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Krzowski B, Kutyifa V, Vloka M, Huang DT, Attari M, Aktas M, Shah AH, Musat D, Rosenthal L, McNitt S, Polonsky B, Schuger C, Natale A, Ziv O, Beck C, Daubert JP, Goldenberg I, Zareba W. Sex-Related Differences in Ventricular Tachyarrhythmia Events in Patients With Implantable Cardioverter-Defibrillator and Prior Ventricular Tachyarrhythmias. JACC Clin Electrophysiol 2024; 10:284-294. [PMID: 38032582 DOI: 10.1016/j.jacep.2023.09.028] [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: 04/21/2023] [Revised: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Data on the risk of ventricular tachycardia (VT), ventricular fibrillation (VF), and death by sex in patients with prior VT/VF are limited. OBJECTIVES This study aimed to assess sex-related differences in implantable cardioverter-defibrillator (ICD)-treated VT/VF events and death in patients implanted for secondary prevention or primary prevention ICD indications who experienced VT/VF before enrollment in the RAID (Ranolazine Implantable Cardioverter-Defibrillator) trial. METHODS Sex-related differences in the first and recurrent VT/VF requiring antitachycardia pacing or ICD shock and death were evaluated in 714 patients. RESULTS There were 124 women (17%) and 590 men observed during a mean follow-up of 26.81 ± 14.52 months. Compared to men, women were at a significantly lower risk of VT/VF/death (HR: 0.67; P = 0.029), VT/VF (HR: 0.68; P = 0.049), VT/VF treated with antitachycardia pacing (HR: 0.59; P = 0.019), and VT/VF treated with ICD shock (HR: 0.54; P = 0.035). The risk of recurrent VT/VF was also significantly lower in women (HR: 0.35; P < 0.001). HR for death was similar to the other endpoints (HR: 0.61; P = 0.162). In comparison to men, women presented with faster VT rates (196 ± 32 beats/min vs 177 ± 30 beats/min, respectively; P = 0.002), and faster shock-requiring VT/VF rates (258 ± 56 beats/min vs 227 ± 57 beats/min, respectively; P = 0.30). There was a significant interaction for the risk of VT/VF by race (P = 0.013) with White women having significantly lower risk than White men (HR: 0.36; P < 0.001), whereas Black women had a similar risk to Black men (HR: 1.06; P = 0.851). CONCLUSIONS Women with a history of prior VT/VF experienced a lower risk recurrent VT/VF requiring ICD therapy when compared to men. Black Women had a risk similar to men, whereas the lower risk for VT/VF in women was observed primarily in White women. (Ranolazine Implantable Cardioverter-Defibrillator Trial; NCT01215253).
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Affiliation(s)
- Bartosz Krzowski
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Valentina Kutyifa
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Margot Vloka
- Cardiology Division, Saint Alphonsus Health System, Boise, Idaho, USA
| | - David T Huang
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Mehmet Aktas
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Abrar H Shah
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Dan Musat
- Valley Health System, Ridgewood, New Jersey, USA
| | - Lawrance Rosenthal
- University of Massachusetts Memorial Health, Worcester, Massachusetts, USA
| | - Scott McNitt
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Bronislava Polonsky
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Ohad Ziv
- Heart and Vascular Center, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Christopher Beck
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ilan Goldenberg
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Wojciech Zareba
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
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Nabavizadeh P, Rajsheker S, Attari M. Hybrid subcutaneous and transvenous approach for cardiac resynchronization defibrillator implant in a patient with congenital heart disease and tricuspid bioprosthetic. HeartRhythm Case Rep 2020; 6:27-28. [PMID: 31956498 PMCID: PMC6962749 DOI: 10.1016/j.hrcr.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Baskar S, Attari M, Czosek RJ, Jais P, Anderson JB, Spar DS. An unusual cause of lone atrial fibrillation in a young female subject due to a rapid-cycling focal atrial trigger. HeartRhythm Case Rep 2018; 4:204-208. [PMID: 29922577 PMCID: PMC6006482 DOI: 10.1016/j.hrcr.2018.02.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shankar Baskar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | | | - David S. Spar
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Address reprint requests and correspondence: Dr David S. Spar, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229.
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Eckman MH, Costea A, Attari M, Munjal J, Wise RE, Knochelmann C, Flaherty ML, Baker P, Ireton R, Harnett BM, Leonard AC, Steen D, Rose A, Kues J. Atrial fibrillation decision support tool: Population perspective. Am Heart J 2017; 194:49-60. [PMID: 29223435 DOI: 10.1016/j.ahj.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/16/2017] [Accepted: 08/21/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients. METHODS This is a retrospective cohort study of patients with paroxysmal or persistent nonvalvular AF. We updated an Atrial Fibrillation Decision Support Tool (AFDST) to include DOACs as treatment options. The tool generates patient-specific recommendations based upon individual patient risk factor profiles for stroke and major bleeding using quality-adjusted life-years (QALYs) calculated for each treatment strategy by a decision analytic model. The setting included inpatient and ambulatory sites in an academic health center in the midwestern United States. The study involved 5,121 adults with nonvalvular AF seen for any ambulatory visit or inpatient hospitalization over the 1-year period (January through December 2016). Outcome measure was net clinical benefit in QALYs. RESULTS When DOACs are a therapeutic option, the AFDST recommends OAT for 4,134 (81%) patients and no antithrombotic therapy or aspirin for 489 (9%). A strong recommendation for OAT could not be made in 498 (10%) patients. When warfarin is the only option, OAT is recommended for 3,228 (63%) patients and no antithrombotic therapy or aspirin for 973 (19%). A strong recommendation for OAT could not be made in 920 (18%) patients. In total, 1,508 QALYs could be gained if treatment were changed to that recommended by the AFDST. CONCLUSIONS Availability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1,500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.
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Affiliation(s)
- Mark H Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH; Center for Health Informatics, University of Cincinnati, Cincinnati, OH.
| | - Alexandru Costea
- Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - Mehran Attari
- Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - Jitender Munjal
- Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - Ruth E Wise
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH
| | | | | | - Pete Baker
- Center for Health Informatics, University of Cincinnati, Cincinnati, OH
| | - Robert Ireton
- Center for Health Informatics, University of Cincinnati, Cincinnati, OH
| | - Brett M Harnett
- Center for Health Informatics, University of Cincinnati, Cincinnati, OH
| | - Anthony C Leonard
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH
| | - Dylan Steen
- Division of Cardiology, University of Cincinnati, Cincinnati, OH
| | - Adam Rose
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH
| | - John Kues
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH
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Zhou Y, Lower EE, Li HP, Costea A, Attari M, Baughman RP. Cardiac Sarcoidosis. Chest 2017; 151:139-148. [DOI: 10.1016/j.chest.2016.08.1457] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 12/19/2022] Open
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Yousuf MA, Haq S, O'Donnell RE, Attari M. Hemodynamically significant atrial septal defect after atrial fibrillation ablation: A hole to remember. Heart Rhythm 2015; 12:1987-9. [PMID: 25933504 DOI: 10.1016/j.hrthm.2015.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Sulsal Haq
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Mehran Attari
- Division of Cardiovascular Disease, University of Cincinnati.
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Rajsheker S, Abo-Salem E, Munjal J, Costea A, Attari M. PERMANENT DEVICE IMPLANTATION USING THE TRANSFEMORAL ROUTE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60327-8] [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: 10/23/2022]
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Abo-Salem E, Miller BE, Wexler L, Attari M. VASCULAR CLOSURE DEVICES FOR VENOUS ACCESSES IN ANTICOAGULATED PATIENTS AFTER CATHETER ABLATION OF ATRIAL FIBRILLATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60420-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: 11/30/2022]
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Meziane N, Yang S, Shokoueinejad M, Webster JG, Attari M, Eren H. Simultaneous comparison of 1 gel with 4 dry electrode types for electrocardiography. Physiol Meas 2015; 36:513-29. [DOI: 10.1088/0967-3334/36/3/513] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolides and fluoroquinolones antibiotics. Torsades de pointes (TdP) is a rare potential side effect of fluoroquinolones and macrolide antibiotics. However, the widespread use of these antibiotics compounds the problem. These antibiotics prolong the phase 3 of the action potential and cause early after depolarization and dispersion of repolarization that precipitate TdP. The potency of these drugs, as potassium channel blockers, is very low, and differences between them are minimal. Underlying impaired cardiac repolarization is a prerequisite for arrhythmia induction. Impaired cardiac repolarization can be congenital in the young or acquired in adults. The most important risk factors are a prolonged baseline QTc interval or a combination with class III antiarrhythmic drugs. Modifiable risk factors, including hypokalemia, hypomagnesemia, drug interactions, and bradycardia, should be corrected. In the absence of a major risk factor, the incidence of TdP is very low. The use of these drugs in the appropriate settings of infection should not be altered because of the rare risk of TdP, except among cases with high-risk factors.
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Affiliation(s)
- Elsayed Abo-Salem
- Department of Cardiovascular Diseases, University of Cincinnati, Cincinnati, OH, USA
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Yousuf MA, Haque S, O'donnell R, Attari M. RIGHT HEART FAILURE FROM PERSISTENT IATROGENIC ATRIAL SEPTAL DEFECT FOLLOWING ATRIAL FIBRILLATION ABLATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60661-6] [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: 11/25/2022]
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Abstract
Patient biopotentials are usually measured with conventional disposable Ag/AgCl electrodes. These electrodes provide excellent signal quality but are irritating for long-term use. Skin preparation is usually required prior to the application of electrodes such as shaving and cleansing with alcohol. To overcome these difficulties, researchers and caregivers seek alternative electrodes that would be acceptable in clinical and research environments. Dry electrodes that operate without gel, adhesive or even skin preparation have been studied for many decades. They are used in research applications, but they have yet to achieve acceptance for medical use. So far, a complete comparison and evaluation of dry electrodes is not well described in the literature. This work compares dry electrodes for biomedical use and physiological research, and reviews some novel systems developed for cardiac monitoring. Lastly, the paper provides suggestions to develop a dry-electrode-based system for mobile and long-term cardiac monitoring applications.
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Affiliation(s)
- N Meziane
- Department of Biomedical Engineering, University of Wisconsin–Madison, 1550 Engineering Dr., Madison, WI 53706-1609, USA.
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Attari M, Legrand M, Philippe C, Rosak P. [Valvular surgery for an exercise-induced functional mitral regurgitation in heart failure and preserved ejection fraction: a case study]. Ann Cardiol Angeiol (Paris) 2013; 62:278-281. [PMID: 22436632 DOI: 10.1016/j.ancard.2011.09.008] [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: 06/04/2011] [Accepted: 09/26/2011] [Indexed: 05/31/2023]
Abstract
We here report the case of a 67-year-old woman with moderate mitral regurgitation without significant structural abnormalities that get worse during severe recurrent heart failures and preserved ejection fraction with concomitant paroxysmal atrial fibrillation. Atrial fibrillation became permanent and despite a well-controlled cardiac frequency, new heart failure episodes occurred. Exercise doppler echocardiography showed that the mechanism of this mitral regurgitation was a two leaflet mitral tenting. We discuss here the different mechanisms that could induce these kinds of mitral regurgitation with excessive tenting. We emphasize the interest of early detection by exercise doppler echocardiography even when a triggering factor like atrial fibrillation seems to be involved. We also discuss the interest of mitral valve replacement for these patients.
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Affiliation(s)
- M Attari
- Pôle Neurocardiologie, centre hospitalier du Mans, 194, avenue Rubillard, 72037 Le Mans cedex 9, France
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Shizukuda Y, Ahmad S, Attari M, Costea A, Muth J. Echocardiographic Apporach to Dissect the Effect of Dyssynchrony on Left Ventricular Function in Heart Failure. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1036.12] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yukitaka Shizukuda
- University of CincinnatiCincinnatiOH
- Cincinnati VA Medical CenterCincinnatiOH
| | | | - Mehran Attari
- University of CincinnatiCincinnatiOH
- Cincinnati VA Medical CenterCincinnatiOH
| | - Alexandru Costea
- University of CincinnatiCincinnatiOH
- Cincinnati VA Medical CenterCincinnatiOH
| | - James Muth
- University of CincinnatiCincinnatiOH
- Cincinnati VA Medical CenterCincinnatiOH
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Silbiger JJ, Ashtiani R, Attari M, Spruill TM, Kamran M, Reynolds D, Stein R, Rubinstein D. Atheroscerlotic heart disease in Bangladeshi immigrants: risk factors and angiographic findings. Int J Cardiol 2009; 146:e38-40. [PMID: 19185940 DOI: 10.1016/j.ijcard.2008.12.175] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 12/14/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of coronary artery disease (CAD) among Bangladeshis greatly exceeds that of Caucasians. Bangladeshis also suffer from premature onset, clinically aggressive and angiographically extensive disease. The role of conventional CAD risk factors (CCRFs) has been questioned. We therefore sought to determine if the CCRFs of Bangladeshis differed from non-Bangladeshis. We also sought to determine whether CAD was more extensive in Bangladeshis and if Bangladeshi ethnicity was independently predictive of extensive i.e., 3-vessel CAD at angiography. METHODS We reviewed the coronary angiograms and medical records of 75 Bangladeshis and 57 non-Bangladeshis presenting with myocardial infarction or angina pectoris. RESULTS Bangladeshis were younger (56.1 vs. 62.4 years, p=.001), had a lower body-mass index (25.2 vs. 27.2 kg/m(2), p=.017) and were less likely to be current or recent smokers (40% vs. 58%, p=.041) than non-Bangladeshis. There were no statistically significant differences in the proportion of subjects in the 2 groups with respect to diabetes mellitus, dyslipidemia, hypertension or family history of CAD. Bangladeshis had twice the rate of 3-vessel CAD of non-Bangladeshis (53% vs. 26%, p=.002). Bangladeshi ethnicity was independently associated with >3X the likelihood of having 3-vessel CAD at angiography (p=.011). CONCLUSIONS This study demonstrated that the CCRF burden of Bangladeshis with CAD is not excessive compared to that of non-Bangladeshis and is therefore unlikely to account for the excessive CAD risk found in this cohort. We also conclude that Bangladeshis have more angiographically extensive CAD than non-Bangladeshis and that Bangladeshi ethnicity is independently predictive of 3-vessel disease.
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McMullan J, Valento M, Attari M, Venkat A. Care of the pacemaker/implantable cardioverter defibrillator patient in the ED. Am J Emerg Med 2007; 25:812-22. [PMID: 17870488 DOI: 10.1016/j.ajem.2007.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/20/2007] [Accepted: 02/03/2007] [Indexed: 02/04/2023] Open
Abstract
As the population ages and the prevalence of cardiovascular disease increases, patients with pacemakers and implantable cardioverter defibrillators (ICDs) more commonly present to the emergency department. These patients can have complex medical issues related to and independent of their pacemaker/ICD that require careful management by the emergency physician. This article will review the major diagnostic and therapeutic considerations in the emergency care of patients with pacemakers and ICDs.
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Affiliation(s)
- Jason McMullan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA
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Badhwar N, Kalman JM, Sparks PB, Kistler PM, Attari M, Berger M, Lee RJ, Sra J, Scheinman MM. Atrial Tachycardia Arising From the Coronary Sinus Musculature. J Am Coll Cardiol 2005; 46:1921-30. [PMID: 16286181 DOI: 10.1016/j.jacc.2005.07.042] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 05/26/2005] [Accepted: 07/04/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We sought to describe the electrophysiological features and long-term outcome after radiofrequency catheter ablation (RFCA) of atrial tachycardia (AT) arising from the coronary sinus (CS) musculature. BACKGROUND Atrial tachycardia requiring RFCA deep within the CS has been described in isolated case reports. However, the mechanism and exact site of origin of this tachycardia have not been well elucidated. METHODS The study included 8 patients (5 men) of a consecutive series of 283 patients undergoing RFCA for focal AT. RESULTS In sinus rhythm, a discrete potential (P) was noted after the CS atrial electrogram and during tachycardia, the CS (P) preceded the surface P-wave by 30 to 50 ms. The CS (P) always preceded the earliest electrogram in the left atrium (LA). Three-dimensional electroanatomical mapping was available in four patients, and in one case it showed earliest activation in the CS with rapid spread to the proximal CS and then to the LA. Ablation of the AT initially attempted from the earliest site in the LA in three patients was unsuccessful. In all patients the tachycardia was safely and successfully ablated at a site 3.6 cm within the CS. There has been no recurrence over a follow-up of 37 +/- 13 months. CONCLUSIONS Focal AT emanating deep within the CS musculature can be recognized by a discrete potential associated with the CS atrial signal both during sinus rhythm and tachycardia. Long-term success without complications can be accomplished by ablating within the CS in close proximity to the CS (P).
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Affiliation(s)
- Nitish Badhwar
- University of California, San Francisco, San Francisco, California 94143, USA
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Krum D, Goel A, Hauck J, Schweitzer J, Hare J, Attari M, Dhala A, Cooley R, Akhtar M, Sra J. Catheter location, tracking, cardiac chamber geometry creation, and ablation using cutaneous patches. J Interv Card Electrophysiol 2005; 12:17-22. [PMID: 15717148 DOI: 10.1007/s10840-005-5837-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 09/23/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The ability to construct a three-dimensional (3-D) surface model of the endocardium and track the location of catheters within a cardiac chamber, using only cutaneous patches, would be a useful advancement in treating arrhythmias. We tested the feasibility of such a system, Ensite NavX (Endocardial Solutions, Inc., St. Paul, MN, USA), in patients undergoing catheter ablation for SVTs. METHODS Sixteen patients with 20 arrhythmias undergoing ablation were selected. Skin electrode patches were placed on the chest to create a 3-D coordinate system. A low-amplitude, 5.7 kHz signal emitted from the patches was received by conventional catheters positioned in the heart. Catheter location was determined by measuring the field strength received by the catheters. Location points were successively acquired while catheters were moved throughout the chamber. This information was collected and processed by a workstation to create a detailed 3-D model of the endocardial surface. Anatomic landmarks were labeled on the model as the mapping catheter was navigated. 3-D cardiac chamber geometry reconstruction, landmark labeling, and real time catheter tracking were performed successfully in all patients. Up to six catheters, with a total of up to 26 intracardiac electrodes, were tracked simultaneously. RESULTS Constructed geometries, including major vessels and valves, correlated closely with traditional anatomic models as well as intracardiac recordings and fluoroscopic images. CONCLUSIONS Real-time catheter tracking and 3-D cardiac chamber model construction is feasible using cutaneous patches and conventional catheters. This approach may be useful in the treatment of patients with cardiac arrhythmias where ablation therapy is primarily anatomically based.
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Affiliation(s)
- David Krum
- Electrophysiology Laboratories of Aurora Sinai and St. Luke's Medical Centers, University of Wisconsin Medical School-Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
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Louzi A, Rifki SE, Benamar Y, Attari M, Kafih M, Zerouali NO. Actinomycose colique : à propos d’un cas et revue de la littérature. ACTA ACUST UNITED AC 2005; 130:101-3. [PMID: 15737322 DOI: 10.1016/j.anchir.2004.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 11/09/2004] [Indexed: 11/20/2022]
Abstract
Actinomycosis is a chronic granulomatosis infection caused by a Gram positive anaerobic bacteria, Actinomyces. Abdominal localizations are rare and simulated a malignant process. The difficulties of diagnosis are usually leading to surgical resection. We report a colonic actinomycosis case of a 62-year-old woman with a abdominal tumor and diagnosed after surgical resection.
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Affiliation(s)
- A Louzi
- Service des urgences chirurgicales viscérales, CHU Ibn-Rochd, 21, ESSALAMA 3, Groupe 9, Bloc N Casablanca, Maroc.
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Attari M, Dhala A. Role of invasive and noninvasive testing in risk stratification of sudden cardiac death in children and young adults: an electrophysiologic perspective. Pediatr Clin North Am 2004; 51:1355-78. [PMID: 15331288 DOI: 10.1016/j.pcl.2004.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sudden cardiac death is a rare, but devastating, event in the young population. Arrhythmia is the mechanism of death in many cases. In addition to clinical history, noninvasive and invasive tests can be used to identify patients who are at risk. Although these tools are not perfect, they can prove valuable if used in proper clinical circumstances. An overview of these tests is presented.
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Affiliation(s)
- Mehran Attari
- Electrophysiology Laboratories, Cardiovascular Disease Section, St. Luke's and Aurora Sinai Medical Centers, University of Wisconsin Medical School-Milwaukee Clinical Campus, 2801 West Kinnickinnic River Parkway, Milwaukee, WI 53215, USA
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Madias JE, Attari M. Exercise-triggered transient R-wave enhancement and ST-segment elevation in II, III, and aVF ECG leads: a testament to the “Plasticity” of the QRS complex during ischemia. J Electrocardiol 2004; 37:121-6. [PMID: 15127379 DOI: 10.1016/j.jelectrocard.2004.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/29/2022]
Abstract
We describe a patient with coronary artery disease who showed transiently augmented R-waves in his electrocardiogram (ECG) during the course of an exercise treadmill test (ETT), an ECG pattern occasionally associated with the hyperacute phase of myocardial infarction and variant angina. This change in the R-waves was noted in II, III, and aVF ECG leads and was associated with ST-segment elevation; both changed gradually and were normalized during the recovery period. Cardiac enzymes after ETT were negative, and arteriography revealed 3-vessel coronary artery disease, with a completely occluded right coronary artery. The ventriculogram showed very mild hypokinesis of the inferior left ventricular wall, while the global ejection fraction was 75%. These ECG changes, noted previously during ETT in precordial ECG leads, are herein reported to occur also in II, III, and aVF ECG leads. The generation of these ECG changes, which hinges upon a late unopposed depolarization occurring in the course and at the site of severe ischemic injury, constitutes a transient focal ventricular conduction abnormality.
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Affiliation(s)
- John E Madias
- Mount Sinai of Medicine of the New York University, New York, NY 11373, USA.
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Madias JE, Narayan V, Attari M. Detection of P waves via a "saline-filled central venous catheter electrocardiographic lead" in patients with low electrocardiographic voltage due to anasarca. Am J Cardiol 2003; 91:910-4. [PMID: 12667590 DOI: 10.1016/s0002-9149(03)00038-9] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John E Madias
- Division of Cardiology, Elmhurst Hospital Center, New York, USA.
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Abstract
We describe two patients with posterior myocardial infarction (PMI) with unusually atypical clinical presentations and cardiac enzymatic profiles, but with the abrupt development of complete AV block in patient 1, and Mobitz II second-degree AV block with paroxysmal phases of higher degrees of AV block in patient 2, and mitral regurgitation leading to symptomatic pulmonary congestion. Also, both patients had complete right bundle-branch block (RBBB) [old in patient 1, new in patient 2], the pattern of which was altered due to the associated PMI. The alteration included tall R waves involving the early part of the QRS complex, and tall T waves, both noted in the right precordial leads. The mechanism of these ECG modulations of the RBBB pattern was believed to be a superimposition of the early depolarization and repolarization consequences of the PMI. The significance of this observation lies in the ECG detection of PMI, frequently underdiagnosed particularly in patients with an atypical presentation, and with the RBBB adding further to the complexity. Thus, it is gratifying to note the contribution of the ECG to diagnostics, the only modality that provided a pathophysiologic insight in these two patients who appeared to be abruptly deteriorating clinically without an apparent reason.
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Affiliation(s)
- John E Madias
- Division of Cardiology, Elmhurst Hospital Center, and the Mount Sinai School of Medicine of the New York University, New York, NY 11373, USA.
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Abstract
We describe a case of a male patient with "giant" R-waves (GRWs) in association with an acute inferior myocardial infarction (MI). Such electrocardiogram (ECG) pattern has been associated heretofore with the hyperacute phase of an anterior MI, and unstable, and variant angina, although it is found in illustrations of many previous publications in conjunction with inferior MI. The GRWs, along with ST-segment elevations, were noted transiently in the inferior ECG leads, early in the clinical course of our patient. Subsequent evolution of the ECG revealed classic appearances for an inferior MI. Cardiac enzymes, and thallium-201 myocardial perfusion scintigraphy revealed evidence for inferiorly-located myocardial necrosis. Coronary arteriography showed stenosis of the right coronary artery, for which the patient underwent an uneventful angioplasty and "stenting" of the culprit vessel. The pathophysiology of the syndrome of GRWs is briefly discussed.
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Affiliation(s)
- J E Madias
- Zena and Michael Wiener Cardiovascular Institute, Mount Sinai/New York University Medical Center Health System, New York, NY, USA.
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