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4. Catheter ablation for persistent atrial fibrillation: A multicenter randomized trial of pulmonary vein isolation (PVI) versus PVI with posterior left atrial wall isolation (PWI) - The CAPLA study.

Author

Chieng D., Sugumar H., Ling L.-H., Segan L., Azzopardi S., Prabhu S., Al-Kaisey A., Voskoboinik A., Parameswaran R., Morton J.B., Pathik B., McLellan A.J., Lee G., Wong M., Finch S., Pathak R.K., Raja D.C., Sanders P., Sterns L., Ginks M., Reid C.M., Kalman J.M., Kistler P.M., Chieng D., Sugumar H., Ling L.-H., Segan L., Azzopardi S., Prabhu S., Al-Kaisey A., Voskoboinik A., Parameswaran R., Morton J.B., Pathik B., McLellan A.J., Lee G., Wong M., Finch S., Pathak R.K., Raja D.C., Sanders P., Sterns L., Ginks M., Reid C.M., Kalman J.M., and Kistler P.M.

Abstract

Background: The success of pulmonary vein isolation (PVI) is reduced in persistent AF (PsAF) compared to paroxysmal AF. Adjunctive ablation strategies have failed to show consistent incremental benefit over PVI alone in randomized studies. The left atrial posterior wall is a potential source of non-PV triggers and atrial substrate which may promote the initiation and maintenance of PsAF. Adding posterior wall isolation (PWI) to PVI had shown conflicting outcomes, with earlier studies confounded by methodological limitations. Objective(s): To determine whether combining PWI with PVI significantly improves freedom from AF recurrence, compared to PVI alone, in patients with PsAF. Method(s): This is a multi-center, prospective, international randomized clinical trial. 338 patients with symptomatic PsAF refractory to anti-arrhythmic therapy (AAD) will be randomized to either PVI alone or PVI with PWI in a 1:1 ratio. PVI involves wide antral circumferential pulmonary vein (PV) isolation, utilizing contact force sensing ablation catheters. PWI involves the creation of a floor line connecting the inferior aspect of the PVs, and a roof line connecting the superior aspect of the PVs. Follow up is for a minimum of 12 months with rhythm monitoring via implantable cardiac device and/or loop monitor, or frequent intermittent monitoring with an ECG device. The primary outcome is freedom from any documented atrial arrhythmia of > 30 seconds off AAD at 12 months, after a single ablation procedure. Conclusion(s): This randomized study aims to determine the success and safety of adjunctive PWI to PVI in patients with persistent AF.Copyright © 2021 Elsevier Inc.

Published
2022

5. Catheter Ablation for Persistent Atrial Fibrillation: a Multicentre Randomised Trial of Pulmonary Vein Isolation (PVI) versus PVI with Posterior Left Atrial Wall Isolation (PWI) - the CAPLA Study: CAPLA: randomised trial for persistent AF.

Author

Chieng D., Sugumar H., Ling L.-H., Segan L., Azzopardi S., Prabhu S., Al-Kaisey A., Voskoboinik A., Parameswaran R., Morton J.B., Pathik B., McLellan A.J., Lee G., Wong M., Finch S., Pathak R.K., Raja D.C., Sanders P., Sterns L., Ginks M., Reid C.M., Kalman J.M., Kistler P.M., Chieng D., Sugumar H., Ling L.-H., Segan L., Azzopardi S., Prabhu S., Al-Kaisey A., Voskoboinik A., Parameswaran R., Morton J.B., Pathik B., McLellan A.J., Lee G., Wong M., Finch S., Pathak R.K., Raja D.C., Sanders P., Sterns L., Ginks M., Reid C.M., Kalman J.M., and Kistler P.M.

Abstract

BACKGROUND: The success of pulmonary vein isolation (PVI) is reduced in persistent AF (PsAF) compared to paroxysmal AF. Adjunctive ablation strategies have failed to show consistent incremental benefit over PVI alone in randomised studies. The left atrial posterior wall is a potential source of non-PV triggers and atrial substrate which may promote the initiation and maintenance of PsAF. Adding posterior wall isolation (PWI) to PVI had shown conflicting outcomes, with earlier studies confounded by methodological limitations. OBJECTIVE(S): To determine whether combining PWI with PVI significantly improves freedom from AF recurrence, compared to PVI alone, in patients with PsAF. METHOD(S): This is a multi-centre, prospective, international randomised clinical trial. 338 patients with symptomatic PsAF refractory to anti-arrhythmic therapy (AAD) will be randomised to either PVI alone or PVI with PWI in a 1:1 ratio. PVI involves wide antral circumferential pulmonary vein (PV) isolation, utilising contact force sensing ablation catheters. PWI involves the creation of a floor line connecting the inferior aspect of the PVs, and a roof line connecting the superior aspect of the PVs. Follow up is for a minimum of 12 months with rhythm monitoring via implantable cardiac device/ loop monitor, or frequent intermittent monitoring with an ECG device. The primary outcome is freedom from any documented atrial arrhythmia of > 30 seconds off AAD at 12 months, after a single ablation procedure. CONCLUSION(S): This randomised study aims to determine the success and safety of adjunctive PWI to PVI in patients with persistent AF.Copyright © 2021 Elsevier Ltd. All rights reserved.

Published
2021

7. Outcomes of paroxysmal AF ablation studies are affected more by study design and patient mix than ablation technique

Author

Ferreira-Martins, J, Howard, J, Al-Khayatt, BM, Shalhoub, J, Sohaib, A, Shun-Shin, M, Novak, P, Leather, R, Sterns, L, Lane, C, Lim, P, Kanagaratnam, P, Peters, N, Francis, D, Sikkel, M, and Wellcome Trust

Subjects
CATHETER ABLATION, Science & Technology, Cardiac & Cardiovascular Systems, ELECTROGRAM ABLATION, COLLABORATION, ablation, GANGLIONATED PLEXI ABLATION, Cardiovascular System & Hematology, CRYOBALLOON, Cardiovascular System & Cardiology, MANAGEMENT, SINGLE PROCEDURE, RADIOFREQUENCY ABLATION, PULMONARY VEIN ISOLATION, PREDICTORS, Life Sciences & Biomedicine, paroxysmal atrial fibrillation, 1102 Cardiorespiratory Medicine and Haematology
Abstract

Objective: We tested whether ablation methodology and study design can explain the varying outcomes in terms of AF-free survival at 1 year. Background: There have been numerous paroxysmal AF ablation trials, which are heterogeneous in their use of different ablation techniques and study design. A useful approach to understanding how these factors influence outcome is to dismantle the trials into individual arms and reconstitute them as a large meta-regression. Methods: Data was collected from 66 studies (6941 patients). With freedom from AF as the dependent variable, we performed meta-regression using the individual study arm as the unit. Results: Success rates did not change regardless of the technique used to produce pulmonary vein isolation. Neither were adjunctive lesion sets associated with any improvement in outcome. Studies that included more males and fewer hypertensive patients were found more likely to report better outcomes. ECG method selected to assess outcome also plays an important role. Outcomes were worse in studies that used regular telemonitoring (by 23%, p

Published
2018

8. P1872Canadian electrophysiology labs registry report update 2011–2018

Author

Kaoutskaia, A, primary, Shurrab, M, additional, Amit, G, additional, Parkash, R, additional, Exner, D, additional, Toal, S, additional, Sterns, L, additional, Sarrazin, J F, additional, Glover, B, additional, Chauhan, V, additional, Sultan, O, additional, Nair, G, additional, Deyell, M W, additional, Macle, L, additional, and Crystal, E, additional

Published
2019
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9. PILOT STUDY TO ASSESS THE FEASIBILITY OF REMOTE ONLY FOLLOW-UP FOR CARDIAC IMPLANTABLE ELECTRONIC DEVICES

Author

Sapp, J., primary, Nault, I., additional, Lockwood, E., additional, AbdelWahab, A., additional, Sears, S., additional, Gillis, A., additional, Yee, R., additional, Sterns, L., additional, Philippon, F., additional, Healey, J., additional, Nery, P., additional, Raj, S., additional, Wells, G., additional, Tang, A., additional, and Parkash, R., additional

Published
2019
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10. P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort

Author

Davis, S, primary, Thibault, B, additional, Mangat, I, additional, Coutu, B, additional, Bennett, M, additional, Philippon, F, additional, Sandhu, R, additional, Sterns, L, additional, Essebad, V, additional, Nery, P, additional, Wells, G, additional, Yee, R, additional, Exner, D, additional, Krahn, A, additional, and Parkash, R, additional

Published
2019
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12. CANADIAN REGISTRY OF ELECTRONIC DEVICE OUTCOMES (CREDO): THE ABBOTT BATTERY PERFORMANCE ALERT, A MULTICENTRE REGISTRY.

Author

Davis, J., primary, Mangat, I., additional, Bennett, M., additional, Philippon, F., additional, Sandhu, R., additional, Essebag, V., additional, Sterns, L., additional, Nery, P., additional, Wells, G., additional, Yee, R., additional, Exner, D., additional, Krahn, A., additional, Parkash, R., additional, and Coutu, B., additional

Published
2018
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13. CANADIAN ELECTROPHYSIOLOGY LABS REGISTRY REPORT UPDATE 2011-2018

Author

Kaoutskaia, A., primary, Shurrab, M., additional, Amit, G., additional, Parkash, R., additional, Exner, D., additional, Toal, S., additional, Sterns, L., additional, Sarrazin, J., additional, Glover, B., additional, Chauhan, V., additional, Sultan, O., additional, Nair, G., additional, Deyell, M., additional, Macle, L., additional, Klassen, S., additional, and Crystal, E., additional

Published
2018
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17. COST EFFECTIVENESS OF VENTRICULAR TACHYCARDIA ABLATION VERSUS ESCALATION OF ANTIARRHYTHMIC DRUG THERAPY IN THE VANISH TRIAL

Author

Sapp, J., primary, Coyle, K., additional, Parkash, R., additional, Healey, J., additional, Gray, C., additional, Gardner, M., additional, Sterns, L., additional, Essebag, V., additional, Hruczkowski, T., additional, Blier, L., additional, Wells, G., additional, Tang, A., additional, Stevenson, W., additional, and Coyle, D., additional

Published
2017
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18. EFFECT OF BASELINE ANTIARRHYTHMIC DRUG ON OUTCOMES WITH ABLATION IN ISCHEMIC VENTRICULAR TACHYCARDIA: A VANISH SUBSTUDY

Author

Parkash, R., primary, Nault, I., additional, Rivard, L., additional, Gula, L., additional, Essebag, V., additional, Nery, P., additional, Tung, S., additional, Raymond, J., additional, Sterns, L., additional, Doucette, S., additional, Wells, G., additional, Tang, A., additional, Stevenson, W., additional, and Sapp, J., additional

Published
2017
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24. Destabilization of the Northeast Greenland Ice Stream

Author

Korsgaard, N. J., Khan, Shfaqat Abbas, Kjaer, K. H., Bevis, M. G., Bamber, J. L., Kjeldsen, K. K., Bjork, A. A., Wahr, J. M., Sterns, L. A., van den Broeke, M. R., Muresan, Ioana Stefania, Larsen, N. K., Korsgaard, N. J., Khan, Shfaqat Abbas, Kjaer, K. H., Bevis, M. G., Bamber, J. L., Kjeldsen, K. K., Bjork, A. A., Wahr, J. M., Sterns, L. A., van den Broeke, M. R., Muresan, Ioana Stefania, and Larsen, N. K.

Abstract

The Greenland Ice Sheet (GrIS) has been one of the largest contributors to global sea level rise over the last 20 years, accounting for c. 0.5 of a total of c. 3.2 mm yr-1. A significant portion of this contribution is associated with the speed up of glaciers in southeast and northwest Greenland. Here, we reveal that the Northeast Greenland Ice Stream (NEGIS), which extends more than 600 km into the interior of the ice sheet, is now undergoing dynamic thinning after more than a quarter of a century of stability. This sector of the GrIS is of particular interest in sea level projections, because the glacier flows into a large submarine basin with a negative bed slope near the grounding line. Our findings unfold the next step in mass loss of the GrIS as we show a heightened risk of rapid sustained loss from Northeast Greenland on top of the thinning in Southeast and Northwestern Greenland.

Published
2013

25. Ablation of atrial fibrillation after the retirement age: considerations on safety and outcome

Author

Haegeli, L M, Duru, F, Lockwood, E E, Lüscher, T F, Sterns, L D, Novak, P G, Leather, R A, Haegeli, L M, Duru, F, Lockwood, E E, Lüscher, T F, Sterns, L D, Novak, P G, and Leather, R A

Abstract

BACKGROUND: Although the incidence of atrial fibrillation (AF) progressively increases with age, the vast majority of AF ablation is done in middle-aged patients. We evaluated the feasibility and safety of catheter ablation in patients older than 65 years of age with paroxysmal and persistent AF. METHODS: Out of a total of 230 consecutive AF ablation procedures, 45 patients were older than 65 years of age and underwent 53 procedures. The ablation strategy consisted of wide-area circumferential lines around both ipsilateral pulmonary veins using a three-dimensional mapping system. RESULTS: The mean age was 69 ± 3.5 years (35 males). The mean duration for AF was 8.7 ± 6.5 years. Thirty-nine had paroxysmal and six persistent AF despite use of 1.38 ± 0.77 antiarrhythmic drugs. All patients had a structurally normal heart. Eleven had systemic hypertension. Mean procedure time was 187 ± 33 min. Acute procedural success rate with abolition of all pulmonary vein potentials was achieved in all patients. Pericardial tamponade requiring percutaneous drainage occurred in one (1.9%) patient. There were no cardioembolic events. Among the 43 patients whose clinical outcome was assessed at 6 months, 34 (79%) had a significant reduction (>90%) of the total symptomatic AF burden, compared to pre-ablation, with a complete lack of symptomatic AF in 32 (74%) patients. The success rate was higher for patients with paroxysmal versus persistent AF (81 vs. 67%). Six patients (11%) underwent repeat procedures. CONCLUSIONS: Catheter ablation is a safe and effective treatment for patients over the age of 65 years with symptomatic, drug-refractory AF. Therefore, patients should not be excluded from undergoing AF catheter ablation on the basis of age alone.

Published
2010

28. Snapshot of Invasive Electrophysiology in Canada in 2012: Results From the National Survey

Author

Shurrab, M, primary, Fishman, E, additional, Kaoutskaia, A, additional, Birnie, D, additional, Ayala-Paredes, F, additional, Sultan, O, additional, Chauhan, V, additional, Skanes, A, additional, Parkash, R, additional, Morillo, C, additional, Janmohamed, A, additional, Toal, S, additional, Essebag, V, additional, Sterns, L, additional, Veenhuyzen, G, additional, Mangat, I, additional, Redfearn, D, additional, Verma, A, additional, and Crystal, E, additional

Published
2013
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29. The Prevalence and Risk Factors for Atrio-esophageal Fistula After Percutaneous Radiofrequency Catheter Ablation for Atrial Fibrillation: A Canadian National Survey

Author

Shurrab, M, primary, Mohanan Nair, K, additional, Skanes, A, additional, Chauhan, V, additional, Birnie, D, additional, Nair, G, additional, Khaykin, Y, additional, Pantano, A, additional, Redfearn, D, additional, Sterns, L, additional, Veenhuyzen, G, additional, Tang, A, additional, Champagne, J, additional, Gula, L, additional, Ayala-Paredes, F, additional, Nault, I, additional, Mangat, I, additional, Lashevsky, I, additional, Greiss, I, additional, Tischenko, A, additional, Morillo, C, additional, Verma, A, additional, Singh, S, additional, and Crystal, E, additional

Published
2013
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32. [The implantable cardioverter/defibrillator (ICD). Developments up to the present time and future perspectives]

Author

Brachmann J, Hilbel T, Schöls W, Beyer T, Schweizer M, Sterns L, Laszlo Karolyi, Melichercik J, Kd, Freigang, and Kübler W

Subjects
Survival Rate, Death, Sudden, Cardiac, Tachycardia, Ventricular, Humans, Equipment Failure, Equipment Design, Defibrillators, Implantable, Forecasting
Abstract

The implantable cardioverter/defibrillator is gaining increasing significance in the therapy of life-threatening ventricular arrhythmias. Independently, the team of Mirowski and the team of Schuder started to develop experimental automatic implantable defibrillators in the seventies. In 1980, the first human implant of an automatic defibrillator was done by Levi Watkins together with the team of Mirowski in Baltimore, USA. Since 1989 implantable cardioverter/defibrillators exhibit multiple functions among which are high energy defibrillation therapy, low energy cardioversion, antitachycardia pacing, permanent and post therapy antibradycardia pacing, diagnostic counters, and device status parameters. This offers a markedly improved technical device to the patients. Evaluation of the patient's diagnostic counters provide a detailed overview about the patient's arrhythmia history and information for optimizing antitachycardia pacing therapy and additional antiarrhythmic drug therapy. The availability of non-thoractomy transvenous lead systems and biphasic shock forms allows the insertion of the device without open chest surgery and even without subcutaneous leads resulting in low mortality rates and an exclusively transvenous system. Single-lead unipolar devices are currently investigated in clinical trials. Future development of atrial sensing lead systems may further reduce inappropriate shock therapy triggered by sinus tachycardia or atrial tachyarrhythmias, e.g. atrial fibrillation, and may be used for dual chamber stimulation. Hemodynamic sensors for determining the severity of the arrhythmia are currently under experimental evaluation. Possible prognostic indications of ICD therapy in patients without a history of malignant arrhythmias are currently studied in several prospective trials. All new directions hold promise to expand and improve the use of ICDs in patients at risk for sudden cardiac death.

Published
1994

41. Antimicrobial prophylaxis for open heart operations

Author

Miedzinski, L.J., primary, Callaghan, J.C., additional, Fanning, E.A., additional, Gelfand, E.T., additional, Goldsand, G., additional, Modry, D., additional, Penkoske, P., additional, Preiksaitis, J., additional, Sheehan, G., additional, Sterns, L., additional, Taylor, G.D., additional, and Tyrrell, D.L.J., additional

Published
1990
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43. New lCD-Technologies: First Clinical Experience with Dual-Chamber Sensing for Differentiation of Supraventricular Tachyarrhythmias.

Author

Osswald, S., Cron, T. A., Sterns, L., Alt, E., Stotts, L., and Coenen, M.

Subjects
HEART diseases, ARRHYTHMIA, TACHYCARDIA, ATRIAL fibrillation, HEART beat, ATRIAL arrhythmias
Abstract

Inappropriate ICD therapy for supraventricular arrhythmias remains an unsolved problem and may lead to serious clinical situations. Current algorithms for differentiation of supraventricular and ventricular arrhythmias are based on ventricular sensing solely and, therefore, lack senstivity and specificity. This preliminary analysis from a multicenter trial comprises data from the first 26 patients who received a Res-QTM Micron active-can ICD (Sulzer Intermedics) with a ventricular defibrillation lead and an additional bipolar lead for atrial sensing. Digitized atrial and ventricular waveform storage as well as interval charts from 102 induced and 30 spontaneous arrhythmia episodes were prospectively collected and analyzed with regard to appropriateness of ICD therapy. From all 132 arrhythmia episodes, high-quality stored dual-chamber intracardiac electrograms (IEGM) could be retrieved for further analysis: in 40 (30%) episodes, atrial fibrillation (AF with rapid ventricular response 22, AF with VT 9, AF with VF 9) was identified as the underlying intrinsic rhythm, and inappropriate ICD therapy was delivered in 4/22 (18%) episodes of AF with rapid ventricular response. In the remaining 92 (70%) episodes, sinus rhythm was the underlying atrial rhythm (SR with VT13, SR with VF 79), and no inappropriate therapy was observed. Three of 22 (15%) high-energy shocks delivered for ventricular arrhythmias (VT 9, VF 9, rapid AF 4) terminated AF at the same time. In total, there were 3 complications (2 atrial lead dislodgments, 1 revision for bleeding). Both atrial lead dislodgments occurred in the 2 patients with passive-fixation leads compared to none in the 24 patients with active-fixation leads (p = 0.003). In conclusion, dual-chamber sensing and waveform storage of the new Res-QTM Micron offer very helpful diagnostic tools for the detection of inappropriate ICD-therapy. Placement of an additional atrial lead is safe and does not interfere with proper ICD function. However, for avoidance of atrial lead dislodgment, active fixation leads are recommended. With the tested active-can lead configuration, the efficacy of successful atrial cardioversion by high-energy shocks delivered for ventricular arrhythmias seems to be low. [ABSTRACT FROM AUTHOR]

Published
1998
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45. Coronary Arteriography: New Method Under Induced Hypotension by Pacing Experimental and Clinical Application

Author

BILGUTAY, AYDIN M., GANNON, PAUL, STERNS, L. P., FERLIC, RANDOLPH, and LILLEHEI, WALTON

Abstract

Coronary artery heart disease is the commonest form of clinical heart disease beyond age 40. In common practice its diagnosis is usually based on clinical signs and symptoms. Frequently extensive pathologic lesions may be present but cannot be diagnosed by ordinary measures unless they produce overt clinical manifestations. Careful evaluation of history, EKG, including Master's Test, and other related laboratory tests can at best confirm or rule out the clinical impression of coronary heart disease. Objective demonstration of the anatomic extent of disease in the coronary arteries, as they exist in life, is however essential for more accurate diagnosis and for better selection of patients for surgical procedures, designed to improve myocardial blood flow. If anatomic information about the coronaries can be obtained in vivo perhaps as many as 56% of the patients can be helped significantly by surgical means as suggested by the studies of Szilagyi.Coronary arteriography, at

Published
1964
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46. An unusual case of recurrent left atrial myxoma

Author

Jugdutt, B. I., Rossall, R. E., and Sterns, L. P.

Subjects
Male, Cardiac Catheterization, Time Factors, Blood Sedimentation, Intracranial Embolism and Thrombosis, Middle Aged, Heart Neoplasms, Recurrence, Cineangiography, Humans, Autopsy, Heart Atria, Neoplasm Recurrence, Local, Myxoma, Research Article
Abstract

In a patient who had a calcified left atrial myxoma resected, recurrence developed 31 months later. Although complete radical resection of the recurrent tumour presented a special problem, the patient survived the second operation. The tumour recurred again and the patient had two episodes of cerebral embolism 1 1/2 and 2 years later, respectively, and died 3 1/2 years after the second operation. The erythrocyte sedimentation rate correlated with the size of the tumor, and the recurrent tumour seemed to grow more rapidly than the primary tumour. Experience with this case and a review of the nine reported cases of recurrent left atrial myxoma suggest that a radical approach is necessary at the primary operation.

Published
1975

48. Destabilization of the Northeast Greenland Ice Stream

Author

Korsgaard, N. J., Shfaqat Abbas Khan, Kjaer, K. H., Bevis, M. G., Bamber, J. L., Kjeldsen, K. K., Bjork, A. A., Wahr, J. M., Sterns, L. A., Den Broeke, M. R., Ioana Stefania Muresan, and Larsen, N. K.

Abstract

The Greenland Ice Sheet (GrIS) has been one of the largest contributors to global sea level rise over the last 20 years, accounting for c. 0.5 of a total of c. 3.2 mm yr-1. A significant portion of this contribution is associated with the speed up of glaciers in southeast and northwest Greenland. Here, we reveal that the Northeast Greenland Ice Stream (NEGIS), which extends more than 600 km into the interior of the ice sheet, is now undergoing dynamic thinning after more than a quarter of a century of stability. This sector of the GrIS is of particular interest in sea level projections, because the glacier flows into a large submarine basin with a negative bed slope near the grounding line.Our findings unfold the next step in mass loss of the GrIS as we show a heightened risk of rapid sustained loss from Northeast Greenland on top of the thinning in Southeast and Northwestern Greenland.

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