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Robert Kenneth Lewis

Assistant Professor of Medicine
Medicine, Cardiology

Selected Publications


Strategies to maximize lead tensile strength during extraction in three families of pacing leads.

Journal Article Heart Rhythm · January 11, 2024 BACKGROUND: Traction force that can be applied to an extraction rail is based on lead tensile strength, a product of its construction. A strong rail allows safe advancement of the extraction sheath. This study expands previous work providing strategies to ... Full text Link to item Cite

Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection.

Journal Article JAMA Cardiol · December 1, 2023 IMPORTANCE: Complete hardware removal is a class I recommendation for cardiovascular implantable electronic device (CIED) infection, but practice patterns and outcomes remain unknown. OBJECTIVE: To quantify the number of Medicare patients with CIED infecti ... Full text Link to item Cite

Colchicine for the Prevention of Recurrent Arrhythmia After Catheter Ablation of Atrial Fibrillation: Results of a Single-Center, Retrospective Study.

Journal Article Am J Cardiovasc Drugs · November 2023 BACKGROUND: There is evidence to suggest that colchicine reduces the risk of recurrent atrial fibrillation (AF) after catheter ablation; however, the tolerability and safety of colchicine in routine practice is unknown. METHODS: Patients undergoing cathete ... Full text Link to item Cite

Efficacy and Safety of Adjunctive and Primary Use of the TightRail Mechanical Cutting Sheath for Lead Extraction.

Journal Article Circ Arrhythm Electrophysiol · June 2023 BACKGROUND: Rotational cutting tools are increasingly used in transvenous lead extraction. There are limited data on their safety and efficacy, particularly when used adjunctively for stalled progression. The aim of this study was to evaluate the utilizati ... Full text Link to item Cite

Leadless pacemaker implantation after lead extraction for cardiac implanted electronic device infection.

Journal Article J Cardiovasc Electrophysiol · March 2022 BACKGROUND: Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for ma ... Full text Link to item Cite

Cases of Azygous Coil Extraction.

Journal Article Heart Rhythm O2 · February 2022 BACKGROUND: Procedural and clinical outcomes of patients undergoing extraction or removal of azygous coils are not well characterized. OBJECTIVE: Evaluate outcomes in patients who undergo device extraction with an azygous coil in situ. METHODS: Patients un ... Full text Link to item Cite

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience.

Journal Article Heart Rhythm O2 · October 2021 BACKGROUND: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. OBJECTIV ... Full text Open Access Link to item Cite

Strategies to increase the INGEVITY lead strength during lead extraction procedures based on laboratory bench testing.

Journal Article Pacing Clin Electrophysiol · August 2021 BACKGROUND: The INGEVITY lead (Boston Scientific, St Paul, MN, USA) has excellent clinical performance. However, its single filar design results in decreased lead tensile strength and a possible challenging extraction. This study's goal is to evaluate tech ... Full text Link to item Cite

Primary Results From the Understanding Outcomes With the S-ICD in Primary Prevention Patients With Low Ejection Fraction (UNTOUCHED) Trial.

Journal Article Circulation · January 5, 2021 BACKGROUND: The subcutaneous (S) implantable cardioverter-defibrillator (ICD) is safe and effective for sudden cardiac death prevention. However, patients in previous S-ICD studies had fewer comorbidities, had less left ventricular dysfunction, and receive ... Full text Link to item Cite

Subcutaneous implantable cardioverter-defibrillator troubleshooting in patients with a left ventricular assist device: A case series and systematic review.

Journal Article Heart Rhythm · September 2020 BACKGROUND: There are limited data on the performance of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients with a left ventricular assist device (LVAD). OBJECTIVE: The purpose of this study was to describe the clinical course and ... Full text Link to item Cite

Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. BACKGROUND: Many patients with a left ventricular assist device (LVAD) will requ ... Full text Link to item Cite

Catheter ablation of atrial fibrillation in patients with diabetes mellitus.

Journal Article Heart rhythm O2 · August 2020 BackgroundDiabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM.ObjectiveThe purpose of this study ... Full text Open Access Cite

Hands on: How to approach patients undergoing lead extraction.

Journal Article J Cardiovasc Electrophysiol · July 2020 Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preproce ... Full text Link to item Cite

Implantable cardioverter-defibrillator lead revision following left ventricular assist device implantation.

Journal Article J Cardiovasc Electrophysiol · June 2020 INTRODUCTION: Lead dysfunction can lead to serious consequences including failure to treat ventricular tachycardia or fibrillation (VT/VF). The incidence and mechanisms of lead dysfunction following left ventricular assist device (LVAD) implantation are no ... Full text Link to item Cite

Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices.

Journal Article JACC Clin Electrophysiol · June 2020 OBJECTIVES: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). BACKGROUND: The use of transvenous lead ... Full text Link to item Cite

Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication, technique, and approach to interpretation.

Journal Article J Cardiovasc Electrophysiol · March 2020 Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed w ... Full text Link to item Cite

Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation.

Journal Article Am Heart J · February 2020 BACKGROUND: Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter abl ... Full text Link to item Cite

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology.

Journal Article J Arrhythm · February 2020 BACKGROUND: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs ... Full text Open Access Link to item Cite

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems.

Journal Article Pacing Clin Electrophysiol · November 2019 BACKGROUND: Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence af ... Full text Open Access Link to item Cite

Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction.

Journal Article Heart Rhythm · May 2018 BACKGROUND: Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). OBJECTIVE: The purpose of this study was to compare outcomes of AF ablation in pa ... Full text Link to item Cite

Strategies to maximize lead tensile strength during extraction in three families of pacing leads.

Journal Article Heart Rhythm · January 11, 2024 BACKGROUND: Traction force that can be applied to an extraction rail is based on lead tensile strength, a product of its construction. A strong rail allows safe advancement of the extraction sheath. This study expands previous work providing strategies to ... Full text Link to item Cite

Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection.

Journal Article JAMA Cardiol · December 1, 2023 IMPORTANCE: Complete hardware removal is a class I recommendation for cardiovascular implantable electronic device (CIED) infection, but practice patterns and outcomes remain unknown. OBJECTIVE: To quantify the number of Medicare patients with CIED infecti ... Full text Link to item Cite

Colchicine for the Prevention of Recurrent Arrhythmia After Catheter Ablation of Atrial Fibrillation: Results of a Single-Center, Retrospective Study.

Journal Article Am J Cardiovasc Drugs · November 2023 BACKGROUND: There is evidence to suggest that colchicine reduces the risk of recurrent atrial fibrillation (AF) after catheter ablation; however, the tolerability and safety of colchicine in routine practice is unknown. METHODS: Patients undergoing cathete ... Full text Link to item Cite

Efficacy and Safety of Adjunctive and Primary Use of the TightRail Mechanical Cutting Sheath for Lead Extraction.

Journal Article Circ Arrhythm Electrophysiol · June 2023 BACKGROUND: Rotational cutting tools are increasingly used in transvenous lead extraction. There are limited data on their safety and efficacy, particularly when used adjunctively for stalled progression. The aim of this study was to evaluate the utilizati ... Full text Link to item Cite

Leadless pacemaker implantation after lead extraction for cardiac implanted electronic device infection.

Journal Article J Cardiovasc Electrophysiol · March 2022 BACKGROUND: Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for ma ... Full text Link to item Cite

Cases of Azygous Coil Extraction.

Journal Article Heart Rhythm O2 · February 2022 BACKGROUND: Procedural and clinical outcomes of patients undergoing extraction or removal of azygous coils are not well characterized. OBJECTIVE: Evaluate outcomes in patients who undergo device extraction with an azygous coil in situ. METHODS: Patients un ... Full text Link to item Cite

Optimizing mechanically sensed atrial tracking in patients with atrioventricular-synchronous leadless pacemakers: A single-center experience.

Journal Article Heart Rhythm O2 · October 2021 BACKGROUND: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described. OBJECTIV ... Full text Open Access Link to item Cite

Strategies to increase the INGEVITY lead strength during lead extraction procedures based on laboratory bench testing.

Journal Article Pacing Clin Electrophysiol · August 2021 BACKGROUND: The INGEVITY lead (Boston Scientific, St Paul, MN, USA) has excellent clinical performance. However, its single filar design results in decreased lead tensile strength and a possible challenging extraction. This study's goal is to evaluate tech ... Full text Link to item Cite

Primary Results From the Understanding Outcomes With the S-ICD in Primary Prevention Patients With Low Ejection Fraction (UNTOUCHED) Trial.

Journal Article Circulation · January 5, 2021 BACKGROUND: The subcutaneous (S) implantable cardioverter-defibrillator (ICD) is safe and effective for sudden cardiac death prevention. However, patients in previous S-ICD studies had fewer comorbidities, had less left ventricular dysfunction, and receive ... Full text Link to item Cite

Subcutaneous implantable cardioverter-defibrillator troubleshooting in patients with a left ventricular assist device: A case series and systematic review.

Journal Article Heart Rhythm · September 2020 BACKGROUND: There are limited data on the performance of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients with a left ventricular assist device (LVAD). OBJECTIVE: The purpose of this study was to describe the clinical course and ... Full text Link to item Cite

Cardiovascular Implantable Electronic Device Surgery Following Left Ventricular Assist Device Implantation.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD. BACKGROUND: Many patients with a left ventricular assist device (LVAD) will requ ... Full text Link to item Cite

Catheter ablation of atrial fibrillation in patients with diabetes mellitus.

Journal Article Heart rhythm O2 · August 2020 BackgroundDiabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM.ObjectiveThe purpose of this study ... Full text Open Access Cite

Hands on: How to approach patients undergoing lead extraction.

Journal Article J Cardiovasc Electrophysiol · July 2020 Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preproce ... Full text Link to item Cite

Implantable cardioverter-defibrillator lead revision following left ventricular assist device implantation.

Journal Article J Cardiovasc Electrophysiol · June 2020 INTRODUCTION: Lead dysfunction can lead to serious consequences including failure to treat ventricular tachycardia or fibrillation (VT/VF). The incidence and mechanisms of lead dysfunction following left ventricular assist device (LVAD) implantation are no ... Full text Link to item Cite

Lead Extraction for Cardiovascular Implantable Electronic Device Infection in Patients With Left Ventricular Assist Devices.

Journal Article JACC Clin Electrophysiol · June 2020 OBJECTIVES: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD). BACKGROUND: The use of transvenous lead ... Full text Link to item Cite

Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication, technique, and approach to interpretation.

Journal Article J Cardiovasc Electrophysiol · March 2020 Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed w ... Full text Link to item Cite

Safety and efficacy outcomes of left atrial posterior wall isolation compared to pulmonary vein isolation and pulmonary vein isolation with linear ablation for the treatment of persistent atrial fibrillation.

Journal Article Am Heart J · February 2020 BACKGROUND: Pulmonary wall isolation (PWI) is increasingly used as an adjunctive lesion set to compliment pulmonary vein isolation (PVI), especially in patients with persistent atrial fibrillation (AF). The objective was to compare outcomes of catheter abl ... Full text Link to item Cite

Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology.

Journal Article J Arrhythm · February 2020 BACKGROUND: Catheter ablation is an important rhythm control therapy in patients with atrial fibrillation (AF) with concomitant heart failure (HF). The objective of this study was to assess the comparative efficacy of AF ablation patients with ischemic vs ... Full text Open Access Link to item Cite

Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems.

Journal Article Pacing Clin Electrophysiol · November 2019 BACKGROUND: Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence af ... Full text Open Access Link to item Cite

Catheter ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction.

Journal Article Heart Rhythm · May 2018 BACKGROUND: Few studies have examined outcomes of catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) with preserved ejection fraction (HFpEF). OBJECTIVE: The purpose of this study was to compare outcomes of AF ablation in pa ... Full text Link to item Cite

Left Atrial Appendage Electrical Isolation for Treatment of Recurrent Atrial Fibrillation: A Meta-Analysis.

Journal Article JACC Clin Electrophysiol · January 2018 OBJECTIVES: In this study, the authors sought to perform a meta-analysis of controlled studies assessing the relationship between left atrial appendage (LAA) electrical isolation (EI) and recurrent atrial fibrillation (AF). BACKGROUND: LAA triggers could p ... Full text Link to item Cite

Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads.

Journal Article Circulation · October 10, 2017 BACKGROUND: Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads. METHODS: Using the 5% Medicare ... Full text Link to item Cite

Use of Preprocedural MDCT for Cardiac Implantable Electric Device Lead Extraction: Frequency of Findings That Change Management.

Journal Article AJR Am J Roentgenol · April 2017 OBJECTIVE: Five percent of cardiac implantable electric devices (CIEDs) are removed each year. Percutaneous extraction is preferred but can be complicated if the leads adhere to the vasculature or perforate. The goal of this study is to assess the frequenc ... Full text Link to item Cite

Leukocyte iNOS is required for inflammation and pathological remodeling in ischemic heart failure.

Journal Article Basic Res Cardiol · March 2017 In the failing heart, iNOS is expressed by both macrophages and cardiomyocytes. We hypothesized that inflammatory cell-localized iNOS exacerbates left ventricular (LV) remodeling. Wild-type (WT) C57BL/6 mice underwent total body irradiation and reconstitut ... Full text Link to item Cite

Cable externalization and electrical failure of the Riata family of implantable cardioverter-defibrillator leads: A systematic review and meta-analysis.

Journal Article Heart Rhythm · June 2015 BACKGROUND: The Riata class of defibrillator leads were placed under US Food and Drug Association (FDA) advisory as of November 2011 because of high rates of cable externalization (CE) and electrical failure (EF). The overall rates of these complications r ... Full text Open Access Link to item Cite

Optimal management of Riata leads with no known electrical abnormalities or externalization: a decision analysis.

Journal Article J Cardiovasc Electrophysiol · February 2015 INTRODUCTION: Riata and Riata ST implantable cardioverter-defibrillator (ICD) leads (St. Jude Medical, Sylmar, CA, USA) can develop conductor cable externalization and/or electrical failure. Optimal management of these leads remains unknown. METHODS AND RE ... Full text Open Access Link to item Cite

Cardiac implantable electronic device removal in patients with left ventricular assist device associated infections.

Journal Article J Cardiovasc Electrophysiol · November 2014 INTRODUCTION: Heart failure patients with left ventricular assist devices (LVADs) are at risk for infection. Cardiac implantable electronic devices (CIEDs) are commonly present in these patients. The course of infections in patients with an LVAD and a CIED ... Full text Link to item Cite

Preprocedural ECG-gated computed tomography for prevention of complications during lead extraction.

Journal Article Pacing Clin Electrophysiol · October 2014 BACKGROUND: Preprocedural multidetector computed tomography (MDCT) may identify patients at risk for mechanical complications during lead extraction. METHODS: To describe the use and feasibility of computed tomography scanning for preprocedural planning of ... Full text Link to item Cite

Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.

Journal Article Transpl Infect Dis · June 2012 Transmission of pathogens from donor to recipient is a potential complication of organ transplantation. Herein, we describe the clinical course and outcomes of 4 transplant recipients who received tissues from a donor with multi-organ infection with Klebsi ... Full text Link to item Cite

Cardioprotective and antiapoptotic effects of heme oxygenase-1 in the failing heart.

Journal Article Circulation · May 4, 2010 BACKGROUND: Heme oxygenase-1 (HO-1) is an inducible stress-response protein that imparts antioxidant and antiapoptotic effects. However, its pathophysiological role in cardiac remodeling and chronic heart failure (HF) is unknown. We hypothesized that induc ... Full text Link to item Cite

Employee exposure to (222)Rn and (220)Rn in three fish culture stations in Pennsylvania.

Journal Article Health Phys · March 2010 Employee exposures to Rn and Rn were measured in three Commonwealth fish hatcheries using specially designed personal dosimeters to determine whether remediation might be necessary. Employees utilizing the hatch house would wear the dosimeter and keep trac ... Full text Link to item Cite

Impact of valvular calcification on the diagnostic accuracy of transesophageal echocardiography for the detection of congenital aortic valve malformation.

Journal Article Echocardiography · August 2007 BACKGROUND: Degeneration of congenital bicuspid or unicuspid aortic valves can progress more rapidly than that of tricuspid valves, and an early diagnosis significantly impacts decision making and outcome. We hypothesized that the extent of valvular calcif ... Full text Link to item Cite

Evaluation of SLC11A1 as an inflammatory bowel disease candidate gene.

Journal Article BMC Med Genet · March 9, 2005 BACKGROUND: Significant evidence suggests that a promoter polymorphism within the gene SLC11A1 is involved in susceptibility to both autoimmune and infectious disorders. The aim of this study was to evaluate whether SLC11A1 has a role in the susceptibility ... Full text Link to item Cite

A pilot study to determine the feasibility of continuous cefazolin infusion.

Journal Article Surg Infect (Larchmt) · 2002 BACKGROUND: Animal studies have shown that continuous infusion of beta-lactam antibiotics is more effective than intermittent dosing. We studied several dosing regimens of cefazolin in humans to determine safety and whether or not adequate serum and tissue ... Full text Link to item Cite

Identification of candidate genes in ulcerative colitis and Crohn's disease using cDNA array technology.

Journal Article Int J Oncol · October 2001 Inflammatory bowel disease (IBD) follows a multigenic mode of inheritance, encompassing the clinically discrete phenotypes of ulcerative colitis (UC) and Crohn's disease (CD). The risk of malignant transformation of the colon increases with the duration an ... Full text Link to item Cite

Suppository administration of chemotherapeutic drugs with concomitant radiation for rectal cancer.

Journal Article Dis Colon Rectum · December 1997 PURPOSE: Preoperative radiation with combined chemotherapy is effective in shrinking advanced rectal cancer locally and facilitating subsequent surgery. Suppository delivery of 5-fluorouracil is associated with less toxicity and higher rectal tissue concen ... Full text Link to item Cite