Faculty Bibliography
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214
Journal of interventional cardiac electrophysiology. 2023:66(2):257-259.DOI: 10.1007/s10840-022-01387-7
Persistent atrial fibrillation ablation: the ongoing search for the perfect wave [Editorial]
PMID: 36322372
ISSN: 1572-8595
CID: 5358632
Correlation between AV synchrony and device collected AM-VP sequence counter in atrioventricular synchronous leadless pacemakers: A real-world assessment
INTRODUCTION/BACKGROUND:Micra atrioventricular (AV) provides leadless atrioventricular synchronous pacing by sensing atrial contraction (A4 signal). Real-world operation and reliability of AV synchrony (AVS) assessment using device data have not been described. The purposes of this study were to (1) assess the correlation between AVS and atrial mechanical sensed-ventricular pacing (AM-VP) percentages in patients with permanent high-degree AV block and (2) report on the real-world effectiveness of Micra AV. METHODS:The correlation between ECG-determined AVS in-clinic and device-collected %AM-VP was assessed using data from 40 patients with high-degree AV block enrolled in the Micra Atrial tRacking using a Ventricular AccELerometer (MARVEL) 2 study. A retrospective analysis to assess continuously-sampled %AM-VP since last session, device programming, and electrical parameters was performed using Micra AV transmissions from the Medtronic CareLink database. Patients with transmissions ≥180 days postimplant were included. RESULTS:at 28 weeks. In patients with %VP >90% (n = 1662), the median %AM-VP was 74.7%. For the full cohort, median %VP was 65.6% and median projected battery longevity was 10.5 years. CONCLUSION/CONCLUSIONS:In patients with a high pacing burden, %AM-VP provides a reasonable estimation of AVS. The first large real-world analysis of Micra AV patients with >90% VP showed stable atrial sensing over time with a median %AM-VP, a correlate of AVS, of 74.7%.
PMID: 36317470
ISSN: 1540-8167
CID: 5358502
Ambulatory AV synchronous pacing over time using a leadless ventricular pacemaker: Primary results from the AccelAV study
BACKGROUND:Prior studies demonstrated that accelerometer-based mechanically-timed AV synchrony (AVS) is feasible using a leadless ventricular pacemaker. OBJECTIVE:This study reports on the performance of a leadless ventricular pacemaker with accelerometer-based algorithms that provide AVS pacing. METHODS:AccelAV was a prospective single-arm study to characterize AVS in patients implanted with a Micra AV, which uses the device accelerometer to mechanically detect atrial contractions and promote VDD pacing. The primary objective was to characterize resting AVS at 1-month in patients with complete AV block (AVB) and normal sinus function. RESULTS:A total of 152 patients (age 77±11 years, 48% female) from 20 centers were enrolled and implanted with a leadless pacemaker. Among patients with normal sinus function and complete AVB (n=54), mean resting AVS was 85.4% at 1-month, while ambulatory AVS was 74.8%. In the subset of patients (n=20) with programming optimization, mean ambulatory AVS was 82.6%, representing a 10.5% improvement (P<0.001). Quality of life as measured by the EQ-5D-3L improved significantly from pre-implant to 3 months (P=0.031). In 37 patients with AVB at both 1-month and 3-months, mean AVS during rest did not differ (86.1% vs 84.1%, P=0.43). There were no upgrades to dual-chamber devices or CRT through 3 months. CONCLUSION/CONCLUSIONS:Accelerometer-based mechanical atrial sensing provided by a leadless pacemaker implanted in the right ventricle significantly improves quality of life in a select cohort of patients with AV block and normal sinus function. AVS remained stable through 3 months and there were no system upgrades to dual-chamber pacemakers.
PMID: 36075532
ISSN: 1556-3871
CID: 5337172
Repetitive nonreentrant ventriculoatrial synchrony inducing atrial fibrillation in setting of dofetilide [Case Report]
PMCID:9123322
PMID: 35607350
ISSN: 2214-0271
CID: 5232852
Urgent catheter ablation for treatment refractory symptomatic atrial fibrillation: Health care utilization and outcomes
PMID: 35490709
ISSN: 1556-3871
CID: 5215712
Author Correction: Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility
PMID: 35474365
ISSN: 1546-1718
CID: 5205632
Symphony to leadless pacing-An Ode to Joy [Editorial]
ISI:000767960400001
ISSN: 1045-3873
CID: 5182092
Symphony to Leadless pacing - An Ode to Joy [Editorial]
Ludwig van Beethoven's 9th Symphony is regarded by many musicologists as one of the finest works in the history of music. It is notable for several reasons, particularly being the first example of a composer using voices, with words sung by a chorus and vocal soloist in the final movement. This article is protected by copyright. All rights reserved.
PMID: 35233870
ISSN: 1540-8167
CID: 5174422
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
Subcutaneous Versus Transvenous Implantable Defibrillator in Patients with Hypertrophic Cardiomyopathy
BACKGROUND:Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiomyopathy. Implantable Cardioverter Defibrillator (ICD) is important for prevention of sudden cardiac death (SCD) in patients at high risk. In recent years the subcutaneous ICD (S-ICD) has emerged as a viable alternative to the transvenous ICD (TV-ICD). The S-ICD does not require intravascular access, but cannot provide antitachycardia pacing therapy (ATP). OBJECTIVE:To assess the real world incidence of ICD therapy in patients with HCM implanted with TV-ICD versus S-ICD. METHODS:We compared the incidence of ATP and shock therapies between all HCM patients with S-ICD and TV-ICD enrolled in the Boston Scientific ALTITUDE database. Cumulative Kaplan Meier incidence was used to compare therapy free survival and Cox proportional hazard ratios were calculated. We performed an unmatched as well as propensity match analysis. RESULTS:We included 2047 patients with TV-ICD and 626 patients with S-ICD followed for an average of 1650.5±1038.5 and 933.4±550.6 days, respectively. Patients with HCM and TV-ICD had significantly higher rate of device therapy as compared to those with S-ICD (32.7 vs. 14.5 therapies /100 patient year; p<0.001), driven by a high incidence of ATP therapy in the TV-ICD group which accounted for more than 67% of therapies delivered. Shock incidence was similar between groups, both in the general and in the matched cohorts. CONCLUSIONS:Patients with HCM and S-ICD had significantly lower therapy rate than patients with TV-ICD without difference in shock therapy, suggesting potentially unnecessary ATP therapy. Empiric ATP programing in patients with HCM may be unbeneficial.
PMID: 35038570
ISSN: 1556-3871
CID: 5131402
