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Introduction
Current institution
Additional affiliations
July 2017 - present
July 2017 - present
January 2013 - December 2016
Publications
Publications (126)
Aims
Atrial fibrillation (AF), the most common sustained arrhythmia in adults, is increasing in prevalence globally. Catheter ablation (CA), particularly pulmonary vein isolation (PVI), is a key treatment option. Pulmonary vein isolation can be performed using different energy sources, including cryoballoon ablation (CBA), radiofrequency ablation (...
Aim
A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in pati...
Background
While Atrial fibrillation is considered a risk factor for tricuspid regurgitation (TR), prospective long term data in the field is lacking. This analysis aimed to identify risk factors of TR progression during a decade of follow up among patients with and without AF.
Methods
Patients with full echocardiographic and clinical follow of at...
Background
Within cardiovascular medicine, AI-driven electrocardiogram (ECG) analysis has emerged as a powerful tool, capable of predicting clinically significant abnormalities. The increasing growth of wearable technologies for ECG monitoring underscores the importance of advancing AI methodologies. While Convolutional Neural Networks (CNNs) have...
Background
Exercise Stress Testing (EST), an inexpensive noninvasive modality, is widely used for preliminary cardiovascular evaluation and ongoing monitoring of cardiac patients. The MET (Metabolic Equivalent of Task) score from EST, indicating physical fitness, is associated with overall mortality risk and is extremely helpful for preoperative ev...
Background and aims
Long-term data on atrial fibrillation (AF) impact on tricuspid regurgitation (TR) progression and its relation to pulmonary pressure are scant. We investigated this association in a study spanning over a decade.
Methods and results
Adults with echocardiographic evaluation before 2014, free of significant TR, were included. Pati...
Background
Ventricular arrhythmias (VAs) after atrial fibrillation (AF) electrical cardioversion (ECV) have been reported.
Objective
We sought to assess incidence, timing, and clinical characteristics of patients with post-AF ECV-related VAs.
Methods
Multicenter observational retrospective study including 13 centers, incorporating patients with V...
Background
Diagnosis of Brugada syndrome (BrS) may be established by exposing a Type 1 Brugada pattern using a sodium channel blocker. Data on the outcomes of different patient populations with drug‐induced Type 1 Brugada pattern are limited. The present study reports on the characteristics and outcome of subjects with ajmaline induced Type 1 Bruga...
Background
Permanent pacing is often required following valve intervention (either surgical or percutaneous), however tricuspid interventions pose specific challenges to conventional pacing.
Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention.
Objective...
Background
Electromechanical window (EMW) negativity is a novel parameter that identifies long-QT syndrome (LQTS) patients at increased arrhythmia risk. Whether the EMW remains stable or alters, especially close to arrhythmic events, is unknown.
Purpose
To study temporal variability of the EMW in controls and in patients with LQTS or drug-induced...
Background
Cases of ventricular arrhythmias (VAs) associated with QT prolongation after electrical cardioversion (ECV) for atrial fibrillation have been reported.
Purpose
To assess the incidence, timing and clinical characteristics of patients with VAs post-ECV for AF.
Methods
This is a multicenter international study. Seventy-seven centers were...
Background
Pulmonary vein isolation (PVI) has become an essential therapeutic approach for managing paroxysmal and persistent atrial fibrillation. Besides the fact its application increases, a substantial proportion of patients will suffer from arrhythmia recurrence.
Objectives
This study aims to determine the clinical and echocardiographic factor...
Background and Aims
Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-r...
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electri...
Background
Permanent pacing is often required following valve intervention (either surgical or percutaneous); however, tricuspid interventions pose specific challenges to conventional pacing. Therefore, leadless pacemaker (LP) implantation may be the preferred strategy when permanent pacing is required after tricuspid valve intervention.
Purpose
T...
Background
Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication.
Objectives
We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry.
Methods
Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device...
Background and Aims
Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to asses...
Levetiracetam is widely used in post-stroke epilepsy. However, it is suspected to possess P-glycoprotein (P-gp) induction properties, and therefore, a potentially significant interaction with direct oral anticoagulants (DOACs). We aimed to search for ischemic stroke signals with levetiracetam and the DOACs.
In this retrospective pharmacovigilance s...
Introduction
New-onset atrial fibrillation (AF) occurs in 25-50% of patients after cardiac surgery. For some patients, post-operative AF (POAF) is thought to be a transient entity, while in others it represents a first presentation of paroxysmal or persistent AF. The long-term rate of AF recurrence in patients with POAF is not well defined.
Object...
Introduction
Clinical outcome of patients with hypertrophic cardiomyopathy (HCM) largely depends on ventricular arrhythmias. Parametric T2 mapping from Cardiac MRI (CMR) was found to be a measure of myocardial edema. We sought to study whether elevated T2 values on CMR in patients with hypertrophic cardiomyopathy (HCM) might predict ventricular arr...
Background: Levetiracetam is widely used in post stroke epilepsy. However, it is suspected to possess P-glycoprotein induction properties and therefore a potential significant interaction with DOACs . Our aim was to search for ischemic stroke signals with levetiracetam and the DOACs.
Methods: In this retrospective, pharmacovigilance study, we used...
Mitral valve prolapse (MVP) is the most frequent valve condition but remains a conundrum in many aspects, particularly in regard to the existence and frequency of an arrhythmic form (AMVP) and its link to sudden cardiac death. Furthermore, the presence, frequency, and significance of the anatomic functional feature called mitral annular disjunction...
This article will discuss the past, present, and future of ventricular tachycardia ablation and the continuing contribution of the Europace journal as the platform for publication of milestone research papers in this field of ventricular tachycardia ablation.
Background:
Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden cardiac death (SCD). Ventricular fibrillation (VF) is thought to be the common culprit arrhythmia.
Objective:
To describe the incidence and predictors of sustained ventricular arrhythmias (VTA) in HCM patients.
Methods:
We retrospectively analyzed all patients wi...
Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure’s end) in 2014–2...
Background
Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the...
Funding Acknowledgements
Type of funding sources: None.
Introduction
Diagnosis of Brugada Syndrome (BrS) is established either by a observing a spontaneous Type 1 Brugada pattern on ECG or by unmasking Type 1 pattern with a drug challenge using a sodium channel blocker in suspected individuals. There are no clear indications on when to apply the A...
Brugada syndrome (BrS) is a primary electrical disease predisposing to ventricular tachyarrhythmias and sudden cardiac death [...]
Background:
Atrial fibrillation (AF) in young adults is an uncommon and not well studied entity.
Methods:
Consecutive patients aged 18-45 years admitted to internal or cardiology services in a large tertiary medical center (January 1, 2009 through December 31, 2019) were included. Clinical, electrocardiographic, and echocardiographic data were c...
Background:
Diabetes mellitus (DM) type 2 is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with AF undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM type 2 on early and long-term outcomes of patients following surgica...
Background: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with (AF) undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM on early and long-term outcomes of patients following surgical AF ablation...
(1) Background: Implantable cardioverter defibrillators (ICDs) have become the standard of care in the prevention of sudden cardiac death, yet studies have shown that competing causes of death may limit ICD benefits. The Norton scale is a pressure ulcer risk score shown to have prognostic value in other fields. The purpose of this study was to asse...
Objectives
Ventricular tachycardia ablation (VTA) with hemodynamic compromise presents a challenge. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support allows the safe completion of the procedure. There are limited data regarding the safety of weaning off VA-ECMO at the end of the procedure. We report our experience with early VA-EC...
Background
The use of cardiovascular implantable electronic device (CIED) is steadily increasing, and complications include venous occlusion and fractured leads. Transvenous lead extraction (TLE) can facilitate the re-implantation of new leads.
Aims
This study aims to explore predictors and complications of non-infectious TLE.
Methods
This study...
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Risk stratification scheme. Risk stratification aiming at assessing the risk of VAs and SCD in patients with MVP, involving two phases based on the clinical and imaging context and the uncovered arrhythmia. In the absence of ventricular tachycardia, phenotypic risk features will trigger the intensity of screening for...
Funding Acknowledgements
Type of funding sources: None.
Background
Left atrial appendage occlusion (LAAO) had emerged as an alternative to anticoagulation in patients with non-valvular atrial fibrillation and a contraindication to long-term oral anticoagulants (OAC). LAAO implantation aims to reduce the risk of both systemic thromboembolism and th...
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular implantable electronic device (CIED) use is steadily increasing, with subsequent need to solve lead failure issues and device upgrades with an occluded vein. Transvenous lead extraction (TLE) has inherent risks that must be carefully weighed. Currently there is lack...
Funding Acknowledgements
Type of funding sources: None.
Introduction
An implantable cardioverter-defibrillator (ICD) is used in selected high-risk hypertrophic cardiomyopathy (HCM) patients in order to prevent sudden arrhythmic death. The unique features of this population raise concerns regarding the reliability of successful defibrillation.
Pur...
INTRODUCTION: Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE requiring femoral vein bailout are poorly defined. We aimed to analyze predictors and consequences of TLE requiring femoral bailout. METHODS: A single tertiary center cohort of 421 consecutive patients who underwent TLE betwe...
Aims:
To describe the phenotype, genetics, and events associated with the development of hypertrophic cardiomyopathy (HCM) with reduced ventricular function (HCMr). Heart failure in HCM is usually associated with preserved ejection fraction, yet some HCM patients develop impaired systolic function that is associated with worse outcomes.
Methods a...
None. This article is protected by copyright. All rights reserved
Background
Mitral-valve-prolapse (MVP) is often considered benign but recent suggestion of an arrhythmic MVP form (AMVP) remains incompletely defined and uncertain.
Purpose
To determine ventricular-arrhythmia prevalence, severity, phenotypical context and independent impact on outcome in patients with MVP.
Methods
A cohort of 595 (65 ± 16 years,...
Background
Clinical knowledge regarding mitral annulus disjunction (MAD) of mitral-valve-prolapse (MVP) remains limited, controversial and its potential link with untoward outcomes unsubstantiated.
Purpose
To assess in MVP-patients, MAD prevalence, phenotypic characteristics and long-term outcome (clinical arrhythmic events and excess-mortality)....
Aim
To describe clinical characteristics, procedural details, specific challenges, and outcomes in patients with HeartMate3™ (HM3), a left ventricular assist device system with a magnetically levitated pump, undergoing ventricular tachycardia ablation (VTA).
Methods and results
Data were collected from patients with an HM3 system who underwent VTA...
Background
Transvenous Lead Extraction (TLE) is usually performed via a superior approach. Predictors and outcomes of TLE via femoral vein bailout are ill defined.
Methods
A single tertiary center cohort of 426 consecutive patients who underwent TLE between May 2010 and February 2020 were analyzed. Venography was routinely performed before system...
Objectives
The aim of this study was to assess in patients with mitral valve prolapse (MVP) mitral annular disjunction (MAD) prevalence, phenotypic characteristics, and long-term outcomes (clinical arrhythmic events and excess mortality).
Background
Clinical knowledge regarding MAD of MVP remains limited and controversial, and its potential link w...
Introduction
To assess in MVP-patients, MAD prevalence, phenotypic characteristics and long-term outcome.
Method
A cohort of 595 (278 female, age 61 ± 16 years) patients with isolated MVP, clinical, rhythmic, Doppler-echocardiographic and MAD assessment was examined. MAD prevalence, phenotype and outcome (survival, clinical arrhythmic events) star...
Funding Acknowledgements
Type of funding sources: None.
Introduction
Atrial fibrillation (AF) onset in the young (≤45 years) is uncommon and not well studied.
Purpose
Identifying the determinants of AF in this population in order to help direct timely diagnosis, appropriate follow up and management.
Methods
We retrospectively evaluated all patie...
Funding Acknowledgements
Type of funding sources: None.
Background
HeartMate3TM (HM3) is a relatively new left ventricular assist device (LVAD) system. Its design and magnetically levitated pump may impact VTA.
Objectives
To describe clinical characteristics, procedural details, specific challenges and outcomes in patients with HM3 referred for v...
Objectives
To assess in MVP-patients, MAD prevalence, phenotypic characteristics and long-term outcome.
Methods
A cohort of 595 (278 female, age 61 ± 16 years) consecutive patients with isolated MVP, comprehensive clinical, rhythmic, Doppler-echocardiographic and consistent MAD assessment, was examined. MAD prevalence, associated MVP-phenotype and...
Modern implantable cardioverter‐defibrillators (ICDs) include many of the features seen in pacemakers and are therefore capable of adequately treating bradycardia. As the utilization of ICDs expanded and the majority of devices are now implanted for the primary prevention of sudden arrhythmic death, we are faced with the challenge of tailoring and...
We present an asymptomatic 26-year-old athlete, with no family history of sudden cardiac death and no structural heart disease, who displayed short-coupled premature ventricular contractions on exercise test and Holter monitoring. The rarity of the case as well as management dilemmas are discussed. (Level of Difficulty: Intermediate.)
We appreciate the interest and the questions generated by our arrhythmic mitral valve prolapse (AMVP) report.
Dr. Han and colleagues and Dr. Muthukumar and colleagues discuss coexistent coronary artery disease (CAD), mainly based on age, which is also mentioned by Papatheodorou and Anastasakis. We did not observe a link arrhythmia–CAD: severe vent...
Background:
Mitral-annulus-disjunction (MAD), often described in mitral-valve-prolapse (MVP) patients, remains incompletely defined and its clinical outcome consequences are unknown.
Objectives:
To assess MAD prevalence, clinical and echocardiographic characteristics, and independent impact on outcome in patients with isolated-MVP.
Methods:
A coh...
Introduction
Hypertrophic cardiomyopathy (HCM) is a structural heart disease defined by an increase in left-ventricular (LV) wall thickness, that may be complicated with a clinical syndrome of heart failure, arrhythmia and death.
Purpose
To characterize the clinically significant factors for female HCM patients and bring forward the awareness to g...
Background
Advanced hypertrophic cardiomyopathy (HCM) may be complicated by a dilated hypokinetic transformation. Reduced left ventricular ejection fraction (HFrEF) has been described in terms of specific risks of morbidity and mortality, and specifically in terms of increased risk for fatal arrhythmias. Nevertheless, recent publications have caste...
Background
Mitral valve prolapse (MVP) is often considered benign but recent suggestion of an arrhythmic MVP (AMVP) form remains incompletely defined and uncertain.
Objectives
This study determined ventricular arrhythmia prevalence, severity, phenotypical context, and independent impact on outcome in patients with MVP.
Methods
A cohort of 595 (ag...
Purpose
Response to cardiac resynchronization therapy (CRT) is well-established in patients with typical left bundle branch block (LBBB) but modest or even negative in those with intraventricular conduction delay (IVCD). However, IVCD pattern is heterogeneous, and it is possible that QRS patterns may also respond to CRT.
Methods
Consecutive baseli...
Background
The majority of patients with of Mitral-valve-prolapse (MVP) have a excellent prognosis. Until recently most cases of mortality were thought to be related to mitral regurgitation and left ventricular dysfunction. The concept of the arrhythmic MVP emerged to describe cases of sudden cardiac death (SCD) in the presence of isolated MVP yet...
After 50 years of a fundamentally unchanged pacemaker schema—a pulse generator with battery and electronics connects to insulated conductors (leads) that sense and stimulate atrial and/or ventricular myocardium—the basic paradigm of how cardiac tissue is stimulated to treat arrhythmias is dramatically changing. The aim of this chapter is to review...
Background:
The clinical benefit of primary prevention implantable cardioverter-defibrillator (ICD) therapy in asymptomatic patients (New York Heart Association [NYHA] functional class I) with ischemic cardiomyopathy and left ventricular dysfunction is continually disputed.
Objective:
The purpose of this study was to evaluate the incidence of ve...
Background:
Catheter ablation (CA) is a well-established therapeutic option for patients with recurrent symptomatic atrial fibrillation (AF). Data on gender-related differences are limited with regard to baseline characteristics and long-term success rates of catheter ablation for AF.
Methods:
We analyzed a cohort of 251 consecutive patients who...
Cardiac implantable electronic devices (CIED) are utilized in increasing number and in heterogeneous populations. With excellent training, checklists and “muscle memory”, the implantation procedure is generally very safe and efficient. Nevertheless, significant and potentially life‐threatening complications can occur.
Aims:
Diabetes mellitus (DM) aggravates the clinical features of ischaemic and hypertensive heart diseases and worsens the prognosis of heart failure patients. Hypertrophic cardiomyopathy (HCM) and diabetes coexist fairly frequently in elderly patients but the impact of DM on the clinical phenotype of HCM is yet unknown. We sought to describe if p...
The burden of atrial fibrillation (AF) is projected to increase substantially over the next decade in parallel with the aging of the population. The increasing age, level of comorbidity, and polypharmacy will complicate the treatment of older adults with AF. For instance, advanced age and chronic kidney disease have been shown to increase the risk...
Background
Takotsubo cardiomyopathy affects between 1.7% and 2.2% of patients hospitalized with suspected acute coronary syndromes. Characterized by chest pain, electrocardiogram changes, and transient left ventricular apical wall motion abnormality, it is under-recognized and often misdiagnosed.
Objectives
In order to better differentiate between...
Background:
About half of all patients with heart failure are diagnosed with heart failure preserved ejection fraction (HFpEF). Until now, studies have failed to show that medical treatment improves the prognosis of patients with HFpEF.
Objectives:
To evaluate changes in exercise capacity of patients with HFpEF compared to those with heart failu...
Atrial fibrillation (AF) is associated with increased morbidity and mortality. We sought to determine whether atrial premature complexes (APCs) detected during a standard exercise stress test (EST) in patients undergoing cardiac rehabilitation (CR) are associated with an increased risk of AF. The present study population comprised 6,523 consecutive...
Introduction
There are limited contemporary data regarding the association between improvement in cardiovascular fitness in heart failure patients who participate in a cardiac rehabilitation programme and the risk of subsequent hospitalisations.
Methods
The study population comprised 421 patients with heart failure who participated in our cardiac...
Background:
Multiform fascicular tachycardia (FT) was recently described as a ventricular tachycardia (VT) that has a reentrant mechanism using multiple fascicular branches and produces alternate fascicular VT forms. Ablating the respective fascicle may cause a change in the reentrant circuit resulting in a change in morphology. Ablation of the se...
Background:
Multiform fascicular tachycardia (FT) was recently described as a ventricular tachycardia (VT) that has a reentrant mechanism using multiple fascicular branches and produces alternate fascicular VT forms. Ablating the respective fascicle may cause a change in the reentrant circuit resulting in a change in morphology. Ablation of the se...
Importance
Dual anti-platelet therapy represents standard care for treating patients with ST-segment elevation myocardial infarction (STEMI). Ticagrelor is a direct-acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation.
Objective
To evaluate whether chewing a loading dose (LD) of ticagrelor, 180 mg, vs...
Background:
Left posterior fascicular ventricular tachycardia (LPF-VT) is frequently misdiagnosed as supraventricular tachycardia with aberrant right bundle branch block (RBBB) and left anterior hemiblock (LAHB). The purpose of the present study was to define the morphological ECG characteristics of LPF-VT and attempt to differentiate it from RBBB...
(E. coli) endocarditis is a rare disease, accountable for only a fraction of the definite endocarditis cases.
As such, thorough elimination of endocarditis is not considered to be a common practice in the workup of patients presenting with E. coli bacteremia. The presence of an implanted pacemaker increases the risk for the development of infective...
Background
Young women are usually protected against coronary artery disease due to hormonal and risk-factor profile. Previous studies have suggested poorer outcome in women hospitalized with acute coronary syndrome as compared to men. However, when adjusted to age and other risk factors, this difference does not remain significant. We compared the...
It was the study objective to evaluate whether chewing a 180 mg loading dose of ticagrelor versus an equal dose of traditional oral administration, enhances inhibition of platelet aggregation 1 hour (h) after administering a ticagrelor loading dose in non-ST elevation myocardial infarction (NSTEMI) patients. Dual anti-platelet therapy represents st...
