Angel R Leon

Emory University, Atlanta, Georgia, United States

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Publications (104)836.72 Total impact

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    ABSTRACT: The Sprint Fidelis (SF) and the Riata (RT) implantable cardioverter-defibrillator leads have been recalled for premature failure. Data on SF and RT extractions are limited; therefore, we performed a pooled analysis to compare the safety and efficacy of lead extraction for the SF and RT lead families. We retrospectively reviewed consecutive patients undergoing transvenous extraction of SF and RT leads at Emory University and the University of Pittsburgh Medical Center from January 2007 to October 2013. Patients were placed into 2 groups based on the presence of an SF or RT lead. The primary endpoint was a major procedural complication, defined as death, need for urgent cardiac surgery, and hemopericardium or hemothorax that required an intervention. A total of 462 patients underwent extraction of recalled leads (SF, n = 360; RT, n = 102). The mean number of leads extracted in the RT group was higher than in the SF group (1.8 ± 0.9 vs 1.3 ± 0.7, P < .001), and there was a longer implantation time in the RT group (5.5 ± 2.5 vs 4.3 ± 2.0 years, P < .001). Complete procedural success was higher in the SF group (99.4% vs 96.1%, P =.024). Clinical success was similar (SF 99.4% vs RT 97.1%, P = .075). There were 6 major procedural complications in the entire cohort (1.3%). The rate of major complications was not different between the SF and RT groups (SF 1.1% vs RT 2.0%, P = .618). Total mortality was 0.65%, with no difference between the groups CONCLUSION: Our data from 2 high-volume centers suggest that extraction of SF and RT leads is associated with excellent clinical success and a similar rate of major procedural complications. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2015; 12(6). DOI:10.1016/j.hrthm.2015.02.031 · 4.92 Impact Factor
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    ABSTRACT: Although the subcutaneous ICD (S-ICD(®) ) is an attractive alternative in patients with end-stage renal disease (ESRD), data on S-ICD outcomes in dialysis patients is lacking. Patients with cardiomyopathy undergoing S-ICD implantation in our center were stratified by need for chronic dialysis at the time of implant. The primary endpoint was incidence of death, heart failure hospitalization or appropriate S-ICD shocks, and secondary endpoints were incidence of inappropriate shocks or implant related complications requiring surgical re-intervention. Mean follow-up was longer in the non-dialysis cohort (514 ± 495 vs. 227 ± 233 days, p = 0.006), so all endpoints were analyzed using time-dependent comparisons and reported as annual event rates. Out of 79 S-ICD implants included in this analysis, 27 patients were on dialysis. Dialysis patients were older and more likely to be diabetic. Mean ejection fraction across the entire cohort was 26.9% without significant difference between dialysis and non-dialysis groups. Although not significant, the incidence of the primary endpoint was higher in the dialysis cohort (23.8%/year vs. 10.9%/year, p = 0.317), driven primarily by a higher rate of appropriate shocks. The rate of inappropriate shocks was similar between groups (dialysis 6.0%/year vs. non-dialysis 6.8%/year, p = 0.509). No patients in the dialysis cohort had complications requiring surgical re-intervention versus 6 patients in the non-dialysis cohort (p = 0.086). Our data suggest that S-ICD implantation in dialysis patients is not associated with an excess risk of implant related complications or inappropriate shocks. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 05/2015; DOI:10.1111/jce.12705 · 2.88 Impact Factor
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    ABSTRACT: The entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) is the first implantable defibrillator that avoids placing electrodes in or around the heart. Two large prospective studies (IDE [S-ICD System IDE Clinical Investigation] and EFFORTLESS [Boston Scientific Post Market S-ICD Registry]) have reported 6-month to 1-year data on the S-ICD.
    Journal of the American College of Cardiology 04/2015; 363(16). DOI:10.1016/j.jacc.2015.02.047 · 15.34 Impact Factor
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    ABSTRACT: The aim of this study was to retrospectively investigate whether performing surgical atrial fibrillation (AF) ablation in conjunction with cardiac surgery (CS) increases the risk for postoperative permanent pacemaker (PPM) requirement. The 30-day risk for PPM requirement was analyzed in consecutive patients who underwent CS from January 2007 to August 27, 2013. Patients were divided into 3 groups: (1) those who underwent AF ablation concomitant with CS (AF ABL), (2) patients with any history of AF who underwent surgery who did not undergo ablation (AF NO ABL), and (3) those with no histories of AF who underwent surgery (NO AF). Logistic regression analysis was performed adjusting for age, gender, and surgery type. Of 13,453 CS patients, 353 (3%) were in the AF ABL group, 1,701 (12%) in the AF NO ABL group, and 11,399 (85%) in the NO AF group. A total of 7,651 patients (57%) underwent coronary artery bypass grafting, 4,384 (33%) underwent valve surgery, and 1,418 (10%) underwent coronary artery bypass grafting and valve surgery. The overall PPM risk was 1.6% (212 of 13,453); risk was 5.7% (20 of 353) in the AF ABL group, 3.1% (53 of 1,701) in the AF NO ABL group, and 1.2% (139 of 11,399) in the NO AF group. The unadjusted and adjusted odds of PPM were higher in the AF ABL and AF NO ABL groups than in the NO AF group (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.7 to 4.4, and adjusted OR 1.7, 95% CI 1.2 to 2.4, respectively). The unadjusted OR comparing the AF ABL group and the AF NO ABL group was significant (unadjusted OR 1.9, 95% CI 1.9 to 3.2); however, the OR adjusted for surgery type, age, and gender showed a trend toward significance (adjusted OR 1.6, 95% CI 0.9 to 2.7). In conclusion, in this large cohort of patients who underwent CS, surgical AF ablation appeared to carry an increased risk for postoperative PPM implantation. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American journal of cardiology 04/2015; 116(1). DOI:10.1016/j.amjcard.2015.03.046 · 3.43 Impact Factor
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    ABSTRACT: Despite considerable improvements in the medical management of patients with myocardial infarction (MI), patients with large MI still have substantial risk to develop heart failure. In the early post MI setting, implantable cardioverter defibrillators have reduced arrhythmic deaths but have no impact on overall mortality. Hence, additional interventions are required to further reduce the overall morbidity and mortality of patients with large MI. The pacing remodeling prevention therapy (PRomPT) trial is designed to study the effects of peri-infarct pacing in preventing adverse post-MI remodeling. Up to 250 subjects with a peak creatine phosphokinase (CPK) > 3000 U/L (or a troponin T (TnT) > 10 mcg/L) at time of MI will be randomized to either dual-site or single-site biventricular pacing with the LV lead implanted in a peri-infarct region or a non-implanted control. Those randomized to a device will be blinded to the pacing mode, however randomization to a device or control cannot be blinded. Subjects randomized to pacing will have the device implanted within 10 days of MI. The primary objective is to assess the change in left ventricular end diastolic volume (LVEDV) from baseline to 18 months. Secondary objectives are to assess changes in clinical and mechanistic parameters between the groups, including rates of hospitalization for heart failure and cardiovascular events, the incidence of sudden cardiac death and all-cause mortality, NYHA functional class, 6 minute walking distance, and quality of life CONCLUSIONS: The PRomPT trial will provide important evidence regarding the potential of peri-infarct pacing to interrupt adverse remodeling in patients with large MI. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of cardiac failure 03/2015; DOI:10.1016/j.cardfail.2015.03.005 · 3.07 Impact Factor
  • Journal of the American College of Cardiology 03/2015; 65(10):A367. DOI:10.1016/S0735-1097(15)60367-9 · 15.34 Impact Factor
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    ABSTRACT: Despite marked benefits in many heart failure patients, a considerable proportion of patients treated with cardiac resynchronization therapy (CRT) fail to respond appropriately. Recently, a "U-shaped" (type II) wall motion pattern identified by cardiovascular magnetic resonance (CMR) has been associated with improved CRT response compared to a homogenous (type I) wall motion pattern. There is also evidence that a left ventricular (LV) lead localized to the latest contracting LV site predicts superior response, compared to an LV lead localized remotely from the latest contracting LV site. We prospectively evaluated patients undergoing CRT with pre-procedural CMR to determine the presence of type I and type II wall motion patterns and pre-procedural echocardiography to determine end systolic volume (ESV). We assessed the final LV lead position on post-procedural fluoroscopic images to determine whether the lead was positioned concordant to or remote from the latest contracting LV site. CRT response was defined as a ≥ 15 % reduction in ESV on a 6 month follow-up echocardiogram. The study included 33 patients meeting conventional indications for CRT with a mean New York Heart Association class of 2.8 ± 0.4 and mean LV ejection fraction of 28 ± 9 %. Overall, 55 % of patients were echocardiographic responders by ESV criteria. Patients with both a type II pattern and an LV lead concordant to the latest contracting site (T2CL) had a response rate of 92 %, compared to a response rate of 33 % for those without T2CL (p = 0.003). T2CL was the only independent predictor of response on multivariate analysis (odds ratio 18, 95 % confidence interval 1.6-206; p = 0.018). T2CL resulted in significant incremental improvement in prediction of echocardiographic response (increase in the area under the receiver operator curve from 0.69 to 0.84; p = 0.038). The presence of a type II wall motion pattern on CMR and a concordant LV lead predicts superior CRT response. Improving patient selection by evaluating wall motion pattern and targeting LV lead placement may ultimately improve the response rate to CRT.
    Journal of Cardiovascular Magnetic Resonance 01/2015; 17:57. DOI:10.1186/s12968-015-0158-5 · 5.11 Impact Factor
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    ABSTRACT: BACKGROUND Lead malfunction is an important cause of morbidity and mortality in patients with an implantable cardioverterdefibrillator (ICD). We have shown that the failure of recalled highvoltage Leads significantly increases after ICD generator replacement. However, generator replacement has not been recognized as a predictor of lead failure in general. OBJECTIVE The purpose of this study is to assess the effect of ICD generator exchange on the rate of ICD lead alerts. METHODS A time-dependent Cox proportional hazards model was used to analyze a database of remotely monitored ICDs. The model assessed the impact of generator exchange on the rate of lead alerts after ICD generator replacement. RESULTS The analysis included 60,219 patients followed for 37 t 19 months. The 5-year Lead survival was 99.3% (95% confidence interval 99.2%-99.4%). Of 60,219 patients, 7458 patients (12.9%) underwent ICD generator exchange without Lead replacement. After generator replacement, the rate of lead alerts was more than 5-fold higher than in controls with leads of the same age without generator replacement (hazard ratio 5.19; 95% confidence interval 3.45-7.84). A large number of lead alerted within 3 months of generator replacement. Lead alerts were more common in patients with single- vs dual-chamber ICDs and in younger patients. Sex was not associated with Lead alerts. CONCLUSION Routine generator replacement is associated with a 5-fold higher risk of lead alert compared to age-matched leads without generator replacement. This suggests the need for intense surveillance after generator replacement and the development of techniques to minimize the risk of lead damage during generator replacement.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; 11(10). DOI:10.1016/j.hrthm.2014.06.018 · 4.92 Impact Factor
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    ABSTRACT: The recently commercially available Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) utilizes a completely subcutaneous electrode configuration to treat potentially lethal ventricular tachyarrhythmia. Clinical trials have proven its effectiveness in detecting and treating ventricular fibrillation and tachycardia. The S-ICD offers the advantage of eliminating the need for intravenous and intracardiac leads and their associated risks and shortcomings. However, its major disadvantage is its inability to provide bradycardia rate support and anti-tachycardia pacing to terminate ventricular tachycardia. This article reviews the S-ICD clinical trials and the advantages and disadvantages of this novel technology to help the physician identify its role and select candidates that will benefit from this device.
    Journal of the American College of Cardiology 04/2014; 63(15). DOI:10.1016/j.jacc.2014.01.018 · 15.34 Impact Factor
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    ABSTRACT: The subcutaneous ICD system (S-ICD) uses a novel detection algorithm previously shown to discriminate induced tachyarrhythmias (ventricular vs supraventricular) effectively. To evaluate the role of the S-ICD discrimination algorithm in reducing the incidence of spontaneous inappropriate shocks. There were 314 subjects who underwent implantation with an S-ICD System as part of the S-ICD Clinical Investigation (IDE Trial). Subjects were grouped according to programming at discharge, to either a single shock zone or two shock zones, with a discrimination algorithm in the lower rate zone. This cohort had 226 (72%) subjects with dual zone programming and 88 (28%) subjects with single zone programming. Over a mean follow-up period of 661 ± 174 days, inappropriate shocks occurred in 23 subjects from the dual zone sub-group (10.2%) and 23 subjects from the single zone sub-group (26.1%; P < 0.001), with 2 year inappropriate shock free rates of 89.7% vs 73.6%; respectively (HR=0.38; P = 0.001). Freedom from appropriate shocks did not differ between sub-groups (92.2% vs 90.3%; HR=0.82; P=0.64). Moreover, mean time to appropriate therapy did not differ between sub-groups and there was only one episode of arrhythmic syncope in the cohort. The addition of a second shock zone with an active discrimination algorithm was strongly associated with a reduction in inappropriate shocks with the S-ICD system and did not result in prolongation of detection times or increased syncope. These data support the use of dual zone programming as a standard setting for S-ICD patients.
    Heart rhythm: the official journal of the Heart Rhythm Society 04/2014; 11(8). DOI:10.1016/j.hrthm.2014.04.012 · 4.92 Impact Factor
  • Journal of the American College of Cardiology 04/2014; 63(12):A392. DOI:10.1016/S0735-1097(14)60392-2 · 15.34 Impact Factor
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    ABSTRACT: Background Lead malfunction is an important cause of morbidity and mortality in patients with an implantable cardiac defibrillator (ICD). We have shown that failure of recalled high voltage leads significantly increases following ICD generator replacement. However, generator exchange hasn’t been recognized as a predictor of lead failure in general. Objective The purpose of this study is to assess the effect of ICD generator exchange on the rate of ICD lead alerts. Methods A time-dependent Cox proportional hazards model was used to analyze a database of remotely monitored ICDs. The model assessed the impact of generator exchange on the rate of lead alerts following ICD generator replacement. Results The analysis included 60,219 patients followed for 37 ± 19 months. The 5-year lead survival was 99.3% (95% CI 99.2-99.4%). 7458 patients (12.9%) underwent ICD generator exchange without lead replacement. Following generator replacement, the rate of lead alerts was more than 5-fold higher than in controls with leads of the same age without a generator exchange (HR: 5.19, 95% CI: 3.45-7.84). A large number of lead alerted within 3 months of generator exchange. Lead alerts were more common in patients with single vs. dual chamber ICDs and in younger patients. Gender wasn’t associated with lead alerts. Conclusions Routine generator exchange is associated with a 5-fold higher risk of lead alert compared to age-matched leads without generator exchange. This suggests the need for intense surveillance after generator exchange and the development of techniques to minimize the risk of lead damage during generator exchange.
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    ABSTRACT: Background The subcutaneous ICD system (S-ICD) uses a novel detection algorithm previously shown to discriminate induced tachyarrhythmias (ventricular vs supraventricular) effectively. Objective To evaluate the role of the S-ICD discrimination algorithm in reducing the incidence of spontaneous inappropriate shocks. Methods There were 314 subjects who underwent implantation with an S-ICD System as part of the S-ICD Clinical Investigation (IDE Trial). Subjects were grouped according to programming at discharge, to either a single shock zone or two shock zones, with a discrimination algorithm in the lower rate zone. Results This cohort had 226 (72%) subjects with dual zone programming and 88 (28%) subjects with single zone programming. Over a mean follow-up period of 661 ± 174 days, inappropriate shocks occurred in 23 subjects from the dual zone sub-group (10.2%) and 23 subjects from the single zone sub-group (26.1%; P < 0.001), with 2 year inappropriate shock free rates of 89.7% vs 73.6%; respectively (HR=0.38; P = 0.001). Freedom from appropriate shocks did not differ between sub-groups (92.2% vs 90.3%; HR=0.82; P=0.64). Moreover, mean time to appropriate therapy did not differ between sub-groups and there was only one episode of arrhythmic syncope in the cohort. Conclusions The addition of a second shock zone with an active discrimination algorithm was strongly associated with a reduction in inappropriate shocks with the S-ICD system and did not result in prolongation of detection times or increased syncope. These data support the use of dual zone programming as a standard setting for S-ICD patients.
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    ABSTRACT: The most frequent complications associated with implantable cardioverter-defibrillators (ICDs) involve the transvenous leads. A subcutaneous implantable cardioverter-defibrillator (S-ICD) has been developed as an alternative system. This study evaluated the safety and effectiveness of the S-ICD System (Cameron Health/Boston Scientific) for the treatment of life-threatening ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation). This prospective, nonrandomized, multicenter trial included adult patients with a standard indication for an ICD, who neither required pacing nor had documented pace-terminable ventricular tachycardia. The primary safety end point was the 180-day S-ICD System complication-free rate compared with a prespecified performance goal of 79%. The primary effectiveness end point was the induced ventricular fibrillation conversion rate compared with a prespecified performance goal of 88%, with success defined as 2 consecutive ventricular fibrillation conversions of 4 attempts. Detection and conversion of spontaneous episodes were also evaluated. Device implantation was attempted in 321 of 330 enrolled patients, and 314 patients underwent successful implantation. The cohort was followed for a mean duration of 11 months. The study population was 74% male with a mean age of 52±16 years and mean left ventricular ejection fraction of 36±16%. A previous transvenous ICD had been implanted in 13%. Both primary end points were met: The 180-day system complication-free rate was 99%, and sensitivity analysis of the acute ventricular fibrillation conversion rate was >90% in the entire cohort. There were 38 discrete spontaneous episodes of ventricular tachycardia/ventricular fibrillation recorded in 21 patients (6.7%), all of which successfully converted. Forty-one patients (13.1%) received an inappropriate shock. The findings support the efficacy and safety of the S-ICD System for the treatment of life-threatening ventricular arrhythmias. http://www.clinicaltrials.gov. Unique identifier: NCT01064076.
    Circulation 08/2013; 128(9):944-953. DOI:10.1161/CIRCULATIONAHA.113.003042 · 14.95 Impact Factor
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    ABSTRACT: OBJECTIVES: This study sought to investigate the prevalence, predictors, and outcomes of patients with postoperative ventricular arrhythmia (POVA) in a large cohort of patients. BACKGROUND: New-onset POVA after cardiac surgery (CS) is uncommon and has controversial prognostic value. METHODS: A total of 14,720 consecutive patients undergoing CS at Emory University between January 2004 and July 2010 were included in the study. Data on all-cause mortality were obtained from Social Security Administration death records. Multivariable regression models were constructed to determine the risk factors for POVA and to estimate the independent impact of POVA on long-term survival after adjusting for 40 different covariates. RESULTS: POVA occurred in 248 patients (1.7%). Patients with POVA were older (63.5 vs. 61.6 years), had lower left ventricular ejection fraction (EF) (43.7 vs. 51.3), and had greater comorbidities (Society of Thoracic Surgeons mortality risk score of 7.2% vs. 3.1%, p < 0.001). Multivariable analysis showed that older age (odds ratio [OR]: 1.018 per 1-year increase, p < 0.001), emergent surgery (OR: 1.77, p = 0.019), and the presence of PVD (OR: 1.41, p = 0.049) were associated with a higher incidence of POVA, whereas higher left ventricular EF (OR: 0.97 per 1% increase, p < 0.001), mild chronic obstructive pulmonary disease (OR: 0.37, p < 0.001), and off-pump surgery (OR: O.41, p < 0.001) were associated with a lower incidence of POVA. POVA was associated with substantially increased adjusted long-term mortality (hazard rate: 2.53, p < 0.001) over 3.5 years of follow-up. CONCLUSIONS: POVA is associated with increased long-term mortality after CS. Older age, PVD, lower EF, and emergent surgery are associated with a higher risk of POVA, whereas off-pump surgery seems to be protective.
    Journal of the American College of Cardiology 11/2012; 60(25). DOI:10.1016/j.jacc.2012.08.1011 · 15.34 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality and improves symptoms in patients with systolic heart failure (HF) and ventricular dyssynchrony. This randomized, double-blind, controlled study evaluated whether optimizing the interventricular stimulating interval (V-V) to sequentially activate the ventricles is clinically better than simultaneous V-V stimulation during CRT. Patients with New York Heart Association (NYHA) III or IV HF, meeting both CRT and implantable cardioverter-defibrillator indications, randomly received either simultaneous CRT or CRT with optimized V-V settings for 6 months. Patients also underwent echocardiography-guided atrioventricular delay optimization to maximize left ventricular filling. The V-V optimization involved minimizing the left ventricular septal to posterior wall motion delay during CRT. The primary objective was to demonstrate noninferiority using a clinical composite end point that included mortality, HF hospitalization, NYHA functional class, and patient global assessment. Secondary end points included changes in NYHA classification, 6-minute hall walk distance, quality of life, peak VO(2), and event-free survival. The composite score improved in 75 (64.7%) of 116 simultaneous patients and in 92 (75.4%) of 122 optimized patients (P < .001, for noninferiority). A prespecified test of superiority showed that more optimized patients improved (P = .03). New York Heart Association functional class improved in 58.0% of simultaneous patients versus 75.0% of optimized patients (P = .01). No significant differences in exercise capacity, quality of life, peak VO(2), or HF-related event rate between the 2 groups were observed. These findings demonstrate modest clinical benefit with optimized sequential V-V stimulation during CRT in patients with NYHA class III and IV HF. Optimizing V-V timing may provide an additional tool for increasing the proportion of patients who respond to CRT.
    American heart journal 11/2012; 164(5):735-41. DOI:10.1016/j.ahj.2012.07.026 · 4.56 Impact Factor
  • Heart Rhythm 09/2012; 9(9):1579–1580. DOI:10.1016/j.hrthm.2012.06.019 · 4.92 Impact Factor
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    ABSTRACT: The Medtronic Sprint Fidelis defibrillator lead is at an increased risk for failure and was recalled in October 2007. Approximately 268,000 leads were implanted, and more than 100,000 patients still have active Fidelis leads. A number of studies have examined the rate and clinical predictors of lead failure, but none has addressed the effect of an implantable cardioverter-defibrillator generator exchange on subsequent lead failure. Although the manufacturer asserts that "Sprint Fidelis performance after device change-out is similar to lead performance without device change-out," published data are lacking. To assess the effect of implantable cardioverter-defibrillator generator exchange on the rate of Fidelis lead failure. A chart review was conducted in patients who underwent implantation of a Fidelis lead. Patients with a functioning Fidelis lead at generator exchange were compared with controls with leads implanted for a comparable amount of time not undergoing ICD replacement. A total of 1366 patients received a Fidelis lead prior to the recall, of which 479 were still actively followed. Seventy-two patients with a functioning lead underwent generator exchange without lead replacement. Following generator replacement, 15 leads failed. Sixty percent of the Fidelis leads failed within 3 months. Generator exchange increased the rate of lead failure compared with matched controls (20.8% vs 2.54%; P < .001). Generator exchange is associated with a higher than expected rate of Fidelis lead failure, often within 3 months. The risk-benefit ratio of Fidelis lead replacement at the time of generator exchange may be greater than appreciated.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2012; 9(10):1615-8. DOI:10.1016/j.hrthm.2012.06.009 · 4.92 Impact Factor
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    ABSTRACT: The aim of this study was to create a simple risk index to predict new-onset atrial fibrillation (AF) after coronary artery bypass grafting in patients with histories of AF. AF after coronary artery bypass grafting (referred to here as AF) is associated with increased morbidity and mortality. Identifying patients at high risk for developing AF may help identify a group of patients who might benefit from strategies to prevent postoperative AF. A cohort of 18,517 patients enrolled from January 1, 1996, to December 31, 2009, was used to derive a risk index for AF prediction. A multivariate logistic regression model determined the independent predictive impact of clinical and demographic characteristics on the occurrence of AF. A subset of these variables was used to construct a risk index to predict AF. This risk index was validated in a sequential cohort of 1,378 consecutive patients who underwent coronary artery bypass grafting from January 1, 2010, to June 30, 2011. AF occurred in 3,486 patients in the calibration cohort (18.83%) and in 269 patients in the validation cohort (19.52%). After considering patients' demographics, co-morbid conditions, and severity of illness, advanced age appeared as the most powerful predictor of AF (odds ratio 1.059/year, 95% confidence interval 1.055 to 1.063). Age, height, weight, and the presence of peripheral vascular disease contributed most to the prediction model. An AF risk index including these variables had adequate discriminatory power, with a concordance index of 0.68. In conclusion, using a large cohort of patients, a simple risk index relying only on preoperative clinical variables was developed, which will help predict AF. This risk index can be used clinically to identify patients at high risk for the development of AF.
    The American journal of cardiology 05/2012; 110(5):649-54. DOI:10.1016/j.amjcard.2012.04.048 · 3.43 Impact Factor
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    Journal of the American College of Cardiology 03/2012; 59(13). DOI:10.1016/S0735-1097(12)60629-9 · 15.34 Impact Factor

Publication Stats

9k Citations
836.72 Total Impact Points

Institutions

  • 1993–2015
    • Emory University
      • • School of Medicine
      • • Division of Cardiology
      Atlanta, Georgia, United States
  • 2009
    • Boston Scientific
      Boston, Massachusetts, United States
  • 2008
    • Emory Hospitals
      Atlanta, Georgia, United States
  • 1992–1994
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • Georgia Institute of Technology
      • School of Electrical & Computer Engineering
      Atlanta, Georgia, United States