Jeffrey Osborn - Academia.edu (original) (raw)

Papers by Jeffrey Osborn

Pacing and clinical electrophysiology : PACE, Jan 23, 2016

LV lead implant success rates have historically ranged between 70.5% and 95.5%. To date, there ar... more LV lead implant success rates have historically ranged between 70.5% and 95.5%. To date, there are few large studies that evaluate LV lead implant success utilizing a single family of delivery catheters and leads. The Attain Success study was a prospective non-randomized multi-center global study with the main objectives of assessing single system LV lead implant success and complication rates. Patients undergoing CRT implantation were eligible for enrollment. There was no pre-specified level of experience for investigator participation. LV lead implant success and complication rates were assessed though 3 months of follow-up. A total of 2014 patients (69.1±12.0 years, 71% male, and 38% AFib) were enrolled from 114 centers with a follow-up of 3.5±2.1 months. CS cannulation success rate was 96.4% with Attain Family delivery catheters. Implant success rate for Attain Family leads using Attain Family catheters was 94.0%; overall LV lead implant success rate was 97.1%. Median procedure ...

National surveys indicate that 20–50% of adult Americans use herbal and dietary supplements (HDSs... more National surveys indicate that 20–50% of adult Americans use herbal and dietary supplements (HDSs), but the majority do not report their use. Significant patient harm may occur when HDSs are taken in conjunction with warfarin. One hundred warfarin-treated patients were surveyed regarding habits of and attitudes to HDS use, and communication about HDSs with their medical provider. Additionally, the top 40 HDSs were reviewed for their potential to interact with warfarin using three herbal supplement databases. Database search terms included common herbal names, warfarin, anticoagulants, and drug–drug interactions. Survey results of warfarin-treated patients found that 69% use at least one HDS, yet over half do not view HDSs as ‘‘drugs’’. Additionally, patients reported that while physicians routinely inquire about drug use (89%), they frequently fail to ask specifically about HDS use (63%). HDS use was not documented in the medical chart for the majority of patients (73%). Of the top ...

Journal of the American Heart Association, Jul 11, 2016

The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We pr... more The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure. A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included. Warfarin indication was for AF (n=4460), thromboembolism (n=5868), and mechanical heart valve(s) (n=209). Patients in the latter 2 categories were included only if they had no prior history of AF. The primary outcome was dementia. Patients with AF were older and had higher rates of hypertension, diabetes, heart failure, and stroke. AF patients experienced higher rates of total dementia (5.8% versus 1.6%, P<0.0001), Alzheimer di...

Journal of cardiovascular electrophysiology, 2016

Remote magnetic navigation (RMN) and contact force (CF) sensing technologies have been utilized i... more Remote magnetic navigation (RMN) and contact force (CF) sensing technologies have been utilized in an effort to improve safety and efficacy of catheter ablation. A comparative analysis of the relative short- and long-term outcomes of AF patients has not been performed. As such, we comparatively evaluated the safety and efficacy of these technologies. A total of 627 patients who underwent catheter ablation with either a manual irrigated tip catheter: (312, 49.8%) or by RMN: (315, 50.2%) were included in this single-center cohort study. Patients treated with CF (59) were analyzed separately as well. One- and 3-year endpoints included death, HF hospitalization, stroke, TIA, and atrial flutter or AF recurrence. Age averaged 65.1 ± 10.7 years and 64.1% male. One- and 3-year endpoints of death, HF hospitalization, stroke, TIA, and atrial flutter or AF recurrence were statistically similar between manual and RMN treated groups. Fluoroscopy times were significantly lower in the RMN group co...

Circulation: Arrhythmia and Electrophysiology, 2015

Background— There are a paucity of data about the long-term natural history of adult Wolff–Parkin... more Background— There are a paucity of data about the long-term natural history of adult Wolff–Parkinson–White syndrome (WPW) patients in regard to risk of mortality and atrial fibrillation. We sought to describe the long-term outcomes of WPW patients and ascertain the impact of ablation on the natural history. Methods and Results— Three groups of patients were studied: 2 WPW populations (ablation: 872, no ablation: 1461) and a 1:5 control population (n=11 175). Long-term mortality and atrial fibrillation rates were determined. The average follow-up for the WPW group was 7.9±5.9 (median: 6.9) years and was similar between the ablation and nonablation groups. Death rates were similar between the WPW group versus the control group (hazard ratio, 0.96; 95% confidence interval, 0.83–1.11; P =0.56). Nonablated WPW patients had a higher long-term death risk compared with ablated WPW patients (hazard ratio, 2.10; 95% confidence interval: 1.50–20.93; P <0.0001). Incident atrial fibrillation ...

Journal of Cardiovascular Electrophysiology, 2012

BACKGROUND: Esophageal injury during left atrial ablation is associated with a significant risk o... more BACKGROUND: Esophageal injury during left atrial ablation is associated with a significant risk of mortality and morbidity. There are no validated approaches to reduce injury outside of avoidance, a strategy critically dependent on a precise understanding of the esophageal anatomy and location. Intracardiac ultrasound (ICE) can provide a real-time assessment of the esophagus during ablation. We hypothesized that ICE can accurately define esophageal anatomy and location to enhance avoidance strategies during ablation.

Circulation, 2007

Background— Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibri... more Background— Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators have relied on multiple ventricular fibrillation (VF) induction/defibrillation tests at implantation to ensure that the device can reliably sense, detect, and convert VF. The ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations) is the first large, multicenter, prospective trial comparing vulnerability safety margin testing versus defibrillation safety margin testing with a single VF induction/defibrillation. Methods and Results— A total of 426 patients receiving an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator underwent vulnerability safety margin or defibrillation safety margin screening at 14 J in a randomized order. After this, patients underwent confirmatory testing, which required 2 VF conversi...

Cardiology, 2010

Background: Multiple factors influence warfarin metabolism and can significantly affect the risk ... more Background: Multiple factors influence warfarin metabolism and can significantly affect the risk of adverse events. The extent to which patients understand the modifiable factors that impact on warfarin safety and efficacy is unclear. Methods: A 52-item questionnaire related to knowledge of warfarin was administered to patients with atrial fibrillation in a face-to-face interview with a dietitian. Results were compiled based on five categories: general warfarin knowledge, compliance, drug interactions, herbal or vitamin interactions, and diet. Results: 100 patients were surveyed. Stroke risk factors included hypertension (57%), heart failure (36%), age >75 years (33%), diabetes (22%), and prior stroke/transient ischemic attack (29%). The majority were either high-school (49%) or college graduates (27%). Ten (10%) had a stroke while on warfarin, 11 (11%) had a blood transfusion, and 26 (26%) had at least one fall. The percentages correct for questionnaire items in the five categor...

American Heart Journal, 1995

Predictors of a successful outcome of serial electrophysiologic (EP) and drug studies have been i... more Predictors of a successful outcome of serial electrophysiologic (EP) and drug studies have been identified from among baseline patient characteristics but not from among measures of baseline and drug-related EP effects. Identifying such predictors would be useful in ...

Heart Rhythm, 2013

BACKGROUND Atrial fibrillation (AF) is a leading cause of total and fatal ischemic stroke. Stroke... more BACKGROUND Atrial fibrillation (AF) is a leading cause of total and fatal ischemic stroke. Stroke risk after AF ablation appears to be favorably affected; however, it is largely unknown whether the benefit extends to all stroke CHADS2 risk profiles of AF patients. OBJECTIVE To determine if ablation of atrial fibrillation reduces stroke rates in all risk groups. METHODS A total of 4212 consecutive patients who underwent AF ablation were compared (1:4) with 16,848 age-/sex-matched controls with AF (no ablation) and to 16,848 age-/sex-matched controls without AF. Patients were enrolled from the large ongoing prospective Intermountain Atrial Fibrillation Study and were followed for at least 3 years. RESULTS Of the 37,908 patients, the mean age was 65.0 Ϯ 13 years and 4.4% (no AF), 6.3% (AF, no ablation), and 4.5% (AF ablation) patients had a prior stroke (P o .0001). The profile of CHADS2 scores between comparative groups was similar: 0-1 (69.3%, no AF; 62.3%, AF, no ablation; 63.6%, AF ablation), 2-3 (26.5%, no AF; 29.7%, AF, no ablation; 28.7%, AF ablation), and ≥4 (4.3%, no AF; 8.0%, AF, no ablation; 7.7%, AF ablation). A total of 1296 (3.4%) patients had a stroke over the follow-up period. Across all CHADS2 profiles and ages, AF patients with ablation had a lower long-term risk of stroke compared to patients without ablation. Furthermore, AF ablation patients had similar long-term risks of stroke across all CHADS2 profiles and ages compared to patients with no history of AF. CONCLUSIONS In our study populations, AF ablation patients have a significantly lower risk of stroke compared to AF patients who do not undergo ablation independent of baseline stroke risk score.

Clinical Cardiology, 2019

Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which i... more Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which is more pronounced in patients with a history of clinical stroke. Observational trials suggest that the implementation and quality of long-term anticoagulation impact dementia risk. Emerging evidence suggests that direct oral anticoagulants may improve long-term risk of dementia in AF patients. This manuscript describes the rational and trial design of the the Cognitive Decline and Dementia in Atrial Fibrillation Patients (CAF) Trial. CAF investigates if AF patients randomized to dabigatran etexilate will have long-term higher cognition scores and lower rates of dementia compared in the long term to dose-adjusted warfarin (International Normalized Ratio [INR]: 2.0-3.0). As of 27 February 2019, a total of 120 subjects will be enrolled at one investigational site in the United States and will be followed for 2 years after study enrollment. To date, 97 have been enrolled. The average age is 74.2 years, 53% are male, and 9% had a prior stroke. In this Vanguard study, patients will be followed for 2 years after study enrollment. These prospective, randomized data will inform the understanding of two anticoagulants in AF patients as it relates to risk of cognitive decline and dementia. Cranial imaging and biomarkers collected will assist in understanding mechanisms of brain injury.

Journal of the American College of Cardiology, 2014

background: Magnetic resonance imaging (MRI) in patients with left ventricular (LV) leads may cau... more background: Magnetic resonance imaging (MRI) in patients with left ventricular (LV) leads may cause tissue or lead heating, dislodgement, venous damage, or lead dysfunction. MRI conditional LV leads are not available. We therefore investigated the safety of MRI in patients with LV pacing leads. methods: Prospective data were collected in patients with coronary sinus (CS) LV leads undergoing clinically indicated MRI at 3 institutions. Eligible patients were not pacemaker dependent. Scans were performed under pacing nurse, technician, radiologist, and physicist supervision using continuous vital sign, pulse oximetry, and ECG monitoring and a 1.5 T scanner with specific absorption rate < 1.5 Watts/kg. Devices were interrogated pre-and post-MRI, programmed to asynchronous pacing or inhibition mode with tachyarrhythmia therapies off and reprogrammed to their original settings post-MRI. results: MRI scans (n=38) were performed in 36 patients with non-MRI conditional LV leads between 2005-2013 (mean age 66.0 ± 10.4 years, 16 women, lead implant duration 27.9 ± 31.5 months). MRIs were performed on the: head/neck/spine (n=33, 86.8%), lower extremities (n=4, 10.5%), and chest (n=1, 2.6%). There were no overall differences in pre-and post-MRI interrogation in LV lead sensing (12.4 ± 6.2 mV and 12.9