Andrea Natale

University of Texas at Austin, Austin, Texas, United States

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Publications (675)4228.25 Total impact

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    ABSTRACT: Background: Balloon catheters have been designed to facilitate pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). The visually guided laser balloon (VGLB) employs laser energy to ablate tissue under direct visual guidance. Objectives: This study compared the efficacy and safety of VGLB ablation with standard irrigated radiofrequency ablation (RFA) during catheter ablation of AF. Methods: Patients with drug-refractory paroxysmal AF were enrolled in a multicenter, randomized controlled study of PV isolation using either the VGLB or RFA (control). The primary efficacy endpoint was freedom from protocol-defined treatment failure at 12 months, including symptomatic AF occurring after the 90-day blanking period. The primary efficacy and safety endpoints were powered for noninferiority. Results: A total of 353 patients (178 VGLB, 175 control) were randomized at 19 clinical sites. The mean procedure, ablation, and fluoroscopy times were longer with VGLB compared with controls. The primary efficacy endpoint was met in 61.1% in the VGLB group versus 61.7% in controls (absolute difference -0.6%; lower limit of 95% confidence interval [CI]: -9.3%; p = 0.003 for noninferiority). The primary adverse event rate was 11.8% in the VGLB group versus 14.5% in controls (absolute difference -2.8%; upper limit of 95% CI: 3.5; p = 0.002 for noninferiority), and was mainly driven by cardioversions. Diaphragmatic paralysis was higher (3.5% vs. 0.6%; p = 0.05), but PV stenosis was lower (0.0% vs. 2.9%; p = 0.03) with VGLB. Conclusions: Despite minimal prior experience, the safety and efficacy of VGLB ablation proved noninferior to RFA for the treatment of paroxysmal AF. (Pivotal Clinical Study of the CardioFocus Endoscopic Ablation System-Adaptive Contact [EAS-AC] [HeartLight] in Patients With Paroxysmal Atrial Fibrillation [PAF] [HeartLight]; NCT01456000).
    Journal of the American College of Cardiology 09/2015; 66(12):1350-60. DOI:10.1016/j.jacc.2015.07.036 · 16.50 Impact Factor
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    ABSTRACT: Introduction: Next generation catheters have been developed to reduce irrigation volume and preserve power delivery. A novel design employs a flexible tip (FlexAbility™ catheter) that directs flow to the contact surface. Due to recent safety issues with new catheters, we undertook a study in a canine heart with three irrigated catheters to compare efficacy and safety. Methods: Endocardial ablation was performed by two independent operators in 12 anesthetized canines with the FlexAbility (St. Jude Medical), ThermoCool™(1) (Biosense Webster), and ThermoCool™ SF (Biosense Webster) catheters. Endocardial RF lesions were delivered with each catheter in all 4 chambers of each animal for 52 ± 16 seconds. Each chamber was randomized to receive ablation from one catheter with recording of safety events. Cardiac pathology was performed with TTC stain. Results: Average lesion dimensions were not significantly different between the three catheters. FlexAbility™ demonstrated a lower risk of steam pops relative to ThermoCool SF (P-value = 0.013) despite equal mean power and RF time. High temperature generator shutdowns were observed with FlexAbility™ but not with either ThermoCool catheter. High temperature shutdowns were associated with larger average impedance drops (28.5 vs 19 ohms) without compromising lesion size. Conclusions: The FlexAbility™ tip is safe and effective with no significant difference in lesions sizes compared to both standard ThermoCool and ThermoCool SF. FlexAbility™ has a significantly lower risk of steam pops compared to ThermoCool SF in a beating heart as defined predominantly by an abrupt rise of impedance. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 09/2015; DOI:10.1111/jce.12835 · 2.96 Impact Factor
  • Ranjan K Thakur · Andrea Natale
    Cardiac electrophysiology clinics 09/2015; 7(3):xiii. DOI:10.1016/j.ccep.2015.07.002
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    ABSTRACT: Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST.
    Journal of Interventional Cardiac Electrophysiology 08/2015; DOI:10.1007/s10840-015-0040-2 · 1.58 Impact Factor
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    ABSTRACT: Whether in patients with paroxysmal atrial fibrillation (PAF) ablation of non-pulmonary vein triggers after antral pulmonary vein isolation (PVAI) improves the long-term outcome in patients with LV systolic dysfunction (LVSD) is unknown. We sought to evaluate whether a more extensive ablation improve outcomes at follow up. Consecutive patients with PAF refractory to AADs presenting for PVAI were prospectively studied. Patients were categorized into 2 groups: Group I patients with LVEF ≤ 35% (N = 175) and Group II patients with LVEF ≥ 50% (N = 545). Patients in Group I were further divided according to whether additional ablation of non-PV triggers was performed (Group IA, N = 88) or not (Group IB, N = 87). Long-term ablation success off AAD after a single procedure was analyzed. Patients in Group I had more non-PV triggers than patients in Group II (69.1% vs. 26.6%; p < 0.001). During a follow-up of 15.8 ± 4.7 months, less patients in Group I remained free from recurrences compared to Group II (53.7% vs. 81.7% p < 0.001). Group IA long-term ablation success was higher compared to Group IB (75.0% vs. 32.2%, p < 0.001), and similar to Group II (75.0% vs. 81.7%, p = 0.44). In the multivariate analysis, LVEF ≤ 35% (hazard ratio [HR], 1.68; p = 0.003), and non-PV triggers (HR, 3.12; p < 0.001) were independent predictors of recurrences. In patients with PAF and LVSD, ablation of non-PV triggers in addition to PVAI significantly improves their long-term outcome. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2015; DOI:10.1016/j.hrthm.2015.08.029 · 5.08 Impact Factor
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    ABSTRACT: Whether the isolation of LAPW offers additional benefits over PVAI alone in pts with persistent atrial fibrillation (PersAF) is unclear. We sought to determine the impact of PVAI and LA posterior wall isolation (PVAI+LAPW) versus PVAI alone on the outcome of ablation of PersAF. During the 1(st) procedure, PVAI was performed in 20 pts (Group 1) while in 32 pts (Group 2) PVAI was extended to the LA septum and CS and isolation of the LA posterior wall was targeted (ePVAI+LAPW). SVC isolation was achieved in both groups. All 6 pts regardless of arrhythmia recurrence underwent a 2(nd) procedure 3 months after the 1(st) procedure. In pts with reconnection of PVs and/or LAPW, re-isolation was performed and a 3(rd) procedure was performed 3 months later to verify isolation. Pts entered follow-up only after PVAI (Group 1) or PVAI+LAPW (Group 2) isolation was proven. At the 1, 2, 3-year follow-up, the rate of freedom from atrial tachyarrhythmia without anti-arrhythmic drug was 20%, 15% and 10% in Group 1, and 65%, 50% and 40% in Group 2, respectively (log rank p<0.001). The median recurrence-free survival time is 8.5 months (IQR 6.5-11.0) in Group 1 and 28.0 months (IQR 8.5-32.0) in Group 2. Proven isolation of the LAPW provides additional benefits over PVAI alone in the treatment of PersAF and improves procedural outcome at follow-up. However, the ablation strategy of ePVAI+LAPW is still associated with a significant high incidence of very late atrial tachyarrhythmia recurrence. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2015; DOI:10.1016/j.hrthm.2015.08.019 · 5.08 Impact Factor
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    ABSTRACT: -Contact Force (CF) is a major determinant of lesion size and transmurality, and has the potential to improve efficacy of atrial fibrillation (AF) ablation. This study sought to evaluate the safety and effectiveness of a novel irrigated radiofrequency ablation (RFA) catheter which measures real-time CF in the treatment of patients with paroxysmal AF. -A total of 300 patients with symptomatic, drug-refractory, paroxysmal AF were enrolled in a prospective, multicenter, randomized controlled trial and randomized to RFA with either a novel CF sensing catheter or a non-CF catheter (Control). The primary effectiveness endpoint consisted of acute electrical isolation of all pulmonary veins (PVs) and freedom from recurrent symptomatic atrial arrhythmia off all anti-arrhythmic drugs at 12 months. The primary safety endpoint included device-related serious adverse events. Endpoints were powered to show non-inferiority. All PVs were isolated in both groups. Effectiveness was achieved in 67.8% and 69.4% of subjects in the CF and Control arms, respectively (absolute difference -1.6%, lower limit of one-sided 95% CI -10.7%, p=0.0073 for non-inferiority). When the CF arm was stratified into optimal CF (≥90% ablations with ≥10g) and non-optimal CF groups, effectiveness was achieved in 75.9% vs. 58.1%, respectively (p=0.018). The primary safety endpoint occurred in 1.97% and 1.40% of CF patients and Controls, respectively (absolute difference 0.57%, upper limit of one-sided 95% CI 3.61%, p=0.0004 for non-inferiority). -The CF ablation catheter met the primary safety and effectiveness endpoints. Additionally, optimal CF was associated with improved effectiveness. Clinical Trial Registration; Identifier: NCT01278953.
    Circulation 08/2015; 132(10). DOI:10.1161/CIRCULATIONAHA.114.014092 · 14.43 Impact Factor
  • David F Briceno · Andrea Natale · Luigi Di Biase
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    ABSTRACT: Catheter ablation of atrial fibrillation (AF) is the standard of care to achieve rhythm control in selected patients who have failed medical therapy. Despite advances in ablation strategies and technology, thromboembolism and bleeding are still important complications of catheter ablation of AF occurring in up to 5% of cases. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 07/2015; DOI:10.1111/pace.12683 · 1.13 Impact Factor
  • Philip Aagaard · Andrea Natale · Luigi Di Biase
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    ABSTRACT: Manual radio frequency (RF) ablation to restore a normal cardiac rhythm requires significant skill, manual dexterity and experience. In response to this, ablation methods and technologies have evolved rapidly in the past decade, including the development of remote navigation technologies. Today, two principal methods of remote navigation are available. One utilizes magnetic field vectors to navigate proprietary catheters, the other maneuvers standard catheters robotically. The main advantages of remote navigation include improved catheter stability, reduced fluoroscopy times and decreased total radiation exposure to both the patient and the operator. The main limitations include cost and longer procedure times. Remote magnetic navigation appears to have the best safety profile; however, its efficacy in creating lesions may be lower, which has been attributed to the soft-tip catheter used. Remote robotic navigation on the other hand, which uses regular catheter tips, is associated with a slightly higher overall complication rate, but higher efficacy. This article reviews the pros and cons of remote navigation for ablation of both atrial and ventricular substrates. Finally, it attempts to predict the direction of this field in the coming years.
    Expert Review of Medical Devices 07/2015; 12(4):457-469. DOI:10.1586/17434440.2015.1052406 · 1.68 Impact Factor
  • Mary Mosley · A. Natale · L. Di Biase
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    ABSTRACT: In patients with nonvalvular atrial fibrillation who are undergoing catheter ablation, VENTURE AF has shown that uninterrupted rivaroxaban compared with uninterrupted warfarin is associated with a risk of periprocedural thromboembolic events and major bleeding that was similar to that seen with warfarin. An open-label multicenter registry with uninterrupted apixaban vs uninterrupted warfarin yielded the same result.
    07/2015; 15(12):7-8. DOI:10.1177/1559897715593733
  • Jorge Romero · Andrea Natale · Luigi Di Biase
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    ABSTRACT: Atrial fibrillation (AF) related cardioembolic cerebrovascular accidents (CVA) are well-known massive health care problems worldwide.(1, 2) It has been estimated that 2.2 million individuals in America and 4.5 million in Europe have paroxysmal or persistent AF.(3) AF is associated with an increased long-term risk of embolic CVA.(4) The rate of stroke among patients with non-valvular AF averages 5% per year.(5-7) Additionally, the prevalence of AF and the associated risk of ischemic stroke might be to a large extent underestimated given that AF is frequently asymptomatic and undiagnosed.(8) This was corroborated by a recent study, which revealed that subclinical atrial tachyarrhythmias without clinical AF occurred often in patients with pacemakers and were linked to a greater risk of ischemic stroke or systemic embolism.(9) Moreover, prolonged cardiac monitoring with 30-day event monitor or implantable loop recorders has dramatically increased the connection between AF and the so-called "cryptogenic stroke" by a factor of five and double the rate of anticoagulant treatment.(10, 11) This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 06/2015; 26(9). DOI:10.1111/jce.12746 · 2.96 Impact Factor
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    ABSTRACT: Previous studies reported the usefulness of an irrigated circular radiofrequency ablation catheter (nMARQ(TM), Biosense Webster) for pulmonary vein isolation (PVI). We evaluated the role of intracardiac echocardiography (ICE) to optimize the manipulation of nMARQ(TM) catheter. Thirty-seven patients (pts), (mean age 55 ± 12 years; 28 males) were enrolled to perform PVI. All pts underwent PVI with the nMARQ(TM) catheter. In 20 pts (group 1), we utilized ICE to guide nMARQ(TM) catheter positioning at the PV ostia; in the other 17 pts (group 2), nMARQ(TM) catheter was positioned at the PV ostia guided by fluoroscopy and TissueConnect(TM) technology. Radiofrequency (RF) applications were significantly lower in group 1 compared to group 2 [left PVs: 6 (range 3 to 12) in group 1 and 12 (range 5 to 16) in group 2 (p < 0.001); right PVs: 7 (range 4 to 14) in group 1 and 10 (range 5 to 16) in group 2 (p = 0.04)]; similarly regarding the time of RF delivery [left PVs: 318 ± 194 s in group 1 vs. 542 ± 104 s in group 2 (p < 0.001); right PVs: 410 ± 270 s in group 1 vs. 550 ± 156 s in group 2 (p = 0.05)]. Fluoroscopy time (23 ± 9 min vs. 28 ± 5 min; p = 0.05), procedural time (83 ± 23 min vs. 160 ± 42 min; p < 0.001), and radiation dose (109 ± 20 Gy/cm(2) vs. 127 ± 29 Gy/cm(2); p = 0.04) were significantly lower in group 1 compared to group 2. ICE might be a useful tool to guide nMARQ(TM) catheter position in the left atrium during atrial fibrillation (AF) ablation procedures.
    Journal of Interventional Cardiac Electrophysiology 06/2015; 44(1). DOI:10.1007/s10840-015-0026-0 · 1.58 Impact Factor
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    ABSTRACT: -A "dry" epicardial access (EA) is increasingly used for advanced cardiovascular procedures. Conventionally used large bore needles (Tuohy or Pajunk needle; LBN) have been associated with low but definite incidence of major complications with EA. Use of micropuncture needle (MPN) may decrease the risk of complications. We intended to compare the outcomes of LBN with MPN for EA. -We report a multicenter observational study of consecutive patients who underwent EA for ventricular tachycardia (VT) ablation or lariat procedure using the LBN or MPN. Oral anticoagulation was stopped prior to the procedure. Baseline characteristics and procedure related complications were collected and compared. Of the 404 patients, LBN and MPN was used in 46% and 54% of patients respectively. There was no significant difference in the incidence of inadvertent puncture of myocardium between LBN and MPN needle (7.6% vs 6.8%, p=0.76). However, there was a significantly higher rate of large pericardial effusions with LBN compared to MPN (8.1% vs 0.9%: p<0.001). The incidence of pleural effusions were not significantly different between both (1.6% vs 2.3%, p=0.64). LBN group had an increase in "other complications" compared to MP (open heart surgery to repair cardiac laceration (6 vs 0), injury to liver (1vs 0), coronaries (1 vs 0) and superior epigastric artery requiring surgical exploration (0 vs 1). -The use of MPN is associated with decreased incidence of major complications and the need for surgical repair and routine use should be considered for EA.
    Circulation Arrhythmia and Electrophysiology 06/2015; 8(4). DOI:10.1161/CIRCEP.115.002921 · 4.51 Impact Factor
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    ABSTRACT: Visually-guided laser balloon (VGLB) ablation is unique in that the operator delivers ablative energy under direct visual guidance. In this multicenter study, we sought to determine the feasibility, efficacy, and safety of performing pulmonary vein isolation (PVI) using this VGLB. Patients with symptomatic, drug-refractory paroxysmal atrial fibrillation (AF) underwent PVI using the VGLB with the majority of operators conducting their first-ever clinical VGLB cases. The primary effectiveness endpoint was defined as freedom from treatment failure that included: occurrence of symptomatic AF episodes ≥1 min beyond the 90-day blanking, the inability to isolate one superior and two total PVs, occurrence of left atrial flutter or atrial tachycardia, or left atrial ablation/surgery during follow-up. A total of 86 patients (mean age 56±10 years, 67% male) were treated with the VGLB at 10 US centers. Mean fluoroscopy, ablation, and procedure times were 39.8±24.3 min, 205.2±61.7 min, and 253.5±71.3 min, respectively. Acute PVI was achieved in 314/323 (97.2%) of targeted PVs. Of 84 patients completing follow-up, the primary effectiveness endpoint was achieved in 50 (60%) patients. Freedom from symptomatic or asymptomatic AF was 61%. The primary adverse event rate was 16.3% (8.1% pericarditis, phrenic nerve injury 5.8%, and cardiac tamponade 3.5%). There were no cerebrovascular events, atrioesophageal fistulas, or significant PV stenosis. This multicenter study of operators in the early stage of the learning curve demonstrates that PVI can be achieved with the VGLB with a reasonable safety profile and an efficacy similar to radiofrequency ablation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 06/2015; DOI:10.1111/jce.12727 · 2.96 Impact Factor
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    ABSTRACT: Angiotensin-Converting Enzyme Inhibitors (ACEI) reduce AF incidence. To assess the impact of upstream ACEI therapy on post-ablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n 187 (54%), paroxysmal AF [PAF] 44 (23.5%)) and group 2 (ACEI-, n 158 (46%), PAF 31 (16.6%)). Additionally, 703 consecutive patients with LVEF >45% undergoing 1st AF ablation were included for a secondary analysis evaluating effect of ACEI treatment in normal EF. In group 1, ACEI-therapy started ≥3 months pre-ablation and continued through follow-up. Baseline characteristics were similar except for hypertension, which was significantly prevalent in ACEI+ (71% vs. 51%, p <0.001). At 24±7 months follow-up, 109(76%) non-paroxysmal (NPAF) patients in group 1 and 81(64%) in group2 (p = 0.015) were recurrence-free. In multivariate analysis, ACEI therapy was an independent predictor of long-term success [HR 1.7, 95% CI 1.1 to 2.73), p=0.026]. However, in PAF patients, ACEI use was not associated with ablation-success (80% vs. 77% in ACEI+ and ACEI- respectively, p=0.82). In normal-EF population, the success between ACEI+ and ACEI- cohorts were similar (71% vs. 74%, p = 0.36). Following the index procedure, 17 (9.1%) patients in ACEI+ and 28 (17.7%) in ACEI- cohort (p= 0.02) required re-hospitalization, showing 49% relative risk reduction (RR 0.51, [95% CI 0.29 to 0.90]). Pre-ablation use of ACEI is associated with improvement in ablation outcome in NPAF patients with low LVEF. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2015; 12(9). DOI:10.1016/j.hrthm.2015.06.007 · 5.08 Impact Factor
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  • Ranjan K Thakur · Andrea Natale
    Cardiac electrophysiology clinics 06/2015; 7(2):xiii. DOI:10.1016/j.ccep.2015.04.001
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    ABSTRACT: Atrial fibrillation (AF) is the most common arrhythmia in the elderly population and it is associated with a four-fold to five-fold increased risk of thromboembolic events. It was not until the mid-1950s that the left atrial appendage (LAA) was identified as the main location of thrombus formation, particularly in patients with non-valvular AF. In this review, we explain at some extent its embryology, anatomy and physiology, and as well as the clinical and pre-clinical trials published to date testing the safety and efficacy of most LAA closure devices. Among those devices, the most studied include the PLAATO system (ev3 Endovascular, Plymouth, MN), the Amplatzer cardiac plug (St Jude, Golden Valley, MN; St. Jude Medical, Minneapolis, MN), the WATCHMAN device (Boston Scientific, Plymouth, MN; Atritech Inc., Plymouth, MN), and the LARIAT device (SentreHEART, Palo Alto, CA). Similarly, newer LAA closure devices currently under investigation such as the Transcatheter Patch (Custom Medical Devices, Athens, Greece), AEGIS, and the Coherex WaveCrest (Salt Lake City, UT) will also be discussed. Future perspectives and the need for well-designed prospective studies between devices and new oral anticoagulant drugs are also proposed. Copyright © 2015 Elsevier Inc. All rights reserved.
    Trends in Cardiovascular Medicine 06/2015; DOI:10.1016/j.tcm.2015.05.009 · 2.91 Impact Factor
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    ABSTRACT: The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. To examine the association between VT recurrence after ablation and survival in patients with scar-related VT. Analysis of 2,061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in non-ischemic cardiomyopathy). 57 (3%) patients underwent cardiac transplantation and 216 (10%) died during follow-up. At one year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and non-ischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence compared to those with recurrence (90% vs. 71%, p<0.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality (HR 6.9 (5.3-9.0); p<0.001). In patients with EF<30% and across all NYHA classes, improved transplant-free survival was seen in those without VT recurrence. Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 05/2015; 12(9). DOI:10.1016/j.hrthm.2015.05.036 · 5.08 Impact Factor
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    ABSTRACT: VENTURE-AF is the first prospective randomized trial of uninterrupted rivaroxaban and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) undergoing catheter ablation (CA). Trial size was administratively set at 250, the protocol-specified target. Events were independently and blindly adjudicated. We randomly assigned 248 NVAF patients to uninterrupted rivaroxaban (20 mg once-daily) or to an uninterrupted VKA prior to CA and for 4 weeks afterwards. The primary endpoint was major bleeding events after CA. Secondary endpoints included thromboembolic events (composite of stroke, systemic embolism, myocardial infarction, and vascular death) and other bleeding or procedure-attributable events. Patients were 59.5 ± 10 years of age, 71% male, 74% paroxysmal AF, and had a CHA2DS2-VASc score of 1.6. The average total heparin dose used to manage activated clotting time (ACT) was slightly higher (13 871 vs. 10 964 units; P < 0.001) and the mean ACT level attained slightly lower (302 vs. 332 s; P < 0.001) in rivaroxaban and VKA arms, respectively. The incidence of major bleeding was low (0.4%; 1 major bleeding event). Similarly, thromboembolic events were low (0.8%; 1 ischemic stroke and 1 vascular death). All events occurred in the VKA arm and all after CA. The number of any adjudicated events (26 vs. 25), any bleeding events (21 vs. 18), and any other procedure-attributable events (5 vs. 5) were similar. In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy. trial registration number is NCT01729871. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.
    European Heart Journal 05/2015; 36(28). DOI:10.1093/eurheartj/ehv177 · 15.20 Impact Factor

Publication Stats

18k Citations
4,228.25 Total Impact Points


  • 2009–2015
    • University of Texas at Austin
      • Department of Biomedical Engineering
      Austin, Texas, United States
  • 2008–2015
    • Stanford University
      Palo Alto, California, United States
    • St. David's North Austin Medical Center
      Austin, Texas, United States
  • 2014
    • University of Florence
      • Dipartimento di Chirurgia e Medicina Traslazionale (DCMT)
      Florens, Tuscany, Italy
    • University of Rome Tor Vergata
      Roma, Latium, Italy
    • Texas Heart Institute
      Houston, Texas, United States
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • Case Western Reserve University
      Cleveland, Ohio, United States
  • 2011–2014
    • Michigan State University
      • Thoracic and Cardiovascular Institute
      East Lansing, Michigan, United States
  • 2013
    • California Pacific Medical Center Research Institute
      San Francisco, California, United States
  • 2000–2013
    • Cleveland Clinic
      • • Center for Atrial Fibrillation
      • • Department of Cardiovascular Medicine
      • • Department of Cardiology
      Cleveland, Ohio, United States
  • 1990–2013
    • Catholic University of the Sacred Heart
      • Institute of Cardiology
      Milano, Lombardy, Italy
  • 2012
    • Southlake Regional Health Centre
      Bradford West Gwillimbury, Ontario, Canada
    • Ospedale Luigi Sacco
      Milano, Lombardy, Italy
  • 1998–2012
    • University of Kentucky
      • Department of Medicine
      Lexington, Kentucky, United States
  • 2008–2010
    • Università degli studi di Foggia
      Foggia, Apulia, Italy
  • 2007
    • Columbia University
      New York, New York, United States
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
    • Johns Hopkins Medicine
      • Division of Cardiology
      Baltimore, Maryland, United States
  • 2006
    • Spokane VA Medical Center
      Spokane, Washington, United States
    • Marin General Hospital
      San Rafael, California, United States
  • 1995–2006
    • Duke University
      Durham, North Carolina, United States
    • Duke University Medical Center
      • • Division of Cardiology
      • • Department of Medicine
      Durham, NC, United States
  • 2003
    • Massachusetts General Hospital
      • Division of Cardiology
      Boston, Massachusetts, United States
  • 2001
    • Our Lady of Lourdes Hospital
      Camden, New Jersey, United States
  • 1991–1997
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
    • Robarts Research Institute
      London, Ontario, Canada
  • 1994–1995
    • University of Wisconsin - Milwaukee
      Milwaukee, Wisconsin, United States
  • 1989–1993
    • The Catholic University of America
      Washington, Washington, D.C., United States