Jeffrey L. Williams

ACC 2009 survey results and recommendations: Addressing the cardiology workforce crisis A report of the ACC board of trustees workforce task force.

The prevalence of cardiovascular disease (CVD) is increasing by 1% to 2% per year, and will continue to do so over the next 2 decades ([1][1]). The American Heart Association predicts that by 2020, at least 20 million more people in the United States will be afflicted with heart disease than there

Feasibility of Myxomatous Mitral Valve Repair Using Direct Leaflet and Chordal Radiofrequency Ablation

OBJECTIVE Minimally invasive repair of mitral valve prolapse (MVP) causing severe mitral regurgitation (MR) should reduce MR and have chronic durability. Our ex vivo, acute in vivo, and chronic in vivo studies suggest that direct application of radiofrequency ablation (RFA) to mitral leaflets and chordae can effect these repair goals to decrease MR. METHODS A total of seven canines were studied to assess the effects of RFA on mitral valve structure and function. RFA was applied ex vivo (n = 1), acutely in vivo using a right lateral thoracotomy and cardiopulmonary bypass (n = 3), and chronically in vivo using percutaneous access to the heart (n = 3). RFA was applied to the mitral valve and its associated chordae. Mitral valve structure and function (in vivo preparations) were then assessed. RESULTS Ex vivo application of RFA resulted in qualitative reduction in mitral leaflet surface area and chordal length. Acute in vivo application of RFA to canines found to have MVP causing severe MR demonstrated a 43.7-60.7% statistically significant (P = 0.039) reduction in postablation MR. Chronic, in vivo, percutaneous application of RFA was found to be feasible and the engendered alterations durable. CONCLUSION These data suggest that myxomatous mitral valve repair using radiofrequency energy delivered via catheter is feasible.

Predicting adverse drug reactions in older adults; a systematic review of the risk prediction models.

Adverse drug reaction (ADR) risk-prediction models for use in older adults have been developed, but it is not clear if they are suitable for use in clinical practice. This systematic review aimed to identify and investigate the quality of validated ADR risk-prediction models for use in older adults. Standard computerized databases, the gray literature, bibliographies, and citations were searched (2012) to identify relevant peer-reviewed studies. Studies that developed and validated an ADR prediction model for use in patients over 65 years old, using a multivariable approach in the design and analysis, were included. Data were extracted and their quality assessed by independent reviewers using a standard approach. Of the 13,423 titles identified, only 549 were associated with adverse outcomes of medicines use. Four met the inclusion criteria. All were conducted in inpatient cohorts in Western Europe. None of the models satisfied the four key stages in the creation of a quality risk prediction model; development and validation were completed, but impact and implementation were not assessed. Model performance was modest; area under the receiver operator curve ranged from 0.623 to 0.73. Study quality was difficult to assess due to poor reporting, but inappropriate methods were apparent. Further work needs to be conducted concerning the existing models to enable the development of a robust ADR risk-prediction model that is externally validated, with practical design and good performance. Only then can implementation and impact be assessed with the aim of generating a model of high enough quality to be considered for use in clinical care to prioritize older people at high risk of suffering an ADR.

A Pilot Study Examining the Performance of Polynomial-Modeled Ventricular Shock Electrograms for Rhythm Discrimination in Implantable Devices

Background: Inappropriate shocks continue to be a problem for patients with implantable defibrillators (ICD). We evaluated the performance of polynomial‐modeled ventricular electrograms (EGM) to discriminate between supraventricular tachycardia (SVT) and ventricular tachycardia (VT).

Effect of Ischemia on Implantable Defibrillator Intracardiac Shock Electrograms

Introduction: Few attempts have been made to extract information from the ventricular electrogram (EGM) recorded by implantable cardioverter defibrillators (ICD) aside from the discrimination of supraventricular tachycardia and ventricular tachycardia. The current study aims to examine the effect of ischemia in the major coronary artery distributions on the shock EGM from ICDs.

A segmental polynomial model of ventricular electrograms as a simple and efficient morphology discriminator for implantable devices.

Background: The goal of this study is to construct a polynomial model of the ventricular electrogram (EGM) that faithfully reproduces the EGM and can be implemented in current, low computational power implantable devices. Such a model of ventricular EGMs is still lacking.

Modes of death in defibrillator patients: Learning from clinical experience

R T o Modes of death in chronic heart failure Historically, mortality rates from trials with implantable cardioverter-defibrillator (ICD) treatment arms for primary and secondary prevention have ranged from 6% to 8%. Mortality rates for cardiac resynchronization therapy with defibrillators (CRT-D) have ranged from 9% to 12%. Annual heart failure mortality rates have been reported at 3%, with sudden cardiac death rates at 20%–27% in primary prevention trials (MADIT-I, MADIT-II) and 30%– 36% in secondary prevention trials (AVID, CIDS). The study of Thijssen et al in this issue of HeartRhythm xamines the modes of death in ICD and CRT-D patients. It s a prospective evaluation of 2859 ICD and CRT-D patients ver a 14-year period with an annual mortality rate of 5% or the cohort. When compared with earlier ICD trials, they ound lower all-cause mortality rates of 2.9% in primary revention, 4.5% in secondary prevention, and 6.9% in the RT-D patients. Heart failure death and noncardiac death ere the most common modes of death, with sudden death ccounting for 7% of the cases. Heart failure was the cause f death in 34% of primary prevention, 28% of secondary revention, and 43% of CRT-D patients. The sudden death ate for all patients was markedly lower than that reported in rior reports but may be attributed to the unknown cause of eath in 17% of the patients. The authors should be comended for their study because it opens discussion on the ole of continued analyses of health outcomes. The differnce in mortality rates (and modes of death) from prior tudies compared with the incidences in their “routine clincal practice” were attributed to “a healthier population . . . etter (pharmacotherapeutic) treatment . . . [higher] baseline ean left ventricular function . . . differences in the selecion and composition of the patient population . . . more ppropriate ICD shocks . . . prolongation of QRS . . . diferent time periods during which the studies were conducted s well as differences in patients’ characteristics.”