Catheter ablation of atrial fibrillation in patients with diabetes mellitus.
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2020-08
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Abstract
Background
Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM.Objective
The purpose of this study was to compare AF ablation outcomes in patients with and those without DM.Methods
We performed a retrospective analysis of 351 consecutive patients who underwent first-time AF ablation. Clinical outcomes included freedom from recurrent atrial arrhythmia, symptom burden (Mayo AF Symptom Inventory score), cardiovascular and all-cause hospitalizations, and periprocedural complications.Results
Patients with DM (n = 65) were older, had a higher body mass index, more persistent AF, more hypertension, and larger left atrial diameter (P <.05 for all). Median (Q1, Q3) total radiofrequency duration [64.0 (43.6, 81.4) minutes vs 54.3 (39.2, 76.4) minutes; P = .132] and periprocedural complications (P = .868) did not differ between patients with and those without DM. After a median follow-up of 29.5 months, arrhythmia recurrence was significantly higher in the DM group compared to the no-DM group after adjustment for baseline differences (adjusted hazard ratio [HR] 2.24; 95% confidence [CI] 1.42-3.55; P = .001). There was a nonsignificant trend toward higher AF recurrence with worse glycemic levels (HR 1.29; 95% CI 0.99-1.69; P = .064).Conclusion
Although safety outcomes associated with AF ablation were similar between patients with and those without DM, arrhythmia-free survival was significantly lower among patients with DM. Poor glycemic control seems to an important risk factor for AF recurrence.Type
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Wang, Allen, Tracy Truong, Eric Black-Maier, Cynthia Green, Kristen B Campbell, Adam S Barnett, Janice Febre, Zak Loring, et al. (2020). Catheter ablation of atrial fibrillation in patients with diabetes mellitus. Heart rhythm O2, 1(3). pp. 180–188. 10.1016/j.hroo.2020.04.006 Retrieved from https://hdl.handle.net/10161/25526.
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Scholars@Duke
Tracy Truong
Tracy currently collaborates with clinicians, residents, and fellows in the Department of Obstetrics and Gynecology, Neurology, Pediatrics, and Center for Childhood Obesity Research. Her professional experience includes data management, observational studies, with an emphasis on reproducible research utilizing R markdown.
Cynthia Lea Green
Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods
Zak Loring
I am a cardiac electrophysiologist specializing in the treatment of heart rhythm disorders and management of cardiac implantable electronic devices (CIEDs). My research utilizes signal processing of electrocardiographic data and novel analytic techniques to better phenotype patients and identify those for whom interventional electrophysiology procedures may be most beneficial. This includes predicting which patients with left bundle branch block may benefit from early cardiac resynchronization therapy or conduction system pacing. I also analyze population level data to identify patients at high risk for adverse sequelae of rhythm disorders who may benefit from early intervention.
Sana Mustapha Al-Khatib
Dr. Sana M. Al-Khatib is a tenured Professor of Medicine at Duke University Medical Center, a board-certified clinical electrophysiologist and an experienced clinical researcher in cardiac arrhythmias. She is currently the Director of the Fellowship Program at the Duke Clinical Research Institute. As a graduate of the NIH-funded Clinical Research Training Program, she is one of a few electrophysiologists nationwide with expertise in quantitative research methods. Her clinical expertise is in sudden cardiac death prevention, atrial fibrillation and ventricular arrhythmias, and implantable cardiac devices. Her research expertise lies in the design and conduct of clinical trials, outcomes research, and cost-effectiveness analyses. She is a recipient of a National Heart, Lung and Blood Institute’s R-01 grant titled “Implantable Cardioverter Defibrillator Therapy in Patients with Heart Failure” (2009-2013) and of an American Heart Association Career Development Award (2002-2006). She is a Co-Principal Investigator on an NHLBI-funded T-32 Postdoctoral Training in Cardiovascular Clinical Research and is a co-investigator on several NIH-funded projects. She has more than 350 publications in peer-reviewed journals. She has established several collaborative research efforts both within and outside her institution. The goals of these collaborations are to synergize efforts aimed at improving the survival and quality of life of patients at risk for sudden cardiac death and those with atrial and ventricular arrhythmias through clinical trials and outcomes-based research and to evaluate study design and data analysis in order to improve the quality of research done in these arenas. Dr. Al-Khatib is a Senior Associate Editor for Circulation and is on the Editorial Board for Circulation: Arrhythmia and Electrophysiology, Heart Rhythm, Journal of Cardiovascular Electrophysiology, JACC:EP, the Cardiovascular Digital Health Journal, and the American Heart Journal. Dr. Al-Khatib has served on multiple national committees including the Heart Rhythm Society Board of Trustees (current), the Heart Rhythm Society Finance Committee (current), the Heart Rhythm Society Audit Committee (current), the Heart Rhythm Society Health Policy committee (past), the Heart Rhythm Society Legislative subcommittee (past), and the Heart Rhythm Society Program Planning committee (past). She chaired the 2017 AHA/ACC/HRS Guideline for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
James Patrick Daubert
Atrial fibrillation ablation.
Cardiac resynchronization therapy.
Implantable defibrillator, including inappropriate shocks.
Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Hypertrophic cardiomyopathy.
Long QT syndrome
Sudden cardiac arrest and resuscitation.
Ventricular tachycardia
Camille Genise Frazier
Donald Dale Hegland
Kevin Patrick Jackson
Research interests include:
- optimization of device timing for Cardiac Resynchronzation Therapy (CRT)
- novel cardiac imaging technologies for CRT
- catheter ablation versus anti-arrhythmic drug for treatment of atrial fibrillation.
Larry Ronald Jackson
Dr. Jackson is a physician-scientist with clinical expertise in adult clinical cardiac electrophysiology. His research focuses on identifying determinants of racial/ethnic differences in arrhythmia care and the development and implementation of patient-centered interventions aimed at facilitating shared decision-making in populations that have been systemically disadvantaged with abnormal heart rhythm conditions. Dr. Jackson has an advanced degree (MHSc) in clinical and qualitative research methodology and is a member of the Duke Clinical Research Institute. His research skills, obtained during his time at the Duke Clinical Research Institute Research Fellowship, include formal training in large database analysis, clinical trial operations, scientific writing, clinical trial adjudication and statistical analysis. Dr. Jackson’s research funding consists of two career development awards: 1) National Institute of Health/National Heart, Lung, and Blood Institute-K01 focused on racial and ethnic differences in oral anticoagulation use in patients with atrial fibrillation and 2) AHA career development award focused on analyzing racial and ethnic differences in the use of rhythm control strategies in patients with atrial fibrillation. Dr. Jackson’s long-term, overarching goal as a physician-scientist is to decrease racial and ethnic disparities in arrhythmia care for patients with abnormal heart rhythm conditions.
Jason Koontz
Robert Kenneth Lewis
Sean Pokorney
Albert Y. Sun
Kevin Lindsey Thomas
Tristram Dan Bahnson
Jonathan Paul Piccini
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist and Professor of Medicine and Population Health at Duke University Hospital and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology section at the Duke Heart Center. His focus is on the care of patients with atrial fibrillation and complex arrhythmias, with particular emphasis on catheter ablation, pacing, and lead extraction. His research interests include the development and evaluation of innovative cardiovascular interventions for the treatment of heart rhythm disorders. He serves on the Board of Trustees of the Heart Rhythm Society, is an Associate Editor at JACC: Clinical Electrophysiology, and is an elected member of the American Society for Clinical Investigation. Dr. Piccini has more than 600 publications in the field of heart rhythm medicine and has been the recipient of several teaching and mentorship awards.
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