12 results on '"Birnie DH"'
Search Results
2. Continued versus interrupted direct oral anticoagulation for cardiac electronic device implantation: A systematic review.
- Author
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Mendoza PA, Narula S, McIntyre WF, Whitlock RP, Birnie DH, Healey JS, and Belley-Côté EP
- Subjects
- Administration, Oral, Hematoma chemically induced, Humans, Risk Factors, Thromboembolism prevention & control, Anticoagulants administration & dosage, Cardiac Resynchronization Therapy Devices, Prosthesis Implantation
- Abstract
Background: Many patients undergoing cardiac device implantation are taking direct oral anticoagulation (DOAC). Continuing DOAC during device implantation may increase periprocedural bleeding risk; however, interrupting DOACs may increase thromboembolic risk., Objective: To compare the incidence of clinically significant pocket hematoma and thromboembolism in patients who have their DOAC continued or interrupted for cardiac device implantation., Methods: We searched MEDLINE, EMBASE, and randomized controlled trial (CENTRAL) until December 2019 and included randomized controlled trials (RCTs) and observational studies that compared outcomes after continuing or interrupting DOAC during cardiac device implantation. Independently and in duplicate, reviewers screened titles, abstracts, and full text of potentially eligible studies. They then evaluated risk of bias and abstracted data. RCT data were pooled using a fixed-effect model. Quality of evidence was assessed using grading of recommendations assessment, development and evaluation (GRADE)., Results: Two RCTs, representing 763 patients, and three observational studies met eligibility criteria. In RCTs, continuing DOAC for device implantation compared to interrupting DOAC resulted in no significant difference in clinically significant pocket hematoma (2.1% vs 1.8%; RR 1.15; 95% CI 0.44-3.05) or thromboembolism (0.03% vs 0.03%; RR 1.02; 95% CI 0.06-16.21). Quality of evidence for both outcomes was moderate due to imprecision. Observational studies showed similar results., Conclusions: Continuing DOACs for device implantation results in little to no difference in the incidence of clinically significant pocket hematoma or thromboembolism. Given the ease of stopping and restarting DOACs, interrupting DOACs may be the preferred strategy for most patients. However, whenever continuous therapeutic anticoagulation is desired, DOAC continuation should be preferred over bridging with parenteral anticoagulation., (© 2020 Wiley Periodicals LLC.)
- Published
- 2020
- Full Text
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3. Effect of Applying Force to Self-Adhesive Electrodes on Transthoracic Impedance: Implications for Electrical Cardioversion.
- Author
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Ramirez FD, Fiset SL, Cleland MJ, Zakutney TJ, Nery PB, Nair GM, Redpath CJ, Sadek MM, and Birnie DH
- Subjects
- Adhesives, Adult, Atrial Fibrillation therapy, Electric Countershock instrumentation, Humans, Male, Middle Aged, Young Adult, Cardiography, Impedance methods, Electric Countershock methods, Electrodes
- Abstract
Background: Current guidelines disagree on the role for applying force to electrodes during electrical cardioversion (ECV) for atrial fibrillation, particularly when using self-adhesive pads. We evaluated the impact of this practice on transthoracic impedance (TTI) with varying force and in individuals with differing body mass indices (BMI). We additionally assessed whether specific prompts could improve physicians' ECV technique., Methods: The study comprised three parts: (1) TTI was measured in 11 participants throughout the respiratory cycle and with variable force applied to self-adhesive electrodes in anteroposterior (AP) and anterolateral (AL) configurations. (2) Three participants in different BMI classes then had TTI measured with prespecified incremental force applied. (3) Ten blinded cardiology trainees simulated ECV on one participant with and without prompting (guideline reminders and force analogies) while force applied and TTI were measured., Results: The AP approach was associated with 13% lower TTI than AL (P < 0.001). Strongly negative correlations were observed between force applied and TTI in the AL position, irrespective of BMI (P ≤ 0.003). In all cases, 80% of the total reduction in TTI observed was achieved with 8 kg-force (∼80 N). All prompts resulted in significantly greater force applied and modest reductions in TTI., Conclusions: Applying force to self-adhesive electrodes reduces TTI and should be considered as a means of improving ECV success. Numerically greater mean force applied with a "push-up" force analogy suggests that "concrete" cues may be useful in improving ECV technique., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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4. Meta-analysis of continuous oral anticoagulants versus heparin bridging in patients undergoing CIED surgery: reappraisal after the BRUISE study.
- Author
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Sant'anna RT, Leiria TL, Nascimento T, Sant'anna JR, Kalil RA, Lima GG, Verma A, Healey JS, Birnie DH, and Essebag V
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- Administration, Oral, Aged, Comorbidity, Defibrillators, Implantable statistics & numerical data, Female, Hemorrhage prevention & control, Humans, Incidence, Male, Pacemaker, Artificial statistics & numerical data, Premedication statistics & numerical data, Risk Assessment, Treatment Outcome, Vitamin K antagonists & inhibitors, Anticoagulants administration & dosage, Hemorrhage epidemiology, Heparin administration & dosage, Prosthesis Implantation statistics & numerical data, Thromboembolism epidemiology, Thromboembolism prevention & control
- Abstract
Background: Management of patients treated with oral anticoagulation (OAC) requiring a cardiovascular implantable electronic device (CIED) surgery is a challenge that requires balancing the risk of bleeding complications with the risk of thromboembolic events. Recently the approach of performing these procedures while the patient remains with a therapeutic international normalized ratio has gained interest due to several publications showing its relative safety., Objectives: To evaluate the safety and effectiveness of continuous use of OAC compared with heparin bridging in the perioperative setting of CIED surgery using a meta-analysis., Methods: A systematic review of PubMed/MEDLINE, Ovid, and Elsevier databases was performed. Eligible randomized controlled trials and cohort studies were included. The outcomes studied were risk of clinically significant bleeding and of thromboembolic events. Our analysis was restricted to OAC with vitamin K antagonists., Results: Of 560 manuscripts initially considered relevant, seven were included in the meta-analysis, totaling 2,191 patients. Data are reported as odds ratios (ORs) with confidence interval (CI) of 95%. Maintenance of OAC was associated with a significantly lower risk of postoperative bleeding compared with heparin bridge (OR = 0.25, 95% CI 0.17-0.36, P < 0.00001). There was no difference noted in the risk of thromboembolic events between the two strategies (OR = 1.86, 95% CI 0.29-12.17, P = 0.57)., Conclusions: Uninterrupted use of OAC in the perioperative of CIED surgery was associated with a reduced risk of bleeding. This strategy should be considered the preferred one in patients at moderate-to-high risk of thromboembolic events., (© 2014 Wiley Periodicals, Inc.)
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- 2015
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5. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia.
- Author
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Nery PB, Mc Ardle BA, Redpath CJ, Leung E, Lemery R, Dekemp R, Yang J, Keren A, Beanlands RS, and Birnie DH
- Subjects
- Cardiomyopathies, Causality, Comorbidity, Female, Humans, Male, Middle Aged, Ontario epidemiology, Prevalence, Risk Assessment, Sarcoidosis diagnosis, Sarcoidosis epidemiology, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular epidemiology
- Abstract
Introduction: Sarcoidosis is a granulomatous disease of unknown etiology, which involves the heart in 5-25% of cases. Although ventricular tachycardia (VT) has been reported as the first presentation of sarcoidosis, its prevalence has not previously been investigated. In this prospective study, we sought to systematically investigate the prevalence of cardiac sarcoidosis (CS) in patients presenting with monomorphic VT (MMVT) and no previous history of sarcoidosis., Methods: Consecutive patients presenting with MMVT to a tertiary care center were screened for inclusion. Patients with idiopathic VT, VT secondary to coronary artery disease, or prior diagnosis of sarcoidosis were excluded. Included patients underwent F-18-fluorodeoxyglucose positron emission tomography (PET) scan. In subjects with PET scanning suggestive of active myocardial inflammation, histological diagnosis was confirmed through extracardiac or endomyocardial biopsy (EMB)., Results: A total of 182 patients presented to our institution with VT between February 2010 and September 2012 and 14 subjects met inclusion criteria. Within this group, six of 14 (42%) patients had abnormal PET scans suggesting active myocardial inflammation. Four of the six patients had tissue biopsies that were diagnostic of sarcoidosis; the remaining two patients had guided EMB indicating nonspecific myocarditis. Atrioventricular block was observed in three of four (75%) patients with CS and none in 10 of the others (P = 0.022). Three of the four patients had pulmonary sarcoidosis and one patient had isolated CS. All four patients were treated with corticosteroids., Conclusion: In this prospective study, four of 14 (28%) patients presenting with MMVT (without idiopathic VT, ischemic VT, or known sarcoidosis) had CS as the underlying etiology. Clinicians should consider screening for CS in patients with unexplained MMVT., (©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.)
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- 2014
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6. Degenerating regenerating torsades de pointes.
- Author
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Perrin MJ, Gollob MH, Birnie DH, Nery PB, and Keren A
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- Aged, 80 and over, Humans, Male, Remission, Spontaneous, Torsades de Pointes physiopathology, Ventricular Fibrillation physiopathology, Torsades de Pointes complications, Ventricular Fibrillation etiology
- Abstract
Ventricular fibrillation (VF) commonly ends in death. Isolated case reports describe the uncommon occurrence of spontaneous termination of VF. Torsades de pointes (TdP), a peculiar form of polymorphic ventricular tachycardia associated with a prolonged QT interval on the surface electrocardiogram, most often spontaneously terminates and then returns to the underlying rhythm. Here, we present an unusual case of TdP degenerating into VF, reorganizing into TdP, and then spontaneously terminating. Our case suggests that the mechanisms underlying the maintenance of TdP and VF are not dissimilar. The precipitants to this event and the likely mechanisms operative are discussed., (©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.)
- Published
- 2013
- Full Text
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7. Anticoagulation bridging around device surgery: compliance with guidelines.
- Author
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Perrin MJ, Vezi BZ, Ha AC, Keren A, Nery PB, and Birnie DH
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- Adult, Aged, Aged, 80 and over, Anticoagulants adverse effects, Female, Heparin, Low-Molecular-Weight adverse effects, Humans, Male, Retrospective Studies, Risk Assessment, Risk Factors, Anticoagulants therapeutic use, Cardiac Resynchronization Therapy Devices, Cardiac Surgical Procedures, Guideline Adherence, Heart Valve Diseases surgery, Heart Valve Prosthesis, Heparin, Low-Molecular-Weight therapeutic use, Thromboembolism prevention & control
- Abstract
Background: Current guidelines recommend bridging anticoagulation in patients undergoing cardiac rhythm device surgery with a "moderate to high risk" of thromboembolism. Patients at "low risk" are advised to stop oral anticoagulation without bridging to the procedure. This study examines real world adherence to accepted guidelines and the clinical sequelae of nonadherence., Methods: We performed a review of all patients undergoing device surgery receiving chronic anticoagulation over a prespecified time period of 14 months. Patients were classified per American College of Chest Physician guidelines as "moderate/high risk" or "low risk" of thromboembolism. We then compared perioperative management of anticoagulation to guideline recommendations and assessed the rate of perioperative bleeding and thromboembolism., Results: One hundred and twenty-nine patients were included in this study. Sixty-two (48%) were classified as "moderate/high risk" and 67 (52%) "low risk." In the "moderate/high risk" group 47/62 (76%) received perioperative anticoagulation but only 25/62 (40%) were bridged both pre- and postprocedure or maintained on uninterrupted warfarin. In the "low risk" group, 22/67 (33%) received bridging therapy. Device pocket hematoma or perioperative bleeding occurred in 10/129 (8%) with 4/10 receiving inappropriate bridging for a calculated low risk of thromboembolism. There were no perioperative thromboembolisms., Conclusions: Our study identified significant underutilization of bridging, particularly in the postoperative period, in patients at "moderate/high risk" of thromboembolism. Conversely, bridging was overused in "low risk" patients and associated with bleeding complications. Physicians should be urged to follow current expert guidelines in regard to bridging anticoagulation for cardiac rhythm device surgery. (PACE 2012;35:1480-1486)., (©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.)
- Published
- 2012
- Full Text
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8. Predictors of fracture risk of a small caliber implantable cardioverter defibrillator lead.
- Author
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Ha AC, Vezi BZ, Keren A, Alanazi H, Gollob MH, Green MS, Lemery R, Nery PB, Posan E, and Birnie DH
- Subjects
- Aged, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Radiography, Thoracic, Risk Factors, Defibrillators, Implantable, Prosthesis Failure
- Abstract
Introduction: The Sprint Fidelis 6949 implantable cardioverter defibrillator (ICD; Medtronic Inc., Minneapolis, MN, USA) lead has a high rate of fracture. Identification of predictors of subsequent fracture is useful in decision making about lead replacement and for future lead design. We sought to determine if there are clinical, procedural, or radiological features associated with a greater risk of subsequent lead fracture., Methods: Patients with Sprint Fidelis 6949 lead fractures (Fracture group) were identified from our institutional database. Each patient in the Fracture group was matched to two controls, immediately preceeding and succeeding Sprint Fidelis 6949 implant. Clinical and procedural characteristics were compared. Chest radiographs performed 2 weeks after ICD implant were reviewed by an observer blinded to outcomes. The following features were assessed: ICD tip location, lead slack, kinking of the lead body (> or =90 degrees ), and presence of lead "crimping" within the anchoring sleeve., Results: Twenty-six patients with Sprint Fidelis 6949 lead fractures were identified and were matched to 52 control patients. On univariate analysis, a higher left ventricular ejection fraction (LVEF), prior ipsilateral device implant, history of prior ICD lead fracture, and noncephalic venous access were associated with risk of lead fracture. On multivariate analysis, a higher LVEF was the only independent predictor of lead fracture (P = 0.006). Radiological features were similar between the two groups., Conclusions: In this study, a higher LVEF was associated with a greater risk of lead fracture in patients with Sprint Fidelis 6949 ICD leads. Radiographic features did not predict subsequent risk of lead fracture in our population. (PACE 2010; 437-443).
- Published
- 2010
- Full Text
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9. Living with an advisory ICD: how are the patients doing?--Actually just fine.
- Author
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Birnie DH and Keren A
- Subjects
- Humans, Arrhythmias, Cardiac prevention & control, Arrhythmias, Cardiac psychology, Attitude to Health, Defibrillators, Implantable psychology, Disclosure, Equipment Failure, Product Surveillance, Postmarketing
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- 2009
- Full Text
- View/download PDF
10. Remote magnetic navigation-assisted catheter ablation enhances catheter stability and ablation success with lower catheter temperatures.
- Author
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Davis DR, Tang AS, Gollob MH, Lemery R, Green MS, and Birnie DH
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- Female, Humans, Magnetics instrumentation, Male, Temperature, Treatment Outcome, Catheter Ablation methods, Magnetics therapeutic use, Robotics methods, Tachycardia, Atrioventricular Nodal Reentry diagnosis, Tachycardia, Atrioventricular Nodal Reentry surgery, Telemedicine methods
- Abstract
Background: It has been suggested that remote magnetic navigation (RMN) may provide enhanced catheter stability and substrate contact to aid in ablation. To date, no study has examined this claim. Accordingly, we compared the characteristics of the successful ablation of atrioventricular reentry tachycardia (AVNRT) using RMN with a matched population ablated using a conventional (CON) manual approach., Methods: Sixteen patients who underwent RMN-assisted ablation of typical AVNRT were matched with 16 patients who had a CON-AVNRT ablation., Results: All patients had successful slow pathway modification without complication. The mean catheter temperature achieved with the successful ablation was significantly lower with RMN than with CON (42 +/- 7 degrees C vs 47 +/- 3 degrees C, P
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- 2008
- Full Text
- View/download PDF
11. Appropriate result from an inappropriate ICD shock.
- Author
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Davis DR, Gollob MH, Green MS, Lemery R, Tang AS, and Birnie DH
- Subjects
- Electric Injuries, Heart Failure therapy, Humans, Male, Middle Aged, Myocardial Ischemia therapy, Prosthesis Failure, Defibrillators, Implantable, Electric Countershock
- Abstract
A case of inappropriate detection of an ungrounded external AC current by an implantable cardioverter defibrillator (ICD) is reported. The resultant ICD shock dislodged the patient from the electrical source, thus preventing injury or electrocution.
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- 2006
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12. Ventricular tachycardia terminated by an ICD: is there more than what meets the eye?
- Author
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Lau EW, Green MS, Birnie DH, Lemery R, and Tang AS
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- Adult, Diagnosis, Differential, Electrocardiography, Ambulatory, Equipment Failure Analysis, Female, Heart Atria physiopathology, Heart Ventricles physiopathology, Humans, Tachycardia, Ventricular etiology, Tachycardia, Ventricular physiopathology, Telemetry, Ventricular Premature Complexes etiology, Ventricular Premature Complexes physiopathology, Defibrillators, Implantable adverse effects, Electrocardiography instrumentation, Tachycardia, Ventricular therapy, Ventricular Premature Complexes therapy
- Published
- 2004
- Full Text
- View/download PDF
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