Ablation of Atrial Fibrillation Using an Irrigated‐Tip Catheter: Open or Closed?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91175/1/j.1540-8159.2012.03333.x.pd

Infrequent Intraprocedural Premature Ventricular Complexes: Implications for Ablation Outcome

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109287/1/jce12454.pd

Predictors of Outcome After Catheter Ablation of Premature Ventricular Complexes

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107382/1/jce12400.pd

Anticoagulant Therapy and Risk of Cerebrovascular Events After Catheter Ablation of Atrial Fibrillation in the Elderly

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90264/1/j.1540-8167.2011.02141.x.pd

An update on TroVax® for the treatment of progressive castration-resistant prostate cancer

Prostate cancer is a common human malignancy with few effective therapeutic options for treating advanced castration-resistant disease. The potential therapeutic effectiveness of immunotherapy and vaccines, in particular, has gained popularity based on the identification of prostate-associated antigens, potent expression vectors for vaccination, and data from recent clinical trials. A modified vaccinia Ankara (MVA) virus expressing 5T4, a tumor-associated glycoprotein, has shown promise in preclinical studies and clinical trials in patients with colorectal and renal cell carcinoma. This review will discuss the rationale for immunotherapy in prostate cancer and describe preclinical and limited clinical data in prostate cancer for the MVA-5T4 (TroVax®) vaccine

Perceived Quality of Care and Lifestyle Counseling Among Patients With Heart Disease

Background: To examine patients' perceived quality of care and reported receipt of information on diet and exercise related to cardiovascular disease prevention. Methods: Patients admitted with acute coronary syndromes or elective cardiac catheterization were eligible for enrollment. Baseline medical information was collected through medical-record review. Patients completed surveys at the time of hospitalization that included items on perceived quality of care and whether they had received information from a healthcare provider on diet and exercise as related to their heart. Perceived quality of care was grouped into 3 categories: (1) poor to fair, (2) good, and (3) very good to excellent. Results: Among the 182 cardiac patients who completed the survey, those who reported poor to fair quality of care were more likely to report that they had received no advice regarding diet as compared with those who perceived their quality of care as good or very good to excellent (61%, 59%, and 26%, respectively, P < 0.0001). A similar pattern was observed for exercise (71%, 74%, and 36%, respectively, P < 0.0001). Conclusions: Patients with low perceived quality of care were less likely to have discussed diet and exercise habits with healthcare providers. Improving receipt of lifestyle counseling is warranted given the central role that diet and exercise play in secondary prevention. Copyright © 2010 Wiley Periodicals, Inc. Dr. Jackson receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (K23 HL073310-01). The authors have no other funding, financial relationships, or conflicts of interest to disclose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78479/1/20839_ftp.pd

Atrioventricular conduction in patients undergoing pacemaker implant following self‐expandable transcatheter aortic valve replacement

BackgroundHeart block requiring a pacemaker is common after self‐expandable transcatheter aortic valve replacement (SE‐TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown.ObjectiveTo evaluate the long‐term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE‐TAVR.MethodsAll patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE‐TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow‐up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery.ResultsFollowing SE‐TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow‐up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long‐term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28–0.86]/mm, P = 0.02) predicted lack of conduction recovery.ConclusionsHalf of the patients undergoing CIED placement for heart block following SE‐TAVR recovered AV conduction within several months and maintained this over an extended follow‐up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150495/1/pace13694_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150495/2/pace13694.pd

Ablation of paroxysmal atrial fibrillation using a second‐generation cryoballoon catheter or contact‐force sensing radiofrequency ablation catheter: A comparison of costs and long‐term clinical outcomes

IntroductionAlthough noninferiority of cryoballoon ablation (CBA) and radiofrequency catheter ablation for antral pulmonary vein isolation (APVI) has been reported in patients with paroxysmal atrial fibrillation (PAF), it is not clear whether contact force sensing (CF‐RFA) and CBA with the second‐generation catheter have similar procedural costs and long‐term outcomes. The objective of this study is to compare the long‐term efficacy and cost implications of CBA and CF‐RFA in patients with PAF.Methods and resultsA first APVI was performed in 146 consecutive patients (age: 63 ± 10 years, men: 95 [65%], left atrial diameter: 42 ± 6 mm) with PAF using CBA (71) or CF‐RFA (75). Clinical outcomes and procedural costs were compared. The mean procedure time was significantly shorter with CBA than with CF‐RFA (98 ± 39 vs. 158 ± 47 minutes, P < 0.0001). Despite a higher equipment cost in the CBA than the CF‐RFA group, the total procedure cost was similar between the two groups (P = 0.26), primarily driven by a shorter procedure duration that resulted in a lower anesthesia cost. At 25 ± 5 months after a single ablation procedure, 51 patients (72%) in the CBA, and 55 patients (73%) in the CF‐RFA groups remained free from atrial arrhythmias without antiarrhythmic drug therapy (P = 0.84).ConclusionsThe procedure duration was approximately 60 minutes shorter with CBA than CF‐RFA. The procedural costs were similar with both approaches. At 2 years after a single procedure, CBA and CF‐RFA have similar single‐procedure efficacies of 72–73%.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142442/1/jce13378_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142442/2/jce13378.pd

Baseline and decline in device‐derived activity level predict risk of death and heart failure in patients with an ICD for primary prevention

BackgroundImplanted defibrillators are capable of recording activity data based on company‐specific proprietary algorithms. This study aimed to determine the prognostic significance of baseline and decline in device‐derived activity level across different device companies in the real world.MethodsWe performed a retrospective cohort study of patients (n = 280) who underwent a defibrillator implantation (Boston, Medtronic, St. Jude, and Biotronik) for primary prevention at the University of Michigan from 2014 to 2016. Graphical data obtained from device interrogations were retrospectively converted to numerical data. The activity level averaged over a month from a week postimplantation was used as baseline. Subsequent weekly average activity levels (SALs) were standardized to this baseline. SAL below 59.4% was used as a threshold to group patients. All‐cause mortality and death/heart failure were the primary end‐points of this study.ResultsFifty‐six patients died in this study. On average, they experienced a 50% decline in SAL prior to death. Patients (n = 129) who dropped their SAL below threshold were more likely to be older, male, diabetic, and have more symptomatic heart failure. They also had a significantly increased risk of heart failure/death (hazard ratio [HR] 3.6, 95% confidence interval [95% CI] 2.3‐5.8, P < .0001) or death (HR 4.2, 95% CI 2.2‐7.7, P < .0001) compared to those who had sustained activity levels. Lower baseline activity level was also associated with significantly increased risk of heart failure/death and death.ConclusionSignificant decline in device‐derived activity level and low baseline activity level are associated with increased mortality and heart failure in patients with an ICD for primary prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156452/2/pace13981.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156452/1/pace13981_am.pd

Prevalence and Predictors of Complications of Radiofrequency Catheter Ablation for Atrial Fibrillation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86907/1/j.1540-8167.2010.01995.x.pd