Vicki Freedenberg - Academia.edu (original) (raw)

Papers by Vicki Freedenberg

Research paper thumbnail of Exploring Mind Body Resilience and Coping/Cognitive Exercises (Embrace): A Psychoeducational Intervention for Adult Congenital Heart Disease, a Randomized Control Trial

Journal of the American College of Cardiology, Apr 1, 2024

Research paper thumbnail of Exploring Mind Body Resilience and Coping/Cognitive Exercises (Embrace): A Psychoeducational Intervention for Adult Congenital Heart Disease, a Randomized Control Trial

Journal of the American College of Cardiology, Apr 1, 2024

Research paper thumbnail of 2023 <scp>HRS</scp>/<scp>EHRA</scp>/<scp>APHRS</scp>/<scp>LAHRS</scp> Expert Consensus Statement on Practical Management of the Remote Device Clinic

Journal of Arrhythmia, May 19, 2023

Research paper thumbnail of Are steroid-eluting cardiac pacing leads really beneficial in the pediatric and young adult age group?

Journal of the American College of Cardiology, Mar 1, 2003

OOa.m. Background: In the past decade, there have been many enhancements in cardiac pacing leads ... more OOa.m. Background: In the past decade, there have been many enhancements in cardiac pacing leads (PL), steroid-elusion (SE) beinq the most sianificant.

Research paper thumbnail of From Patient Studies to a Hospital-Wide Initiative: A Mindfulness Journey

Research paper thumbnail of Intra-Atrial Reentry Tachycardia Ablation in Adults with Congenital Disease - Curative or Just a Successful Procedure?

Journal of the American College of Cardiology, Mar 1, 2010

Background: The frequency of atrial arrhythmias (AA) increases with time following repair of cong... more Background: The frequency of atrial arrhythmias (AA) increases with time following repair of congenital cardiac defects (CHD). The most common and clinically significant AA is intra-atrial reentry tachycardia (IART). Little is known regarding the occurrence of other AA following IART ablation. Methods: We reviewed our combined institutional experience for IART ablation in adult patients post repair of CHD to assess whether IART ablation was curative. Attempts were made to ablate all inducible or spontaneous sustained AA with cycle length > 180 msec. Results: Twenty-eight patients ranging in age from 16 to 57 years (mean age = 34 ± 12 years) underwent 29 ablation procedures. CHD consisted of single ventricle (6), tetralogy of Fallot (4), partial or total anomalous pulmonary venous return (4), d-transposition of the great arteries (2), atrial septal defect (8), atrio-ventricular septal defect (3), and Ebstein's (1). Number of IART circuits ranged from 1-3 (median = 2). IART was isthmus dependent in 14 and atypical in 14 patients. Twenty-six of 29 (90%) procedures were successful (defined as lack of inducible IART). Procedure failures (3) were secondary to a supra-annular prosthetic TV valve (1), a patch overlying the TV (1), and unknown (1). Four recurrences (15%) occurred post-ablation between 17 days and 3.5 years; 1 patient had repeat successful IART ablation. Mean post ablation follow-up duration was 44 ± 37 months. Sinus node dysfunction was observed prior to ablation (15) and in the post-ablation period in 16 (57 %) patients. AV node dysfunction was noted pre-ablation in (9) and post-ablation in 10 (36 %) patients. Sixteen (57 %) patients had either pacemakers (11) or defibrillators (5). Following ablation, 11 (39 %) patients were on anti-arrhythmic medication for atrial tachycardia (2), atrial fibrillation (3), IART (5), and ventricular arrhythmia (1). Conclusions: Our results confirm a high success rate of IART ablation in adults with CHD in the current era. Despite ablation success, IART in adult patients with CHD is frequently associated with additional arrhythmias-Sinus or AV node dysfunction and other AA; these patients should be warned of the probable need for adjunctive arrhythmia therapies.

Research paper thumbnail of A Pilot Study of a Mindfulness Based Stress Reduction Program in Adolescents with Implantable Cardioverter Defibrillators or Pacemakers

Pediatric Cardiology, Dec 12, 2014

Objective: A variety of results from both population and laboratory studies suggest that stress a... more Objective: A variety of results from both population and laboratory studies suggest that stress and hot flashes (HFs) are correlated and that HFs are more severe in women with lower coping abilities. The objective of this pilot study was to obtain information on the feasibility and effect of participation in a mindfulness-based stress reduction (MBSR) program on HF severity and menopause-related quality of life. Design: Fifteen women volunteers reporting a minimum of seven moderate to severe HFs per day at study intake attended the eight weekly MBSR classes at the University of Massachusetts Medical School. Participants were assessed for menopause-related quality of life before beginning and at the conclusion of the MBSR program. Women also kept a daily log of their HFs through the course of the 7 weeks of the MBSR program and for 4 weeks after it. Results: Women_s scores on quality-of-life measures increased significantly, and the median reported HF severity, calculated as the weekly average of a daily HF severity score, decreased 40% over the course of the 11 weeks of the assessment period. The women were individually interviewed at the completion of their participation, and the results of the interviews were consistent with the results from daily diaries. Conclusions: These results provide preliminary positive evidence of the feasibility and efficacy of MBSR in supporting women who are experiencing severe HFs, and it warrants further investigation.

Research paper thumbnail of Mindfulness-Based Stress Reduction and Group Support Decrease Stress in Adolescents with Cardiac Diagnoses: A Randomized Two-Group Study

Pediatric Cardiology, Jul 12, 2017

Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. T... more Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. This study compares a Mindfulness-Based Stress Reduction (MBSR) program to a video online support group for adolescents with cardiac diagnoses. MBSR is a structured psycho-educational program which includes yoga, meditation, cognitive restructuring, and group support. A published feasibility study by our group showed significant reduction in anxiety following this intervention. Participants were randomized to MBSR or video online support group, and completed measures of anxiety, depression, illness-related stress, and coping pre-and post-6-session interventions. Qualitative data were obtained from post-intervention interviews. A total of 46 teens participated (mean 14.8 years; 63% female). Participants had congenital heart disease and/or cardiac device (52%), or postural orthostatic tachycardia syndrome (48%). Illness-related stress significantly decreased in both groups. Greater use of coping skills predicted lower levels of depression in both groups post-study completion. Higher baseline anxiety/depression scores predicted improved anxiety/depression scores in both groups. Each group reported the benefits of social support. The MBSR group further expressed benefits of learning specific techniques, strategies, and skills that they applied in real-life situations to relieve distress. Both the MBSR intervention and video support group were effective in reducing distress in this sample. Qualitative data elucidated the added benefits of using MBSR techniques to manage stress and symptoms. The video group format is useful for teens that cannot meet in person but can benefit from group support. Psychosocial interventions with stress management techniques and/or group support can reduce distress in adolescents with cardiac diagnoses.

Research paper thumbnail of Multi-Institutional Study of Implantable Defibrillator Lead Performance in Children and Young Adults

Circulation, Jun 18, 2013

Manufacturers have developed distinct strategies in an attempt to deal with these critical issues... more Manufacturers have developed distinct strategies in an attempt to deal with these critical issues of long-term lead Background-Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease patients is hampered by poor long-term lead survival. Lead extraction is technically difficult and carries substantial morbidity. We sought to determine the outcomes of ICD leads in pediatric and congenital heart disease patients. Methods and Results-The Pediatric Lead Extractability and Survival Evaluation (PLEASE) is a 24-center international registry. Pediatric and congenital heart disease patients with ICD lead implantations from 2005 to 2010 were eligible. Study subjects comprised 878 ICD patients (44% congenital heart disease). Mean±SD age at implantation was 18.6±9.8 years. Of the 965 total leads, 54% were thin (≤7F), of which 57% were Fidelis, and 23% were coated with expanded polytetrafluoroethylene. There were 139 ICD lead failures (14%) in 132 patients (15%) at a mean lead age of 2.0±1.4 years, causing shocks in 53 patients (40%). Independent predictors of lead failure included younger implantation age and Fidelis leads. Actuarial analysis showed an incremental risk of lead failure with younger age at implantation: <8 years compared with >18 years (P=0.015). The actuarial yearly failure rate was 2.3% for non-Fidelis and 9.1% for Fidelis leads. Extraction was performed on 143 leads (80% thin, 7% expanded polytetrafluoroethylene coated), with lead age as the only independent predictor for advanced extraction techniques. There were 6 major extraction complications (4%) but no procedural mortality. Conclusions-This study demonstrates that ICD leads in children and congenital heart disease patients have an age-related suboptimal performance, further compounded by a high failure rate of Fidelis leads. Advanced extraction techniques were common and correlated with older lead age.

Research paper thumbnail of Palpitations and Chest Pain - Basketball

Medicine and Science in Sports and Exercise, May 1, 1995

Research paper thumbnail of Fidelis Implantable Defibrillator Lead Performance in Children: Data from the International Pediatric Lead Extractability and Survival Evaluation (Please) Study

Journal of the American College of Cardiology, Mar 1, 2013

Background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart... more Background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease (CHD) patients is hindered by poor long-term lead survival. Distinct lead design changes including thinner diameter leads were introduced in order to improve extractability; however, a subset of these leads was recalled due to high failure rates. methods: We examined the outcomes of the recalled Sprint Fidelis® leads in pediatric and CHD patients as a sub-analysis within the Pediatric Lead Extractability and Survival Evaluation (PLEASE) study, an international registry involving 24 centers. Pediatric and CHD patients who underwent ICD lead implants from 2005-2010 were eligible. results: Study subjects comprised 878 young ICD patients (44% CHD). Mean±SD age at implant was 18.6±9.8 years. Of the 965 total ICD leads, 54% were Thin (≤ 7Fr) with 300 (58%) being Fidelis® leads. There was a total of 139 (14%) failed leads in 132 (15%) patients at mean lead age of 2.0±1.4 years. Of the Fidelis® leads, 33% (98/300) failed, accounting for 71% (98/139) of all failed leads and 85% (98/115) of all failed thin leads. For the 4 Fidelis® models (6930, 6931, 6948 and 6949) the number of failed leads was 0/1, 57/138 (41%), 3/16 (19%), and 38/145 (26%), respectively. Of the failed single coil leads, 72% (57/79) were Fidelis®model 6931. The majority (44%) of failed Fidelis® leads were associated with inappropriate shocks. The actuarial yearly failure rate was 9.1% for Fidelis® leads compared to 2.1% for non-thin leads. conclusions: Fidelis® leads accounted for the majority of ICD lead failures and associated inappropriate shocks during the study period. The annual failure rate is several-fold higher compared to non-thin leads as well as published Fidelis® annual failure rates in adult cohorts. The steady and high annual failure rate represents an ongoing burden for these young patients. Although children may have potentially benefitted from a thinner ICD lead, unfortunately they have been disproportionately impacted by this specific lead failure and recall. More robust ICD lead designs are critical for the long-term well-being of pediatric device patients. Clinical Trial Registration: NCT00335036 brought to you by CORE View metadata, citation and similar papers at core.ac.uk

Research paper thumbnail of Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation

The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 2013

The study objective was to compare the incidence of short-and intermediate-term arrhythmias among... more The study objective was to compare the incidence of short-and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure. Methods: We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac conduit, and lateral tunnel. Rhythm was classified as normal or abnormal. A rhythm dysfunction grading was devised and used to identify worsening of rhythm for patients with abnormal rhythm preoperatively. Multivariable logistic regression was used to determine predictors of abnormal rhythm. To eliminate confounding effects of transient immediate postoperative arrhythmias, data were analyzed for abnormal rhythm within the first 2 weeks and for more than 2 weeks after surgery.

Research paper thumbnail of Potential for shock leads to potential for stress

Heart Rhythm, Sep 1, 2022

Research paper thumbnail of Creating Interdisciplinary Engagement Through a Hospital-Based Endowed Chair in Nursing Research

Nursing administration quarterly, Feb 15, 2022

Although clinical nurses' involvement in research is a role expectation, efforts to engage cl... more Although clinical nurses' involvement in research is a role expectation, efforts to engage clinical nurses in nurse-led research have had notably mixed results. These efforts have most typically been single discipline–focused (nursing), although nursing care is a collaborative, interdisciplinary practice. Adding an interdisciplinary strategy to multiple other efforts to engage clinical nurses in research may contribute to more nurse involvement. Here, we describe the use of a hospital-based endowed chair in nursing research to simultaneously engage nursing and other disciplines in a monthly dialogue about clinically relevant, research-related challenges and solutions. Outcomes indicate that the research-related dialogue among nurses and interprofessional colleagues would likely not have taken place without this approach.

Research paper thumbnail of Non-Transvenous Lead Implantation in Pediatric and Congenital Heart Disease Patients: Early Analysis from the Ncdr®

Journal of the American College of Cardiology, Apr 1, 2014

background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart... more background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease (CHD) patients is challenging due to small patient size, complex venous and/or intracardiac anatomy. We sought to determine if patients with CHD or under age 21 had higher rates of non-transvenous lead implantation. methods: ICD procedures in patients with CHD or < 21 years of age in the ICD Registry between April 2010-Dec. 2012 were included. Patients with transvenous (TV) and non-TV lead implants were compared for demographics, type of CHD, and implant indication. Non-TV included subcutaneous, epicardial, and pericardial coil placement, without a TV ICD lead. Univariate associations for continuous variables were assessed using F-test in ANOVA, categorical variables with X2 test. results: There were 4,614 ICD procedures for 4,527 patients in the cohort, in which 1576 were pediatric and 3076 had CHD. Overall, 97% of leads were TV (N=4477), and 3% non-TV (N=137). Mean age was lower in the non-TV (35.9±23 yr) than TV cohort (40.1±25, p=.05). Height was lower in non-TV (167.1±19cm) vs. TV group (170.4±13, p<.01). There were higher rates of non-TV lead implants among patients with transposition of great vessels (TGV) (16.1% vs. 7.9%, p<.01), and common ventricle (3.6% vs. 0.4%, p<.01). Among the pediatric cohort, the non-TV had lower age (10.3±8 vs. 12.6±8 yr, p=.04), height (163.7±26 vs. 169.1±16 cm, p=.03) and weight (67.2±25 vs. 76.5±27 kg, p=.02). There was no significant difference in TV or non-TV routes between this cohort and all other implants in the registry over same period (TV leads: N=406,010, 97.5%; non-TV: 10,558, 2.5%, p=.09). conclusion: ICD Registry data show that non-TV leads were implanted in younger and smaller patients. Higher rates of non-TV implants occurred in patients with TGV and common ventricle. These pediatric and CHD patients are not adequately served by current technology and TV approach to ICD lead implantation.

Research paper thumbnail of Implant and Clinical Characteristics for Primary Versus Secondary Prevention Icd Indications for Pediatric and Congenital Heart Patients in the Ncdr®

Journal of the American College of Cardiology, Apr 1, 2014

background: The ICD Registry® began collecting pediatric and congenital heart disease (CHD) speci... more background: The ICD Registry® began collecting pediatric and congenital heart disease (CHD) specific data with version 2.1 in April 2010. There is limited data on who are these patients and their indications for ICD. methods: ICD procedures between April 2010-December 2012 in the ICD Registry for all patients with CHD or < 21 years were included. Variables included implant indications, demographic, diagnostic and clinical history. Univariate associations with F-test in ANOVA for continuous variables and χ2 test for categorical variables were used. results: There were 4,614 ICD procedures in 4,527 patients in the study cohort, of which 3,076 patients had CHD and 1,576 patients were < 21 years. The mean age was 40.0 + 24.6 years (range 0-92 years). CHD patients underwent 3,139 ICD procedures. Implant indications were 1° prevention in 2,819 (61%) and 2° prevention in 1,630 (35%). Among CHD patients, tetralogy of Fallot (TOF, 379/751=51%) and common ventricle (13/25=52%) had highest rates of 2° prevention. Among pediatric non-CHD group, primary electrical disorders (296/516=57%), CPVT (18/23=78%), and idiopathic VT/VF (80/120=67%) had highest rates of 2° prevention. 1° prevention patients had higher NHYA scores than 2° prevention patients. Pediatric cardiologists performed only 153 cases (9.6%) in patients <21 years and 187 cases (4.1%) in the total study cohort. conclusions: This is the largest pooled analysis of ICD implantation characteristics in CHD or pediatrics. Rates of 1° prevention implantation exceeded 2° prevention for the total cohort and specifically among pediatric patients. 2° prevention represented a majority for TOF, common ventricle, CPVT, and idiopathic VT/VF patients. Pediatric cardiologists accounted for implanting < 5% of all CHD and pediatric ICD patients in ICD Registry. Greater participation by pediatric electrophysiologists in the ICD Registry is desirable to accurately measure quality and outcomes of care in pediatric and CHD patients receiving ICD therapy.

Research paper thumbnail of Implant and Clinical Characteristics for Pediatric and Congenital Heart Patients in the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry

Circulation-arrhythmia and Electrophysiology, Dec 1, 2014

The National Cardiovascular Data Registry (NCDR) ICD Registry is a nationwide quality program hel... more The National Cardiovascular Data Registry (NCDR) ICD Registry is a nationwide quality program helping hospitals measure and improve care for patients receiving ICDs, including cardiac resynchronization therapy defibrillators (CRT-D). In April 2010, the NCDR expanded data acquisition for implant characteristics specifically related to pediatrics and CHD with version 2.1 (V2.1). In this article, we report descriptive statistics on demographics and lead implantation characteristics for 2 separate, but related cohorts: pediatric patients <21 years of age and patients with CHD of all ages from April 2010 through December 2012. We sought to determine the

Research paper thumbnail of Abstract 11402: Mindfulness Based Stress Reduction and Group Support Decrease Stress, Anxiety and Depression in Adolescents With Cardiac Diagnoses: A Randomized Two-Group Study

Circulation, Nov 11, 2016

Introduction: Adolescents with cardiac diagnoses face unique challenges that can cause psychosoci... more Introduction: Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac diagnoses and may also...

Research paper thumbnail of EP News: Pediatric and Congenital Electrophysiology

Heart Rhythm, Nov 1, 2021

Research paper thumbnail of Mindful Mentors: Is a Longitudinal Mind–Body Skills Training Pilot Program Feasible for Pediatric Cardiology Staff?

Global advances in health and medicine, 2020

Background: Stress and burnout among medical professionals are common and costly, placing profess... more Background: Stress and burnout among medical professionals are common and costly, placing professionals, organizations, and patients at risk. Objectives: To determine feasibility and acceptability of a longitudinal mind-body skills training initiative to help staff decrease stress and burnout, improve well-being, and empower them to utilize basic mindfulness methods with coworkers, patients, and families. Methods: Prospective cohort, mixed methods approach. Nurses, doctors, technicians, social workers, child life specialists were eligible to participate. The 12-month curriculum consisted of 16 hours of intensive education/practice over 2 days, with training in mindfulness skills, self-compassion, nonviolent communication, overcoming barriers to practice, and mindful listening/speaking, followed by monthly 1 hour booster/debriefing sessions. Results: A total of 37 staff participated (RN ¼ 18, MD ¼ 5, Technician ¼ 6, Social Worker ¼ 3, Child life ¼ 3, others ¼ 2) in the initial training, and 24 (65%) completed the 3-and 12-month follow-up surveys. Compared with pretraining scores, there were significant improvements 3 to 12 months after the initial training in stress (P <.0001), distress (P .04), anxiety (P ¼.01), self-efficacy in providing non-drug therapies (P <.0001), mindfulness (P ¼.002), burnout (P <.0001), and confidence in providing compassionate care (P <.0001). In addition, 25 (67%) participants initiated projects incorporating what they learned into staff/patient wellness activities. Conclusion: This longitudinal pilot program was feasible and was associated with improvements in measures of psychological well-being over the 12-month intervention. The innovative approach of training participants to teach basic techniques to coworkers and other staff can increase the impact of this program beyond any individual participant. Future research will investigate the aspects of implementation and potential effects on patient care and experience.

Research paper thumbnail of Exploring Mind Body Resilience and Coping/Cognitive Exercises (Embrace): A Psychoeducational Intervention for Adult Congenital Heart Disease, a Randomized Control Trial

Journal of the American College of Cardiology, Apr 1, 2024

Research paper thumbnail of Exploring Mind Body Resilience and Coping/Cognitive Exercises (Embrace): A Psychoeducational Intervention for Adult Congenital Heart Disease, a Randomized Control Trial

Journal of the American College of Cardiology, Apr 1, 2024

Research paper thumbnail of 2023 <scp>HRS</scp>/<scp>EHRA</scp>/<scp>APHRS</scp>/<scp>LAHRS</scp> Expert Consensus Statement on Practical Management of the Remote Device Clinic

Journal of Arrhythmia, May 19, 2023

Research paper thumbnail of Are steroid-eluting cardiac pacing leads really beneficial in the pediatric and young adult age group?

Journal of the American College of Cardiology, Mar 1, 2003

OOa.m. Background: In the past decade, there have been many enhancements in cardiac pacing leads ... more OOa.m. Background: In the past decade, there have been many enhancements in cardiac pacing leads (PL), steroid-elusion (SE) beinq the most sianificant.

Research paper thumbnail of From Patient Studies to a Hospital-Wide Initiative: A Mindfulness Journey

Research paper thumbnail of Intra-Atrial Reentry Tachycardia Ablation in Adults with Congenital Disease - Curative or Just a Successful Procedure?

Journal of the American College of Cardiology, Mar 1, 2010

Background: The frequency of atrial arrhythmias (AA) increases with time following repair of cong... more Background: The frequency of atrial arrhythmias (AA) increases with time following repair of congenital cardiac defects (CHD). The most common and clinically significant AA is intra-atrial reentry tachycardia (IART). Little is known regarding the occurrence of other AA following IART ablation. Methods: We reviewed our combined institutional experience for IART ablation in adult patients post repair of CHD to assess whether IART ablation was curative. Attempts were made to ablate all inducible or spontaneous sustained AA with cycle length > 180 msec. Results: Twenty-eight patients ranging in age from 16 to 57 years (mean age = 34 ± 12 years) underwent 29 ablation procedures. CHD consisted of single ventricle (6), tetralogy of Fallot (4), partial or total anomalous pulmonary venous return (4), d-transposition of the great arteries (2), atrial septal defect (8), atrio-ventricular septal defect (3), and Ebstein's (1). Number of IART circuits ranged from 1-3 (median = 2). IART was isthmus dependent in 14 and atypical in 14 patients. Twenty-six of 29 (90%) procedures were successful (defined as lack of inducible IART). Procedure failures (3) were secondary to a supra-annular prosthetic TV valve (1), a patch overlying the TV (1), and unknown (1). Four recurrences (15%) occurred post-ablation between 17 days and 3.5 years; 1 patient had repeat successful IART ablation. Mean post ablation follow-up duration was 44 ± 37 months. Sinus node dysfunction was observed prior to ablation (15) and in the post-ablation period in 16 (57 %) patients. AV node dysfunction was noted pre-ablation in (9) and post-ablation in 10 (36 %) patients. Sixteen (57 %) patients had either pacemakers (11) or defibrillators (5). Following ablation, 11 (39 %) patients were on anti-arrhythmic medication for atrial tachycardia (2), atrial fibrillation (3), IART (5), and ventricular arrhythmia (1). Conclusions: Our results confirm a high success rate of IART ablation in adults with CHD in the current era. Despite ablation success, IART in adult patients with CHD is frequently associated with additional arrhythmias-Sinus or AV node dysfunction and other AA; these patients should be warned of the probable need for adjunctive arrhythmia therapies.

Research paper thumbnail of A Pilot Study of a Mindfulness Based Stress Reduction Program in Adolescents with Implantable Cardioverter Defibrillators or Pacemakers

Pediatric Cardiology, Dec 12, 2014

Objective: A variety of results from both population and laboratory studies suggest that stress a... more Objective: A variety of results from both population and laboratory studies suggest that stress and hot flashes (HFs) are correlated and that HFs are more severe in women with lower coping abilities. The objective of this pilot study was to obtain information on the feasibility and effect of participation in a mindfulness-based stress reduction (MBSR) program on HF severity and menopause-related quality of life. Design: Fifteen women volunteers reporting a minimum of seven moderate to severe HFs per day at study intake attended the eight weekly MBSR classes at the University of Massachusetts Medical School. Participants were assessed for menopause-related quality of life before beginning and at the conclusion of the MBSR program. Women also kept a daily log of their HFs through the course of the 7 weeks of the MBSR program and for 4 weeks after it. Results: Women_s scores on quality-of-life measures increased significantly, and the median reported HF severity, calculated as the weekly average of a daily HF severity score, decreased 40% over the course of the 11 weeks of the assessment period. The women were individually interviewed at the completion of their participation, and the results of the interviews were consistent with the results from daily diaries. Conclusions: These results provide preliminary positive evidence of the feasibility and efficacy of MBSR in supporting women who are experiencing severe HFs, and it warrants further investigation.

Research paper thumbnail of Mindfulness-Based Stress Reduction and Group Support Decrease Stress in Adolescents with Cardiac Diagnoses: A Randomized Two-Group Study

Pediatric Cardiology, Jul 12, 2017

Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. T... more Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. This study compares a Mindfulness-Based Stress Reduction (MBSR) program to a video online support group for adolescents with cardiac diagnoses. MBSR is a structured psycho-educational program which includes yoga, meditation, cognitive restructuring, and group support. A published feasibility study by our group showed significant reduction in anxiety following this intervention. Participants were randomized to MBSR or video online support group, and completed measures of anxiety, depression, illness-related stress, and coping pre-and post-6-session interventions. Qualitative data were obtained from post-intervention interviews. A total of 46 teens participated (mean 14.8 years; 63% female). Participants had congenital heart disease and/or cardiac device (52%), or postural orthostatic tachycardia syndrome (48%). Illness-related stress significantly decreased in both groups. Greater use of coping skills predicted lower levels of depression in both groups post-study completion. Higher baseline anxiety/depression scores predicted improved anxiety/depression scores in both groups. Each group reported the benefits of social support. The MBSR group further expressed benefits of learning specific techniques, strategies, and skills that they applied in real-life situations to relieve distress. Both the MBSR intervention and video support group were effective in reducing distress in this sample. Qualitative data elucidated the added benefits of using MBSR techniques to manage stress and symptoms. The video group format is useful for teens that cannot meet in person but can benefit from group support. Psychosocial interventions with stress management techniques and/or group support can reduce distress in adolescents with cardiac diagnoses.

Research paper thumbnail of Multi-Institutional Study of Implantable Defibrillator Lead Performance in Children and Young Adults

Circulation, Jun 18, 2013

Manufacturers have developed distinct strategies in an attempt to deal with these critical issues... more Manufacturers have developed distinct strategies in an attempt to deal with these critical issues of long-term lead Background-Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease patients is hampered by poor long-term lead survival. Lead extraction is technically difficult and carries substantial morbidity. We sought to determine the outcomes of ICD leads in pediatric and congenital heart disease patients. Methods and Results-The Pediatric Lead Extractability and Survival Evaluation (PLEASE) is a 24-center international registry. Pediatric and congenital heart disease patients with ICD lead implantations from 2005 to 2010 were eligible. Study subjects comprised 878 ICD patients (44% congenital heart disease). Mean±SD age at implantation was 18.6±9.8 years. Of the 965 total leads, 54% were thin (≤7F), of which 57% were Fidelis, and 23% were coated with expanded polytetrafluoroethylene. There were 139 ICD lead failures (14%) in 132 patients (15%) at a mean lead age of 2.0±1.4 years, causing shocks in 53 patients (40%). Independent predictors of lead failure included younger implantation age and Fidelis leads. Actuarial analysis showed an incremental risk of lead failure with younger age at implantation: <8 years compared with >18 years (P=0.015). The actuarial yearly failure rate was 2.3% for non-Fidelis and 9.1% for Fidelis leads. Extraction was performed on 143 leads (80% thin, 7% expanded polytetrafluoroethylene coated), with lead age as the only independent predictor for advanced extraction techniques. There were 6 major extraction complications (4%) but no procedural mortality. Conclusions-This study demonstrates that ICD leads in children and congenital heart disease patients have an age-related suboptimal performance, further compounded by a high failure rate of Fidelis leads. Advanced extraction techniques were common and correlated with older lead age.

Research paper thumbnail of Palpitations and Chest Pain - Basketball

Medicine and Science in Sports and Exercise, May 1, 1995

Research paper thumbnail of Fidelis Implantable Defibrillator Lead Performance in Children: Data from the International Pediatric Lead Extractability and Survival Evaluation (Please) Study

Journal of the American College of Cardiology, Mar 1, 2013

Background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart... more Background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease (CHD) patients is hindered by poor long-term lead survival. Distinct lead design changes including thinner diameter leads were introduced in order to improve extractability; however, a subset of these leads was recalled due to high failure rates. methods: We examined the outcomes of the recalled Sprint Fidelis® leads in pediatric and CHD patients as a sub-analysis within the Pediatric Lead Extractability and Survival Evaluation (PLEASE) study, an international registry involving 24 centers. Pediatric and CHD patients who underwent ICD lead implants from 2005-2010 were eligible. results: Study subjects comprised 878 young ICD patients (44% CHD). Mean±SD age at implant was 18.6±9.8 years. Of the 965 total ICD leads, 54% were Thin (≤ 7Fr) with 300 (58%) being Fidelis® leads. There was a total of 139 (14%) failed leads in 132 (15%) patients at mean lead age of 2.0±1.4 years. Of the Fidelis® leads, 33% (98/300) failed, accounting for 71% (98/139) of all failed leads and 85% (98/115) of all failed thin leads. For the 4 Fidelis® models (6930, 6931, 6948 and 6949) the number of failed leads was 0/1, 57/138 (41%), 3/16 (19%), and 38/145 (26%), respectively. Of the failed single coil leads, 72% (57/79) were Fidelis®model 6931. The majority (44%) of failed Fidelis® leads were associated with inappropriate shocks. The actuarial yearly failure rate was 9.1% for Fidelis® leads compared to 2.1% for non-thin leads. conclusions: Fidelis® leads accounted for the majority of ICD lead failures and associated inappropriate shocks during the study period. The annual failure rate is several-fold higher compared to non-thin leads as well as published Fidelis® annual failure rates in adult cohorts. The steady and high annual failure rate represents an ongoing burden for these young patients. Although children may have potentially benefitted from a thinner ICD lead, unfortunately they have been disproportionately impacted by this specific lead failure and recall. More robust ICD lead designs are critical for the long-term well-being of pediatric device patients. Clinical Trial Registration: NCT00335036 brought to you by CORE View metadata, citation and similar papers at core.ac.uk

Research paper thumbnail of Intra/extracardiac fenestrated modification leads to lower incidence of arrhythmias after the Fontan operation

The Journal of Thoracic and Cardiovascular Surgery, Mar 1, 2013

The study objective was to compare the incidence of short-and intermediate-term arrhythmias among... more The study objective was to compare the incidence of short-and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure. Methods: We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac conduit, and lateral tunnel. Rhythm was classified as normal or abnormal. A rhythm dysfunction grading was devised and used to identify worsening of rhythm for patients with abnormal rhythm preoperatively. Multivariable logistic regression was used to determine predictors of abnormal rhythm. To eliminate confounding effects of transient immediate postoperative arrhythmias, data were analyzed for abnormal rhythm within the first 2 weeks and for more than 2 weeks after surgery.

Research paper thumbnail of Potential for shock leads to potential for stress

Heart Rhythm, Sep 1, 2022

Research paper thumbnail of Creating Interdisciplinary Engagement Through a Hospital-Based Endowed Chair in Nursing Research

Nursing administration quarterly, Feb 15, 2022

Although clinical nurses' involvement in research is a role expectation, efforts to engage cl... more Although clinical nurses' involvement in research is a role expectation, efforts to engage clinical nurses in nurse-led research have had notably mixed results. These efforts have most typically been single discipline–focused (nursing), although nursing care is a collaborative, interdisciplinary practice. Adding an interdisciplinary strategy to multiple other efforts to engage clinical nurses in research may contribute to more nurse involvement. Here, we describe the use of a hospital-based endowed chair in nursing research to simultaneously engage nursing and other disciplines in a monthly dialogue about clinically relevant, research-related challenges and solutions. Outcomes indicate that the research-related dialogue among nurses and interprofessional colleagues would likely not have taken place without this approach.

Research paper thumbnail of Non-Transvenous Lead Implantation in Pediatric and Congenital Heart Disease Patients: Early Analysis from the Ncdr®

Journal of the American College of Cardiology, Apr 1, 2014

background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart... more background: Implantable cardioverter-defibrillator (ICD) therapy in children and congenital heart disease (CHD) patients is challenging due to small patient size, complex venous and/or intracardiac anatomy. We sought to determine if patients with CHD or under age 21 had higher rates of non-transvenous lead implantation. methods: ICD procedures in patients with CHD or < 21 years of age in the ICD Registry between April 2010-Dec. 2012 were included. Patients with transvenous (TV) and non-TV lead implants were compared for demographics, type of CHD, and implant indication. Non-TV included subcutaneous, epicardial, and pericardial coil placement, without a TV ICD lead. Univariate associations for continuous variables were assessed using F-test in ANOVA, categorical variables with X2 test. results: There were 4,614 ICD procedures for 4,527 patients in the cohort, in which 1576 were pediatric and 3076 had CHD. Overall, 97% of leads were TV (N=4477), and 3% non-TV (N=137). Mean age was lower in the non-TV (35.9±23 yr) than TV cohort (40.1±25, p=.05). Height was lower in non-TV (167.1±19cm) vs. TV group (170.4±13, p<.01). There were higher rates of non-TV lead implants among patients with transposition of great vessels (TGV) (16.1% vs. 7.9%, p<.01), and common ventricle (3.6% vs. 0.4%, p<.01). Among the pediatric cohort, the non-TV had lower age (10.3±8 vs. 12.6±8 yr, p=.04), height (163.7±26 vs. 169.1±16 cm, p=.03) and weight (67.2±25 vs. 76.5±27 kg, p=.02). There was no significant difference in TV or non-TV routes between this cohort and all other implants in the registry over same period (TV leads: N=406,010, 97.5%; non-TV: 10,558, 2.5%, p=.09). conclusion: ICD Registry data show that non-TV leads were implanted in younger and smaller patients. Higher rates of non-TV implants occurred in patients with TGV and common ventricle. These pediatric and CHD patients are not adequately served by current technology and TV approach to ICD lead implantation.

Research paper thumbnail of Implant and Clinical Characteristics for Primary Versus Secondary Prevention Icd Indications for Pediatric and Congenital Heart Patients in the Ncdr®

Journal of the American College of Cardiology, Apr 1, 2014

background: The ICD Registry® began collecting pediatric and congenital heart disease (CHD) speci... more background: The ICD Registry® began collecting pediatric and congenital heart disease (CHD) specific data with version 2.1 in April 2010. There is limited data on who are these patients and their indications for ICD. methods: ICD procedures between April 2010-December 2012 in the ICD Registry for all patients with CHD or < 21 years were included. Variables included implant indications, demographic, diagnostic and clinical history. Univariate associations with F-test in ANOVA for continuous variables and χ2 test for categorical variables were used. results: There were 4,614 ICD procedures in 4,527 patients in the study cohort, of which 3,076 patients had CHD and 1,576 patients were < 21 years. The mean age was 40.0 + 24.6 years (range 0-92 years). CHD patients underwent 3,139 ICD procedures. Implant indications were 1° prevention in 2,819 (61%) and 2° prevention in 1,630 (35%). Among CHD patients, tetralogy of Fallot (TOF, 379/751=51%) and common ventricle (13/25=52%) had highest rates of 2° prevention. Among pediatric non-CHD group, primary electrical disorders (296/516=57%), CPVT (18/23=78%), and idiopathic VT/VF (80/120=67%) had highest rates of 2° prevention. 1° prevention patients had higher NHYA scores than 2° prevention patients. Pediatric cardiologists performed only 153 cases (9.6%) in patients <21 years and 187 cases (4.1%) in the total study cohort. conclusions: This is the largest pooled analysis of ICD implantation characteristics in CHD or pediatrics. Rates of 1° prevention implantation exceeded 2° prevention for the total cohort and specifically among pediatric patients. 2° prevention represented a majority for TOF, common ventricle, CPVT, and idiopathic VT/VF patients. Pediatric cardiologists accounted for implanting < 5% of all CHD and pediatric ICD patients in ICD Registry. Greater participation by pediatric electrophysiologists in the ICD Registry is desirable to accurately measure quality and outcomes of care in pediatric and CHD patients receiving ICD therapy.

Research paper thumbnail of Implant and Clinical Characteristics for Pediatric and Congenital Heart Patients in the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry

Circulation-arrhythmia and Electrophysiology, Dec 1, 2014

The National Cardiovascular Data Registry (NCDR) ICD Registry is a nationwide quality program hel... more The National Cardiovascular Data Registry (NCDR) ICD Registry is a nationwide quality program helping hospitals measure and improve care for patients receiving ICDs, including cardiac resynchronization therapy defibrillators (CRT-D). In April 2010, the NCDR expanded data acquisition for implant characteristics specifically related to pediatrics and CHD with version 2.1 (V2.1). In this article, we report descriptive statistics on demographics and lead implantation characteristics for 2 separate, but related cohorts: pediatric patients <21 years of age and patients with CHD of all ages from April 2010 through December 2012. We sought to determine the

Research paper thumbnail of Abstract 11402: Mindfulness Based Stress Reduction and Group Support Decrease Stress, Anxiety and Depression in Adolescents With Cardiac Diagnoses: A Randomized Two-Group Study

Circulation, Nov 11, 2016

Introduction: Adolescents with cardiac diagnoses face unique challenges that can cause psychosoci... more Introduction: Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac diagnoses and may also...

Research paper thumbnail of EP News: Pediatric and Congenital Electrophysiology

Heart Rhythm, Nov 1, 2021

Research paper thumbnail of Mindful Mentors: Is a Longitudinal Mind–Body Skills Training Pilot Program Feasible for Pediatric Cardiology Staff?

Global advances in health and medicine, 2020

Background: Stress and burnout among medical professionals are common and costly, placing profess... more Background: Stress and burnout among medical professionals are common and costly, placing professionals, organizations, and patients at risk. Objectives: To determine feasibility and acceptability of a longitudinal mind-body skills training initiative to help staff decrease stress and burnout, improve well-being, and empower them to utilize basic mindfulness methods with coworkers, patients, and families. Methods: Prospective cohort, mixed methods approach. Nurses, doctors, technicians, social workers, child life specialists were eligible to participate. The 12-month curriculum consisted of 16 hours of intensive education/practice over 2 days, with training in mindfulness skills, self-compassion, nonviolent communication, overcoming barriers to practice, and mindful listening/speaking, followed by monthly 1 hour booster/debriefing sessions. Results: A total of 37 staff participated (RN ¼ 18, MD ¼ 5, Technician ¼ 6, Social Worker ¼ 3, Child life ¼ 3, others ¼ 2) in the initial training, and 24 (65%) completed the 3-and 12-month follow-up surveys. Compared with pretraining scores, there were significant improvements 3 to 12 months after the initial training in stress (P <.0001), distress (P .04), anxiety (P ¼.01), self-efficacy in providing non-drug therapies (P <.0001), mindfulness (P ¼.002), burnout (P <.0001), and confidence in providing compassionate care (P <.0001). In addition, 25 (67%) participants initiated projects incorporating what they learned into staff/patient wellness activities. Conclusion: This longitudinal pilot program was feasible and was associated with improvements in measures of psychological well-being over the 12-month intervention. The innovative approach of training participants to teach basic techniques to coworkers and other staff can increase the impact of this program beyond any individual participant. Future research will investigate the aspects of implementation and potential effects on patient care and experience.