109 results on '"Jeffrey Arkles"'
Search Results
2. Impact of Left Atrial Bipolar Electrogram Voltage on First Pass Pulmonary Vein Isolation During Radiofrequency Catheter Ablation
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Lohit Garg, Naga Venkata K. Pothineni, J. Michael Daw, Matthew C. Hyman, Jeffrey Arkles, Cory M. Tschabrunn, Pasquale Santangeli, and Francis E. Marchlinski
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first pass isolation ,voltage mapping ,atrial fibrillation ,pulmonary vein isolation ,atriopathy ,Physiology ,QP1-981 - Abstract
BackgroundFirst pass pulmonary vein isolation (PVI) is associated with durable isolation and reduced recurrence of atrial fibrillation (AF).ObjectiveWe sought to investigate the relationship between left atrial electrogram voltage using multielectrode fast automated mapping (ME-FAM) and first pass isolation with radiofrequency ablation.MethodsWe included consecutive patients (pts) undergoing first time ablation for paroxysmal AF (pAF), and compared the voltage characteristics between patients with and without first pass isolation. Left atrium (LA) adjacent to PVs was divided into 6 regions, and mean voltages obtained with ME-FAM (Pentaray, Biosense Webster) in each region and compared. LA electrograms with marked low voltage (
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- 2020
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3. A Nurse‐Led Limited Risk Factor Modification Program to Address Obesity and Obstructive Sleep Apnea in Atrial Fibrillation Patients
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Amaryah Yaeger, Nancy R. Cash, Tara Parham, David S. Frankel, Rajat Deo, Robert D. Schaller, Pasquale Santangeli, Saman Nazarian, Gregory E. Supple, Jeffrey Arkles, Michael P. Riley, Fermin C. Garcia, David Lin, Andrew E. Epstein, David J. Callans, Francis E. Marchlinski, Daniel M. Kolansky, Jorge I. Mora, Anastassia Amaro, Richard Schwab, Allan Pack, and Sanjay Dixit
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atrial fibrillation ,obesity ,obstructive sleep apnea ,weight loss ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Obesity and obstructive sleep apnea (OSA) are associated with atrial fibrillation (AF), yet these conditions remain inadequately treated. We report on the feasibility and efficacy of a nurse‐led risk factor modification program utilizing a pragmatic approach to address obesity and OSA in AF patients. Methods and Results AF patients with obesity (body mass index ≥30 kg/m2) and/or the need for OSA management (high risk per Berlin Questionnaire or untreated OSA) were voluntarily enrolled for risk factor modification, which comprised patient education, lifestyle modification, coordination with specialists, and longitudinal management. Weight loss and OSA treatment were monitored by monthly follow‐up calls and/or continuous positive airway pressure (CPAP) unit downloads. Quality of life and arrhythmia symptoms were assessed with the SF‐36 and AF Severity Scale at baseline and at 6 months. From November 1, 2016 to October 31, 2017, 252 patients (age 63±11 years; 71% male; 57% paroxysmal AF) were enrolled, 189 for obesity and 93 for OSA. Obese patients who enrolled lost significantly greater percent body weight than those who declined (3% versus 0.3%; P
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- 2018
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4. Neuromodulation for the Treatment of Refractory Ventricular Arrhythmias
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Timothy M. Markman, Douglas Gugger, Jeffrey Arkles, Michael P. Riley, Sanjay Dixit, Gustavo S. Guandalini, David S. Frankel, Andrew E. Epstein, David J. Callans, Sunil Singhal, Francis E. Marchlinski, and Saman Nazarian
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- 2023
5. Multicenter experience with andexanet alfa for refractory pericardial bleeding during catheter ablation of atrial fibrillation
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Tarek Zghaib, John D. Allison, Christopher Barrett, Jeffrey Arkles, Benjamin D'Souza, Jeffrey Luebbert, Fermin Garcia, E. Kevin Heist, Wendy Tzou, David Callans, Francis E. Marchlinski, and David S. Frankel
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Pericardial bleeding is a rare but life-threatening complication of atrial fibrillation (AF) ablation. Patients taking uninterrupted oral anticoagulation (AC) may be at increased risk for refractory bleeding despite pericardiocentesis and administration of protamine. In such cases, andexanet alfa can be given to reverse rivaroxaban or apixaban. In this study, we aim to describe the rate of acute hemostasis and thromboembolic complications with andexanet for refractory pericardial bleeding during AF ablation.In this multicenter, case series, participating centers identified patients who received a dose of apixaban or rivaroxaban within 24 hours of AF ablation, developed refractory pericardial bleeding during the procedure despite pericardiocentesis and administration of protamine and received andexanet. Eleven patients met inclusion criteria, with mean age of 73.5 ± 5.3 years and median CHAIn patients on uninterrupted apixaban or rivaroxaban, who develop refractory pericardial bleeding during AF ablation, andexanet can achieve hemostasis thereby avoiding the need for emergent surgery. However, there is a risk of thromboembolism following administration. This article is protected by copyright. All rights reserved.
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- 2023
6. Impact of Left Ventricular Papillary Muscle Ventricular Arrhythmia Ablation on Mitral Valve Function
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Jennifer Chee, Aung N. Lin, Howard Julien, David Lin, Robert D. Schaller, David S. Frankel, Gregory E. Supple, Pasquale Santangeli, Michael P. Riley, Saman Nazarian, Rajat Deo, Jeffrey Arkles, Ramanan Kumareswaran, Matthew C. Hyman, Gustavo Guandalini, Andrew E. Epstein, Erica S. Zado, David J. Callans, Francis E. Marchlinski, and Sanjay Dixit
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Male ,Tachycardia, Ventricular ,Catheter Ablation ,Humans ,Mitral Valve ,Female ,Arrhythmias, Cardiac ,Middle Aged ,Papillary Muscles ,Aged - Abstract
Although efficacious, catheter ablation (CA) of ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs) has the potential to affect mitral valve (MV) function.The aim of this study was to determine whether lesions delivered during CA of VAs from LV PAPs affected MV function.Consecutive patients undergoing CA of LV PAP VAs from January 2015 to December 2020 in whom both preprocedural and postprocedural transthoracic echocardiography was performed were included. Radiofrequency ablation was performed with an irrigated-tip catheter with or without contact force sensing and intracardiac echocardiographic guidance. The PAPs were delineated into segments: tip, body, and base. Pre- and post-CA transthoracic echocardiograms were reviewed to assess MV regurgitation, which was graded 0 (none), 1 (mild), 2 (moderate), or 3 (severe). A change of ≥2 grades from baseline was considered significant.A total of 103 patients (mean age 63 ± 15 years, 78% men) were included. VAs were ablated from the anterolateral PAP in 35% (n = 36), posteromedial PAP in 55% (n = 57), and both PAPs in 10% (n = 10). Lesion distribution was as follows: PAP tip in 52 (50%), PAP base in 34 (33%), PAP body in 13 (13%), and entire PAP in 4 (4%). The mean number of lesions delivered was 16 ± 13 (median 14). Of 103 patients, 102 (99%) showed no change in MV function.Using intracardiac echocardiographic guidance, lesions can be safely delivered on various aspects of this structure without adverse impact on MV function.
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- 2022
7. Composite Index Tagging for PVI in Paroxysmal AF
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Luigi Di Biase, George Monir, Daniel Melby, Paul Tabereaux, Andrea Natale, Harish Manyam, Charles Athill, Craig Delaughter, Anshul Patel, Philip Gentlesk, Christopher Liu, Jeffrey Arkles, Hugh Thomas McElderry, and Jose Osorio
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- 2022
8. Esophageal image segmentation for guidance of posterior wall lesions during atrial fibrillation ablation
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Mirmilad Khoshknab, Tarek Zghaib, Lingyu Xu, Jeffrey Arkles, Pasquale Santangeli, Francis E. Marchlinski, Yuchi Han, Benoit Desjardins, and Saman Nazarian
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Male ,Esophagus ,Pulmonary Veins ,Physiology (medical) ,Atrial Fibrillation ,Catheter Ablation ,Humans ,Female ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies ,Body Temperature - Abstract
Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without image segmentation for esophageal visualization (EV).The retrospective cohort included 73 patients (mean age 65.2 ± 8.6 years, 36% female, 55% paroxysmal AF) who underwent pre-procedural cardiac magnetic resonance or computed tomography and LET monitoring. Of all patients, 35 were historical patients that underwent standard AF ablation without EV, and 38 were contemporary patients, 28 of whom underwent AF ablation with EV and 10 that underwent AF ablation without EV.Total RF time was similar between the groups. The distribution of ablation power delivery was skewed toward higher power in the contemporary patients. However, among patients in the contemporary group, the proportion of 35 Watts lesions was lower with EV (P 0.001). There was no difference between the max or mean LET. The standard deviation of LET change within patient during posterior wall ablation was lower in those with esophageal visualization compared to historical controls, but no change was seen compared to a smaller group of contemporary controls. No long-term clinical esophageal injury was observed.In a retrospective analysis, EV was successfully performed in 28 patients. EV impacted RF power delivery decisions but was unassociated with RF time, changes in LET, or long-term safety.
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- 2022
9. Simultaneous comparison of patch versus multielectrode cardiac monitoring for the detection of arrhythmias: The COMPARE study
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Lohit Garg, Juwann Moss, Matthew C. Hyman, Jeffrey Arkles, David J. Callans, Sanjay Dixit, Andrew E. Epstein, David S. Frankel, Fermin C. Garcia, Ramanan Kumareswaran, Tiffany Sharkoski, Timothy M. Markman, Saman Nazarian, Michael P. Riley, Pasquale Santangeli, Robert D. Schaller, Gregory E. Supple, Francis Marchlinski, and Rajat Deo
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
10. A novel artificial intelligence based algorithm to reduce wearable cardioverter-defibrillator alarms
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Jeffrey Arkles, Craig Delaughter, and Benjamin D’Souza
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. PO-03-043 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY WITH LEFT BUNDLE AREA PACING DELIVERS HIGHLY SUCCESSFUL ANTITACHYCARDIA PACING THERAPY FOR VENTRICULAR TACHYCARDIA AND SUCCESSFUL DEFIBIRILLATION
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Jeffrey Arkles, Sandeep Bansal, R. Ward Pulliam, Douglas C. Gohn, Lynn M. Brewer, Jill B. Schaeffer, Wenwen Li, Steve Stabinger, and Matthew A. Bernabei
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
12. Subserratus implantation of the subcutaneous implantable cardioverter-defibrillator
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David S. Frankel, Francis E. Marchlinski, Jeffrey Smietana, Joseph M. Serletti, Naga Venkata K. Pothineni, Robert D. Schaller, and Jeffrey Arkles
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Adult ,Male ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Surgery ,Death, Sudden, Cardiac ,Physiology (medical) ,Tachycardia, Ventricular ,medicine ,Humans ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Retrospective Studies - Published
- 2021
13. Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes
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Michael P. Riley, Luis C. Saenz, Gregory E. Supple, David S. Frankel, Sanjay Dixit, Pasquale Santangeli, Jeffrey Arkles, Alonso Arroyo, Robert D. Schaller, Diego Rodríguez, Matthew C. Hyman, David Lin, Fermin C. Garcia, Ramanan Kumareswaran, Francis E. Marchlinski, Lohit Garg, Erica S. Zado, David J. Callans, Saman Nazarian, and Naga Venkata K. Pothineni
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Heart Rate ,Tachycardia ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Atrial Septum ,business.industry ,Bipolar ablation ,Atrial fibrillation ,medicine.disease ,Ablation ,Cardiac surgery ,Electrophysiology ,Catheter Ablation ,Cardiology ,Female ,Cardiac Electrophysiology ,Left Atrial Myxoma ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background Interatrial septal tachycardias (IAS-ATs) following atrial fibrillation (AF) ablation or cardiac surgery are rare, and their management is challenging. Objective The purpose of this study was to investigate the electrophysiological features and outcomes associated with catheter ablation of IAS-AT. Methods We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery. Diagnosis of IAS-AT was based on activation mapping and analysis of response to atrial overdrive pacing. Results Twenty-nine patients (9%) had IAS-AT (cycle length [CL] 311 ± 104 ms); 16 (55%) had prior AF ablation procedures (median 3; range 1–5), 3 (10%) had prior surgical maze, and 12 (41%) had prior cardiac surgery (including atrial septal defect surgical repair in 5 and left atrial myxoma resection in 1). IAS substrate abnormalities were documented in all patients. Activation mapping always demonstrated a diffuse early IAS breakout with centrifugal biatrial activation, and atrial overdrive pacing showed a good postpacing interval (equal or within 25 ms of the AT CL) only at 1 or 2 anatomically opposite IAS sites in all cases. Ablation was acutely successful in 27 patients (93%) (from only the right IAS in 2, only the left IAS in 9, both IAS sides with sequential ablation in 13, and both IAS sides with bipolar ablation in 3). After median follow-up of 15 (6–52) months, 17 patients (59%) remained free from recurrent arrhythmias. Conclusion IAS-ATs are rare and typically occur in patients with evidence of IAS substrate abnormalities and prior cardiac surgery. Catheter ablation can be challenging and may require sequential unipolar ablation or bipolar ablation.
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- 2021
14. Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes
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Lauren A. Eberly, Aung Lin, Joseph Park, Mirmilad Khoshnab, Lohit Garg, Jennifer Chee, Michael J. Kallan, Katie Walsh, Gregory E. Supple, Robert D. Schaller, Pasquale Santangeli, Michael P. Riley, Saman Nazarian, Jeffrey Arkles, Matthew Hyman, David Lin, Gustavo Guandalini, Ramanan Kumareswaran, Rajat Deo, Erica S. Zado, Andrew Epstein, David S. Frankel, David J. Callans, Francis E. Marchlinski, and Sanjay Dixit
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Adverse structural and electrical remodeling underlie persistent atrial fibrillation (PersAF). Restoration of sinus rhythm (SR) prior to ablation in PersAF may improve the underlying substrate, thus improving arrhythmia outcomes. The aim of this study was to evaluate if the presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of a limited catheter ablation (CA) strategy in PersAF.Patients with PersAF undergoing pulmonary vein isolation at our institution from 2014-2018 were included. We compared patients who presented for ablation in SR (by cardioversion and/or antiarrhythmic drugs [AADs]) to those who presented in AF. Primary outcome of interest was freedom from atrial arrhythmias (AAs) on or off AADs at 1 year after single ablation. Secondary outcomes included freedom from AAs on or off AADs overall, freedom from AAs off AADs at 1 year, and time to recurrent AF.Five hundred seventeen patients were included (322 presented in AF, 195 SR). The primary outcome was higher in those who presented for CA in SR as compared to AF (85.6% vs. 77.0%, p = 0.017). Freedom from AAs off AAD at 12 months was also higher in those presenting in SR (59.0% vs. 44.4%; p = 0.001) and time to recurrent AF was longer (p = 0.008). Presence of SR at CA was independently associated with the primary outcome at 12 months (OR 1.77; 95% CI 1.08-2.90) and overall (OR 1.89; 95% CI 1.26-2.82).Presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of limited CA in PersAF.
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- 2022
15. PO-02-059 INFLAMMATORY REACTION TO ANTIBIOTIC ELUTING POUCH MASQUERADING AS RECURRENT CARDIAC IMPLANTABLE ELECTRONIC DEVICE INFECTION
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Aaron Vigdor, Jeffrey Arkles, Jeffrey J. Luebbert, and Robert D. Schaller
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
16. Myocardial Substrate Characterization by CMR T1 Mapping in Patients With NICM and No LGE Undergoing Catheter Ablation of VT
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Pasquale Santangeli, Sanjay Dixit, Simon A. Castro, David Lin, David S. Frankel, Cory M. Tschabrunn, Robert D. Schaller, Andres Enriquez, Jeffrey Arkles, Silvia Magnani, Matthew C. Hyman, Saman Nazarian, Erica S. Zado, Gaetano Nucifora, Gregory E. Supple, Daniele Muser, C. Anwar A. Chahal, Francis E. Marchlinski, David J. Callans, and Ramanan Kumareswaran
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Dilative cardiomyopathy ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Diffuse fibrosis ,Internal medicine ,medicine ,Cardiology ,Late gadolinium enhancement ,In patient ,030212 general & internal medicine ,Cardiac magnetic resonance ,Inverse correlation ,business - Abstract
Objectives The goal of this study was to characterize the relationship between DF, the electroanatomic mapping (EAM) substrate, and outcomes of catheter ablation of VT in NICM. Background A substantial proportion of patients with nonischemic dilated cardiomyopathy (NICM) and ventricular tachycardia (VT) do not have scar detectable by cardiac magnetic resonance late gadolinium enhancement (LGE) imaging. In these patients, the significance of diffuse fibrosis (DF) detected with T1 mapping has not been previously investigated. Methods This study included 51 patients with NICM and VT undergoing catheter ablation (median age 55 years; 77% male subjects) who had no evidence of LGE on pre-procedural cardiac magnetic resonance. Post-contrast T1 relaxation time determined on the septum was assessed as a surrogate of DF burden. The extent of endocardial low-voltage areas (LVAs) at EAM was correlated with T1 mapping data. Results Bipolar LVAs were present in 22 (43%) patients (median extent 15 cm2 [8 to 29 cm2]) and unipolar LVA in all patients (median extent 48 cm2 [26 to 120 cm2]). A significant inverse correlation was found between T1 values and both unipolar-LVA (R2 = 0.64; β = –0.85; p Conclusions In patients with NICM and no evidence of LGE undergoing catheter ablation of VT, DF estimated by using post-contrast T1 mapping correlates with the voltage abnormality at EAM and seems to affect post-ablation outcomes.
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- 2021
17. Stroke, Timing of Atrial Fibrillation Diagnosis, and Risk of Death
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Saman Nazarian, Pasquale Santangeli, David Lin, Jackson J. Liang, Jeffrey Arkles, David S. Frankel, Yuliya Borovskiy, Ronit Katz, Francis E. Marchlinski, Parin J. Patel, Michael P. Riley, Matthew C. Hyman, Fermin C. Garcia, David J. Callans, Neel Chokshi, Sanjay Dixit, Anjali Bhatla, Ramanan Kumareswaran, Andrew E. Epstein, Steven R. Messé, Scott E. Kasner, Gregory E. Supple, Robert D. Schaller, and Rajat Deo
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,National Death Index ,Risk Factors ,Interquartile range ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Stroke ,Aged ,Proportional hazards model ,business.industry ,Mortality rate ,Hazard ratio ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Cardiology ,Female ,Neurology (clinical) ,business - Abstract
ObjectiveTo evaluate the prognosis of patients with ischemic stroke according to the timing of an atrial fibrillation (AF) diagnosis, we created an inception cohort of incident stroke events and compared the risk of death between patients with stroke with (1) sinus rhythm, (2) known AF (KAF), and (3) AF diagnosed after stroke (AFDAS).MethodsWe used the Penn AF Free study to create an inception cohort of patients with incident stroke. Mortality events were identified after linkage with the National Death Index through June 30, 2017. We also evaluated initiation of anticoagulants and antiplatelets across the study duration. Cox proportional hazards models evaluated associations between stroke subtypes and death.ResultsWe identified 1,489 individuals who developed an incident ischemic stroke event: 985 did not develop AF at any point during the study period, 215 had KAF before stroke, 160 had AF detected ≤6 months after stroke, and 129 had AF detected >6 months after stroke. After a median follow-up of 4.9 years (interquartile range 1.9–6.8), 686 deaths occurred. The annualized mortality rate was 8.8% in the stroke, no AF group; 12.2% in the KAF group; 15.8% in the AFDAS ≤6 months group; and 12.7% in the AFDAS >6 months group. Patients in the AFDAS ≤6 months group had the highest independent risk of all-cause mortality even after multivariable adjustment for demographics, clinical risk factors, and the use of antithrombotic therapies (hazard ratio 1.62 [1.22–2.14]). Compared to the stroke, no AF group, those with KAF had a higher mortality risk that was rendered nonsignificant after adjustment.ConclusionsThe AFDAS group had the highest risk of death, which was not explained by comorbidities or use of antithrombotic therapies.
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- 2021
18. Percutaneous Removal of a Pulmonary Artery Catheter Inadvertently Sutured to the Heart During Valve Surgery
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DO Robert D. Schaller, Jeffrey Arkles, and Lohit Garg
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0301 basic medicine ,mitral valve ,medicine.medical_specialty ,Percutaneous ,Valve surgery ,LLD, lead-locking stylets ,medicine.medical_treatment ,F, French ,thoracotomy ,030105 genetics & heredity ,IJ, internal jugular ,SVC, superior vena cava ,03 medical and health sciences ,0302 clinical medicine ,Mitral valve ,Procedural Complications: Part 1 ,IVC, inferior vena cava ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Thoracotomy ,PAC, pulmonary artery catheter ,pulmonary artery catheter ,Case Report: Technical Corner ,business.industry ,Pulmonary artery catheter ,pledget ,valve repair ,snaring ,Surgery ,lead extraction ,medicine.anatomical_structure ,RC666-701 ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Lead extraction - Abstract
A 74-year old woman underwent “mini-mitral” valve surgery via a right thoracotomy. The pulmonary artery catheter could not be removed thereafter and was found to be pierced by the atriotomy suture. Removal was performed by percutaneously lacerating the catheter above and below the suture, leaving behind a small segment. (Level of Difficulty: Advanced.), Graphical abstract
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- 2020
19. Effect of Transcutaneous Magnetic Stimulation in Patients With Ventricular Tachycardia Storm: A Randomized Clinical Trial
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Timothy M. Markman, Naga Venkata K. Pothineni, Tarek Zghaib, Jeffrey Smietana, Daniel McBride, Nigel A. Amankwah, Kristin A. Linn, Ramanan Kumareswaran, Matthew Hyman, Jeffrey Arkles, Pasquale Santangeli, Robert D. Schaller, Gregory E. Supple, David S. Frankel, Rajat Deo, David Lin, Michael P. Riley, Andrew E. Epstein, David J. Callans, Francis E. Marchlinski, Roy Hamilton, and Saman Nazarian
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Adult ,Male ,Treatment Outcome ,Brief Report ,Magnetic Phenomena ,Tachycardia, Ventricular ,Humans ,Female ,Heart ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Anti-Arrhythmia Agents - Abstract
IMPORTANCE: Autonomic neuromodulation provides therapeutic benefit in ventricular tachycardia (VT) storm. Transcutaneous magnetic stimulation (TcMS) can noninvasively and nondestructively modulate a patient’s nervous system activity and may reduce VT burden in patients with VT storm. OBJECTIVE: To evaluate the safety and efficacy of TcMS of the left stellate ganglion for patients with VT storm. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, sham-controlled randomized clinical trial took place at a single tertiary referral center between August 2019 and July 2021. The study included 26 adult patients with 3 or more episodes of VT in 24 hours. INTERVENTIONS: Patients were randomly assigned to receive a single session of either TcMS that targeted the left stellate ganglion (n = 14) or sham stimulation (n = 12). MAIN OUTCOMES AND MEASURES: The primary outcome was freedom from VT in the 24-hour period following randomization. Key secondary outcomes included safety of TcMS on cardiac implantable electronic devices, as well as burden of VT in the 72-hour period following randomization. RESULTS: Among 26 patients (mean [SD] age, 64 [13] years; 20 [77%] male), a mean (SD) of 12.7 (10.3) episodes of VT occurred within the 24 hours preceding randomization. Patients had recurrent VT despite taking a mean (SD) of 2.0 (0.6) antiarrhythmic drugs (AADs), and 11 patients (42%) required mechanical hemodynamic support at the time of randomization. In the 24-hour period after randomization, VT recurred in 4 of 14 patients (29% [SD 47%]) in the TcMS group vs 7 of 12 patients (58% [SD 51%]) in the sham group (P = .20). In the 72-hour period after randomization, patients in the TcMS group had a mean (SD) of 4.5 (7.2) episodes of VT vs 10.7 (13.8) in the sham group (incidence rate ratio, 0.42; P
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- 2022
20. Strategies for Catheter Ablation of Left Ventricular Papillary Muscle Arrhythmias
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Shiquan Chen, David J. Callans, Francis E. Marchlinski, David Lin, Gregory E. Supple, Jeffrey Arkles, Jackson J. Liang, Ramanan Kumareswaran, David S. Frankel, Aung Lin, Robert D. Schaller, Sanjay Dixit, Erica C. Zado, Matthew C. Hyman, Fermin C. Garcia, Saman Nazarian, Arshneel Kochar, Pasquale Santangeli, Michael P. Riley, and Yasuhiro Shirai
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,food and beverages ,Catheter ablation ,030204 cardiovascular system & hematology ,Ablation ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Medicine ,030212 general & internal medicine ,business ,Papillary muscle - Abstract
Objectives This study sought to address whether technological innovations such as contact force sensing (CFS) can improve acute and long-term ablation outcomes of left ventricular papillar...
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- 2020
21. QRS morphology in lead V1 for the rapid localization of idiopathic ventricular arrhythmias originating from the left ventricular papillary muscles: A novel electrocardiographic criterion
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Andres Enriquez, Rajat Deo, Katie Walsh, Michael P. Riley, Robert D. Schaller, Jeffrey Arkles, Francis E. Marchlinski, Saman Nazarian, David S. Frankel, Yasuhiro Shirai, David J. Callans, David F. Briceno, Pasquale Santangeli, Ramanan Kumareswaran, Timothy M. Markman, Sanjay Dixit, Jackson J. Liang, Matthew C. Hyman, Fermin C. Garcia, Gregory E. Supple, David Lin, and Andrew E. Epstein
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Qrs morphology ,medicine.medical_specialty ,Intracardiac echocardiography ,Heart disease ,business.industry ,Intrinsicoid deflection ,030204 cardiovascular system & hematology ,Right bundle branch block ,medicine.disease ,03 medical and health sciences ,QRS complex ,Ostium ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Lead (electronics) ,business - Abstract
Background Twelve-lead electrocardiogram (ECG) criteria have been developed to identify idiopathic ventricular arrhythmias (VAs) from the left ventricular (LV) papillary muscles (PAPs), but accurate localization remains a challenge. Objective The purpose of this study was to develop ECG criteria for accurate localization of LV PAP VAs using lead V1 exclusively. Methods Consecutive patients undergoing mapping and ablation of VAs from the LV PAPs guided by intracardiac echocardiography from 2007 to 2018 were reviewed (study group). The QRS morphology in lead V1 was compared to patients with VAs with a "right bundle branch block" morphology from other LV locations (reference group). Patients with structural heart disease were excluded. Results One hundred eleven patients with LV PAP VAs (mean age 54 ± 16 years; 65% men) were identified, including 64 (55%) from the posteromedial PAP and 47 (42%) from the anterolateral PAP. The reference group included patients with VAs from the following LV locations: fascicles (n = 21), outflow tract (n = 36), ostium (n = 37), inferobasal segment (n = 12), and apex (5). PAP VAs showed 3 distinct QRS morphologies in lead V1 93% of the time: Rr (53%), R with a slurred downslope (29%), and RR (11%). Sensitivity, specificity, positive predictive value, and negative predictive value for the 3 morphologies combined are 93%, 98%, 98%, and 93%, respectively. The intrinsicoid deflection of PAP VAs in lead V1 was shorter than that of the reference group (63 ± 13 ms vs 79 ± 24 ms; P Conclusion VAs originating from the LV PAPs manifest unique QRS morphologies in lead V1, which can aid in rapid and accurate localization.
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- 2020
22. COVID-19 and cardiac arrhythmias
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Saman Nazarian, David S. Frankel, John R. Bullinga, Christopher M. Domenico, Ramanan Kumareswaram, Srinivas Denduluri, Anjali Bhatla, Robert D. Schaller, Francis E. Marchlinski, Eric J. Oh, Pasquale Santangeli, Matthew C. Hyman, David J. Callans, Juwann Moss, Jeffrey Arkles, Fermin C. Garcia, Srinath Adusumalli, Michael P. Riley, David Lin, Sanjay Dixit, Ann Tierney, Rajat Deo, Andrew E. Epstein, Gregory E. Supple, George L. Anesi, Michael Mayer, Anwar A. Chahal, and Benjamin S. Abella
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Male ,cardiac arrest ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,law.invention ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,law ,Hospital Mortality ,030212 general & internal medicine ,COVID-19, Coronavirus disease 2019 ,education.field_of_study ,Incidence ,Atrial fibrillation ,Middle Aged ,ICU, intensive care unit ,Intensive care unit ,Hospitalization ,cardiovascular system ,Cardiology ,Female ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,Cohort study ,Adult ,medicine.medical_specialty ,AF, atrial fibrillation ,Pneumonia, Viral ,Population ,arrhythmia ,SARS-CoV-2, severe acute respiratory syndrome coronavirus 2 ,Article ,Betacoronavirus ,03 medical and health sciences ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,education ,Pandemics ,BNP, B-type natriuretic peptide ,Aged ,SARS-CoV-2 ,business.industry ,COVID-19 ,Arrhythmias, Cardiac ,Odds ratio ,medicine.disease ,mortality ,Heart Arrest ,NSVT, nonsustained ventricular tachycardia ,Heart failure ,business ,Kidney disease - Abstract
Background Early studies suggest that coronavirus disease 2019 (COVID-19) is associated with a high incidence of cardiac arrhythmias. SARS-CoV-2 infection may cause injury to cardiac myocytes and increase arrhythmia risk. Objective To evaluate the risk of cardiac arrest and arrhythmias including incident atrial fibrillation (AF), bradyarrhythmias, and nonsustained ventricular tachycardia (NSVT) in a large urban population hospitalized for COVID-19. We also evaluated correlations between the presence of these arrhythmias and mortality. Methods We reviewed the characteristics of all COVID-19 patients admitted to our center over a 9-week period. Throughout hospitalization, we evaluated the incidence of cardiac arrests, arrhythmias and in-patient mortality. We also used logistic regression to evaluate age, sex, race, body mass index, prevalent cardiovascular disease, diabetes, hypertension, kidney disease and ICU status as potential risk factors for each arrhythmia. Results Among 700 patients (mean age 50±18 years, 45% men, 71% African American, and 11% received ICU care), there were 9 cardiac arrests, 25 incident AF events, 9 clinically significant bradyarrhythmias, and 10 NSVTs. All cardiac arrests occurred among patients admitted to the ICU. In addition, admission to the ICU was associated with incident AF (OR 4.68 [95% CI 1.66 – 13.18]) and NSVT (OR 8.92 [95% CI 1.73 – 46.06]) after multivariable adjustment. Also, age and incident AF (OR 1.05 [95% CI 1.02 – 1.09]); and prevalent heart failure and bradyarrhythmias (OR 9.75 [95% CI 1.95 – 48.65]) were independently associated. Only cardiac arrests were associated with acute, in-hospital mortality. Conclusion Cardiac arrests and arrhythmias are likely the consequence of systemic illness and not solely the direct effects of COVID-19 infection., Graphical abstract
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- 2020
23. Massive myocardial edema and inflow cannula obstruction due to epicardial surgical ventricular tachycardia cryoablation at time of left ventricular assist device implantation
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Paul J. Mather, Pasquale Santangeli, Jeffrey Arkles, C. Anwar A. Chahal, Pavan Atluri, and Sriram D. Rao
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medicine.medical_specialty ,LVAD ,medicine.medical_treatment ,Myocardial edema ,Case Report ,Heart failure ,Ablation ,Ventricular tachycardia ,Stellate ganglion block ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,business.industry ,Cryoablation ,medicine.disease ,RC666-701 ,Ventricular assist device ,Cardiology ,Inflow cannula ,Cardiology and Cardiovascular Medicine ,Complication ,business - Published
- 2020
24. Evaluation of Radiofrequency Ablation Irrigation Type
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Francis E. Marchlinski, Naga Venkata K. Pothineni, Jonathan Salas, David J. Callans, Andrew E. Epstein, William H. Sauer, Ting-Wei Liao, Jeffrey Arkles, Robert D. Schaller, Sanjay Dixit, Gregory E. Supple, Daniel Doynow, Matthew C. Hyman, Fermin C. Garcia, Saman Nazarian, Cory M. Tschabrunn, Pasquale Santangeli, and David S. Frankel
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business.industry ,Radiofrequency ablation ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,Ablation ,Ventricular tachycardia ,law.invention ,Lesion ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,law ,medicine ,030212 general & internal medicine ,Thrombus ,medicine.symptom ,Nuclear medicine ,business ,Lead (electronics) ,Saline - Abstract
Objectives This study investigated the impact of the type of catheter irrigant used during delivery of radiofrequency ablation. Background The use of half-normal saline (HNS) as an irrigant has been suggested as a method for increasing ablation lesion size but has not been rigorously studied in the beating heart or the use of a low-flow irrigation catheter. Methods Sixteen swine underwent left ventricular mapping and ablation using either normal saline (NS) (group 1: n = 9) or half-normal saline (HNS) (group 2: n = 7). All lesions were delivered using identical parameters (40 W with 10-second ramp, 30-second duration, 15 ml/min flow, and 8- to14-g target contact force). An occurrence of steam pop, catheter char, or thrombus was assessed using intracardiac echocardiography and catheter inspection following each application. Lesion depth, width, and area were measured using electronic calibers. Results A total of 109 lesions were delivered in group 1 and 77 in group 2. There were significantly more steam pops in group 2 (32 of 77 [42%] vs. 24 of 109 [22%], respectively). The frequencies of catheter tip char were similar (group 1: 9 of 109 [8%] vs. group 2: 10 of 77 [13%]; p = 0.29). Lesion depths, widths, and areas also were similar in both groups. Conclusions The use of an HNS irrigant using a low-flow open irrigated ablation catheter platform results in more tissue heating due to higher radiofrequency current delivery directed to tissue, but this can lead to higher rate of steam pops. In this in vivo porcine beating-heart model, the use of HNS does not appear to significantly increase lesion size in normal myocardium despite evidence of increased radiofrequency heating.
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- 2020
25. Collateral injury of the conduction system during catheter ablation of septal substrate in nonischemic cardiomyopathy
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G Supple, David Lin, Francis E. Marchlinski, Robert D. Schaller, Ramanan Kumareswaran, Fermin C. Garcia, Ioan Liuba, Simon A. Castro, David J. Callans, Pasquale Santangeli, Sanjay Dixit, Jeffrey Arkles, Erica S. Zado, Silvia Magnani, Cory M. Tschabrunn, Jackson J. Liang, Andres Enriquez, Daniele Muser, and David S. Frankel
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Interventricular septum ,Ejection fraction ,business.industry ,Stroke Volume ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Nonischemic cardiomyopathy ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Lower prevalence ,Electrical conduction system of the heart ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Abstract
In patients with nonischemic cardiomyopathy (NICM) little is known about the clinical impact of catheter ablation (CA) of septal ventricular tachycardia (VT) resulting in the collateral injury of the conduction system (CICS).Ninety-five consecutive patients with NICM underwent CA of septal VT. Outcomes in patients with no baseline conduction abnormalities who developed CICS (group 1, n = 28 [29%]) were compared to patients with no CICS (group 2, n = 17 [18%]) and to patients with preexisting conduction abnormalities or biventricular pacing (group 3, n = 50 [53%]). Group-1 patients were younger, had a higher left ventricular ejection fraction and a lower prevalence of New York Heart Association III/IV class compared to group 3 while no significant differences were observed with group 2. After a median follow-up of 15 months, VT recurred in 14% of patients in group 1, 12% in group 2 (P = .94) and 32% in group 3 (P = .08) while death/transplant occurred in 14% of patients in group 1, 18% in group 2 (P = .69) and 28% in group 3 (P = .15). A worsening of left ventricular ejection fraction (LVEF) (median LVEF variation, -5%) was observed in group 1 compared to group 2 (median LVEF variation, 0%; P .01) but not group-3 patients (median LVEF variation, -4%; P = .08) with a consequent higher need for new biventricular pacing in group 1 (43%) compared to group 2 (12%; P = .03) and group 3 (16%; P .01).In patients with NICM and septal substrate, sparing the abnormal substrate harboring the conduction system provides acceptable VT control while preventing a worsening of the systolic function.
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- 2020
26. Wire countertraction for sheath placement through stenotic and tortuous veins: The 'body flossing' technique
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Fermin C. Garcia, Prakash Goutham Suryanarayana, Jay Giri, Mouhannad M. Sadek, Robert D. Schaller, David S. Frankel, Jeffrey Arkles, and Joshua M. Cooper
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Simultaneous traction ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Extraction ,Balloon ,Implantable cardioverter-defibrillator ,medicine.disease ,Tortuosity ,Venous stenosis ,Venous tortuosity ,Stenosis ,Clinical ,Permanent pacemaker ,Snaring ,Implantable cardioverter–defibrillator ,Devices ,Medicine ,Radiology ,Lead Placement ,business ,Venous occlusion - Abstract
Background Innominate vein stenosis and venous tortuosity are common findings during cardiac implantable electronic device upgrades or replacements and present a challenge to the implanting physician. Various techniques have been described to facilitate lead placement, including serial dilation, balloon venoplasty, and percutaneous access medial to the stenosis, each with its own benefits and risks. Objective The purpose of this study was to assess the feasibility, safety, and efficacy of the wire countertraction ("body flossing") technique to facilitate sheath placement through tortuous and stenotic vessels. Methods Patients undergoing cardiac implantable electronic device procedures requiring the body flossing technique due to inability to place vascular sheaths over the wire through stenoses or tortuosity were retrospectively analyzed. Clinical characteristics, procedural equipment, and outcomes were analyzed. Results Simultaneous countertraction was successful in all attempted cases, including 8 patients with stenoses and 2 with tortuosity. In 2 of the stenosis cases, venoplasty had previously failed. No complications occurred. Conclusion Simultaneous countertraction (body flossing) is an effective tool to overcome venous stenosis and tortuosity that are amenable to wire advancement but not to vascular sheaths. It seems to be a safe and effective alternative to other techniques used in these scenarios.
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- 2020
27. Trends in Successful Ablation Sites and Outcomes of Ablation for Idiopathic Outflow Tract Ventricular Arrhythmias
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Daniele Muser, David S. Frankel, Jeffrey Arkles, Ramanan Kumareswaran, Michael P. Riley, Maciej Kubala, Tatsuya Hayashi, Sanjay Dixit, Erica S. Zado, Gregory E. Supple, Francis E. Marchlinski, Robert D. Schaller, David J. Callans, Fermin C. Garcia, Jackson J. Liang, Yasuhiro Shirai, Ling Kuo, David Lin, and Pasquale Santangeli
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Adult ,Male ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Bundle-Branch Block ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Ventricular outflow tract ,Effective treatment ,In patient ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Left bundle branch block ,Arrhythmias, Cardiac ,Middle Aged ,Right bundle branch block ,medicine.disease ,Ablation ,Treatment Outcome ,Catheter Ablation ,cardiovascular system ,Cardiology ,Female ,Outflow ,business - Abstract
This study sought to examine clinical characteristics of procedural and long-term outcomes in patients undergoing catheter ablation (CA) of outflow tract ventricular arrhythmias (OT-VAs) over 16 years.CA is an effective treatment strategy for OT-VAs.Patients undergoing CA for OT-VAs from 1999 to 2015 were divided into 3 periods: 1999 to 2004 (early), 2005 to 2010 (middle), and 2011 to 2015 (recent). Successful ablation site (right ventricular OT, aortic cusps/left ventricular OT, or coronary venous system/epicardium), VA morphology (right bundle branch block or left bundle branch block), and acute and clinical success rates were assessed.Six hundred eighty-two patients (336 female) were included (early: n = 97; middle: n = 204; recent: n = 381). Over time there was increase in use of irrigated ablation catheters and electroanatomic mapping, and more VAs were ablated from the aortic cusp/left ventricular OT or coronary venous system/epicardium (14% vs. 45% vs. 56%; p 0.0001). Acute procedural success was achieved in 585 patients (86%) and was similar between groups (82% vs. 84% vs. 88%; p = 0.27). Clinical success was also similar between groups (86% vs. 87% vs. 88%; p = 0.94), but more patients in earlier periods required repeat ablation (18% vs. 17% vs. 9%; p = 0.02). Overall complication rate was 2% (similar between groups).Over a 16-year period there was an increase in patients undergoing CA for OT-VTs, with more ablations performed at non-right ventricular outflow tract locations using electroanatomic mapping and irrigated-tip catheters. Over time, single procedure success has improved and complications have remained limited.
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- 2020
28. Non–Scar-Related and Purkinje-Related Ventricular Tachycardia in Patients With Structural Heart Disease
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Michael P. Riley, Robert D. Schaller, David S. Frankel, David J. Callans, Pasquale Santangeli, Sanjay Dixit, Saman Nazarian, Gregory E. Supple, Kenzo Hirao, Jackson J. Liang, Jeffrey Arkles, Yasuhiro Shirai, David Lin, Matthew C. Hyman, Ramanan Kumareswaran, Fermin C. Garcia, and Francis E. Marchlinski
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Tachycardia ,medicine.medical_specialty ,Ischemic cardiomyopathy ,Heart disease ,business.industry ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ablation ,medicine.disease ,Ventricular tachycardia ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,In patient ,030212 general & internal medicine ,Electrical conduction system of the heart ,medicine.symptom ,business - Abstract
Objectives This study sought to evaluate the prevalence, mapping features, and ablation outcomes of non–scar-related ventricular tachycardia (NonScar-VT) and Purkinje-related VT (Purkinje-VT) in patients with structural heart disease. Background VT in structural heart disease is typically associated with scar-related myocardial re-entry. NonScar-VTs arising from areas of normal myocardium or Purkinje-VTs originating from the conduction system are less common. Methods We retrospectively analyzed 690 patients with structural heart disease who underwent VT ablation between 2013 and 2017. Results A total of 37 (5.4%) patients (16 [43%] with ischemic cardiomyopathy, 16 [43%] with nonischemic dilated cardiomyopathy, and 5 [14%] others) demonstrated NonScar/Purkinje-VTs, which represented the clinical VT in 76% of cases. Among the 37 VTs, 31 (84%) were Purkinje-VTs (28 bundle branch re-entrant VT). The remaining 6 (16%) VTs were NonScar-VTs and included 4 idiopathic outflow tract VTs. A total of 16 patients had prior history of VT ablations: empirical scar substrate modification was performed in 6 (38%) patients and residual inducibility of VT had not been assessed in 7 (44%). In all 37 patients, the NonScar/Purkinje-VT was successfully ablated. After a median follow-up of 18 months, the targeted NonScar/Purkinje-VT did not recur in any patients, and 28 (76%) of patients were free from any recurrent VT episodes. Conclusions NonScar/Purkinje-VTs can be identified in 5.4% of patients undergoing VT ablation in the setting of structural heart disease. Careful effort to induce, characterize, and map these VTs is important because substrate-based ablation strategies would fail to eliminate these types of VT.
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- 2020
29. Substrate Characterization and Outcome of Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy and Isolated Epicardial Scar
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Saman Nazarian, Gregory E. Supple, Jeffrey Arkles, Gustavo S. Guandalini, Matthew C. Hyman, Fermin C. Garcia, Pasquale Santangeli, Katie Walsh, Sanjay Dixit, David Lin, David S. Frankel, Robert D. Schaller, Michael P. Riley, Ioan Liuba, Anwar A. Chahal, Cory M. Tschabrunn, Naga Venkata K. Pothineni, Martin Arceluz, Daniele Muser, Ling Kuo, Erica S. Zado, David J. Callans, Ramanan Kumareswaran, and Francis E. Marchlinski
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Magnetic Resonance Imaging, Cine ,Catheter ablation ,Ventricular tachycardia ,Risk Assessment ,Basal (phylogenetics) ,Predictive Value of Tests ,Recurrence ,Risk Factors ,Interquartile range ,Physiology (medical) ,Internal medicine ,Prevalence ,medicine ,Humans ,Endocardium ,Retrospective Studies ,business.industry ,Myocardium ,Hazard ratio ,Middle Aged ,Pennsylvania ,Ablation ,medicine.disease ,Fibrosis ,Progression-Free Survival ,Heart failure ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,Cardiomyopathies ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Pericardium - Abstract
Background: The substrate for ventricular tachycardia (VT) in left ventricular (LV) nonischemic cardiomyopathy may be epicardial. We assessed the prevalence, location, endocardial electrograms, and VT ablation outcomes in LV nonischemic cardiomyopathy with isolated epicardial substrate. Methods: Forty-seven of 531 (9%) patients with LV nonischemic cardiomyopathy and VT demonstrated normal endocardial (>1.5 mV)/abnormal epicardial bipolar low-voltage area (LVA, Results: Epicardial bipolar LVA (27.3 cm 2 [interquartile range, 15.8–50.0]) localized to basal (40), mid (8), and apical (3) LV with basal inferolateral LV most common (28/47, 60%). Of 44 endocardial maps available, 40 (91%) had endocardial unipolar LVA (24.5 cm 2 [interquartile range, 9.4–68.5]) and 29 (67%) had characteristic normal amplitude endocardial split electrograms opposite the epicardial LVA. At mean of 34 months, the VT-free survival was 55% after one and 72% after multiple procedures. Greater endocardial unipolar LVA than epicardial bipolar LVA (hazard ratio, 10.66 [CI, 2.63–43.12], P =0.001) and number of inducible VTs (hazard ratio, 1.96 [CI, 1.27–3.00], P =0.002) were associated with VT recurrence. Conclusions: In patients with LV nonischemic cardiomyopathy and VT, the substrate may be confined to epicardial and commonly basal inferolateral. LV endocardial unipolar LVA and normal amplitude bipolar split electrograms identify epicardial LVA. Ablation targeting epicardial VT and substrate achieves good long-term VT-free survival. Greater endocardial unipolar than epicardial bipolar LVA and more inducible VTs predict VT recurrence.
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- 2021
30. Abstract 10387: Utility of Esophageal Image Segmentation for Guidance of Posterior Wall Lesions During Atrial Fibrillation Ablation
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MirMilad Pourmousavi Khoshknab, Tarek Zghaib, Lingyu Xu, Jeffrey Arkles, Pasquale Santangeli, Francis Marchlinski, Yuchi Han, Benoit Desjardins, and Saman Nazarian
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genetic structures ,Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without visualization of esophageal segmentations relative to the left atrial dome. Hypothesis: We sought to test the hypothesis that esophageal image registration and visualization during AF ablation would improve operator efficiency and reduce esophageal temperature changes during the procedure. Methods: The retrospective cohort included 63 patients (mean age 65.5 ± 8.8 years, 33% female, 54% paroxysmal AF) that underwent pre-procedural cardiac magnetic resonance (CMR) and LET monitoring. Of all patients, 35 underwent standard AF ablation without esophageal image segmentation, and 28 underwent AF ablation with registration of esophageal image segmentation. Results: Total RF time was shorter with esophageal visualization (28.6 ± 11.8 min versus 39.1 ± 22.5 min, P Conclusions: Esophageal visualization was associated with improved efficiency of AF ablation using higher power and resulting in shorter RF time, while reducing the variation in esophageal temperature.
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- 2021
31. Persistent Opioid Use After Cardiac Implantable Electronic Device Procedures
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Saman Nazarian, Robert D. Schaller, Gregory E. Supple, Lin Yang, Timothy M. Markman, Jeffrey Arkles, Chase R. Brown, Rajat Deo, Peter W. Groeneveld, David J. Callans, Francis E. Marchlinski, Pasquale Santangeli, Andrew E. Epstein, Gustavo S. Guandalini, Matthew C. Hyman, Sanjay Dixit, and David S. Frankel
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Postoperative Care ,medicine.medical_specialty ,Duration of Therapy ,POU domain ,Databases, Factual ,business.industry ,Opioid use ,Incidence (epidemiology) ,Clinical Decision-Making ,Disease Management ,Drug Prescriptions ,Defibrillators, Implantable ,Analgesics, Opioid ,Physiology (medical) ,Health Care Surveys ,Emergency medicine ,medicine ,Humans ,Public Health Surveillance ,Medical prescription ,Cardiology and Cardiovascular Medicine ,Opioid analgesics ,business - Abstract
Background: Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown. Methods: This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure. Results: Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; P =0.005), preoperative muscle relaxant (odds ratio, 1.52; P P =0.001) use, or opioid use in the previous 5 years (OR, 1.76; P P =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU. Conclusions: POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.
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- 2021
32. PO-715-06 RINGLIKE LEFT VENTRICULAR CARDIOMYOPATHY: A DISTINCT FAMILIAL FORM OF ARRHYTHMOGENIC CARDIOMYOPATHY
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Daniele Muser, Gaetano Nucifora, Michela Casella, Massimo Tritto, Silvia Magnani, Paolo Compagnucci, Domenico Zagari, Andres Enriquez, Ioan Liuba, Anwar A. Chahal, Martín Ricardo Arceluz, Simon A. Castro, Weeranun Dechyapirom Bode, Jeffrey Arkles, David Lin, Cory M. Tschabrunn, Erica S. Zado, Robert D. Schaller, Rajat Deo, Fermin C. Garcia, David S. Frankel, Antonio Dello Russo, David J. Callans, Maurizio Pieroni, Francis E. Marchlinski, and Pasquale Santangeli
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
33. HF-566-03 EMD MISSENSE VARIANTS ARE ASSOCIATED WITH A DILATED CARDIOMYOPATHY AND CONDUCTION SYSTEM DISEASE/ATL
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Ahmed Alsalem, Renae Judy, Erica S. Zado, Gustavo S. Guandalini, Rajat Deo, Jeffrey Arkles, Robert D. Schaller, Pasquale Santangeli, Saman Nazarian, David S. Frankel, Michael P. Riley, Sanjay Dixit, Fermin C. Garcia, Andrew E. Epstein, David J. Callans, Francis E. Marchlinski, Scott Damrauer, and Matthew Craig Hyman
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
34. PO-683-06 MULTICENTER EXPERIENCE WITH ANDEXANET ALFA FOR REFRACTORY PERICARDIAL BLEEDING DURING CATHETER ABLATION OF ATRIAL FIBRILLATION IN PATIENTS TAKING FACTOR XA INHIBITORS
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Tarek Zghaib, John Allison, Christopher Barrett, Jeffrey Arkles, Benjamin Dsouza, Jeffrey J. Luebbert, Fermin C. Garcia, E. Kevin Heist, Wendy S. Tzou, David J. Callans, Francis E. Marchlinski, and David S. Frankel
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
35. BS-400-19 INTRAMURAL EXTENSION OF THE POST-INFARCTION SUBSTRATE IN PATIENTS UNDERGOING CATHETER ABLATION OF VENTRICULAR TACHYCARDIA: PREVALENCE AND PROGNOSTIC IMPLICATIONS
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Weeranun Dechyapirom Bode, Karla Asturias Gonzalez, Daniele Muser, Saman Nazarian, Fermin C. Garcia, Gregory E. Supple, Robert D. Schaller, David S. Frankel, Jeffrey Arkles, Matthew Craig Hyman, Ramanan Kumareswaran, Gustavo S. Guandalini, David Lin, Sanjay Dixit, David J. Callans, Francis E. Marchlinski, and Pasquale Santangeli
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
36. Impact of left atrial posterior wall isolation on arrhythmia outcomes in patients with atrial fibrillation undergoing repeat ablation
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Rajat Deo, Robert D. Schaller, Sanjay Dixit, Michael Riley, Ramanan Kumareswaran, David J. Callans, Andrew E. Epstein, Francis E. Marchlinski, Pasquale Santangeli, Matthew C. Hyman, Fermin C. Garcia, Naga Venkata K. Pothineni, David Lin, Gregory E. Supple, David S. Frankel, Saman Nazarian, Jeffrey Arkles, and Aung Lin
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,Catheter ablation ,Repeat ablation ,Outcomes ,medicine.disease ,Ablation ,Pulmonary vein ,Posterior wall ,Clinical ,Left atrial ,Internal medicine ,Atrial Fibrillation ,Clinical endpoint ,Cardiology ,Medicine ,In patient ,business - Abstract
Background It remains unclear whether additional left atrial posterior wall isolation (LAPWI) beyond pulmonary vein reisolation (PVRI) is beneficial in atrial fibrillation (AF) patients undergoing repeat ablation. Objective We sought to assess impact of LAPWI on arrhythmia outcomes in patients undergoing repeat AF ablation. Methods All AF patients that underwent repeat ablation between January 2016 and December 2018 were included. Those undergoing PVRI only served as control, whereas those undergoing LAPWI (with or without PVRI) were the study group. Primary endpoint was freedom from atrial arrhythmias (AA) off antiarrhythmic drugs (AADs) at 1 year follow-up. Secondary endpoint was freedom from AA on/off AADs at 1 year follow-up. Results One hundred ninety-six patients (61% paroxysmal AF, 39% persistent AF) participated; 93 underwent PVRI and 103 underwent LAPWI±PVRI. Patients in the LAPWI group were older, had more hypertension and persistent AF, and had lower rates of PV reconnection (52.4% vs 100%, P < .001). LAPWI was performed empirically in 79.6% and to target triggers in 20.4%. It was accomplished by linear lesions across the LA floor and roof alone in 65% and additional LAPW lesions in 35%. The primary and secondary endpoints were similar between patients undergoing LAPWI and those undergoing PVRI (43.7% vs 69.9%, P = .50 and 66% vs 77.4%, P = .36, respectively). There was no difference in adverse events between the 2 groups. Conclusion LAPWI did not improve freedom from atrial arrhythmias on or off AADs at 1 year beyond PVRI in AF patients undergoing repeat ablation. Differences in patient demographics and AF type may underlie the observed lack of benefit of LAPWI, and further study is warranted., Graphical abstract Outcomes of left atrial posterior wall isolation during repeat atrial fibrillation ablation
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- 2021
37. Utility of Prolonged Duration Endocardial Ablation for Ventricular Arrhythmias Originating From the Left Ventricular Summit
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Lohit Garg, Thomas Daubert, Aung Lin, Bishnu Dhakal, Pasquale Santangeli, Robert Schaller, Matthew C. Hyman, Ramanan Kumareswaran, Jeffrey Arkles, Saman Nazarian, David Lin, Michael P. Riley, Gregory E. Supple, David S. Frankel, Erica Zado, David J. Callans, Francis E. Marchlinski, and Sanjay Dixit
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Male ,Treatment Outcome ,Heart Ventricles ,Catheter Ablation ,Humans ,Arrhythmias, Cardiac ,Female ,Middle Aged ,Aged ,Endocardium - Abstract
This study sought to explore whether prolonged duration (PD) radiofrequency ablation (RFA) from adjacent endocardial locations can improve catheter ablation (CA) outcomes of left ventricular summit (LVS) ventricular arrhythmias (Vas).CA of VAs originating from the LVS region can be challenging.Patients undergoing CA of LVS VAs from January 1, 2015, to December 31, 2019, were included. Standard RFA approach involved incremental power titration (20-45 W) over 60-120 seconds with irrigated tip catheter to achieve 10%-12% impedance drop. Prolonged duration RFA involved similar power titration; however, lesion application was extended beyond 120 seconds (maximum 5 minutes). Lesions were confined to lowest aspect of aortic cusps and/or subvalvular LV outflow tract region (≤0.5 cm from the valve). Procedural success was defined as suppression of VA ≥30 minutes postablation and clinical success as no arrhythmia symptoms on follow-up and80% reduction of VA burden on postprocedure monitor.This study included 102 patients (60±14 years old, 62% male): standard RFA in 80 and PD RFA in 38. Procedural success was achieved in 54 patients with standard and 32 patients with PD RFA (68% vs 84%; P = 0.05). Short-term clinical success was achieved in 48 patients (60%) with standard and 30 patients (79%) with PD RFA (P = 0.04). Two pericardial effusions occurred (1 in each group) and no steam pops were noted. Patients in whom standard RFA was successful were more likely to have R/S ratio1 or absence of qS in lead I (odds ratio: 3.35; 95% CI: 1.20-9.35; P = 0.03).Prolonged duration RFA from adjacent endocardial locations is a safe and effective technique for successfully targeting challenging LVS VAs that fail standard RFA.
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- 2021
38. Diagnostic Approach to Wide Complex Tachycardia
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Jeffrey Arkles, Maxime Cerantola, and David S. Frankel
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Lightheadedness ,Skin Neoplasms ,Metastatic melanoma ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Biopsy ,Heart Ventricles ,MEDLINE ,Diagnosis, Differential ,Heart Neoplasms ,Electrocardiography ,Fatal Outcome ,Internal medicine ,Internal Medicine ,Palpitations ,Medicine ,Humans ,Neoplasm Metastasis ,Melanoma ,business.industry ,Middle Aged ,Wide complex tachycardia ,Echocardiography ,Tachycardia, Ventricular ,Female ,medicine.symptom ,business - Published
- 2021
39. Analysis of local ventricular repolarization using unipolar recordings in patients with arrhythmogenic right ventricular cardiomyopathy
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Francis E. Marchlinski, Gregory E. Supple, David J. Callans, Robert D. Schaller, Pasquale Santangeli, Jeffrey Arkles, Rajeev K. Pathak, Shuanglun Xie, Fermin C. Garcia, Cory M. Tschabrunn, Maciej Kubala, Erica S. Zado, and Jackson J. Liang
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Adult ,Male ,Ventricular Repolarization ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Right ventricular cardiomyopathy ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,T wave ,medicine ,Humans ,Repolarization ,In patient ,030212 general & internal medicine ,Arrhythmogenic Right Ventricular Dysplasia ,business.industry ,Mean age ,medicine.disease ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
In arrhythmogenic right ventricular cardiomyopathy (ARVC), abnormal electroanatomic mapping (EAM) areas are proportional to extent of T-wave inversion on 12-lead ECG. We aimed to evaluate local repolarization changes and their relationship to EAM substrate in ARVC. Using unipolar recordings, we analyzed the proportion of negative T waves ≥ 1 mV in depth (NegT), NegT area, Q-Tpeak (QTP), Tpeak-Tend (TPE) intervals and their relationship to bipolar (
- Published
- 2019
40. Septal Coronary Venous Mapping to Guide Substrate Characterization and Ablation of Intramural Septal Ventricular Arrhythmia
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Pasquale Santangeli, Francis E. Marchlinski, Jackson J. Liang, Yasuhiro Shirai, David J. Callans, David S. Frankel, Jeffrey Arkles, David F. Briceño, Luis C. Saenz, Robert D. Schaller, Carlos Tapias, Gregory E. Supple, Gustavo S. Guandalini, Diego Rodriguez, Andres Enriquez, and Fermin C. Garcia
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Heart Septum ,medicine ,Humans ,Sinus rhythm ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Coronary Vein ,business.industry ,Middle Aged ,Control subjects ,Ablation ,medicine.disease ,Ventricular Premature Complexes ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,business - Abstract
Objectives This study describes the use of septal coronary venous mapping to facilitate substrate characterization and ablation of intramural septal ventricular arrhythmia (VA). Background Intramural septal VA represents a challenge for substrate definition and catheter ablation. Methods Between 2015 and 2018, 12 patients with structural heart disease, recurrent VA, and suspected intramural septal substrate underwent a septal coronary venous procedure in which mapping was performed by advancement of a wire into the septal perforator branches of the anterior interventricular vein. A total of 5 patients with idiopathic VA were also included as control subjects to compare substrate characteristics. Results Patients were 63 ± 14 years of age, and 11 (92%) were men. Most patients with structural heart disease had nonischemic cardiomyopathy (83%). Six patients underwent ablation for premature ventricular contractions (PVC) and 6 for ventricular tachycardia. All patients had larger septal unipolar voltage abnormalities than bipolar voltage abnormalities (mean area 35.3 ± 16.8 cm2 vs. 10.7 ± 8.4 cm2, respectively; p = 0.01), Patients with idiopathic VA had normal voltage. Septal coronary venous mapping revealed low-voltage, fractionated, and multicomponent electrograms in sinus rhythm in all patients with substrate compared to that in patients with idiopathic VA (amplitude 0.9 ± 0.9 mV vs. 4.4 ± 3.7 mV, respectively; p = 0.007; and duration 147 ± 48 ms vs. 92 ± 10 ms, respectively; p = 0.03). Ablation targeted early activation, pace map match, and/or good entrainment sites from intraseptal recording. Over a mean follow-up of 339 ± 240 days, the PVC and insertable cardioverter-defibrillator therapies burden were significantly reduced (from a mean of 22 ± 11% to 4 ± 8%; p = 0.005; and a mean 5 ± 2 to 1 ± 1; p = 0.001, respectively). Most patients (80%) with idiopathic VA remained arrhythmia free. Conclusions In patients with suspected intramural septal VA, mapping of the septal coronary veins may be helpful to characterize the arrhythmia substrate, identify ablation targets, and guide endocardial ablation.
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- 2019
41. Noninvasive Programmed Ventricular Stimulation-Guided Management Following Ventricular Tachycardia Ablation
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Pasquale Santangeli, Francis E. Marchlinski, David S. Frankel, Simon A. Castro, Tatsuya Hayashi, Ramanan Kumareswaran, Robert D. Schaller, Daniele Muser, David J. Callans, Saman Nazarian, Rajat Deo, Gregory E. Supple, David Lin, Jeffrey Arkles, Andrew E. Epstein, and Sanjay Dixit
- Subjects
Epicardial Mapping ,Male ,Reoperation ,medicine.medical_specialty ,Heart disease ,Heart Ventricles ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Lower risk ,Disease-Free Survival ,Ventricular stimulation ,03 medical and health sciences ,0302 clinical medicine ,Ventricular tachycardia ablation ,Recurrence ,Interquartile range ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Proportional Hazards Models ,business.industry ,Middle Aged ,medicine.disease ,Ablation ,Electric Stimulation ,Defibrillators, Implantable ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,business - Abstract
This study sought to determine the impact of repeat catheter ablation (CA) prior to hospital discharge based on inducibility of clinical ventricular tachycardia (VT) during noninvasive programmed ventricular stimulation (NIPS).Inducibility of clinical VT during NIPS performed several days after CA identifies patients at high risk of recurrence. The impact of NIPS-guided repeat CA has not been reported.Consecutive patients with structural heart disease undergoing CA of VT followed by NIPS were studied. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Among those with inducible clinical VT at NIPS, VT-free survival was compared between those in whom ablation was repeated (group 1) versus those in whom ablation was not repeated (group 2) prior to hospital discharge.Among 469 patients (64 ± 12 years of age; 85% males; 60% ischemic), 216 patients (46%) underwent NIPS 3 days (interquartile range: 2 to 4 days) after CA. Clinical VT was induced in 45 patients (21%). Among those 45, CA was repeated in 11 patients (24%). There were no significant differences in baseline clinical or index CA characteristics between groups 1 and 2. Over a median 36-month follow-up, only 1 patient (9%) in group 1 experienced VT recurrence compared to 24 patients (71%) in group 2 (p 0.01). In univariate Cox regression, repeat CA guided by NIPS (hazard ratio: 0.07; 95% confidence interval: 0.01 to 0.58; p = 0.01) was the only predictor of VT-free survival.In patients with inducible clinical VT during post-ablation NIPS, repeat CA was associated with significantly lower risk of subsequent recurrence.
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- 2019
42. Electrophysiologic Substrate, Safety, Procedural Approaches, and Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients After Aortic Valve Replacement
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Pasquale Santangeli, David J. Callans, Michael P. Riley, Francis E. Marchlinski, Jackson J. Liang, Jeffrey Arkles, Ramanan Kumareswaran, Daniele Muser, Robert D. Schaller, Yasuhiro Shirai, Saman Nazarian, Sanjay Dixit, Simon A. Castro, David S. Frankel, David Lin, Fermin C. Garcia, Erica S. Zado, David F. Briceno, Gregory E. Supple, and Andres Enriquez
- Subjects
Epicardial Mapping ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiomyopathy ,Catheter ablation ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Aortic valve replacement ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Ejection fraction ,business.industry ,Middle Aged ,Ablation ,medicine.disease ,Treatment Outcome ,Aortic Valve ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,Patient Safety ,Cardiomyopathies ,business - Abstract
Objectives This study sought to investigate the substrate, procedural strategies, safety, and outcomes of catheter ablation (CA) for ventricular tachycardia (VT) in patients with aortic valve replacement (AVR). Background VT ablation in patients with AVR is challenging, particularly when mapping and ablation in the periaortic region are necessary. Methods We identified consecutive patients with mechanical, bioprosthetic, and transcatheter AVR who underwent CA for VT refractory to antiarrhythmic drugs and analyzed VT substrate, approach to LV access, complications, and long-term outcomes. Results Overall, 29 patients (87% men, mean age 67.9 ± 9.8 years, left ventricular ejection fraction 39 ± 10%) with prior AVR (13 mechanical, 15 bioprosthetic, 1 transcatheter AVR) underwent 40 ablations from 2004 to 2016. Left-sided mapping/CA was performed in 27 patients (36 procedures). Access was retrograde aortic in 11 procedures (all bioprosthetic), transseptal in 24 (13 mechanical; 10 bioprosthetic; 1 transcatheter AVR), or transventricular septal in 1. Periaortic bipolar or unipolar scar was detected in all 24 patients in whom detailed periaortic mapping was performed. Clinical VT circuit(s) involved the periaortic region in 10 patients (34%), 2 (7%) had bundle branch re-entry VT, and 17 (59%) had substrate unrelated to AVR. There were 2 major complications (both related to vascular access). Only 2 patients (9.1%) had VT recurrence. Over median follow-up of 12.8 months, 11 patients died (none as a result of recurrent VT). Conclusions Whereas most patients undergoing CA for VT after AVR had VT from substrate unrelated to AVR, periaortic scar is universally present and bundle branch re-entry can be the VT mechanism. CA can be safely performed with excellent long-term VT elimination.
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- 2019
43. PO-681-01 SEPTAL SUBSTRATE ABLATION GUIDED BY DELAYED TRANSMURAL CONDUCTION TIMES: A NOVEL ABLATION APPROACH TO TARGET INTRAMURAL SUBSTRATES
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Martín Ricardo Arceluz, Bryce Hambach, Fermin C. Garcia, David J. Callans, Gregory E. Supple, Robert D. Schaller, David S. Frankel, Jeffrey Arkles, Matthew C. Hyman, Ramanan Kumareswaran, Gustavo S. Guandalini, David Lin, Sanjay Dixit, Saman Nazarian, Daniele Muser, Francis E. Marchlinski, and Pasquale Santangeli
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
44. PO-714-08 DIFFUSE INTERSTITIAL FIBROSIS DETECTED BY CMR-T1 MAPPING TO IDENTIFY IRREVERSIBILITY OF LV CARDIOMYOPATHY IN PATIENTS WITH FREQUENT PREMATURE VENTRICULAR COMPLEXES
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Daniele Muser, Silvia Magnani, Gaetano Nucifora, Andres Enriquez, Ioan Liuba, Anwar A. Chahal, Martín Ricardo Arceluz, Simon A. Castro, Weeranun Dechyapirom Bode, Jeffrey Arkles, David Lin, Cory M. Tschabrunn, Erica S. Zado, Robert D. Schaller, Rajat Deo, Fermin C. Garcia, David S. Frankel, David J. Callans, Francis E. Marchlinski, and Pasquale Santangeli
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
45. PO-636-02 UTILITY OF HIGH OUTPUT PACING TO IDENTIFY CRITICAL COMPONENTS OF VENTRICULAR TACHYCARDIA CIRCUITS IN PATIENTS WITH ISCHEMIC AND NONISCHEMIC CARDIOMYOPATHY
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Bishnu P. Dhakal, Lohit Garg, David S. Frankel, Matthew Craig Hyman, Gustavo S. Guandalini, Gregory E. Supple, Saman Nazarian, Ramanan Kumareswaran, Michael P. Riley, Pasquale Santangeli, David Lin, David J. Callans, Jeffrey Arkles, Fermin C. Garcia, Robert D. Schaller, Erica S. Zado, Francis E. Marchlinski, and Sanjay Dixit
- Subjects
Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
46. CE-544-03 INCIDENCE AND PREDICTORS OF ACQUIRED LV DYSFUNCTION IN PATIENTS WITH ASYMPTOMATIC FREQUENT PREMATURE VENTRICULAR COMPLEXES: A LONGITUDINAL CMR STUDY
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Silvia Magnani, Daniele Muser, Gaetano Nucifora, Andres Enriquez, Simon A. Castro, Ioan Liuba, Weeranun Dechyapirom Bode, Jeffrey Arkles, Erica S. Zado, Robert D. Schaller, Rajat Deo, Fermin C. Garcia, David S. Frankel, David J. Callans, Martín Ricardo Arceluz, David Lin, Cory M. Tschabrunn, Francis E. Marchlinski, and Pasquale Santangeli
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
47. Idiopathic Atypical Atrial Flutter Is Associated With a Distinct Atriopathy
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Pasquale Santangeli, Gregory E. Supple, Saman Nazarian, Jeffrey Smietana, David Lin, Katie Walsh, Matthew C. Hyman, Jeffrey Arkles, Tharian S. Cherian, and Francis E. Marchlinski
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medicine.medical_specialty ,Electrocardiography ,Atrial Flutter ,business.industry ,Internal medicine ,Cardiology ,Catheter Ablation ,Medicine ,Humans ,business ,Atypical atrial flutter - Published
- 2021
48. Esophageal luminal temperature rise during atrial fibrillation ablation is associated with lower radiofrequency electrode distance and baseline impedance
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Benoit Desjardins, Saman Nazarian, Yuchi Han, Ling Kuo, MirMilad Pourmousavi Khoshknab, Pasquale Santangeli, Francis E. Marchlinski, Jeffrey Arkles, and Tarek Zghaib
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Male ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Article ,Lesion ,03 medical and health sciences ,Esophagus ,0302 clinical medicine ,Physiology (medical) ,Atrial Fibrillation ,Electric Impedance ,Medicine ,Humans ,Baseline impedance ,030212 general & internal medicine ,Electrodes ,Aged ,Retrospective Studies ,business.industry ,Temperature ,Atrial fibrillation ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Ablation ,medicine.anatomical_structure ,Catheter Ablation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Nuclear medicine - Abstract
INTRODUCTION: Esophageal injury during atrial fibrillation (AF) ablation is a life-threatening complication. We sought to measure the association of esophageal temperature attenuation with radiofrequency (RF) electrode impedance, contact force, and distance from the esophagus. METHODS: The retrospective study cohort included 35 patients with mean age 64 ± 10 years, of whom 74.3% were male, and 40% had persistent AF. All patients had undergone preprocedural cardiac magnetic resonance (CMR) followed by AF ablation with luminal esophageal temperature monitoring. Lesion locations were co-registered with CMR image segmentations of left atrial and esophageal anatomy. Luminal esophageal temperature, time matched RF lesion data, and ablation distance from the nearest esophageal location were collected as panel data. RESULTS: Luminal esophageal temperature changes corresponding to 3667 distinct lesions, delivered with mean power 27.9 ± 5.5 W over a mean duration of 22.2 ± 10.5 s were analyzed. In multivariable analyses, clustered per patient, examining posterior wall lesions only, and adjusted for lesion power and duration as set by the operator, lesion distance from the esophagus (−0.003°C/mm, p < .001), and baseline impedance (−0.015°C/Ω, p < .001) were associated with changes in luminal esophageal temperature. CONCLUSION: Esophageal luminal temperature rises are associated with shorter lesion distance from esophagus and lower baseline impedance during RF lesion delivery. When procedural strategy requires RF delivery near the esophagus, selection of sites with higher baseline impedance may improve safety.
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- 2021
49. B-PO03-216 VENTRICULAR TACHYCARDIA SECONDARY TO CORONARY VASOSPASM: A CASE SERIES
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Gregory E. Supple, Katie Walsh, David J. Callans, David Lin, Matthew C. Hyman, Fermin C. Garcia, Jeffrey Arkles, Andrew E. Epstein, Rajat Deo, Robert D. Schaller, Sanjay Dixit, Pasquale Santangeli, Francis E. Marchlinski, Michael P. Riley, David S. Frankel, Ramanan Kumareswaran, Cory M. Tschabrunn, Saman Nazarian, and Gustavo S. Guandalini
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,Coronary vasospasm ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Ventricular tachycardia - Published
- 2021
50. B-PO02-127 OUTCOMES OF CATHETER ABLATION OF VENTRICULAR ARRHYTHMIAS ORIGINATING FROM A LEFT VENTRICULAR FALSE TENDON
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David J. Callans, David Lin, Aravind G. Kalluri, Jeffrey Arkles, Francis E. Marchlinski, Katie Walsh, Pasquale Santangeli, Bishnu P. Dhakal, Cory M. Tschabrunn, Erica S. Zado, Gregory E. Supple, Lohit Garg, David S. Frankel, Saman Nazarian, Ramanan Kumareswaran, Sanjay Dixit, Matthew C. Hyman, and Fermin C. Garcia
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,Internal medicine ,medicine ,Cardiology ,Catheter ablation ,False tendon ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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