30 results on '"Passman, Rod S"'
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2. Artificial Intelligence–Based Feature Analysis of Pulmonary Vein Morphology on Computed Tomography Scans and Risk of Atrial Fibrillation Recurrence After Catheter Ablation: A Multi-Site Study
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Asaeikheybari, Golnoush, El-Harasis, Majd, Gupta, Amit, Shoemaker, M. Benjamin, Barnard, John, Hunter, Joshua, Passman, Rod S., Sun, Han, Kim, Hyun Su, Schilling, Taylor, Telfer, William, Eldridge, Britta, Chen, Po-Hao, Midya, Abhishek, Varghese, Bibin, Harwood, Samuel J., Jin, Alison, Wass, Sojin Y., Izda, Aleksandar, Park, Kevin, Abraham, Abel, Van Wagoner, David R., Tandon, Animesh, Chung, Mina K., and Madabhushi, Anant more...
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- 2024
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3. Temporal Association Between Episodes of Atrial Fibrillation and Risk of Ischemic Stroke
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Singer, Daniel E., Ziegler, Paul D., Koehler, Jodi L., Sarkar, Shantanu, and Passman, Rod S.
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IMPORTANCE: Understanding the temporal association between atrial fibrillation (AF) and ischemic stroke informs our understanding of the AF-stroke mechanism and treatment of paroxysmal AF. OBJECTIVE: To define the temporal association between episodes of AF and stroke in patients with cardiac implantable electronic devices (CIEDs). DESIGN, SETTING, AND PARTICIPANTS: In this case-crossover study, data from a large national electronic health record database were linked with a single-vendor database of heart rhythm records of patients with CIEDs capable of continuous heart rhythm monitoring. Patients with CIEDs who sustained an ischemic stroke who also had 120 days of continuous remote rhythm monitoring prestroke were included. Data were collected from January 2007 to March 2017, and data were analyzed from November 2019 to June 2020. EXPOSURE: AF for 5.5 hours or more on any given day during days 1 to 30 vs days 91 to 120 prestroke. MAIN OUTCOMES AND MEASURES: Odds ratio for stroke comparing AF during days 1 to 30 vs 91 to 120 prestroke. This analysis was planned prior to the study. RESULTS: From 466 635 patients included in both the Optum electronic health record and CareLink databases, 891 patients with CIEDs and ischemic stroke with continuous monitoring in the 120 days prestroke were identified. Of 891 included patients, 575 (64.5%) were male, and the median (interquartile range) age was 76 (67-82) years. The vast majority of patients with stroke had either no AF meeting the threshold duration of 5.5 hours or more in both the case and control periods (682 of 891 [76.5%]) or AF of 5.5 hours or more in both periods (143 of 891 [16.0%]). For those not meeting the 5.5-hour AF threshold in either period, there was no or very little AF throughout the 120 days prestroke. A total of 66 patients had informative, discordant arrhythmic states, with 52 having AF of 5.5 hours or more in the case period vs 14 in the control period (odds ratio [OR], 3.71; 95% CI, 2.06-6.70). Stroke risk was increased most in days 1 to 5 following an AF episode (OR, 5.00; 95% CI, 2.62-9.55). AF greater than 23 hours on a given day was associated with the clearest increase in stroke risk (OR, 5.00; 95% CI, 2.08-12.01). CONCLUSIONS AND RELEVANCE: In this large cohort of patients with CIEDs and continuous rhythm monitoring prior to ischemic stroke, excess stroke risk above baseline was highest within 5 days of an episode of AF of 5.5 hours or more in duration and diminished rapidly thereafter. Our findings are consistent with the traditional view that AF is directly and transiently associated with ischemic stroke. These results provide support for trials of time-delimited anticoagulation for patients with infrequent multihour episodes of AF and rigorous, continuous rhythm monitoring. more...
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- 2021
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4. HRS White Paper on Clinical Utilization of Digital Health Technology
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Wan, Elaine Y., Ghanbari, Hamid, Akoum, Nazem, Itzhak Attia, Zachi, Asirvatham, Samuel J., Chung, Eugene H., Dagher, Lilas, Al-Khatib, Sana M., Stuart Mendenhall, G., McManus, David D., Pathak, Rajeev K., Passman, Rod S., Peters, Nicholas S., Schwartzman, David S., Svennberg, Emma, Tarakji, Khaldoun G., Turakhia, Mintu P., Trela, Anthony, Yarmohammadi, Hirad, and Marrouche, Nassir F. more...
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This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers. more...
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- 2021
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5. Use of continuous cardiac monitoring to assess the influence of atrial fibrillation burden and patterns on patient symptoms and healthcare utilization: the DEFINE AFib study
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Lakkireddy, Dhanunjaya R., Russo, Andrea M., Hylek, Elaine M., Mittal, Suneet, Peacock, James, Hills, Mellanie True, Stanelle, Evan J., Lande, Jeffrey D., Franco, Noreli C., Johnson, Lawrence C., Kanwar, Rahul, Passman, Rod S., and Piccini, Jonathan P. more...
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Atrial fibrillation (AF) has a significant impact on health and quality of life. The relationship of AF burden and temporal patterns of AF on patient symptoms, outcomes, and healthcare utilization is unknown. Insertable cardiac monitors (ICMs) are a strategic and as yet untapped, tool to investigate these relationships. more...
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- 2024
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6. Stroke Risk as a Function of Atrial Fibrillation Duration and CHA2DS2-VASc Score
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Kaplan, Rachel M., Koehler, Jodi, Ziegler, Paul D., Sarkar, Shantanu, Zweibel, Steven, and Passman, Rod S.
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Supplemental Digital Content is available in the text.
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- 2019
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7. Chronic kidney disease and arrhythmias: highlights from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
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Wanner, Christoph, Herzog, Charles A., Turakhia, Mintu P., Blankestijn, Peter J., Carrero, Juan-Jesus, Clase, Catherine M., Deo, Rajat, Kasner, Scott E., Passman, Rod S., Pecoits-Filho, Roberto, Reinecke, Holger, Shroff, Gautam R., Zareba, Wojciech, Cheung, Michael, Wheeler, David C., and Winkelmayer, Wolfgang C. more...
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- 2018
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8. LOCALIZING ATYPICAL ATRIAL FLUTTER WITH AN ADVANCED MACHINE LEARNING PIPELINE
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Gay, Hawkins, Besler, Emre, Mathur, Priyanka, Skeete, Jamario R., Post, Zoe, Wasserlauf, Jeremiah, Sahakian, Alan, and Passman, Rod S.
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- 2022
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9. Cardiac Monitoring for Atrial Fibrillation in Cryptogenic Stroke
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Ringwala, Sukit M., Tomson, Todd T., and Passman, Rod S.
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Despite an extensive initial evaluation, the cause of up to a third of ischemic strokes remains undetermined. The detection of atrial fibrillation (AF) in these patients with cryptogenic stroke is critical as the diagnosis of AF would warrant anticoagulation to reduce the risk of recurrent stroke. Observational studies and prospective randomized controlled trials have shown that a substantial proportion of patients with cryptogenic stroke have AF detected by post-stroke cardiac monitoring with higher AF detection rates observed with longer monitoring periods. more...
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- 2016
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10. Predictors for atrial fibrillation detection after cryptogenic stroke
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Thijs, Vincent N., Brachmann, Johannes, Morillo, Carlos A., Passman, Rod S., Sanna, Tommaso, Bernstein, Richard A., Diener, Hans-Christoph, Di Lazzaro, Vincenzo, Rymer, Marilyn M., Hogge, Laurence, Rogers, Tyson B., Ziegler, Paul D., and Assar, Manish D. more...
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- 2016
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11. Abstract 14782: Expression of Ngf Shrna in the Left Atrial Appendage Alone is Sufficient to Attenuate Global Left Atrial Parasympathetic and Sympathetic Nerve Sprouting and Resulting Development of Persistent Atrial Fibrillation in a Canine Model
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Pfenniger, Anna, Yoo, Shin, Johnson, David, Zhang, Wenwei, Panni, Azaria, Burrell, Amy, Mandava, Suman, Rottmann, Markus, Passman, Rod S, Knight, Bradley P, and Arora, Rishi
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Introduction:The autonomic nervous system plays a major role in development of atrial fibrillation (AF), with evidence of marked autonomic remodeling in a canine rapid atrial pacing (RAP) model of AF. Nerve growth factor (NGF), a neurotrophin essential for peripheral neuron growth, was upregulated in fibrillating atria, particularly in the left atrial appendage (LAA).Hypothesis:Inhibiting NGF signaling in the entire atria or the LAA alone can prevent the development of AF.Methods:NGF shRNA was injected in both atria or in the LAA of dogs followed by electroporation to facilitate gene delivery. Animals were subjected to RAP for up to 12 weeks. Duration of AF was recorded. At terminal EP study, residual AF electrograms were recorded in the posterior left atrium, left atrial free wall and LAA for analysis of AF characteristics. Tissue of each region was used for IHC with markers for parasympathetic (acetylcholinesterase) or sympathetic nerves (dopamine beta-hydroxylase).Results:Controls (n=10) developed persistent AF (>8 hours) after a median of 14 days. In contrast, pan-atrial NGF shRNA animals (n=4) never developed this burden of AF. Residual AF was less fractionated (longer fractionation interval), more organized (higher organization index and lower Shannon's entropy) and more homogeneous (coefficient of variation of dominant frequency). RAP-induced nerve bundle hypertrophy and atrial myocardium hyperinnervation was significantly attenuated in pan-atrial NGF shRNA dogs. Importantly, these findings were reproduced when NGF shRNA injection was limited to the LAA alone (n=4), with prevention of development of persistent AF, and global attenuation of left atrial hyperinnervation.Conclusion:Targeted inhibition of atrial autonomic remodeling by NGF shRNA prevents development of persistent AF. NGF Inhibition in the LAA alone is sufficient to attenuate global atrial autonomic remodeling. This approach may lead to a novel, mechanism-guided therapy for AF. more...
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- 2022
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12. Abstract 15072: Targeted Atrial Inhibition of Parasympathetic Signaling With GiGo Inhibitory Peptides Attenuates Electrical Remodeling and Development of Persistent Atrial Fibrillation in a Canine Model
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Pfenniger, Anna, Yoo, Shin, Johnson, David, Zhang, Wenwei, Panni, Azaria, Burrell, Amy, Mandava, Suman, Rottmann, Markus, Passman, Rod S, Knight, Bradley P, and Arora, Rishi
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Background:While vagal contribution to paroxysmal atrial fibrillation (AF) is well demonstrated, a role for parasympathetic signaling in persistent AF is less clear. We have shown marked atrial parasympathetic hyperinnervation in a canine rapid atrial pacing (RAP) model of AF. However, the role of these new nerves in AF development is unknown.Hypothesis:RAP-induced parasympathetic hyperinnervation contributes to the onset and maintenance of AF, and a gene therapy approach inhibiting muscarinic M2 signaling (Gαiand Gαo- GiGo) in the atria can prevent persistent AF.Methods:Plasmids expressing GiGo inhibitory peptides (GiGo_ct) were injected in the atria of 7 dogs followed by electroporation to facilitate gene delivery. RAP was performed for up to 12 weeks. At terminal EP study, residual AF was recorded in the posterior left atrium (PLA), left atrial free wall (LAFW) and left atrial appendage (LAA). Regional atrial ERP was measured.Results:Controls developed ≥30 minutes of AF after a median of 4 days, and persistent AF (≥8 hours) after a median of 14 days. GiGo_ct delayed onset of AF of ≥30 minutes, and attenuated development of persistent AF. ERP was markedly shortened in the PLA and LAA of controls, and this was attenuated by GiGo_ct (p<0.001). Residual AF was slower (lower dominant frequency; PLA 9.4±0.6Hz Vs 11.0±0.7Hz; LAFW 7.8±0.3Hz Vs 10.4±0.7Hz; LAA 8.9±0.6Hz Vs 9.9±0.5Hz p<0.01), less fractionated (longer fractionation interval; PLA 70.0.4±5.2ms Vs 68.1±5.2ms; LAFW 98.8±4.1ms Vs 70.9±3.1ms; LAA 88.9±7.8ms Vs 80.3±2.0ms p<0.01) and more organized (lower Shannon's entropy; p<0.05).Conclusion:Newly sprouted atrial parasympathetic nerves play a functional role in development of persistent AF. Gene-based, selective M2 signaling inhibition by GiGo_ct attenuates electrical remodeling and prevents initiation and maintenance AF. Future optimization of gene therapy targeting autonomic remodeling may lead to novel, mechanism-guided treatments for AF. more...
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- 2022
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13. Abstract 14784: Outcomes Associated With Implementation of an Intravenous Sotalol Initiation Protocol
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Liu, Albert Y, Charron, Jessica, Fugaro, Dana, Spoolstra, Scott, Kaplan, Rachel, Lohrmann, Graham, Gao, Xu, Gay, Hawkins, Passman, Rod S, Kim, Susan, Lin, Albert, Chicos, Alexandru, Arora, Rishi, Patil, Kaustubha, Pfenniger, Anna, Knight, Bradley P, and Verma, Nishant more...
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Introduction:Oral sotalol initiation frequently requires a multi-day hospitalization for electrocardiographic monitoring. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on its clinical use currently exists. The aim of this study was to describe the outcomes of implementation of the IV sotalol initiation protocol within an integrated health system.Methods:An IV sotalol loading protocol was started in August 2021 for adult patients who were candidates for oral sotalol and had a creatinine clearance (CrCl) > 30 mL/min. Patients with a heart rate < 60 bpm or QTc > 450 ms (500 ms for those with widened QRS) were excluded. Patients with persistent atrial arrhythmias were cardioverted prior to drug infusion. IV sotalol infusion was administered in the Cardiac Recovery and Observation Unit with one-on-one nursing and was stopped for a heart rate < 50 bpm or QTc > 500 ms (550 ms for those with widened QRS). Patients were admitted for monitoring post-infusion and received two oral sotalol doses prior to discharge. Serial EKGs were performed according to protocol. Expected length of stay (LOS) with oral initiation was calculated for the same patients using CrCl.Results:A total of 27 patients (average age 66 years, 26% women) underwent IV sotalol initiation. Average LVEF was 52% and average CrCl was 91.4 ± 24.8 mL/min. Primary indication was atrial arrhythmia for 74% and ventricular arrhythmia for 26%. Sotalol loading was successfully completed in 21 (78%) patients. Adverse events interrupting sotalol load included bradycardia (5 patients, 19%) and QT prolongation (2 patients, 7%). No patients developed sustained ventricular arrhythmias. LOS for patients completing IV load was 2.3 days shorter (mean 1.0 vs 3.3, p<0.001) compared to expected LOS with oral load.Conclusions:A one-day IV sotalol loading protocol is a safe alternative to a multi-day oral sotalol initiation protocol and significantly shortens hospital LOS, potentially leading to significant cost savings. more...
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- 2022
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14. ACCURACY OF THE APPLE WATCH FOR DETECTION OF ATRIAL FIBRILLATION: A MULTI-CENTER EXPERIENCE
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Wasserlauf, Jeremiah, Vogel, Kelly, Helm, Robert H., Steinhaus, Daniel, and Passman, Rod S.
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- 2022
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15. Role of Atrial Fibrillation Burden in Assessing Thromboembolic Risk
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Zimetbaum, Peter, Waks, Jonathan W., Ellis, Ethan R., Glotzer, Taya V., and Passman, Rod S.
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- 2014
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16. Surgical Treatment for Isolated Atrial Fibrillation Minimally Invasive vs Classic Cut and Sew Maze
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Lee, Richard, McCarthy, Patrick M., Passman, Rod S., Kruse, Jane, Malaisrie, S. Chris, McGee, Edwin C., Lapin, Brittany, Jacobson, Jason T., Goldberger, Jeffrey, and Knight, Bradley P.
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Objective We sought to compare outcomes after two surgical approaches for the treatment of atrial fibrillation (AF): a minimally invasive, staged hybrid approach combining surgery with catheter ablation, [Hybrid Maze (HM)] and the classic cut and sew Maze (CM).Methods From April 2004 to March 2010, 63 stand-alone AF procedures were performed by two surgeons at a single center and followed up for =6 months. CM was offered to all patients. After July 2007, patients were also prospectively offered a two-stage HM: stage 1 = a beating heart bipolar radiofrequency pulmonary vein isolation and left atrial appendage ligation; stage 2 = transvenous catheter ablation connecting the pulmonary veins to each other and the mitral annulus when AF was present after stage 1. Outcomes were compared between 25 HM and 38 CM using ?2or Fisher exact test analysis.Results Postoperatively, there was no difference in 30-day mortality (0%), complications (4% HM vs 18% CM), or median length of stay (5 days). At last follow-up, 88% of HM and 95% of CM were free from AF; 80% of HM and 90% of CM were free from AF and antiarrhythmic medication (P = 0.3). Twenty-nine percent of HM required a subsequent catheter ablation (stage 2) when compared with 8% of the CM patients (P = 0.04). Freedom from AF and antiarrhythmic medication at 1 year was 52% for the HM and 87.5% for the CM (P = 0.004).Conclusions In AF patients reluctant to undergo a CM but willing to undergo subsequent catheter ablation, a minimally invasive approach is a reasonable strategy. Because pulmonary vein isolation alone may be sufficient in two-thirds of patients and delayed reconnection is common, an interval two-stage hybrid approach may prove preferable over a one-stage combined hybrid approach; however, successful sinus restoration may take longer with this approach. more...
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- 2011
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17. Surgical Treatment for Isolated Atrial Fibrillation Minimally Invasive vs Classic Cut and Sew Maze
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Lee, Richard, McCarthy, Patrick M., Passman, Rod S., Kruse, Jane, Malaisrie, S. Chris, McGee, Edwin C., Lapin, Brittany, Jacobson, Jason T., Goldberger, Jeffrey, and Knight, Bradley P.
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Objective We sought to compare outcomes after two surgical approaches for the treatment of atrial fibrillation (AF): a minimally invasive, staged hybrid approach combining surgery with catheter ablation, [Hybrid Maze (HM)] and the classic cut and sew Maze (CM).Methods From April 2004 to March 2010, 63 stand-alone AF procedures were performed by two surgeons at a single center and followed up for ≥6 months. CM was offered to all patients. After July 2007, patients were also prospectively offered a two-stage HM: stage 1 = a beating heart bipolar radiofrequency pulmonary vein isolation and left atrial appendage ligation; stage 2 = transvenous catheter ablation connecting the pulmonary veins to each other and the mitral annulus when AF was present after stage 1. Outcomes were compared between 25 HM and 38 CM using χ2or Fisher exact test analysis.Results Postoperatively, there was no difference in 30-day mortality (0%), complications (4% HM vs 18% CM), or median length of stay (5 days). At last follow-up, 88% of HM and 95% of CM were free from AF; 80% of HM and 90% of CM were free from AF and antiarrhythmic medication (P ≥ 0.3). Twenty-nine percent of HM required a subsequent catheter ablation (stage 2) when compared with 8% of the CM patients (P = 0.04). Freedom from AF and antiarrhythmic medication at 1 year was 52% for the HM and 87.5% for the CM (P = 0.004).Conclusions In AF patients reluctant to undergo a CM but willing to undergo subsequent catheter ablation, a minimally invasive approach is a reasonable strategy. Because pulmonary vein isolation alone may be sufficient in two-thirds of patients and delayed reconnection is common, an interval two-stage hybrid approach may prove preferable over a one-stage combined hybrid approach; however, successful sinus restoration may take longer with this approach. more...
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- 2011
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18. Response by Kaplan et al to Letter Regarding Article, “Stroke Risk as a Function of Atrial Fibrillation Duration and CHA2DS2-VASc Score”
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Kaplan, Rachel M., Ziegler, Paul D., and Passman, Rod S.
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- 2020
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19. Abstract 9161: Referral Patterns Do Not Contribute to Racial Differences in Catheter Ablation for Atrial Fibrillation
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Marot, Jessica E, Pool, Lindsay R, Tanaka, Yoshihiro, Witting, Celeste, Khan, Sadiya S, and Passman, Rod S
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Introduction:Non-Hispanic Black (NHB) adults with atrial fibrillation (AF) are less likely to undergo catheter ablation (AFCA) compared with non-Hispanic White (NHW) adults even among those with heart failure and even though previous studies have shown that NHB patients with AF were more symptomatic.Hypothesis:We hypothesize that differences in outpatient referrals to Cardiology and Electrophysiology (EP) contribute to the racial disparity in AFCA.Methods:Using data from the Northwestern Medicine Enterprise Data Warehouse, we curated a retrospective cohort of NHB and NHW patients with newly diagnosed AF between 1/1/2011 and 12/31/2019 in an outpatient office visit to Internal Medicine/Primary Care (IM/PC), Cardiology, or Heart Failure (HF). Rates of AFCA and referral rates from IM/PC to Cardiology or EP and from Cardiology and HF to EP were compared between NHB and NHW patients using logistic regression models adjusted for demographic characteristics and comorbidities.Results:Of the 5,555 included patients, the mean age was 68 years (SD 13.4), 61% were male, 15% were NHB, and the mean CHA2DS2-VASc score was 3.5 (SD 2.0). 373 patients (6.7%) underwent AFCA. NHB patients had a higher prevalence of comorbidities. NHB patients were significantly less likely to undergo AFCA compared with NHW patients (OR 0.61, 95% CI 0.40-0.92, p= 0.02), and this difference persisted even when limited to the subset of patients who had visited EP (N=1,840, OR 0.65, CI 0.42-0.98, p= 0.04). Among patients diagnosed in IM/PC, NHB patients were 1.47 times more likely to be referred to Cardiology than NHW patients (CI 1.09-1.97, p= 0.01), but the rates of referral to EP were similar (OR 0.94, CI 0.72-1.24, p= 0.68) (Figure).Conclusion:NHB patients diagnosed in the outpatient setting are less likely to undergo AFCA compared with NHW patients, but referral patterns do not explain these findings. Exploration of other factors should be considered to mitigate disparities in care related to AFCA. more...
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- 2021
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20. Abstract 11519: CHA2DS2VASc Score as a Predictor of Ablation Success Defined by Continuous Long-Term Monitoring
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Liu, Albert Y, Lohrmann, Graham, Ziegler, Paul D, Monteiro, Joao V, Varberg, Nathan V, and Passman, Rod S
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Introduction:There are few readily available and effective risk stratification tools for successful catheter ablation (CA) of atrial fibrillation (AF). CHA2DS2VASc score is a marker for vascular disease and has been shown to be mildly predictive of CA success, although prior studies have used short-term external monitors to define success.Hypothesis:Lower CHA2DS2VASc score correlates with CA success as measured by continuous monitoring via cardiac implantable electronic devices (CIED).Methods:Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink device database, we identified patients who underwent a 1stCA procedure for AF following CIED implantation. CA success was defined as absence of ≥1 hour of AF on any day following a 3-month blanking period. A proportional hazard model was used to estimate hazard ratios (HR) between CHA2DS2VASc subgroups (0-2, 3-4, ≥5).Results:A total of 665 patients (age 66.9±9.1 years, 73.4% male, CHA2DS2VASc 3.5±1.8, 37.3% paroxysmal AF, 62.7% persistent AF) were analyzed and included 36.2% insertable cardiac monitor, 28.0% PPM, 21.4% ICD, 13.2% CRT-D, and 1.2% CRT-P. CA success at 24 months post blanking period was 39.8% (95% CI 32.4%-48.9%), 36.9% (95% CI 29.7%-45.8%), and 20.9% (95% CI 13.9%-31.4%) for CHA2DS2VASc subgroups of 0-2, 3-4, and ≥5, respectively. Kaplan-Meier curves demonstrate a difference in survival free from AF between the three CHA2DS2VASc subgroups (p=0.007, Figure), with CHA2DS2VASc score being a significant predictor of CA ablation success (c-statistic 0.533). After controlling for AF type, patients with a score ≥5 remained at higher risk for AF recurrence compared to patients with a score of 0-2 (HR 1.28, 95% CI 1.001-1.63).Conclusions:In this real-world dataset of AF patients with continuous monitoring undergoing CA, CHA2DS2VASc score is a modest predictor of CA success. more...
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- 2021
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21. Abstract 12592: Acute Administration of N-Acytylcysteine Leads to Highly Specific Sub-Regional Changes in AF Electrogram Characteristics - A New Way to ‘Uncover’ Regions of High Oxidative Injury in the Fibrillating Atrium?
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Rottmann, Markus, Pfenniger, Anna, Yoo, Shin, Johnson, David, Geist, Gail E, Zhang, Wenwei, Shanab, Bassel, Mandava, Suman, Burrel, Amy, Wasserstrom, Andrew J, Kim, Susan, Knight, Bradley P, Passman, Rod S, and Arora, Rishi more...
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Introduction:It is currently not possible to measure and therapeutically target oxidative injury (OI) in the intact fibrillating atrium.Hypothesis:We postulated that measurement of AF electrogram characteristics after acute administration of a reactive oxygen species (ROS) scavenger can help ‘uncover’ regions of high OI in the fibrillating human atrium.Methods:We mapped in both atria pre/post NAC (intravenous, 100mg/kg) in 15 persistent AF dogs (3-14 weeks rapid atrial pacing) using a high-density epicardial mapping-plaque (6 atrial regions in both atria, 130 electrodes, electrode-distance 2.5mm) and in 4 patients using the HD-grid catheter. We quantified the OS-levels as ratio of oxidatively damaged nuclei (Figure A) against the total number in 8-OHdG staining (N=36) and the degree of dense fibro-fatty tissue in Masson’s trichrome stained tissue (N=24) using Qupath. We analyzed cycle length (CL) and dominant frequency (DF) in ‘hot spot’-sub-region sizes with >10% change pre vs. post NAC.Results:Oxidative stress (OS) levels, highest in the left atrial free wall, lowest in the appendages increased with increasing degree of fibro-fatty tissue (R=0.6,P<0.05) and with decreasing cycle length (R=0.5, P<0.05) in all regions (Figure C). NAC selectively reduced AF characteristics in ‘hot spot’-sub-regions (Figure D). OS level correlated with delta CL, delta DF, and delta Organization Index in delta maps (NAC - baseline) (R=0.5, P<0.05, all comparisons) (Figure E). In patients, NAC (Figure G)reduced AF characteristics in subregions (Figure H)and increased cycle length from 210±50ms to 252±18ms (P<0.05) in the left atrium (Figure I).Conclusions:OS-level correlated with the degree of dense fibro-fatty tissue and with electrogram measures in both atria. Acute scavenging of ROS reduced AF characteristics in the left atrium in dogs and patients. We might have found a new way to target regions of high OS in the atrium in the individual patient. more...
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- 2021
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22. Abstract 11730: Data Quality and Monitoring Completion Rates Are Similar Between Clinic-Applied and Self-Applied Continuous ECG Monitoring Patches Prior to and During COVID-19
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Goergen, Jack A, Hsu, Mike, Wilk, Alan, Crosson, Lori, Lenane, Judith C, Knight, Bradley P, and Passman, Rod S
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Introduction:Prior to COVID-19, ECG patches (ECGp) were applied almost exclusively in-clinic (CA) by technicians which required an office visit and fee. Since the pandemic, direct-to-patient, self-applied patch use (SA) has substantially increased, though the metrics surrounding SA are unknown. This study compares monitoring completion rates and data quality between CA and SA ECGp prior to and during COVID-19.Hypothesis:CA and SA ECGp have similar data quality and monitoring completion metrics.Methods:We performed a retrospective cohort analysis of patients prescribed an iRhythm Zio XT patch at Northwestern Memorial Hospital during the “pre-COVID” (3/1/2019-3/1/2020) and “COVID” (4/1/2020-4/1/2021) timeframes. Differences in ECGp with data available, actual vs prescribed wear time, and analyzable data between groups were assessed. ECGp without data was defined as devices which were not returned or not activated.Results:The cohort included 29,118 ECGp prescriptions; 13,180 pre-COVID (45%). The cohort was 56% female with mean age of 59.3 +17.7 years. Palpitations (29%) and atrial fibrillation (19%) were the most common indications. In the pre-COVID cohort, there were no (0%) SA ECGp and data were available for 12,932 CA patches. In the COVID cohort, 34% of ECGp were SA; data were available for 10,231 CA ECGp and 4,902 SA ECGp. Average delay between prescription and SA ECGp activation was 8.1 ± 12.2 days. Comparisons between percent analyzable data, wear times, and ECGp with data available are shown in figure 1.Conclusions:COVID-19 resulted in a rapid adoption of SA ECGp use. Compared to CA, SA was associated with an inherent delay in ECGp application and a higher proportion of ECGp without data. However, there was no difference in actual vs prescribed wear time and a small but statistically significant decrease in percent analyzable data. These differences must be balanced with the additional cost and need for in-person visit for CA vs SA. more...
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- 2021
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23. Abstract 10878: New Bleeding Risk Prediction Model for Patients with Atrial Fibrillation on Direct Oral Anticoagulants
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Tanaka, Yoshihiro, Lancki, Nicola, Khan, Sadiya, Martin, Karlyn, and Passman, Rod S
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Introduction:Although several risk scores exist to predict major bleeding events (MBEs) in patients with atrial fibrillation (AF) on anticoagulation therapy, most were derived from warfarin treated patients. Therefore, we sought to develop a new bleeding risk score specifically for AF patients on direct oral anticoagulants (DOAC).Hypothesis:A DOAC-specific risk prediction model will have good discrimination and calibration for 1-year and 3-year MBEs.Methods:AF patients aged ≥ 18 years on DOAC therapy who had at least 12-month follow-up between 2010 and 2017 were extracted from the Northwestern Medicine EHR. The primary endpoint was MBE defined by the International Society on Thrombosis and Hemostasis (ISTH) criteria. Seventy percent of patients were randomly assigned to a derivation cohort and the rest of 30% was used as an internal validation cohort. In the derivation cohort, all significant univariate predictors (p < 0.05) were incorporated into a multivariate Cox proportional hazard model. Harrel’s c-statistics was used for discrimination and Hosmer-Lemeshow test for calibration.Results:A total of 7,642 patients with AF on DOAC (Apixaban 43.9%, Rivaroxaban 36.4%, Edoxaban 0.1%, Dabigatran 19.5%) were analyzed (mean age, 69 ± 12 years: men, 59.5%: non-Hispanic White, 85.8%). During a median follow-up period of 3.3 years (interquartile range 2.0-5.0), 1,283 MBEs (922 in derivation cohort and 361 in validation cohort) were observed. Final model involved age, race, body mass index in addition to all components of CHA2DS2-Vasc score. Calibration plots at 1 year and 3 years looked good fit and Hosmer-Lemeshow test was not statistically significant. C-statistics of the new model at 1 year and 3 years were 0.70 (95% CI: 0.67 - 0.72) and 0.67 (95% CI: 0.65 - 0.69), both of which were higher than the reported c-statistics from HAS-BLED score. In the validation cohort, we observed the same significant differences in c-statistics at both years.Conclusions:A DOAC-specific risk prediction score had good model performance to quantify bleeding risk in patients with AF on DOAC. more...
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- 2021
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24. Abstract 11773: Impact of Race on Incident Atrial Fibrillation in a Large Cohort With Cardiac Implantable Electronic Devices
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Goergen, Jack A, Varberg, Nathan, Nayak, Tanvi, Ziegler, Paul D, Soderlund, Dana, and Passman, Rod S
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Introduction:Prior studies showed lower rates of atrial fibrillation (AF) in African Americans (AA) compared to Caucasians (CC) despite a higher prevalence of AF risk factors. These studies often relied on a clinical diagnosis of AF or limited analyses to Medicare beneficiaries which may bias the results. Our objective is to compare AF-free survival in AA vs CC patients with dual chamber cardiac implantable electronic devices (CIEDs) capable of continuous AF monitoring.Hypothesis:There is no significant difference in incident AF between AA and CC patients with dual chamber CIEDs.Methods:Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink® device database, we identified self-described AA and CC patients with dual chamber CIEDs and no prior AF history. The primary endpoint was time to first AF ≥ 6 minutes. Cox proportional hazards models were used to examine the association between race and AF while adjusting for age, sex, and vascular risk factors in the pacemaker and ICD cohorts.Results:Of the 110,323 patients analyzed, mean age was 69±13 years, 64% were male, 8.9% were AA, and 39% had a pacemaker. CC were older (69.5 vs 63.4 years) and more were male (65% vs 54%). Heart failure, hypertension and diabetes were more common in AA (36% vs 22%; 60% vs 47%; 32% vs 22%, respectively). Over a mean follow-up of 2.3±1.8 years, unadjusted AF-free survival was higher in AA compared to CC in both CIED cohorts (p<0.0001). After adjusting for age, sex and vascular risk factors, CC with pacemakers had a higher risk of incident AF (HR 1.10; 95% CI 1.03-1.17) but a lower risk was observed in CC with ICDs (HR 0.91; 95% CI 0.87-0.94) (Figure 1).Conclusions:In contrast to previous studies, this analysis of 110,323 CIED patients showed that adjusted AF-free survival was higher in AAs with pacemakers but not ICDs. These results challenge our understanding of the interaction between race and incident AF. more...
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- 2021
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25. Abstract 14447: Increased Autophagy Flux May Underline Cardiomyocyte Remodeling in Atrial Fibrillation
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Zhang, Wenwei, Burrell, Amy, Geist, Elizabeth, Yoo, Shin, Knight, Bradley P, Passman, Rod S, and Arora, Rishi
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Atrial fibrillation (AF), the most common progressive tachyarrhythmia, results in structural remodeling that impairs electrical activation of the atria. Studies have shown that mitochondrial dysfunction underlies cardiomyocyte remodeling. Here, we report a 50% reduction in total mitochondrial DNA in the atria tissue of RAP dogs as compared to control dogs, as assessed by qPCR the levels of mitochondrial DNA including mt-NT-1, mt-NT-4, mt-NT 5, mt-NT 6. This reduction in mitochondrial DNA suggests reduced mitochondria number in RAP dogs. Autophagic flux (LC3 II protein levels) was markedly increased in the atria tissue of the AF dog model (vs control dog).Furthermore, we examined autophagy flux in isolated cardiomyocytes. Results showed that LC3II was remarkably activated when subject to electrical stimulation for 6 hours under 3 Hertz condition, suggesting the direct effect of electrical stimulation on increasing autophagy. There was no change in the mRNA levels of autophagosome genes including Belin 1, ATG8, LC3, Lamp1 in the RAP dog tissue as compared to control, however, ATG7 increased by 2 fold and GNG2 increased by 5 fold. In conclusion, our study suggests that electrical stimulation-induced autophagy, and reduced mitochondria number and function, may underlie cardiomyocyte remodeling in AF. Targeting the autophagy pathway may present new therapeutic targets for AF. Ongoing AAV-mediated knockdown experiments in isolated cardiomyocytes will further elucidate the mechanism of electrical stimulation-induced autophagy. more...
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- 2021
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26. Artificial Intelligence and Machine Learning in Arrhythmias and Cardiac Electrophysiology
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Feeny, Albert K., Chung, Mina K., Madabhushi, Anant, Attia, Zachi I., Cikes, Maja, Firouznia, Marjan, Friedman, Paul A., Kalscheur, Matthew M., Kapa, Suraj, Narayan, Sanjiv M., Noseworthy, Peter A., Passman, Rod S., Perez, Marco V., Peters, Nicholas S., Piccini, Jonathan P., Tarakji, Khaldoun G., Thomas, Suma A., Trayanova, Natalia A., Turakhia, Mintu P., and Wang, Paul J. more...
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Supplemental Digital Content is available in the text.Artificial intelligence (AI) and machine learning (ML) in medicine are currently areas of intense exploration, showing potential to automate human tasks and even perform tasks beyond human capabilities. Literacy and understanding of AI/ML methods are becoming increasingly important to researchers and clinicians. The first objective of this review is to provide the novice reader with literacy of AI/ML methods and provide a foundation for how one might conduct an ML study. We provide a technical overview of some of the most commonly used terms, techniques, and challenges in AI/ML studies, with reference to recent studies in cardiac electrophysiology to illustrate key points. The second objective of this review is to use examples from recent literature to discuss how AI and ML are changing clinical practice and research in cardiac electrophysiology, with emphasis on disease detection and diagnosis, prediction of patient outcomes, and novel characterization of disease. The final objective is to highlight important considerations and challenges for appropriate validation, adoption, and deployment of AI technologies into clinical practice. more...
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- 2020
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27. Abstract 15877: Focal Impulse Rotor Modulation Guided Ablation versus Isolated Repeat Pulmonary Vein Isolation of Non-Paroxysmal Atrial Fibrillation After Failed Pulmonary Vein Isolation: A Case Control Study
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Peigh, Graham, Wasserlauf, Jeremiah, Kaplan, Rachel M, Trivedi, Amar, Amaral, Ansel P, Chicos, Alexandru B, Arora, Rishi, Kim, Susan, Lin, Albert, Verma, Nishant, Knight, Bradley P, and Passman, Rod S more...
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Introduction:Focal Impulse Rotor Modulation (FIRM) ablation targets non-pulmonary vein sources of atrial fibrillation (AF). No prior studies have compared freedom from AF (FFAF) after FIRM plus pulmonary vein re-isolation (PVRI) to PVRI alone in patients undergoing redo ablation.Hypothesis:In patients undergoing repeat ablation for AF, FIRM with PVRI is associated with greater FFAF than PVRI alone.Methods:A 3:1 case-control study was performed in 21 patients who underwent FIRM-guided ablation plus PVRI (cases) and 63 patients who underwent PVRI alone (controls) for recurrent AF at a single institution. All control patients had PVRI using cryoballoon without additional lesion sets. Controls were matched based on left atrial diameter, left ventricular ejection fraction, duration of AF, and age. The primary endpoint was FFAF after a 3-month blanking period.Results:Out of 53 total FIRM cases performed at Northwestern Memorial Hospital between 2015 and 2017, 21 patients had FIRM + PVRI for recurrent AF after a failed pulmonary vein isolation. These patients had an average of 3.3 ? 2.1 rotors (61% left atrial) ablated. Over a median follow-up time of 29.5 months (IQR 17-39 months), FFAF was observed in 7 patients (33.3%) who underwent FIRM-guided ablation, and 33 controls (52.4%) who underwent PVRI alone (p=0.13) (Figure).Conclusions:In patients undergoing repeat ablations for AF, FIRM-guided ablation plus PVRI did not increase freedom from AF when compared to PVRI alone. Future randomized controlled studies are needed to further investigate this approach. more...
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- 2019
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28. Abstract 14613: Preferential Release of Nerve Growth Factor by the Left Atrial Appendage - A New Mechanism Underlying Autonomic Nerve Remodeling in Persistent Atrial Fibrillation?
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Pfenniger, Anna, Yoo, Shin, Zhang, Wenwei, Burrell, Amy, Johnson, David A, Gussak, Georg, Wren, Lisa, Gilani, Mehul, Knight, Bradley P, Passman, Rod S, and Arora, Rishi
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Introduction:Persistent atrial fibrillation (peAF) is accompanied by left atrial sympathetic and parasympathetic hyperinnervation. Although nerve growth factor (NGF) is a key factor for cardiac autonomic nerve sprouting, the mechanisms leading to NGF release in the atria are poorly understood.Hypothesis:NGF secretion is determined by frequency and regularity of atrial myocyte activation in AF.Methods:We quantified NGF mRNA and protein in fat pads (ganglionated plexi) and left atrial regions (left atrial appendage (LAA), left atrial free wall (LAFW) and posterior left atrium (PLA)) of control dogs or after induction of peAF by 3-6 weeks of rapid atrial pacing. We obtained AF electrograms (Dominant Frequency, Fractional Interval (FI), Organization Index (OI)) in LAA, LAFW and PLA. An atrial myocyte cell line (HL1) was paced with varying rates and regularity.Results:NGF expression was increased 6 fold in the rapidly paced atria (Fig. A). NGF was only mildly increased in atrial fat pads (2.1?0.7 Vs 1.0?0.2 in control, p=0.3), suggesting atrial myocytes as the primary source of NGF in peAF. In vitroHL1 pacing elicited a rate-dependent increase in NGF, consistent with our in vivofindings (Fig. B). AF is less fractionated and more organized in the LAA (representative electrograms in Fig. C): FI is 77?4 Vs 67?2 in PLA, p<0.05; and OI is 0.38?0.01 Vs 0.32?0.02 in PLA, p<0.05. Whereas no regional difference in normal atrial NGF levels was seen, NGF mRNA was markedly higher in the rapidly paced LAA than the PLA or LAFW (Fig. D). Irregular HL1 pacing was less effective at inducing NGF than regular pacing (Fig. E), consistent with a preferential release of NGF by the LAA.Conclusion:Rapid atrial myocyte activation in peAF leads to secretion of NGF, likely causing atrial autonomic hyperinnervation via retrograde transport to the autonomic ganglia. This is most pronounced with regular activation as seen in the LAA, highlighting a particular role for the LAA in the creation of AF substrate. more...
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- 2019
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29. Sex, Symptoms, and Atrial Fibrillation
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Passman, Rod S.
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- 2016
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30. Uncovering Atrial Fibrillation Beyond Short-Term Monitoring in Cryptogenic Stroke Patients
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Brachmann, Johannes, Morillo, Carlos A., Sanna, Tommaso, Di Lazzaro, Vincenzo, Diener, Hans-Christoph, Bernstein, Richard A., Rymer, Marylin, Ziegler, Paul D., Liu, Shufeng, and Passman, Rod S.
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- 2016
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