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Catheter ablation compared to medical therapy for ventricular tachycardia in sarcoidosis: nationwide outcomes and hospital readmissions
Gurin, Michael I; Xia, Yuhe; Tarabanis, Constantine; Goldberg, Randal I; Knotts, Robert J; Donnino, Robert; Reyentovich, Alex; Bernstein, Scott; Jankelson, Lior; Kushnir, Alexander; Holmes, Douglas; Spinelli, Michael; Park, David S; Barbhaiya, Chirag R; Chinitz, Larry A; Aizer, Anthony
BACKGROUND/UNASSIGNED:Catheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy (MT) in the sarcoidosis population. OBJECTIVE/UNASSIGNED:To assess in-hospital outcomes and unplanned readmissions following CA for VT compared to MT in patients with sarcoidosis. METHODS/UNASSIGNED:Data was obtained from the Nationwide Readmissions Database between 2010 and 2019 to identify patients with sarcoidosis admitted for VT either undergoing CA or MT during elective and non-elective admission. Primary endpoints were a composite endpoint of inpatient mortality, cardiogenic shock, cardiac arrest and 30-day hospital readmissions. Procedural complications at index admission and causes of readmission were also identified. RESULTS/UNASSIGNED: = 0.343). The most common cause of readmission were ventricular arrhythmias (VA) in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective CA. The most common complication in the CA group was cardiac tamponade (4.8 %). CONCLUSION/UNASSIGNED:VT ablation is associated with similar rates of 30-day readmission compared to MT and does not confer increased risk of harm with respect to inpatient mortality, cardiogenic shock or cardiac arrest. Further research is warranted to determine if a subgroup of sarcoidosis patients admitted with VT are better served with an initial conservative management strategy followed by VT ablation.
PMCID:11279686
PMID: 39070127
ISSN: 2666-6022
CID: 5731242
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
Tzeis, Stylianos; Gerstenfeld, Edward P; Kalman, Jonathan; Saad, Eduardo; Shamloo, Alireza Sepehri; Andrade, Jason G; Barbhaiya, Chirag R; Baykaner, Tina; Boveda, Serge; Calkins, Hugh; Chan, Ngai-Yin; Chen, Minglong; Chen, Shih-Ann; Dagres, Nikolaos; Damiano, Ralph J; De Potter, Tom; Deisenhofer, Isabel; Derval, Nicolas; Di Biase, Luigi; Duytschaever, Mattias; Dyrda, Katia; Hindricks, Gerhard; Hocini, Meleze; Kim, Young-Hoon; la Meir, Mark; Merino, Jose Luis; Michaud, Gregory F; Natale, Andrea; Nault, Isabelle; Nava, Santiago; Nitta, Takashi; O'Neill, Mark; Pak, Hui-Nam; Piccini, Jonathan P; Pürerfellner, Helmut; Reichlin, Tobias; Saenz, Luis Carlos; Sanders, Prashanthan; Schilling, Richard; Schmidt, Boris; Supple, Gregory E; Thomas, Kevin L; Tondo, Claudio; Verma, Atul; Wan, Elaine Y
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
PMID: 38609733
ISSN: 1572-8595
CID: 5711252
Risk of malignant ventricular arrhythmias in patients with mildly to moderately reduced ejection fraction after permanent pacemaker implantation
Dai, Matthew; Peterson, Connor; Chorin, Udi; Leiva, Orly; Katz, Moshe; Sliman, Hend; Aizer, Anthony; Barbhaiya, Chirag; Bernstein, Scott; Holmes, Douglas; Knotts, Robert; Park, David; Spinelli, Michael; Chinitz, Larry; Jankelson, Lior
BACKGROUND:Many patients with mildly to moderately reduced left ventricular ejection fraction (LVEF) who require permanent pacemaker (PPM) implantation do not have a concurrent indication for implantable cardioverter-defibrillator (ICD) therapy. However, the risk of ventricular tachycardia/ventricular fibrillation (VT/VF) in this population is unknown. OBJECTIVE:The aim of this study was to describe the risk of VT/VF after PPM implantation in patients with mildly to moderately reduced LVEF. METHODS:Retrospective analysis was performed of 243 patients with LVEF between 35% and 49% who underwent PPM placement and did not meet indications for an ICD. The primary end point was occurrence of sustained VT/VF. Competing risks regression was performed to calculate subhazard ratios for the primary end point. RESULTS:Median follow-up was 27 months; 73% of patients were male, average age was 79 ± 10 years, average LVEF was 42% ± 4%, and 70% were New York Heart Association class II or above. Most PPMs were implanted for sick sinus syndrome (34%) or atrioventricular block (50%). Of 243 total patients, 11 (4.5%) met the primary end point of VT/VF. Multivessel coronary artery disease (CAD) was associated with significantly higher rates of VT/VF, with a subhazard ratio of 5.4 (95% CI, 1.5-20.1; P = .01). Of patients with multivessel CAD, 8 of 82 (9.8%) patients met the primary end point for an annualized risk of 4.3% per year. CONCLUSION:Patients with mildly to moderately reduced LVEF and multivessel CAD undergoing PPM implantation are at increased risk for the development of malignant ventricular arrhythmias. Patients in this population may benefit from additional risk stratification for VT/VF and consideration for upfront ICD implantation.
PMID: 38490597
ISSN: 1556-3871
CID: 5713832
Heart Rhythm Society Scientific and Clinical Documents Committee Viewpoint
Cha, Yong-Mei; Bhakta, Deepak; Barbhaiya, Chirag R; Chung, Eugene H; Fisher, John D; Fix, Angela M; Ghia, Kasturi K; Glikson, Michael; Hart, S Alexandra; Hushcha, Stephanie V; Kannankeril, Prince J; Kramer, Daniel B; Mendenhall, G Stuart; Morin, Daniel P; Ottoboni, Linda K; Pathak, Rajeev Kumar; Pillarisetti, Jayasree; Rajagopalan, Bharath; Russo, Andrea M; See, Vincent Y; Shah, Maully J; Sridhar, Arun Raghav M; Patton, Kristen K
PMID: 38816149
ISSN: 1556-3871
CID: 5663872
One shot to challenge single-shot [Editorial]
Dai, Matthew; Barbhaiya, Chirag
PMID: 38557947
ISSN: 1572-8595
CID: 5668492
Caudal-Tilt Ultrasound Guided Axillary Venous Access for Transvenous Pacing Lead Implant
Kaul, Risheek; Yang, Felix; Jankelson, Lior; Knotts, Robert J; Holmes, Douglas; Aizer, Anthony; Chinitz, Larry A; Barbhaiya, Chirag R
PMID: 38266750
ISSN: 1556-3871
CID: 5624992
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
Tzeis, Stylianos; Gerstenfeld, Edward P; Kalman, Jonathan; Saad, Eduardo B; Sepehri Shamloo, Alireza; Andrade, Jason G; Barbhaiya, Chirag R; Baykaner, Tina; Boveda, Serge; Calkins, Hugh; Chan, Ngai-Yin; Chen, Minglong; Chen, Shih-Ann; Dagres, Nikolaos; Damiano, Ralph J; De Potter, Tom; Deisenhofer, Isabel; Derval, Nicolas; Di Biase, Luigi; Duytschaever, Mattias; Dyrda, Katia; Hindricks, Gerhard; Hocini, Meleze; Kim, Young-Hoon; la Meir, Mark; Merino, Jose Luis; Michaud, Gregory F; Natale, Andrea; Nault, Isabelle; Nava, Santiago; Nitta, Takashi; O'Neill, Mark; Pak, Hui-Nam; Piccini, Jonathan P; Pürerfellner, Helmut; Reichlin, Tobias; Saenz, Luis Carlos; Sanders, Prashanthan; Schilling, Richard; Schmidt, Boris; Supple, Gregory E; Thomas, Kevin L; Tondo, Claudio; Verma, Atul; Wan, Elaine Y; Steven, Daniel; Agbayani, Michael-Joseph; Jared Bunch, T; Chugh, Aman; DÃaz, Juan Carlos; Freeman, James V; Hardy, Carina Abigail; Heidbuchel, Hein; Johar, Sofian; Linz, Dominik; Maesen, Bart; Noseworthy, Peter A; Oh, Seil; Porta-Sanchez, Andreu; Potpara, Tatjana; Rodriguez-Diez, Gerardo; Sacher, Frederic; Suwalski, Piotr; Trines, Serge A
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
PMID: 38587017
ISSN: 1532-2092
CID: 5725582
A Hard Look at EASY AF [Editorial]
Kaul, Risheek; Barbhaiya, Chirag R
PMID: 38069974
ISSN: 2405-5018
CID: 5589752
Conduction velocity is reduced in the posterior wall of hypertrophic cardiomyopathy patients with normal bipolar voltage undergoing ablation for paroxysmal atrial fibrillation
Zahid, Sohail; Malik, Tahir; Peterson, Connor; Tarabanis, Constantine; Dai, Matthew; Katz, Moshe; Bernstein, Scott A; Barbhaiya, Chirag; Park, David S; Knotts, Robert J; Holmes, Douglas S; Kushnir, Alexander; Aizer, Anthony; Chinitz, Larry A; Jankelson, Lior
OBJECTIVES/OBJECTIVE:We investigated characteristics of left atrial conduction in patients with HCM, paroxysmal AF and normal bipolar voltage. BACKGROUND:Patients with hypertrophic cardiomyopathy (HCM) exhibit abnormal cardiac tissue arrangement. The incidence of atrial fibrillation (AF) is increased fourfold in patients with HCM and confers a fourfold increased risk of death. Catheter ablation is less effective in HCM, with twofold increased risk of AF recurrence. The mechanisms of AF perpetuation in HCM are poorly understood. METHODS:We analyzed 20 patients with HCM and 20 controls presenting for radiofrequency ablation of paroxysmal AF normal left atrial voltage(> 0.5 mV). Intracardiac electrograms were extracted from the CARTO mapping system and analyzed using Matlab/Python code interfacing with Core OpenEP software. Conduction velocity maps were calculated using local activation time gradients. RESULTS: = 0.13, p = 0.03). CONCLUSIONS:Atrial conduction velocity is significantly reduced in patients with HCM and paroxysmal AF, possibly contributing to arrhythmia persistence after catheter ablation.
PMID: 36952090
ISSN: 1572-8595
CID: 5523872
Sex differences in outcomes of transvenous lead extraction: insights from National Readmission Database
Khalil, Mahmoud; Maqsood, Muhammad Haisum; Maraey, Ahmed; Elzanaty, Ahmed; Saeyeldin, Ayman; Ong, Kenneth; Barbhaiya, Chirag R; Chinitz, Larry A; Bernstein, Scott; Shokr, Mohamed
BACKGROUND:With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. OBJECTIVE:The present study aims at evaluating the impact of sex on outcomes of lead extraction. METHODS:We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. RESULTS:Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07-1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02-1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14-3.1), P = 0.014; OR 3.4, 95% CI (1.8-6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18-1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3-2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02-1.17), P < 0.01). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87-1.14), P = 0.95). CONCLUSION/CONCLUSIONS:In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.
PMID: 36445605
ISSN: 1572-8595
CID: 5373942