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  • 1
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    Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients With Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 145, No. 23 ( 2022-06-07), p. 1693-1704
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. 23 ( 2022-06-07), p. 1693-1704
    Abstract: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and can be challenging to treat. Pharmacologically based rhythm control of AF has not proven to be superior to rate control. Ablation-based rhythm control was compared with rate control to evaluate if clinical outcomes in patients with HF and AF could be improved. Methods: This was a multicenter, open-label trial with blinded outcome evaluation using a central adjudication committee. Patients with high-burden paroxysmal ( 〉 4 episodes in 6 months) or persistent (duration 〈 3 years) AF, New York Heart Association class II to III HF, and elevated NT-proBNP (N-terminal pro brain natriuretic peptide) were randomly assigned to ablation-based rhythm control or rate control. The primary outcome was a composite of all-cause mortality and all HF events, with a minimum follow-up of 2 years. Secondary outcomes included left ventricular ejection fraction, 6-minute walk test, and NT-proBNP. Quality of life was measured using the Minnesota Living With Heart Failure Questionnaire and the AF Effect on Quality of Life. The primary analysis was time-to-event using Cox proportional hazards modeling. The trial was stopped early because of a determination of apparent futility by the Data Safety Monitoring Committee. Results: From December 1, 2011, to January 20, 2018, 411 patients were randomly assigned to ablation-based rhythm control (n=214) or rate control (n=197). The primary outcome occurred in 50 (23.4%) patients in the ablation-based rhythm-control group and 64 (32.5%) patients in the rate-control group (hazard ratio, 0.71 [95% CI, 0.49–1.03]; P =0.066). Left ventricular ejection fraction increased in the ablation-based group (10.1±1.2% versus 3.8±1.2%, P =0.017), 6-minute walk distance improved (44.9±9.1 m versus 27.5±9.7 m, P =0.025), and NT-proBNP demonstrated a decrease (mean change –77.1% versus –39.2%, P 〈 0.0001). Minnesota Living With Heart Failure Questionnaire demonstrated greater improvement in the ablation-based rhythm-control group (least-squares mean difference of –5.4 [95% CI, –10.5 to –0.3]; P =0.0036), as did the AF Effect on Quality of Life score (least-squares mean difference of 6.2 [95% CI, 1.7–10.7]; P =0.0005). Serious adverse events were observed in 50% of patients in both treatment groups. Conclusions: In patients with high-burden AF and HF, there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm control versus rate control; however, there was a nonsignificant trend for improved outcomes with ablation-based rhythm control over rate control. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01420393.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.121.057095
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 2
    Online Resource
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    Narrow, Intermediate, and Wide Complex Tachycardia: What Is the Mechanism?
    Wiley ; 2016
    In:  Journal of Cardiovascular Electrophysiology Vol. 27, No. 4 ( 2016-04), p. 494-496
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 27, No. 4 ( 2016-04), p. 494-496
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.2016.27.issue-4
    DOI: 10.1111/jce.12862
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2037519-0
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  • 3
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    Paced P‐wave morphology templates to guide atrial tachycardia localization: A derivation and validation study
    Wiley ; 2023
    In:  Pacing and Clinical Electrophysiology Vol. 46, No. 8 ( 2023-08), p. 1019-1031
    Details
    In: Pacing and Clinical Electrophysiology, Wiley, Vol. 46, No. 8 ( 2023-08), p. 1019-1031
    Abstract: Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). Objectives We aimed to construct 12‐lead ECG templates for P‐wave morphology (PWM) during endocardial pacing from different sites in both atria in patients with no apparent structural heart disease (derivation cohort), with the goal of creating a localization algorithm, which could subsequently be validated in a cohort of patients undergoing catheter ablation of focal AT (validation cohort). Methods We prospectively enrolled consecutive patients who underwent electrophysiology study, had no structural heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced PWM and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients. Overall and site‐specific accuracy were determined. Results Derivation cohort included 65 patients (25 men, age 37 ± 13 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in RA and in 15 patients (23%) in LA. The validation cohort included 71 patients (28 men, age 52 ± 19 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by one adjacent segment in the remaining 8.5%. Conclusions A simple ECG algorithm based on paced PWM templates was highly accurate in localizing site of origin of focal AT in patients with structurally normal hearts.
    Type of Medium: Online Resource
    ISSN: 0147-8389 , 1540-8159
    URL: Issue
    URL: Article
    DOI: 10.1111/pace.v46.8
    DOI: 10.1111/pace.14774
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2037547-5
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  • 4
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    Abstract 13385: Long Term Outcomes in Catheter Ablation of Atrial Fibrillation Compared to Medical Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: The long-term effects of catheter ablation (CA) compared to medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined. We examined the outcomes associated with CA compared to rate or rhythm control therapy in a population cohort with AF. Methods: Using Alberta administrative data, patients with AF as the primary diagnosis during hospitalization or emergency department/physician visit were included between 2008-2018. Based on therapy received, patients were assigned to CA, rate (digoxin, calcium channel or beta blocker) or rhythm control (amiodarone, sotalol, flecainide, propafenone, dronedarone). If treatment changed over time, the patient was censored in the prior treatment arm and assigned to the new arm. The association of treatment (included as time-varying covariate) with the primary composite outcome of death, hospitalization for heart failure or stroke was examined using multivariable Cox models after adjusting for age, sex, comorbidities and baseline medications. Secondary outcomes included cardiovascular hospitalizations, and individual components of the composite. Results: There were 2,149 (4.0%) patients treated with CA and 51,315 with medical treatment (rate : 41,948, (81.5%) rhythm: 9,367 (18.2%). During a median follow-up of 4.2 years, CA for AF was associated with a lower crude incidence of the composite outcome (rate per 100 person-years was 3.3 for CA, 9.5 for rate control, and 6.3 for rhythm control). In multivariate analysis, compared to CA, both rate (adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI), 1.44 to 1.68) and rhythm control (aHR 1.37; 95% CI 1.27 to 1.49) were associated with a higher risk of the primary composite outcome.(Figure) Secondary outcomes are shown in the Figure. Conclusions: Only a small percentage of patients with AF undergo CA. Patients selected for CA have a lower risk of long-term adverse outcomes compared to medical therapy in patients with AF.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13385
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 5
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    Abstract 21033: Effect of Baseline Antiarrhythmic Drug on Outcomes With Ablation in Ischemic Ventricular Tachycardia: A Vanish Substudy
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation Vol. 136, No. suppl_1 ( 2017-11-14)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 136, No. suppl_1 ( 2017-11-14)
    Abstract: Introduction: The VANISH trial enrolled patients with prior myocardial infarction, an implanted defibrillator and ventricular tachycardia (VT) despite antiarrhythmic (AAD) drugs and compared the effectiveness of escalated AAD therapy to catheter ablation. We sought to compare the effectiveness of these interventions in patients with sotalol-refractory VT versus amiodarone-refractory VT. Methods: All patients enrolled in the VANISH study were included (n=259). VT recurrence was compared in patients despite amiodarone (amio-refractory) as compared to non-amiodarone drugs (sotalol-refractory). Outcomes were a composite of death, VT storm, appropriate ICD shock, each of these components and any ventricular arrhythmia. Results: At baseline, 169 (65.2%) were amio-refractory and 90 (34.7%) were sotalol-refractory (1 patient was enrolled with VT despite procainamide). Amio-refractory patients had more renal insufficiency (23.7% vs 10%, p=0.0008), worse NYHA class (82.3% II/III vs 65.5%, p=0.0003), and lower ejection fraction (29 ± 9.7% vs 35.2 ± 11%, p 〈 0.0001). After adjusting for these baseline differences, there was no difference in mortality between the two groups. When examined within the escalated drug therapy arm, amio-refractory patients had a higher incidence of the composite outcome (HR 1.94, 95%CI (1.14, 3.29), p=0.0144), and a trend to higher mortality (HR 2.40, 95%CI (0.93, 6.22), p=0.07), while no difference in outcomes were observed within the ablation treatment group. Within the amio-refractory group, ablation resulted in significant reduction of any ventricular arrhythmia (HR 0.53, 95%CI (0.31, 0.9), p=0.020). Sotalol-refractory patients had trends towards higher mortality and VT storm with ablation, with no effect on ICD shocks. Conclusions: The benefit of catheter ablation is greater for patients with amio-refractory VT than for patients with sotalol-refractory VT who are then switched to amiodarone.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.136.suppl_1.21033
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 6
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    Combined Epicardial‐Endocardial Approach to Ablation of Inappropriate Sinus Tachycardia
    Wiley ; 2004
    In:  Journal of Cardiovascular Electrophysiology Vol. 15, No. 2 ( 2004-02), p. 237-240
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 15, No. 2 ( 2004-02), p. 237-240
    Abstract: A combined epicardial‐endocardial approach to ablation of inappropriate sinus tachycardia in a highly symptomatic patient who failed to respond to medical therapy and endocardial ablation is described. The anatomy and physiology of the sinus node is discussed, providing a basis for performing this procedure. This case provides an additional therapeutic option for a condition that often is difficult to manage. (J Cardiovasc Electrophysiol, Vol. 15, pp. 237‐240, February 2004)
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Article
    DOI: 10.1046/j.1540-8167.2004.03370.x
    Language: English
    Publisher: Wiley
    Publication Date: 2004
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  • 7
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    Quality of life with ablation or medical therapy for ventricular arrhythmias: A substudy of VANISH
    Wiley ; 2018
    In:  Journal of Cardiovascular Electrophysiology Vol. 29, No. 3 ( 2018-03), p. 421-434
    Details
    In: Journal of Cardiovascular Electrophysiology, Wiley, Vol. 29, No. 3 ( 2018-03), p. 421-434
    Abstract: We compared health‐related quality of life (HRQoL) in patients randomized to escalated therapy and those randomized to ablation for ventricular tachycardia in the VANISH trial. Methods HRQoL was assessed among VANISH patients at baseline and 3‐, 6‐, and 12‐month follow‐up visits. Four validated instruments were used: the SF‐36, the implanted cardioverter defibrillator (ICD) Concerns questionnaire (ICDC), the Hospital Anxiety and Depression Scale (HADS), and the EuroQol five dimensions questionnaire (EQ‐5D). Linear mixed‐effects modeling was used for repeated measures with SF‐36, HADS, ICDC, and EQ‐5D as dependent variables. In a second model, treatment was subdivided by amiodarone use prior to enrollment. Results HRQoL did not differ significantly between those randomized to ablation or escalated therapy. On subgroup analysis, improvement in SF‐36 measures was seen at 6 months in the ablation group for social functioning (63.5–69.3, P = 0.03) and energy/fatigue (43.0–47.9, P = 0.01). ICDC measures showed a reduction in ICD concern in the ablation group at 6 months (10.4–8.7, P = 0.01) and a reduction in ICD concern in the escalated therapy group at 6 months (10.9–9.4, P = 0.04). EQ‐5D measures showed a significant improvement in overall health in ablation patients at 6 months (63.4–67.3, P = 0.04). Conclusion Patients in the VANISH study randomized to ablation did not have a significant change in quality of life outcomes compared to those randomized to escalated therapy. Some subgroup findings were significant, as those randomized to ablation showed persistent improvement in SF‐36 energy/fatigue and ICD concern, and transient improvement in SF‐36 social functioning and EQ‐5D overall health.
    Type of Medium: Online Resource
    ISSN: 1045-3873 , 1540-8167
    URL: Issue
    URL: Article
    DOI: 10.1111/jce.2018.29.issue-3
    DOI: 10.1111/jce.13419
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 8
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    Complications Associated With Revision of Sprint Fidelis Leads : Report From the Canadian Heart Rhythm Society Device Advisory Committee
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation Vol. 121, No. 22 ( 2010-06-08), p. 2384-2387
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 121, No. 22 ( 2010-06-08), p. 2384-2387
    Abstract: Background— It has been observed that replacement of an implantable cardioverter-defibrillator generator in response to a device advisory may be associated with a substantial rate of complications, including death. The risk of lead revision in response to a lead advisory has not been determined previously. Methods and Results— Twenty-five implantable cardioverter-defibrillator implantation and follow-up centers from the Canadian Heart Rhythm Society Device Advisory Committee were surveyed to assess complication rates as a result of lead revisions due to the Sprint Fidelis advisory issued in October 2007. As of June 1, 2009, there had been 310 lead failures found in 6237 Sprint Fidelis leads in Canada (4.97%) over a follow-up of 40 months. There were 469 leads to be revised, 66% for confirmed fracture. Of the patients who underwent revision, 95% had a new lead inserted, whereas 4% had a pace/sense lead added. The lead was removed in 248 cases (53%), by simple traction in 61% and by laser lead extraction in 33%. Complications were encountered in 14.5% of the lead revisions; 7.25% of these were major, whereas 7.25% were minor. There were 2 deaths (0.43%). The overall risk of complications (19.8%) was greater in those who underwent lead removal at the time of revision than in those whose leads were abandoned (8.6%; P =0.0008). Conclusions— The overall rate of major complications that arose from lead revision due to the Sprint Fidelis advisory was significant. This must be taken into account when lead revision is planned in those patients who have not yet demonstrated an abnormality in lead performance.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.109.924357
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 9
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    Ventricular tachycardia characteristics and outcomes with catheter ablation vs. antiarrhythmic therapy: insights from the VANISH trial
    Oxford University Press (OUP) ; 2022
    In:  EP Europace Vol. 24, No. 7 ( 2022-07-21), p. 1112-1118
    Details
    In: EP Europace, Oxford University Press (OUP), Vol. 24, No. 7 ( 2022-07-21), p. 1112-1118
    Abstract: Catheter ablation is superior to escalated antiarrhythmic drugs among patients with ventricular tachycardia (VT) and prior myocardial infarction (MI). However, it is uncertain whether clinical VT characteristics, should influence choice of therapy. The purpose of this study was to evaluate whether presentation with electrical storm and the clinical VT cycle length predicted response to ablation vs. escalated antiarrhythmic therapy. Methods and results All patients enrolled in the Ventricular Tachycardia Ablation vs. Escalated Antiarrhythmic Drug Therapy in Ischaemic Heart Disease (VANISH) trial were included. The association between VT cycle length and presentation with electrical storm and the primary outcome of death, subsequent VT storm or appropriate ICD shock was evaluated. Among the study population of 259 patients, escalated antiarrhythmic drug therapy had worse outcomes for those presenting with a VT cycle length & gt;400 ms [ & lt;150 b.p.m., 89/259, hazard ratio (HR) 1.7 (1.02–3.13)]. This effect was more pronounced among those taking amiodarone at baseline [HR of 2.22 (1.19–4.16)] . Presentation with VT storm (32/259) did not affect the primary outcome between groups. However, those presenting with VT storm on amiodarone had a trend towards worse outcomes with escalated antiarrhythmic therapy [HR 4.31 (0.55–33.93)]. Conclusion The VT cycle length can influence response to either ablation or escalated drug therapy in patients with VT and prior MI. Those with slow VT had improved outcomes with ablation. Patients presenting with electrical storm demonstrated similar outcomes to the overall trial population, with a trend to benefit of catheter ablation, particularly in those on amiodarone.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    URL: Article
    DOI: 10.1093/europace/euab328
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2002579-8
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  • 10
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    Atrial pacing and atrial fibrillation in sinus node dysfunction: a relationship that remains elusive
    Oxford University Press (OUP) ; 2023
    In:  European Heart Journal ( 2023-08-28)
    Details
    In: European Heart Journal, Oxford University Press (OUP), ( 2023-08-28)
    Type of Medium: Online Resource
    ISSN: 0195-668X , 1522-9645
    URL: Article
    DOI: 10.1093/eurheartj/ehad569
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2001908-7
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