Publications by authors named "David Frankel"
Background: Pacing-induced cardiomyopathy (PICM) is a frequent complication of right ventricular pacing that often requires re-operation for biventricular or conduction system pacing. Better methods for predicting PICM may inform initial pacing strategy and follow-up monitoring.
Objective: To determine if the spatial ventricular gradient (SVG), a vectorcardiographic marker of ventricular electrical and mechanical heterogeneity, is associated with subsequent development of PICM.
Background: Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.
View Article and Find Full Text PDFBackground: The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recovery among those with recent-onset nonischemic cardiomyopathy.
Methods: We analyzed the left ventricular voltage maps of patients included in the eMAP trial (Electrogram-Guided Myocardial Advanced Phenotyping; NCT03293381), a prospective, nonrandomized, interventional trial conducted at 2 institutions between 2017 and 2020.
Objectives: To investigate tailored approaches, techniques, and outcomes of catheter ablation in patients with persistent left superior vena cava (PLSVC) undergoing atrial fibrillation (AF) ablation.
Background: PLSVC presents unique challenges for AF ablation due to its potential as an arrhythmogenic source and the complex anatomical variations it introduces.
Methods: The retrospective cohort included 16 patients with PLSVC that underwent 21 AF ablation procedures between August 1, 2008, and February 14, 2024, at the Hospital of the University of Pennsylvania.
Article Synopsis
- Premature ventricular contractions (PVCs) are common in individuals with left ventricular (LV) systolic dysfunction, yet their prevalence in the general population is not well understood.
- A multicenter study evaluated the prevalence of frequent (PVCs >5%) and high burden (PVCs >10%) PVCs among patients monitored with ambulatory Holter monitors, analyzing demographics and left ventricle ejection fraction (LVEF).
- Results showed that PVCs >5% and >10% were present in 4% and 5% of participants, respectively, with higher prevalence in older males, while females had a lower occurrence of PVCs despite similar rates when LVEF <50%.
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 AF. Recent data suggest that early initiation of rhythm control within 1 year can improve outcomes.
Methods: In this open-label pragmatic clinical trial nested within the Get with The Guidelines Atrial Fibrillation registry, approximately 3,000 patients with first-detected AF will be enrolled at approximately 200 sites.
Article Synopsis
- Lead-related venous stenosis (LRVS), often diagnosed incidentally, can cause symptoms like swelling and discomfort in patients with transvenous leads, although actual symptomatic cases are rarer.
- A study at the Hospital of the University of Pennsylvania analyzed 18 patients with symptomatic LRVS who did not respond to anticoagulation and underwent balloon venoplasty, finding that a significant majority (72%) experienced complete symptom relief post-procedure.
- The study concluded that while balloon venoplasty is generally safe and effective, timely intervention is crucial, especially as treatment becomes less effective when secondary lymphedema is present.
Article Synopsis
- The study investigates the long-term risk of damage to the right coronary artery (RCA) after patients undergo radiofrequency ablation (RFA) for atrial flutter related to the cavotricuspid isthmus (CTI).
- A comparison was made between patients who had CTI RFA and those who only received ablation for atrial fibrillation (AF), with coronary angiography performed afterward to evaluate any differences in RCA stenosis.
- Results indicate that there were no significant differences in the incidence or severity of RCA stenoses between the two groups, suggesting that CTI RFA does not increase the risk of RCA damage in the long term.
Most people with atrial fibrillation are older adults, in whom atrial fibrillation co-occurs with other chronic conditions, polypharmacy, and geriatric syndromes such as frailty. Yet most randomized controlled trials and expert guidelines use an age agnostic approach. Given the heterogeneity of aging, these data may not be universally applicable across the spectrum of older adults.
View Article and Find Full Text PDFBackground: Cardiac implantable electronic device (CIED) procedures can cause significant postoperative pain. Opioid use for postoperative pain is associated with risk of persistent use. The benefits of pectoral nerve (PECs) blocks have been established for other chest wall surgeries, but adoption in electrophysiology has been limited.
View Article and Find Full Text PDFBackground: The importance of nonpulmonary vein (PV) triggers for the initiation/recurrence of atrial fibrillation (AF) is well established.
Objectives: This study sought to assess the incremental benefit of provocative maneuvers for identifying non-PV triggers.
Methods: We included consecutive patients undergoing first-time AF ablation between 2020 and 2022.
Introduction: Identifying the origin of nonpulmonary vein atrial fibrillation (AF) triggers (NPVTs) after pulmonary vein isolation (PVI) can be challenging. We aimed to determine if noninvasive electrocardiographic imaging (ECGi) could localize pacing from common NPVT sites. ECGi combines measured body surface potentials with heart-torso geometry acquired from computed tomography (CT) to generate an activation map.
View Article and Find Full Text PDFArticle Synopsis
- The study examines the effectiveness of endocardial (ENDO) ablation in treating arrhythmogenic right ventricular cardiomyopathy (ARVC), specifically focusing on its long-term outcomes and factors influencing survival without ventricular tachycardia (VT).
- A total of 74 patients with ARVC underwent ENDO-only VT ablation between 1998 and 2020, with about 66% achieving noninducibility of VT and a median follow-up of 6.6 years revealing that over 54% remained free of VT recurrence.
- Important predictors for long-term VT-free survival included being over 45 years at diagnosis and achieving VT noninducibility, suggesting that ENDO-only ablation could be a viable initial
Article Synopsis
- Epicardial access is important during ventricular tachycardia ablation, and the study compares two methods: traditional ConvEpi access and a newer method called EpiCO, which involves puncturing coronary venous branches.
- The study included 153 patients and found that both methods had similar success rates, but ConvEpi was quicker and associated with more complications, especially significant bleeding.
- Overall, EpiCO access showed a decrease in major complications and bleeding compared to ConvEpi, suggesting it might be a safer option for patients.
Background: The subcutaneous implantable cardioverter-defibrillator (ICD) is associated with fewer lead-related complications than a transvenous ICD; however, the subcutaneous ICD cannot provide bradycardia and antitachycardia pacing. Whether a modular pacing-defibrillator system comprising a leadless pacemaker in wireless communication with a subcutaneous ICD to provide antitachycardia and bradycardia pacing is safe remains unknown.
Methods: We conducted a multinational, single-group study that enrolled patients at risk for sudden death from ventricular arrhythmias and followed them for 6 months after implantation of a modular pacemaker-defibrillator system.
Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology.
View Article and Find Full Text PDFBackground: Endocardial electrogram (EGM) characteristics in nonischemic cardiomyopathy (NICM) have not been explored adequately for prognostication.
Objective: We aimed to study correlation of bipolar and unipolar EGM characteristics with left ventricular ejection fraction (LVEF) and ventricular tachycardia (VT) in NICM.
Methods: Electroanatomic mapping of the left ventricle was performed.