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Kawamura I, Wang BJ, Nies M, Watanabe K, Chaudhry HW, Maejima Y, Sasano T, Gordon R, Dukkipati SR, Reddy VY, Koruth J. Ultrastructural insights from myocardial ablation lesions from microsecond pulsed field vs radiofrequency energy. Heart Rhythm 2024; 21:389-396. [PMID: 38159790 DOI: 10.1016/j.hrthm.2023.12.017] [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: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Ultrastructural findings immediately after pulsed field ablation (PFA) of the myocardium have not been described. OBJECTIVES The purpose of this study was to elucidate ultrastructural characteristics and differences between microsecond PFA at the 1- and 4-hour timepoints after pulse delivery and to compare them to irrigated radiofrequency ablation (RFA) lesions. METHODS Healthy swine underwent endocardial PFA or RFA followed by necropsy. Discrete microsecond PFA and irrigated RFA lesions were created in the ventricles with a lattice tip ablation catheter. Lesions were delivered in a manner so as to allow sampling to occur 1 and 4 hours after ablation. All lesions were located at necropsy, and samples were carefully obtained from within the lesion core, lesion periphery, and adjacent healthy myocardium. Transmission electron microscopic assessment was performed after fixation using paraformaldehyde and glutaraldehyde. RESULTS One hour after microsecond PFA delivery, myocytes were noted to be significantly and uniformly disrupted. Clustered, misaligned, swollen mitochondria coupled with degenerating nuclei and condensed chromatin were visualized. These findings progressed over the subsequent few hours with worsening edema. Similar changes were seen with RFA but reduced in severity. However, there was prominent extravasation of red blood cells with occlusion of capillaries that was not seen in PFA. At the lesion periphery, an abrupt change in the degree of myocyte damage was observed with PFA but not RFA. CONCLUSION Transmission electron microscopy demonstrates evidence of widespread destruction of myocytes as early as an hour after PFA and corroborates known histologic features such as sparing of vessels and sharp lesion margins.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bingyan J Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Moritz Nies
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keita Watanabe
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hina W Chaudhry
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan; Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ronald Gordon
- Pathology, Molecular and Cell based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Malyshev Y, Neuzil P, Petru J, Funasako M, Hala P, Kopriva K, Schneider C, Achyutha A, Vanderper A, Musikantow D, Turagam M, Dukkipati SR, Reddy VY. Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation. JACC Clin Electrophysiol 2024:S2405-500X(24)00011-2. [PMID: 38385916 DOI: 10.1016/j.jacep.2023.12.015] [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] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In treating atrial fibrillation, pulsed-field ablation (PFA) has comparable efficacy to conventional thermal ablation, but with important safety advantages: no esophageal injury or pulmonary vein stenosis, and rare phrenic nerve injury. However, when PFA is delivered in proximity to coronary arteries using a pentaspline catheter, which generates a broad electrical field, severe vasospasm can be provoked. OBJECTIVES The authors sought to study the vasospastic potential of a focal PFA catheter with a narrower electrical field and develop a preventive strategy with nitroglycerin. METHODS During atrial fibrillation ablation, a focal PFA catheter was used for cavo-tricuspid isthmus ablation. Angiography of the right coronary artery (some with fractional flow reserve measurement) was performed before, during, and after PFA. Beyond no nitroglycerin (n = 5), and a few testing strategies (n = 8), 2 primary nitroglycerin administration strategies were studied: 1) multiple boluses (3-2 mg every 2 min) into the right atrium (n = 10), and 2) a bolus (3 mg) into the right atrium with continuous peripheral intravenous infusion (1 mg/min; n = 10). RESULTS Without nitroglycerin, cavo-tricuspid isthmus ablation provoked moderate-severe vasospasm in 4 of 5 (80%) patients (fractional flow reserve 0.71 ± 0.08). With repetitive nitroglycerin boluses, severe spasm did not occur, and mild-moderate vasospasm occurred in only 2 of 10 (20%). Using the bolus + infusion strategy, severe and mild-moderate spasm occurred in 1 and 3 of 10 patients (aggregate 40%). No patient had ST-segment changes. CONCLUSIONS Ablation of the cavotricuspid isthmus using a focal PFA catheter routinely provokes right coronary vasospasm. Pretreatment with high doses of parenteral nitroglycerin prevents severe spasm.
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Affiliation(s)
- Yury Malyshev
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Jan Petru
- Homolka Hospital, Prague, Czech Republic
| | | | - Pavel Hala
- Homolka Hospital, Prague, Czech Republic
| | | | | | - Anitha Achyutha
- Farapulse-Boston Scientific, Inc, Menlo Park, California, USA
| | | | | | - Mohit Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA; Homolka Hospital, Prague, Czech Republic.
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Zhang C, Neuzil P, Petru J, Funasako M, Hala P, Kopriva K, Koruth JS, Dukkipati SR, Reddy VY. Coronary Artery Spasm During Pulsed Field vs Radiofrequency Catheter Ablation of the Mitral Isthmus. JAMA Cardiol 2024; 9:72-77. [PMID: 38019505 PMCID: PMC10687713 DOI: 10.1001/jamacardio.2023.4405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023]
Abstract
Importance In treating atrial fibrillation, pulsed field ablation (PFA) is a novel energy modality with comparable efficacy to conventional thermal ablation, such as radiofrequency ablation (RFA), but with the benefit of some preferentiality to myocardial tissue ablation. Studies have demonstrated important safety advantages, including the absence of esophageal injury or pulmonary vein stenosis and only rare phrenic nerve injury. However, there is emerging evidence of coronary artery vasospasm provoked by PFA. Objective To compare the incidence and severity of left circumflex arterial vasospasm between PFA and RFA during adjacent ablation along the mitral isthmus. Design, Setting, and Participants This prospective cohort study enrolled consecutive adult patients receiving first-ever PFA or RFA of the mitral isthmus during catheter ablation of atrial fibrillation in 2022 with acute follow-up at a single referral European center. Exposure A posterolateral mitral isthmus line was created using either a multielectrode pentaspline PFA catheter (endocardial ablation) or a saline-irrigated RFA catheter. Simultaneous diagnostic coronary angiography was performed before, during, and after catheter ablation. Nitroglycerin was planned for spasm persisting beyond 20 minutes or for significant electrocardiographic changes. Main Outcomes and Measures The frequency and severity of left circumflex arterial vasospasm was assessed and monitored, as were time to remission and any need for nitroglycerin administration. Results Of 26 included patients, 19 (73%) were male, and the mean (SD) age was 65.5 (9.3) years. Patients underwent either PFA (n = 17) or RFA (n = 9) along the mitral isthmus. Coronary spasm was observed in 7 of 17 patients (41.2%) undergoing PFA: in 7 of 9 (77.8%) when the mitral isthmus ablation line was situated superiorly and in 0 of 8 when situated inferiorly. Conversely, coronary spasm did not occur in any of the 9 patients undergoing RFA. Of 5 patients in whom crossover PFA was performed after RFA failed to achieve conduction block, coronary spasm occurred in 3 (60%). Most instances of spasm (9 of 10 [90%]) were subclinical, with 2 (20%) requiring nitroglycerin administration. The median (range) time to resolution of spasm was 5 (5-25) minutes. Conclusion and Relevance When creating a mitral isthmus ablation line during catheter ablation of atrial fibrillation, adjacent left circumflex arterial vasospasm frequently occurred with PFA and not RFA but was typically subclinical.
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Affiliation(s)
- Chi Zhang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jan Petru
- Homolka Hospital, Prague, Czech Republic
| | | | - Pavel Hala
- Homolka Hospital, Prague, Czech Republic
| | | | | | | | - Vivek Y. Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Homolka Hospital, Prague, Czech Republic
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Miller MA, Devesa A, Robson PM, Liao SL, Pyzik R, El-Eshmawi A, Boateng P, Pandis D, Dukkipati SR, Reddy VY, Adams DH, Fayad ZA, Trivieri MG. Arrhythmic Mitral Valve Prolapse With Only Mild or Moderate Mitral Regurgitation: Characterization of Myocardial Substrate. JACC Clin Electrophysiol 2023; 9:1709-1716. [PMID: 37227360 DOI: 10.1016/j.jacep.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Sustained ventricular tachycardia and sudden cardiac death due to degenerative mitral valve prolapse (MVP) can occur in the absence of severe mitral regurgitation (MR). A significant percentage of patients with MVP-related sudden death do not have any evidence of replacement fibrosis, suggesting other unrecognized proarrhythmic factors may place these patients at risk. OBJECTIVES This study aims to characterize myocardial fibrosis/inflammation and ventricular arrhythmia complexity in patients with MVP and only mild or moderate MR. METHODS Prospective observational study of patients with MVP and only mild or moderate MR underwent ventricular arrhythmia characterization and hybrid positron emission tomography (PET)/magnetic resonance imaging (MRI). Coregistered hybrid 18F-fluorodeoxyglucose (18F-FDG)-PET and MRI late gadolinium enhancement images were assessed and categorized. Recruitment occurred in the cardiac electrophysiology clinic. RESULTS In 12 patients with degenerative MVP with only mild or moderate MR, of which a majority had complex ventricular ectopy (n = 10, 83%), focal (or focal-on-diffuse) uptake of 18F-FDG (PET-positive) was detected in 83% (n = 10) of patients. Three-quarters of the patients (n = 9, 75%) had FDG uptake that coexisted with areas of late gadolinium enhancement (PET/MRI-positive). Abnormal T1, T2 and extracellular volume (ECV) values were observed in 58% (n = 7), 25% (n = 3), and 16% (n = 2), respectively. CONCLUSIONS Most patients with degenerative MVP, ventricular ectopy, and mild or moderate MR show myocardial inflammation that is concordant with myocardial scar. Further study is needed to determine whether these findings contribute to the observation that most MVP-related sudden deaths occur in patients with less than severe MR.
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Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Ana Devesa
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Philip M Robson
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steve L Liao
- Division of Non-invasive Cardiovascular, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Renata Pyzik
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zahi A Fayad
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria G Trivieri
- The BioMedical Engineering and Imaging Institute (BMEII), Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lampert J, Power D, Havaldar S, Govindarajulu U, Kawamura I, Maan A, Miller MA, Menon K, Koruth J, Whang W, Bagiella E, Bayes-Genis A, Musikantow D, Turagam M, Bayes de Luna A, Halperin J, Dukkipati SR, Vaid A, Nadkarni G, Glicksberg B, Fuster V, Reddy VY. Interatrial Block Association With Adverse Cardiovascular Outcomes in Patients Without a History of Atrial Fibrillation. JACC Clin Electrophysiol 2023; 9:1804-1815. [PMID: 37354170 DOI: 10.1016/j.jacep.2023.04.006] [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: 12/19/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Interatrial block (IAB) is associated with thromboembolism and atrial arrhythmias. However, prior studies included small patient cohorts so it remains unclear whether IAB predicts adverse outcomes particularly in context of atrial fibrillation (AF)/atrial flutter (AFL). OBJECTIVES This study sought to determine whether IAB portends increased stroke risk in a large cohort in the presence or absence of AFAF/AFL. METHODS We performed a 5-center retrospective analysis of 4,837,989 electrocardiograms (ECGs) from 1,228,291 patients. IAB was defined as P-wave duration ≥120 ms in leads II, III, or aVF. Measurements were extracted as .XML files. After excluding patients with prior AF/AFL, 1,825,958 ECGs from 458,994 patients remained. Outcomes were analyzed using restricted mean survival time analysis and restricted mean time lost. RESULTS There were 86,317 patients with IAB and 355,032 patients without IAB. IAB prevalence in the cohort was 19.6% and was most common in Black (26.1%), White (20.9%), and Hispanic (18.5%) patients and least prevalent in Native Americans (9.2%). IAB was independently associated with increased stroke probability (restricted mean time lost ratio coefficient [RMTLRC]: 1.43; 95% CI: 1.35-1.51; tau = 1,895), mortality (RMTLRC: 1.14; 95% CI: 1.07-1.21; tau = 1,924), heart failure (RMTLRC: 1.94; 95% CI: 1.83-2.04; tau = 1,921), systemic thromboembolism (RMTLRC: 1.62; 95% CI: 1.53-1.71; tau = 1,897), and incident AF/AFL (RMTLRC: 1.16; 95% CI: 1.10-1.22; tau = 1,888). IAB was not associated with stroke in patients with pre-existing AF/AFL. CONCLUSIONS IAB is independently associated with stroke in patients with no history of AF/AFL even after adjustment for incident AF/AFL and CHA2DS2-VASc score. Patients are at increased risk of stroke even when AF/AFL is not identified.
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Affiliation(s)
- Joshua Lampert
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA. https://twitter.com/joshuamlampertmd
| | - David Power
- Mount Sinai Heart, Mount Sinai Hospital, New York, New York, USA
| | - Shreyas Havaldar
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health, Mount Sinai Hospital, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Abhishek Maan
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Kartikeya Menon
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - William Whang
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Emilia Bagiella
- Center for Biostatistics, Department of Population Health, Mount Sinai Hospital, New York, New York, USA
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitario Germans trias I Pujol, Badalona, Spain
| | - Daniel Musikantow
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Antoni Bayes de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA
| | - Akhil Vaid
- Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish Nadkarni
- Division of Data-Driven and Digital Medicine (D3M), Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- Mount Sinai Heart, Mount Sinai Hospital, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Mount Sinai Hospital, New York, New York, USA.
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Oates CP, Santos-Gallego CG, Smith A, Basyal B, Moss N, Kawamura I, Musikantow DR, Turagam MK, Miller MA, Whang W, Dukkipati SR, Reddy VY, Koruth JS. SGLT2 inhibitors reduce sudden cardiac death risk in heart failure: Meta-analysis of randomized clinical trials. J Cardiovasc Electrophysiol 2023; 34:1277-1285. [PMID: 36950852 DOI: 10.1111/jce.15894] [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: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Multiple randomized controlled trials have demonstrated sodium-glucose cotransporter-2 inhibitors (SGLT2i) decrease the composite endpoint of cardiovascular death or heart failure hospitalizations in all heart failure patients. It is uncertain whether SGLT2i impacts the risk of sudden cardiac death in patients with heart failure. METHODS A comprehensive search was performed to identify relevant data published before August 28, 2022. Trials were included if: (1) all patients had clinical heart failure (2) SGLT2i and placebo were compared (3) all patients received conventional medical therapy and (4) reported outcomes of interest (sudden cardiac death [SCD], ventricular arrhythmias, atrial arrhythmias). RESULTS SCD was reported in seven of the eleven trials meeting selection criteria: 10 796 patients received SGLT2i and 10 796 received placebo. SGLT2i therapy was associated with a significant reduction in the risk of SCD (risk ratios [RR]: 0.68; 95% confidence intervals [CI]: 0.48-0.95; p = .03; I2 = 0%). Absent dedicated rhythm monitoring, there were no significant differences in the incidence of sustained ventricular arrhythmias not associated with SCD (RR: 1.03; 95% CI: 0.83-1.29; p = .77; I2 = 0%) or atrial arrhythmias (RR: 0.91; 95% CI: 0.77-1.09; p = .31; I2 = 29%) between patients receiving an SGLT2i versus placebo. CONCLUSION SGLT2i therapy is associated with a reduced risk of SCD in patients with heart failure receiving contemporary medical therapy. Prospective trials are needed to determine the long-term impact of SGLT2i therapy on atrial and ventricular arrhythmias.
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Affiliation(s)
- Connor P Oates
- MedStar Heart and Vascular Institute, Georgetown University-Washington Hospital Center, Washington, District of Columbia, USA
| | - Carlos G Santos-Gallego
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alex Smith
- MedStar Heart and Vascular Institute, Georgetown University-Washington Hospital Center, Washington, District of Columbia, USA
| | - Binaya Basyal
- MedStar Heart and Vascular Institute, Georgetown University-Washington Hospital Center, Washington, District of Columbia, USA
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel R Musikantow
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohit K Turagam
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Whang
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob S Koruth
- Helmsley Center for Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Salter BS, Gross CR, Weiner MM, Dukkipati SR, Serrao GW, Moss N, Anyanwu AC, Burkhoff D, Lala A. Temporary mechanical circulatory support devices: practical considerations for all stakeholders. Nat Rev Cardiol 2023; 20:263-277. [PMID: 36357709 PMCID: PMC9649020 DOI: 10.1038/s41569-022-00796-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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] [Accepted: 09/23/2022] [Indexed: 11/12/2022]
Abstract
Originally intended for life-saving salvage therapy, the use of temporary mechanical circulatory support (MCS) devices has become increasingly widespread in a variety of clinical settings in the contemporary era. Their use as a short-term, prophylactic support vehicle has expanded to include procedures in the catheterization laboratory, electrophysiology suite, operating room and intensive care unit. Accordingly, MCS device design and technology continue to develop at a rapid pace. In this Review, we describe the functionality, indications, management and complications associated with temporary MCS, together with scenario-specific utilization, goal-directed development and bioengineering of future devices. We address various considerations for the use of temporary MCS devices in both prophylactic and rescue scenarios, with input from stakeholders from various cardiovascular specialties, including interventional and heart failure cardiology, electrophysiology, cardiothoracic anaesthesiology, critical care and cardiac surgery.
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Affiliation(s)
- Benjamin S Salter
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Caroline R Gross
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Menachem M Weiner
- Department of Anaesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gregory W Serrao
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Noah Moss
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA
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8
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Doshi SK, Kar S, Sadhu A, Horton R, Osorio J, Ellis C, Stone J, Shah M, Dukkipati SR, Adler S, Nair DG, Kim J, Wazni O, Price MJ, Holmes DR, Shipley R, Christen T, Allocco DJ, Reddy VY. Two-Year Outcomes With a Next-Generation Left Atrial Appendage Device: Final Results of the PINNACLE FLX Trial. J Am Heart Assoc 2023; 12:e026295. [PMID: 36789852 PMCID: PMC10111496 DOI: 10.1161/jaha.122.026295] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Indexed: 02/16/2023]
Abstract
Background The PINNACLE FLX (Protection Against Embolism for Non-valvular AF [Atrial Fibrillation] Patients: Investigational Device Evaluation of the Watchman FLX LAA [Left Atrial Appendage] Closure Technology) trial evaluated the safety and efficacy of a next-generation left atrial appendage closure device (WATCHMAN FLX; Boston Scientific, Marlborough, MA). At 1 year, the study met the primary end points of safety and anatomical efficacy/appendage closure. This final report of the PINNACLE FLX trial includes the prespecified secondary end point of ischemic stroke or systemic embolism at 2 years, also making it the first report of 2-year outcomes with this next-generation left atrial appendage closure device. Methods and Results Patients with nonvalvular atrial fibrillation with CHA2DS2-VASc score ≥2 (men) or ≥3 (women), with an appropriate rationale for left atrial appendage closure, were enrolled to receive the left atrial appendage closure device at 29 US centers. Adverse events were assessed by an independent clinical events committee, and imaging was assessed by independent core laboratories. Among 395 implanted patients (36% women; mean age, 74 years; CHA2DS2-VASc, 4.2±1.5), the secondary efficacy end point of 2-year ischemic stroke or systemic embolism was met, with an absolute rate of 3.4% (annualized rate, 1.7%) and an upper 1-sided 95% confidence bound of 5.3%, which was superior to the 8.7% performance goal. Two-year rates of adverse events were as follows: 9.3% all-cause mortality, 5.5% cardiovascular death, 3.4% all stroke, and 10.1% major bleeding (Bleeding Academic Research Consortium 3 or 5). There were no additional systemic embolisms, device embolizations, pericardial effusions, or symptomatic device-related thrombi after 1 year. Conclusions The secondary end point of 2-year stroke or systemic embolism was met at 3.4%. In these final results of the PINNACLE FLX trial, the next-generation WATCHMAN FLX device demonstrated favorable safety and efficacy outcomes.
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Affiliation(s)
- Shephal K Doshi
- Providence, Saint Johns Health Center Pacific Heart Institute Santa Monica CA
| | - Saibal Kar
- Los Robles Regional Medical Center Thousand Oaks CA
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group Phoenix AZ
| | | | - Jose Osorio
- Arrhythmia Institute at Grandview Birmingham AL
| | | | | | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai New York NY
| | | | - Devi G Nair
- St Bernard's Heart and Vascular Center Jonesboro AR
| | - Jamie Kim
- New England Heart and Vascular Institute at Catholic Medical Center Manchester NH
| | | | | | | | | | | | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai New York NY
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Koruth J, Kawamura I, Dukkipati SR, Neuzil P, Reddy VY. Preclinical assessment of the feasibility, safety and lesion durability of a novel 'single-shot' pulsed field ablation catheter for pulmonary vein isolation. Europace 2023; 25:1369-1378. [PMID: 36794699 PMCID: PMC10105880 DOI: 10.1093/europace/euad030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS Single-shot pulmonary vein isolation can improve procedural efficiency. To assess the capability of a novel, expandable lattice-shaped catheter to rapidly isolate thoracic veins using pulsed field ablation (PFA) in healthy swine. METHODS AND RESULTS The study catheter (SpherePVI; Affera Inc) was used to isolate thoracic veins in two cohorts of swine survived for 1 and 5 weeks. In Experiment 1, an initial dose (PULSE2) was used to isolate the superior vena cava (SVC) and the right superior pulmonary vein (RSPV) in six swine and the SVC only in two swine. In Experiment 2, a final dose (PULSE3) was used for SVC, RSPV, and left superior pulmonary vein (LSPV) in five swine. Baseline and follow-up maps, ostial diameters, and phrenic nerve were assessed. Pulsed field ablation was delivered atop the oesophagus in three swine. All tissues were submitted for pathology. In Experiment 1, all 14/14 veins were isolated acutely with durable isolation demonstrated in 6/6 RSPVs and 6/8 SVC. Both reconnections occurred when only one application/vein was used. Fifty-two and 32 sections from the RSPVs and SVC revealed transmural lesions in 100% with a mean depth of 4.0 ± 2.0 mm. In Experiment 2, 15/15 veins were isolated acutely with 14/15 veins (5/5 SVC, 5/5 RSPV, and 4/5 LSPV) durably isolated. Right superior pulmonary vein (31) and SVC (34) sections had 100% transmural, circumferential ablation with minimal inflammation. Viable vessels and nerves were noted without evidence of venous stenosis, phrenic palsy, or oesophageal injury. CONCLUSION This novel expandable lattice PFA catheter can achieve durable isolation with transmurality and safety.
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Affiliation(s)
- Jacob Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA
| | | | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, PO Box 1030, New York, NY 10029, USA
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10
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Kuroki K, Reddy VY, Iwasawa J, Kawamura I, Neuzil P, Estabrook B, Melsky G, Dukkipati SR, Koruth J. Preclinical evaluation of semi-automated laser ablation for pulmonary vein isolation: A comparative study. J Cardiovasc Electrophysiol 2023; 34:315-324. [PMID: 36511472 DOI: 10.1111/jce.15777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Visually-guided laser balloon ablation (VGLA) currently requires careful manual rotation of the laser to create overlapping lesions. A novel semi-automated VGLA may reduce ablation times and lesion gaps. We aimed to compare semi-automated (SA) VGLA to that of manual (MN) VGLA. METHODS Acute: Nine swine underwent right superior pulmonary vein isolation (PVI) using either SA (n = 3, 13-18 W), MN (n = 3, 8.5-12 W), or radiofrequency (RF, n = 3, 25-40 W) and were killed acutely. Chronic: 16 swine, underwent PVI using either SA (n = 8, 15 W) or MN (n = 8, 10 W), and were survived for 1 month before being killed. All hearts were then submitted for pathological evaluation. RESULTS Acute: PVI was successful in all 9/9 swine with lesion counts significantly lower in the SA arm (5.3 ± 5.9, 33.7 ± 10.0, and 28.0 ± 4.4 in SA, MN, and RF arms; p = .007 for SA and MN). At necropsy, circumferentiality and transmurality were 98% and 94% in SA, 98% and 80% in MN, and 100% and 100% in RF arms. A single steam pop was noted on sectioning in the SA arm swine and occurred in the high dose (18 W) strategy. Chronic: PVI was acutely successful in 16/16 swine with no difference in PVI durability rates (62.5% vs. 75.0%), lesion transmurality (95.8 ± 17.4% vs.91.9 ± 25.9%), and circumferentiality (95.8 ± 6.6% vs. 94.8 ± 6.3%) between SA and MN arms. Catheter use time and lesion counts were lower in the SA arm compared to the MN arm (11.5 ± 12.7 vs. 21.8 ± 3.8 min, p = .046 and 4.8 ± 3.83 vs. 35.4 ± 4.4, p < .001). CONCLUSION Motor-assisted semi-automated laser balloon ablation can improve upon procedural efficiency by reducing ablation time.
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Affiliation(s)
- Kenji Kuroki
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jin Iwasawa
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | | | | | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Kawamura I, Reddy VY, Santos-Gallego CG, Wang BJ, Chaudhry HW, Buck ED, Mavroudis G, Jerrell S, Schneider CW, Speltz M, Dukkipati SR, Koruth JS. Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine. Circ Arrhythm Electrophysiol 2023; 16:e011369. [PMID: 36595634 DOI: 10.1161/circep.122.011369] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) has recently been shown to penetrate ischemic scar, but details on its efficacy, risk of arrhythmias, and imaging insights are lacking. In a porcine model of myocardial scar, we studied the ability of ventricular PFA to penetrate scarred tissue, induce ventricular arrhythmias, and assess the influence of QRS gating during pulse delivery. METHODS Of a total of 6 swine, 5 underwent coronary occlusion and 1 underwent radiofrequency ablation to create infarct scar and iatrogenic scar models, respectively. Two additional swine served as healthy controls. An 8 Fr focal PFA catheter was used to deliver bipolar, biphasic PFA (2.0 kV) lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography over both scarred and healthy myocardium. Swine underwent magnetic resonance imaging 2-7 days post-PFA. RESULTS PFA successfully penetrated scar without significant difference in lesion depth between lesion at the infarct border (5.9±1.0 mm, n=41) and healthy myocardium (5.7±1.3 mm, n=26; P=0.53). PFA penetration of both infarct and iatrogenic radiofrequency abalation scar was observed in all examined sections. Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated applications, whereas no ventricular arrhythmias occurred during gated PFA applications (0 of 64 [0%]). Dark-blood late-gadolinium-enhanced sequences allowed for improved endocardial border detection as well as lesion boundaries compared with conventional bright-blood late-gadolinium-enhanced sequences. CONCLUSIONS PFA penetrates infarct and iatrogenic scar successfully to create deep lesions. Gated delivery eliminates the occurrence of ventricular arrhythmias observed with ungated porcine PFA. Optimized magnetic resonance imaging sequences can be helpful in detecting lesion boundaries.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
| | | | - Bingyan J Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Hina W Chaudhry
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.J.W., H.W.C.)
| | - Eric D Buck
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - George Mavroudis
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Samantha Jerrell
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | - Christopher W Schneider
- FARAPULSE, Menlo Park, CA (E.D.B., G.M., S.J., C.W.S.). R. & M. Speltz, LLC, Pathology Services, Stanchfield, MN
| | | | | | - Jacob S Koruth
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.)
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Farhan S, Silbiger JJ, Halperin JL, Zhang L, Dukkipati SR, Vogel B, Kini A, Sharma S, Lerakis S. Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:2314-2330. [PMID: 36480974 DOI: 10.1016/j.jacc.2022.09.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 12/07/2022]
Abstract
The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR-atrial functional MR (AF-MR)-is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.
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Affiliation(s)
- Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey J Silbiger
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York, USA.
| | - Jonathan L Halperin
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily Zhang
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Kawamura I, Reddy VY, Lampert J, Musikantow D, Turagam MK, Miller MA, Whang W, Dukkipati SR, Koruth JS. Potential Utility of Catheter-Induced Ectopy During Ventricular Electroanatomical Mapping. Circ Arrhythm Electrophysiol 2022; 15:e011205. [DOI: 10.1161/circep.122.011205] [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: 11/16/2022]
Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Lampert
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Musikantow
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mohit K. Turagam
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc A. Miller
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William Whang
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srinivas R. Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Kawamura I, Reddy VY, Wang BJ, Dukkipati SR, Chaudhry HW, Santos-Gallego CG, Koruth JS. Pulsed Field Ablation of the Porcine Ventricle Using a Focal Lattice-Tip Catheter. Circ Arrhythm Electrophysiol 2022; 15:e011120. [PMID: 36074657 PMCID: PMC9794124 DOI: 10.1161/circep.122.011120] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our understanding of catheter-based pulsed field ablation (PFA) of the ventricular myocardium is limited. We conducted a series of exploratory evaluations of ventricular PFA in swine ventricles. METHODS A focal lattice-tip catheter was used to deliver proprietary biphasic monopolar PFA applications to swine ventricles under general anesthesia, with guidance from electroanatomical mapping, fluoroscopy, and intracardiac echocardiography. We conducted experiments to assess the impact of (1) delivery repetition (2×, 3×, or 4×) at each location, (2) epicardial PFA delivery, and (3) confluent areas of shallow healed endocardial scar created by prior PFA (4 weeks earlier) on subsequent endocardial PFA. Additional assessments included PFA optimized for the ventricle, lesion visualization by intracardiac echocardiography imaging, and immunohistochemical insights. RESULTS Experiment no. 1: lesions (n=49) were larger with delivery repetition of either 4× or 3× versus 2×: length 17.6±3.9 or 14.2±2.0 versus 12.7±2.0 mm (P<0.01, P=0.22), width 13.4±1.8 or 10.6±1.3 versus 10.5±1.1 mm (P<0.01, P=1.00), and depth 6.1±2.1 or 5.1±1.3 versus 4.2±1.0 mm (P<0.01, P=0.21). Experiment no. 2: epicardial lesions (n=18) were reliably created and comparable to endocardial lesions: length 24.6±9.7 mm (n=5), width 15.6±4.6 mm, and depth 4.5±3.7 mm. Experiment no. 3: PFA (n=16) was able to penetrate to a depth of 4.8 (interquartile range, 4.5-5.4) mm in healthy myocardium versus 5.6 (interquartile range, 3.6-6.6) mm in adjacent healed endocardial scar (P=0.79), suggesting that superficial scar does not significantly impair PFA. Finally, we demonstrate, PFA optimized for the ventricle yielded adequate lesion dimensions, can result in myocardial activation, can be visualized by intracardiac echocardiography, and have unique immunohistochemical characteristics. CONCLUSIONS This in vivo evaluation offers insights into the behavior of endocardial or epicardial PFA delivered using the lattice-tip catheter to normal or scarred porcine ventricular myocardium, thereby setting the stage for future clinical studies.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vivek Y. Reddy
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bingyan J. Wang
- Cardiovascular Regenerative Medicine (B.J.W., H.W.C.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srinivas R. Dukkipati
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hina W. Chaudhry
- Cardiovascular Regenerative Medicine (B.J.W., H.W.C.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carlos G Santos-Gallego
- Atherothrombosis Research Unit, Department of Cardiology (C.G.S.-G.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S. Koruth
- Helmsley Electrophysiology Center (I.K., V.Y.R., S.R.D., J.S.K.), Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Zhang C, Musikantow DR, Pugliese DN, Mitter SS, Koruth J, Moss N, Mancini DM, Dukkipati SR, Reddy VY, Miller MA. Chest-Wall Adipose Tissue Excisional Biopsy During Pacemaker or Defibrillator Implantation: New Technique to Diagnose Amyloidosis. J Am Coll Cardiol 2022; 80:93-94. [PMID: 35772920 DOI: 10.1016/j.jacc.2022.05.002] [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] [Received: 04/19/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
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16
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Ekanem E, Turagam M, Musikantow D, Lampert J, Maan A, Pugliese DN, Gandhi J, Miller MA, Koruth JS, Whang W, Syros G, Langan MNS, Dukkipati SR, Reddy VY, Sljapic TN. PO-666-04 HYPOXIC RESPIRATORY FAILURE DUE TO IATROGENIC ATRIAL SEPTAL DEFECT AFTER RADIOFREQUENCY ABLATION REQUIRING PERCUTANEOUS CLOSURE. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.372] [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: 11/04/2022]
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17
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Dukkipati SR, Nakamura T, Nakajima I, Oates C, Narui R, Tanigawa S, Sljapic T, Whang W, Koruth JS, Choudry S, Schaeffer B, Fujii A, Tedrow UB, Sapp JL, Stevenson WG, Reddy VY. Intramural Needle Ablation for Refractory Premature Ventricular Contractions. Circ Arrhythm Electrophysiol 2022; 15:e010020. [PMID: 35476455 DOI: 10.1161/circep.121.010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) are often amenable to catheter ablation. However, a deep intramural focus may lead to failure due to inability of standard ablation techniques to penetrate the focus. We sought to assess the efficacy and safety of infusion needle ablation (INA) for PVCs that are refractory to standard radiofrequency ablation. METHODS Under 2 Food and Drug Administration approved protocols, INA was evaluated in patients with frequent PVCs that were refractory to standard ablation. Initial targets for ablation were selected by standard mapping techniques. INA was performed with a deflectable catheter equipped with an extendable/retractable needle at the tip that can be extended up to 12 mm into the myocardium and is capable of pacing and recording. After contrast injection for location assessment, radiofrequency ablation was performed with the needle tip using a temperature-controlled mode (maximum temperature 60 °C) with saline infusion from the needle. The primary end point was a decrease in PVC burden to <5000/24 hours at 6 months. The primary safety end point was incidence of procedure- or device-related serious adverse events. RESULTS At 4 centers, 35 patients (age 55.3±16.9 years, 74.2% male) underwent INA. The baseline median PVC burden was 25.4% (interquartile range, 18.4%-33.9%) and mean left ventricular ejection fraction was 37.7±12.3%. Delivering 10.3±8.0 INA lesions/patient (91% had adjunctive standard radiofrequency ablation also) resulted in acute PVC elimination in 71.4%. After a mean follow-up of 156±109 days, the primary efficacy end point was met in 73.3%. The median PVC burden decreased to 0.8% (interquartile range, 0.1%-6.0%; P<0.001). The primary safety end point occurred in 14.3% consisting of 1 (2.9%) heart block, 1 (2.9%) femoral artery dissection, and 3 (8.6%) pericardial effusions (all treated percutaneously). CONCLUSIONS INA is effective for the elimination of frequent PVCs that are refractory to conventional ablation and is associated with an acceptable safety profile. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01791543 and NCT03204981.
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Affiliation(s)
- Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Tomofumi Nakamura
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Ikutaro Nakajima
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Connor Oates
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Shinichi Tanigawa
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Tatjana Sljapic
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - William Whang
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Subbarao Choudry
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Benjamin Schaeffer
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Akira Fujii
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - John L Sapp
- Heart Rhythm Service, Division of Cardiology, Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (J.L.S.)
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
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Maan A, Musikantow D, Needelman BS, Lampert J, Ekanem E, Gandhi J, Turagam MK, Whang W, Dukkipati SR, Reddy VY. CE-541-03 OCCURRENCE OF ATRIAL FIBRILLATION AFTER RECEIVING A SARS- COV-2 VACCINE: REPORT FROM CENTERS FOR DISEASE CONTROL AND PREVENTION VAERS DATABASE. Heart Rhythm 2022. [PMCID: PMC9049654 DOI: 10.1016/j.hrthm.2022.03.689] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Koruth JS, Kawamura I, Garrity JM, Kingston A, Brose R, Miller MA, Whang W, Dukkipati SR, Reddy VY. PO-637-02 PRECLINCIAL FEASIBILITY OF LINEAR ABLATION USING A FOCAL PULSED FIELD ABLATION CATHETER INTEGRATED WITH AN ELECTROANATOMICAL MAPPING SYSTEM. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.950] [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: 11/16/2022]
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Arbiol AD, Patel S, Miller MA, Liao S, Robson P, Pyzik R, Jacobi A, Adams DH, El-Eshmawi A, Boateng P, Pandis D, Pugliese DN, Gandhi J, Ekanem E, Musikantow DR, Koruth JS, Wang W, Turagam M, Dukkipati SR, Reddy VY, Fayad Z, Patel S. PO-684-06 ARRHYTHMIC MITRAL VALVE PROLAPSE WITH ONLY MILD OR MODERATE MITRAL REGURGITATION: CHARACTERIZATION BY PET/MRI. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.539] [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: 11/28/2022]
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Kawamura I, Reddy VY, Wang B, Santos-Gallego C, Buck ED, Kingston A, Garrity JM, Brose R, Ekanem E, Musikantow DR, Turagam MK, Whang W, Miller MA, Dukkipati SR, Koruth JS. PO-676-02 RISK OF VENTRICULAR ACTIVATION CULMINATING IN SUSTAINED VENTRICULAR ARRHYTHMIAS DURING PULSED FIELD ABLATION: PRECLINICAL INSIGHTS FROM ABLATION IN HEALTHY OR POST-MYOCARDIAL INFARCT MODELS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kawamura I, Santos-Gallego C, Reddy VY, Wang B, Buck ED, Hadley M, LaRocca G, Pugliese DN, Gandhi J, Musikantow DR, Turagam MK, Whang W, Miller MA, Dukkipati SR, Koruth JS. PO-624-03 MAGNETIC RESONANCE IMAGING FEATURES OF VENTRICULAR LESIONS AFTER PULSED FIELD ABLATION: PRECLINICAL INSIGHTS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.860] [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: 11/04/2022]
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Turagam MK, Kawamura I, Della Rocca DG, Hala P, Flautt T, Adedokun D, Funasako M, Musikantow DR, Dukkipati SR, Yoo DH, Neuzil P, Nair DG, Gibson DN, Valderrabano M, Natale A, Reddy VY. PO-713-05 ISCHEMIC STROKE AFTER PROPHYLAXIS WITH LEFT ATRIAL APPENDAGE CLOSURE VS NON-WARFARIN ORAL ANTICOAGULANTS: A “REAL-WORLD” MULTICENTER COMPARISON OF STROKE SEVERITY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1146] [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: 11/04/2022]
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Lampert J, Pulaski M, Miller MA, Whang W, Koruth JS, Musikantow DR, Pugliese DN, Maan A, Havaldar S, Glicksberg B, Sharma S, Fuster V, Dukkipati SR, Reddy VY. PO-631-02 RIGHT PRECORDIAL U WAVES IN SEVERE AORTIC STENOSIS: PREVALENCE IN A "REAL WORLD" COHORT AND DIMINUTION BY TAVR. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.902] [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: 11/29/2022]
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Koruth JS, Kawamura I, Buck ED, Brose R, Dukkipati SR, Whang W, Turagam MK, Musikantow D, Miller MA, Reddy VY. CA-534-04 UNDERSTANDING THE RISK OF CORONARY ARTERY SPASM DURING PULSED FIELD ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.714] [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: 11/04/2022]
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Berte B, Bogun FM, Santangeli P, Tedrow UB, Ene E, Takigawa M, Garg L, Dherange P, CHENITI G, Garg L, Dilling-Boer DM, Takashi N, Ghannam M, Siontis KC, Deneke T, Reddy VY, Vijgen JM, Kobza R, Mahida SN, Winterfield JR, Dukkipati SR, Wilber DJ, Marchlinski FE, Sermesant M, Sacher F, Jais P, Cochet H. PO-651-03 IMAGE-INTEGRATION DURING VT ABLATION RESULTS IN MAJOR PROCEDURAL SHORTENING: RESULTS FROM THE INTERNATIONAL MUSIC CONSORTIUM. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.237] [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: 11/04/2022]
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Lampert J, Havaldar S, Power D, Miller MA, Maan A, Menon K, Ekanem E, Gandhi J, Pugliese DN, Musikantow DR, Turagam MK, Fuster V, Dukkipati SR, Glicksberg B, Reddy VY. CE-543-04 INTER-ATRIAL BLOCK IDENTIFIES PATIENTS WITH LOW CHA2DS2-VASC SCORE BUT HIGH STROKE RISK. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.750] [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: 11/27/2022]
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Ekanem E, Turagam M, Neuzil P, Doshi SK, Valderrabano M, Hala P, Tang S, Musikantow D, Lampert J, Maan A, Pugliese DN, Gandhi J, Miller MA, Koruth JS, Whang W, Langan MNS, Dukkipati SR, Reddy VY. PO-700-02 FEASIBILITY AND SAFETY OF INTRACARDIAC ECHOCARDIOGRAPHY-GUIDED IMPLANTATION OF THE WATCHMAN-FLX LEFT ATRIAL APPENDAGE CLOSURE DEVICE WITHOUT PRE-PROCEDURAL IMAGING: A MULTI-NATIONAL REGISTRY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1029] [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: 11/26/2022]
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Kawamura I, Reddy VY, Sauter ED, Mickelsen S, Gandhi J, Maan A, Musikantow DR, Turagam MK, Whang W, Miller MA, Dukkipati SR, Koruth JS. PO-667-02 PRECLINICAL FEASIBILITY OF DELIVERING PULSED FIELD ABLATION USING A FOCAL CONTACT FORCE SENSING CATHETER PREVIOUSLY CAPABLE OF RADIOFREQUENCY ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.379] [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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Pugliese DN, Musikantow DR, Whang W, Dukkipati SR, Reddy VY. PO-682-07 FIRST USE OF A NOVEL ULTRA-LOW TEMPERATURE CRYOABLATION CATHETER FOR VENTRICULAR TACHYCARDIA ABLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.522] [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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Maan A, Musikantow D, Needelman BS, Lampert J, Turagam MK, Whang W, Dukkipati SR, Reddy VY. PO-710-05 MANAGEMENT OF A CORONARY SINUS PERFORATION WITH TEMPORARY BALLOON INFLATION DURING CATHETER ABLATION FOR ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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Zhang C, Musikantow DR, Pugliese DN, Ekanem E, Mitter S, Moss N, Mancini D, Gandhi J, Maan A, Sljapic TN, Lampert J, Whang W, Koruth JS, Langan MNS, Turagam MK, Dukkipati SR, Miller MA, Reddy VY. PO-619-07 CHEST WALL ADIPOSE TISSUE EXCISIONAL BIOPSY DURING PACEMAKER OR DEFIBRILLATOR IMPLANTATION: FIRST REPORT OF A NEW TECHNIQUE TO DIAGNOSE AND SUBTYPE AMYLOIDOSIS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.826] [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: 11/04/2022]
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Ekanem E, Neuzil P, Turagam M, Petru J, Funasako M, Kralovec S, Musikantow D, Maan A, Lampert J, Pugliese DN, Gandhi J, Sljapic TN, Miller MA, Whang W, Koruth JS, Syros G, Dukkipati SR, Reddy VY. PO-681-02 FEASIBILITY OF FLUOROLESS PERSISTENT ATRIAL FIBRILLATION ABLATION USING A FOCAL LATTICE-TIP CATHETER THAT TOGGLES BETWEEN PULSE FIELD AND RADIOFREQUENCY ENERGY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.504] [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: 11/28/2022]
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Lampert J, Pulaski M, Miller MA, Whang W, Koruth J, Glicksberg B, Sharma S, Dukkipati SR, Fuster V, Reddy VY. Right Precordial U-Waves in Severe Aortic Stenosis: “Real World” Prevalence and Diminution by TAVR. J Am Coll Cardiol 2022; 79:2467-2469. [DOI: 10.1016/j.jacc.2022.04.012] [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] [Received: 01/31/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
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Turagam MK, Neuzil P, Hala P, Mraz T, Dukkipati SR, Reddy VY. Intracardiac Echocardiography-Guided Left Atrial Appendage Closure With a Novel Foam-Based Conformable Device: Safety and 1-Year Outcomes. JACC Clin Electrophysiol 2022; 8:197-207. [PMID: 35210077 DOI: 10.1016/j.jacep.2021.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/22/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This is a first report of the safety and 1-year outcomes of left atrial appendage closure (LAAC) using a novel foam-based conformable device, guided by intracardiac echocardiography (ICE). BACKGROUND Limitations of current transcatheter LAAC devices include the need for precise coaxial delivery into the left atrial appendage (LAA), potential for traumatic implantation, incomplete LAA seal, and device-related thrombus. METHODS The device (Conformal Left Atrial Appendage Seal, Conformal Medical Inc) is a self-expanding occluder consisting of a cylindrical nitinol endoskeleton with low-profile anchor barbs around the midpoint, covered with a porous foam cup. In a prospective single-center series, under conscious sedation, the device was delivered under fluoroscopic and ICE guidance. After positioning, a transesophageal echocardiography probe was placed to confirm ICE findings before device release. After closure, dual antiplatelet therapy was administered for 6 months. Follow-up imaging was planned for 45 days and 6 and 12 months. RESULTS A total of 15 patients (age 71.3 ± 10.8 years, 33% men, CHA2DS2-VASc 4.1 ± 1.7, HAS-BLED 3.4 ± 1.4) underwent LAAC, 100% successfully. There were no procedure/device-related complications requiring intervention. Asymptomatic pericardial effusion occurred in 2 patients. The 45-day, 6-month, and 12-month follow-up imaging in 11, 9, and 13 patients, respectively, revealed adequate LAA seal (leak ≤5 mm) in all patients; device-related thrombus was detected in 1 patient at 6 months. Over 1-year follow-up, there were no ischemic strokes and 1 minor bleed. Nonprocedure-/device-related death occurred in 2 patients. CONCLUSIONS This first report indicates that LAAC with the conformable implant guided by ICE imaging is feasible with encouraging 1-year clinical outcomes. (The Conformal Prague Study; NCT04193826).
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Affiliation(s)
- Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/mohitkturagam
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Pavel Hala
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Tomas Mraz
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Homolka Hospital, Prague, Czech Republic.
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Oates CP, Kawamura I, Turagam MK, Langan MN, McDonaugh M, Whang W, Miller MA, Musikantow DR, Dukkipati SR, Reddy VY, Koruth JS. A single-center experience with early adoption of physiologic pacing approaches. J Cardiovasc Electrophysiol 2021; 33:308-314. [PMID: 34845805 DOI: 10.1111/jce.15303] [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: 08/23/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasing interest in physiological pacing has been countered with challenges such as accurate lead deployment and increasing pacing thresholds with His-bundle pacing (HBP). More recently, left bundle branch area pacing (LBBAP) has emerged as an alternative approach to physiologic pacing. OBJECTIVE To compare procedural outcomes and pacing parameters at follow-up during initial adoption of HBP and LBBAP at a single center. METHODS Retrospective review, from September 2016 to January 2020, identified the first 50 patients each who underwent successful HBP or LBBAP. Pacing parameters were then assessed at first follow-up after implantation and after approximately 1 year, evaluating for acceptable pacing parameters defined as sensing R-wave amplitude >5 mV, threshold <2.5 V @ 0.5 ms, and impedance between 400 and 1200 Ω. RESULTS The HBP group was younger with lower ejection fraction compared to LBBAP (73.2 ± 15.3 vs. 78.2 ± 9.2 years, p = .047; 51.0 ± 15.9% vs. 57.0 ± 13.1%, p = .044). Post-procedural QRS widths were similarly narrow (119.8 ± 21.2 vs. 116.7 ± 15.2 ms; p = .443) in both groups. Significantly fewer patients with HBP met the outcome for acceptable pacing parameters at initial follow-up (56.0% vs. 96.4%, p = .001) and most recent follow-up (60.7% vs. 94.9%, p ≤ .001; at 399 ± 259 vs. 228 ± 124 days, p ≤ .001). More HBP patients required lead revision due to early battery depletion or concern for pacing failure (0% vs. 13.3%, at a mean of 664 days). CONCLUSION During initial adoption, HBP is associated with a significantly higher frequency of unacceptable pacing parameters, energy consumption, and lead revisions compared with LBBAP.
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Affiliation(s)
- Connor P Oates
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Iwanari Kawamura
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohit K Turagam
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marie-Noelle Langan
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary McDonaugh
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Whang
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel R Musikantow
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas R Dukkipati
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jacob S Koruth
- Department of Cardiology, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gandhi J, Zeldin L, Maniar YM, Choy A, Musikantow DR, Chu EW, Maan A, Sljapic TN, Pugliese DN, Turagam MK, Miller MA, Koruth JS, Whang W, Langan MNS, Dukkipati SR, Reddy VY. B-PO05-071 WHAT IS THE RISK OF NOSOCOMIAL COVID-19 INFECTION FOLLOWING AN ELECTIVE ELECTROPHYSIOLOGY PROCEDURE WITH AN OVERNIGHT HOSPITAL STAY? Heart Rhythm 2021. [PMCID: PMC8315754 DOI: 10.1016/j.hrthm.2021.06.1142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lampert J, Jaladanki S, Vaid A, Havaldar S, Nadkami G, Halperin JL, Miller MA, Koruth JS, Whang W, Turagam MK, Dukkipati SR, Glicksberg B, Reddy VY. B-PO01-082 ARTIFICIAL INTELLIGENCE-ASSISTED QRS AMPLITUDE ANALYSIS OF THE PRESENTING ELECTROCARDIOGRAM PREDICTS MORTALITY IN COVID-19. Heart Rhythm 2021. [PMCID: PMC8315748 DOI: 10.1016/j.hrthm.2021.06.227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chu EW, Miller MA, Torina P, Musikantow DR, Pugliese DN, Gandhi J, Sharaf J, Harmaty M, Dukkipati SR, Reddy VY. B-PO02-217 NOVEL SOLUTION TO THE MIGRATION OF A TRANSVENOUS ICD PULSE GENERATOR. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.469] [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: 10/20/2022]
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Rashed E, Musikantow DR, Kocovic N, Choy A, Chu EW, Gandhi J, Pugliese DN, Sljapic TN, Turagam MK, Koruth JS, Whang W, Langan MNS, Miller MA, Dukkipati SR, Reddy VY. B-PO03-059 INCIDENCE AND KINETICS OF PREMATURE BATTERY DEPLETION OF THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.534] [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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Oates CP, Musikantow DR, Weiner MM, Boateng P, El-Eshmawi A, Salter BS, Montgomery ML, Chu EW, Pugliese D, Gandhi J, Sljapic T, Mann A, Koruth JS, Whang W, Anyanwu A, Dukkipati SR, Adams DH, Reddy VY, Miller MA. B-PO05-061 SAFETY OF INTRAOPERATIVE PLACEMENT OF PERMANENT LEADLESS PACEMAKERS COMPARED TO TEMPORARY EPICARDIAL WIRE PLACEMENT. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.981] [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: 10/20/2022]
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Koruth JS, Kawamura I, Dukkipati SR, Whang W, Turagam M, Reddy VY. B-AB06-03 PRECLINICAL ASSESSMENT OF THE FEASIBILITY, SAFETY AND LESION DURABILITY OF A NOVEL “SINGLE-SHOT” PULSE FIELD ABLATION CATHETER FOR PULMONARY VEIN ISOLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.038] [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: 10/20/2022]
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Chu EW, Pumill CA, Alexander SA, Ross Musikantow D, Pugliese DN, Gandhi J, Maan A, Sljapic TN, Miller MA, Dukkipati SR, Reddy VY. B-PO05-205 NOVEL TREATMENT OF VAGALLY MEDIATED ASYSTOLE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1124] [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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45
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Pugliese DN, Chu EW, Gandhi J, Maan A, Musikantow DR, Sljapic TN, Turagam M, Choudry S, Sofi AA, Langan MNS, Miller MA, Koruth JS, Whang W, Dukkipati SR, Reddy VY. B-PO02-117 PERICARDIAL EFFUSIONS DURING LEFT ATRIAL ABLATION PROCEDURES IN PATIENTS RECEIVING NON-WARFARIN ORAL ANTICOAGULANTS: MANAGEMENT AND OUTCOMES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.371] [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: 11/15/2022]
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46
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Chu EW, Zhang C, Musikantow DR, Turagam MK, Langan MNS, Sofi AA, Choudry S, Syros G, Miller MA, Koruth JS, Whang W, Dukkipati SR, Reddy VY. B-PO05-127 SAFETY OF SAME-DAY DISCHARGE AFTER PREMATURE VENTRICULAR CONTRACTION ABLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1046] [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: 10/20/2022]
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47
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Turagam MK, Neuzil P, Hala P, Mraz T, Dukkipati SR, Reddy VY. B-PO03-150 INTRACARDIAC ECHOCARDIOGRAPHY-GUIDED IMPLANTATION OF A CONFORMABLE LEFT ATRIAL APPENDAGE OCCLUSION DEVICE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.623] [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: 10/20/2022]
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48
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Koruth JS, Kawamura I, Dukkipati SR, Miller MA, Whang W, Turagam M, Reddy VY. B-AB03-01 DOSE-DEPENDENT TRANSIENT AV NODAL CONDUCTION BLOCK USING REVERSIBLE ELECTROPORATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Sljapic TN, Musikantow DR, Pugliese DN, Miller MA, Dukkipati SR, Reddy VY. B-PO02-214 LEAD EXTRACTION FACILITATED BY INTRACARDIAC ECHOCARDIOGRAPHY AND WITH USE OF ENDOSCOPIC FORCEPS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.466] [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: 10/20/2022]
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50
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Kawamura I, Reddy VY, Turagam MK, Gandhi J, Maan A, Miller MA, Dukkipati SR, Whang W, Koruth J. B-PO04-017 LEAD PARAMETERS AND CURRENT OF INJURY ASSESSMENT DURING INTRAVENTRICULAR SEPTUM PERFORATION - PRECLINICAL EXPERIENCE OF LEFT BUNDLE BRANCH AREA PACING. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.714] [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: 10/20/2022]
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