Publications by authors named "Mark S Link"
Introduction: It remains unclear if pacing induced cardiomyopathy (PICM) may be minimized by standard pacing of the right ventricle (RV) at sites other than the RV apex. The purpose of this study is to compare the relative frequency of PICM in a population of patients paced at either the superficial RV mid septum (RVMS) or RV apex (RVA), and other outcomes that may differ between these sites.
Methods And Results: A retrospective evaluation was performed on all patients undergoing pacemaker implantation between 2011 and 2022.
Vigorous exercise and sports participation in individuals with hypertrophic cardiomyopathy.
Trends Cardiovasc Med
September 2024
Article Synopsis
- Historically, people with Hypertrophic Cardiomyopathy (HCM) were discouraged from playing intense competitive sports due to fears of sudden death.
- Recent studies indicate that individuals with HCM engaging in vigorous sports may not face a higher risk of heart arrhythmias compared to less active individuals.
- Current guidelines are adapting to recommend personalized assessments and shared decision-making for HCM athletes looking to return to their sports.
Article Synopsis
- The study focused on understanding the rates of implantable cardioverter-defibrillator (ICD) placement among survivors of out-of-hospital cardiac arrest, specifically in patients aged 65 and older with shockable rhythms.
- Out of 3226 patients analyzed, only 30.9% received an ICD before discharge, and factors like older age, being female, and a history of diabetes were linked to lower chances of obtaining one, but race/ethnicity showed no significant differences in ICD placement.
- The research highlighted substantial variability in ICD implantation rates among different hospitals, with some facilities providing them to nearly 50% of survivors, while others offered them to only 20%, indicating a need for more uniform practices in
Article Synopsis
- Omega-3 polyunsaturated fatty acids (n-3 PUFAs) were initially thought to have antiarrhythmic properties that could help prevent sudden cardiac death and atrial fibrillation (AF), but later trials did not consistently support these benefits.
- Some studies showed high-dose n-3 PUFAs might reduce sudden cardiac death, but these results are not universally accepted and more research is needed to confirm their efficacy.
- Recent trials indicated that high doses of n-3 PUFAs could actually increase the risk of AF, and the reasons for this are unclear, necessitating further investigation into their effects on heart health.
Background: In patients with hypertrophic cardiomyopathy (HCM), impaired augmentation of stroke volume and diastolic dysfunction contribute to exercise intolerance. Systolic-diastolic (S-D) coupling characterizes how systolic contraction of the left ventricle (LV) primes efficient elastic recoil during early diastole. Impaired S-D coupling may contribute to the impaired cardiac response to exercise in patients with HCM.
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- The document outlines guidelines for diagnosing and managing cardiac arrhythmias in athletes, given the rise in sports participation among youth and adults.
- It highlights the importance of expert risk assessments based on athlete symptoms to ensure safe return to sports while minimizing restrictions.
- Key topics covered include treatment strategies, shared decision-making, emergency planning, and recommendations for future research in managing these conditions.
Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.
Circ Arrhythm Electrophysiol
April 2024
Background: Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs.
Methods: To develop a standard to assess chest protectors, 4 phases occurred.
Article Synopsis
- The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" aims to provide updated recommendations for clinicians treating atrial fibrillation patients.
- A thorough literature review was conducted to gather evidence from various medical databases, including studies and reviews published on human subjects from May to November 2022.
- The guideline updates previous recommendations, introducing new strategies for thromboembolic risk assessment, anticoagulation, and methods for prevention and management of atrial fibrillation.
Article Synopsis
- The 2023 guideline aims to provide healthcare professionals with updated recommendations for diagnosing and managing patients with atrial fibrillation.
- A thorough literature review was conducted to gather relevant studies and evidence from multiple databases, ensuring the guideline reflects current knowledge and practices.
- The guidelines build upon earlier recommendations, introducing new insights on thromboembolic risk, anticoagulation, surgical options, and preventive measures related to atrial fibrillation.
Article Synopsis
- * Recent treatment strategies have improved outcomes, including the use of direct oral anticoagulants after the first symptomatic AF episode, while traditional stroke risk scoring systems are not practical for HCM patients.
- * Although rate control is useful for asymptomatic patients, restoring sinus rhythm is crucial for those with significant symptoms, and treatments range from antiarrhythmic medications to catheter ablation and surgical options, with varying success rates.
Background Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy. Methods and Results Patients with hypertrophic cardiomyopathy were randomized to either 5 months of MIT, or 1 month of MIT followed by 4 months of progressive HIT.
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- Cardiac physiologic pacing (CPP) includes techniques like cardiac resynchronization therapy (CRT) and conduction system pacing (CSP) aimed at reducing heart failure in patients with issues in heart rhythm.
- The clinical guideline outlines recommendations for when to use CRT in heart failure patients, how to select suitable candidates, and key steps for pre-procedure preparation and ongoing care.
- It also highlights areas where more research is needed to improve understanding and application of these pacing therapies, especially for children.
Article Synopsis
- This study analyzed how QRS prolongation (a specific measurement in ECG) affects heart health differently based on sex and race in healthy adults participating in the Dallas Heart Study.
- Researchers found that longer QRS durations were linked to higher left ventricular mass and volume and lower ejection fraction, with differences seen between men and women and Black and White individuals.
- Although longer QRS durations were associated with a higher risk of major adverse cardiac events (MACE) in women, the link was less clear for men and not significant for either race after adjusting for cardiovascular risk factors.
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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- The study investigates whether vigorous exercise increases the risk of ventricular arrhythmias and mortality in individuals with hypertrophic cardiomyopathy (HCM).
- Researchers enrolled 1,660 participants aged 8 to 60 with HCM or its genetic markers, categorizing them by their exercise levels (sedentary, moderate, vigorous).
- The primary outcomes included serious events like death and arrhythmias, with findings analyzed by an unbiased committee to evaluate the effects of exercise intensity on these health risks.
A 17-year-old male elite athlete presented for evaluation after an abnormal pre-competitive college screening electrocardiogram. Subsequent evaluation revealed the presence of hypertrophic cardiomyopathy. He remained asymptomatic throughout four years of follow-up.
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- A study analyzed the use of early coronary angiography (CAG) for patients who experienced out-of-hospital cardiac arrest (OHCA), revealing inconsistent results in previous studies and a lack of real-world data on its application.
- In a trial involving over 26,000 patients, it was found that about 26% of those who survived to hospital admission received CAG, with significantly higher rates for patients showing ST-elevation or shockable rhythms.
- The research highlighted substantial variation in CAG usage across different regions, underscoring the uncertainty about the benefits of early CAG for OHCA patients.
A 20-year-old female competitive collegiate swimmer presented after 2 postexercise syncopal episodes and 1 episode while actively swimming. Ambulatory monitoring and exercise testing revealed nonsustained ventricular tachycardia. Electroanatomic mapping demonstrated multifocal premature ventricular contractions and ventricular flutter originating from the right ventricular outflow tract, consistent with borderline arrhythmogenic right ventricular cardiomyopathy.
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