Ablation of Atrial Fibrillation Using an Irrigated‐Tip Catheter: Open or Closed?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91175/1/j.1540-8159.2012.03333.x.pd

Infrequent Intraprocedural Premature Ventricular Complexes: Implications for Ablation Outcome

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109287/1/jce12454.pd

Predictors of Outcome After Catheter Ablation of Premature Ventricular Complexes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107382/1/jce12400.pd

Atrioventricular conduction in patients undergoing pacemaker implant following self‐expandable transcatheter aortic valve replacement

BackgroundHeart block requiring a pacemaker is common after self‐expandable transcatheter aortic valve replacement (SE‐TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown.ObjectiveTo evaluate the long‐term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE‐TAVR.MethodsAll patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE‐TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow‐up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery.ResultsFollowing SE‐TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow‐up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long‐term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28–0.86]/mm, P = 0.02) predicted lack of conduction recovery.ConclusionsHalf of the patients undergoing CIED placement for heart block following SE‐TAVR recovered AV conduction within several months and maintained this over an extended follow‐up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150495/1/pace13694_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150495/2/pace13694.pd

Anticoagulant Therapy and Risk of Cerebrovascular Events After Catheter Ablation of Atrial Fibrillation in the Elderly

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90264/1/j.1540-8167.2011.02141.x.pd

Ablation of paroxysmal atrial fibrillation using a second‐generation cryoballoon catheter or contact‐force sensing radiofrequency ablation catheter: A comparison of costs and long‐term clinical outcomes

IntroductionAlthough noninferiority of cryoballoon ablation (CBA) and radiofrequency catheter ablation for antral pulmonary vein isolation (APVI) has been reported in patients with paroxysmal atrial fibrillation (PAF), it is not clear whether contact force sensing (CF‐RFA) and CBA with the second‐generation catheter have similar procedural costs and long‐term outcomes. The objective of this study is to compare the long‐term efficacy and cost implications of CBA and CF‐RFA in patients with PAF.Methods and resultsA first APVI was performed in 146 consecutive patients (age: 63 ± 10 years, men: 95 [65%], left atrial diameter: 42 ± 6 mm) with PAF using CBA (71) or CF‐RFA (75). Clinical outcomes and procedural costs were compared. The mean procedure time was significantly shorter with CBA than with CF‐RFA (98 ± 39 vs. 158 ± 47 minutes, P < 0.0001). Despite a higher equipment cost in the CBA than the CF‐RFA group, the total procedure cost was similar between the two groups (P = 0.26), primarily driven by a shorter procedure duration that resulted in a lower anesthesia cost. At 25 ± 5 months after a single ablation procedure, 51 patients (72%) in the CBA, and 55 patients (73%) in the CF‐RFA groups remained free from atrial arrhythmias without antiarrhythmic drug therapy (P = 0.84).ConclusionsThe procedure duration was approximately 60 minutes shorter with CBA than CF‐RFA. The procedural costs were similar with both approaches. At 2 years after a single procedure, CBA and CF‐RFA have similar single‐procedure efficacies of 72–73%.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142442/1/jce13378_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142442/2/jce13378.pd

Baseline and decline in device‐derived activity level predict risk of death and heart failure in patients with an ICD for primary prevention

BackgroundImplanted defibrillators are capable of recording activity data based on company‐specific proprietary algorithms. This study aimed to determine the prognostic significance of baseline and decline in device‐derived activity level across different device companies in the real world.MethodsWe performed a retrospective cohort study of patients (n = 280) who underwent a defibrillator implantation (Boston, Medtronic, St. Jude, and Biotronik) for primary prevention at the University of Michigan from 2014 to 2016. Graphical data obtained from device interrogations were retrospectively converted to numerical data. The activity level averaged over a month from a week postimplantation was used as baseline. Subsequent weekly average activity levels (SALs) were standardized to this baseline. SAL below 59.4% was used as a threshold to group patients. All‐cause mortality and death/heart failure were the primary end‐points of this study.ResultsFifty‐six patients died in this study. On average, they experienced a 50% decline in SAL prior to death. Patients (n = 129) who dropped their SAL below threshold were more likely to be older, male, diabetic, and have more symptomatic heart failure. They also had a significantly increased risk of heart failure/death (hazard ratio [HR] 3.6, 95% confidence interval [95% CI] 2.3‐5.8, P < .0001) or death (HR 4.2, 95% CI 2.2‐7.7, P < .0001) compared to those who had sustained activity levels. Lower baseline activity level was also associated with significantly increased risk of heart failure/death and death.ConclusionSignificant decline in device‐derived activity level and low baseline activity level are associated with increased mortality and heart failure in patients with an ICD for primary prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156452/2/pace13981.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156452/1/pace13981_am.pd

Prevalence and Predictors of Complications of Radiofrequency Catheter Ablation for Atrial Fibrillation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86907/1/j.1540-8167.2010.01995.x.pd

Temporal trends and factors associated with increased mortality among atrial fibrillation weekend hospitalizations: an insight from National Inpatient Sample 2005–2014

Abstract Objective Atrial fibrillation (AF) weekend hospitalizations were reported to have poor outcomes compared to weekday hospitalizations. The relatively poor outcomes on the weekends are usually referred to as ‘weekend effect’. We aim to understand trends and outcomes among weekend AF hospitalizations. The primary purpose of this study is to evaluate the trends for weekend AF hospitalizations using Nationwide Inpatient Sample 2005–2014. Hospitalizations with AF as the primary diagnosis, in-hospital mortality, length of stay, co-morbidities and cardioversion procedures have been identified using the international classification of diseases 9 codes. Results Since 2005, the weekend AF hospitalizations increased by 27% (72,216 in 2005 to 92,220 in 2014), mortality decreased by 29% (1.32% in 2005 to 0.94% in 2014), increase in urban teaching hospitalizations by 72% (33.32% in 2005 to 57.64% in 2014), twofold increase in depression and a threefold increase in the prevalence of renal failure were noted over the period of 10 years. After adjusting for significant covariates, weekend hospitalizations were observed to have higher odds of in-hospital mortality OR 1.17 (95% CI 1.108–1.235, P < 0.0001). Weekend AF hospitalizations appear to be associated with higher in-hospital mortality. Opportunities to improve care in weekend AF hospitalizations need to be explored.https://deepblue.lib.umich.edu/bitstream/2027.42/152157/1/13104_2019_Article_4440.pd

2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary

Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias