1
|
Titus A, Syeed S, Baburaj A, Bhanushali K, Gaikwad P, Sooraj M, Saji AM, Mir WAY, Kumar PA, Dasari M, Ahmed MA, Khan MO, Titus A, Gaur J, Annappah D, Raj A, Noreen N, Hasdianda A, Sattar Y, Narasimhan B, Mehta N, Desimone CV, Deshmukh A, Ganatra S, Nasir K, Dani S. Catheter ablation versus medical therapy in atrial fibrillation: an umbrella review of meta-analyses of randomized clinical trials. BMC Cardiovasc Disord 2024; 24:131. [PMID: 38424483 PMCID: PMC10902941 DOI: 10.1186/s12872-023-03670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
This umbrella review synthesizes data from 17 meta-analyses investigating the comparative outcomes of catheter ablation (CA) and medical treatment (MT) for atrial fibrillation (AF). Outcomes assessed were mortality, risk of hospitalization, AF recurrence, cardiovascular events, pulmonary vein stenosis, major bleeding, and changes in left ventricular ejection fraction (LVEF) and MLHFQ score. The findings indicate that CA significantly reduces overall mortality and cardiovascular hospitalization with high strength of evidence. The risk of AF recurrence was notably lower with CA, with moderate strength of evidence. Two associations reported an increased risk of pulmonary vein stenosis and major bleeding with CA, supported by high strength of evidence. Improved LVEF and a positive change in MLHFQ were also associated with CA. Among patients with AF and heart failure, CA appears superior to MT for reducing mortality, improving LVEF, and reducing cardiovascular rehospitalizations. In nonspecific populations, CA reduced mortality and improved LVEF but had higher complication rates. Our findings suggest that CA might offer significant benefits in managing AF, particularly in patients with heart failure. However, the risk of complications, including pulmonary vein stenosis and major bleeding, is notable. Further research in understudied populations may help refine these conclusions.
Collapse
Affiliation(s)
- Anoop Titus
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | | | | | | | | | - Mannil Sooraj
- Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Kanakapura, Karnataka, India
| | | | | | | | | | | | | | - Aishwarya Titus
- Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
| | | | | | - Arjun Raj
- University Hospital of Leicester, Leicester, UK
| | | | - Adrian Hasdianda
- Brigham and Women's Hospital, Harvard University, Cambridge, MA, USA
| | | | - Bharat Narasimhan
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Nishaki Mehta
- Beaumont Hospital Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | | | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
| | - Khurram Nasir
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| | - Sourbha Dani
- Department of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, 41 Mall Road, Burlington, MA, 10805, USA
| |
Collapse
|
2
|
Tseng AS, Desimone CV, Kowlgi GN. Antiarrhythmic drugs for atrial fibrillation in the outpatient setting. Minerva Med 2023; 114:839-849. [PMID: 37338231 DOI: 10.23736/s0026-4806.23.08524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
With burgeoning evidence for early rhythm control in patients with atrial fibrillation (AF), the management of AF in the outpatient setting has become more challenging. The primary care clinician often serves as the frontline in the pharmacologic management of AF. Because of drug interactions and the risk of proarrhythmia, many clinicians remain hesitant about the initiation and chronic management of antiarrhythmic drug prescriptions. However, with the likely increased use of antiarrhythmics for early rhythm control, understanding and familiarity with these medications have likewise become more important, especially since patients with AF probably have other non-cardiac medical conditions that can impact their antiarrhythmic therapy. In this comprehensive review, we provide informative, high-yield cases and edifying references that will help primary care providers become comfortable handling various clinical scenarios.
Collapse
Affiliation(s)
- Andrew S Tseng
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA -
| |
Collapse
|
3
|
Garcia-Sanchez T, P Ladas T, Van Zyl M, Y Tan N, Christopoulos G, A Tri J, Z Yasin O, M Sugrue A, J Connolly R, V Desimone C, M Killu A, Del-Carpio Munoz F, J Asirvatham S, Ivorra A. MRI-based numerical modeling of cardiac pulsed field ablation (PFA) with sub-microsecond pulses. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The use of irreversible electroporation (IRE) for cardiac ablation in the management of cardiac arrhythmias, known as Pulsed Field Ablation (PFA), has gained the attention of many researchers, physicians and companies. Despite the demonstrated efficacy and safety profiles of the technique, there are still many open questions. One of them deals with the effective electric field thresholds necessary for cardiac tissue ablation.
Contrary to radiofrequency (RF) ablation, where the thermotemporal thresholds for tissue damage are well established, the electric field thresholds for effective IRE are uncertain and depend on the tissue type and the waveform characteristics of the delivered electric field.
Purpose
The use of numerical models to understand the electric field distribution and the corresponding lesion for a specific electrode geometry are widely used in IRE for cancer treatment. Models can predict ablation volumes when the field thresholds are known or can be used to estimate the field thresholds when the lesion geometry is established post-treatment. The goal of the present study was to build a subject-specific realistic 3D numerical model to assess the ability of modeling to predict PFA lesions.
Methods
PFA experiments were performed in male mongrel dogs following a protocol approved by the Mayo Clinic Institutional Animal Care and Use Committee. Briefly, animals were sedated and intubated, and two non-irrigated deflectable catheters with an 8-mm tip were positioned on both sides of the interventricular septum under fluoroscopy guidance. Submicrosecond pulses were delivered in a bipolar fashion across both catheters. Sequences of pulses of 300 ns duration (or other durations in that range) were repetitively applied with voltage levels in the kV range. 30 days after the procedure, MRI with late gadolinium enhancement (LGE) were acquired to assess the presence of ablation lesions in the treated tissue. Ventricular areas were segmented from MRI images and 3D volumes were created. The generated 3D geometries were imported into software COMSOL Multiphysics. Realistic 3D geometries of the catheters were placed in the same positions than during the experiments, fluoroscopy videos recorded during the procedures were used as a guidance.
The computed electric field intensity distributions were compared to the LGE areas to extract the range of electric field thresholds where the predicted lesion size was compatible with the real size of the LGE areas for each application site and pulsing protocol.
Results and conclusions
Our results show how the numerical model is able to reproduce the shape of the LGE fibrotic lesion areas observed 30 days after the procedure. Additionally, the model clearly confirms the dose-dependent lesion sizes observed experimentally. This study supports that numerical modeling is a valuable tool for understanding PFA treatments and that it could be used as patient-specific treatment planning tool.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie
Collapse
Affiliation(s)
| | - T P Ladas
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - M Van Zyl
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - N Y Tan
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - G Christopoulos
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - J A Tri
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - O Z Yasin
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - A M Sugrue
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - R J Connolly
- Pulse Biosciences Inc. , Hayward , United States of America
| | - C V Desimone
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - A M Killu
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - F Del-Carpio Munoz
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - S J Asirvatham
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - A Ivorra
- University Pompeu Fabra , Barcelona , Spain
| |
Collapse
|
4
|
Lee JZ, Majmundar M, Kumar A, Thakkar S, Patel HP, Sorajja D, Valverde AM, Kalra A, Cha YM, Mulpuru SK, Asirvatham SJ, Desimone CV, Deshmukh AJ. Impact of Timing of Transvenous Lead Removal on Outcomes in Infected Cardiac Implantable Electronic Devices. Heart Rhythm 2021; 19:768-775. [PMID: 34968739 DOI: 10.1016/j.hrthm.2021.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality and morbidity. OBJECTIVE This study sought to evaluate the impact of early versus delayed transvenous lead removal (TLR) on in-hospital mortality and outcomes in patients with CIED infection. METHODS Using the nationally representative, all-payer, Nationwide Readmissions Database, we evaluated patients undergoing TLR for CIED infection between January 1, 2016, to December 31, 2018. The timing of the TLR procedure was determined based on hospitalization days after initial admission for CIED infection. The impact of early (≤ 7 days) versus delayed (> 7 days) TLR on mortality and major adverse events was studied. RESULTS Of 12,999 patients who underwent TLR for CIED infections, 8,834 patients underwent early TLR versus 4,165 patients who underwent delayed TLR. Delayed TLR was associated with a significant increase in in-hospital mortality (8.3% vs. 3.5%, adjusted odds ratio:1.70; 95% confidence interval, 1.43-2.03; P value<0.001). Subgroup analysis of patients with CIED infection and systemic infection showed that delayed TLR in patients with systemic infection was associated with a higher rate of in-hospital mortality compared with early TLR (10.4% vs. 7.5%, adjusted odds ratio:1.24; 95% confidence interval, 1.04-1.49; P value<0.019). Delayed TLR was also associated with significantly higher adjusted odds of major adverse events and post-procedural length of stay. CONCLUSIONS These data suggest that delayed transvenous lead removal in patients with CIED infections is associated with increased in-hospital mortality and major adverse events, especially in patients with systemic infection.
Collapse
Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Monil Majmundar
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, NY; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH
| | | | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL
| | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Arturo M Valverde
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department. Cleveland Clinic Akron General, Akron, OH; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | | | | |
Collapse
|
5
|
Smit J, Dalager-Pedersen M, Adelborg K, Kaasch AJ, Thomsen RW, Frøslev T, Nielsen H, Schønheyder HC, Sørensen HT, Desimone CV, Desimone DC, Søgaard M. Influence of Acetylsalicylic Acid Use on Risk and Outcome of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Study. Open Forum Infect Dis 2019; 6:ofz356. [PMID: 31660413 PMCID: PMC6754079 DOI: 10.1093/ofid/ofz356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/01/2019] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the influence of acetylsalicylic acid (ASA) use on risk and outcome of community-acquired Staphylococcus aureus bacteremia (CA-SAB). Method We used population-based medical databases to identify all patients diagnosed in northern Denmark with first-time CA-SAB and matched population controls from 2000–2011. Categories for ASA users included current users (new or long-term users), former users, and nonusers. The analyses were adjusted for comorbidities, comedication use, and socioeconomic indicators. Results We identified 2638 patients with first-time CA-SAB and 26 379 matched population controls. Compared with nonusers, the adjusted odds ratio (aOR) for CA-SAB was 1.00 (95% confidence interval [CI], 0.88–1.13) for current users, 1.00 (95% CI, 0.86–1.16) for former users, 2.04 (95% CI, 1.42–2.94) for new users, and 0.95 (95% CI, 0.84–1.09) for long-term users. Thirty-day cumulative mortality was 28.0% among current users compared with 21.6% among nonusers, yielding an adjusted hazard rate ratio (aHRR) of 1.02 (95% CI, 0.84–1.25). Compared with nonusers, the aHRR was 1.10 (95% CI, 0.87–1.40) for former users, 0.60 (95% CI, 0.29–1.21) for new users, and 1.06 (95% CI, 0.87–1.31) for long-term users. We observed no difference in the risk or outcome of CA-SAB with increasing ASA dose or by presence of diseases commonly treated with ASA. Conclusions Use of ASA did not seem to influence the risk or outcome of CA-SAB. The apparent increased risk among new users may relate to residual confounding from the circumstances underlying ASA treatment initiation. Our finding of no association remained robust with increasing ASA dose and across multiple patient subsets.
Collapse
Affiliation(s)
- Jesper Smit
- Department of Infectious Diseases, Aalborg University Hospital, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Denmark
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University, Düsseldorf, Germany
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Microbiology, Aalborg University Hospital, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Daniel C Desimone
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Minnesota.,Division of Infectious Diseases, Mayo Clinic Rochester, Minnesota
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Aalborg University, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| |
Collapse
|
6
|
El-Harasis M, Desimone CV, Egbe AC. P292Outcomes of adults with tetralogy of fallot undergoing catheter ablation for atrial and ventricular arrhythmias. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M El-Harasis
- Mayo Clinic, Rochester, United States of America
| | - C V Desimone
- Mayo Clinic, Rochester, United States of America
| | - A C Egbe
- Mayo Clinic, Rochester, United States of America
| |
Collapse
|
7
|
Egbe AC, Asirvatham SJ, Connolly HM, Kapa S, Desimone CV, Vaidya VR, Deshmukh AJ, Khan AR, McLeod CJ, Melduni RM, Ammash NM. Outcomes of Direct Current Cardioversion in Adults With Congenital Heart Disease. Am J Cardiol 2017; 119:1468-1472. [PMID: 28262200 DOI: 10.1016/j.amjcard.2017.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
Few data exist on direct current cardioversion (DCCV) in adult patients with congenital heart disease (CHD). This is a retrospective case-control study of 279 adults with CHD and 279 adults without CHD (control group) who had elective DCCV for atrial arrhythmias at Mayo Clinic, 2001 to 2013. Control patients were matched by gender and arrhythmia type. The objective was to compare DCCV procedural failure (failure to terminate the presenting arrhythmia) and arrhythmia recurrence (AR). In the CHD group (mean age 55 ± 20 years; men 166 [59%]), the most common diagnosis was Fontan palliation (61; 22%). Transesophageal echocardiography was performed before DCCV in 216 patients (77%); 162 (58%) had atrial flutter, and 117 (42%) had atrial fibrillation. Procedural failure and AR between the case and the control groups were more common in the CHD group (14% vs 7%, p = 0.01) and (83% vs 66% at 60 months, p = 0.001) respectively. There were no deaths or thromboembolic complications. The multivariable risk factors for procedural failure were Fontan palliation and spontaneous echocardiographic contrast; the risk factors for AR were Fontan palliation and atrial fibrillation. When patients with Fontan palliation were excluded from the analysis, the outcome of DCCV (failure and recurrence rates) was similar for the CHD and non-CHD groups despite the age difference between the cohorts. In conclusion, the present study showed that DCCV outcomes were similar for CHD and non-CHD patients, with the exception of patients with Fontan palliation.
Collapse
Affiliation(s)
- Alexander C Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | | | - Heidi M Connolly
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Arooj R Khan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Rowlens M Melduni
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
Ponamgi SP, Vaidya VR, Desimone CV, Noheria A, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality. Pacing Clin Electrophysiol 2017; 40:310-322. [PMID: 27943333 DOI: 10.1111/pace.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/24/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. METHODS In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. RESULTS Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447-2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593-2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351-1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. CONCLUSIONS In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.
Collapse
Affiliation(s)
- Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota
| | - Vaibhav R Vaidya
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Amit Noheria
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
9
|
Killu AM, Naksuk N, Desimone CV, Gaba P, Suddendorf S, Powers J, Ladewig DJ, Lerman LO, Borlaug BA, Asirvatham SJ. Beating Heart Validation of Safety and Efficacy of a Percutaneous Pericardiotomy Tool. J Cardiovasc Electrophysiol 2016; 28:357-361. [PMID: 27759180 DOI: 10.1111/jce.13108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Epicardial procedures frequently require pericardial manipulation. We aimed to develop a nonsurgical percutaneous pericardial modification tool that may (1) facilitate epicardial-based procedures by enabling adhesiolysis or (2) attenuate the myocardial constraining effect of the pericardium. METHODS Three novel devices were developed to enable pericardiotomy, all of which can be deployed in over-the-wire fashion following percutaneous epicardial access. The grasper permits us to seize the pericardial membrane providing leverage for incision. The scissors enables anterograde cutting maneuvers. The reverse-slitter allows retrograde incisions; in addition, this device has a deflectable tip that increases the potential cutting area. We optimized these tools for safety by including electrodes to test for phrenic nerve stimulation as well as myocardial stimulation to determine directionality of the cutting devices. The base of the scissors and reverse-slitter are also blunt ensuring that the cutting element is always away from the myocardium. RESULTS Following 5 nonbeating heart bench test experiments for prototype development, 11 animal (9 canine, 2 swine) studies were performed. Of these 2 were proof-of-concept open chest studies; the remaining 9 were entirely closed-chest, percutaneous procedures allowing for remodification of the prototypes. The tools successfully permitted incision of the pericardium in all studies. Hemodynamic measurements were assessed postincision and showed no compromise of systolic function. No coronary artery or phrenic nerve damage was seen in any study. CONCLUSION Percutaneous pericardiotomy is feasible and appears to be safe. It may provide leverage in epicardial-based procedures and offer treatment options in disease processes characterized by pericardial restraint.
Collapse
Affiliation(s)
- Ammar M Killu
- Department of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Niyada Naksuk
- Department of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Christopher V Desimone
- Department of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Prakriti Gaba
- Mayo Medical School, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Scott Suddendorf
- Department of Surgical Research, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Joanne Powers
- Department of Surgical Research, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Dorothy J Ladewig
- Mayo Clinic Ventures, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota, USA.,Department of Pediatric Cardiology, Rochester, Minnesota, USA
| |
Collapse
|
10
|
El Rafei A, Desimone DC, Sohail MR, Desimone CV, Steckelberg JM, Wilson WR, Baddour LM. Cardiovascular Implantable Electronic Device Infections due to Propionibacterium Species. Pacing Clin Electrophysiol 2016; 39:522-30. [PMID: 26970081 DOI: 10.1111/pace.12845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/04/2016] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Propionibacterium species are part of the normal skin flora and often considered contaminants when identified in cultures. However, they can cause life-threatening infections, including prosthetic cardiovascular device infections. Clinical presentation and management of cardiovascular implantable electronic device (CIED) infection due to Propionibacterium species has not been well described. METHODS Retrospective review of all cases of CIED infection due to Propionibacterium species admitted to Mayo Clinic between January 1, 1990 and December 31, 2014. Patient charts were reviewed for clinical, microbiological, and imaging data. Descriptive analysis was performed. RESULTS We identified 14 patients with CIED infection due to Propionibacterium species, accounting for 2.3% of all CIED infections. Patients were predominantly male (n = 12, 86%). The median age at admission was 58.5 years (range 22-83). Twelve patients had implantable cardioverter defibrillators (ICDs) and two had permanent pacemaker systems. Twelve patients had generator pocket infection (86%). Two patients met clinical criteria for CIED-related infective endocarditis. Median time between last device manipulation and infection was 9 months (range 1-98). All patients were treated with complete device removal and antibiotic therapy. Six-month follow-up data were available for 10 patients (71%), with no relapses documented. CONCLUSION CIED infections due to Propionibacterium species accounted for 2.3% of all device infections over a 25-year period. The most common infectious syndrome was generator pocket infection with delayed onset. There was an unanticipated predominance of ICDs in this cohort. Cure was achieved in all cases with complete device removal and antibiotic therapy.
Collapse
Affiliation(s)
- Abdelghani El Rafei
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Daniel C Desimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - M Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christopher V Desimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - James M Steckelberg
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Walter R Wilson
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| |
Collapse
|
11
|
Madhavan M, Venkatachalam KL, Swale MJ, Desimone CV, Gard JJ, Johnson SB, Suddendorf SH, Mikell SB, Ladewig DJ, Nosbush TG, Danielsen AJ, Knudson M, Asirvatham SJ. Novel Percutaneous Epicardial Autonomic Modulation in the Canine for Atrial Fibrillation: Results of an Efficacy and Safety Study. Pacing Clin Electrophysiol 2016; 39:407-17. [PMID: 26854009 DOI: 10.1111/pace.12824] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/24/2015] [Accepted: 01/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endocardial ablation of atrial ganglionated plexi (GP) has been described for treatment of atrial fibrillation (AF). Our objective in this study was to develop percutaneous epicardial GP ablation in a canine model using novel energy sources and catheters. METHODS Phase 1: The efficacy of several modalities to ablate the GP was tested in an open chest canine model (n = 10). Phase 2: Percutaneous epicardial ablation of GP was done in six dogs using the most efficacious modality identified in phase 1 using two novel catheters. RESULTS Phase 1: Direct current (DC) in varying doses (blocking [7-12 μA], electroporation [300-500 μA], ablation [3,000-7,500 μA]), radiofrequency ablation (25-50 W), ultrasound (1.5 MHz), and alcohol (2-5 mL) injection were successful at 0/8, 4/12, 5/7, 3/8, 1/5, and 5/7 GP sites. DC (500-5,000 μA) along with alcohol irrigation was tested in phase 2. Phase 2: Percutaneous epicardial ablation of the right atrium, oblique sinus, vein of Marshall, and transverse sinus GP was successful in 5/6 dogs. One dog died of ventricular fibrillation during DC ablation at 5,000 μA. Programmed stimulation induced AF in six dogs, preablation and no atrial arrhythmia in three, flutter in one, and AF in one postablation. Heart rate, blood pressure, effective atrial refractory period, and local atrial electrogram amplitude did not change significantly postablation. Microscopic examination showed elimination of GP, and minimal injury to atrial myocardium. CONCLUSION Percutaneous epicardial ablation of GP using DC and novel catheters is safe and feasible and may be used as an adjunct to pulmonary vein isolation in the treatment of AF in order to minimize additional atrial myocardial ablation.
Collapse
Affiliation(s)
- Malini Madhavan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida.,Department of Surgical Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Susan B Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Scott H Suddendorf
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Susan B Mikell
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | - Dorothy J Ladewig
- Department of Research Administrative Services, Mayo Clinic, Rochester, Minnesota
| | | | | | - Mark Knudson
- Mayo Clinic, Rochester, Minnesota.,EnteroMedics, Inc, St. Paul, Minnesota
| | | |
Collapse
|
12
|
Noheria A, Ponamgi SP, Desimone CV, Vaidya VR, Aakre CA, Ebrille E, Hu T, Hodge DO, Slusser JP, Ammash NM, Bruce CJ, Rabinstein AA, Friedman PA, Asirvatham SJ. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads. Europace 2015; 18:246-52. [PMID: 25767086 DOI: 10.1093/europace/euv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are commonly associated with transvenous lead-related thrombi that can cause pulmonary embolism (PE). METHODS AND RESULTS We retrospectively evaluated all patients with transvenous CIED leads implanted at Mayo Clinic Rochester between 1 January 2000, and 25 October 2010. Pulmonary embolism outcomes during follow-up were screened using diagnosis codes and confirmed with imaging study reports. Of 5646 CIED patients (age 67.3 ± 16.3 years, 64% men, mean follow-up 4.69 years) 88 developed PE (1.6%), incidence 3.32 [95% confidence interval (CI) 2.68-4.07] per 1000 person-years [men: 3.04 (95% CI 2.29-3.96) per 1000 person-years; women: 3.81 (95% CI 2.72-5.20) per 1000 person-years]. Other than transvenous CIED lead(s), 84% had another established risk factor for PE such as deep vein thrombosis (28%), recent surgery (27%), malignancy (25%), or prior history of venous thromboembolism (15%). At the time of PE, 22% had been hospitalized for ≥ 48 h, and 59% had been hospitalized in the preceding 30 days. Pulmonary embolism occurred in 22% despite being on systemic anticoagulation therapy. Out of 88 patients with PE, 45 subsequently died, mortality rate 93 (95% CI 67-123) per 1000 person-years (hazard ratio 2.0, 95% CI 1.5-2.7, P < 0.0001). CONCLUSIONS Though lead-related thrombus is commonly seen in patients with transvenous CIED leads, clinical PE occurs with a low incidence. It is possible that embolism of lead thrombus is uncommon or emboli are too small to cause consequential pulmonary infarction.
Collapse
Affiliation(s)
- Amit Noheria
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Christopher V Desimone
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | | | - Elisa Ebrille
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Naser M Ammash
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles J Bruce
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
13
|
Desimone CV, Bos JM, Bos KM, Liang JJ, Patel NA, Hodge DO, Noheria A, Asirvatham SJ, Ackerman MJ. Effects on repolarization using dynamic QT interval monitoring in long-QT patients following left cardiac sympathetic denervation. J Cardiovasc Electrophysiol 2015; 26:434-439. [PMID: 25559122 DOI: 10.1111/jce.12609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/02/2014] [Accepted: 12/10/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Videoscopic left cardiac sympathetic denervation (LCSD) is an adjunct therapy for reduction of arrhythmia-induced events in patients with long-QT syndrome (LQTS). LCSD reduces LQTS-triggered breakthrough cardiac events. The temporal effects of QTc changes post-LCSD have not been studied. METHODS We utilized continuous QTc monitoring on 72 patients with LQTS. We evaluated acute and long-term QTc changes in comparison to 12-lead ECG-derived QTc values prior to surgery, 24 hours postsurgery, and at follow up ≥3 months. RESULTS Seventy-two patients underwent LCSD at our institution (46% male, mean age at LCSD was 14 ± 10 years). The mean baseline, pre-LCSD QTc was 505 ± 56 ms, which had decreased significantly at ≥3 months post-LCSD to 491 ± 40 ms (P = 0.001). QTc monitoring revealed that the majority of the cohort (53/72; 74%) had a transient increase >30 ms in QTc from baseline, with an average maximum increase of 72 ± 30 ms. Resolution within 10 ms of baseline or less occurred in 57% (30/53) at 24 hours post-LCSD. CONCLUSIONS Although LQTS patients may have a paradoxically increased QTc post-LCSD, the effects are transient in most patients. Importantly, no patients experienced any arrhythmias in the postoperative setting related to this transient rise in QTc.
Collapse
Affiliation(s)
| | - J Martijn Bos
- Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Katy M Bos
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
| | - Jackson J Liang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Amit Noheria
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Michael J Ackerman
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
| |
Collapse
|
14
|
Affiliation(s)
- Christopher V Desimone
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
15
|
Madhavan M, Desimone CV, Ebrille E, Mulpuru SK, Mikell SB, Johnson SB, Suddendorf SH, Ladewig DJ, Gilles EJ, Danielsen AJ, Asirvatham SJ. Transvenous stimulation of the renal sympathetic nerves increases systemic blood pressure: a potential new treatment option for neurocardiogenic syncope. J Cardiovasc Electrophysiol 2014; 25:1115-8. [PMID: 24902981 DOI: 10.1111/jce.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/13/2014] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurocardiogenic syncope (NCS) is a common and sometimes debilitating disorder, with no consistently effective treatment. NCS is due to a combination of bradycardia and vasodilation leading to syncope. Although pacemaker devices have been tried in treating the bradycardic aspect of NCS, no device-based therapy exists to treat the coexistent vasodilation that occurs. The renal sympathetic innervation has been the target of denervation to treat hypertension. We hypothesized that stimulation of the renal sympathetic nerves can increase blood pressure and counteract vasodilation in NCS. METHODS AND RESULTS High-frequency stimulation (800-900 pps, 10 V, 30-200 seconds) was performed using a quadripolar catheter in the renal vein of 7 dogs and 1 baboon. A significant increase in blood pressure (BP; mean [SD] systolic BP 117 [±28] vs. 128 [±33], diastolic BP 75 [±19] vs. 87 [±29] mmHg) was noted during the stimulation, which returned to baseline after cessation of stimulation. The mean increase in systolic and diastolic BP was 13.0 (±3.3) (P = 0.006) and 10.2 (±4.6) (P = 0.08), respectively. CONCLUSION We report the first ever study of feasibility and safety of high-frequency electrical stimulation of the renal sympathetic innervation to increase BP in animal models. This has potential applications in the treatment of hypotensive states such as NCS.
Collapse
Affiliation(s)
- Malini Madhavan
- Department of Cardiovascular Diseases, Rochester, Minnesota, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Desimone CV, Hu T, Ebrille E, Syed FF, Vaidya VR, Cha YM, Valverde AM, Friedman PA, Suri RM, Asirvatham SJ. Catheter ablation related mitral valve injury: the importance of early recognition and rescue mitral valve repair. J Cardiovasc Electrophysiol 2014; 25:971-975. [PMID: 24758402 DOI: 10.1111/jce.12439] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/20/2014] [Accepted: 04/11/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes. METHODS We searched the Mayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention. RESULTS Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure. CONCLUSION Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.
Collapse
Affiliation(s)
- Christopher V Desimone
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tiffany Hu
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisa Ebrille
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Internal Medicine, Division of Cardiovascular Diseases, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Faisal F Syed
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arturo M Valverde
- Department of Cardiovascular Disease, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakesh M Suri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
17
|
Vaidya VR, Desimone CV, Madhavan M, Noheria A, Shahid M, Walters J, Ladewig DJ, Mikell SB, Johnson SB, Suddendorf SH, Asirvatham SJ. Compatibility of electroanatomical mapping systems with a concurrent percutaneous axial flow ventricular assist device. J Cardiovasc Electrophysiol 2014; 25:781-6. [PMID: 24758340 DOI: 10.1111/jce.12437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
Collapse
Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hai JJ, Lachman N, Syed FF, Desimone CV, Asirvatham SJ. The anatomic basis for ventricular arrhythmia in the normal heart: what the student of anatomy needs to know. Clin Anat 2014; 27:885-93. [PMID: 24446306 DOI: 10.1002/ca.22362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/25/2013] [Indexed: 11/11/2022]
Abstract
The traditional route for teaching cardiac anatomy involves didactic instruction, cadaver dissections, and familiarization with the main structure and relationships of the cardiac chambers, valves, and vasculature. In contemporary cardiac electrophysiology, however, a very different view of anatomy is required including details rarely appreciated with a general overview. In this review, we discuss the critical advances in cardiac electrophysiology that were possible only because of understanding detailed anatomic relationships. While we briefly discuss the clinical relevance, we explain in depth the necessary structural information for the student of clinical anatomy. Interspersed through the text are boxes that highlight and summarize the critical pieces of knowledge to be borne in mind while studying the fascinating structural anatomy of the human heart.
Collapse
Affiliation(s)
- Jo Jo Hai
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | |
Collapse
|
19
|
Hai JJ, Desimone CV, Vaidya VR, Asirvatham SJ. Endocavitary structures in the outflow tract: anatomy and electrophysiology of the conus papillary muscles. J Cardiovasc Electrophysiol 2013; 25:94-8. [PMID: 24102678 DOI: 10.1111/jce.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022]
Abstract
Catheter ablation is an increasingly used and successful treatment choice for right ventricular outflow tract (RVOT) arrhythmias. While the role of endocavitary structures and the regional morphology of the ventricular inflow tract and the right atrium as a cause for difficulty with successful ablation are well described, similar issues within the RVOT are not well understood. It is also not commonly appreciated that one of the papillary muscles is located within the proximal RVOT. We report 3 patients in which ventricular arrhythmia was targeted and ablated in the conus papillary muscle. The anatomic features, potential role of the fascicular conduction system, and unique challenges with mapping arrhythmia arising from this structure are discussed.
Collapse
Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
| | | | | | | |
Collapse
|
20
|
Desimone CV, Santoro SC, Xie C, Hoefler EC, Makhija P, Bondarenko VE, Morales MJ. Diversity in Interaction and Gating Modification of Kv4 Channels by Hptx2. Biophys J 2011. [DOI: 10.1016/j.bpj.2010.12.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|