Frank Bogun

Concordia University–Ann Arbor, Ann Arbor, Michigan, United States

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Publications (184)1135.08 Total impact

  • Journal of the American College of Cardiology 08/2014; 64(6):630. · 14.09 Impact Factor
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    ABSTRACT: Epicardial left ventricular idiopathic ventricular arrhythmias (VAs) can be approached via the pericardial space, the coronary venous system (CVS), or other surrounding structures. The anatomic relationships between epicardial sites of origin (SOO) of VAs and surrounding anatomic structures have not been systematically described.
    Journal of Cardiovascular Electrophysiology 07/2014; · 3.48 Impact Factor
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    ABSTRACT: Twelve-lead electrocardiogram (ECG) criteria for epicardial ventricular tachycardia (VT) origins have been described. In patients with structural heart disease, the ability to predict an epicardial origin based on the QRS morphology is limited and has been investigated only for limited regions in the heart.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; · 4.56 Impact Factor
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    ABSTRACT: -Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal endpoints for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of non-inducibility of post-infarction VT for long-term outcomes after VT ablation.
    Circulation Arrhythmia and Electrophysiology 05/2014; · 5.95 Impact Factor
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    ABSTRACT: Frequent premature ventricular complexes (PVCs) can be eliminated with an ablation procedure. Ablation success rates have been reported to be in the 80% range. Reasons for failure of ablation have not been described in detail. The purpose of this study was to determine whether the paucity of PVCs at the beginning of the ablation procedure affects the outcome.
    Journal of Cardiovascular Electrophysiology 05/2014; · 3.48 Impact Factor
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    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; · 4.56 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is associated with a significant increase in the risk of stroke and mortality. It is unclear whether maintaining sinus rhythm (SR) after radiofrequency ablation (RFA) is associated with an improvement in stroke risk and survival. To determine whether SR after RFA of AF is associated with an improvement in the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up. RFA was performed in 3,058 patients (age=58±10 years) with paroxysmal (n=1,888) or persistent AF (n=1,170). The effects of time-dependent rhythm status on CVEs, cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up. Independent predictors of a higher arrhythmia burden after RFA were age (β [estimated beta coefficient]: 0.017 per 10 years; 95% CI: 0.006-0.029, P=0.003), left atrial (LA) diameter (β: 0.044 per 5-mm increase in LA diameter; 95% CI: 0.034-0.055, P<0.0001) and persistent AF (β: 0.174; 95% CI: 0.147-0.201, P<0.0001). CVEs, cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%) and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR]: 0.41; 95% CI: 0.20-0.84, P=0.015). There was not a significant reduction in all-cause mortality (HR: 0.86; 95% CI: 0.58-1.29, P=0.48), or CVEs (HR: 0.79; 95% CI: 0.48-1.29, P=0.34), in patients who remained in SR after RFA. Maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2014; · 4.56 Impact Factor
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    ABSTRACT: Background The purpose of this study was to assess how well acute procedural outcomes predict the clinical outcome of catheter ablation of premature ventricular complexes (PVCs). MethodsA consecutive series of 50 patients (28 women, age: 51±13 years) with frequent PVCs was referred for PVC ablation. Acute failure was defined as inability to eliminate the predominant PVC or recurrence of the predominant PVC within 12 h. The PVC burden was reassessed 3 months after the ablation procedure. A successful procedure was defined as reduction of the PVC burden at 3 months by ≥80% of the initial burden. ResultsThe procedure was acutely effective in 37 patients (74%) and at 3 months in 40 patients (80%). The presence or absence of the predominant PVC in the 12 hours post-ablation had the highest accuracy for outcome at 3 months (accuracy: 90%). From among the 13 /50 patients (26%) with evidence of acute failure, 4 had a PVC reduction of ≥80% at 3 months and 10 had a PVC reduction of >50% resulting in symptomatic improvement at 3 months. Conclusion The presence or absence of the predominant PVC within 12 hours post-ablation best correlated with the 3-month-efficacy data. Recurrence of the predominant PVC shortly after ablation did not indicate a procedural failure and the necessity for a repeat procedure. The majority of these patients had a significant, clinically meaningful reduction in their PVC burden. Acute predictors for procedural outcome at 3 months have a high positive but rather low negative predictive value.This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 03/2014; · 3.48 Impact Factor
  • Rakesh Latchamsetty, Frank Bogun
    Cardiac electrophysiology clinics 01/2014;
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    ABSTRACT: Background Atrial fibrillation (AF) is associated with a significant increase in the risk of stroke and mortality. It is unclear whether maintaining sinus rhythm (SR) after radiofrequency ablation (RFA) is associated with an improvement in stroke risk and survival. Objective To determine whether SR after RFA of AF is associated with an improvement in the risk of cerebrovascular events (CVEs) and mortality during an extended 10-year follow-up. Methods RFA was performed in 3,058 patients (age=58±10 years) with paroxysmal (n=1,888) or persistent AF (n=1,170). The effects of time-dependent rhythm status on CVEs, cardiac and all-cause mortality were assessed using multivariable Cox models adjusted for baseline and time-dependent variables during 11,347 patient-years of follow-up. Results Independent predictors of a higher arrhythmia burden after RFA were age (β [estimated beta coefficient]: 0.017 per 10 years; 95% CI: 0.006-0.029, P=0.003), left atrial (LA) diameter (β: 0.044 per 5-mm increase in LA diameter; 95% CI: 0.034-0.055, P<0.0001) and persistent AF (β: 0.174; 95% CI: 0.147-0.201, P<0.0001). CVEs, cardiac and all-cause mortality occurred in 71 (2.3%), 33 (1.1%) and 111 (3.6%), respectively. SR after RFA was associated with a significantly lower risk of cardiac mortality (hazard ratio [HR]: 0.41; 95% CI: 0.20-0.84, P=0.015). There was not a significant reduction in all-cause mortality (HR: 0.86; 95% CI: 0.58-1.29, P=0.48), or CVEs (HR: 0.79; 95% CI: 0.48-1.29, P=0.34), in patients who remained in SR after RFA. Conclusions Maintenance of SR after RFA is associated with a reduction in cardiovascular mortality in patients with AF.
    Heart Rhythm. 01/2014;
  • Heart Rhythm. 01/2014;
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    ABSTRACT: -Ventricular arrhythmias have been described to originate from intramural locations. Intramural scar can be assessed by delayed enhanced magnetic resonance imaging (DE-MRI) but MRIs cannot be performed on every patient. The objective of this study was to assess the value of voltage mapping to detect MRI defined intramural scar and to correlate the scar with ventricular arrhythmias. -In 15 consecutive patients (3 women, age: 55±16 years, ejection fraction: 49±13%) with structural heart disease, intramural scar was detected by DE-MRI. All patients underwent endocardial unipolar and bipolar voltage mapping guided by the registered intramural scar. Scar volume by MRI was 11.7±8 cm(3) with a scar thickness of 4.6±0.7 mm and a preserved endocardial/epicardial rim of 3.3±1.6 and 4.8±2.6 mm respectively. Endocardial bipolar voltage was 1.6±1.73 mV at the scar, 2.12±2.15 mV in a 1 cm perimeter around the scar, and 2.83±3.39 mV in remote myocardium without scar. The corresponding unipolar voltage was 4.94±3.25 mV, 6.59±3.81 mV and 8.32±3.39 mV respectively (P<0.0001). Using ROC curves, a unipolar cut-off value of 6.78 mV (AUC 0.78) and a bipolar cut-off value of 1.55 mV (AUC 0.69) best separated endocardial measurements overlying scar as compared to areas not overlying a scar. At least one intramural ventricular arrhythmia was eliminated in all but 2 patients in this series. -Intramural scar can be detected by unipolar and bipolar voltage, unipolar voltage being more useful. Mapping and ablation of intramural arrhythmias originating from an intramural focus can be accomplished.
    Circulation Arrhythmia and Electrophysiology 08/2013; · 5.95 Impact Factor
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    ABSTRACT: BACKGROUND: The right ventricular outflow tract (RVOT) is the most common site of origin of ventricular arrhythmias (VA) in patients with idiopathic VA. A left bundle branch block inferior axis morphology arrhythmia is the hallmark of RVOT arrhythmias. VAs from other sites of origin can mimic RVOT VAs and ablation in the RVOT typically fails for these VAs. The purpose of this study was to analyze reasons for failed ablations of RVOT-like VAs. METHODS: Among a consecutive series of 197 patients with an RVOT like Electrocardiographic (ECG) morphology who were referred for ablation, 38 patients (13 men, age: 46±14 years, left ventricular ejection fraction: 47±14%) in whom a prior procedure failed within the RVOT underwent a second ablation procedure. ECG characteristics of the VA were compared to a consecutive series of 50 patients with RVOT VAs. RESULTS: The origin of the VA was identified in 95% of the patients. In 28 of 38 patients (74%) the arrhythmia origin was not in the RVOT. The VA originated from intramural sites (n=8; 21%), the pulmonary arteries (n=7; 18%), the aortic cusps (n=6; 16%), and the epicardium (n=5; 13%). The origin was within the RVOT in 10 patients (26%). In 2 patients (5%), the origin could not be identified despite biventricular, aortic and epicardial mapping. The VA was eliminated in 34/38 patients (89%) with repeat procedures. ECG features of patients with failed RVOT-like arrhythmias were different from the characteristics of RVOT arrhythmias. CONCLUSIONS: In patients in whom ablation of a VA with an RVOT like appearance fails, mapping of the pulmonary artery, the aortic cusps, the epicardium, the left ventricular outflow tract and the aortic cusps will help to identify the correct site of origin. The 12 lead ECG is helpful in differentiating these VAs from RVOT VAs.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2013; · 4.56 Impact Factor
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    ABSTRACT: BACKGROUND: -Uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF) is associated with a lower risk of periprocedural complications than when warfarin is temporarily discontinued. However, the optimal international normalized ratio (INR) levels during RFA have not been defined. METHODS AND RESULTS: -In this retrospective analysis, RFA was performed in 1133 consecutive patients (mean age: 61±10 years) with paroxysmal (550) or persistent AF (583). Patients were grouped based on the INR on the day of RFA. There was a quadratic relationship between the INR and bleeding and vascular complications (P<0.001). Complications were less prevalent when INR was ≥2.0 and ≤3.0 (5% [31/572]), than when INR was <2.0 (10% [49/485], P=0.004) and >3.0 (12% [9/76], P=0.03). The prevalence of pericardial tamponade (1%) was similar at all INRs. From the quadratic model, the optimal range of INR was calculated as 2.1 to 2.5. INRs <2.0 and >3.0 were associated with a >2-fold increase in complications, with a further steep rise beyond an INR >3.5. Concomitant clopidogrel use was associated with a significant increase in complications at all INRs (OR=3.1, ±95% CI: 1.4-7.4). Unfractionated heparin requirements to maintain a therapeutic ACT during RFA was reduced by 50% in patients with an INR >2.0. CONCLUSIONS: -The optimal INR range during uninterrupted periprocedural anticoagulation using warfarin is narrow. Therefore INR levels should be carefully monitored in preparation for radiofrequency catheter ablation of AF.
    Circulation Arrhythmia and Electrophysiology 02/2013; · 5.95 Impact Factor
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    Journal of Cardiovascular Magnetic Resonance 01/2013; 15(1). · 4.44 Impact Factor
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    ABSTRACT: BACKGROUND: While macro-reentrant atrial tachycardias (AT) have been reasonably well described, little is known about small reentrant circuits. OBJECTIVE: The goal of the study was to compare characteristics of large and small reentrant circuits after ablation of persistent atrial fibrillation (AF). METHODS: Seventy-seven patients (age=61±10 years; LA=46±6 mm; EF=0.52±0.13) underwent a procedure for post-ablation AT. The p-wave duration, circuit size, electrogram characteristics, and conduction velocity were determined. RESULTS: AT was due to macro-reentry in 62 patients (80%), a small reentrant circuit in 13 (17%), and a focal mechanism in 2 (3%). The p-wave duration during small reentrant ATs was shorter than that during macro-reentry (174±12 vs. 226±22 ms; p<0.0001). The duration of fractionated electrograms at the critical site was longer in small vs. large circuits (167±43 vs. 98±38 ms, respectively, p<0.0001), and accounted for a greater percentage of the tachycardia cycle length (59±18 vs. 38±14%, respectively, p<0.0001). The mean diameters of macro-reentrant vs. small reentrant circuits were 44±7 and 26±11 mm, respectively (p<0.0001). The mean conduction velocity along the small circuits was lower (0.5±0.2 vs. 1.2±0.3 m/s, p<0.0001). Catheter ablation eliminated the AT in all 77 patients. CONCLUSIONS: AT due to a small reentrant circuit after ablation of AF may be distinguished from macro-reentry by a shorter p-wave duration, and the presence of long-duration electrograms at the critical site owing to extremely slow conduction. These features may aid the clinician in mapping of post-ablation ATs.
    Heart rhythm: the official journal of the Heart Rhythm Society 12/2012; · 4.56 Impact Factor
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    ABSTRACT: BACKGROUND: It is not clear whether dabigatran is as safe and effective as uninterrupted anticoagulation using warfarin during radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). OBJECTIVE: To compare the safety and efficacy of dabigatran using a novel administration protocol, and uninterrupted anticoagulation with warfarin for periprocedural anticoagulation in patients undergoing RFA of AF. METHODS AND RESULTS: In this case-control analysis, 763 consecutive patients (mean age: 61±10 years) underwent RFA of AF using dabigatran (n=191) or uninterrupted warfarin (n=572) for periprocedural anticoagulation. In all patients, anticoagulation was started ≥4 weeks prior to RFA. Dabigatran was held after the morning dose on the day before the procedure and resumed 4 hours after vascular hemostasis was achieved. A TEE performed in all patients receiving dabigatran did not demonstrate an intracardiac thrombus. There were no thromboembolic complications in either group. The prevalence of major,4/191 (2.1%), and minor bleeding complications, 5/191 (2.6%) in the dabigatran group, were similar to those in the warfarin group,12/572 (2.1%, P=1.0), and 19/572 (3.3%, P=0.8), respectively. Pericardial tamponade occurred in 2/191 patients (1%) in the dabigatran and in 7/572 patients (1.2%) in the warfarin groups, respectively (P=1.0). All patients who had a pericardial tamponade including 2 in the dabigatran group had uneventful recovery after perdicardiocentesis. On multivariate analysis, INR (OR: 4.0, ±95% CI: 1.1-15.0; P=0.04), clopidogrel use (OR: 4.2, ±95% CI: 1.5-12.3; P=0.01), and CHA(2)DS(2)-VASc score (OR: 1.4, ±95% CI: 1.1-1.8; P=0.01) were theindependent risk factors of bleeding complications only in the warfarin group. CONCLUSIONS: When held ~24 hours prior to the procedure and resumed 4 hours after vascular hemostasis dabigatran appears to be as safe and effective as uninterrupted warfarin for periprocedural anticoagulation in patients undergoing RFA of AF.
    Heart rhythm: the official journal of the Heart Rhythm Society 12/2012; · 4.56 Impact Factor
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    ABSTRACT: BACKGROUND: Patients with frequent premature ventricular complexes (PVCs) and PVC-induced cardiomyopathy usually have recovery of left ventricular (LV) dysfunction post-ablation. The time course for recovery of LV function has not been described. METHODS: In a consecutive series of 263 patients with frequent idiopathic PVCs referred for PVC ablation, LV dysfunction was present in 87 patients (mean ejection fraction 40±10%). The PVC burden was reduced to <20% of the initial PVC burden in 75 patients. In these patients, echocardiography was repeated 3-4 months post-ablation. If LV function did not normalize after 3-4 months, a repeat echocardiogram was performed every 3 months until there was normalization or stabilization of LV function. RESULTS: The ejection fraction normalized at a mean of 5±6 months post-ablation. The majority of patients (51/75 [68%]) with PVC-induced LV dysfunction had recovery of LV function within 4 months. In 24 of the patients (32%), recovery of LV function took more than 4 months (mean 12±9 months, range 5-45 months). An epicardial origin of PVCs was more often present (13/24; 54%) in patients with delayed recovery of LV function than those with early recovery of LV function (2/51; 4%, p<0.0001). The PVC-QRS width was significantly longer in patients with delayed recovery compared to patients with recovery <4 months (170±21 vs 159±16 ms; p=0.02). In multivariate analysis, only an epicardial PVC origin was predictive of delayed recovery of LV function in patients with PVC-cardiomyopathy. CONCLUSION: PVC-induced cardiomyopathy resolves within 4 months of successful ablation in most patients. In about one third of patients, recovery is delayed and can take up to 45 months. An epicardial origin predicts delayed recovery of LV function.
    Heart rhythm: the official journal of the Heart Rhythm Society 10/2012; · 4.56 Impact Factor
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    ABSTRACT: OBJECTIVES: The purpose of this study was to assess the determinants of ventricular tachycardia (VT) recurrence in patients who underwent VT ablation for post-infarction VT. BACKGROUND: The factors that predict recurrence of VT after catheter ablation in patients with prior infarctions are not well described. METHODS: Catheter ablation was performed in 98 consecutive patients (88 males [90%]; mean age 67 ± 10 years; ejection fraction 27 ± 13%) with post-infarction VT. Electrograms from the implantable cardioverter-defibrillator were analyzed, and VTs were classified as clinical, nonclinical, or new clinical. RESULTS: A total of 725 VTs were induced during the ablation procedure. All VTs were targeted. In 76 patients, 105 clinical VTs were inducible. Critical sites were identified with entrainment mapping and pace-mapping (≥10 of 12 matching leads) for 75 of 105 clinical VTs (71%) and for 278 of 620 nonclinical VTs (45%). Post-ablation, the clinical VT was not inducible in any patient, and all VTs were rendered noninducible in 63% of the patients. Over a mean follow-up period of 35 ± 23 months, 65 of 98 patients (66%) had no recurrent VTs and 33 (34%) had VT recurrence. A new VT occurred in 26 of 33 patients (79%), and a prior clinical VT recurred in 7 patients (21%). Patients with recurrent VT had a larger scar area as assessed by electroanatomic mapping compared with patients without recurrent VTs (93 ± 40 cm(2) vs. 69 ± 30 cm(2); p = 0.002). In patients with repeat procedures, the majority of inducible VTs for which a critical area could be identified were at a distance of 6 ± 3 mm to the prior ablation lesions. CONCLUSIONS: Patients with recurrent VTs have a larger scar as assessed by electroanatomic mapping. Most recurrent VTs were new, and the majority of these VTs were mapped to the vicinity of prior ablation lesions in patients with repeat procedures.
    Journal of the American College of Cardiology 10/2012; · 14.09 Impact Factor
  • Rakesh Latchamsetty, Frank Bogun
    Cardiac electrophysiology clinics 09/2012; 4(3):439–445.

Publication Stats

4k Citations
1,135.08 Total Impact Points

Institutions

  • 1995–2014
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • University of Michigan
      • • Division of Cardiovascular Medicine
      • • Department of Internal Medicine
      Ann Arbor, Michigan, United States
  • 2012
    • University of Chicago
      Chicago, Illinois, United States
  • 2011
    • University of Pennsylvania
      • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 2009
    • Wayne State University
      Detroit, Michigan, United States
    • Hospital of the University of Pennsylvania
      Philadelphia, Pennsylvania, United States
  • 2002–2006
    • Henry Ford Hospital
      Detroit, Michigan, United States
  • 1997–2002
    • Goethe-Universität Frankfurt am Main
      • Zentrum der Inneren Medizin
      Frankfurt am Main, Hesse, Germany