Dec 15 2023 This Week in Cardiology Medscape
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Category Archives: Cardiology
Jean-Philippe Collet, Thrombosis Expert and Trialist, Dies at 59 – TCTMD
Jean-Philippe Collet, MD, PhD (Hpital de la Piti-Salptrire, Paris, France), an interventionalist and well-respected authority on antithrombotic therapies, died suddenly at home on December 15, 2023, at age 59. News of his death was confirmed by colleagues and his institution.
Well known for his leadership in co-chairing the 2020 European Society of Cardiology guidelines for non-ST-segment elevation acute coronary syndromes as well as conducting prominent research on antithromboticsincluding the ATLANTIS and ARCTIC trialsCollet will be remembered for his genuine care for patients and colleagues alike, modest yet effective demeanor, and passion for the field of cardiology.
Professor Collet was more than a colleague; he was a friend, a confidant and a role model to all those lucky enough to work alongside him, his colleague and mentor Gilles Montalescot, MD, PhD (Centre Hospitalier Universitaire Piti-Salptrire, Paris, France), wrote in an email that was circulated throughout their institution. His colleagues, his students, his patients and all those who had the chance to know him mourn the loss of an exceptional man, of rare intelligence and humanity, who devoted his life to cardiology.
To TCTMD, Montalescot reminisced about how their careers intertwined. He was my first buddy in cardiology 30 years ago and we started building this group that we have here, he said. Now it's a big group of cardiologists and a big network of cardiology centers, but we built that network together, Jean-Philippe and myself. We were the two pioneers, and one has disappeared.
Accomplished Yet Humble
Several themes emerged from Collets colleagues, who remember him for reaching unusual levels of achievement while remaining steadfastly kind and modest.
I am so devastated, P. Gabriel Steg, MD (Hpital Bichat, Paris, France), told TCTMD. He was a long-standing friend and colleague, warm, generous, hardworking, brilliant yet humble, highly respected by colleagues and staff, and loved by patients and families.
Calling Collet a friend first, Pierre Sabouret, MD (Hpital de la Piti-Salptrire, Paris, France), told TCTMD that his kindness stood out over the more than 20 years they knew each other. I want to underline that before being an international expert, he was a gentleman, he said.
Remembering Collet as both accomplished and unpretentious, Davide Capodanno, MD, PhD (University of Catania, Italy), told TCTMD that his loss will leave a gap in the field of cardiology. What really impressed me was that he was famous, but at the same time, always a person that came to you trying to have a conversation, he said. It was very easy to speak with him. And when you realize how famous he was and how friendly he was, this approach tells you how great he was as a man.
Thomas Cuisset, MD, PhD (CHU Timone, Marseille, France), too, said Collets attitude was special. Jean-Philippe was unique in the way that he made possible what many think contradictory; being one of the most famous French cardiologists, head of [his department], chair of ESC guidelines, but also a truly passionate clinician, dedicated to education, and always so friendly and supportive for the younger generation, he told TCTMD in an email. I had the privilege to work with him, and all this inspiration will stay [with me] forever.
Sunil Rao, MD (NYU Langone Medical Center, New York, NY), who also took to X (formerly Twitter) to express his condolences, called Collet "a powerful force in cardiology."
"Not only was he on the cutting edge of science, but he was also a gentleman and very approachable," Rao told TCTMD. "He will be greatly missed, but his legacy lives on in his contributions to the field, which will never be forgotten."
Eric Van Belle, MD, PhD (CHU Lille, France), a frequent research partner most recently on ATLANTIS, called Collet a trailblazer and his death a major loss. We were following his path, he said. Most of us were trying to be as good as he was, which was difficult to do. He was a very good example for all of us. He pushed us in a good direction by inspiring us.
Holger Thiele, MD (Heart Center Leipzig at University of Leipzig, Germany), who served as co-author of the 2020 ESC guidelines, told TCTMD Collet was suited to the job because he knew everything about all the evidence, in particular on antiplatelet therapy, and he was always extremely concise.
Outside of his work, Thiele added, Collet loved to be athleticthe pair would often run togetherand he enjoyed riding his motorcycle, which he would take on multiday trips to places like Rome and Barcelona for ESC Congresses.
Training and Leadership
Collet trained in cardiology at Universit Paris XII and earned his PhD in thrombosis at the University of Rouen, France. Since 2022, Collet served as head of the department of cardiology at his institution, where he also served as director of the cath lab.
John Weisel, PhD (Perelman School of Medicine, University of Pennsylvania, Philadelphia), who mentored Collet as a PhD candidate as well as a postdoctoral fellow, remembered him as very low key but enthusiastic and glad to try to do things. Weisel told TCTMD: He was probably my most productive postdoctoral fellow in the sense that I think in that 1 year he eventually got 13 papers out of the work he did.
What was unique about Collet was that he combined clinical expertise with basic science to improve patient care, Weisel continued, adding that he also really paid attention to people.
Montalescot called Collets natural leadership skills indisputable. He transformed the cardiology department into a place of excellence and innovation, where each member of the team was encouraged to reach their full potential, Montalescot continued, noting Collets charisma and ability to inspire as well as his kindness. Always approachable and modest, he was generous, attentive and loved by all his colleagues. We will always remember his kind smile, his availability and his willingness to share his knowledge.
Sabouret agreed, saying, I hope that [Collets team] will follow his model in terms of research but also in terms of attitude.
Collet was also a professor of cardiology at Sorbonne Universit and a founding and senior member of the academic research organization ACTION. His research interests were many, including finding new models for experimental thrombosis, demonstrating the prognostic role of biomarkers, and comparing antithrombotic therapies.
Throughout his career, Collet published almost 500 articles as well as 45 book chapters and 200 abstracts. One of his early works was lauded for playing an important role in the discovery of the clopidogrel resistance polymorphism.
A member of many organizations, including the French Society of Cardiology, European Society of Cardiology, Working Group 18, and European Association of Percutaneous Cardiovascular Interventions, Collet also served as an associate editor of JACC: Cardiovascular Interventions since 2018.
Collet is survived by his wife, Hlne, and their children, Antoine, Alexis, and Olivier.
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Jean-Philippe Collet, Thrombosis Expert and Trialist, Dies at 59 - TCTMD
Piedmont Cardiologist Starts Non-Profit to Resolve Cardiac Crisis in Ethiopia – The Citizen.com
Piedmont interventional cardiologist Tesfaye Telila, M.D., is on a mission to resolve what can be deemed a cardiac crisis in his homeland of Ethiopia. As the population in that country adopted a more western lifestyle, the incidence of heart disease has risen drastically. Knowing this epidemiologic shift and the increase in premature deaths due to heart attacks and strokes, Dr. Telila founded the nonprofit organization, Heart Attack Ethiopia, to raise the needed funds to raise awareness, and train more interventional cardiologists, in a country where only five cardiac surgeons exist for 120 million people. According to research published in ScienceDirect, more than 15,000 patients are on the waitlist for cardiac surgery in Ethiopia.
The mission of our organization is to establish a sustainable cardiovascular service line in Ethiopia, Dr. Telila said. In this first phase of our intervention, we are recruiting volunteers to provide mission-based lifesaving heart attack care at currently available institutions in Ethiopia and eventually establish a more comprehensive Cardiovascular Center of Excellence that will be operated by the local healthcare professionals and that is fully accessible to everyone in need of emergency lifesaving cardiovascular care irrespective of their socioeconomic background
Dr. Telila is also working to establish a collaborative common ground between the Ethiopian government and the State of Georgia to build and virtually integrate cardiovascular centers in Ethiopia with cardiac centers in Georgia with the aim of alleviating the critical shortage of trained cardiac professionals. Currently, the country of Ethiopia has no established primary percutaneous coronary intervention (PCI) center to provide a timely treatment for patients with heart attacks. A somewhat interrupted lifesaving cardiac care is only provided at four local centers in Addis Ababa, a city of over 7 million people. While one is a charity, patients at the other three centers must have the needed funds to pay out of pocket for their heart attack care if they are lucky to get to the center on time despite the lack of EMS services.
Cardiovascular disease remains the number one killer in the world and 75 to 80 percent of all cardiovascular deaths occur in the low and middle income countries. So, incidents that people would survive here in the U.S. are mostly fatal in Ethiopia Dr. Telila said. We can make a big impact in the world by collaborating with healthcare systems like Piedmont, medical device companies and industries, recruiting volunteers to save lives while also expanding our footprints internationally
Dr. Telila received his medical degree from Addis Ababa University in Addis Ababa, Ethiopia before moving to the U.S. where he completed his internal medicine residency and Cardiovascular fellowships. He received his fellowship in interventional and structural cardiology from the University of Wisconsin in Madison, Wisc. He is board certified in Internal Medicine, Cardiovascular Disease, Interventional Cardiology, Nuclear Cardiology and Adult Echocardiography. He now treats patients at Piedmont Fayette and Piedmont Newnan hospitals.
To learn more about cardiovascular services at Piedmont, visit piedmont.org/heart. To learn more about Heart Attack Ethiopia and how you can help, visit heartattackethiopia.org.
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Piedmont Cardiologist Starts Non-Profit to Resolve Cardiac Crisis in Ethiopia - The Citizen.com
New vest developed by cardiologists uses advanced heart imaging to screen for sudden cardiac arrest – Cardiovascular Business
We identified a problem in cardiology, Captur said in a statement. Heart imaging has made remarkable progress in recent decades, but the electrics of the heart have eluded us. The standard technology to monitor the hearts electrical activity, the 12-lead electrocardiogram (ECG), has barely changed in 50 years. We believe the vest we have developed could be a quick and cost-effective screening tool and that the rich electrical information it provides could help us better identify peoples risk of life-threatening heart rhythms in the future.
The teams analysis includes data from 77 healthy volunteers who were imaged using the ECGI vest. The authors concluded that its use is feasible and shows good reproducibility in younger and older participants.
To date, more than 800 patients have been treated using this new screening tool. The group is currently exploring its options when it comes to the large-scale manufacturing of additional vests.
Click here to read the full analysis.
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Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI – Physician’s Weekly
The following is a summary of Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy, published in the December 2023 issue of Cardiology by Steen et al.
Researchers conducted a retrospective study to assess whether myocardial strain and T1 mapping derived from Fast Strain-Encoded Cardiac Magnetic Resonance (SENC-CMR) could effectively differentiate between Hypertrophic Cardiomyopathy (HCM) and Cardiac Amyloidosis.
They analyzed 99 patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis). Assessed were LV-ejection fraction, LV-mass index, septal wall thickness, and native T1 mapping values. Global and segmental circumferential/longitudinal strain were calculated in basal, mid-ventricular, and apical segments and constructed as a ratio by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).
The results showed equal myocardial strain distribution in apical and basal segments in HCM patients. At the same time, cardiac amyloidosis exhibited apical sparing with less impaired apical strain (apical-to-basal ratio of 1.01 0.23 versus 1.20 0.28, P<0.001). T1 values were significantly higher in amyloidosis than in HCM patients (1170.7 66.4 ms versus 1078.3 57.4 ms, P<0.001). The T1-to-basal segmental strain ratio showed high accuracy for differentiation (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.810.95, P<0.001). In multivariable analysis, age and the T1-to-basal-strain ratio were the most robust factors for HCM and cardiac amyloidosis differentiation.
Investigators concluded that T1-to-basal strain, a quick MRI measure, effectively distinguished heart conditions HCM and amyloidosis, skipping risky contrast injections.
Source: link.springer.com/article/10.1007/s00392-023-02348-4
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The benefits of implementing FFR-CT in clinical practice – Cardiovascular Business
He said the integration of FFR-CT not only informs medical decisions, but also profoundly impacts patient care. Gupta said the images can be shown to patients to help explain their condition to empower them with a deeper comprehension of their condition. Sharing FFR-CT results and images with referring providers and patients also fosters a collaborative approach, ensuring everyone involved comprehends the nuances of the diagnosis and treatment strategy.
Valley Health System sends about 25-29% of patients undergoing coronary CT exams to also undergo a HeartFlow analysis. Rather than employing FFR-CT universally, Gupta's team judiciously selects patients falling within the intermediate category, typically encompassing those with coronary disease that appears to block from 40% to 90% of a vessel. This selective approach allows for a nuanced assessment of patients who stand to benefit most from FFR information. It is not merely about determining who needs a catheterization procedure, but understanding the physiology of the disease for appropriate decision-making.
"We make sure that the referring providers, who are many times interventionalists, understand what the disease is, the severity of disease and if the patient is going to benefit form an invasive procedure. Alternatively, we would do FFR and we will find disease, which in some cases may not necessarily need invasive angiogram, despite knowing that there is significant disease. This is partly because we know from medical literature that medical management is equally good if not better, especially in a lower risk population. So we are trying to stratify the patient population. Thirdly, I think it provides a peace of mind to the patients, because they understand their disease better," Gupta explained.
Efficiency is paramount in cardiac care, and Gupta underscored the fast turnaround times for FFR-CT results. Reports are usually available within a day, he said, and it can be even quicker in emergency cases.
Implementing FFR-CT as a gatekeeper has impacted cath lab utilization. While diagnostic catheterizations may see a reduction, the precision of FFR-CT aids interventionalists in planning procedures more efficiently. Guta said this can help reduce radiation exposure and optimize contrast use. Also, the 3D FFR-CT images can serve as a clear roadmap for interventions, contributing to enhanced patient safety and procedural efficacy.
"I believe that it is actually helping the interventionalist plan the procedure in which we are finding frequently, at least at our center, they would either take very limited pictures of the coronary arteries or use special kinds of catheters where they can directly go for intervention based on what the study results shows on the CT and the FFR. They also know upfront exactly what to fix and what not to fix," Gupta explained.
One unique factor about Valley Health System is it uses a collaborative model for reading cardiac exams, combining the expertise of both radiologists and cardiologists. Gupta said their joint efforts, coupled with robust quality control processes, ensure the optimal integration of FFR-CT into clinical practice.
"We basically thrive on each other's strength. So we have a couple of very high-quality radiologists working with a couple of high-quality cardiologists and we are continually expanding our team," Gupta said.
Beyond its conventional use in coronary artery stenosis, Gupta's team is exploring other novel applications of FFR-CT. This includes evaluating anomalous coronary artery physiology, studying gender-based differences in chest pain presentations and evaluating patients during transcatheter aortic valve replacement (TAVR) pre-procedural workups.
"We are able to do a CT angiogram at the same time of a TAVR evaluation for the coronary arteries. We combine it with FFR data to try to risk prognosticate what is the risk of any event during the TAVR procedure and determine if they need an invasive angiogram or any kind of interventional procedure. So it really helps optimize high-risk, frail patients in terms of more optimal outcome," Gupta said.
FFR-CT was included as a recommendation in the 2021 ACC/AHA chest pain guidelines to evaluate chest pain. It was the first clinical artificial intelligence (AI) algorithm to be included in any U.S. cardiology guidelines.
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The benefits of implementing FFR-CT in clinical practice - Cardiovascular Business
Hybrid coronary revascularization vs. CABG for multivessel CAD: New meta-analysis tracks long-term outcomes – Cardiovascular Business
Hybrid coronary revascularization (HCR) and coronary artery bypass grafting (CABG) are associated with comparable long-term mortality rates among patients with multivessel coronary artery disease (MVCAD), according to new data published in the American Journal of Cardiology.[1] However, HCR patients were more likely to experience certain adverse events.
HCR, as the name suggests, is a combination of two different revascularization techniques. It includes both minimally invasive for the left anterior descending (LAD) coronary artery and traditional percutaneous coronary intervention (PCI) for non-LAD lesions.
Previous studies showed the short-term benefits of HCR, including comparable mortality, reduced lengths of intubation and hospital stay, and less transfusion than CABG, wrote first author Junichi Shimamura, MD, with the division of cardiothoracic surgery at Westchester Medical Center in New York, and colleagues. However, the current guidelines do not recommend HCR as a routine procedure. This is partly because the previous analyses were based on retrospective data, and there is a lack of randomized controlled trials and meta-analyses in a large population with a long-term outcome.
Shimamura et al. tracked data from 13 different studies comparing the two techniques. The mean patient age was 64.3 years old, and the mean follow-up period was 5.1 years.
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5 Things Not to Do at Your Cardiologist Appointment – Livestrong
Lying to your cardiologist about your symptoms could be harmful to your health.
Image Credit: SDI Productions/E+/GettyImages
Before we dive into the things you shouldn't do at the cardiologist, let's start by saying it's great you're seeing a cardiologist in the first place. Taking care of your heart is important especially as you age.
Heart disease is responsible for one out of every five deaths in the U.S., according to the Centers for Disease Control and Prevention, but catching it early (or its risk factors like high blood pressure and elevated cholesterol) gives you enough time to treat it properly.
While seeing your cardiologist is a great first step, there are some things you may unintentionally do to sabotage these appointments, like withholding information or lying to your doctor.
Here, learn habits that cardiologists wish their patients would stop doing at checkups.
No, this doesn't mean dressing in your best outfit, but rather, telling your cardiologist what you think they want to hear, says Elizabeth Klodas, MD, FACC, a preventive cardiologist in Edina, MN and creator of Step One Foods.
For example, you might say you never eat fast food (when you do), or that you eat fruits and vegetables every day (when you don't). The thing is, this information may change the course of your treatment, if a condition is uncovered at an appointment.
"A statin [cholesterol-lowering medication] is much more likely to be prescribed to someone with high cholesterol who also reports eating a healthy diet and not drinking too much," Dr. Klodas says.
On the other hand, if you have high cholesterol but admit to a not-so-great diet, your doctor may suggest trying diet and lifestyle changes first before medication, if that makes sense with your health history, Dr. Klodas says.
"Physicians are not mind readers. They can only rely on what you tell them," Dr. Klodas says. "They've also seen and heard it all, so you don't have to worry that you will shock or disappoint them," she adds.
The internet can be a scary place, especially if you're worried about a certain health symptom and you recruit Google to get answers.
"Sometimes a patient has been Googling their symptoms and without proper context, pressures their doctor to order or prescribe certain things," says Mary Greene, MD, a cardiologist with Manhattan Cardiology in NYC and contributor to LabFinder.
The problem is that this can lead to "unnecessary and expensive" testing, she says.
While it's absolutely important to be an informed patient and advocate for yourself (especially if you feel your doctor's not listening to you), try to approach your appointment with a collaborative mindset, Dr. Greene says.
This means, it's OK to ask, "what do you think about this?" or "I read this online, does it apply to me?" and being open to what your doctor has to say. This will lead to a much more helpful discussion about what's best for you, Dr. Greene says.
Maybe you've found it difficult to walk up the stairs lately. Or, you've started circling the parking lot to find a parking space closest to the grocery store entrance. Dr. Klodas wants you to pay attention to those symptoms and report them to your cardiologist.
"No doubt our bodies become less cooperative as we age. But a lot of symptoms that people don't bother reporting (because they think they're a normal part of aging) can be clues to potentially reversible underlying health issues," she adds.
For instance, being short of breath during normal activities is a potential sign of cardiovascular disease not just a sign that you're out of shape or getting older.
Another interesting example? Erectile dysfunction can also be a "first clue" you have atherosclerosis, Dr. Klodas says. Even when you think it isn't related, it might be, so don't be afraid to speak up.
Similar to wanting to "look good" for your cardiologist, there's a specific tendency to hide how much alcohol you drink, whether you smoke cigarettes and whether you use recreational drugs, says Allan Stewart, MD, a cardiac surgeon in Miami, FL.
These things are important to disclose at checkups, especially if you need heart surgery in the future. Why? Because it can affect your post-op recovery.
For example, if you drink every day and then go into surgery, you may have symptoms of alcohol withdrawal during recovery, and these symptoms can mimic a stroke, Dr. Stewart says. You may then be prescribed lots of expensive testing, which will also delay alcohol withdrawal treatment.
Dr. Stewart also says that smoking affects your recovery, while recreational drug use may affect the heart's response to medications and anesthesia.
"Surgeons are not judgmental people. We just want to know all of the possible issues we may face, so we can properly plan for your safe recovery," Dr. Stewart says.
The best time to talk about these things is during an in-office visit, when that planning can be done.
Not all of your concerns can or will be resolved in one office visit, Dr. Greene says. "Whenever you see any doctor, expect there to be some follow up," she says.
When it comes to specific heart issues, it may take time (and often multiple tests) to figure out what's going on. After these tests are complete, your cardiologist can come up with a personalized treatment plan.
Try to schedule any follow-up appointments at the end of your initial visit. And aim to see the same cardiologist each time, so they can continue the conversation about your specific needs.
"Building this doctor-patient relationship takes time, but can be helpful in getting the best treatment possible," Dr. Greene says.
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5 Things Not to Do at Your Cardiologist Appointment - Livestrong
BLOG: Combining Local Impedance with Contact Force to Perform RF Ablation – Diagnostic and Interventional Cardiology
When performing radiofrequency (RF) ablation to treat cardiac arrhythmia, medical professionals must balance the safety of the patient with the efficacy of the procedure. Several important safety considerations are at play.
Physicians want to avoid mechanical perforation of the cardiac tissue, which can be caused by applying too much force in positioning the catheter. They also want to avoid unintentional damage to tissue or nontargeted structures during RF delivery.
Among the rare but serious complications associated with RF ablation are steam pops, which occur when ablated tissue is heated above 100 C, causing an explosion of steam to be released and unwanted damage to the tissue. In a worst-case scenario, a steam pop can tear a hole in the wall of the cardiac tissue allowing blood to leak into the pericardium. This can lead to cardiac tamponade, when the pressure from the blood surrounding the heart prevents it from beating.
Since the introduction of RF ablation as a cardiac arrhythmia therapy, advances have been made in the technologies and methods of delivering RF. These include the introduction of advanced mapping, multi-electrode and irrigated catheters, contact force, and the use of measures of tissue resistivity, or impedance, as a means to track RF delivery and lesion development.1
Boston Scientific offers RF ablation catheters with technology that enables capture of impedance metrics nearer the tissue to be treated. With the DIRECTSENSE Technology-enabled catheters, impedance can be measured around the tip of the catheter, avoiding the interference of far-field signals and capturing insights on cardiac tissue resistivity.
Local impedance has been demonstrated to more accurately indicate subsurface tissue temperature and lesion formation than does surface temperature. In tissue tests with embedded thermocouples, local impedance drop followed the rate and magnitude of the rise in intra-lesion temperature, demonstrating a correlation between the metric and volumetric heating as it occurs.2 Local impedance has also been found to respond with greater specificity and sensitivity in identifying abnormal substrate all valuable feedback in helping inform optimal delivery of ablation therapy.
Boston Scientific has now incorporated contact force capabilities into their DIRECTSENSE-enabled ablation catheters.
The investigational device INTELLANAV STABLEPOINT Ablation Catheter brings together the handling and inputs of contact force catheters with the ablation feedback offered by DIRECTSENSE local impedance. Available with RHYTHMIA HDx Mapping System (pictured above), the STABLEPOINT catheter is designed to help physicians verify contact, discern tissue characteristics, monitor subsurface tissue heating for predictable and controlled delivery of RF.
With the addition of force technology, the STABLEPOINT catheter can help confirm tissue contact and catheter-tip stability for the duration of RF delivery. In one study, force readings enabled two independent users to maintain a stable average force of +/- 5 grams, compared to starting force, for the full duration of >90 percent of point-by-point PVI applications.3
Using local impedance, physicians gain insights into tissue characteristics and resistivity, input that can help guide the ablation strategy. Changes in local impedance during ablation offer information on lesion development and feedback that can help safeguard against tissue overheating.
Recent studies have examined the STABLEPOINT catheters use in clinical settings. In a multicenter, prospective study conducted across Europe, Asia, and the United States, 299 patients treated for de novo atrial fibrillation (AF) underwent pulmonary vein isolation with the STABLEPOINT catheter guided by RHYTHMIA HDx Mapping System. STABLEPOINT in the NEwTON AF Study met the 30-day and 12-month primary safety endpoints as well as the acute, 6-month and 12-month primary effectiveness performance criteria for the use of the catheter in this patient population.4 At 12 months, data indicated a 4 percent incidence of adverse events. Freedom from atrial flutter and atrial tachycardia in the study group was 90.2 and 97.6 percent, respectively.4
A separate, multicenter study of 212 consecutive patients treated for AF with the STABLEPOINTcatheter assessed results across 13,891 RF applications of a 3 second duration. High-power, short-duration ablation with contact force and local impedance resulted in a 93.3 percent rate of successful first-pass isolation with no reported steam pops or major complications. Researchers also noted that the combination of local impedance drop with good contact led to a reduction in the duration of RF.5
Editor's note: This is the conclusion of a three-part series on cardiac ablation technology.Part one,Pulsed Field Ablation: A New Ablation Method,addressed pulsed field ablation; Part two, Cryoablation Gets New Tech," covers next-generation cryoballoon technology.
1. Habibi M, Berger RD, Calkins, H. Radiofrequency ablation: technological trends, challenges, and opportunities. EP Europace. 2021;23(4): 511519. doi.org/10.1093/europace/euaa328
2. Garrott KE, et al. Intra-lesion temperature rise and local impedance drop predictive of lesion growth on RF ablation catheter with mini electrodes. Abstract. Heart Rhythm Annual Meeting. May 2020.
3. Internal BSC Report 92464384.
4. NEwTON AF: Clinical Evaluation of the STABLEPOINTTM Catheter and Force Sensing System for Paroxysmal Atrial Fibrillation. NEwTON AF Study (NCT04580914) presented at AHA, November 2023.
5. Lepillier A, Maggio R, De Sanctis V, et al. Insight into contact force local impedance technology for predicting effective pulmonary vein isolation. Front Cardiovasc Med. 2023;10. doi.org/10.3389/fcvm.2023.1169037
Caution: Investigational device. Limited by Federal (or U.S.) law to investigational use only. Not available for sale. 2023 Boston Scientific Corporation or its affiliates. All rights reserved. All trademarks are the property of their respective owners. EP-1755903-AA
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Heart attack breakthrough: New protocol saves 71% of patients with deadly complication – News-Medical.Net
Published results of a large, national heart attack study show that patients with a life-threatening complication known as cardiogenic shock survived at a significantly higher rate when treated with a protocol developed by cardiologists at Henry Ford Health, in collaboration with 80 hospitals nationwide.
Cardiogenic shock is a critical condition in which the heart is unable to pump enough blood to sustain the body's needs, depriving vital organs of blood supply. This can cause those organs to eventually stop functioning. The typical survival rate of this deadly complication during a heart attack has historically hovered around 50%.
Led by a cardiology research team based at Henry Ford Hospital in Detroit, the National Cardiogenic Shock Initiative (NCSI) results demonstrate a survival rate of 71% in patients whose heart attack was complicated by cardiogenic shock and were treated with the protocol. Final results from the national study published in the Journal of the American Heart Association were achieved from looking at 406 patients from hospitals across 29 states.
The National Cardiogenic Shock Initiative is the largest prospective study of therapy for severe heart attack cardiogenic shock done in the United States in the past two decades. The impressive results from our study in the U.S. have also prompted the use of our protocol in Japan where they are experiencing similar great outcomes."
William O'Neill, M.D., medical director emeritus of Henry Ford's Center for Structural Heart Disease and principal investigator of the study
The treatment algorithm, available at henryford.com/cardiogenicshock, emphasizes quick recognition of the condition, then inserting a temporary straw-sized pump into the heart to keep blood flowing throughout the body. The Impella heart pump, an FDA-approved device, is inserted through a catheter in the groin as soon as the patient arrives at the hospital. Doctors then treat the cause of the heart attack, either inserting a stent, removing a clot or taking other necessary action.
The NCSI study involved cardiologists at both community hospitals, where many patients with heart attack first present, and large academic centers. Of the more than 1,100 patients who were screened, 406 were enrolled into the study. The study also isolated predictive markers that indicate a patient's condition, an invaluable tool in determining treatment.
The NCSI participating hospitals agreed to treat patients who presented with acute myocardial infarction and cardiogenic shock using a standard protocol, which involved rapid initiation of mechanical circulatory support (MCS) with an Impella 2.5 or Impella CP heart pump, along with right heart catheterization to assess status of right and left ventricular heart function. Patients were enrolled between July 2016 and December 2020.
"The study results show remarkable survival, the highest we've seen in any study so far," said Babar Basir, D.O., Director of Acute Mechanical Circulatory Support at Henry Ford Health and principal investigator of the study. "The results show that we now have therapy that can save lives and improve outcomes for people who've had severe heart attacks and we haven't had results like these in 20 years. The protocol has already saved many lives and will continue to do so as more hospitals adopt its principles."
In the U.S., approximately 80,000 people are diagnosed with cardiogenic shock as a result from a heart attack each year according to data from a published study that looked at a 15-year trend from 2004 to 2018.
Dr. O'Neill will continue to lead research in the next NCSI phase in an upcoming study titled Recover IV Trial.
"Implementing this protocol has truly been a joint effort with hospitals that have experienced the devastating burden of cardiogenic shock," said Sarah Gorgis, M.D., a cardiologist at Henry Ford Health and co-researcher for the study. "Our work has just begun, but this protocol gives us hope since we have seen first-hand the impact it can make on survival."
"The NCSI initiative was critically important. It changed how we approach the management of patients with cardiogenic shock, and with those changes, we witnessed improvements in survival , for the first time in decades," said Herb Aronow, M.D., medical director of Heart & Vascular Services at Henry Ford Health.
"Bringing together 80 different sites to investigate an innovative treatment protocol for Acute myocardial infarction complicated by cardiogenic shock is an incredible accomplishment by our NCSI team and heralds highly promising new approaches to improving outcomes in this challenging patient population," said Henry Kim, M.D., Division Head of Cardiology at Henry Ford Health.
Source:
Journal reference:
Basir, M. B., et al. (2023) Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.031401.
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