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Scholarly Contributions

Chapters

• Hutchinson, M. D. (2020). Arrhythmogenic Right Ventricular Cardiomyopathy. In Cardiac Electrophysiology(pp 439-497). Springer International Publishing. doi:10.1007/978-3-030-28533-3_117
• Hutchinson, M. D. (2020). Ischemic Ventricular Tachycardia. In Cardiac Electrophysiology(pp 435-438). doi:10.1007/978-3-030-28533-3_104
• Hutchinson, M. D., Santangeli, P., & Callans, D. J. (2019). Intracardiac Echocardiography. In Cardiac Mapping, Fifth Edition(pp 95-103). John Wiley & Sons, Ltd. doi:10.1002/9781119152637.ch9
• Santangeli, P., & Hutchinson, M. D. (2019). Atrial Transseptal Catheterization. In Catheter Ablation of Cardiac Arrhythmias(pp 648-663). Elsevier. doi:10.1016/B978-0-323-52992-1.00039-9
• Hutchinson, M. D., & Callans, D. J. (2018). 64 – Intracardiac Echocardiography for Electrophysiology. In Zipes and Jalife’s Cardiac Electrophysiology: From Cell to Bedside. doi:10.1016/B978-0-323-44733-1.00064-X
• Hutchinson, M. D., & Callans, D. J. (2014). 62 – Intracardiac Echocardiography for Electrophysiology. In Zipes and Jalife’s Cardiac Electrophysiology: From Cell to Bedside. doi:10.1016/B978-1-4557-2856-5.00062-5
• Hutchinson, M. D., & Marchlinski, F. E. (2012). Combined Endocardial and Epicardial Mapping of Ventricular Tachycardia. In Cardiac Mapping, Fourth Edition(pp 500-513). Wiley‐Blackwell. doi:10.1002/9781118481585.CH45
• Hutchinson, M. D., & Callans, D. J. (2009). Role of Imaging Techniques in Catheter Ablation of Ventricular Tachycardia. In Ventricular Arrhythmias and Sudden Cardiac Death. Blackwell Futura. doi:10.1002/9781444300307.CH13
• Hutchinson, M. D., & Marchlinski, F. E. (2009). Endocardial and Epicardial Mapping of Nonischemic Right and Left Ventricular Cardiomyopathy. In Cardiac Mapping, Third Edition(pp 323-336). Wiley‐Blackwell. doi:10.1002/9781444303438.CH25

Journals/Publications

• Chinyere, I. R., Mori, S., & Hutchinson, M. D. (2024). Cardiac blood vessels and irreversible electroporation: findings from pulsed field ablation. Vessel plus, 8.
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  The clinical use of irreversible electroporation in invasive cardiac laboratories, termed pulsed field ablation (PFA), is gaining early enthusiasm among electrophysiologists for the management of both atrial and ventricular arrhythmogenic substrates. Though electroporation is regularly employed in other branches of science and medicine, concerns regarding the acute and permanent vascular effects of PFA remain. This comprehensive review aims to summarize the preclinical and adult clinical data published to date on PFA's effects on pulmonary veins and coronary arteries. These data will be contrasted with the incidences of iatrogenic pulmonary vein stenosis and coronary artery injury secondary to thermal cardiac ablation modalities, namely radiofrequency energy, laser energy, and liquid nitrogen-based cryoablation.
• Ford, P., Cheung, A. R., Khan, M. S., Rollo, G., Paidy, S., Hutchinson, M., & Chaudhry, R. (2024). Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review. Journal of cardiothoracic and vascular anesthesia, 38(11), 2754-2760.
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  Atrial fibrillation, the most prevalent cardiac arrhythmia, has witnessed significant advancements in treatment modalities, transitioning from invasive procedures like the maze procedure to minimally invasive catheter ablation techniques. This review focuses on recent improvements in anesthetic approaches that enhance outcomes in catheter atrial fibrillation ablation. We highlight the efficacy of contact force sensing catheters with steerable introducer sheaths, which outperform traditional catheters by ensuring more effective contact time and lesion formation. Comparing general anesthesia with conscious sedation, we find that general anesthesia provides superior catheter stability due to reduced respiratory variability, resulting in more effective lesion formation, and reduced pulmonary vein reconnection. The use of high-frequency jet ventilation under general anesthesia, delivering low tidal volumes, effectively minimizes left atrial movement, decreasing catheter displacement and procedure time, and reducing recurrence in paroxysmal atrial fibrillation. An alternative, high-frequency low tidal volume ventilation using conventional ventilators, also shows improved catheter stability and lesion durability compared to traditional ventilation methods. However, a detailed comparative study of high-frequency jet ventilation, high-frequency low tidal volume ventilation, and conventional mechanical ventilation in catheter ablation for atrial fibrillation is lacking. This review emphasizes the need for such studies to identify optimal anesthetic techniques, potentially enhancing patient outcomes in atrial fibrillation treatment. Our findings suggest that careful selection of anesthetic methods, including ventilation strategies, plays a crucial role in the success of catheter ablation for atrial fibrillation, warranting further research for evidence-based practice.
• Indik, J. H., Altamirano Ufion, A., Whitaker, B., Geyer, T., Balakrishnan, M., Butt, K., Klewer, J., Indik, R. A., & Hutchinson, M. D. (2024). A novel computational platform to analyze left atrial voltage acquired from electroanatomic mapping. Heart rhythm, 21(6), 965-966.
• Balakrishnan, M., & Hutchinson, M. D. (2023). Increasing trend in ventricular tachycardia related mortality: Cause or effect?. Journal of cardiovascular electrophysiology.
• Hutchinson, M. D., & Sridharan, A. (2023).

  Coronary arterial injury during right ventricular outflow tract ablation: Know your neighbors

  . J Cardiovasc Electrophysiol, 34(5), 1310-1311. doi:10.22541/au.167436723.34548253/v1
• Sridharan, A., & Hutchinson, M. D. (2023). Coronary arterial injury during right ventricular outflow tract ablation: Know your neighbors. Journal of cardiovascular electrophysiology.
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  Left anterior descending (LAD) coronary arterial injury is an underappreciated and rare consequence of ablation in the right ventricular outflow tract (RVOT). The authors present five cases of acute or subacute LAD injury after RVOT ablation. Most patients had fairly extensive ablation and two had coincident cardiac perforation. The patients reported also had a strikingly similar ECG morphology of their spontaneous ventricular arrhythmias. The authors' report serves an important cautionary tale regarding ablation of intramural septal VAs This article is protected by copyright. All rights reserved.
• Cendrowski, E., & Hutchinson, M. D. (2022). Slow pathway modification in an adult patient with unrepaired partial atrioventricular canal defect. HeartRhythm case reports, 8(6), 433-436.
• Hutchinson, M. D. (2022). Characterization of septal coronary venous tributaries with computed tomography: What's in a name?. Journal of cardiovascular electrophysiology, 33(5), 973-974.
• Ajmal, M., Hutchinson, M. D., Lee, K., & Indik, J. H. (2021). Outcomes in patients implanted with a Watchman device in relation to choice of anticoagulation and indication for implant. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing.
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  Patients with atrial fibrillation are increasingly prescribed a direct oral anticoagulant (DOAC) over warfarin and seek to avoid anticoagulation even without a history of major bleeding. This study explores the outcomes of patients implanted with a Watchman device in relation to anticoagulation choice (warfarin versus DOAC) in the post-procedure period and a history of bleeding.
• Balakrishnan, M., & Hutchinson, M. D. (2021). Prevention and Early Recognition of Complications During Catheter Ablation by Intracardiac Echocardiography. Cardiac electrophysiology clinics, 13(2), 357-364.
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  The effective diagnosis and management of procedural complications remains an important challenge for electrophysiology operators. Intracardiac echocardiography provides a real-time imaging modality with spectral and color Doppler capabilities that integrates directly with electroanatomic mapping systems. It provides detailed characterization of anatomic variants, which allows the operator to optimize the ablation strategy to the individual thereby avoiding the inherent risk of excessive or ineffective lesions. Complications, such as intracardiac thrombus or pericardial effusion, can be detected and managed before the onset of clinical symptoms. Intracardiac echocardiography facilitates the diagnosis and management of intraoperative hypotension.
• Chinyere, I. R., Balakrishnan, M., & Hutchinson, M. D. (2022). The emerging role of cardiac contractility modulation in heart failure treatment. Current opinion in cardiology, 37(1), 30-35.
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  Heart failure often progresses despite optimal medical and device therapies, and advanced mechanical circulatory support has limited availability and substantial associated morbidity. Cardiac contractility modulation (CCM) provides nonexcitatory stimulation to ventricular myocardium which increases cardiac contractility without increasing oxygen demand. This review describes the emerging role of CCM in heart failure treatment.
• Chinyere, I. R., Hutchinson, M. D., Moukabary, T., Goldman, S., Lancaster, J. J., Juneman, E., & Koevary, J. W. (2021). Modulating the Infarcted Ventricle’s Refractoriness with an Epicardial Biomaterial. Journal of Investigative Medicine, 69(2), 364-370. doi:10.1136/jim-2020-001486
• Chinyere, I. R., Moukabary, T., Hutchinson, M. D., Lancaster, J. J., Juneman, E., & Goldman, S. (2021). Progression of infarct-mediated arrhythmogenesis in a rodent model of heart failure. American journal of physiology. Heart and circulatory physiology, 320(1), H108-H116.
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  Heart failure (HF) post-myocardial infarction (MI) presents with increased vulnerability to monomorphic ventricular tachycardia (mmVT). To appropriately evaluate new therapies for infarct-mediated reentrant arrhythmia in the preclinical setting, chronologic characterization of the preclinical animal model pathophysiology is critical. This study aimed to evaluate the rigor and reproducibility of mmVT incidence in a rodent model of HF. We hypothesize a progressive increase in the incidence of mmVT as the duration of HF increases. Adult male Sprague-Dawley rats underwent permanent left coronary artery ligation or SHAM surgery and were maintained for either 6 or 10 wk. At end point, SHAM and HF rats underwent echocardiographic and invasive hemodynamic evaluation. Finally, rats underwent electrophysiologic (EP) assessment to assess susceptibility to mmVT and define ventricular effective refractory period (ERP). In 6-wk HF rats ( = 20), left ventricular (LV) ejection fraction (EF) decreased ( < 0.05) and LV end-diastolic pressure (EDP) increased ( < 0.05) compared with SHAM ( = 10). Ten-week HF ( = 12) revealed maintenance of LVEF and LVEDP ( > 0.05), ( > 0.05). Electrophysiology studies revealed an increase in incidence of mmVT between SHAM and 6-wk HF ( = 0.0016) and ERP prolongation ( = 0.0186). The incidence of mmVT and ventricular ERP did not differ between 6- and 10-wk HF ( = 1.0000), ( = 0.9831). Findings from this rodent model of HF suggest that once the ischemia-mediated infarct stabilizes, proarrhythmic deterioration ceases. Within the 6- and 10-wk period post-MI, no echocardiographic, invasive hemodynamic, or electrophysiologic changes were observed, suggesting stable HF. This is the necessary context for the evaluation of experimental therapies in rodent HF. Rodent model of ischemic cardiomyopathy exhibits a plateau of inducible monomorphic ventricular tachycardia incidence between 6 and 10 wk postinfarction.
• Gelfman, L. P., Mather, H., McKendrick, K., Wong, A. Y., Hutchinson, M. D., Lampert, R. J., Lipman, H. I., Matlock, D. D., Swetz, K. M., Pinney, S. P., Morrison, R. S., & Goldstein, N. E. (2021). Non-Concordance between Patient and Clinician Estimates of Prognosis in Advanced Heart Failure. Journal of cardiac failure, 27(6), 700-705.
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  Despite efforts to enhance serious illness communication, patients with advanced heart failure (HF) lack prognostic understanding.
• Hutchinson, M. D. (2021). Cardiac resynchronization in pacing-associated cardiomyopathy: Is it time to upgrade?. Heart rhythm O2, 2(6Part B), 680-681.
• Gelfman, L. P., Sudore, R. L., Mather, H., McKendrick, K., Hutchinson, M. D., Lampert, R. J., Lipman, H. I., Matlock, D. D., Swetz, K. M., Pinney, S. P., Morrison, R. S., & Goldstein, N. E. (2020). Prognostic Awareness and Goals of Care Discussions Among Patients With Advanced Heart Failure. Circulation. Heart failure, 13(9), e006502.
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  Prognostic awareness (PA)-the understanding of limited life expectancy-is critical for effective goals of care discussions (GOCD) in which patients discuss their goals and values in the context of their illness. Yet little is known about PA and GOCD in patients with advanced heart failure (HF). This study aims to determine the prevalence of PA among patients with advanced HF and patient characteristics associated with PA and GOCD.
• Hutchinson, M. D., Goldstein, N. E., Morrison, R. J., Pinney, S., Kalman, J., Swetz, K. M., Matlock, D. D., Lipman, H. I., Lampert, R., Gelfman, L. P., McKendrick, K., Mather, H., & Kwok, I. (2020). Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure. Journal of Palliative Medicine, 23(12), 1619-1625. doi:10.1089/jpm.2020.0022
• Hutchinson, M. D., Hutchinson, M. D., Dhakal, B. P., & Dhakal, B. P. (2020). Left Atrial Electroanatomical Voltage Mapping to Characterize Substrate and Guide Ablation. Current Treatment Options in Cardiovascular Medicine, 22(10), 1-23. doi:10.1007/s11936-020-00833-x
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  Despite enthusiasm for catheter ablation of atrial fibrillation, procedural outcomes are less robust when compared to other atrial arrhythmias Adverse atrial remodeling is associated with both the perpetuation of atrial fibrillation as well as decreased responsiveness to restorative therapies. However, characterization of remodeling has historically relied on demographic factors and echocardiographic imaging which provide inadequate insight into the pattern and distribution of atrial fibrosis. Advancements in electroanatomical mapping allow rapid collection of dense three-dimensional maps that display both structural and functional datasets. The purpose of this review is to discuss contemporary studies that seek to determine bipolar electrogram characteristics in patients with and without atrial fibrillation. We will also review studies that use electrogram data to guide substrate-based ablation in AF patients.
• Indik, J., Hutchinson, M., Ajmal, M., & Lee, K. (2020). Outcomes in Patients Implanted With a Watchman Device in Relation to Choice of Anticoagulation and Indication for Implant. J Interv Card Electrophysiol, 64(1), 1-8. doi:10.22541/au.160312877.77986248/v1
• Kwok, I. B., Mather, H., McKendrick, K., Gelfman, L., Hutchinson, M. D., Lampert, R. J., Lipman, H. I., Matlock, D. D., Swetz, K. M., Kalman, J., Pinney, S., Morrison, R. S., & Goldstein, N. E. (2020). Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure. Journal of palliative medicine, 23(12), 1619-1625.
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  Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16,  = 0.252) and skill (-0.20,  = 0.843) after the training session. Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.
• Mehdirad, A., Hutchinson, M. D., & Gerstenfeld, E. P. (2020). Mapping the Left Ventricular Summit for Ablation Success.. The Journal of innovations in cardiac rhythm management, 11(12), 4318-4323. doi:10.19102/icrm.2020.111204
• Bala, R., & Hutchinson, M. D. (2019). Recurrent ventricular tachycardia after catheter ablation in arrhythmogenic right ventricular cardiomyopathy: Scar progression or ineffective ablation?. Journal of cardiovascular electrophysiology.
• Chinyere, I. R., Hutchinson, M., Moukabary, T., Lancaster, J., Goldman, S., & Juneman, E. (2019). Monophasic action potential amplitude for substrate mapping. American journal of physiology. Heart and circulatory physiology, 317(4), H667-H673.
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  Although radiofrequency ablation has revolutionized the management of tachyarrhythmias, the rate of arrhythmia recurrence is a large drawback. Successful substrate identification is paramount to abolishing arrhythmia, and bipolar voltage electrogram's narrow field of view can be further reduced for increased sensitivity. In this report, we perform cardiac mapping with monophasic action potential (MAP) amplitude. We hypothesize that MAP amplitude (MAPA) will provide more accurate infarct sizes than other mapping modalities via increased sensitivity to distinguish healthy myocardium from scar tissue. Using the left coronary artery ligation Sprague-Dawley rat model of ischemic heart failure, we investigate the accuracy of in vivo ventricular epicardial maps derived from MAPA, MAP duration to 90% repolarization (MAPD), unipolar voltage amplitude (UVA), and bipolar voltage amplitude (BVA) compared with gold standard histopathological measurement of infarct size. Numerical analysis reveals discrimination of healthy myocardium versus scar tissue using MAPD ( = 0.0158) and UVA ( < 0.001, = 21). MAPA and BVA decreased between healthy and border tissue ( = 0.0218 and 0.0015, respectively) and border and scar tissue ( = 0.0037 and 0.0094, respectively). Contrary to our hypothesis, BVA mapping performed most accurately regarding quantifying infarct size. MAPA mapping may have high spatial resolution for myocardial tissue characterization but was quantitatively less accurate than other mapping methods at determining infarct size. BVA mapping's superior utility has been reinforced, supporting its use in translational research and clinical electrophysiology laboratories. MAPA may hold potential value for precisely distinguishing healthy myocardium, border zone, and scar tissue in diseases of disseminated fibrosis such as atrial fibrillation. Monophasic action potential mapping in a clinically relevant model of heart failure with potential implications for atrial fibrillation management.
• Goldstein, N. E., Mather, H., McKendrick, K., Gelfman, L. P., Hutchinson, M. D., Lampert, R., Lipman, H. I., Matlock, D. D., Strand, J. J., Swetz, K. M., Kalman, J., Kutner, J. S., Pinney, S., & Morrison, R. S. (2019). Improving Communication in Heart Failure Patient Care. Journal of the American College of Cardiology, 74(13), 1682-1692.
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  Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heart failure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function.
• Harhash, A. A., Huang, J. J., Reddy, S., Natarajan, B., Balakrishnan, M., Shetty, R., Hutchinson, M. D., & Kern, K. B. (2019). aVR ST Segment Elevation: Acute STEMI or NOT? Incidence of an Acute Coronary Occlusion. The American journal of medicine.
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  Identification of ST-elevation myocardial infarction is critical as early reperfusion can save myocardium and increase survival. ST-elevation (STE) in aVR, co-existent with multi-lead ST-depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI Guidelines. We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multi-lead ST-depression.
• Hutchinson, M. D., & Dhakal, B. P. (2019). Normal Relativism: The Impact of Remodeling on Electrogram Amplitude After Myocardial Infarction. JACC. Clinical electrophysiology, 5(10), 1127-1129.
• Hutchinson, M. D., Jagielski, D., Butter, C., Hayes, J. J., Merliss, A. D., Drucker, M., Peterson, M., Smith, T. W., Saleem, M. A., Gupta, S., Gutleben, K., Stellbrink, C., Westlund, R., Costanzo, M. R., Afzal, M. R., & Augostini, R. (2019). How to implant a phrenic nerve stimulator for treatment of central sleep apnea?. Journal of Cardiovascular Electrophysiology, 30(5), 792-799. doi:10.1111/jce.13898
• Gordon, J. P., Liang, J. J., Pathak, R. K., Zado, E. S., Garcia, F. C., Hutchinson, M. D., Santangeli, P., Schaller, R. D., Frankel, D. S., Marchlinski, F. E., & Supple, G. E. (2018). Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation. Journal of cardiovascular electrophysiology, 29(12), 1654-1663.
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  Catheter ablation of ventricular arrhythmias (VA) from the papillary muscles (PM) is challenging due to limited catheter stability and contact on the PMs with their anatomic complexity and mobility.
• Hutchinson, M. D., & Garza, H. (2018). Contemporary Tools and Techniques for Substrate Ablation of Ventricular Tachycardia in Structural Heart Disease. Current Treatment Options in Cardiovascular Medicine, 20(2). doi:10.1007/s11936-018-0610-6
• Hutchinson, M. D., & Garza, H. K. (2018). Contemporary Tools and Techniques for Substrate Ablation of Ventricular Tachycardia in Structural Heart Disease. Current treatment options in cardiovascular medicine, 20(2), 16.
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  As we have witnessed in other arenas of catheter-based therapeutics, ventricular tachycardia (VT) ablation has become increasingly anatomical in its execution. Multi-modality imaging provides anatomical detail in substrate characterization, which is often complex in nonischemic cardiomyopathy patients. Patients with intramural, intraseptal, and epicardial substrates provide challenges in delivering effective ablation to the critical arrhythmia substrate due to the depth of origin or the presence of adjacent critical structures. Novel ablation techniques such as simultaneous unipolar or bipolar ablation can be useful to achieve greater lesion depth, though at the expense of increasing collateral damage. Disruptive technologies like stereotactic radioablation may provide a tailored approach to these complex patients while minimizing procedural risk. Substrate ablation is a cornerstone of the contemporary VT ablation procedure, and recent data suggest that it is as effective and more efficient that conventional activation guided ablation. A number of specific targets and techniques for substrate ablation have been described, and all have shown a fairly high success in achieving their acute procedural endpoint. Substrate ablation also provides a novel and reproducible procedural endpoint, which may add predictive value for VT recurrence beyond conventional programmed stimulation. Extrapolation of outcome data to nonischemic phenotypes requires caution given both the variability in substrate nonischemic distribution and the underrepresentation of these patients in previous trials.
• Hutchinson, M. D., Klewer, J. A., Garza, H., & Suryanarayana, P. (2018). Electrophysiologic Considerations After Sudden Cardiac Arrest. Current Cardiology Reviews, 14(2), 102-108. doi:10.2174/1573403x14666180507164443
• Liang, J. J., D'Souza, B. A., Betensky, B. P., Zado, E. S., Desjardins, B., Santangeli, P., Chik, W. W., Frankel, D. S., Callans, D. J., Supple, G. E., Hutchinson, M. D., Dixit, S., Schaller, R. D., Garcia, F. C., Lin, D., Riley, M. P., & Marchlinski, F. E. (2018). Importance of the Interventricular Septum as Part of the Ventricular Tachycardia Substrate in Nonischemic Cardiomyopathy. JACC. Clinical electrophysiology, 4(9), 1155-1162.
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  This study sought to characterize septal substrate in patients with nonischemic left ventricular cardiomyopathy (NILVCM) undergoing ventricular tachycardia (VT) ablation.
• Mendelson, T. B., Santangeli, P. M., Frankel, D. S., Arkles, J. S., Supple, G. E., Lin, D., Riley, M. P., Callans, D. J., Nazarian, S., Hyman, M. C., Kumareswaran, R., Epstein, A. E., Deo, R., Dixit, S., Garcia, F. C., Zado, E. S., Hutchinson, M. D., Sadek, M. M., Cooper, J. M., , Marchlinski, F. E., et al. (2018). Feasibility of Complex Trans-Femoral Electrophysiology Procedures in Patients with Inferior Vena Cava Filters. Heart rhythm.
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  Presence of inferior vena cava filters (IVCFs) have been considered a relative contraindication to electrophysiology (EP) procedures that require trans-femoral venous placement of multiple catheters and/or long sheaths. There are inadequate data related to complex EP procedures in this population.
• Suryanarayana, P., Garza, H. K., Klewer, J., & Hutchinson, M. D. (2018). Electrophysiologic Considerations After Sudden Cardiac Arrest. Current cardiology reviews, 14(2), 102-108.
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  Sudden Cardiac Death (SCD) remains a major public health concern, accounting for more than 50% of cardiac deaths. The majority of these deaths are related to ischemic heart disease, however increasingly recognized are non-ischemic causes such as cardiac channelopathies. Bradyarrhythmias and pulseless electrical activity comprise a larger proportion of out-ofhospital arrests than previously realized, particularly in patients with more advanced heart failure or noncardiac triggers such as pulmonary embolism. Patients surviving Sudden Cardiac Arrest (SCA) have a substantial risk of recurrence, particularly within 18 months post event. The timing of tachyarrhythmias complicating acute infarction has important implications regarding the likelihood of recurrence, with those occurring within 48 hours having a more favorable long-term outcome. In the absence of a clear reversible cause, implantable cardioverter defibrillators remain the mainstay in the secondary prevention of SCD. Post defibrillation electromechanical dissociation is common in patients with cardiomyopathy and can lead to SCD despite successful defibrillation of the primary tachyarrhythmia. Antiarrhythmic agents are highly effective in preventing recurrent arrhythmias in specific diseases such as the congenital long QT syndrome.
• Zado, E. S., Vallabhajosyula, P., Szeto, W. Y., Supple, G. E., Schaller, R. D., Santangeli, P., Riley, M. P., Muser, D., Marchlinski, F. E., Lin, D., Liang, J. J., Hutchinson, M. D., Frankel, D. S., Dixit, S., Desai, N. D., Deo, R., Callans, D. J., Betensky, B. P., Bavaria, J. E., , Anter, E., et al. (2018). Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy.. 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, 20(3), e30-e41. doi:10.1093/europace/eux029
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  Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA..Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001)..In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.
• Derkac, W. M., Finkelmeier, J. R., Horgan, D. J., & Hutchinson, M. D. (2017). Diagnostic yield of asymptomatic arrhythmias detected by mobile cardiac outpatient telemetry and autotrigger looping event cardiac monitors. Journal of cardiovascular electrophysiology.
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  Asymptomatic arrhythmias can have important therapeutic implications in certain patient populations, for example, atrial fibrillation in patients with prior ischemic stroke. We sought to compare the diagnostic yield of two commercially available monitoring systems with automated arrhythmia detection algorithms.
• Hayashi, T., Santangeli, P., Pathak, R. K., Muser, D., Liang, J. J., Castro, S. A., Garcia, F. C., Hutchinson, M. D., Supple, G. E., Frankel, D. S., Riley, M. P., Lin, D., Schaller, R. D., Dixit, S., Callans, D. J., Zado, E. S., & Marchlinski, F. E. (2017). Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity. Journal of cardiovascular electrophysiology.
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  In outflow tract ventricular arrhythmias (OT-VAs), an abrupt loss of the R wave in lead V2 compared to V1 and V3 (pattern break in V2-PBV2) suggests an origin close to the anterior interventricular sulcus (anatomically opposite to lead V2) and adjacent to proximal coronaries. We studied the outcome of catheter ablation of OT-VAs with a PBV2.
• Huang-tsang, J., Shetty, R., Shetty, R., Reddy, S., Natarajan, B., Kern, K. B., Hutchinson, M. D., Harhash, A., & Balakrishnan, M. (2017). TCT-388 Does ST Segment Elevation in Lead aVR Correlate with Left Main Occlusion?. Journal of the American College of Cardiology, 70(18), B159. doi:10.1016/j.jacc.2017.09.484
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  Prompt identification of ST-elevation myocardial infarction (STEMI) on ECG is critical as early reperfusion can be lifesaving. The ACCF/AHA guidelines established that ST elevation (STE) must be present in at least 2 contiguous leads to qualify for a diagnosis of STEMI. STE in aVR, co-existent with
• Lancaster, J., Novak, S., Witte, R., Weigand, K., Moukabary, T., Juneman, E., Hutchinson, M., Gregorio, C., Goldman, S., Chu, M., & Chinyere, I. (2017). Abstract 86: Mapping and Inducing Ventricular Tachycardia in Cardiomyopathic Animal Models. Circulation Research, 121(suppl_1). doi:10.1161/res.121.suppl_1.86
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  Introduction: In the United States, one in three deaths is attributed to cardiovascular disease (CVD). With CVD, sudden cardiac death is a common cause of mortality, specifically by way of ventricular tachycardia (VT) and ventricular fibrillation. We propose the application of our custom software to evaluate the electrophysiologic (EP) properties of animal models of ischemic and non-ischemic dilated cardiomyopathies. Methods: Adult male Sprague-Dawley rats with left coronary artery ligation and adult male and female transgenic Fragile X cardiomyopathic mice were sedated with Inactin and Isoflurane, respectively, and underwent hemodynamic measurements and/or EP testing. Using a PowerLab system and LabChart software, three-lead electrocardiograms were recorded. Using a pressure catheter, hemodynamic parameters were calculated. Using a concentric microelectrode (World Precision Inc.), a clinical EP catheter (Bard Inc.), and custom MATLAB software, local epicardial monophasic action potentials (MAP) and local epicardial voltages were recorded. Using custom MATLAB software for programmed electrical stimulation (PES), VT was induced epicardially with a clinically-accepted drivetrain. Animals underwent eight equidistant ‘S1’ stimulations followed by a premature ‘S2’ stimulation. The S2 stimulation was decreased by 5 milliseconds until loss of capture, indicating the effective refractory period. Sustained ventricular tachycardia (sVT) has been defined as more than fifteen consecutive premature ventricular contractions. Results: The chronic heart failure (CHF) rats had documented hemodynamic heart failure with elevated LV EDPs, and decreased EFs. Mapping and PES was performed on the two groups of rats, namely CHF and Sham-operated. In the CHF group, 71% (27/39) of the rats exhibited sVT, while 0% (0/10) of the Sham-operated rats exhibited sVT. Mapping was also performed on the two groups of mice, namely Wild-Type and Fragile X. Conclusions: We have performed clinically-relevant EP studies in CHF rats and in Fragile X dilated cardiomyopathic mice. These EP studies demonstrate our ability to evaluate and validate the phenotypes of animal models of cardiomyopathies and demonstrate the potential to evaluate the effectiveness of new therapies.
• Liang, J. J., Betensky, B. P., Muser, D., Zado, E. S., Anter, E., Desai, N. D., Callans, D. J., Deo, R., Frankel, D. S., Hutchinson, M. D., Lin, D., Riley, M. P., Schaller, R. D., Supple, G. E., Santangeli, P., Acker, M. A., Bavaria, J. E., Szeto, W. Y., Vallabhajosyula, P., , Marchlinski, F. E., et al. (2017). Long-term outcome of surgical cryoablation for refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy. 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.
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  Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
• Liang, J. J., Yang, W., Santangeli, P., Schaller, R. D., Supple, G. E., Hutchinson, M. D., Garcia, F., Lin, D., Dixit, S., Epstein, A. E., Callans, D. J., Marchlinski, F. E., & Frankel, D. S. (2017). Amiodarone Discontinuation or Dose Reduction Following Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease. JACC. Clinical electrophysiology, 3(5), 503-511.
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  This study sought to examine long-term outcomes in patients with structural heart disease in whom amiodarone was reduced/discontinued after ventricular tachycardia (VT) ablation.
• Tandri, H., & Hutchinson, M. D. (2017). Scar-Related Right Ventricular Tachycardias in Athletes: Too Much of a Good Thing?. Journal of the American College of Cardiology, 69(5), 508-510.
• Hutchinson, M. D., Marchlinski, F. E., Riley, M. P., Zado, E. S., Callans, D. J., Schaller, R. D., Lin, D., Frankel, D. S., Supple, G. E., Desjardins, B., Garcia, F. C., Dixit, S., Pathak, R. K., Magnani, S., Muser, D., Santangeli, P., & Castro, S. A. (2016). Abstract 15236: Mode of Initiation and Timing of Spontaneous Ventricular Arrhythmias in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation.
• Liang, J. J., Elafros, M. A., Muser, D., Pathak, R. K., Santangeli, P., Zado, E. S., Frankel, D. S., Supple, G. E., Schaller, R. D., Deo, R., Garcia, F. C., Lin, D., Hutchinson, M. D., Riley, M. P., Callans, D. J., Marchlinski, F. E., & Dixit, S. (2016). Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation. Circulation. Arrhythmia and electrophysiology, 9(11).
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  Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure.
• Muser, D., Santangeli, P., Castro, S. A., Pathak, R. K., Liang, J. J., Hayashi, T., Magnani, S., Garcia, F. C., Hutchinson, M. D., Supple, G. G., Frankel, D. S., Riley, M. P., Lin, D., Schaller, R. D., Dixit, S., Zado, E. S., Callans, D. J., & Marchlinski, F. E. (2016). Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy. Circulation. Arrhythmia and electrophysiology, 9(10).
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  Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy.
• Muser, D., Santangeli, P., Pathak, R. K., Castro, S. A., Liang, J. J., Magnani, S., Hayashi, T., Garcia, F. C., Hutchinson, M. D., Supple, G. E., Frankel, D. S., Riley, M. P., Lin, D., Schaller, R. D., Desjardins, B., Dixit, S., Callans, D. J., Zado, E. S., & Marchlinski, F. E. (2016). Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis. Circulation. Arrhythmia and electrophysiology, 9(8).
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  Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis.
• Sadek, M. M., Maeda, S., Chik, W., Santangeli, P., Zado, E. S., Schaller, R. D., Supple, G. E., Frankel, D. S., Hutchinson, M. D., Garcia, F. C., Riley, M. P., Lin, D., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2016). Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation. Heart rhythm : the official journal of the Heart Rhythm Society.
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  Atrial arrhythmias may still occur in patients after durable pulmonary vein isolation (PVI).
• Santangeli, P., Hutchinson, M. D., Supple, G. E., Callans, D. J., Marchlinski, F. E., & Garcia, F. C. (2016). Right Atrial Approach for Ablation of Ventricular Arrhythmias Arising From the Left Posterior-Superior Process of the Left Ventricle. Circulation. Arrhythmia and electrophysiology, 9(7).
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  The posterior-superior process of the left ventricle (PSP-LV) is the most inferior and posterior aspect of the basal LV that extends posteriorly to the plane of the tricuspid valve. The PSP-LV is anatomically adjacent to the inferior and medial aspect of the right atrium (RA). We report a series of patients with ventricular arrhythmias (VAs) arising from the PSP-LV and describe a mapping and ablation approach from the RA guided by intracardiac echocardiography.
• Santangeli, P., Zado, E. S., Hutchinson, M. D., Riley, M. P., Lin, D., Frankel, D. S., Supple, G. E., Garcia, F. C., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2016). Prevalence and distribution of focal triggers in persistent and long-standing persistent atrial fibrillation. Heart rhythm : the official journal of the Heart Rhythm Society, 13(2), 374-82.
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  The relevance of focal triggers in persistent atrial fibrillation (PerAF) and long-standing persistent atrial fibrillation (LSPAF) has not been previously investigated.
• Akoum, N., Wilber, D., Hindricks, G., Jais, P., Cates, J., Marchlinski, F., Kholmovski, E., Burgon, N., Hu, N., Mont, L., Deneke, T., Duytschaever, M., Neumann, T., Mansour, M., Mahnkopf, C., Hutchinson, M., Herweg, B., Daoud, E., Wissner, E., , Brachmann, J., et al. (2015). MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study. Journal of cardiovascular electrophysiology, 26(5), 473-80.
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  There is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF.
• Favilla, C. G., Ingala, E., Jara, J., Fessler, E., Cucchiara, B., Messé, S. R., Mullen, M. T., Prasad, A., Siegler, J., Hutchinson, M. D., & Kasner, S. E. (2015). Predictors of finding occult atrial fibrillation after cryptogenic stroke. Stroke; a journal of cerebral circulation, 46(5), 1210-5.
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  Occult paroxysmal atrial fibrillation (AF) is found in a substantial minority of patients with cryptogenic stroke. Identifying reliable predictors of paroxysmal AF after cryptogenic stroke would allow clinicians to more effectively use outpatient cardiac monitoring and ultimately reduce secondary stroke burden.
• Frankel, D. S., Liang, J. J., Supple, G., Dixit, S., Hutchinson, M. D., Elafros, M. A., Callans, D. J., & Marchlinski, F. E. (2015). Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation. JACC. Clinical electrophysiology, 1(5), 398-407.
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  This study sought to identify predictors of transplantation/left ventricular assist device (LVAD)-free survival among patients with left ventricular nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT).
• Hutchinson, M. D. (2015).

  Idiopathic Premature Ventricular Contraction Ablation: Prime Time or Second Line?

   

  . JACC: Clinical Electrophysiology, 1(3), 124-126. doi:10.1016/j.jacep.2015.05.001
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  Repetitive premature ventricular contractions (PVCs) cause significant morbidity in a minority of affected individuals. Although most patients with symptomatic ectopy endorse nondisabling palpitations, more severe manifestations are relatively common. A reduction in cardiac output during ectopic
• Hutchinson, M. D. (2015). Idiopathic Premature Ventricular Contraction Ablation: Prime Time or Second Line?. JACC. Clinical electrophysiology, 1(3), 124-126.
• Hutchinson, M. D. (2015). Multielectrode left ventricular mapping: too much or not enough?. Pacing and clinical electrophysiology : PACE, 38(6), 660-2.
• Hutchinson, M. D. (2015). Pulmonic Cusp Ablation: Novel Mechanism or a New Approach to an Old Problem?. Journal of the American College of Cardiology, 66(23), 2645-7.
• Hutchinson, M. D., Bala, R., Dixit, S., Callans, D. J., Desjardins, B., Garcia, F. C., Supple, G. E., Riley, M. P., Frankel, D. S., Lin, D., Benhayon, D., Zado, E. S., Marchlinski, F. E., & Santangeli, P. (2015). Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising From the Left Ventricular Summit. Circulation-arrhythmia and Electrophysiology, 8(2), 337-343. doi:10.1161/circep.114.002377
• Hutchinson, M. D., Marchlinski, F. E., Callans, D. J., Elafros, M. A., Supple, G. E., Dixit, S., & Frankel, D. S. (2015). Electrophysiological Predictors of Transplantation and Left Ventricular Assist Device-Free Survival in Patients With Nonischemic Cardiomyopathy Undergoing Ventricular Tachycardia Ablation. JACC: Clinical Electrophysiology, 1(5), 398-407. doi:10.1016/j.jacep.2015.07.005
• Liang, J. J., Elafros, M. A., Chik, W. W., Santangeli, P., Zado, E. S., Frankel, D. S., Supple, G. E., Schaller, R. D., Lin, D., Hutchinson, M. D., Riley, M. P., Callans, D. J., Marchlinski, F. E., & Dixit, S. (2015). Early recurrence of atrial arrhythmias following pulmonary vein antral isolation: Timing and frequency of early recurrences predicts long-term ablation success. Heart rhythm : the official journal of the Heart Rhythm Society, 12(12), 2461-8.
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  Early recurrence of atrial arrhythmia (ERAA) is common after atrial fibrillation (AF) ablation and is associated with long-term recurrence. However, the association between timing or frequency of ERAA and long-term ablation success remains unclear.
• Lin, D., Santangeli, P., Zado, E. S., Bala, R., Hutchinson, M. D., Riley, M. P., Frankel, D. S., Garcia, F., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2015). Electrophysiologic findings and long-term outcomes in patients undergoing third or more catheter ablation procedures for atrial fibrillation. Journal of cardiovascular electrophysiology, 26(4), 371-7.
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  Pulmonary vein (PV) status, arrhythmia sources, and outcomes with ≥3 ablation procedures have not been characterized.
• Mountantonakis, S. E., Elkassabany, N., Kondapalli, L., Marchlinski, F. E., Mandel, J. E., & Hutchinson, M. D. (2015). Provocation of atrial fibrillation triggers during ablation: does the use of general anesthesia affect inducibility?. Journal of cardiovascular electrophysiology, 26(1), 16-20.
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  The autonomic nervous system exerts important effects upon atrial fibrillation (AF) initiation. The strategy of anesthesia used during AF ablation may impact the provocation of AF triggers. We hypothesized that the use of general anesthesia (GA) would reduce the incidence of provokable AF triggers in patients undergoing AF ablation compared to patients studied while receiving only conscious sedation (CS).
• Mountantonakis, S. E., Frankel, D. S., Tschabrunn, C. M., Hutchinson, M. D., Riley, M. P., Lin, D., Bala, R., Garcia, F. C., Dixit, S., Callans, D. J., Zado, E. S., & Marchlinski, F. E. (2015). Ventricular arrhythmias from the coronary venous system: Prevalence, mapping, and ablation. Heart rhythm : the official journal of the Heart Rhythm Society, 12(6), 1145-53.
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  The coronary venous system (CVS) is linked to the origin of idiopathic epicardial ventricular arrhythmias (VAs).
• Sadek, M. M., Benhayon, D., Sureddi, R., Chik, W., Santangeli, P., Supple, G. E., Hutchinson, M. D., Bala, R., Carballeira, L., Zado, E. S., Patel, V. V., Callans, D. J., Marchlinski, F. E., & Garcia, F. C. (2015). Idiopathic ventricular arrhythmias originating from the moderator band: Electrocardiographic characteristics and treatment by catheter ablation. Heart rhythm : the official journal of the Heart Rhythm Society, 12(1), 67-75.
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  The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF).
• Santangeli, P., Marchlinski, F. E., Zado, E. S., Benhayon, D., Hutchinson, M. D., Lin, D., Frankel, D. S., Riley, M. P., Supple, G. E., Garcia, F. C., Bala, R., Desjardins, B., Callans, D. J., & Dixit, S. (2015). Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success. Circulation. Arrhythmia and electrophysiology, 8(2), 337-43.
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  Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation.
• Santangeli, P., Muser, D., Zado, E. S., Magnani, S., Khetpal, S., Hutchinson, M. D., Supple, G., Frankel, D. S., Garcia, F. C., Bala, R., Riley, M. P., Lin, D., Rame, J. E., Schaller, R., Dixit, S., Marchlinski, F. E., & Callans, D. J. (2015). Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circulation. Arrhythmia and electrophysiology, 8(1), 68-75.
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  The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated.
• Santangeli, P., Zado, E. S., Supple, G. E., Haqqani, H. M., Garcia, F. C., Tschabrunn, C. M., Callans, D. J., Lin, D., Dixit, S., Hutchinson, M. D., Riley, M. P., & Marchlinski, F. E. (2015). Long-Term Outcome With Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation. Arrhythmia and electrophysiology, 8(6), 1413-21.
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  Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy improves short-term VT-free survival. We sought to determine the long-term outcomes of VT control and need for antiarrhythmic drug therapy after endocardial (ENDO) and adjuvant epicardial (EPI) substrate modification in patients with arrhythmogenic right ventricular cardiomyopathy.
• Aldhoon, B., Frankel, D. S., Hutchinson, M. D., Callans, D. J., Epstein, A. E., Dixit, S., Riley, M. P., Lin, D., Garcia, F. C., Supple, G. E., Cooper, J. M., Bala, R., Deo, R., Zado, E. S., & Marchlinski, F. E. (2014). Unipolar voltage abnormality is associated with greater left ventricular dysfunction in ischemic cardiomyopathy. Journal of cardiovascular electrophysiology, 25(3), 293-8.
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  Following myocardial infarction (MI), left ventricular function is determined by cardiac remodeling occurring in both infarcted and noninfarcted myocardium (NIM). Unipolar voltage mapping may detect remodeling changes in NIM that are associated with the left ventricular ejection fraction (LVEF). We aimed to identify (1) unipolar voltage characteristics in patients with chronic MI, and (2) association of voltage abnormalities with degree of left ventricular dysfunction (LVD).
• Goldstein, N. E., Kalman, J., Kutner, J. S., Fromme, E. K., Hutchinson, M. D., Lipman, H. I., Matlock, D. D., Swetz, K. M., Lampert, R., Herasme, O., & Morrison, R. S. (2014). A study to improve communication between clinicians and patients with advanced heart failure: methods and challenges behind the working to improve discussions about defibrillator management trial. Journal of pain and symptom management, 48(6), 1236-46.
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  We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.
• Hutchinson, M. D. (2014). Redefining the golden ratio: a novel ECG tool for approaching outflow tract arrhythmias. Journal of cardiovascular electrophysiology, 25(7), 754-5.
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Zado, E. S., Squara, F., Dixit, S., Supple, G. E., Callans, D. J., Garcia, F. C., Lin, D., Riley, M. P., Frankel, D. S., & Liuba, I. (2014). Scar progression in patients with nonischemic cardiomyopathy and ventricular arrhythmias. Heart Rhythm, 11(5), 755-762. doi:10.1016/j.hrthm.2014.02.012
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  Background Disease progression in patients with nonischemic cardiomyopathy (NICM) is poorly understood. Objective To assess left ventricular (LV) scar progression and dilatation by using endocardial electroanatomic mapping. Methods We studied 13 patients with NICM and recurrent ventricular tachycardia. Two detailed sinus rhythm endocardial voltage maps (265 ± 122 points/map) were obtained after a mean of 32 months (range 9–77 months). The scar area, defined by low bipolar (BI;
• Hutchinson, M. D., Morrison, R. J., Herasme, O., Lampert, R., Swetz, K. M., Matlock, D. D., Lipman, H. I., Fromme, E. K., Kutner, J. S., Kalman, J., & Goldstein, N. E. (2014). A Study to Improve Communication Between Clinicians and Patients With Advanced Heart Failure: Methods and Challenges Behind the Working to Improve Discussions About Defibrillator Management Trial. Journal of Pain and Symptom Management, 48(6), 1236-46. doi:10.1016/j.jpainsymman.2014.03.005
• Liuba, I., Frankel, D. S., Riley, M. P., Hutchinson, M. D., Lin, D., Garcia, F. C., Callans, D. J., Supple, G. E., Dixit, S., Bala, R., Squara, F., Zado, E. S., & Marchlinski, F. E. (2014). Scar progression in patients with nonischemic cardiomyopathy and ventricular arrhythmias. Heart rhythm : the official journal of the Heart Rhythm Society, 11(5), 755-62.
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  Disease progression in patients with nonischemic cardiomyopathy (NICM) is poorly understood.
• Patel, P. J., Ahlemeyer, L., Freas, M., Cooper, J. M., Marchlinski, F. E., Callans, D. J., & Hutchinson, M. D. (2014). Outflow tract premature ventricular depolarizations after atrial fibrillation ablation may reflect autonomic influences. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 41(2), 187-92.
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  Autonomic modulation following catheter ablation of atrial fibrillation may promote the development of catecholamine-sensitive arrhythmias, such as outflow tract (OT) ventricular premature depolarizations (VPDs). The purpose of this study was to determine the incidence and prognostic significance of OT VPDs occurring in patients after atrial fibrillation (AF) ablation.
• Prasad, A., Mullen, M. T., Messe, S. R., Kasner, S. E., Jara, J., Ingala, E., Hutchinson, M. D., Fessler, E., & Cucchiara, B. (2014). Abstract 24: Predictors of Occult Atrial Fibrillation in Cryptogenic Stroke. Stroke, 45. doi:10.1161/str.45.suppl_1.24
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  Background and Purpose: Prolonged cardiac monitoring may identify paroxysmal atrial fibrillation (AF) in patients with cryptogenic stroke. We aimed to identify clinical, echocardiographic, and neuroimaging features which may increase the efficiency of detecting AF on cardiac monitoring. Methods: We studied a retrospective cohort of 227 subjects with cryptogenic ischemic stroke referred for 28 day mobile cardiac outpatient telemetry (MCOT). Patients with large artery disease or high risk sources of cardioembolism were excluded. We reviewed medical records, brain images, and echocardiograms, blinded to MCOT results. Acute and/or chronic infarctions were characterized by size, location, and as cortical, subcortical, or both; wedge-shaped; lacunar; borderzone; and/or multiple territories. Cardiac features included left atrial (LA) size, ejection fraction, aortic arch atheroma, and PFO. Variables were tested in univariate analyses and further incorporated in a multivariate logistic regression model to determine independent predictors of detecting AF. Results: The cohort age was 62.9±2.9 years, 42% were men, and 53% were white. Median CHADS was 3 and CHADS2Vasc was 5. Infarcts were >1.5 cm in 62% of subjects, predominantly cortical in 47%, subcortical in 39%. Only 9% were single, deep, and 60 (OR 3.6 [1.2-10.4], p=0.02) and prior (chronic) cortical or cerebellar infarction (OR 3.3 [1.3-8.6], p=0.013) (C-statistic 0.72). There was no association with any other clinical, echocardiographic, or radiographic parameter. AF was detected in 32% of patients with age >60 and the presence of prior cortical or cerebellar infarction, compared to 4% with neither of these factors. Conclusion: Atrial fibrillation is detected on MCOT in a substantial minority of cryptogenic stroke patients. Age>60 and the presence of prior cortical or cerebellar strokes are predictive of detecting AF in these patients. Other brain and cardiac characteristics were not found to be helpful. These data may aid in the selection of patients for prolonged arrhythmia monitoring.
• Prasad, A., Mullen, M. T., Messe, S. R., Kasner, S. E., Jara, J., Ingala, E., Hutchinson, M. D., Fessler, E., & Cucchiara, B. (2014). Mobile Cardiac Outpatient Telemetry Identifies Occult Atrial Fibrillation After Cryptogenic Stroke (S12.004). Neurology, 82.
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  OBJECTIVE: We aimed to assess the prevalence of occult atrial fibrillation (AF), as detected by mobile cardiac outpatient telemetry (MCOT), in patients with recent cryptogenic stroke, and to identify clinical, echocardiographic, and neuroimaging features which may increase the efficiency of detecting AF on cardiac monitoring. BACKGROUND: Paroxysmal AF is often found in patients with cryptogenic stroke, and poses a high risk of subsequent stroke. DESIGN/METHODS: We studied a retrospective cohort of 227 subjects with cryptogenic ischemic stroke referred for 28 day MCOT. We reviewed records, neuroimaging, and echocardiograms, blinded to MCOT results. Acute and/or chronic infarctions were characterized by size, location, and as cortical, subcortical, or both; wedge-shaped; lacunar; borderzone; and/or multiple territories. Cardiac features included left atrial (LA) size, ejection fraction, aortic arch atheroma, and PFO. Variables from univariate analyses were further incorporated in a multivariate logistic regression model. RESULTS: The cohort age was 62.9±2.9 years, 42% were men, and 53% were white. Median CHADS was 3 and CHADS2Vasc was 5. Infarcts were 蠅1.5 cm in 62% of subjects, predominantly cortical in 47%, subcortical in 39%. Only 9% were single, deep, and less than 1.5 cm. LA size was 3.6±0.7 cm and ejection fraction was 61±9%. MCOT detected AF in 30 (13%) patients. In multivariate analysis, AF was only associated with age蠅60 (OR 3.6 [1.2-10.4], p=0.02) and prior (chronic) cortical or cerebellar infarction (OR 3.3 [1.3-8.6], p=0.013) (C-statistic 0.72). There was no association with any other clinical, echocardiographic, or radiographic parameter. AF was detected in 32% of patients with age蠅60 and the presence of prior cortical or cerebellar infarction, compared to 4% with neither of these factors. CONCLUSIONS: Atrial fibrillation is detected on MCOT in a substantial minority of cryptogenic stroke patients. Age蠅60 and the presence of prior cortical or cerebellar strokes should raise suspicion for occult AF. These data may aid in the selection of patients for prolonged arrhythmia monitoring. Disclosure: Dr. Ingala has nothing to disclose. Dr. Jara has nothing to disclose. Dr. Fessler has nothing to disclose. Dr. Cucchiara has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals, Inc. as a speaker. Dr. Messe has received personal compensation for activities with GlaxoSmithKline, Inc. Dr. Messe has received research support from WL Gore, and GlaxoSmithKline, Inc. Dr. Mullen has nothing to disclose. Dr. Prasad has nothing to disclose. Dr. Hutchinson has nothing to disclose. Dr. Kasner has received personal compensation for activities with Pfizer Inc, Novartis, AstraZeneca Pharmaceuticals, Parexel, Brainsgate, Medtronic, Inc., and Boehringer Ingelheim. Dr. Kasner has received personal compensation in an editorial capacity for Up To Date. Dr. Kasner has receied research support from WL Gore & Associates, Acorda, and Asubio.
• Riley, M. P., Zado, E., Hutchinson, M. D., Lin, D., Bala, R., Garcia, F. C., Callans, D. J., Cooper, J. M., Verdino, R. J., Dixit, S., & Marchlinski, F. E. (2014). Risk of stroke or transient ischemic attack after atrial fibrillation ablation with oral anticoagulant use guided by ECG monitoring and pulse assessment. Journal of cardiovascular electrophysiology, 25(6), 591-6.
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  We sought to gain insight into stroke risk after atrial fibrillation (AF) ablation.
• Sadek, M. M., Schaller, R. D., Supple, G. E., Frankel, D. S., Riley, M. P., Hutchinson, M. D., Garcia, F. C., Lin, D., Dixit, S., Zado, E. S., Callans, D. J., & Marchlinski, F. E. (2014). Ventricular Tachycardia Ablation - The Right Approach for the Right Patient. Arrhythmia & electrophysiology review, 3(3), 161-7.
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  Scar-related reentry is the most common mechanism of monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Catheter ablation has assumed an increasingly important role in the management of VT in this setting, and has been shown to reduce VT recurrence and implantable cardioverter defibrillator (ICD) shocks. The approach to mapping and ablation will depend on the underlying heart disease etiology, VT inducibility and haemodynamic stability. This review explores pre-procedural planning, approach to ablation of both mappable and unmappable VT, and post-procedural testing. Future developments in techniques and technology that may improve outcomes are discussed.
• Van Herendael, H., Zado, E. S., Haqqani, H., Tschabrunn, C. M., Callans, D. J., Frankel, D. S., Lin, D., Garcia, F., Hutchinson, M. D., Riley, M., Bala, R., Dixit, S., Yadava, M., & Marchlinski, F. E. (2014). Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers. Heart rhythm : the official journal of the Heart Rhythm Society, 11(4), 566-73.
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  Monomorphic ventricular premature depolarizations (VPDs) have been found to initiate ventricular fibrillation (VF) or polymorphic ventricular tachycardia (PMVT) in patients with and without structural heart disease.
• Zado, E. S., Santangeli, P., Muser, D., Marchlinski, F. E., Hutchinson, M. D., Epstein, A. J., & Callans, D. J. (2014). COMPARATIVE EFFECTIVENESS OF LEFT VENTRICULAR VERSUS BIVENTRICULAR PACING FOR CARDIAC RESYNCHRONIZATION THERAPY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Journal of the American College of Cardiology, 63(12), A317. doi:10.1016/s0735-1097(14)60317-x
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  Cardiac resynchronization therapy (CRT) reduces symptoms and improves survival in patients with severe left ventricular (LV) dysfunction and a prolonged QRS duration. The extent to which such benefit is due to biventricular (BV) versus LV pacing is unclear. This systematic review and meta-analysis
• Zado, E., Tschabrunn, C., Supple, G., Schaller, R., Santangeli, P., Riley, M., Marchlinski, F., Liuba, I., Lin, D., Hutchinson, M., Garcia, F., Frankel, D., Callans, D., Bala, R., Zado, E. S., Tschabrunn, C. M., Supple, G. E., Schaller, R. D., Santangeli, P., , Riley, M., et al. (2014). Abstract 12941: Disease Progression in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Ventricular Tachycardia: A Longitudinal Study With Unipolar Voltage Mapping. Circulation, 130(suppl_2). doi:10.1161/circ.130.suppl_2.12941
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  Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is believed to result in progressive fibrofatty replacement of the RV myocardium with development of multiple ventricular tachycardia (VT) circuits. Endocardial unipolar voltage mapping has been shown to reliably identify epicardial and endocardial (epi-endo) scar in ARVC. Hypothesis: We studied the prevalence and mechanisms of disease progression in patients with ARVC and VT through longitudinal unipolar voltage mapping studies. Methods: Eighteen consecutive patients (age 38±14 years) who fulfilled the revised Task Force criteria for ARVC underwent two detailed sinus rhythm endocardial unipolar voltage maps (mean 348±118 points) performed a median of 36 months apart (interquartile range 21 to 36 months, minimum 9 months) as part of VT ablation procedures. Epi-endo scar was defined using established unipolar voltage cutoff (5.5 mV). The extent of RV scar and total RV volume was measured by a dedicated software. A >5% increase in RV scar area or volume over follow-up was considered significant. Results: At baseline, all patients had evidence of epi-endo RV scar (mean 141±82 cm 2 ; 56±27% of the RV surface area). After a mean follow-up of 49±36 months, no significant progression of unipolar voltage scar was observed (mean 159±83 cm 2 , P=0.14; 63±27% of the RV surface area, P=0.07). Specifically, only 3 (17%) patients presented with progression of the RV scar >5%. The RV volumes increased during follow-up (from 206±74 mL to 258±77 mL, P=0.0003), with the majority of patients (15/18, 83%) having a significant increase in the RV volume (mean increase = 38.9%). Only 3 (17%) patients had no change in both RV scar size and volume over time. Conclusions: In patients with ARVC and VT, progressive RV dilatation is almost uniformly observed, while rapid epi-endo scar progression is rare. These findings suggest that aggressive epi-endocardial substrate ablation should provide long-term VT control, and further research is needed to identify the mechanism(s) for and to prevent ongoing RV dilatation in these patients.
• Aldhoon, B., Tzou, W. S., Riley, M. P., Lin, D., Callans, D. J., Hutchinson, M. D., Dixit, S., Garcia, F. C., Zado, E. S., & Marchlinski, F. E. (2013). Nonischemic cardiomyopathy substrate and ventricular tachycardia in the setting of coronary artery disease. Heart rhythm : the official journal of the Heart Rhythm Society, 10(11), 1622-7.
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  Patients with coronary artery disease (CAD) may have ventricular tachycardia (VT) from a separate nonischemic process. Catheter ablation in these patients can be misguided by abnormalities of coronary arteries.
• Bala, R., Hutchinson, M. D., Dixit, S., Patel, V. V., Verdino, R. J., Deo, R., Supple, G. E., Cooper, J. M., Frankel, D. S., Marchlinski, F. E., Tzou, W. S., Gerstenfeld, E. P., Riley, M. A., Lin, D., Garcia, F. C., Callans, D. J., Epstein, A. J., & Kapa, S. (2013). Assessing Arrhythmia Burden After Catheter Ablation of Atrial Fibrillation Using an Implantable Loop Recorder: The ABACUS Study. Journal of Cardiovascular Electrophysiology, 24(8), 875-881. doi:10.1111/jce.12141
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  Arrhythmia monitoring in patients undergoing atrial fibrillation (AF) ablation is challenging. Transtelephonic monitors (TTMs) are cumbersome to use and provide limited temporal assessment. Implantable loop recorders (ILRs) may overcome these limitations. We sought to evaluate the utility of ILRs versus conventional monitoring (CM) in patients undergoing AF ablation.Forty-four patients undergoing AF ablation received ILRs and CM (30-day TTM at discharge and months 5 and 11 postablation). Over the initial 6 months, clinical decisions were made based on CM. Subjects were then randomized for the remaining 6 months to arrhythmia assessment and management by ILR versus CM. The primary endpoint was arrhythmia recurrence. The secondary endpoint was actionable clinical events (change of antiarrhythmic drugs [AADs], anticoagulation, non-AF arrhythmia events, etc.) due to either monitoring strategy. Over the study period, 6 patients withdrew. In the first 6 months, AF recurred in 18 patients (7 noted by CM, 18 by ILR; P = 0.002). Five patients in the CM (28%) and 5 in the ILR arm (25%; P = NS) had AF recurrence during the latter 6 months. AF was falsely diagnosed frequently by ILR (730 of 1,421 episodes; 51%). In more patients in the ILR compared with the CM arm, rate control agents (60% vs 39%, P = 0.02) and AADs (71% vs 44%, P = 0.04) were discontinued.In AF ablation patients, ILR can detect more arrhythmias than CM. However, false detection remains a challenge. With adequate oversight, ILRs may be useful in monitoring these patients after ablation.
• Betensky, B. P., Kapa, S., Desjardins, B., Garcia, F. C., Callans, D. J., Dixit, S., Frankel, D. S., Hutchinson, M. D., Supple, G. E., Zado, E. S., & Marchlinski, F. E. (2013). Characterization of trans-septal activation during septal pacing: criteria for identification of intramural ventricular tachycardia substrate in nonischemic cardiomyopathy. Circulation. Arrhythmia and electrophysiology, 6(6), 1123-30.
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  Identification of intramural basal-septal ventricular tachycardia (VT) substrate is challenging in nonischemic cardiomyopathy. We sought to (1) characterize normal/abnormal trans-septal right ventricular (RV) to left ventricular activation; (2) assess the effect of opposite RV pacing on left ventricular septal bipolar electrograms (EGMs); and (3) establish criteria for the identification of intramural septal VT substrate.
• Hutchinson, M. D. (2013). Maximizing LV reverse remodeling in AF-related cardiomyopathy: staying regular is not just for your bowels anymore. Heart rhythm : the official journal of the Heart Rhythm Society, 10(9), 1340-1.
• Hutchinson, M. D., & Garcia, F. C. (2013). An organized approach to the localization, mapping, and ablation of outflow tract ventricular arrhythmias. Journal of cardiovascular electrophysiology, 24(10), 1189-97.
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  The outflow tract (OT) regions of the right and left ventricles, common sites of origin for idiopathic ventricular arrhythmias (VA), have complex three-dimensional anatomical relationships. The understanding of in situ or "attitudinal" relationships not only informs the electrocardiographic interpretation of VA site of origin, but also facilitates their catheter-based mapping and ablation strategies. By viewing each patient as his or her own "control," the expected changes in ECG morphology (i.e., frontal plane QRS axis and precordial transition) between adjacent intracardiac structures (e.g., RVOT and aortic root) can be reliably predicted. Successful mapping of OT VAs involve a combination of activation and pacemapping guided by fluoroscopy, electroanatomical mapping, and intracardiac echocardiography. The purpose of this manuscript is to provide a simple, reliable strategy for catheter based mapping and ablation of OT VAs. We also discuss 2 specific challenges in OT VA mapping: (1) differentiating posterior RVOT from right coronary cusp VA origin; and (2) mapping VAs originating from the LV summit.
• Hutchinson, M. D., & Kapa, S. (2013). Bipolar Mapping, Revisited Or: These Aren't the Electrograms You're Looking For. Journal of Cardiovascular Electrophysiology, 6(655-657), 24. doi:10.1111/jce.12118
• Hutchinson, M. D., Garcia, F. C., Mandel, J. E., Elkassabany, N., Zado, E. S., Riley, M. P., Cooper, J. M., Bala, R., Frankel, D. S., Lin, D., Supple, G. E., Dixit, S., Gerstenfeld, E. P., Callans, D. J., & Marchlinski, F. E. (2013). Efforts to enhance catheter stability improve atrial fibrillation ablation outcome. Heart rhythm : the official journal of the Heart Rhythm Society, 10(3), 347-53.
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  Contemporary techniques to enhance anatomical detail and catheter contact during atrial fibrillation (AF) ablation include (1) the integration of preacquired tomographic reconstructions with electroanatomical mapping (3-dimensional image integration [I-EAM]), (2) the use of steerable introducers (SIs), and (3) high-frequency jet ventilation (HFJV).
• Hutchinson, M. D., Marchlinski, F. E., Zado, E. S., Garcia, F. C., Dixit, S., Callans, D. J., Lin, D., Riley, M. P., Tzou, W. S., & Aldhoon, B. (2013). Nonischemic cardiomyopathy substrate and ventricular tachycardia in the setting of coronary artery disease. Heart Rhythm, 10(11), 1622-1627. doi:10.1016/j.hrthm.2013.08.021
• Kapa, S., & Hutchinson, M. D. (2013). Bipolar mapping, revisited or: these aren't the electrograms you're looking for. Journal of cardiovascular electrophysiology, 24(6), 655-7.
• Kapa, S., Epstein, A. E., Callans, D. J., Garcia, F. C., Lin, D., Bala, R., Riley, M. P., Hutchinson, M. D., Gerstenfeld, E. P., Tzou, W., Marchlinski, F. E., Frankel, D. S., Cooper, J. M., Supple, G., Deo, R., Verdino, R. J., Patel, V. V., & Dixit, S. (2013). Assessing arrhythmia burden after catheter ablation of atrial fibrillation using an implantable loop recorder: the ABACUS study. Journal of cardiovascular electrophysiology, 24(8), 875-81.
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  Arrhythmia monitoring in patients undergoing atrial fibrillation (AF) ablation is challenging. Transtelephonic monitors (TTMs) are cumbersome to use and provide limited temporal assessment. Implantable loop recorders (ILRs) may overcome these limitations. We sought to evaluate the utility of ILRs versus conventional monitoring (CM) in patients undergoing AF ablation.
• Leong-Sit, P., Robinson, M., Zado, E. S., Callans, D. J., Garcia, F., Lin, D., Dixit, S., Bala, R., Riley, M. P., Hutchinson, M. D., Cooper, J., Gerstenfeld, E. P., & Marchlinski, F. E. (2013). Inducibility of atrial fibrillation and flutter following pulmonary vein ablation. Journal of cardiovascular electrophysiology, 24(6), 617-23.
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  Prior reports demonstrate prognostic value in noninducibility of atrial arrhythmias after atrial fibrillation (AF) ablation and suggest their utility in guiding additional ablation lesion sets. The type and mechanism of induced atrial arrhythmias, their relationship to the underlying atrial substrate, and prognostic significance of induced organized atrial arrhythmias are unknown.
• Mountantonakis, S. E., Park, R. E., Frankel, D. S., Hutchinson, M. D., Dixit, S., Cooper, J., Callans, D., Marchlinski, F. E., & Gerstenfeld, E. P. (2013). Relationship between voltage map "channels" and the location of critical isthmus sites in patients with post-infarction cardiomyopathy and ventricular tachycardia. Journal of the American College of Cardiology, 61(20), 2088-95.
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  The goal of this study was to determine the relationship of the ventricular tachycardia (VT) isthmus to channels of preserved voltage on an electroanatomic voltage map in postinfarction cardiomyopathy.
• Ren, J., Marchlinski, F. E., Supple, G. E., Hutchinson, M. D., Garcia, F. C., Riley, M. P., Lin, D., Zado, E. S., Callans, D. J., & Ferrari, V. A. (2013). Intracardiac echocardiographic diagnosis of thrombus formation in the left atrial appendage: a complementary role to transesophageal echocardiography. Echocardiography (Mount Kisco, N.Y.), 30(1), 72-80.
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  We sought to develop and validate an intracardiac echocardiography (ICE) imaging strategy for evaluation of left atrial (LA) appendage (LAA) anatomy and function to clarify equivocal findings of LAA thrombus with transesophageal echocardiography (TEE).
• Bala, R., Hutchinson, M. D., Marchlinski, F. E., Callans, D. J., Verdino, R. J., Tzou, W. S., Robinson, M. J., Riley, M. A., Patel, V. V., Lin, D., Gerstenfeld, E. P., Garcia, F. C., Epstein, A. J., Dixit, S., Deo, R., Cooper, J. M., Anter, E., Zado, E. S., Mountantonakis, S. E., & Frankel, D. S. (2012). Noninvasive Programmed Ventricular Stimulation Early After Ventricular Tachycardia Ablation to Predict Risk of Late Recurrence. Journal of the American College of Cardiology, 59(17), 1529-1535. doi:10.1016/j.jacc.2012.01.026
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  The goal of this study was to evaluate the ability of noninvasive programmed stimulation (NIPS) after ventricular tachycardia (VT) ablation to identify patients at high risk of recurrence.Optimal endpoints for VT ablation are not well defined.Of 200 consecutive patients with VT and structural heart disease undergoing ablation, 11 had clinical VT inducible at the end of ablation and 11 recurred spontaneously. Of the remaining 178 patients, 132 underwent NIPS through their implantable cardioverter-defibrillator 3.1 ± 2.1 days after ablation. At 2 drive cycle lengths, single, double, and triple right ventricular extrastimuli were delivered to refractoriness. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Patients were followed for 1 year.Fifty-nine patients (44.7%) had no VT inducible at NIPS; 49 (37.1%) had inducible nonclinical VT only; and 24 (18.2%) had inducible clinical VT. Patients with inducible clinical VT at NIPS had markedly decreased 1-year VT-free survival compared to those in whom no VT was inducible (80%; p = 0.001), including 33% recurring with VT storm. Patients with inducible nonclinical VT only, had intermediate 1-year VT-free survival (65%).When patients with VT and structural heart disease have no VT or nonclinical VT only inducible at the end of ablation or their condition is too unstable to undergo final programmed stimulation, NIPS should be considered in the following days to further define risk of recurrence. If clinical VT is inducible at NIPS, repeat ablation may be considered because recurrence over the following year is high.
• Campos, B., Jauregui, M. E., Park, K., Mountantonakis, S. E., Gerstenfeld, E. P., Haqqani, H., Garcia, F. C., Hutchinson, M. D., Callans, D. J., Dixit, S., Lin, D., Riley, M. P., Tzou, W., Cooper, J. M., Bala, R., Zado, E. S., & Marchlinski, F. E. (2012). New unipolar electrogram criteria to identify irreversibility of nonischemic left ventricular cardiomyopathy. Journal of the American College of Cardiology, 60(21), 2194-204.
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  This study sought to assess the value of left ventricular (LV) endocardial unipolar electroanatomical mapping (EAM) in identifying irreversibility of LV systolic dysfunction in patients with left ventricular nonischemic cardiomyopathy (LVCM).
• Dahu, M. I., & Hutchinson, M. D. (2012). What is the mechanism of the atrial arrhythmia in a patient after orthotopic heart transplantation?. Journal of cardiovascular electrophysiology, 23(2), 225-7.
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  Atrial arrhythmias are quite common in patients after heart transplantation; they can occur via focal or reentrant mechanisms and are amenable to curative therapy with catheter ablation. Integration of the individual patient's surgical anatomy with the arrhythmia pattern on 12-lead electrocardiogram can help both to narrow the potential arrhythmia diagnoses and to facilitate therapeutic decision making. This case highlights the differential diagnosis and management of such a patient. 
• Deyell, M. W., Park, K., Han, Y., Frankel, D. S., Dixit, S., Cooper, J. M., Hutchinson, M. D., Lin, D., Garcia, F., Bala, R., Riley, M. P., Gerstenfeld, E., Callans, D. J., & Marchlinski, F. E. (2012). Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart rhythm : the official journal of the Heart Rhythm Society, 9(9), 1465-72.
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  Frequent ventricular premature depolarizations (VPDs) can cause reversible left ventricular (LV) dysfunction. However, not all patients normalize their LV function after VPD elimination.
• Dixit, S., Marchlinski, F. E., Lin, D., Callans, D. J., Bala, R., Riley, M. P., Garcia, F. C., Hutchinson, M. D., Ratcliffe, S. J., Cooper, J. M., Verdino, R. J., Patel, V. V., Zado, E. S., Cash, N. R., Killian, T., Tomson, T. T., & Gerstenfeld, E. P. (2012). Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study. Circulation. Arrhythmia and electrophysiology, 5(2), 287-94.
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  The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF.
• Frankel, D. S., Lin, D., Anastasio, N., Mountantonakis, S. E., Dixit, S., Gerstenfeld, E. P., Hutchinson, M. D., Riley, M. P., Marchlinski, F. E., & Callans, D. J. (2012). Frequent additional tachyarrhythmias in patients with inappropriate sinus tachycardia undergoing sinus node modification: an important cause of symptom recurrence. Journal of cardiovascular electrophysiology, 23(8), 835-9.
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  Symptom recurrence following sinus node modification (SNM) for inappropriate sinus tachycardia (IST) remains significant despite achieving acute procedural success. The impact of non-IST tachyarrhythmias on symptom recurrence remains poorly characterized.
• Frankel, D. S., Mountantonakis, S. E., Zado, E. S., Anter, E., Bala, R., Cooper, J. M., Deo, R., Dixit, S., Epstein, A. E., Garcia, F. C., Gerstenfeld, E. P., Hutchinson, M. D., Lin, D., Patel, V. V., Riley, M. P., Robinson, M. R., Tzou, W. S., Verdino, R. J., Callans, D. J., & Marchlinski, F. E. (2012). Noninvasive programmed ventricular stimulation early after ventricular tachycardia ablation to predict risk of late recurrence. Journal of the American College of Cardiology, 59(17), 1529-35.
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  The goal of this study was to evaluate the ability of noninvasive programmed stimulation (NIPS) after ventricular tachycardia (VT) ablation to identify patients at high risk of recurrence.
• Frankel, D. S., Shah, M. J., Aziz, P. F., & Hutchinson, M. D. (2012). Catheter ablation of atrial fibrillation in transposition of the great arteries treated with mustard atrial baffle. Circulation. Arrhythmia and electrophysiology, 5(2), e41-3.
• Hutchinson, M. D., & Dahu, M. I. (2012). What Is the Mechanism of the Atrial Arrhythmia in a Patient After Orthotopic Heart Transplantation?. Journal of Cardiovascular Electrophysiology, 23(2), 225-227. doi:10.1111/j.1540-8167.2011.02106.x
• Hutchinson, M. D., & Kapa, S. (2012). The Role of Preventive Ablation of Ventricular Tachycardia in the Patient with Coronary Artery Disease, Reduced Left Ventricular Function, and a New Implantable Cardioverter Defibrillator Implant. Cardiac Electrophysiology Clinics, 4(2), 189-198. doi:10.1016/j.ccep.2012.02.006
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  Most patients referred for ventricular tachycardia (VT) ablation have already suffered multiple therapies for recurrent VT, typically in the form of implantable cardioverter defibrillator (ICD) shocks. Recent landmark trials have looked at these populations and suggest potential usefulness of early, preventive ablation of VT in patients with ischemic cardiomyopathy. In this review the potential role of early VT ablation in patients with ischemic cardiomyopathy, current controversies regarding VT ablation in this population, and ongoing and future research that may further inform clinical decision making regarding optimal timing of ablation in these patients are discussed.
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Callans, D. J., Cooper, J. M., Riley, M. A., Lin, D., Tzou, W. S., Dixit, S., Garcia, F. C., Mountantonakis, S. E., Gerstenfeld, E. P., Park, R. E., Frankel, D. S., Tschabrunn, C. M., Park, K. U., Campos, B., & Jáuregui-Abularach, M. E. (2012). Erratum. Heart Rhythm. doi:10.1016/j.hrthm.2012.05.023
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Callans, D. J., Cooper, J. M., Riley, M. P., Lin, D., Tzou, W. S., Dixit, S., Garcia, F. C., Mountantonakis, S. E., Gerstenfeld, E. P., Park, R. E., Frankel, D. S., Tschabrunn, C. M., Park, K., Campos, B., & Abularach, M. E. (2012). Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart Rhythm. doi:10.1016/j.hrthm.2012.01.022
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Cooper, J. M., Verdino, R. J., Garcia, F. C., Riley, M. P., Callans, D. J., Dixit, S., Gerstenfeld, E. P., Zado, E. S., Frankel, D. S., & Lin, D. (2012). Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation without Additional Substrate Modification for Treating Longstanding Persistent Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 23(8), 806-813. doi:10.1111/j.1540-8167.2012.02307.x
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Zado, E. S., Cooper, J. M., Tzou, W. S., Riley, M. P., Lin, D., Dixit, S., Callans, D. J., Garcia, F. C., Haqqani, H. M., Gerstenfeld, E. P., Mountantonakis, S. E., Park, K., Jauregui, M. E., & Campos, B. (2012). New Unipolar Electrogram Criteria to Identify Irreversibility of Nonischemic Left Ventricular Cardiomyopathy. Journal of the American College of Cardiology, 60(21), 2194-2204. doi:10.1016/j.jacc.2012.08.977
• Hutchinson, M. D., Dixit, S., Marchlinski, F. E., Callans, D. J., Deo, R., Gerstenfeld, E. P., & Moss, J. D. (2012). ECG Criteria for Accurate Localization of Left Anterolateral and Posterolateral Accessory Pathways. Pacing and Clinical Electrophysiology, 35(12), 1444-1450. doi:10.1111/pace.12011
• Jauregui Abularach, M. E., Campos, B., Park, K., Tschabrunn, C. M., Frankel, D. S., Park, R. E., Gerstenfeld, E. P., Mountantonakis, S. E., Mountantonakis, S., Garcia, F. C., Dixit, S., Tzou, W. S., Hutchinson, M. D., Lin, D., Riley, M. P., Cooper, J. M., Bala, R., Callans, D. J., & Marchlinski, F. E. (2012). Ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of Valsalva region: ECG features, anatomic distance, and outcome. Heart rhythm : the official journal of the Heart Rhythm Society, 9(6), 865-73.
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  Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system.
• Kapa, S., & Hutchinson, M. D. (2012). The Role of Preventive Ablation of Ventricular Tachycardia in the Patient with Coronary Artery Disease, Reduced Left Ventricular Function, and a New Implantable Cardioverter Defibrillator Implant. Cardiac electrophysiology clinics, 4(2), 189-98.
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  Most patients referred for ventricular tachycardia (VT) ablation have already suffered multiple therapies for recurrent VT, typically in the form of implantable cardioverter defibrillator (ICD) shocks. Recent landmark trials have looked at these populations and suggest potential usefulness of early, preventive ablation of VT in patients with ischemic cardiomyopathy. In this review the potential role of early VT ablation in patients with ischemic cardiomyopathy, current controversies regarding VT ablation in this population, and ongoing and future research that may further inform clinical decision making regarding optimal timing of ablation in these patients are discussed.
• Lin, D., Frankel, D. S., Zado, E. S., Gerstenfeld, E., Dixit, S., Callans, D. J., Riley, M., Hutchinson, M., Garcia, F., Bala, R., Verdino, R., Cooper, J., & Marchlinski, F. E. (2012). Pulmonary vein antral isolation and nonpulmonary vein trigger ablation without additional substrate modification for treating longstanding persistent atrial fibrillation. Journal of cardiovascular electrophysiology, 23(8), 806-13.
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  Effectiveness of antral pulmonary vein isolation (PVAI) and ablation of non-PV triggers (non-PVTA) in controlling longstanding persistent atrial fibrillation (AF) has not been reported. We sought to describe clinical outcomes with this ablation strategy in patients (pts) followed for at least 1 year.
• Moss, J. D., Gerstenfeld, E. P., Deo, R., Hutchinson, M. D., Callans, D. J., Marchlinski, F. E., & Dixit, S. (2012). ECG criteria for accurate localization of left anterolateral and posterolateral accessory pathways. Pacing and clinical electrophysiology : PACE, 35(12), 1444-50.
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  BACKGround : Left lateral accessory pathway (AP) location along the mitral annulus (MA) can influence ablation strategy, including choice of a transseptal or retrograde aortic approach and the use of deflectable sheaths and/or bidirectional catheters. We aimed to develop electrocardiographic (ECG) criteria to accurately localize a left lateral AP, hypothesizing that the relationship of QRS amplitudes in limb leads II and III could be used to differentiate left anterolateral (LAL) from left posterolateral (LPL) AP locations.
• Anter, E., Hutchinson, M. D., Deo, R., Haqqani, H. M., Callans, D. J., Gerstenfeld, E. P., Garcia, F. C., Bala, R., Lin, D., Riley, M. P., Litt, H. I., Woo, J. Y., Acker, M. A., Szeto, W. Y., Zado, E. S., Marchlinski, F. E., & Dixit, S. (2011). Surgical ablation of refractory ventricular tachycardia in patients with nonischemic cardiomyopathy. Circulation. Arrhythmia and electrophysiology, 4(4), 494-500.
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  The surgical approach for the treatment of ventricular tachycardia (VT) has been largely replaced by percutaneous, catheter-based techniques. However, some VT circuits, particularly in patients with nonischemic cardiomyopathy, remain inaccessible to percutaneous ablation. Surgical therapy of these VTs is an alternative approach; however, its methodology has not been well defined. The purpose of this study was to evaluate the efficacy of preoperative electroanatomic and electrophysiological characterization of the VT substrate and circuit to guide surgical ablation.
• Bala, R., Hutchinson, M. D., Marchlinski, F. E., Gerstenfeld, E. P., Deo, R., Riley, M. A., Garcia, F. C., Cooper, J. M., Dixit, S., Callans, D. J., Lin, D., Zado, E. S., & Tzou, W. S. (2011). Sinus Rhythm ECG Criteria Associated with Basal-Lateral Ventricular Tachycardia Substrate in Patients with Nonischemic Cardiomyopathy. Journal of Cardiovascular Electrophysiology, 22(12), 1351-1358. doi:10.1111/j.1540-8167.2011.02129.x
• Bala, R., Ren, J., Hutchinson, M. D., Desjardins, B., Tschabrunn, C., Gerstenfeld, E. P., Deo, R., Dixit, S., Garcia, F. C., Cooper, J., Lin, D., Riley, M. P., Tzou, W. S., Verdino, R., Epstein, A. E., Callans, D. J., & Marchlinski, F. E. (2011). Assessing epicardial substrate using intracardiac echocardiography during VT ablation. Circulation. Arrhythmia and electrophysiology, 4(5), 667-73.
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  Intracardiac echocardiography (ICE) has played a limited role in defining the substrate for ventricular tachycardia (VT). The purpose of this study was to assess whether ICE could identify abnormal epicardial substrate in patients with nonischemic cardiomyopathy (NICM) and VT.
• Bala, R., Verdino, R. J., Tzou, W. S., Riley, M. P., Patel, V. V., Maslowski, K., Marchlinski, F. E., Lin, D., Kapa, S., Hutchinson, M. D., Gerstenfeld, E. P., Garcia, F. C., Epstein, A. E., Dixit, S., Deyell, M. W., Deo, R., Cooper, J. M., Clayton, R., Callans, D. J., & Anter, E. (2011). Abstract 12521: Assessing Arrhythmia Burden After Catheter Ablation of Atrial Fibrillation by a Subcutaneous Implantable Loop Recorder: ABACUS Study. Circulation, 124.
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  Introduction Arrhythmia monitoring in patients (pts) undergoing atrial fibrillation (AF) ablation remains challenging. Holter and trans-telephonic monitors (TTMs) are cumbersome to use and provide ...
• Betensky, B. P., Park, R. E., Marchlinski, F. E., Hutchinson, M. D., Garcia, F. C., Dixit, S., Callans, D. J., Cooper, J. M., Bala, R., Lin, D., Riley, M. P., & Gerstenfeld, E. P. (2011). The V(2) transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin. Journal of the American College of Cardiology, 57(22), 2255-62.
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  We sought to develop electrocardiography (ECG) criteria for distinguishing left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin in patients with idiopathic outflow tract ventricular tachycardia (OTVT) and lead V(3) R/S transition.
• Haqqani, H. M., Tschabrunn, C. M., Tzou, W. S., Dixit, S., Cooper, J. M., Riley, M. P., Lin, D., Hutchinson, M. D., Garcia, F. C., Bala, R., Verdino, R. J., Callans, D. J., Gerstenfeld, E. P., Zado, E. S., & Marchlinski, F. E. (2011). Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications. Heart rhythm : the official journal of the Heart Rhythm Society, 8(8), 1169-76.
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  The substrate for ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) has a predilection for the basolateral left ventricle with right bundle branch block VT morphology.
• Hutchinson, M. D., Bala, R., Dixit, S., Marchlinski, F. E., Zado, E. S., Szeto, W. Y., Acker, M. A., Woo, J., Litt, H., Riley, M. A., Lin, D., Garcia, F. C., Gerstenfeld, E. P., Callans, D. J., Haqqani, H. M., Deo, R., & Anter, E. (2011). Surgical Ablation of Refractory Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy. Circulation-arrhythmia and Electrophysiology, 4(4), 494-500. doi:10.1161/circep.111.962555
• Hutchinson, M. D., Gerstenfeld, E. P., Desjardins, B., Bala, R., Riley, M. P., Garcia, F. C., Dixit, S., Lin, D., Tzou, W. S., Cooper, J. M., Verdino, R. J., Callans, D. J., & Marchlinski, F. E. (2011). Endocardial unipolar voltage mapping to detect epicardial ventricular tachycardia substrate in patients with nonischemic left ventricular cardiomyopathy. Circulation. Arrhythmia and electrophysiology, 4(1), 49-55.
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  Patients with nonischemic left ventricular cardiomyopathy (LVCM) and ventricular tachycardia (Vt) have complex 3-dimensional substrate with variable involvement of the endocardium (ENDO) and epicardium (EPI). The purpose of this study was to determine whether ENDO unipolar (UNI) mapping with a larger electric field of view could identify EPI low bipolar (BIP) voltage regions in patients with LVCM undergoing Vt ablation.
• Jacobson, J. T., Hutchinson, M. D., Cooper, J. M., Woo, Y. J., Shandler, R. S., & Callans, D. J. (2011). Tissue-specific variability in human epicardial impedance. Journal of cardiovascular electrophysiology, 22(4), 436-9.
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  Epicardial ablation can be employed to treat ventricular tachycardia. Voltage attenuation in regions of fat can mimic epicardial scar, limiting its specificity. Ablation over fat may not be as effective. Prior animal data have shown that infarcted myocardium has lower impedance than normal, and human bioimpedance studies suggest peripheral fat displays higher impedance. Therefore, we tested the hypothesis that human epicardial fat has higher impedance than myocardium when measured with standard ablation tools.
• Leong-Sit, P., Roux, J., Zado, E., Callans, D. J., Garcia, F., Lin, D., Marchlinski, F. E., Bala, R., Dixit, S., Riley, M., Hutchinson, M. D., Cooper, J., Russo, A. M., Verdino, R., & Gerstenfeld, E. P. (2011). Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study. Circulation. Arrhythmia and electrophysiology, 4(1), 11-4.
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  We previously demonstrated that treatment with antiarrhythmic drugs (AADs) during the first 6 weeks after atrial fibrillation (AF) ablation reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion or hospitalization for arrhythmia management. Whether early rhythm suppression decreases longer-term arrhythmia recurrence is unknown. We now report the 6-month follow-up data from this study.
• Mandel, J. E., Hutchinson, M. D., & Marchlinski, F. E. (2011). Remifentanil-midazolam sedation provides hemodynamic stability and comfort during epicardial ablation of ventricular tachycardia. Journal of cardiovascular electrophysiology, 22(4), 464-6.
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  Epicardial ablation of ventricular tachycardia (VT) presents multiple challenges for anesthetic management. General anesthesia lowers blood pressure, may interfere with arrhythmia mapping, and use of muscle relaxants precludes identification of the phrenic nerve. We describe a case in which remifentanil with minimal doses of midazolam was employed in a series of epicardial VT ablations and noninvasive programmed stimulations (NIPS), including 5 external cardioversions and discuss the advantages of this approach.
• Mountantonakis, S. E., & Hutchinson, M. D. (2011). Indications for implantable cardioverter-defibrillator placement in ischemic cardiomyopathy and after myocardial infarction. Current heart failure reports, 8(4), 252-9.
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  Dramatic reductions in the rate of sudden cardiac death due to use of implantable cardioverter-defibrillators (ICDs) have been well-established in several large randomized clinical trials including patients with left ventricular dysfunction after myocardial infarction. This article reviews the literature regarding ICD utilization in the postinfarction population, with a strong emphasis on recent clinical trials. The most current indications for, and timing of, ICD implantation postinfarction also are summarized.
• Mountantonakis, S. E., Frankel, D. S., Gerstenfeld, E. P., Dixit, S., Lin, D., Hutchinson, M. D., Riley, M., Bala, R., Cooper, J., Callans, D., Garcia, F., Zado, E. S., & Marchlinski, F. E. (2011). Reversal of outflow tract ventricular premature depolarization-induced cardiomyopathy with ablation: effect of residual arrhythmia burden and preexisting cardiomyopathy on outcome. Heart rhythm : the official journal of the Heart Rhythm Society, 8(10), 1608-14.
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  Outflow tract ventricular premature depolarizations (VPDs) can be associated with reversible left ventricular cardiomyopathy (LVCM). Limited data exist regarding the outcome after ablation of outflow tract VPDs from the LV and the impact of residual VPDs or preexisting LVCM prior to the diagnosis of VPDs on recovery of LV function.
• Mountantonakis, S., Frankel, D. S., Hutchinson, M. D., Dixit, S., Riley, M., Callans, D. J., Garcia, F., Lin, D., Tzou, W., Bala, R., Marchlinski, F. E., & Gerstenfeld, E. P. (2011). Feasibility of catheter ablation of mitral annular flutter in patients with prior mitral valve surgery. Heart rhythm : the official journal of the Heart Rhythm Society, 8(6), 809-14.
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  Mitral annular flutter (MAF) may occur after ablation of atrial fibrillation in patients with prior mitral valve (MV) replacement or repair. Percutaneous catheter ablation may be challenging owing to the presence of surgical scar and a prosthetic MV.
• Polin, G. M., Haqqani, H., Tzou, W., Hutchinson, M. D., Garcia, F. C., Callans, D. J., Zado, E. S., & Marchlinski, F. E. (2011). Endocardial unipolar voltage mapping to identify epicardial substrate in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart rhythm : the official journal of the Heart Rhythm Society, 8(1), 76-83.
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  The risk and success of epicardial substrate ablation for ventricular tachycardia (VT) support the value of techniques identifying the epicardial substrate with endocardial mapping.
• Tzou, W. S., Zado, E. S., Lin, D., Callans, D. J., Dixit, S., Cooper, J. M., Bala, R., Garcia, F., Hutchinson, M. D., Riley, M. P., Deo, R., Gerstenfeld, E. P., & Marchlinski, F. E. (2011). Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy. Journal of cardiovascular electrophysiology, 22(12), 1351-8.
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  Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT.
• Van Herendael, H., Garcia, F., Lin, D., Riley, M., Bala, R., Cooper, J., Tzou, W., Hutchinson, M. D., Verdino, R., Gerstenfeld, E. P., Dixit, S., Callans, D. J., Tschabrunn, C. M., Zado, E. S., & Marchlinski, F. E. (2011). Idiopathic right ventricular arrhythmias not arising from the outflow tract: prevalence, electrocardiographic characteristics, and outcome of catheter ablation. Heart rhythm : the official journal of the Heart Rhythm Society, 8(4), 511-8.
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  Most idiopathic right ventricular (RV) ventricular tachycardias (VTs) originate from the outflow tract. Data on VT from the lower body of the RV are limited.
• Bala, R., Garcia, F. C., Hutchinson, M. D., Gerstenfeld, E. P., Dhruvakumar, S., Dixit, S., Cooper, J. M., Lin, D., Harding, J., Riley, M. P., Zado, E., Callans, D. J., & Marchlinski, F. E. (2010). Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart rhythm : the official journal of the Heart Rhythm Society, 7(3), 312-22.
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  Ventricular arrhythmias are known to originate from the aortic sinus of Valsalva.
• Bala, R., Hutchinson, M. D., Marchlinski, F. E., Gerstenfeld, E. P., Cooper, J. M., Riley, M. P., Dixit, S., Lin, D., Garcia, F. C., Callans, D. J., Zado, E. S., & Leong-Sit, P. (2010). Efficacy and Risk of Atrial Fibrillation Ablation Before 45 Years of Age. Circulation-arrhythmia and Electrophysiology, 3(5), 452-7. doi:10.1161/circep.110.938860
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  Background— Young patients with atrial fibrillation (AF) tend to be more symptomatic and less willing to take long-term medications, yet catheter ablation remains recommended as second-line therapy for AF regardless of age. This study seeks to characterize the effectiveness and risk of AF ablation in the young. Methods and Results— Consecutive (n=1548) patients who underwent 2038 AF ablation procedures were included. Major procedural complications and efficacy were analyzed on the basis of age at the initial procedure:
• Bala, R., Riley, M., Marchlinski, F. E., Lin, D., Hutchinson, M. D., Ho, S. Y., Gerstenfeld, E. P., Garcia, F. C., Fan, R., Dixit, S., Cano, O., & Callans, D. J. (2010). Erratum: Characterization of the phrenic nerve course within the epicardial substrate of patients with nonischemic cardiomyopathy and ventricular tachycardia (HeartRhythm Journal). Heart Rhythm, 7(12), 1920. doi:10.1016/j.hrthm.2010.11.018
• Hutchinson, M. D., & Callans, D. J. (2010). Imaging the Left Atrial Appendage With Intracardiac Echocardiography: Leveling the Playing Field. Circulation-arrhythmia and Electrophysiology, 3(6), 564-565. doi:10.1161/circep.110.960245
• Hutchinson, M. D., & Callans, D. J. (2010). Imaging the left atrial appendage with intracardiac echocardiography: leveling the playing field. Circulation. Arrhythmia and electrophysiology, 3(6), 564-5.
• Hutchinson, M. D., & Marchlinski, F. E. (2010). Epicardial Ablation of VT in Patients with Nonischemic LV Cardiomyopathy. Cardiac Electrophysiology Clinics, 1(93-103), 2. doi:10.1016/j.ccep.2009.11.007
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  The past decade has seen a remarkable period of discovery and refinement of ventricular tachycardia (VT) ablation in patients with left ventricular cardiomyopathy (LVCM). Patients with LVCM presenting with VT have a common substrate distribution involving predominantly the basal or perivalvular LV, which is often more dramatic on the LV epicardium. They typically present with multiple and often unstable tachycardias due to scar-based reentry. Percutaneous intrapericardial access can be safely performed in the electrophysiology laboratory and has greatly enhanced the efficacy of VT ablation in this setting by allowing detailed mapping. Epicardial ablation incurs unique procedural considerations that must be understood to safely and effectively perform the procedure.
• Hutchinson, M. D., & Marchlinski, F. E. (2010). Epicardial Ablation of VT in Patients with Nonischemic LV Cardiomyopathy. Cardiac electrophysiology clinics, 2(1), 93-103.
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  The past decade has seen a remarkable period of discovery and refinement of ventricular tachycardia (VT) ablation in patients with left ventricular cardiomyopathy (LVCM). Patients with LVCM presenting with VT have a common substrate distribution involving predominantly the basal or perivalvular LV, which is often more dramatic on the LV epicardium. They typically present with multiple and often unstable tachycardias due to scar-based reentry. Percutaneous intrapericardial access can be safely performed in the electrophysiology laboratory and has greatly enhanced the efficacy of VT ablation in this setting by allowing detailed mapping. Epicardial ablation incurs unique procedural considerations that must be understood to safely and effectively perform the procedure.
• Hutchinson, M. D., Jacobson, J. T., Michele, J. J., Silvestry, F. E., & Callans, D. J. (2010). A comparison of intracardiac and transesophageal echocardiography to detect left atrial appendage thrombus in a swine model. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 27(1), 3-7.
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  Transesophageal echocardiography (TEE) is the gold standard in the evaluation for left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and is often performed prior to AF ablation. We routinely use intracardiac echocardiography (ICE) to assist in AF ablation; however, standard right atrial views do not provide adequate visualization of the LAA. As the incidence of thrombus in this population is relatively low, TEE incurs additional risk, cost, and patient discomfort. Novel views of the LAA with ICE may obviate the need for TEE in this population. We tested the hypothesis that due to their proximity, imaging the LAA from the pulmonary artery (PA) would provide equivalent sensitivity and specificity to TEE in detecting LAA thrombus in a swine model.
• Leong-Sit, P., Zado, E., Callans, D. J., Garcia, F., Lin, D., Dixit, S., Bala, R., Riley, M. P., Hutchinson, M. D., Cooper, J., Gerstenfeld, E. P., & Marchlinski, F. E. (2010). Efficacy and risk of atrial fibrillation ablation before 45 years of age. Circulation. Arrhythmia and electrophysiology, 3(5), 452-7.
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  Young patients with atrial fibrillation (AF) tend to be more symptomatic and less willing to take long-term medications, yet catheter ablation remains recommended as second-line therapy for AF regardless of age. This study seeks to characterize the effectiveness and risk of AF ablation in the young.
• Riley, M. P., Zado, E., Bala, R., Callans, D. J., Cooper, J., Dixit, S., Garcia, F., Gerstenfeld, E. P., Hutchinson, M. D., Lin, D., Patel, V., Verdino, R., & Marchlinski, F. E. (2010). Lack of uniform progression of endocardial scar in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy and ventricular tachycardia. Circulation. Arrhythmia and electrophysiology, 3(4), 332-8.
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  The endocardial substrate for ventricular arrhythmias in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is thought to be caused by a progressive degenerative process. Many clinical decisions and treatment plans are guided by this pathophysiologic assumption, but the extent of progression of macroscopic endocardial scar and right ventricular (RV) dilatation have not been assessed.
• Robinson, M. R., & Hutchinson, M. D. (2010). Use of imaging techniques to guide catheter ablation procedures. Current cardiology reports, 12(5), 374-81.
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  Paralleling the growth in ablation of complex arrhythmias such as atrial fibrillation and ventricular tachycardia, advanced imaging technologies are becoming more commonplace in the care of the electrophysiology patients. Although intracardiac ultrasound remains the most commonly used imaging technique, advances in real-time MRI may change this in the future. We discuss the current use of intracardiac ultrasound, CT, including rotational angiography, MRI, with an emphasis on delayed-enhancement MRI, and positron emission tomography-CT in advanced ablation procedures. Image integration is emphasized and new technologies such as direct endoscopic visualization are discussed.
• Tzou, W. S., Marchlinski, F. E., Zado, E. S., Lin, D., Dixit, S., Callans, D. J., Cooper, J. M., Bala, R., Garcia, F., Hutchinson, M. D., Riley, M. P., Verdino, R., & Gerstenfeld, E. P. (2010). Long-term outcome after successful catheter ablation of atrial fibrillation. Circulation. Arrhythmia and electrophysiology, 3(3), 237-42.
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  Pulmonary vein isolation (PVI) is increasingly used for treatment of atrial fibrillation (AF), but few reports exist regarding long-term success. We determined 5-year outcomes of PVI among patients with freedom from AF off antiarrhythmic drugs (AAD) for 1 year after PVI.
• Cano, O., Hutchinson, M., Lin, D., Garcia, F., Zado, E., Bala, R., Riley, M., Cooper, J., Dixit, S., Gerstenfeld, E., Callans, D., & Marchlinski, F. E. (2009). Electroanatomic substrate and ablation outcome for suspected epicardial ventricular tachycardia in left ventricular nonischemic cardiomyopathy. Journal of the American College of Cardiology, 54(9), 799-808.
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  The aim of the study was to define the epicardial substrate and ablation outcome in patients with left ventricular nonischemic cardiomyopathy (NICM) and suspected epicardial ventricular tachycardia (VT).
• Fan, R., Cano, O., Ho, S. Y., Bala, R., Callans, D. J., Dixit, S., Garcia, F., Gerstenfeld, E. P., Hutchinson, M., Lin, D., Riley, M., & Marchlinski, F. E. (2009). Characterization of the phrenic nerve course within the epicardial substrate of patients with nonischemic cardiomyopathy and ventricular tachycardia. Heart rhythm : the official journal of the Heart Rhythm Society, 6(1), 59-64.
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  Patients with nonischemic cardiomyopathy and ventricular tachycardia (VT) often have low-voltage areas in the lateral left ventricular (LV) epicardium that serve as the VT substrate. The course of the left phrenic nerve in this region may pose a challenge to successful and safe ablation.
• Hutchinson, M. D., & Callans, D. J. (2009). Should doctors recommend automated external defibrillators for use at home after myocardial infarction? No. BMJ (Clinical research ed.), 338, b876.
• Hutchinson, M. D., Callans, D. J., & Anter, E. (2009). The Role of Intracardiac Echocardiography in Atrial Fibrillation Ablation. Journal of Atrial Fibrillation, 2(3), 223. doi:10.4022/jafib.223
• Hutchinson, M. D., Callans, D. J., & Anter, E. (2009). The Role of Intracardiac Echocardiography in Atrial Fibrillation Ablation.. Journal of atrial fibrillation, 2(3), 223. doi:10.4022/jafib.223
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  Radiofrequency catheter ablation of pulmonary veins has emerged as an effective therapy for patients with symptomatic atrial fibrillation. Advances in real-time intracardiac echocardiography with 2D and Doppler color flow imaging have led to it integration in atrial fibrillation ablation procedures. It allows imaging of the left atrium and pulmonary veins, including identification of anatomic variations. It has an important role in guiding transseptal catheterization, imaging the pulmonary vein ostia, assisting in accurate placement of mapping and ablation catheters, monitoring lesion morphology and flow changes in the ablated pulmonary veins, hence allowing titration of energy delivery. Importantly, it allows instant detection of procedural complications.
• Mountantonakis, S., & Hutchinson, M. D. (2009). Who should receive an implantable cardioverter-defibrillator after myocardial infarction?. Current heart failure reports, 6(4), 236-44.
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  Despite a decline in overall cardiovascular mortality, the incidence of sudden cardiac death (SCD) continues to rise. Patients who survive a myocardial infarction (MI) with depressed ejection fraction are at particularly high risk for SCD. The development of implantable cardioverter-defibrillators (ICDs) has revolutionized SCD prevention; however, despite the current fervor for device implantation, many unresolved questions remain about risk stratification in post-MI patients. This review presents the current indications and timing of ICD implantation for primary and secondary prevention of SCD after MI. Several conventional and investigational methods of risk stratification after MI, as well as current controversies regarding device implantation in specific patient populations, are also reviewed.
• Roux, J., Gojraty, S., Bala, R., Liu, C. F., Dixit, S., Hutchinson, M. D., Garcia, F., Lin, D., Callans, D. J., Riley, M., Marchlinski, F., & Gerstenfeld, E. P. (2009). Effect of pulmonary vein isolation on the distribution of complex fractionated electrograms in humans. Heart rhythm : the official journal of the Heart Rhythm Society, 6(2), 156-60.
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  Targeting of complex fractionated electrograms (CFEs) has been used as an adjunctive strategy to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF). However, it is unclear whether CFEs should be targeted before or after PVI.
• Roux, J., Zado, E., Callans, D. J., Garcia, F., Lin, D., Marchlinski, F. E., Bala, R., Dixit, S., Riley, M., Russo, A. M., Hutchinson, M. D., Cooper, J., Verdino, R., Patel, V., Joy, P. S., & Gerstenfeld, E. P. (2009). Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation, 120(12), 1036-40.
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  Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias.
• Bala, R., Hutchinson, M. D., Gerstenfeld, E. P., Marchlinski, F. E., Callans, D. J., Dixit, S., Liu, C., Gojraty, S., & Roux, J. C. (2008). Complex Fractionated Electrogram Distribution and Temporal Stability in Patients Undergoing Atrial Fibrillation Ablation. Journal of Cardiovascular Electrophysiology, 19(8), 815-820. doi:10.1111/j.1540-8167.2008.01133.x
• Hutchinson, M. D., Bala, R., Marchlinski, F. E., Gerstenfeld, E. P., Dixit, S., Russo, A. M., Verdino, R. J., Cooper, J. M., Lin, D., Garcia, F. C., Riley, M. A., Callans, D. J., & Zado, E. S. (2008). Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in the Elderly. Journal of Cardiovascular Electrophysiology, 19(6), 621-626. doi:10.1111/j.1540-8167.2008.01183.x
• Riley, M. P., Marchlinski, F. E., Lin, D., Hutchinson, M. D., Gerstenfeld, E. P., Garcia, F. C., Dixit, S., Cooper, J. M., Cano, O., Callans, D. J., Bala, R., Riley, M. P., Marchlinski, F. E., Lin, D., Hutchinson, M. D., Gerstenfeld, E. P., Garcia, F. C., Dixit, S., Cooper, J. M., , Cano, O., et al. (2008). Abstract 4089: Unique Epicardial Substrate in Non-Ischemic CM: Echo Signature, Electrogram Correlates and Outcome with Substrate Based Ablation. Circulation, 118(suppl_18). doi:10.1161/circ.118.suppl_18.s_826-a
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  We present a unique series of patients (pts) with non-ischemic cardiomyopathy (NICM) and unmappable ventricular tachycardia (VT) who demonstrated predominantly normal left ventricular (LV) endocardial (ENDO) voltage and abnormal epicardial (EPI) substrate defined by intracardiac echo (ICE) and fractionated electrograms (EGMS). This substrate served as an appropriate ablation target for VT. All patients underwent ICE imaging and detailed ENDO and EPI voltage mapping to further characterize the substrate and define the EGM correlates. 5 pts with NICM had increased echogenicity in the lateral epicardium by ICE imaging. Detailed LV ENDO mapping (199 ± 94.5 points) identified no voltage abnormalities in 4 pts. In one pt, a 16.2cm2 low voltage area in the LV ENDO was present and adjacent to the EPI abnormality. In all pts, detailed EPI mapping (477 ± 158 points) revealed a distinct area (20.6 ± 3.6 cm2) of low voltage (80msec), split, and late (beyond QRS). (Figure 1 ). After excluding coronary branch vessels and the course of the phrenic nerve, all pts underwent substrate based ablation based on pace-mapping and targeting of abnormal EGMS to eliminate the targeted VT. No VT has recurred during mean follow-up of 20mo (range 1–30 mo). Unique EPI substrate in NICM, defined by echo imaging and confirmed by EGM correlates, can be successfully targeted for RF ablation to provide effective VT control.
• Roux, J., Gojraty, S., Bala, R., Liu, C. F., Hutchinson, M. D., Dixit, S., Callans, D. J., Marchlinski, F., & Gerstenfeld, E. P. (2008). Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation. Journal of cardiovascular electrophysiology, 19(8), 815-20.
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  Targeting of complex fractionated electrograms (CFEs) has been described as an approach for catheter ablation of atrial fibrillation (AF); however, the distribution and temporal stability of CFE regions remain poorly defined.
• Valles, E., Fan, R., Roux, J. F., Liu, C. F., Harding, J. D., Dhruvakumar, S., Hutchinson, M. D., Riley, M., Bala, R., Garcia, F. C., Lin, D., Dixit, S., Callans, D. J., Gerstenfeld, E. P., & Marchlinski, F. E. (2008). Localization of atrial fibrillation triggers in patients undergoing pulmonary vein isolation: importance of the carina region. Journal of the American College of Cardiology, 52(17), 1413-20.
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  This study sought to identify the origin within the pulmonary vein (PV) of reproducible atrial fibrillation (AF) triggers.
• Zado, E., Callans, D. J., Riley, M., Hutchinson, M., Garcia, F., Bala, R., Lin, D., Cooper, J., Verdino, R., Russo, A. M., Dixit, S., Gerstenfeld, E., & Marchlinski, F. E. (2008). Long-term clinical efficacy and risk of catheter ablation for atrial fibrillation in the elderly. Journal of cardiovascular electrophysiology, 19(6), 621-6.
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  The number of elderly patients with atrial fibrillation (AF) is increasing rapidly, and the safety and efficacy of catheter ablation in this demographic group has not been established.
• Zado, E., Verdino, R., Russo, A., Riley, M., Marchlinski, F., Lin, D., Hutchinson, M., Harding, J., Gerstenfeld, E., Garcia, F., Dixit, S., Cooper, J., Callans, D., Bala, R., Bala, R., Zado, E. S., Verdino, R. J., Russo, A. M., Riley, M. P., , Marchlinski, F. E., et al. (2008). Abstract 4632: Left Atrial Size and Advancing Age Predict the Need to Restart Drug Therapy after AF Ablation to Maintain AF Control. Circulation, 118(suppl_18). doi:10.1161/circ.118.suppl_18.s_923
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  Background : While many patients (pts) remain free of atrial fibrillation (AF) without anti-arrhythmic drug(AAD) therapy after ablation, some pts require re-initiation of medications to control AF long-term. Factors associated with need for reinstituting AAD have not been identified. Methods: A total of 578 pts who underwent AF ablation and demonstrated AF control for at least 12months were included in this study. The ablation included proximal pulmonary vein (PV) isolation with entry and exit block and elimination of non PV triggers. AAD were reinitiated if with ECG documented AF recurrence after the 2 month blanking period. Confirmation of AF control was based on symptoms and transtelephonic ECG monitoring at 6 mos, 12 mos, and with symptoms. Clinical variables were compared between each group by univariate analysis to determine if significant differences existed. Significant parameters were included in a multivariate analysis to determine interaction between variables. Results: Table 1 delineates clinical parameters included in the analysis, with unadjusted P values for each variable. Multivariate analysis with forward and backward regression identified larger LA size and advancing age as only factors which correlated with the need for AAD therapy after ablation to maintain AF control. Conclusions: Increased LA size and advancing age are clinical parameters which suggest progressive fibrosis of the LA. In our analysis, these two variables strongly predicted the need to restart AAD therapy after proximal PV ablation and elimination of non PV triggers in order to maintain long-term control of AF. Table 1
• Hutchinson, M., & Callans, D. J. (2007). Assessing the complications from atrial fibrillation ablation: closer to truth. Heart rhythm : the official journal of the Heart Rhythm Society, 4(10), 1272-3.
• Sussman, J. S., Rupa, B., Marchlinski, F. E., Hutchinson, M. D., Gerstenfeld, E. P., Garcia, F. C., Dixit, S., & Bazan, V. (2006). P5-56: Prospective evaluation of described ECG criteria for epicardial VT origin. Heart Rhythm, 3(5), S278-S279. doi:10.1016/j.hrthm.2006.02.834

Poster Presentations

• Chinyere, I. R., Weigand, K., Moukabary, T., Witte, R. S., Chu, M., Novak, S., Hutchinson, M., Lancaster, J., Gregorio, C. C., Goldman, S., & Juneman, E. B. (2018, spring). Mapping and Inducing Ventricular Tachycardia in Cardiomyopathic Animal Models. Circ Res. San Antonio, TX: 2018 Circ Res 121:A86.

Others

• Kern, K. B., Shetty, R., Hutchinson, M., Harhash, A. A., Reddy, S., Huang-Tsang, J., Natarajan, B., & Balakrishnan, M. (2017, Spring). Does ST segment elevation in lead AVR correlate with left main occlusion?. Journal of American College of Cardiology.
• Betensky, B. P., Zado, E. S., Anter, E., Desai, N., Callans, D. J., Deo, R., Frankel, D. S., Hutchinson, M., Lin, D., Riley, M. P., Schaller, R., Supple, G., Acker, M., Bavaria, J., Szeto, W., Vallabhajosyula, P., Marchlinski, F. E., & Dixit, S. (2015, May). Surgical ablation of refractory ventricular tachycardia in patients with non-ischemic cardiomyopathy: Ablation strategies and long term outcomes.. Heart Rhythm.
• Hipp, R., & Hutchinson, M. (2015, May). Malignant ventricular proarrhythmia: An uncommon complication of biventricular pacing.. Heart Rhythm.
• Sadek, M., Ren, J., Chik, W. W., Supple, G. E., Frankel, D. S., Hutchinson, M., Riley, M. P., Garcia, F. C., Verdino, R. J., Lin, D., Dixit, S., Callans, D. J., Epstein, A. E., & Marchlinski, F. E. (2015, May). Utility of intracardiac echocardiography during transvenous lead extraction. Heart Rhythm.
• Sadek, M., Santangeli, P., Maeda, S., Mirza, B., Chik, W. W., Zado, E. S., Schaller, R., Supple, G. E., Frankel, D. S., Hutchinson, M., Garcia, F. C., Riley, M. P., Lin, D., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2015, May). Recurrent arrhythmias in the setting of chronic pulmonary vein isolation.. Heart Rhythm.
• Santangeli, P., Muser, D., Zado, E. S., Magnani, S., Hutchinson, M., Frankel, D. S., Supple, G., Lin, D., Garcia, F. E., Riley, M. P., Schaller, R., Maeda, S., Dixit, S., Marchlinski, F. E., & Callans, D. J. (2015, May). : Clinical profile of patients experiencing early mortality after catheter ablation of scar-related ventricular tachycardia.. Heart Rhythm.
• Santangeli, P., Zado, E. S., Garcia, F. C., Hutchinson, M., Supple, G., Frankel, D. S., Lin, D., Riley, M. P., Schaller, R., Sadek, R., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2015, May). Prevalence, trigger distribution and long-term outcome of idiopathic ventricular fibrillation ablation: A 15-year experience.. Heart Rhythm.
• Santangeli, P., Zado, E. S., Lin, D., Frankel, D. S., Supple, G., Hutchinson, M., Riley, M. P., Garcia, F. C., Schaller, R., Dixit, S., Callans, D. J., & Marchlinski, F. E. (2015, May). Lack of prognostic value of atrial arrhythmia inducibility and change in inducibility status following catheter ablation of atrial fibrillation.. Heart Rhythm.
• Zado, E. S., Santangeli, P., Lin, D., Supple, G., Riley, M. p., Frankel, D. S., Hutchinson, M., Pammer, M., Callans, D. J., & Marchlinski, F. E. (2015, May). Clinical factors associated with patients preference for multiple repeat procedures or conservative management to treat recurrent atrial fibrillation after catheter ablation.. Heart Rhythm.