Peter Hoffmeister’s research while affiliated with Harvard Medical School and other places

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Publications (19)


Figure 2. Pooled atrial fibrillation recurrence rate (95% CI) after ablation between the three heart failure categories. CI: confidence interval; AF: atrial fibrillation; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
Figure 3. Pooled hazard ratio (95% CI) of all-cause mortality and heart failure hospitalization after ablation or other rhythm control compared to other conservative management between the heart failure categories. CI: confidence interval; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
Figure 4. Funnel plot (a) and contour-enhanced funnel plot (b) of atrial fibrillation recurrence post-ablation studies included in meta-analysis. Egger's test P value = 0.4175. CI: confidence interval; HFrEF: heart failure with reduced ejection fraction; HFmrEF: heart with mildly reduced ejection fraction; HFpEF: heart failure with preserved ejection fraction.
Atrial Fibrillation Recurrence Post-Ablation Across Heart Failure Categories: A Systematic Review and Meta-analysis
  • Article
  • Full-text available

February 2025

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12 Reads

Cardiology Research

Carl Hashem

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Jacob Joseph

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Scott Kinlay

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[...]

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Matthew F. Yuyun

Background Previous studies have provided evidence of reduced recurrence of atrial fibrillation (AF), all-cause mortality, and heart failure (HF) hospitalizations after catheter ablation (CA) in both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the efficacy of AF ablation and clinical endpoints in HF with mildly reduced ejection fraction (HFmrEF) to HFrEF and HFpEF are lacking. Methods We conducted a systematic review and meta-analysis aimed at determining any differences in AF recurrence rate, all-cause mortality, and HF hospitalizations among patients with HFrEF, HFmrEF, and HFpEF who underwent AF ablation. A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library databases was performed until October 31, 2023. Results A total of seven studies comprising 3,795 patients were retained: HFrEF 1,281 (33.8%), HFmrEF 870 (22.9%), and HFpEF 1,644 (43.3%). After median follow-up of 24 months, there was no significant difference in rate of AF recurrence between the three HF categories: HFrEF 40% (30-49%), HFmrEF 35% (28-43%); and HFpEF 35% (25-45%). Only two studies which included outcomes in the three HF categories were identified. Pooled hazard ratio (HR) of all-cause mortality and HF hospitalization combined after ablation or other rhythm control compared to other conservative management were: HFrEF 0.77 (0.63 - 0.94); HFmrEF 0.81 (0.55 - 1.20); and HFpEF 0.74 (0.55 - 1.00). Conclusions CA has similar efficacy in the long-term resolution of AF among patients with HFrEF, HFmrEF, and HFpEF. Further studies are needed to provide a robust analysis on the potential impact of CA on all-cause mortality.

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Evolution and Prognosis of Tricuspid and Mitral Regurgitation Following Cardiac Implantable Electronic Devices. A Systematic Review and Meta-analysis

May 2024

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25 Reads

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3 Citations

Europace

Background Significant changes in tricuspid regurgitation (TR) and mitral regurgitation (MR) post-cardiac implantable electronic devices (CIED) are increasingly recognized. However, uncertainty remains as to whether risk of CIED-associated TR and MR differs with right ventricular pacing (RVP) via CIED with trans-tricuspid RV leads, compared to cardiac resynchronization therapy (CRT), conduction system pacing (CSP), and leadless pacing (LP). Aims Synthesize extant data on risk and prognosis of significant post-CIED TR and MR across pacing strategies. Methods We searched PubMed, EMBASE, and Cochrane Library databases published until October 31st, 2023. Significant post-CIED TR and MR were defined as ≥ moderate. Results Fifty-seven TR studies (N=13,723 patients) and 90 MR studies (N =14,387 patients) were included. For all CIED, risk of post-CIED TR increased (pooled odds ratio (OR)=2.46 and 95% CI=1.88-3.22), while risk of post-CIED MR reduced (OR=0.74, 95% CI=0.58-0.94) after 12 and 6 months of median follow-up respectively. RVP via CIED with trans-tricuspid RV leads was associated with increased risk of post-CIED TR (OR=4.54, 95% CI=3.14-6.57) and post-CIED MR (OR=2.24, 95% CI=1.18-4.26). Binarily, CSP did not alter TR risk (OR=0.37, 95% CI=0.13-1.02), but significantly reduced MR (OR =0.15, 95% CI=0.03-0.62). CRT did not significantly change TR risk (OR=1.09, 95% CI=0.55-2.17), but significantly reduced MR with prevalence pre-CRT of 43%, decreasing post-CRT to 22% (OR =0.49, 95% CI=0.40-0.61). There was no significant association of LP with post-CIED TR (OR=1.15, 95% CI=0.83-1.59) or MR (OR=1.31, 95% CI=0.72-2.39). CIED-associated TR was independently predictive of all-cause mortality (pooled hazard ratio (HR)=1.64, 95% CI=1.40-1.90) after median of 53 months. MR persisting post-CRT independently predicted all-cause mortality (HR=2.00, 95% CI=1.57-2.55) after 38 months. Conclusions Our findings suggest that, when possible, adoption of pacing strategies which avoid isolated trans-tricuspid RV leads may be beneficial in preventing incident or deteriorating atrioventricular valvular regurgitation and might reduce mortality.


Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta-analysis

February 2024

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40 Reads

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5 Citations

Journal of Cardiovascular Electrophysiology

Introduction Heart failure (HF) and atrial fibrillation (AF) frequently co‐exist. Contemporary classification of HF categorizes it into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Aggregate data comparing the risk profile of AF between these three HF categories are lacking. Methods We conducted a systematic review and meta‐analysis aimed at determining any significant differences in AF‐associated all‐cause mortality, HF hospitalizations, cardiovascular mortality (CV), and stroke between HFrEF, HFmrEF, and HFpEF. A systematic search of PubMed, EMBASE, and Cochrane Library databases until February 28, 2023. Data were combined using DerSimonian‐Laird random effects model. Results A total of 22 studies comprising 248 323 patients were retained: HFrEF 123 331 (49.7%), HFmrEF 40 995 (16.5%), and HFpEF 83 997 (33.8%). Pooled baseline AF prevalence was 36% total population, 30% HFrEF, 36% HFmrEF, and 42% HFpEF. AF was associated with a higher risk of all‐cause mortality in the total population with pooled hazard ratio (HR) = 1.13 (95% confidence interval [CI] = 1.07−1.21), HFmrEF (HR = 1.25, 95% CI = 1.05−1.50) and HFpEF (HR = 1.16, 95% CI = 1.09−1.24), but not HFrEF (HR = 1.03, 95% CI = 0.93−1.14). AF was associated with a higher risk of HF hospitalizations in the total population (HR = 1.29, 95% CI = 1.14−1.46), HFmrEF (HR = 1.64, 95% CI = 1.20−2.24), and HFpEF (HR = 1.46, 95% CI = 1.17−1.83), but not HFrEF (HR = 1.01, 95% CI = 0.87−1.18). AF was only associated with CV in the HFpEF subcategory but was associated with stroke in all three HF subtypes. Conclusions AF appears to be associated with a higher risk of all‐cause mortality and HF hospitalization in HFmrEF and HFpEF. With these findings, the paucity of data and treatment guidelines on AF in the HFmrEF subgroup becomes even more significant and warrant further investigations.


Abstract 12069: Impact of Atrial Fibrillation on Outcomes in Patients With Heart Failure With Reduced, Mildly Reduced and Preserved Ejection Fraction. A Systematic Review and Meta-Analysis of Published Studies

November 2023

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47 Reads

Circulation

Background: Atrial fibrillation (AF) is highly prevalent in patients with heart failure (HF), however the difference in outcomes between the HF sub-types is not well known. Contemporary classification of HF categorizes it into HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). With the new designation of HFmrEF, there have been studies researching the risk profile of AF in the three HF categories, however there is not yet a unifying statement on these data. Aim: Systematic review and meta-analysis aimed to determine if there are any significant differences in AF-associated all-cause mortality (primary endpoint), heart failure hospitalizations, cardiovascular mortality, and stroke (secondary endpoints) between HFrEF, HFmrEF, and HFpEF. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library databases until February 28 th , 2023, identified studies reporting clinical outcomes linked to AF by HF category status. Data were combined using D+L random effects model. Results: The review included 21 studies comprising 238,107 patients. Pooled AF prevalence: 32% in HFrEF, 38% in HFmrEF, and 43% in HFpEF. AF was associated with a higher risk of all-cause mortality in HFmrEF and HFpEF only (Figure for pooled hazard ratio (HR) and 95% CI). AF associated with a higher risk of HF hospitalizations, in the total population (HR=1.29, 95% CI=1.14-1.46), HFmrEF (HR=1.64, 95% CI=1.20-2.24), and HFpEF (HR=1.46, 95% CI=1.17-1.83), but not HFrEF (HR=1.01, 95% CI=0.87-1.18). AF was only associated with cardiovascular mortality in the HFpEF subcategory but was associated with stroke in all three HF subtypes. Conclusion: AF was associated with a higher risk of all-cause mortality and heart failure hospitalization in HFmrEF and HFpEF only. As treatment guidelines for AF in HFmrEF are limited, the benefit of treatments to control AF in this subgroup should be further investigated.


Flow chart of systematic search of databases
Relative risk of moderate-severe secondary mitral regurgitation (MR) post-cardiac resynchronization compared to pre-cardiac resynchronization therapy (CRT). D + L, DerSimonian-Laird random-effects model; M-H, Mantel–Haenszel fixed-effects model
Pooled hazard ratio (95% confidence interval) of studies comparing of persistent significant unimproved versus improved secondary MR post-cardiac resynchronization therapy and all-cause mortality. D + L, DerSimonian-Laird random-effects model; M-H, Mantel–Haenszel fixed-effects model
A Funnel plot and B contour-enhanced funnel plot of studies included in meta-analysis of hazard ratios of persistent significant secondary mitral regurgitation (MR) post-cardiac resynchronization therapy and all-cause mortality
Sensitivity analysis of studies included in quantification of pooled hazard ratio of persistent significant secondary mitral regurgitation (MR) post-cardiac resynchronization therapy and all-cause mortality
Persistence of significant secondary mitral regurgitation post-cardiac resynchronization therapy and survival: a systematic review and meta-analysis

October 2023

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33 Reads

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1 Citation

Heart Failure Reviews

Cardiac resynchronization therapy (CRT) significantly reduces secondary mitral regurgitation (MR) in patients with severe left ventricular systolic dysfunction. However, uncertainty remains as to whether improvement in secondary MR correlates with improvement with mortality seen in CRT. We conducted a meta-analysis to determine the association of persistent unimproved significant secondary MR (defined as moderate or moderate-to-severe or severe MR) compared to improved MR (no MR or mild MR) post-CRT with all-cause mortality, cardiovascular mortality, and heart failure hospitalization. A systematic search of PubMed, EMBASE, and Cochrane Library databases till July 31, 2022 identified studies reporting clinical outcomes by post-CRT secondary MR status. In 12 prospective studies of 4954 patients (weighted mean age 66.8 years, men 77.8%), the median duration of follow-up post-CRT at which patients were re-evaluated for significant secondary MR was 6 months and showed significant relative risk reduction of 30% compared to pre-CRT. The median duration of follow-up post-CRT for ascertainment of main clinical outcomes was 38 months. The random effects pooled hazard ratio (95% confidence interval) of all-cause mortality in patients with unimproved secondary MR compared to improved secondary MR was 2.00 (1.57–2.55); p < 0.001). There was insufficient data to evaluate secondary outcomes in a meta-analysis, but limited data that examined the relationship showed significant association of unimproved secondary MR with increased cardiovascular mortality and heart failure hospitalization. The findings of this meta-analysis suggest that lack of improvement in secondary MR post-CRT is associated with significantly elevated risk of all-cause mortality and possibly cardiovascular mortality and heart failure hospitalization. Future studies may investigate approaches to address persistent secondary MR post-CRT to help improved outcome in this population.


Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis

February 2021

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16 Reads

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5 Citations

Circulation Arrhythmia and Electrophysiology

Background - Uncertainty still surrounds implantable cardioverter defibrillator (ICD) generator change at time of elective replacement indicator (ERI), in primary prevention patients with improved left ventricular ejection fraction (LVEF) beyond guideline recommendations or without prior appropriate ICD therapies. Methods - We conducted a meta-analysis of studies assessing the risk of appropriate ICD therapies and all-cause mortality after generator change in patients with improved LVEF > 35% versus unimproved LVEF ≤ 35% or patients without versus with prior appropriate ICD therapies during the life of their first ICD generator. A systematic electronic search of PubMed, EMBASE, and Cochrane Library databases until December 31 st , 2019 was performed. Estimates were combined using random-effects model meta-analyses. Results - In 15 studies that included 29730 patients, 25.3% had LVEF improvement >35% at time of generator change. The pooled annual incidence of appropriate ICD therapies was significantly lower in those with improved LVEF, compared to patients with unimproved LVEF: 4.6% versus 10.7%; risk ratio (RR) 0.50 (95% CI 0.36-0.68), p <0.0001. The pooled rate of all-cause mortality was 6.6% versus 10.9% per year, RR of 0.65 (95% CI 0.62-0.69), p < 0.0001. Risk of inappropriate shock was comparable between the two groups (p = 0.750). In 8 studies (N = 27209), the pooled incidence of ventricular arrhythmia (VA) was significantly lower in patients without prior ICD therapies (3.9% per annum), compared to those with prior ICD therapies (12.5 % per annum), RR of 0.37 (95% CI 0.33-0.41), P<0.001. Conclusions - There was significant reduction in risk of ventricular arrhythmias and mortality in patients with improved versus unimproved LVEF or those who received versus those who did not receive appropriate ICD therapies during the life of their first ICD generator. However, we found a substantial residual outcome risk in these groups of patients.


Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis

January 2021

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12 Reads

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19 Citations

Europace

Aims Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. Methods and results We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39–0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30–0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12–0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33–0.66, P < 0.0001). Conclusions Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators.


Posttraumatic stress disorder and mortality in VA patients with implantable cardioverter defibrillator

March 2018

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27 Reads

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3 Citations

Background: The association between posttraumatic stress disorder (PTSD) and mortality in patients undergoing implantable cardioverter defibrillator (ICD) placement has not been evaluated in US veterans. Methods and results: Retrospective cohort of 25,678 veterans who underwent ICD implant between September 30, 2002 and December 31, 2011. 3,280 of these subjects carried the diagnosis of PTSD prior to ICD implant. Primary outcome was mortality from any cause between the date of ICD implant and the end of follow-up, which was September 30, 2013. We used Cox proportional hazard models to compute multivariable adjusted hazard ratios (HR) with corresponding 95% confidence intervals (CI) for the relation between PTSD diagnosis and death following ICD placement. During a mean follow-up of 4.21±2.62 years 11,015 deaths were reported. The crude incidence rate of death was 87.8 and 103.9/1000 person-years for people with and without PTSD respectively. We did not find an association between presence of PTSD before or after ICD implant and incident death when adjusted for multiple risk factors (HR 1.003; 95% CI 0.948-1.061 when adjusted for all covariates). In secondary analysis no statistically significant association was found. Conclusion: In this retrospective cohort study among more than 25,000 veterans undergoing ICD implantation almost 13% had a diagnosis of PTSD. Subjects with PTSD were significantly younger yet they had a higher incidence of CHD, major cardiac comorbidities, cancer, and mental health conditions. Our study did not find an association between presence of PTSD before or after ICD implant and incident death when adjusted for all covariates.


ERRATUM: Unexpected Serious Cardiac Arrhythmias in the Setting of Loperamide Abuse

August 2017

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9 Reads

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5 Citations

Loperamide (Imodium) is a non-prescription opioid receptor agonist available over-the-counter for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain barrier and is reported to produce euphoria, central nervous system and respiratory depression, and cardiotoxicity. There is an emerging trend in its use among drug abusers for its euphoric effects or for self-treatment of opioid withdrawal. We report a case of ventricular dysrhythmias associated with loperamide abuse in a 28-year-old man who substituted loperamide for the opioids that he used to abuse. [Full article available at http://rimed.org/rimedicaljournal-2017-04.asp, free with no login].


Citations (13)


... There is an association between even mild CIED-associated TR and higher mortality rates, with aHR value of 1 In a recent meta-analysis including eight studies with a median follow-up period of 53 months, the pooled adjusted HR for all-cause mortality associated with significant TR post-CIED was 1.64 (1.40-1.90) (p < 0.001, I 2 30.28% and Egger's test p-value = 0.088) [26]. In the first meta-analysis and meta-regression analysis, and thereby the largest study to date evaluating the true incidence and prognostic implications of CIED-associated TR, similar data were found [11]. ...

Reference:

Tricuspid Regurgitation Associated with Implantable Cardiac Devices: A Double-Edged Sword
Evolution and Prognosis of Tricuspid and Mitral Regurgitation Following Cardiac Implantable Electronic Devices. A Systematic Review and Meta-analysis
  • Citing Article
  • May 2024

Europace

... Both conditions are strongly associated with one another and are significant independent causes of cardiovascular morbidity and mortality [1,2]. The presence of AF has been found to accentuate the risk of all-cause mortality and HF hospitalizations among HF subgroups [3][4][5][6]. ...

Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta-analysis
  • Citing Article
  • February 2024

Journal of Cardiovascular Electrophysiology

... A potential implication of the EF improvement with CCM is whether CCM-therapy could render primary prevention ICD indication moot in some patients, who with CCM, experience improvement of EF to > 35%. Nonetheless, in CRT and non-CRT heart failure populations, recovery of EF does not normalize the risk of sudden death [32,34]. There is no data that EF improvement in CCM patients reduces the risk of sudden death, and in fact, there was early concern that the increased intracellular myocardial calcium observed with CCM therapy could increase arrhythmogenicity. ...

Ongoing Risk of Ventricular Arrhythmias and All-Cause Mortality at Implantable Cardioverter Defibrillator Generator Change: A Systematic Review and Meta-Analysis
  • Citing Article
  • February 2021

Circulation Arrhythmia and Electrophysiology

... One of such is patients with CRT, where there is a challenge of balancing the risks of malignant ventricular arrhythmias and non-arrhythmic mortality as CRT affects nonarrhythmic mortality and pro-arrhythmic risks. [29][30][31] Kaplan-Meier time-to-event analyses demonstrated higher non-arrhythmic mortality in CRT-D patients compared to patients with an ICD, potentially attributed to the anti-arrhythmic effect exerted by CRT. Both the MADIT-ICD score and the multimodal ML model, which was trained on a real-world ICD population (37.8% had CRT), showed differences in AUROCs between CRT-D only (0.81, 95% CI: 0.73-0.88) ...

Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis
  • Citing Article
  • January 2021

Europace

... Nearly one-third of patients persist to have PTSD up to 2 years after ACS [9]. In addition to studies in patients with ACS, there is a growing body of research showing that other forms of CVD and CVD-related procedures can also induce PTSD [14]. Particularly 20% of patients with an implantable cardioverter defibrillator (ICD) were found to have PTSD at their initial assessment [15]. ...

Posttraumatic stress disorder and mortality in VA patients with implantable cardioverter defibrillator
  • Citing Article
  • March 2018

... The exact mechanism by which loperamide produces heart rhythm disturbances has not been elucidated, but since it is a piperidine derivative it may behave similarly to Vaughan-Williams class IA, III, and IV antiarrhythmics. It blocks hERG/Ikr potassium channel, cardiac sodium channels, and L-type calcium channels [48]. Blocking these ion channels causes changes on the electrocardiogram, prolongation of the QRS complex due to sodium channel blockade, and prolongation of the QTc interval by blocking hERG potassium channels, which explains the cardiac toxic effects reported for loperamide [49]. ...

ERRATUM: Unexpected Serious Cardiac Arrhythmias in the Setting of Loperamide Abuse
  • Citing Article
  • August 2017

... 8 Other measures-such as combination prophylactic regimens and methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization-have limited data supporting their effectiveness. 38 Evidence supporting topical application of antimicrobials, either through the use of antibacterialimpregnated envelopes (TYRX™, TYRX-A™) or antimicrobial washes is also limited. 39 Bundled approaches, which include a collection of infection prevention measures performed simultaneously, have demonstrated promising effectiveness; however, due to the nature of the study designs, it remains unclear which bundle components are effective and which increase costs and complexity without improving care. ...

Implementation of a Surgical Site Infection Prevention Bundle in the Cardiac Electrophysiology Laboratory for Management of a Cluster of Cardiac Device Infections

Open Forum Infectious Diseases

... For the prevention of POAF, numerous attempts have been made to introduce the cardioprotective potential of n-3 PUFA against ischemia-reperfusion injury [114][115][116][117][118][119]. The supporting rationale is that, among other mechanisms [120], omega-3 PUFA are known to induce low to moderate increments in ROS levels, which leads to a heightened endogenous antioxidant capacity by up-regulating cardiac antioxidant enzymes, e.g., catalase and glutathione peroxidase, through activation of the nuclear factor erythroid 2-related factor 2 transcription factor. ...

Do Omega-3 Fatty Acids Decrease the Incidence of Atrial Fibrillation?
  • Citing Article
  • June 2013

Journal of Atrial Fibrillation

... In particular, aspirin, which is a potent antiplatelet agent, has historically been associated with a lower risk of thrombus formation [118] in the left atrial appendage; however, the most recent guidelines provided by AHA/ACC/HRS 2023 [119] and ESC/EHRA 2024 [2] do not recommend a single antiplatelet treatment over VKA or NOAC administration due to inferiority in stroke prevention. NSAIDs, both non-selective and COX-2-selective, are also known to increase the risk of bleeding in patients taking NOACs and VKAs, which is the rationale for their discouragement among patients with AF. ...

Aspirin Use and Risk of Atrial Fibrillation in the Physicians' Health Study

Journal of the American Heart Association

... Kunutsor et al. conducted a meta-analysis involving approximately 2 million participants and found no significant relationship between PA and AF risk in the general population, though they observed sexspecific differences (39). Similarly, Ofman et al. reported no significant association between PA and AF, challenging the assumption that regular PA provides protection against AF (40). In contrast, our study employed latent class trajectory analysis, allowing for a more nuanced classification of participants based on long-term PA patterns. ...

Regular Physical Activity and Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis.
  • Citing Article
  • March 2013

Circulation Arrhythmia and Electrophysiology