Cardiology Commons^™

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Designing Tailored Patient Education On Atrial Fibrillation, Tammy Toscos, R Ahmed, Romisa Rohani Ghahari, Elizabeth Martin, Shauna Wagner, Michelle Drouin, Michael J. Mirro

Presentations and Events

Background & Hypothesis: Research has revealed a high prevalence of depression, anxiety, and burnout among medical students accompanied by widespread lack of treatment. We hypothesize that by leveraging our study findings examining the use of telemental health(TMH) among youth (ages 14-24) alongside results from existing research focused on the mental health needs of medical students (median age at start 22-24 years old), we will gain valuable insight into the potential for TMH to address the needs of this high-risk population.

Methods: Using the Delphi method, a sample of 25 experts were surveyed anonymously, thus avoiding group pressure for conformity while …

New Oral Anticoagulants And Their Reversal Agents, Crista L. Laslo, Anca Pantea Stoian, Bogdan Socea, Dan N. Paduraru, Oana Bodean, Laura I. Socea, Tiberiu P. Neagu, Ana Maria Alexandra Stanescu, Dragos Marcu, Camelia C. Diaconu

Journal of Mind and Medical Sciences

Atrial fibrillation is a commonly encountered pathology in medical practice, and its prevalence has shown a continuous rise over the past years. Atrial fibrillation has a significant impact on patients' quality of life, not only due to the standard anticoagulant treatment with vitamin K antagonists that require close monitoring and dose adjustment, but also due to the fragile equilibrium between hemorrhagic and thrombotic risks. The introduction of new oral anticoagulants (NOACs) in the treatment guidelines for atrial fibrillation has improved the quality of life, as NOACs do not require close monitoring or dose adjustments. However, even if the safety profile …

Heparin Bridging Therapy Is Not Necessary For Patients With Atrial Fibrillation Undergoing Temporary Interruption Of Warfarin Therapy For Elective Invasive Procedures Or Surgery, Shannon Paquette

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. New Engl J Med. Aug 2015;373(9):823-833. doi: 10.1056/NEJMoa1501035

Drug Therapy Vs. Ablation Therapy For Patients With Atrial Fibrillation, Jessica Ansara

Theses and Graduate Projects

The prevalence of atrial fibrillation is 6.5 percent in the adult population in the United States, in an attempt to treat this patient population, there are numerous options and this study attempts to find the optimal treatment plan that has the least Atrial fibrillation(AF) reoccurrence, best quality of life and is the most effective. This is a Systematic Review comparing catheter ablation therapy vs. drug therapy in treating patients with atrial fibrillation. The search engines used in this analysis include PubMed, UpToDate, Google Scholar and Academic Search Premier. A total of 19 articles were analyzed and data was extracted, and …

New Migraine With Visual Disturbance After Cryoballoon Ablation Of Atrial Fibrillation., Annupreet Nadha, Eric S Williams

Articles, Abstracts, and Reports

We report the case of a 58-year-old woman who developed a headache and visual disturbances after a cryoballoon ablation procedure for atrial fibrillation at our institution. She presented to the emergency department four days post ablation and was admitted the hospital for overnight observation. Serial neurological examinations and neuroimaging were unremarkable for stroke or transient ischemic attack. The patient had some brief transient visual changes which resolved completely after several days, with no further clinical sequelae. She followed up in the outpatient neuro-ophthalmology clinic and had a normal visual field examination. She was given a diagnosis of new onset migraine …

Arrhythmias In Hospitalized Heart Transplanted Patients: A United States National Study, Srikanth Yandrapalli, Prakash Harikrishnan, Zeeshan Solangi, Wilbert S. Aronow, Sachin Sule, Alan L. Gass, Chhaya Aggarwal, William H. Frishman, Sei Iwai, Howard A. Cooper, Julio A. Panza, Gregg M. Lanier

NYMC Faculty Posters

No abstract provided.

Routine Screening For Silent Atrial Fibrillation, Zach Stevens

Theses and Graduate Projects

Atrial fibrillation (AF) is the most common arrhythmia and is particularly prevalent in the elderly population. It is associated with an elevated stroke risk which can be easily minimized with anticoagulation. However, AF detection is often difficult due to infrequent or absent symptoms and the first presentation of AF may be a stroke. Advances in technology have made screening for AF more feasible and accessible. Opportunistic screening with pulse palpation and confirmatory ECG is now strongly supported by the evidence and more recent studies have demonstrated that systematic screening – particularly of those with AF risk factors – may be …

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 anticoagulation …

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 …

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 confounders, atrial …

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 to …

The Crux Of The Heart –– The Closest Approach Of The Right Atrium To The Left Ventricle, Lynn Erickson, David Krum, Hannah Samuel, Anwer Dhala, Jasbir Sra

Journal of Patient-Centered Research and Reviews

Background: Accessory pathways, the source of atrioventricular reentry tachycardia, occasionally connect the left ventricle to the right atrium. This is possible because, in some patients, a portion of the right atrium abuts the left ventricle on the posterior wall of the heart, near the mid-coronary sinus. This anatomic region is known as the “crux” of the heart. These accessory pathways can be difficult to ablate because of the unusual and unexpected substrate. While the presence of these accessory pathways is described in the literature, the prevalence of the underlying anatomic substrate is not currently known.

Purpose: To measure the closest …

Barriers To Anticoagulation In Atrial Fibrillation Among Cardiologists, Internists And Family Physicians, Jad Al Danaf, Md, Mph, Mitul Kanzaria, Md, John U. Doherty, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Current Performance:

The rates of AC in patients 18 years or older who visited general internists & family physicians not seen by cardiologists from 4/30/2013 to 4/30/2015, cardiologists from 11/29/2012 to 11/29/2014 and all 3 specialties from 1/30/2014 to 1/30/2016 were derived from the EHR.

A 12-question survey was shared using RedCap with these physicians to examine potential reasons for not prescribing AC.

Comparing Direct Factor Xa Inhibitors And Warfarin In The Prevention Of Stroke In Patients With Atrial Fibrillation, Alessandra Lof, Stephanie Pillai

Physician Assistant Capstones, 2016 to 2019

Objective: To evaluate the overall efficacy, advantages, and disadvantages of treatment with direct factor Xa inhibitors as compared to warfarin in the prevention of stroke in patients with atrial fibrillation. Methods: A quantitative meta-analysis was performed on three separate studies, each of which evaluated the efficacy and safety outcomes of a direct factor Xa inhibitor versus warfarin in preventing stroke in patients with atrial fibrillation. The direct factor Xa inhibitors that were evaluated included apixaban, edoxaban, and rivaroxaban. Results: The direct factor Xa inhibitors were found to be as effective, and in some cases more effective, than …

Feasibility Of Atrial Delivery And Tracking Of Stem Cells In A Porcine Model, Nina Garlie, Timothy Hacker, Eric G. Schmuck, Jill Koch, Jayant Khitha, Amish Raval, Indrajit Choudhuri

Journal of Patient-Centered Research and Reviews

Background: Many patients undergoing open heart surgery have sinus node dysfunction and atrial fibrillation, leading to adverse outcomes. Mesenchymal stem cells (MSC) delivered at the time of surgery may have a reparative effect on atrial tissue, thereby improving sinus node function and reducing or preventing atrial fibrillation. Stem cell delivery to the atrium is entirely unstudied. This is a significant gap in medical research, as atrial disease contributes significantly to health care costs.

Purpose: The purpose of this pilot study is to establish a technique to deliver MSC to the atria through an open-chest model, to assess the safety of …

Novel Oral Anticoagulants For Stroke Prophylaxis And Venous Thromboembolism Prevention And Treatment, Laith G. Alsayegh

Journal of Patient-Centered Research and Reviews

Novel oral anticoagulants (NOACs) are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

Ablation Of Myocardial Tissue With Nanosecond Pulsed Electric Fields, Fei Xie, Frency Varghese, Andrei G. Pakhomov, Iurii Semenov, Shu Xiao, Jonathan Philpott, Christian Zemlin

Bioelectrics Publications

Background

Ablation of cardiac tissue is an essential tool for the treatment of arrhythmias, particularly of atrial fibrillation, atrial flutter, and ventricular tachycardia. Current ablation technologies suffer from substantial recurrence rates, thermal side effects, and long procedure times. We demonstrate that ablation with nanosecond pulsed electric fields (nsPEFs) can potentially overcome these limitations.

Methods

We used optical mapping to monitor electrical activity in Langendorff-perfused New Zealand rabbit hearts (n = 12). We repeatedly inserted two shock electrodes, spaced 2–4 mm apart, into the ventricles (through the entire wall) and applied nanosecond pulsed electric fields (nsPEF) (5–20 kV/cm, 350 ns duration, …

Is Dabigatran Superior To Warfarin In Treating Patients With Atrial Fibrillation?, Kelly Higgins

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Dabigatran is superior to Warfarin in patients with atrial fibrillation.

STUDY DESIGN: Review of three English language primary studies published in 2007, 2009, and 2010.

DATA SOURCES: Three randomized control trials found using Cochrane Database.

OUTCOME(S) MEASURED: Outcomes measured were presence or absence of stroke or systolic embolism and intracranial hemorrhage. The absence of these events preserved neurologic function in patients with atrial fibrillation.

RESULTS: In both VKA-naïve and VKA-experienced patients, Dabigatran 150 mg was superior to Warfarin in both the prevention of stroke …

Stabilization Of The Cardiac Nervous System During Cardiac Stress Induces Cardioprotection, David D. Gibbons

Electronic Theses and Dissertations

The cardiac nervous system consists of nested reflex feedback loops that interact to regulate regional heart function. Cardiac disease affects multiple components of the cardiac nervous system and the myocytes themselves. This study aims to determine: 1) how select components of the cardiac nervous system respond to acute cardiac stress, including myocardial ischemia (MI) and induced neural imbalance leading to cardiac electrical instability, and 2) how neuromodulation can affect neural-myocyte interactions to induce cardioprotection. Thoracic spinal cord stimulation (SCS) is recognized for its anti-anginal effects and ability to reduce apoptosis in response to acute MI, primarily via modulation of adrenergic …

Increase In Organization Index Predicts Atrial Fibrillation Termination With Flecainide Post-Ablation: Spectral Analysis Of Intracardiac Electrograms, Jiun Tuan, Faizel Osman, Jeilan Mohamed, Suman Kundu, Rajkumar Mantravadi, Peter J. Stafford, G. André Ng

Internal Medicine, East Africa

Aims: The mechanism of the action of flecainide in the termination of human atrial fibrillation (AF) is not fully understood. We studied the acute effects of flecainide on AF electrograms in the time and frequency domain to identify factors associated with AF termination.

Methods and results: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. Dominant frequency (DF) and organization index (OI) were obtained by fast Fourier transform of electrograms from the coronary sinus catheter over 10 s in AF, before and after flecainide infusion. Mean AF cycle length (CL) was …

Ganglionic Plexus Ablation During Pulmonary Vein Isolation--Predisposing To Ventricular Arrhythmias?, Faizel Osman, Suman Kundu, Jiun Tuan, Jeilan Mohamed, Peter J. Stafford, G. Andre' Ng

Internal Medicine, East Africa

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation. Reduced vagal modulation is known to predispose to ventricular arrhythmias and vagal denervation following AF ablation may predispose to ventricular arrhythmias and requires further study.

Relationship Of Paroxysmal Atrial Tachyarrhythmias To Volume Overload, Rajat Jhanjee Md, Grant A. Templeton Md, Srinivasan Sattiraju Md, John Nguyen Md, Simon Milstein Md, Laura Van Heel, Keith G. Lurie Md, David Benditt Md

Articles

BACKGROUND:

Clinical experience suggests that atrial tachyarrhythmias (ATs) are a frequent comorbidity in heart failure patients with left ventricular systolic dysfunction and that volume overload may increase AT susceptibility. However, substantiating this apparent relationship in free-living patients is difficult. Recently, certain implantable cardioverter-defibrillators provide, by measuring transpulmonary electric bioimpedance, an index of intrathoracic fluid status (OptiVol index [OI]). The goal of this study was to determine whether periods of greater intrathoracic fluid congestion (as detected by OI) correspond with increased AT event frequency.

METHODS AND RESULTS:

This analysis retrospectively assessed the relation between AT events and OI estimate of volume …

The Value Of Implantable Cardioverter-Defibrillators In Managing Atrial Fibrillation, Daniel Frisch

Division of Cardiology Faculty Papers

Atrial fibrillation (AF) is associated with an increased risk of mortality as well as significant morbidity including bothersome symptoms, exacerbation of heart failure, and thromboembolic events. Explanations for the mortality risk are variable, but the majority opinion favors AF as a marker of reduced health status, especially cardiovascular health.