Searched for: person:tanr01
in-biosketch:true
Variations in the Evaluation and Management of Vascular Rings: A Survey of American Clinicians
Pasternack, Daniel M; Ludomirsky, Achiau; Tan, Reina B; Amirtharaj, Cynthia
Vascular rings are arterial malformations that lead to the compression of the trachea and/or esophagus. While "tight" rings often produce symptoms and require surgery, "loose" rings rarely produce symptoms. Given advances in fetal echocardiography, this diagnosis is now more often made prenatally. This poses a new conundrum in the management of asymptomatic patients, leading to practice variation and creating a target for clinical system improvement. Hence, we conducted this survey aiming to demonstrate the practice variation existing in current evaluation and management of these patients. An anonymous web-based survey was distributed to several listservs for pediatric cardiologists and pediatric cardiothoracic surgeons. Survey questions targeted respondent practice characteristics, testing obtained, and indications for testing or surgical referral. In total 61 responses were received, predominantly from pediatric cardiologists (95%) in the United States (97%). About 60% of clinicians reported frequently diagnosing patients with vascular rings by fetal echocardiogram, with only about 20% diagnosing them frequently on evaluation of symptoms. Computed tomography angiography and echocardiogram were the most common imaging modalities employed. Most clinicians obtained cross-sectional imaging at the time of diagnosis and referred to surgery once patients had at least occasional symptoms. Respondents demonstrated a low degree of agreement (Krippendorf's alpha 0.48). Few statistically significant patterns were identified between respondents based on their practice characteristics. This study identified significant variation between clinicians regarding the evaluation and management of vascular rings. Further research or expert opinions may help to standardize practice, saving costs and improving the quality of care for affected patients.
PMID: 38467893
ISSN: 1432-1971
CID: 5694592
Rationale and Design of the Multicenter Catheter Ablation of Ventricular Tachycardia Before Transcatheter Pulmonary Valve Replacement in Repaired Tetralogy of Fallot Study
Moore, Jeremy P; Aboulhosn, Jamil A; Zeppenfeld, Katja; Waldmann, Victor; Bessière, Francis; Blom, Nico A; Combes, Nicolas; Fish, Frank A; McLeod, Christopher J; Kanter, Ronald J; Tan, Weiyi; Patel, Nimesh; von Alvensleben, Johannes C; Kamp, Anna; Lloyd, Michael S; Anderson, Charles C; Tan, Reina B; Mariucci, Elisabetta; Levi, Daniel S; Salem, Morris; Shivkumar, Kalyanam; Khairy, Paul
Patients with repaired tetralogy of Fallot are at elevated risk for ventricular arrhythmia and sudden cardiac death. Over the past decade, the pathogenesis and natural history of ventricular tachycardia has become increasingly understood, and catheter ablation has emerged as an effective treatment modality. Concurrently, there has been great progress in the development of a versatile array of transcatheter valves that can be placed in the native right ventricular outflow tract for the treatment of long-standing pulmonary regurgitation. Although such valve platforms may eliminate the need for repeat cardiac operations, they may also impede catheter access to the myocardial substrates responsible for sustained macro-reentrant ventricular tachycardia. This manuscript provides the rationale and design of a recently devised multicenter study that will examine the clinical outcomes of a uniform, preemptive strategy to eliminate ventricular tachycardia substrates before transcatheter pulmonary valve implantation in patients with tetralogy of Fallot.
PMID: 37536198
ISSN: 1879-1913
CID: 5618972
Cardiac Resynchronization Therapy for Adult Patients With a Failing Systemic Right Ventricle: A Multicenter Study
Kharbanda, Rohit K; Moore, Jeremy P; Lloyd, Michael S; Galotti, Robert; Bogers, Ad J J C; Taverne, Yannick J H J; Madhavan, Malini; McLeod, Christopher J; Dubin, Anne M; Mah, Douglas Y; Chang, Philip M; Kamp, Anna N; Nielsen, Jens C; Aydin, Alper; Tanel, Ronn E; Shah, Maully J; Pilcher, Thomas; Evertz, Reinder; Khairy, Paul; Tan, Reina B; Czosek, Richard J; Shivkumar, Kalyanam; de Groot, Natasja M S
Background The objective of this international multicenter study was to investigate both early and late outcomes of cardiac resynchronization therapy (CRT) in patients with a systemic right ventricle (SRV) and to identify predictors for congestive heart failure readmissions and mortality. Methods and Results This retrospective international multicenter study included 13 centers. The study population comprised 80 adult patients with SRV (48.9% women) with a mean age of 45±14 (range, 18-77) years at initiation of CRT. Median follow-up time was 4.1 (25th-75th percentile, 1.3-8.3) years. Underlying congenital heart disease consisted of congenitally corrected transposition of the great arteries and dextro-transposition of the great arteries in 63 (78.8%) and 17 (21.3%) patients, respectively. CRT resulted in significant improvement in functional class (before CRT: III, 25th-75th percentile, II-III; after CRT: II, 25th-75th percentile, II-III; P=0.005) and QRS duration (before CRT: 176±27; after CRT: 150±24 milliseconds; P=0.003) in patients with pre-CRT ventricular pacing who underwent an upgrade to a CRT device (n=49). These improvements persisted during long-term follow-up with a marginal but significant increase in SRV function (before CRT; 30%, 25th-75th percentile, 25-35; after CRT: 31%, 25th-75th percentile, 21-38; P=0.049). In contrast, no beneficial change in the above-mentioned variables was observed in patients who underwent de novo CRT (n=31). A quarter of all patients were readmitted for heart failure during follow-up, and mortality at latest follow-up was 21.3%. Conclusions This international experience with CRT in patients with an SRV demonstrated that CRT in selected patients with SRV dysfunction and pacing-induced dyssynchrony yielded consistent improvement in QRS duration and New York Heart Association functional status, with a marginal increase in SRV function.
PMID: 36346046
ISSN: 2047-9980
CID: 5357172
2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary
Silka, Michael J.; Shah, Maully J.; Avari Silva, Jennifer N.; Balaji, Seshadri; Beach, Cheyenne M.; Benjamin, Monica N.; Berul, Charles I.; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I.; Dalal, Aarti S.; Dechert, Brynn E.; Foster, Anne; Gebauer, Roman; Corcia, M. Cecilia Gonzalez; Kannankeril, Prince J.; Karpawich, Peter P.; Kim, Jeffery J.; Krishna, Mani Ram; KubuÅ¡, Peter; LaPage, Martin J.; Mah, Douglas Y.; Malloy"‘Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S.; Niu, Mary C.; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V.; Silvetti, Massimo Stefano; Stephenson, Elizabeth A.; Tan, Reina B.; Triedman, John; Von Bergen, Nicholas H.; Wackel, Philip L.
SCOPUS:85145092814
ISSN: 0974-2069
CID: 5407712
2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: executive summary
Silka, Michael J; Shah, Maully J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannakeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
PMID: 34796795
ISSN: 1467-1107
CID: 5049672
2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary [Comment]
Silka, Michael J; Shah, Maully J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
PMID: 34363987
ISSN: 1556-3871
CID: 5103652
2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients
Shah, Maully J; Silka, Michael J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Bergen, Nicholas H Von; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMID: 34363988
ISSN: 1556-3871
CID: 5171792
2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: Executive summary
Silka, Michael J; Shah, Maully J; Avari Silva, Jennifer N; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [1]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [2], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [3], with further data easily accessible in electronic searches or textbooks.
PMCID:8577082
PMID: 34333142
ISSN: 0972-6292
CID: 5066662
2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS)
Shah, Maully J; Silka, Michael J; Silva, Jennifer N Avari; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Bergen, Nicholas H Von; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMID: 34794667
ISSN: 2405-5018
CID: 5049572
2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients
Shah, Maully J; Silka, Michael J; Avari Silva, Jennifer N; Balaji, Seshadri; Beach, Cheyenne M; Benjamin, Monica N; Berul, Charles I; Cannon, Bryan; Cecchin, Frank; Cohen, Mitchell I; Dalal, Aarti S; Dechert, Brynn E; Foster, Anne; Gebauer, Roman; Gonzalez Corcia, M Cecilia; Kannankeril, Prince J; Karpawich, Peter P; Kim, Jeffery J; Krishna, Mani Ram; Kubuš, Peter; LaPage, Martin J; Mah, Douglas Y; Malloy-Walton, Lindsey; Miyazaki, Aya; Motonaga, Kara S; Niu, Mary C; Olen, Melissa; Paul, Thomas; Rosenthal, Eric; Saarel, Elizabeth V; Silvetti, Massimo Stefano; Stephenson, Elizabeth A; Tan, Reina B; Triedman, John; Von Bergen, Nicholas H; Wackel, Philip L
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
PMCID:8577100
PMID: 34333141
ISSN: 0972-6292
CID: 5066652