Publications by authors named "Christopher Madias"

Permanent pacing from the right ventricular apex can reduce quality of life and increase the risk of heart failure and death. This review summarizes the milestones in the evolution of pacemakers toward physiological pacing with biventricular pacing systems and lead implantation into the cardiac conduction system to synchronize cardiac contraction and relaxation. Both approaches aim to reproduce normal cardiac activation and help to prevent and treat heart failure.

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Background: In hypertrophic cardiomyopathy (HCM), 48-hour ambulatory monitoring has been standard practice to detect nonsustained ventricular tachycardia (NSVT), a sudden death risk marker. Extended-wear ambulatory electrocardiographic (ECG) devices have more recently used for monitoring patients with HCM.

Objective: We aimed to evaluate NSVT burden identified with continuous ambulatory monitoring for up to 2 weeks compared with initial 48 hours.

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Article Synopsis
  • *A study analyzing hospital data from 2016 to 2020 revealed that while the rate of AF/AFL hospitalizations was stable prior to 2020, it dropped sharply in 2020 alongside an increase in severe outcomes like mortality and stroke.
  • *Key factors associated with worse outcomes included older age, ischemic heart disease, chronic kidney disease, and COVID-19 infection itself.
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  • Patients with hypertrophic cardiomyopathy (HCM) face a risk of sudden death, especially if they have major risk markers, leading to the consideration of implantable cardioverter-defibrillators and cardiac magnetic resonance (CMR) imaging for risk assessment.
  • A study aimed to develop deep-learning models based on electrocardiogram (ECG) data to identify high-risk imaging features in HCM patients, using a cohort from Tufts Medical Center in Boston.
  • The ECG deep-learning models showed reliable identification of high-risk features and could potentially reduce the need for CMR testing by using a screening strategy that combines echocardiography with selective CMR recommendations.
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Background Routine addition of an atrial lead during an implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death, in patients without pacing indications, was not shown beneficial in contemporary studies. We aimed to investigate the use and safety of single- versus dual-chamber ICD implantations in these patients. Methods and Results Using the National Inpatient Sample database, we identified patients with no pacing indications who underwent primary-prevention ICD implantation in the United States between 2015 and 2019.

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This case describes a 74-year-old male who presented with rapid atrial flutter in association with large atrial lipoma along the interatrial septum. Conversion to sinus rhythm revealed the electrocardiographic criteria for advanced interatrial block. Interatrial block results from disruption of conduction through Bachmann's bundle, most commonly due to progressive atrial fibrosis.

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  • * In contrast, most patients in the Tufts HCM study only needed 1 (66%) or between 1 to 3 (91%) ICD interventions during a similar time frame.
  • * The findings highlight the effectiveness of ICDs in preventing sudden death in HCM patients, supporting the reliability of established risk assessment strategies by the American Heart Association and the American College of Cardiology.
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  • The study investigates the relationship between comorbid diseases and the occurrence of atrial fibrillation (AF) and sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM).
  • Among 2269 HCM patients, 75% had at least one comorbidity, with obesity being the most common, but overall, these comorbidities did not significantly affect AF or SCD risk.
  • The findings suggest that factors like age and left atrial size are more critical in predicting AF outcomes, while comorbidities like obesity do not independently contribute to the risk of AF or SCD in HCM patients.
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  • - A man believed to have hypertrophic cardiomyopathy suffered a cardiac arrest due to ventricular fibrillation.
  • - Previous cardiac MRI showed unusual patterns in the heart that didn't match typical signs of hypertrophic cardiomyopathy but instead pointed to cardiac sarcoidosis.
  • - The final diagnosis of cardiac sarcoidosis was confirmed through a biopsy of the heart tissue.
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  • Moderate-intensity exercise has beneficial effects on cardiovascular health, while long-term high-intensity training may increase the risk of atrial fibrillation (AF) in male and veteran athletes.
  • Unlike the general population, athletes with AF do not have a higher mortality risk, but they may experience significant health issues such as reduced exercise ability, performance, and quality of life.
  • More research is necessary to understand the causes and management of AF specifically in athletes and to improve their health outcomes.
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Background: The implantable cardioverter-defibrillator (ICD) is effective for preventing sudden death in patients with hypertrophic cardiomyopathy. However, data on performance and complications of implanted ICDs over particularly long time periods to inform clinical practice is presently incomplete.

Methods: The study cohort comprises 217 consecutive hypertrophic cardiomyopathy patients with primary prevention ICDs implanted before 2008 and followed for ≥10 years (mean 12±4; range to 31).

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  • The convergent procedure is a hybrid treatment for atrial fibrillation, combining surgical and catheter ablation techniques, particularly for persistent and long-standing cases.
  • It involves minimally invasive surgery on the left atrium and includes a procedure to isolate the left atrial appendage to improve outcomes.
  • The article discusses a multidisciplinary approach to this procedure, reviews existing literature on its effectiveness, and highlights areas for improvement and future research.
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  • A study evaluated the risk of sudden death (SD) in children and adolescents with hypertrophic cardiomyopathy (HC) and the effectiveness of implantable cardioverter-defibrillators (ICDs) in preventing lethal arrhythmias.
  • Out of 146 patients under 20 years old, 60 received ICDs, with a significant portion experiencing device therapy that restored normal heart rhythms after several years.
  • The research demonstrated that an enhanced risk stratification strategy based on individual risk markers had 100% sensitivity for predicting SD events and was effective in protecting high-risk young patients from serious heart complications.
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Patients with hypertrophic cardiomyopathy (HC) may require higher energies to terminate ventricular fibrillation (VF); thus, dual coil defibrillation leads are often implanted. However, single coil leads may be preferred in young patients. All patients with HCM implanted with a transvenous ICD from years 2000 to 2014 were included.

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There has been a recent proliferation of consumer health devices (CHDs) that enable user-initiated screening for a variety of diseases. These devices represent a paradigm shift in the deployment of disease screening, a process that has historically been led by clinicians following the guidance of professional bodies. The detection of AF via CHDs is a contemporary example of this phenomenon and highlights several important implications of the shift of disease screening from clinicians to CHD users.

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