Jonathan Peter Weiss

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Journals/Publications

• Aguilar, M., Tedrow, U. B., Tzou, W. S., Tung, R., Frankel, D. S., Santangeli, P., Vaseghi, M., Bunch, T. J., Di Biase, L., Tholakanahalli, V. N., Lakkireddy, D., Dickfeld, T., Weiss, J. P., Mathuria, N., Vergara, P., Nakahara, S., Bradfield, J. S., Burkhardt, J. D., Stevenson, W. G., , Callans, D. J., et al. (2021). Catheter ablation of ventricular tachycardia in patients with prior cardiac surgery: An analysis from the International VT Ablation Center Collaborative Group. Journal of cardiovascular electrophysiology, 32(2), 409-416.
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  Patients with prior cardiac surgery may represent a subgroup of patients with ventricular tachycardia (VT) that may be more difficult to control with catheter ablation.
• Weiss, J. P. (2021). Telemedicine in cardiac procedures: considerations for a remote future. Current opinion in cardiology, 36(1), 51-55.
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  Present a review of relevant literature and suggest a framework for discussion of the considerations affecting the evolution and adoption of Telerobotic Support and Telerobotic Collaboration in the practice of cardiac procedural medicine.
• Bunch, T. J., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Graves, K. G., Jacobs, V., Mallender, C., Osborn, J. S., Weiss, J. P., & May, H. T. (2020). Stroke and dementia risk in patients with and without atrial fibrillation and carotid arterial disease.. Heart rhythm, 17(1), 20-26. doi:10.1016/j.hrthm.2019.07.007
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  Patients with carotid arterial disease (CD) with and without atrial fibrillation (AF) are at risk of stroke. Patients with AF are at a higher risk of stroke and dementia..We sought to understand the risks of stroke, transient ischemic attack (TIA), and dementia in patients with and without AF and CD or a combination of both as well as to determine whether therapies for each disease may influence risks..A total of 11,572 patients were included in 4 groups, with 2893 patients populating each group (1: no AF or CD; 2: AF, no CD; 3: CD and no AF; 4: AF and CD) and matched for age, sex, and comorbidities. Long-term outcomes of stroke/TIA and dementia were assessed. Subset analyses of these outcomes were performed in patients with CD treated with revascularization and in patients with AF treated with ablation..CD increased the risk of stroke/TIA (hazard ratio [HR] 2.74; P < .0001) and dementia (HR 1.44; P < .0001). Similarly, AF increased the risk of stroke/TIA (HR 2.08; P < .0001) and dementia (HR 1.30; P = .004). The coexistence of AF and CD further augmented the risk of both end points. CD revascularization was associated with a decreased risk of dementia (HR 0.47; P 
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Mallender, C., Weiss, J. P., Osborn, J. S., & Day, J. D. (2020). Long-term outcomes after low power, slower movement versus high power, faster movement irrigated-tip catheter ablation for atrial fibrillation.. Heart rhythm, 17(2), 184-189. doi:10.1016/j.hrthm.2019.08.001
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  High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation..The purpose of this study was to determine the long-term outcomes of arrhythmia-free survival from AF and atrial flutter (AFL) between HPSD and low power, longer duration (LPLD) ablation strategies..Of a total of 1333 first time AF ablation procedures with 3 years of follow-up, propensity-matched populations for baseline risk factors were created, comprising 402 patients treated with LPLD ablation (30 W for 5 seconds: posterior wall; 30 W for 10-20 seconds: anterior wall) and 402 patients treated with HPSD ablation (50 W for 2-3 seconds: posterior wall; 50 W for 5-15 seconds: anterior wall). AF/AFL outcomes after a 90-day blanking period were assessed..HPSD ablation was associated with shorter procedure and fluoroscopy times (P < .0001 for both). The recurrence of AF at 1 year (12.9% vs 16.2%; P = .19) and 3 years (26.5% vs 30.7%; P = .23) was similar between LPLD and HPSD groups. AFL was higher at 1 year (7.2% vs 11.2%; P = .03) and 3 years (16.1% vs 21.8%; P = .06; P = .04 after multivariate adjustment) with HPSD ablation. Patients who underwent an LPLD approach had lower rates of need for repeat ablation (21% vs 30%; P = .002)..Long-term freedom from AF rates were not significantly different between both approaches. An HPSD ablation strategy compared with an LPLD approach was associated with an increased risk of AFL and need for repeat ablation but with lowered procedure times.
• Weiss, J. P. (2020). Partnering with robotic technology in electrophysiology: have we arrived at a tipping point?. Current opinion in cardiology, 35(1), 8-12. doi:10.1097/hco.0000000000000699
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  Bring readers up to date on the rationale for, current state of, and promising innovations in remote and robotic technology in electrophysiology..There is a growing peer-reviewed literature regarding existing nontraditional technology for mapping and ablation. There also is accelerated innovation under early evaluation that promises significant impact..The development and adoption of remote technologies in electrophysiology has faced considerable challenges yet holds tremendous promise for our patients. First principles must include benefit for patients in both safety and effectiveness, optimization of the process for providers, and sound economic and clinical justification for integration into healthcare systems. The limitations of traditional methods and tools that dominate current practice are discussed as a rationale for considering remote robotic systems. The growing library of published outcomes as well as the emergence of promising new technology merits fresh consideration.
• Bunch, T. J., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Graves, K. G., Jacobs, V., Mallender, C., Osborn, J. S., Weiss, J. P., & May, H. T. (2019). Stroke and dementia risk in patients with and without atrial fibrillation and carotid arterial disease. Heart rhythm.
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  Patients with carotid arterial disease (CD) with and without atrial fibrillation (AF) are at risk of stroke. Patients with AF are at a higher risk of stroke and dementia.
• Bunch, T. J., Jacobs, V., May, H., Stevens, S. M., Crandall, B., Cutler, M., Day, J. D., Mallender, C., Olson, J., Osborn, J., Weiss, J. P., & Woller, S. C. (2019). Rationale and design of the impact of anticoagulation therapy on the Cognitive Decline and Dementia in Patients with Nonvalvular Atrial Fibrillation (CAF) Trial: A Vanguard study. Clinical cardiology, 42(5), 506-512.
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  Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which is more pronounced in patients with a history of clinical stroke. Observational trials suggest that the implementation and quality of long-term anticoagulation impact dementia risk. Emerging evidence suggests that direct oral anticoagulants may improve long-term risk of dementia in AF patients. This manuscript describes the rational and trial design of the the Cognitive Decline and Dementia in Atrial Fibrillation Patients (CAF) Trial. CAF investigates if AF patients randomized to dabigatran etexilate will have long-term higher cognition scores and lower rates of dementia compared in the long term to dose-adjusted warfarin (International Normalized Ratio [INR]: 2.0-3.0). As of 27 February 2019, a total of 120 subjects will be enrolled at one investigational site in the United States and will be followed for 2 years after study enrollment. To date, 97 have been enrolled. The average age is 74.2 years, 53% are male, and 9% had a prior stroke. In this Vanguard study, patients will be followed for 2 years after study enrollment. These prospective, randomized data will inform the understanding of two anticoagulants in AF patients as it relates to risk of cognitive decline and dementia. Cranial imaging and biomarkers collected will assist in understanding mechanisms of brain injury.
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Mallender, C., Weiss, J. P., Osborn, J. S., & Day, J. D. (2019). Long-term outcomes after low power, slower movement versus high power, faster movement irrigated-tip catheter ablation for atrial fibrillation. Heart rhythm.
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  High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation.
• Jacobs, V., T May, H., L Bair, T., G Crandall, B., J Cutler DO, M., D Day, J., Le, V., Mallender, C., S Osborn, J., Weiss, J. P., & Bunch, T. J. (2019). The Impact of Repeated Cardioversions for Atrial Fibrillation on Stroke, Hospitalizations, and Catheter Ablation Outcomes. Journal of atrial fibrillation, 11(6), 2164.
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  Long-term outcomes after direct current cardioversion (DCCV) in patients that receive anticoagulation have demonstrated to have no adverse sequela. Less is known about the impact on atrial fibrillation (AF) outcomes and resource utilization of repeated DCCVs that are often required for long-term rhythm control.
• Weiss, J. P. (2019). Partnering with robotic technology in electrophysiology: have we arrived at a tipping point?. Current opinion in cardiology.
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  Bring readers up to date on the rationale for, current state of, and promising innovations in remote and robotic technology in electrophysiology.
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Jacobs, V., Mallender, C., Osborn, J. S., & Weiss, J. P. (2018). Five-year impact of catheter ablation for atrial fibrillation in patients with a prior history of stroke. Journal of cardiovascular electrophysiology, 29(2), 221-226.
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  Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach. Patients with a prior history of a stroke (CVA) represent a unique high-risk population for recurrent thromboembolic events. The role of antiarrhythmic treatment on the natural history of stroke recurrence in these patients is not fully understood.
• Golive, A., May, H. T., Bair, T. L., Jacobs, V., Crandall, B. G., Cutler, M. J., Day, J. D., Mallender, C., Osborn, J. S., Weiss, J. P., & Bunch, T. J. (2018). The Impact of Gender on Atrial Fibrillation Incidence and Progression to Dementia. The American journal of cardiology, 122(9), 1489-1495.
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  There are a paucity of data regarding the role of gender and atrial fibrillation (AF) on cognitive decline and incidence of dementia. Such data may provide insight into the disproportionate incidence of dementia in women and may help identify high-risk characteristics to target for prevention. We examined patients who underwent coronary angiography at an Intermountain Healthcare Medical Center and enrolled in a prospective cardiovascular database. To be included, patients could not have a previous diagnosis of AF or dementia and had to have 5years of follow-up. Endpoints included incident AF and dementia. Study cohort consisted of 35,608 patients without a previous history of AF or dementia, with 14,377 (40.4%) being woman. Women had lower rates of hypertension, diabetes, coronary artery disease, and prior myocardial infarction, but higher rates of prior stroke. Men had a higher incidence of 5-year and long-term AF. However, women trended toward a higher incidence of 5-year and long-term dementia and stroke compared with men. In all groups of patients with and without AF, prior stroke predicted cognitive decline. In patients without a history of or development of AF, diabetes significantly increased risk of dementia. Women have higher rates of dementia over time than men, driven by higher baseline stroke rates and nontraditional cardiovascular risk factors. The higher dementia rates were in the setting of lower AF rates. However, in both men and women who develop AF, dementia rates are increased and do not show gender-based differences in risk.
• Jacobs, V., May, H. T., Crandall, B. G., Ballantyne, B., Chisum, B., Johnson, D., Graves, K. G., Cutler, M., Day, J. D., Mallender, C., Osborn, J. S., Weiss, J. P., & Bunch, T. J. (2018). Vagus nerve injury symptoms after catheter ablation for atrial fibrillation. Pacing and clinical electrophysiology : PACE, 41(4), 389-395.
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  Vagus nerve injury during catheter ablation for atrial fibrillation can significantly impact quality of life and result in lingering gastrointestinal symptoms. This study was designed to define risk factors of vagus nerve injury, symptoms, prevalence, and temporal resolution.
• Vaseghi, M., Hu, T. Y., Tung, R., Vergara, P., Frankel, D. S., Di Biase, L., Tedrow, U. B., Gornbein, J. A., Yu, R., Mathuria, N., Nakahara, S., Tzou, W. S., Sauer, W. H., Burkhardt, J. D., Tholakanahalli, V. N., Dickfeld, T. M., Weiss, J. P., Bunch, T. J., Reddy, M., , Callans, D. J., et al. (2018). Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease: An International Ventricular Tachycardia Ablation Center Collaborative Study. JACC. Clinical electrophysiology, 4(9), 1141-1150.
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  This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates.
• Vergara, P., Tung, R., Vaseghi, M., Brombin, C., Frankel, D. S., Di Biase, L., Nagashima, K., Tedrow, U., Tzou, W. S., Sauer, W. H., Mathuria, N., Nakahara, S., Vakil, K., Tholakanahalli, V., Bunch, T. J., Weiss, J. P., Dickfeld, T., Vunnam, R., Lakireddy, D., , Burkhardt, J. D., et al. (2018). Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. Heart rhythm, 15(1), 48-55.
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  The purpose of this study was to evaluate the characteristics and outcome of patients undergoing ablation after electrical storm (ES).
• Vergara, P., Tzou, W. S., Tung, R., Brombin, C., Nonis, A., Vaseghi, M., Frankel, D. S., Di Biase, L., Tedrow, U., Mathuria, N., Nakahara, S., Tholakanahalli, V., Bunch, T. J., Weiss, J. P., Dickfeld, T., Lakireddy, D., Burkhardt, J. D., Santangeli, P., Callans, D., , Natale, A., et al. (2018). Predictive Score for Identifying Survival and Recurrence Risk Profiles in Patients Undergoing Ventricular Tachycardia Ablation. Circulation. Arrhythmia and electrophysiology, 11(12), e006730.
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  Several distinct risk factors for arrhythmia recurrence and mortality following ventricular tachycardia (VT) ablation have been described. The effect of concurrent risk factors has not been assessed so far; thus, it is not yet possible to estimate these risks for a patient with several comorbidities. The aim of the study was to identify specific risk groups for mortality and VT recurrence using the Survival Tree (ST) analysis method.
• Golive, A., May, H. T., Bair, T. L., Jacobs, V., Crandall, B. G., Cutler, M. J., Day, J. D., Mallender, C., Osborn, J. S., Stevens, S. M., Weiss, J. P., Woller, S. C., & Bunch, T. J. (2017). The Population-Based Long-Term Impact of Anticoagulant and Antiplatelet Therapies in Low-Risk Patients With Atrial Fibrillation. The American journal of cardiology, 120(1), 75-82.
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  Among patients with atrial fibrillation (AF), the risk of stroke risk is a significant concern. CHADS and CHADS-VASc ≤2 scoring have been used to stratify patients into categories of risk. Without randomized, prospective data, the need and type of long-term antithrombotic medications for thromboembolism prevention in lower risk AF patients remains controversial. We sought to define the long-term impact of anticoagulant and antiplatelet therapy use in AF patients at low risk of stroke. A total of 56,764 patients diagnosed with AF and a CHADS score of 0 or 1, or CHADS-VASc score of 0, 1, or 2 were studied. Antithrombotic therapy was defined as aspirin, clopidogrel (antiplatelet therapy), or warfarin monotherapy (anticoagulation) initiated within 6 months of AF diagnosis. End points included all-cause mortality, cerebrovascular accident, transient ischemic attack (TIA), and major bleed. The average age of the population was 67.0 ± 14.1 years and 56.6% were male. In total, 9,682 received aspirin, 1,802 received clopidogrel, 1,164 received warfarin, and 46,042 did not receive any antithrombotic therapy. Event rates differed between patients with a CHADS score of 0 and 1; 18.5% and 37.8% had died, 1.7% and 3.4% had a stroke, 2.2% and 3.2% had a TIA, and 14% and 12.5% had a major bleed, respectively (p
• Jacobs, V., May, H. T., Bair, T. L., Crandall, B. G., Cutler DO, M. J., Day, J. D., Mallender, C., Osborn, J. S., Weiss, J. P., & Bunch, T. J. (2017). Long-term aspirin does not lower risk of stroke and increases bleeding risk in low-risk atrial fibrillation ablation patients. Journal of cardiovascular electrophysiology, 28(11), 1241-1246.
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  Stroke risk is a significant concern in patients with atrial fibrillation (AF). Low stroke risk patients (CHADS VASc 0-2) are often treated long-term with aspirin after catheter ablation. Defining the long-term risks versus benefits of aspirin therapy, after an ablation, is essential to validate this common clinical approach.
• Tzou, W. S., Tung, R., Frankel, D. S., Di Biase, L., Santangeli, P., Vaseghi, M., Bunch, T. J., Weiss, J. P., Tholakanahalli, V. N., Lakkireddy, D., Vunnam, R., Dickfeld, T., Mathuria, N., Tedrow, U., Vergara, P., Vakil, K., Nakahara, S., Burkhardt, J. D., Stevenson, W. G., , Callans, D. J., et al. (2017). Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group. Heart rhythm, 14(7), 991-997.
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  Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited.
• Tzou, W. S., Tung, R., Frankel, D. S., Vaseghi, M., Bunch, T. J., Di Biase, L., Tholakanahalli, V. N., Lakkireddy, D., Dickfeld, T., Saliaris, A., Weiss, J. P., Mathuria, N., Tedrow, U., Afzal, M. R., Vergara, P., Nagashima, K., Patel, M., Nakahara, S., Vakil, K., , Burkhardt, J. D., et al. (2017). Ventricular Tachycardia Ablation in Severe Heart Failure: An International Ventricular Tachycardia Ablation Center Collaboration Analysis. Circulation. Arrhythmia and electrophysiology, 10(1).
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  Ventricular tachycardia (VT) radiofrequency ablation has been associated with reduced VT recurrence and mortality, although it is typically not considered among New York Heart Association class IV (NYHA IV) heart failure patients. We compared characteristics and VT radiofrequency ablation outcomes of those with and without NYHA IV in the International VT Ablation Center Collaboration.
• Vakil, K., Garcia, S., Tung, R., Vaseghi, M., Tedrow, U., Della Bella, P., Frankel, D. S., Vergara, P., Di Biase, L., Nagashima, K., Nakahara, S., Tzou, W. S., Burkhardt, J. D., Dickfeld, T., Weiss, J. P., Bunch, J., Callans, D., Lakkireddy, D., Natale, A., , Sauer, W. H., et al. (2017). Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis. Circulation. Arrhythmia and electrophysiology, 10(12).
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  Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined.
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Jacobs, V., Mallender, C., Osborn, J. S., Stevens, S. M., Weiss, J. P., & Woller, S. C. (2016). Atrial Fibrillation Patients Treated With Long-Term Warfarin Anticoagulation Have Higher Rates of All Dementia Types Compared With Patients Receiving Long-Term Warfarin for Other Indications. Journal of the American Heart Association, 5(7).
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  The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure.
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Jacobs, V., Mallender, C., Muhlestein, J. B., Osborn, J. S., Weiss, J. P., & Day, J. D. (2016). Long-term influence of body mass index on cardiovascular events after atrial fibrillation ablation. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 46(3), 259-65.
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  Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. However, being both overweight and underweight drives long-term cardiac and general health risks. Long-term data are needed to understand the influence of body mass index (BMI) on outcomes after ablation in regard to arrhythmia recurrence and cardiovascular outcomes.
• Bunch, T. J., May, H. T., Bair, T. L., Jacobs, V., Crandall, B. G., Cutler, M., Weiss, J. P., Mallender, C., Osborn, J. S., Anderson, J. L., & Day, J. D. (2016). The Impact of Age on 5-Year Outcomes After Atrial Fibrillation Catheter Ablation. Journal of cardiovascular electrophysiology, 27(2), 141-6.
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  Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Many studies have shown that age has little to no impact on outcomes during the first year after ablation. However, AF is a disease of aging and age-based substrate for arrhythmia is likely to progress. To this regard, we examined patients with 5-year outcome data following an index AF ablation procedure to define the impact of age on long-term outcomes.
• Frankel, D. S., Tung, R., Santangeli, P., Tzou, W. S., Vaseghi, M., Di Biase, L., Nagashima, K., Tedrow, U., Bunch, T. J., Tholakanahalli, V. N., Dendi, R., Reddy, M., Lakkireddy, D., Dickfeld, T., Weiss, J. P., Mathuria, N., Vergara, P., Patel, M., Nakahara, S., , Vakil, K., et al. (2016). Sex and Catheter Ablation for Ventricular Tachycardia: An International Ventricular Tachycardia Ablation Center Collaborative Group Study. JAMA cardiology, 1(8), 938-944.
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  Significant differences have been described between women and men regarding presentation, mechanism, and treatment outcome of certain arrhythmias. Previous studies of ventricular tachycardia (VT) ablation have not included sufficient women for meaningful comparison.
• Jacobs, V., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Mallender, C., Osborn, J. S., Stevens, S. M., Weiss, J. P., Woller, S. C., & Bunch, T. J. (2016). Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared With Warfarin Among Long-term Anticoagulated Patients for Atrial Fibrillation. The American journal of cardiology, 118(2), 210-4.
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  Direct oral anticoagulants (DOACs) have been used in clinical practice in the United States for the last 4 to 6 years. Although DOACs may be an attractive alternative to warfarin in many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/transient ischemic attack (TIA), bleeding, major bleeding, and dementia in patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation from June 2010 to December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score. Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and dementia by the anticoagulant therapy received. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4 ± 10.9 years, and 59.0% were men. Most patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs DOAC: 92.7%, p
• Miller, A. C., Evans, A. C., Revenaugh, J., Weiss, J. P., Reid, B. B., & Kfoury, A. G. (2016). Combined use of TandemHeart percutaneous ventricular assist device and Stereotaxis magnetic navigation during cardiac ablation procedure. HeartRhythm case reports, 2(1), 14-16.
• Weiss, J. P., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Day, J. D., Osborn, J. S., Mallender, C., & Bunch, T. J. (2016). A Comparison of Remote Magnetic Irrigated Tip Ablation versus Manual Catheter Irrigated Tip Catheter Ablation With and Without Force Sensing Feedback. Journal of cardiovascular electrophysiology, 27 Suppl 1, S5-S10.
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  Remote magnetic navigation (RMN) and contact force (CF) sensing technologies have been utilized in an effort to improve safety and efficacy of catheter ablation. A comparative analysis of the relative short- and long-term outcomes of AF patients has not been performed. As such, we comparatively evaluated the safety and efficacy of these technologies.
• Bunch, T. J., May, H. T., Bair, T. L., Anderson, J. L., Crandall, B. G., Cutler, M. J., Jacobs, V., Mallender, C., Muhlestein, J. B., Osborn, J. S., Weiss, J. P., & Day, J. D. (2015). Long-Term Natural History of Adult Wolff-Parkinson-White Syndrome Patients Treated With and Without Catheter Ablation. Circulation. Arrhythmia and electrophysiology, 8(6), 1465-71.
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  There are a paucity of data about the long-term natural history of adult Wolff-Parkinson-White syndrome (WPW) patients in regard to risk of mortality and atrial fibrillation. We sought to describe the long-term outcomes of WPW patients and ascertain the impact of ablation on the natural history.
• Bunch, T. J., May, H. T., Bair, T. L., Jacobs, V., Crandall, B. G., Cutler, M., Weiss, J. P., Mallender, C., Osborn, J. S., Anderson, J. L., & Day, J. D. (2015). Five-year outcomes of catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction. Journal of cardiovascular electrophysiology, 26(4), 363-370.
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  Catheter ablation of atrial fibrillation (AF) is an established therapy for symptomatic patients. The long-term efficacy and impact of catheter ablation among patients with severe systolic heart failure (SHF) requires additional study to understand if outcomes achieved at 1 year are maintained and mechanisms of AF recurrence.
• Jacobs, V., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M., Day, J. D., Weiss, J. P., Osborn, J. S., Muhlestein, J. B., Anderson, J. L., Mallender, C., & Bunch, T. J. (2015). The impact of risk score (CHADS2 versus CHA2DS2-VASc) on long-term outcomes after atrial fibrillation ablation. Heart rhythm, 12(4), 681-6.
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  Risk stratification tools are needed to select the right candidates for catheter ablation of atrial fibrillation (AF). Both the CHADS2 and CHA2DS2-VASc scores have utility in predicting AF-related outcomes and guiding anticoagulation treatment.
• Jacobs, V., Woller, S. C., Stevens, S. M., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M., Day, J. D., Weiss, J. P., Osborn, J. S., Mallender, C., Anderson, J. L., & Bunch, T. J. (2015). Percent Time With a Supratherapeutic INR in Atrial Fibrillation Patients Also Using an Antiplatelet Agent Is Associated With Long-Term Risk of Dementia. Journal of cardiovascular electrophysiology, 26(11), 1180-1186.
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  Patients with atrial fibrillation (AF) are at higher risk of developing dementia. AF patients treated with warfarin with poor time in therapeutic ranges are significantly more likely to develop dementia. AF patients are also frequently treated with antiplatelet agents due to coexistent vascular disease. We hypothesize that AF patients with anticoagulation and antiplatelet therapies will be at higher risk of dementia, particularly with chronic exposure to over-anticoagulation.
• Tung, R., Vaseghi, M., Frankel, D. S., Vergara, P., Di Biase, L., Nagashima, K., Yu, R., Vangala, S., Tseng, C. H., Choi, E. K., Khurshid, S., Patel, M., Mathuria, N., Nakahara, S., Tzou, W. S., Sauer, W. H., Vakil, K., Tedrow, U., Burkhardt, J. D., , Tholakanahalli, V. N., et al. (2015). Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart rhythm, 12(9), 1997-2007.
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  The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown.
• Bunch, T. J., Weiss, J. P., Crandall, B. G., Day, J. D., May, H. T., Bair, T. L., Osborn, J. S., Mallender, C., Fischer, A., Brunner, K. J., & Mahapatra, S. (2014). Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only. Heart rhythm, 11(4), 533-40.
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  Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes.
• Jacobs, V., Woller, S. C., Stevens, S., May, H. T., Bair, T. L., Anderson, J. L., Crandall, B. G., Day, J. D., Johanning, K., Long, Y., Mallender, C., Olson, J. L., Osborn, J. S., Weiss, J. P., & Bunch, T. J. (2014). Time outside of therapeutic range in atrial fibrillation patients is associated with long-term risk of dementia. Heart rhythm, 11(12), 2206-13.
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  The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. One possibility is that exposure to chronic microembolism or microbleeds results in repetitive cerebral injury that is manifest by cognitive decline.
• Bunch, T. J., May, H. T., Bair, T. L., Johnson, D. L., Weiss, J. P., Crandall, B. G., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Lappe, D. L., & Day, J. D. (2013). Increasing time between first diagnosis of atrial fibrillation and catheter ablation adversely affects long-term outcomes. Heart rhythm, 10(9), 1257-62.
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  Many patients who develop atrial fibrillation (AF) will experience a worsening of their arrhythmia over time. The optimal time to proceed with catheter ablation during the disease course is unknown. Further, whether delays in treatment will negatively influence outcomes is unknown.
• Bunch, T. J., May, H. T., Bair, T. L., Weiss, J. P., Crandall, B. G., Osborn, J. S., Mallender, C., Anderson, J. L., Muhlestein, B. J., Lappe, D. L., & Day, J. D. (2013). Atrial fibrillation ablation patients have long-term stroke rates similar to patients without atrial fibrillation regardless of CHADS2 score. Heart rhythm, 10(9), 1272-7.
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  Atrial fibrillation (AF) is a leading cause of total and fatal ischemic stroke. Stroke risk after AF ablation appears to be favorably affected; however, it is largely unknown whether the benefit extends to all stroke CHADS2 risk profiles of AF patients.
• Bunch, T. J., May, H. T., Crandall, B. G., Weiss, J. P., Bair, T. L., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Lappe, D. L., Johnson, D. L., & Day, J. D. (2013). Intracardiac ultrasound for esophageal anatomic assessment and localization during left atrial ablation for atrial fibrillation. Journal of cardiovascular electrophysiology, 24(1), 33-9.
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  Esophageal injury during left atrial ablation is associated with a significant risk of mortality and morbidity. There are no validated approaches to reduce injury outside of avoidance, a strategy critically dependent on a precise understanding of the esophageal anatomy and location. Intracardiac ultrasound (ICE) can provide a real-time assessment of the esophagus during ablation. We hypothesized that ICE can accurately define esophageal anatomy and location to enhance avoidance strategies during ablation.
• Weiss, J. P., & Manwaring, P. (2013). Freedom from electromagnetic interference between cardiac implantable electronic devices and the FMwand ferromagnetic surgical system. Journal of clinical anesthesia, 25(8), 681-4.
• Bunch, T. J., Darby, A., May, H. T., Ragosta, M., Lim, D. S., Taylor, A. M., DiMarco, J. P., Ailawadi, G., Revenaugh, J. R., Weiss, J. P., & Mahapatra, S. (2012). Efficacy and safety of ventricular tachycardia ablation with mechanical circulatory support compared with substrate-based ablation techniques. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 14(5), 709-14.
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  Catheter ablation of ventricular tachycardia (VT) can be limited by haemodynamic instability. In these cases, substrate-based ablation is typically performed. An alternative is to perform activation and entrainment mapping during VT supported by a percutaneous left ventricular assist device (pVAD). We sought to compare the complication and success rates of pVAD-assisted VT ablation with scar-based techniques.
• Bunch, T. J., Crandall, B. G., Weiss, J. P., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Horne, B. D., Lappe, D. L., & Day, J. D. (2011). Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. Journal of cardiovascular electrophysiology, 22(8), 839-45.
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   Atrial fibrillation (AF) adversely impacts mortality, stroke, heart failure, and dementia. AF ablation eliminates AF in most patients. We evaluated the long-term impact of AF ablation on mortality, heart failure (HF), stroke, and dementia in a large system-wide patient population.
• Bunch, T. J., Horne, B. D., Asirvatham, S. J., Day, J. D., Crandall, B. G., Weiss, J. P., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Lappe, D. L., & Pope, C. A. (2011). Atrial fibrillation hospitalization is not increased with short-term elevations in exposure to fine particulate air pollution. Pacing and clinical electrophysiology : PACE, 34(11), 1475-9.
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  Previous studies have observed that short-term exposure to elevated concentrations of particulate matter (PM) air pollution increases risk of acute ischemic heart disease events and heart failure hospitalization, alters cardiac autonomic function, and increases risk of arrhythmias. This study explored the potential associations between short-term elevations in PM exposure and atrial fibrillation (AF).
• Bunch, T. J., Mahapatra, S., Murdock, D., Molden, J., Weiss, J. P., May, H. T., Bair, T. L., Mader, K. M., Crandall, B. G., Day, J. D., Osborn, J. S., Muhlestein, J. B., Lappe, D. L., & Anderson, J. L. (2011). Ranolazine reduces ventricular tachycardia burden and ICD shocks in patients with drug-refractory ICD shocks. Pacing and clinical electrophysiology : PACE, 34(12), 1600-6.
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  There are limited options for patients who present with antiarrhythmic-drug (AAD)-refractory ventricular tachycardia (VT) with recurrent implantable cardioverter defibrillator (ICD) shocks. Ranolazine is a drug that exerts antianginal and antiischemic effects and also acts as an antiarrhythmic in isolation and in combination with other class III medications. Ranolazine may be an option for recurrent AAD-refractory ICD shocks secondary to VT, but its efficacy, outcomes, and tolerance are unknown.
• Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Weiss, J. P., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Horne, B. D., Lappe, D. L., & Day, J. D. (2011). Trends in early and late mortality in patients undergoing coronary catheterization for myocardial infarction: implications on observation periods and risk factors to determine ICD candidacy. Heart rhythm, 8(9), 1460-6.
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  Survivors of acute myocardial infarction (MI) are at high risk for death from both sudden cardiac death and progressive heart failure.
• Lindsay, B. D., Asirvatham, S. J., Curtis, A. B., Gura, M. T., Hayes, D. L., Jalife, J., Klein, G. J., Knight, B. P., Lampert, R., Natale, A., Packer, D. L., Page, R. L., Scheinman, M. M., Shanker, A. J., Wang, P. J., Weiss, J. P., Wilkoff, B. L., & Busky, C. D. (2011). Guidance for the Heart Rhythm Society pertaining to interactions with industry endorsed by the Heart Rhythm Society on April 26, 2011. Heart rhythm, 8(7), e19-23.
• Malasana, G., Day, J. D., Weiss, J. P., Crandall, B. G., Bair, T. L., May, H. T., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Lappe, D. L., Nelson, J., & Bunch, T. J. (2011). A strategy of rapid cardioversion minimizes the significance of early recurrent atrial tachyarrhythmias after ablation for atrial fibrillation. Journal of cardiovascular electrophysiology, 22(7), 761-6.
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  The significance of early recurrent atrial tachyarrhythmias after atrial fibrillation (AF) ablation is unclear. Atrial remodeling driven by these tachyarrhythmias can result in electrical, contractile, and structural changes that may impair long-term therapy success. Aggressive attempts to restore sinus rhythm in the temporal period of healing after ablation might improve outcomes.
• Bunch, T. J., Weiss, J. P., Crandall, B. G., Day, J. D., DiMarco, J. P., Ferguson, J. D., Mason, P. K., McDaniel, G., Osborn, J. S., Wiggins, D., & Mahapatra, S. (2010). Image integration using intracardiac ultrasound and 3D reconstruction for scar mapping and ablation of ventricular tachycardia. Journal of cardiovascular electrophysiology, 21(6), 678-84.
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  Ablation of ventricular tachycardia (VT) reduces implantable cardioverter defibrillator shocks. Intracardiac ultrasound (ICE) can visualize and quantify the function of all left ventricular wall segments. We thus hypothesized that ICE could identify scar tissue and provide a guide to facilitate substrate-guided VT ablation.
• Bunch, T. J., Weiss, J. P., Crandall, B. G., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., Lappe, D. L., Muhlestein, J. B., Nelson, J., & Day, J. D. (2010). Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in octogenarians. Pacing and clinical electrophysiology : PACE, 33(2), 146-52.
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  Radiofrequency ablation is an effective treatment for atrial fibrillation (AF). With improved safety, the therapy has been offered to increasingly older populations. Arrhythmia mechanisms, medical comorbidities, and safety may vary in the very elderly population.
• Bunch, T. J., Weiss, J. P., Crandall, B. G., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., Muhlestein, J. B., Horne, B. D., Lappe, D. L., & Day, J. D. (2010). Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia. Heart rhythm, 7(4), 433-7.
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  The aging population has resulted in more patients living with cardiovascular disease, such as atrial fibrillation (AF). Recent focus has been placed on understanding the long-term consequences of chronic cardiovascular disease, such as a potential increased risk of dementia.
• Smith, M. B., Christensen, N., Wang, S., Strohecker, J., Day, J. D., Weiss, J. P., Crandall, B. G., Osborn, J. S., Anderson, J. L., Horne, B. D., Muhlestein, J. B., Lappe, D. L., Moss, H., Oliver, J., Viau, K., & Bunch, T. J. (2010). Warfarin knowledge in patients with atrial fibrillation: implications for safety, efficacy, and education strategies. Cardiology, 116(1), 61-9.
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  Multiple factors influence warfarin metabolism and can significantly affect the risk of adverse events. The extent to which patients understand the modifiable factors that impact on warfarin safety and efficacy is unclear.
• Bunch, T. J., Anderson, J. L., May, H. T., Muhlestein, J. B., Horne, B. D., Crandall, B. G., Weiss, J. P., Lappé, D. L., Osborn, J. S., & Day, J. D. (2009). Relation of bisphosphonate therapies and risk of developing atrial fibrillation. The American journal of cardiology, 103(6), 824-8.
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  Bisphosphonates comprise the most common treatment for patients with osteoporosis and fracture risk. Large randomized trials have shown that these therapies may increase the risk of atrial fibrillation (AF). Controversy over the arrhythmia risk prompted the Federal Drug Administration to recently pursue an ongoing safety review to determine the cardiac risk across the entire drug class. Study patients came from 2 large prospective databases (ongoing registry of consecutive patients who underwent coronary angiography and the Intermountain Healthcare health plans database). Medical details regarding bisphosphonate use and cardiovascular risk factors were abstracted from the records. End points included AF, myocardial infarction, and death. In the angiographic database (n = 9,623), patients treated with bisphosphonates were older and more likely to have hypertension, a previous myocardial infarction, heart failure, and osteoporosis. Over 1,481 +/- 1,024 days we found no increased risk of AF in the drug-treated group (hazard ratio 0.90, 95% confidence interval 0.48 to 1.68, p = 0.74). In the Intermountain Healthcare health plans database (n = 37,485), patients treated with bisphosphonates were older and were more likely to have hyperlipidemia and osteoporosis. Over 1,667.5 +/- 557.0 days, there was no increased risk of AF (hazard ratio 0.82, 95% confidence interval 0.66 to 1.01, p = 0.63). In the 2 databases there was no statistical difference in long-term rates of myocardial infarction or mortality. In conclusion, in a long-term study of >47,000 patients, we were unable to find an association between bisphosphonate therapy and AF. However, patients who received bisphosphonates were older and had more cardiovascular disease that we suspect accounts for the increased arrhythmia risk reported in other trials.
• Bunch, T. J., Crandall, B. G., Weiss, J. P., May, H. T., Bair, T. L., Osborn, J. S., Anderson, J. L., Lappe, D. L., Muhlestein, J. B., Nelson, J., Allison, S., Foley, T., Anderson, L., & Day, J. D. (2009). Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures. Journal of cardiovascular electrophysiology, 20(9), 988-93.
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  The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients.
• Crandall, M. A., Horne, B. D., Day, J. D., Anderson, J. L., Muhlestein, J. B., Crandall, B. G., Weiss, J. P., Lappé, D. L., & Bunch, T. J. (2009). Atrial fibrillation and CHADS2 risk factors are associated with highly sensitive C-reactive protein incrementally and independently. Pacing and clinical electrophysiology : PACE, 32(5), 648-52.
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  Inflammation has been shown to have a direct role in the initiation, maintenance, and recurrence of atrial fibrillation (AF) although the underlying mechanisms are unknown. Similarly, it is unclear if inflammatory markers are elevated due to the AF alone or the coexisting cardiovascular diseases that increase the risk of AF.
• Crandall, M. A., Horne, B. D., Day, J. D., Anderson, J. L., Muhlestein, J. B., Crandall, B. G., Weiss, J. P., Osborne, J. S., Lappé, D. L., & Bunch, T. J. (2009). Atrial fibrillation significantly increases total mortality and stroke risk beyond that conveyed by the CHADS2 risk factors. Pacing and clinical electrophysiology : PACE, 32(8), 981-6.
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  Atrial fibrillation (AF) is associated with an increased risk of mortality and stroke. However, it is unclear if AF is independently associated with these poor outcomes or it is merely a risk marker of other processes that convey the risk.
• Daccarett, M., Segerson, N. M., Weiss, J. P., & Day, J. D. (2007). Dual tachycardia in the setting of amiodarone-induced hyperthyroidism. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 9(12), 1217.
• Day, J. D., Doshi, R. N., Belott, P., Birgersdotter-Green, U., Behboodikhah, M., Ott, P., Glatter, K. A., Tobias, S., Frumin, H., Lee, B. K., Merillat, J., Wiener, I., Wang, S., Grogin, H., Chun, S., Patrawalla, R., Crandall, B., Osborn, J. S., Weiss, J. P., , Lappe, D. L., et al. (2007). Inductionless or limited shock testing is possible in most patients with implantable cardioverter- defibrillators/cardiac resynchronization therapy defibrillators: results of the multicenter ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations). Circulation, 115(18), 2382-9.
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  Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators have relied on multiple ventricular fibrillation (VF) induction/defibrillation tests at implantation to ensure that the device can reliably sense, detect, and convert VF. The ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations) is the first large, multicenter, prospective trial comparing vulnerability safety margin testing versus defibrillation safety margin testing with a single VF induction/defibrillation.
• Bunch, T. J., Nelson, J., Foley, T., Allison, S., Crandall, B. G., Osborn, J. S., Weiss, J. P., Anderson, J. L., Nielsen, P., Anderson, L., Lappe, D. L., & Day, J. D. (2006). Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures. Journal of cardiovascular electrophysiology, 17(4), 435-9.
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  Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA.
• Schleinitz, M. D., Weiss, J. P., & Owens, D. K. (2004). Clopidogrel versus aspirin for secondary prophylaxis of vascular events: a cost-effectiveness analysis. The American journal of medicine, 116(12), 797-806.
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  Clopidogrel is more effective than aspirin in preventing recurrent vascular events, but concerns about its cost-effectiveness have limited its use. We evaluated the cost-effectiveness of clopidogrel and aspirin as secondary prevention in patients with a prior myocardial infarction, a prior stroke, or peripheral arterial disease.
• Weiss, J. P., Froelicher, V. F., Myers, J. N., & Heidenreich, P. A. (2004). Health-care costs and exercise capacity. Chest, 126(2), 608-13.
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  While the beneficial effect of exercise capacity on mortality is well-accepted, its effect on health-care costs remains uncertain. This study investigates the relationship between exercise capacity and health-care costs.
• Weiss, J. P., Parsons, L. S., Every, N. R., Weaver, W. D., & Hlatky, M. A. (2002). Does enrollment in a randomized clinical trial lead to a higher cost of routine care?. American heart journal, 143(1), 140-4.
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  Reimbursement for the routine care of patients enrolled in clinical trials is controversial. Our objective was to determine the added medical costs, if any, associated with enrollment in a randomized clinical trial.
• Weiss, J. P., Saynina, O., McDonald, K. M., McClellan, M. B., & Hlatky, M. A. (2002). Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among medicare beneficiaries. The American journal of medicine, 112(7), 519-27.
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  The implantable cardioverter defibrillator has been assessed in randomized trials, but the generalizability of trial results to broader clinical settings is unclear. Our purpose was to evaluate the outcomes and costs of defibrillator use in an unselected population.
• Weiss, J. P., Gruver, C., Kaul, S., Harrell, F. E., Sklenar, J., & Dent, J. M. (2000). Ordering an echocardiogram for evaluation of left ventricular function: level of expertise necessary for efficient use. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 13(2), 124-30.
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  This prospective study was performed to test the hypothesis that the yield of 2-dimensional echocardiography (2DE) would be higher when it is ordered by a cardiologist than by a noncardiologist. Patients referred for transthoracic 2DE for the evaluation of left ventricular systolic function for the 11-month period between July 10, 1995, and June 10, 1996, were included in the study. Demographic, historical, and clinical findings were recorded. Whether the patient was referred by a cardiologist versus a noncardiologist was used as the predictor variable in a binary logistic regression analysis. To address the possibility that the yield of 2DE may be higher for cardiologists because the prevalence of disease in patients referred to them may be higher (selection bias), the analysis was subjected to a propensity score adjustment. Of 2176 patients referred for 2DE during the study, 1033 were referred for the evaluation of left ventricular function. The test had a positive yield in 52% of patients for cardiologists versus 31% for noncardiologists (chi(2) = 45.5, P