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64


Diagnostic utility of a novel leadless arrhythmia monitoring device

Turakhia, Mintu P; Hoang, Donald D; Zimetbaum, Peter; Miller, Jared D; Froelicher, Victor F; Kumar, Uday N; Xu, Xiangyan; Yang, Felix; Heidenreich, Paul A
Although extending the duration of ambulatory electrocardiographic monitoring beyond 24 to 48 hours can improve the detection of arrhythmias, lead-based (Holter) monitors might be limited by patient compliance and other factors. We, therefore, evaluated compliance, analyzable signal time, interval to arrhythmia detection, and diagnostic yield of the Zio Patch, a novel leadless, electrocardiographic monitoring device in 26,751 consecutive patients. The mean wear time was 7.6 ± 3.6 days, and the median analyzable time was 99% of the total wear time. Among the patients with detected arrhythmias (60.3% of all patients), 29.9% had their first arrhythmia and 51.1% had their first symptom-triggered arrhythmia occur after the initial 48-hour period. Compared with the first 48 hours of monitoring, the overall diagnostic yield was greater when data from the entire Zio Patch wear duration were included for any arrhythmia (62.2% vs 43.9%, p <0.0001) and for any symptomatic arrhythmia (9.7% vs 4.4%, p <0.0001). For paroxysmal atrial fibrillation (AF), the mean interval to the first detection of AF was inversely proportional to the total AF burden, with an increasing proportion occurring after 48 hours (11.2%, 10.5%, 20.8%, and 38.0% for an AF burden of 51% to 75%, 26% to 50%, 1% to 25%, and <1%, respectively). In conclusion, extended monitoring with the Zio Patch for ≤14 days is feasible, with high patient compliance, a high analyzable signal time, and an incremental diagnostic yield beyond 48 hours for all arrhythmia types. These findings could have significant implications for device selection, monitoring duration, and care pathways for arrhythmia evaluation and AF surveillance.
PMID: 23672988
ISSN: 1879-1913
CID: 5375832

Differences and trends in stroke prevention anticoagulation in primary care vs cardiology specialty management of new atrial fibrillation: The Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) study

Turakhia, Mintu P; Hoang, Donald D; Xu, Xiangyan; Frayne, Susan; Schmitt, Susan; Yang, Felix; Phibbs, Ciaran S; Than, Claire T; Wang, Paul J; Heidenreich, Paul A
BACKGROUND:Atrial fibrillation and flutter (AF, collectively) cause stroke. We evaluated whether treating specialty influences warfarin prescription in patients with newly diagnosed AF. METHODS:In the TREAT-AF study, we used Veterans Health Administration health record and claims data to identify patients with newly diagnosed AF between October 2004 and November 2008 and at least 1 internal medicine/primary care or cardiology outpatient encounter within 90 days after diagnosis. The primary outcome was prescription of warfarin. RESULTS:In 141,642 patients meeting the inclusion criteria, the mean age was 72.3 ± 10.2 years, 1.48% were women, and 25.8% had cardiology outpatient care. Cardiology-treated patients had more comorbidities and higher mean CHADS2 scores (1.8 vs 1.6, P < .0001). Warfarin use was higher in cardiology-treated vs primary care only-treated patients (68.6% vs 48.9%, P < .0001). After covariate and site-level adjustment, cardiology care was significantly associated with warfarin use (odds ratio [OR] 2.05, 95% CI 1.99-2.11). These findings were consistent across a series of adjusted models (OR 2.05-2.20), propensity matching (OR 1.98), and subgroup analyses (OR 1.58-2.11). Warfarin use in primary-care-only patients declined from 2004 to 2008 (51.6%-44.0%, P < .0001), whereas the adjusted odds of warfarin receipt with cardiology care (vs primary care) increased from 2004 to 2008 (1.88-2.24, P < .0001). CONCLUSION/CONCLUSIONS:In patients with newly diagnosed AF, we found large differences in anticoagulation use by treating specialty. A divergent 5-year trend of risk-adjusted warfarin use was observed. Treating specialty influences stroke prevention care and may impact clinical outcomes.
PMID: 23237139
ISSN: 1097-6744
CID: 5375812

Examination of explanted heart after radiofrequency ablation for intractable ventricular arrhythmia [Case Report]

Kelesidis, Iosif; Yang, Felix; Maybaum, Simon; Goldstein, Daniel; D'Alessandro, David A; Ferrick, Kevin; Kim, Soo; Palma, Eugen; Gross, Jay; Fisher, John; Krumerman, Andrew
PMID: 23250554
ISSN: 1941-3084
CID: 5375822

INTERACTION AMONG DIGOXIN USE, KIDNEY FUNCTION, AND MORTALITY IN PATIENTS WITH ATRIAL FIBRILLATION: THE TREAT-AF STUDY [Meeting Abstract]

Turakhia, Mintu; Yang, Felix; Xu, Xiangyan; Winkelmayer, Wolfgang; Hoang, Donald; Heidenreich, Paul
ISI:000302326700687
ISSN: 0735-1097
CID: 5376112

AMIODARONE USE IS NOT ASSOCIATED WITH MORTALITY IN PATIENTS WITH ATRIAL FIBRILLATION AND KIDNEY DYSFUNCTION OR DIALYSIS: THE TREAT-AF STUDY [Meeting Abstract]

Turakhia, Mintu; Yang, Felix; Xu, Xiangyan; Winkelmayer, Wolfgang; Hoang, Donald; Heidenreich, Paul
ISI:000302326700684
ISSN: 0735-1097
CID: 5376102

CLINICAL EXPERIENCE AND DIAGNOSTIC YIELD FROM A NATIONAL REGISTRY OF 14-DAY AMBULATORY ECG PATCH MONITORING [Meeting Abstract]

Turakhia, Mintu; Hoang, Donald; Zimetbaum, Peter; Yang, Felix; Froelicher, Victor; Heidenreich, Paul
ISI:000302326700648
ISSN: 0735-1097
CID: 5376092

Impact of Baseline Stroke Risk and Bleeding Risk on INR Control among Patients with Atrial Fibrillation on Warfarin: the TREAT-AF Study [Meeting Abstract]

Turakhia, Mintu P.; Than, Claire T.; Xu, Xiangyan; Schmitt, Susan K.; Yang, Felix; Frayne, Susan M.; Phibbs, Ciaran S.; Holmes, Tyson H.; Heidenreich, Paul A.
ISI:000208885006200
ISSN: 0009-7322
CID: 5376082

Warfarin in haemodialysis patients with atrial fibrillation: what benefit?

Yang, Felix; Chou, Denise; Schweitzer, Paul; Hanon, Sam
Warfarin is commonly used to prevent stroke in patients with atrial fibrillation; however, patients on haemodialysis may not derive the same benefit from warfarin as the general population. There are no randomized controlled studies in dialysis patients which demonstrate the efficacy of warfarin in preventing stroke. In fact, warfarin places the dialysis patient at increased risk for haemorrhagic stroke and possibly ischaemic stroke. Additionally, warfarin increases the risk of major bleeding and has been associated with vascular calcification. Routine use of warfarin in dialysis for stroke prevention should be discouraged, and therapy should only be reserved for dialysis patients at high risk for thrombo-embolic stroke and carefully monitored if implemented.
PMID: 21045011
ISSN: 1532-2092
CID: 5375802

Ventricular arrhythmias in patients treated with methadone for opioid dependence

Hanon, Sam; Seewald, Randy M; Yang, Felix; Schweitzer, Paul; Rosman, Jonathan
PURPOSE/OBJECTIVE:Over the last decade, there has been a significant rise in reported cases of methadone induced QT prolongation (QTP) and Torsades de Pointes (TdP) in patients treated for opioid dependence. Optimal management of these patients is challenging. METHODS:We report a case series of 12 consecutive patients admitted to our institution with methadone-induced QTP and ventricular arrhythmias. RESULTS:All patients survived the presenting arrhythmia. Successful transition to buprenorphine was accomplished in three patients. QT interval normalized and none of these patients had recurrent arrhythmias. Methadone dose was reduced in five patients with improvement of QT interval and resolution of arrhythmia. Four patients, including two with ICDs, refused or did not tolerate a reduction in their methadone dose. CONCLUSION/CONCLUSIONS:Ventricular arrhythmias in patients on methadone are an uncommon but important problem. Buprenorphine, a partial micro-opiate-receptor agonist and a kappa-opiate-receptor antagonist does not cause QTP or TdP. Buprenorphine is a useful and effective alternative to methadone in a select group of patients, including those with documented ventricular arrhythmias on methadone. Pacemakers or defibrillators should be reserved for patients who have failed buprenorphine or a reduced methadone dose.
PMID: 20177760
ISSN: 1572-8595
CID: 5375792

Quinidine revisited

Yang, Felix; Hanon, Sam; Lam, Patrick; Schweitzer, Paul
One of the earliest antiarrhythmic drugs developed, quinidine had a significant role in the treatment of many arrhythmias. After concerns for increased risk of ventricular arrhythmia and death with quinidine emerged, the use of quinidine fell dramatically in favor of newer antiarrhythmic medications. However, recent trials have generated renewed interest in the use of quinidine. In particular, quinidine appears to be safe and efficacious in combination with verapamil for the treatment of atrial fibrillation. Quinidine has also been used successfully to treat idiopathic ventricular fibrillation, Brugada syndrome, and Short QT syndrome. Although it is one of the oldest drugs in our armamentarium, quinidine continues to have a role in modern cardiology.
PMID: 19249010
ISSN: 1555-7162
CID: 5375772