Omar Ziad Meziab

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Scholarly Contributions

Journals/Publications

• Meziab, O. (2024). The Difficulty in Navigating a Storm Without a Compass. JACC: Case Reports, 29(16). doi:10.1016/j.jaccas.2024.102413
• Meziab, O., Dereszkiewicz, E., Guerrero, C., Hoyer, A., Barber, B., Klewer, S., & Seckeler, M. (2024). Adverse Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology: From the Pediatric Heart Network Fontan Public Data Set. Pediatric Cardiology. doi:10.1007/s00246-024-03500-1
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  Patients with Fontan physiology have reduced exercise performance compared to their peers as well as a higher incidence of bundle branch block (BBB). This study aims to investigate the association between BBB and exercise performance in the Fontan population through a retrospective review of the Pediatric Heart Network Fontan study public use dataset. “Low Performers” were defined as ≤ 25th percentile (for Fontan patients) for each exercise parameter at anaerobic threshold (AT) for gender and age and “Normal Performers” were all other patients. A total of 303 patients with Fontan physiology who underwent exercise testing reached AT and had complete data for BBB. BBB occurred more frequently in Low Performers for VO2 [OR (95% CI): 2.6 (1.4, 4.8)] and Work [OR (95% CI): 2.7 (1.4, 5.1)], suggesting that BBB in the Fontan population is associated with reduced exercise performance. This data adds to the existing clinical evidence of the adverse effects of conduction abnormalities on single ventricle cardiac output and adds support for consideration of cardiac resynchronization and multi-site ventricular pacing in this patient population.
• Meziab, O., Seckeler, M., Scherer, K., & Barber, B. (2024). Prevalence of cardiovascular implantable electronic devices in children with type 1 myotonic dystrophy. Muscle and Nerve, 70(5). doi:10.1002/mus.28188
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  Introduction/Aims: Type 1 myotonic dystrophy (DM1) is a neuromuscular disorder of multiple organ systems with important electrophysiologic (EP) manifestations, leading to a cumulative incidence of sudden death of 6.6%. Due to genetic anticipation, there is a pediatric subset of this patient population. However, most EP research on DM1 patients has been in adults, making cardiac care for pediatric patients difficult and directed by adult guidelines which often leads to cardiovascular implantable electronic device (CIED) implants. We sought to investigate the prevalence of CIEDs in the pediatric DM1 population. Methods: The Vizient® Clinical Data Base was queried from October 2019 to October 2023 for admissions with and without ICD-10 code for myotonic dystrophy (G71.11), with and without codes for presence of a pacemaker or ICD (Z95.0, Z95.810). Patients who were identified were stratified by age: Pediatric (0–21 years) and Adult (22–50 years). Results: Prevalence of CIED in pediatric DM1 was 2.1% and in adult DM1 was 15.8%. When comparing to pediatric and adult patients with CIED and without DM1, the odds ratio for CIED in pediatric DM1 was 48.8, compared to 23.3 for CIED in adult DM1. Discussion: There are pediatric DM1 patients who have received CIED despite a lack of data to inform this decision-making. Further research will be important to ensure appropriate use of CIED in this population and to develop appropriate guidelines to direct management.
• Przybylski, R., Meziab, O., Gauvreau, K., Dionne, A., DeWitt, E., Bezzerides, V., & Abrams, D. (2024). Premature ventricular contractions in children and young adults: natural history and clinical implications. Europace, 26(3). doi:10.1093/europace/euae052
• Whitehill, R., Hill, A., Baskar, S., Jackson, L., Scheiber, J., Yoon, J., Dresner, L., Williams, M., Meziab, O., Mah, D., Jimenez, E., & Dionne, A. (2024). Thromboembolic Complications From Atrial Fibrillation and Atrial Flutter in Pediatrics and Young Adults: A Multicenter Study. Journal of Cardiovascular Electrophysiology. doi:10.1111/jce.16518
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  Background: Atrial fibrillation and atrial flutter are relatively rare in young people and the incidence of thromboembolic complications is unknown. These issues contribute to the limited utility of present guidelines regarding anticoagulation in this population. Objective: To report the number of thromboembolic complications in a cohort of pediatric and young adult patients presenting with atrial fibrillation (AFib) or atrial flutter (AFl) while also assessing anticoagulation practice in a multicenter cohort of young patients with these arrhythmias. Methods: Multicenter, retrospective cohort of patients aged < 25 years old who presented with atrial flutter (AFl) or atrial fibrillation (AFib) between 2000 and 2019 to several large, quaternary pediatric centers, excluding episodes occurring within 30 days of an invasive cardiac procedure. Results: There were 311 episodes of AFib/AFl among 210 patients with a median age of 17 (IQR 14, 20) years. Structural heart disease (SHD) was present in 120 patients (57%) and 20 patients (10%) had a primary cardiomyopathy. Twelve AFib/AFl episodes (8 with AFL, 4 with AFib) were associated with a thrombus, of which 8 (67%) patients had SHD, 2 (17%) had cardiomyopathy and 5 (42%) ventricular dysfunction. The CHADSVASc score was 0–3 for all patients with a thrombus. Of patients with no thrombus at presentation who were cardioverted, 102 (34%) patients were discharged on aspirin and 80 (27%) on anticoagulation. Two patients had symptoms concerning for a thromboembolic event on follow-up, but none had a newly documented thrombus. Conclusions: Thromboembolic complications occur in children and young adults presenting with AFib/AFl. The majority are associated with SHD, cardiomyopathy, and/or ventricular dysfunction. CHADSVASc was calculated for each patient and was of limited utility. Thromboembolic complications at follow up after cardioversion are rare, and anticoagulation strategies at discharge varied.
• June, C., Culbert, M. H., Meziab, O., Caryl, N. E., Klewer, S. E., & Seckeler, M. D. (2023). Additional Burden of Esophageal and Gastric Varices on Hospitalized Patients With Moderate or Severe Congenital Heart Disease. The American journal of cardiology, 209, 163-164.
• Meziab, O., Dionne, A., Przybylski, R., Triedman, J. K., Walsh, E. P., & Mah, D. Y. (2023). Clinical implications of a unique delta wave pattern in patients with left-sided Wolff-Parkinson-White. 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, 25(5).
• Meziab, O., Hoyer, A. W., Fox, K. A., & Seckeler, M. D. (2023). 3-Dimensional Printing for Planning for Transvenous Pacemaker Placement in Complex Congenital Heart Disease. JACC. Clinical electrophysiology, 9(8 Pt 1), 1433-1435.
• Przybylski, R., DeWitt, E. S., Meziab, O., Gauvreau, K., Dionne, A., O'Leary, E. T., Alexander, M. E., Walsh, E. P., & Mah, D. Y. (2023). Retroflexed catheter course reduces the risk of right free wall accessory pathway recurrence. Journal of cardiovascular electrophysiology, 34(9), 1828-1834.
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  Accessory atrioventricular pathways (APs) may mediate atrioventricular reciprocating tachycardia and, in some cases, have the potential to conduct atrial tachycardia rapidly, which can be life threatening. While catheter ablation can be curative, ablation of right free wall APs is associated with a high rate of recurrence, likely secondary to reduced catheter stability along the right free wall atrioventricular groove. We sought to identify characteristics associated with a lower rate of recurrence and hypothesized ablation lesions placed on the ventricular side of the atrioventricular groove using a retroflexed catheter approach would decrease rates of recurrence.
• Meziab, O., Byrum, C. J., Randall, J., & Dionne, A. (2022). Multiple QRS Morphologies: Findings on an Initial Newborn ECG. JACC: Case Reports, 4(10), 610-612.
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  Regular wide complex tachycardia carries with it a standard array of differential diagnoses. This electrocardiogram demonstrates wide complex tachycardia and multiple QRS configurations in a neonate without structural heart disease with an uncommon suspected underlying diagnosis. ().
• Meziab, O., Marcondes, L., Friedman, K. G., O'Leary, E. T., Gurvitz, M., VanderPluym, C. J., Walsh, E. P., Triedman, J. K., & Mah, D. Y. (2020). Difference in the prevalence of intracardiac thrombus on the first presentation of atrial fibrillation versus flutter in the pediatric and congenital heart disease population. Journal of cardiovascular electrophysiology, 31(12), 3243-3250.
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  Guidelines recommend trans-esophageal echocardiography (TEE) for patients with atrial fibrillation (AF) or atrial flutter (AFL) for >48 h, due to risk of intracardiac thrombus formation. With growing evidence that AFL in adults with structurally normal hearts has less thrombogenic potential compared to AF, and the need for TEE questioned, we compared prevalence of intracardiac thrombus detected by TEE in pediatric and congenital heart disease (CHD) patients presenting in AF and AFL.
• Meziab, O., Abrams, D. J., Alexander, M. E., Bevilacqua, L., Bezzerides, V., Mah, D. Y., Walsh, E. P., & Triedman, J. K. (2018). Utility of incomplete right bundle branch block as an isolated ECG finding in children undergoing initial cardiac evaluation. Congenital heart disease, 13(3), 419-427.
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  This study evaluates the ability of experienced pediatric electrophysiologists (EPs) to reliably classify incomplete right bundle branch block (IRBBB) and assesses its clinical utility as an isolated ECG finding in a group of healthy outpatient children without prior cardiac evaluation.
• Seckeler, M. D., Thomas, I. D., Andrews, J., Meziab, O., Moe, T., Heller, E., & Klewer, S. E. (2018). Higher Cost of Hospitalizations for Non-cardiac Diagnoses in Adults with Congenital Heart Disease. Pediatric cardiology, 39(3), 437-444.
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  Adults with congenital heart disease (CHD) are a rapidly increasing population and their impact on healthcare resources is not fully understood. The purpose of this study was to describe the costs of hospitalizations for non-cardiac disease for adults with CHD. We conducted a retrospective review of hospital discharge data from the University HealthSystem Consortium Clinical Data Base/Resource Manager from January 2011 through December 2013. Patients were ≥ 18 years old at admission with any ICD-9 code for moderate or high severity CHD; cardiac surgical admissions were excluded. The comparison group consisted of patients ≥ 18 years old with no ICD-9 codes for any severity CHD. There were 9,169,700 non-CHD, 28,224 moderate CHD, and 3045 high severity CHD hospital admissions. Total length of stay was longer for acute kidney injury, depressive disorder, esophageal reflux, and obstructive sleep apnea for any severity CHD; ICU admission rates were higher for all diagnoses with any severity CHD. Mean observed direct costs were higher for all diagnoses for moderate CHD and all diagnoses except dehydration, type 2 diabetes, obesity, and obstructive sleep apnea for high severity CHD. This review identified significantly increased hospitalization costs for adults with moderate and high severity CHD who are admitted for non-cardiac medical conditions not associated with concomitant cardiac surgical procedures. Admissions with CHD diagnoses had higher ICU admission rates, longer lengths of stay, and higher mortality for most non-cardiac admission diagnoses. These data will add to our understanding of the economic impact of adults with CHD.
• Colombo, J. N., Samson, R. A., Valdes, S. O., Meziab, O., Sisk, D., & Klewer, S. E. (2017). Decreased false-positive adolescent pre-athletic screening with Seattle Criteria-interpreted electrocardiograms. Cardiology in the young, 27(3), 512-517.
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  Sudden cardiac arrest is a rare but devastating cause of death in young adults. Electrocardiograms may detect many causes of sudden cardiac arrest, but are not routinely included in pre-athletic screening in the United States of America partly because of high rates of false-positive interpretation. To improve electrocardiogram specificity for identifying cardiac conditions associated with sudden cardiac arrest, an expert panel developed refined criteria known as the Seattle Criteria. Ours is the first study to compare standard electrocardiogram criteria with Seattle Criteria in 11- to 13-year-olds. In total, 1424 students completed the pre-athletic screening and electrocardiogram; those with a positive screen or abnormal electrocardiogram interpreted by a paediatric electrophysiologist completed further work-up. Electrocardiograms referred for additional evaluation were re-interpreted by a paediatric electrophysiologist using Seattle Criteria. Electrocardiogram abnormalities were identified in 98 (6.9%); Seattle Criteria identified 28 (2.0%). Formal evaluation confirmed four students at risk for sudden cardiac arrest (0.3%): long QT syndrome (n=2), Wolff-Parkinson-White (n=1), and pulmonary hypertension (n=1). All students with at-risk phenotypes for sudden cardiac arrest were identified by both standard electrophysiologist and Seattle Criteria. The false-positive interpretation rate decreased from 6.6 to 1.7% with Seattle Criteria. Downstream costs associated with screening using standard paediatric electrocardiogram interpretations and Seattle Criteria were projected at $24 versus $7, respectively. In conclusion, using Seattle Criteria for electrocardiogram interpretation decreases the rate of false-positive results compared with standard interpretation without omitting true-positive electrocardiogram findings. This may decrease unnecessary referrals and costs associated with formal cardiology evaluation.
• Seckeler, M. D., Moe, T. G., Thomas, I. D., Meziab, O., Andrews, J., Heller, E., & Klewer, S. E. (2015). Hospital Resource Utilization for Common Noncardiac Diagnoses in Adult Survivors of Single Cardiac Ventricle. The American journal of cardiology, 116(11), 1756-61.
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  Single ventricle congenital heart disease (SV CHD) has transformed from a nearly universally fatal condition to a chronic illness. As the number of adults living with SV CHD continues to increase, there needs to be an understanding of health care resource utilization (HCRU), particularly for noncardiac conditions, for this patient population. We performed a retrospective database review of the University HealthSystem Consortium Clinical Database/Resource Manager for adult patients with SV CHD hospitalized for noncardiac conditions from January 2011 to November 2014. Patients with SV CHD were identified using International Classification of Disease (ICD)-9 codes associated with SV CHD (hypoplastic left heart, tricuspid atresia, and SV) and stratified into 2 groups by age (18 to 29 years and 30 to 40 years). Direct cost, length of stay (LOS), intensive care unit (ICU) admission rate and mortality data were compared with age-matched patients without CHD. There were 2,083,651 non-CHD and 590 SV CHD admissions in Group 1 and 2,131,046 non-CHD and 297 SV CHD admissions in Group 2. There was no difference in LOS in Group 1, but there were higher costs for several diagnoses. LOS and costs were higher for several diagnoses in Group 2. ICU admission rate and in-hospital mortality were higher for several diagnoses for patients with SV CHD in both groups. In conclusion, adults with SV CHD admitted for noncardiac diagnoses have higher HCRU (longer LOS and higher ICU admission rates) compared with similarly aged patients without CHD. These findings stress the importance of good primary care in this population with complex, chronic cardiac disease to prevent hospitalizations and higher HCRU.
• Meziab, O. Z. (2014). Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. Alzheimer's & Dementia, 10(3S). doi:10.1016/j.jalz.2014.04.004
• Meziab, O., Kirby, K. A., Williams, B., Yaffe, K., Byers, A. L., & Barnes, D. E. (2014). Prisoner of war status, posttraumatic stress disorder, and dementia in older veterans. Alzheimer's & dementia : the journal of the Alzheimer's Association, 10(3 Suppl), S236-41.
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  It is not known whether prisoners of war (POWs) are more likely to develop dementia independently of the effects of posttraumatic stress disorder (PTSD).
• Panchal, A. R., Meziab, O., Stolz, U., Anderson, W., Bartlett, M., Spaite, D. W., Bobrow, B. J., & Kern, K. B. (2014). The impact of ultra-brief chest compression-only CPR video training on responsiveness, compression rate, and hands-off time interval among bystanders in a shopping mall. Resuscitation, 85(9), 1287-90.
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  Recent studies have demonstrated higher-quality chest compressions (CCs) following a 60 s ultra-brief video (UBV) on compression-only CPR (CO-CPR). However, the effectiveness of UBVs as a CPR-teaching tool for lay bystanders in public venues remains unknown.

Presentations

• Caryl, N., Hoyer, A., Yaddanapudi, K., Chandra, S., Camarena, M., Meziab, O., Chatterjee, A., & Seckeler, M. (2023, May). Not every TIA is a PFO – the importance of other shunts. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Chandra, S., Meziab, O., Caryl, N., Hoyer, A., Chatterjee, A., & Seckeler, M. (2023, May). 3D printing of patient-specific intravascular stents for congenital heart disease – proof of concept. The Society for Cardiovascular Angiography and Interventions 2023 Scientific Sessions. Phoenix, Arizona.
• Dereszkiewicz, E., Meziab, O., Guerrero, C. E., Hoyer, A., Barber, B. J., Klewer, S. E., & Seckeler, M. (2023, March). Negative Effect of Bundle Branch Block on Exercise Performance in Patients with Fontan Physiology (from the Pediatric Heart Network Fontan Public Data Set) . American College of Cardiology ACC.23/WCC Scientific Sessions. New Orleans, Louisiana.

Poster Presentations

• Bose, C., Chin, C., Caryl, N., Meziab, O., Barber, B. J., Andrews, J. G., Seckeler, M., Bose, C., Chin, C., Caryl, N., Meziab, O., Barber, B. J., Andrews, J. G., & Seckeler, M. (2024, November). Hospital Outcomes of Patients With Type I Diabetes Mellitus and Moderate and Severe Congenital Heart Disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Klewer, S. E., Seckeler, M., Meziab, O., & Kleinsasser, R. (2024, November). No Change in Endocarditis Rates in Patients with Congenital Heart disease During the COVID-19 Pandemic. AMA Research Challenge (virtual event). Virtual.
• Seckeler, M., Barber, B. J., Andrews, J. G., Guerrero, C., Meziab, O., Bose, C., Macaraeg, M., & Caryl, N. (2024, November). Incidence of Autoimmune Disease in Patients with Congenital Heart Disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Seckeler, M., Barber, B. J., Andrews, J. G., Meziab, O., Caryl, N., & Hendrickson, A. (2024, November). Association Between G6PD Deficiency and Congenital Heart Disease Incidence and Hospital Outcomes. American Heart Association 2024 Scientific Sessions. Chicago.
• Seckeler, M., Klewer, S. E., Guerrero, C., Meziab, O., Fox, K., Hoyer, A., Barber, B. J., Andrews, J. G., Mathena, S., & Yatsenko, V. (2024, November). Healthcare utilization trends for adolescents and young adults with moderate and severe congenital heart disease. American Heart Association 2024 Scientific Sessions. Chicago.
• Meziab, O., Seckeler, M., Scherer, K., & Barber, B. J. (2023, August). Prevalence of Cardiovascular Implantable Electronic Devices in Children with Type 1 Myotonic Dystrophy. 8th World Congress of Pediatric Cardiology and Cardiac Surgery. Washington, DC.
• Culbert, H., June, C., Meziab, O., Caryl, N., Klewer, S. E., & Seckeler, M. (2022, November). Additional Burden Of Esophageal And Gastric Varices On Hospitalized Patients With Moderate Or Severe Congenital Heart Disease. American Heart Association 2022 Scientific Sessions. Chicago, IL.
• Meziab, O., Maschietto, N., Mah, D. Y., & O'Leary, E. T. (2022). Proximity of Transcatheter Pulmonary Valve Prostheses to Anatomical Ventricular Tachycardia Isthmuses in Repaired Tetralogy of Fallot. Heart Rhythm Society Annual Scientific Sessions. San Francisco, CA: HRS.
• Meziab, O., Feins, E., Kheir, J., Delgado, M., Godsay, M., O'Leary, E., Triedman, J. K., Walsh, E. P., & Dionne, A. (2021). Sinus Node Dysfunction After Surgery for Congenital Heart Disease. Heart Rhythm Society Annual Scientific Sessions. Boston, MA: HRS.
• Meziab, O., Marcondes, L., Friedman, K. G., O'Leary, E. T., Gurvitz, M., VanderPluym, C. J., Walsh, E. P., Triedman, J. K., & Mah, D. Y. (2020). Difference in Prevalence of Intracardiac Thrombus on the First Presentation of Atrial Fibrillation Versus Flutter in the Pediatric and Congenital Heart Disease Population. Heart Rhythm Society Annual Scientific Sessions. San Diego, CA (Accepted but not presented due to COVID-19 pandemic): HRS.
• Meziab, O., Abrams, D. J., Alexander, M. E., Bevilacqua, L., Bezzerides, V., Mah, D. Y., Walsh, E. P., & Triedman, J. K. (2017). Limited Utility of Incomplete Right Bundle Branch Block in Children. Heart Rhythm Society Annual Scientific Sessions. Chicago, IL: HRS.

Others

• Meziab, O. (2024, May). Co-moderator for Pediatric Oral Abstract Session at Heart Rhythm Society Meeting.