Publications by authors named "Elaine Wan"
Background: Asthma is a known risk factor for atrial fibrillation (AF), the most common sustained arrhythmia. While radiofrequency catheter ablation is effective in treating AF, the impact of asthma and its severity on ablation outcomes has not been previously explored.
Objective: To evaluate the impact of asthma and its severity on AF recurrence following ablation.
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
Stylianos Tzeis Edward P Gerstenfeld Jonathan Kalman Eduardo B Saad Alireza Sepehri Shamloo Elaine Y Wan
J Arrhythm
December 2024
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017.
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- The study aimed to understand the mechanisms behind reentrant ventricular tachycardia (VT) and enhance the targeting of catheter ablation procedures in postinfarction patients.
- Researchers collected and analyzed electrogram data during both sinus rhythm and VT, finding distinct voltage gradients, with significantly lower mean voltage at the VT isthmus compared to its boundaries.
- The findings suggest that the isthmus has uniform slow conduction, which helps maintain the VT circuit, challenging previous assumptions about conducting channels.
Article Synopsis
- Transthyretin cardiac amyloidosis (ATTR-CA) leads to a higher incidence of arrhythmias, prompting a study to monitor patients for 2 weeks.
- The study included 38 ATTR-CA patients and an age-matched control group, finding that 26.3% had atrial fibrillation/atrial flutter (AF/AFL) and a significant 81.6% had nonsustained ventricular tachycardia (NSVT).
- Although ATTR-CA patients showed increased rates of these arrhythmias, there was no link between their presence and negative clinical outcomes over a median follow-up of 45 weeks, suggesting noninvasive monitoring may help in assessing arrhythmia risk.
Cardiac arrhythmias are commonly noted in patients during infections with and recovery from COVID-19. Arrhythmic manifestations span the spectrum of innocuous and benign to life-threatening and deadly. Various pathophysiological mechanisms have been proposed.
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- - The prevalence of neurologic diseases like stroke and dementia is projected to increase significantly, making brain health a key public health concern.
- - Cardiovascular diseases are the primary cause of death and disability globally, and emerging research highlights the connection between heart and brain health through shared risk factors.
- - This statement focuses on how specific cardiac conditions (heart failure, atrial fibrillation, and coronary heart disease) may lead to cognitive impairment, suggesting that improving heart health early on could help prevent future brain-related issues.
Article Synopsis
- Catheter ablation for ventricular tachycardia (VT) currently uses isochronal late activation mapping (ILAM), which helps identify isthmus regions by categorizing activation times into a limited number of isochrones.
- This study evaluates whether the methods used in ILAM are the most effective by testing various numbers of isochrones and exploring continuous metrics that improve isthmus detection.
- Results showed that increasing the number of isochrones or using continuous metrics significantly enhanced the identification precision of isthmus regions, indicating that current practices can be optimized for better outcomes in VT ablation.
Article Synopsis
- Atrial fibrillation (AF) is the most common heart arrhythmia, but its underlying mechanisms, particularly cellular and mitochondrial changes, are not well understood, which hampers the development of effective treatments.
- The study explores mitochondrial structure and interactions with other organelles in AF using advanced 3D imaging techniques, revealing that AF leads to enlarged and more complex mitochondria in heart cells and increased interactions with the sarcoplasmic reticulum and T-tubules.
- Findings suggest that mitophagy, the process of degrading dysfunctional mitochondria, is altered in AF, with larger mitophagosomes observed in affected cardiomyocytes, indicating structural remodeling associated with the disease.
Article Synopsis
- Geographic disparities exist in the use of remote monitoring (RM) for patients with cardiac implantable electronic devices (CIED), but reasons for this variability are not well understood.
- An international survey of CIED clinic staff from 47 countries revealed that the average RM usage among patients was around 80%, with factors like national income and clinic type influencing RM adoption.
- Economic and structural barriers contribute to the inconsistencies in RM utilization, suggesting a need for targeted efforts by stakeholders to enhance its usage globally.
Article Synopsis
- Advancements in cardiac implantable electronic devices like pacemakers and defibrillators require an updated framework for their management during medical procedures.
- The statement consolidates expertise from various healthcare professionals to provide guidelines covering patient planning, procedural execution, and post-procedure care.
- Emphasizing patient safety and optimal device function, the objective is to improve quality care for the growing number of patients with these technologies, while also setting the stage for ongoing education and research.
Article Synopsis
- The study investigates using a graph convolutional network (GCN) to identify critical isthmus areas in patients with scar-related reentrant atrial tachycardia (SRRAT) for effective ablation.
- Researchers collected electroanatomic maps from 29 SRRAT cases to create an optimal GCN model for predicting isthmus points based on key electrogram features.
- Results indicated that the GCN successfully predicted isthmus areas with a median distance of approximately 8 mm from actual areas, suggesting potential for improved identification of critical ablation targets in clinical practice.
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
Stylianos Tzeis Edward P Gerstenfeld Jonathan Kalman Eduardo Saad Alireza Sepehri Shamloo Elaine Y Wan
J Interv Card Electrophysiol
August 2024
Article Synopsis
- Ablation of atrial fibrillation (AF) has become a widely accepted and effective treatment for managing this common heart rhythm disorder over the last 30 years.
- Since the initial consensus document in 2007, new research and technologies have significantly changed AF ablation practices, necessitating updates in 2012 and 2017.
- A new consensus document was recently created by various cardiac societies to provide a current framework for selecting and managing patients for catheter or surgical AF ablation, reflecting the evolving nature of the field.
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
Stylianos Tzeis Edward P Gerstenfeld Jonathan Kalman Eduardo B Saad Alireza Sepehri Shamloo Elaine Y Wan
Heart Rhythm
September 2024
Article Synopsis
- * The first expert guidelines for AF ablation were published in 2007, and updates were necessary in 2012 and 2017 due to advancements in research and technology.
- * A new consensus document is now being released to provide updated guidelines for healthcare professionals on selecting and managing patients for AF ablation, created by various international cardiac societies.
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
Stylianos Tzeis Edward P Gerstenfeld Jonathan Kalman Eduardo B Saad Alireza Sepehri Shamloo Elaine Y Wan
Europace
March 2024
Article Synopsis
- Atrial fibrillation (AF) ablation has become a well-established treatment method in the last 30 years, supported by evidence showing it is safe and effective.
- In response to advancements in research and technology, new guidelines have been released over the years, the latest being necessary to provide updated recommendations for patient care.
- This revised consensus involves collaboration among major cardiac electrophysiology societies from Europe, Asia-Pacific, and Latin America to ensure comprehensive guidelines for AF treatment.
Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation.
J Interv Card Electrophysiol
March 2024
Article Synopsis
- Esophageal perforation and fistula formation are rare but serious complications that can occur after atrial fibrillation ablation, with incidences varying depending on the type of thermal ablation used.
- A review of 130 studies highlighted that thermal ablation (like radiofrequency and cryoballoon) has a significantly higher chance of causing esophageal injuries compared to non-thermal methods.
- Preventative strategies, such as using temperature monitoring and mechanical esophageal deviation, can help reduce risks, but the prognosis for those who develop atrioesophageal fistulas remains very poor without surgical intervention; new technologies like pulsed field ablation may further mitigate these risks in the future.
Article Synopsis
- Successful synchronized direct current cardioversion (DCCV) requires sufficient current delivery, but optimal current levels for effective DCCV remain undefined.
- A study analyzed data from 220 patients who underwent DCCV, revealing that factors like body mass index (BMI), being female, sleep apnea, and chronic kidney disease are linked to higher transthoracic impedance (TTI).
- Results suggest that understanding these factors can aid in determining the right shock energy needed for patients undergoing DCCV, particularly for conditions like atrial fibrillation and flutter.
Catheter ablation of typical atrial flutter improves cardiac chamber size and function.
J Cardiovasc Electrophysiol
January 2024
Article Synopsis
- Cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) is a common heart rhythm issue that often requires radiofrequency catheter ablation, but its impact on heart size and function was previously unclear.
- A study of 130 patients who underwent this procedure revealed significant improvements in heart function, such as an increase in left ventricular ejection fraction and reductions in left atrial and right atrial volumes.
- These results suggest that restoring normal heart rhythm through ablation can positively affect cardiac size and function, although long-term effects remain to be determined.
Correlation relationships of the reentrant ventricular tachycardia circuit.
Comput Methods Programs Biomed
November 2023
Article Synopsis
- A study was conducted using 19 canine experiments to examine how reentrant ventricular tachycardia (VT) is initiated and sustained, focusing on mapping heart circuitry post-infarction.
- Findings revealed a correlation between the extrastimulus interval used to induce VT and the VT cycle length, suggesting that a specific boundary length (LIB) within the heart's circuitry plays a crucial role in VT dynamics.
- The research concluded that while shorter LIBs are closely related to VT cycle length, other circuit parameters like isthmus width and angle showed less relevance, potentially due to changes in the heart tissue's structure after an infarct.
Long-Term Outcomes of Permanent Pacemaker Implantation in Bicaval Heart Transplant Recipients.
JACC Clin Electrophysiol
September 2023
Article Synopsis
- Up to 10% of heart transplant patients may require permanent pacemakers (PPMs), with this study focusing on the long-term outcomes of those who did.
- Out of 1,082 heart transplant recipients studied, 41 (3.8%) needed PPMs mainly due to sinus node dysfunction and AV nodal disease, experiencing few complications.
- Notably, PPM implantations decreased after 2018, suggesting a shift towards more cautious management in the early postoperative period, with no significant differences in mortality or re-transplantation rates among patients with and without PPMs.
Article Synopsis
- Direct current cardioversion (DCCV) is used to treat atrial fibrillation (AF), but many patients revert to AF after treatment; Electromechanical Cycle Length Mapping (ECLM) is a new method that analyzes heart activity to understand AF better.
- In a study with 45 subjects, including AF patients and healthy controls, ECLM was used to track heart electrical activity before and after DCCV, and the data helped predict which patients would respond to the treatment.
- ECLM proved effective in identifying the irregular electrical activity in AF and differentiating between short-term and long-term treatment responses, offering a potential noninvasive tool for clinicians to personalize AF treatment plans.
Article Synopsis
- The study investigates how mapping electrical activity during sinus rhythm can help identify areas of disrupted conduction in hearts affected by ischemic re-entrant ventricular tachycardia.
- Researchers constructed activation maps from electrograms of canines with postinfarction hearts, focusing on regions known as isthmus lateral boundaries (ILB).
- Results show significant differences in activation times at ILB locations compared to other circuit parts, suggesting that these areas may be linked to long-lasting changes in electrical properties due to heart tissue damage.