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1دورية أكاديمية
المؤلفون: Toshiaki Isogai, Ankit Agrawal, Anas M. Saad, Shunsuke Kuroda, Shashank Shekhar, Abdelrahman I. Abushouk, Oussama M. Wazni, Ayman A. Hussein, Amar Krishnaswamy, Samir R. Kapadia
المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
مصطلحات موضوعية: complication, left atrial appendage closure, paroxysmal atrial fibrillation, persistent atrial fibrillation, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2047-9980
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2دورية أكاديمية
المؤلفون: Eoin Donnellan, Oussama M. Wazni, Mazen Hanna, Mohamed Kanj, Walid I. Saliba, Wael A. Jaber
المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 9, Iss 14 (2020)
مصطلحات موضوعية: amyloid, cardiac resynchronization therapy, cardiomyopathy, heart failure, Diseases of the circulatory (Cardiovascular) system, RC666-701
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2047-9980
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المؤلفون: Medhat Farwati, Mustapha Amin, Walid I. Saliba, Hiroshi Nakagawa, Khaldoun G. Tarakji, Mohamed Diab, Anna Scandinaro, Ruth Madden, Patricia Bouscher, Shunsuke Kuroda, Mohamed Kanj, Thomas J. Dresing, Thomas D. Callahan, Mandeep Bhargava, Jakub Sroubek, Bryan Baranowski, John Rickard, Daniel J. Cantillon, Patrick J. Tchou, Oussama M. Wazni, Ayman A. Hussein
المصدر: Journal of Cardiovascular Electrophysiology. 34:54-61
مصطلحات موضوعية: Physiology (medical), Cardiology and Cardiovascular Medicine
الوصف: Catheter ablation for atrial fibrillation (AF) is frequently used for the purpose of rhythm control and improved quality of life (QoL). Although success rates are high, a significant proportion of patients require redo ablation. Data are scarce on patient-centered outcomes and QoL in patients undergoing redo AF ablation. We aimed to assess QoL and clinical outcomes using a large prospectively maintained patient-reported outcomes (PRO) registry.All patients undergoing redo AF ablation (2013-2016) at our center were enrolled in a prospective registry for outcomes and assessed for QoL using automated PRO surveys (baseline, 3 and 6 months after ablation, every 6 months thereafter). Data were collected over 3 years of follow-up. The atrial fibrillation symptom severity scale (AFSSS) was used as the main measure for QoL. Additional variables included patient-reported improvement, AF burden, and AF-related healthcare utilization including emergency room (ER) visits and hospitalizations.A total of 848 patients were included (28% females, mean age 63.8, 51% persistent AF). By automated PRO, significant improvement in QoL was noted (baseline median AFSSS of 12 [5-18] and ranged between 2 and 4 on subsequent assessments; p .0001), with ≥70%of patients reported remarkable improvement in their AF-related symptoms. The proportion of patients in AF at the time of baseline survey was 36%, and this decreased to8% across all time points during follow-up (p .0001). AF burden was significantly reduced (including frequency and duration of episodes; p .0001), with an associated decrease in healthcare utilization after 6 months from the time of ablation (including ER visits and hospitalizations; p .0001). The proportion of patients on anticoagulants or antiarrhythmics decreased on follow-up across all time points (p .0001 for all variables).Most patients derive significant QoL benefit from redo AF ablation; with reduction of both AF burden and healthcare utilization.
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المؤلفون: Oussama M. Wazni, Moussa Mansour, Gerhard Hindricks, Johannes Brachmann, Tom Greene, Francis E. Marchlinski, Hugh Calkins, Nassir F. Marrouche, Prashanthan Sanders, Lilas Dagher, Eugene G. Kholmovski, Nazem Akoum, David J. Wilber, Christian Mahnkopf, J. Michael Dean, Pierre Jaïs, Leonie Morrison-de Boer, Jereon Bax, Decaaf Ii Investigators
المصدر: Journal of Cardiovascular Electrophysiology, 32(4), 916-924. WILEY
مصطلحات موضوعية: medicine.medical_specialty, guided ablation, medicine.medical_treatment, cardiac magnetic resonance imaging, Contrast Media, Gadolinium, Catheter ablation, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Cardiac magnetic resonance imaging, Physiology (medical), Multicenter trial, Internal medicine, Atrial Fibrillation, Clinical endpoint, Humans, Medicine, Prospective Studies, cardiovascular diseases, 030212 general & internal medicine, Atrial tachycardia, medicine.diagnostic_test, business.industry, Atrial fibrillation, Ablation, medicine.disease, Fibrosis, Magnetic Resonance Imaging, fibrosis‐, persistent atrial fibrillation, Treatment Outcome, Pulmonary Veins, Catheter Ablation, cardiovascular system, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Atrial flutter
الوصف: Introduction Success rates of catheter ablation in persistent atrial fibrillation (AF) remain suboptimal. A better and more targeted ablation strategy is urgently needed to optimize outcomes of AF treatment. We sought to assess the safety and efficacy of targeting atrial fibrosis during ablation of persistent AF patients in improving procedural outcomes. Methods The DECAAF II trial (ClinicalTrials. gov identifier number NCT02529319) is a prospective, randomized, multicenter trial of patients with persistent AF. Patients with persistent AF undergoing a first-time ablation procedure were randomized in a 1:1 fashion to receive conventional pulmonary vein isolation (PVI) ablation (Group 1) or PVI + fibrosis-guided ablation (Group 2). Left atrial fibrosis and ablation induced scarring were defined by late gadolinium enhancement magnetic resonance imaging at baseline and at 3-12 months postablation, respectively. The primary endpoint is the recurrence of atrial arrhythmia postablation, including atrial fibrillation, atrial flutter, or atrial tachycardia after the 90-day postablation blanking period. Patients were followed for a period of 12-18 months with a smartphone ECG Device (ECG Check Device, Cardiac Designs Inc.). With an anticipated enrollment of 900 patients, this study has an 80% power to detect a 26% reduction in the hazard ratio of the primary endpoint. Results and conclusion The DECAAF II trial is the first prospective, randomized, multicenter trial of patients with persistent AF using imaging defined atrial fibrosis as a treatment target. The trial will help define an optimal approach to catheter ablation of persistent AF, further our understanding of influencers of ablation lesion formation, and refine selection criteria for ablation based on atrial myopathy burden.
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المؤلفون: Mazen Hanna, Kevin Trulock, Wael A. Jaber, Michael Martyn, Oussama M. Wazni, Philip Aagaard, Bryan Baranowski, Walid Saliba, Mohamed Kanj, Divyang Patel, Eoin Donnellan, Venu Menon, Ayman A. Hussein
المصدر: Journal of Cardiovascular Electrophysiology. 30:2427-2432
مصطلحات موضوعية: Male, Pacemaker, Artificial, Time Factors, Databases, Factual, 030204 cardiovascular system & hematology, Severity of Illness Index, Ventricular Function, Left, Cardiac Resynchronization Therapy, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, Prospective cohort study, Aged, 80 and over, Ejection fraction, biology, Amyloidosis, Cardiac Pacing, Artificial, Mitral Valve Insufficiency, Treatment Outcome, Disease Progression, cardiovascular system, Cardiology, Mitral Valve, Female, Cardiomyopathies, Cardiology and Cardiovascular Medicine, circulatory and respiratory physiology, Cohort study, medicine.medical_specialty, Clinical Decision-Making, 03 medical and health sciences, Physiology (medical), Internal medicine, medicine, Humans, Cardiac Resynchronization Therapy Devices, cardiovascular diseases, Aged, Retrospective Studies, Heart Failure, Amyloid Neuropathies, Familial, Mitral regurgitation, business.industry, Hemodynamics, Recovery of Function, medicine.disease, Transthyretin, Cardiac amyloidosis, Heart failure, Ventricular Function, Right, biology.protein, business
الوصف: The aim of our study was to investigate outcomes of patients with ATTR (amyloidosis and transthyretin) CA (cardiac amyloidosis) and implantable devices with respect to left ventricular ejection fraction (LVEF), mitral regurgitation (MR), New York Heart Association (NYHA) functional class, and mortality.This was a retrospective observational cohort study of 78 patients with ATTR CA and implantable devices. During a mean follow-up of 42 months we investigated the impact of right ventricular (RV) pacing burden and biventricular (BiV) pacing on LVEF, MR severity, NYHA functional class, and mortality.Worsening MR occurred in 11% of patients with a RV pacing %40% compared to 62% of those with a RV pacing burden40% (P = .002). Similarly, worsening LVEF occurred in 26% of patients who were RV paced40% and 89% of those who were RV paced40% of the time (P .0001) and worsening in NYHA functional class occurred in 22% and 89%, respectively (P .0001). Improvement in LVEF, NYHA functional class, and MR severity occurred in 78%, 67%, and 67%, respectively, in those with BiV devices. Death occurred in 67% of patients in the cardiac resynchronization therapy group compared to 68% of those with a RV pacing burden40% and 92% of those with a RV pacing burden40%.A higher RV pacing burden is associated with deleterious remodeling and congestive heart failure in patients with ATTR CA, whereas BiV pacing is associated with improvements in LVEF, NYHA class, and degree of MR. BiV pacing should be considered in patients with ATTR CA and an indication for pacing. However, further larger prospective studies will need to be performed.
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المؤلفون: Ayman A. Hussein, Thomas Callahan, Thomas Dresing, Patrick J. Tchou, Mandeep Bhargava, John Rickard, John O Lopez, Shunsuke Kuroda, Bryan Baranowski, Koji Higuchi, Hiroshi Nakagawa, Khaldoun G. Tarakji, Oussama M. Wazni, Walid Saliba, Daniel J. Cantillon, Elad Anter, Henry Hilow
المصدر: Journal of Cardiovascular Electrophysiology.
مصطلحات موضوعية: Tachycardia, Electroanatomic mapping, business.industry, medicine.medical_treatment, Catheter ablation, Pattern recognition, 030204 cardiovascular system & hematology, Data mapping, 03 medical and health sciences, 0302 clinical medicine, Software, Physiology (medical), medicine, Standard algorithms, 030212 general & internal medicine, Artificial intelligence, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Lead (electronics), Kappa
الوصف: Background Activation maps of scar-related atrial tachycardias (AT) can be challenging to interpret due to difficulty in inaccurate annotation of electrograms, and an arbitrarily predefined mapping window. A novel mapping software integrating vector data and applying an algorithmic solution taking into consideration global activation pattern has been recently described (Coherent™, Biosense Webster "Investigational"). Objective We aimed to assess the investigational algorithm to determine the mechanism of AT compared with the standard algorithm. Methods This study included patients who underwent ablation of scar-related AT using the Carto 3 and the standard activation algorithm. The mapping data was analyzed retrospectively using the investigational algorithm, and the mechanisms were evaluated by two independent electrophysiologists. Results A total of 77 scar-related AT activation maps were analyzed (89.6% left atrium, median tachycardia cycle length of 273 milliseconds). Of those, 67 cases with confirmed mechanism of the arrhythmia were used to compare the activation software. The actual mechanism of the arrhythmia was more likely to be identified with the investigational algorithm (67.2% vs 44.8%, P=0.009). In 5 patients with dual-loop circuits, 3/5 (60%) were correctly identified by the investigational algorithm compared to 0/5 (0%) with the standard software. The reduced atrial voltage was prone to lead to less capable identification of mechanism (P for trend: 0.05). The investigational algorithm showed higher inter-reviewer agreement (Cohen's kappa 0.62 vs 0.47). Conclusions In patients with scar-related ATs, activation mapping algorithms integrating vector data and "best-fit" propagation solution may help in identifying the mechanism and the successful site of termination. This article is protected by copyright. All rights reserved.
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المؤلفون: Oussama M. Wazni, Joseph M. Bumgarner, Mohamed Kanj, Milind Y. Desai, Venu Menon, Anirudh Kumar, Divyang Patel, Kevin Trulock, Zoran B. Popović, Brian P. Griffin, Vidyasagar Kalahasti, Joshua Clevenger
المصدر: Pacing and Clinical Electrophysiology. 42:447-452
مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Population, Catheter ablation, 030204 cardiovascular system & hematology, Ventricular tachycardia, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Mitral valve prolapse, 030212 general & internal medicine, education, Papillary muscle, education.field_of_study, Mitral regurgitation, business.industry, Sudden cardiac arrest, General Medicine, Implantable cardioverter-defibrillator, medicine.disease, medicine.anatomical_structure, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business
الوصف: Background While there is an association between isolated mitral valve prolapse (MVP) and sudden cardiac arrest (SCA), the baseline characteristics and outcomes of patients with isolated MVP who experience ventricular arrhythmias (VAs) and then subsequently undergo catheter ablation and/or implantable cardioverter defibrillator (ICD) implantation are unknown. Methods We performed a retrospective review of all patients at the Cleveland Clinic with isolated MVP between 1997 and 2016 who underwent VA catheter ablation or secondary prevention ICD implantation. Results Of 617 screened patients, we identified 43 patients with isolated MVP and significant VA who underwent ICD placement (n = 13, 30%) or catheter ablation (n = 30, 70%). Both leaflets were most commonly involved (n = 22, 52%) with posterior MVP being next most common (n = 15, 36%). The most common foci of VA origin was the left ventricular papillary muscle (n = 9, 27%). Ablation was successful in the majority of cases (n = 20, 65%). At a mean follow-up of 2.5 years, 11 patients (26%) had recurrent VT. Conclusions Patients with isolated MVP and VA were more likely to have bileaflet prolapse and at least moderate mitral regurgitation. VA originated more commonly from left-sided foci. While ablation was acutely successful in the majority of cases, there was still a moderate rate of VA recurrence. There is still more study needed on factors that will predict malignant VAs and management of these VAs in the MVP population.
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المؤلفون: Patrick J. Tchou, Mina K. Chung, Milind Y. Desai, Walid Saliba, Harry M. Lever, Lucille E. Anzia, Mandeep Bhargava, Bruce L. Wilkoff, Oussama M. Wazni, Mohamed Bassiouny, Jay Sengupta, JoEllyn C. Moore, Lena Trager, Ross Garberich, Bruce D. Lindsay
المصدر: Pacing and Clinical Electrophysiology. 41:396-401
مصطلحات موضوعية: Male, medicine.medical_specialty, Population, Dofetilide, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Atrial Fibrillation, Phenethylamines, medicine, Humans, 030212 general & internal medicine, Adverse effect, education, Lung cancer, Retrospective Studies, Sulfonamides, education.field_of_study, Ejection fraction, business.industry, Hypertrophic cardiomyopathy, Atrial fibrillation, General Medicine, Cardiomyopathy, Hypertrophic, Middle Aged, medicine.disease, Treatment Outcome, Cohort, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, medicine.drug
الوصف: Background Limited medical options are available for rhythm control in patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM). There are no published reports of dofetilide use in this population. Methods A retrospective chart review was conducted on 1,404 patients loaded on dofetilide for AF suppression at the Cleveland Clinic from 2008 to 2012, 25 of whom were found to have HCM. Results The HCM cohort was 32% female, 76% with persistent AF, mean age of 59 ± 10 years, and mean ejection fraction of 54 ± 9 %. Of the 25 patients, 21 were discharged on dofetilide, three discontinued during loading due to QTc prolongation, and one due to inefficacy. There were no adverse events during loading. Of those discharged on dofetilide, 11/21 (52%) were still on it at a median follow-up of 396 (198, 699) days at the time of the chart review. For those in whom it was discontinued, the median time on the drug was 301 (111, 738) days. Of the 10 patients who discontinued dofetilide during follow-up, six were due to inefficacy, one postablation, one postheart transplant, one due to death secondary to lung cancer, and one due to worsening edema. Conclusions Dofetilide was well tolerated in this group of patients with AF and HCM and it facilitated management of AF in 21/25 (84%) patients. Further research is needed to assess the safety and efficacy of dofetilide in order to develop evidence-based guidelines for the pharmacological management of AF in this population.
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المؤلفون: Thomas Callahan, Mohamed Bassiouny, Mohamed Kanj, Oussama M. Wazni, Khaldoun G. Tarakji, Ram Amuthan, Edlira Yzeiraj, Amr F. Barakat, Patrick J. Tchou, Mina K. Chung, Bruce D. Lindsay, Bryan Baranowski, Walid Saliba, Mandeep Bhargava, Karim Abdur Rehman, Thomas Dresing, Daniel J. Cantillon, Ayman A. Hussein
المصدر: Journal of Cardiovascular Electrophysiology. 29:551-558
مصطلحات موضوعية: Male, Reoperation, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Action Potentials, Rhythm control, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Recurrence, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, Clinical endpoint, Humans, Medicine, In patient, Registries, 030212 general & internal medicine, Aged, business.industry, Atrial fibrillation, Middle Aged, Ablation, medicine.disease, Combined Modality Therapy, Progression-Free Survival, Persistent atrial fibrillation, Catheter Ablation, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, Medical therapy
الوصف: INTRODUCTION Management of persistent atrial fibrillation (PersAF) remains challenging, and many patients are left on medical therapy after a failed first ablation. In patients with recurrent symptomatic arrhythmias after PersAF ablation, we aimed to compare outcomes of repeat ablation and medical therapy versus medical therapy alone. METHODS AND RESULTS All 682 consecutive patients with recurrent symptomatic arrhythmia after a first ablation for PersAF at our institution (2005-2012) were included. Repeat ablation with continuation of medical therapy was performed in 364 patients (Group 1) and 318 were only medically managed (Group 2). The outcome of interest was freedom from arrhythmia recurrence beyond a 3-month blanking period. Separate analyses were performed to assess this endpoint totally off antiarrhythmics (primary endpoint) or alternatively with/without use of antiarrhythmics (secondary endpoint). Over a median follow-up of 26 months, 41.5% of Group 1 patients met the primary endpoint and remained free from arrhythmia recurrence off antiarrhythmics (vs. 14.5% in Group 2, P
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المؤلفون: Brandon M. Jones, Susan J. Rehm, Mehdi H. Shishehbor, Oussama M. Wazni
المصدر: Catheterization and Cardiovascular Interventions. 91:318-321
مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, medicine.medical_treatment, 030106 microbiology, Fungus, 030204 cardiovascular system & hematology, Right atrial, 03 medical and health sciences, 0302 clinical medicine, medicine, Endocarditis, Radiology, Nuclear Medicine and imaging, Lead (electronics), Candida albicans, biology, business.industry, General Medicine, biology.organism_classification, medicine.disease, Implantable cardioverter-defibrillator, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, Vegetation (pathology), business, Lead extraction
الوصف: Infections involving internal cardiac devices can be very challenging to treat, and almost universally require complete device extraction for successful management. Of the pathogens that cause device-related endocarditis, fungi such as Candida albicans are notoriously difficult to manage because of their propensity to produce large vegetations and the need for long-term treatment with potentially toxic medications. Furthermore, individuals who develop fungal, device-associated endocarditis are typically among the most complex patients, with significant comorbidities that place them at high risk for open heart procedures such as surgical device extraction. We present a case of one such patient in whom treatment of Candida albicans device-related endocarditis was managed using AngioVac® aspiration of a large right atrial vegetation with simultaneous laser sheath extraction of the implantable cardioverter-defibrillator lead.
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