Publications by authors named "Joseph L Schuller"

The authors sought to evaluate a method for improving radiofrequency (RF) lesion durability using doxorubicin encased in heat-sensitive liposomes (HSL-dox). Using a porcine model, RF ablations were performed in the right atrium after systemic infusion of either HSL-dox or saline control given immediately before mapping and ablation. Lesion geometry was measured with voltage mapping immediately postablation and after 2 weeks of survival.

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Article Synopsis
  • Cardiac sarcoidosis (CS) can lead to serious heart issues like arrhythmias and sudden death, especially in patients with preserved heart function, making it hard to assess risk effectively.* -
  • In a study of 120 patients with biopsy-confirmed CS, electrophysiologic testing (EPS) was performed to identify those at higher risk, and 7 patients (6%) showed inducible ventricular tachycardia, leading to the placement of implantable defibrillators.* -
  • The results indicated that a positive EPS was linked to higher risks of arrhythmias, highlighting its value for those with probable CS; however, negative EPS does not completely rule out the risk of sudden cardiac death due to disease
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A 62-year-old man was referred to our institution for high-density, symptomatic premature ventricular contractions (PVCs) with resultant decrease in left ventricular (LV) function having failed prior ablation attempts. Successful, durable ablation of the patient's mid-myocardial PVC arising from the LV summit region was achieved through the proximal great cardiac vein with ablation depth augmented by use of half-normal saline irrigant. Though standard ablation of ventricular arrhythmias using normal saline irrigation from the coronary venous system has been well-reported, this may be of limited value in addressing mid-myocardial sites of origin.

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  • The study examines the effectiveness and safety of repeat ablation procedures for treating ventricular arrhythmias in patients with nonischemic cardiomyopathy (NICM).* -
  • Among the 88 NICM patients analyzed, those requiring multiple ablations had similar survival rates from arrhythmias as those who had only one, but experienced higher complication rates and used more nonstandard ablation methods.* -
  • Midmyocardial substrate (MMS) presence was linked to a higher need for repeat procedures; however, with multiple ablations, the outcomes in terms of arrhythmia-free survival were comparable to those without MMS.*
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Background: Bipolar radiofrequency ablation (bRFA) has been used to create larger ablation lesions and to treat refractory arrhythmias. However, little is known about optimal bRFA settings.

Objective: The purpose of this study was to evaluate various bRFA settings, including active and ground catheter tip orientation and use of variable active and ground catheters during bRFA.

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Background: Remote heating of metal located near a radiofrequency ablation source has been previously demonstrated. Therefore, ablation of cardiac tissue treated with metallic nanoparticles may improve local radiofrequency heating and lead to larger ablation lesions. We sought to evaluate the effect of magnetic nanoparticles on tissue sensitivity to radiofrequency energy.

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Background: Patients with hypertrophic cardiomyopathy (HCM) are at a fourfold to sixfold higher risk of developing atrial fibrillation (AF) compared to the general population, though incidence rates among patients undergoing alcohol septal ablation (ASA) are not well characterized. The purpose of this study was to evaluate atrial fibrillation incidence following ASA.

Methods: We studied 132 consecutive HCM patients without comorbid AF that underwent 154 ASA procedures.

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Article Synopsis
  • Exercise-induced syncope can indicate Long QT Syndrome (LQTS) and requires differentiation from serious conditions like hypertrophic cardiomyopathy and other heart rhythm issues.* -
  • Clinicians need to be aware of the potential connection between LQTS and the risk of atrial fibrillation and cardiomyopathy due to specific gene mutations.* -
  • Understanding these links is crucial for proper diagnosis and management of patients experiencing syncope during physical activity.*
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Objectives: This study was designed to identify the incidence of late complete heart block (CHB) first identified at least 48 hours post alcohol septal ablation (ASA).

Background: Septal reduction with ASA is a therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy (HCM). CHB, resulting from the septal infarct, is a known complication with a reported incidence of 9-22%.

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Objectives: The study sought to characterize the performance of implanted leads among a cohort of patients with cardiac sarcoidosis (CS) and implantable cardiac-defibrillators (ICDs).

Background: An ICD is indicated for some patients with CS for the prevention of sudden cardiac death. CS can lead to myocardial inflammation and scar that may interfere with lead performance.

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Randomized, controlled trials have demonstrated that chronic therapy with macrolide antibiotics reduces the morbidity of patients with cystic fibrosis, non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, and nontuberculous mycobacterial infections. Lower levels of evidence indicate that chronic macrolides are also effective in treating patients with panbronchiolitis, bronchiolitis obliterans, and rejection after lung transplant. Macrolides are known to cause torsade des pointes and other ventricular arrhythmias, and a recent observational study prompted the FDA to strengthen the Warnings and Precautions section of azithromycin drug labels.

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Because alcohol septal ablation (ASA) for the treatment of symptomatic hypertrophic cardiomyopathy (HC) with left ventricular (LV) outflow tract (LVOT) obstruction results in a myocardial infarct of up to 10% of ventricular mass, LV systolic function could decline over time. We evaluated LV function during longitudinal follow-up in a cohort of patients who underwent ASA. We studied 145 consecutive patients with HC that underwent 167 ASA procedures from 2002 to 2011.

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Background: Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) are associated with persistent symptoms and ventricular dysfunction. Approved medical therapies have undesirable side effects and proarrhythmic liability. Ranolazine is a novel antianginal that preferentially blocks the late sodium current.

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Background: The efficient delivery of radiofrequency (RF) energy through an endocardial ablation catheter is affected by variable tissue contact due to cardiac motion with myocardial contraction and respiration. In addition, many operators intentionally move an ablation catheter during the delivery of radiofrequency energy when targeting specific arrhythmias that require lines of conduction block such as atrial flutter and atrial fibrillation. We sought to characterize and quantify any effects of catheter movement and intermittent ablation catheter contact on lesion characteristics.

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Article Synopsis
  • Most ventricular arrhythmias can be treated with endocardial approaches, but some require epicardial mapping and ablation, which can be challenging to identify accurately from surface electrocardiograms.
  • A study analyzed electrogram data from patients who had successful endo and epi mapping for ventricular arrhythmias, identifying key indicators that suggest a need for epicardial intervention.
  • The findings highlight three main characteristics: a large area of diffusely early activation, a specific sequence of EGM components, and the inability to capture a far-field EGM, all pointing towards the necessity of epicardial ablation for effective treatment.
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  • Ventricular fibrillation (VF) can be treated by identifying and ablating its triggering sources, often found in the Purkinje network or right ventricular outflow tract (RVOT), without needing to induce VF or premature ventricular complexes (PVC).
  • A study involving 11 patients with frequent VF episodes used stored electrograms from implantable cardioverter defibrillators (ICDs) to locate and successfully ablate VF triggers, targeting areas like the left posterior and anterior fascicles and the RVOT.
  • All procedures were successful, with no complications, leading to 10 out of 11 patients being free of VF after about 288 days of follow-up, indicating effective short-term outcomes of this ablation strategy.
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Unlabelled: ICD Shocks in Cardiac Sarcoidosis.

Background: An implantable cardioverter defibrillator (ICD) is indicated for some patients with cardiac sarcoidosis (CS) for prevention of sudden death. However, there are little data regarding the event rates of ICD therapies in these patients.

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The most commonly prescribed class of medications in the United States for chronic severe pain is opioid analgesics. Due to their low cost and widespread availability, the synthetic opioids are popular choices among clinicians and patients. However, there is an increasingly recognized risk of QT prolongation with several drugs in this class, and recently propoxyphene (Darvon) was withdrawn from the market by the Food and Drug Administration (FDA) due to, in part, the risk of QT prolongation and ventricular arrhythmias Updated Epidemiological Review of Propoxyphene Safety.

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Article Synopsis
  • Some patients diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) may actually have cardiac sarcoidosis (CS), which affects treatment and familial screening.
  • A study analyzed cardiac MRI scans of patients with either condition, confirming all CS cases through histology and ARVC through task force criteria.
  • Results indicated significant differences in MRI characteristics: CS patients were older, had more left ventricular scar, and distinct findings like lymphadenopathy, while ARVC patients showed a family history of sudden cardiac death.
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Introduction: Sarcoidosis is a multisystem granulomatous disease that can affect the heart. Early identification of cardiac sarcoidosis (CS) is critical because sudden death can be the initial presentation. We sought to evaluate the potential role of the ECG for identification of cardiac involvement in a cohort of patients with biopsy-proven pulmonary sarcoidosis.

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