1
|
Rao BH, Lokre A, Patnala N, Padmanabhan TNC. Stellate ganglion ablation by conventional radiofrequency in patients with electrical storm. Europace 2023; 25:euad290. [PMID: 37738408 PMCID: PMC10558399 DOI: 10.1093/europace/euad290] [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: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS We report a series of patients with Electrical Storm (ES) who underwent bilateral stellate ganglion ablation by using conventional radio frequency (RFA). METHODS AND RESULTS The procedure was done with fluoroscopic guidance using the COSMAN™ 1A RF Generator and a 22G RF needle (5 cm length and 5 mm active tip). Six patients, four male and two female (mean age 55 ± 7 years and mean LVEF-42 ± 21%) with ES underwent the procedure under fluoroscopic guidance. All patients experienced recurrent ICD shocks or required multiple external defibrillation shocks. There were no procedural complications. All patients survived free of ES at discharge. At a mean follow-up of 22 ± 8months, all were alive free of ES but two patients received appropriate shocks for VT and one patient had VT terminated by ATP. CONCLUSION This small series of cases is a proof of concept that neuromodulation by conventional RFA targeting bilateral stellate ganglia appears safe, feasible, and effective in treating selected unstable patients with ES.
Collapse
Affiliation(s)
- B Hygriv Rao
- Department of Cardiology, KIMS Hospitals, Minister Road, Secunderabad 500003, India
- Arrhythmia, Research and Training Society (ARTS), Hyderabad, India
| | - Avinash Lokre
- Department of Cardiology, KIMS Hospitals, Minister Road, Secunderabad 500003, India
| | | | - T N C Padmanabhan
- Department of Cardiology, KIMS Hospitals, Minister Road, Secunderabad 500003, India
| |
Collapse
|
2
|
Premchand RK, Garipalli R, Padmanabhan TNC, Manik G. Percutaneous closure of post-myocardial infarction ventricular septal rupture - A single centre experience. Indian Heart J 2016; 69 Suppl 1:S24-S27. [PMID: 28400035 PMCID: PMC5388014 DOI: 10.1016/j.ihj.2016.10.004] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/21/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR. METHODS AND RESULTS In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2005 and 2015 at KIMS Hospital were included. Primary outcome was mortality rate at 30 days. Seven patients were included in the study (mean age, 58.29±9.8 years). 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy. Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate) and are doing well on follow up at 1 and 5 years respectively. Cardiogenic shock, IWMI and serpigenious form of VSR were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes. CONCLUSION Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis.
Collapse
Affiliation(s)
| | | | | | - Geetesh Manik
- Krishna Institute of Medical Sciences, Hyderabad, India
| |
Collapse
|
3
|
Padmanabhan TNC, Dani S, Chopra VK, Guha S, Vasnawala H, Ammar R. Prevalence of sympathetic overactivity in hypertensive patients - a pan India, non-interventional, cross sectional study. Indian Heart J 2014; 66:686-90. [PMID: 25634406 DOI: 10.1016/j.ihj.2014.10.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/09/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- T N C Padmanabhan
- Department of Cardiology, Krishna Institute of Medical Science, Secunderabad, India
| | - Sameer Dani
- Department of Cardiology, Life Care Science, Ahmedabad, India
| | - V K Chopra
- Department of Cardiology, Medanta - The Medicity, Sector 38, Gurgaon, India
| | - Santanu Guha
- Department of Cardiology, Calcutta Medical College, Kolkata, India
| | - Hardik Vasnawala
- Department of Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India.
| | - Raza Ammar
- Department of Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| |
Collapse
|
4
|
Jain RK, Padmanabhan TNC, Chitnis N. Causes of failure with Szabo technique - an analysis of nine cases. Indian Heart J 2013; 65:264-8. [PMID: 23809379 DOI: 10.1016/j.ihj.2013.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 01/07/2013] [Accepted: 04/03/2013] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. METHODS AND RESULTS From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. CONCLUSION This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty.
Collapse
Affiliation(s)
- Rajendra Kumar Jain
- Senior Consultant Interventional Cardiologist, Director, Department of Cardiology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, India.
| | | | | |
Collapse
|
5
|
Prudhvi K, Rao VDS, Jain RK, Jiwani PA, Padmanabhan TNC, Ravikanth G, Srinath VS, Tavva NVRPK. Study on incidence of bleeding in hospitalized patients after antithrombotic therapy at a tertiary care hospital. J Assoc Physicians India 2013; 61:110-113. [PMID: 24471249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To monitor the different antithrombotic drug combinations, determine the incidence, magnitude of bleeding and the association of HAS-BLED risk scoring schema with the magnitude of bleeding as defined using TIMI bleeding criteria. METHODS A prospective observational study in a cohort of patients for a period of 8 months, at one of the tertiary care center-Krishna Institute of Medical Sciences, Hyderabad, was conducted. Consecutive patients were enrolled and followed from the date of admission till the adverse events are perceived/date of discharge. Pearson Correlation Statistics (Fisher's z Transformation) is applied to assess the association between HAS-BLED risk factors and the total risk score with bleeding criteria. RESULTS A total of 400 cases were collected during the 8-month study period, of which 372 satisfied the inclusion criteria. Among them 34 (9.1%) bleeding cases were reported with mean (+/- SD) age of 57.8 (+/- 14.19) years. Bleeding occurred mostly in males 79.4% and a HAS-BLED Score of > or = 3 has been observed in 67.6% (n = 23) patients out of 34 bled patients. Two antiplatelets + One anticoagulant is the most common combination which caused bleeding in 41.2% (n = 14). Stroke history, bleeding predisposition, labile INR's are the HAS-BLED risk factors which are significant (< 0.05) with the TIMI Bleeding Criteria. CONCLUSION There was a linear correlation between the HAS-BLED risk score and the TIMI bleeding criteria-higher the risk score the more frequent is the incidence of major bleeding. A HAS-BLED risk score of > or = 3 is associated with TIMI major bleeding.
Collapse
Affiliation(s)
- K Prudhvi
- Department of Hospital and Clinical Pharmacy, Bharat Institute of Pharmacy, Hyderabad 501510, Andhra Pradesh
| | | | - R K Jain
- Krishna Institute of Medical Sciences, Hyderabad
| | - P A Jiwani
- Krishna Institute of Medical Sciences, Hyderabad
| | | | - G Ravikanth
- Krishna Institute of Medical Sciences, Hyderabad
| | - V S Srinath
- Krishna Institute of Medical Sciences, Hyderabad 500003, Andhra Pradesh
| | | |
Collapse
|
6
|
Abstract
The burden of cardiovascular disease (CVD) is increasing worldwide. The increase in the burden is a major concern in developing countries like India. It is well-established that hypertension and dyslipidemia are the two major contributing risk factors for CVD. Various epidemiological studies have shown the prevalence of the co-existence of hypertension and dyslipidemia, in the range of 15 to 31%. The co-existence of the two risk factors has more than an additive adverse impact on the vascular endothelium, which results in enhanced atherosclerosis, leading to CVD. This review emphasizes on the 'co-existence and interplay of dyslipidemia and hypertension'. The authors have termed the co-existence as, 'LIPITENSION'. The term LIPITENSION may help clinicians in easy identification and aggressive management of the two conditions together, ultimately preventing future cardiovascular events.
Collapse
Affiliation(s)
- Jamshed J. Dalal
- Department of Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Andheri, Mumbai, India
| | - T. N. C. Padmanabhan
- Department of Cardiology, Krishna Institute of Medical Sciences, Secunderabad, India
| | - Piyush Jain
- Non-invasive Cardiology, Preventive and Rehabilitative Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Shiva Patil
- AstraZeneca India Ltd., Hebbal, Bangalore, India
| | | | | |
Collapse
|
7
|
Bhuvaneswaran JS, Premchand RK, Iyengar SS, Rajeev Khare, Chabra CB, Padmanabhan TNC, Sharma SK, Jain A, Pandian SA, Rajdev S, Modi N, Kumar V. Tenecteplase in the treatment of acute pulmonary thrombo-embolism. J Thromb Thrombolysis 2010; 31:445-8. [PMID: 20972606 DOI: 10.1007/s11239-010-0524-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 11/25/2022]
Abstract
This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P < 0.0001) and increase in the oxygen saturation (SaO₂) (P < 0.0001) were seen at discharge as compared to at the time of presentation. Eighteen patients had hypotension which recovered in all patients till the time of discharge (P < 0.0001). There was a significant reduction in right ventricular systolic pressure in all 18 patients who underwent 2-D echocardiography both before and after the tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.
Collapse
Affiliation(s)
- J S Bhuvaneswaran
- Department of Cardiology, PSG Hospitals, P.B. No. 1674, Peelamedu, Coimbatore 641004, India.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|