Scholars@Duke
Sean Pokorney

Sean Pokorney

Assistant Professor of Medicine
Medicine, Cardiology

Selected Publications

Design and rationale of a pragmatic randomized clinical trial of early dronedarone versus usual care to change and improve outcomes in persons with first-detected atrial fibrillation - the CHANGE AFIB study.

Journal Article Am Heart J · January 2025 BACKGROUND: While there are several completed clinical trials that address treatment strategies in patients with symptomatic and recurrent atrial fibrillation (AF), there are no randomized clinical trials that address first-line rhythm control of new-onset ... Full text Link to item Cite

Indications for Lead Extraction.

Journal Article Cardiac electrophysiology clinics · December 2024 Cardiac implantable electronic devices (CIEDs) are being implanted at increasing rates. Patients with CIEDs require more lead management in contemporary clinical practice, given the increased survival of heart failure patients. There are multiple indicatio ... Full text Cite

Transvenous extraction of conduction system and lumenless pacing leads.

Journal Article J Cardiovasc Electrophysiol · December 2024 INTRODUCTION: Conduction system pacing (CSP), often accomplished with lumenless pacing leads, is increasingly employed to achieve physiologic ventricular activation. There are limited data on the extraction of these leads. The objective of this study was t ... Full text Link to item Cite

Imaging findings associated with costoclavicular intervention during lead extraction.

Journal Article Heart Rhythm · November 18, 2024 BACKGROUND: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. It is not known whether preprocedural ... Full text Link to item Cite

Complications associated with pulsed field ablation vs radiofrequency catheter ablation of atrial fibrillation.

Journal Article Heart Rhythm · November 6, 2024 BACKGROUND: The first commercial systems for pulsed field ablation (PFA) were recently approved by the Food and Drug Administration, but their safety profile in nationwide practice remains underexplored. OBJECTIVES: This study aimed to describe reported ad ... Full text Link to item Cite

Performance of Ambulatory Electrocardiographic Data for Prediction of Stroke and Heart Failure Events.

Journal Article JACC Adv · November 2024 BACKGROUND: Despite clear associations between arrhythmia burden and cardiovascular risk, clinical risk scores that predict cardiovascular events do not incorporate individual-level arrhythmia characteristics from long-term continuous monitoring (LTCM). OB ... Full text Link to item Cite

Appropriate and inappropriate ICD shocks in patients with LVADs: Prevalence, associated factors, and etiologies.

Journal Article Heart Rhythm · July 23, 2024 BACKGROUND: Implantable cardioverter-defibrillator (ICD) shocks are a common complication after left ventricular assist device (LVAD) implantation; however, data on their frequency and causes are limited. OBJECTIVE: The purpose of this study was to define ... Full text Link to item Cite

Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study.

Journal Article Int J Cardiol · May 15, 2024 BACKGROUND: Few data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures a ... 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

Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis.

Journal Article Am J Cardiol · October 1, 2023 Cardiac sarcoidosis (CS) is a relapsing-remitting disease, and immune suppression (IS) is the mainstay of therapy. Predictors of relapse for patients with CS in remission are not well characterized. We assessed incidence of relapse in consecutive patients ... Full text Link to item Cite

Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): a multicentre, randomised trial.

Journal Article Lancet · July 8, 2023 BACKGROUND: Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for on-demand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. We aimed to evaluate the efficacy and safety of etripami ... Full text Link to item Cite

Use of Ripple mapping to enhance localization and ablation of outflow tract premature ventricular contractions.

Journal Article J Cardiovasc Electrophysiol · July 2023 INTRODUCTION: Accurate localization of septal outflow tract premature ventricular contractions (PVCs) is often difficult due to frequent mid-myocardial or protected origin. Compared with traditional activation mapping, CARTO Ripple mapping provides visuali ... Full text Link to item Cite

Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF.

Journal Article Circulation · June 6, 2023 BACKGROUND: There is uncertainty surrounding the use of direct oral anticoagulants (DOACs) in patients with kidney dysfunction. METHODS: Using the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral ... 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

Early Lead Extraction for Infected Implanted Cardiac Electronic Devices: JACC Review Topic of the Week.

Journal Article J Am Coll Cardiol · April 4, 2023 Infection remains a serious complication associated with the cardiac implantable electronic devices (CIEDs), leading to substantial clinical and economic burden globally. This review assesses the burden of cardiac implantable electronic device infection (C ... Full text Link to item Cite

Apixaban for Patients With Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial.

Journal Article Circulation · December 6, 2022 BACKGROUND: There are no randomized data evaluating the safety or efficacy of apixaban for stroke prevention in patients with end-stage kidney disease on hemodialysis and with atrial fibrillation (AF). METHODS: The RENAL-AF trial (Renal Hemodialysis Patien ... Full text Link to item Cite

Residual stroke risk despite oral anticoagulation in patients with atrial fibrillation.

Journal Article Heart Rhythm O2 · December 2022 BACKGROUND: Oral anticoagulation (OAC) reduces the risk of thromboembolic events in patients with atrial fibrillation (AF); however, thromboembolism (TE) still can occur despite OAC. Factors associated with residual risk for stroke, systemic embolism, or t ... Full text Link to item Cite

Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation : A Decision Analysis.

Journal Article Ann Intern Med · September 2022 BACKGROUND: Left atrial appendage occlusion (LAAO) is a potential alternative to oral anticoagulants in selected patients with atrial fibrillation (AF). Compared with anticoagulants, LAAO decreases major bleeding risk, but there is uncertainty regarding th ... Full text Open Access Link to item Cite

Syncope Recurrence and Downstream Diagnostic Testing after Insertable Cardiac Monitor Placement for Syncope.

Journal Article Diagnostics (Basel) · August 16, 2022 Despite advances in syncope evaluation strategies and risk stratification, the high cost of syncope is largely driven by extensive and often repetitive testing. This analysis of a large deidentified US claims database compared the use of diagnostic tests, ... Full text Open Access Link to item Cite

Atrial branch coronary artery stenosis as a mechanism for atrial fibrillation.

Journal Article Heart Rhythm · August 2022 BACKGROUND: The etiology of atrial fibrillation (AF) is multifactorial and incompletely understood. OBJECTIVE: The purpose of this study was to evaluate the association between coronary artery disease (CAD) affecting atrial tissue and AF. METHODS: Patients ... Full text Link to item Cite

Effect of Mailing Educational Material to Patients With Atrial Fibrillation and Their Clinicians on Use of Oral Anticoagulants: A Randomized Clinical Trial.

Journal Article JAMA Netw Open · May 2, 2022 IMPORTANCE: Only about half of patients with atrial fibrillation (AF) who are at increased risk for stroke are treated with an oral anticoagulant (OAC), despite guideline recommendations for their use. Educating patients with AF about prevention of stroke ... 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

Comparative outcomes of Riata and Fidelis lead management strategies: Results from the NCDR-ICD Registry.

Journal Article Pacing Clin Electrophysiol · November 2021 BACKGROUND: The Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi-center population are unkn ... 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

Getting (Left Atrial Appendage) Closure With Kidney Disease.

Journal Article JACC Cardiovasc Interv · August 23, 2021 Full text Link to item Cite

Electrical storm in patients with left ventricular assist devices: Risk factors, incidence, and impact on survival.

Journal Article Heart Rhythm · August 2021 BACKGROUND: Ventricular arrhythmias (VAs) and electrical storm (ES) are recognized complications following left ventricular assist device (LVAD) implantation; however, their association with long term-outcomes remains poorly understood. OBJECTIVE: The purp ... Full text Link to item Cite

Prevalence and incidence of patients with paroxysmal supraventricular tachycardia in the United States.

Journal Article J Cardiovasc Electrophysiol · August 2021 BACKGROUND: Paroxysmal supraventricular tachycardia (PSVT) encompasses a range of heart rhythm disorders leading to rapid heart rates. By virtue of its episodic nature, diagnosing PSVT is difficult and estimating incidence and prevalence on a population le ... Full text Link to item Cite

Patterns of oral anticoagulation use with cardioversion in clinical practice.

Journal Article Heart · April 2021 BACKGROUND: Cardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversio ... Full text Link to item Cite

Trends in health care resource use and expenditures in patients with newly diagnosed paroxysmal supraventricular tachycardia in the United States.

Journal Article Am Heart J · March 2021 BACKGROUND: Few data are available on the temporal patterns of health resource utilization (HRU) and expenditures around paroxysmal supraventricular tachycardia (PSVT) diagnosis. This study assessed the longitudinal trends in HRU and expenditures in the 3 ... Full text Link to item Cite

Implantable Cardioverter Defibrillator Utilization and Mortality Among Patients ≥65 Years of Age With a Low Ejection Fraction After Coronary Revascularization.

Journal Article Am J Cardiol · January 1, 2021 The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Regist ... Full text Link to item Cite

VVI pacing with normal QRS duration and ventricular function: MOST trial findings relevant to leadless pacemakers.

Journal Article Pacing Clin Electrophysiol · December 2020 BACKGROUND: Leadless pacemakers (LPs) provide ventricular pacing without the risks associated with transvenous leads and device pockets. LPs are appealing for patients who need pacing, but do not need defibrillator or cardiac resynchronization therapy. Mos ... Full text Open Access Link to item Cite

Underuse of oral anticoagulants in privately insured patients with atrial fibrillation: A population being targeted by the IMplementation of a randomized controlled trial to imProve treatment with oral AntiCoagulanTs in patients with Atrial Fibrillation (IMPACT-AFib).

Journal Article Am Heart J · November 2020 BACKGROUND: Many studies showing underuse of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) predated the advent of the non-vitamin K antagonist OACs. We retrospectively examined use of OACs in a large commercially insured population. ... Full text Link to item Cite

Disparities in the Management of Newly Diagnosed Paroxysmal Supraventricular Tachycardia for Women Versus Men in the United States.

Journal Article J Am Heart Assoc · October 20, 2020 Background Information on differences in paroxysmal supraventricular tachycardia (PSVT) diagnosis, healthcare resource use, expenditures, and treatment among women versus men is limited. Methods and Results Study participants identified in the IBM MarketSc ... Full text Link to item Cite

Shared decision-making in atrial fibrillation: patient-reported involvement in treatment decisions.

Journal Article Eur Heart J Qual Care Clin Outcomes · October 1, 2020 AIMS: To determine the extent of shared decision-making (SDM), during selection of oral anticoagulant (OAC) and rhythm control treatments, in patients with newly diagnosed atrial fibrillation (AF). METHODS AND RESULTS: We evaluated survey data from 1006 pa ... 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

Catheter ablation of atrial fibrillation in cardiac amyloidosis.

Journal Article Pacing Clin Electrophysiol · September 2020 BACKGROUND: Cardiac amyloidosis is a progressive infiltrative disease involving deposition of amyloid fibrils in the myocardium and cardiac conduction system that frequently manifests with heart failure (HF) and arrhythmias, most frequently atrial fibrilla ... Full text Link to item Cite

Collaborative care for the wearable cardioverter defibrillator patient: Getting the patient and medical team "vested and active".

Journal Article J Cardiovasc Electrophysiol · September 2020 Patients with a reduced ejection fraction of 35% or less and a history of myocardial infarction (MI) are at increased risk of sudden cardiac death (SCD). These patients have a class I indication for an implantable cardioverter-defibrillator after allowing ... Full text Link to item Cite

Cardiac Implantable Electronic Devices: A Window Into the Evolution of Conduction Disease in Cardiac Amyloidosis.

Journal Article JACC Clin Electrophysiol · September 2020 OBJECTIVES: This study characterized the relationship between conduction disease and cardiac amyloidosis (CA) through longitudinal analysis of cardiac implantable electronic device (CIED) data. BACKGROUND: Bradyarrhythmias and tachyarrhythmias are commonly ... 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 BACKGROUND: Diabetes 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. OBJECTIVE: The purpose of this study was to compa ... Full text Open Access Link to item Cite

Practical challenges in the conduct of pragmatic trials embedded in health plans: Lessons of IMPACT-AFib, an FDA-Catalyst trial.

Journal Article Clin Trials · August 2020 IMPACT-AFib was an 80,000-patient randomized clinical trial implemented by five US insurance companies (health plans) aimed at increasing the use of oral anticoagulants by individuals with atrial fibrillation who were at high risk of stroke and not on trea ... Full text Link to item 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

Periprocedural Risk and Survival Associated With Implantable Cardioverter-Defibrillator Placement in Older Patients With Advanced Heart Failure.

Journal Article JAMA Cardiol · June 1, 2020 IMPORTANCE: Little is known about the utilization rates and outcomes of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) placement among patients with advanced heart failure (HF). OBJECTIVE: To examin ... 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

Predictors of Cardiac Perforation With Catheter Ablation of Atrial Fibrillation.

Journal Article JACC Clin Electrophysiol · June 2020 OBJECTIVES: This study identified factors associated with risk for cardiac perforation in the setting of atrial fibrillation (AF) ablation in contemporary clinical practice. BACKGROUND: Cardiac perforation is an uncommon but potentially fatal complication ... 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

One-year mortality after implantable cardioverter-defibrillator placement within the Veterans Affairs Health System.

Journal Article Eur J Heart Fail · May 2020 AIMS: Implantable cardioverter-defibrillator (ICD) therapy reduces mortality in patients with heart failure and current guidelines advise implantation of ICDs in patients with a life expectancy of >1 year. We examined trends in all-cause mortality in patie ... Full text Link to item Cite

Risk of major cardiovascular and neurologic events with obstructive sleep apnea among patients with atrial fibrillation.

Journal Article Am Heart J · May 2020 BACKGROUND: Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF). However, it remains unclear whether OSA is independently associated with worse cardiovascular and neurological outcomes in patients with AF. METHODS: We used the ... Full text Link to item Cite

Outcomes following cardioversion for patients with cardiac amyloidosis and atrial fibrillation or atrial flutter.

Journal Article Am Heart J · April 2020 Atrial arrhythmias commonly occur in patients with cardiac amyloidosis (CA), but there is limited data on safety or efficacy of cardioversion (DCCV) for management of these rhythms in CA. We identified 25 patients with CA (20 with transthyretin (TTR) and 5 ... Full text Link to item Cite

Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Advanced Chronic Kidney Disease.

Journal Article Circulation · April 2020 BackgroundCompared with the general population, patients with advanced chronic kidney disease have a >10-fold higher burden of atrial fibrillation. Limited data are available guiding the use of nonvitamin K antagonist oral anticoagulants in this p ... Full text Cite

Oral Anticoagulation and Cardiovascular Outcomes in Patients With Atrial Fibrillation and End-Stage Renal Disease.

Journal Article J Am Coll Cardiol · March 24, 2020 BACKGROUND: Atrial fibrillation (AF) is common in patients with end-stage renal disease (ESRD). The impact of oral anticoagulation (OAC) in ESRD patients is uncertain. OBJECTIVES: The purpose of this study was to describe patterns of OAC use in ESRD patien ... 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

Patterns of amiodarone use and outcomes in clinical practice for atrial fibrillation.

Journal Article Am Heart J · February 2020 BACKGROUND: Amiodarone is the most effective antiarrhythmic drug (AAD) for atrial fibrillation (AF), but it has a high incidence of adverse effects. METHODS: Using the ORBIT AF registry, patients with AF on amiodarone at enrollment, prescribed amiodarone d ... Full text Link to item Cite

Healthcare Resource Use and Expenditures in Patients Newly Diagnosed With Paroxysmal Supraventricular Tachycardia.

Journal Article Am J Cardiol · January 15, 2020 Information on paroxysmal supraventricular tachycardia (PSVT) patient characteristics and the associated economic burden of the disease is limited. Therefore, we sought to characterize newly diagnosed PSVT patients and quantify their healthcare resource us ... Full text Link to item Cite

Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association.

Journal Article Circulation · December 17, 2019 The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated wit ... Full text Link to item Cite

Phrenic Nerve Stimulation for the Treatment of Central Sleep Apnea: A Pooled Cohort Analysis.

Journal Article J Clin Sleep Med · November 5, 2019 STUDY OBJECTIVES: Early evidence with transvenous phrenic nerve stimulation (PNS) demonstrates improved disease severity and quality of life (QOL) in patients with central sleep apnea (CSA). The goal of this analysis is to evaluate the complete prospective ... 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

Fidelis Replacement: Can We Abandon With Reckless Abandon?

Journal Article JACC Clin Electrophysiol · September 2019 Full text Link to item Cite

Association Between Warfarin Control Metrics and Atrial Fibrillation Outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation.

Journal Article JAMA Cardiol · August 1, 2019 IMPORTANCE: Bleeding and thrombotic events (eg, stroke and systemic embolism) are common in patients with atrial fibrillation (AF) taking warfarin sodium despite a well-established therapeutic range. OBJECTIVE: To evaluate whether history of therapeutic wa ... Full text Link to item Cite

Bystander Ethics and Good Samaritanism: A Paradox for Learning Health Organizations.

Journal Article Hastings Cent Rep · July 2019 In 2012, a U.S. Institute of Medicine report called for a different approach to health care: "Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets." The answer, they suggested, wo ... Full text Link to item Cite

Efficacy and safety of apixaban vs warfarin in patients with atrial fibrillation and prior bioprosthetic valve replacement or valve repair: Insights from the ARISTOTLE trial.

Journal Article Clin Cardiol · May 2019 BACKGROUND: The optimal anticoagulation strategy for patients with atrial fibrillation (AF) and bioprosthetic valve (BPV) replacement or native valve repair remains uncertain. HYPOTHESIS: We evaluated the safety and efficacy of apixaban vs warfarin in pati ... Full text Link to item Cite

Exploring patient-provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study.

Journal Article Eur J Cardiovasc Nurs · April 2019 BACKGROUND: Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs). AIMS: Given that the etiology of this gap in care is not well understood, we explored decision- ... Full text Link to item Cite

FDA-Catalyst-Using FDA's Sentinel Initiative for large-scale pragmatic randomized trials: Approach and lessons learned during the planning phase of the first trial.

Journal Article Clin Trials · February 2019 BACKGROUND: The US Food and Drug Administration's Sentinel Initiative is well positioned to support pragmatic clinical trials. FDA-Catalyst combines direct contact with health plan members and/or providers with data in the Sentinel infrastructure. Here, we ... Full text Link to item Cite

Adaptive servo-ventilation reduces atrial fibrillation burden in patients with heart failure and sleep apnea.

Journal Article Heart Rhythm · January 2019 BACKGROUND: Patients with heart failure and sleep apnea are at increased risk for developing arrhythmias. Whether treatment of sleep apnea reduces arrhythmias is unknown. OBJECTIVE: The purpose of this study was to determine whether adaptive servo-ventilat ... Full text Link to item Cite

Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.

Journal Article Int J Cardiol · January 1, 2019 BACKGROUND: Renal function has been associated with an increased stroke risk in patients with atrial fibrillation (AF). However, whether renal function incrementally adds to risk prediction in both anticoagulated and non-anticoagulated patients with AF is ... Full text Link to item Cite

Knowledge and Insights Vested in Us by the VEST.

Journal Article Circulation · December 11, 2018 Full text Link to item Cite

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation.

Journal Article Heart · November 2018 OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes ... Full text Link to item Cite

Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT-AF.

Journal Article J Am Heart Assoc · September 18, 2018 Background Chronic kidney disease ( CKD ) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Reg ... Full text Link to item Cite

The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients.

Journal Article Am Heart J · July 2018 BACKGROUND: Left ventricular ejection fraction (LVEF) is used to select patients for primary prevention implantable cardioverter defibrillators (ICDs). The relationship between baseline and long-term follow-up LVEF and clinical outcomes among primary preve ... Full text Link to item Cite

Dofetilide dose reductions and discontinuations in women compared with men.

Journal Article Heart Rhythm · April 2018 BACKGROUND: Compared with men, women have longer corrected QT (QTc) intervals, lower clearance of dofetilide, and higher rates of drug-induced torsades de pointes, but the dofetilide dosing algorithm is the same for men and women. OBJECTIVE: The purpose of ... Full text Link to item Cite

Sudden cardiac death after acute heart failure hospital admission: insights from ASCEND-HF.

Conference Eur J Heart Fail · March 2018 AIMS: The incidence of and factors associated with sudden cardiac death (SCD) early after an acute heart failure (HF) hospital admission have not been well defined. METHODS AND RESULTS: We assessed SCD and ventricular arrhythmias in the Acute Study of Clin ... 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

A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial.

Journal Article Lancet · October 14, 2017 BACKGROUND: Oral anticoagulation is underused in patients with atrial fibrillation. We assessed the impact of a multifaceted educational intervention, versus usual care, on oral anticoagulant use in patients with atrial fibrillation. METHODS: This study wa ... 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

Regional differences in presentation and antithrombotic treatment of patients with atrial fibrillation: Baseline characteristics from a clustered randomized trial to IMProve treatment with AntiCoagulanTs in patients with atrial fibrillation (IMPACT-AF).

Journal Article Am Heart J · October 2017 UNLABELLED: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there are few contemporary comparative data on AF from middle-income countries. METHODS: Baseline characteristics of the IMPACT-AF trial were analyzed to asses ... Full text Link to item Cite

Risk of atrioesophageal fistula formation with contact force-sensing catheters.

Journal Article Heart Rhythm · September 2017 BACKGROUND: Atrioesophageal fistula formation is a rare but life-threatening complication of atrial fibrillation ablation. Contact force (CF)-sensing catheters improve procedural effectiveness. However, the impact of the implementation of CF-sensing techno ... Full text Link to item Cite

Ranolazine reduces atrial fibrillatory wave frequency.

Journal Article Europace · July 1, 2017 AIMS: Antiarrhythmic medications for the treatment of atrial fibrillation (AF) have limited efficacy and rare but potentially life-threatening side effects. Ranolazine is an antianginal agent that may have antiarrhythmic activity in AF. METHODS AND RESULTS ... Full text Link to item Cite

When Less Is Not More.

Journal Article J Am Coll Cardiol · June 13, 2017 Full text Link to item Cite

Temporal Trends in and Factors Associated With Use of Single- Versus Dual-Coil Implantable Cardioverter-Defibrillator Leads: Data From the NCDR ICD Registry.

Journal Article JACC Clin Electrophysiol · June 2017 OBJECTIVES: This analysis evaluated temporal trends and factors associated with the use of dual-coil implantable cardioverter-defibrillator (ICD) leads. BACKGROUND: Data suggest that dual-coil ICD leads are not associated with lower mortality and can be mo ... Full text Link to item Cite

Use of Antiarrhythmic Medications in Medicare Part D Patients With an Implantable Cardioverter-Defibrillator and Ventricular Tachycardia.

Journal Article Am J Cardiol · May 1, 2017 Ventricular tachycardia (VT) is common in cardiomyopathy patients with an implantable cardioverter-defibrillator. This analysis evaluated antiarrhythmic medication use and change in use over time in patients with VT and structural heart disease. Query of M ... Full text Link to item Cite

Sudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting: Results From the STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure).

Journal Article Circulation · March 21, 2017 BACKGROUND: The risk of sudden cardiac death (SCD) in patients with heart failure after coronary artery bypass graft surgery (CABG) has not been examined in a contemporary clinical trial of surgical revascularization. This analysis describes the incidence, ... Full text Link to item Cite

Cardioversion and subsequent quality of life and natural history of atrial fibrillation.

Journal Article Am Heart J · March 2017 UNLABELLED: Cardioversion is a class I procedure for patients with symptomatic atrial fibrillation (AF) pursuing rhythm control. There are few contemporary reports on quality of life and outcomes after cardioversion. METHODS: Using the nationwide prospecti ... Full text Link to item Cite

Reassessment of Cardiac Function and Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Myocardial Infarction.

Journal Article Circulation · January 3, 2017 BACKGROUND: Guidelines recommend that patients with low ejection fraction (EF) after myocardial infarction (MI) have their EF reassessed 40 days after MI for implantable cardioverter-defibrillator (ICD) candidacy. This study examines rates of EF reassessme ... Full text Link to item Cite

Catheter ablation of ventricular tachycardia: Lessons learned from past clinical trials and implications for future clinical trials.

Journal Article Heart Rhythm · August 2016 Catheter ablation of ventricular tachycardia (VT) has evolved in recent years, especially in patients with ischemic heart disease. Data from prospective studies show that VT catheter ablation reduces the risk of recurrent VT; however, there is a paucity of ... Full text Link to item Cite

A clustered randomized trial to IMProve treatment with AntiCoagulanTs in patients with Atrial Fibrillation (IMPACT-AF): design and rationale.

Journal Article Am Heart J · June 2016 Atrial fibrillation (AF) is common, increasing as the population ages, and a major cause of embolic stroke. While oral anticoagulation (OAC) is highly effective at preventing stroke in patients with AF, it continues to be underused in eligible patients wor ... Full text Link to item Cite

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation: Data From ROCKET AF.

Journal Article J Am Heart Assoc · March 8, 2016 BACKGROUND: Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. METHODS AND RESULTS: In the Rivaroxaban Once Daily Oral Direct Factor Xa I ... Full text Link to item Cite

Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.

Journal Article J Interv Card Electrophysiol · March 2016 BACKGROUND: Patients with ischemic heart disease may have implantable cardioverter defibrillators (ICDs) implanted for primary or secondary prevention of sudden cardiac death. Although ICD shocks can be life saving, in some patients, they have been associa ... Full text Link to item Cite

High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction.

Journal Article Am Heart J · January 2016 UNLABELLED: Non-ST-segment myocardial infarction (NSTEMI) can be complicated by high-degree atrioventricular (AV) block, asystole, or electromechanical dissociation (EMD), but these events are not well characterized in the contemporary era. This analysis a ... Full text Link to item Cite

Therapeutic Hypothermia for Patients with Out-of-Hospital Cardiac Arrest in North Carolina.

Journal Article Prehosp Emerg Care · 2016 INTRODUCTION: While therapeutic hypothermia has been the standard of care for patients who suffer out-of-hospital cardiac arrest (OHCA), recent trials have led to an advisory statement recommending a focus on targeted in-hospital temperature management and ... Full text Link to item Cite

Calcified Pipes: You Better Call the Electrician Too.

Journal Article Circ Cardiovasc Imaging · December 2015 Full text Link to item Cite

Management of pace-terminated ventricular arrhythmias.

Journal Article Card Electrophysiol Clin · September 2015 An implantable-cardioverter defibrillator (ICD) can terminate ventricular arrhythmias by delivering a shock or by antitachycardia pacing (ATP). The ATP works by capturing the excitable gap and disrupting re-entrant ventricular arrhythmias. Multiple studies ... Full text Link to item Cite

Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry.

Journal Article Am Heart J · July 2015 BACKGROUND: Time in therapeutic range (TTR) of international normalized ratio (INR) of 2.0 to 3.0 is important for the safety and effectiveness of warfarin anticoagulation. There are few data on TTR among patients with atrial fibrillation (AF) in community ... Full text Link to item Cite

Digoxin Use and Subsequent Outcomes Among Patients in a Contemporary Atrial Fibrillation Cohort.

Journal Article J Am Coll Cardiol · June 30, 2015 BACKGROUND: Although digoxin has long been used to treat atrial fibrillation (AF) and heart failure (HF), its safety remains controversial. OBJECTIVES: This study sought to describe digoxin use over time in patients with AF who were stratified by the prese ... Full text Link to item Cite

Implantable Cardioverter-Defibrillator Use Among Medicare Patients With Low Ejection Fraction After Acute Myocardial Infarction.

Journal Article JAMA · June 23, 2015 IMPORTANCE: Implantable cardioverter-defibrillators (ICDs) are not recommended within 40 days of myocardial infarction (MI); thus, ICD implantation might not be considered during the post-MI care transition. OBJECTIVE: To examine ICD implantation rates and ... 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

Catheter ablation for ventricular tachycardia in patients with an implantable cardioverter defibrillator (CALYPSO) pilot trial.

Journal Article J Cardiovasc Electrophysiol · February 2015 INTRODUCTION: We conducted this pilot randomized clinical trial to determine the feasibility of a large clinical trial aimed at testing whether early use of catheter ablation of ventricular tachycardia (VT) is superior to antiarrhythmic medications at redu ... Full text Link to item Cite

Primary prevention implantable cardioverter-defibrillators in older racial and ethnic minority patients.

Journal Article Circ Arrhythm Electrophysiol · February 2015 BACKGROUND: Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, ... Full text Link to item Cite

Incidence and predictors of appropriate therapies delivered by the implantable cardioverter defibrillator in patients with ischemic cardiomyopathy: a systematic review.

Journal Article Int J Cardiol · December 20, 2014 BACKGROUND: Although the implantable cardioverter defibrillator (ICD) improves the survival of patients at increased risk of sudden cardiac death due to systolic heart failure, ICD shocks have been associated with both worse survival and quality of life. W ... Full text Link to item Cite

Novel mechanism of premature battery failure due to lithium cluster formation in implantable cardioverter-defibrillators.

Journal Article Heart Rhythm · December 2014 BACKGROUND: Battery failure is an uncommon complication of implantable cardioverter-defibrillators (ICDs), but unanticipated battery depletion can have life-threatening consequences. OBJECTIVE: The purpose of this study was to describe the prevalence of a ... Full text Link to item Cite

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation.

Journal Article Heart · December 2014 OBJECTIVE: Catheter ablation of atrial fibrillation (AF) has become an increasingly safe and effective therapy. This has been partly attributed to the use of adjunctive imaging modalities. We aimed to describe the use and associated outcomes of periprocedu ... Full text 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

Cost analysis of periprocedural imaging in patients undergoing catheter ablation for atrial fibrillation.

Journal Article Am J Cardiol · July 15, 2014 Cardiovascular imaging is an important part of procedural planning and safety for catheter ablation of atrial fibrillation (AF). However, the costs of imaging surrounding catheter ablation of AF have not been described. Medicare fee-for-service data were u ... Full text Link to item Cite

Clinical strategies for selecting oral anticoagulants in patients with atrial fibrillation.

Journal Article J Thromb Thrombolysis · August 2013 Atrial fibrillation is a common arrhythmia. One of the important aspects of the management of atrial fibrillation is stroke prevention. Warfarin has been the longstanding anticoagulant used for stroke prevention in patients with atrial fibrillation. There ... Full text Link to item Cite

Atrial fibrillation complicating acute coronary syndromes

Journal Article Journal of Atrial Fibrillation · October 1, 2012 Atrial fibrillation frequently complicates myocardial infarction. Patients with atrial fibrillation complicating acute coronary syndrome have increased morbidity and mortality relative to patients that remain in normal sinus rhythm. No studies have identif ... Cite

Infarct healing is a dynamic process following acute myocardial infarction.

Journal Article J Cardiovasc Magn Reson · September 2, 2012 BACKGROUND: The role of infarct size on left ventricular (LV) remodeling in heart failure after an acute ST-segment elevation myocardial infarction (STEMI) is well recognized. Infarct size, as determined by cardiovascular magnetic resonance (CMR), decrease ... Full text Link to item Cite

Effect of amiodarone-induced hyperthyroidism on left ventricular outflow obstruction after septal myectomy for hypertrophic cardiomyopathy.

Journal Article Am J Cardiol · December 1, 2010 Patients with obstructive hypertrophic cardiomyopathy who undergo septal myectomy are at risk for developing postoperative atrial fibrillation. Amiodarone is effective in treating this arrhythmia but is associated with multiple adverse effects, often with ... Full text Link to item Cite