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Bodziock G, Shantha G. The era of muti-electrode mapping catheters and ventricular arrhythmia ablation. J Interv Card Electrophysiol 2024; 67:235-236. [PMID: 37966659 DOI: 10.1007/s10840-023-01683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Affiliation(s)
- George Bodziock
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Ghanshyam Shantha
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Shantha G, Singleton M, Kozak P, Bodziock G, Atreya AR, Narasimhan B, Deshmukh A, Liang JJ, Hranitzky P, Whalen P, Bhave P. Role of dofetilide in patients with ventricular arrhythmias. J Interv Card Electrophysiol 2024; 67:91-97. [PMID: 37247098 DOI: 10.1007/s10840-023-01578-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND OR PURPOSE To assess effectiveness of dofetilide in reducing the burden of ventricular arrhythmias (VAs). BACKGROUND Prior small sample studies show that dofetilide has benefit in reducing VA. However, large sample investigations with long-term follow-up are lacking. METHODS Two hundred seventeen consecutive patients admitted between January 2015 and December 2021 for dofetilide initiation for control of VA were assessed. Dofetilide was successfully started in 176 patients (81%) and had to be discontinued in the remaining 41 patients (19%). Dofetilide was initiated for control of ventricular tachycardia (VT) in 136 patients (77%), whereas 40 (23%) patients were initiated on dofetilide for reducing the burden of premature ventricular complexes (PVCs). RESULTS The mean follow-up was 24 ± 7 months. In total, among the 136 VT patients, 33 (24%) died, 11 (8%) received a left ventricular assist device (LVAD), and 3 (2%) received a heart transplant during follow-up. Dofetilide was discontinued in 117 (86%) patients due to lack of sustained effectiveness during follow-up. Dofetilide use was associated with similar odds of the composite outcome of all-cause mortality/LVAD/heart transplant (OR: 0.97, 0.55-4.23) in patients with ischemic cardiomyopathy (ICM) compared to those with non-ischemic cardiomyopathy (NICM). Dofetilide did not reduce PVC burden during follow-up in the 40 patients with PVCs (mean baseline PVC burden: 15%, at 1-year follow-up: 14%). CONCLUSIONS Dofetilide use was less effective in reducing VA burden in our cohort of patients. Randomized controlled studies are needed to confirm our findings.
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Affiliation(s)
- Ghanshyam Shantha
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | | | - Patrick Kozak
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - George Bodziock
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Auras R Atreya
- Cardiac Electrophysiology, University of Arkansas, Little Rock, USA
| | - Bharat Narasimhan
- Debakey Cardiovascular Center, Houston Methodist Hospital, Houston, TX, USA
| | | | - Jackson J Liang
- Cardiac Electrophysiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Patrick Whalen
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Prashant Bhave
- Cardiac Electrophysiology, Wake Forest University, 1, Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Bodziock G, Lata A, Bhave P, Whalen P, Shantha G. Lung herniation presenting nearly 4 years after tunneling epicardial leads through the intercostal space. J Interv Card Electrophysiol 2023; 66:1783-1784. [PMID: 37354367 DOI: 10.1007/s10840-023-01603-y] [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] [Received: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Affiliation(s)
- George Bodziock
- Section of Cardiovascular Medicine, Cardiac Electrophysiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Adrian Lata
- Cardiothoracic Surgery, Wake Forest University School of Medicine, 1 Medical Center Blvd, NC, 27157, Winston-Salem, USA
| | - Prashant Bhave
- Section of Cardiovascular Medicine, Cardiac Electrophysiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Patrick Whalen
- Section of Cardiovascular Medicine, Cardiac Electrophysiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Ghanshyam Shantha
- Section of Cardiovascular Medicine, Cardiac Electrophysiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Shrestha DB, Pathak BD, Thapa N, Shrestha O, Karki S, Shtembari J, Patel NK, Kapoor K, Kalahasty G, Bodziock G, Whalen P, Pothineni NVK, Narasimhan B, Koneru J, Shantha G. Catheter ablation using pulmonary vein isolation with versus without left atrial posterior wall isolation for persistent atrial fibrillation: an updated systematic review and meta-analysis. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01656-z. [PMID: 37773559 DOI: 10.1007/s10840-023-01656-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation of atrial fibrillation (AF); however, the results are suboptimal for persistent AF. The left atrial posterior wall (LAPW) is thought to be a major additional area in initiation and perpetuation of persistent AF. Therefore, adjunctive ablation of the posterior wall may reduce AF recurrence in patients with persistent AF. OBJECTIVE The objective of this study was to compare outcomes of catheter ablation in patients with persistent AF using PVI alone versus a combination of PVI and LAPW isolation. METHODS Literature search was conducted in PubMed, PubMed Central, Scopus, and Embase since inception to February 2023. Screening of studies was done via Covidence software. Risk of bias assessment was done using appropriate tools. Data extraction and a narrative synthesis were carried out accordingly. RESULTS Ten studies were included, of which five were randomized controlled trials. PVI with LAPW ablation group had significantly lower recurrence of overall atrial tachyarrhythmia (OR 0.47, CI 0.32-0.70) and AF (OR 0.39, CI 0.23-0.69). In sensitivity analysis, freedom from atrial arrhythmias was noted to be significantly higher in the PVI with LAPW ablation group (OR 2.22, CI 1.36-3.64). However, there was no significant difference in occurrence of atrial flutter (OR 1.36, CI 0.86-2.14) or with periprocedural adverse events (OR 1.10, CI 0.60-1.99). CONCLUSION LAPW ablation, in addition to PVI, significantly improves the rates of arrhythmia freedom and reduces the recurrence of overall atrial tachyarrhythmia. There was no significant difference in atrial flutter or periprocedural adverse events.
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Affiliation(s)
| | - Bishnu Deep Pathak
- Department of Internal Medicine, Jibjibe Primary Health Care Center, Rasuwa, Nepal
| | - Niranjan Thapa
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Oshan Shrestha
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sagun Karki
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA
| | - Nimesh K Patel
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kunal Kapoor
- Department of Internal Medicine, Division of Cardiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Gautham Kalahasty
- Department of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - George Bodziock
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Patrick Whalen
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | | | - Bharat Narasimhan
- Department of Cardiology, Debakey Cardiovascular Institute, Houston Methodist, Houston, TX, USA
| | - Jayanthi Koneru
- Department of Internal Medicine, Division of Electrophysiology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ghanshyam Shantha
- Department of Cardiology, Division of Electrophysiology, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Shantha G, Brock J, Singleton MJ, Schmitt AJ, Kozak P, Bodziock G, Bradford N, Whalen P, Bhave P. A comparative study of the two leadless pacemakers in clinical practice. J Cardiovasc Electrophysiol 2023; 34:1896-1903. [PMID: 37522245 DOI: 10.1111/jce.16019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/01/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION AVEIR-VR leadless pacemaker (LP) was recently approved for clinical use. Although trial data were promising, post-approval real world data with regard to its effectiveness and safety is lacking. To report our early experience with AVEIR-VR LP with regard to its effectiveness and safety and compare it with MICRA-VR. METHODS The first 25 patients to undergo AVEIR-VR implant at our institution between June and November 2022, were compared to 25 age- and sex-matched patients who received MICRA-VR implants. RESULTS In both groups, mean age was 73 years and 48% were women. LP implant was successful in 100% of patients in both groups. Single attempt deployment was achieved in 80% of AVEIR-VR and 60% of MICRA-VR recipients (p = 0.07). Fluoroscopy, implant, and procedure times were numerically longer in the AVEIR-VR group compared to MICRA-VR group (p > 0.05). No significant periprocedural complications were noted in both groups. Incidence of ventricular arrhythmias were higher in the AVEIR-VR group (20%) compared to the MICRA-VR group (0%) (p = 0.043). At 2 and 8 weeks follow-up, device parameters remained stable in both groups with no device dislodgements. The estimated battery life at 8 weeks was significantly longer in the AVEIR-VR group (15 years) compared to the MICRA-VR group (8 years) (p = 0.047). With 3-4 AVEIR-VR implants, the learning curve for successful implantation reached a steady state. CONCLUSION Our initial experience with AVEIR-VR show that it has comparable effectiveness and safety to MICRA-VR. Larger sample studies are needed to confirm our findings.
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Affiliation(s)
- Ghanshyam Shantha
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jonathan Brock
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | | | - Patrick Kozak
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - George Bodziock
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Natalie Bradford
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Patrick Whalen
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Prashant Bhave
- Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
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Shantha G, Brock J, Singleton M, Kozak P, Bodziock G, Bradford N, Deshmukh A, Liang JJ, Pothineni NVK, Hranitzky P, Whalen P, Bhave PD. Anatomical location of leadless pacemaker and the risk of pacing-induced cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:1418-1426. [PMID: 37161942 DOI: 10.1111/jce.15925] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/30/2023] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND It is unclear if the location of implantation of the leadless pacemaker (LP) makes a difference in the incidence of pacing-induced cardiomyopathy (PICM). AIM The aim of this study was to compare the incidence of PICM based on the location of implantation of LP. METHODS A total of 358 consecutive patients [women: 171 (48%), mean age: 73 ± 15 years] with left ventricular ejection fraction (EF) > 50%, who received an LP (Micra) between January 2017 and June 2022, formed the study cohort. Micra-AV and Micra-VR were implanted in 122 (34%) and 236 (66%) patients, respectively. Fluoroscopically, the location of implantation of LP in the interventricular septum (IS) was divided into two equal halves (apex/apical septum [AS] and mid/high septum [HS]). During follow-up, PICM was defined as an EF drop of ≥10%. RESULTS LP was implanted in 109 (34%) and 249 (66%) patients at AS and HS locations, respectively. During a mean 18 ± 8 months follow-up, 28 patients (7.8%) developed PICM. Among the 249 patients with HS placement of LP, 10 (4%) developed PICM, whereas among the 109 patients with AS placement of LP, 18 (16.5%) developed PICM (p = .002). AS location was associated with a higher risk of PICM compared to HS locations (adjusted hazard ratio: 4.42, p < .001). CONCLUSION AS location of LP was associated with a higher risk of PICM compared to HS placement. Larger randomized studies are needed to confirm our findings.
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Affiliation(s)
- Ghanshyam Shantha
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jonathan Brock
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | | | - Patrick Kozak
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - George Bodziock
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Natalie Bradford
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Abhishek Deshmukh
- Department of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jackson J Liang
- Department of Cardiac Electrophysiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Patrick Hranitzky
- Department of Cardiac, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Patrick Whalen
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Prashant D Bhave
- Department of Cardiac Electrophysiology, Wake Forest University, Winston-Salem, North Carolina, USA
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Hansen R, Crespo E, Bodziock G, Brock J, Dixon J, Pisani BA, Bhave PD. BEING “DELTA” PREEXCITED HEART: A CASE OF ORTHODROMIC REENTRANT TACHYCARDIA (ORT) AFTER HEART TRANSPLANTATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04339-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bodziock G, Kozak P, Patel N, Whalen P. MANAGING IDIOPATHIC PREMATURE VENTRICULAR COMPLEXES WITH ATTENTION TO THE SPECIALIZED CONDUCTION SYSTEM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03504-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bodziock G, Chandrasekhar M, Richardson K. HYPOXIA, RIGHT-LEFT SHUNT, AND A UNFORTUNATELY LOCATED MASS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33761-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bodziock G, Armstrong C, Montgomery J. Flecainide overdose presenting with long QT and acute Takotsubo cardiomyopathy. J Electrocardiol 2018; 52:7-9. [PMID: 30476643 DOI: 10.1016/j.jelectrocard.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/14/2018] [Accepted: 09/22/2018] [Indexed: 01/27/2023]
Affiliation(s)
- George Bodziock
- Department of Internal Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, TN 37232, United States of America.
| | - Chadwick Armstrong
- Cardiovascular Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, TN 37232, United States of America
| | - Jay Montgomery
- Cardiovascular Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, TN 37232, United States of America; Electrophysiology program, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, TN 37232, United States of America
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