Podcasts about jacc clinical electrophysiology

CardioNerds (Dr. Colin Blumenthal, Dr. Kelly Arps, and Dr. Natalie Marrero) discuss anti-arrhythmic drugs in the management of atrial fibrillation and atrial flutter with electrophysiologist Dr. Andrew Epstein. We discuss two major classes of anti-arrhythmic drugs, class IC and class III, as well as digoxin. Dr. Epstein explains their mechanisms of action, indications and specific patient populations in which they would be particularly helpful, efficacy, adverse side effects, contraindications, and key drug-drug interactions. We also elaborate on defining clinical trials and their clinical implications. Given the large burden of atrial fibrillation and atrial flutter in our patient population and the high prevalence of anti-arrhythmic drug use, this episode is sure to be applicable to many practicing physicians and trainees. Audio editing by CardioNerds academy intern, Grace Qiu.  Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Anti-arrhythmic drugs should not be thought of as an alternative to ablation but, instead, should be considered an adjunct to catheter ablation.   Class IC anti-arrhythmic drugs, flecainide and propafenone, are highly efficacious for acute cardioversion and a great option for patients with infrequent episodes of AF who do not have a history of ischemic heart disease.    Class III anti-arrhythmic drugs like ibutilide, sotalol, and dofetilide, are highly effective for acute conversion; however, they require hospitalization for close monitoring during initiation and dose titration given the risk of prolonged QT.   Amiodarone should not be used as a first line agent given its toxicities, prolonged half-life, large volume of distribution, and drug-drug interactions.   Dr. Epstein notes that, “All drugs are poisons with a few beneficial side effects,” when highlighting the many adverse side effects of anti-arrhythmic drugs, particularly amiodarone, and the importance of balancing their benefit in rhythm control with their side effect profile.   Notes Notes: Notes drafted by Dr. Natalie Marrero. What are the Class IC anti-arrhythmic drugs and what indications exist for their use?   Class IC anti-arrhythmic drugs are anti-arrhythmic drugs that work by blocking sodium channels and, thereby, prolonging depolarizing.   Class IC anti-arrhythmic drugs include flecainide and propafenone.   Class IC anti-arrhythmic drugs are good agents to use in patients that have infrequent episodes of AF and do not want daily dosing as these agents can be used by patients when they feel palpitations and desire acute conversion back to sinus rhythm (“pill in the pocket” approach).    What are the adverse consequences and/or contraindications to using a class IC agent?  Class IC anti-arrhythmic agents are contraindicated in patients with a history of ischemic heart disease based on increased mortality associated with their use in these patients in the CAST trial.   Given the results of the CAST trial, providers should screen annually for ischemia via a functional stress test in patients on these drugs at risk for coronary disease.   These drugs can increase 1:1 conduction of atrial flutter and, therefore, require concomitant use of a beta blocker.   These agents are generally well-tolerated without any organ toxicities; however, they can precipitate heart failure in patients with cardiomyopathies, cause sinus node depression, and unmask genetic arrythmias such as a Brugada pattern.   What are the class III agents and what are indications for their use?   Class III agents are drugs that block the potassium channel, prolonging the QT, and include Ibutilide, Sotalol, and Dofetilide.    Class III agents can be considered in patients with or without a history of ischemic heart disease that desire effective acute chemical cardioversion and are willing to go to the hospital for close monitoring during dose initiation and titration.   Other specific circumstances in which one can use these agents, specifically Ibutilide, are in patients with recurrent atrial fibrillation and Wolf Parkinson White (due to slowed conduction via the accessory pathway).  What are the adverse consequences and/or contraindications to using a class III agent?  Ibutilide, Sotalol, and Dofetilide prolong the QT and increase the risk of torsade de pointes, which is why they require ECG monitoring in-patient during drug initiation and dose titration.    These agents are generally well-tolerated.   Sotalol should be avoided or used cautiously in patients with left ventricular dysfunction, while dofetilide can be used and has dose-response beneficial effects in patients with left ventricular dysfunction.   Both sotalol and dofetilide are renally cleared with specific creatinine clearance cutoffs (CrCl < 20 for dofetilide and CrCl

Dr. Francis Marchlinski, Deputy Editor of JACC Clinical Electrophysiology, discusses Anatomy of the Isthmus: Unraveling the Tissue Composition of the Ventricular Tachycardia Diastolic Pathway.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Tricuspid Right Ventricular lead entrapment in transcatheter tricuspid interventions.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Atrial Fibrillation Recurrence After Left Atrial Appendage Occlusion in Patients Undergoing Atrial Fibrillation Ablation.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Impact of Device Compression on Peridevice Leak After Left Atrial Appendage Closure: The Impression LAAC Study

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Prevalence of peri-device leak in Watchman patients with versus without electrically isolated left atrial appendage.

Dr. Francis Marchlinski, Deputy Editor of JACC: Clinical Electrophysiology, discusses Electrode Thermal Profile During Ventricular RF Ablation: A novel indication to potentially inform energy delivery.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC: Clinical Electrophysiology, discusses Mental Disorders Following Implantable Cardioverter-Defibrillator Therapy: Incidence and Prognostic Implications in a Nationwide Cohort Study.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology, discusses Risk Stratification in LBBB after TAVI: Comparison Between a Novel ECG Algorithm and ESC Criteria.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Outcomes of Left Atrial Appendage Occlusion in Patients With and Without Gastrointestinal Bleeds.

Dr. Ratika Parkash, Deputy Editor of JACC Clinical Electrophysiology, discusses The Association Between Atrial Fibrillation Burden and Quality of Life in Patients Undergoing Pulmonary Vein Isolation.

Dr. Ratika Parkash, Deputy Editor of JACC Clinical Electrophysiology, discusses The Association Between Atrial Fibrillation Burden and Quality of Life in Patients Undergoing Pulmonary Vein Isolation: A Sub-study of the SHAM-PVI Trial.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Risk Stratification in LBBB after TAVI: Comparison Between a Novel ECG Algorithm and ESC Criteria.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Pulsed-Field Ablation of Atrial Flutter.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC Clinical Electrophysiology discusses Pressure-Volume Analysis Demonstrates Short and Long-Term Hemodynamic Effects of Atrioventricular Interval Modulation Therapy in Hypertension.

Dr. Francis Marchlinski, Deputy Editor of JACC: Clinical Electrophysiology, discusses electrical storm in patients with hypertrophic cardiomyopathy.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses mechanistic insights into reduced arrhythmia prevalence in female endurance athletes.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses the impact of prior exercise practice on disease characteristics in Desmoplakin-related arrhythmogenic left ventricular cardiomyopathy.

In this episode of JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC spotlights major electrophysiology research and clinical insights from the July 8 issue of JACC. This week's issue features new findings on left atrial appendage occlusion techniques, comparisons of atrial fibrillation stroke prevention guidelines across regions, and device-related complications such as pacemaker lead perforation and device embolization. You'll also hear highlights from JACC: Clinical Electrophysiology, including striking Amara Yad anatomical visuals and real-world clinical scenarios.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC Clinical Electrophysiology discusses new ECG morphologic criteria for the identification of left bundle branch capture.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses mechanistic insights into reduced arrhythmia prevalence in female endurance athletes.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC Clinical Electrophysiology discusses Septal intra-myocardial Purkinje network: a potential new mechanism explaining left bundle branch area pacing physiology.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Premature Ventricular Complexes after Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: admIRE Subanalysis.

Dr. Kenneth Ellenbogen, Deputy Editor of JACC Clinical Electrophysiology discusses the Clinical Response to Resynchronization Therapy: Conduction System Pacing vs Biventricular Pacing. CONSYST-CRT trial.

Dr. Francis Marchlinski, MD, Deputy Editor of JACC Clinical Electrophysiology, discusses Ablation Targeting Rotational Activation Pattern Around Localized Line of Conduction Block for Scar-Related Ventricular Tachycardia.

Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Characterization and Clinical Outcomes of High-Risk Device-Related Thrombus in the Amulet IDE Trial.

Dr. Francis Marchlinski, MD, Deputy Editor of JACC Clinical Electrophysiology, discusses the Olive Strategy: improved pulmonary vein isolation durability with the pentaspline pulsed field catheter.

Dr. Francis Marchlinski, MD, Deputy Editor of JACC Clinical Electrophysiology, discusses Optimizing Interelectrode Distance for Accurate Mapping of Post-Infarct Scars: Insights on Electrogram Characteristics

Dr. Ratika Parkash, MD, MSc, Deputy Editor of JACC Clinical Electrophysiology, discusses the reduction of atrial fibrillation burden after cryoballoon ablation in patients with early persistent atrial fibrillation

Dr. Kenneth Ellenbogen, MD, Deputy Editor of JACC Clinical Electrophysiology, discusses Clinical outcomes and electrophysiological characteristics of partial perforation after left bundle branch area pacing

Dr. Kenneth Ellenbogen, MD, Deputy Editor of JACC Clinical Electrophysiology, discusses Optimizing CRT Lead Placement Accuracy with MRI-Guided On-Screen Targeting: a Randomized Controlled Trial (ADVISE-CRT III)

Edward Gerstenfeld, MD, Executive Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on pulsed-field vs thermal catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy

Ratika Parkash, MD, Deputy Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on cardioverter-defibrillator implantation as a risk factor for motor vehicle crashes.

Emile Daoud, MD, Deputy Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on the results of ICE-Guided isolation of the superior vena cava with pulsed field ablation.

Emile Daoud, MD, Deputy Editor of JACC: Clinical Electrophysiology discusses a recently published new research artle on the clinical and electrophysiological characteristics of Marshall bundle-related atrial tachycardia

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on the Safety and Feasibility of Pulsed Field Ablation in Patients with Mechanical Prosthetic Valves

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on Clinical Characteristics and Outcomes in Patients with Atrial Fibrillation and Pathogenic TTN Variants.

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on overcoming lead penetration failure in left bundle branch pacing.

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology discusses a recently published original research paper on Stereotactic Radioablation for Septal Ventricular Tachycardias

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology discusses a recently published original research

Emile Daoud, MD, Associate Editor of JACC: Clinical Electrophysiology, discusses a recently published original research paper on the impact of operator experience on left atrial appendage occlusion outcomes.

Commentary by Dr. Christian Meyer

Commentary by Dr. Emile Daoud

Commentary by Dr. Ratika Parkash

Commentary by Dr. Emile Daoud

Commentary by Dr. Emile Daoud

Commentary by Dr. Emile Daoud

Commentary by Dr. Emile Daoud

Commentary by Ratika Parkash

Commentary by Dr. Ratika Parkash