Implementation of a Patient Decision Aid for Atrial Fibrillation Ablation Improves Patient Procedural Knowledge but Does Not Impact Perceived Involvement With the Shared Decision-Making Process.

Purpose: Shared decision-making (SDM) is a method for a patient and physician to cooperatively consider a diagnostic or therapeutic option, ultimately empowering the patient to make an informed decision. Atrial fibrillation (AF) ablation is a procedure that would benefit from SDM given the risk of serious adverse events, the high rate of arrhythmia recurrence, and alternative treatment options. Implementing a patient decision aid (PDA) may help facilitate AF ablation SDM by succinctly conveying important information to patients.

Development of a comprehensive cardiac atlas on a 1.5 Tesla Magnetic Resonance Linear Accelerator.

Background And Purpose: The 1.5 Tesla (T) Magnetic Resonance Linear Accelerator (MRL) provides an innovative modality for improved cardiac imaging when planning radiation treatment. No MRL based cardiac atlases currently exist, thus, we sought to comprehensively characterize cardiac substructures, including the conduction system, from cardiac images acquired using a 1.

Profibrotic COVID-19 subphenotype exhibits enhanced localized ER-dependent HSP47 expression in cardiac myofibroblasts in situ.

We recently described a subgroup of autopsied COVID-19 subjects (∼40%), termed 'profibrotic phenotype,' who exhibited clusters of myofibroblasts (Mfbs), which were positive for the collagen-specific chaperone heat shock protein 47 (HSP47) in situ. This report identifies increased, localized (hot spot restricted) expression of αSMA, COLα1, POSTN and FAP supporting the identity of HSP47 cells as myofibroblasts and characterizing a profibrotic extracellular matrix (ECM) phenotype. Coupled with increased GRP78 in COVID-19 subjects, these data could reflect induction of the unfolded protein response for mitigation of proteostasis (i.

Onset of the COVID-19 pandemic reduced active time in patients with implanted cardiac devices.

Background: Physical inactivity and sedentary behavior are modifiable risk factors for chronic disease and all-cause mortality that may have been negatively impacted by the COVID-19 shutdowns.

Methods: Accelerometry data was retrospectively collected from 332 permanent pacemaker (PPM) and 244 implantable cardiac defibrillation (ICD) patients for 6 time points: March 15-May 15, 2020 (pandemic period), January 1-March 14, 2020, October 1-December 31, 2019, March 15-May 15, 2019, January 1-March 14, 2019, and October 1-December 31, 2018. Paired t-tests, with Bonferroni correction, were used to compare time periods.

Value CMR: Towards a Comprehensive, Rapid, Cost-Effective Cardiovascular Magnetic Resonance Imaging.

Cardiac magnetic resonance imaging (CMR) is considered the gold standard for measuring cardiac function. Further, in a single CMR exam, information about cardiac structure, tissue composition, and blood flow could be obtained. Nevertheless, CMR is underutilized due to long scanning times, the need for multiple breath-holds, use of a contrast agent, and relatively high cost.

Cardiac Magnetic Resonance for Early Detection of Radiation Therapy-Induced Cardiotoxicity in a Small Animal Model.

Background: Over half of all cancer patients receive radiation therapy (RT). However, radiation exposure to the heart can cause cardiotoxicity. Nevertheless, there is a paucity of data on RT-induced cardiac damage, with limited understanding of safe regional RT doses, early detection, prevention and management.

Pandemic Perspective: Commonalities Between COVID-19 and Cardio-Oncology.

Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer.

A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy.

Purpose/objectives: Node-positive breast cancer patients often receive chemotherapy and regional nodal irradiation. The cardiotoxic effects of these treatments, however, may offset some of the survival benefit. Cardiac magnetic resonance (CMR) is an emerging modality to assess cardiac injury.

Optimized cardiac functional MRI of small-animal models of cancer radiation therapy.

Cardiac MRI of small animal models of cancer radiation therapy (RT) is a valuable tool for studying the effect of RT on the heart. However, standard cardiac MRI exams require long scanning times, which is challenging for sick animals that may not survive extended periods of imaging under anesthesia. The purpose of this study is to develop an optimized, fast MRI exam for comprehensive cardiac functional imaging of small-animal models of cancer RT.

Tachyarrhythmia discriminator for implantable cardioverter-defibrillators in bundle branch block.

Background: Inaccurate arrhythmia classification by implantable cardioverter-defibrillators (ICDs) contributes to inappropriate shocks and increased health care utilization.

Objective: The purpose of this study was to evaluate the ability of a novel discriminator using far-field (FF) and near-field (NF) right ventricular lead electrograms (EGMs) to differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) in patients with underlying conducted narrow QRS, right bundle branch block (RBBB), and left bundle branch block (LBBB).

Methods: ICD interrogations were reviewed, identifying subjects with tachycardia events at least 5 beats in duration with stable morphology and cycle length.

Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator.

Background: The presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverter-defibrillator (ICD) that was "non-MRI-conditional" (i.

The relationship between defibrillation threshold and total mortality.

Background: The relationship between the defibrillation threshold (DFT) and total mortality is unclear.

Methods: A university hospital prospectively maintained implantable defibrillator (ICD) database identified 508 patients who underwent ICD implantation and had DFT testing performed at implant. Patients were placed in one of three groups based on the implant DFT (high (≥20 J), moderate (19-11 J), or low DFT (≤10 J)).

Effectiveness of VF induction with DC fibber versus conventional induction methods in patients on chronic amiodarone therapy.

Background: Amiodarone therapy, especially chronic, can result in difficult ventricular fibrillation (VF) inductions during implantable cardioverter defibrillator (ICD) testing. The efficacy of various VF induction methods on patients treated with amiodarone has not been well described. This prospective analysis evaluated the impact of direct current (DC) fibber, burst fibber, and synchronized T-wave shock VF induction methods.

A comparison of cardiac magnetic resonance imaging peri-infarct border zone quantification strategies for the prediction of ventricular tachyarrhythmia inducibility.

Background: Peri-infarct border zone (BZ) as quantified by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) has been proposed as a risk stratification tool, and is associated with increased mortality. BZ has been measured by various methods in the literature. We assessed which BZ analysis best predicts inducible arrhythmia during electrophysiological study (EPS).

Atrial Fibrillation in Acute Coronary Syndrome.

Atrial fibrillation (AF) is a common cardiac arrhythmia occurring in an estimated 2.7 to 6.1 million people in the United States.

Atrioventricular junction ablation and pacemaker implantation for heart failure associated with atrial fibrillation: potential issues and therapies in the setting of acute heart failure syndrome.

Atrial fibrillation is the most common arrhythmia and is especially clinically important in patients with heart failure. Prolonged atrial fibrillation with high ventricular rate response may lead to development or worsening of left ventricular function. If adequate heart rate control cannot be obtained medically, often patients will undergo pacemaker implant and catheter ablation of the atrioventricular junction.

Diurnal heart rate patterns in inappropriate sinus tachycardia.

Background: Inappropriate sinus tachycardia (IAST) is a supraventricular tachycardia originating from the sinus node. Proposed etiologies for this symptom complex include autonomic dysfunction, abnormal automaticity, or hypersensitivity of the sinus node.

Methods: Patients with IAST were identified by symptomatic tachycardia, with P-wave morphology consistent with origination from a sinus location.