14 results on '"Danna Spears"'
Search Results
2. Assessment of Severity of Long QT Syndrome Phenotype and Risk of Fetal Death
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Lisa Albertini, Jordan Ezekian, Melanie Care, Candice Silversides, Mathew Sermer, Michael H. Gollob, and Danna Spears
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fetal death ,long QT ,long QT syndrome ,miscarriage ,stillbirth ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background It has been postulated that long QT syndrome (LQTS) can cause fetal loss through putative adverse effects of the channelopathy on placenta and myometrial function. The authors aimed to describe the fetal death rate in a population of pregnant women with long QT syndrome and investigate whether women with more severe phenotype had worse fetal outcomes. Methods and Results The authors retrospectively evaluated fetal outcomes of 64 pregnancies from 23 women with long QT syndrome followed during pregnancy in a tertiary pregnancy and heart disease program. Thirteen of 64 pregnancies (20%) resulted in a fetal loss, 12 miscarriages (19%), and 1 stillbirth (1.6%). Baseline maternal characteristics, including age and use of β‐blockers, did not differ between women who experienced a fetal death or not. Maternal corrected QT interval (QTc) was significantly longer in pregnancies that resulted in fetal death compared with live births (median, 518 ms [interquartile range (IQR), 482‐519 ms] versus 479 ms [IQR, 454–496 ms], P500 ms was significantly lower compared with women with QTc 500 ms is lower, suggesting that patients with more marked phenotype may experience worse fetal outcomes.
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- 2023
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3. Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
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Adrian M. Suszko, Praloy Chakraborty, Karthik Viswanathan, Scott Barichello, John Sapp, Mario Talajic, Zachary Laksman, Raymond Yee, Anna Woo, Danna Spears, Arnon Adler, Harry Rakowski, and Vijay S. Chauhan
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hypertrophic cardiomyopathy ,myocardial disarray ,QRS fractionation ,risk stratification ,sudden cardiac death ,ventricular arrhythmias ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Patients with hypertrophic cardiomyopathy (HCM) are at risk of ventricular arrhythmia (VA) attributed to abnormal electrical activation arising from myocardial fibrosis and myocyte disarray. We sought to quantify intra‐QRS peaks (QRSp) in high‐resolution ECGs as a measure of abnormal activation to predict late VA in patients with HCM. Methods and Results Prospectively enrolled patients with HCM (n=143, age 53±14 years) with prophylactic implantable cardioverter‐defibrillators had 3‐minute, high‐resolution (1024 Hz), digital 12‐lead ECGs recorded during intrinsic rhythm. For each precordial lead, QRSp was defined as the total number of peaks detected in the QRS complex that deviated from a smoothing filtered version of the QRS. The VA end point was appropriate implantable cardioverter‐defibrillator therapy during 5‐year prospective follow‐up. After 5 years, 21 (16%) patients had VA. Patients who were VA positive had greater QRSp (6.0 [4.0–7.0] versus 4.0 [2.0–5.0]; P
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- 2022
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4. Microvolt QRS Alternans in Hypertrophic Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias
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Praloy Chakraborty, Adrian M. Suszko, Karthik Viswanathan, Kimia Sheikholeslami, Danna Spears, Arnon Adler, Anna Woo, Harry Rakowski, and Vijay S. Chauhan
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alternans ,ECG ,hypertrophic cardiomyopathy ,risk assessment ,ventricular arrhythmia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Unlike T‐wave alternans (TWA), the relation between QRS alternans (QRSA) and ventricular arrhythmia (VA) risk has not been evaluated in hypertrophic cardiomyopathy (HCM). We assessed microvolt QRSA/TWA in relation to HCM risk factors and late VA outcomes in HCM. Methods and Results Prospectively enrolled patients with HCM (n=130) with prophylactic implantable cardioverter‐defibrillators underwent digital 12‐lead ECG recordings during ventricular pacing (100–120 beats/min). QRSA/TWA was quantified using the spectral method. Patients were categorized as QRSA+ and/or TWA+ if sustained alternans was present in ≥2 precordial leads. The VA end point was appropriate implantable cardioverter‐defibrillator therapy over 5 years of follow‐up. QRSA+ and TWA+ occurred together in 28% of patients and alone in 7% and 7% of patients, respectively. QRSA magnitude increased with pacing rate (1.9±0.6 versus 6.2±2.0 µV; P=0.006). Left ventricular thickness was greater in QRSA+ than in QRSA− patients (22±7 versus 20±6 mm; P=0.035). Over 5 years follow‐up, 17% of patients had VA. The annual VA rate was greater in QRSA+ versus QRSA− patients (5.8% versus 2.0%; P=0.006), with the QRSA+/TWA− subgroup having the greatest rate (13.3% versus 2.6%; P
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- 2021
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5. Approach to inherited arrhythmias in pregnancy
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Lisa Albertini and Danna Spears
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Inherited arrhythmia ,Genetics ,Pregnancy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Pregnancy is not contraindicated and generally safe in women with IA. Vaginal delivery is generally well tolerated and operative delivery should be reserved to patients with heart failure, recurrent arrhythmia, or obstetric indications. Maternal risk stratification is mandatory to identify women at higher risk of cardiac events during pregnancy and labor. This is ideally considered as part of pre-conception counselling. Beta-blockers are the first line therapy in many IAs and should be continued through pregnancy. Consultation with a multidisciplinary team with experience in high-risk obstetrics, anesthesia, cardiology, electrophysiology, pediatrics, and genetics is key to the successful management of women with inherited arrhythmia conditions through their reproductive years.
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- 2021
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6. Complex interactions in a novel SCN5A compound mutation associated with long QT and Brugada syndrome: Implications for Na+ channel blocking pharmacotherapy for de novo conduction disease.
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Jie Liu, Jason D Bayer, Roozbeh Aschar-Sobbi, Marianne Wauchop, Danna Spears, Michael Gollob, Edward J Vigmond, Robert Tsushima, Peter H Backx, and Vijay S Chauhan
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Medicine ,Science - Abstract
BACKGROUND:The SCN5A mutation, P1332L, is linked to a malignant form of congenital long QT syndrome, type 3 (LQT3), and affected patients are highly responsive to the Na+ channel blocking drug, mexiletine. In contrast, A647D is an atypical SCN5A mutation causing Brugada syndrome. An asymptomatic male with both P1332L and A647D presented with varying P wave/QRS aberrancy and mild QTc prolongation which did not shorten measurably with mexiletine. OBJECTIVE:We characterized the biophysical properties of P1332L, A647D and wild-type (WT) Na+ channels as well as their combinations in order to understand our proband's phenotype and to guide mexilitine therapy. METHODS:Na+ channel biophysics and mexilitine-binding kinetics were assessed using heterologous expression studies in CHO-K1 cells and human ventricular myocyte modeling. RESULTS:Compared to WT, P1332L channels displayed a hyperpolarizing shift in inactivation, slower inactivation and prominent late Na+ currents (INa). While A647D had no effect on the biophysical properties of INa, it reduced peak and late INa density when co-expressed with either WT or P1332L. Additionally, while P1332L channels had greater sensitivity to block by mexiletine compared to WT, this was reduced in the presence of A647D. Modelling studies revealed that mixing P1332L with A647D channels, action potential durations were shortened compared to P1332L, while peak INa was reduced compared to either A647D coexpressing with WT or WT alone. CONCLUSIONS:While A647D mitigates the lethal LQT3 phenotype seen with P1332L, it also reduces mexilitine sensitivity and decreases INa density. These results explain our proband's mild repolarization abnormality and prominent conduction defect in the atria and ventricles, but also suggest that expression of P1332L with A647D yields a novel disease phenotype for which mexiletine pharmacotherapy is no longer suitable.
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- 2018
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7. Incidence, Diagnosis, and Management of QT Prolongation Induced by Cancer Therapies: A Systematic Review
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Andreu Porta‐Sánchez, Cameron Gilbert, Danna Spears, Eitan Amir, Joyce Chan, Kumaraswamy Nanthakumar, and Paaladinesh Thavendiranathan
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cancer therapy ,cardiac arrhythmia ,cardio‐oncology ,ECG ,oncology ,QT interval electrocardiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe cardiovascular complications of cancer therapeutics are the focus of the burgeoning field of cardio‐oncology. A common challenge in this field is the impact of cancer drugs on cardiac repolarization (ie, QT prolongation) and the potential risk for the life‐threatening arrhythmia torsades de pointes. Although QT prolongation is not a perfect marker of arrhythmia risk, this has become a primary safety metric among oncologists. Cardiologists caring for patients receiving cancer treatment should become familiar with the drugs associated with QT prolongation, its incidence, and appropriate management strategies to provide meaningful consultation in this complex clinical scenario. Methods and ResultsIn this article, we performed a systematic review (using Preferred Reporting Items of Systematic Reviews and Meta‐Analyses (PRISMA) guidelines) of commonly used cancer drugs to determine the incidence of QT prolongation and clinically relevant arrhythmias. We calculated summary estimates of the incidence of all and clinically relevant QT prolongation as well as arrhythmias and sudden cardiac death. We then describe strategies to prevent, identify, and manage QT prolongation in patients receiving cancer therapy. We identified a total of 173 relevant publications. The weighted incidence of any corrected QT (QTc) prolongation in our systematic review in patients treated with conventional therapies (eg, anthracyclines) ranged from 0% to 22%, although QTc >500 ms, arrhythmias, or sudden cardiac death was extremely rare. The risk of QTc prolongation with targeted therapies (eg, small molecular tyrosine kinase inhibitors) ranged between 0% and 22.7% with severe prolongation (QTc >500 ms) reported in 0% to 5.2% of the patients. Arrhythmias and sudden cardiac death were rare. ConclusionsOur systematic review demonstrates that there is variability in the incidence of QTc prolongation of various cancer drugs; however, the clinical consequence, as defined by arrhythmias or sudden cardiac death, remains rare.
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- 2017
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8. Case report: Ablation of diffuse inter-trabecular substrate in a patient with isolated ventricular non-compaction
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Nicholas Jackson, Benjamin King, Karthik Viswanathan, Eugene Downar, and Danna Spears
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Noncompaction cardiomyopathy ,Ventricular tachycardia ,Catheter ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2015
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9. Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations
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Jeff S, Healey, Andrew D, Krahn, Jamil, Bashir, Guy, Amit, François, Philippon, William F, McIntyre, Bernice, Tsang, Jacqueline, Joza, Derek V, Exner, David H, Birnie, Mouhannad, Sadek, Darryl P, Leong, Markus, Sikkel, Victoria, Korley, John L, Sapp, Jean-Francois, Roux, Shun Fu, Lee, Gloria, Wong, Angie, Djuric, Danna, Spears, Sandra, Carroll, Eugene, Crystal, Tom, Hruczkowski, Stuart J, Connolly, Blandine, Mondesert, and Melissa Braga, Gomes
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Treatment Outcome ,Death, Sudden, Cardiac ,Risk Factors ,Internal Medicine ,Humans ,Female ,Arrhythmias, Cardiac ,General Medicine ,Defibrillators, Implantable ,Heart Arrest - Abstract
Implantable cardioverter defibrillators (ICDs) improve survival in patients at risk for cardiac arrest, but are associated with intravascular lead-related complications. The subcutaneous ICD (S-ICD), with no intravascular components, was developed to minimize lead-related complications.To assess key ICD performance measures related to delivery of ICD therapy, including inappropriate ICD shocks (delivered in absence of life-threatening arrhythmia) and failed ICD shocks (which did not terminate ventricular arrhythmia).Randomized, multicenter trial. (ClinicalTrials.gov: NCT02881255).The ATLAS trial.544 eligible patients (141 female) with a primary or secondary prevention indication for an ICD who were younger than age 60 years, had a cardiogenetic phenotype, or had prespecified risk factors for lead complications were electrocardiographically screened and 503 randomly assigned to S-ICD (251 patients) or transvenous ICD (TV-ICD) (252 patients). Mean follow-up was 2.5 years (SD, 1.1). Mean age was 49.0 years (SD, 11.5).The primary outcome was perioperative major lead-related complications.There was a statistically significant reduction in perioperative, lead-related complications, which occurred in 1 patient (0.4%) with an S-ICD and in 12 patients (4.8%) with TV-ICD (-4.4%; 95% CI, -6.9 to -1.9;At present, the ATLAS trial is underpowered to detect differences in clinical shock outcomes; however, extended follow-up is ongoing.The S-ICD reduces perioperative, lead-related complications without significantly compromising the effectiveness of ICD shocks, but with more early postoperative pain and a trend for more inappropriate shocks.Boston Scientific.
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- 2022
10. 2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy
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Jose A. Joglar, Suraj Kapa, Elizabeth V. Saarel, Anne M. Dubin, Bulent Gorenek, Afshan B. Hameed, Sissy Lara de Melo, Miguel A. Leal, Blandine Mondésert, Luis D. Pacheco, Melissa R. Robinson, Andrea Sarkozy, Candice K. Silversides, Danna Spears, Sindhu K. Srinivas, Janette F. Strasburger, Usha B. Tedrow, Jennifer M. Wright, Carolyn M. Zelop, and Dominica Zentner
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
11. Importance of newer cardiac magnetic resonance–based risk markers for sudden death prevention in hypertrophic cardiomyopathy: An international multicenter study
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Ethan J, Rowin, Martin S, Maron, Arnon, Adler, Alfred J, Albano, Armanda M, Varnava, Danna, Spears, Dana, Marsy, Stephen B, Heitner, Emilie, Cohen, Kevin M W, Leong, Stephen L, Winters, Matthew W, Martinez, Benjamin C, Koethe, Harry, Rakowski, and Barry J, Maron
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Magnetic Resonance Spectroscopy ,Contrast Media ,Gadolinium ,Cardiomyopathy, Hypertrophic ,Risk Assessment ,Defibrillators, Implantable ,Primary Prevention ,Death, Sudden, Cardiac ,Risk Factors ,Physiology (medical) ,Ventricular Fibrillation ,Humans ,Longitudinal Studies ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
The sudden death (SD) risk stratification algorithm in hypertrophic cardiomyopathy (HCM) has evolved, underscored recently by novel cardiac magnetic resonance (CMR)-based risk markers (left ventricular apical aneurysm, extensive late gadolinium enhancement, and end-stage disease with systolic dysfunction) incorporated into the 2020 American Heart Association (AHA)/American College of Cardiology (ACC) HCM guidelines.The purpose of this study was to assess the specific impact of newer, predominantly CMR-based risk markers in a large multicenter HCM population that underwent primary prevention implantable cardioverter-defibrillator (ICD) implants.Longitudinal study of 1149 consecutive HCM patients from 6 North American and European HCM centers prospectively judged to be at high SD risk based on ≥1 AHA/ACC individual risk markers and prophylactically implanted with an ICD was performed. European Society of Cardiology (ESC) risk score was retrospectively analyzed with respect to the known clinical outcome.Of 1149 patients with an ICD, 162 (14%) experienced device therapy terminating ventricular tachycardia/ventricular fibrillation 4.6 ± 4.2 years after implant. CMR-based markers solely or in combination led to ICD implantation in 49 of the 162 patients (30%) experiencing device therapy. Particularly low ESC scores (4%/5 years) would have excluded an ESC ICD recommendation for 67 patients who nevertheless experienced appropriate ICD therapy, including 26 with the CMR-based risk markers not part of the ESC formula.Identification and incorporation of novel guideline-supported CMR-based risk markers enhance selection of HCM patients for SD prevention with ICDs. Absence of CMR-based markers from the ESC risk score accounts, in part, for it not identifying many HCM patients with SD events. These data support inclusion of CMR as a routine part of HCM patient evaluation and risk stratification.
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- 2022
12. Reinventing Larrey’s approach for epicardial mapping: The closed pericardiostomy technique
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Melanie R. Burg, Robert D. Anderson, Sirish Chandra Srinath Patloori, Gabriel Acosta-Vélez, Danna Spears, Andrew C.T. Ha, Vijay S. Chauhan, Abhishek P. Bhaskaran, Krishnakumar Nair, Robert J. Cusimano, and Kumaraswamy Nanthakumar
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
13. PO-02-179 DYNAMICS OF VENTRICULAR ACTIVATION DURING EXERCISE IN PATIENTS WITH BRUGADA SYNDROME: IMPLICATIONS FOR IMPROVING DISEASE PHENOTYPING AND DIAGNOSIS
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Praloy Chakraborty, Mahbod Rahimi, Adrian M. Suszko, Sophia Z. Massin, Danna Spears, Michael H. Gollob, and Vijay S. Chauhan
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
14. Rapid Device-Detected Nonsustained Ventricular Tachycardia in the Risk Stratification of Hypertrophic Cardiomyopathy
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Karthik, Viswanathan, Adrian M, Suszko, Moloy, DAS, Nicholas, Jackson, Michael, Gollob, Douglas, Cameron, Danna, Spears, Anna, Woo, Harry, Rakowski, Mamta, Khurana, and Vijay S, Chauhan
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Adult ,Aged, 80 and over ,Male ,Adolescent ,Reproducibility of Results ,Pilot Projects ,Cardiomyopathy, Hypertrophic ,Middle Aged ,Risk Assessment ,Sensitivity and Specificity ,Young Adult ,Electrocardiography, Ambulatory ,Tachycardia, Ventricular ,Humans ,Female ,Diagnosis, Computer-Assisted ,Aged - Abstract
Nonsustained ventricular tachycardia (NSVT) detected by ambulatory Holter (Holter NSVT) is a major risk factor for sudden cardiac death in hypertrophic cardiomyopathy (HCM). We hypothesized that the prognostic utility of Holter NSVT in HCM would improve with prolonged monitoring and a higher heart rate cut-off for detection.We enrolled 60 patients (44 ± 14 years) with HCM, who had a prophylactic implantable cardioverter defibrillator (ICD). Positive Holter NSVT (prior to implant) was defined as ≥3 beats at ≥120 beats per minute (bpm). We assessed the prevalence of rapid NSVT (RNSVT) detected by their ICD within 12 months of its implant, defined as 4-16 beats at ≥150-200 bpm. The primary outcome was appropriate ICD therapy (antitachycardia pacing and shocks) for sustained ventricular arrhythmia (VA).Holter NSVT was detected in 34 patients. RNSVT occurred in 21 (35%) patients of whom five did not have Holter NSVT. Over a median follow-up of 61 (interquartile range 29, 129) months after ICD implant, nine patients had VA. RNSVT, but not Holter NSVT, was significantly associated with VA (hazard ratio 6.2, 95% confidence interval [1.3-30], P = 0.01) by multivariable Cox regression analysis that included conventional risk factors. Receiver operating characteristic analysis for RNSVT (area under curve 0.80, P = 0.005) showed that the occurrence of ≥2 episodes of RNSVT discriminated patients for VA optimally (sensitivity 78%, specificity 84%, positive predictive value 47%, negative predictive value 96%).In this pilot study, RNSVT detected by continuous monitoring independently predicted VA in HCM and offered superior discrimination of VA risk compared to conventional risk factors, including Holter NSVT. Future studies are needed to validate these findings in a larger, unselected HCM cohort.
- Published
- 2015
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