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1.
J Innov Card Rhythm Manag ; 9(8): 3291-3296, 2018 Aug.
Article in English | MEDLINE | ID: mdl-32494503

ABSTRACT

As the number and complexity of cardiovascular implantable electronic devices has increased, so too has the incidence of device-related infections. Such a rise requires that the focus be directed toward developing universal standards for infected lead removal. To date, no consensus currently exists regarding the optimal management of patients with large vegetations (diameter > 2 cm). In these individuals, medical therapy is universally ineffective and they are often too ill for surgical extraction; furthermore, transvenous lead extraction (TLE) carries with it a risk of large septic pulmonary emboli. We present a series of five cases in which the AngioVac thrombectomy system (AngioDynamics Inc., Latham, NY, USA) was used as an adjunct to TLE. Debridement of infected leads prior to percutaneous lead extraction was accomplished as either a bridge to or as concomitant therapy with laser lead removal at our institution. This study included three males and two females with an average age of 52 years. The sizes of vegetations removed from leads ranged from 1.5 cm to 3.9 cm in the largest dimension and the average diameter was 2.65 cm ± 1.1 cm. The vegetations were successfully debulked in all five patients. This suggests that TLE performed with assistance from the AngioVac system (AngioDynamics Inc., Latham, NY, USA) is a safe and effective alternative to open surgical lead removal in patients with large lead vegetations.

3.
Heart Rhythm ; 10(3): 394-400, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23178686

ABSTRACT

BACKGROUND: Common single nucleotide polymorphisms at chromosome 4q25 (rs2200733, rs10033464) are associated with both lone and typical atrial fibrillation (AF). Risk alleles at 4q25 have recently been shown to predict recurrence of AF after ablation in a population of predominately lone AF, but lone AF represents only 5%-30% of AF cases. OBJECTIVE: To test the hypothesis that 4q25 AF risk alleles can predict response to AF ablation in the majority of AF cases. METHODS: Patients enrolled in the Vanderbilt AF Registry underwent 378 catheter-based AF ablations (median age 60 years; 71% men; 89% typical AF) between 2004 and 2011. The primary end point was time to recurrence of any nonsinus atrial tachyarrhythmia (atrial tachycardia, atrial flutter, or AF). RESULTS: Two-hundred atrial tachycardia, atrial flutter, or AF recurrences (53%) were observed. In multivariable analysis, the rs2200733 risk allele predicted a 24% shorter recurrence-free time (survival time ratio 0.76; 95% confidence interval [CI] 0.6-0.95; P = .016) compared with wild type. The heterozygous haplotype demonstrated a 21% shorter recurrence-free time (survival time ratio 0.79; 95% CI 0.62-0.99) and the homozygous risk allele carriers a 39% shorter recurrence-free time (survival time ratio 0.61; 95% CI 0.37-1.0; P = .037). CONCLUSIONS: Risk alleles at the 4q25 loci predict impaired clinical response to AF ablation in a population of patients with predominately typical AF. Our findings suggest that the rs2200733 polymorphism may hold promise as an objectively measured patient characteristic that can be used as a clinical tool for selecting patients for AF ablation.


Subject(s)
Atrial Fibrillation/genetics , Catheter Ablation/methods , Chromosomes, Human, Pair 4 , DNA/genetics , Genetic Predisposition to Disease , Polymorphism, Single Nucleotide , Adult , Aged , Alleles , Atrial Fibrillation/epidemiology , Atrial Fibrillation/surgery , Female , Follow-Up Studies , Genotype , Humans , Male , Middle Aged , Postoperative Period , Recurrence , Retrospective Studies , Risk Factors
4.
Am J Cardiol ; 111(3): 368-73, 2013 Feb 01.
Article in English | MEDLINE | ID: mdl-23168290

ABSTRACT

Obese patients with atrial fibrillation (AF) are frequently treated with AF ablation. We sought to examine whether a body mass index (BMI) threshold exists beyond which the odds of experiencing a complication from AF ablation increases. All patients enrolled in the Vanderbilt AF Registry who underwent catheter-based AF ablation from May 1999 to February 2012 were included. Major complications were recorded. Morbid obesity was defined as a BMI >40 kg/m(2) and examined in multivariable analysis. A total of 35 complications (6.8%) occurred in 512 ablations. Morbidly obese patients experienced a greater rate of complications (6 of 42, 14.3%) than the nonmorbidly obese (29 of 470, 6.2%; p = 0.046). Using a discrete BMI cutoff, the odds of complications increased 3.1-fold in those with morbid obesity (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1 to 8.4, p = 0.03) and 2.1-fold for female gender (OR 2.1, 95% CI 1.04 to 4.38, p = 0.04). With BMI as a continuous variable, the odds of complications increased by 5% per 1 unit increase in BMI (OR 1.05, 95% CI 1.0 to 1.11, p = 0.05), and the increase for female gender was 2.2-fold (OR 2.2, 95% CI 1.1 to 4.6, p = 0.03). In conclusion, morbid obesity represents a BMI threshold above which the odds of complications with AF ablation increase significantly. The increase in complications appears to be driven primarily by events in women, suggesting that morbidly obese women are a special population when considering AF ablation.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Obesity, Morbid/complications , Postoperative Complications/epidemiology , Risk Assessment , Atrial Fibrillation/complications , Body Mass Index , Confidence Intervals , Electrocardiography , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Odds Ratio , Prospective Studies , Risk Factors , Sex Factors , Survival Rate/trends , Tennessee/epidemiology , Treatment Outcome
5.
Pacing Clin Electrophysiol ; 35(7): e206-9, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22433038

ABSTRACT

Vasovagal syncope usually occurs during upright posture, but Jardine et al. have described a variant that occurs at night. During "sleep syncope" patients are awakened from sleep with nausea, abdominal cramping, or a sense of impending diarrhea; get up; and faint in the bathroom. We report on a patient with recurrent sleep syncope (with physical injury) in whom an asystolic pause was documented during one of her "sleep syncope" spells. Implantation of a dual chamber pacemaker (5-year follow-up) "cured" her of further syncope. This is a report of pacemaker use for this unusual form of reflex syncope.


Subject(s)
Cardiac Pacing, Artificial/methods , Pacemaker, Artificial , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/prevention & control , Syncope, Vasovagal/diagnosis , Syncope, Vasovagal/prevention & control , Adult , Female , Humans , Sleep Wake Disorders/complications , Syncope, Vasovagal/complications , Treatment Outcome
6.
Diab Vasc Dis Res ; 5(1): 59-66, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18398815

ABSTRACT

Type 2 diabetes mellitus (DM) is increasing around the world, and the public health impact of DM, driven largely by cardiovascular disease complications, underpins the importance of continued efforts toward primary prevention of DM. Only a few interventions have been shown to prevent DM, with none of them yet proven to improve cardiovascular risk commensurately. Accumulating evidence suggest that drugs that block the renin-angiotensin-aldosterone system (RAAS), many of which have proven cardiovascular disease (CVD) benefit, also have favourable effects on parameters of glucose metabolism and incident diabetes. Here we review the evidence accumulated to date from animal studies, clinical mechanistic studies and clinical trials regarding the effect of RAAS inhibition and incident DM.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/pharmacology , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Diabetes Mellitus/prevention & control , Renin-Angiotensin System/drug effects , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Animals , Blood Glucose/metabolism , Cardiovascular Diseases/prevention & control , Clinical Trials as Topic , Diabetes Complications/prevention & control , Humans , Insulin Resistance/physiology , Renin-Angiotensin System/physiology
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