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Zero-Fluoroscopy Cavotricuspid Isthmus Ablation Using Carto Mapping System As Sole Guiding Method, Wassim Ballany, Indrajit Choudhuri, Mohamed Djelmami-Hani, Ryan L. Cooley 2017 Aurora Health Care

Zero-Fluoroscopy Cavotricuspid Isthmus Ablation Using Carto Mapping System As Sole Guiding Method, Wassim Ballany, Indrajit Choudhuri, Mohamed Djelmami-Hani, Ryan L. Cooley

Aurora Electrophysiology Fellows

Background: Catheter ablation of the cavotricuspid isthmus (CTI) is traditionally performed using fluoroscopy and electroanatomical mapping systems. Zero-fluoroscopy approaches have recently been studied, mostly using the EnSite® mapping system (St. Jude Medical Inc., St. Paul, MN). We studied the feasibility and efficacy of zero-fluoroscopic mapping and ablation of the CTI using the Carto® 3 system (Biosense Webster Inc., South Diamond Bar, CA).

Purpose: To evaluate the efficacy and safety of a zero-fluoroscopic approach to CTI ablation.

Methods: We included 9 patients with typical atrial flutter for whom mapping and ablation of the CTI was done using Carto mapping as the ...


We Have No Real Evidence Related To Anticoagulation Plus Aspirin For Stroke Prevention In Atrial Fibrillation, Yuxiang Wang 2017 wayne state university school of medicine

We Have No Real Evidence Related To Anticoagulation Plus Aspirin For Stroke Prevention In Atrial Fibrillation, Yuxiang Wang

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Flaker GC, Gruber M, Connolly SJ, et al. Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials. Am Heart J. 2006;152:967-973. doi: 10.1016/j.ahj.2006.06.024


Von Willebrand Disease, Ramon Misla David 2017 Liberty University

Von Willebrand Disease, Ramon Misla David

The Kabod

Von Willebrand Disease (VWD) is a blood clotting disorder characterized by low levels of the Von Willebrand Factor (VWF) in the blood. VWF is functions to bind platelets and promote clotting of the blood when vascular injury occurs. Therefore, VWD leads to decreased or impaired clotting. There are three main types and four subtypes of VWD (type 1, 2A, 2B, 2N, 2M, and 3). Each type of VWD increases in severity. VWD is diagnosed preliminarily through a personal and family history and physical examination. Upon indications toward the possibility of a bleeding disorder, an initial hemostasis evaluation is performed followed ...


Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri 2017 Aurora Health Care

Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri

Mohammad Mortada, MD, FACC, FHRS

Background: About 20% of patients who develop left ventricular (LV) systolic dysfunction will have improvement in ejection fraction (LVEF) over time. This patient cohort is generally excluded from large sudden death trials and, hence, understudied.

Purpose: To evaluate the predictors of mortality in patients with severe LV systolic dysfunction who have improvement in LVEF during follow-up.

Methods: Patients who had transient LV systolic dysfunction from 2010 to 2014 within the Aurora Health Care system and who had LVEF improve to ≥ 40%, irrespective of implantable cardioverter-defibrillator (ICD) implant, were studied. Predictors of mortality were identified using Cox proportional hazards model. Patients ...


Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada 2017 Aurora Sinai/Aurora St. Luke’s Medical Centers, Aurora Health Care

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Mohammad Mortada, MD, FACC, FHRS

Purpose Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads. Methods We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 ...


Score Big For Decreasing Mortality: Icd Risk Score Model, Linda Francaviglia, Rachel Petersen, Maria Stone, M. Eyman Mortada 2017 Cardiovascular Data Services, Aurora Health Care

Score Big For Decreasing Mortality: Icd Risk Score Model, Linda Francaviglia, Rachel Petersen, Maria Stone, M. Eyman Mortada

Mohammad Mortada, MD, FACC, FHRS

Background: Aurora Health Care, a system of 14 acute care hospitals in eastern Wisconsin, has been a long-time participant in the American College of Cardiology’s National Cardiovascular Data Registries, submitting data to its ICD Registry™ since 2005. Our system’s implantable cardioverter-defibrillator (ICD) procedure volume averages 930 cases annually. During 2012 we experienced an increase in in-hospital mortality/morbidity for ICD cases.

Purpose: A single-center study examining in-hospital mortality/morbidity post-ICD implant before and after changes in practice and patient selection.

Methods: ICD implants and generator changes discharged from January 1, 2009, to December 31, 2012, were included in ...


A Comparison Of Measured And Self-Reported Blood Pressure Status Among Low-Income Housing Residents In New York City, James H. Williams AB, Dustin T. Duncan ScD, Jonathan Cantor MS, Brian Elbel PhD MPH, Gbenga Ogedegbe MD MS MPH, Joseph Ravenell MD MS 2017 New York University School of Medicine

A Comparison Of Measured And Self-Reported Blood Pressure Status Among Low-Income Housing Residents In New York City, James H. Williams Ab, Dustin T. Duncan Scd, Jonathan Cantor Ms, Brian Elbel Phd Mph, Gbenga Ogedegbe Md Ms Mph, Joseph Ravenell Md Ms

Journal of Health Disparities Research and Practice

Self-report is widely used to measure hypertension prevalence in population-based studies, but there is little research comparing self-report with measured blood pressure among low-income populations. The objective of this study was to compare self-reported and measured blood pressure status among a sample of low-income housing residents in New York City (n=118). We completed a cross-sectional analysis comparing self-report with measured blood pressure status. We determined the sensitivity, specificity, and positive predictive value (PPV) of each self-report metric. Of the sample, 68.1% was Black, 71.1% had a household income under $25,000/year, and 28.5% did not ...


Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Robert J. Goldberg

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI).

METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department ...


Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Catarina I. Kiefe

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI).

METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department ...


Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg 2016 University of Massachusetts Medical School

Decade-Long Trends In The Timeliness Of Receipt Of A Primary Percutaneous Coronary Intervention, Han-Yang Chen, Joel M. Gore, Kate L. Lapane, Jorge L. Yarzebski, Sharina D. Person, Catarina I. Kiefe, Robert J. Goldberg

Jorge L. Yarzebski

OBJECTIVES: The purpose of this study was to examine decade-long trends (2001-2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). METHODS: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department ...


Seeing The Invisible: Revealing Atrial Ablation Lesions Using Hyperspectral Imaging Approach, Narine Muselimyan, Luther Swift, Huda Asfour, Tigran Chahbazian, Ramesh Mazhari, Marco Mercader, Narine Sarvazyan 2016 George Washington University

Seeing The Invisible: Revealing Atrial Ablation Lesions Using Hyperspectral Imaging Approach, Narine Muselimyan, Luther Swift, Huda Asfour, Tigran Chahbazian, Ramesh Mazhari, Marco Mercader, Narine Sarvazyan

Pharmacology and Physiology Faculty Publications

Background

Currently, there are limited means for high-resolution monitoring of tissue injury during radiofrequency ablation procedures.

Objective

To develop the next generation of visualization catheters that can reveal irreversible atrial muscle damage caused by ablation and identify viability gaps between the lesions.

Methods

Radiofrequency lesions were placed on the endocardial surfaces of excised human and bovine atria and left ventricles of blood perfused rat hearts. Tissue was illuminated with 365nm light and a series of images were acquired from individual spectral bands within 420-720nm range. By extracting spectral profiles of individual pixels and spectral unmixing, the relative contribution of ablated ...


Seniors Welcome! Avoiding The Trap Of Age Limits In Health Research, Arshad Jahangir 2016 Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging, Aurora Research Institute

Seniors Welcome! Avoiding The Trap Of Age Limits In Health Research, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

The guest editor introduces this specialty issue of the Journal of Patient-Centered Research and Reviews, which focuses on cardiovascular diseases in the elderly. The reality of an aging population has increased the need for better evidence-based medicine in older patients. However, randomized controlled trials frequently exclude such patients, especially those with comorbidities, from study. This practice ignores the fact that physiologic changes to the cardiovascular system caused by the aging process and aging-associated diseases create clinical dilemmas distinct from those in younger patients. Considering the rising costs of health care and growing incidence of cardiovascular disease, research efforts and resources ...


Predicting Outcomes In Patients With Atrial Fibrillation And Acute Mesenteric Ischemia, Sanjay Bhandari, Geetanjali Dang, Muhammad Shahreyar, Ahmad Hanif, Vijayadershan Muppidi, Atul Bhatia, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir 2016 Medical College of Wisconsin

Predicting Outcomes In Patients With Atrial Fibrillation And Acute Mesenteric Ischemia, Sanjay Bhandari, Geetanjali Dang, Muhammad Shahreyar, Ahmad Hanif, Vijayadershan Muppidi, Atul Bhatia, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

Purpose

Outcomes in patients with atrial fibrillation who develop acute mesenteric ischemia, and the impact of anticoagulation on complications, are not defined.

Methods

Patients admitted with acute mesenteric ischemia in the National Inpatient Sample from 2007, with and without atrial fibrillation, were compared for in-hospital outcomes using multivariate regression, and the impact of prior anticoagulation determined.

Results

Of 48,872 patients with acute mesenteric ischemia, 8,306 had atrial fibrillation, with 680 patients also on anticoagulation. Atrial fibrillation patients were more likely to be older and have hypertension, heart failure, or chronic lung or renal disease. After adjusting for potential ...


Advanced Heart Failure Treatment Options Among The Elderly, German Guzman-Gutierrez, Yang Shi, Matthew Rappelt, Arshad Jahangir, Vinay Thohan 2016 Hospital Monte Naranco

Advanced Heart Failure Treatment Options Among The Elderly, German Guzman-Gutierrez, Yang Shi, Matthew Rappelt, Arshad Jahangir, Vinay Thohan

Journal of Patient-Centered Research and Reviews

The aging human population has emerged as a critically important factor in health care, not only due to the unique physiologic and pathologic processes associated with aging but also because of the evolution of medical and surgical therapies that have increased quality and quantity of life. Heart failure is a disease found most commonly among older populations in whom it is associated with high morbidity and mortality. Heart failure disproportionately affects the elderly, and it stands to reason that the most terminal stage, known as advanced heart failure (AHF), is more common among the elderly. Despite limited data, treatment options ...


Functional Alterations Of Ion Channels From Cardiac Fibroblasts In Heart Diseases, Gracious R. Ross, Arshad Jahangir 2016 Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging, Aurora Research Institute, Aurora Health Care

Functional Alterations Of Ion Channels From Cardiac Fibroblasts In Heart Diseases, Gracious R. Ross, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

In an aged population, cardiovascular disease is the leading cause of fatality and morbidity. Age-related fibrotic remodeling of the heart contributes to progressive myocardial dysfunction. Cardiac fibroblasts (CF), responsible for the maintenance of extracellular matrix and fibrosis process, play an important role in cardiac health and disease. CFs influence myocardial function by their chemical, electrical and mechanical interactions with cardiomyocytes through extracellular matrix deposition or secretion of cytokines and growth factors. These, in turn, are modulated by ion channels, macromolecular pores in the plasma membrane that allow selective ionic fluxes of major ions like K+, Ca2+, Na+ or Cl ...


Atrial Fibrillation And Stroke In Elderly Patients, Geetanjali Dang, Imaan Jahangir, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir 2016 Medical College of Wisconsin; Aurora Research Institute

Atrial Fibrillation And Stroke In Elderly Patients, Geetanjali Dang, Imaan Jahangir, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

The increasing prevalence of stroke, with an estimated annual cost of $71.5 billion, has made it a major health problem that increases disability and death, particularly in patients with atrial fibrillation. Although advanced age and atrial fibrillation are recognized as strong risk factors for stroke, the basis for this susceptibility are not well defined. Aging or associated diseases are accompanied by changes in rheostatic, humoral, metabolic and hemodynamic factors that may contribute more to stroke predisposition than rhythm abnormality alone. Several thromboembolism-predisposing clinical characteristics and serum biomarkers with prognostic significance have been identified in patients with atrial fibrillation. Although ...


Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure In The Emergency Department? A Clin-Iq, Miranda Gaskamp, Mark Blubaugh, Laine H. McCarthy, Dewey C. Scheid 2016 Northeastern Health Systems

Can Bedside Ultrasound Inferior Vena Cava Measurements Accurately Diagnose Congestive Heart Failure In The Emergency Department? A Clin-Iq, Miranda Gaskamp, Mark Blubaugh, Laine H. Mccarthy, Dewey C. Scheid

Journal of Patient-Centered Research and Reviews

Congestive heart failure (CHF) is a major cause of morbidity and mortality. Early diagnosis of CHF in patients presenting to the emergency department with undifferentiated dyspnea would allow clinicians to begin appropriate treatment more promptly. Current guidelines recommend B-type natriuretic peptide (BNP) levels for more accurate diagnosis of CHF in dyspneic patients. Although BNP levels are relatively inexpensive, the test is not usually performed at bedside and results may take up to an hour or more. BNP also may have a “gray zone” in which the values can neither confirm nor rule out CHF. BNP has a reported sensitivity of ...


Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri 2016 Aurora Health Care

Predictors Of Mortality In Patients With Transient Severe Left Ventricular Systolic Dysfunction, Kanwar Y. Singh, Firas Zahwe, Bilal Omery, Crystal Platz, Wassim Ballany, Robyn Shearer, Tadele Mengesha, M. Eyman Mortada, Jasbir Sra, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: About 20% of patients who develop left ventricular (LV) systolic dysfunction will have improvement in ejection fraction (LVEF) over time. This patient cohort is generally excluded from large sudden death trials and, hence, understudied.

Purpose: To evaluate the predictors of mortality in patients with severe LV systolic dysfunction who have improvement in LVEF during follow-up.

Methods: Patients who had transient LV systolic dysfunction from 2010 to 2014 within the Aurora Health Care system and who had LVEF improve to ≥ 40%, irrespective of implantable cardioverter-defibrillator (ICD) implant, were studied. Predictors of mortality were identified using Cox proportional hazards model. Patients ...


The Association Between Doppler Measures Of Cardiac Function And Outcomes In Patients With Left Ventricular Ejection Fraction ≤ 40% Undergoing Noncardiovascular Surgeries, Yang Shi, Rachel Pedersen, Matthew Rappelt, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan 2016 Sheikh Khalifa bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging, Aurora Research Institute

The Association Between Doppler Measures Of Cardiac Function And Outcomes In Patients With Left Ventricular Ejection Fraction ≤ 40% Undergoing Noncardiovascular Surgeries, Yang Shi, Rachel Pedersen, Matthew Rappelt, Robyn Shearer, Nasir Z. Sulemanjee, Dianne L. Zwicke, T. Edward Hastings, Omar M. Cheema, Vinay Thohan

Journal of Patient-Centered Research and Reviews

Background: Preoperative risk assessments of individuals who undergo major noncardiac surgery have focused on ischemic heart disease. Information on how to assess the noncardiac surgical risks for patients with depressed cardiac function, as seen in heart failure, is sparse. Echocardiography is routinely performed in patients with depressed cardiac function and is an accepted standard cardiac assessment. Transthoracic echocardiography (TTE) provides strong independent prognostic implications in a wide range of cardiovascular conditions.

Purpose: To identify the echocardiographic parameters associated with outcomes among patients undergoing major noncardiac surgery.

Methods: A retrospective single-institution investigation identified 1,770 patients who underwent one or more ...


Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz 2016 Aurora Research Institute

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing ...


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