Try a new search

Format these results:

Searched for:

person:jankel01

in-biosketch:true

Total Results:

84


Catheter ablation in rate-controlled atrial fibrillation with severely reduced ejection fraction: intervention for irregularity-mediated cardiomyopathy

Maidman, Samuel D; Aizer, Anthony; Jankelson, Lior; Holmes, Douglas; Park, David S; Bernstein, Scott A; Knotts, Robert; Kushnir, Alex; Chinitz, Larry A; Barbhaiya, Chirag R
BACKGROUND:Recent evidence suggests atrial fibrillation (AF) causes cardiomyopathy due to remodeling driven by both irregular rate and rhythm. Atrial fibrillation (AF) ablation in patients with reduced ejection fraction (EF) ≤ 35% has been shown to improve EF and mortality. It is unknown whether the benefits of AF ablation among patients with reduced EF are affected by the degree of pre-ablation rate control. OBJECTIVES/OBJECTIVE:To evaluate AF ablation echocardiographic outcomes for patients who have EF ≤ 35% with varying degrees of pre-ablation rate control. METHODS:Single-center, retrospective study of patients with EF ≤ 35% undergoing first-time ablation of persistent AF. Primary analyses evaluated the degree to which pre-ablation rate control impacted echocardiographic outcomes. Rates of EF recovery to > 35% were compared at three different cutoffs: 110 bpm, 90 bpm, and 70 bpm. A linear regression analysis was then performed to evaluate whether baseline heart rate (HR) predicted change in EF. RESULTS: = 0.05, p = 0.07). CONCLUSIONS:Catheter ablation of persistent AF in patients with reduced EF frequently resulted in recovery in EF > 35%, irrespective of pre-ablation achieved rate control. While patients with HR > 70 bpm experienced a greater improvement in EF compared to those ≤ 70 bpm, patients with baseline HR below this target still experienced significant EF improvements. Further investigation into irregularity-mediated cardiomyopathy is warranted.
PMID: 39702550
ISSN: 1572-8595
CID: 5764822

Catheter ablation alone versus catheter ablation with combined percutaneous left atrial appendage closure for atrial fibrillation: a systematic review and meta-analysis

Junarta, Joey; Siddiqui, Muhammad U; Abaza, Ehab; Zhang, Peter; Roshandel, Aarash; Barbhaiya, Chirag R; Jankelson, Lior; Park, David S; Holmes, Douglas; Chinitz, Larry A; Aizer, Anthony
BACKGROUND:Combined catheter ablation (CA) with percutaneous left atrial appendage closure (LAAC) may produce comprehensive treatment for atrial fibrillation (AF) whereby rhythm control is achieved and stroke risk is reduced without the need for chronic oral anticoagulation. However, the efficacy and safety of this strategy is still controversial. METHODS:This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. The risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. Eligible studies reported outcomes in patients with AF who underwent combined CA and LAAC vs CA alone. Studies performing CA without pulmonary vein isolation were excluded. RESULTS:Eight studies comprising 1878 patients were included (2 RCT, 6 observational). When comparing combined CA and LAAC vs CA alone, pooled results showed no difference in arrhythmia recurrence (risk ratio (RR) 1.04; 95% confidence interval (CI) 0.82-1.33), stroke or systemic embolism (RR 0.78; 95% CI 0.27-2.22), or major periprocedural complications (RR 1.28; 95% CI 0.28-5.89). Total procedure time was shorter with CA alone (mean difference 48.45 min; 95% CI 23.06-74.62). CONCLUSION/CONCLUSIONS:Combined CA with LAAC for AF is associated with similar rates of arrhythmia-free survival, stroke, and major periprocedural complications when compared to CA alone. A combined strategy may be as safe and efficacious for patients at moderate to high risk for bleeding events to negate the need for chronic oral anticoagulation.
PMID: 39230634
ISSN: 1572-8595
CID: 5687972

Evaluating Patient-Oriented Echocardiogram Reports Augmented by Artificial Intelligence [Letter]

Martin, Jacob A; Hill, Theodore; Saric, Muhamed; Vainrib, Alan F; Bamira, Daniel; Bernard, Samuel; Ro, Richard; Zhang, Hao; Austrian, Jonathan S; Aphinyanaphongs, Yindalon; Koesmahargyo, Vidya; Williams, Mathew R; Chinitz, Larry A; Jankelson, Lior
PMID: 39093252
ISSN: 1876-7591
CID: 5743582

Personalized Ablation Strategies Optimize First Pass Isolation and Minimize Pulmonary Vein Reconnection During Paroxysmal Atrial Fibrillation Ablation

Junarta, Joey; Qiu, Jessica; Cheng, Austin V; Barbhaiya, Chirag R; Jankelson, Lior; Holmes, Douglas; Kushnir, Alexander; Knotts, Robert J; Yang, Felix; Bernstein, Scott A; Park, David S; Chinitz, Larry A; Aizer, Anthony
PMID: 39447812
ISSN: 1556-3871
CID: 5740132

Performance of a Protein Language Model for Variant Annotation in Cardiac Disease

Hochstadt, Aviram; Barbhaiya, Chirag; Aizer, Anthony; Bernstein, Scott; Cerrone, Marina; Garber, Leonid; Holmes, Douglas; Knotts, Robert J; Kushnir, Alex; Martin, Jacob; Park, David; Spinelli, Michael; Yang, Felix; Chinitz, Larry A; Jankelson, Lior
BACKGROUND:Genetic testing is a cornerstone in the assessment of many cardiac diseases. However, variants are frequently classified as variants of unknown significance, limiting the utility of testing. Recently, the DeepMind group (Google) developed AlphaMissense, a unique artificial intelligence-based model, based on language model principles, for the prediction of missense variant pathogenicity. We aimed to report on the performance of AlphaMissense, accessed by VarCardio, an open web-based variant annotation engine, in a real-world cardiovascular genetics center. METHODS AND RESULTS/RESULTS:<0.001). Genotype-phenotype concordance was highly aligned using VarCard.io predictions, at 95.9% (95% CI, 92.8-97.9) concordance rate. For 109 variants classified as pathogenic, likely pathogenic, benign, or likely benign by ClinVar, concordance with VarCard.io was high (90.5%). CONCLUSIONS:AlphaMissense, accessed via VarCard.io, may be a highly efficient tool for cardiac genetic variant interpretation. The engine's notable performance in assessing variants that are classified as variants of unknown significance in ClinVar demonstrates its potential to enhance cardiac genetic testing.
PMID: 39392163
ISSN: 2047-9980
CID: 5706292

Electric storm triggered by short-coupled premature ventricular complexes in a young patient with non-obstructive hypertrophic cardiomyopathy [Case Report]

Manongi, Ngoda; Jankelson, Lior; Massera, Daniele; Bhatt, Reema; Goldbarg, Seth
Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.
PMID: 39306335
ISSN: 1757-790x
CID: 5722302

Electric storm triggered by short-coupled premature ventricular complexes in a young patient with non-obstructive hypertrophic cardiomyopathy [Case Report]

Manongi, Ngoda; Jankelson, Lior; Massera, Daniele; Bhatt, Reema; Goldbarg, Seth
Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.
PMID: 39306335
ISSN: 1757-790x
CID: 5722312

Electric storm triggered by short-coupled premature ventricular complexes in a young patient with non-obstructive hypertrophic cardiomyopathy [Case Report]

Manongi, Ngoda; Jankelson, Lior; Massera, Daniele; Bhatt, Reema; Goldbarg, Seth
Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.
PMID: 39306335
ISSN: 1757-790x
CID: 5722282

Electric storm triggered by short-coupled premature ventricular complexes in a young patient with non-obstructive hypertrophic cardiomyopathy [Case Report]

Manongi, Ngoda; Jankelson, Lior; Massera, Daniele; Bhatt, Reema; Goldbarg, Seth
Ventricular arrhythmias are commonly associated with hypertrophic cardiomyopathy with and without midventricular obstruction. Although the overall prognosis is relatively good with an annual mortality rate <1%, the propensity to potentially fatal ventricular arrhythmias (ventricular tachycardia) is the most feared complication. Electrical storms are a severe manifestation of ventricular arrhythmias, with poor outcomes. In this report, we present a case of a young patient with non-obstructive hypertrophic cardiomyopathy who presents after a syncopal episode and is found to have an electric storm that is refractory to medical therapy.
PMID: 39306335
ISSN: 1757-790x
CID: 5722292

Performance of Publicly Available Large Language Models on Internal Medicine Board-style Questions

Tarabanis, Constantine; Zahid, Sohail; Mamalis, Marios; Zhang, Kevin; Kalampokis, Evangelos; Jankelson, Lior
Ongoing research attempts to benchmark large language models (LLM) against physicians' fund of knowledge by assessing LLM performance on medical examinations. No prior study has assessed LLM performance on internal medicine (IM) board examination questions. Limited data exists on how knowledge supplied to the models, derived from medical texts improves LLM performance. The performance of GPT-3.5, GPT-4.0, LaMDA and Llama 2, with and without additional model input augmentation, was assessed on 240 randomly selected IM board-style questions. Questions were sourced from the Medical Knowledge Self-Assessment Program released by the American College of Physicians with each question serving as part of the LLM prompt. When available, LLMs were accessed both through their application programming interface (API) and their corresponding chatbot. Mode inputs were augmented with Harrison's Principles of Internal Medicine using the method of Retrieval Augmented Generation. LLM-generated explanations to 25 correctly answered questions were presented in a blinded fashion alongside the MKSAP explanation to an IM board-certified physician tasked with selecting the human generated response. GPT-4.0, accessed either through Bing Chat or its API, scored 77.5-80.7% outperforming GPT-3.5, human respondents, LaMDA and Llama 2 in that order. GPT-4.0 outperformed human MKSAP users on every tested IM subject with its highest and lowest percentile scores in Infectious Disease (80th) and Rheumatology (99.7th), respectively. There is a 3.2-5.3% decrease in performance of both GPT-3.5 and GPT-4.0 when accessing the LLM through its API instead of its online chatbot. There is 4.5-7.5% increase in performance of both GPT-3.5 and GPT-4.0 accessed through their APIs after additional input augmentation. The blinded reviewer correctly identified the human generated MKSAP response in 72% of the 25-question sample set. GPT-4.0 performed best on IM board-style questions outperforming human respondents. Augmenting with domain-specific information improved performance rendering Retrieval Augmented Generation a possible technique for improving accuracy in medical examination LLM responses.
PMCID:11407633
PMID: 39288137
ISSN: 2767-3170
CID: 5720442