Jeremy N Ruskin

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (362)2428.81 Total impact

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    ABSTRACT: Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A novel catheter localization system (Mediguide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and X-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this novel catheter tracking system to guide transseptal (TS) access. The feasibility of performing TS puncture with MediGuide was assessed in a prospective observational study in 16 patients undergoing radiofrequency ablation (RFA) for atrial fibrillation (AF). These patients were compared to 16 matched patients undergoing similar procedures during the same time frame using conventional approach. There were no differences in mean age, gender distribution, and body mass index between the two groups. Total duration of fluoroscopic exposure during TS puncture was compared between the two groups. All patients underwent successful TS puncture. Fluoroscopy time (FT) for double TS puncture using the MediGuide system was significantly lower than the control group (0.48 ± 0.17 min vs. 5.9 ± 0.65 min; p < 0.0001). No major complications occurred during the procedures in either group. TS puncture can be successfully performed using MediGuide, and results in significant reduction in radiation exposure. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 02/2015; DOI:10.1111/pace.12617 · 1.25 Impact Factor
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    ABSTRACT: Recent research and publication of various landmark trials have led to the approval and subsequent use of novel oral anticoagulants (NOACs) in clinical practice. The use of these newer agents for anticoagulation offers several benefits such as greater specificity, relatively rapid onset and offset of action and a predictable pharmacological profile as compared to warfarin. With the increasing use of these agents, several key issues ranging from appropriate selection to management of complications and considerations for concurrent procedures (cardioversion and catheter ablation) have also emerged. The timing of interruption of anticoagulants prior to catheter ablation and re-initiation after the procedure to minimize the peri-procedural thromboembolism risk without increasing the bleeding risk is of key relevance in electrophysiology practice. The use of NOACs in patients undergoing catheter ablation and cardioversion also requires special considerations based on the pharmacological properties of the individual agent and the presence of comorbidities such as renal and or hepatic impairment. In this review we aim to discuss the practical considerations with the use of NOACs in the setting of cardioversion and catheter ablation based on the currently available data.
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    ABSTRACT: Pulmonary vein isolation (PVI) of the remnant pulmonary vein (PV) stumps in pneumonectomy patients has not been well characterized. This is a multicenter observational study of patients with a remnant PV stump after pneumonectomy. Consecutive patients with a history of pneumonectomy and who had undergone RF ablation for drug refractory AF were identified from the AF database at the participating institutions. There were 15 patients in whom pneumonectomy was performed, for resection of tumors in 10, infection in 4 and bullae in 1 patient and who underwent RF ablation for AF. The mean age was 63 ± 7 years. The stumps were from the right lower PV in 5, left upper PV in 5, left lower PV in 3 and right upper PV in 2 patients. All the PV stumps were electrically active with PV potentials and 9 (60%) of them had triggered activity. PVI was performed in 14 and focal isolation in 1 patient. At one-year follow-up, 80% were free of AF, off of antiarrhythmic medications. PV stumps in AF patients with previous pneumonectomy are electrically active and are frequently the sites of active firing. Isolation of these PV stumps can be accomplished safely and effectively using catheter ablation with no practical concern for PV stenosis or compromising PV stump integrity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 01/2015; DOI:10.1111/jce.12619 · 2.88 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is a common cause of stroke. Silent cerebral infarctions (SCIs) are known to occur in the presence and absence of AF, but the association between these disorders has not been well-defined.
    Annals of internal medicine 11/2014; 161(9):650-8. DOI:10.7326/M14-0538 · 16.10 Impact Factor
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    ABSTRACT: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay. Copyright © 2014 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 10/2014; DOI:10.1016/j.amjcard.2014.10.027 · 3.43 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is the most common cardiac arrhythmia, contributing to increased morbidity and reduced survival through its associations with stroke and heart failure. AF contributes to a four- to fivefold increase in the risk of stroke in the general population and is responsible for 10-15 % of all ischemic strokes. Diagnosis and treatment of AF require considerable health care resources. Current therapies to restore sinus rhythm in AF are suboptimal and are limited either by their pro-arrhythmic effects or by their procedure-related complications. These limitations have necessitated identification of newer therapeutic targets to expand the treatment options. There has been a considerable amount of research interest in investigating the mechanisms of initiation and propagation of AF. Despite extensive research focused on the pathogenesis of AF, a thorough understanding of various pathways mediating initiation and propagation of AF still remains limited. Research efforts focused on the identification of these pathways and molecular mediators have generated a great degree of interest for developing more targeted therapies. This review discusses the potential therapeutic targets and the results from experimental and clinical research investigating these targets.
    American Journal of Cardiovascular Drugs 08/2014; 14(6). DOI:10.1007/s40256-014-0085-0 · 2.20 Impact Factor
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    ABSTRACT: BACKGROUND Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear. OBJECTIVE We sought to define predictors of and clinical outcomes associated with progressive ventricular dysfunction despite CRT. METHODS We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a >= 5% increase in ejection fraction) and progressors (those with a >= 5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF). RESULTS MuLtivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio [HR] 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with Lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 330/e; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors. CONCLUSION Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2014; 11(11). DOI:10.1016/j.hrthm.2014.08.005 · 4.92 Impact Factor
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    Journal of the American Heart Association 06/2014; 3(4). DOI:10.1161/JAHA.114.001179 · 2.88 Impact Factor
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    ABSTRACT: Aims To determine the incidence and predictors of atrial fibrillation (AF) and its impact on survival in patients with other forms of supraventricular arrhythmias (SVAs) including atrial flutter (AFL), atrial tachycardia (AT), atrioventricular reentrant (AVRT), andAV nodal reentrant tachycardia (AVNRT). We hypothesized that SVAmay increase risk of AF and concomitant AF may influence long-term survival. Methods and results All patients who underwent catheter ablation for SVA from 2000 to 2010 were included in this study. The patients were identified retrospectively and the vital status determined prospectively. Observed survival in the study cohort was compared with survival rates in the age-and sex-matched general population. The study group included 1573 patients (mean age 50.5 +/- 18 years, 47% female) with AVNRT (38.5%), AFL (29.6%), AVRT (22.6%) and AT (9.3%). The patients were followed for a mean of 35 months (median 23 months). Atrial fibrillation was documented in 424 patients (27%) with a higher incidence inmales (35 vs. 18%). Atrial fibrillationwas present in 19.6% of patients before the ablation and developed in 9.07% after ablation. Atrial fibrillation commonly occurred in patientswith AFL (57.5%), AT (27.4%), AVRT (13.5%), and AVNRT (9.7%). Older age, prolonged PR interval, dilated left atrium, low left ventricular ejection fraction and presence of AFL were independent predictors for concomitant AF. Long-term survival was worse in the presence of AF. Conclusion The incidence of AF is high in patients with other forms of SVA. The most common association is between AFL and AF. Long-term survival is decreased in those who have concomitant AF, although AF did not emerge as an independent predictor of mortality when adjusted for other covariates.
    Europace 06/2014; 16(10). DOI:10.1093/europace/euu129 · 3.05 Impact Factor
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    ABSTRACT: Although atrial fibrillation (AF) symptom severity is used to guide clinical care, a simple, standardized assessment tool is not available for routine clinical use. We sought to develop and validate a patient-generated score and classification scheme for AF-related symptom severity and burden. Atrial Fibrillation Symptom and Burden, a simple 2-part questionnaire, was designed to assess (1) AF symptom severity using 8 questions to determine how symptoms affect daily life and (2) AF burden using 6 questions to measure AF frequency, duration, and health-care utilization. The resulting score was used to classify patients into 4 classes of symptom and burden severity. Patients were asked to complete the questionnaire, a survey evaluating the questionnaire, and an Short Form-12v2 generic health-related quality-of-life form. Validation of the questionnaire included assessments of its reliability and construct and known groups validity. The strength of interrater agreement between patient-generated and blinded provider-generated classifications of AF symptom severity was also assessed. The survey had good internal consistency (Cronbach α >0.82) and reproducibility (intraclass correlation coefficient = 0.93). There was a good linear correlation with health-related quality-of-life aggregates measured by Pearson correlation coefficient (r = 0.62 and 0.42 vs physical component summary and mental component summary, respectively). Compared with physical and mental component summary scores, the patient-generated symptom severity classification scheme showed robust discrimination between mild and moderate severity (p <0.0001 and p = 0.0009) and between moderate and severe groups (p = 0.0001 and p = 0.012). In conclusion, this simple patient-generated AF classification scheme is robust, internally consistent, reproducible, and highly correlated with standardized quality-of-life measures.
    The American Journal of Cardiology 05/2014; 114(2). DOI:10.1016/j.amjcard.2014.04.032 · 3.43 Impact Factor
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    ABSTRACT: To evaluate the association between selective serotonin reuptake inhibitors (SSRIs) and corrected QT interval (QTc) prolongation via meta-analysis of prospective studies.
    The Journal of Clinical Psychiatry 05/2014; 75(5):e441-e449. DOI:10.4088/JCP.13r08672 · 5.14 Impact Factor
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    ABSTRACT: Background: Catheter ablation has emerged as a widely used treatment modality for atrial fibrillation (AF). P-wave abnormalities have been described in the patients with AF, and catheter ablation may potentially further impact P-wave parameters due to ablation of atrial tissue. Methods: We reviewed data on P-wave parameters (P-wave duration, amplitude and P-wave duration and amplitude product) in leads V1 and aVF and changes in the P-terminal force (Ptf; product of duration and amplitude of terminal part of P-wave) in lead V1 from 12-lead electrocardiograms obtained prior to and after CA of a total of 46 (28 paroxysmal and 18 persistent) AF patients. Results: The median age of patients in our study was 63 (range: 30-77) years. We noticed a significant reduction in the P-wave duration (from 87.39 +/- 28.62 ms at baseline to 72.09 +/- 24.59 ms; p = 0.0072) and the product of P-wave duration and amplitude in lead V1 (12.16 +/- 5.54 mV ms at baseline to 8.30 +/- 5.78 mV ms, p = 0.0015) after CA. There was also a significant decrease in P-wave duration (from 92.57 +/- 19.67 ms at baseline to 76.48 +/- 16.32 ms after CA, p = 0.0001) and P-wave duration and amplitude product in lead aVF (12.61 +/- 4.05 mV ms at baseline to 9.77 +/- 3.86 m V ms after CA,p = 0.0001). CA also led to a significant decrease in Ptf (from 4.56 +/- 1.88 at baseline to 2.85 +/- 1.42 mV ms,p < 0.0001). Conclusion: Radiofrequency catheter ablation of AF leads to modification of P-wave parameters with substantial diminution in both the amplitude and duration of the P-wave in leads V1 and aVF. This likely represents reduction in electrically active atrial tissue after ablation, and may serve as a marker for the extent of ablated atrial tissue.
    Journal of Electrocardiology 04/2014; 47(5). DOI:10.1016/j.jelectrocard.2014.04.010 · 1.36 Impact Factor
  • Abhishek Maan, Jeremy N. Ruskin, E. Kevin Heist
    04/2014; 3(2):175–190. DOI:10.1016/j.iccl.2013.11.001
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    ABSTRACT: Objectives The purpose of this study was to evaluate the feasibility and safety of uninterrupted rivaroxaban therapy during atrial fibrillation (AF) ablation. Background Optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during and after AF ablation. The safety and efficacy of uninterrupted rivaroxaban therapy as a periprocedural anticoagulant for AF ablation are unknown. Methods We performed a multicenter, observational, prospective study of a registry of patients undergoing AF ablation in 8 centers in North America. Patients taking uninterrupted periprocedural rivaroxaban were matched by age, sex, and type of AF with an equal number of patients taking uninterrupted warfarin therapy who were undergoing AF ablation during the same period. Results A total of 642 patients were included in the study, with 321 in each group. Mean age was 63 +/- 10 years, with 442 (69%) males and 328 (51%) patients with paroxysmal AF equally distributed between the 2 groups. Patients in the warfarin group had a slightly higher mean HAS- BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score (1.70 +/- 1.0 vs. 1.47 +/- 0.9, respectively; p = 0.032). Bleeding and embolic complications occurred in 47 (7.3%) and 2 (0.3%) patients (both had transient ischemic attacks) respectively. There were no differences in the number of major bleeding complications (5 [1.6%] vs. 7 [1.9%], respectively; p = 0.772), minor bleeding complications (16 [5.0%] vs. 19 [5.9%], respectively; p = 0.602), or embolic complications (1 [0.3%] vs. 1 [0.3%], respectively; p = 1.0) between the rivaroxaban and warfarin groups in the first 30 days. Conclusions Uninterrupted rivaroxaban therapy appears to be as safe and efficacious in preventing bleeding and thromboembolic events in patients undergoing AF ablation as uninterrupted warfarin therapy. (C) 2014 by the American College of Cardiology Foundation
    Journal of the American College of Cardiology 03/2014; 63(10):982-988. DOI:10.1016/j.jacc.2013.11.039 · 15.34 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression. Large clinical trials performed to date have failed to show benefit of rhythm control compared with rate control, but these trials primarily included patients at late stages in the disease process. One possible explanation is that intervention at only an early stage of progression may improve prognosis. Evolving observations about the progressive nature of AF, along with the occurrences of major complications such as strokes upon AF presentation, led to the notion that earlier and more active approaches to AF detection, rhythm-reversion, and maintenance of sinus rhythm may be a useful strategy in AF management. Approaches to early and sustained rhythm control include measures that prevent development of the AF substrate, earlier catheter ablation, and novel antiarrhythmic drugs. Improved classifications of AF mechanism, pathogenesis, and remodelling may be helpful to enable patient-specific pathophysiological diagnosis and therapy. Potential novel therapeutic options under development include microRNA-modulation, heatshock protein inducers, agents that influence Ca(2+) handling, vagal stimulators, and more aggressive mechanism-based ablation strategies. In this review, of research into the basis and management of AF in acute and early settings, it is proposed that progression from paroxysmal to persistent AF can be interrupted, with potentially favourable prognostic impact.
    European Heart Journal 02/2014; 35(22). DOI:10.1093/eurheartj/ehu028 · 14.72 Impact Factor
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    ABSTRACT: -Data on relative safety, efficacy and role of different percutaneous left ventricular assist devices (pLVADs) for hemodynamic support during the ventricular tachycardia (VT) ablation procedure are very limited. -We performed a multicenter, observational study from a prospective registry including all consecutive patients (N=66) undergoing VT ablation with a pLVAD in 6 centers in United States. Patients with intra aortic balloon pump (IABP group; N=22) were compared with patients with either an Impella or a TandemHeart deivce (Non-IABP group; N=44). There were no significant differences in the baseline characteristics between both the groups. In Non-IABP group a) more patients could undergo entrainment/activation mapping (82% vs 59%; p=0.046), b) more number of unstable VTs could be mapped and ablated per patient (1.05±0.78 vs 0.32±0.48; p<0.001), c) more number of VTs could be terminated by ablation (1.59±1.0 vs 0.91±0.81; p=0.007) and d) fewer VTs were terminated with rescue shocks (1.9±2.2 vs 3.0±1.5; p=0.049) when compared to IABP group. Complications of the procedure trended to be more in the Non-IABP group when compared to the IABP group (32% vs 14%; p=0.143). Intermediate term outcomes (mortality and VT recurrence) during 12±5 month follow-up were not different between both the groups. Left ventricular ejection fraction ≤ 15% was a strong and independent predictor of in-hospital mortality (53% vs 4%; p<0.001). -Impella and TandemHeart use in VT ablation facilitates extensive activation mapping of several unstable VTs and requires fewer rescue shocks during the procedure when compared to using IABP.
    Circulation Arrhythmia and Electrophysiology 02/2014; 7(2). DOI:10.1161/CIRCEP.113.000548 · 5.42 Impact Factor
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    ABSTRACT: -Cardiac tamponade is the most dramatic complication observed during atrial fibrillation (AF) ablation and the leading cause of procedure-related mortality. Female gender is a known risk factor for complications during AF ablation; however, it is unknown whether women have a higher risk of tamponade. -A systematic Medline search was used to locate academic electrophysiologic (EP) centers that reported cases of tamponade occurring during AF ablation. Centers were asked to provide information on cases of acute tamponade according to gender and their mode of management including any case of related mortality. Nineteen EP centers provided information on 34,943 ablation procedures involving 25,261 (72%) males. Overall 289 (0.9%) cases of tamponade were reported: 120 (1.24%) in females and 169 (0.67%) in males (odds ratio 1.83, P<0.001). There was a reciprocal association between center volume and the occurrence of tamponade with substantial lower risk in high volume centers. Most cases of tamponade occurred during catheter manipulation or ablation; females tended to develop more tamponades during transseptal catheterization. No gender difference in the mode of management was observed. However, 16% cases of tamponade required surgery with lower rates in high volume centers. Three cases of tamponade (1%) culminated in death. -Tamponade during AF ablation procedures is relatively rare. Women have an almost twofold higher risk for developing this complication. The risk of tamponade among women decreases substantially in high volume centers. Surgical back-up and acute management skills for treating tamponade are important in centers performing AF ablation.
    Circulation Arrhythmia and Electrophysiology 02/2014; 7(2). DOI:10.1161/CIRCEP.113.000760 · 5.42 Impact Factor
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    ABSTRACT: -Early recurrences of atrial fibrillation (ERAF) are common after radiofrequency catheter ablation for atrial fibrillation (AF). We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation. Moreover, the benefit of early reablation for ERAF after cryoballoon ablation is undetermined. -The STOP AF trial randomized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation. Patients were followed for 12 months. ERAF was defined as any recurrence of AF >30 seconds during the first 3 months of follow-up. Late recurrence (LR) was defined as any recurrence of AF >30 seconds between 3-12 months. Of the 163 patients randomized to cryoablation, 84 patients experienced ERAF (51.5%). The only significant factor associated with ERAF was male sex (HR 2.18; 95%CI 1.03-4.61; p=0.041). Late recurrence was observed in 41 patients (25.1%), and was significantly related to ERAF (55.6% LR with ERAF vs. 12.7% without ERAF; p<0.001). Among patients with ERAF, only current tobacco use (HR 3.84; 95%CI 1.82-8.11; p<0.001) was associated with late recurrence. Conversely early reablation was associated with greater freedom from LR (3.3% LR with early reablation vs. 55.6% without; HR 0.04; 95%CI 0.01-0.32; p=0.002). -ERAF following cryoballoon ablation occurs in approximately 50% of patients, and is strongly associated with late recurrence. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF.
    Circulation Arrhythmia and Electrophysiology 01/2014; DOI:10.1161/CIRCEP.113.000586 · 5.42 Impact Factor
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    ABSTRACT: A pathophysiological model of posttraumatic stress disorder (PTSD) posits that an overly strong stress response at the time of the traumatic event leads to overconsolidation of the event's memory in part through a central β-adrenergic mechanism. We hypothesized that the presence of a β-blocker in the patient's brain at the time of the traumatic event would reduce the PTSD outcome by blocking this effect. The unpredictable, uncontrollable discharge of an implantable intracardiac defibrillator (ICD) is experienced by most patients as highly stressful, and it has previously been shown to be capable of causing PTSD symptoms. The present pilot study evaluated a convenience sample of 18 male cardiac patients who had been taking either a lipophilic β-blocker (which penetrates the blood-brain barrier) or a hydrophilic β-blocker (which does not) at the time of a discharge of their ICD. The self- report PTSD Checklist-Specific Version quantified 17 PTSD symptoms pertaining to the ICD discharge during the month preceding the evaluation. There was a statistical trend for patients who had been taking a lipophilic β-blocker at the time of the ICD discharge to have (35%) less severe PTSD symptoms than patients who had been taking a hydrophilic β-blocker (one-tailed p=0.07, g=0.64). Further, prospective, randomized, controlled studies are suggested.
    Neurobiology of Learning and Memory 01/2014; 112. DOI:10.1016/j.nlm.2013.12.013 · 4.04 Impact Factor

Publication Stats

11k Citations
2,428.81 Total Impact Points

Institutions

  • 1982–2015
    • Massachusetts General Hospital
      • • Division of Cardiology
      • • Department of Medicine
      Boston, Massachusetts, United States
  • 2012
    • Montreal Heart Institute
      Montréal, Quebec, Canada
  • 1986–2012
    • Harvard Medical School
      • • Department of Radiology
      • • Department of Medicine
      Boston, Massachusetts, United States
    • Spaulding Rehabilitation Hospital
      Boston, Massachusetts, United States
  • 1985–2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 1981–2012
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2009
    • University of California, Davis
      Davis, California, United States
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 2008
    • The Police Academy of the Czech Republic in Prague
      Praha, Praha, Czech Republic
  • 2006
    • San Francisco VA Medical Center
      San Francisco, California, United States
    • University of California, San Francisco
      San Francisco, California, United States
  • 1984–2006
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2004
    • Boston University
      Boston, Massachusetts, United States
  • 1995
    • Massachusetts Institute of Technology
      • Division of Health Sciences and Technology
      Cambridge, MA, United States
  • 1990
    • Houston Methodist Hospital
      Houston, Texas, United States
  • 1988
    • University of Tennessee
      Knoxville, Tennessee, United States
  • 1987
    • Loyola University Medical Center
      Maywood, Illinois, United States