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John Boehmer - One of the best experts on this subject based on the ideXlab platform.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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ambulatory monitoring of heart sounds via an Implanted Device is superior to auscultation for prediction of heart failure events
Journal of Cardiac Failure, 2020Co-Authors: Michael Cao, Pramodsingh Hirasingh Thakur, Roy S Gardner, Ramesh Hariharan, Devi Nair, Christopher Schulze, Brian Kwan, Yi Zhang, John BoehmerAbstract:Abstract Objectives To compare the relationship between the third heart sound (S3) measured by implantable cardiac Devices (devS3) and auscultation (ausS3) and evaluate their prognostic power for predicting heart failure events (HFEs). Methods In the MultiSENSE study, devS3 was measured daily with continuous values while ausS3 was assessed at study visits with discrete grades. They were compared between patients with and without HFEs at baseline and against each other directly. Cox proportional hazard models were developed between follow-up visits (FUs) and over the whole study. Simulations were performed on devS3 to match limitations of auscultation. Results Nine hundred patients were studied, of whom 106 patients experienced 192 HFEs. Two S3 sensing modalities correlated with each other but at baseline only devS3 differentiated patients with or without HFEs (p Conclusions S3 measured from implantable cardiac Devices has stronger prognostic power to predict episodes of future HF events than that of auscultation.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
Antonio Russo - One of the best experts on this subject based on the ideXlab platform.
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ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an Implanted Device results from the aatac multicenter randomized trial
Circulation, 2016Co-Authors: Luigi Di Biase, Prashant Mohanty, Sanghamitra Mohanty, Pasquale Santangeli, Chintan Trivedi, Dhanunjaya Lakkireddy, Madhu Reddy, Pierre Jais, Sakis Themistoclakis, Antonio RussoAbstract:Background—Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown. Methods and Results—This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%–78%) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%–44%) in group 2 (log-ra...
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ablation versus amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an Implanted Device results from the aatac multicenter randomized trial
Circulation, 2016Co-Authors: Luigi Di Biase, Prashant Mohanty, Sanghamitra Mohanty, Pasquale Santangeli, Chintan Trivedi, Dhanunjaya Lakkireddy, Madhu Reddy, Pierre Jais, Sakis Themistoclakis, Antonio RussoAbstract:Background— Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown. Methods and Results— This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction <40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%–78%) patients in group 1 were recurrence free after an average of 1.4±0.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%–44%) in group 2 (log-rank P <0.001). The success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5–4.3; P <0.001) than CA. Over the 2-year follow-up, the unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2; P <0.001), showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39–0.76). A significantly lower mortality was observed in CA (8 [8%] versus AMIO (18 [18%]; P =0.037). Conclusions— This multicenter randomized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF. Clinical Trial Registration— URL: . Unique identifier: [NCT00729911][1]. # CLINICAL PERSPECTIVE {#article-title-39} [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00729911&atom=%2Fcirculationaha%2F133%2F17%2F1637.atom
George Mark - One of the best experts on this subject based on the ideXlab platform.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
Alexander J Javois - One of the best experts on this subject based on the ideXlab platform.
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inadvertent stenting of patent ductus arteriosus with amplatzer vascular plug
Catheterization and Cardiovascular Interventions, 2006Co-Authors: Alexander J Javois, Tarek S Husayni, David G Thoele, Andrew H Van BergenAbstract:We report a 12-month old patient who presented for murmur evaluation after percutaneous closure of type C patent ductus arteriosus (PDA) using a 10 mm Amplatzer Vascular Plug (AGA Medical Corporation, Golden Valley, MN) at an outside institution. Echocardiography revealed a large left-to-right shunt through the Implanted Device, inadvertently stenting the PDA instead of closing it. The patient underwent repeat catheterization with successful coil implantation within the Amplatzer Vascular Plug, completely eliminating the large residual ductal shunt. Although challenging, this case illustrates the technique of implanting coils within this occlusion Device. This case also illustrates that occlusion of type C PDA utilizing the Amplatzer Vascular Plug may not only result in incomplete occlusion but also create a potentially worse clinical situation in which the PDA is stretched larger and stented open. Without consideration of simultaneous coil implantation within this Device, use of the Amplatzer Vascular Plug might be contraindicated in type C PDA, because there may be no way to ensure successful closure by the Vascular Plug alone. © 2006 Wiley-Liss, Inc.
Qi An - One of the best experts on this subject based on the ideXlab platform.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in af
Heart & Lung, 2020Co-Authors: Qi An, Viktoria A Averina, John Boehmer, George Mark, Pramodsingh Hirasingh ThakurAbstract:Background The third heart sound (S3), which is caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is regarded as an early and specific sign of heart failure and elevated filling pressure. Objectives Studies have shown phonocardiogram-based S3 to be coincident with the deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is more difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound and echo data while the patient was in AF. Methods MultiSENSE enrolled patients were Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment the CRT-Ds were converted to enable collection of heart sound (HS) data using the Device-based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echocardiogram was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24-hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, the third heart sound measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation amid an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
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third heart sound during atrial fibrillation confirming the existence of cardiac vibrations during deceleration phase of early diastolic filling while in atrial fibrillation
Journal of Cardiac Failure, 2018Co-Authors: George Mark, Viktoria A Averina, Pramod Thakur, Qi An, John BoehmerAbstract:Introduction The third heart sound (S3), caused by rapid deceleration of the blood against a stiff ventricle during early diastolic filling, is an early and specific sign of heart failure and elevated filling pressure. Studies have shown S3 to be coincident with deceleration phase of E-wave and associated with a steeper E-wave. Atrial fibrillation (AF) is a common comorbidity in HF, however questions have arisen regarding the ability to reliably detect S3 during AF as typically it is difficult to auscultate an S3 during AF. Here we present a case of simultaneous Implanted Device measured heart sound (HS) and echo data while the patient was in AF. Methods MultiSENSE enrolled patients Implanted with COGNIS CRT-D Devices and followed for up to a year. At enrollment CRT-Ds were converted to enable collection of HS data using Device based accelerometer. HS data was periodically collected as ensemble averaged (EA) waveforms of multiple neighboring beats that closely matched in RR interval. An optional echo was conducted if the patient was hospitalized for worsening HF. An independent core laboratory measured parameters from the echo images, including E-wave timing within the cardiac cycle (Q-E interval and E-wave deceleration time or EDT). EA waveforms over multiple days around the day of echo that matched the average heart rate (HR) around the echo exam to within 10 beats per min were identified and compared against E-wave timing. Results The patient, enrolled in November 2011 and reported to have a history of AF, was hospitalized for worsening HF on day 38 post enrollment. Device interrogation revealed ongoing AF burden of 24 hours since enrollment which transiently terminated on day 41 for several days before reverting to 24 hour AF burden. Patient underwent an echocardiogram starting at 9:22AM on day 39, which showed a Q-E interval of 562msec and EDT of 169msec. Figure shows one heart sound EA recorded at 10:49AM and clearly shows cardiac vibrations during the deceleration phase of the E-wave as deduced from Q-E interval and EDT (horizontal line). This observation is consistent across all EAs collected over 5 days around the day of the echo with matched HR. Conclusion Consistent with its known physiologic genesis, S3 measured using an Implanted Device occurred during the deceleration phase of early diastolic filling even when the patient was in AF. A Device based objective measure may provide more consistent assessment of S3 than auscultation in the midst of an arrhythmic rumble of AF.
