Journal of Interventional Cardiac Electrophysiology
Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with r... more Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with recurrence despite intact pulmonary vein isolation (PVI). As the ability to perform durable PVI improves, the need for advanced mapping to identify extra-PV sources of AF becomes increasingly evident. Multiple mapping technologies attempt to localize these self-sustained triggers and/or drivers responsible for initiating and/or maintaining AF; however, current approaches suffer from technical limitations. Electrographic flow (EGF) mapping is a novel mapping method based on well-established principles of optical flow and fluid dynamics. It enables the full spatiotemporal reconstruction of organized wavefront propagation within the otherwise chaotic and disorganized electrical conduction of AF. Given the novelty of EGF mapping and relative unfamiliarity of most clinical electrophysiologists with the mathematical principles powering the EGF algorithm, this paper provides an in-depth explanat...
BackgroundāIn patients with recurrent persistent atrial fibrillation (AF), vulnerability to AF pe... more BackgroundāIn patients with recurrent persistent atrial fibrillation (AF), vulnerability to AF persists indefinitely despite presumed completion of reverse electrical remodeling within days of return to normal sinus rhythm. Atrial electrical and anatomic remodeling and reverse remodeling were studied in a canine model of chronic AF. Methods and ResultsāChronic AF was induced in 8 dogs by creating moderate mitral regurgitation and rapidly pacing the right atrium at 640 bpm for.8 weeks. Measurements performed at baseline, after establishment of chronic AF, and then at 4 hours and again at 7 to 14 days after cardioversion to sinus rhythm included atrial effective refractory periods, AF cycle lengths, left atrial dimensions, premature atrial contraction (PAC) frequency, and atrial vulnerability to atrial extrastimuli. After establishing chronic AF, atrial effective refractory period shortening, increases in spontaneous PAC frequency, increases in left atrial size with loss of contractil...
The clinical trial is not registered as data was collected prior to trial registration standards ... more The clinical trial is not registered as data was collected prior to trial registration standards by guest on March 5,
Circulation. Arrhythmia and electrophysiology, 2013
Asymptomatic cerebral lesions have been observed on diffusion weighted MRI (DWI) scans shortly af... more Asymptomatic cerebral lesions have been observed on diffusion weighted MRI (DWI) scans shortly after catheter ablation of atrial fibrillation, but the pathogenesis of these lesions is incompletely understood. Twelve dogs underwent selective catheterization of the internal carotid or vertebral arteries. Either a microbubbled mixture of air (1.0-4.0 mL), blood, contrast, and saline (n=5), or heat-dried pulverized blood (particle size <600 Ī¼m) mixed with saline and contrast (n=6) was injected. One sham control experiment was performed. MRI scans were performed preinjection, and at 1, 2, and 4 days postinjection. Neurological tests were performed daily. Gross pathology and histopathology were performed on the brains after being euthanized on day 4. Three animals died <24 hours after injection. Hyperintense lesions were observed on DWI (median maximum diameter 3.1 mm) in 2 of 4 animals after air embolism and in 3 of 5 animals after particulate embolism. No DWI lesions were detected...
Circulation. Arrhythmia and electrophysiology, 2013
Because of the technical difficulty with achieving pulmonary vein (PV) isolation in the treatment... more Because of the technical difficulty with achieving pulmonary vein (PV) isolation in the treatment of patients with paroxysmal atrial fibrillation, novel catheter designs to facilitate the procedure are in development. A visually guided laser ablation (VGLA) catheter was designed to allow the operator to directly visualize target tissue for ablation and then deliver laser energy to perform point-to-point circumferential ablation. Single-center studies have demonstrated favorable safety and efficacy. We sought to determine the multicenter feasibility, efficacy, and safety of performing PV isolation using the VGLA catheter. This study includes the first 200 paroxysmal atrial fibrillation patients treated with the VGLA catheter (33 operators, 15 centers). After transseptal puncture, the VGLA catheter was used to perform PV isolation. Electric isolation was assessed using a circular mapping catheter. Using the VGLA catheter, 98.8% (95% confidence interval, 97.8%-99.5%) of targeted PVs we...
Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early i... more Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bidirectional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. Methods: A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. Results: The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5 min, compared to 1.6 min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Conclusions: Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.
Journal of the American College of Cardiology, 1999
This document provides guidance to cardiovascular specialists on appropriate and ethical coding o... more This document provides guidance to cardiovascular specialists on appropriate and ethical coding of physician services and procedures. The rapid evolution of coding practice and policy has confused physicians and office personnel about how to code for physicians' services. Recent attempts by the federal government to identify inappropriate or fraudulent claims have increased concern among physicians that unintentional mistakes in coding could lead to prosecution for Medicare fraud. We surveyed professional medical societies and coding professionals for guidelines on appropriate and ethical "Ethical Coding and Billing Practices for Cardiovascular Medicine Specialists" was approved by the American College of Cardiology Board of Trustees on October 24, 1998.
Journal of the American College of Cardiology, 2002
The purpose of this study was to determine if burst atrial pacing would have an effect on termina... more The purpose of this study was to determine if burst atrial pacing would have an effect on terminating atrial fibrillation. BACKGROUND We hypothesized that frequency domain analysis of a filtered wide bipolar atrial electrogram describes the global organization of atrial fibrillation (AF) and should vary over time. Timing burst pacing to periods of high organization of AF should promote regional atrial conduction block and terminate AF. METHODS Nine dogs were conditioned with rapid atrial pacing for 48 h. Electrogram recordings were made from a wide right atrium (RA) to left atrium (LA) bipole and digitally filtered. A fast-Fourier transform was performed every 0.5 s on a sliding 2-s window, and the organization index (OI) was calculated as a ratio of the area of the first four harmonic peaks to the total power of the spectrum. Organization indexes Ļ¾0.5 indicated more organized AF activity. Right atrium and LA burst pacing (burst) (cycle length 50 ms, 9.9 ms, 9.9 mA, 1 to 4 s) was performed through decapolar catheters. Burst was either random or synchronized to OI Ļ¾0.5. RESULTS Burst termination was attempted 1,814 times (889 OI sync, 925 random) and succeeded in seven of nine dogs. Burst had an overall success rate of 11.1% versus 6.3% for random (p Ļ½ 0.0003). Biatrial pacing had the highest efficacy for terminating AF, with a success rate of 16.5% for OI sync versus 8.2% for random (p Ļ½ 0.0001). CONCLUSIONS Timing the delivery of the burst pace when the OI is Ļ¾0.5 increases the efficacy of burst pace termination of AF. Biatrial pacing is more effective than either RA or LA pacing alone.
Journal of the American College of Cardiology, 2010
Background: CMS policy denying routine inpatient status for elective ICD implantation is supporte... more Background: CMS policy denying routine inpatient status for elective ICD implantation is supported by the low complication rate in this group. Yet a subset of patients (pts) may remain at risk for poor outcome and may need higher level post-op care. Methods: Records from 268,701 implantations from 1300 centers prospectively enrolled in the National ICDR database from 2006 through June 2008 were reviewed. Pts with thoracotomy lead implants were excluded. Thirty-six preimplant clinical variables were tested as predictors for any of 20 post implant adverse outcomes including bleeding, infection, pneumothorax, lead dislodgement and death. Of the overall cohort, 179,401 (66.8%) were coded as "admitted for this procedure". Preimplant clinical factors were used to develop a simple predictive model for adverse outcome using randomly half of the data, and then verified with the remaining half. ROC curves were calculated. Results: The overall rate of in-hospital complications or death for the elective ICD implant cohort was 2.51%, and risk of death was 0.12%. For endpoints of any in-hospital complication or death, 7 independent risk factors (RF) were identified (in order of weight): procedure not elective generator change, dual or biventricular device, NYHA class III or IV, previous valve surgery, atrial fibrillation/flutter, female sex, and chronic lung disease (ROC 0.651). Risk in the validation cohort increased from 0.22% (0 RF) to 8.14% (7 RF) in a linear fashion ~ 1% / RF. Pts with >3 RF (59.5% of pts) had a 3.4% complication rate. For endpoints of in-hospital death, 5 independent RF were identified (in order of weight): NYHA class III or IV CHF, history of Cardiac arrest, serum BUN >30 mg/dl, serum Creatinine >2.0 mg/dl, and systolic Blood pressure <100 mmHg (ROC 0.841). Mortality risk in the validation cohort increased from 0.02% (0 RF) to 1.27% (4 RF). Mortality was 0.35% for RF>2 (18.9% of pts), and 0.65% for RF>3 (5.2% of pts). Conclusions: In a low risk population of patients admitted for the indication of ICD implant, in-hospital complication rate and risk of death is low. High risk pt subsets should be monitored carefully post implant, but a lower intensity care level would be appropriate for the lower risk cohort.
Journal of the American College of Cardiology, 1988
A defibrillator method and apparatus wherein a patient's measured transthoracic impedance (TTI) i... more A defibrillator method and apparatus wherein a patient's measured transthoracic impedance (TTI) is used to control the amount of energy contained in a defibrillation pulse applied to the patient. Prior to delivering a defibrillation pulse, the patient's TTI is measured by an impedance measuring circuit (11). The patient's TTI may also be measured during delivery of a prior defibrillation pulse. A
Journal of the American College of Cardiology, 1996
S-Pester 123A conduction, the later was felt to be arrhy~mogenic, and radlofrequency (Rf) cathete... more S-Pester 123A conduction, the later was felt to be arrhy~mogenic, and radlofrequency (Rf) catheter ablation was proposed. Extensive multtpoisr catheter mapping using an encircling technique during fixed N.RA paring revealed efectdcal propagalian through the suture line at the level Of the RA appendage (n = 2) or the low I~eral RA (n = 1). 4, 3 and 1 Rf pulses were dally,areal at the site et shortest condu~on time batWesn the pacing site and the ablation catheter when bosilionnad across the suture line. Local electmgram molphology was double spikes (n = 2) 0r fragmenled potential (n = I). Results: Complete abolition of alrioa~al conduction was obtained in the 3 cases with a mean prOcedure duration of 4 hours and a mean fluorOscopy time of 27 min, No tachycardia was observed during a mean follow up of ,~ months (range 6-15). A total disappearance o! premature atrial contractions was seen at control 24 hours Hotter recordings. Conclusion: Although unfrequent, abnormal atricavial conduction may be seen after orthotopio heart Iransplantation an~ may result in clinically relevant G.RA arltlythmies. Rf catheter ablation at the level of impulse propagation across the suture line may provide a definite cure of arrflythmias in this selected group of I~tients.
The Journal of thoracic and cardiovascular surgery, 2008
The objective was to evaluate the effects of atrial synchronous biventricular pacing in postopera... more The objective was to evaluate the effects of atrial synchronous biventricular pacing in postoperative patients with severe cardiomyopathy.
Journal of the American College of Cardiology, 2011
This document was approved by the American College of Cardiology Foundation Board of Trustees in ... more This document was approved by the American College of Cardiology Foundation Board of Trustees in November 2010.
Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity... more Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity and mortality. The circumferential pulmonary vein isolation technique is established as the principal procedure, with a high cure rate and acceptable safety, for paroxysmal AF, but new adjunctive ablation strategies targeting the AF substrates and sources for long-standing persistent/chronic AF have been developed. These new techniques include linear ablation, complex fractionated atrial electrogram guided ablation, dominant frequency map-guided ablation, ganglionated plexi ablation and disconnection of the coronary sinus and superior vena cava to ablate the AF substrates and sources. The long-term usefulness of the established technique and these innovative adjunctive approaches for the treatment of AF remains to be investigated.
Journal of Interventional Cardiac Electrophysiology
Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with r... more Ablation strategies remain poorly defined for persistent atrial fibrillation (AF) patients with recurrence despite intact pulmonary vein isolation (PVI). As the ability to perform durable PVI improves, the need for advanced mapping to identify extra-PV sources of AF becomes increasingly evident. Multiple mapping technologies attempt to localize these self-sustained triggers and/or drivers responsible for initiating and/or maintaining AF; however, current approaches suffer from technical limitations. Electrographic flow (EGF) mapping is a novel mapping method based on well-established principles of optical flow and fluid dynamics. It enables the full spatiotemporal reconstruction of organized wavefront propagation within the otherwise chaotic and disorganized electrical conduction of AF. Given the novelty of EGF mapping and relative unfamiliarity of most clinical electrophysiologists with the mathematical principles powering the EGF algorithm, this paper provides an in-depth explanat...
BackgroundāIn patients with recurrent persistent atrial fibrillation (AF), vulnerability to AF pe... more BackgroundāIn patients with recurrent persistent atrial fibrillation (AF), vulnerability to AF persists indefinitely despite presumed completion of reverse electrical remodeling within days of return to normal sinus rhythm. Atrial electrical and anatomic remodeling and reverse remodeling were studied in a canine model of chronic AF. Methods and ResultsāChronic AF was induced in 8 dogs by creating moderate mitral regurgitation and rapidly pacing the right atrium at 640 bpm for.8 weeks. Measurements performed at baseline, after establishment of chronic AF, and then at 4 hours and again at 7 to 14 days after cardioversion to sinus rhythm included atrial effective refractory periods, AF cycle lengths, left atrial dimensions, premature atrial contraction (PAC) frequency, and atrial vulnerability to atrial extrastimuli. After establishing chronic AF, atrial effective refractory period shortening, increases in spontaneous PAC frequency, increases in left atrial size with loss of contractil...
The clinical trial is not registered as data was collected prior to trial registration standards ... more The clinical trial is not registered as data was collected prior to trial registration standards by guest on March 5,
Circulation. Arrhythmia and electrophysiology, 2013
Asymptomatic cerebral lesions have been observed on diffusion weighted MRI (DWI) scans shortly af... more Asymptomatic cerebral lesions have been observed on diffusion weighted MRI (DWI) scans shortly after catheter ablation of atrial fibrillation, but the pathogenesis of these lesions is incompletely understood. Twelve dogs underwent selective catheterization of the internal carotid or vertebral arteries. Either a microbubbled mixture of air (1.0-4.0 mL), blood, contrast, and saline (n=5), or heat-dried pulverized blood (particle size <600 Ī¼m) mixed with saline and contrast (n=6) was injected. One sham control experiment was performed. MRI scans were performed preinjection, and at 1, 2, and 4 days postinjection. Neurological tests were performed daily. Gross pathology and histopathology were performed on the brains after being euthanized on day 4. Three animals died <24 hours after injection. Hyperintense lesions were observed on DWI (median maximum diameter 3.1 mm) in 2 of 4 animals after air embolism and in 3 of 5 animals after particulate embolism. No DWI lesions were detected...
Circulation. Arrhythmia and electrophysiology, 2013
Because of the technical difficulty with achieving pulmonary vein (PV) isolation in the treatment... more Because of the technical difficulty with achieving pulmonary vein (PV) isolation in the treatment of patients with paroxysmal atrial fibrillation, novel catheter designs to facilitate the procedure are in development. A visually guided laser ablation (VGLA) catheter was designed to allow the operator to directly visualize target tissue for ablation and then deliver laser energy to perform point-to-point circumferential ablation. Single-center studies have demonstrated favorable safety and efficacy. We sought to determine the multicenter feasibility, efficacy, and safety of performing PV isolation using the VGLA catheter. This study includes the first 200 paroxysmal atrial fibrillation patients treated with the VGLA catheter (33 operators, 15 centers). After transseptal puncture, the VGLA catheter was used to perform PV isolation. Electric isolation was assessed using a circular mapping catheter. Using the VGLA catheter, 98.8% (95% confidence interval, 97.8%-99.5%) of targeted PVs we...
Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early i... more Background: A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bidirectional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. Methods: A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. Results: The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5 min, compared to 1.6 min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Conclusions: Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.
Journal of the American College of Cardiology, 1999
This document provides guidance to cardiovascular specialists on appropriate and ethical coding o... more This document provides guidance to cardiovascular specialists on appropriate and ethical coding of physician services and procedures. The rapid evolution of coding practice and policy has confused physicians and office personnel about how to code for physicians' services. Recent attempts by the federal government to identify inappropriate or fraudulent claims have increased concern among physicians that unintentional mistakes in coding could lead to prosecution for Medicare fraud. We surveyed professional medical societies and coding professionals for guidelines on appropriate and ethical "Ethical Coding and Billing Practices for Cardiovascular Medicine Specialists" was approved by the American College of Cardiology Board of Trustees on October 24, 1998.
Journal of the American College of Cardiology, 2002
The purpose of this study was to determine if burst atrial pacing would have an effect on termina... more The purpose of this study was to determine if burst atrial pacing would have an effect on terminating atrial fibrillation. BACKGROUND We hypothesized that frequency domain analysis of a filtered wide bipolar atrial electrogram describes the global organization of atrial fibrillation (AF) and should vary over time. Timing burst pacing to periods of high organization of AF should promote regional atrial conduction block and terminate AF. METHODS Nine dogs were conditioned with rapid atrial pacing for 48 h. Electrogram recordings were made from a wide right atrium (RA) to left atrium (LA) bipole and digitally filtered. A fast-Fourier transform was performed every 0.5 s on a sliding 2-s window, and the organization index (OI) was calculated as a ratio of the area of the first four harmonic peaks to the total power of the spectrum. Organization indexes Ļ¾0.5 indicated more organized AF activity. Right atrium and LA burst pacing (burst) (cycle length 50 ms, 9.9 ms, 9.9 mA, 1 to 4 s) was performed through decapolar catheters. Burst was either random or synchronized to OI Ļ¾0.5. RESULTS Burst termination was attempted 1,814 times (889 OI sync, 925 random) and succeeded in seven of nine dogs. Burst had an overall success rate of 11.1% versus 6.3% for random (p Ļ½ 0.0003). Biatrial pacing had the highest efficacy for terminating AF, with a success rate of 16.5% for OI sync versus 8.2% for random (p Ļ½ 0.0001). CONCLUSIONS Timing the delivery of the burst pace when the OI is Ļ¾0.5 increases the efficacy of burst pace termination of AF. Biatrial pacing is more effective than either RA or LA pacing alone.
Journal of the American College of Cardiology, 2010
Background: CMS policy denying routine inpatient status for elective ICD implantation is supporte... more Background: CMS policy denying routine inpatient status for elective ICD implantation is supported by the low complication rate in this group. Yet a subset of patients (pts) may remain at risk for poor outcome and may need higher level post-op care. Methods: Records from 268,701 implantations from 1300 centers prospectively enrolled in the National ICDR database from 2006 through June 2008 were reviewed. Pts with thoracotomy lead implants were excluded. Thirty-six preimplant clinical variables were tested as predictors for any of 20 post implant adverse outcomes including bleeding, infection, pneumothorax, lead dislodgement and death. Of the overall cohort, 179,401 (66.8%) were coded as "admitted for this procedure". Preimplant clinical factors were used to develop a simple predictive model for adverse outcome using randomly half of the data, and then verified with the remaining half. ROC curves were calculated. Results: The overall rate of in-hospital complications or death for the elective ICD implant cohort was 2.51%, and risk of death was 0.12%. For endpoints of any in-hospital complication or death, 7 independent risk factors (RF) were identified (in order of weight): procedure not elective generator change, dual or biventricular device, NYHA class III or IV, previous valve surgery, atrial fibrillation/flutter, female sex, and chronic lung disease (ROC 0.651). Risk in the validation cohort increased from 0.22% (0 RF) to 8.14% (7 RF) in a linear fashion ~ 1% / RF. Pts with >3 RF (59.5% of pts) had a 3.4% complication rate. For endpoints of in-hospital death, 5 independent RF were identified (in order of weight): NYHA class III or IV CHF, history of Cardiac arrest, serum BUN >30 mg/dl, serum Creatinine >2.0 mg/dl, and systolic Blood pressure <100 mmHg (ROC 0.841). Mortality risk in the validation cohort increased from 0.02% (0 RF) to 1.27% (4 RF). Mortality was 0.35% for RF>2 (18.9% of pts), and 0.65% for RF>3 (5.2% of pts). Conclusions: In a low risk population of patients admitted for the indication of ICD implant, in-hospital complication rate and risk of death is low. High risk pt subsets should be monitored carefully post implant, but a lower intensity care level would be appropriate for the lower risk cohort.
Journal of the American College of Cardiology, 1988
A defibrillator method and apparatus wherein a patient's measured transthoracic impedance (TTI) i... more A defibrillator method and apparatus wherein a patient's measured transthoracic impedance (TTI) is used to control the amount of energy contained in a defibrillation pulse applied to the patient. Prior to delivering a defibrillation pulse, the patient's TTI is measured by an impedance measuring circuit (11). The patient's TTI may also be measured during delivery of a prior defibrillation pulse. A
Journal of the American College of Cardiology, 1996
S-Pester 123A conduction, the later was felt to be arrhy~mogenic, and radlofrequency (Rf) cathete... more S-Pester 123A conduction, the later was felt to be arrhy~mogenic, and radlofrequency (Rf) catheter ablation was proposed. Extensive multtpoisr catheter mapping using an encircling technique during fixed N.RA paring revealed efectdcal propagalian through the suture line at the level Of the RA appendage (n = 2) or the low I~eral RA (n = 1). 4, 3 and 1 Rf pulses were dally,areal at the site et shortest condu~on time batWesn the pacing site and the ablation catheter when bosilionnad across the suture line. Local electmgram molphology was double spikes (n = 2) 0r fragmenled potential (n = I). Results: Complete abolition of alrioa~al conduction was obtained in the 3 cases with a mean prOcedure duration of 4 hours and a mean fluorOscopy time of 27 min, No tachycardia was observed during a mean follow up of ,~ months (range 6-15). A total disappearance o! premature atrial contractions was seen at control 24 hours Hotter recordings. Conclusion: Although unfrequent, abnormal atricavial conduction may be seen after orthotopio heart Iransplantation an~ may result in clinically relevant G.RA arltlythmies. Rf catheter ablation at the level of impulse propagation across the suture line may provide a definite cure of arrflythmias in this selected group of I~tients.
The Journal of thoracic and cardiovascular surgery, 2008
The objective was to evaluate the effects of atrial synchronous biventricular pacing in postopera... more The objective was to evaluate the effects of atrial synchronous biventricular pacing in postoperative patients with severe cardiomyopathy.
Journal of the American College of Cardiology, 2011
This document was approved by the American College of Cardiology Foundation Board of Trustees in ... more This document was approved by the American College of Cardiology Foundation Board of Trustees in November 2010.
Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity... more Curing atrial fibrillation (AF) by catheter ablation has significantly improved patient morbidity and mortality. The circumferential pulmonary vein isolation technique is established as the principal procedure, with a high cure rate and acceptable safety, for paroxysmal AF, but new adjunctive ablation strategies targeting the AF substrates and sources for long-standing persistent/chronic AF have been developed. These new techniques include linear ablation, complex fractionated atrial electrogram guided ablation, dominant frequency map-guided ablation, ganglionated plexi ablation and disconnection of the coronary sinus and superior vena cava to ablate the AF substrates and sources. The long-term usefulness of the established technique and these innovative adjunctive approaches for the treatment of AF remains to be investigated.
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Papers by David Haines