Publications by authors named "Alan Bulava"
Article Synopsis
- The HeartInsight multiparametric algorithm uses remote monitoring data from implantable cardioverter-defibrillators (ICDs) to calculate an HF Score, which helps predict worsening heart failure hospitalizations (WHFHs).
- A study pooled data from 9 clinical trials involving 1,841 ICD patients, finding that a high baseline HF Score significantly correlates with increased long-term risks of death and WHFHs.
- The analysis revealed that patients with an HF Score over 23 faced more than double the risk of experiencing death or WHFH compared to those with lower scores, emphasizing the score's potential in risk stratification for heart failure patients.
Article Synopsis
- A prospective observational study evaluated the use of pulsed electric field (PF) ablation for treating ventricular arrhythmias, focusing on its efficacy and safety in a small patient population of 44 individuals.
- The study showed an 84% acute success rate in eliminating frequent ventricular premature complexes (VPCs) and non-inducibility of ventricular tachycardia (VT), indicating that PF ablation can effectively treat these conditions.
- At a 3-month follow-up, 81% of patients with VPCs experienced sustained suppression, but only 52% of patients with scar-related VT remained free of any arrhythmias, suggesting that while PF ablation is promising, its long-term effectiveness for VT may need further
Article Synopsis
- Pulsed field ablation (PFA) is a new method for treating atrial fibrillation (AF) that focuses on ablating heart tissue while minimizing harm to nearby structures.
- In the MANIFEST-17K study, data from 106 centers involved 17,642 patients and showed no serious complications like esophageal damage, with only a 1% major complication rate.
- The results suggest that PFA has a strong safety profile and may change how AF is treated, compared to traditional thermal ablation methods.
Article Synopsis
- This study evaluates the results of concomitant cryo-ablation for treating atrial fibrillation (AF) in patients also undergoing cardiac surgery.
- Researchers analyzed data from 103 patients after they had a hybrid treatment involving radiofrequency catheter ablation performed 105 days post-surgery.
- The findings showed that a significant number of patients had successful isolation of pulmonary veins and conduction blocks, with specific areas exhibiting more gaps, indicating varied effectiveness in the ablation technique.
Objectives: Cardiac arrhythmias predict poor outcome after myocardial infarction (MI). We studied if arrhythmia monitoring with an insertable cardiac monitor (ICM) can improve treatment and outcome.
Design: BIO|GUARD-MI was a randomized, international open-label study with blinded outcome assessment.
Article Synopsis
- Conduction system pacing (CSP) is shown to potentially outperform traditional right ventricular pacing methods, prompting exploration of a new catheter for easier implantation.
- The BIO|MASTER.Selectra 3D study reported a 93.6% success rate for achieving CSP in 147 out of 157 patients, with no serious complications within a week post-implantation.
- Results indicate that patient outcomes can improve with the Selectra 3D catheter, which allows flexibility between His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), yielding nearly 99% success in procedures where both methods were considered.
Aims: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone.
Methods And Results: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation [Hybrid Group (HG)] or no further treatment (Surgery Group).
Article Synopsis
- The HeartInsight algorithm predicts worsening heart failure hospitalizations (WHFHs) by assessing a heart failure score calculated from seven physiological parameters, including heart rate and patient activity.
- Data from 2050 defibrillator patients showed that those who later experienced WHFH had a significantly higher HF score, both at the start and over a 12-week period, compared to those without WHFH.
- The study concluded that monitoring trends in the HF score and its components could effectively indicate deteriorating heart failure status before WHFH occurs.
Article Synopsis
- The study compares the effectiveness of hybrid epicardial-endocardial ablation (HA) to standard endocardial catheter ablation (CA) for patients with persistent and longstanding persistent atrial fibrillation (PersAF/LSPAF), suggesting HA may offer better long-term results.
- The CEASE-AF trial enrolled participants across nine European countries, focusing on those with symptomatic, drug-resistant atrial fibrillation and specific heart size measurements, making it a randomized controlled study.
- Results showed that 71.6% of patients in the HA group achieved freedom from significant arrhythmias after 12 months, compared to only 39.2% in the CA group, indicating a substantial improvement in effectiveness with HA.
Article Synopsis
- - Interventional electrophysiology provides various treatments for patients with cardiac arrhythmias, with catheter ablation being a key method for managing tachycardias.
- - The field has advanced significantly, using multiple ablation tools and techniques to improve the accuracy of procedures while relying heavily on fluoroscopy for guidance.
- - However, the use of X-ray technology presents health risks, prompting a focus on strategies to minimize fluoroscopy use and enhance radiation protection for both patients and healthcare providers.
Article Synopsis
- * The SurHyb study is a randomized trial comparing the effectiveness of surgical CryoMaze alone versus a combined approach of CryoMaze followed by radiofrequency catheter ablation after three months in patients with persistent atrial fibrillation.
- * This study aims to provide deeper insights into which treatment option is more effective for patients undergoing surgery, potentially improving outcomes for those with atrial fibrillation during heart surgeries.
Article Synopsis
- - The study investigated the effectiveness and safety of the CartoFinder algorithm in ablating persistent atrial fibrillation (PsAF) by targeting specific activation patterns and impulses, with patients followed for 12 months post-procedure.
- - A total of 64 patients participated, with a notable 9.4% reporting primary adverse events during the procedure, and significant improvements were seen in heart rhythm cycles after mapping and ablation.
- - Results showed a 60.9% rate of being arrhythmia-free and 75.0% symptom-free after one year, particularly highlighting that patients whose atrial fibrillation converted to sinus rhythm had better outcomes compared to those who did not.
Background: Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population.
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- The study examined the effects of the COVID-19 lockdown in March/April 2020 on physical activity and arrhythmia issues in heart failure (HF) patients using cardiac resynchronization therapy (CRT) devices.
- Results showed a significant decrease in activity levels (mean -6.5%), an increase in atrial high rate episodes (AHRE) by 17%, and a 75% drop in follow-up rates during the lockdown.
- Key predictors for these changes included pre-lockdown activity levels, left ventricular ejection fraction (LVEF), NYHA class, and a history of atrial fibrillation among the patients.
Article Synopsis
- The study examined the acceptance of remote monitoring (RM) technology among octogenarians compared to younger patients, aiming to highlight concerns and issues faced by both age groups.
- Participants included elderly patients aged 80+ and younger patients aged 40 or less, both groups having received implantable cardioverter-defibrillators and evaluated via surveys.
- Results showed high satisfaction with the RM system in both age groups, but many were unaware of its health benefits, with reported personal advantages including enhanced safety and reduced travel costs.
Introduction: Cryoenergy is the most commonly used method of lesion formation in patients who have undergone surgical ablation of atrial fibrillation. Despite frequent use, the clinical effect of cryoenergy in endocardial and epicardial approaches is unknown.
Aim: To compare the effect of various cryoenergy applications on the postoperative incidence of sinus rhythm and completeness of lesions performed.
Article Synopsis
- This study evaluated a new catheter designed for high-power, short-duration ablation to treat paroxysmal atrial fibrillation, focusing on its safety and effectiveness in the short term.
- The clinical trial, named QDOT-FAST, included 52 patients and showed that the catheter successfully isolated pulmonary veins in all cases with very few adverse events.
- Most patients (94.2%) maintained sinus rhythm after 3 months, with only two reported adverse incidents, confirming the procedure is generally safe and effective.
Introduction: Stroke is one of the most feared complications during catheter ablation of atrial fibrillation (AF). While symptomatic thromboembolic events are rare, magnetic resonance imaging (MRI) may identify asymptomatic (ie, silent) cerebral lesions (SCLs) following pulmonary vein isolation (PVI) procedures.
Methods And Results: The REDUCE-TE Pilot was a prospective multicenter, single-arm observational study investigating the incidence of SCL in patients with symptomatic paroxysmal AF undergoing PVI with a novel gold-tip, externally irrigated ablation catheter.
Background: Catheter ablation procedures have recently become a widely accepted method for treating cardiac arrhythmias, and referrals for these procedures have been steadily increasing. As a result, it is now common that sheath removal is handled as a nursing procedure. Regardless of who performs the sheath removal, it is important to extract ablation sheaths without any early or late complications.
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- The study focused on evaluating an automated algorithm that identifies focal (FA) and rotational (RoA) activations in patients with persistent atrial fibrillation (PeAF) during ablation procedures.
- Researchers analyzed data from 86 PeAF patients and found that the algorithm demonstrated high sensitivity for detecting FA (84%) and RoA (86%) compared to expert adjudicators.
- Results indicated that successful ablation of FA was linked to the termination of atrial fibrillation, while RoA ablation did not show a significant correlation with AF termination, suggesting further research is needed to clarify the roles of FA and RoA.
Article Synopsis
- The study compared patients who upgraded to cardiac resynchronization therapy (CRT) from previous devices versus those receiving CRT for the first time (de novo).
- Out of over 11,000 patients, about 23% were upgrades, showing that upgraded patients were generally older and had more serious health issues like heart failure and atrial fibrillation.
- Although upgraded patients faced worse symptoms and conditions, their CRT procedures had similar success rates and complications as de novo patients, highlighting a need for more research in this area.