Newswise — Cardiologists from Hackensack Meridian Health’s Hackensack University Medical Center and Jersey Shore University Medical Center, the Hackensack Meridian School of Medicine and collaborators will present seven new clinical research and complex clinical cases as well as poster presentations at the ACC 23: American College of Cardiology/World Congress of Cardiology Scientific Session. The conference will be held March 4-6 with virtual and in person sessions in New Orleans, LA.
“We are honored to participate in the ACC 23 meeting where our cardiologists and their collaborators will present their latest research and teach continuing medical education,” said Elizabeth A. Maiorana, MBA, MSN, R.N., CCCC, vice president, Cardiovascular Care Transformation Service, Hackensack Meridian Health. “Our goal is to advance patient care and extend patients’ lives, and we welcome the opportunity to share insights and gain more knowledge as well.”
Key Hackensack Meridian and collaborator presentations include:
March 5, 2:30 p.m. – Part of Complex Clinical Case Presentations: Heart Failure and Cardiomyopathies session
Title: “Delayed Onset Doxorubicin Induced Cardiomyopathy”
Presenters: Hirva Vyas, Harsh Jain, Marian Vandyck-Acquah, Hackensack University Medical Center, Hackensack, NJ; Montefiore Medical Center, Bronx, NY
Summary:
Doxorubicin, a strong chemotherapeutic agent for breast cancer and other cancers, has a known toxicity profile that includes cardiomyopathy. This side effect typically occurs after a few cycles of therapy. Delayed onset of doxorubicin-induced cardiomyopathy is infrequently reported.
In this case study, the authors report on a 72-year-old female with a history of non-Hodgkin’s lymphoma who was treated with 6 cycles of doxorubicin in 2020. She remained well for 2 years with an ejection fraction (EF), the percentage of blood leaving heart each time it contracts, in the normal range of 55% to 60% until March 2022 when she developed progressively worsening heart failure, with EFs of 30% and ultimately <20% on cardiac MRI. She also had new abnormalities on SPECT and MRI suggestive of scarring process. Extensive work up of various causes was negative.
The patient was treated on goal-directed therapy, milrinone infusion for low cardiac output state, and had a wearable defibrillator placed. Her heart failure is slowly improving and EF after 6 months is 35% and is being assessed for CCM (cardiac contractility modulation) and AICD (automatic implantable cardioverter-defibrillator).
The authors conclude that clinicians should be highly alert to delayed onset of doxorubicin-induced cardiomyopathy. They advise that further guidelines regarding duration and frequency of echocardiography monitoring, even when normal, and the role of prophylactic use of goal directed medical therapy, should be further investigated for patients treated with doxorubicin as a means to prevent worsening of cardiomyopathy and associated downstream costly health care.
Marian VanDyck-Acquah, M.D., FACC, FASNC, FASE, is the director, Education and Quality-Noninvasive Cardiology at Hackensack Meridian Health Heart and Vascular Hospital, Interim Director, Noninvasive Cardiology Labs, Medical Director of the Hackensack UMC Heart Center at Glenpointe and an Assistant Professor of Medicine - Division of Cardiology at the Hackensack Meridian School of Medicine. Hirva Vyas, M.D., Harsh Jain, M.D., are Hackensack Meridian Health residents.
March 5, 8 a.m. - “Conduction System Pacing: For Who and Why?” CME program
Title: “Who is most likely to benefit from CSP?”
Presenter: Taya V. Glotzer, M.D.
Summary:
In this Continuing Medical Education (CME) session, Taya V. Glotzer, MD, FACC, FHRS, professor of medicine, Hackensack Meridian School of Medicine, and director of cardiac research at Hackensack University Medical Center, addressed the question of “Who is most likely to benefit from conduction system pacing (CSP)?,” a treatment that uses electronic “pacing” to target and correct abnormal heartbeats and restore heart function in patients with heart failure and abnormalities in the heart’s electrical conduction system. The pacing leads during CSP transmit electrical activity from a generator to the heart muscles.
Dr. Glotzer explained that over the past 30 to 40 years the field of cardiology has learned that right ventricular pacing can actually worsen left ventricular function, sometimes called pacing induced cardiomyopathy, causing patients to be short of breath. “Right ventricular pacing can cause the heart to weaken,” said Dr. Glotzer. “Under normal conditions, the right and left chambers of the heart squeeze simultaneously. When the right ventricle is paced, the right and left chambers squeeze sequentially instead of simultaneously, causing both an electric and physical delay, which can weaken the heart muscle.”
This understanding led to the development of pacing techniques that could resynchronize left and right ventricular function, such as pacing both sides of the heart using two pacing leads (biventricular pacing), or more elegantly, pacing the natural conduction system of the heart which requires only one lead, termed conduction system pacing (CSP). In patients with heart failure and electric delays, these pacing therapies remarkably make the heart muscle stronger.
During CSP, the pacing leads are placed directly in specific areas of the cardiac conduction system, the “His bundle” and the “left bundle branch area.” Dr. Glotzer cited a number of studies that have demonstrated the benefits of both His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) over conventional right ventricular pacing , resulting in keeping the heart muscle stronger.
Dr. Glotzer is part of the writing group of the Heart Rhythm Society Expert Consensus Statement on Conduction System Pacing that will be published in late 2023. In her concluding remarks, she commented that left bundle branch area pacing (LBBAP) is currently being studied as an alternative to biventricular pacing, which is currently the gold standard for treatment of patients with electrical delays and heart failure. Hackensack University Medical Center will be part of the NIH-sponsored randomized controlled trial called “Left vs. Left.” Dr. Glotzer thinks the results will be promising for patients.
Taya Glotzer, M.D., is professor of Medicine, Hackensack Meridian School of Medicine, and director of cardiac research, Hackensack Meridian University Medical Center, Hackensack, NJ.
March 4, Available digitally at 1 a.m. - As part of Electrophysiology Clinical Science Digital Presentations –
Title: “Comparison of Fluoroscopy Times and Procedural Durations Obtained During Pulmonary Vein Isolation Using Modern-Generation Cryoballoon Catheters Versus Contact Force-Sensing Radiofrequency Ablation Catheters”
Presenters: Scott W. Simons, Sejal Patel, Joseph E. Parrillo, Simon Gelman, Grant R. Simons
Summary:
Atrial fibrillation, also known as A-fib or AF, affects more than 2 million adults in the US and is the most common type of irregular heart rhythm. It is caused by abnormal electrical activity in the heart and is the leading cause of cardiac stroke.
Using the prospective real-world Hackensack Heart Rhythm Database of patients, the researchers in this study compared fluoroscopy (real-time video using X-rays) time and procedural durations obtained during pulmonary vein isolation for atrial fibrillation (AF) using modern-generation cryoballoon catheters versus contact force-sensing radiofrequency ablation catheters.
Atrial fibrillation ablation uses heat or cold energy to create scars in the heart that block faulty electrical signals. Cryoablation freezes heart tissue to block electrical signals that cause AF to restore the heart’s normal rhythm. Using heat energy, radiofrequency ablation catheters restore a regular heartbeat by disrupting abnormal electrical signals in the heart that cause arrhythmia.
Previous comparisons between cryoballoon and radiofrequency catheter pulmonary vein isolation have shown cryoballoon vein isolation to have shorter procedural durations but longer fluoroscopy times than radiofrequency catheter pulmonary vein isolation. Significant technical catheter improvements have occurred since the earlier studies were reported, and there are no available comparisons between modern-generation cryoballoon and radiofrequency catheters for pulmonary vein isolation.
The review included only cases using fourth-generation cryoballoon catheters or contact force-sensing radiofrequency catheters. The endpoints for the study were total procedural duration from groin access until end of case and total fluoroscopy time.
The study concluded that use of modern-generation catheters revealed significantly shorter overall procedural durations for cryoballoon catheters compared with radiofrequency catheters for pulmonary vein isolation, with a mean difference of almost one hour. No difference in fluoroscopy times was observed, which is different from prior studies showing shorter times for radiofrequency catheters.
Hackensack Meridian Hackensack University Medical Center, Hackensack, NJ, Hackensack Meridian University School of Medicine, Nutley, NJ. Joseph Parrillo, M.D., is the director of Research Program and Research Database at Hackensack Meridian Hackensack University Medical Center and Professor of Cardiology and Medicine at the Hackensack Meridian School of Medicine in Nutley, NJ. Grant R. Simons, M.D., is a cardiologist at Hackensack Meridian Hackensack University Medical Center.
Additional Hackensack Meridian and collaborator presentations include:
March 4, 3 p.m. – Electrophysiology Moderated Posters
Title: “AF in Understudied Groups”
Poster Moderated by Taya V. Glotzer, M.D.
Taya Glotzer, M.D., is professor of Medicine, Hackensack Meridian School of Medicine, and director of cardiac research, Hackensack Meridian University Medical Center, Hackensack, NJ.
March 5, 9:15 a.m. – Electrophysiology Moderated Poster
Title: “Increased Mortality in Patients Admitted Over the Weekend with Complete Heart Block, an Analysis From the National Inpatient Sample, 2001-2013”
Presenters: Harsh Jain, Hirva Vyas, David A. Vorchheimer, Montefiore Medical Center, Moses Weiler Campus, Albert Einstein College of Medicine NY, NY; Hackensack University Medical Center, Hackensack NJ
Hirva Vyas, M.D., Harsh Jain, M.D., are Hackensack Meridian Health residents.
March 6 presentations include:
9:30 a.m. – Complex Clinical Case Presentations: Vascular Medicine
Title: “Double Threat: Covid 19 Infection and Post-Partum State Associated with Extensive Arterial Thromboembolism”
Presenters: Hirva Vyas, Harsh Jain, Davood Karimi Hosseini, Dennis Villegas; Hackensack University Medical Center; Montefiore Medical Center, Bronx, NY
12:30 p.m. – Ischemic Heart Disease Clinical Science – Poster
Title: “Risk of Unstable Coronary Artery Disease After Myocardial Infarction Type 2: Analysis of Nationwide Readmission Database 2018”
Presenters: Abbas Alshami, Abdulrahman Museedi, Steven Douedi, Dhaval Desai, Anas Alrefaee, Renato Apolito, Matthew Schoenfeld; Jersey Shore University Medical Center, Neptune, NJ; Tulane University School of Medicine, New Orleans, LA
Renato Apolito, M.D., is the medical director of cardiac catheterization at Hackensack Meridian Jersey Shore University Medical Center. Hirva Vyas, M.D., Harsh Jain, M.D., are Hackensack Meridian Health residents.
For information about Hackensack Meridian Health’s cardiovascular services, visit https://www.hackensackmeridianhealth.org/en/Services/Heart-Care.
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ACC 23: American College of Cardiology/World Congress of Cardiology Scientific Session
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