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1. Renal Sympathetic Denervation as Upstream Therapy During Atrial Fibrillation Ablation: Pilot HFIB Studies and Meta-Analysis

Author

Mohit K, Turagam, William, Whang, Marc A, Miller, Petr, Neuzil, Arash, Aryana, Alexander, Romanov, Frank A, Cuoco, Moussa, Mansour, Dhanunjaya, Lakkireddy, Gregory F, Michaud, Srinivas R, Dukkipati, Sam, Cammack, and Vivek Y, Reddy

Subjects
Treatment Outcome, Recurrence, Atrial Fibrillation, Catheter Ablation, Humans, Pilot Projects, Prospective Studies, Sympathectomy, Randomized Controlled Trials as Topic
Abstract

This study sought to determine the impact of adjunctive renal sympathetic denervation to catheter ablation in patients with atrial fibrillation (AF) and history of hypertension.There are limited data regarding the impact of upstream adjunctive renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) and hypertension.The data for this study were obtained from 2 prospective randomized pilot studies, the HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-1 (n = 30) and HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-2 (n = 50) studies, and we performed a meta-analysis including all published studies comparing RSDN+PVI versus PVI alone up to January 25, 2020, in patients with AF and hypertension.At 24 months, AF recurrence occurred in 53% and 38% in the PVI and PVI+RSDN groups (p = 0.43) in the HFIB-1 study, respectively, and 27% and 25% in the PVI and PVI+RSDN groups (p = 0.80) in the HFIB-2 study, respectively. When combined in a meta-analysis including 6 studies (n = 725), adjunctive RSDN significantly decreased the risk of AF recurrence (risk ratio [RR]: 0.68; 95% confidence interval [CI]: 0.55 to 0.83; p = 0.0002; IThe pilot HFIB-1 and HFIB-2 studies did not demonstrate a benefit with RSDN as an adjunctive upstream therapy during PVI. However, in the meta-analysis, adjunctive RSDN to PVI appears to be safe, and improves clinical outcomes in AF patients with a history of hypertension.

Published
2020

2. The Effect of Chronic Kidney Disease on Mortality with Cardiac Resynchronization Therapy

Author

David D, Daly, Anbukarasi, Maran, J Madison, Hyer, Frederick, Funke, Ashley, Waring, Frank A, Cuoco, J Lacy, Sturdivant, Robert B, Leman, and Michael R, Gold

Subjects
Heart Failure, Male, Incidence, Comorbidity, Middle Aged, United States, Article, Defibrillators, Implantable, Cardiac Resynchronization Therapy, Causality, Cohort Studies, Survival Rate, Treatment Outcome, Risk Factors, Humans, Female, Renal Insufficiency, Chronic, Aged, Retrospective Studies
Abstract

Cardiac resynchronization therapy (CRT) improves functional status, reduces heart failure hospitalizations, and decreases mortality. Several comorbidities including renal function affect outcomes with CRT. However, moderate to severe chronic kidney disease (CKD) was an exclusion criterion in the large randomized control trials.To evaluate the association of renal function on survival following CRT implantation.This was a retrospective analysis of 432 consecutive patients implanted with an implantable cardioverter defibrillator with CRT (CRT-D). The primary end point was defined as death by any cause, and it was determined using hospital records and the U.S. Social Security Death Index. A Kaplan-Meier analysis was performed separating renal dysfunction into renal stage based on glomerular filtration rate. Multivariate analysis was performed to assess the clinical predictors of mortality.Patients were followed for up to 12 years with a mean follow-up time of 4.3 ± 3.2 years. A total of 164 patients (39.3%) died over the course of the study. Patients with normal and mild renal diseases (Stages 1 and 2) had improved survival compared with those with moderate-, severe-, or end-stage (Stages 3-5) renal disease. This effect remained statistically significant after multivariate analysis. The estimated 5-year mortality was 36.3% for stage 1, 33.4% for stage 2, 40.6% for stage 3, and 62.1% for stage 4/5 kidney disease (P = 0.004 by log-rank test).CKD is a strong and an independent predictor of long-term mortality among patients undergoing CRT-D implantation.

Published
2016

3. Contributors

Author

Hugues Abriel, Wayne O. Adkisson, Esperanza Agullo-Pascual, Olujimi A. Ajijola, Amin Al-Ahmad, Oluseun Alli, Robert K. Altman, Elad Anter, Charles Antzelevitch, Justus M.B. Anumonwo, Luciana Armaganijan, Hiroshi Ashikaga, Felipe Atienza, Uma Mahesh R. Avula, Peter H. Backx, Elise Balse, Conor D. Barrett, David G. Benditt, Omer Berenfeld, Donald M. Bers, Charles I. Berul, A. Christian Blank, Raffaella Bloise, Frank Matthias Bogun, Martin Borggrefe, Noel G. Boyle, Günter Breithardt, Marisa Brini, Peter R. Brink, Josep Brugada, Pau Brugada, Pedro Brugada, Ramon Brugada, Victoria Brugada, Eric Buch, Feliksas F. Bukauskas, J. David Burkhardt, Nenad Bursac, Hugh Calkins, David J. Callans, Oscar Campuzano, Sean M. Caples, Ernesto Carafoli, Augustin Castellanos, William Catterall, Marina Cerrone, Lan S. Chen, Lei Chen, Peng-Sheng Chen, Ashley Chin, Aman Chugh, Ira S. Cohen, Stuart J. Connolly, Jason Constantino, Lia Crotti, Frank A. Cuoco, Anne B. Curtis, Ralph J. Damiano, Dawood Darbar, Mithilesh K. Das, Mario Delmar, Eva Delpón, Luigi Di Biase, Sanjay Dixit, Dobromir Dobrev, Derek J. Dosdall, John W. Dyer, Lars Eckardt, Andrew G. Edwards, Igor R. Efimov, Kenneth A. Ellenbogen, Patrick T. Ellinor, Emilia Entcheva, N.A. Mark Estes, Rodolphe Fischmeister, John D. Fisher, Glenn I. Fishman, David S. Frankel, Michael R. Franz, Paul A. Friedman, Victor F. Froelicher, Apoor S. Gami, Alfred L. George, Edward P. Gerstenfeld, Michael R. Gold, Jeffrey J. Goldberger, Eleonora Grandi, Richard A. Gray, William J. Groh, Blair P. Grubb, Michel Haissaguerre, Johan Hake, Henry R. Halperin, Louise Harris, Stéphane Hatem, David L. Hayes, Meleze Hocini, Stefan H. Hohnloser, David Richard Holmes, Masahiko Hoshijima, Yuxuan Hu, Thomas J. Hund, Mathew D. Hutchinson, Hye Jin Hwang, Raymond E. Ideker, Leonard Ilkhanoff, Jodie Ingles, Warren M. Jackman, Pierre Jais, José Jalife, Bong Sook Jhun, Roy M. John, Monique Jongbloed, Mark E. Josephson, Alan H. Kadish, Jérôme Kalifa, Jonathan M. Kalman, Timothy J. Kamp, Mohamed Hani Kanj, Beverly Karabin, Robert S. Kass, Demosthenes G. Katritsis, Kuljeet Kaur, Jong J. Kim, Paulus Kirchhof, André G. Kléber, George J. Klein, Peter Kohl, Aravindan Kolandaivelu, Andrew D. Krahn, Andrew Krumerman, Saurabh Kumar, Karl-Heinz Kuck, Edward G. Lakatta, Rakesh Latchamsetty, Dennis H. Lau, Bruce B. Lerman, Jérôme Leroy, William R. Lewis, Shien-Fong Lin, Mark S. Link, Christopher F. Liu, Deborah J. Lockwood, Peter Loh, Anatoli N. Lopatin, John C. Lopshire, Steven A. Lubitz, Christopher Madias, Aman Mahajan, Jonathan C. Makielski, Marek Malik, Victor A. Maltsev, Francis E. Marchlinski, Ariane J. Marelli, Steven M. Markowitz, Barry J. Maron, Jeffrey R. Martens, Steven O. Marx, Andrew D. McCulloch, Andreas Metzner, Anuska P. Michailova, John Michael Miller, Michelle Lynne Milstein, Peter Mohler, Fred Morady, Robert J. Myerburg, Hiroshi Nakagawa, Carlo Napolitano, Sanjiv M. Narayan, Andrea Natale, Stanley Nattel, Saman Nazarian, Jeanne M. Nerbonne, Fu Siong Ng, Akihiko Nogami, Sami F. Noujaim, Brian Olshansky, Hakan Oral, Jin O-Uchi, Feifan Ouyang, Cevher Ozcan, Douglas L. Packer, Olle Pahlm, Sandeep V. Pandit, David S. Park, Geoffrey S. Pitt, Sunny S. Po, Silvia G. Priori, Wouter-Jan Rappel, Vivek Y. Reddy, Jason O. Robertson, Richard B. Robinson, Dan M. Roden, Robert A. Rose, Michael R. Rosen, Raphael Rosso, Yoram Rudy, Jeremy N. Ruskin, Hani N. Sabbah, Frank B. Sachse, Lindsey L. Saint, Javier Saiz, José A. Sánchez-Chapula, Prashanthan Sanders, Michael C. Sanguinetti, Pasquale Santangeli, Georgia Sarquella-Brugada, Jonathan Satin, Martin Jan Schalij, Benjamin J. Scherlag, Rainer Schimpf, Georg Schmidt, Peter J. Schwartz, Christopher Semsarian, Ashok J. Shah, Robin Shaw, Shey Shing Sheu, Kalyanam Shivkumar, Allan C. Skanes, Virend K. Somers, Bruce S. Stambler, Adam B. Stein, Lynne Warner Stevenson, William G. Stevenson, Jian Sun, Richard Sutton, Michael O. Sweeney, Charles Swerdlow, Juan Tamargo, Harikrishna Tandri, Rabi Tawil, Usha Tedrow, Cecile Terrenoire, Catalina Tobón, Jeffrey A. Towbin, Natalia A. Trayanova, Martin Tristani-Firouzi, Richard G. Trohman, Zian H. Tseng, Mintu P. Turakhia, Ravi Vaidyanathan, Héctor H. Valdivia, Virginijus Valiunas, Marcel A.G. van der Heyden, Christian van der Werf, George F. Van, Marmar Vaseghi, Christian Veltmann, Victoria L. Vetter, Sami Viskin, Niels Voigt, Marc A. Vos, Galen S. Wagner, Paul J. Wang, Rukshen Weerasooriya, Arthur A.M. Wilde, Bruce L. Wilkoff, Erik Wissner, Y. Joseph Woo, Masatoshi Yamazaki, Felix Yang, Yael Yaniv, Sing-Chien Yap, Raymond Yee, Manuel Zarzoso, Katja Zeppenfeld, and Douglas P. Zipes

Published
2014
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4. Abstract 5686: Predictors of Hypocalcemia after Wide Area Circumferential Ablation of Atrial Fibrillation

Author

Matthew S Forcina, Matthew Luff, Anish Amin, Frank A Cuoco, Matthew H Klein, Brent A Lawhon, Barbara J Knick, J. Lacy Sturdivant, Robert B Leman, Michael R Gold, and J. Marcus Wharton

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Introduction: Hypocalcemia occurs frequently after wide area circumferential ablation (WACA) of atrial fibrillation and is more common with the use of open-irrigated tip ablation catheters (ITAC) than 8-mm tip ablation catheters. The mechanism of this phenomenon is unknown, but may be related to binding of calcium to myocardial proteins, volume infusion, or other factors. The present study aims to identify variables associated with acute hypocalcemia after WACA with ITAC. Methods: We analyzed 106 patients undergoing WACA with ITAC. Pre- and post-procedural values of calcium, creatinine, glomerular filtration rate (GFR), hemoglobin, cardiac enzymes (CK, CK-MB and troponin-I), albumin, left atrial size, presence of post-procedure pericardial effusion, infused volume of normal saline, urine output, heparin, furosemide dosage, and procedure time were recorded. Univariate and multivariate analysis were performed to determine variables associated with post-ablation hypocalcemia. Results: The population had mean age of 59±9 years, mean weight of 95±22 kilograms, and 76% were male. Mean pre-procedure GFR was 101±39 mL/min, and mean volume of normal saline infused was 5.5±1.3 liters. The means for pre-procedure calcium, post-procedure calcium, and decrease in calcium were 9.2±0.4, 7.3±0.6, and 1.9±0.7 mg/dL respectively. Of the variables measured, multivariate analysis identified pre-procedure GFR (parameter estimate −0.005) and infused volume of normal saline (parameter estimate 0.11) as factors independently associated with post-ablation hypocalcemia (p value = 0.03). Factors associated with myocardial injury were not apparently related. Conclusions: Lower GFR and higher infused volume of normal saline correlated with acute hypocalcemia after WACA with ITAC. Rather than binding to injured myocardium, these results suggest impaired renal calcium absorption and/or dilutional effects as the principal mechanism(s).

Published
2008
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