Papers by Lawrence A Rosenthal
Heart Surgery Forum
Background: Surgical therapy for atrial fibrillation is extremely effective but not widely applie... more Background: Surgical therapy for atrial fibrillation is extremely effective but not widely applied. Minimally invasive methods may be more attractive. We report a case of complete pulmonary vein isolation performed entirely through a thoracoscopic approach.
Cardiology, 2004
Brain natriuretic peptide (BNP) levels have been reported to fall following cardioversion of atri... more Brain natriuretic peptide (BNP) levels have been reported to fall following cardioversion of atrial fibrillation (AF). The mechanism for the fall in BNP has not been elucidated and the potential confounding effects of sedation have not been investigated. Sedation may alter BNP levels via its effects on loading conditions. Accordingly, we studied whether BNP levels change shortly after cardioversion and attempted to control for possible effects of sedation. BNP levels were obtained before and after cardioversion in patients with AF and in a control group of patients undergoing intravenous conscious sedation for transesophageal echocardiography. BNP levels dropped (260 +/- 255 vs. 190 +/- 212 pg/ml, p < 0.05) 40 min after cardioversion, decreasing in 33 of 41 subjects who achieved sinus rhythm. By contrast, mean BNP did not fall in subjects in whom cardioversion was not successful. The change in BNP level was not related to the degree of change in heart rate. No control subject experienced a change in cardiac rhythm; BNP levels increased (195 +/- 407 vs. 238 +/- 458 pg/ml, p < 0.05) in 18/22 subjects after sedation. Baseline BNP levels were elevated in subjects with AF, and BNP levels were elevated in parallel with heart failure symptoms. The rapid fall in BNP after cardioversion (1) may reflect prompt hemodynamic improvement associated with rhythm change and (2) does not appear to be due to the effects of sedation.
Indian pacing and electrophysiology journal, 2009
Inadvertent lead placement in the left ventricle (LV) is an uncommon and often under-diagnosed co... more Inadvertent lead placement in the left ventricle (LV) is an uncommon and often under-diagnosed complication of cardiac device implantation. Thromboembolic (TE) events are common and usually secondary to fibrosis or thrombus formation on or around the lead. Anticoagulation can prevent TE events. Percutaneous and surgical LV lead extractions have been performed successfully, but the risks of percutaneous lead removal are not well-defined. In this report, we describe a case of inadvertent LV lead placement and briefly review the contemporary literature.
Pacing and Clinical Electrophysiology, 2000
Background: Modern pacemakers include many added features designed to improve the ease of patient... more Background: Modern pacemakers include many added features designed to improve the ease of patient follow-up, as well as algorithms to reduce pacing outputs and/or reduce the atrial or ventricular pacing percentages, thus improving longevity.
Journal of the American College of Cardiology, 2004
Journal of the American Academy of Dermatology, 1988
Heart Rhythm, 2005
in pediatric patients with ]. Patients with accessory pathways or previous ablations were exclude... more in pediatric patients with ]. Patients with accessory pathways or previous ablations were excluded. Baseline values were determined in all patients. Additional medications (isoproterenol, atropine, or epinephrine) were used when supraventricular tachycardia (SVT) was not inducible at baseline. The longest AH jump was defined as the largest increase in AH interval with a 10 msec decrease in the premature stimulus. Results: At baseline, there were significant differences in dual AV node physiology between younger and older children.
Heart Rhythm, 2007
BACKGROUND Ninety-nine percent of pacemakers implanted in the United States include an option for... more BACKGROUND Ninety-nine percent of pacemakers implanted in the United States include an option for rate modulation.
Cardiology, 2004
Brain natriuretic peptide (BNP) levels have been reported to fall following cardioversion of atri... more Brain natriuretic peptide (BNP) levels have been reported to fall following cardioversion of atrial fibrillation (AF). The mechanism for the fall in BNP has not been elucidated and the potential confounding effects of sedation have not been investigated. Sedation may alter BNP levels via its effects on loading conditions. Accordingly, we studied whether BNP levels change shortly after cardioversion and attempted to control for possible effects of sedation. BNP levels were obtained before and after cardioversion in patients with AF and in a control group of patients undergoing intravenous conscious sedation for transesophageal echocardiography. BNP levels dropped (260 +/- 255 vs. 190 +/- 212 pg/ml, p < 0.05) 40 min after cardioversion, decreasing in 33 of 41 subjects who achieved sinus rhythm. By contrast, mean BNP did not fall in subjects in whom cardioversion was not successful. The change in BNP level was not related to the degree of change in heart rate. No control subject experienced a change in cardiac rhythm; BNP levels increased (195 +/- 407 vs. 238 +/- 458 pg/ml, p < 0.05) in 18/22 subjects after sedation. Baseline BNP levels were elevated in subjects with AF, and BNP levels were elevated in parallel with heart failure symptoms. The rapid fall in BNP after cardioversion (1) may reflect prompt hemodynamic improvement associated with rhythm change and (2) does not appear to be due to the effects of sedation.
Circulation, Oct 28, 2008
Circulation Cardiovascular Quality and Outcomes, Jul 1, 2014
American Journal of Contact Dermatitis, 1996
Background: Allergic contact dermatitis is a significant cause of cutaneous disease for which pat... more Background: Allergic contact dermatitis is a significant cause of cutaneous disease for which patch testing often provides diagnostic support.Objective: This paper reports, as a follow-up of our previous studies, the results of patch testing from July 1, 1992, to June 30, 1994, by the North American Contact Dermatitis Group.Methods: Patients evaluated in the patch test clinics of the North American
Current cardiology reports, 2005
Sudden cardiac death (SCD) is a significant cause of mortality in patients suffering from heart f... more Sudden cardiac death (SCD) is a significant cause of mortality in patients suffering from heart failure and left ventricular dysfunction. Implantable cardioverter defibrillators have been shown to effectively reduce the incidence of SCD in this population. Recent clinical trials have redefined the indications and patient profiles for their use: from secondary prevention to primary prevention of SCD. In this article, we review the clinical trials contributing to the current practice guidelines, which include device therapy.
Dermatitis, 1994
Abstract: Standardized patch tests were performed on 3,974 patients between August 1, 1985 and Ju... more Abstract: Standardized patch tests were performed on 3,974 patients between August 1, 1985 and July 31, 1989. Significant determinants of positive responses based on previously reported bivariate analysis of response were entered into a logistic regression model; the ...
Heart Rhythm, 2015
Permanent cardiac pacemakers have historically been considered a contraindication to magnetic res... more Permanent cardiac pacemakers have historically been considered a contraindication to magnetic resonance imaging (MRI). The ProMRI/ProMRI AFFIRM Study is a multicenter, prospective, single arm, non-randomized study to evaluate the clinical safety of the Biotronik ProMRI Pacemaker System under specific MRI conditions. The ProMRI (US) and ProMRI AFFIRM (Outside US (OUS)) studies with identical design enrolled 272 patients with stable baseline pacing indices implanted with an Entovis or Evia pacemaker (DR-T or SR-T) and Setrox or Safio 53cm or 60cm lead(s). Device interrogation was performed at enrollment, pre- and post-MRI scan, 1- and 3-months post-MRI. Endpoints were 1) Freedom from MRI and pacing system related Serious Adverse Device Effects (SADE) through 1-month post-MRI, 2) Freedom from atrial and ventricular MRI induced pacing threshold increase (>0.5V), and 3) Freedom from P- and R-wave amplitude attenuation (<50%), or P-wave < 1.5mV, or R-wave < 5.0mV at 1-Month post-MRI. 226 patients completed the MRI and 1-month post-MRI follow-up. No adverse events related to the implanted system and the MRI procedure occurred resulting in an SADE free rate of 100.0% (229/229), p < 0.001. Freedom from atrial and ventricular pacing threshold increase was 99.0% (189/191), p=0.003 and 100% (217/217), p<0.001 respectively. Freedom from P- and R- wave amplitude attenuation was 99.4% (167/168), p< 0.001 and 99.5% (193/194), p<0.001 respectively. The results of the ProMRI/ProMRI AFFIRM study demonstrate the clinical safety and efficacy of the ProMRI Pacemaker System in patients subjected to head and lower lumbar MRI imaging conditions.
Journal of Evidence-Based Complementary & Alternative Medicine, 2012
Background Psychological distress is common in patients with implantable cardioverter defibrillat... more Background Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. We examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs.
PLoS ONE, 2012
Objectives: To identify genetic factors that would be predictive of individuals who require an im... more Objectives: To identify genetic factors that would be predictive of individuals who require an implantable cardioverterdefibrillator (ICD), we conducted a genome-wide association study among individuals with an ICD who experienced a lifethreatening arrhythmia (LTA; cases) vs. those who did not over at least a 3-year period (controls).
Pacing and Clinical Electrophysiology, 1998
Rhythm and the Defibrillation Threshold in Patients with Implantahle Cardioverter Defibriilators.... more Rhythm and the Defibrillation Threshold in Patients with Implantahle Cardioverter Defibriilators. The upper limit of vulnerability is the strength above which ventricular fibriilation is no Ionger inducible with a shock delivered during the vulnerable phase of the cardiac cycle. It has been demonstrated that the upper limit of vulnerability correlates with tbe defibrillation threshold in a paced rhythm. The purpose of this study is to evaluate the correlation of the upper limit of vulnerability determined in normal sinus rhythm with the defibrillation threshold using a simplified protocol in patients undergoing placement of an ICD. We studied 28 patients who underwent ICD implantation. CPI generators and Endotak leads were used in all patients. Device-based testing was used to determine the defibrillation threshold and the upper limit of vulnerability. The upper limit of vulnerability was tested with three shocks delivered at 0, 20, and 40 ms before the peak of the T wave during normal sinus rhythm. The defibrillation threshold was determined by a simple step up-down protocol. The upper limit of vulnerability (9.0 ± 4.5 f) did not significantly differ from the defibrillation threshold (9.9 ± 4.0 f), P = NS. A close correlation was present, correlation coefficient = 0.75. P < 0.0001. The upper limit of vulnerability was within 5 f of the defibrillation threshold in 27 (96%) of the 28 patients. The upper limit of vulnerability underestimated the defibrillation threshold by 10 f in one patient who had a defibrillation threshold of 15 J. The upper limit of vulnerability determined in normal sinus rhythm correlates significantly with the defibrillation threshoid in patients undergoing ICD implantation. The protocol is simple and easily implemented clinically. (PACE 1998; 2l(Pt. I]. [687][688][689][690][691][692][693] upper limit of vulnerability, defibrillation threshold, implantable cardioverter defibrillator
Pacing and Clinical Electrophysiology, 1997
ROSENTHAL, L.S., ET AL.: Acute Radiation Dermatitis Following Radiofrequency Catheter Ablation of... more ROSENTHAL, L.S., ET AL.: Acute Radiation Dermatitis Following Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia. Radiation exposure during fluoroscopic imaging poses potential risks to patients and physicians, especially during protracted cardiovascular or radiological interventional procedures. We describe a woman with refractory paroxysmal supraventricular tachycardia who underwent radiofrequency catheter ablation of the slow pathway involved in atrioventricular nodal reentrant tachycardia. The patient subsequently returned 4 weeks later with acute radiation dermatitis that was retrospectively attributed to a malfunction in the fluoroscopy unit that lacked a maximum current output cut-off switch. Using dose reconstruction studies and her estimated biological response, we determined that she received between 15 and 20 Gy (1 Gy -100 rods) to the skin on her back during the procedure. The exposure will result in an increase in her lifelong risk of skin and lung cancer. This article underscores the potential for radiation-induced injury during lengthy therapeutic procedures using xray equipment. (PACE 1997; 20:1834-1839
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Papers by Lawrence A Rosenthal