Vein Isolation Versus Amiodarone Therapy in Patients with Coexistent Persistent AF and Congestive Heart Failure
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Michela Faggioni, Domenico G Della Rocca, Sanghamitra Mohanty, Chintan Trivedi, Ugur Canpolat, Carola Gianni, Amin Al-Ahmad, Rodney Horton, Gerald Joseph Gallinghouse, John David Burkhardt, and Andrea Natale
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although pharmacological rhythm control of AF in patients with heart failure with reduced ejection fraction (HFrEF) does not seem to provide any benefit over rate control, catheter ablation of AF has been shown to improve clinical outcomes. These results can be explained with higher success rates of catheter ablation in restoring and maintaining sinus rhythm compared with antiarrhythmic drugs. In addition, pharmacotherapy is not void of side-effects, which are thought to offset its potential antiarrhythmic benefits. Therefore, efforts should be made towards optimisation of ablation techniques for AF in patients with HFrEF.
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- 2020
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11. Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes
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Nicola Tarantino, Domenico G. Della Rocca, Nicole S. De Leon De La Cruz, Eric D. Manheimer, Michele Magnocavallo, Carlo Lavalle, Carola Gianni, Sanghamitra Mohanty, Chintan Trivedi, Amin Al-Ahmad, Rodney P. Horton, Mohamed Bassiouny, J. David Burkhardt, G. Joseph Gallinghouse, Giovanni B. Forleo, Luigi Di Biase, and Andrea Natale
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athletes ,catheter ablation ,sports cardiology ,ventricular arrhythmia ,ventricular tachycardia ,Medicine (General) ,R5-920 - Abstract
A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.
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- 2021
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12. Takotsubo Syndrome Following Catheter Ablation for Atrial Fibrillation
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Sanghamitra Mohanty, Carola Gianni, Angel Mayedo, Bryan MacDonald, Amin Al-Ahmad, Mohamed Bassiouny, G. Joseph Gallinghouse, Rodney Horton, John D. Burkhardt, and Andrea Natale
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- 2023
13. Risk Assessment and Management of Patients Undergoing Left Atrial Appendage Isolation
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Carola Gianni, Domenico Della Rocca, Bryan C. MacDonald, Angel Quintero Mayedo, Sanghamitra Mohanty, Mohamed A. Bassiouny, J. David Burkhardt, Rodney P. Horton, G. Joseph Gallinghouse, Javier E. Sanchez, Andrea Natale, and Amin Al-Ahmad
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Pharmacology ,Pharmacology (medical) - Published
- 2022
14. Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation
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Sanghamitra Mohanty, Prasant Mohanty, Danielle Kessler, Carola Gianni, Karim K. Baho, Trevor Morris, Tuna Yildiz, Angel Quintero Mayedo, Bryan MacDonald, Domenico G. Della Rocca, Amin Al-Ahmad, Mohamed Bassiouny, G. Joseph Gallinghouse, Rodney Horton, John D. Burkhardt, Luigi di Biase, and Andrea Natale
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- 2023
15. Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience
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Sanghamitra Mohanty, John D Burkhardt, Luigi Di Biase, Prasant Mohanty, Sai Shishir Shetty, Carola Gianni, Domenico G Della Rocca, Karim K Baho, Trevor Morris, Angel Mayedo, Bryan MacDonald, Amin Al-Ahmad, Mohamed Bassiouny, Gerald Joseph Gallinghouse, Rodney Horton, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
AimsThis study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only.Methods and resultsA total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of ConclusionIn this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.
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- 2023
16. Endocardial Scar-Homogenization With vs Without Epicardial Ablation in VT Patients With Ischemic Cardiomyopathy
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Sanghamitra Mohanty, Chintan Trivedi, Luigi Di Biase, John D. Burkhardt, Domenico Giovanni Della Rocca, Carola Gianni, Bryan MacDonald, Angel Mayedo, Sai Shishir Shetty, Will Zagrodzky, Faiz Baqai, Mohamed Bassiouny, G. Joseph Gallinghouse, Rodney Horton, Amin Al-Ahmad, and Andrea Natale
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Cicatrix ,Treatment Outcome ,Catheter Ablation ,Myocardial Ischemia ,Tachycardia, Ventricular ,Humans ,Cardiomyopathies ,Endocardium - Abstract
In this study, the authors investigated the ablation success of scar homogenization with combined (epicardial + endocardial) vs endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up.Best ablation approach to achieve long-term success rate in VT patients with ICM is not known yet.Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial + epicardial scar homogenization and group 2: endocardial scar homogenization. Patients with previous open heart surgery were excluded. Epicardial ablation was performed despite being noninducible after endocardial ablation in all group 1 patients. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue1.5 mV and severe scar 0.5 mV. Noninducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up every 4 months for 5 years with implantable device interrogations.A total of 361 patients (group 1: n = 70 and group 2: n = 291) were included in the study. At 5 years, 81.4% (n = 57/70) patients from group 1 and 66.3% (n = 193/291) from group 2 were arrhythmia-free (P = 0.01) Of those patients, 26 of 57 (45.6%) and 172 of 193 (89.1%) from group 1 and group 2 respectively were on anti-arrhythmic drugs (AAD) (log-rank P0.001). After adjusting for age, sex, and obstructive sleep apnea, endo-epicardial scar homogenization was associated with a significant reduction in arrhythmia-recurrence (HR: 0.48; 95% CI: 0.27-0.86; P = 0.02).In this series of patients with ICM and VT, epicardial substrate was detected in all group 1 patients despite being noninducible after endocardial ablation. Moreover, combined endo-epicardial scar homogenization was associated with a significantly higher success rate at 5 years of follow-up and a substantially lower need for antiarrhythmic drugs after the procedure compared with the endocardial ablation alone.
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- 2022
17. PO-03-189 THROMBOEMBOLISM BEFORE VS AFTER PERCUTANEOUS CLOSURE OF PERI-DEVICE LEAKS RESULTING FROM PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION
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Domenico G. Della Rocca, Rodney P. Horton, Michele Magnocavallo, Nicholas King, Mohit Turagam, Kerstin Piayda, Anders Dahl Kramer, Ammar M. Killu, Roberto Galea, Gregory Jackson, Iwanari Kawamura, Arvindh N. Kanagasundram, Emmanuel Ekanem, Stefan Bertog, Gian Battista Chierchia, Carlo de Asmundis, Kasper Korsholm, Kolja Sievert, Carola Gianni, Trevor Simard, Lorenz Räber, Mohamad A. Alkhouli, David R. Holmes, Jens Erik Nielsen-Kudsk, Horst Sievert, Vivek Y. Reddy, Christopher R. Ellis, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
18. PO-03-160 TRANS-FABRIC APPROACH TO ACHIEVE PERI-DEVICE LEAK CLOSURE FOLLOWING INCOMPLETE WATCHMAN LEFT ATRIAL APPENDAGE OCCLUSION
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Carola Gianni, Rodney P. Horton, Domenico G. Della Rocca, Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Amin Al-Ahmad, Mohamed A. Bassiouny, J. David Burkhardt, G. Joseph Gallinghouse, Patrick M. Hranitzky, Javier E. Sanchez, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
19. PO-05-035 FASCICULAR SUBSTRATE MODIFICATION TO TREAT HUMAN VENTRICULAR FIBRILLATION: A MULTICENTER STUDY
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Weeranun D. Bode, Sanghamitra Mohanty, John D. Burkhardt, Prem G. Torlapati, Carola Gianni, Vincenzo Mirco La Fazia, Domenico G. Della Rocca, Mohamed Bassiouny, G. Joseph Gallinghouse, Rodney P. Horton, Amin Al-Ahmad, Xiaodong Zhang, Fengwei Zou, Luigi Di Biase, Pasquale Santangeli, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
20. PO-01-102 RISK FACTORS FOR PROGRESSION OF PAROXYSMAL TO PERSISTENT ATRIAL FIBRILLATION FOLLOWING PV ISOLATION
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Sanghamitra Mohanty, Carola Gianni, Bryan MacDonald, Angel Quintero Mayedo, Vincenzo Mirco La Fazia, Prem Geeta Torlapati, Domenico G. Della Rocca, Mohamad Bassiouny, G. Joseph Gallinghouse, John D. Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Xiaodong Zhang, Fengwei Zou, Luigi Di Biase, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
21. PO-03-168 IMPORTANCE OF COMPRESSION RATE DURING LEFT ATRIAL APPENDAGE CLOSURE WITH WATCHMAN FLX
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Vincenzo Mirco La Fazia, Carola Gianni, Sanghamitra Mohanty, Bryan MacDonald, Angel Quintero Mayedo, Domenico G. Della Rocca, Nethuja Salagundla, Prem Geeta Torlapati, Mohamed A. Bassiouny, G. Joseph Gallinghouse, J. David Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Luigi Di Biase, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
22. AB-452663-3 DISTRIBUTION OF TRIGGERS IN THE LEFT ATRIAL POSTERIOR WALL IN AF PATIENTS UNDERGOING CATHETER ABLATION
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Sanghamitra Mohanty, Pasquale Santangeli, Carola Gianni, Bryan MacDonald, Angel Quintero Mayedo, Vincenzo Mirco La Fazia, Prem Geeta Torlapati, Domenico G. Della Rocca, Rami Helmy, mohanad Elchouemi, Mohamad Bassiouny, G. Joseph Gallinghouse, John D. Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Xiaodong Zhang, Fengwei Zou, Luigi Di Biase, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
23. PO-01-002 ASSOCIATION OF NOVEL COMBINED GENETIC POLYMORPHISMS WITH RISK OF THROMBOEMBOLISM IN PATIENTS WITH ATRIAL FIBRILLATION
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Sanghamitra Mohanty, Amitabh C. Pandey, Bryan MacDonald, Angel Quintero Mayedo, Carola Gianni, Prem Geeta Torlapati, Vincenzo Mirco La Fazia, Domenico G. Della Rocca, Mohamad Bassiouny, G. Joseph Gallinghouse, John D. Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Kristi C. Pangborn, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
24. PO-01-089 ARRHYTHMIA PROFILE IN FEMALE ATRIAL FIBRILLATION PATIENTS WITH VERSUS WITHOUT AUTOIMMUNE DISORDERS
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Sanghamitra Mohanty, Carola Gianni, Bryan MacDonald, Angel Quintero Mayedo, Prem Geeta Torlapati, Vincenzo Mirco La Fazia, Domenico G. Della Rocca, Mohamad Bassiouny, G. Joseph Gallinghouse, John D. Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Xiaodong Zhang, Fengwei Zou, Luigi Di Biase, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
25. Radiofrequency Energy Applications Targeting Significant Residual Leaks After Watchman Implantation
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Andrea Natale, Subramaniam C. Krishnan, Dhanunjaya Lakkireddy, Krishna Akella, J. David Burkhardt, Rodney Horton, Rakesh Gopinathannair, Giovanni B. Forleo, Javier Sanchez, Nicola Tarantino, Domenico G. Della Rocca, Ghulam Murtaza, Chintan Trivedi, Armando Del Prete, Amin Al-Ahmad, Jorge Romero, Carola Gianni, Shephal K. Doshi, G. Joseph Gallinghouse, Carlo Lavalle, Michele Magnocavallo, Mohamed Bassiouny, Sanghamitra Mohanty, Luigi Di Biase, Veronica Natale, and Philip J. Patel
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Leak ,Percutaneous ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Transesophageal echocardiogram ,medicine.disease ,Left atrial ,Occlusion ,Medicine ,Nuclear medicine ,business ,Stroke ,Radiofrequency energy - Abstract
Objectives The aim of this study was to evaluate the efficacy of radiofrequency (RF) energy applications targeting the atrial side of a significant residual leak in patients with acute and chronic evidence of incomplete percutaneous left atrial appendage (LAA) occlusion. Background RF applications have been proved to prevent recanalization of intracranial aneurysms after coil embolization, thereby favoring complete sealing. From a mechanistic standpoint, in vitro and in vivo experiments have demonstrated that RF promotes collagen deposition and tissue retraction. Methods Forty-three patients (mean age 75 ± 7 years mean CHA2DS2-VASc score 4.6 ± 1.4, mean HAS-BLED score 4.0 ± 1.1) with residual leaks ≥4 mm after Watchman implantation were enrolled. Procedural success was defined as complete LAA occlusion or presence of a mild or minimal (1- to 2-mm) peridevice leak on follow-up transesophageal echocardiography (TEE), which was performed approximately 45 days after the procedure. Results RF-based leak closure was performed acutely after Watchman implantation in 19 patients (44.2%) or scheduled after evidence of significant leaks on follow-up TEE in 24 others (55.8%). The median leak size was 5 mm (range: 4-7 mm). On average, 18 ± 7 RF applications per patient (mean maximum contact force 16 ± 3 g, mean power 44 ± 2 W, mean RF time 5.1 ± 2.5 minutes) were performed targeting the atrial edge of the leak. Post-RF median leak size was 0 mm (range: 0-1 mm). A very low rate (2.3% [n = 1]) of major periprocedural complications was observed. Follow-up TEE revealed complete LAA sealing in 23 patients (53.5%) and negligible residual leaks in 15 (34.9%). Conclusions RF applications targeting the atrial edge of a significant peri-Watchman leak may promote LAA sealing via tissue remodeling, without increasing complications. (RF Applications for Residual LAA Leaks [REACT]; NCT04726943 )
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- 2021
26. Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion
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Nicola Tarantino, J. David Burkhardt, Armando Del Prete, Carlo Lavalle, Carola Gianni, Giovanni B. Forleo, G. Joseph Gallinghouse, Dhanunjaya Lakkireddy, Veronica Natale, Domenico G. Della Rocca, David F. Briceno, Chintan Trivedi, Mohamed Bassiouny, Amin Al-Ahmad, Andrea Natale, Sanghamitra Mohanty, Javier Sanchez, Douglas N. Gibson, Jorge Romero, Luigi Di Biase, Michele Magnocavallo, Rodney Horton, and Christoffel J. van Niekerk
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medicine.medical_specialty ,Aspirin ,business.industry ,medicine.medical_treatment ,Watchman ,antiplatelet therapy ,aspirin ,left atrial appendage ,oral anticoagulation ,stroke ,thromboembolism ,medicine.disease ,Thrombosis ,Left atrial appendage occlusion ,Interquartile range ,Heart failure ,Internal medicine ,Antithrombotic ,medicine ,Cardiology ,Liver function ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,medicine.drug - Abstract
Objectives This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation. Background No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure. Methods After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events. Results Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002). Conclusions After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy.
- Published
- 2021
27. 1120 DIAGNOSTIC ACCURACY OF SMART GADGETS/WEREABLE DEVICES IN ATRIAL FIBRILLATION DETECTION: A METANALYSIS
- Author
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Giampaolo Vetta, Michele Magnocavallo, Antonio Parlavecchio, Carola Gianni, Marco Polselli, Francesco De Vuono, Luigi Pannone, Sanghamitra Mohanty, Fillippo Maria Cauti, Rodolfo Caminiti, Vincenzo Miraglia, Cinzia Monaco, Gian Battista Chierchia, Pietro Rossi, Luigi Di Biase, Stefano Bianchi, Carlo De Asmundis, Andrea Natale, and Domenico Giovanni Della Rocca
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Introduction Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis. Hypothesis We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices. Methods We systematically searched Medline, Embase and Cochrane electronic databases up to April 15th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities. Results A total of 79 studies were included enrolling 36903 patients, 66.3% male with average age of 68.3±8 years. In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(95% CI: 94–96%), the specificity 96%(95% CI: 96–97%). Wrist-worn wearables had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 92–97%), the specificity 97%(95% CI: 96–98%)(Figure 1A). Smartphone applications had AUC of 0.98 (95% CI: 0.96-0.99), the sensitivity 96%(9% CI: 94–97%), the specificity 96%(95% CI: 93–98%)(Figure 1B). External devices had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 95%(9% CI: 93–97%), the specificity 96%(95% CI: 95–97%)(Figure 1C). Single-lead ECG had AUC of 0.99 (95% CI: 0.98- 1.00), the sensitivity 95%(9% CI: 92–96%), the specificity 96%(95% CI: 95–97%). PPG had AUC of 0.99 (95% CI: 0.98-1.00), the sensitivity 96%(9% CI: 95–97%), the specificity 97%(95% CI: 95–98%). Conclusions Smartphone application, wrist-worn devices and external devices with PPG and single-lead ECG have excellent diagnostic accuracy in atrial fibrillation diagnosis. Figure 1. Summary Receiver Operating Characteristic curves and Areas Under The Curve of Wrist-worn wearables (A), Smartphone applications (B) and External devices (C).
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- 2022
28. 1092 CATHETER ABLATION VERSUS MEDICAL THERAPY OF ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
- Author
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Michele Magnocavallo, Antonio Parlavecchio, Giampaolo Vetta, Carola Gianni, Marco Polselli, Francesco De Vuono, Luigi Pannone, Sanghamitra Mohanty, Fillippo Maria Cauti, Rodolfo Caminiti, Vincenzo Miraglia, Cinzia Monaco, Gian Battista Chierchia, Pietro Rossi, Luigi Di Biase, Stefano Bianchi, Carlo De Asmundis, Andrea Natale, and Domenico Giovanni Della Rocca
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Background Atrial fibrillation (AF) and heart failure (HF) often coexist and syner-gistically contribute to an increased risk of hospitalization, stroke, and mortality. Objective: To compare the efficacy of catheter ablation (CA) versus medical therapy (MT) in HF patients with AF. Methods Electronic databases were queried for randomized controlled trials (RCTs) of CA versus MT of AF in patients with HF. Risk ratios (RRs), mean differences (MDs), and 95% confidence in-tervals (CIs) were measured using the Mantel–Haenszel method. Results A total of nine RCTs enrolling 2155 patients met the inclusion criteria. Compared to MT, CA led to a significant reduction in the composite of all-cause mortality and HF hospitalization (24.6% vs. 37.1%; RR: 0.65 (95% CI: 0.53–0.80); p < 0.0001) (Figure 1), all-cause mortality (8.8% vs. 13.6%; RR: 0.65 (95% CI: 0.51–0.82); p = 0.0005), HF hospitalization (15.4% vs. 22.4%; (RR: 0.67 (95% CI: 0.54–0.82); p = 0.0001), AF re-currence (31.8% vs. 77.0%; RR: 0.36 (95% CI: 0.24–0.54); p < 0.0001), and cardiovascular (CV) death (4.9% vs. 8.4%; RR: 0.58 (95% CI: 0.39–0.86); p = 0.007). CA improved the left ventricular ejection fraction (MD:4.76% (95% CI: 2.35–7.18); p = 0.0001), 6 min walk test (MD: 20.48 m (95% CI: 10.83–30.14); p < 0.0001), peak oxygen consumption (MD: 3.1 2mL/kg/min (95% CI: 1.01–5.22); p = 0.004), Minnesota Living with Heart Failure Questionnaire score (MD: −6.98 (95% CI: −12–03, −1.93); p = 0.007), and brain natriuretic peptide levels (MD:−133.94 pg/mL (95% CI: −197.33, −70.55); p < 0.0001). Conclusions In HF patients, AF catheter ablation was superior to MT in re-ducing CV and all-cause mortality. Further significant benefits occurred within the ablation group in terms of HF hospitalizations, AF recurrences, the systolic function, exercise capacity, and quality of life. Figure 1: Forest plot displaying a decrease in the composite endpoint in patients with AF and HF undergoing CA versus MT.
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- 2022
29. Intracardiac echocardiography‐ versus transesophageal echocardiography‐guided left atrial appendage occlusion with Watchman FLX
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Domenico G. Della Rocca, Carola Gianni, Rodney Horton, Mohamed Bassiouny, J. David Burkhardt, Javier Sanchez, Amin Al-Ahmad, G. Joseph Gallinghouse, Sanghamitra Mohanty, Patrick Hranitzky, and Andrea Natale
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,Intracardiac echocardiography ,business.industry ,medicine.medical_treatment ,Fluoroscopy dose ,medicine.disease ,Left atrial appendage occlusion ,Thrombosis ,Cohort Studies ,Treatment Outcome ,Embolism ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Cardiology ,Humans ,Medicine ,Atrial Appendage ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Echocardiography, Transesophageal ,Ultrasonography, Interventional - Abstract
Introduction Watchman FLX has been recently approved for left atrial appendage occlusion (LAAO) in the US. Intracardiac echocardiography (ICE) - which is already commonly used to guide trans-septal access - can serve as an alternative to TEE, simplifying the procedure and reducing associated costs. Herein, we report our experience with ICE-guided LAAO with Watchman FLX. Methods and results This cohort study included the first 190 consecutive patients who underwent LAAO with Watchman FLX in our center. LAAO was successful in all patients without significant peri-procedural, device-related complications in either group. Compared to TEE, we observed a significant reduction in procedural times when using ICE. In addition, there was a potentially clinically relevant reduction in fluoroscopy dose, mainly secondary to fewer cine acquisition runs. At follow-up, no cases of device embolism were noted, whereas the rate of device-related thrombosis and peri-device leaks were comparable between groups. Conclusion ICE-guided LAAO with Watchman FLX is safe and feasible, with a significant reduction in procedural time and potential reduction in fluoroscopy dose when compared to TEE.
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- 2021
30. Decreased biventricular pacing with high burden PVCs, what is the cause?
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Carola Gianni, J. David Burkhardt, Andrea Natale, and Amin Al-Ahmad
- Subjects
medicine.medical_specialty ,business.industry ,Cardiac Pacing, Artificial ,medicine.disease ,Ventricular Premature Complexes ,Cardiac Resynchronization Therapy ,Electrocardiography ,Atrial Flutter ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Published
- 2021
31. Prevalence of atrial fibrillation and procedural outcome in patients undergoing catheter ablation for premature ventricular complexes
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Fengwei Zou, Luigi Di Biase, Sanghamitra Mohanty, Xiaodong Zhang, Sai Shishir Shetty, Carola Gianni, Domenico G. Della Rocca, Aung Lin, Roberto Arosio, Marco Schiavone, Giovanni Forleo, Angel Mayedo, Bryan MacDonald, Amin Al‐Ahmad, Mohamed Bassiouny, G. Joseph Gallinghouse, Rodney Horton, John D. Burkhardt, and Andrea Natale
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Atrial fibrillation (AF) and premature ventricular complexes (PVC) are common arrhythmias. We aimed to investigate AF prevalence in patients with PVC and its impact on PVC ablation outcomes.Consecutive patients undergoing PVC ablation at a single institution between 2016 and 2019 were included and prospectively followed for 2 years. Patients with severe valvular heart disease, hyperthyroidism, malignancy, alcohol use disorder and advanced renal/hepatic diseases were excluded. Twelve-lead electrocardiograms were used to diagnose AF and assess PVC morphology. All PVCs were targeted for ablation using 4-mm irrigated-tip catheters at standardized radiofrequency power guided by 3-D mapping and intracardiac echocardiography. Patients were followed with remote monitoring, device interrogations and office visits every 6 months for 2 years. Detection of any PVCs in follow-up was considered as recurrence.A total of 394 patients underwent PVC ablation and 96 (24%) had concurrent AF. Patients with PVC and AF were significantly older (68.2 ± 10.8 vs. 58.3 ± 15.8 years, p .001), had lower LV ejection fraction (43.3 ± 13.3% vs. 49.6 ± 12.4%, p .001), higher CHAAF was documented in 1/4 of patients undergoing PVC ablation and was associated with lower procedural success at long-term follow-up. This was likely attributed to older age, worse LV function and higher prevalence of multiple PVC morphologies in patients with concurrent AF.
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- 2022
32. PO-03-005 BEST ANTICOAGULATION STRATEGY FOR STROKE PROPHYLAXIS IN ATRIAL FIBRILLATION PATIENTS WITH AMYLOIDOSIS
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Andrea Natale, Carola Gianni, Bryan MacDonald, Angel Quintero Mayedo, Vincenzo Mirco La Fazia, Prem Geeta Torlapati, Domenico G. Della Rocca, Rami Helmy, Mohanad Elchouemi, Mohamad Bassiouny, G. Joseph Gallinghouse, John D. burkhardt, Rodney P. Horton, Luigi Di Biase, Amin Al-Ahmad, and Sanghamitra Mohanty
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
33. PO-04-065 THREE-DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY FOR LEFT ATRIAL APPENDAGE SIZING AND PERCUTANEOUS OCCLUSION GUIDANCE
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Domenico G. Della Rocca, Michele Magnocavallo, Carola Gianni, Sanghamitra Mohanty, Amin Al-Ahmad, G. Joseph Gallinghouse, Mohamed Bassiouny, Javier E. Sanchez, Gian Battista Chierchia, Carlo de Asmundis, Pasquale Santangeli, Luigi Di Biase, David J. Burkhardt, Rodney P. Horton, and Andrea Natale
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
34. PO-02-093 IMPACT OF ABLATION OUTCOME ON COGNITIVE FUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION
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Sanghamitra Mohanty, Angel Quintero Mayedo, Bryan MacDonald, Carola Gianni, VincenzoMirco La Fazia, Domenico G. Della Rocca, Prem Geeta Torlapati, Mohamed A. Bassiouny, G. Joseph Gallinghouse, John D. Burkhardt, Rodney P. Horton, Amin Al-Ahmad, Xiaodong Zhang, Fengwei zou, Luigi Di Biase, and Andrea Natale
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
35. PO-03-161 INTRA-PROCEDURAL CROSSOVER OF LEFT ATRIAL APPENDAGE OCCLUSION DEVICES, A SINGLE CENTER EXPERIENCE
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Carola Gianni, Rodney P. Horton, Domenico G. Della Rocca, Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Amin Al-Ahmad, Mohamed A. Bassiouny, J. David Burkhardt, G. Joseph Gallinghouse, Patrick M. Hranitzky, Javier E. Sanchez, and Andrea Natale
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
36. Fluoroless 3D mapping‐guided pacemaker implant in a pregnant patient
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Domenico G. Della Rocca, Carola Gianni, Rodney Horton, and Andrea Natale
- Subjects
Adult ,Epicardial Mapping ,Pacemaker, Artificial ,medicine.medical_specialty ,Intracardiac echocardiography ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Syncope ,Prosthesis Implantation ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,3d mapping ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,3 d mapping ,Ultrasonography, Interventional ,business.industry ,Pregnant patient ,General Medicine ,Pacemaker implant ,Female ,Radiology ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
We describe a case of pacemaker implant guided by intracardiac echocardiography and three-dimensional anatomical mapping in a pregnant patient, with no peri-procedural use of radiation.
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- 2021
37. Intracardiac Echocardiography to Guide Catheter Ablation of Atrial Fibrillation
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Javier Sanchez, Carola Gianni, Rodney Horton, Domenico G. Della Rocca, Amin Al-Ahmad, Andrea Natale, and Luigi Di Biase
- Subjects
medicine.medical_specialty ,Standard of care ,Intracardiac echocardiography ,Cardiac anatomy ,medicine.medical_treatment ,Ablation of atrial fibrillation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Guide catheter ,business.industry ,Atrial fibrillation ,medicine.disease ,Ablation ,Surgery, Computer-Assisted ,Echocardiography ,Catheter Ablation ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,human activities - Abstract
Intracardiac echocardiography (ICE) is a valuable tool and should be standard of care in any modern electrophysiology laboratory. Through real-time imaging of cardiac anatomy, ICE is used to guide electrophysiology procedures and monitor for complications. This article is a short overview of the application of real-time ICE imaging during atrial fibrillation ablation procedures.
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- 2021
38. Atrial pacing above the lower rate limit: What is the cause?
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Amin Al-Ahmad, Domenico G. Della Rocca, Carola Gianni, and Anna Sarcon
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medicine.medical_specialty ,Atrial pacing ,business.industry ,Cardiac Pacing, Artificial ,Ventricular tachycardia ,medicine.disease ,Electrocardiography ,Physiology (medical) ,Internal medicine ,Cardiology ,Humans ,Medicine ,Heart Atria ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
39. 3-Dimensional Intracardiac Echocardiography-Guided Percutaneous Closure of a Residual Leak via Radiofrequency Applications After LAAO
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Domenico G. Della Rocca, Carola Gianni, Michele Magnocavallo, Sanghamitra Mohanty, Amin Al-Ahmad, David R. Tschopp, J. David Burkhardt, Luigi Di Biase, Rodney P. Horton, Andrea Natale, and Heartrhythmmanagement
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Echocardiography, Transesophageal/methods ,Atrial Fibrillation ,Atrial Appendage/diagnostic imaging ,Humans ,heart - Published
- 2022
40. Transesophageal Echocardiography Following Left Atrial Appendage Electrical Isolation: Diagnostic Pitfalls and Clinical Implications
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Carola Gianni, Javier E. Sanchez, Qiong Chen, Domenico G. Della Rocca, Sanghamitra Mohanty, Chintan Trivedi, Amin Al-Ahmad, Mohamed A. Bassiouny, J. David Burkhardt, G. Joseph Gallinghouse, Rodney P. Horton, Patrick M. Hranitzky, Jorge E. Romero, Luigi Di Biase, Mario J. Garcia, and Andrea Natale
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Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Anticoagulants ,Humans ,Atrial Appendage ,Cardiology and Cardiovascular Medicine ,Echocardiography, Transesophageal - Abstract
Background: Following left atrial appendage (LAA) electrical isolation, the decision on whether to continue oral anticoagulation after successful atrial fibrillation ablation is based on the study of its mechanical function on transesophageal echocardiography (TEE). In this cohort, LAA contraction is absent and the incorrect interpretation of emptying flow velocities can lead to unwanted clinical sequelae. Methods: One hundred and sixty consecutive TEE exams performed to evaluate the LAA mechanical function following its electrical isolation were reviewed by an experienced operator blinded to the original diagnosis of LAA dysfunction. The rate of diagnostic discrepancy in the assessment LAA dysfunction and its clinical implications were evaluated. Results: Diagnostic discrepancy with misclassification of the LAA mechanical function occurred 36% (58/160) of TEE exams. In most cases (57/58), such discrepancy was observed in the setting of an incorrect original diagnosis of a normal LAA mechanical function despite absent/reduced or inconsistent LAA contraction. This main source of this wrong diagnosis was the wrong interpretation of passive LAA flows (34/57; 60%), followed by failure to identify dissociated firing (15/57; 26%). In rare cases (8/57; 14%), velocities of surrounding structures were interpreted as LAA flow due to misplacement of the pulsed-wave Doppler sample volume. Following LAA isolation, the proportion of patients who experienced a cerebrovascular event while off oral anticoagulation due to the misclassification of their LAA mechanical function was 70% (7/10 [95% CI, 40%–89%]). Conclusions: Underdiagnosis of LAA mechanical dysfunction is common in TEEs performed following LAA electrical isolation, and it is associated with an increased risk of cerebrovascular events owing to oral anticoagulation discontinuation despite absent/reduced LAA contraction. Careful review of the TEE exam by an operator with specific expertise in LAA imaging and familiar with the functional implications of LAA isolation is necessary before interrupting oral anticoagulation in this cohort.
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- 2022
41. Predictors of recurrent atrial fibrillation following catheter ablation
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Chintan Trivedi, Carola Gianni, Sanghamitra Mohanty, Domenico G. Della Rocca, Bryan MacDonald, Angel Mayedo, and Andrea Natale
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medicine.medical_specialty ,medicine.medical_treatment ,Recurrent atrial fibrillation ,Catheter ablation ,Comorbidity ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Fibrosis ,Internal medicine ,Atrial Fibrillation ,Internal Medicine ,medicine ,Humans ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Treatment Outcome ,Lifestyle factors ,Echocardiography ,Catheter Ablation ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atrial fibrillation (AF) is a complex and multi-factorial rhythm disorder. Catheter ablation is widely used for the management of AF. However, it is limited by relapse of the arrhythmia necessitating repeat procedures.This review aims to discuss the predictors of post-ablation recurrent AF including age, gender, genetic predisposition, AF type and duration, comorbidities, lifestyle factors, echocardiographic parameters of heart chambers, left atrial fibrosis and ablation strategies and targets. An extensive literature search was undertaken on PubMed and Google Scholar to obtain full texts of relevant AF-related articles.Maintenance of stable sinus rhythm is the main intended outcome of AF ablation. Therefore, it is very crucial to identify the risk factors that may influence the ablation success. Most of these predictors such as comorbidities, ablation strategy and targets and lifestyle factors are either reversible or modifiable. Thus, not only the awareness of these known risk factors by both patients and their physicians but also future research to identify the unknown predictors are critical to optimize care in this multi-faceted morbidity.
- Published
- 2021
42. Thromboembolic Risk in Atrial Fibrillation Patients With Left Atrial Scar Post-Extensive Ablation
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Carola Gianni, G. Joseph Gallinghouse, John Burkhardt, Andrea Natale, Faiz M. Baqai, Luigi Di Biase, Angel Mayedo, Sanghamitra Mohanty, Rodney Horton, Chintan Trivedi, Amin Al-Ahmad, Bryan MacDonald, Domenico G. Della Rocca, Alisara Anannab, and Mohamed Bassiouny
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Ablation ,Single Center ,Thromboembolic risk ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,business ,Stroke - Abstract
Objectives This study evaluated the association of the post-ablation scar with stroke risk in patients undergoing atrial fibrillation (AF) ablation. Background Late gadolinium enhancement–...
- Published
- 2021
43. Half‐normal saline versus normal saline for irrigation of open‐irrigated radiofrequency catheters in atrial fibrillation ablation
- Author
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Chintan Trivedi, J. David Burkhardt, Rodney Horton, Domenico G. Della Rocca, Andrea Natale, Luigi Di Biase, Amin Al-Ahmad, G. Joseph Gallinghouse, Carola Gianni, Mohamed Bassiouny, Patrick Hranitzky, Shane Bailey, Sanghamitra Mohanty, Bryan MacDonald, Javier Sanchez, and Angel Mayedo
- Subjects
Catheters ,medicine.medical_treatment ,Population ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,education ,Saline ,education.field_of_study ,business.industry ,Hazard ratio ,Atrial fibrillation ,Equipment Design ,medicine.disease ,Ablation ,Catheter ,Treatment Outcome ,Pulmonary Veins ,Anesthesia ,Catheter Ablation ,Saline Solution ,Cardiology and Cardiovascular Medicine ,Hyponatremia ,business - Abstract
Background The creation of effective and permanent lesions is a crucial factor in determining the success rate of atrial fibrillation (AF) ablation. By increasing the efficacy of radiofrequency (RF) energy-mediated lesion formation, half-normal saline (HNS) as an irrigant for open-irrigated ablation catheters has the potential to reduce procedural times and improve acute and long-term outcomes. Methods This is a double-blind randomized clinical trial of 99 patients undergoing first-time RF catheter ablation for AF. Patients enrolled were randomly assigned in a 1:1 fashion to perform ablation using HNS or normal saline (NS) as an irrigant for the ablation catheter. Results The use of HNS is associated with shorter RF times (26 vs. 33 min; p = .02) with comparable procedure times (104 vs. 104 min). The rate of acute pulmonary vein reconnections (16% vs. 18%) was comparable, with a median of 1 vein reconnection in the HNS arm versus 2 in the NS arm. There was no difference in procedure-related complications, including the incidence of postprocedural hyponatremia when using HNS. Over the 1-year follow-up, there is no significant difference between the HNS and NS with respect to the recurrence of any atrial arrhythmia (off antiarrhythmic drugs [AAD]: 47% vs. 52%; hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 0.66-2.06; off/on AAD: 66% vs. 66%, HR: 1.06, 95% CI: 0.53-2.12), with a potential benefit of using HNS when considering the paroxysmal AF cohort (on/off AAD 73% vs. 62%, HR: 0.72, 95% CI: 0.19-2.70). Conclusions In a mixed cohort of patients undergoing first-time AF ablation, irrigation of open-irrigated RF ablation catheters with HNS is associated with shorter RF times, with a comparably low rate of procedure-related complications. In the long term, there is no significant difference with respect to the recurrence of any atrial arrhythmia. Larger studies with a more homogeneous population are necessary to determine whether HNS improves clinical outcomes.
- Published
- 2021
44. Prevalence, Management, and Outcome of Atrial Fibrillation and Other Supraventricular Arrhythmias in COVID-19 Patients
- Author
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Michele Magnocavallo, Giampaolo Vetta, Domenico G. Della Rocca, Carola Gianni, Sanghamitra Mohanty, Mohamed Bassiouny, Luca Di Lullo, Armando Del Prete, Donatello Cirone, Carlo Lavalle, Cristina Chimenti, Amin Al-Ahmad, J. David Burkhardt, G. Joseph Gallinghouse, Javier E. Sanchez, Rodney P. Horton, Luigi Di Biase, and Andrea Natale
- Subjects
rhythm control ,SARS-CoV-2 ,COVID-19 ,supraventricular arrhythmias ,Article ,Atrial Flutter ,atrial fibrillation ,catheter ablation ,atrial flutter ,Physiology (medical) ,Atrial Fibrillation ,cardiovascular system ,Catheter Ablation ,Prevalence ,Tachycardia, Supraventricular ,Humans ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine - Abstract
COVID-19 mainly affects the respiratory system but has been correlated with cardiovascular manifestations such as myocarditis, heart failure, acute coronary syndromes, and arrhythmias. Cardiac arrhythmias are the second most frequent complication affecting about 30% of patients. Several mechanisms may lead to an increased risk of cardiac arrhythmias during COVID-19 infection, ranging from direct myocardial damage to extracardiac involvement. The aim of this review is to describe the role of COVID-19 in the pathogenesis of cardiac arrhythmias and provide a comprehensive guidance for their monitoring and management.
- Published
- 2022
45. Amplatzer PFO Occluder for treatment of incomplete LAA closure with AtriClip
- Author
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Domenico G. Della Rocca, Andrea Natale, Rodney Horton, Carola Gianni, and J. David Burkhardt
- Subjects
medicine.medical_specialty ,business.industry ,Physiology (medical) ,medicine ,Closure (topology) ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Abstract
Herein, we describe the use of an Amplatzer PFO Occluder to treat incomplete LAA closure due to a malpositioned AtriClip.
- Published
- 2021
46. Laser‐assisted lead extraction of a retained lead remnant in the femoral and iliac veins
- Author
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Robert Canby, Andrea Natale, Carola Gianni, Domenico G. Della Rocca, and Amin Al-Ahmad
- Subjects
Iliac veins ,business.industry ,Physiology (medical) ,Extraction (chemistry) ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Lead (electronics) ,Nuclear medicine ,Laser assisted ,Lead extraction - Abstract
Herein, we present a case of laser-assisted extraction of a retained lead remnant following incomplete removal of an implantable cardiac defibrillator system implanted via a left femoral approach.
- Published
- 2021
47. Dizziness during atrial antitachycardia pacing: What is the cause
- Author
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Amin Al-Ahmad, Carola Gianni, Andrea Natale, Domenico G. Della Rocca, and Robert Canby
- Subjects
Pacemaker, Artificial ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Dizziness ,Intermittent AV Block ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,030212 general & internal medicine ,Sinus (anatomy) ,Aged ,Sick Sinus Syndrome ,business.industry ,Node (networking) ,Cardiac Pacing, Artificial ,Atrial fibrillation ,medicine.disease ,medicine.anatomical_structure ,Antitachycardia Pacing ,Cardiology ,Implant ,Permanent pacemaker ,Cardiology and Cardiovascular Medicine ,business - Abstract
A 74-year-old with a history of sinus node dysfunction and intermittent AV block s/p permanent pacemaker implant 6 years prior, complains of one episode of dizziness.
- Published
- 2020
48. A simple method to detect leaks after left atrial appendage occlusion with Watchman
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J. David Burkhardt, Andrea Natale, Alisara Annanab, Uğur Canpolat, Anu Salwan, Carola Gianni, Gerald Gallinghouse, Alfredo Chauca Tapia, Angel Mayedo, Chintan Trivedi, Luigi Di Biase, Amin Al-Ahmad, Rodney Horton, Sanghamitra Mohanty, Qiong Chen, Bryan MacDonald, Domenico G. Della Rocca, Ömer Gedikli, and Hüseyin Ayhan
- Subjects
Cardiac Catheterization ,medicine.medical_specialty ,Leak ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Left atrial appendage occlusion ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Occlusion ,medicine ,Humans ,Atrial Appendage ,030212 general & internal medicine ,Thrombus ,education ,education.field_of_study ,business.industry ,Odds ratio ,medicine.disease ,Confidence interval ,Treatment Outcome ,Baseline characteristics ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
BACKGROUND We evaluated the efficacy of a new method in identifying peri-device leak (PDL) using morphology of the thrombus formed inside the left atrial appendage (LAA) as seen on follow-up transesophageal echo (TEE). METHOD A total of 291 consecutive patients undergoing Watchman procedure were included in this analysis. TEE was performed at 45 days postprocedure. Based on the presence of the thrombus inside the LAA behind the device, patients were grouped as (1) white (W) group: LAA completely filled with thrombus (n = 101), 2) nonwhite (NW) group: LAA completely black or mixed (part black and part white; n = 190). Follow-up TEE was repeated at 6 and 12 months. RESULTS Baseline characteristics were comparable between groups except the device size, number of patients with chicken-wing morphology, and prevalence of left atrial "smoke" that were significantly higher in the NW group. Detection of black appearance was comparable between the pre-coil closure image and the NW population (26/36 [72.2%] vs 99/154 [64.3%], p = .37). After adjusting for clinically relevant covariates, NW appearance of the LAA was associated with the presence of significant leak (odds ratio: 47.96, 95% confidence interval: 2.91-790.2, p
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- 2020
49. Non‐pulmonary vein triggers in nonparoxysmal atrial fibrillation: Implications of pathophysiology for catheter ablation
- Author
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Carola Gianni, Sanghamitra Mohanty, Rodney Horton, Anu Salwan, Andrea Natale, Chintan Trivedi, G. Joseph Gallinghouse, Mohamed Bassiouny, Alisara Anannab, David F. Briceno, Amin Al-Ahmad, Nicola Tarantino, Luigi Di Biase, Domenico G. Della Rocca, J. David Burkhardt, and Jorge Romero
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,education ,Coronary sinus ,education.field_of_study ,Cardiac electrophysiology ,business.industry ,Atrial fibrillation ,medicine.disease ,Ablation ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary Veins ,Catheter Ablation ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
Rhythm control of persistent atrial fibrillation (AF) patients represents a challenge for the modern interventional cardiac electrophysiologist; as a matter of fact, there is still divergence regarding the best ablative approach to adopt in this population. Different investigational endpoints, variability of techniques and tools, significant technological evolution, and the lack of universally accepted pathophysiological models engendered a considerable heterogeneity in terms of techniques and outcomes, so much that the treatment of persistent subtypes of AF commonly still relies mainly on pulmonary vein (PV) isolation. The purpose of the present review is to report the current experimental and clinical evidence supporting the importance of mapping and ablating non-PV triggers and describe our institutional approach for the ablation of nonparoxysmal AF.
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- 2020
50. Recurrent Atrial Fibrillation with Isolated Pulmonary Veins
- Author
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Anu Salwan, Carola Gianni, Alisara Anannab, Domenico G. Della Rocca, Andrea Natale, Sanghamitra Mohanty, Bryan MacDonald, Chintan Trivedi, Luigi Di Biase, and Angel Mayedo
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Recurrent atrial fibrillation ,Atrial fibrillation ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Superior vena cava ,Physiology (medical) ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Vein ,Antrum ,Coronary sinus - Abstract
When patients have symptomatic recurrent atrial tachyarrhythmias after 2 months following pulmonary vein antral isolation, a repeat ablation should be considered. Patients might present with isolated pulmonary veins posterior wall. In these patients, posterior wall isolation is extended, and non-pulmonary vein triggers are actively sought and ablated. Moreover, in those with non-paroxysmal atrial fibrillation or a known higher prevalence of non-pulmonary vein triggers, empirical isolation of the superior vena cava, coronary sinus, and/or left atrial appendage might be performed. In this review, we will focus on ablation of non-pulmonary vein triggers, summarizing our current approach for their mapping and ablation.
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- 2020
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