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Sadeghi S, Johnson EF, Sominidi Damodaran S, Mittal S, Mohandesi NA. Solitary ulcerated nodule on the scalp in an 11-year-old girl. Pediatr Dermatol 2024. [PMID: 39011668 DOI: 10.1111/pde.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/24/2024] [Indexed: 07/17/2024]
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2
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Shah A, Mittal S, Tollefson MM, Davis DM, Mohandesi NA. Treatment of actinic prurigo with dupilumab in an adolescent. Int J Dermatol 2024. [PMID: 38872584 DOI: 10.1111/ijd.17298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
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Mittal S, Ravichandran J, Shanmugasundaram S, Kanagarajan A. Verrucous Cyst with Cutaneous Horn. Indian Dermatol Online J 2024; 15:518-520. [PMID: 38845652 PMCID: PMC11152488 DOI: 10.4103/idoj.idoj_314_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/09/2024] Open
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Kanagarajan A, Mittal S, Chandrasekaran S, Shanmugasundaram P. Curcumin artefacta. Clin Exp Dermatol 2024; 49:160-161. [PMID: 37757851 DOI: 10.1093/ced/llad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
Ultraviolet-induced fluorescence dermoscopy (UVFD) utilizes 365 nm UV light to induce fluorescence. Curcumin, the bioactive product of turmeric produces artefactual fluorescence when seen under UVFD. The purpose of this case report is to share this observation, which can help prevent misdiagnosis.
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Aghazadeh Mohandesi N, Puiu T, Mittal S, Hall MR, Sokumbi O, Mangold AR, Colgan MB, Tollefson MM, Sartori-Valinotti JC. Teledermatology in practice: Report of Mayo Clinic experience. Digit Health 2024; 10:20552076241234581. [PMID: 38410791 PMCID: PMC10896044 DOI: 10.1177/20552076241234581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Background Delivery of dermatologic care through telemedicine was accelerated by the COVID-19 pandemic. We sought to analyze the teledermatology experience across Mayo Clinic's health care system to identify strengths and limitations of teledermatology. Methods Electronic health records of dermatology televisits were reviewed from multiple U.S. Mayo Clinic sites from January 2020 through January 2021. Results A total of 13,181 dermatology televisits were conducted in 6468 unique patients. Patients were primarily female (60.2%), and mean age of all patients was 34.1 years. Synchronous / live video conferencing visits were the most common (40.0%) telecare modality. Synchronous / live audio conferencing and asynchronous / store-and-forward visits comprised 33.0% and 27.0% of appointments. In total, 3944 televisits (29.9%) were successfully concluded via a single appointment. An in-person appointment was needed for 1693 patients (26.2%) after their initial televisit. For patients with a single televisit, synchronous / live video conferencing was the most common virtual modality (58.0% vs 32.2% of patients with multiple visits, p < 0.001). Patients needing in-person follow-up visits were slightly older than those who did not (mean [SD], 38.8 [22.3] vs 35.0 [23.6] years; p < 0.001) but without any sex-based difference. Around one-third of patients needed an in-person follow-up visit after their initial asynchronous / store-and-forward visit which was higher when compared with synchronous / live audio and video conferencing. Conclusion Single dermatology televisits effectively managed nearly one-third of patients who did not require in-person follow-up. An initial synchronous / live video conferencing was more likely to yield a single clinical encounter, whereas asynchronous / store-and-forward visits required more in-person follow-up. Future studies are required that focus on dermatology-specific cost, diagnoses, access, quality of care, and outcomes.
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Mittal S, Kanagarajan A, Ravichandran J, Shanmugasundaram S. Syringocystadenoma papilliferum presenting as an isolated scalp nodule. BMJ Case Rep 2023; 16:e256535. [PMID: 37793848 PMCID: PMC10551978 DOI: 10.1136/bcr-2023-256535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
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Muralitharan A, Mittal S, Shanmugasekar C. Dermoscopy of acrodermatitis continua of Hallopeau. Indian Dermatol Online J 2023; 14:301-302. [PMID: 37089830 PMCID: PMC10115322 DOI: 10.4103/idoj.idoj_249_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 03/12/2023] Open
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Sryma PB, Mittal S, Madan NK, Tiwari P, Hadda V, Mohan A, Guleria R, Madan K. Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis. Pulmonology 2023; 29:50-64. [PMID: 33441246 DOI: 10.1016/j.pulmoe.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s. METHODS We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy. RESULTS Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy. CONCLUSIONS R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.
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Dadhich JP, Kumar P, Mittal S, Dadhich CP. Adenomyomatosis of Gallbladder in a Neonate. Indian Pediatr 2022; 59:813-814. [PMID: 36263500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Milstein N, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger M, Shaw R, Mittal S, Musat D. Absence of atrial fibrillation in the blanking period following cryoballoon pulmonary vein isolation – does it always portend a good prognosis? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). Freedom from AF in the blanking period (BP), conventionally defined as the first 3-months post-PVI, has been associated with the best long-term outcomes. However, the influence of antiarrhythmic drugs (AADs) during the BP on long-term outcomes is not well understood.
Objective
To compare long-term outcomes between patients who were and were not on an AAD prior to ablation and remained free from AF during the 3-month BP post CB PVI.
Methods
We enrolled consecutive AF patients undergoing CB PVI; all pts had an implantable loop recorder (ILR). No patient had any AF in the first 90 days post CB PVI. We divided the patients into three groups: (1) never had exposure to an AAD; (2) were intolerant to/failed AAD and thus were not taking an AAD at time of ablation; and (3) were on AAD at time of ablation. In the latter group, every effort was made to stop the AAD before the end of the BP.
Results
The cohort included 96 pts (66±10 years; 60 [63%] male; 55 [57%] PAF; CHA2DS2-VASc 2.5±1.4). There were 23 (24%) patients in group 1, 13 (14%) patients in group 2, and 60 (63%) pts in group 3. Patients in group 3 were more likely to have PeAF; AADs were stopped at a median of 36 days IQR (27, 91) in this group. Patients were followed for 1-year during which time 28 (29%) patients had recurrent AF (despite having no AF during the BP). The best outcome was seen in patients who never used an AAD; the worst outcome was seen in patients who were on an AAD at time of ablation (Figure 1).
Conclusion
Our data show that absence of AF during a 3-month post CB PVI BP alone does not guarantee good-long term outcome, unless the patient was never treated with an AAD. In contrast, in patients ablated while taking an AAD, recurrent AF was observed in 37% even though they were completely AF-free during the BP.
Funding Acknowledgement
Type of funding sources: None.
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Milstein N, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger M, Shaw R, Mittal S, Musat D. Recurrence of atrial fibrillation following pulmonary vein isolation: impact of body mass index on one- and three-year outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted method for ablation in patients with paroxysmal and persistent atrial fibrillation (PAF, PeAF). However, there are a paucity of data about the impact of body mass index (BMI) on one-year and longer-term outcomes following ablation.
Objective
To objectively understand the impact of BMI on outcomes following CB PVI.
Methods
We enrolled consecutive AF patients undergoing CB PVI; all patients had an implantable loop recorder (ILR), which transmitted data wirelessly daily. We assessed AF recurrences after excluding an initial 3-month post-ablation blanking period.
Results
The cohort included 222 pts (66±9 years; 143 [64%] male; 120 [54%] PAF; CHA2DS2-VASc 2.6±1.6). The mean BMI was 30±5. Patients were followed for 763±347 days, during which time 50% and 68% had recurrent AF 1- and 3-years post ablation. We divided the cohort based on the mean BMI into 2 groups: BMI <30 and BMI >30. Heavier patients were younger and more likely to have PeAF. Over 1-year of follow-up, patients with a BMI <30 had similar likelihood of being free of AF to patients with a BMI >30 (46% vs, 56%, p=0.0.097, Figure 1, left). However, as patients were followed for 3-years, freedom from AF was significantly higher in patients with a BMI <30 (59% vs. 81% in BMI >30, p=0.002, Figure 1, right).
Conclusions
Our data show that although patients had similar outcomes 1-year post-ablation, during longer-term follow-up patients with a BMI >30 had a much worse outcome. Our study uniquely offers objective (using an ILR) assessment of the impact of BMI on long-term outcomes following CB PVI (homogenous ablation strategy). These data highlight the need to identify strategies to improve outcomes in obese patients.
Funding Acknowledgement
Type of funding sources: None.
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Delaney RD, Urmey MD, Mittal S, Brubaker BM, Kindem JM, Burns PS, Regal CA, Lehnert KW. Superconducting-qubit readout via low-backaction electro-optic transduction. Nature 2022; 606:489-493. [PMID: 35705821 DOI: 10.1038/s41586-022-04720-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Entangling microwave-frequency superconducting quantum processors through optical light at ambient temperature would enable means of secure communication and distributed quantum information processing1. However, transducing quantum signals between these disparate regimes of the electro-magnetic spectrum remains an outstanding goal2-9, and interfacing superconducting qubits, which are constrained to operate at millikelvin temperatures, with electro-optic transducers presents considerable challenges owing to the deleterious effects of optical photons on superconductors9,10. Moreover, many remote entanglement protocols11-14 require multiple qubit gates both preceding and following the upconversion of the quantum state, and thus an ideal transducer should impart minimal backaction15 on the qubit. Here we demonstrate readout of a superconducting transmon qubit through a low-backaction electro-optomechanical transducer. The modular nature of the transducer and circuit quantum electrodynamics system used in this work enable complete isolation of the qubit from optical photons, and the backaction on the qubit from the transducer is less than that imparted by thermal radiation from the environment. Moderate improvements in the transducer bandwidth and the added noise will enable us to leverage the full suite of tools available in circuit quantum electrodynamics to demonstrate transduction of non-classical signals from a superconducting qubit to the optical domain.
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. The impact of atrial fibrillation burden early post cryoballoon pulmonary vein isolation on long-term freedom from recurrent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A three-month blanking period (BP) is commonly used in clinical trials and practice. Early recurrence of AF portends worse ablation long-term outcome; however, the utility of using AF burden (AFB) early post cryoballoon (CB) PVI to predict long-term outcome is unknown.
Purpose
To determine, using ECG data acquired by an implantable loop recorder (ILR), the relationship between post-ablation AFB and long-term freedom from AF.
Methods
We enrolled consecutive patients with AF who had CB PVI and an ILR. We determined the monthly AFB for the first 3 months post CB PVI and assessed the relationship between AFB and 1-year freedom from AF. We defined 4 distinct AFB groups: (1) 0%, (2) > 0-0.1%, (3) > 0.1-0.5%, and (4) > 0.5%.
Results
There were 210 patients (66 ± 9 years; 138 [66%] male; 116 [55%] paroxysmal AF; CHA2DS2-VASc 2.5 ± 1.6). Following a 3-month BP, 101 (48%) patients had a recurrence of AF at 160 ± 86 days post-ablation. An AFB of > 0% over the first 3 months predicted AF recurrence (p < 0.0001, Figure 1). Patients with > 0.5% AF burden after 1st month and any AF after 2nd month post CB PVI have a very high long-term AF recurrence rate (Figure 2).
Conclusion
The best long term outcome post CB PVI is seen in pts who have no AF in the first 3 months post ablation. An AFB >0.5% after the first month and any AF after the second month portend ablation failure. These data define a clinical utility of using AFB to risk stratify patients post CB PVI.
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. Yearly incidence and pattern of very late recurrence of atrial fibrillation as detected by continuous electrocardiographic monitoring using an implantable loop recorder. Europace 2022. [DOI: 10.1093/europace/euac053.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A very late recurrence (VLR) of atrial fibrillation (AF) is considered present when patients have their first recurrence of AF > 12 months post-ablation. Little is known about the yearly rates and patterns of VLR AF recurrence.
Objective
To assess the yearly incidence and pattern of VLR in pts with AF who underwent cryoballoon (CB) pulmonary vein isolation (PVI).
Methods
We prospectively enrolled consecutive patients with AF who underwent CB PVI and had an implantable loop recorder (ILR) inserted up to 3 months post-ablation. Patients were followed for recurrent AF (excluding a 3-month post-ablation blanking period).
Results
Our cohort included 222 patients (66 ± 9 years; 143 [64%] male; 120 [54%] paroxysmal AF; CHA2DS2-VASc 2.6 ± 1.6). At 1-year, 111 (50%) patients remained free of AF. Two-year follow-up was available in 95 of these patients; 62 (65%) remained in sinus. Three-year follow-up was available in 42 of these patients; 36 (86%) remained in sinus (Figure). Of the 39 patients who developed AF after initially being free of AF for at least 1-year post ablation, 24 (62%) patients had either a frequent or persistent pattern of AF.
Conclusions
Our data show that the greatest likelihood of failure following a CB PVI occurs in the first year of ablation. The rate of failure becomes lower year by year. These data suggest that long term outcome may be driven more by the initial ablation as opposed to progressive evolution of the patient’s substrate
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Mittal S, Poole J, Kennergren C, Birgersdotter-Green U, Lustgarten DL, Tomassoni GF, Hilleren G, Lande J, Lensing C, Wilkoff B, Tarakji K. Risk factors of mortality after secondary procedures during the world-wide randomized antibiotic envelope infection prevention trial (WRAP-IT). Europace 2022. [DOI: 10.1093/europace/euac053.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background
Previous analysis of WRAP-IT (World-wide Randomized Antibiotic Envelope Infection Prevention trial) data identified both patient and procedural characteristics as risk factors for cardiac implantable electronic device (CIED) infection. In the current analysis, we sought to similarly use prospectively collected WRAP-IT data to assess risk factors of all-cause mortality. Understanding if mortality risk can be modified and identifying baseline characteristics associated with high risk can help guide physician decision making.
Purpose
To identify modifiable and non-modifiable risk factors for 1-year all-cause mortality after a secondary (replacement, revision, or upgrade) CIED procedure.
Methods
This analysis included 5,461 secondary procedure patients from the WRAP-IT study. Included as candidate factors were patient and procedural characteristics. Patients with more than one year follow-up were censored at one year. A multivariate Cox Proportional Hazards model was reached by stepwise selection to minimize Akaike Information Criterion.
Results
The overall one-year mortality rate was 5.2% after secondary procedures. Of the 26 patient and 18 procedural characteristics analyzed, the following variables best predicted risk of a 1-year all-cause mortality: age, NYHA class, renal dysfunction, anticoagulant use, ischemic cardiomyopathy, diabetes, BMI, procedure time, myocardial infarction, valve surgery, and hypertrophic cardiomyopathy (Table).
Conclusion
In WRAP-IT patients undergoing secondary procedures, the only procedure characteristics that had any association with all-cause 1-year mortality risk was procedure time suggesting that most of the risk factors of mortality are non-modifiable. Baseline patient characteristics and co-morbidities were the principal risk factors of all-cause 1-year mortality. Specifically, increasing age, NYHA class, and a history of renal dysfunction were strongly associated with mortality.
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Musat D, Milstein N, Saberito M, Bhatt A, Habibi M, Preminger M, Sichrovsky T, Shaw R, Mittal S. Is there clinical utility to replacement of an implantable loop recorder in patients who have previously undergone cryoballoon pulmonary vein isolation? Europace 2022. [DOI: 10.1093/europace/euac053.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Implantable loop recorders (ILRs) are used for long-term ECG monitoring following catheter ablation in patients (pts) with atrial fibrillation (AF) to guide clinical management. However, little is known about what do when the ILR reaches end of service (EOS).
Purpose
To identify pts who underwent replacement of their ILR and determine the diagnostic yield and clinical utility of the replacement device.
Methods
We enrolled 222 consecutive pts with AF who underwent cryoballoon pulmonary vein isolation (CB PVI) and had an ILR. We identified pts who subsequently underwent ILR replacement. The diagnostic and clinical utility of the newly replaced ILR was determined.
Results
The cohort included 56 pts (64 + 9 years; 35 [63%] male; 27 [48%] PAF; CHA2DS2-VASc 2.3 ± 1.5) in whom the initial ILR reached EOS. They were followed for 3.7 ± 2.1 years. Recurrent AF was observed in 41 (73%) of these pts; this triggered an intervention in 17 (41%) pts (Figure). Of the other 15 (27%) pts without any documented AF, anticoagulation was withheld in 13 [87%] pts. Following ILR replacement, 33 (80%) of the 41 pts had more AF (n=11 [33%] required an intervention) and 5 additional pts had AF for the first time.
Conclusions
Our data show that after CB PVI, ILRs help guide decisions regarding rhythm management and oral anticoagulation. When the initial ILR was replaced by a second ILR, AF was detected (often for the first time) in some patients; the findings were used to guide clinical decision making in the entire cohort. Thus, at this time, it remains undefined when ECG monitoring of these pts can be stopped because it is no longer clinical meaningful.
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Vinitha NM, Mittal S, Chaitra V. Dermoscopy of isolated lip lichen planus. Indian Dermatol Online J 2022; 13:165-166. [PMID: 35198499 PMCID: PMC8809156 DOI: 10.4103/idoj.idoj_858_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/08/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022] Open
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Milstein N, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger M, Shaw R, Mittal S, Musat D. Defining the optimal blanking period duration after cryoballoon pulmonary vein isolation in patients with atrial fibrillation who have never been treated with an antiarrhythmic drug. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB) pulmonary vein isolation (PVI) is an approved method for ablation in patients with paroxysmal (PAF) or persistent (PeAF) atrial fibrillation (AF). Although the first 90 days post-ablation are considered within the blanking period (BP), the optimal duration of the BP remains undefined.
Purpose
To objectively define the BP duration in pts undergoing CB PVI by evaluating a cohort never treated with an antiarrhythmic drug (AAD).
Methods
We enrolled consecutive pts with either PAF or PeAF who underwent initial CB PVI; all pts had an implantable loop recorder (ILR) for long-term ECG monitoring. No pt received an AAD either before or after ablation. We determined the time to last AF episode within the first 90 days of ablation. We then correlated this to the likelihood a patient had recurrent AF between 91 and 365 days of ablation.
Results
There were 45 pts (67±8 years; 26 [58%] male; 40 [89%] PAF; CHA2DS2-VASc 2.6±1.3). We defined 4 distinct groups post ablation based on whether or not they had AF in the BP: (1) no AF days 0–90 (n=19 [42%]), (2) last AF days 0–30 (n=11 [24%]), (3) last AF days 31–60 (n=3 [7%]), and (4) last AF days 61–90 (n=12 [27%]). After the 90-day BP, 15 (33%) pts had AF recurrence. Pts with no AF and those with AF only within 30 days of ablation had similar long-term outcome; however, recurrent AF more than 32 days after ablation predicted long-term ablation failure (Figure).
Conclusion
The post CB PVI blanking period is just a month. AF recurrences beyond a month in patients not on an AAD are associated with AF recurrence in the majority of pts.
Funding Acknowledgement
Type of funding sources: None. Blanking Group by AF Recurrence
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Musat D, Milstein NS, Saberito M, Bhatt A, Habibi M, Sichrovsky T, Preminger MW, Shaw RE, Mittal S. Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs? Europace 2021. [DOI: 10.1093/europace/euab116.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined.
Objective
To compare the BP duration in pts undergoing CB while either taking or not taking an AAD.
Methods
We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI.
Results
The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure).
Conclusion
Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.
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Musat D, Milstein NS, Saberito M, Bhatt A, Habibi M, Preminger MW, Sichrovsky T, Shaw R, Mittal S. Defining the blanking period duration after cryoballoon pulmonary vein isolation in patients taking an antiarrhythmic drug. Europace 2021. [DOI: 10.1093/europace/euab116.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, the actual BP duration in patients (pts) on an antiarrhythmic drug (AAD) at time of ablation remains undefined.
Objective
To objectively define the BP duration in pts undergoing CB while taking an AAD.
Methods
We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI.
Results
The cohort included 92 pts (66 ± 10 years; 62 [67%] male; 33 [36%] PAF; CHA2DS2-VASc 2.6 ± 1.7). AADs used included dofetilide (42), dronedarone (14), amiodarone (25), sotalol and propafenone (3 each), and flecainide (5). The AAD was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 45 [49%]); (2) last AF within 30 days of PVI (n = 17 [18%]); (3) last AF within 60 days of PVI (n = 13 [15%]); and (4) last AF within 90 days of PVI (n = 17 [18%]). Following the 90-day BP, 47 (51%) pts had a recurrence of AF. Once recurrent AF was observed > 30 days post-ablation, patients had high likelihood of having a long term AF recurrence (p = 0.037, Figure).
Conclusion
Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up. Abstract Figure.
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Mittal S, Nagendran S. A study on the effects of stress and hopelessness in isolated COVID-19 patients in relation to severity of infection. Eur Psychiatry 2021. [PMCID: PMC9479952 DOI: 10.1192/j.eurpsy.2021.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionIn India, Coronavirus pandemic started in the month of march 2020 and is growing day by day. In view of India being one of the most populous countries, it is hard to follow social distancing and abide by the lockdown rules. Therefore, as of December 2020, total number of covid-19 cases has crossed the 10 million. But the recovery rate in India is high, so the fear due to Covid-19 has decreased in intensity.ObjectivesTo assess level of perceived stress in isolated covid-19 patients To assess level of hopelessness in isolated covid-19 patientsMethods30 Patients of diagnosed Covid-19 positive,who were isolated in covid care setting in Uttar Pradesh(India),above 18yrs of age,of both sexes and willing to participate in the study were included, their socio-demographic data collected. Beck’s hopelessness scale and Perceived stress scale were administered. Infection severity upto moderate was selected and ICU patients were excluded. Results were analysed using SPSS software.ResultsIt was observed that level of hopelessness increased with increasing age and increasing severity of covid-19.Level of perceived stress also increased with increasing age and increasing covid severity. There was no relation seen between hopelessness level and perceived stress level and no difference was seen in the levels of hopelessness and perceived stress between the two sexes.ConclusionsLevels of hopelessness and stress increased with increasing age and increasing severity of covid-19.No relation seen between hopelessness level and perceived stress level and no difference was seen in the levels of hopelessness and perceived stress between the two sexes.DisclosureNo significant relationships.
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Sahoo PK, Salomão GN, da Silva Ferreira Júnior J, de Lima Farias D, Powell MA, Mittal S, Garg VK. COVID-19 lockdown: a rare opportunity to establish baseline pollution level of air pollutants in a megacity, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL SCIENCE AND TECHNOLOGY : IJEST 2021; 18:1269-1286. [PMID: 33643420 PMCID: PMC7899058 DOI: 10.1007/s13762-021-03142-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/25/2020] [Accepted: 01/09/2021] [Indexed: 05/30/2023]
Abstract
UNLABELLED This paper analyses air quality data from megacity Delhi, India, during different periods related to the COVID-19, including pre-lockdown, lockdown and unlocked (post-lockdown) (2018-2020) to determine what baseline levels of air pollutants might be and the level of impact that could be anticipated under the COVID-19 lockdown emission scenario. The results show that air quality improved significantly during the lockdown phases, with the most significant changes occurring in the transportation and industrially dominated areas. A pronounced decline in PM2.5 and PM10 up to 63% and 58%, respectively, was observed during the lockdown compared to the pre-lockdown period in 2020. When compared to 2018 and 2019, they were lower by up to 51% and 61%, respectively, dropping by 56% during unlock. Some pollutants (NOx and CO) dropped significantly during lockdown, while SO2 and O3 declined only slightly. Moreover, when compared between the different phases of lockdown, the maximum decline for most of the pollutants and air quality index occurred during the lockdown phase 1; thus, this period was used to report the COVID-19 baseline threshold values (CBT; threshold value is the upper limit of baseline variation). Of the various statistical methods used median + 2 median absolute deviation (mMAD) was most suitable, indicating CBT values of 143 and 75 ug/m3 for PM10 and PM2.5, respectively. This results although preliminary, but it gives a positive indication that temporary lockdown can be considered as a boon to mitigate the damage we have done to the environment. Also, this baseline levels can be helpful as a first line of information to set future target limits or to develop effiective management policies for achieving better air quality in urban centres like Delhi. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13762-021-03142-3.
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Bajpai J, Majumdar A, Satwik R, Rohatgi N, Jain V, Gupta D, Agarwal R, Mittal S, Verma SK, Parikh PM, Aggarwal S. Practical consensus recommendations on fertility preservation in patients with breast cancer. South Asian J Cancer 2020; 7:110-114. [PMID: 29721475 PMCID: PMC5909286 DOI: 10.4103/sajc.sajc_113_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Expert oncologists along with reproductive medicine specialists discuss fertility preservation options in this chapter since fertility preservation is becoming a priority for young women with breast cancer. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations for the benefit of community oncologists.
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Kaur H, Kaushal S, Kumar S, Badru R, Singh P, Mittal S. Kinetic Study and Isotherm Analysis for Removal and Recovery of Coexistent Hazardous Acidic and Basic Dyes from Wastewater Using PTD-ZrPB Nanocomposite. RUSS J INORG CHEM+ 2020. [DOI: 10.1134/s0036023620120062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mittal S, Wilkoff B, Poole J, Kennergren C, Wright D, Berman B, Riggio D, Sholevar S, Moubarak J, Schaller R, Love J, Pickett R, Philippon F, Lande J, Tarakji K. Low-temperature electrocautery reduces lead-related complications: insights from the WRAP-IT study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with an existing cardiovascular implantable electronic device (CIED) often require a generator replacement or system upgrade/revision, during which some degree of dissection is usually necessary to free the existing lead(s). Commonly used techniques include blunt dissection, standard surgical electrocautery, or newer forms of electrocautery such as the low-temperature electrosurgical device (PlasmaBlade Soft Tissue Dissection Device) designed to minimize inadvertent thermal injury to leads.
Objective
Determine whether the dissection technique impacts the likelihood of developing a lead-related complication.
Methods
The WRAP-IT trial enrolled patients undergoing CIED replacement, upgrade, revision or de novo CRT-D implant. This analysis excluded patients undergoing a de novo procedure. All adverse events were adjudicated by an independent physician committee. Data were analyzed using Cox proportional hazard regression modeling, controlling for capsulectomies and lead dissections.
Results
5639 patients (mean [±SD] age: 70.6±12.7 years; 28.8% female) underwent a replacement/upgrade/revision. Electrocautery was used in 5203 (92.3%) patients and among these, low-temperature electrocautery was used in 1866 (35.9%) patients. Compared to standard electrocautery, low-temperature electrocautery was used more often when leads were dissected or mobilized (P<0.001) or when a partial or complete capsulectomy was performed (P<0.001). Use of low-temperature electrocautery was associated with a 31% reduction in lead-related complications (HR: 0.69, 95% CI: 0.49–0.98, P=0.037) (Figure).
Conclusion
The low-temperature electrosurgical device (PlasmaBlade) uses precise pulses of radiofrequency energy to dissect tissue with only minimal thermal damage. In this large cohort of replacement, revision, and upgrade procedures, use of low-temperature electrocautery led to significantly fewer lead-related complications.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
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