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Gerontitis D, Pope MT, Elmowafy M, Sadagopan S, Yue AM. High-density electro-anatomical activation mapping to guide slow pathway modification in patients with persistent left superior vena cava. Heart Rhythm 2023:S1547-5271(23)02025-8. [PMID: 37019166 DOI: 10.1016/j.hrthm.2023.03.1537] [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: 02/18/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Slow pathway (SP) mapping and modification can be challenging in patients with persistent left superior vena cava (PLSVC) due to anatomical variance of Koch's triangle (KT) and coronary sinus (CS) dilatation. There is a lack of studies using detailed 3-dimensional (3D) electro-anatomical mapping (EAM) to investigate conduction characteristics and guide ablation targets in this condition. OBJECTIVES To describe a novel technique of slow pathway mapping and ablation in sinus rhythm using 3D EAM in patients with PLSVC after validation in a cohort with normal coronary sinus anatomy. METHODS Seven patients with PLSVC and dual AV node physiology who underwent slow pathway modification with the use of 3D EAM were included. Twenty-one normal heart patients with AV nodal re-entrant tachycardias formed the validation group. High-resolution, ultra-high-density local activation timing (LAT) mapping of the right atrial septum and proximal coronary sinus in sinus rhythm was performed. RESULTS SP ablation targets were consistently identified by an area in the right atrial septum with the latest activation time and multi-component atrial electrogram (EGM) adjacent to a region with isochronal crowding (deceleration zone). In PLSVC patients, these targets were located at or within 1 cm of the mid anterior CS ostium. Ablation in this area led to successful SP modification reaching standard clinical endpoints with a median of 43 sec of radio frequency energy or 14 mins of cryoablation without complications. CONCLUSION High-resolution activation mapping of Koch's triangle in sinus rhythm can facilitate localisation and safe slow pathway ablation in patients with PLSVC.
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Affiliation(s)
- Dimitrios Gerontitis
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michael Tb Pope
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mahmoud Elmowafy
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Shankar Sadagopan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Arthur M Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Kefala A, Claridge S, Wijayagoonawardana P, Sadagopan S, Ullah W, Yue AM. Targeted cluster ablation of non‐CTI dependent atrial arrhythmias in congenital heart disease using ultra‐high definition mapping. J Cardiovasc Electrophysiol 2022; 33:932-942. [DOI: 10.1111/jce.15425] [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: 10/30/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Kefala
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Simon Claridge
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | | | | | - Waqas Ullah
- University Hospital SouthamptonSouthamptonUnited Kingdom
| | - Arthur M. Yue
- University Hospital SouthamptonSouthamptonUnited Kingdom
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Norrish G, Chubb H, Field E, McLeod K, Ilina M, Spentzou G, Till J, Daubeney PEF, Stuart AG, Matthews J, Hares D, Brown E, Linter K, Bhole V, Pillai K, Bowes M, Jones CB, Uzun O, Wong A, Yue A, Sadagopan S, Bharucha T, Yap N, Rosenthal E, Mathur S, Adwani S, Reinhardt Z, Mangat J, Kaski JP. Clinical outcomes and programming strategies of implantable cardioverter-defibrillator devices in paediatric hypertrophic cardiomyopathy: a UK National Cohort Study. Europace 2021; 23:400-408. [PMID: 33221861 DOI: 10.1093/europace/euaa307] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/28/2020] [Accepted: 09/18/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in paediatric hypertrophic cardiomyopathy (HCM). This study describes the implant and programming strategies with clinical outcomes following implantable cardioverter-defibrillator (ICD) insertion in a well-characterized national paediatric HCM cohort. METHODS AND RESULTS Data from 90 patients undergoing ICD insertion at a median age 13 (±3.5) for primary (n = 67, 74%) or secondary prevention (n = 23, 26%) were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM from the UK. Seventy-six (84%) had an endovascular system [14 (18%) dual coil], 3 (3%) epicardial, and 11 (12%) subcutaneous system. Defibrillation threshold (DFT) testing was performed at implant in 68 (76%). Inadequate DFT in four led to implant adjustment in three patients. Over a median follow-up of 54 months (interquartile range 28-111), 25 (28%) patients had 53 appropriate therapies [ICD shock n = 45, anti-tachycardia pacing (ATP) n = 8], incidence rate 4.7 per 100 patient years (95% CI 2.9-7.6). Eight inappropriate therapies occurred in 7 (8%) patients (ICD shock n = 4, ATP n = 4), incidence rate 1.1/100 patient years (95% CI 0.4-2.5). Three patients (3%) died following arrhythmic events, despite a functioning device. Other device complications were seen in 28 patients (31%), including lead-related complications (n = 15) and infection (n = 10). No clinical, device, or programming characteristics predicted time to inappropriate therapy or lead complication. CONCLUSION In a large national cohort of paediatric HCM patients with an ICD, device and programming strategies varied widely. No particular strategy was associated with inappropriate therapies, missed/delayed therapies, or lead complications.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Henry Chubb
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Lucile Packard Children's Hospital, Stanford University, CA, USA
| | - Ella Field
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | | | | | | | - Jan Till
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | - Piers E F Daubeney
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, Harefield, UK
| | | | - Jane Matthews
- University Hospitals Bristol NHS Foundation Trust, UK
| | | | | | | | - Vinay Bhole
- Birmingham Women and Children's NHS Foundation Trust, UK
| | | | | | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, UK
| | - Amos Wong
- University Hospital of Wales, Cardiff, UK
| | - Arthur Yue
- University Hospital Southampton NHS Foundation Trust, UK
| | | | - Tara Bharucha
- University Hospital Southampton NHS Foundation Trust, UK
| | - Norah Yap
- University Hospital Southampton NHS Foundation Trust, UK
| | - Eric Rosenthal
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | - Sujeev Mathur
- Evelina London Children's Hospital, Guys and St Thomas', NHS Foundation Trust, UK
| | | | | | - Jasveer Mangat
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular diseases, Great Ormond Street Hospital, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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Norrish G, Chubb H, Field E, McCleod K, Till J, Stuart G, Hares D, Linter K, Bhole V, Bowes M, Uzun O, Sadagopan S, Rosenthal E, Mangat J, Kaski J. Clinical outcomes and programming strategies of implantable cardioverter defibrillator (ICD) devices during childhood in hypertrophic cardiomyopathy: a UK national cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). ICDs have been shown to be effective at terminating malignant ventricular arrhythmias but at the expense of a high incidence of complications. The optimal device and programming strategies to reduce complications in this patient group are unknown.
Purpose
To describe the programming strategies and clinical outcomes of ICD implantation in childhood HCM.
Methods
Anonymised, non-invasive clinical data were collected from a retrospective, longitudinal multi-centre cohort of children (<16 years) with HCM (n=687) and an ICD in-situ from the United Kingdom.
Results
96 patients (61 male (64%), 6 non-sarcomeric (6%)) underwent ICD implantation at a median age 14yr (IQR 11–16, range 3–16) and weight 52.3 kg (IQR 34.8–63.1). Indication for ICD was primary prevention in 72 (75%). 82 (85%) had an endovascular system, 3 (3%) epicardial and 11 (12%) subcutaneous system. 61 patients (74%) were receiving one or more cardioactive medications at implantation [B blockers n=66, 70%, disopyramide n=14, 15%, amiodarone n=7, 7%, calcium channel blocker n=7, 9%, other n=5, 6%]. Programming practices varied: all had VF therapies activated (median 220bpm, IQR 212–230); 70 (73%) had a VT zone programmed (median rate 187 bpm, SD 20.9), of which 26 (27%) had therapies activated. 50 patients (61%) had antitachycardia pacing (ATP) activated. Over a median follow up of 53.6 months (IQR 27.3,108.4), 4 patients (4.2%) died following arrhythmic events despite a functioning device. 25 patients had 53 appropriate therapies (ICD shock n=47, ATP n=8), incidence rate 5.22 (95% CI 3.5–7.8). On univariable analysis, secondary prevention indication for ICD implantation was the only predictor of therapy [16 (64%) vs 8 (11.3%), p value <0.001]. 8 (8.3%) patients had 9 inappropriate therapies (ICD shock n=4, ATP n=5), incidence rate 1.37 (95% CI 0.65–2.8), caused by T wave oversensing (n=2), lead migration (n=1), supraventricular tachycardia (n=1). Device complications were seen in 30 patients (31%), including lead complications (n=16) and infection (n=10). No clinical characteristics predicted time to inappropriate therapy or lead complication.
Conclusions
In a contemporary cohort of children with HCM, the incidence of inappropriate therapies is lower than previously reported, yet complication rates remain higher than reported in adult patients. No clinical, device or programming strategies were associated with inappropriate therapies or lead complications.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): British Heart Foundation
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Affiliation(s)
- G Norrish
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - H Chubb
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - E Field
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - K McCleod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - J Till
- Stanford University Medical Center, Paediatric Heart Centre, Stanford, United States of America
| | - G Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - D Hares
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Linter
- Glenfield Hospital, Leicester, United Kingdom
| | - V Bhole
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - M Bowes
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - O Uzun
- Children's Hospital for Wales, Cardiff, United Kingdom
| | - S Sadagopan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - E Rosenthal
- Guy's and St Thomas' NHS Foundation Trust, Greater London, United Kingdom
| | - J.P Mangat
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
| | - J.P Kaski
- Great Ormond Street Hospital for Children, Inherited Cardiovascular Disease, London, United Kingdom
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Jones JP, Ramcharan T, Chaudhari M, Bhole V, Mcleod K, Sadagopan S, Uzun O, Parry A, Till J, McMahon CJ, Stuart AG, Walsh MA. Ventricular fibromas in children, arrhythmia risk, and outcomes: A multicenter study. Heart Rhythm 2018; 15:1507-1512. [DOI: 10.1016/j.hrthm.2018.06.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 11/16/2022]
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Sadagopan S, Veettil MV, Chakraborty S, Sharma-Walia N, Paudel N, Bottero V, Chandran B. Angiogenin functionally interacts with p53 and regulates p53-mediated apoptosis and cell survival. Oncogene 2012; 31:4835-47. [PMID: 22266868 PMCID: PMC3337890 DOI: 10.1038/onc.2011.648] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Angiogenin, a 14-kDa multi-functional pro-angiogenic growth factor, is up-regulated in several types of cancers. Anti-angiogenin monoclonal antibodies used as antagonists inhibited the establishment, progression, and metastasis of human cancer cells in athymic mice (Olson et al. 1994). Silencing angiogenin and inhibition of angiogenin’s nuclear translocation blocked cell survival and induced cell death in B-lymphoma and endothelial cells latently infected with Kaposi sarcoma associated herpesvirus (KSHV) (Sadagopan et al. 2009) suggesting that actively proliferating cancer cells could be inducing angiogenin for inhibiting apoptotic pathways. However, the mechanism of cell survival and apoptosis regulation by angiogenin and their functional significance in cancer is not known. We demonstrate that angiogenin interacts with p53 and colocalizes in the nucleus. Silencing endogenous angiogenin induced p53 promoter activation and p53 target gene (p53, p21 and Bax) expression, down-regulated anti-apoptotic Bcl-2 gene expression and increased p53 mediated cell death. In contrast, angiogenin expression blocked pro-apoptotic Bax and p21 expression, induced Bcl-2 and blocked cell death. Angiogenin also co-immunoprecipitated with p53 regulator protein Mdm2. Angiogenin expression resulted in the inhibition of p53 phosphorylation, increased p53-Mdm2 interaction, and consequently increased ubiquitination of p53. Taken together these studies demonstrate that angiogenin promotes the inhibition of p53 function to mediate anti-apoptosis and cell survival. Our results reveal for the first time a novel p53 interacting function of angiogenin in anti-apoptosis and survival of cancer cells and suggest that targeting angiogenin could be an effective therapy for several cancers.
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Affiliation(s)
- S Sadagopan
- Department of Microbiology and Immunology, H.M. Bligh Cancer Research Laboratories, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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El-Naggar M, Sadagopan S, Levine H, Kantor H, Collins VJ. Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: a prospective study. Anesth Analg 1976; 55:195-201. [PMID: 943979 DOI: 10.1213/00000539-197603000-00015] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
One of the problems of prolonged ventilatory therapy in acute respiratory failure (ARF) is the need to choose between tracheostomy after 48 to 72 hours of translaryngeal (TL) tracheal intubation or the continuous use of the TL tube for a period of 10 days. Too often the choice has been based on retrospective studies or personal preference. To investigate this problem prospectively, 52 adults in ARF were divided sequentially into 2 groups on their 3rd day of TL intubation. Patients in group I (G-I) retained the TL tube for a total of 11 days; those in group II (G-II) were tracheostomized on the 3rd day. The following factors ere used to evaluate the efficiency and complications in each group: patient's epidemiologic variables, daily pulmonary functions, severity of respiratory infections, and scores of post-intubation airway lesions. No consistent statistically significant differences between the two procedures were seen in the pulmonary functions or the range of individual patient variables. However, with an early tracheostomy, there was an eightfold greater incidence of contamination of the airway by new organisms, airway lesions were more frequent and severe, and the need for the tracheal tube was extended. To identify the epidemiologic variables and the pulmonary functions that discriminate between patients with serious airway lesions and those with mild lesions, and to evaluate the ability of these variables to differentiate the patients who died from those who survived, the distribution of all factors was compared in the two categories. The epidemiologic variables separated the patients according to their airway lesions only, while the difference in pulmonary functions was statistically significant only between the patients who died and those who survived.
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