Jeremy N Ruskin

Massachusetts General Hospital, Boston, Massachusetts, United States

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Publications (418)3063.97 Total impact

  • [Show abstract] [Hide abstract]
    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. · 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; · 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; · 2.20 Impact Factor
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    ABSTRACT: Cardiac Resynchronization Therapy (CRT) non-responders have poor outcomes. The significance of progressive ventricular dysfunction among non-responders remains unclear.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2014; · 4.56 Impact Factor
  • Source
    Journal of the American Heart Association. 06/2014; 3(4).
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    ABSTRACT: 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), and AV nodal reentrant tachycardia (AVNRT). We hypothesized that SVA may increase risk of AF and concomitant AF may influence long-term survival.
    Europace 06/2014; 16(10). · 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; · 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. · 5.14 Impact Factor
  • Heart Rhythm. 05/2014; 11(5S):S126.
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    ABSTRACT: 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.
    Journal of Electrocardiology 04/2014; · 1.36 Impact Factor
  • Abhishek Maan, Jeremy N. Ruskin, E. Kevin Heist
    Interventional Cardiology Clinics. 04/2014; 3(2):175–190.
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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; · 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; · 5.95 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; · 5.95 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; · 5.95 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; · 4.04 Impact Factor
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    ABSTRACT: Thank you for giving us the opportunity to respond to Dr. Feld's valid concerns. As stated in the article, the ablation strategy was altered when heating was encountered along the posterior wall. Specifically, in addition to limiting power to 25 watts and duration to 30 seconds, the catheter was moved away from the esophagus along with a further decrease in power and/or duration of ablation lesions. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 10/2013; · 3.48 Impact Factor
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    ABSTRACT: Although left ventricular ejection fraction (LVEF) is the primary determinant for sudden cardiac death (SCD) risk stratification, in isolation, LVEF is a sub-optimal risk stratifier. We assessed whether a multi-marker strategy would provide more robust SCD risk stratification than LVEF alone. We collected patient-level data (n = 3355) from 6 studies assessing the prognostic utility of microvolt T-wave alternans (MTWA) testing. Two thirds of the group was used for derivation (n = 2242) and one-third for validation (n = 1113). The discriminative capacity of the multivariable model was assessed using the area under the receiver-operating characteristic curve (c-index). The primary endpoint was SCD at 24 months. In the derivation cohort, 59 patients experienced SCD by 24 months. Stepwise selection suggested that a model based on 3 parameters (LVEF, coronary artery disease and MTWA status) provided optimal SCD risk prediction. In the derivation cohort, the c-index of the model was 0.817, which was significantly better than LVEF used as a single variable (0.637, P < .001). In the validation cohort, 36 patients experienced SCD by 24 months. The c-index of the model for predicting the primary endpoint was again significantly better than LVEF alone (0.774 vs 0.671, P = .020). A multivariable model based on presence of coronary artery disease, LVEF and MTWA status provides significantly more robust SCD risk prediction than LVEF as a single risk marker. These findings suggest that multi-marker strategies based on different aspects of the electro-anatomic substrate may be capable of improving primary prevention implantable cardioverter-defibrillator treatment algorithms.
    American heart journal 10/2013; 166(4):744-752. · 4.56 Impact Factor
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    ABSTRACT: Radiation exposure in the electrophysiology (EP) lab is a major concern to most electrophysiologists. A new technology, MediGuide™ nonfluoroscopic catheter tracking system, has been used for the first time in the USA recently. We intended to evaluate the efficacy of this novel catheter tracking system in reducing radiation exposure. We performed a prospective observational study by comparing the radiation exposure with MediGuide™ system to that of conventional mapping systems. The first 45 EP procedures performed with the MediGuide™ system were compared to 45 matched patients undergoing similar procedures during the same time frame using conventional mapping systems (CARTO and NavX) and fluoroscopy. We collected and compared baseline characteristics, procedural variables including fluoroscopic exposure between both groups. Forty-five patients underwent EP procedures using the MediGuide™ technology. They were matched with an equal number of patients with conventional mapping systems. Of the 45 patients included in the study, 33 underwent right atrial flutter ablations, 5 underwent atrioventricular nodal reentrant tachycardia ablations, 4 underwent ablation of Wolf-Parkinson-White syndrome, and 3 underwent EP studies with no ablation. There were no differences in mean age, gender distribution, and body mass index between the groups. Procedure duration in the MediGuide™ group was significantly lower than the duration in the conventional group (103 vs. 142 min, p = 0.03). The fluoroscopic time was significantly less during the procedures performed with the MediGuide™ technology when compared to the control group (8 vs. 21 min, p < 0.001). No major complications occurred during the procedures in either group. MediGuide™, a new nonfluoroscopic catheter tracking system, is associated with more than a 50 % reduction in fluoroscopic time when compared to conventional mapping systems.
    Journal of Interventional Cardiac Electrophysiology 09/2013; · 1.39 Impact Factor
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    ABSTRACT: Prior work has demonstrated that magnetic resonance imaging (MRI) strain can separate necrotic/stunned myocardium from healthy myocardium in the left ventricle (LV). We surmised that high-resolution MRI strain, using navigator-echo-triggered DENSE, could differentiate radiofrequency ablated tissue around the pulmonary vein (PV) from tissue that had not been damaged by radiofrequency energy, similarly to navigated 3D myocardial delayed enhancement (3D-MDE).METHODS AND RESULTS: A respiratory-navigated 2D-DENSE sequence was developed, providing strain encoding in two spatial directions with 1.2 × 1.0 × 4 mm(3) resolution. It was tested in the LV of infarcted sheep. In four swine, incomplete circumferential lesions were created around the right superior pulmonary vein (RSPV) using ablation catheters, recorded with electro-anatomic mapping, and imaged 1 h later using atrial-diastolic DENSE and 3D-MDE at the left atrium/RSPV junction. DENSE detected ablation gaps (regions with >12% strain) in similar positions to 3D-MDE (2D cross-correlation 0.89 ± 0.05). Low-strain (<8%) areas were, on average, 33% larger than equivalent MDE regions, so they include both injured and necrotic regions. Optimal DENSE orientation was perpendicular to the PV trunk, with high shear strain in adjacent viable tissue appearing as a sensitive marker of ablation lesions.CONCLUSIONS: Magnetic resonance imaging strain may be a non-contrast alternative to 3D-MDE in intra-procedural monitoring of atrial ablation lesions.
    Europace 09/2013; · 3.05 Impact Factor

Publication Stats

12k Citations
3,063.97 Total Impact Points

Institutions

  • 1981–2014
    • Massachusetts General Hospital
      • • Division of Cardiology
      • • Department of Medicine
      Boston, Massachusetts, United States
  • 2013
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
    • Icahn School of Medicine at Mount Sinai
      Manhattan, New York, United States
  • 2012
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • Montreal Heart Institute
      Montréal, Quebec, Canada
  • 2011–2012
    • University of Massachusetts Medical School
      • Department of Medicine
      Worcester, MA, United States
  • 1985–2012
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
  • 1981–2012
    • Harvard Medical School
      • • Department of Radiology
      • • Department of Medicine
      Boston, Massachusetts, United States
  • 2010
    • St. David's North Austin Medical Center
      Austin, Texas, United States
  • 2006–2010
    • University of California, San Francisco
      • Cardiovascular Research Institute
      San Francisco, California, United States
  • 2009
    • Ludwig-Maximilian-University of Munich
      • Department of Internal Medicine I
      München, Bavaria, Germany
    • St Vincent's University Hospital
      Dublin, Leinster, Ireland
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 2008
    • The Police Academy of the Czech Republic in Prague
      Praha, Praha, Czech Republic
  • 2007–2008
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 1986–2006
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
    • Spaulding Rehabilitation Hospital
      Boston, Massachusetts, United States
  • 2005
    • St. James's Hospital
      Dublin, Leinster, Ireland
  • 2003
    • University Medical Center Utrecht
      • Department of Cardiothoracic surgery
      Utrecht, Provincie Utrecht, Netherlands
    • Beth Israel Deaconess Medical Center
      Boston, Massachusetts, United States
  • 2001
    • St. George's School
      • Department of Cardiological Sciences
      Middletown, Rhode Island, United States
  • 1995
    • Massachusetts Institute of Technology
      • Division of Health Sciences and Technology
      Cambridge, MA, United States
    • Beth Israel Medical Center
      New York City, New York, United States
  • 1989
    • Tufts Medical Center
      • Department of Medicine
      Boston, MA, United States
  • 1988
    • St. Vincent's Hospital Sydney
      • Department of Cardiology
      Sydney, New South Wales, Australia
  • 1987
    • Loyola University Medical Center
      Maywood, Illinois, United States
  • 1976
    • Staten Island University Hospital
      New York, United States