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Article: Ablation for Persistent Atrial Fibrillation-Is There a Role for More Than PVI?

Lappe, Jason M / Cutler, Michael J / Day, John D / Bunch, T Jared

Current treatment options in cardiovascular medicine

2016 Volume 18, Issue 3, Page(s) 15

Abstract: Opinion statement: Persistent atrial fibrillation (AF) is a prevalent condition that can be difficult to treat medically, and an ablation strategy is often sought. Currently, the cornerstone of AF ablation strategies is pulmonary vein isolation (PVI). ... ...

Abstract	Opinion statement: Persistent atrial fibrillation (AF) is a prevalent condition that can be difficult to treat medically, and an ablation strategy is often sought. Currently, the cornerstone of AF ablation strategies is pulmonary vein isolation (PVI). Unfortunately, the single procedure success rates are limited, particularly when long-term outcomes (>1 year) are considered. As a result, the most recent consensus statement recommends that in patients with persistent AF a more extensive ablation be considered. Many additive procedural approaches to PVI have been investigated. These include electrical compartmentalization of the atria with linear lesions (LLs), ablation of complex fractionated atrial electrograms (CFAEs), ablation of the dominant frequency (DF) signals, and focal impulse and rotor modulation (FIRM) ablation. Each of these approaches has demonstrated degrees of additive success when performed with a PVI in patients with persistent AF. This review provides an in-depth discussion of these techniques, their successes in treating persistent AF, and their shortcomings.
Language	English
Publishing date	2016-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2057337-6
ISSN	1534-3189 ; 1092-8464
ISSN (online)	1534-3189
ISSN	1092-8464
DOI	10.1007/s11936-016-0437-y
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Zs.A 5529: Show issues

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Article ; Online: Epidemiology of SARS-CoV-2 transmission and superspreading in Salt Lake County, Utah, March-May 2020.

PloS one

2023 Volume 18, Issue 6, Page(s) e0275125

Abstract: Background: Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact ...

Abstract	Background: Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact of this intervention and identify risk factors for transmission. Methods: RT-PCR positive and untested symptomatic contacts were classified as confirmed and probable secondary case-patients, respectively. We compared the number of case-patients and close contacts generated by different groups, and used logistic regression to evaluate factors associated with transmission. Results: Data were collected on 184 index case-patients and up to six generations of contacts. Of 1,499 close contacts, 374 (25%) were classified as secondary case-patients. Decreased transmission odds were observed for contacts aged <18 years (OR = 0.55 [95% CI: 0.38-0.79]), versus 18-44 years, and for workplace (OR = 0.36 [95% CI: 0.23-0.55]) and social (OR = 0.44 [95% CI: 0.28-0.66]) contacts, versus household contacts. Higher transmission odds were observed for case-patient's spouses than other household contacts (OR = 2.25 [95% CI: 1.52-3.35]). Compared to index case-patients identified in the community, secondary case-patients identified through contract-tracing generated significantly fewer close contacts and secondary case-patients of their own. Transmission was heterogeneous, with 41% of index case-patients generating 81% of directly-linked secondary case-patients. Conclusions: Given sufficient resources and complementary public health measures, contact tracing can contain known chains of SARS-CoV-2 transmission. Transmission is associated with age and exposure setting, and can be highly variable, with a few infections generating a disproportionately high share of onward transmission.
MeSH term(s)	Humans ; SARS-CoV-2 ; COVID-19/epidemiology ; Utah/epidemiology ; Contact Tracing ; Risk Factors
Language	English
Publishing date	2023-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275125
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Article ; Online: Altered collagen chemical compositional structure in osteopenic women with past fractures: A case-control Raman spectroscopic study.

Mandair, Gurjit S / Akhter, Mohammed P / Esmonde-White, Francis W L / Lappe, Joan M / Bare, Susan P / Lloyd, William R / Long, Jason P / Lopez, Jessica / Kozloff, Kenneth M / Recker, Robert R / Morris, Michael D

Bone

2021 Volume 148, Page(s) 115962

Abstract: Incidences of low-trauma fractures among osteopenic women may be related to changes in bone quality. In this blinded, prospective-controlled study, compositional and heterogeneity contributors of bone quality to fracture risk were examined. We ... ...

Abstract	Incidences of low-trauma fractures among osteopenic women may be related to changes in bone quality. In this blinded, prospective-controlled study, compositional and heterogeneity contributors of bone quality to fracture risk were examined. We hypothesize that Raman spectroscopy can differentiate between osteopenic women with one or more fractures (cases) from women without fractures (controls). This study involved the Raman spectroscopic analysis of cortical and cancellous bone composition using iliac crest biopsies obtained from 59-cases and 59-controls, matched for age (62.0 ± 7.5 and 61.7 ± 7.3 years, respectively, p = 0.38) and hip bone mineral density (BMD, 0.827 ± 0.083 and 0.823 ± 0.072 g/cm
MeSH term(s)	Aged ; Bone Density ; Case-Control Studies ; Collagen ; Female ; Fractures, Bone/diagnostic imaging ; Humans ; Middle Aged ; Prospective Studies ; Spectrum Analysis, Raman
Chemical Substances	Collagen (9007-34-5)
Language	English
Publishing date	2021-04-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632515-4
ISSN	1873-2763 ; 8756-3282
ISSN (online)	1873-2763
ISSN	8756-3282
DOI	10.1016/j.bone.2021.115962
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Zs.A 1571: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Prevalence and prediction of obstructive coronary artery disease in patients referred for valvular heart surgery.

Lappé, Jason M / Grodin, Justin L / Wu, Yuping / Bott-Silverman, Corinne / Cho, Leslie

The American journal of cardiology

2015 Volume 116, Issue 2, Page(s) 280–285

Abstract: Current guidelines recommend a coronary evaluation before valvular heart surgery (VHS). Diagnostic coronary angiography is recommended in patients with known coronary artery disease (CAD) and those with high pretest probability of CAD. In patients with ... ...

Abstract	Current guidelines recommend a coronary evaluation before valvular heart surgery (VHS). Diagnostic coronary angiography is recommended in patients with known coronary artery disease (CAD) and those with high pretest probability of CAD. In patients with low or intermediate pretest probability of CAD, the guidelines recommend coronary computed tomographic angiography. However, there are no tools available to objectively assess a patient's risk for obstructive CAD before VHS. To address this deficit, 5,360 patients without histories of CAD who underwent diagnostic coronary angiography as part of preoperative evaluation for VHS were identified. Obstructive CAD was defined as ≥50% stenosis in ≥1 artery. Of the patients assessed, 1,035 (19.3%) were found to have obstructive CAD. Through multivariate analysis, age, gender, diabetes, renal dysfunction, hyperlipidemia, and a family history of premature CAD were found to be associated with the presence of obstructive CAD (p <0.001 for all). After adjustment, the specific dysfunctional valve was not associated with the presence of obstructive CAD. Patients were then randomly split into derivation and validation cohorts. Within the derivation cohort, using only age, gender, and the presence or absence of risk factors, a model was constructed to predict the risk for obstructive CAD (C statistic 0.766, 95% confidence interval 0.750 to 0.783). The risk prediction model performed well within the validation cohort (C statistic 0.767, 95% confidence interval 0.751 to 0.784, optimism 0.004). The bias-corrected C statistic for the model was 0.765 (95% confidence interval 0.748 to 0.782). In conclusion, this novel risk prediction tool can be used to objectively risk-stratify patients who undergo preoperative evaluation before VHS and to facilitate appropriate triage to computed tomographic angiography or diagnostic coronary angiography.
MeSH term(s)	Age Factors ; Aged ; Coronary Angiography ; Coronary Occlusion/complications ; Coronary Occlusion/diagnosis ; Coronary Occlusion/epidemiology ; Female ; Follow-Up Studies ; Heart Valve Diseases/complications ; Heart Valve Diseases/surgery ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Ohio/epidemiology ; Prevalence ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Tomography, X-Ray Computed
Language	English
Publishing date	2015-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2015.03.063
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Article ; Online: Cellular proliferative response to cardiac troponin-I in patients with idiopathic dilated cardiomyopathy.

Lappé, Jason M / Pelfrey, Clara M / Cotleur, Anne / Tang, Wai Hong Wilson

Clinical and translational science

2011 Volume 4, Issue 5, Page(s) 317–322

Abstract: Background: Approximately 20% of patients with idiopathic dilated cardiomyopathy (iDCM) have autoantibodies (AAbs) specific to cardiac troponin-I (cTnI). However, there has been no work evaluating active cellular autoimmunity. We aimed to identify a ... ...

Abstract	Background: Approximately 20% of patients with idiopathic dilated cardiomyopathy (iDCM) have autoantibodies (AAbs) specific to cardiac troponin-I (cTnI). However, there has been no work evaluating active cellular autoimmunity. We aimed to identify a cTnI-stimulated cellular autoimmune response and to correlate our findings with cTnI AAb production. Methods: Samples were obtained from stable ambulatory iDCM patients and healthy controls. Peripheral blood monocytes were incubated with cTnI, and cellular proliferation was measured using flow cytometry. AAbs against cTnI were detected by enzyme-linked immunosorbent assay. Results: A positive cellular proliferative response to cTnI was identified in 20.5% (9/44) patients with iDCM and 5.7% (2/35) of healthy controls (p < 0.05). Positive cTnI AAbs were identified in 20% (7/35) of healthy controls and 13.6% (6/44) of patients with iDCM (p = NS). The presence of cTnI AAbs did not correlate with a positive cellular proliferative response. However, patients with iDCM who had an AAb response to cTnI were less likely to be taking a statin (p < 0.05). Conclusions: A cellular autoimmune response to cTnI is demonstrated in a subset of patients with iDCM. However, the presence of a cellular response did not correlate with the presence of AAbs to the same antigen.
MeSH term(s)	Autoantibodies/immunology ; Autoimmunity/drug effects ; Cardiomyopathy, Dilated/immunology ; Cardiomyopathy, Dilated/pathology ; Cell Proliferation/drug effects ; Female ; Humans ; Immunity, Humoral/drug effects ; Male ; Middle Aged ; Myocardium/metabolism ; Myocardium/pathology ; Troponin I/pharmacology
Chemical Substances	Autoantibodies ; Troponin I
Language	English
Publishing date	2011-10-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2433157-0
ISSN	1752-8062 ; 1752-8054
ISSN (online)	1752-8062
ISSN	1752-8054
DOI	10.1111/j.1752-8062.2011.00313.x
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Article ; Online: Recent insights into the role of autoimmunity in idiopathic dilated cardiomyopathy.

Lappé, Jason M / Pelfrey, Clara M / Tang, W H Wilson

Journal of cardiac failure

2008 Volume 14, Issue 6, Page(s) 521–530

Abstract: Dilated cardiomyopathy is a devastating disease associated with poor outcomes. Although the etiology of this disease remains largely unknown, so-called "idiopathic" dilated cardiomyopathy (iDCM) is associated with evidence of an autoimmune process that ... ...

Abstract	Dilated cardiomyopathy is a devastating disease associated with poor outcomes. Although the etiology of this disease remains largely unknown, so-called "idiopathic" dilated cardiomyopathy (iDCM) is associated with evidence of an autoimmune process that may be contributing to the pathophysiology of this disease. Indeed, iDCM shares many characteristics with other autoimmune diseases, including an association with systemic and organ-specific inflammation, an association with viral infections, a genetic predisposition, and a correlation with specific human leukocyte antigen subtypes. Additionally, numerous pathologic cardiac-specific autoantibodies have been associated with iDCM, including those against alpha-myosin, the beta(1)-adrenoceptor, and cardiac troponin I. This review highlights the emerging evidence regarding autoimmune characteristics of iDCM, and summarizes the data of specific immunomodulatory therapies used to target autoimmune mechanisms in the treatment of patients with this devastating disease.
MeSH term(s)	Autoimmune Diseases/immunology ; Autoimmune Diseases/pathology ; Autoimmune Diseases/physiopathology ; Cardiomyopathy, Dilated/immunology ; Cardiomyopathy, Dilated/pathology ; Cardiomyopathy, Dilated/physiopathology ; Clinical Trials as Topic/methods ; Humans
Language	English
Publishing date	2008-05-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1281194-4
ISSN	1532-8414 ; 1071-9164
ISSN (online)	1532-8414
ISSN	1071-9164
DOI	10.1016/j.cardfail.2008.02.016
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Article ; Online: Epidemiology of SARS-CoV-2 transmission and superspreading in Salt Lake County, Utah, March-May 2020.

PLoS ONE, Vol 18, Iss 6, p e

2023 Volume 0275125

Abstract: Background Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact ... ...

Abstract	Background Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact of this intervention and identify risk factors for transmission. Methods RT-PCR positive and untested symptomatic contacts were classified as confirmed and probable secondary case-patients, respectively. We compared the number of case-patients and close contacts generated by different groups, and used logistic regression to evaluate factors associated with transmission. Results Data were collected on 184 index case-patients and up to six generations of contacts. Of 1,499 close contacts, 374 (25%) were classified as secondary case-patients. Decreased transmission odds were observed for contacts aged <18 years (OR = 0.55 [95% CI: 0.38-0.79]), versus 18-44 years, and for workplace (OR = 0.36 [95% CI: 0.23-0.55]) and social (OR = 0.44 [95% CI: 0.28-0.66]) contacts, versus household contacts. Higher transmission odds were observed for case-patient's spouses than other household contacts (OR = 2.25 [95% CI: 1.52-3.35]). Compared to index case-patients identified in the community, secondary case-patients identified through contract-tracing generated significantly fewer close contacts and secondary case-patients of their own. Transmission was heterogeneous, with 41% of index case-patients generating 81% of directly-linked secondary case-patients. Conclusions Given sufficient resources and complementary public health measures, contact tracing can contain known chains of SARS-CoV-2 transmission. Transmission is associated with age and exposure setting, and can be highly variable, with a few infections generating a disproportionately high share of onward transmission.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Sex-Specific Response to Cardiac Resynchronization Therapy: Effect of Left Ventricular Size and QRS Duration in Left Bundle Branch Block.

Varma, Niraj / Lappe, Jason / He, Jiayan / Niebauer, Mark / Manne, Mahesh / Tchou, Patrick

JACC. Clinical electrophysiology

2017 Volume 3, Issue 8, Page(s) 844–853

Abstract: Objectives: In this study, the authors sought to assess the impact of body and heart size on sex-specific cardiac resynchronization therapy (CRT) response rate, according to QRS duration (QRSd) as a continuum.: Background: Effects of CRT differ ... ...

Abstract	Objectives: In this study, the authors sought to assess the impact of body and heart size on sex-specific cardiac resynchronization therapy (CRT) response rate, according to QRS duration (QRSd) as a continuum. Background: Effects of CRT differ between sexes for any given QRSd. Methods: New York Heart Association functional class III/IV patients with nonischemic cardiomyopathy and "true" left bundle branch block (LBBB) were evaluated. Left ventricular mass (LVM) and end-diastolic volume were measured echocardiographically. Positive response was defined by left ventricular ejection fraction (LVEF) improvement post-CRT. Results: Among 130 patients (LVEF 19 ± 7.1%; QRSd 165 ± 20 ms; 55% female), CRT improved LVEF to 32 ± 14% (p < 0.001) during a median 2 years follow-up. Positive responses occurred in 103 of 130 (79%) (78% when QRSd <150 ms vs. 80% when QRSd ≥150 ms; p = 0.8). Body surface area (BSA), QRSd, and LVM were lower in women, but QRSd/LVM ratio greater (p < 0.0001). Sexes did not differ for pharmacotherapy and comorbidities, but female CRT response was greater: 90% (65 of 72) versus 66% (38 of 58) in males (p < 0.001). With QRSd as a continuum, the overall CRT-response relationship showed a progressive increase to plateau between 150 and 170 ms, then a decrease. Sex-specific differences were conspicuous: among females, a peak effect was observed between 135 and 150 ms, thereafter a decline, with the male response rate lower, but with a gradual increase as QRSd lengthened. Sex-specific differences were unaltered by BSA, but resolved with integration of LVM or end-diastolic volume. Conclusions: Sex differences in the QRSd-response relationship among CRT patients with LBBB were unexplained by application of strict LBBB criteria or by BSA, but resolved by QRSd normalization for heart size using LV mass or volume.
MeSH term(s)	Bundle-Branch Block/pathology ; Bundle-Branch Block/physiopathology ; Bundle-Branch Block/therapy ; Cardiac Resynchronization Therapy ; Defibrillators, Implantable ; Echocardiography ; Electrocardiography ; Female ; Heart Ventricles/pathology ; Humans ; Male ; Middle Aged ; Organ Size ; Sex Factors ; Stroke Volume ; Treatment Outcome
Language	English
Publishing date	2017-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2846739-5
ISSN	2405-5018 ; 2405-500X ; 2405-500X
ISSN (online)	2405-5018 ; 2405-500X
ISSN	2405-500X
DOI	10.1016/j.jacep.2017.02.021
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Article: Estimation of detection thresholds for redirected walking techniques.

Steinicke, Frank / Bruder, Gerd / Jerald, Jason / Frenz, Harald / Lappe, Markus

IEEE transactions on visualization and computer graphics

2010 Volume 16, Issue 1, Page(s) 17–27

Abstract: ... greater than 22 m while they believe that they are walking straight. ...

Abstract	In immersive virtual environments (IVEs), users can control their virtual viewpoint by moving their tracked head and walking through the real world. Usually, movements in the real world are mapped one-to-one to virtual camera motions. With redirection techniques, the virtual camera is manipulated by applying gains to user motion so that the virtual world moves differently than the real world. Thus, users can walk through large-scale IVEs while physically remaining in a reasonably small workspace. In psychophysical experiments with a two-alternative forced-choice task, we have quantified how much humans can unknowingly be redirected on physical paths that are different from the visually perceived paths. We tested 12 subjects in three different experiments: (E1) discrimination between virtual and physical rotations, (E2) discrimination between virtual and physical straightforward movements, and (E3) discrimination of path curvature. In experiment E1, subjects performed rotations with different gains, and then had to choose whether the visually perceived rotation was smaller or greater than the physical rotation. In experiment E2, subjects chose whether the physical walk was shorter or longer than the visually perceived scaled travel distance. In experiment E3, subjects estimate the path curvature when walking a curved path in the real world while the visual display shows a straight path in the virtual world. Our results show that users can be turned physically about 49 percent more or 20 percent less than the perceived virtual rotation, distances can be downscaled by 14 percent and upscaled by 26 percent, and users can be redirected on a circular arc with a radius greater than 22 m while they believe that they are walking straight.
MeSH term(s)	Adult ; Computer Graphics ; Computer Simulation ; Female ; Gait/physiology ; Humans ; Imaging, Three-Dimensional/methods ; Middle Aged ; Models, Theoretical ; Orientation/physiology ; Psychomotor Performance/physiology ; Sensory Thresholds/physiology ; User-Computer Interface ; Walking/physiology ; Young Adult
Language	English
Publishing date	2010-01
Publishing country	United States
Document type	Journal Article
ISSN	1077-2626
ISSN	1077-2626
DOI	10.1109/TVCG.2009.62
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Article ; Online: Red cell distribution width, C-reactive protein, the complete blood count, and mortality in patients with coronary disease and a normal comparison population.

Lappé, Jason M / Horne, Benjamin D / Shah, Svati H / May, Heidi T / Muhlestein, Joseph B / Lappé, Donald L / Kfoury, Abdallah G / Carlquist, John F / Budge, Deborah / Alharethi, Rami / Bair, Tami L / Kraus, William E / Anderson, Jeffrey L

Clinica chimica acta; international journal of clinical chemistry

2011 Volume 412, Issue 23-24, Page(s) 2094–2099

Abstract: Background: Red cell distribution width (RDW) is associated with morbidity and mortality in coronary artery disease (CAD), but the connection of RDW with chronic inflammation is equivocal.: Methods: In 1,489 patients with CAD and 8.4-15.2 years of ... ...

Abstract	Background: Red cell distribution width (RDW) is associated with morbidity and mortality in coronary artery disease (CAD), but the connection of RDW with chronic inflammation is equivocal. Methods: In 1,489 patients with CAD and 8.4-15.2 years of follow-up all-cause mortality and RDW were studied using Cox regression. RDW and its associations with inflammation, liver function, renal function, and body mass were assessed. A population of 449 normal (No-CAD) patients also was evaluated. Results: RDW predicted all-cause mortality in a step-wise manner (HR=1.37 per quintile; 95% CI=1.29, 1.46; p-trend<0.001). A significant but meaningless correlation between RDW and high-sensitivity C-reactive protein (hsCRP) was identified (r=0.181; p<0.001). With full adjustment, RDW remained significant (p-trend<0.001) and the strongest predictor of mortality among all factors included in the model. RDW also strongly predicted all-cause mortality in the normal control population (HR=1.33 per quintile, CI=1.15, 1.55; p-trend<0.001), but hsCRP did not predict mortality among normal controls. Conclusions: RDW was associated with mortality in patients with CAD and may provide clinically useful prognostication. Although RDW was correlated with hsCRP, they were independent predictors of mortality. RDW has been incorporated into risk prediction tool using data from basic chemistries available at: http://intermountainhealthcare.org/IMRS.
MeSH term(s)	Aged ; Blood Cell Count ; C-Reactive Protein/metabolism ; Case-Control Studies ; Coronary Disease/blood ; Coronary Disease/mortality ; Erythrocytes/metabolism ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2011-11-20
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80228-1
ISSN	1873-3492 ; 0009-8981
ISSN (online)	1873-3492
ISSN	0009-8981
DOI	10.1016/j.cca.2011.07.018
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