Brian Olshansky

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.

Jonathan L. Halperin, MD, FACC, FAHA, Chair nnGlenn N. Levine, MD, FACC, FAHA, Chair-Elect nnJeffrey L. Anderson, MD, FACC, FAHA, Immediate Past Chair [¶][1]nnNancy M. Albert, PhD, RN, FAHA[¶][1]nnSana M. Al-Khatib, MD, MHS, FACC, FAHAnnKim K. Birtcher, PharmD, AACCnnBiykem Bozkurt, MD, PhD, FACC

Heart Rate Predicts Outcomes in an Implantable Cardioverter-Defibrillator Population

Background— Elevated heart rate (HR) is associated with adverse cardiovascular events and total mortality in the general population and in individuals with heart disease. Our hypothesis was that mean HR predicts total mortality and heart failure hospitalization in patients undergoing implantable cardioverter-defibrillator (ICD) implantation. Methods and Results— The Inhibition of Unnecessary RV Pacing With AV Search Hysteresis in ICDs (INTRINSIC RV) trial included 1530 patients undergoing ICD implantation. After implantation of a dual-chamber ICD, patients were followed for a mean of 10.4 months. The mean HR for 1436 patients over the follow-up period was determined from device histograms. Patients were grouped into strata by mean HR, and the relationship between the primary end point and mean HR was analyzed with Mantel-Haenszel ordinal &khgr;2 tests. Higher intrinsic (unpaced) HR was associated with greater risk of achieving the primary end point of death or heart failure hospitalization (P<0.001). Of patients with a mean HR <75 bpm, 5.8% died or were hospitalized for heart failure, whereas 20.9% with a mean HR >90 bpm achieved the same end point, a 3.6-fold difference (P<0.0001). In a multivariate model with the use of Cox regression, HR was a significant predictor with a hazard ratio of 1.34 (P=0.0001; 95% confidence interval, 1.19 to 1.50), as were age, New York Heart Association functional class, and percent right ventricular pacing, but it was independent of gender and &bgr;-blocker dosing. When considered as continuous or discrete variables grouped by 5-bpm increments, HR remained a significant predictor. Conclusions— In this ICD population, the mean intrinsic HR was strongly associated with outcomes. Clinical Trial Registration— http://www.clinicaltrials.gov. Identifier: NCT00148967.

News from the Heart Rhythm SocietyHRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection: Developed in partnership between the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) and in collaboration with the Society of Thoracic Surgeons

Anne M. Gillis, MD, FHRS, Andrea M. Russo, MD, FHRS, FACC, Kenneth A. Ellenbogen, MD, FHRS, FACC, Charles D. Swerdlow, MD, FHRS, CCDS, FACC, Brian Olshansky, MD, FHRS, CCDS, FACC, Sana M. Al-Khatib, MD, MHS, FHRS, CCDS, FACC, John F. Beshai, MD, FHRS, FACC, Janet M. McComb, MD, FHRS, Jens Cosedis Nielsen, MD, Jonathan M. Philpott, MD, Win-Kuang Shen, MD, FHRS, FACC From University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada, Cooper Medical School of Rowan University, Cooper University Hospital, New Jersey, USA, Virginia Commonwealth University Medical Center, irginia, USA, David Geffen School of Medicine at UCLA, California, USA, University of Iowa Hospital, Iowa, USA, Duke University Medical Center, North Carolina, USA, University of Chicago Hospitals, Illinois, USA, Freeman ospital, Newcastle-upon-Tyne, United Kingdom, Skejby Hospital, Aarhus, Denmark, Mid-Atlantic Cardiothoracic Surgeons, Virginia, USA, Mayo Clinic College of Medicine, Arizona, USA. Representing the Society of Thoracic Surgeons

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary

Win-Kuang Shen, MD, FACC, FAHA, FHRS, Chair, Writing Committee Member, Robert S. Sheldon, MD, PhD, FHRS, Vice Chair, Writing Committee Member, David G. Benditt, MD, FACC, FHRS, Writing Committee Member, Mitchell I. Cohen, MD, FACC, FHRS, Writing Committee Member, Daniel E. Forman, MD, FACC, FAHA, Writing Committee Member, Zachary D. Goldberger, MD, MS, FACC, FAHA, FHRS, Writing Committee Member, Blair P. Grubb, MD, FACC, Writing Committee Member, Mohamed H. Hamdan, MD, MBA, FACC, FHRS, Writing Committee Member, Andrew D. Krahn, MD, FHRS, Writing Committee Member, Mark S. Link, MD, FACC, Writing Committee Member, Brian Olshansky, MD, FACC, FAHA, FHRS, Writing Committee Member, Satish R. Raj, MD, MSc, FACC, FHRS, Writing Committee Member, Roopinder Kaur Sandhu, MD, MPH, Writing Committee Member, Dan Sorajja, MD, Writing Committee Member, Benjamin C. Sun, MD, MPP, FACEP, Writing Committee Member, Clyde W. Yancy, MD, MSc, FACC, FAHA, Writing Committee Member

State-of-the-Art PaperSports and Exercise Cardiology in the United States: Cardiovascular Specialists as Members of the Athlete Healthcare Team

In recent years, athletic participation has more than doubled in all major demographic groups, while simultaneously, children and adults with established heart disease desire participation in sports and exercise. Despite conferring favorable long-term effects on well-being and survival, exercise can be associated with risk of adverse events in the short term. Complex individual cardiovascular (CV) demands and adaptations imposed by exercise present distinct challenges to the cardiologist asked to evaluate athletes. Here, we describe the evolution of sports and exercise cardiology as a unique discipline within the continuum of CV specialties, provide the rationale for tailoring of CV care to athletes and exercising individuals, define the role of the CV specialist within the athlete care team, and lay the foundation for the development of Sports and Exercise Cardiology in the United States. In 2011, the American College of Cardiology launched the Section of Sports and Exercise Cardiology. Membership has grown from 150 to over 4,000 members in just 2 short years, indicating marked interest from the CV community to advance the integration of sports and exercise cardiology into mainstream CV care. Although the current athlete CV care model has distinct limitations, here, we have outlined a new paradigm of care for the American athlete and exercising individual. By practicing and promoting this new paradigm, we believe we will enhance the CV care of athletes of all ages, and serve the greater athletic community and our nation as a whole, by allowing safest participation in sports and physical activity for all individuals who seek this lifestyle.

2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

This document was approved by the American College of Cardiology Cli American Heart Association Science Advisory and Coordinating Committe Rhythm Society Board of Trustees in January 2017. The American College of Cardiology requests that this document be cite Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B guideline for the evaluation and management of patients with syncope: a rep Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am C This article has been copublished in Circulation and HeartRhythm. Copies: This document is available on the World Wide Web sites of the Ame (professional.heart.org), and the Heart Rhythm Society (www.hrsonline.o Department via fax (212-633-3820) or e-mail (reprints@elsevier.com). Permissions: Multiple copies, modification, alteration, enhancement, and permission of the American College of Cardiology. Requests may be compl author-agreement/obtaining-permission). Satish R. Raj, MD, MSC, FACC, FHRS*x Roopinder Kaur Sandhu, MD, MPHz Dan Sorajja, MDz Benjamin C. Sun, MD, MPP, FACEPk Clyde W. Yancy, MD, MSC, FACC, FAHAz{

Increased Prevalence of Atrial Fibrillation in the Endurance Athlete: Potential Mechanisms and Sport Specificity

Abstract Atrial fibrillation is a common, often symptomatic, and concerning arrhythmia that can lead to heart failure, decreased athletic tolerance, and thromboembolic events; it has also been associated with increased mortality. Although atrial fibrillation is an uncommon condition in younger and otherwise healthy people, recent emerging evidence indicates that endurance athletes may be at particularly high risk of developing atrial fibrillation. We review the evidence that atrial fibrillation is associated with intense endurance athletics and we also explore the mechanisms by which this may occur. Finally, we consider some of the options that are available to treat athletes who develop atrial fibrillation.

Hormone Replacement Therapy and Adverse Outcomes in Women With Atrial Fibrillation An Analysis From the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial

Background and Purpose— Hormone replacement therapy (HRT) use has been related to thromboembolism, but whether HRT increases adverse outcomes in females with atrial fibrillation is uncertain. Methods— We used the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial data set that included 1594 women (39.3% of the population, mean age 71±8), of whom 376 (23.6%) were taking HRT at baseline. The primary end point, a composite of all-cause death, stroke, systemic/pulmonary embolism, and myocardial infarction, and secondary outcomes (ie, each individual end point) and major bleeding, were considered. Results— HRT was not independently associated with the primary end point (hazard ratio=0.894; 95% confidence interval, 0.658–1.214; P=0.473) or any secondary outcome. Age (P<0.001), diabetes mellitus (P<0.001), previous stroke (P=0.011), and heart failure (P<0.001) predicted the primary end point. Lack of association between HRT and the primary end point was confirmed in a propensity score–matched control group (hazard ratio=0.966; 95% confidence interval, 0.663–1.409; P=0.858). Conclusions— HRT does not independently predict mortality, thromboembolism, or bleeding in a large cohort of women with atrial fibrillation.

Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators

Background—The risks of sports participation for implantable cardioverter-defibrillator (ICD) patients are unknown. Methods and Results—Athletes with ICDs (age, 10–60 years) participating in organized (n=328) or high-risk (n=44) sports were recruited. Sports-related and clinical data were obtained by phone interview and medical records. Follow-up occurred every 6 months. ICD shock data and clinical outcomes were adjudicated by 2 electrophysiologists. Median age was 33 years (89 subjects <20 years of age); 33% were female. Sixty were competitive athletes (varsity/junior varsity/traveling team). A pre-ICD history of ventricular arrhythmia was present in 42%. Running, basketball, and soccer were the most common sports. Over a median 31-month (interquartile range, 21–46 months) follow-up, there were no occurrences of either primary end point—death or resuscitated arrest or arrhythmia- or shock-related injury—during sports. There were 49 shocks in 37 participants (10% of study population) during competition/pr...

Wide QRS, narrow QRS: what's the difference?

Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in properly selected patients. The Combined Medicare and Medicaid Services (CMS) had recommended prophylactic ICDs only for those patients with ischemic heart disease, a left ventricular ejection fraction ≤0.30, and a QRS