2024
Atrial cardiomyopathy revisited—evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS)
Goette A, Corradi D, Dobrev D, Aguinaga L, Cabrera J, Chugh S, de Groot J, Soulat-Dufour L, Fenelon G, Hatem S, Jalife J, Lin Y, Lip G, Marcus G, Murray K, Pak H, Schotten U, Takahashi N, Yamaguchi T, Zoghbi W, Nattel S, Mont L, Akar J, Akoum N, Althoff T, Diaz J, Guichard J, Jadidi A, Kalman J, Lim H, Teixeira R. Atrial cardiomyopathy revisited—evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS). EP Europace 2024, 26: euae204. PMID: 39077825, PMCID: PMC11431804, DOI: 10.1093/europace/euae204.Peer-Reviewed Original ResearchConceptsEuropean Heart Rhythm AssociationLatin American Heart Rhythm SocietyHeart Rhythm SocietyClinical consensus statementAtrial fibrillationConsensus statementDevelopment of atrial fibrillationConsensus documentAtrial cardiomyopathyStaging systemElectrophysiological changesClinical validationExpert working groupAtrial geometryHeartObservational study protocol for an arrhythmia notification feature
Kumar S, Weinstein J, Melchinger H, Smith A, Capodilupo E, Akar J, Garg K, O’Connor K, Staunton M, Martin M, Akhlaghi N, Edeh O, Perez S, Lee V, Lee K, Wilson F. Observational study protocol for an arrhythmia notification feature. BMJ Open 2024, 14: e075110. PMID: 38830741, PMCID: PMC11149124, DOI: 10.1136/bmjopen-2023-075110.Peer-Reviewed Original ResearchConceptsAtrial fibrillationInstitution of appropriate treatmentGold standardClinical research journalsAssessment of risk factorsObservational study protocolRecruited participantsEthics BoardGeneral populationDiagnosed AFHealthy controlsPrimary outcomeAppropriate treatmentStudy protocolRisk factorsConsent documentsWHOOP strapParticipantsArrhythmiasDetect AFWearable technology
2023
Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation
Lamy J, Taoutel R, Chamoun R, Akar J, Niederer S, Mojibian H, Huber S, Baldassarre L, Meadows J, Peters D. Atrial fibrosis by cardiac MRI is a correlate for atrial stiffness in patients with atrial fibrillation. The International Journal Of Cardiovascular Imaging 2023, 40: 107-117. PMID: 37857929, PMCID: PMC11378145, DOI: 10.1007/s10554-023-02968-x.Peer-Reviewed Original ResearchConceptsLate gadolinium enhancementLA reservoir strainLeft atrial pressureLA volumeReservoir strainLA fibrosisLA strainStiffness indexLA late gadolinium enhancementAtrial stiffness indexMaximal LA volumeAtrial fibrillation cohortLA minimum volumeAtrial tissue fibrosisMaximum LA volumeCardiac MR examsAtrial stiffnessAtrial strainAF ablationAtrial pressureAF cohortAtrial fibrillationAtrial fibrosisPatient subgroupsLGE volumePPP1R12C Promotes Atrial Hypocontractility in Atrial Fibrillation
Perike S, Gonzalez-Gonzalez F, Abu-Taha I, Damen F, Hanft L, Lizama K, Aboonabi A, Capote A, Aguilar-Sanchez Y, Levin B, Han Z, Sridhar A, Grand J, Martin J, Akar J, Warren C, Solaro R, Ong S, Darbar D, McDonald K, Goergen C, Wolska B, Dobrev D, Wehrens X, McCauley M. PPP1R12C Promotes Atrial Hypocontractility in Atrial Fibrillation. Circulation Research 2023, 133: 758-771. PMID: 37737016, PMCID: PMC10616980, DOI: 10.1161/circresaha.123.322516.Peer-Reviewed Original ResearchConceptsSinus rhythm controlsAtrial hypocontractilityAF inducibilityAtrial contractilityAtrial fibrillationRhythm controlHuman patientsRight atrial appendage tissuePacing-induced AFThromboembolic stroke riskAtrial ejection fractionAtrial appendage tissueAtrial HL-1 cellsHL-1 cellsAtrial strainStroke riskAtrial sizeEjection fractionContractile functionElectrophysiology studyHypocontractilityWestern blotPatientsAtrial myosin light chainSarcomere functionVariation 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 mixInitial 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 populationPredicting 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 ratePatients
2022
Sex-based differences in atrial fibrillation ablation adverse events
Mszar R, Friedman D, Ong E, Du C, Wang Y, Zeitler E, Cunningham S, Akar J, Curtis J, Freeman J. Sex-based differences in atrial fibrillation ablation adverse events. Heart 2022, 109: 595-605. PMID: 36104219, DOI: 10.1136/heartjnl-2022-321192.Peer-Reviewed Original ResearchConceptsAcute pulmonary vein isolationAdverse eventsPulmonary vein isolationAtrial fibrillationHigh riskSex-based differencesVein isolationCatheter ablationFemale sexLarge prospective registryHospital adverse eventsMajor adverse eventsObservational cohort studyPhrenic nerve damageAF ablation proceduresQuality of lifeAblation RegistryMore comorbiditiesProspective registryAF ablationCohort studyPericardial effusionNerve damagePatient sexVascular injury
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 ResearchReply to: “QT prolongation with hydroxychloroquine and azithromycin for the treatment of COVID‐19: The need for pharmacogenetic insights”
Hummel JP, Akar JG. Reply to: “QT prolongation with hydroxychloroquine and azithromycin for the treatment of COVID‐19: The need for pharmacogenetic insights”. Journal Of Cardiovascular Electrophysiology 2020, 31: 2795-2795. PMID: 32864768, DOI: 10.1111/jce.14721.Peer-Reviewed Original ResearchIncidence and determinants of QT interval prolongation in COVID‐19 patients treated with hydroxychloroquine and azithromycin
Maraj I, Hummel JP, Taoutel R, Chamoun R, Workman V, Li C, Tran L, DelVecchio A, Howes C, Akar JG. Incidence and determinants of QT interval prolongation in COVID‐19 patients treated with hydroxychloroquine and azithromycin. Journal Of Cardiovascular Electrophysiology 2020, 31: 1904-1907. PMID: 32485061, PMCID: PMC7300464, DOI: 10.1111/jce.14594.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 interventionsTorsadesPointesUnderstanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography.
Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, Ivey-Miranda JB, Pereira J, Crandall I, DaSilva P, Bouman E, Brooks A, Gerardi C, Ugonabo I, Chen W, Houle H, Akar JG, Lin BA, McNamara RL, Lombo-Lievano B, Arias-Godinez JA, Sugeng L. Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography. European Heart Journal - Cardiovascular Imaging 2020, 21: 747-755. PMID: 32372089, DOI: 10.1093/ehjci/jeaa058.Peer-Reviewed Original ResearchConceptsLeft heart diseaseSevere tricuspid regurgitationTricuspid regurgitationAtrial fibrillationTransoesophageal echocardiographyBiatrial dilatationHigher systolic pulmonary artery pressureNormal right ventricular sizeSystolic pulmonary artery pressureImpact of AFSevere functional tricuspid regurgitationTricuspid annulus dilationPulmonary artery pressureRight ventricular sizeFunctional tricuspid regurgitationFractional area changeTA fractional area changeThree-dimensional echocardiographyRV enlargementArtery pressureBiventricular functionTricuspid valveVentricular sizeAF groupSinus rhythm3-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 ResearchLuminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review
Kadado AJ, Akar JG, Hummel JP. Luminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review. Trends In Cardiovascular Medicine 2018, 29: 264-271. PMID: 30282588, DOI: 10.1016/j.tcm.2018.09.010.Peer-Reviewed Original Research