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Charting a course for cardiac electrophysiology training in Canada: the vital role of fellows in advanced cardiovascular care.

https://arctichealth.org/en/permalink/ahliterature106382
Source
Can J Cardiol. 2013 Nov;29(11):1527-30
Publication Type
Article
Date
Nov-2013
Author
Richard A Leather
Martin Gardner
Martin S Green
Katherine Kavanagh
Laurent Macle
Kamran Ahmad
Chris Gray
Felix Ayala-Paredes
Peter G Guerra
Gilles O'Hara
Vidal Essebag
Marcio Sturmer
Adrian Baranchuk
Tomasz Hruczkowski
Ilan Lahevsky
Paul Novak
Shanta Chakrabarti
Louise Harris
Lorne J Gula
Carlos Morillo
Shubhayan Sanatani
Robert M Hamilton
Robert M Gow
Andrew D Krahn
Author Affiliation
Royal Jubilee Hospital, Victoria, British Columbia, Canada. Electronic address: rleather@shaw.ca.
Source
Can J Cardiol. 2013 Nov;29(11):1527-30
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Cardiac Electrophysiology - education
Education, Medical, Graduate
Fellowships and Scholarships - statistics & numerical data
Foreign Medical Graduates - statistics & numerical data
Humans
Questionnaires
Abstract
Canadian electrophysiology (EP) fellowship programs have evolved in an ad hoc fashion over 30 years. This evolution has occurred in many fields in medicine and is natural when innovators and pioneers attract research fellows who help change the status quo from predominantly research to a predominantly clinical application and focus. Fellows not only push their supervisors and their centres into new areas of inquiry but also function at the most advanced level to encourage and teach junior trainees and to provide examples of excellence to residents, medical students, and other health professionals. Funding for fellows has never been provided in the traditional way through the Ministry of Health or the Ministry of Advanced Education. Each Canadian centre has over the years found novel ways to fund fellowship programs, and many centres have used value-adds from procurement programs. These sources of funding are eroding as provincial government agencies are beginning to assume procurement responsibilities and local flexibility to fund fellowships is lost. In particular, provincial government agencies feel that valuable financial resources should be restricted to Canadian trainees only, despite the international consensus that fellowship is an essential time for advanced trainees to travel abroad to acquire a broad a range of experience, learn new techniques and approaches, make lifelong research connections, and hopefully return home with these skills and expertise. This article summarizes the long history of EP fellowship training in Canada, as well as EP fellowship experiences at home and abroad by Canadian electrophysiologists, in an attempt to contextualize these new realities.
PubMed ID
24182759 View in PubMed
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Epinephrine infusion in the evaluation of unexplained cardiac arrest and familial sudden death: from the cardiac arrest survivors with preserved Ejection Fraction Registry.

https://arctichealth.org/en/permalink/ahliterature121050
Source
Circ Arrhythm Electrophysiol. 2012 Oct;5(5):933-40
Publication Type
Article
Date
Oct-2012
Author
Andrew D Krahn
Jeffrey S Healey
Vijay S Chauhan
David H Birnie
Jean Champagne
Shubhayan Sanatani
Kamran Ahmad
Emily Ballantyne
Brenda Gerull
Raymond Yee
Allan C Skanes
Lorne J Gula
Peter Leong-Sit
George J Klein
Michael H Gollob
Christopher S Simpson
Mario Talajic
Martin Gardner
Author Affiliation
University of British Columbia, Vancouver, BC, Canada. akrahn@mail.ubc.ca
Source
Circ Arrhythm Electrophysiol. 2012 Oct;5(5):933-40
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Analysis of Variance
Canada - epidemiology
Chi-Square Distribution
Death, Sudden, Cardiac - epidemiology
Electrocardiography
Epinephrine - administration & dosage - diagnostic use
Exercise Test
Female
Heart Rate - physiology
Humans
Infusions, Intravenous
Long QT Syndrome - diagnosis - genetics - physiopathology
Male
Middle Aged
Registries
Stroke Volume
Survivors
Tachycardia, Ventricular - diagnosis - genetics - physiopathology
Vasoconstrictor Agents - administration & dosage - diagnostic use
Abstract
Epinephrine infusion may unmask latent genetic conditions associated with cardiac arrest, including long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia (VT).
Patients with unexplained cardiac arrest (normal left ventricular function and QT interval) and selected family members from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) registry underwent epinephrine challenge at doses of 0.05, 0.10, and 0.20 µg/kg per minute. A test was considered positive for long-QT syndrome if the absolute QT interval prolonged by = 30 ms at 0.10 µg/kg per minute and borderline if QT prolongation was 1 to 29 ms. Catecholaminergic polymorphic VT was diagnosed if epinephrine provoked = 3 beats of polymorphic or bidirectional VT and borderline if polymorphic couplets, premature ventricular contractions, or nonsustained monomorphic VT was induced. Epinephrine infusion was performed in 170 patients (age, 42 ± 16 years; 49% men), including 98 patients with unexplained cardiac arrest. Testing was positive for long-QT syndrome in 31 patients (18%) and borderline in 24 patients (14%). Exercise testing provoked an abnormal QT response in 42% of tested patients with a positive epinephrine response. Testing for catecholaminergic polymorphic VT was positive in 7% and borderline in 5%. Targeted genetic testing of abnormal patients was positive in 17% of long-QT syndrome patients and 13% of catecholaminergic polymorphic VT patients.
Epinephrine challenge provoked abnormalities in a substantial proportion of patients, most commonly a prolonged QT interval. Exercise and genetic testing replicated the diagnosis suggested by the epinephrine response in a small proportion of patients. Epinephrine infusion combined with exercise testing and targeted genetic testing is recommended in the workup of suspected familial sudden death syndromes. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00292032.
Notes
Comment In: Circ Arrhythm Electrophysiol. 2012 Oct;5(5):879-8123074323
PubMed ID
22944906 View in PubMed
Less detail

Recommendations for the use of genetic testing in the clinical evaluation of inherited cardiac arrhythmias associated with sudden cardiac death: Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position paper.

https://arctichealth.org/en/permalink/ahliterature135656
Source
Can J Cardiol. 2011 Mar-Apr;27(2):232-45
Publication Type
Article
Author
Michael H Gollob
Louis Blier
Ramon Brugada
Jean Champagne
Vijay Chauhan
Sean Connors
Martin Gardner
Martin S Green
Robert Gow
Robert Hamilton
Louise Harris
Jeff S Healey
Kathleen Hodgkinson
Christina Honeywell
Michael Kantoch
Joel Kirsh
Andrew Krahn
Michelle Mullen
Ratika Parkash
Damian Redfearn
Julie Rutberg
Shubhayan Sanatani
Anna Woo
Author Affiliation
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. mgollob@ottawaheart.ca
Source
Can J Cardiol. 2011 Mar-Apr;27(2):232-45
Language
English
Publication Type
Article
Keywords
Arrhythmias, Cardiac - congenital - diagnosis - mortality
Canada - epidemiology
Death, Sudden, Cardiac - epidemiology - etiology
Genetic Testing - standards
Humans
Incidence
Practice Guidelines as Topic
Reproducibility of Results
Societies, Medical
Abstract
The era of gene discovery and molecular medicine has had a significant impact on clinical practice. Knowledge of specific genetic findings causative for or associated with human disease may enhance diagnostic accuracy and influence treatment decisions. In cardiovascular disease, gene discovery for inherited arrhythmia syndromes has advanced most rapidly. The arrhythmia specialist is often confronted with the challenge of diagnosing and managing genetic arrhythmia syndromes. There is now a clear need for guidelines on the appropriate use of genetic testing for the most common genetic conditions associated with a risk of sudden cardiac death. This document represents the first ever published recommendations outlining the role of genetic testing in various clinical scenarios, the specific genes to be considered for testing, and the utility of test results in the management of patients and their families.
PubMed ID
21459272 View in PubMed
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Sentinel symptoms in patients with unexplained cardiac arrest: from the cardiac arrest survivors with preserved ejection fraction registry (CASPER).

https://arctichealth.org/en/permalink/ahliterature130928
Source
J Cardiovasc Electrophysiol. 2012 Jan;23(1):60-6
Publication Type
Article
Date
Jan-2012
Author
Andrew D Krahn
Jeffrey S Healey
Christopher S Simpson
Vijay S Chauhan
David H Birnie
Jean Champagne
Martin Gardner
Shubhayan Sanatani
Santabhanu Chakrabarti
Raymond Yee
Allan C Skanes
Peter Leong-Sit
Kamran Ahmad
Michael H Gollob
George J Klein
Lorne J Gula
Robert S Sheldon
Author Affiliation
University of Western Ontario, London, Ontario, Canada Hamilton Health Sciences Center, Hamilton, Ontario, Canada. akrahn@uwo.ca
Source
J Cardiovasc Electrophysiol. 2012 Jan;23(1):60-6
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Female
Genetic Predisposition to Disease
Heart Arrest - epidemiology - genetics - mortality - physiopathology
Humans
Male
Middle Aged
Pedigree
Phenotype
Prognosis
Prospective Studies
Questionnaires
ROC Curve
Registries
Risk assessment
Risk factors
Sentinel Surveillance
Stroke Volume
Syncope - epidemiology - genetics - mortality - physiopathology
Abstract
Warning symptoms may provide an opportunity to diagnose genetic disorders leading to preventative therapy. We explored the symptom history of patients with apparently unexplained cardiac arrest to determine the frequency of sentinel symptoms.
Patients with apparently unexplained cardiac arrest and no evident cardiac disease underwent systematic clinical evaluation. Patients and first-degree relatives were interviewed to determine the presence of cardiac symptoms, and those with syncope underwent 2 structured Calgary Syncope Score questionnaires to determine the probable mechanism of syncope.
One hundred consecutive cardiac arrest patients (age 43.0 ± 13.4 years, 60% male) and 63 first-degree relatives (age 37.6 ± 16.3 years, 54% female) were enrolled. Previous cardiac symptoms were present in 69% of cardiac arrest patients compared to 43% of family members (P = 0.001). Prior syncope was present in 26% of cardiac arrest patients, compared to 22% of family members (P = 0.59). Twenty-four of 25 cardiac arrest patients who completed the syncope questionnaires had a syncope versus seizure score
PubMed ID
21955300 View in PubMed
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Use of primary prevention implantable cardioverter-defibrillators in a population-based cohort is associated with a significant survival benefit.

https://arctichealth.org/en/permalink/ahliterature123590
Source
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):706-13
Publication Type
Article
Date
Aug-1-2012
Author
Ratika Parkash
John L Sapp
Magdy Basta
Steve Doucette
Kara Thompson
Martin Gardner
Chris Gray
Brenda Brownell
Hena Kidwai
Jafna Cox
Author Affiliation
Department of Medicine, Queen Elizabeth II Health Sciences Center and the Department of Community Health and Epidemiology, Research Methods Unit, Dalhousie University, Halifax, Nova Scotia, Canada. parkashr@cdha.nshealth.ca
Source
Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):706-13
Date
Aug-1-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Chi-Square Distribution
Death, Sudden, Cardiac - etiology - prevention & control
Defibrillators, Implantable
Electric Countershock - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Nova Scotia
Patient Selection
Primary prevention - methods
Propensity Score
Referral and Consultation
Registries
Retrospective Studies
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
Underuse of implantable defibrillators has been previously noted in patients at risk for sudden cardiac death, as well as for survivors of sudden cardiac death. We sought to determine the utilization rates in a primary prevention implantable cardioverter-defibrillator (ICD)-eligible population and mortality in this group compared with a group that had undergone implantation of this therapy.
A retrospective cohort of patients from April 1, 2006, to December 31, 2009, was used to define a primary prevention ICD-eligible population. Two groups were compared on the basis of ICD implantation (no-ICD versus ICD). The primary outcome measure was mortality. Of the 717 patients found to be potentially eligible for a primary prevention ICD, 116 (16%) were referred. The remaining cohort of 601 patients were compared with an existing cohort of primary prevention ICD patients (n=290). A significant survival benefit was associated with primary prevention ICD implantation (hazard ratio, 0.46; 95% CI [0.33-0.64]; P
Notes
Comment In: Circ Arrhythm Electrophysiol. 2012 Aug 1;5(4):624-522895600
PubMed ID
22685111 View in PubMed
Less detail