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Dive into the research topics where Danette Guertin is active.

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Featured researches published by Danette Guertin.


Heart Rhythm | 2010

The prognostic impact of shocks for clinical and induced arrhythmias on morbidity and mortality among patients with implantable cardioverter-defibrillators

Sanjeev P. Bhavnani; Jeffrey Kluger; Craig I Coleman; C Michael White; Danette Guertin; Nabil A. Shafi; Ravi K. Yarlagadda; Christopher A. Clyne

BACKGROUND Recent investigations have demonstrated that the occurrence of implantable cardioverter-defibrillator (ICD) shocks is associated with adverse long-term outcomes. These studies have emphasized that the risk is most reasonably due to arrhythmias rather than to the shock itself. We sought to compare the impact of shock delivery for induced ventricular arrhythmias during implantation defibrillation threshold testing and noninvasive electrophysiology study (NIPS) to clinical shocks on long-term outcomes among patients with ICDs. METHODS This was a cohort evaluation of 1,372 patients undergoing ICD implantation at a tertiary hospital from December 1997 to January 2007. The probability of all-cause mortality and hospitalization for acute decompensated heart failure (ADHF) was evaluated based upon the type of ICD shock received using multivariable Cox proportional analyses. The four shock types analyzed were implantation shocks only (n = 694), additional NIPS shocks only (n = 319), additional appropriate shocks only (n = 128), or additional inappropriate shocks only (n = 104). RESULTS The risk of death (adjusted hazard ratio [AHR] 0.91 [95% confidence interval (CI) 0.69-1.20]; P = .491) or ADHF (AHR 0.71 [95% CI 0.46-1.16]; P = .277) were similar between recipients of NIPS shocks and recipients of implantation shocks. Receiving an appropriate ICD shock increased the risk of death (AHR 2.09 [95% CI 1.38-2.69]; P <.001) and ADHF (AHR 2.40 [95% CI 1.51-3.81]; P <.002) as compared with implantation shocks and also increased the risk of death (AHR 2.61 [95% CI 1.86-3.67]; P <.001) and ADHF (AHR 2.29 [95% CI 1.33-3.97]; P = .003) as compared with NIPS shocks. CONCLUSIONS ICD shocks delivered during induced ventricular arrhythmias at the time of NIPS testing does not increase the risk of death or ADHF as compared with recipients of appropriate ICD shocks. The occurrence of spontaneous arrhythmias in vulnerable substrates may explain the increased risk.


Europace | 2008

Association between statin therapy and reductions in atrial fibrillation or flutter and inappropriate shock therapy.

Sanjeev P. Bhavnani; Craig I Coleman; White Cm; Christopher A. Clyne; Ravi K. Yarlagadda; Danette Guertin; Jeffrey Kluger

AIMS In patients without implantable cardioverter defibrillators (ICDs), statins have been shown to reduce the incidence of atrial fibrillation and atrial flutter (AF/AFL). We sought to determine if statin therapy could reduce the occurrence of AF/AFL with rapid ventricular rates with and without inappropriate shock therapy among a large heterogeneous ICD cohort. METHODS AND RESULTS We prospectively followed 1445 consecutive patients receiving an ICD for the primary (n = 833) or secondary (n = 612) prevention from December 1997 through January 2007. Outcome measures include incidence of AF/AFL that initiated ICD therapy or was detected during ICD interrogation. Cox hazard regression analyses were conducted to determine the predictors of AF/AFL with and without inappropriate shock delivery and did not include inappropriate shocks resulting from lead dysfunction or other exogenous factors. Patients in this study (n = 1445) were followed over a mean follow-up period of (mean +/- SD) 874 +/- 805 days. There were 563 episodes of AF/AFL detected, with 200 episodes resulting in inappropriate shock therapy. Overall, 745 patients received statin therapy and 700 did not. The use of statin therapy was associated with an adjusted hazard ratio of 0.472 [95% confidence interval (CI), 0.349-0.638, P < 0.001] for the development of AF/AFL with shock therapy and 0.613 (95% CI, 0.496-0.758, P < 0.001) without shock therapy when compared with the group without statin use. CONCLUSION Among a cohort with ICDs at high risk for cardiac arrhythmias, statin therapy was associated with a reduction in AF/AFL tachyarrhythmia detection and inappropriate shock therapy.


Pacing and Clinical Electrophysiology | 2007

Electromagnetic Interference (EMI) and Arrhythmic Events in ICD Patients Undergoing Gastrointestinal Procedures

Danette Guertin; Osman Faheem; Thea Ling; Glenn Pelletier; David Mccomas; Ravi K. Yarlagadda; Christopher A. Clyne; Jeffrey Kluger

Background: The objective was to determine the effect of electromagnetic interference (EMI) in patients undergoing gastrointestinal endoscopy. The implantable cardioverter‐defibrillator (ICD) is the primary therapeutic modality for patients at risk for sudden cardiac death. One potential problem with ICDs is interactions with electrical devices and medical procedures causing EMI or triggering arrhythmic events. Endoscopy frequently employs electrocautery (EC) for diagnosis and treatment of gastrointestinal diseases. Current guidelines advise inactivating ICDs before any surgical procedure. There is limited information on management of ICDs during endoscopy with or without EC. We prospectively evaluated patients with ICDs undergoing endoscopic procedures at our institution.


Pacing and Clinical Electrophysiology | 2013

The Gender-Paradox among Patients with Implantable Cardioverter-Defibrillators: A Propensity-Matched Study

Sanjeev P. Bhavnani; Vamsimohan Pavuluri; Craig I Coleman; Danette Guertin; Ravi K. Yarlagadda; Christopher A. Clyne; Jeffery Kluger

Several meta‐analyses of the implantable cardioverter‐defibrillator (ICD) clinical trials have demonstrated that while men derived a mortality reduction with prophylactic ICD implantation, women did not. These trials also observed that women receive less appropriate ICD shock therapy compared to men. We aimed to investigate this “gender‐paradox” among a heterogeneous community cohort of patients receiving ICDs.


Heart Rhythm | 2008

Association between statin use and mortality in patients with implantable cardioverter-defibrillators and left ventricular systolic dysfunction

Craig I Coleman; Jeffrey Kluger; Sanjeev P. Bhavnani; Christopher A. Clyne; Ravi K. Yarlagadda; Danette Guertin; C Michael White

BACKGROUND A few previous nested cohort trials have evaluated the use of statins on survival and the occurrence of ventricular tachycardia or fibrillation (VT/VF). While the studies generally agreed on the survival effects, they disagreed on the magnitude of the mortality benefit and on the effect on VT/VF. OBJECTIVE The purpose of this study was to determine in a large, long-term follow-up cohort whether statin therapy could reduce mortality and the occurrence of VT/VF in a mixed population receiving an implantable cardioverter-defibrillator (ICD) for primary or secondary prevention and either ischemic or nonischemic cardiomyopathy. METHODS Cohort evaluation of all patients undergoing implantation of an ICD with a left ventricular ejection fraction <40% at an urban U.S. teaching hospital from December 1997 through January 2007. Multivariable analysis of predictors of mortality and VT/VF were conducted. RESULTS There were 314 deaths among the 1204 patients (26.1%). The use of statin therapy (n = 642) was associated with an adjusted hazard ratio of 0.67 (95% confidence interval [CI] 0.53-0.85; P<.001) for mortality as compared with the no-statin group (n = 562). The use of statin therapy was not associated with a reduction in the adjusted hazard ratio for VT/VF (0.85; 95% CI 0.68-1.06; P = .14). CONCLUSIONS Statin therapy is associated with a reduction in overall mortality in patients with ischemic or nonischemic cardiomyopathy with an ICD implanted for either primary or secondary prevention. The magnitude of survival benefit might have been underestimated given our inability to use statin as a time-dependent covariate.


Annals of Noninvasive Electrocardiology | 2013

Evaluation of the Charlson Comorbidity Index to Predict Early Mortality in Implantable Cardioverter Defibrillator Patients

Sanjeev P. Bhavnani; Craig I Coleman; Danette Guertin; Ravi K. Yarlagadda; Christopher A. Clyne; Jeffrey Kluger

Current guidelines consider the implantation of an implantable cardioverter defibrillator (ICD) a class III indication in patients with a life expectancy of <1 year. An evaluation of concomitant noncardiac conditions may identify patients whom may not derive benefit with ICD therapy. We sought to evaluate the association of the Charlson comorbidity index (CCI) on the prediction of early mortality (EM), death <1 year after ICD implant.


Pacing and Clinical Electrophysiology | 2005

The Impact of Catecholamines on Defibrillation Threshold in Patients with Implanted Cardioverter Defibrillators

James S. Kalus; C Michael White; Michael F. Caron; Danette Guertin; Brian F. McBride; Jeffrey Kluger

Objectives: To determine the effect of physiologic catecholamine concentrations on the defibrillation threshold (DFT) in patients with implanted cardioverter defibrillators.


Pacing and Clinical Electrophysiology | 2014

The Healthcare Utilization and Cost of Treating Patients Experiencing Inappropriate Implantable Cardioverter Defibrillator Shocks: A Propensity Score Study

Sanjeev P. Bhavnani; Dalia Giedrimiene; Craig I Coleman; Danette Guertin; Meena Azeem; Jeffrey Kluger

Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs.


Pacing and Clinical Electrophysiology | 2004

Inappropriate Implantable Cardioverter Defibrillator Discharge Following Consumption of a Dietary Weight Loss Supplement

Brian F. McBride; Danette Guertin; C Michael White; Jeffrey Kluger

This report describes the clinical course of a 40‐year‐old female who experienced repetitive ICD firing after consuming Metabolife 356, a multicomponent dietary weight loss supplement. Following the initiation of Metabolife 356, the patient experienced four shocks over a 3 day period with two 30 J shocks being delivered sequentially. Interrogation of the device revealed atrial tachycardia with 1:1 AV conduction at a rate of 240 beats/min. Metabolife 356 was discontinued and the dosage of sotalol was increased to 120 mg twice daily without recurrence of ICD discharge.


Europace | 2014

The prognostic impact of pre-implantation hyponatremia on morbidity and mortality among patients with left ventricular dysfunction and implantable cardioverter-defibrillators

Sanjeev P. Bhavnani; Anupam Kumar; Craig I Coleman; Danette Guertin; Ravi K. Yarlagadda; Christopher A. Clyne; Jeffrey Kluger

AIMS Hyponatremia is commonly observed among patients with left ventricular (LV) dysfunction and is a marker for adverse outcomes. We aimed to determine the prognostic significance of pre-implant hyponatremia on the outcomes of death, acute decompensated heart failure (ADHF) and appropriate implantable cardioverter-defibrillator (ICD) therapy for ventricular arrhythmias among patients with ICDs. METHODS AND RESULTS The study population consisted of patients with an ejection fraction ≤40% undergoing ICD implantation (n = 911) for the primary or secondary prevention of sudden cardiac death from 1997 to 2007. The predictive value of the severity of pre-implantation hyponatremia stratified into mild hyponatremia (n = 268, sodium 134-136 mmol/L), moderate hyponatremia (n = 105, sodium 131-133 mmol/L), and severe hyponatremia (n = 31, sodium ≤130 mmol/L) on the risk of death, ADHF, and appropriate ICD therapy for ventricular arrhythmias as compared with patients a normal serum sodium (n = 507, sodium ≥ 137 mmol/L), was calculated using multivariable Cox proportional hazards analyses. During a mean follow-up of 775 ± 750 days as the severity of hyponatremia (from a normal sodium to severe hyponatremia) increased an incremental incidence of death (25% to 61%, P < 0.001) and ADHF (11% to 26%, P = 0.004) was observed with a reduced incidence of ICD therapy for ventricular tachycardia/ventricular fibrillation (37-29%, P = 0.037). Compared with the normal sodium cohort, patients with severe hyponatremia demonstrated an increased risk of death [adjusted hazard ratio (AHR) 2.69 (95% confidence interval, CI 1.57-4.59), P = 0.004] and ADHF [AHR 2.98 (95% CI 1.41-6.30), P = 0.004], with a lower probability of appropriate ICD therapy [AHR 0.68 (95% CI 0.27-0.88), P = 0.031]. CONCLUSION Hyponatremia is commonly observed among ICD recipients with LV dysfunction. Patients with an increasing severity of hyponatremia are at increased risk of death and HF related morbidity with a reduced incidence of appropriate ICD therapy particularly among patients with severe hyponatremia.

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Jeffrey Kluger

University of Connecticut

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Craig I Coleman

University of Connecticut

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C Michael White

University of Connecticut

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Dalia Giedrimiene

Saint Joseph College Maasin City

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