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Futyma PR, Aksu T, Cooper JM, Schaller R, Winterfield J, Payne J, Omarov M, Vazquez O, Guler TE, Bozyel S, Zahwe F, Gautam S, Futyma M, Vijayaraman P, Kulakowski P. P1127Occurrence, management and outcomes of iatrogenic aortic dissections as a complication of catheter ablation. A multicenter study. Europace 2020. [DOI: 10.1093/europace/euaa162.011] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on occurrence, management and outcomes of iatrogenic aortic dissections (IAD) as a complication of catheter ablation (CA) do not exist.
Purpose
To evaluate multicenter data on occurrence, management and outcomes of IAD as a complication of CA.
Methods
Data on occurrence, management and outcomes of documented vascular dissections from 10 centers were evaluated.
Results
IADs occurred in 7 patients (2 females, age 63 ± 8 years). Indications for CA were frequent premature ventricular complexes (PVC)/ventricular tachycardia (VT) in 6 patients (86%) and left-sided accessory pathway in the remaining one (14%). Hypertension was most frequent comorbidity (4 pts, 57%). All IADs occurred during retrograde advancement of ablation catheter. In the vast majority of patients creation of IAD during catheter advancement was not associated with any symptoms (6 pts, 86%). IAD was initially detected using trans-luminal angiogram in 5 (71%) and further confirmed using computed tomography (CT) (5 pts, 71%), conventional angiography (2 pts, 28%) and ultrasound (2 pts, 28%). One IAD was detected during CT scan performed for other indication after CA. There was one IAD-related death and IAD was evaluated post-mortem. Follow-up lasted 10 ± 19 months. Four patients were treated conservatively, one patient underwent descending aorta stenting and one femoral artery stenting.
Conclusions
IAD during CA is a rare but can be devastating. Early recognition can be difficult. Conservative management of IAD is an option of treatment.
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Affiliation(s)
- P R Futyma
- St. Joseph"s Heart Center, Invasive Cardiology Department, Rzeszów, Poland
| | - T Aksu
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - J M Cooper
- Temple Heart & Vascular Institute, Cardiac Electrophysiology , Philadelphia, United States of America
| | - R Schaller
- University of Pennsylvania, Department of Cardiology, Philadelphia, United States of America
| | - J Winterfield
- Medical University of South Carolina, Division of Cardiology, Charleston, United States of America
| | - J Payne
- Medical University of South Carolina, Division of Cardiology, Charleston, United States of America
| | - M Omarov
- FCCVS, Department of Cardiology, Perm, Russian Federation
| | - O Vazquez
- Lic Adolfo López Mateos Hospital, ISSSTE, Mexico City, Mexico
| | - T E Guler
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - S Bozyel
- Kocaeli Derince Hospital, Department of Cardiology, Kocaeli, Turkey
| | - F Zahwe
- Michigan Heart Rhythm Center, Dearborn, United States of America
| | - S Gautam
- University of Missouri, Division of Cardiovascular Medicine, Columbia, United States of America
| | - M Futyma
- St. Joseph"s Heart Center, Invasive Cardiology Department, Rzeszów, Poland
| | - P Vijayaraman
- Geisinger Heart Institute, Wilkes Barre, United States of America
| | - P Kulakowski
- Grochowski Hospital, Postgraduate Medical School, Warsaw, Poland
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Slawuta A, Boczar K, Zabek A, Ciesielski A, Hiczkiewicz J, Vijayaraman P, Malecka B, Gajek J. P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Abstract
The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use.
The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death.
Methods
The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy.
Results
The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table:
Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05
During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity.
Conclusions
His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.
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Affiliation(s)
- A Slawuta
- Klodzko County Hospital, Department of Cardiology, Klodzko, Poland
| | - K Boczar
- John Paul II Hospital, Krakow, Poland
| | - A Zabek
- John Paul II Hospital, Krakow, Poland
| | - A Ciesielski
- Multidisciplinary Public Hospital, Depertment of Cardiology, Nowa Sol, Poland
| | - J Hiczkiewicz
- Multidisciplinary Public Hospital, Depertment of Cardiology, Nowa Sol, Poland
| | - P Vijayaraman
- Geisinger Heart Institute, Depertment of Cardiology, Wilkes-Barre, United States of America
| | - B Malecka
- Jagiellonian University Medical College, Krakow, Poland
| | - J Gajek
- Wroclaw Medical University, Wroclaw, Poland
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Huang WJ, Wu SJ, Su L, Chen XY, Cai BN, Zhou JG, Lan RF, Fu GS, Xu L, Xiao FY, Wang SJ, Mao GY, Vijayaraman P, Ellenbogen K. P4528Feasibility and safety of left bundle branch area pacing by transvenous approach through the interventricular septum in patients with left bundle branch block. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0921] [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: 11/13/2022] Open
Abstract
Abstract
Background
His bundle pacing (HBP) has been shown to correct left bundle branch block (LBBB), however it often requires high pacing output and the success rate is variable.
Objective
To assess the feasibility and safety of left bundle branch area pacing (LBBAP) in patients with LBBB.
Methods
From Apr 2014 to Aug 2018, patients with LBBB from multicenters indicated for CRT or pacing therapy were included. LBBAP was performed by advancing the MDT 3830 lead deep into the septum about 1 cm distal to the His bundle region (Figure 1F). Pacing characteristics, success rate, threshold and R-wave amplitude were assessed.
Results
A total of 94 patients aged 68.3±10.7 y with the native QRS duration of 167.2±17.2 ms were included. In 92 patients, LBBAP was successfully achieved and demonstrated RBBB pattern during unipolar tip pacing (UTP), with the paced QRS duration of 116.4±12.6ms (Figure 1C). Fusion of LBBAP and native conduction via the RBB eliminated RBBB and resulted in an average QRS duration of 103.2±10.1 ms (Figure 1D). LBB potential could be recorded from the LBB lead during correction of LBBB by HBP in 21 patients who used two leads method (His lead and LBB lead, Figure 1B). Output dependent selective and non-selective LBBAP were demonstrated in 48 patients (Figure 1C, D). The LBB capture threshold by UTP was 0.53±0.18V/0.5ms at acute and 0.62±0.17V/0.5ms at 6 months and 0.65±0.2V/0.5ms at 1 year. The R-wave amplitude were 11.4±5.2mV, 12.4±5.8mV and 12.0±5.8mV at acute, 6 month and 1 year. During follow-up, only one patient had an increase in LBB capture threshold to 2.5V/0.5ms at 3 months and there were no other complications such as dislodgment, infections, embolism or stroke associated with the implantation.
Conclusion
Permanent LBBAP is feasible and safe in patients with LBBB.
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Affiliation(s)
- W J Huang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - S J Wu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - L Su
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - X Y Chen
- Zhongshan Hospital, Fudan University, Department of Cardiology, Shanghai, China
| | - B N Cai
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - J G Zhou
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - R F Lan
- Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - G S Fu
- Sir Run Run Shaw Hospital affiliated to Medical College of Zhejiang University, Hangzhou, China
| | - L Xu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - F Y Xiao
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - S J Wang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - G Y Mao
- School of Environmental Science & Public Health, Wenzhou Medical University,, Wenzhou, China
| | - P Vijayaraman
- Virginia Commonwealth University, Richmond, United States of America
| | - K Ellenbogen
- Geisinger Heart Institute, Wilkes Barre, United States of America
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Slawuta A, Boczar K, Zabek A, Vijayaraman P, Malecka B, Gajek J, Hiczkiewicz J. P1827Dual chamber ICD implantation using His-bundle pacing in CHF-patients with narrow QRS and chronic AF can reverse cardiac remodeling. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1827] [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: 11/13/2022] Open
Affiliation(s)
- A Slawuta
- Klodzko County Hospital, Dept. of Cardiology, Klodzko, Poland
| | - K Boczar
- John Paul II Hospital, Krakow, Poland
| | - A Zabek
- John Paul II Hospital, Krakow, Poland
| | - P Vijayaraman
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, United States of America
| | - B Malecka
- Jagiellonian University Medical College, Krakow, Poland
| | - J Gajek
- Wroclaw Medical University, Wroclaw, Poland
| | - J Hiczkiewicz
- Multidyscyplinary Public Hospital, Dept. of Cardiology, Nowa Sol, Poland
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5
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Slawuta A, Boczar K, Zabek A, Gajek J, Lelakowski J, Vijayaraman P, Malecka B. P1013Cardiac remodeling reversed by His-bundle pacing in CHF-patients with narrow QRS and chronic AF undergoing ICD implantation. Europace 2017. [DOI: 10.1093/ehjci/eux151.194] [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: 11/12/2022] Open
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Camm AJ, Toft E, Torp-Pedersen C, Vijayaraman P, Juul-Moller S, Ip J, Beatch GN, Dickinson G, Wyse DG. Efficacy and safety of vernakalant in patients with atrial flutter: a randomized, double-blind, placebo-controlled trial. Europace 2012; 14:804-9. [DOI: 10.1093/europace/eur416] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Palma EC, Saxenberg V, Vijayaraman P, Ferrick KJ, Gross JN, Kim SG, Fisher JD. Histopathological correlation of ablation lesions guided by noncontact mapping in a patient with peripartum cardiomyopathy and ventricular tachycardia. Pacing Clin Electrophysiol 2001; 24:1812-5. [PMID: 11817817 DOI: 10.1046/j.1460-9592.2001.01812.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/20/2022]
Abstract
A patient with peripartum cardiomyopathy developed a nearly incessant nonsustained VT. Guided by a noncontact mapping system, the tachycardia was mapped to the mid-septum of the right ventricle and ablated. Despite transient success, the tachycardia recurred and the patient subsequently died of multiorgan failure. Histopathological correlation of the ablation site revealed a nontransmural lesion that may have contributed to the failure of the ablation.
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Affiliation(s)
- E C Palma
- Division of Cardiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA.
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Abstract
This case report demonstrates that the sinus node can recover relatively quickly even after being suppressed by atrial flutter for 25 years, and that a permanent pacemaker may not always be necessary in all patients with sinus arrest after a successful atrial flutter ablation.
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Affiliation(s)
- E C Palma
- Arrhythmia Service of the Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA.
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Palma EC, Vijayaraman P, Ferrick KJ, Gross JN, Kim SG, Fisher JD. Case report: is this SVT or VT? An exception to the rule. J Interv Card Electrophysiol 2001; 5:67-70. [PMID: 11248776 DOI: 10.1023/a:1009857824675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This case illustrates the difficulties sometimes encountered by clinicians when using algorithms in diagnosing a wide-complex tachycardia based on a 12-lead EKG.
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Affiliation(s)
- E C Palma
- Arrhythmia Service of the Albert Einstein College of Medicine/Montefiore Medical Center, USA.
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10
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Hanon S, Vijayaraman P, Sonnenblick EH, Le Jemtel TH. Persistent formation of angiotensin II despite treatment with maximally recommended doses of angiotensin converting enzyme inhibitors in patients with chronic heart failure. J Renin Angiotensin Aldosterone Syst 2000; 1:147-50. [PMID: 11967806 DOI: 10.3317/jraas.2000.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Ilercil A, Meisner JS, Vijayaraman P, Gentilucci M, Metveyeva P, Hla A, Strom JA, Chang CJ, Shirani J. Clinical significance of fossa ovalis membrane aneurysm in adults with cardioembolic cerebral ischemia. Am J Cardiol 1997; 80:96-8. [PMID: 9205032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fossa ovalis membrane aneurysm was diagnosed by transesophageal echocardiography in 45 of 134 consecutive patients (34%) with embolic cerebrovascular ischemic events. A potential cardiovascular source of embolism, other than the fossa ovalis membrane aneurysm, was found in 91% of these patients (41 of 45).
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Affiliation(s)
- A Ilercil
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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