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Michael J Ackerman - One of the best experts on this subject based on the ideXlab platform.
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role of genetic heart disease in Sentinel sudden cardiac arrest survivors across the age spectrum
International Journal of Cardiology, 2018Co-Authors: John R Giudicessi, Michael J AckermanAbstract:Abstract Background Sudden cardiac arrest (SCA) may be the Sentinel expression of a sudden cardiac death-predisposing genetic heart disease (GHD). Although shown to underlie many unexplained SCAs in the young, the contribution of GHDs to Sentinel SCA has never been quantified across the age spectrum. Thus, we sought to determine the contribution of GHDs in single-center referral cohort of non-ischemic SCA survivors. Methods and results Retrospective analysis of 3037 patients was used to identify all individuals who experienced a Sentinel Event of SCA. Following exclusion of patients with ischemic or complex congenital heart disease, cases were classified by clinical diagnoses. Overall, 180 (5.9%) referral patients experienced a Sentinel SCA (average age at SCA 28 ± 15 years, 99 females). An etiology was identified in 113/180 patients (62.8%) including channelopathies in 26.7%, arrhythmogenic bileaflet mitral valve prolapse in 10.6%, cardiomyopathies in 9.4%, other etiologies in 6.7%, acquired long QT syndrome in 6.7%, and multiple disorders in 2.8%. The remaining 67/180 (37.2%) cases were classified as idiopathic ventricular fibrillation (IVF). Interestingly, the contribution of GHDs declined precipitously after the first decade of life [90.0% (age 0–9; n = 20), 58.7% (age 10–19; n = 46), 28.1% (age 20–29; n = 32), 23.8% (age 30–39; n = 42), 16.7% (age 40–49; n = 24), and 12.5% (age 50+; n = 16)]. Conclusions Within a referral population enriched for GHDs, the ability of a comprehensive cardiac evaluation, including genetic testing, to elucidate a root cause in non-ischemic SCA survivors declined with age. Although rare, GHDs can underlie SCA into adulthood and merit consideration across the age spectrum.
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malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out of hospital cardiac arrest
Journal of the American College of Cardiology, 2013Co-Authors: Chenni S Sriram, Faisal F Syed, Eric M Ferguson, Jonathan N Johnson, Maurice Enriquezsarano, Frank Cetta, Bryan C Cannon, Samuel J Asirvatham, Michael J AckermanAbstract:Objectives The aim of this study was to investigate the prevalence of mitral valve prolapse (MVP) and its association with ventricular arrhythmias in a cohort with “unexplained” out-of-hospital cardiac arrest. Background Ventricular arrhythmias are an important cause of sudden unexpected death in the young. The role of MVP in sudden unexpected death remains controversial. Methods Of 1,200 patients evaluated between July 2000 and December 2009 in the Mayo Clinic’s Long QT Syndrome/Genetic Heart Rhythm Clinic, all 24 (16 women, median age 33.5 years) with idiopathic out-of-hospital cardiac arrest (i.e., negative for ischemia, cardiomyopathy, and channelopathy) were reviewed. Results All 24 patients had implantable cardioverter-defibrillators (ICDs). Out-of-hospital cardiac arrest was the Sentinel Event in 22 (92%). Bileaflet MVP was found in 10 (42%). Compared with patients with normal mitral valves, patients with bileaflet MVP: 1) were over-represented by women (9 of 10 [90%] vs. 7 of 14 [50%], p = 0.04); 2) had a higher prevalence of biphasic or inverted T waves (7 of 9 [77.8%] vs. 4 of 14 [29%], p = 0.04); and 3) on Holter interrogation had higher prevalence of ventricular bigeminy (9 of 9 [100%] vs. 1 of 10 [10%], p Conclusions The authors describe a “malignant” subset of patients with MVP who experienced life-threatening ventricular arrhythmias. This phenotype is characterized by bileaflet MVP, female sex, and frequent complex ventricular ectopic activity, including premature ventricular contractions of the outflow tract alternating with papillary muscle or fascicular origin.
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a novel tpm1 mutation in a family with hypertrophic cardiomyopathy and sudden cardiac death in childhood
American Journal of Cardiology, 2002Co-Authors: Sara L Van Driest, Melissa L Will, Michael J Ackerman, Dianne L AtkinsAbstract:We sought to define the pathogenic mutation in a family with hypertrophic cardiomyopathy (HC) and a markedly arrhythmogenic phenotype. The proband was an 8-year-old female with a Sentinel Event of sudden death. Screening echocardiograms revealed HC in 2 of her 3 siblings and her father. Her youngest male sibling was diagnosed with HC at age 2 years and died suddenly at age 6 years from ventricular fibrillation despite an implanted cardioverter defibrillator. Using DNA extracted from peripheral lymphocytes, linkage exclusion was performed by haplotype analysis of polymorphic markers for the HC genes. Genes not excluded by linkage were analyzed for mutations using denaturing high-performance liquid chromatography (DHPLC) and direct DNA sequencing. Using this strategy, a 610 T>G nucleotide substitution in the alpha-tropomyosin gene (TPM1) was identified resulting in a novel L185R (Leucine [L] to Arginine [R]) missense mutation. This mutation was a spontaneous germ-line mutation originating in the proband's father. L185R-TPM1 cosegregated with family members having clinical evidence of HC, including the proband as confirmed by molecular autopsy. The mutation was not present in 400 reference alleles. Thus, a novel missense mutation in TPM1 was discovered in a family with HC and sudden death in childhood. Unlike previously defined mutations that may disrupt the interactions between alpha-tropomyosin monomers, the L185R mutation may affect troponin-T binding. Defining the pathogenic mutation enabled definitive molecular diagnosis of 2 surviving children.
Jodie Ingles - One of the best experts on this subject based on the ideXlab platform.
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implantable cardioverter defibrillators in previously undiagnosed patients with catecholaminergic polymorphic ventricular tachycardia resuscitated from sudden cardiac arrest
European Heart Journal, 2019Co-Authors: Christian Van Der Werf, Krystien V V Lieve, Martijn J Bos, Conor M Lane, I Denjoy, Ferran Rosesnoguer, Takeshi Aiba, Yuko Wada, Jodie InglesAbstract:AIMS: In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), implantable cardioverter-defibrillator (ICD) shocks are sometimes ineffective and may even trigger fatal electrical storms. We assessed the efficacy and complications of ICDs placed in patients with CPVT who presented with a Sentinel Event of sudden cardiac arrest (SCA) while undiagnosed and therefore untreated. METHODS AND RESULTS: We analysed 136 patients who presented with SCA and in whom CPVT was diagnosed subsequently, leading to the initiation of guideline-directed therapy, including β-blockers, flecainide, and/or left cardiac sympathetic denervation. An ICD was implanted in 79 patients (58.1%). The primary outcome of the study was sudden cardiac death (SCD). The secondary outcomes were composite outcomes of SCD, SCA, appropriate ICD shocks, and syncope. After a median follow-up of 4.8 years, SCD had occurred in three patients (3.8%) with an ICD and none of the patients without an ICD (P = 0.1). SCD, SCA, or appropriate ICD shocks occurred in 37 patients (46.8%) with an ICD and 9 patients (15.8%) without an ICD (P < 0.0001). Inappropriate ICD shocks occurred in 19 patients (24.7%) and other device-related complications in 22 patients (28.9%). CONCLUSION: In previously undiagnosed patients with CPVT who presented with SCA, an ICD was not associated with improved survival. Instead, the ICD was associated with both a high rate of appropriate ICD shocks and inappropriate ICD shocks along with other device-related complications. Strict adherence to guideline-directed therapy without an ICD may provide adequate protection in these patients without all the potential disadvantages of an ICD.
Geoffrey M. Calvert - One of the best experts on this subject based on the ideXlab platform.
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acute illnesses and injuries related to total release foggers 10 states 2007 2015
Morbidity and Mortality Weekly Report, 2018Co-Authors: Ruiling Liu, John Beckman, Prakash Mulay, Sheila Higgins, Geoffrey M. Calvert, Walter A Alarcon, Kathleen G Aubin, Karen R Cummings, Lucia S Graham, Ketki PatelAbstract:Total release foggers (TRFs) (also known as "bug bombs") are pesticide products often used indoors to kill insects. After an earlier report found that TRFs pose a risk for acute illness (1), the Environmental Protection Agency required improved labels on TRFs manufactured after September 2012 (2). To examine the early impact of relabeling, the magnitude and characteristics of acute TRF-related illness were evaluated for the period 2007-2015. A total of 3,222 TRF-related illnesses were identified in 10 participating states, based on three data sources: Sentinel Event Notification System for Occupational Risk-Pesticides (SENSOR) programs, the California Department of Pesticide Regulation (CDPR) program, and poison control centers (PCCs) in Florida, Texas, and Washington. No statistically significant decline in the overall TRF-illness incidence rate was found. Failure to vacate treated premises during application was the most commonly reported cause of exposure. To reduce TRF-related illness, integrated pest management strategies (3) need to be adopted, as well as better communication about the hazards and proper uses of TRFs. Redesigning TRFs to prEvent sudden, unexpected activation might also be useful.
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Acute pesticide poisoning in the U.S. retail industry, 1998-2004.
Public health reports (Washington D.C. : 1974), 2007Co-Authors: Geoffrey M. Calvert, Louise N Mehler, Ann M Petersen, Jennifer Sievert, Rupali Das, Lucy C Harter, Cinzia Romioli, Alan Becker, Cynthia Ball, Dorilee MaleAbstract:OBJECTIVE: This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. METHODS: Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. RESULTS: A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. CONCLUSIONS: PrEventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prEvention. Language: en
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acute pesticide poisoning in the u s retail industry 1998 2002
Annals of Epidemiology, 2005Co-Authors: Ann M Petersen, Geoffrey M. CalvertAbstract:Purpose Workers and customers in retail establishments face a potential risk of pesticide poisoning while performing work-related activities or shopping; however little information is presently available concerning this hazard. The magnitude and incidence of acute pesticide-related poisoning among retail workers will be estimated in this analysis. Methods Surveillance data from 1998–2002 were collected from the Sentinel Event Notification System for Occupational Risks and the California Department of Pesticide Regulation. Cases were 15–64 years old who met the case definition of acute pesticide poisoning. Incidence rates of pesticide-related illness and incidence rate ratios (IRR) comparing rates to nonagricultural, nonretail workers are used to assess risk magnitude. Results There were 208 cases identified (198 retail employees [95%] and 10 customers [5%]). Common exposures were from disinfectants (N = 99, 48%) and insecticides (N = 94, 45%). Illness severity was low for 175 cases (84%), moderate for 30 (14%), high for two (1%) and one fatality was identified. There was a significant decrease in incidence rates among retail workers (8.16/million FTEs in 1998 to 4.02/million FTEs in 2002, p ). Retail employees had a significantly reduced rate of illness compared to nonagricultural, nonretail workers (IRR = 0.34, 95% CI = 0.29, 0.39). Occupations most commonly exposed were stock handlers/baggers (N = 51, 26%), sales workers (N = 44, 22%), and clerks/cashiers (N = 37, 19%). Stock handlers/baggers had a significant illness risk as compared to non-agricultural, nonretail workers (IRR = 1.97, 95% CI = 1.49, 2.60). Retail employees at miscellaneous general stores additionally displayed a significant risk for pesticide poisoning (IRR = 2.04, 95% CI = 1.23, 3.39). Conclusion Additional prEventive measures are needed to decrease the risk of pesticide-related exposures in specific retail settings. Interventions include educational efforts regarding appropriate risk prEvention, requirements that pesticide containers be unbreakable and tear-resistant, and greater adaptation of integrated pest management practices.
Chenni S Sriram - One of the best experts on this subject based on the ideXlab platform.
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malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out of hospital cardiac arrest
Journal of the American College of Cardiology, 2013Co-Authors: Chenni S Sriram, Faisal F Syed, Eric M Ferguson, Jonathan N Johnson, Maurice Enriquezsarano, Frank Cetta, Bryan C Cannon, Samuel J Asirvatham, Michael J AckermanAbstract:Objectives The aim of this study was to investigate the prevalence of mitral valve prolapse (MVP) and its association with ventricular arrhythmias in a cohort with “unexplained” out-of-hospital cardiac arrest. Background Ventricular arrhythmias are an important cause of sudden unexpected death in the young. The role of MVP in sudden unexpected death remains controversial. Methods Of 1,200 patients evaluated between July 2000 and December 2009 in the Mayo Clinic’s Long QT Syndrome/Genetic Heart Rhythm Clinic, all 24 (16 women, median age 33.5 years) with idiopathic out-of-hospital cardiac arrest (i.e., negative for ischemia, cardiomyopathy, and channelopathy) were reviewed. Results All 24 patients had implantable cardioverter-defibrillators (ICDs). Out-of-hospital cardiac arrest was the Sentinel Event in 22 (92%). Bileaflet MVP was found in 10 (42%). Compared with patients with normal mitral valves, patients with bileaflet MVP: 1) were over-represented by women (9 of 10 [90%] vs. 7 of 14 [50%], p = 0.04); 2) had a higher prevalence of biphasic or inverted T waves (7 of 9 [77.8%] vs. 4 of 14 [29%], p = 0.04); and 3) on Holter interrogation had higher prevalence of ventricular bigeminy (9 of 9 [100%] vs. 1 of 10 [10%], p Conclusions The authors describe a “malignant” subset of patients with MVP who experienced life-threatening ventricular arrhythmias. This phenotype is characterized by bileaflet MVP, female sex, and frequent complex ventricular ectopic activity, including premature ventricular contractions of the outflow tract alternating with papillary muscle or fascicular origin.
Ann M Petersen - One of the best experts on this subject based on the ideXlab platform.
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Acute pesticide poisoning in the U.S. retail industry, 1998-2004.
Public health reports (Washington D.C. : 1974), 2007Co-Authors: Geoffrey M. Calvert, Louise N Mehler, Ann M Petersen, Jennifer Sievert, Rupali Das, Lucy C Harter, Cinzia Romioli, Alan Becker, Cynthia Ball, Dorilee MaleAbstract:OBJECTIVE: This study was conducted to describe the national magnitude and characteristics of acute pesticide poisoning among workers and customers in retail establishments. METHODS: Analyses included retail employees 15-64 years of age and customers with acute pesticide poisoning identified from the Sentinel Event Notification System for Occupational Risks-Pesticides (SENSOR-Pesticides) and California Department of Pesticide Regulation from 1998 to 2004. Pesticide poisoning incidence rates and incidence rate ratios (IRR) were calculated. RESULTS: A total of 325 cases of acute pesticide poisoning were identified. Of these cases, 287 (88%) were retail employees and 38 (12%) were customers. Overall, retail employees had a significantly lower acute pesticide poisoning incidence rate compared with non-agricultural, non-retail employees (IRR=0.53; 95% confidence interval 0.47, 0.59). However, significantly elevated pesticide poisoning incidence rates were observed for four retail occupations (janitors, stock handlers/baggers, bakery/deli clerks, and shipping/receiving handlers). In addition, workers employed in two retail industry sectors (farm supply stores and hardware stores) had significantly elevated acute pesticide poisoning incidence rates. Incidence rates among the retail employees demonstrated a quadratic trend, monotonically decreasing from 1998 to 2000 and monotonically increasing from 2000 to 2003. The rates appear to have leveled off in 2003 and 2004. CONCLUSIONS: PrEventive measures to decrease acute pesticide poisoning incidence in the retail sector include adoption of unbreakable and tear-resistant container requirements, increased utilization of integrated pest management strategies, and advisement to store managers, employees, and customers about poisoning prEvention. Language: en
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acute pesticide poisoning in the u s retail industry 1998 2002
Annals of Epidemiology, 2005Co-Authors: Ann M Petersen, Geoffrey M. CalvertAbstract:Purpose Workers and customers in retail establishments face a potential risk of pesticide poisoning while performing work-related activities or shopping; however little information is presently available concerning this hazard. The magnitude and incidence of acute pesticide-related poisoning among retail workers will be estimated in this analysis. Methods Surveillance data from 1998–2002 were collected from the Sentinel Event Notification System for Occupational Risks and the California Department of Pesticide Regulation. Cases were 15–64 years old who met the case definition of acute pesticide poisoning. Incidence rates of pesticide-related illness and incidence rate ratios (IRR) comparing rates to nonagricultural, nonretail workers are used to assess risk magnitude. Results There were 208 cases identified (198 retail employees [95%] and 10 customers [5%]). Common exposures were from disinfectants (N = 99, 48%) and insecticides (N = 94, 45%). Illness severity was low for 175 cases (84%), moderate for 30 (14%), high for two (1%) and one fatality was identified. There was a significant decrease in incidence rates among retail workers (8.16/million FTEs in 1998 to 4.02/million FTEs in 2002, p ). Retail employees had a significantly reduced rate of illness compared to nonagricultural, nonretail workers (IRR = 0.34, 95% CI = 0.29, 0.39). Occupations most commonly exposed were stock handlers/baggers (N = 51, 26%), sales workers (N = 44, 22%), and clerks/cashiers (N = 37, 19%). Stock handlers/baggers had a significant illness risk as compared to non-agricultural, nonretail workers (IRR = 1.97, 95% CI = 1.49, 2.60). Retail employees at miscellaneous general stores additionally displayed a significant risk for pesticide poisoning (IRR = 2.04, 95% CI = 1.23, 3.39). Conclusion Additional prEventive measures are needed to decrease the risk of pesticide-related exposures in specific retail settings. Interventions include educational efforts regarding appropriate risk prEvention, requirements that pesticide containers be unbreakable and tear-resistant, and greater adaptation of integrated pest management practices.
