2023
Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes
Chui P, Lan Z, Freeman J, Enriquez A, Khera R, Akar J, Masoudi F, Ong E, Curtis J. Variation in hospital use of cardiac resynchronization therapy-defibrillator among eligible patients and association with clinical outcomes. Heart Rhythm 2023, 20: 1000-1008. PMID: 36963741, DOI: 10.1016/j.hrthm.2023.03.022.Peer-Reviewed Original ResearchConceptsEligible patientsICD RegistryCardiac resynchronizationNational Cardiovascular Data Registry ICD RegistryCRT-D implantationCRT-D useHospital-level outcomesStrong guideline recommendationsHospital-level variationPatient-level outcomesIntraclass correlation coefficientQuality improvement effortsHospital mortalityGuideline indicationsReadmission ratesSelect patientsClinical outcomesGuideline recommendationsHospital variationHospital ratesUse of CRTHospital levelHospital usePatientsCase mixPredicting Malignant Ventricular Arrhythmias Using Real-Time Remote Monitoring
Ginder C, Li J, Halperin J, Akar J, Martin D, Chattopadhyay I, Upadhyay G. Predicting Malignant Ventricular Arrhythmias Using Real-Time Remote Monitoring. Journal Of The American College Of Cardiology 2023, 81: 949-961. PMID: 36889873, DOI: 10.1016/j.jacc.2022.12.024.Peer-Reviewed Original ResearchConceptsAppropriate device therapyMalignant ventricular arrhythmiasDevice therapyVentricular arrhythmiasImplantable cardioverter-defibrillator therapyLogistic regressionSeparate multivariable logistic regressionsLead impedanceAppropriate ICD therapyCardioverter-defibrillator therapyCardiac resynchronization therapyMultivariable logistic regressionRemote monitoring dataShock lead impedanceAtrial lead impedanceICD therapyHeart failureResynchronization therapyAppropriate therapyAtrial tachyarrhythmiasVentricular tachycardiaVentricular fibrillationDefibrillator devicesHeart ratePatientsInitial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures
Hsu J, Darden D, Du C, Marine J, Nichols S, Marcus G, Natale A, Noseworthy P, Selzman K, Varosy P, Masoudi F, Freeman J, Curtis J, Akar J, Kowey P. Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures. Journal Of The American College Of Cardiology 2023, 81: 867-878. PMID: 36858707, DOI: 10.1016/j.jacc.2022.11.060.Peer-Reviewed Original ResearchConceptsAtrial fibrillation ablation proceduresAblation RegistryHospital outcomesAblation proceduresSuccessful pulmonary vein isolationNational Cardiovascular Data RegistryOutcomes of patientsProspective cohort studyMajority of patientsPulmonary vein isolationEvidence-based guidelinesDifferent patient outcomesReal-world prevalenceProcedural admissionsHospital deathAF ablationCohort studyPericardial effusionVein isolationHeart failureLarge multicenterMajor complicationsCatheter ablationTreatment patternsPatient population
2020
Temporal Trends in Arrhythmogenicity Related to Treatment of COVID-19 Infection
Hummel JP, Maraj I, Taoutel R, Chamoun R, Workman VK, Tran L, Abboud JM, Afif C, Chouairi S, Delvecchio A, Howes CJ, Enriquez AD, Akar JG. Temporal Trends in Arrhythmogenicity Related to Treatment of COVID-19 Infection. Circulation Arrhythmia And Electrophysiology 2020, 13: e008841-e008841. PMID: 32931318, PMCID: PMC7566294, DOI: 10.1161/circep.120.008841.Peer-Reviewed Original ResearchEnhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019
Jain S, Workman V, Ganeshan R, Obasare ER, Burr A, DeBiasi RM, Freeman JV, Akar J, Lampert R, Rosenfeld LE. Enhanced electrocardiographic monitoring of patients with Coronavirus Disease 2019. Heart Rhythm 2020, 17: 1417-1422. PMID: 32387247, PMCID: PMC7200355, DOI: 10.1016/j.hrthm.2020.04.047.Peer-Reviewed Original ResearchConceptsQT prolongationCoronavirus disease 2019Electrocardiographic monitoringDisease 2019Pandemic coronavirus disease 2019QT-prolonging medicationsModifiable risk factorsIntensive care unitQT-prolonging drugsOngoing pandemic coronavirus disease 2019Assessment-Recommendation (SBAR) toolCOVID-19Electrophysiology serviceElectrolyte abnormalitiesCare unitUnique patientsPrimary teamRisk factorsPatientsPatient safetyECG monitoringProlongationRelevant interventionsTorsadesPointes3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis A Fluoroscopy-Free and Echocardiography-Free Method
Yu R, Liu N, Lu J, Zhao X, Hu Y, Zhang J, Xu F, Tang R, Bai R, Akar JG, Dong J, Ma C. 3-Dimensional Transseptal Puncture Based on Electrographic Characteristics of Fossa Ovalis A Fluoroscopy-Free and Echocardiography-Free Method. JACC Cardiovascular Interventions 2020, 13: 1223-1232. PMID: 32438994, DOI: 10.1016/j.jcin.2020.03.015.Peer-Reviewed Original ResearchConceptsAtrial fibrillation ablationFossa ovalisElectrographic characteristicsFibrillation ablationElectroanatomic mappingTransseptal puncture techniqueMajor complicationsRight atriumAncillary imagingAtrial potentialsCatheter connectionsTransseptal needleTransseptal punctureElectrogram voltageIntracardiac echocardiographyElectroanatomic mapsPuncture techniqueEchocardiographyFos mappingPatientsFluoroscopyAblationComplicationsPrecise localizationAtriumThe NCDR Left Atrial Appendage Occlusion Registry
Freeman JV, Varosy P, Price MJ, Slotwiner D, Kusumoto FM, Rammohan C, Kavinsky CJ, Turi ZG, Akar J, Koutras C, Curtis JP, Masoudi FA. The NCDR Left Atrial Appendage Occlusion Registry. Journal Of The American College Of Cardiology 2020, 75: 1503-1518. PMID: 32238316, PMCID: PMC7205034, DOI: 10.1016/j.jacc.2019.12.040.Peer-Reviewed Original ResearchConceptsHospital adverse event ratesAdverse event ratesEvent ratesMean HAS-BLED scoreHAS-BLED scoreHospital adverse eventsMean patient ageAtrial appendage occlusionMedian annual numberMajor bleedingMean CHAMore comorbiditiesVASc scoreWATCHMAN procedureAdverse eventsCommon complicationPatient agePericardial effusionPivotal trialsAppendage occlusionRandomized trialsAtrial fibrillationPatient populationPresent patientPhysician characteristicsPredictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation
Friedman DJ, Pokorney SD, Ghanem A, Marcello S, Kalsekar I, Yadalam S, Akar JG, Freeman JV, Goldstein L, Khanna R, Piccini JP. Predictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation. JACC Clinical Electrophysiology 2020, 6: 636-645. PMID: 32553212, DOI: 10.1016/j.jacep.2020.01.011.Peer-Reviewed Original ResearchConceptsPrevious cardiac surgeryCardiac perforationAF ablationIntracardiac echocardiographyCardiac surgeryFemale sexDiagnosis of hemopericardiumPatient risk factorsSubset of patientsAtrial fibrillation ablationContemporary clinical practiceIntraprocedural intracardiac echocardiographyLogistic regression modelsCardiac tamponadeFatal complicationProcedural complicationsRare complicationCatheter ablationFibrillation ablationAtrial fibrillationModifiable factorsRisk factorsProcedural safetyRisk scoreLower risk
2019
Recurrence quantification analysis of complex‐fractionated electrograms differentiates active and passive sites during atrial fibrillation
Baher A, Buck B, Fanarjian M, Mounsey J, Gehi A, Chung E, Akar FG, Webber CL, Akar JG, Hummel JP. Recurrence quantification analysis of complex‐fractionated electrograms differentiates active and passive sites during atrial fibrillation. Journal Of Cardiovascular Electrophysiology 2019, 30: 2229-2238. PMID: 31507008, DOI: 10.1111/jce.14161.Peer-Reviewed Original ResearchOutcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database
Hummel JP, Leipold RJ, Amorosi SL, Bao H, Deger KA, Jones PW, Kansal AR, Ott LS, Stern S, Stein K, Curtis JP, Akar JG. Outcomes and costs of remote patient monitoring among patients with implanted cardiac defibrillators: An economic model based on the PREDICT RM database. Journal Of Cardiovascular Electrophysiology 2019, 30: 1066-1077. PMID: 30938894, PMCID: PMC6850124, DOI: 10.1111/jce.13934.Peer-Reviewed Original ResearchAgedAged, 80 and overArrhythmias, CardiacCost-Benefit AnalysisDatabases, FactualDeath, Sudden, CardiacDefibrillators, ImplantableElectric CountershockFemaleHealth Care CostsHumansMaleMedicareModels, EconomicPatient ReadmissionPredictive Value of TestsQuality-Adjusted Life YearsRegistriesRemote Sensing TechnologyTelemetryTime FactorsTreatment OutcomeUnited States
2018
Atrial Fibrillation Thermographic and Endoscopic Monitoring of Patients: Safety Algorithm for the Esophagus
Hummel JP, Kadado AJ, Baker M, Gehi AK, Mounsey JP, Sadaf MI, Enriquez AD, Freeman JV, Akar JG. Atrial Fibrillation Thermographic and Endoscopic Monitoring of Patients: Safety Algorithm for the Esophagus. Circulation Arrhythmia And Electrophysiology 2018, 11: e006814. PMID: 30562101, DOI: 10.1161/circep.118.006814.Peer-Reviewed Original ResearchVentricular Fibrillation Conversion Testing After Implantation of a Subcutaneous Implantable Cardioverter Defibrillator
Friedman DJ, Parzynski CS, Heist EK, Russo AM, Akar JG, Freeman JV, Curtis JP, Al-Khatib SM. Ventricular Fibrillation Conversion Testing After Implantation of a Subcutaneous Implantable Cardioverter Defibrillator. Circulation 2018, 137: 2463-2477. PMID: 29463509, PMCID: PMC5988932, DOI: 10.1161/circulationaha.117.032167.Peer-Reviewed Original ResearchConceptsImplantable cardioverter defibrillatorS-ICD implantationLogistic regression analysisInhospital complicationsPatient characteristicsCT testingS-ICDsCardioverter defibrillatorConversion testingPrior implantable cardioverter defibrillatorHigher body mass indexMultivariable logistic regression analysisLarger body surface areaSubcutaneous implantable cardioverter defibrillatorTransvenous implantable cardioverter defibrillatorInhospital adverse eventsLow ejection fractionAvailable patient characteristicsBody mass indexBody surface areaFirst-time recipientsMaximum device outputRegression analysisPredictors of useInsufficient safety margin
2017
Deleterious protein‐altering mutations in the SCN10A voltage‐gated sodium channel gene are associated with prolonged QT
Ziki M, Seidelmann SB, Smith E, Atteya G, Jiang Y, Fernandes RG, Marieb MA, Akar JG, Mani A. Deleterious protein‐altering mutations in the SCN10A voltage‐gated sodium channel gene are associated with prolonged QT. Clinical Genetics 2017, 93: 741-751. PMID: 28407228, PMCID: PMC5640462, DOI: 10.1111/cge.13036.Peer-Reviewed Original ResearchConceptsLong QT syndromeSCN10A mutationsWhole-exome sequencingVoltage-gated sodium channel geneCongenital long QT syndromeHistory of palpitationsQT prolonging medicationsLife-threatening complicationsIdiopathic long QT syndromeProtein-altering mutationsSodium channel geneConfirmatory Sanger sequencingMutation burden analysisGenetic programAtrial fibrillationIdentifiable causeProlonged QTChannel genesMutation carriersArrhythmia genesQT syndromeGenesLQTS genesFrameshift mutationGenetic causeAddition of Blood Pressure and Weight Transmissions to Standard Remote Monitoring of Implantable Defibrillators and its Association with Mortality and Rehospitalization
Al-Chekakie MO, Bao H, Jones PW, Stein KM, Marzec L, Varosy PD, Masoudi FA, Curtis JP, Akar JG. Addition of Blood Pressure and Weight Transmissions to Standard Remote Monitoring of Implantable Defibrillators and its Association with Mortality and Rehospitalization. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003087. PMID: 28506978, DOI: 10.1161/circoutcomes.116.003087.Peer-Reviewed Original ResearchConceptsBlood pressure dataImplantable defibrillatorsRemote patient monitoringTransmission of weightHeart failure hospitalizationImpaired ejection fractionCardiac resynchronization therapyCox regression modelRisk of mortalityLogistic regression modelsRoutine weightCause hospitalizationFailure hospitalizationBlood pressureCardiovascular hospitalizationEjection fractionResynchronization therapyRegression modelsDevice implantationService patientsHospital characteristicsIndependent associationImproved outcomesLandmark analysisSimilar riskNational Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999–2013
Freeman JV, Wang Y, Akar J, Desai N, Krumholz H. National Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999–2013. Circulation 2017, 135: 1227-1239. PMID: 28148599, DOI: 10.1161/circulationaha.116.022388.Peer-Reviewed Original Research
2016
Determinants of Time in Therapeutic Range in Patients Receiving Oral Anticoagulants (A Substudy of IMPACT)
Lip GY, Waldo AL, Ip J, Martin DT, Bersohn MM, Choucair WK, Akar JG, Wathen M, Halperin JL, Investigators I. Determinants of Time in Therapeutic Range in Patients Receiving Oral Anticoagulants (A Substudy of IMPACT). The American Journal Of Cardiology 2016, 118: 1680-1684. PMID: 27665206, DOI: 10.1016/j.amjcard.2016.08.047.Peer-Reviewed Original ResearchConceptsMean therapeutic rangeTherapeutic rangeSAMe-TTAnticoagulation controlDeterminants of timeNew York Heart Association class INew York Heart Association class IVVitamin K antagonist-treated patientsAdditional stroke risk factorsBetter therapeutic rangeGood anticoagulation controlMean TTR valueOverall TTRStroke risk factorsVitamin K antagonistsRisk of strokeNon-US sitesStroke risk assessmentAHRE durationOral anticoagulationK antagonistsOral anticoagulantsRosendaal methodArrhythmia centersAtrial tachyarrhythmias
2015
Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators
Akar JG, Bao H, Jones PW, Wang Y, Varosy PD, Masoudi FA, Stein KM, Saxon LA, Normand SL, Curtis JP. Use of Remote Monitoring Is Associated With Lower Risk of Adverse Outcomes Among Patients With Implanted Cardiac Defibrillators. Circulation Arrhythmia And Electrophysiology 2015, 8: 1173-1180. PMID: 26092577, DOI: 10.1161/circep.114.003030.Peer-Reviewed Original ResearchConceptsImplantable cardioverter defibrillatorInitial implantable cardioverter defibrillatorCause mortalityLower riskAdverse outcomesNational Cardiovascular Data Registry ICD RegistryRemote patient monitoringSocial Security Death Master FileCause rehospitalization rateRisk of rehospitalizationImplanted cardiac defibrillatorsDeath Master FileCardiomyopathy pathogenesisCause rehospitalizationICD RegistryRehospitalization ratesMultivariable analysisStudy cohortVital statusService patientsCardioverter defibrillatorCox modelMedicare populationMedicare feePatientsRandomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices
Martin DT, Bersohn MM, Waldo AL, Wathen MS, Choucair WK, Lip GY, Ip J, Holcomb R, Akar JG, Halperin JL. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. European Heart Journal 2015, 36: 1660-1668. PMID: 25908774, DOI: 10.1093/eurheartj/ehv115.Peer-Reviewed Original ResearchConceptsAtrial tachyarrhythmiasMajor bleedingImplanted defibrillatorsInterruption of anticoagulationRemote rhythm monitoringStandard clinical criteriaCardiac resynchronization devicesAT burdenSystemic embolismThromboembolism ratesPrimary endpointComposite endpointBiventricular defibrillatorMedian timeAtrial fibrillationClinical criteriaResynchronization devicesEarly initiationAnticoagulationRhythm monitoringBleedingPatientsPrimary analysisControl groupAtrial electrograms
2013
Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators
Akar JG, Bao H, Jones P, Wang Y, Chaudhry SI, Varosy P, Masoudi FA, Stein K, Saxon LA, Curtis JP. Use of Remote Monitoring of Newly Implanted Cardioverter-Defibrillators. Circulation 2013, 128: 2372-2383. PMID: 24043302, DOI: 10.1161/circulationaha.113.002481.Peer-Reviewed Original ResearchConceptsMedian odds ratioOdds ratioNational Cardiovascular Data Registry ICD RegistryRemote patient monitoringMultivariable logistic regressionHealth-related factorsImplanted cardioverter defibrillatorEligible patientsICD RegistryLack of enrollmentCurrent guidelinesCardioverter defibrillatorPatientsLogistic regressionLocal practice environmentMajor causeHealth insuranceSubsequent activationEnrollmentPractice environmentPatient monitoringPhysiciansActivationRPM systemSuccessful usePlasma Profiles of Matrix Metalloproteinases and Tissue Inhibitors of the Metalloproteinases Predict Recurrence of Atrial Fibrillation Following Cardioversion
Mukherjee R, Akar JG, Wharton JM, Adams DK, McClure CD, Stroud RE, Rice AD, DeSantis SM, Spinale FG, Gold MR. Plasma Profiles of Matrix Metalloproteinases and Tissue Inhibitors of the Metalloproteinases Predict Recurrence of Atrial Fibrillation Following Cardioversion. Journal Of Cardiovascular Translational Research 2013, 6: 528-535. PMID: 23722357, DOI: 10.1007/s12265-013-9471-2.Peer-Reviewed Original ResearchMeSH KeywordsAgedAtrial FibrillationBiomarkersChi-Square DistributionC-Reactive ProteinElectric CountershockFibrosisHeart AtriaHumansLogistic ModelsMatrix MetalloproteinasesMiddle AgedMultivariate AnalysisNatriuretic Peptide, BrainPeptide FragmentsPredictive Value of TestsRecurrenceRisk FactorsTime FactorsTissue Inhibitor of MetalloproteinasesTreatment OutcomeConceptsAF recurrenceMatrix metalloproteinasesMMP-9TIMP-4MMP-3N-terminus pro B type natriuretic peptideHigh-sensitivity C-reactive protein levelsPro-B-type natriuretic peptideTissue inhibitorC-reactive protein levelsB-type natriuretic peptideLevels of MMPsAtrial fibrillation recurrenceNovel biomarker panelAtrial volumeNatriuretic peptideAtrial fibrosisSinus rhythmPredicts RecurrenceBiomarker panelRecurrenceMultivariate analysisPostcardioversionProtein levelsPlasma samples