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name:Bernstein, Neil

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Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence: A Meta-Analysis

Shukla, Ashish; Aizer, Anthony; Holmes, Douglas; Fowler, Steven; Park, David S; Bernstein, Scott; Bernstein, Neil; Chinitz, Larry
OBJECTIVES/OBJECTIVE:This study aimed to evaluate the cumulative effect of treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) on atrial fibrillation (AF) recurrence. BACKGROUND:OSA is a known predictor for onset and recurrence of AF. The effect of treatment with CPAP on AF recurrence has been evaluated in small studies with varied outcomes. METHODS:We searched MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Trials Register for relevant studies. Evaluation of AF recurrence in CPAP users and nonusers in patients with OSA was the primary outcome evaluated in this study. The secondary outcome was evaluation of AF recurrence in CPAP users and nonusers after pulmonary vein isolation (PVI). RESULTS: = 0%). The beneficial effect of CPAP use was statistically significant in both groups of patients: those who underwent catheter ablation with PVI and those who did not undergo ablation and were managed medically. No other study covariates had any significant association with these outcomes of AF reduction. CONCLUSIONS:The use of CPAP is associated with significant reduction in recurrence of AF in patients with OSA. This effect remains consistent and similar across patient populations irrespective of whether they undergo PVI.
PMID: 29759338
ISSN: 2405-5018
CID: 3114672

Triple alternans during a tachycardia- What is the mechanism?

Garcia, Luis I; Park, David S; Bernstein, Neil E; Chinitz, Larry A
PMID: 24846375
ISSN: 1547-5271
CID: 1012862

Atrial fibrillation ablation in patients with known sludge in the left atrial appendage

Hajjiri, Mohammed; Bernstein, Scott; Saric, Muhamed; Benenstein, Ricardo; Aizer, Anthony; Dym, Glenn; Fowler, Steven; Holmes, Douglas; Bernstein, Neil; Mascarenhas, Mark; Park, David; Chinitz, Larry
PURPOSE: Transesophageal echocardiography (TEE) is routinely used to assess for thrombus in the left atrium (LA) and left atrial appendage (LAA) in patients undergoing atrial fibrillation (AF) ablation. However, little is known about the outcome of AF ablation in patients with documented LAA sludge. We hypothesize that AF ablation can be performed safely in a proportion of patients with sludge in the LAA and may have a significant benefit for these patients. METHODS: We performed a retrospective analysis of all patients undergoing AF ablation at New York University Langone Medical Center (NYULMC) from January 1st 2011 to June 30, 2013. Patients with sludge found on their TEE immediately prior to AF ablation were identified and followed for stroke, AF recurrence, procedural complications, major bleeding, or death. RESULTS: Among 1,076 patients who underwent AF ablation, 8 patients (mean age 69 +/- 13 years; 75 % men) with sludge were identified. Patients with sludge in their LAA had no incidence of early or late occurrence of stroke during mean follow-up of 10 months. One patient had a left groin hematoma, and two patients had atrial tachycardias that needed a repeat ablation. TEE at the time of repeat ablation demonstrated the presence of spontaneous echo contrast (smoke) and resolution of sludge. There were no deaths. CONCLUSION: In a cohort of eight patients with LAA sludge who underwent AF ablation, no significant thromboembolic events occurred during or after the procedure. AF ablation can be performed safely and may be beneficial in these patients. Larger studies are warranted to better determine the most appropriate management route.
PMID: 24752792
ISSN: 1383-875x
CID: 909162

Use of a Lateral Infraclavicular Puncture to Obtain Proximal Venous Access with Occluded Subclavian/Axillary Venous Systems for Cardiac Rhythm Devices

Bernstein, Neil E; Aizer, Anthony; Chinitz, Larry A
BACKGROUND: Venous occlusion is not uncommon and total venous obstruction with more proximal patency may occur in as many as 10% of previous implants. Many techniques are available to obtain ipsilateral access; however, most require special equipment or skills. We describe a technique of infraclavicular cannulation of the brachiocephalic vein ipsilateral to the occlusion that is safe and feasible for most implanters. METHODS: Fourteen patients with subclavian/axillary occlusions ipsilateral to the implanted device and requiring revision or upgrade of their system or venous occlusion with contraindication to implant on the contralateral side underwent lead addition/placement via a brachiocephalic approach. Following venography, an 18-gauge needle was used to gain brachiocephalic access. The needle was initially positioned in a lateral infraclavicular location. The needle was then advanced under the clavicle in a horizontal plane and advanced toward the sternal notch under fluoroscopic guidance. RESULTS: Fourteen patients underwent an attempt at brachiocephalic access. Cannulation of the brachiocephalic was possible in all 14 and lead(s) were successfully implanted in all. There were no complications with the procedure, specifically no pneumothoraces. In follow-up (mean 36 months, range 1-86 months), all implanted leads function well, with no evidence of lead failure or impedance changes. CONCLUSION: A lateral infraclavicular approach is a safe and effective technique for obtaining brachiocephalic access when the subclavian/axillary vein is occluded. This technique is easy to learn and may be useful for implanters without the equipment or skills needed for lead extraction or microdissection or in cases where patients refuse these procedures.
PMID: 24645698
ISSN: 0147-8389
CID: 909152

The benign nature of mild induced therapeutic hypothermia-Induced long QTc

Weitz, Daniel; Greet, Brian; Bernstein, Scott A; Holmes, Douglas S; Bernstein, Neil; Aizer, Anthony; Chinitz, Larry; Roswell, Robert O
PMID: 23410493
ISSN: 0167-5273
CID: 395462

Clinical Comparison of ICD Detection Algorithms that Include Rapid-VT Zones

Hirsh, David S; Chinitz, Larry A; Bernstein, Neil E; Holmes, Douglas S; Rao, Satya; Aizer, Anthony
Introduction: The safe use of antitachycardia pacing (ATP) to terminate rapid ventricular tachycardias (VTs) (cycle length 240-320 ms) is predicated on the ability of implantable cardioverter defibrillators (ICDs) to distinguish rapid VT from ventricular fibrillation (VF). We set out to compare the time to device charging following the induction of VF of various ICD multizone detection algorithms for rapid VT/VF discrimination. Methods and Results: Data on the time to device charging following the induction of VF at the time to device implantation were collected on 62 consecutive patients in a nonrandomized prospective cohort fashion. Multizone programming for the Boston Scientific, Medtronic, and St. Jude Medical devices was based on prior clinically validated data. Sixty-two subjects were studied (Boston Scientific = 16, Medtronic = 27, St. Jude Medical = 19) and 124 tests for VF detection were performed (Boston Scientific = 32, Medtronic = 54, St. Jude Medical = 38). Mean time to charging was significantly prolonged in the Boston Scientific group as was the percentage of tests where charge initiation occurred >5 seconds from VF-induction: 4.24, 3.99, and 3.00 seconds and 19%, 4%, and 0% for the Boston Scientific, Medtronic, and St. Jude Medical groups, respectively, P < 0.05. ATP was the first therapy administered in 9.4% of tests in the Boston Scientific group. Conclusion: The Boston Scientific multizone VT/VF discrimination algorithm results in a prolonged time to VF detection, and consequently, prolonged time to appropriate initiation of device charging. Further studies are needed to determine whether prolonged detection times lead to clinically significant events. (PACE 2012; 35:1222-1231).
PMID: 22385019
ISSN: 0147-8389
CID: 179072

Right-Sided Implantation and Subpectoral Position are Predisposing Factors for Fracture of a 6.6 French ICD Lead

Bernstein, Neil E; Karam, Edmund T; Aizer, Anthony; Wong, Brian C; Holmes, Douglas S; Bernstein, Scott A; Chinitz, Larry A
Background: The Medtronic Sprint Fidelis (Medtronic Inc., Minneapolis, MN, USA) lead family is associated with an unacceptable incidence of premature lead failure. There are limited data on risk factors for lead fracture. We hypothesized that factors leading to potential increased forces on the lead related to device implantation or technique may be associated with premature lead failure. Methods: We reviewed the implant data from our group and identified 176 patients who received active fixation Medtronic Fidelis (Model 6931, single coil and Model 6949, dual coil) leads. Implant data, including age, sex, venous access site, implant side, implant location, and number of venous leads were reviewed. Hospital, pacemaker clinic, and Medtronic registration databases were reviewed for evidence of lead failure, replacement, or abandonment. Data was evaluated in univariate and multivariate regression analyses. Results: Of the 176 leads implanted, 10 (5.7%) were noted to develop malfunction. This presented as inappropriate shocks from sensed noise or elevated impedance measurements. Of the above noted implant features, only right-sided (vs left-sided) implant (hazard ratio [HR] 18.8, 95% confidence intervals [CI] 3.8, 93.3), and subpectoral implant (vs prepectoral; HR 14.31, 95% CI 3.2, 64.0) were predictive of lead failure in maximally adjusted models. Conclusions: We have identified both right-sided implantation and subpectoral generator positioning as factors associated with premature lead malfunction in Fidelis active fixation leads. Clinical decisions regarding patient management should incorporate these findings in regard to lead replacement in high-risk patients. (PACE 2012; 35:659-664).
PMID: 22469148
ISSN: 0147-8389
CID: 169243

The Benign Nature of Therapeutic Hypothermia-Induced Long QTc [Meeting Abstract]

Weitz, Daniel; Greet, Brian; Roswell, Robert; Bernstein, Scott A; Berger, Jeffrey S; Holmes, Douglas S; Bernstein, Neil; Aizer, Anthony; Chinitz, Larry; Keller, Norma M
ISI:000299738700103
ISSN: 0009-7322
CID: 2793552

Cardiac device interrogation for safer care of surgical wound patients

Buchanan, Krysti; Bernstein, Neil; Ayello, Elizabeth A; O'Neill, Daniel K
Although most clinicians would agree comprehensive assessment of a wound patient is important, not all know the importance of including cardiac device interrogation as part of the standard preoperative evaluation. Using clinical exemplars, the authors highlight key concepts to raise awareness among wound colleagues of this important patient safety concern.
PMID: 22015749
ISSN: 1527-7941
CID: 156356

Meta-analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia

Stern, Joshua D; Rolnitzky, Linda; Goldberg, Judith D; Chinitz, Larry A; Holmes, Douglas S; Bernstein, Neil E; Bernstein, Scott A; Khairy, Paul; Aizer, Anthony
BACKGROUND: There are little data on the appropriate endpoint for slow pathway ablation that balances acceptable procedural times, recurrence rates, and complication rates. This study compared recurrence rates of three commonly utilized endpoints of slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT). METHODS: We performed a meta-analysis of AVNRT slow pathway ablation cohorts by searching electronic databases, the Internet, and conference proceedings. Inclusion criteria were age >18 years, >20 human subjects per study, primary AVNRT ablation, English language publication, and >1 month of follow-up. Data were analyzed with a fixed-effects model using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). RESULTS: We included 10 studies encompassing 1,204 patients with a mean age of 41-53 years. Endpoints were complete slow pathway ablation, residual jump only, and single remaining echo beat. Pooled estimates revealed 28 of 641 patients (4.4%) with complete slow pathway ablation, 13 of 192 patients (6.8%) with a residual jump only, and 24 of 371 patients (6.5%) with one echo had recurrences. With uniform isoproterenol use after ablation, there was no significant difference in recurrence rates among the endpoints. However, when isoproterenol was utilized after ablation only if needed to induce AVNRT before ablation, a significantly higher recurrence rate occurred in patients with a residual jump (P = 0.002), a single echo (P = 0.003), or the combined group of a residual jump and/or one echo (P = 0.001). CONCLUSIONS: Isoproterenol should be used routinely after slow pathway modification, when a residual jump and/or single echo remain
PMID: 21070256
ISSN: 1540-8159
CID: 132603