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Article ; Online: Modulation of Cardiac Potassium Current by Neural Tone and Ischemia.

Tomson, Todd T / Arora, Rishi

Cardiac electrophysiology clinics

2016 Volume 8, Issue 2, Page(s) 349–360

Abstract: The cardiac action potential is generated by intricate flows of ions across myocyte cell membranes in a coordinated fashion to control myocardial contraction and the heart rhythm. Modulation of the flow of these ions in response to a variety of stimuli ... ...

Abstract	The cardiac action potential is generated by intricate flows of ions across myocyte cell membranes in a coordinated fashion to control myocardial contraction and the heart rhythm. Modulation of the flow of these ions in response to a variety of stimuli results in changes to the action potential. Abnormal or altered ion currents can result in cardiac arrhythmias. Abnormalities of autonomic regulation of potassium current play a role in the genesis of cardiac arrhythmias, and alterations in acetylcholine-activated potassium channels may play a key role in atrial fibrillation. Ischemia is another important modulator of cardiac cellular electrophysiology.
MeSH term(s)	Animals ; Arrhythmias, Cardiac/physiopathology ; Autonomic Nervous System/physiology ; Cardiac Electrophysiology ; Dogs ; Heart/physiopathology ; Humans ; Mice ; Myocardial Ischemia/physiopathology ; Potassium Channels/physiology
Chemical Substances	Potassium Channels
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1877-9190
ISSN (online)	1877-9190
DOI	10.1016/j.ccep.2016.01.007
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.

Tomson, Todd T / Passman, Rod

Cardiology in review

2016 Volume 25, Issue 1, Page(s) 22–29

Abstract: Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields ... ...

Abstract	Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promising and emerging use for ICMs is in the management of anticoagulation in patients with known paroxysmal AF. The introduction in recent years of ICMs with automatic AF detection algorithms and continuous remote monitoring in combination with novel oral anticoagulants have opened the door for targeted anticoagulation guided by remote monitoring, a strategy that has recently shown promise in pilot studies of this technique. While further research is needed before official recommendations can be given, this use of ICMs opens exciting new possibilities for personalized medicine that could potentially reduce bleeding risk and improve quality of life in patients with atrial fibrillation.
MeSH term(s)	Atrial Fibrillation/diagnosis ; Electrocardiography, Ambulatory ; Electrodes, Implanted ; Humans ; Syncope/diagnosis
Language	English
Publishing date	2016-08-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1294965-6
ISSN	1538-4683 ; 1061-5377
ISSN (online)	1538-4683
ISSN	1061-5377
DOI	10.1097/CRD.0000000000000129
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Article ; Online: Management of device-detected atrial high-rate episodes.

Tomson, Todd T / Passman, Rod

Cardiac electrophysiology clinics

2015 Volume 7, Issue 3, Page(s) 515–525

Abstract: Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs) with atrial leads. These atrial tachyarrhythmias are detected as atrial high-rate episodes (AHREs) by the CIED. AHREs may be brief, infrequent, and ... ...

Abstract	Atrial tachyarrhythmias are common in patients with cardiac implantable electronic devices (CIEDs) with atrial leads. These atrial tachyarrhythmias are detected as atrial high-rate episodes (AHREs) by the CIED. AHREs may be brief, infrequent, and asymptomatic, and may be detected before clinical arrhythmia is apparent. These subclinical device-detected AHREs are associated with an increased stroke risk, similar to, but to a lesser degree than, clinically apparent atrial fibrillation detected by routine methods. Whether a specific duration of AHREs is needed before the risk of stroke increases and whether treatment with anticoagulation for subclinical device-detected AHREs reduces stroke risk is unclear.
MeSH term(s)	Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/therapy ; Defibrillators, Implantable ; Female ; Heart Atria/physiopathology ; Humans ; Male
Language	English
Publishing date	2015-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ISSN	1877-9190
ISSN (online)	1877-9190
DOI	10.1016/j.ccep.2015.05.010
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Article ; Online: The Reveal LINQ insertable cardiac monitor.

Tomson, Todd T / Passman, Rod

Expert review of medical devices

2015 Volume 12, Issue 1, Page(s) 7–18

Abstract: Insertable cardiac monitors (ICMs) are leadless subcutaneous devices that continuously monitor the heart rhythm and record events over a timeframe measured in years, allowing for the diagnosis of infrequent rhythm abnormalities that can be the cause of ... ...

Abstract	Insertable cardiac monitors (ICMs) are leadless subcutaneous devices that continuously monitor the heart rhythm and record events over a timeframe measured in years, allowing for the diagnosis of infrequent rhythm abnormalities that can be the cause of palpitations, syncope and stroke. To date, ICMs have primarily been used in the work-up and management of syncope; however, their use in other areas of rhythm evaluation, particularly atrial fibrillation monitoring, is increasing. The Reveal LINQ™ is the smallest and most versatile ICM available and represents a dramatic leap forward in ICM technology that has the potential to transform patient care in a number of circumstances. Device miniaturization, simplified implant procedure and enhanced automation vastly increase physician and patient acceptance. The next 5 years can be expected to bring a greatly increased use of ICMs for disease diagnosis and management in a variety of clinical settings.
MeSH term(s)	Arrhythmias, Cardiac/physiopathology ; Heart Rate ; Humans ; Monitoring, Physiologic/instrumentation ; Monitoring, Physiologic/methods
Language	English
Publishing date	2015-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2250857-0
ISSN	1745-2422 ; 1743-4440
ISSN (online)	1745-2422
ISSN	1743-4440
DOI	10.1586/17434440.2014.953059
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Article ; Online: Cardiac Monitoring for Atrial Fibrillation in Cryptogenic Stroke.

Ringwala, Sukit M / Tomson, Todd T / Passman, Rod S

Cardiology clinics

2016 Volume 34, Issue 2, Page(s) 287–297

Abstract: Despite an extensive initial evaluation, the cause of up to a third of ischemic strokes remains undetermined. The detection of atrial fibrillation (AF) in these patients with cryptogenic stroke is critical as the diagnosis of AF would warrant ... ...

Abstract	Despite an extensive initial evaluation, the cause of up to a third of ischemic strokes remains undetermined. The detection of atrial fibrillation (AF) in these patients with cryptogenic stroke is critical as the diagnosis of AF would warrant anticoagulation to reduce the risk of recurrent stroke. Observational studies and prospective randomized controlled trials have shown that a substantial proportion of patients with cryptogenic stroke have AF detected by post-stroke cardiac monitoring with higher AF detection rates observed with longer monitoring periods.
MeSH term(s)	Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Cerebral Infarction/etiology ; Electrocardiography, Ambulatory/methods ; Humans
Language	English
Publishing date	2016-05
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1196385-2
ISSN	1558-2264 ; 0733-8651
ISSN (online)	1558-2264
ISSN	0733-8651
DOI	10.1016/j.ccl.2015.12.010
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Article: The Impact of Early Detection of Atrial Fibrillation on Stroke Outcomes.

Tomson, Todd T / Greenland, Philip / Passman, Rod

Cardiac electrophysiology clinics

2014 Volume 6, Issue 1, Page(s) 125–132

Abstract: Early detection of atrial fibrillation (AF) before an AF-related stroke potentially allows for prevention, but the best methods are uncertain. Population screening trials have demonstrated the ability to increase detection in older individuals by ... ...

Abstract	Early detection of atrial fibrillation (AF) before an AF-related stroke potentially allows for prevention, but the best methods are uncertain. Population screening trials have demonstrated the ability to increase detection in older individuals by systematic screening. The subset of patients with implantable cardiac rhythm management devices are at particular risk. Remote monitoring has substantially reduced the time to detection. Although primary prevention of stroke is a priority, detection in patients with cryptogenic stroke represents another opportunity for therapeutic intervention. Evidence that early detection actually leads to improved stroke outcomes is still being gathered.
Language	English
Publishing date	2014-03
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1877-9182
ISSN	1877-9182
DOI	10.1016/j.ccep.2013.10.008
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Article ; Online: Appropriate Implantable Defibrillator Therapy in Adults With Hypertrophic Cardiomyopathy.

Thavikulwat, Amalie C / Tomson, Todd T / Knight, Bradley P / Bonow, Robert O / Choudhury, Lubna

Journal of cardiovascular electrophysiology

2016 Volume 27, Issue 8, Page(s) 953–960

Abstract: Introduction: Implantable cardioverter-defibrillators (ICDs) are effective at terminating the ventricular arrhythmias that cause sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, identifying patients at risk for SCD remains an ... ...

Abstract	Introduction: Implantable cardioverter-defibrillators (ICDs) are effective at terminating the ventricular arrhythmias that cause sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, identifying patients at risk for SCD remains an ongoing challenge. Methods and results: We retrospectively studied all adult patients with HCM treated with ICDs at our referral center from 2000 to 2013 to determine the risk factor profile, rates of appropriate ICD therapy, and complications associated with ICD implantation and discharge. Over a mean follow-up period of 5.2 ± 4.5 years, ICDs provided appropriate therapy to 25 of 135 patients (2.6%/year for primary prevention, 9.8%/year for secondary prevention). Established risk factors for SCD were equally prevalent among patients who received appropriate therapy and those who did not. There were similar rates of appropriate therapy for primary prevention patients with each risk factor. Patients with multiple risk factors had similar rates of appropriate therapy to patients with a single risk factor. Patients who underwent implantation at a younger age were more likely to experience appropriate therapy. Inappropriate therapy occurred in 27 of 135 patients (20%). Conclusions: These data indicate that the rate of appropriate ICD therapy for primary prevention in a contemporary adult HCM population is lower than previously reported. The frequency of appropriate therapy was equally modest regardless of the nature and number of risk factors that led to ICD implantation, and patients with multiple risk factors for SCD did not have an increased rate of appropriate therapy.
Language	English
Publishing date	2016-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025989-2
ISSN	1540-8167 ; 1045-3873
ISSN (online)	1540-8167
ISSN	1045-3873
DOI	10.1111/jce.13005
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Zs.A 2863: Show issues

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Article ; Online: Real-world performance of an enhanced atrial fibrillation detection algorithm in an insertable cardiac monitor.

Mittal, Suneet / Rogers, John / Sarkar, Shantanu / Koehler, Jodi / Warman, Eduardo N / Tomson, Todd T / Passman, Rod S

Heart rhythm

2016 Volume 13, Issue 8, Page(s) 1624–1630

Abstract: Background: Insertable cardiac monitors (ICMs) are used for long-term ECG monitoring. The Reveal LINQ ICM has an improved atrial fibrillation (AF) detection algorithm.: Objective: The purpose of this study was to investigate the algorithm's real- ... ...

Abstract	Background: Insertable cardiac monitors (ICMs) are used for long-term ECG monitoring. The Reveal LINQ ICM has an improved atrial fibrillation (AF) detection algorithm. Objective: The purpose of this study was to investigate the algorithm's real-world performance in patients with syncope, cryptogenic stroke, and known AF. Methods: Consecutive patients with implanted ICM and AF detection parameters automatically set and maintained depending on the indication for monitoring were included. A single reviewer annotated all stored episodes after ICM implant. A second reviewer annotated a random sample of 10% of all detected AF episodes. The episode detection positive predictive value as well as true and false detection rates were determined for AF episodes of different durations. Results: The study enrolled 3759 patients (1604 [43%] with syncope, 1049 [28%] with known AF, 1106 [29%] with cryptogenic stroke). Overall, 20,659 AF episodes were detected in 1020 patients. The gross episode detection positive predictive value was 84%, 73%, and 26% for all episodes (≥2 minutes) and improved to 97%, 95%, and 91% for detected AF episodes ≥1 hour in the syncope, known-AF, and cryptogenic stroke patient cohorts, respectively. The true (and false) detection rate was 0.23 (0.05), 3.8 (1.4), and 0.23 (0.65) per patient-month of monitoring for the syncope, known-AF, and cryptogenic stroke patient cohorts, respectively. Limiting ECG storage to the longest detected AF episode significantly reduced the burden of episode adjudication without significantly compromising the identification of patients with true AF. Conclusion: The performance of LINQ ICM is dependent on the AF incidence rate in the population being monitored, the programmed sensitivity of AF algorithm, and the duration of detected AF episodes.
Language	English
Publishing date	2016-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2016.05.010
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Article ; Online: Bronchial effects of cryoballoon ablation for atrial fibrillation.

Verma, Nishant / Gillespie, Colin T / Argento, A Christine / Tomson, Todd / Dandamudi, Sanjay / Piña, Paloma / Ringwala, Sukit / Lin, Albert C / Chicos, Alexandru B / Kim, Susan / Arora, Rishi / Passman, Rod S / Knight, Bradley P

Heart rhythm

2017 Volume 14, Issue 1, Page(s) 12–16

Abstract: Background: Damage to extracardiac structures, including the esophagus and phrenic nerve, is a known complication of cryoballoon ablation (CBA) during pulmonary vein (PV) isolation for atrial fibrillation (AF). Other adjacent structures, including the ... ...

Abstract	Background: Damage to extracardiac structures, including the esophagus and phrenic nerve, is a known complication of cryoballoon ablation (CBA) during pulmonary vein (PV) isolation for atrial fibrillation (AF). Other adjacent structures, including the pulmonary bronchi and lung parenchyma, may be affected during CBA at the PV ostia. Objective: The purpose of this study was to prospectively study the bronchial effects of CBA in humans undergoing CBA for PV isolation. Methods: Ten patients undergoing CBA for AF under general anesthesia were enrolled in an institutional review board-approved prospective observational study. Real-time bronchoscopy was performed during cryoablation of PVs adjacent to pulmonary bronchi to monitor for thermal injury. Patients were followed for the development of respiratory complaints postprocedure. Results: In 7 of 10 patients (70%) and in 13 of 22 freezes (59%), ice formation was visualized in the left mainstem bronchus during CBA in the left upper PV. Ice formation was not seen in the right mainstem bronchus during right upper PV CBA. The average time to ice formation was 89 seconds. There was no significant difference (P = -.45) in average minimum balloon temperature during freezes with ice formation (-48.5°C) and freezes without ice formation (-46.3°C). No patients went on to develop respiratory complications. Conclusion: Unrecognized ice formation occurs frequently in the left mainstem bronchus during CBA for AF. This information helps explain the source of cough and hemoptysis in some patients who undergo CBA. The long-term consequences of this novel finding and the implications for procedural safety are unknown.
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2016.10.012
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Article: Reconnection Rate and Long-Term Outcome with Adenosine Provocation During Cryoballoon Ablation for Pulmonary Vein Isolation.

Kaplan, Rachel M / Dandamudi, Sanjay / Bohn, Martha / Verma, Nishant / Tomson, Todd T / Arora, Rishi / Chicos, Alexandru B / Goldberger, Jeffrey J / Kim, Susan S / Knight, Bradley P / Lin, Albert C / Passman, Rod S

Journal of atrial fibrillation

2017 Volume 9, Issue 5, Page(s) 1510

Abstract: Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however ... ...

Abstract	Background: Adenosine can unmask dormant conduction during pulmonary vein isolation (PVI) for atrial fibrillation (AF). Studies of adenosine use in radiofrequency PVI show high reconnection rates and conflicting results for long-term success, however there is limited data with cryoballoon ablation (CBA). Methods: A prospectively maintained database of patients undergoing first CBA at a single institution was analyzed. Adenosine use was at the discretion of the primary operator. Additional freezes were delivered for reconnected veins until dormant conduction was eliminated. The primary endpoint, time to AF recurrence defined as any episode < 30 seconds after a 3-month blanking period, was assessed by Kaplan-Meier analysis. Results: From 2011 to 2015, 406 patients underwent CBA, 361 of whom had > 3 months follow-up. The mean age was 61.7 years, 69% were male, and the prevalence of paroxysmal AF was 79% with no significant difference between those that did and did not receive adenosine (77% vs 86%, respectively, p = 0.23). Adenosine testing was performed in 78 patients (21.6%) with a mean dose of 10.6 mg/vein. Of the 306 veins evaluated, 17 (6%) demonstrated dormant conduction. Over a median 14.4 months follow-up, there was no significant difference in freedom from AF with adenosine use (p= 0.86). Conclusions: Dormant conduction with adenosine is uncommon following CBA and its use does not improve long-term success rates.
Language	English
Publishing date	2017-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2451936-4
ISSN	1941-6911
ISSN	1941-6911
DOI	10.4022/jafib.1510
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