Faculty Bibliography
Searched for:
in-biosketch:true
person:chinil01
Total Results:
205
The Marvel of Leadless Technology [Editorial]
PMID: 35032671
ISSN: 1556-3871
CID: 5119232
Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility
Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings.
PMID: 35210625
ISSN: 1546-1718
CID: 5172442
Outcomes of posterior wall isolation with pulmonary vein isolation for paroxysmal atrial fibrillation
BACKGROUND:Prior studies have shown that addition of posterior wall isolation (PWI) may reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation. No data on PWI in paroxysmal AF (pAF) patients with normal left atrial voltage is available, to date. OBJECTIVE:This study sought to evaluate the efficacy of PWI in addition to pulmonary vein isolation (PVI) in patients presenting with pAF and normal left atrial voltage. METHODS:Consecutive patient registry analysis was performed on all patients with pAF and normal left atrial voltage undergoing initial radiofrequency ablation from November 1, 2018 to November 15, 2019. Primary endpoint was recurrence of atrial arrhythmia including AF, atrial tachycardia (AT) or atrial flutter (AFL). RESULTS:A total of 321 patients were studied, 214 in the PVI group and 107 in the PWI+PVI group. Recurrence of any atrial arrhythmia occurred in 18.2% of patients in the PVI group and 16.8% in the PVI+PWI cohort (p=0.58). At one year, recurrence was 14.0% in the PVI group and 15.0% in the PWI+PVI group (p=0.96). There was a lower AT/AFL recurrence in the PVI+PWI group, not reaching significance (3.7% in the PWI+PVI group vs. 7.9% in PVI group, p=0.31). Need for carina lesions predicted recurrence in the PVI-only group. CONCLUSIONS:Addition of PWI to PVI in pAF patients undergoing their first ablation did not reduce the frequency of atrial arrhythmia recurrence. This warrants further study in a prospective trial. This article is protected by copyright. All rights reserved.
PMID: 34911157
ISSN: 1540-8167
CID: 5093072
Journal of interventional cardiac electrophysiology. 2022:63(1):97-101.DOI: 10.1007/s10840-021-00952-w
Rebooting atrial fibrillation ablation in the COVID-19 pandemic
PURPOSE/OBJECTIVE:Catheter ablation procedures for atrial fibrillation (AF) were significantly curtailed during the peak of coronavirus disease 2019 (COVID-19) pandemic to conserve healthcare resources and limit exposure. There is little data regarding peri-procedural outcomes of medical procedures during the COVID-19 pandemic. We enacted protocols to safely reboot AF ablation while limiting healthcare resource utilization. We aimed to evaluate acute and subacute outcomes of protocols instituted for reboot of AF ablation during the COVID-19 pandemic. METHODS:Perioperative healthcare utilization and acute procedural outcomes were analyzed for consecutive patients undergoing AF ablation under COVID-19 protocols (2020 cohort; n=111) and compared to those of patients who underwent AF ablation during the same time period in 2019 (2019 cohort; n=200). Newly implemented practices included preoperative COVID-19 testing, selective transesophageal echocardiography (TEE), utilization of venous closure, and same-day discharge when clinically appropriate. RESULTS:Pre-ablation COVID-19 testing was positive in 1 of 111 patients. There were 0 cases ablation-related COVID-19 transmission and 0 major complications in either cohort. Pre-procedure TEE was performed in significantly fewer 2020 cohort patients compared to the 2019 cohort patients (68.4% vs. 97.5%, p <0.001, respectively) despite greater prevalence of persistent arrhythmia in the 2020 cohort. Same-day discharge was achieved in 68% of patients in the 2020 cohort, compared to 0% of patients in the 2019 cohort. CONCLUSIONS:Our findings demonstrate the feasibility of safe resumption of complex electrophysiology procedures during the COVID-19 pandemic, reducing healthcare utilization and maintaining quality of care. Protocols instituted may be generalizable to other types of procedures and settings.
PMID: 33543350
ISSN: 1572-8595
CID: 4776662
Symphony to leadless pacing-An Ode to Joy [Editorial]
ISI:000767960400001
ISSN: 1045-3873
CID: 5182092
ICD shocks and complications in patients with inherited arrhythmia syndromes
Background/UNASSIGNED:There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. Methods/UNASSIGNED:Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. Results/UNASSIGNED:123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. Conclusion/UNASSIGNED:The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.
PMCID:8569698
PMID: 34765721
ISSN: 2352-9067
CID: 5050742
Time to diagnosis of acute complications after cardiovascular implantable electronic device insertion and optimal timing of discharge within the first 24 hours
BACKGROUND:More than 3 million cardiovascular implantable electronic devices (CIEDs) are implanted annually. There are minimal data regarding the timing of diagnosis of acute complications after implantation. It remains unclear whether patients can be safely discharged less than 24 hours postimplantation. OBJECTIVE:The purpose of this study was to determine the precise timing of acute complication diagnosis after CIED implantation and optimal timing for same-day discharge. METHODS:A retrospective cohort analysis of adults 18 years or older who underwent CIED implantation at a large urban quaternary care medical center between June 1, 2015, and March 30, 2020, was performed. Standard of care included overnight observation and chest radiography 6 and 24 hours postprocedure. Medical records were reviewed for the timing of diagnosis of acute complications. Acute complications included pneumothorax, hemothorax, pericardial effusion, lead dislodgment, and implant site hematoma requiring surgical intervention. RESULTS:A total of 2421 patients underwent implantation. Pericardial effusion or cardiac tamponade was diagnosed in 13 patients (0.53%), pneumothorax or hemothorax in 19 patients (0.78%), lead dislodgment in 11 patients (0.45%), and hematomas requiring surgical intervention in 5 patients (0.2%). Of the 48 acute complications, 43 (90%) occurred either within 6 hours or more than 24 hours after the procedure. Only 3 acute complications identified between 6 and 24 hours required intervention during the index hospitalization (0.12% of all cases). CONCLUSION/CONCLUSIONS:Most acute complications are diagnosed either within the first 6 hours or more than 24 hours after implantation. With rare exception, patients can be considered for discharge after 6 hours of appropriate monitoring.
PMID: 34517119
ISSN: 1556-3871
CID: 5026662
Utility of device-derived daily activity, a novel digital biomarker, to predict ventricular arrhythmias-data from the CERTITUDE registry [Meeting Abstract]
Background: While there have been prior studies showing an association between activity and outcomes, there have been no studies examining the temporal relationship between device-derived daily activity, a novel digital biomarker, and ventricular tachyarrhythmias (VT).
Purpose(s): In a big dataset with over 55,000 pacemaker, ICD, and CRT devices, we aimed to identify whether changes in activity predict VT, or else VT predict changes in activity.
Method(s): The CERTITUDE registry comprises a de-identified database of over 55,000 U.S. BIOTRONIK pacemaker, ICD, CRT devices, and loop recorders active on Home Monitoring. Daily data on leads, arrhythmias, and physiological parameters such as activity are captured. Patient activity is reported daily as percentage active during the day, assessed by a one-axis accelerometer at ~0.4 Hz frequency. Analysis to ascertain temporal changes in device-derived activity associated with treated VT was performed using the first event per device and 7-day activity windows (baseline, pre- and post-event). Baseline period was defined as 31-38 days prior to VT. VT events were categorized by heart rate (<=200 bpm,>200 bpm) and treatment (shock with or without ATP, ATP alone). Differences in activity between baseline, and pre- and post-VT were analyzed using the binomial proportion test.
Result(s): A total of 16,475 devices (9732 ICDs, 6743 CRT-Ds) had activity data available for analysis. The cumulative follow-up duration was 18,355 years (5.6 million days with transmission). Of the 2636 VT events analyzed, 1409 had a heart rate >200 bpm, and 593 were treated with shock. Patients with VT events >200 bpm treated with shock had a significant reduction in activity post-VT with a median -8.7% reduction (IQR -24.6%; 7.3%, p<0.001). However, there was no reduction in activity before the VT>200 bpm (p=0.690) (Figure). VT events >200 bpm treated with ATP alone were not associated with reduction in activity before or after the episode. Similarly, VT events <=200 bpm treated with shock were also associated with a reduction in activity following the event (-5.8%, IQR -29.5, 12.3%, p=0.003), but not prior to the VT event.
Conclusion(s): In this report from the CERTITUDE registry, we have shown a temporal decline in device-derived activity following ventricular arrhythmias>200 bpm and <=200 bpm treated with a shock, but not in patients treated with ATP. Monitoring device-derived activity post-VT events with a shock could provide relevant clinical information and potentially warrant intensified treatment
Purpose(s): In a big dataset with over 55,000 pacemaker, ICD, and CRT devices, we aimed to identify whether changes in activity predict VT, or else VT predict changes in activity.
Method(s): The CERTITUDE registry comprises a de-identified database of over 55,000 U.S. BIOTRONIK pacemaker, ICD, CRT devices, and loop recorders active on Home Monitoring. Daily data on leads, arrhythmias, and physiological parameters such as activity are captured. Patient activity is reported daily as percentage active during the day, assessed by a one-axis accelerometer at ~0.4 Hz frequency. Analysis to ascertain temporal changes in device-derived activity associated with treated VT was performed using the first event per device and 7-day activity windows (baseline, pre- and post-event). Baseline period was defined as 31-38 days prior to VT. VT events were categorized by heart rate (<=200 bpm,>200 bpm) and treatment (shock with or without ATP, ATP alone). Differences in activity between baseline, and pre- and post-VT were analyzed using the binomial proportion test.
Result(s): A total of 16,475 devices (9732 ICDs, 6743 CRT-Ds) had activity data available for analysis. The cumulative follow-up duration was 18,355 years (5.6 million days with transmission). Of the 2636 VT events analyzed, 1409 had a heart rate >200 bpm, and 593 were treated with shock. Patients with VT events >200 bpm treated with shock had a significant reduction in activity post-VT with a median -8.7% reduction (IQR -24.6%; 7.3%, p<0.001). However, there was no reduction in activity before the VT>200 bpm (p=0.690) (Figure). VT events >200 bpm treated with ATP alone were not associated with reduction in activity before or after the episode. Similarly, VT events <=200 bpm treated with shock were also associated with a reduction in activity following the event (-5.8%, IQR -29.5, 12.3%, p=0.003), but not prior to the VT event.
Conclusion(s): In this report from the CERTITUDE registry, we have shown a temporal decline in device-derived activity following ventricular arrhythmias>200 bpm and <=200 bpm treated with a shock, but not in patients treated with ATP. Monitoring device-derived activity post-VT events with a shock could provide relevant clinical information and potentially warrant intensified treatment
EMBASE:636529888
ISSN: 1522-9645
CID: 5083222
Atrial Arrhythmias and the Pandemic [Comment]
PMID: 34556286
ISSN: 2405-5018
CID: 5147612
Behavior of AV synchrony pacing mode in a leadless pacemaker during variable AV conduction and arrhythmias
INTRODUCTION/BACKGROUND:MARVEL 2 assessed the efficacy of mechanical atrial sensing by a ventricular leadless pacemaker, enabling a VDD pacing mode. The behavior of the enhanced MARVEL 2 algorithm during variable atrio-ventricular conduction (AVC) and/or arrhythmias has not been characterized and is the focus of this study. METHODS:Of the 75 patients enrolled in the MARVEL 2 study, 73 had a rhythm assessment and were included in the analysis. The enhanced MARVEL 2 algorithm included a mode-switching algorithm that automatically switches between VDD and ventricular only antibradycardia pacing (VVI)-40 depending upon AVC status. RESULTS:Forty-two patients (58%) had persistent third degree AV block (AVB), 18 (25%) had 1:1 AVC, 5 (7%) had variable AVC status, and 8 (11%) had atrial arrhythmias. Among the 42 patients with persistent third degree AVB, the median ventricular pacing (VP) percentage was 99.9% compared to 0.2% among those with 1:1 AVC. As AVC status changed, the algorithm switched to VDD when the ventricular rate dropped less than 40 bpm. During atrial fibrillation (AF) with ventricular response greater than 40 bpm, VVI-40 mode was maintained. No pauses longer than 1500 ms were observed. Frequent ventricular premature beats reduced the percentage of AV synchrony. During AF, the atrial signal was of low amplitude and there was infrequent sensing. CONCLUSION/CONCLUSIONS:The mode switching algorithm reduced VP in patients with 1:1 AVC and appropriately switched to VDD during AV block. No pacing safety issues were observed during arrhythmias.
PMID: 33928713
ISSN: 1540-8167
CID: 4873842
