129 results on '"Jose A. Joglar"'
Search Results
2. 2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy
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Jose A. Joglar, Suraj Kapa, Elizabeth V. Saarel, Anne M. Dubin, Bulent Gorenek, Afshan B. Hameed, Sissy Lara de Melo, Miguel A. Leal, Blandine Mondésert, Luis D. Pacheco, Melissa R. Robinson, Andrea Sarkozy, Candice K. Silversides, Danna Spears, Sindhu K. Srinivas, Janette F. Strasburger, Usha B. Tedrow, Jennifer M. Wright, Carolyn M. Zelop, and Dominica Zentner
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
3. Atrial Fibrillation and Heart Failure: Is It the Chicken or the Egg?
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Jose A. Joglar
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Cardiology and Cardiovascular Medicine - Published
- 2023
4. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary
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Deborah B. Diercks, Leslee J. Shaw, Wael A. Jaber, Phillip D. Levy, Robert E. O'Connor, Renee P. Bullock-Palmer, Theresa Conejo, Kim K. Birtcher, Federico Gentile, Steven M. Hollenberg, Ron Blankstein, Erik P. Hess, Ezra A. Amsterdam, Jose A. Joglar, John P Greenwood, David A. Morrow, Debabrata Mukherjee, Deepak L. Bhatt, Hani Jneid, Martha Gulati, Michael A. Ross, and Jack H. Boyd
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medicine.medical_specialty ,Executive summary ,business.industry ,Physical therapy ,Medicine ,Guideline ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Chest pain - Published
- 2021
5. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain
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Federico Gentile, Leslee J. Shaw, Deborah B. Diercks, Ezra A. Amsterdam, Renee P. Bullock-Palmer, Michael A. Ross, Hani Jneid, Deepak L. Bhatt, Jose A. Joglar, Phillip D. Levy, Erik P. Hess, Kim K. Birtcher, Debabrata Mukherjee, David A. Morrow, Martha Gulati, Robert E. O'Connor, John P Greenwood, Wael A. Jaber, Ron Blankstein, Steven M. Hollenberg, Theresa Conejo, and Jack Boyd
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medicine.medical_specialty ,Cochrane collaboration ,Adult patients ,business.industry ,Emergency department ,Guideline ,Chest pain ,Clinical Practice ,Emergency medicine ,Health care ,medicine ,Radiology, Nuclear Medicine and imaging ,Observational study ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aim This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. Methods A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure Chest pain is a frequent cause for emergency department visits in the United States. The “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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- 2021
6. Competency-Based Alternative Training Pathway in Cardiovascular Disease and Clinical Cardiac Electrophysiology
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Lisa A. Mendes, Gaby Weissman, Katie Berlacher, Julie B. Damp, Jose A. Joglar, Judith Mackall, Chittur A. Sivaram, Ada C. Stefanescu Schmidt, Eric S. Williams, and James A. Arrighi
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Cardiovascular Diseases ,Cardiology ,Humans ,Clinical Competence ,Cardiology and Cardiovascular Medicine ,Electrophysiologic Techniques, Cardiac ,Societies, Medical - Published
- 2022
7. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary
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Anita Deswal, Michelle M. Kittleson, Matthew W. Martinez, Christopher Semsarian, Lauren L. Evanovich, Michael A. Burke, Judy Hung, Steve R. Ommen, Christina Y. Miyake, Paul F. Kantor, Paul Sorajja, Carey Kimmelstiel, Seema Mital, Jose A. Joglar, Sharlene M. Day, Perry M. Elliott, Hartzell V. Schaff, Mark S. Link, and Martin S. Maron
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medicine.medical_specialty ,Executive summary ,business.industry ,medicine.medical_treatment ,Psychological intervention ,Hypertrophic cardiomyopathy ,Guideline ,030204 cardiovascular system & hematology ,Implantable cardioverter-defibrillator ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Health care ,medicine ,030212 general & internal medicine ,Dosing ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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- 2020
8. Quantification of Female and Underrepresented Minority Applicants to Clinical Cardiac Electrophysiology Fellowship
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Uyanga Batnyam, David Chang, Jim W. Cheung, Jose A. Joglar, James P. Daubert, and Usha Tedrow
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Humans ,Internship and Residency ,Female ,Fellowships and Scholarships ,Electrophysiologic Techniques, Cardiac ,Minority Groups - Published
- 2022
9. Meta-analysis of Usefulness of Phrenic Nerve Stimulation in Central Sleep Apnea
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Sonia Ali Malik, Jose A. Joglar, Neeraj Kaplish, James D. Daniels, Richard Wu, Mark S. Link, Faraz Khan Luni, and Nath Zungsontiporn
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medicine.medical_specialty ,Central sleep apnea ,Polysomnography ,medicine.medical_treatment ,Rapid eye movement sleep ,Sleep, REM ,Electric Stimulation Therapy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Hypoxia ,Neurostimulation ,Phrenic nerve ,medicine.diagnostic_test ,business.industry ,Sleep apnea ,medicine.disease ,Sleep Apnea, Central ,Confidence interval ,Phrenic Nerve ,Treatment Outcome ,Apnea–hypopnea index ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Transvenous neurostimulation of the phrenic nerve (PNS) is a potentially improved and unique approach to the treatment of central sleep apnea (CSA). There have been multiple studies with limited individuals evaluating the efficacy of PNS. Our aim was to review and pool those studies to better understand whether phrenic nerve stimulation is efficacious in the treatment of CSA. The initial search on Pubmed retrieved a total of 97 articles and after screening all articles, only 5 could be included in our quantitative analysis. Pooling of data from 5 studies with a total of 204 patients demonstrated a reduction of mean apnea hypopnea index with PNS compared to controls by -26.7 events/hour with 95% confidence interval and P value of [CI (-31.99, -21.46), I2 85, p 0.00]. The mean difference in central apnea index was -22.47 [CI (-25.19, -19.76), I2 0, p 0.00]. The mean reduction in the oxygen desaturation index of 4% or more demonstrated a decrease in PNS group by -24.16 events/hour [(CI -26.20, -22.12), I2 0, p 0.00] compared with controls. PNS resulted in mean reduction in arousal index of -13.77 [CI (-16.15, -11.40), I2 0, p 0.00]. The mean change in percent of time spent in rapid eye movement sleep demonstrated a nonsignificant increase in PNS group by 1.01 % [CI (-5.67, 7.86), I293, p 0.75]. In conclusion, PNS therapy for treating CSA demonstrated positive outcomes but larger randomized studies are needed to evaluate the safety and clinical outcomes.
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- 2020
10. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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Renee P. Bullock-Palmer, Debabrata Mukherjee, Phillip D. Levy, Leslee J. Shaw, Michael A. Ross, Deborah B. Diercks, Deepak L. Bhatt, Steven M. Hollenberg, Wael A Jaber, Ezra A. Amsterdam, Robert E. O'Connor, Theresa Conejo, Kim K. Birtcher, Erik P. Hess, John P Greenwood, Ron Blankstein, Hani Jneid, Martha Gulati, Jose A. Joglar, David A. Morrow, Jack H. Boyd, and Federico Gentile
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Research Report ,Chest Pain ,Acute coronary syndrome ,medicine.medical_specialty ,Cardiology ,Chest pain ,Angina ,Coronary artery disease ,Physiology (medical) ,medicine ,Humans ,Registries ,Myocardial infarction ,Societies, Medical ,Randomized Controlled Trials as Topic ,business.industry ,American Heart Association ,Guideline ,Emergency department ,medicine.disease ,United States ,Observational Studies as Topic ,Emergency medicine ,Observational study ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Aim:This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods:A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered.Structure:Chest pain is a frequent cause for emergency department visits in the United States. The “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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- 2021
11. Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association
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Lin Y. Chen, Jose A. Joglar, William K. Cornwell, Nassir F. Marrouche, Rakesh Gopinathannair, Vascular Biology, Andrea Natale, Mina K. Chung, Dhanunjaya Lakkireddy, Brian Olshansky, and Karen L. Furie
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medicine.medical_specialty ,medicine.medical_treatment ,Cardiomyopathy ,Management of atrial fibrillation ,Catheter ablation ,law.invention ,Randomized controlled trial ,law ,Heart Rate ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Stroke ,Heart Failure ,Ejection fraction ,business.industry ,Disease Management ,Atrial fibrillation ,Stroke Volume ,American Heart Association ,medicine.disease ,United States ,Heart failure ,Cardiology ,Catheter Ablation ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee’s consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
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- 2021
12. A New Tachyarrhythmia in a 60-Year-Old Woman
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Ari J. Bennett, Spencer Carter, and Jose A. Joglar
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medicine.medical_specialty ,business.industry ,Physiology (medical) ,General surgery ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
13. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay
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Annemarie Thompson, Nora Goldschlager, Robert M. Hamilton, Robert Kim, Christopher J. McLeod, Michael R. Gold, Fred M. Kusumoto, Kimberly A. Selzman, Richard T. Lee, Jose A. Joglar, Paul D. Varosy, Keith R. Oken, James R. Edgerton, Kenneth A. Ellenbogen, Coletta Barrett, Mark H. Schoenfeld, Kristen K. Patton, Cara N. Pellegrini, and Joseph E. Marine
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Bradycardia ,medicine.medical_specialty ,Cardiac pacing ,Task force ,business.industry ,Guideline ,030204 cardiovascular system & hematology ,Heart Rhythm ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Cardiac conduction ,medicine ,Cardiology ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Holter monitoring - Abstract
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [‡‡][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, PharmD, MS, AACC Biykem Bozkurt, MD, PhD
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- 2019
14. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary
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Richard T. Lee, Mark H. Schoenfeld, Coletta Barrett, Fred M. Kusumoto, Paul D. Varosy, Annemarie Thompson, Nora Goldschlager, Jose A. Joglar, Robert M. Hamilton, Joseph E. Marine, James R. Edgerton, Kimberly A. Selzman, Kenneth A. Ellenbogen, Keith R. Oken, Robert Kim, Kristen K. Patton, Cara N. Pellegrini, Christopher J. McLeod, and Michael R. Gold
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Bradycardia ,medicine.medical_specialty ,Heart block ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Guideline ,medicine.disease ,Sick sinus syndrome ,Cardiac surgery ,Physiology (medical) ,Internal medicine ,Cardiac conduction ,medicine ,Cardiology ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
15. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies
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Joshua A. Beckman, Sana M. Al-Khatib, Joaquin E. Cigarroa, Duminda N. Wijeysundera, Kim K. Birtcher, Glenn N. Levine, Federico Gentile, Mark A. Hlatky, Jose A. Joglar, Anita Deswal, Patrick T. O'Gara, Mariann R. Piano, Lee A. Fleisher, Zachary D. Goldberger, and Lisa de las Fuentes
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medicine.medical_specialty ,business.industry ,Task force ,Cardiovascular health ,MEDLINE ,Evidence-based medicine ,Guideline ,Scientific evidence ,Clinical Practice ,Internal medicine ,Cardiology ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Association (psychology) - Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health [(1)][1]. These guidelines, based on systematic methods to evaluate and classify
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- 2019
16. Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta‐analysis of current evidence
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Sobia Khan, Jose A. Joglar, Richard Wu, Faraz Khan Luni, Sonia Ali Malik, Nath Zungsontiporn, Talha Farid, Mark S. Link, and James D. Daniels
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medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Hemodynamics ,Catheter ablation ,030204 cardiovascular system & hematology ,Ablation ,Ventricular tachycardia ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Ventricular assist device ,Meta-analysis ,medicine ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business - Abstract
Introduction Catheter ablation of ventricular tachycardia (VT) can be an effective therapy to reduce VT burden, but often it is limited by the potential for hemodynamic instability. Percutaneous left ventricular assist devices (pLVADs) have been used to maintain hemodynamic support during VT ablation but the evidence regarding its clinical impact has been inconclusive. Methods and results We sought to assess the clinical impact of pLVAD when used in VT ablation by conducting a meta-analysis of the current evidence. We searched Pubmed and found nine observational studies that compared clinical outcomes of VT ablation in patients with pLVAD support to controls with no pLVAD support. The pooled data did not show a significant difference in mortality between both groups, nor a difference in acute procedural success or in recurrence of VT. There was also no difference in the number of patients receiving a cardiac transplant or being enrolled in the transplant list. Although there was no difference in the ablation time between the groups, patients in the pLVAD group had a longer total procedural time and more procedure-related adverse effects. Conclusion This meta-analysis did not show clinical benefits from using pLVAD support during VT ablation, whereas it was associated with longer procedure times and more complications. This study was, however, limited by the observational nature of the data. In view of these data, the risk and benefit of pLVAD support during VT ablation should be considered on an individual basis.
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- 2019
17. Electrical abnormalities with St. Jude Medical/Abbott pacing leads: Let’s not call it lead failure yet
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Jose A. Joglar
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Defibrillators, Implantable ,Physiology (medical) ,medicine ,Lead failure ,Equipment Failure ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
18. PO-627-02 QUANTIFICATION OF WOMEN AND UNDER-REPRESENTED MINORITY APPLICANTS TO CLINICAL CARDIAC ELECTROPHYSIOLOGY FELLOWSHIP
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Uyanga Batnyam, David Chang, Jim W. Cheung, Jose A. Joglar, James P. Daubert, and Usha B. Tedrow
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
19. EN-728-02 QUANTIFICATION OF WOMEN AND UNDER-REPRESENTED MINORITY APPLICANTS TO CLINICAL CARDIAC ELECTROPHYSIOLOGY FELLOWSHIP
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Uyanga Batnyam, David Chang, Jim W. Cheung, Jose A. Joglar, James P. Daubert, and Usha B. Tedrow
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2022
20. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death
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Christopher B. Granger, David J. Callans, Timm Dickfeld, Stephen C. Hammill, Robert J. Myerburg, Mark A. Hlatky, Anne B. Curtis, Michael E. Field, Sana M. Al-Khatib, William J. Bryant, Anne M. Gillis, Jose A. Joglar, Daniel D. Matlock, Barbara J. Deal, Gregg C. Fonarow, Richard L. Page, William G. Stevenson, G. Neal Kay, and Michael J. Ackerman
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Sudden cardiac arrest ,Guideline ,030204 cardiovascular system & hematology ,Implantable cardioverter-defibrillator ,medicine.disease ,Ventricular tachycardia ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Heart failure ,medicine ,Cardiology ,030212 general & internal medicine ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [¶][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, MS, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC
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- 2018
21. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary
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Stephen C. Hammill, Anne M. Gillis, William J. Bryant, Christopher B. Granger, Michael E. Field, William G. Stevenson, Richard L. Page, Anne B. Curtis, Timm Dickfeld, G. Neal Kay, Michael J. Ackerman, David J. Callans, Sana M. Al-Khatib, Daniel D. Matlock, Mark A. Hlatky, Jose A. Joglar, Gregg C. Fonarow, Barbara J. Deal, and Robert J. Myerburg
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medicine.medical_specialty ,Task force ,business.industry ,medicine.medical_treatment ,Sudden cardiac arrest ,Guideline ,030204 cardiovascular system & hematology ,medicine.disease ,Ventricular tachycardia ,Implantable cardioverter-defibrillator ,Sudden cardiac death ,Heart Rhythm ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Heart failure ,Internal medicine ,medicine ,Cardiology ,030212 general & internal medicine ,Myocardial infarction ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [¶][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, MS, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC
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- 2018
22. Management of Arrhythmias After Heart Transplant: Current State and Considerations for Future Research
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Justin M. Vader, Brian P. Bateson, Mina K. Chung, Mohit K. Turagam, Peter M. Kistler, Edo Y. Birati, Elaine Wan, Mark H. Drazner, Dhanunjaya Lakkireddy, Ghulam Murtaza, Jose A. Joglar, Michael Loguidice, Alejandra Gutierrez, Rakesh Gopinathannair, Basil Saour, Mark S. Slaughter, Jeanne E. Poole, and Ravi Dhingra
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medicine.medical_specialty ,medicine.medical_treatment ,Electric Countershock ,Action Potentials ,Catheter ablation ,030204 cardiovascular system & hematology ,Sudden death ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,Animals ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Heart transplantation ,business.industry ,Atrial fibrillation ,Arrhythmias, Cardiac ,medicine.disease ,Defibrillators, Implantable ,Transplantation ,Treatment Outcome ,Heart failure ,cardiovascular system ,Cardiology ,Catheter Ablation ,Heart Transplantation ,Supraventricular tachycardia ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
Orthotropic heart transplantation remains the most effective therapy for patients with end-stage heart failure, with a median survival of ≈13 years. Yet, a number of complications are observed after orthotropic heart transplantation, including atrial and ventricular arrhythmias. Several factors contribute to arrhythmias, such as autonomic denervation, effect of the surgical technique, acute and chronic rejection, and transplant vasculopathy among others. To minimize risk of future arrhythmias, the bicaval technique and minimizing ischemic time are current surgical standards. Sinus node dysfunction is the most common indication for early (within 30 days) pacemaker implantation, whereas atrioventricular block incidence increases as time from transplant increases. Atrial fibrillation can occur in the first few weeks following transplantation but is uncommon in the long term unless secondary to a precipitant such as acute rejection. The most common atrial arrhythmias are atrial flutters, which are mainly typical, but atypical circuits can be observed such as those that involve the remnant donor atrium in regions immediately adjacent to the atrioatrial anastomosis suture line. Choosing the appropriate pharmacological therapy requires careful consideration due to the potential interaction with immunosuppressive agents. Despite historical concerns, adenosine is effective and safe at reduced doses if administered under cardiac monitoring. Catheter ablation has emerged as an effective treatment strategy for symptomatic supraventricular tachycardias, including ablation of atypical flutter circuits. Cardiac allograft vasculopathy is an important risk factor for sudden cardiac death, yet the role of prophylactic implantable cardioverter-defibrillator implant for sudden death prevention is unclear. Current indications for implantable cardioverter-defibrillator implantation are as in the nontransplant population. A number of questions for future research are posed.
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- 2021
23. Worldwide Survey of COVID-19-Associated Arrhythmias
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Pietro Enea Lazzerini, Alberto Cipriani, Fatima Rodriguez, Mauricio Scanavacca, Connor O'Brien, Lia Crotti, Paul J. Wang, Wee Kooi Cheah, Serena Bricoli, Angelo Auricchio, Yi Li, Nicolas Schaerli, Federico Franchi, Angelo B. Biviano, Saud Ahmed Khawaja, Shashank Jain, Filippo Donato, Anna Rosenblatt, Milton E Guevara-Valdivia, Michela Casella, Stephanie M. Kochav, Chia Siang Kow, Seongwook Han, Paola Ferrari, Cynthia M. Tracy, Daniele Fabbri, Raphael Twerenbold, Stefan Osswald, Julio Echarte-Morales, Aditi Naniwadekar, Carlos Minguito-Carazo, Joseph G. Akar, Federico Migliore, Vahideh Laleh Far, Gianfranco Parati, Masoud Eslami, Elaine Wan, Rosario Bonura, Luciana Sacilotto, Ilhwan Yeo, Melissa Y.Y. Moey, Pier Leopoldo Capecchi, Prapa Kanagaratnam, Carlos A. Rivera-Santiago, Keith Sai Kit Leung, Ludhmila Abrahão Hajjar, Jongmin Hwang, Reza Mollazadeh, Mauricio Pimentel, Amato Santoro, Gary Tse, Giuseppe Boriani, Avinainder Singh, Seth Goldbarg, Isaac L Goldenthal, Anna Vittoria Mattioli, Jose A. Joglar, James Coromilas, Tomás Benito-González, Paolo De Filippo, Joon Hyuk Kim, Felipe Fernández-Vázquez, Brenno Rizerio, Ellie J. Coromilas, Hasan Garan, Marco Zardini, Eduardo Zatarain, Shant Ayanian, Paolo Compagnucci, Kyoko Soejima, Antonio Dello Russo, Giovanni Malanchini, Giulio Conte, Ghada W. Mikhail, Leandro Ioschpe Zimerman, Felipe Atienza, Andrew Aboyme, Clinical sciences, Coromilas, E, Kochav, S, Goldenthal, I, Biviano, A, Garan, H, Goldbarg, S, Kim, J, Yeo, I, Tracy, C, Ayanian, S, Akar, J, Singh, A, Jain, S, Zimerman, L, Pimentel, M, Osswald, S, Twerenbold, R, Schaerli, N, Crotti, L, Fabbri, D, Parati, G, Li, Y, Atienza, F, Zatarain, E, Tse, G, Leung, K, Guevara-Valdivia, M, Rivera-Santiago, C, Soejima, K, De Filippo, P, Ferrari, P, Malanchini, G, Kanagaratnam, P, Khawaja, S, Mikhail, G, Scanavacca, M, Abrahao Hajjar, L, Rizerio, B, Sacilotto, L, Mollazadeh, R, Eslami, M, Laleh Far, V, Mattioli, A, Boriani, G, Migliore, F, Cipriani, A, Donato, F, Compagnucci, P, Casella, M, Dello Russo, A, Coromilas, J, Aboyme, A, O'Brien, C, Rodriguez, F, Wang, P, Naniwadekar, A, Moey, M, Kow, C, Cheah, W, Auricchio, A, Conte, G, Hwang, J, Han, S, Lazzerini, P, Franchi, F, Santoro, A, Capecchi, P, Joglar, J, Rosenblatt, A, Zardini, M, Bricoli, S, Bonura, R, Echarte-Morales, J, Benito-Gonzalez, T, Minguito-Carazo, C, Fernandez-Vazquez, F, and Wan, E
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Tachycardia ,Male ,Time Factors ,Medical Physiology ,Comorbidity ,Practice Patterns ,030204 cardiovascular system & hematology ,Arrhythmias, Cardiac/epidemiology ,Arrhythmias ,Cardiorespiratory Medicine and Haematology ,Global Health ,tachycardia ,Electrophysiologic Techniques, Cardiac/trends ,0302 clinical medicine ,Prevalence ,atrial fibrillation ,030212 general & internal medicine ,Practice Patterns, Physicians' ,COVID-19/epidemiology ,Incidence (epidemiology) ,Incidence ,Atrial fibrillation ,Middle Aged ,Prognosis ,atrial flutter ,cardiovascular system ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Electrophysiologic Techniques ,medicine.symptom ,Risk assessment ,Cardiology and Cardiovascular Medicine ,Electrophysiologic Techniques, Cardiac ,Cardiac ,Bradycardia ,medicine.medical_specialty ,Clinical Sciences ,torsade de pointe ,arrhythmia ,Risk Assessment ,bradycardia ,03 medical and health sciences ,Cardiac Electrophysiology/trends ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Healthcare Disparities ,Retrospective Studies ,Aged ,Global Health/trends ,Physicians' ,SARS-CoV-2 ,business.industry ,COVID-19 ,Retrospective cohort study ,Arrhythmias, Cardiac ,Original Articles ,medicine.disease ,Practice Patterns, Physicians'/trends ,Cardiovascular System & Hematology ,Health Care Surveys ,torsade de pointes ,Cardiac Electrophysiology ,business ,Atrial flutter - Abstract
Supplemental Digital Content is available in the text., Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate
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- 2021
24. Worldwide Survey of COVID-19 Associated Arrhythmias
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Ellie J. Coromilas, Isaac Goldenthal, Angelo Biviano, Hasan Garan, Seth Goldbarg, Joon-Hyuk Kim, Ilhwan Yeo, Cynthia Tracy, Shant Ayanian, Joseph Akar, Avinainder Singh, Shashank Jain, Leandro Zimerman, Maurício Pimentel, Stefan Osswald, Raphael Twerenbold, Nicolas Schaerli, Lia Crotti, Daniele Fabbri, Gianfranco Parati, Yi Li, Felipe Atienza, Eduardo Zatarain, Gary Tse, Keith Sai Kit Leung, Milton E. Guevara-Valdivia, Carlos A. Rivera-Santiago, Kyoko Soejima, Paolo De Filippo, Paola Ferrari, Giovanni Malanchini, Prapa Kanagaratnam, Saud Khawaja, Ghada W. Mikhail, Mauricio Scanavacca, Ludhmila Abrahão Hajjar, Brenno Rizerio Gomes, Luciana Sacilotto, Reza Mollazadeh, Masoud Eslami, Vahideh Laleh far, Anna Vittoria Mattioli, Giuseppe Boriani Federico Migliore, Federico Migliore, Alberto Cipriani, Filippo Donato, Paolo Compagnucci, Michela Casella, Antonio Dello Russo, James Coromilas, Andrew Aboyme, Connor Galen O'Brien, Fatima Rodriguez, Paul J. Wang, Aditi Naniwadekar, Melissa Moey, Chia Siang Know, Wee Kooi Cheah, Angelo Auricchio, Giulio Conte, Jongmin Hwang, Seongwook Han, Pietro Enea Lazzerini, Federico Franchi, Amato Santoro, Pier Leopoldo Capecchi, Jose A. Joglar, Anna G. Rosenblatt, Marco Zardini, Serena Bricoli, Rosario Bonura, Julio Echarte-Morales, Tomás Benito-González, Carlos Minguito-Carazo, Felipe Fernández-Vázquez, and Elaine Y. Wan
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cardiovascular system ,COVID-19 ,cardiovascular diseases ,Arrhythmias ,Survey ,Worldwide - Abstract
BackgroundCOVID-19 has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. MethodsWe conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), non-sustained or sustained ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block (AVB), or marked sinus bradycardia (HR ResultsData was collected for 4,526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes mellitus, 30% had heart failure and 24% coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of AF in Asia compared to other continents (34% vs. 63%). Most patients in in North America and Europe received hydroxychloroquine, though the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. ConclusionsCardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.
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- 2021
25. Arrhythmias in Cardiac Sarcoidosis Bench to Bedside
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Clifford V. Harding, Syed Quadri, Francis Murgatroyd, Mina K. Chung, Konstantinos C. Siontis, David H. Birnie, Davendra Mehta, Thomas Crawford, Jagmeet P. Singh, Logan Vincent, Paul Leis, Christine Jellis, Frank Bogun, Lavanya Bellumkonda, Ashley Bock, Peter Zimetbaum, Johan Grunewald, Christopher Maulion, Edward J. Miller, Jordana Kron, Marc A. Judson, Richard Cheng, Timm Dickfeld, Kenneth A. Ellenbogen, Jerry D. Estep, Edwin T. Zishiri, Ben A. Lin, Jose A. Joglar, Ron Blankstein, Pavan Bhat, Thomas Callahan, Steven Kalbfleish, Lynda E. Rosenfeld, Elizabeth S. Kaufman, Jason Appelbaum, William H. Sauer, Paul Cremer, Daniel A. Culver, Deborah H Kwon, Kristen K. Patton, Paolo Spagnolo, David R. Okada, Jonathan Chrispin, and Maryjane Farr
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Bradycardia ,Tachycardia ,medicine.medical_specialty ,Sarcoidosis ,heart failure ,Disease ,Arrhythmias ,030204 cardiovascular system & hematology ,tachycardia ,bradycardia ,Article ,defibrillator ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Cardiac magnetic resonance imaging ,Physiology (medical) ,medicine ,Humans ,atrial fibrillation ,030212 general & internal medicine ,Intensive care medicine ,medicine.diagnostic_test ,sarcoidosis ,Arrhythmias, Cardiac ,Cardiomyopathies ,business.industry ,Atrial fibrillation ,medicine.disease ,Positron emission tomography ,Heart failure ,cardiovascular system ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cardiac - Abstract
Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and18F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.
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- 2021
26. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary
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Hartzell V. Schaff, Christina Y. Miyake, Matthew W. Martinez, Steve R. Ommen, Paul Sorajja, Paul F. Kantor, Martin S. Maron, Seema Mital, Perry M. Elliott, Judy Hung, Jose A. Joglar, Anita Deswal, Carey Kimmelstiel, Michelle M. Kittleson, Christopher Semsarian, Mark S. Link, Michael A. Burke, Sharlene M. Day, and Lauren L. Evanovich
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medicine.medical_specialty ,Consensus ,medicine.medical_treatment ,Cardiology ,Decision Support Techniques ,Sudden cardiac death ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Pregnancy ,Evidence-Based Medicine ,Executive summary ,business.industry ,Hypertrophic cardiomyopathy ,Atrial fibrillation ,American Heart Association ,Guideline ,Cardiomyopathy, Hypertrophic ,Implantable cardioverter-defibrillator ,medicine.disease ,United States ,Clinical Practice ,Cardiac Imaging Techniques ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Aim This executive summary of the hypertrophic cardiomyopathy clinical practice guideline provides recommendations and algorithms for clinicians to diagnose and manage hypertrophic cardiomyopathy in adult and pediatric patients as well as supporting documentation to encourage their use. Methods A comprehensive literature search was conducted from January 1, 2010, to April 30, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Structure Many recommendations from the earlier hypertrophic cardiomyopathy guidelines have been updated with new evidence or a better understanding of earlier evidence. This summary operationalizes the recommendations from the full guideline and presents a combination of diagnostic work-up, genetic and family screening, risk stratification approaches, lifestyle modifications, surgical and catheter interventions, and medications that constitute components of guideline directed medical therapy. For both guideline-directed medical therapy and other recommended drug treatment regimens, the reader is advised to follow dosing, contraindications and drug-drug interactions based on product insert materials.
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- 2020
27. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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Christopher Semsarian, Steve R. Ommen, Hartzell V. Schaff, Paul F. Kantor, Martin S. Maron, Paul Sorajja, Seema Mital, Jose A. Joglar, Anita Deswal, Perry M. Elliott, Michael A. Burke, Sharlene M. Day, Judy Hung, Christina Y. Miyake, Carey Kimmelstiel, Matthew W. Martinez, Michelle M. Kittleson, Mark S. Link, and Lauren L. Evanovich
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medicine.medical_specialty ,Consensus ,medicine.medical_treatment ,Physical activity ,Cardiology ,Sudden cardiac death ,Decision Support Techniques ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Pregnancy ,Evidence-Based Medicine ,business.industry ,Hypertrophic cardiomyopathy ,Atrial fibrillation ,Guideline ,American Heart Association ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Implantable cardioverter-defibrillator ,United States ,Cardiac Imaging Techniques ,Treatment Outcome ,Risk stratification ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Published
- 2020
28. Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association
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Bharath Rajagopalan, Jacinthe Leclerc, Kristen Bova Campbell, Jose A. Joglar, Mina K. Chung, Muhammad Hammadah, and James E. Tisdale
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Tachycardia ,medicine.medical_specialty ,Torsades de pointes ,030204 cardiovascular system & hematology ,QT interval ,Sudden cardiac death ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Physiology (medical) ,Internal medicine ,medicine ,cardiovascular diseases ,030212 general & internal medicine ,Atrial tachycardia ,Brugada syndrome ,business.industry ,Arrhythmias, Cardiac ,Atrial fibrillation ,American Heart Association ,medicine.disease ,United States ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Abstract
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient’s arrythmia could be drug-induced is important.
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- 2020
29. Procedural Patterns and Safety of Atrial Fibrillation Ablation: Findings From Get With The Guidelines-Atrial Fibrillation
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John D. Day, Jodie L. Hurwitz, Jonathan P. Piccini, Andrea M. Russo, Kenneth A. Ellenbogen, Nihar R. Desai, Mintu P. Turakhia, Mandeep S. Sidhu, Bradley P. Knight, Da Juanicia N. Holmes, David S. Frankel, Jose A. Joglar, Anne B. Curtis, Roland A. Matsouaka, Gregg C. Fonarow, William R. Lewis, Zak Loring, and Gregory K. Feld
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Male ,medicine.medical_specialty ,Time Factors ,hypertension ,medicine.medical_treatment ,Clinical Sciences ,Medical Physiology ,MEDLINE ,Catheter ablation ,Practice Patterns ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Cryosurgery ,Article ,Pulmonary vein ,Postoperative Complications ,Clinical Research ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,catheter ablation ,medicine ,Humans ,Registries ,Practice Patterns, Physicians' ,guideline adherence ,Aged ,pulmonary vein ,Physicians' ,Guideline adherence ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Ablation ,United States ,Treatment Outcome ,Heart Disease ,Cardiovascular System & Hematology ,Pulmonary Veins ,Practice Guidelines as Topic ,Cardiology ,Catheter Ablation ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. Methods: A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ 2 and Wilcoxon rank-sum tests. Results: Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. Conclusions: More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.
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- 2020
30. Incidence of Early Atrial Fibrillation After Transcatheter versus Surgical Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
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Haider, Altaii, Ramez, Morcos, Fady, Riad, Halah, Abdulameer, Houman, Khalili, Brijeshwar, Maini, Eric, Lieberman, Yoel, Vivas, Phi, Wiegn, Jose, A Joglar, Judith, Mackall, Sadeer, G Al-Kindi, and Sergio, Thal
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Atrial fibrillation ,medicine.disease ,law.invention ,Randomized controlled trial ,Aortic valve replacement ,law ,Internal medicine ,Meta-analysis ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Original Research - Abstract
BACKGROUND: Post-operative atrial fibrillation (POAF) is common after aortic valve replacement (AVR) and is associated with worse outcomes. We performed a meta-analysis of randomized controlled trials comparing Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) for incidence of POAF at 30 days. METHODS: We searched databases from 1/1/1990 to 1/1/2020 for randomized studies comparing TAVR and SAVR. POAF was defined as either worsening or new-onset atrial fibrillation. Random effects model was used to estimate the risk of POAF with TAVR vs SAVR in all trials, and in subgroups (low, intermediate, high risk, and in self-expandable vs balloon expandable valves). Sensitivity analysis was performed including only studies reporting new-onset atrial fibrillation. RESULTS: Seven RCTs were identified that enrolled 7,934 patients (3,999 to TAVR and 3,935 to SAVR). The overall incidence of POAF was 9.7% after TAVR and 33.3% after SAVR. TAVR was associated with a lower risk of POAF compared with SAVR (OR 0.21 [0.18-0.24]; P < 0.0001). Compared with SAVR, TAVR was associated with a significantly lower risk of POAF in the high-risk cohort (OR 0.37 [0.27-0.49]; P < 0.0001), in the intermediate-risk cohort (OR 0.23 [0.19-0.28]; P < 0.0001), low-risk cohort (OR 0.13 [0.10-0.16]; P < 0.0001). Sensitivity analysis of 4 trials including only new-onset POAF showed similar summary estimates (OR 0.21, 95% CI [0.18-0.25]; P< 0.0001). CONCLUSIONS: TAVR is associated with a significantly lower risk of post-operative atrial fibrillation compared with SAVR in all strata. Further studies are needed to identify the contribution of post-operative atrial fibrillation to the differences in clinical outcomes after TAVR and SAVR.
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- 2020
31. Abstract 18: Patient-administered Home Inotrope Therapy: A Proof of Concept
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Kavita Bhavan, Sandeep R Das, Chris Mathew, Wally Omar, and Jose A. Joglar
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Inotrope ,medicine.medical_specialty ,Quality of life (healthcare) ,business.industry ,Proof of concept ,Heart failure ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,medicine.disease - Abstract
Background: Palliative use of continuous IV inotrope therapy has shown to improve quality of life and reduce hospital readmissions for patients with end-stage heart failure (HF) who are otherwise ineligible to receive advanced therapies. Administration of home inotrope therapy generally requires a hospice or home-health agency, placing this option out of reach for patients who lack funding. As such, underinsured patients are relegated to the difficult choice of either remaining in the hospital to receive IV inotropes, or going home without the therapy for as long as their symptoms allow. To address this issue at our large county safety-net hospital, we developed and implemented a patient self-administered home inotrope therapy program. Methods: A multidisciplinary team of physicians, pharmacists, nurses, and social workers was assembled to pilot the program. Eligible patients were provided with a peripherally inserted central venous catheter (PICC) and a portable infusion pump. They were then instructed on proper use of the pump, medication administration, medication bag changes, and IV line care using a nursing teach-back technique. After proper understanding was demonstrated, patients were discharged home with weekly follow up in heart failure clinic for PICC-care and medication exchanges. Results: During the initial 12 months of the program, 5 patients were deemed eligible for enrollment. Total hospitalized days for these patients was 277 (mean = 55.4 days) in the one year prior to enrollment and 12 (mean = 2.4 days) while enrolled for a cumulative period of 288 days (Figure 1). One patient was able to secure funding for advanced therapies, two patients died while enrolled, and two patients are currently enrolled and alive. Discussion: A self-administered home IV inotrope therapy program is a feasible alternative for palliation in unfunded patients with end-stage HF who are otherwise not candidates for advanced therapies, allowing for more days at home in the end of life. Thus far, the cost impact of the program has been mitigated by the cost savings for inpatient hospitalizations. Studies to assess patient-centered outcomes, and overall cost savings are ongoing.
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- 2020
32. Association of a Novel Protocol for Rapid Exclusion of Myocardial Infarction With Resource Use in a US Safety Net Hospital
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Lin Zhong, Deborah B. Diercks, José Manuel Gómez Soto, Lorie Thibodeaux, Kyle Molberg, Bryan Bertulfo, Jeffery C. Metzger, James A. de Lemos, Fernabelle Fernandez, Jose A. Joglar, Rebecca Vigen, Ibrahim A. Hashim, Patricia Kutscher, Dergham Alzubaidy, Amy Yu, Sandeep R Das, and Ambarish Pandey
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Adult ,Male ,medicine.medical_specialty ,Chest Pain ,Cardiology ,Myocardial Infarction ,Chest pain ,Troponin T ,medicine ,Humans ,Myocardial infarction ,Original Investigation ,Aged ,Retrospective Studies ,Protocol (science) ,biology ,business.industry ,Research ,Retrospective cohort study ,General Medicine ,Overcrowding ,Emergency department ,Middle Aged ,medicine.disease ,Troponin ,humanities ,Hospitalization ,Online Only ,Early Diagnosis ,Emergency medicine ,biology.protein ,Female ,medicine.symptom ,business ,Emergency Service, Hospital ,Safety-net Providers ,Health care quality - Abstract
Key Points Question Is implementation of a novel high-sensitivity cardiac troponin T protocol in patients with chest pain associated with less resource use and within acceptable safety parameters? Findings This cohort study of 31 543 emergency department encounters found that implementation of the protocol was associated with a shorter length of stay in the emergency department and a higher proportion of patients discharged. There was no difference in the rate of 30-day hospitalization for myocardial infarction or death. Meaning This or similar protocols that rapidly rule out myocardial infarction have the potential to reduce emergency department overcrowding and improve health care quality., This cohort study of patients at a large US safety net hospital examines the safety of and resource use associated with a new protocol for excluding myocardial infarction from diagnosis of patients with chest pains through the use of high-sensitivity troponin., Importance High-sensitivity cardiac troponin T (hs-cTnT) protocols for the evaluation of chest pain in the emergency department (ED) may reduce unnecessary resource use and overcrowding. Objective To determine whether the implementation of a novel hs-cTnT protocol, which incorporated troponin values drawn at 0, 1, and 3 hours after ED presentation and the modified HEART score (history, electrocardiogram, age, risk factors), was associated with improvements in resource use while maintaining safety. Design, Setting, and Participants This retrospective cohort study from Parkland Health and Hospital System, a large safety net hospital in Dallas, Texas, included data on 31 543 unique ED encounters in which patients underwent electrocardiographic and troponin testing from January 1, 2017, to October 16, 2018. The hs-cTnT protocol was implemented in December 2017. Main Outcomes and Measures Resource use outcomes included trends in ED dwell time, troponin to disposition decision time (the difference between the first troponin draw time and the time an order was placed for inpatient admission, admission to observation, or discharge), and final patient disposition. Safety outcomes included readmission for myocardial infarction and death. Results In 31 543 encounters, mean (SD) patient age was 54 (14.4) years and 14 675 patients (48%) were female. Department dwell time decreased by a mean of −1.09 (95% CI, −2.81 to 0.64) minutes per month in the preintervention period. The decline was steeper after the intervention (−4.69 [95% CI, −9.05 to −0.33] minutes per month) (P for interaction = .007). The troponin to disposition time was increasing in the preintervention period by 1.72 (95% CI, 1.08 to 2.36) minutes per month; postintervention, the mean difference increased more slowly (0.37 [95% CI, −1.25 to 1.99 minutes per month; P value for interaction = .007]). The proportion of patients discharged from the ED increased after the intervention (48% vs 54%, P
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- 2020
33. Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association
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Parin Patel, Jim W. Cheung, Rachel Lampert, Tyler J Gluckman, Paul J. Wang, Bharath Rajagopalan, Janet K. Han, Mohit K. Turagam, Brian Olshansky, Joseph E. Marine, Peter A. Noseworthy, Mina K. Chung, Miguel A. Leal, Elaine Wan, Kristin E. Sandau, Elizabeth S Kaufman, Alejandra Gutierrez, Dhanunjaya Lakkireddy, Rakesh Gopinathannair, Jaun Sotomonte, Lee L. Eckhardt, Kristen K. Patton, Jose A. Joglar, and Andrea M. Russo
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Clinical cardiology ,medicine.medical_treatment ,health planning guidelines ,030204 cardiovascular system & hematology ,Electrocardiography ,0302 clinical medicine ,Health care ,Pandemic ,030212 general & internal medicine ,Societies, Medical ,medicine.diagnostic_test ,Cardiac electrophysiology ,Advanced cardiac life support ,American Heart Association ,Implantable cardioverter-defibrillator ,Telemedicine ,Practice Guidelines as Topic ,Cardiology ,Medical emergency ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,Electrophysiologic Techniques, Cardiac ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Cardiac resynchronization therapy ,virus ,03 medical and health sciences ,Betacoronavirus ,Internal medicine ,Physiology (medical) ,Consensus Reports ,medicine ,Humans ,Cardiopulmonary resuscitation ,Pandemics ,Infection Control ,business.industry ,Task force ,SARS-CoV-2 ,practice guideline ,COVID-19 ,Arrhythmias, Cardiac ,electrophysiology ,medicine.disease ,State of the Art ,Cardiopulmonary Resuscitation ,United States ,Heart Rhythm ,pathology ,Triage ,business - Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic that is wreaking havoc on the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint article from representatives of the Heart Rhythm Society, the American College of Cardiology, and the American Heart Association, we identify the potential risks of exposure to patients, allied healthcare staff, industry representatives, and hospital administrators. We also describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and noninvasive electrophysiology procedures, clinic visits, and cardiac device interrogations. In addition, we discuss resource conservation and the role of telemedicine in remote patient care along with management strategies for affected patients.
- Published
- 2020
34. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association
- Author
-
Haitham M. Ahmed, Lee L. Eckhardt, Prashanthan Sanders, Peter A. Noseworthy, Cardiac Rehabilitation Exercise, Quinn R. Pack, Vascular Biology, Lin Y. Chen, Rakesh Gopinathannair, Mina K. Chung, Kevin Trulock, and Jose A. Joglar
- Subjects
medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Weight loss ,Risk Factors ,Physiology (medical) ,Intervention (counseling) ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Intensive care medicine ,Life Style ,business.industry ,Incidence (epidemiology) ,Cardiac arrhythmia ,Sleep apnea ,Atrial fibrillation ,American Heart Association ,medicine.disease ,Obesity ,United States ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
- Published
- 2020
35. Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association
- Author
-
Vascular Biology, Miguel A. Leal, Elizabeth S. Kaufman, Jose A. Joglar, Xiaoxi Yao, Mitchell S.V. Elkind, Sean D. Pokorney, Mina K. Chung, Lin Y. Chen, Pamela J. McCabe, and Peter A. Noseworthy
- Subjects
medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Pacemaker, Artificial ,030204 cardiovascular system & hematology ,Asymptomatic ,Article ,Stroke risk ,03 medical and health sciences ,Wearable Electronic Devices ,0302 clinical medicine ,Risk Factors ,Anesthesiology ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,Clinical significance ,030212 general & internal medicine ,cardiovascular diseases ,Intensive care medicine ,Stroke ,Subclinical infection ,business.industry ,Cardiac arrhythmia ,Atrial fibrillation ,American Heart Association ,medicine.disease ,United States ,Defibrillators, Implantable ,Anesthesiologists ,Increased risk ,cardiovascular system ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.
- Published
- 2019
36. Evaluation of a Novel Rule-Out Myocardial Infarction Protocol Incorporating High-Sensitivity Troponin T in a US Hospital
- Author
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Deborah B. Diercks, Lorie Thibodeaux, Rebecca Vigen, James A. de Lemos, Jose A. Joglar, José Manuel Gómez Soto, Dergham Alzubaidy, Ibrahim A. Hashim, Jeffery C. Metzger, Sandeep R Das, Bryan Bertulfo, Amy Yu, Kyle Molberg, Fernabelle Fernandez, and Patricia Kutscher
- Subjects
Male ,Chest Pain ,medicine.medical_specialty ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Troponin T ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Aged ,biology ,Extramural ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,High Sensitivity Troponin T ,Troponin ,Echocardiography ,biology.protein ,Cardiology ,Female ,Myocardial infarction diagnosis ,Emergency Service, Hospital ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Biomarkers - Published
- 2018
37. B-PO04-059 MEDICATION NONADHERENCE: A PREVIOUSLY UNIDENTIFIED CONFOUNDER UNDERLYING ICD THERAPY
- Author
-
Mohita Singh, Jose A. Joglar, and Mark S. Link
- Subjects
medicine.medical_specialty ,business.industry ,Physiology (medical) ,Internal medicine ,Confounding ,Medication Nonadherence ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Icd therapy - Published
- 2021
38. PREDICTORS OF LATE POST LUNG TRANSPLANT ATRIAL FIBRILLATION AND ORGANIZED ATRIAL TACHYCARDIA DIFFER
- Author
-
Ari J. Bennett, Jose A. Joglar, James D. Daniels, Andrew Sun, Richard Wu, Vaidehi Kaza, Mark S. Link, and Nimesh K. Patel
- Subjects
medicine.medical_specialty ,Lung ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Cardiology ,medicine ,Atrial fibrillation ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Atrial tachycardia - Published
- 2021
39. His-Bundle Pacing for Identifying Optimal Ablation Sites in Patients Undergoing Atrioventricular Junction Ablation
- Author
-
Demetrio Castillo, Richard Wu, Nitin Kulkarni, Jose A. Joglar, Colby Ayers, Ambarish Pandey, and Curtiss Moore
- Subjects
Bundle of His ,medicine.medical_specialty ,Future studies ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Atrioventricular junction ,business.industry ,Body Surface Potential Mapping ,Cardiac Pacing, Artificial ,Reproducibility of Results ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Ablation ,Catheter ,Treatment Outcome ,Bundle ,Atrioventricular Node ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Atrioventricular (AV) junction (AVJ) ablation is conventionally performed by localizing the His-bundle electrogram (HBE). Identification of HBE in the presence of atrial fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His-bundle pacing (HBP). Methods Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach and 11 ablations using HBP. All cases utilized a long femoral guiding sheath and an 8-mm-tip electrode radiofrequency (RF) energy ablation catheter. Pacing was performed at high output (10 mA at 2 ms) to initially achieve right bundle branch capture. The catheter was withdrawn until a narrow QRS morphology and increased stim-to-QRS time were observed. HBP was confirmed when paced and native QRS were identical in morphology. RF energy was applied at the site of HBP capture until AV block was observed. Results Baseline characteristics of patients in each arm were not significantly different. Compared with the standard approach, HBP was associated with trends toward lower RF applications (3 vs. 2, P = 0.16) and shorter mean RF time (208 seconds vs. 128 seconds, P = 0.19). Conclusion HBP is an effective technique to identify optimal ablation sites during AVJ ablation and may shorten procedure time. HBP can be used to identify the AV node during AF without recording the His potential. Future studies with larger sample size are needed to better characterize the utility of this technique.
- Published
- 2017
40. Transvenous or Subcutaneous ICD — Similar but Different
- Author
-
Mark S. Link and Jose A. Joglar
- Subjects
Tachycardia ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,General Medicine ,030204 cardiovascular system & hematology ,Implantable cardioverter-defibrillator ,Surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,030212 general & internal medicine ,medicine.symptom ,business - Abstract
The results of the long-awaited Prospective Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy (PRAETORIAN) trial — a randomized, controlled trial ...
- Published
- 2020
41. Response to the Editor: Percutaneous left ventricular assist device support during ablation of ventricular tachycardia: A meta-analysis of current evidence
- Author
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Nath Zungsontiporn, Jose A. Joglar, Mark S. Link, and Faraz Khan Luni
- Subjects
Tachycardia ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,MEDLINE ,Arrhythmias, Cardiac ,Ablation ,Ventricular tachycardia ,medicine.disease ,Text mining ,Physiology (medical) ,Ventricular assist device ,Meta-analysis ,Internal medicine ,medicine ,Cardiology ,Tachycardia, Ventricular ,Humans ,Heart-Assist Devices ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
42. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association
- Author
-
Jonathan W. Dukes, Jose A. Joglar, Francis D. Pagani, Kristen K. Patton, Kathleen T. Hickey, Mark S. Slaughter, Henri Roukoz, Christopher R. Ellis, Rakesh Gopinathannair, and William K. Cornwell
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Psychological intervention ,Cardiac resynchronization therapy ,Cardiac Output, Low ,Catheter ablation ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,03 medical and health sciences ,0302 clinical medicine ,Professional-Family Relations ,Physiology (medical) ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Heart Atria ,Heart-Assist Devices ,Intensive care medicine ,Heart Failure ,Ejection fraction ,business.industry ,Arrhythmias, Cardiac ,Equipment Design ,Cardiovascular Nurse ,medicine.disease ,Survival Analysis ,Defibrillators, Implantable ,Ventricular assist device ,Heart failure ,cardiovascular system ,Catheter Ablation ,Equipment Failure ,Interdisciplinary Communication ,Cardiology and Cardiovascular Medicine ,business - Abstract
Left ventricular assist devices (LVADs) are an increasingly used strategy for the management of patients with advanced heart failure with reduced ejection fraction. Although these devices effectively improve survival, atrial and ventricular arrhythmias are common, predispose these patients to additional risk, and complicate patient management. However, there is no consensus on best practices for the medical management of these arrhythmias or on the optimal timing for procedural interventions in patients with refractory arrhythmias. Although the vast majority of these patients have preexisting cardiovascular implantable electronic devices or cardiac resynchronization therapy, given the natural history of heart failure, it is common practice to maintain cardiovascular implantable electronic device detection and therapies after LVAD implantation. Available data, however, are conflicting on the efficacy of and optimal device programming after LVAD implantation. Therefore, the primary objective of this scientific statement is to review the available evidence and to provide guidance on the management of atrial and ventricular arrhythmias in this unique patient population, as well as procedural interventions and cardiovascular implantable electronic device and cardiac resynchronization therapy programming strategies, on the basis of a comprehensive literature review by electrophysiologists, heart failure cardiologists, cardiac surgeons, and cardiovascular nurse specialists with expertise in managing these patients. The structure and design of commercially available LVADs are briefly reviewed, as well as clinical indications for device implantation. The relevant physiological effects of long-term exposure to continuous-flow circulatory support are highlighted, as well as the mechanisms and clinical significance of arrhythmias in the setting of LVAD support.
- Published
- 2019
43. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- Author
-
John S. Ikonomidis, Sana M. Al-Khatib, Salim S. Virani, Zachary D. Goldberger, Joseph Yeboah, Ellen J. Hahn, Joshua A. Beckman, Roger S. Blumenthal, Donald M. Lloyd-Jones, Laura Mauri, Amit Khera, Kim K. Birtcher, Aha Task Force Members, Barbara Riegel, Duminda N. Wijeysundera, Michelle A. Albert, J. William McEvoy, Erin D. Michos, Daniel Muñoz, Cheryl Dennison Himmelfarb, Mariann R. Piano, Andrew B. Buroker, Mark A. Hlatky, Michael D. Miedema, Patrick T. O'Gara, Federico Gentile, Kim A. Williams, Boback Ziaeian, Sidney C. Smith, Jose A. Joglar, Anita Deswal, Donna K. Arnett, Lee A. Fleisher, Joaquin E. Cigarroa, and Glenn N. Levine
- Subjects
psychosocial deprivation ,type 2 diabetes mellitus ,primary prevention ,heart failure ,physical activity ,treatment outcomes ,Disease ,Cardiorespiratory Medicine and Haematology ,coronary disease ,tobacco ,cardiovascular disease ,cost ,behavior therapy ,LDL-cholesterol ,risk factors ,risk-enhancing factors ,atrial fibrillation ,guidelines ,Myocardial infarction ,dietary sodium ,risk reduction ,Aspirin ,exercise ,cardiovascular ,public health ,blood pressure ,risk assessment ,atherosclerotic cardiovascular disease ,e-cigarettes ,quality indicators ,antihypertensive agents ,waist circumference ,healthcare disparities ,Primary Prevention ,myocardial infarction ,nutrition ,Cardiovascular Diseases ,cardiovascular team-based care ,social determinants of health ,diabetes mellitus ,Public Health and Health Services ,risk reduction discussion ,Cardiology and Cardiovascular Medicine ,medicine.drug ,index ,ACC/AHA Clinical Practice Guidelines ,lifestyle ,medicine.medical_specialty ,hypertension ,aspirin ,risk treatment discussion ,Clinical Sciences ,Advisory Committees ,dietary patterns ,quality measurement ,socioeconomic factors ,treatment adherence ,Article ,smoking ,coronary artery calcium score ,tobacco smoke pollution ,lipids ,Diabetes mellitus ,Primary prevention ,Internal medicine ,medicine ,Humans ,coronary heart disease ,sleep ,behavior modification ,business.industry ,dyslipidemia ,cholesterol ,dietary fats ,Guideline ,prejudice ,medicine.disease ,body mass ,smoking cessation ,systems of care ,Cardiovascular System & Hematology ,statin therapy ,nonpharmacological treatment ,Heart failure ,blood cholesterol ,health services accessibility ,measurement ,atherosclerosis ,weight loss ,diet ,business ,chronic kidney disease ,Dyslipidemia ,nicotine ,secondhand smoke - Published
- 2019
44. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary
- Author
-
Boback Ziaeian, Sidney C. Smith, Erin D. Michos, Federico Gentile, Anita Deswal, Donna K. Arnett, Duminda N. Wijeysundera, Andrew B. Buroker, Zachary D. Goldberger, Amit Khera, Mark A. Hlatky, Patrick T. O'Gara, Aha Task Force Members, Sana M. Al-Khatib, Michael D. Miedema, Donald M. Lloyd-Jones, Ellen J. Hahn, Joshua A. Beckman, Michelle A. Albert, Barbara Riegel, Kim K. Birtcher, Cheryl Dennison Himmelfarb, Joseph Yeboah, Daniel Muñoz, J. William McEvoy, Mariann R. Piano, Kim A. Williams, John S. Ikonomidis, Laura Mauri, Jose A. Joglar, Roger S. Blumenthal, Glenn N. Levine, Lee A. Fleisher, Joaquin E. Cigarroa, and Salim S. Virani
- Subjects
medicine.medical_specialty ,Executive summary ,business.industry ,Advisory Committees ,Guideline ,Disease ,Article ,Primary Prevention ,Cardiovascular Diseases ,Primary prevention ,Practice Guidelines as Topic ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Geriatrics Society, the American Society of Preventive Cardiology, and the Preventive Cardiovascular Nurses Association
- Published
- 2019
45. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines JACC
- Author
-
Donna K. Arnett, Roger S Blumenthal, Michelle A Albert, Andrew B Buroker, Zachary D Goldberger, Ellen G Hahn, Cheryl D Himmelfarb, Amit Khera, Donald M. Lloyd-Jones, J William McEvoy, Erin D Michos, Michael D Miedema, Daniel Munoz, Sidney C. Smith, Salim S Virani, Kim A Williams, Joseph Yeboah, Boback Ziaeian, Patrick T. O'Gara, Joshua A. Beckman, Glenn N Levine, Sana M. Al-Khatib, Kim Birtcher, Joaquin Cigarroa, Anita Deswal, Lee A. Fleisher, Frederico Gentile, Mark Hlatky, John Ikonomidis, Jose A Joglar, Laura Mauri, Mariann R. Piano, Barbara Riegel, and Duminda Wijeysundera
- Abstract
[Extract] Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease 1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. In addition, assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning. 4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be
- Published
- 2019
46. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society
- Author
-
Christopher J. McLeod, Michael R. Gold, Richard T. Lee, Kimberly A. Selzman, Kristen K. Patton, Cara N. Pellegrini, Keith R. Oken, Robert M. Hamilton, Paul D. Varosy, James R. Edgerton, Jose A. Joglar, Joseph E. Marine, Kenneth A. Ellenbogen, Fred M. Kusumoto, Coletta Barrett, Mark H. Schoenfeld, Annemarie Thompson, Robert Kim, and Nora Goldschlager
- Subjects
Bradycardia ,medicine.medical_specialty ,Cardiotonic Agents ,Heart block ,medicine.medical_treatment ,Advisory Committees ,Cardiac resynchronization therapy ,Cardiology ,Sick sinus syndrome ,Cardiac Resynchronization Therapy ,Electrocardiography ,Cardiac Conduction System Disease ,Heart Rate ,Physiology (medical) ,Internal medicine ,Cardiac conduction ,medicine ,Humans ,Genetic Testing ,Myocardial infarction ,Cardiac Surgical Procedures ,Bundle branch block ,business.industry ,Patient Selection ,Cardiovascular Agents ,Guideline ,American Heart Association ,Adrenergic beta-Agonists ,Calcium Channel Blockers ,medicine.disease ,United States ,Bronchodilator Agents ,Patient Care Management ,Practice Guidelines as Topic ,Quality of Life ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Societies ,Electrophysiologic Techniques, Cardiac ,Algorithms - Published
- 2018
47. Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: A systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
- Author
-
Richard L. Page, Sana M. Al-Khatib, Sandeep R Das, Jonathan C. Hsu, Aysha Arshad, Ethan M Balk, and Jose A. Joglar
- Subjects
medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Asymptomatic ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Physiology (medical) ,Internal medicine ,medicine ,030212 general & internal medicine ,education ,Prospective cohort study ,education.field_of_study ,business.industry ,Atrial fibrillation ,medicine.disease ,Cardiology ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Cohort study - Abstract
Objective To review the literature systematically to determine whether noninvasive or invasive risk stratification, such as with an electrophysiological study of patients with asymptomatic pre-excitation, reduces the risk of arrhythmic events and improves patient outcomes. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (all January 1, 1970, through August 31, 2014) were searched for randomized controlled trials and cohort studies examining noninvasive or invasive risk stratification in patients with asymptomatic pre-excitation. Studies were rejected for low-quality design or the lack of an outcome, population, intervention, or comparator of interest or if they were written in a language other than English. Results Of 778 citations found, 9 studies met all the eligibility criteria and were included in this paper. Of the 9 studies, 1 had a dual design–a randomized controlled trial of ablation versus no ablation in 76 patients and an uncontrolled prospective cohort of 148 additional patients–and 8 were uncontrolled prospective cohort studies (n=1,594). In studies reporting a mean age, the range was 32 to 50 years, and in studies reporting a median age, the range was 19 to 36 years. The majority of patients were male (range, 50% to 74%), and 250 ms) developed in 0% to 16%, malignant atrial fibrillation (shortest RR interval ≤250 ms) in 0% to 9%, and ventricular fibrillation in 0% to 2%, most of whom were children in the last case. Conclusions The existing evidence suggests risk stratification with an electrophysiological study of patients with asymptomatic pre-excitation may be beneficial, along with consideration of accessory-pathway ablation in those deemed to be at high risk of future arrhythmias. Given the limitations of the existing data, well-designed and well-conducted studies are needed.
- Published
- 2016
48. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary
- Author
-
Bruce D. Lindsay, Win Kuang Shen, Jose A. Joglar, Hugh Calkins, Sana M. Al-Khatib, Cynthia M. Tracy, Jamie B. Conti, Zachary D. Goldberger, Stephen C. Hammill, Andrea M. Russo, Brian Olshansky, Michael E. Field, Barbara J. Deal, N.A. Mark Estes, Mary A. Caldwell, Julia H. Indik, and Richard L. Page
- Subjects
Tachycardia ,medicine.medical_specialty ,Sinus tachycardia ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Guideline ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Junctional tachycardia ,Physiology (medical) ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Accessory atrioventricular bundle ,Supraventricular tachycardia ,030212 general & internal medicine ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Atrial flutter - Abstract
Preamble e472 1. Introduction e473 2. General Principles e475 3. Sinus Tachyarrhythmias e480 4. Nonsinus Focal Atrial Tachycardia and MAT e481 5. Atrioventricular Nodal Reentrant Tachycardia e482 6. Manifest and Concealed Accessory Pathways e483 7. Atrial Flutter e485 8. Junctional Tachycardia e487 9. Special Populations e487
- Published
- 2016
49. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
- Author
-
Stephen C. Hammill, Andrea M. Russo, Julia H. Indik, Cynthia M. Tracy, Brian Olshansky, Michael E. Field, Richard L. Page, Sana M. Al-Khatib, Hugh Calkins, N.A. Mark Estes, Mary A. Caldwell, Bruce D. Lindsay, Jamie B. Conti, Win Kuang Shen, Jose A. Joglar, Zachary D. Goldberger, and Barbara J. Deal
- Subjects
medicine.medical_specialty ,Adult patients ,business.industry ,Task force ,Electric countershock ,Guideline ,030204 cardiovascular system & hematology ,medicine.disease ,Clinical Practice ,Heart Rhythm ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,Supraventricular tachycardia ,030212 general & internal medicine ,business ,Cardiology and Cardiovascular Medicine - Abstract
Jonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD, FACC, FAHA, Chair-Elect Jeffrey L. Anderson, MD, FACC, FAHA, Immediate Past Chair [¶][1] Nancy M. Albert, PhD, RN, FAHA[¶][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC
- Published
- 2016
50. Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves
- Author
-
Biykem Bozkurt, John S. Ikonomidis, Kim K. Birtcher, Duminda N. Wijeysundera, Lesley H. Curtis, Thoralf M. Sundt, Mark A. Hlatky, Federico Gentile, Samuel S. Gidding, Sana M. Al-Khatib, Rick A. Nishimura, Frank W. Sellke, Eric M. Isselbacher, Jeffrey L. Anderson, Lars G. Svensson, Jose A. Joglar, E. Magnus Ohman, Win Kuang Shen, Loren F. Hiratzka, Lee A. Fleisher, Ralph G. Brindis, Richard J. Kovacs, Mark A. Creager, Susan J. Pressler, Robert O. Bonow, Jonathan L. Halperin, Joaquin E. Cigarroa, Robert A. Guyton, Nancy M. Albert, and Glenn N. Levine
- Subjects
Aortic valve ,medicine.medical_specialty ,Advisory Committees ,Aortic Diseases ,Cardiology ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,03 medical and health sciences ,0302 clinical medicine ,Bicuspid Aortic Valve Disease ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Disease management (health) ,health care economics and organizations ,Aortic dissection ,business.industry ,valvular heart disease ,American Heart Association ,Guideline ,Evidence-based medicine ,medicine.disease ,United States ,Surgery ,medicine.anatomical_structure ,Aortic Valve ,Practice Guidelines as Topic ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: the “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease” (Circulation. 2010;121:e266–e369) and the “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease” (Circulation. 2014;129:e521–e643). However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines. This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace those contained in Section 9.2.2.1 of the thoracic aortic disease guideline and Section 5.1.3 of the valvular heart disease guideline.
- Published
- 2016
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