Cynthia Tracy - Academia.edu (original) (raw)

Papers by Cynthia Tracy

Research paper thumbnail of ACC/AHA guidelines for ambulatory electrocardiography

Journal of the American College of Cardiology, Sep 1, 1999

Research paper thumbnail of ACC/AHA Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography

Circulation, Dec 17, 2001

interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing C... more interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing Committee are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These changes are reviewed by the Writing Committee and updated as changes occur.

Research paper thumbnail of 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Journal of Arrhythmia

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduc... more 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.

Research paper thumbnail of Artificial Intelligence Advancements in the Cardiovascular Imaging of Coronary Atherosclerosis

Frontiers in Cardiovascular Medicine, 2022

Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advance... more Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice.

Research paper thumbnail of Atrial Fibrillation: Once Again Not So Easy to Prevent

Circulation: Arrhythmia and Electrophysiology, 2017

See Article by Dewland et al The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent... more See Article by Dewland et al The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a multicenter, double-blinded, parallel-group, randomized controlled trial examining the effect of 4 different antihypertensive agents on the incidence of cardiovascular events.1 The study enrolled hypertensive patients at least 55 years old with at least 1 additional risk factor for coronary artery disease. When comparing primary outcomes of combined fatal coronary artery disease or nonfatal myocardial infarction, neither lisinopril nor amlodipine use led to a significant reduction compared with chlorthalidone. Chlorthalidone did result in a significant reduction in combined coronary artery disease, stroke, congestive heart failure, and peripheral arterial disease and treated angina without hospitalization. In addition to antihypertensive randomization, patients with elevated low-density lipoprotein cholesterol were randomized to receive pravastatin or usual car...

Research paper thumbnail of Hormone and autonomic changes of pregnancy and their impact on cardiac electrophysiology

During pregnancy, there are several physiologic changes that are regulated through hormonal, hemo... more During pregnancy, there are several physiologic changes that are regulated through hormonal, hemodynamic, and autonomic alterations. It is common for women during pregnancy to experience some form of palpitations, fortunately the majority of which are benign. A large retrospective study showed that 0.17% of hospital admissions during pregnancy are related to arrhythmias including supraventricular tachycardia (SVT), atrial fibrillation, ventricular tachycardia or fibrillation, and atrioventricular block (Li et al., 2008). The literature is not clear as to whether new onset arrhythmias such as SVT are more likely during pregnancy, but an increase in episodes in women with preexistent arrhythmias is more common. However, a woman with asymptomatic Wolff–Parkinson–White syndrome may experience her first episode of SVT during pregnancy (Tawam et al., 1993; Kounis et al., 1995). In this chapter, we will explore the hormonal and autonomic electrophysiologic effects of pregnancy, which can l...

Research paper thumbnail of Worldwide Survey of COVID-19–Associated Arrhythmias

Circulation: Arrhythmia and Electrophysiology, 2021

Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and ha... more Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each...

Research paper thumbnail of Outcomes of Acute Conduction Abnormalities Following Transcatheter Aortic Valve Implantation With a Balloon Expandable Valve and Predictors of Delayed Conduction System Abnormalities in Follow-up

The American Journal of Cardiology, 2019

Research paper thumbnail of P6594Rate versus rhythm control in patients with atrial fibrillation and normal to mild left atrial enlargement: insights from the AFFIRM trial

European Heart Journal, 2018

Background: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is asso... more Background: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is associated with significant morbidity and mortality. Several trials have demonstrated that no mortality benefit exists when choosing a rhythmcontrol strategy over a rate-control strategy, with some trials suggesting an increase in mortality. Using the AFFIRM trial database we sought to determine the effect of rhythm control strategy in patients with less atrial remodeling. Methods: AFFIRM Trial data was used to evaluate the effect of rhythm control in a subgroup of patients with normal to mild left atrial enlargement. A chi-square test and a t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between rhythm control and rate control. Results: We identified a subgroup of subjects from the AFFIRM trial with normal to mild left atrial enlargement (n=2022 of 4060 total subjects). Subjects were randomly assigned to the rhythm-control group (n=1022) or the rate-control group (n=1000). The mean age and BMI of subjects were 70±8 years and 28±6 kg/m 2 , and the total number of women was 910 (45%). The percentage of subjects who have a history of hypertension, diabetes, and coronary artery disease was 70%, 19%, and 34%, respectively. Those subjects had a mean ejection fraction of 57±7%. Subjects in the rhythm-control group had an increased risk of death (RR 1.34, 95% CI 1.08-1.67; P=0.007) and hospitalization/ED visits (RR 1.10, 95% CI 1.05-2.16; P≤0.001). In this group, the risks of overall death and hospitalization/ED visits were higher among patients who received amiodarone compared to patients who did not. Conclusion: This study demonstrated an increased risk of mortality and hospitalization in patients with normal to mild atrial enlargement randomized to a rhythm-control strategy. These findings were driven by amiodarone use in this group.

Research paper thumbnail of 2017 ACC/HRS lifelong learning statement for clinical cardiac electrophysiology specialists: A report of the ACC Competency Management Committee

Heart rhythm, 2018

Official representative of the Heart Rhythm Society. † Former Competency Management Committee mem... more Official representative of the Heart Rhythm Society. † Former Competency Management Committee member; member during this writing effort.

Research paper thumbnail of ACCF/AHA/CDC Conference Report on Emerging Infectious Diseases and Biological Terrorism Threats ⁎ ⁎ The findings and conclusions in this report are those of the Conference participants and do not necessarily reflect the official position of the American College of Cardiology Foundation, the Ameri...

J Amer Coll Cardiol, 2007

Research paper thumbnail of DBT GL 2012 JACC Oct 2

Research paper thumbnail of Implantation of a Nonthoracotomy Defibrillator Using a Second Defibrillator Patch in the Abdominal Pocket

Pacing and Clinical Electrophysiology, 1996

Research paper thumbnail of Interpretation of Remotely Downloaded Pocket-Size Cardiac Ultrasound Images on a Web-Enabled Smartphone: Validation Against Workstation Evaluation

Journal of the American Society of Echocardiography, 2011

Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care inte... more Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care interpretation may not be readily available. The aim of this study was to test the hypothesis that remote interpretation on a smartphone with dedicated medical imaging software can be as accurate as on a workstation. Eighty-nine patients in a remote Honduran village underwent echocardiography by a nonexpert using a pocket-size ultrasound device. Images were sent for verification of point-of-care diagnosis to two expert echocardiographers in the United States reading on a workstation. Studies were then anonymized, randomly ordered, and reinterpreted on a smartphone with a dedicated, Health Insurance Portability and Accountability Act-compliant application. Point-of-care diagnosis was considered accurate if any abnormal finding was matched and categorized at the same level of severity (mild, moderate, or severe) by either expert interpretation. The mean age was 54 ± 23 years, and 57% of patients were women. The most common indications for echocardiography were arrhythmia (33%), cardiomyopathy (28%), and syncope (15%). Using the workstation, point-of-care diagnoses were changed in 38% of cases by expert overread (41% left ventricular function correction, 38% valvulopathy correction, 18% poor image quality). Expert interobserver agreement was excellent at 82%, with a Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s κ value of 0.82 (95% confidence interval, 0.70-0.94). Intraobserver agreement comparing interpretations on workstations and smartphones was 90%, with a Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s κ value of 0.86 (95% confidence interval, 0.76-0.97), signifying excellent intertechnology agreement. Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.

Research paper thumbnail of American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus)31When citing this document, the American College of Cardiology would appreciate the following citation format: Mintz GS, Nissen SE, ...

Journal of the American College of Cardiology, 2001

Research paper thumbnail of ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography41This document was approved by the American College of Cardiology Board of Trustees in November 2001 and the American Heart Association Science Advisory and Coordinating Committee in August 2001.42When...

Journal of the American College of Cardiology, 2001

interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing C... more interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing Committee are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These changes are reviewed by the Writing Committee and updated as changes occur.

Research paper thumbnail of The use of beta blockers to prevent postoperative atrial fibrillation is limited by adjunctive magnesium

Journal of the American College of Cardiology, 1998

tniemal mammary (LIMA) to laft anterior descending (LAD) t~lsa through a minithoracotomy without ... more tniemal mammary (LIMA) to laft anterior descending (LAD) t~lsa through a minithoracotomy without Cardtopulmor~ry bypass, To evaluate transiHime ultrasound as a means to a~.sess graft paterry, 17 consecutive MIOCAB pts (age 65 ± 13 ym) ~ st~ll~. LIMA flow was asso.ad by an ullmsound ftown~' frramonm) before ~ts d~s~on (after padtcla mobiltzatiorl), and a~or LAD ~I011~<~, UMA flow ~ warn: peak systolic (~) and diastolic (D) flow, mlio (D/S), time-flow integral (TR), % dlagd¢ TR [%0-TFI =

Research paper thumbnail of Pacemakers and defibrillators in patients with cardiac sarcoidosis

Journal of the American College of Cardiology, 2003

Background: The prognosis associated wtth cardiac sarcoidosis remains controversial. Additionally... more Background: The prognosis associated wtth cardiac sarcoidosis remains controversial. Additionally, the use of pacemakers (PM) and defibrillators (ICD) in this population has not been fully evaluated. Mathods: We describe 10 consecutive patients (9 women; 7 African Americans; mean age 51 f 11 years) with biopsy-proven systemic sarcoidosis and presumed sarcoid of the heart. All patients had a PM and/or an ICD. Results: These patients had a mean left ventricular ejection fraction (LVEF) of 0.58 * 0.09 (0.58 * 0.05 in the ventricular tachycardia (VT) population) and have carried a diagnosis of cardiac sarcoidosis for 80 * 38 months. The indications for device implantation were complete heart block in 6 patients, sustained VT in 2 patients, and both complete heart block and VT in 2 patients. In addition, 4 patients had paroxysmal atrial flutter. As a result of these arrhythmias, 6 patients received a PM, 3 patients received an ICD, and one patient had both a PM and an ICD. For patients with a PM, the initial pacing and sensing thresholds were

Research paper thumbnail of Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Heart Rhythm, 2011

Background-The implantable cardioverter-defibrillator (ICD) is an effective therapy for preventin... more Background-The implantable cardioverter-defibrillator (ICD) is an effective therapy for preventing sudden cardiac death (SCD) in patients with prior myocardial infarction (MI) and reduced left ventricular function; however, the optimal timing of ICD implantation after MI remains unknown. Objective-The purpose of this study was to determine whether the benefit of single-lead conservatively programmed ICD therapy varies as a function of time from MI to ICD implantation. Methods-We compared time to all-cause death and SCD between the ICD and placebo arms in the Sudden Cardiac Death in Heart Failure Trial. Rates of appropriate shocks in the ICD arm were also assessed as a function of time after MI. Results-Among the 712 patients with a history of MI, 274 died (38.5%), and 68 of these deaths were SCD (24.8%). Appropriate shocks were more common with increasing time after MI (adjusted hazard ratio [HR] per year after MI 1.04 [1.00-1.08]). Despite these differences, there was no evidence of differential mortality benefit with ICD implantation as a function of time after MI: continuous variable adjusted HR 1.00 [0.98,1.03] and shortest versus longest tertile adjusted HR 0.95 [0.66-1.34]. Sensitivity analyses also failed to show differential mortality benefit by quartile or with the use of an 18-month cutoff: <18 versus ≥ 18 months adjusted HR 1.08 [0.77, 1.51]. Conclusion-There is no evidence that ICD benefit varied with time from MI to implantation/ randomization in this primary prevention population. Single-lead ICD benefit is not restricted to patients with a remote MI (>18 months).

Research paper thumbnail of 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Circulation, 2012

System atic Reviews and Clinical Practice Guidelines We Can Trust. 1b,1c It is noteworthy that th... more System atic Reviews and Clinical Practice Guidelines We Can Trust. 1b,1c It is noteworthy that the ACCF/AHA practice guidelines were cited as being compliant with many of the standards that were proposed. A thorough review of these reports and our current methodology is under way, with further enhancements anticipated. The current document is a republication of the "ACCF/ AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities" 1d , revised to incorporate updated recommendations and text from the 2012 Focused Update. 1 For easy reference, this online-only version denotes sections that have been updated.

Research paper thumbnail of ACC/AHA guidelines for ambulatory electrocardiography

Journal of the American College of Cardiology, Sep 1, 1999

Research paper thumbnail of ACC/AHA Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography

Circulation, Dec 17, 2001

interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing C... more interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing Committee are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These changes are reviewed by the Writing Committee and updated as changes occur.

Research paper thumbnail of 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Journal of Arrhythmia

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduc... more 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.

Research paper thumbnail of Artificial Intelligence Advancements in the Cardiovascular Imaging of Coronary Atherosclerosis

Frontiers in Cardiovascular Medicine, 2022

Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advance... more Coronary artery disease is a leading cause of death worldwide. There has been a myriad of advancements in the field of cardiovascular imaging to aid in diagnosis, treatment, and prevention of coronary artery disease. The application of artificial intelligence in medicine, particularly in cardiovascular medicine has erupted in the past decade. This article serves to highlight the highest yield articles within cardiovascular imaging with an emphasis on coronary CT angiography methods for % stenosis evaluation and atherosclerosis quantification for the general cardiologist. The paper finally discusses the evolving paradigm of implementation of artificial intelligence in real world practice.

Research paper thumbnail of Atrial Fibrillation: Once Again Not So Easy to Prevent

Circulation: Arrhythmia and Electrophysiology, 2017

See Article by Dewland et al The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent... more See Article by Dewland et al The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a multicenter, double-blinded, parallel-group, randomized controlled trial examining the effect of 4 different antihypertensive agents on the incidence of cardiovascular events.1 The study enrolled hypertensive patients at least 55 years old with at least 1 additional risk factor for coronary artery disease. When comparing primary outcomes of combined fatal coronary artery disease or nonfatal myocardial infarction, neither lisinopril nor amlodipine use led to a significant reduction compared with chlorthalidone. Chlorthalidone did result in a significant reduction in combined coronary artery disease, stroke, congestive heart failure, and peripheral arterial disease and treated angina without hospitalization. In addition to antihypertensive randomization, patients with elevated low-density lipoprotein cholesterol were randomized to receive pravastatin or usual car...

Research paper thumbnail of Hormone and autonomic changes of pregnancy and their impact on cardiac electrophysiology

During pregnancy, there are several physiologic changes that are regulated through hormonal, hemo... more During pregnancy, there are several physiologic changes that are regulated through hormonal, hemodynamic, and autonomic alterations. It is common for women during pregnancy to experience some form of palpitations, fortunately the majority of which are benign. A large retrospective study showed that 0.17% of hospital admissions during pregnancy are related to arrhythmias including supraventricular tachycardia (SVT), atrial fibrillation, ventricular tachycardia or fibrillation, and atrioventricular block (Li et al., 2008). The literature is not clear as to whether new onset arrhythmias such as SVT are more likely during pregnancy, but an increase in episodes in women with preexistent arrhythmias is more common. However, a woman with asymptomatic Wolff–Parkinson–White syndrome may experience her first episode of SVT during pregnancy (Tawam et al., 1993; Kounis et al., 1995). In this chapter, we will explore the hormonal and autonomic electrophysiologic effects of pregnancy, which can l...

Research paper thumbnail of Worldwide Survey of COVID-19–Associated Arrhythmias

Circulation: Arrhythmia and Electrophysiology, 2021

Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and ha... more Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each...

Research paper thumbnail of Outcomes of Acute Conduction Abnormalities Following Transcatheter Aortic Valve Implantation With a Balloon Expandable Valve and Predictors of Delayed Conduction System Abnormalities in Follow-up

The American Journal of Cardiology, 2019

Research paper thumbnail of P6594Rate versus rhythm control in patients with atrial fibrillation and normal to mild left atrial enlargement: insights from the AFFIRM trial

European Heart Journal, 2018

Background: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is asso... more Background: Atrial fibrillation is the most commonly encountered sustained arrhythmia and is associated with significant morbidity and mortality. Several trials have demonstrated that no mortality benefit exists when choosing a rhythmcontrol strategy over a rate-control strategy, with some trials suggesting an increase in mortality. Using the AFFIRM trial database we sought to determine the effect of rhythm control strategy in patients with less atrial remodeling. Methods: AFFIRM Trial data was used to evaluate the effect of rhythm control in a subgroup of patients with normal to mild left atrial enlargement. A chi-square test and a t-test were used to examine and compare the binary and continuous variables of baseline characteristics and outcomes between rhythm control and rate control. Results: We identified a subgroup of subjects from the AFFIRM trial with normal to mild left atrial enlargement (n=2022 of 4060 total subjects). Subjects were randomly assigned to the rhythm-control group (n=1022) or the rate-control group (n=1000). The mean age and BMI of subjects were 70±8 years and 28±6 kg/m 2 , and the total number of women was 910 (45%). The percentage of subjects who have a history of hypertension, diabetes, and coronary artery disease was 70%, 19%, and 34%, respectively. Those subjects had a mean ejection fraction of 57±7%. Subjects in the rhythm-control group had an increased risk of death (RR 1.34, 95% CI 1.08-1.67; P=0.007) and hospitalization/ED visits (RR 1.10, 95% CI 1.05-2.16; P≤0.001). In this group, the risks of overall death and hospitalization/ED visits were higher among patients who received amiodarone compared to patients who did not. Conclusion: This study demonstrated an increased risk of mortality and hospitalization in patients with normal to mild atrial enlargement randomized to a rhythm-control strategy. These findings were driven by amiodarone use in this group.

Research paper thumbnail of 2017 ACC/HRS lifelong learning statement for clinical cardiac electrophysiology specialists: A report of the ACC Competency Management Committee

Heart rhythm, 2018

Official representative of the Heart Rhythm Society. † Former Competency Management Committee mem... more Official representative of the Heart Rhythm Society. † Former Competency Management Committee member; member during this writing effort.

Research paper thumbnail of ACCF/AHA/CDC Conference Report on Emerging Infectious Diseases and Biological Terrorism Threats ⁎ ⁎ The findings and conclusions in this report are those of the Conference participants and do not necessarily reflect the official position of the American College of Cardiology Foundation, the Ameri...

J Amer Coll Cardiol, 2007

Research paper thumbnail of DBT GL 2012 JACC Oct 2

Research paper thumbnail of Implantation of a Nonthoracotomy Defibrillator Using a Second Defibrillator Patch in the Abdominal Pocket

Pacing and Clinical Electrophysiology, 1996

Research paper thumbnail of Interpretation of Remotely Downloaded Pocket-Size Cardiac Ultrasound Images on a Web-Enabled Smartphone: Validation Against Workstation Evaluation

Journal of the American Society of Echocardiography, 2011

Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care inte... more Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care interpretation may not be readily available. The aim of this study was to test the hypothesis that remote interpretation on a smartphone with dedicated medical imaging software can be as accurate as on a workstation. Eighty-nine patients in a remote Honduran village underwent echocardiography by a nonexpert using a pocket-size ultrasound device. Images were sent for verification of point-of-care diagnosis to two expert echocardiographers in the United States reading on a workstation. Studies were then anonymized, randomly ordered, and reinterpreted on a smartphone with a dedicated, Health Insurance Portability and Accountability Act-compliant application. Point-of-care diagnosis was considered accurate if any abnormal finding was matched and categorized at the same level of severity (mild, moderate, or severe) by either expert interpretation. The mean age was 54 ± 23 years, and 57% of patients were women. The most common indications for echocardiography were arrhythmia (33%), cardiomyopathy (28%), and syncope (15%). Using the workstation, point-of-care diagnoses were changed in 38% of cases by expert overread (41% left ventricular function correction, 38% valvulopathy correction, 18% poor image quality). Expert interobserver agreement was excellent at 82%, with a Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s κ value of 0.82 (95% confidence interval, 0.70-0.94). Intraobserver agreement comparing interpretations on workstations and smartphones was 90%, with a Cohen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s κ value of 0.86 (95% confidence interval, 0.76-0.97), signifying excellent intertechnology agreement. Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.

Research paper thumbnail of American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus)31When citing this document, the American College of Cardiology would appreciate the following citation format: Mintz GS, Nissen SE, ...

Journal of the American College of Cardiology, 2001

Research paper thumbnail of ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography41This document was approved by the American College of Cardiology Board of Trustees in November 2001 and the American Heart Association Science Advisory and Coordinating Committee in August 2001.42When...

Journal of the American College of Cardiology, 2001

interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing C... more interest of a member of the ACC/AHA Writing Committee. Specifically, all members of the Writing Committee are asked to provide disclosure statements of all such relationships that might be perceived as real or potential conflicts of interest. These changes are reviewed by the Writing Committee and updated as changes occur.

Research paper thumbnail of The use of beta blockers to prevent postoperative atrial fibrillation is limited by adjunctive magnesium

Journal of the American College of Cardiology, 1998

tniemal mammary (LIMA) to laft anterior descending (LAD) t~lsa through a minithoracotomy without ... more tniemal mammary (LIMA) to laft anterior descending (LAD) t~lsa through a minithoracotomy without Cardtopulmor~ry bypass, To evaluate transiHime ultrasound as a means to a~.sess graft paterry, 17 consecutive MIOCAB pts (age 65 ± 13 ym) ~ st~ll~. LIMA flow was asso.ad by an ullmsound ftown~' frramonm) before ~ts d~s~on (after padtcla mobiltzatiorl), and a~or LAD ~I011~<~, UMA flow ~ warn: peak systolic (~) and diastolic (D) flow, mlio (D/S), time-flow integral (TR), % dlagd¢ TR [%0-TFI =

Research paper thumbnail of Pacemakers and defibrillators in patients with cardiac sarcoidosis

Journal of the American College of Cardiology, 2003

Background: The prognosis associated wtth cardiac sarcoidosis remains controversial. Additionally... more Background: The prognosis associated wtth cardiac sarcoidosis remains controversial. Additionally, the use of pacemakers (PM) and defibrillators (ICD) in this population has not been fully evaluated. Mathods: We describe 10 consecutive patients (9 women; 7 African Americans; mean age 51 f 11 years) with biopsy-proven systemic sarcoidosis and presumed sarcoid of the heart. All patients had a PM and/or an ICD. Results: These patients had a mean left ventricular ejection fraction (LVEF) of 0.58 * 0.09 (0.58 * 0.05 in the ventricular tachycardia (VT) population) and have carried a diagnosis of cardiac sarcoidosis for 80 * 38 months. The indications for device implantation were complete heart block in 6 patients, sustained VT in 2 patients, and both complete heart block and VT in 2 patients. In addition, 4 patients had paroxysmal atrial flutter. As a result of these arrhythmias, 6 patients received a PM, 3 patients received an ICD, and one patient had both a PM and an ICD. For patients with a PM, the initial pacing and sensing thresholds were

Research paper thumbnail of Mortality benefits from implantable cardioverter-defibrillator therapy are not restricted to patients with remote myocardial infarction: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Heart Rhythm, 2011

Background-The implantable cardioverter-defibrillator (ICD) is an effective therapy for preventin... more Background-The implantable cardioverter-defibrillator (ICD) is an effective therapy for preventing sudden cardiac death (SCD) in patients with prior myocardial infarction (MI) and reduced left ventricular function; however, the optimal timing of ICD implantation after MI remains unknown. Objective-The purpose of this study was to determine whether the benefit of single-lead conservatively programmed ICD therapy varies as a function of time from MI to ICD implantation. Methods-We compared time to all-cause death and SCD between the ICD and placebo arms in the Sudden Cardiac Death in Heart Failure Trial. Rates of appropriate shocks in the ICD arm were also assessed as a function of time after MI. Results-Among the 712 patients with a history of MI, 274 died (38.5%), and 68 of these deaths were SCD (24.8%). Appropriate shocks were more common with increasing time after MI (adjusted hazard ratio [HR] per year after MI 1.04 [1.00-1.08]). Despite these differences, there was no evidence of differential mortality benefit with ICD implantation as a function of time after MI: continuous variable adjusted HR 1.00 [0.98,1.03] and shortest versus longest tertile adjusted HR 0.95 [0.66-1.34]. Sensitivity analyses also failed to show differential mortality benefit by quartile or with the use of an 18-month cutoff: <18 versus ≥ 18 months adjusted HR 1.08 [0.77, 1.51]. Conclusion-There is no evidence that ICD benefit varied with time from MI to implantation/ randomization in this primary prevention population. Single-lead ICD benefit is not restricted to patients with a remote MI (>18 months).

Research paper thumbnail of 2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Circulation, 2012

System atic Reviews and Clinical Practice Guidelines We Can Trust. 1b,1c It is noteworthy that th... more System atic Reviews and Clinical Practice Guidelines We Can Trust. 1b,1c It is noteworthy that the ACCF/AHA practice guidelines were cited as being compliant with many of the standards that were proposed. A thorough review of these reports and our current methodology is under way, with further enhancements anticipated. The current document is a republication of the "ACCF/ AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities" 1d , revised to incorporate updated recommendations and text from the 2012 Focused Update. 1 For easy reference, this online-only version denotes sections that have been updated.