Paari Dominic

University of Iowa | UI · Department of Internal Medicine

Introduction: Incident cardiac arrhythmias are common in hospitalized COVID-19 patients, but the impact of a second incident cardiac arrhythmia during hospitalization on clinical outcomes remain unclear. Hypothesis: The aim of this study was to assess the frequency and prognostic implications of a second incident arrhythmia in hospitalized COVID-19...

Background: Pulmonary embolism (PE) is a common form of venous thromboembolism that could be potentially fatal. Atrial fibrillation (AF) is the most common arrhythmia, which may lead to thromboembolic complications. They are distinct medical conditions, but PE may lead to AF through right-sided pressure overload. AF, in turn, might lead to right at...

Purpose of Review In this review, we aim to delve into the existing literature, seeking to uncover the mechanisms, investigate the electrocardiographic changes, and examine the treatment methods of various cardiac arrhythmias that occur after administration of the COVID-19 vaccine. Recent Findings A global survey has exposed an incidence of arrhyt...

Background: Syncope is a common complaint in clinical practice. The etiologies and mechanisms can be multiple and complex. Syncope caused by a mediastinal mass compressing the vagus nerve is rare. Case Report: We report the case of a patient who presented to the emergency department experiencing recurrent syncope. Imaging revealed a large, calcifie...

Background: Atrial fibrillation (AF) is the most common arrythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cance...

Introduction: Sacubitril/valsartan reduces all-cause mortality in heart failure (HF) patients compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF). We hypothesized sacubitril-valsartan decreases the incidence of AF com...

Abstract Background Recent single-center reports have suggested that community-acquired bacteremic co-infection in the context of Coronavirus disease 2019 (COVID-19) may be an important driver of mortality; however, these reports have not been validated with a multicenter, demographically diverse, cohort study with data spanning the pandemic. Metho...

Introduction: African Americans (AA) have largely been under-represented in randomized clinical trials investigating chemotherapy-induced cardiomyopathy (CICM) associated with doxorubicin and trastuzumab. Limited and conflicting evidence has linked higher incidence of CICM among AA patients to a higher prevalence of underlying co-morbidities. Hypot...

Introduction: Carcinoid heart disease is one of the major causes of mortality in patients with carcinoid syndrome. Although right-sided valvular dysfunction is well studied in carcinoid heart, there are limited data on the impact of atrial fibrillation (AF) on in-hospital mortality in these patients. We sought to assess the in-hospital outcomes in...

Background: Inflammation has been implicated in the pathogenesis, severity, and outcomes of COVID-19. Extracellular newly identified receptor for advanced glycation end-product (EN-RAGE), a soluble EF-hand calcium-binding protein, causes integrin activation, activates inflammation, and upregulates the synthesis of vascular cell adhesion molecule-1...

Introduction: Anaplastic Lymphoma Kinase tyrosine kinase inhibitors (ALK TKIs) have played a pivotal role in the management of Metastatic Non-Small-Cell Lung Cancer (NSCLC). ALK rearrangements are associated with improved survival compared to the standard first-line therapy. However, the cardiovascular safety profile of these agents remains underst...

Introduction: Ivabradine has been shown to be associated with atrial fibrillation (AF) in a metanalysis of 11 studies, however, AF has not been routinely reported as an adverse event of ivabradine in clinical trials. The FDA Adverse Event Reporting System (FAERS) is a publicly available database of adverse events (AE) of various drugs. We analyzed...

Introduction: Heart failure (HF) in pregnancy is associated with high maternal and neonatal mortality. Remote pulmonary artery pressure (PAP)-guided management of HF has been shown to reduce hospitalizations and mortality in HF patients. However, PAP monitoring systems (CardioMEMS) have not been implanted during pregnancy. We describe the first cas...

Introduction: African Americans (AA) have largely been under-represented in randomized clinical trials investigating chemotherapy-induced cardiomyopathy (CICM) associated with doxorubicin and trastuzumab. Limited and conflicting evidence has linked higher incidence of CICM among AA patients to a higher prevalence of underlying co-morbidities. Hypo...

Introduction: Current guidelines for cardiac resynchronization therapy (CRT) device implant are the same across both sexes however women have been traditionally underrepresented in randomized controlled trials (RCTs). We aimed to identify if the number of women included in CRT trials is representative of the real-world burden of heart failure (HF)...

Introduction: Heart failure (HF) is a major cause of morbidity and mortality, with nearly half of all HF-related deaths resulting from sudden cardiac death (SCD), most often from an arrhythmic event. The pathophysiologic changes that occur in response to the hemodynamic stress of HF may lead to increased arrhythmogenesis. Theoretically, medication...

Methamphetamine (METH) is an addictive illicit drug used worldwide that causes significant damage to blood vessels resulting in cardiovascular dysfunction. Recent studies highlight increased prevalence of cardiovascular disease (CVD) and associated complications including hypertension, vasospasm, left ventricular hypertrophy, and coronary artery di...

There is limited data on in‐hospital outcomes of catheter ablation (CA) for atrial fibrillation (AF) compared between men and women. We investigated National Inpatient Sample database to examine gender differences on in‐hospital outcomes of CA for AF. A total of 30,365 hospitalizations were identified and included in the final analysis. Multivariat...

Hydrogen sulfide (H2S) has emerged as a gaseous signalling molecule with crucial implications for cardiovascular health. H2S is involved in many biological functions, including interactions with nitric oxide, activation of molecular signalling cascades, post-translational modifications and redox regulation. Various preclinical and clinical studies...

Intracellular Ca²⁺-calmodulin (CaM) signaling plays an important role in Ca²⁺-CaM-dependent kinase (CaMKII) and calcineurin (CaN)-mediated cardiac biology. While neurogranin (Ng) is known as a major Ca²⁺-CaM modulator in the brain, its pathophysiological role in cardiac hypertrophy has never been studied before. In the present study, we report that...

Catheter Ablation of Atrial Fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) is associated with decreased all-cause mortality, and improvement in left ventricular ejection fraction (EF). Predictors of EF improvement post-AF ablation is not known. In this study we conducted a retrospective review of patients wh...

Background: Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains common and studies have shown about 5%-9% annual recurrence rate after CA. We sought to assess the echocardiogram derived left atrial appendage (LAA) emptying velocity as a predictor of AF recurrence after CA. Objective: To determine if LAA emptying is a mark...

The role of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in mitigating the risk of atrial fibrillation (AF) remains unknown. We interrogated the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to study the association between AF-related adverse events and the use...

Objective Advancements in fluoroscopy-assisted procedures have increased radiation exposure among cardiologists. Radiation has been linked to cardiovascular complications but its effect on cardiac rhythm, specifically, is underexplored. Methods Demographic, social, occupational, and medical history information was collected from board-certified ca...

Catheter Ablation of Atrial Fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) is associated with decreased all-cause mortality, and improvement in left ventricular ejection fraction (EF). Predictors of EF improvement post-AF ablation is not known. In this study we conducted a retrospective review of patients wh...

Background Patients with active cancer were historically excluded from clinical trials validating the CHA2DS2VASc score for stroke prediction in atrial fibrillation (AF). Limited data have questioned the predictive value of the score in patients with cancer and AF, underscoring the need for more personalized scores for prediction of stroke in these...

Introduction The illicit use of methamphetamine (MA), a dangerous psychostimulant has become a global epidemic. Studies have demonstrated a link between illicit substance use and cardiovascular consequences. The objective of this study was to assess whether MA use is associated with an early onset of cardiovascular diseases (CVD). Methods Retrospe...

Background: Several anti-cancer drugs have been linked to new onset atrial fibrillation (AF) but the true association of these drugs with AF is unknown. The FDA Adverse Event Reporting System (FAERS), a publicly available pharmacovigilance mechanism provided by the FDA, collects adverse event reports from the United States and other countries, thus...

Background Exposure to inhaled smoke, pollutants, volatile organic compounds, and polycyclic aromatic hydrocarbons in the firefighting environment has been associated with detrimental respiratory and cardiovascular effects, making firefighters a unique population with both personal and occupational risk factors for cardiovascular disease. Some of t...

Purpose : Astronauts in space vehicles beyond low-Earth orbit will be exposed to high charge and energy (HZE) ions, and there is concern about potential adverse effects on the cardiovascular system. Thus far, most animal studies that assess cardiac effects of HZE particles have included only males. This study assessed the effects of oxygen ions (¹⁶...

Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effe...

Introduction: Medical radiation has been linked to increased risk of AF but any association between solar irradiation and AF remains unexplored. Aim: To study the role of solar radiation on AF. Methods: State-wise and county-wise CDC data with AF hospitalization rates in Medicare beneficiaries from 2015 to 2017 was used. Data regarding solar irradi...

Introduction: Conduction system pacing is physiological and is therefore gaining interest. The Medtronic SelectSecure 3830 lead was officially approved by the FDA for His-bundle pacing (HBP) in 2018. However, prior to 2017-2018, this lead was mainly used for atrial pacing, ventricular pacing, or both. We evaluated and compared nationwide adverse ev...

Introduction: AHA/ASA guidelines recommend measuring troponin in patients with acute ischemic stroke (AIS) to monitor for acute myocardial infarction (AMI). However, large scale data on the prevalence and outcomes of AMI complicating AIS are lacking. Hypothesis: AMI in patients with AIS is associated with poorer outcomes. Methods: All patients with...

Introduction: Even though some studies have implicated radiation therapy (RT) as a risk factor for atrial fibrillation (AF), the association between RT and AF remains controversial. Hypothesis: To estimate the risk of AF associated with RT and compare it with dobutamine, flecainide, propafenone, ibrutinib and adenosine - the most common drugs causi...

Introduction: Low left atrial (LA) voltage is known to predict Atrial Fibrillation (AF) recurrence after catheter ablation (CA); however, its measurement involves invasive electrophysiology study (EPS). Left Atrial Appendage (LAA) emptying velocities are routinely measured during pre-procedural Transesophageal Echocardiography (TEE). We sought to a...

Introduction: Diabetes mellitus (DM) is a known risk factor for atrial fibrillation (AF). Anti-diabetic agents such as metformin and sodium glucose co-transporter-2 inhibitors have been proven to have a protective role against AF. Recent data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RA) do not increase the risk of AF whereas ev...

Introduction The Atricure EPi-Sense Device is used for the hybrid convergent procedure, an emerging treatment for persistent atrial fibrillation and long standing persistent atrial fibrillation. However, data on the AE related to the EPi-Sense device are scarce. Methods Keyword “EPI-SENSE” was searched on the MAUDE database. There were 80 device r...

Introduction: Sacubitril/valsartan reduces all cause mortality in heart failure (HF) patients compared to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF). Hypothesis: Sacubitril-Valsartan decreases the incidence of AF compared...

Introduction: Atrial fibrillation (AF) is associated with oxidative stress. Hydrogen sulfide and nitric oxide (NOx) are gasotransmitters involved in cardiovascular redox homeostasis. Free sulfide is increased in the plasma of human patients with atrial fibrillation. Although nitric oxide synthase expression and polymorphism has been studied in atri...

Purpose: While there is concern about degenerative tissue effects of exposure to space radiation during deep-space missions, there are no pharmacological countermeasures against these adverse effects. γ-Tocotrienol (GT3) is a natural form of vitamin E that has anti-oxidant properties, modifies cholesterol metabolism, and has anti-inflammatory and...

Introduction Over the last few years, improved outcomes in patients with chronic lymphocytic leukemia (CLL) have been credited to the introduction of novel agents for its treatment. However, the overall cardiovascular safety profile of these agents has not been studied adequately. Methods We searched the Food and Drug Administration Adverse Event...

Introduction: The Atricure EPi-Sense Device is used for the hybrid convergent procedure, an emerging treatment for persistent atrial fibrillation and long standing persistent atrial fibrillation. However, data on the AE related to the EPi-Sense device are scarce. Methods: Keyword “EPI-SENSE” was searched on the MAUDE database. There were 80 device...

Background: Methamphetamine (METH) is an addictive illicit drug used worldwide that can elicit significant damage on blood vessels resulting in increased inflammation and cardiovascular dysfunction. Recent studies highlight increased prevalence of cardiovascular disease (CVD) and associated complications including hypertension, vasospasm, left vent...

Objective To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG). Methods A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction–confirmed COVID-19 diagnosis and age-...

Background Heart complications are the main cause of morbidity and mortality in hemochromatosis, but the liver is the main site for iron deposition in these patients. Large multicenter studies have described cardiovascular (CV) manifestations in patients with secondary hemochromatosis. However, the overall prevalence and risk of CV manifestations i...

Background: Advancement of fluoroscopy-assisted procedures in the field of medicine has led to an increase in the frequency of their use among cardiologists, radiologists and surgeons. The personal health risk involved with radiation exposure is of concern and has come under the limelight in recent times. In addition to other consequences, radiatio...

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is involved in a global outbreak affecting millions of people who manifest a variety of symptoms. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is increasingly associated with cardiovascular complications requiring hospitalizations; however, the mechanisms underlying...

Background End‐stage renal disease (ESRD) is associated with increased morbidity and mortality following lower extremity amputation for critical limb ischemia (CLI). Angioplasty and bypass are used in ESRD patients with CLI; however, the treatment of choice remains controversial. We compared the long‐term outcomes in patients with CLI undergoing an...

Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction; however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. The goal of this meta-analysis was to summarize the evidence regarding the pro...

Background: The association of atrial fibrillation (AF) with cancer and cancer types is inconclusive. Similarly, data regarding the association of AF with different cancer therapies are controversial. Objectives: To study the association of AF with cancer subtypes and cancer therapies. Methods: We studied all patients aged 18–89 years who presented...

Background: There is no clear consensus on the use of aspirin (ASA) in patients with congestive heart failure (CHF) due to its reported interaction with other cardio-prudent medications. The aim was to evaluate the effect of ASA on all-cause mortality and the frequency of hospitalization for heart failure in patients with CHF using meta-analysis,...

Epilepsy-associated Kv1.1 voltage-gated potassium channel subunits encoded by the Kcna1 gene have traditionally been considered absent in heart, but recent studies reveal they are expressed in cardiomyocytes where they could regulate intrinsic cardiac electrophysiology. Although Kv1.1 now has a demonstrated functional role in atria, its role in the...

Importance Coronavirus disease 2019 is associated with a variety of arrhythmias. However, there are limited data regarding bradyarrhythmias and cardiac pauses in COVID-19. Objective The objective was to characterize significant cardiac pauses in critically ill COVID-19 patients. Design This was a case series of 26 consecutive patients with confir...

Oxidative stress drives the pathogenesis of atrial fibrillation (AF), the most common arrhythmia. In the cardiovascular system, cystathionine γ-lyase (CSE) serves as the primary enzyme producing hydrogen sulfide (H2S), a mammalian gasotransmitter that reduces oxidative stress. Using a case control study design in patients with and without AF and a...

Oxidative stress drives the pathogenesis of atrial fibrillation (AF), the most common arrhythmia. In the car-diovascular system, cystathionine γ-lyase (CSE) serves as the primary enzyme producing hydrogen sulfide (H 2 S), a mammalian gasotransmitter that reduces oxidative stress. Using a case control study design in patients with and without AF and...

Methamphetamine-associated cardiomyopathy is the leading cause of death linked with illicit drug use. Here we show that Sigmar1 is a therapeutic target for methamphetamine-associated cardiomyopathy and defined the molecular mechanisms using autopsy samples of human hearts, and a mouse model of “binge and crash” methamphetamine administration. Sigma...

Air pollution and particulate matter (PM) contribute to respiratory and cardiovascular disease over both chronic and acute exposure periods. Firefighters (FF) are a unique population which experiences these exposures, and likewise has a high risk of cardiovascular disease and death. The mechanisms by which air pollution and PM are proposed to cause...

Introduction: Fluoroscopy assisted procedures have increased occupational radiation exposure among Cardiologists. Radiation has been linked to cardiovascular complications but its effects on cardiac rhythm has not been extensively explored. Hypothesis: We hypothesized that radiation exposure is associated with increased risk of atrial arrhythmias (...