Andrea Natale

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

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Publications (645)3943.44 Total impact

  • 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 · 1.78 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; DOI:10.1007/s10840-015-0026-0 · 1.55 Impact Factor
  • 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; DOI:10.1111/jce.12746 · 2.88 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; DOI:10.1161/CIRCEP.115.002921 · 5.42 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 · 2.88 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; DOI:10.1016/j.hrthm.2015.06.007 · 4.92 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
  • Trends in Cardiovascular Medicine 06/2015; DOI:10.1016/j.tcm.2015.05.009 · 2.07 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; DOI:10.1016/j.hrthm.2015.05.036 · 4.92 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; DOI:10.1093/eurheartj/ehv177 · 14.72 Impact Factor
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    ABSTRACT: Electrical storm is an emergency in 'implantation of a cardioverter defibrillator' carriers with ischemic dilated cardiomyopathy (DCM) and negatively impacts long-term prognosis. We evaluated the feasibility, safety, and effectiveness of radiofrequency catheter ablation (RFCA) in controlling electrical storm and its impact on survival and ventricular tachycardia/fibrillation recurrence. We enrolled 27 consecutive patients (25 men, age 73.1 ± 6.5 years) with ischemic DCM and an indication to RFCA for drug-refractory electrical storm. The immediate outcome was defined as failure or success, depending on whether the patient's clinical ventricular tachycardia could still be induced after RFCA; electrical storm resolution was defined as no sustained ventricular tachycardia/ventricular fibrillation in the next 7 days. Of the 27 patients, 1 died before RFCA; in the remaining 26 patients, a total of 33 RFCAs were performed. In all 26 patients, RFCA was successful, although in 6/26 patients (23.1%), repeated procedures were needed, including epicardial ablation in 3/26 (11.5%). In 23/26 patients (88.5%), electrical storm resolution was achieved. At a follow-up of 16.7 ± 8.1 months, 5/26 patients (19.2%) had died (3 nonsudden cardiac deaths, 2 noncardiac deaths) and 10/26 patients (38.5%) had ventricular tachycardia recurrence; none had electrical storm recurrence. A worse long-term outcome was associated with lower glomerular filtration rate, wider baseline QRS, and presence of atrial fibrillation before electrical storm onset. In patients with ischemic DCM, RFCA is well tolerated, feasible and effective in the acute management of drug-refractory electrical storm. It is associated with a high rate of absence of sustained ventricular tachycardia episodes over the subsequent 7 days. After successful ablation, long-term outcome was mainly predicted by baseline clinical variables.
    Journal of Cardiovascular Medicine 05/2015; DOI:10.2459/JCM.0000000000000259 · 1.51 Impact Factor
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    ABSTRACT: Limited data is available regarding the novel Reveal LinQ™ (LinQ) which is a new generation implantable loop recorders (ILRs). We performed a prospective, observational study of all consecutive patients undergoing conventional (Reveal XT™; XT) and LinQ devices at our institution between January 2012 and December 2014. A total of 217 patients underwent ILR implantation. XT was implanted in 105 and LinQ in 112 patients. There were no significant differences in baseline characteristics between the two groups. LinQ implantation using the manufacturer's technique termed, "manufacturer's method" group had significantly higher incidence of pocket infection compared to XT (6/50, 12% vs 3/105, 3%, p=0.032). With modifications to the LinQ implantation technique (using a conventional scalpel and placing a suture when needed to the incision) termed "modified method" group, the rate of infection has decreased significantly compared to "manufacturer's method group" (0/62, 0% vs 6/50, 12%, p=0.004) (Table 3). In multivariate regression analysis, the only independent predictors of infection were younger age (OR 0.95; p=0.04), insertion of LinQ device (OR 30.02; p=0.006) and procedure time (OR 1.07; p=0.03). In our single-center, prospective, observational study we found that with the current implantable techniques, the novel insertable LinQ device is associated with increased risk of complications. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 05/2015; 191:58-63. DOI:10.1016/j.ijcard.2015.04.241 · 6.18 Impact Factor
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    ABSTRACT: Accessory AV-connections capable of antegrade conduction need to be recognized because of the potential for life-threatening arrhythmias. However, the pre-excited ECG pattern may be subtle, especially among left-sided AV-connections. We explored whether additional ECG criteria might help identify left-sided AV-connections. We analyzed 156 patients who underwent an electrophysiology study (EPS) and ablation for paroxysmal supraventricular tachycardias(PSVT). Patients were divided into two groups: those with left-sided AV-connections (Group 1) and all other PSVT (Group 2). Various ECG parameters were compared before and after ablation in both groups. The EPS identified left-sided AV-connections among 43 patients (Group 1) and excluded it among 113 (Group 2). Baseline ECG in Group 1 demonstrated obvious pre-excitation among 24/43 patients (55.8%), the remaining 19/43 missing obvious pre-excitation. R/S ratio ≥0.5 in V1 was noted in 38/43 (88.4%) patients in Group 1 before ablation (median 1.00; IQR 0.58-2.20), including 16/19 (84.2%) patients lacking obvious left-sided AV-connections. Conversely, only 10/113 (8.8%) patients in Group 2 had R/S ratios in V1 ≥0.5 (0.20; 0.10-0.31), p<0.0001. After ablation, the R/S ratio decreased significantly in Group 1 (0.29; 0.17-0.45), p<0.0001. Thus, a combined criterion of classic pre-excitation or R/S ratio ≥0.5 on ECG identified 40/43 left-sided AV-connections (sensitivity 93.0%). The negative predictive value of this combined criterion was 103/106 (97.2%). In symptomatic patients, combining the R/S ratio (≥0.5) in lead V1 with the classic pre-excitation pattern on ECG markedly improves the sensitivity to diagnose left-sided AV-connections. This ratio may be particularly useful among patients lacking obvious pre-excitation. 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.12711 · 2.88 Impact Factor
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    ABSTRACT: Monitoring respiratory rate (RR) is recommended at the time of hospital presentation for acute decompensation in heart failure (HF). Device-based continuous monitoring of RR may be helpful for diagnostic and prognostic stratification after implantable cardioverter-defibrillator (ICD) implantation. This study was undertaken to analyze short- and long-term changes in ICD-measured RR and to relate RR with the patient's clinical status and the occurrence of HF events. One hundred twenty-four consecutive HF patients who received ICD endowed with this diagnostic capability (Boston Scientific Inc., Natick, MA, USA) were prospectively enrolled. Patients were followed up for 12 months. At the baseline, the proportion of New York Heart Association (NYHA) class III-IV was higher among patients with daily maximum RR >27 breaths/min (third tertile) than those with <24 breaths/min (first tertile) (43 vs. 23 %, p < 0.05). Moreover, the ejection fraction was lower (27 ± 7 vs. 34 ± 8 %, p < 0.05). In patients with HF hospitalizations (33 events) and urgent visits for HF (15 events), the weekly average of RR calculated over the 7 days preceding hospital accesses did not differ from values recorded at the baseline and before scheduled follow-up visits. However, the weekly variation in RR (i.e., the difference between maximum and minimum values collected over the week) was significantly higher prior to hospitalization (p < 0.05). A weekly variation >3 breaths/min in maximum RR predicted an impending hospital admission for HF with sensitivity of 73 % and specificity of 57 %. In this study, elevated values of ICD-monitored RR identified patients with worse functional status and lower systolic function. The weekly variation in RR increased before HF exacerbation. This monitoring technology may represent a useful tool in the clinical management of patients with HF.
    Journal of Interventional Cardiac Electrophysiology 04/2015; 43(2). DOI:10.1007/s10840-015-0007-3 · 1.55 Impact Factor
  • Ranjan K. Thakur, Andrea Natale
    04/2015; 1(1):1-2. DOI:10.12945/j.agr.2015.00024-14
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    ABSTRACT: This study examined incidence of AF following cavotricuspid isthmus (CTI) ablation alone or CTI plus prophylactic pulmonary vein isolation (PVI) in patients presenting with isolated atrial flutter (AFL) with no history of AF. We enrolled 216 patients with isolated typical atrial flutter and randomized them to CTI alone (group 1, n = 108, 61.2±9.7 year, 75% male) or CTI+PVI ablation (group 2, n = 108, 62.4±9.3 year, 73% male). Insertible Loop Recorder (ILR) was implanted in 21 and 19 patients from group 1 and 2, respectively. Remaining patients were monitored with event recorders, ECG, 7-day Holter. Follow-up period was for 18±6 months. Compared to group 1, group 2 had significantly longer procedural duration (75.9±33 min vs. 161±48 min [p <0.001]) and fluoroscopy time (15.9±12.3 min vs 56.4+21 min [p<0.001]). At the end of follow-up, 65 (60.2%) in group 1 and 77 (71.3%) in group 2 were arrhythmia free off-AAD (log-rank p = 0.044). A subgroup analysis was performed with 55 year age cut-off. In the <55 age group the CTI only population had similar success as in CTI+PVI, (21 of 24 [83.3%] vs. 19 of 22 [86.4%], respectively, log-rank p = 0.74). In the ≥55 group, having CTI+PVI showed significantly higher success compared to CTI only; 45 of 84 (53.6%) were AF/AT free in CTI only group versus 58 of 86 (67.4%) with CTI+PVI (log-rank p = 0.029). Prophylactic PVI reduced new-onset AF in patients with lone atrial flutter. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 04/2015; DOI:10.1111/jce.12688 · 2.88 Impact Factor
  • Trends in cardiovascular medicine 04/2015; DOI:10.1016/j.tcm.2015.04.006 · 2.07 Impact Factor
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    ABSTRACT: Neurocardiogenic syncope (NCS) is a common clinical condition characterized by abrupt cardiovascular autonomic changes resulting in syncope. This is a recurring condition with mixed results from current strategies of treatment. Subjects with a diagnosis of NCS were screened and enrolled. All the participants were given a DVD containing yoga videos and were instructed to practice yoga therapy for 60 min, three times a week for 3 consecutive months. Syncope functional status questionnaire score (SFSQS) was administered at the beginning and the end of the study. The subjects were followed for 3 months and underwent repeat tilt table testing at the end of the study. Of the 60 patients screened, 44 subjects were enrolled, 21 in the intervention group and 23 in the control group. Most of the participants were females, and the mean age was 21 ± 3 years. In the intervention group, who finished the yoga regimen, there was a statistically significant improvement from control phase to the intervention phase, in number of episodes of syncope (4 ± 1 vs 1.3 ± 0.7, p < 0.001) and presyncope (4.7 ± 1.5 vs 1.5 ± 0.5, p < 0.001). The mean SFSQS also decreased from 67 ± 7.8 to 29.8 ± 4.6 (p < 0.001). All subjects had positive head up tilt table (HUTT) study at the time of enrollment compared to only six patients at the completion of intervention phase (10/100 vs 6/28 %, p < 0.0001). Yoga therapy can potentially improve the symptoms of presyncope and syncope in young female patients with NCS.
    Journal of Interventional Cardiac Electrophysiology 04/2015; 43(2). DOI:10.1007/s10840-015-9996-1 · 1.55 Impact Factor
  • Philip Aagaard, Luigi Di Biase, Andrea Natale
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    ABSTRACT: HF and AF are on the rise and often coexist. Pharmacologic rhythm control has not been shown to improve outcomes compared with pharmacologic rate control. It is possible that the benefits of maintaining SR are offset by the adverse effects of AADs. Catheter ablation of AF offers an opportunity to achieve SR without the downside of AADs. Several studies have shown that AF ablation improves prognostic markers, including ventricular function, exercise tolerance, and perceived quality of life in HF patients. Studies addressing the impact of this treatment strategy on cardiovascular outcomes and cost-effectiveness are ongoing. Copyright © 2015 Elsevier Inc. All rights reserved.
    Heart Failure Clinics 04/2015; 11(2):305-317. DOI:10.1016/j.hfc.2014.12.008 · 1.41 Impact Factor

Publication Stats

17k Citations
3,943.44 Total Impact Points


  • 2009–2015
    • University of Texas at Austin
      • Department of Biomedical Engineering
      Austin, Texas, United States
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2008–2015
    • Stanford University
      Palo Alto, California, United States
    • St. David's North Austin Medical Center
      Austin, Texas, United States
  • 2014
    • Texas Heart Institute
      Houston, Texas, United States
    • University of Florence
      • Dipartimento di Chirurgia e Medicina Traslazionale (DCMT)
      Florens, Tuscany, Italy
    • Case Western Reserve University
      Cleveland, Ohio, United States
    • University of Rome Tor Vergata
      Roma, Latium, Italy
    • Kansas City VA Medical Center
      Kansas City, Missouri, 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
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • 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
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
    • Columbia University
      New York, New York, 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
      Durham, NC, United States
  • 2003–2005
    • Klinikum Coburg
      Landkreis Coburg, Bavaria, Germany
    • Massachusetts General Hospital
      • Division of Cardiology
      Boston, Massachusetts, United States
    • Baptist Hospital
      Nashville, Tennessee, United States
  • 2003–2004
    • University of California, San Francisco
      • Division of Cardiology
      San Francisco, California, United States
  • 1991–1997
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
  • 1994–1996
    • University of Wisconsin - Milwaukee
      Milwaukee, Wisconsin, United States
  • 1991–1993
    • Robarts Research Institute
      London, Ontario, Canada
  • 1989–1993
    • The Catholic University of America
      Washington, Washington, D.C., United States