26
|
Do K, Lee CC, Kiankhooy A, Chang PM, Doshi RN. Substernal subcutaneous implantable cardioverter-defibrillator lead placement for the management of inappropriate shocks. HeartRhythm Case Rep 2019; 5:407-410. [PMID: 31453090 PMCID: PMC6701193 DOI: 10.1016/j.hrcr.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
27
|
Rusia A, Doshi RN. Arrhythmias and Cognitive Function: What is the Best Practice? J Innov Card Rhythm Manag 2018; 9:3454-3456. [PMID: 32494481 PMCID: PMC7252848 DOI: 10.19102/icrm.2018.091207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
28
|
|
29
|
Singh JP, Berger RD, Doshi RN, Lloyd M, Moore D, Daoud EG. Rationale and design for ENHANCE CRT: QLV implant strategy for non-left bundle branch block patients. ESC Heart Fail 2018; 5:1184-1190. [PMID: 30264456 PMCID: PMC6300807 DOI: 10.1002/ehf2.12340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
AIMS Historically, cardiac resynchronization therapy (CRT) response in non-left bundle branch block (non-LBBB) patients has been suboptimal in comparison with that observed in left bundle branch block patients. The electrical activation pattern of the left ventricle (LV) is different between these two QRS morphologies. Small non-randomized studies have suggested that targeting the LV wall with greatest electrical delay may be superior to conventional anatomical pacing from the lateral wall in non-LBBB patients. This article outlines the design and rationale of a prospective, randomized, pilot study, which assesses the effect of a non-traditional LV lead implant strategy on the clinical composite score after 12 months of follow-up in a non-LBBB patient population. METHODS All patients will receive an Abbott quadripolar CRT-D system (Quartet 1458Q LV lead with Unify Quadra™, Quadra Assura™ CRT-D or any market-approved CRT-D device with quadripolar pacing capabilities). Patients will be randomized in a 2:1 ratio between a QLV-based implant strategy vs. standard of care. Up to 250 patients will be enrolled in the study. CONCLUSIONS If the primary endpoint is achieved, this study will provide important information about reducing the non-responder rate in non-LBBB patients and provide further evidence for the QLV-based implant strategy.
Collapse
|
30
|
Sarcon A, Roy D, Laughrun D, Huntsinger M, Schwartz J, Sohn J, Doshi RN. Left Atrial Appendage Occlusion Complicated by Appendage Perforation Rescued by Device Deployment. J Investig Med High Impact Case Rep 2018; 6:2324709618800108. [PMID: 30214906 PMCID: PMC6134491 DOI: 10.1177/2324709618800108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/05/2018] [Indexed: 12/13/2022] Open
Abstract
The Watchman device is a transcatheter left atrial appendage (LAA) occluding device used in patients with nonvalvular atrial fibrillation (NVAF) and a high CHADS2-VA2SC score who are poor long-term anticoagulation candidates. Pericardial effusion related to device deployment and perforation can be a life-threatening complication. While not common in hands of experienced operators, management may require surgical intervention. Here we present a rare case of LAA perforation, which was corrected by successful repositioning of the device foregoing the need for surgical management.
Collapse
|
31
|
Doshi RN. Highlights from Heart Rhythm 2018: Atrial Fibrillation. J Innov Card Rhythm Manag 2018; 9:3317-3320. [PMID: 32477824 PMCID: PMC7252785 DOI: 10.19102/icrm.2018.090907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
32
|
Doshi RN. Posterior Wall Isolation for Atrial Fibrillation: Excessive or Necessary? J Innov Card Rhythm Manag 2018; 9:3195-3196. [PMID: 32494494 PMCID: PMC7252886 DOI: 10.19102/icrm.2018.090606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
33
|
Doshi RN. Microelectrodes for Atrial Flutter: Bringing a Scalpel to a Gun Fight. J Innov Card Rhythm Manag 2018; 9:3204-3205. [PMID: 32494495 PMCID: PMC7252883 DOI: 10.19102/icrm.2018.090607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
34
|
Doshi RN. Three-dimensional Mapping: More Than “Burn as You Learn”. J Innov Card Rhythm Manag 2018; 9:3133-3134. [PMID: 32494490 PMCID: PMC7255413 DOI: 10.19102/icrm.2018.090505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
35
|
Doshi RN. Cardiac Sarcoidosis: What's Bad for the Ventricle is Bad for the Atria. J Innov Card Rhythm Manag 2018; 9:3022-3024. [PMID: 32479570 PMCID: PMC7252772 DOI: 10.19102/icrm.2018.090205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
36
|
Do K, Chang P, Konecny T, Carlson SK, Tun H, Huntsinger M, Doshi RN. Predictors of Elevated Defibrillation Threshold with the Subcutaneous Implantable Cardioverter-defibrillator. J Innov Card Rhythm Manag 2017; 8:2920-2929. [PMID: 32494435 PMCID: PMC7252865 DOI: 10.19102/icrm.2017.081203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022] Open
Abstract
There are limited data regarding defibrillation thresholds (DFTs) for the subcutaneous implantable cardioverter-defibrillator (S-ICD), and factors associated with elevated DFTs remain incompletely understood. The objective of this study was to determine the factors associated with elevated DFTs in patients undergoing S-ICD implantation. A retrospective cross-sectional analysis of all patients undergoing S-ICD implantation at our institution between 2013 and 2016 who underwent step-down DFT testing was performed. Factors associated with a higher DFT were analyzed. In total, 56 patients (mean age: 49.3 ± 13.1 years, mean left ventricular ejection rate: 31.1% ± 13.7%) underwent S-ICD implantation in the study period. Full DFT testing was performed in 31 of the 56 patients (55%), with an average DFT of 46.4 joules (J) ± 25.9 J found among this cohort. The DFT was > 65 J in five of the 31 patients (16%). A high DFT was associated with increased body mass index (BMI) (37.7 kg/m2 versus 29.4 kg/m2; p = 0.02) and either increased septal or posterior wall thickness (1.5 cm versus 1.0 cm; p = 0.0003 and 1.4 cm versus 1.1 cm; p= 0.003, respectively). Patients with high DFTs also had higher failed shock impedance values (138 Ω versus 71 Ω; p = 0.005). Renal failure did not appear to affect DFT (51.4 J versus 51.7 J; p = 0.99). BMI, body surface area (BSA), and septal and posterior left ventricular wall thickness predicted elevated DFT on univariate analysis, although findings were not significant with multivariate analysis due to the small sample size. Thus, elevated S-ICD DFT appears to be associated with increased BMI, BSA, and septal or posterior wall thickness. In contrast, dialysis-dependent renal failure is not associated with elevated DFT. Further investigation is necessary in order to better characterize and predict which patients are at-risk for high DFTs.
Collapse
|
37
|
Doshi RN. Review on Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2958-2962. [PMID: 32494437 PMCID: PMC7252853 DOI: 10.19102/icrm.2017.081209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
38
|
Doshi RN. Highlights from Heart Rhythm Society 2017: Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2817-2819. [PMID: 32477775 PMCID: PMC7252679 DOI: 10.19102/icrm.2017.080801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
39
|
Harris JR, Carlson SK, Wolfson AM, Saxon LA, Doshi RN. Pulmonary arterial pressure sensing in a patient with left ventricular assist device during ventricular arrhythmia. HeartRhythm Case Rep 2017; 3:348-351. [PMID: 28748142 PMCID: PMC5511983 DOI: 10.1016/j.hrcr.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
40
|
Chang PM, Doshi RN. Implantation of a leadless cardiac pacemaker for recurrent pocket infections. HeartRhythm Case Rep 2017; 2:339-341. [PMID: 28491705 PMCID: PMC5419888 DOI: 10.1016/j.hrcr.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
41
|
Kita K, Rusia A, Shah S, Zhang Y, Roy D, Nattiv J, Doshi N, Tun H, Clavijo L, Doshi RN. DOES STROKE RISK INFLUENCE THE DECISION TO ANTICOAGULATE POST PERCUTANEOUS CORONARY INTERVENTION PATIENTS WITH ATRIAL FIBRILLATION: A REVIEW OF 3850 PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Al-Asady NA, Dhillon AS, Burton KR, Toubat O, Schwartzman WS, Doshi RN, Matthews RV, Clavijo LC. CRT-800.43 Left Atrial Appendage Occlusion for Atrial Fibrillation: Eligibility in a Typical Oral Anticoagulation Clinic. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
Carlson SK, Doshi RN. Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke. HeartRhythm Case Rep 2017; 3:18-21. [PMID: 28491759 PMCID: PMC5420035 DOI: 10.1016/j.hrcr.2016.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
44
|
O'Brien DP, Wolfson AM, Fong MW, Doshi RN, Saxon LA, Grazette L, Shavelle DM. Hemodynamic Guided Therapy for Heart Failure: Initial Clinical Experience with the CardioMEMSTMHF System. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Mooney DM, Fung E, Doshi RN, Shavelle DM. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors. Front Physiol 2015; 6:271. [PMID: 26500556 PMCID: PMC4595778 DOI: 10.3389/fphys.2015.00271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/14/2015] [Indexed: 01/03/2023] Open
Abstract
Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension.
Collapse
|
46
|
Huntsinger ME, Rabara R, Peralta I, Doshi RN. Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
Collapse
|
47
|
Carlson SK, Doshi RN. Device therapy for acute systolic heart failure and atrial fibrillation. Card Electrophysiol Clin 2015; 7:469-77. [PMID: 26304527 DOI: 10.1016/j.ccep.2015.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with newly diagnosed cardiomyopathy require careful assessment of cause and initiation of treatment before the decision is made to implant an internal cardiac defibrillator. In patients with medicine-refractory atrial fibrillation and cardiomyopathy, atrioventricular node ablation and implantation of a biventricular pacemaker is the therapy of choice when tachycardia-induced cardiomyopathy is suspected and curative therapy is not possible.
Collapse
|
48
|
Fung E, Järvelin MR, Doshi RN, Shinbane JS, Carlson SK, Grazette LP, Chang PM, Sangha RS, Huikuri HV, Peters NS. Electrocardiographic patch devices and contemporary wireless cardiac monitoring. Front Physiol 2015; 6:149. [PMID: 26074823 PMCID: PMC4444741 DOI: 10.3389/fphys.2015.00149] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/27/2015] [Indexed: 01/19/2023] Open
Abstract
Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable “on-body” ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.
Collapse
|
49
|
Haberman ZC, Jahn RT, Bose R, Tun H, Shinbane JS, Doshi RN, Chang PM, Saxon LA. Wireless Smartphone ECG Enables Large-Scale Screening in Diverse Populations. J Cardiovasc Electrophysiol 2015; 26:520-6. [PMID: 25651872 DOI: 10.1111/jce.12634] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser. OBJECTIVE We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed. METHODS In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists. RESULTS Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities. CONCLUSION Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.
Collapse
|
50
|
Doshi RN, Kalahasty G, Lobban JH, Giudici MC, Gold MR, Zhang G, Hayes K, Shome S, Ellenbogen KA. The Left Ventricular Evoked Response Signal in Bipolar LV Pacing Leads of Large Electrode Surface Area. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|