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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. The impact of supraventricular arrhythmias on the outcomes of guideline-compliant implantable cardioverter defibrillator programming. J Cardiovasc Electrophysiol 2024; 35:794-801. [PMID: 38384108 DOI: 10.1111/jce.16216] [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: 06/25/2023] [Revised: 10/03/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients who underwent ICD insertion for primary prevention were classified into four groups based on SVA status and ICD programming: (1) guideline-concordant group (GC) with SVA, (2) GC without SVA, (3) nonguideline concordant group (NGC) with SVA, and (4) NGC without SVA. Cox proportional hazard models were analyzed for freedom from ICD therapies, shock, and mortality. RESULTS Seven hundred and seventy-two patients (median age, 64 years) were enrolled. ICD therapies were the most frequent in NGC with SVA (24.0%), followed by NGC without SVA (19.9%), GC without SVA (11.6%), and GC with SVA (8.1%). Guideline concordant programming was associated with 68% ICD therapy reduction (HR 0.32, p = .007) and 67% ICD shock reduction (HR 0.33, p = .030) in SVA patients and 44% ICD therapy reduction in those without SVA (HR 0.56, p = .030). CONCLUSION Programming ICDs in primary prevention patients based on current guidelines reduces therapy burden without increasing mortality in both SVA and non-SVA patients. A greater magnitude of reduced ICD therapy was found in those with supraventricular arrhythmias.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Teetouch Ananwattanasuk
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Muazzum Shah
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | - Waseem Barham
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Hakan Oral
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ranjan K Thakur
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Krit Jongnarangsin
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines. J Interv Card Electrophysiol 2023; 66:1359-1366. [PMID: 36422768 DOI: 10.1007/s10840-022-01431-6] [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: 09/02/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality. RESULTS A total of 488 patients were included (mean age, 66 ± 13 years). During a mean follow-up of 1.9 ± 0.9 years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42-0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34-1.52) or mortality (aHR 1.19, 95% CI, 0.47-3.05). CONCLUSIONS Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ronpichai Chokesuwattanaskul
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Cardiac Center, Bangkok, Thailand
| | - Muazzum Shah
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Waseem Barham
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjan K Thakur
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, 1800 N Capitol Ave, Room E300B, Indianapolis, IN, 46202, USA.
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Osman AF, Khor SY, Abdelazeem B, Barham W. Recurrent biventricular takotsubo cardiomyopathy with fatal outcome. BMJ Case Rep 2022; 15:15/9/e249910. [DOI: 10.1136/bcr-2022-249910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A woman in her 60s presented initially with nausea, vomiting and abdominal pain. She rapidly progressed to respiratory failure requiring intubation. ECG demonstrated no significant ST segment changes. Troponin I and brain natriuretic peptide were elevated. Chest CT angiography demonstrated small non-occlusive segmental pulmonary emboli. Transthoracic echocardiogram findings suggested biventricular takotsubo cardiomyopathy (TCM) with left ventricular ejection fraction of less than 20%. She improved with aggressive management and was discharged on carvedilol, lisinopril, atorvastatin and apixaban. Follow-up echocardiogram revealed complete resolution of the left and right ventricular wall motion abnormalities at 9 weeks. She had symptoms recurrence after 7 months from the initial presentation. Repeated echocardiogram was consistent with biventricular TCM recurrence. Despite aggressive medical therapy, multiorgan failure developed and patient care was later transitioned to palliative care.
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Osman AF, Barham W, Abela G. Abstract 272: Infective Endocarditis Of Unicuspid-unicommisural Aortic Valve. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately, 75% of patients with infective endocarditis have underlying structural heart disease at the time of diagnosis. Aortic valve disease is associated with up to a quarter of patients, with aortic regurgitation being the most common abnormality. A unicuspid aortic valve (UAV) is an extremely rare congenital anomaly with a prevalence of 0.02%. We present a unique case of UAV with a devastating association.
Case Summary:
A 32-year-old male intravenous drug abuser presented with weakness after 18-hours of symptom onset. He was afebrile but tachycardic, with left-sided hemiparesis and sensory loss. Brain CT-scan revealed a hypodensity within the right cerebral hemisphere, a CTA of head-neck revealed an acute right MCA infarct with malignant cerebral edema. Due to deteriorating clinical condition, he was intubated for airway protection and underwent emergent hemi-craniectomy. Blood cultures grew enterococcus faecalis. Transthoracic echocardiogram showed abnormal aortic valve with severe regurgitation. Transesophageal echocardiography (TEE) demonstrated unicuspid unicommissural aortic valve with a small mobile echodensity attached to the left ventricular outflow tract aspect.
Decision Making:
He received a 6-weeks course of ceftriaxone and vancomycin with negative repeat blood cultures. Given poor clinical state, he was deemed poor candidate for valve replacement and was discharged to long-term rehabilitation facility. Four-months later, he was re-admitted with fevers. Repeat TEE demonstrated multiple aortic valve vegetations. He subsequently underwent successful minimally invasive aortic valve replacement.
Conclusion:
Unicuspid unicommisural aortic valve is an extremely rare condition that can be complicated by aortic stenosis more often than regurgitation. Infective endocarditis has been reported in 11% among UAV patients and can lead to valvular destruction with severe regurgitation which can be catastrophic in some patients
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Affiliation(s)
| | - Waseem Barham
- Michigan State Univ College of Human Medicine, Lansing, MI
| | - george Abela
- Div of Cardiology, MSU College of Human Medicine, East Lansing, MI
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Osman AF, Yazigi G, Barham W. HIGH GRADE ATRIOVENTRICULAR BLOCK ASSOCIATED WITH TAKOTSUBO CARDIOMYOPATHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ananwattanasuk T, Tanawuttiwat T, Chokesuwattanaskul R, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K. Programming implantable cardioverter–defibrillator in primary prevention: Guideline concordance and outcomes. Heart Rhythm 2020; 17:1101-1106. [DOI: 10.1016/j.hrthm.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/01/2020] [Indexed: 01/19/2023]
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Barham W, Dhar G, S Cho N, Rhine D. Transient Left Atrial Appendage Inversion During Transcatheter Closure Device Placement. J Atr Fibrillation 2019; 12:2211. [PMID: 32435336 DOI: 10.4022/jafib.2211] [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: 07/18/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/10/2022]
Abstract
A 72-year-old female patient underwent left atrial appendage closure. During recapture of the occlusion device, transient inversion of the appendageal wall occurred. We describe the mechanism with real-time imaging and share our experience of handling this situation. To the best of our knowledge, this is the first case report of this unique recapture complication.
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Affiliation(s)
- Waseem Barham
- Michigan State University College of Human Medicine/Sparrow Thoracic Cardiovascular Institute, Division of Cardiology, Lansing, Michigan
| | - Gaurav Dhar
- Michigan State University College of Human Medicine/Sparrow Thoracic Cardiovascular Institute, Division of Cardiology, Lansing, Michigan
| | - Nam S Cho
- Michigan State University College of Human Medicine/Sparrow Thoracic Cardiovascular Institute, Division of Cardiology, Lansing, Michigan
| | - David Rhine
- Michigan State University College of Human Medicine/Sparrow Thoracic Cardiovascular Institute, Division of Cardiology, Lansing, Michigan
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Barham W, Zeayter SA, Safadi A, Thakur RK. Amiodarone-induced Hyponatremia: A Case Report and a Review of the Literature. J Innov Card Rhythm Manag 2018; 9:3071-3076. [PMID: 32477802 PMCID: PMC7252766 DOI: 10.19102/icrm.2018.090303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022] Open
Abstract
Amiodarone is a widely used medication for controlling various types of cardiac arrhythmias. Nonetheless, it carries several known adverse effects that may preclude its use or necessitate discontinuation. Hyponatremia resulting from amiodarone is rarely reported, and its incidence is unknown. We present a case of severe hyponatremia secondary to amiodarone therapy and a review of the literature.
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Affiliation(s)
- Waseem Barham
- Department of Cardiology, Michigan State University, Lansing, MI, USA
| | - Samer A Zeayter
- Department of Nephrology, Michigan State University, Lansing, MI, USA
| | | | - Ranjan K Thakur
- Department of Cardiology, Michigan State University, Lansing, MI, USA
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Cortez D, Barham W, Ruckdeschel E, Sharma N, McCanta AC, von Alvensleben J, Sauer WH, Collins KK, Kay J, Patel S, Nguyen DT. Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement. Clin Cardiol 2017; 40:591-596. [PMID: 28394443 DOI: 10.1002/clc.22707] [Citation(s) in RCA: 7] [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: 11/07/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias. HYPOTHESIS A measure of atrial dispersion, the P-wave vector magnitude (Pvm), can identify patients at risk for perioperative atrial flutter (AFL) or intra-atrial re-entrant tachycardia (IART) in a large TOF cohort. METHODS We performed a blinded, retrospective analysis of 158 TOF patients undergoing pulmonary valve replacement between 1997 and 2015. History of AFL/IART was documented using electrocardiogram, Holter monitor, exercise stress test, implanted cardiac device, and electrophysiology study. P-R intervals, Pvm, QRS duration, and QRS vector magnitude were assessed from resting sinus-rhythm 12-lead electrocardiograms and identification of those with AFL/IART was determined. RESULTS Fourteen patients (8.9%) were found to have AFL/IART. Pvm, QRS duration, and QRS vector magnitude significantly differentiated those with AFL/IART from those without on univariate analysis: 0.09 ± 0.04 vs 0.18 ± 0.07 mV, 161.3 ± 21.9 vs 137.7 ± 31.4 ms, and 1.2 (interquartile range, 1.0-1.2) vs 1.6 mV (1.0-2.3), respectively (P < 0.05 for each). The Pvm had the highest area under the ROC curve (0.88) and was the only significant predictor on multivariate analysis, with odds ratio of 0.02 (95% confidence interval: 0.01-0.53). P-R duration, MRI volumes, and right-heart hemodynamics did not significantly differentiate those with vs those without AFL/IART. CONCLUSIONS In TOF patients undergoing pulmonary valve replacement, Pvm has significant value in predicting those with perioperative AFL/IART. These clinical features may help further evaluate TOF patients at risk for perioperative atrial arrhythmias. Prospective studies are warranted.
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Affiliation(s)
- Daniel Cortez
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Division of Cardiovascular Sciences, Lund University, Sweden.,Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Waseem Barham
- Division of Cardiovascular Sciences, Lund University, Sweden
| | - Emily Ruckdeschel
- Department of Cardiology, Children's Hospital of Philadelphia, Pennsylvania
| | - Nandita Sharma
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Johannes von Alvensleben
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora
| | | | - Kathryn K Collins
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Joseph Kay
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Sonali Patel
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora.,Department of Cardiology, University of Colorado, Aurora.,Department of Cardiology, University of Colorado Denver School of Medicine
| | - Duy T Nguyen
- Department of Cardiology, University of Colorado, Aurora
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Nguyen DT, Tzou WS, Zheng L, Barham W, Schuller JL, Shillinglaw B, Quaife RA, Sauer WH. Enhanced Radiofrequency Ablation With Magnetically Directed Metallic Nanoparticles. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003820. [DOI: 10.1161/circep.115.003820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 08/21/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Remote heating of metal located near a radiofrequency ablation source has been previously demonstrated. Therefore, ablation of cardiac tissue treated with metallic nanoparticles may improve local radiofrequency heating and lead to larger ablation lesions. We sought to evaluate the effect of magnetic nanoparticles on tissue sensitivity to radiofrequency energy.
Methods and Results—
Ablation was performed using an ablation catheter positioned with 10 g of force over prepared ex vivo specimens. Tissue temperatures were measured and lesion volumes were acquired. An in vivo porcine thigh model was used to study systemically delivered magnetically guided iron oxide (FeO) nanoparticles during radiofrequency application. Magnetic resonance imaging and histological staining of ablated tissue were subsequently performed as a part of ablation lesion analysis. Ablation of ex vivo myocardial tissue treated with metallic nanoparticles resulted in significantly larger lesions with greater impedance changes and evidence of increased thermal conductivity within the tissue. Magnet-guided localization of FeO nanoparticles within porcine thigh preps was demonstrated by magnetic resonance imaging and iron staining. Irrigated ablation in the regions with greater FeO, after FeO infusion and magnetic guidance, created larger lesions without a greater incidence of steam pops.
Conclusions—
Metal nanoparticle infiltration resulted in significantly larger ablation lesions with altered electric and thermal conductivity. In vivo magnetic guidance of FeO nanoparticles allowed for facilitated radiofrequency ablation without direct infiltration into the targeted tissue. Further research is needed to assess the clinical applicability of this ablation strategy using metallic nanoparticles for the treatment of cardiac arrhythmias.
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Affiliation(s)
- Duy T. Nguyen
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Wendy S. Tzou
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Lijun Zheng
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Waseem Barham
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Joseph L. Schuller
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Benjamin Shillinglaw
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - Robert A. Quaife
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
| | - William H. Sauer
- From the Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Colorado, Aurora
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Nguyen DT, Barham W, Moss J, Zheng L, Shillinglaw B, Quaife R, Tzou WS, Sauer WH. Gadolinium Augmentation of Myocardial Tissue Heating During Radiofrequency Ablation. JACC Clin Electrophysiol 2015; 1:177-184. [DOI: 10.1016/j.jacep.2015.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/20/2015] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
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12
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Nguyen DT, Barham W, Zheng L, Shillinglaw B, Tzou WS, Neltner B, Mestroni L, Bosi S, Ballerini L, Prato M, Sauer WH. Carbon nanotube facilitation of myocardial ablation with radiofrequency energy. J Cardiovasc Electrophysiol 2014; 25:1385-90. [PMID: 25091811 DOI: 10.1111/jce.12509] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 03/01/2014] [Revised: 06/24/2014] [Accepted: 07/22/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of carbon nanotubes (CNTs) in oncology has been proposed for the purpose of sensitizing tumors to radiofrequency (RF) ablation. We hypothesize that myocardial tissue infiltrated with CNTs will improve thermal conductivity of RF heating and lead to altered ablation lesion characteristics. METHODS An ex vivo model consisting of viable bovine myocardium, a circulating saline bath at 37 °C, a submersible load cell, and a deflectable sheath was assembled. A 4-mm nonirrigated ablation catheter was positioned with 10 gm of force over bovine myocardium infiltrated with CNTs, 0.9% saline, or sham injections. A series of ablation lesions were delivered at 20 and 50 W, and lesion volumes were acquired by analyzing tissue sections with a digital micrometer. Tissue temperature analyses at 3 and 5 mm depths were also performed. RESULTS Myocardial tissue treated with CNTs resulted in significantly larger lesions at both low and high power settings. The electrical impedance was increased in CNT treated tissue with a greater impedance change observed in the CNT infiltrated myocardium. The thermal conductivity of heat generated by application of RF in the tissue was altered by the presence of CNTs, resulting in higher temperatures at 3 and 5 mm depths for both 20 and 50 W. CONCLUSIONS Myocardial tissue treated with CNTs resulted in significantly larger lesions at both low and high power settings. The electrical and thermal conductivity of heat generated by application of RF in myocardial tissue was altered by the presence of CNTs. Further research is needed to assess the in vivo applicability for this concept of facilitated ablation with CNTs.
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Affiliation(s)
- Duy T Nguyen
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
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Barham W, Al-Qadi M, Migdady Y, Rabatin J, Artenstein A. Isolated Pulmonary Capillaritis in a Patient With Cutaneous T-Cell Lymphoma. Chest 2013. [DOI: 10.1378/chest.1705259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Connelly L, Barham W, Onishko HM, Sherrill T, Chodosh LA, Blackwell TS, Yull FE. Inhibition of NF-kappa B activity in mammary epithelium increases tumor latency and decreases tumor burden. Oncogene 2010; 30:1402-12. [PMID: 21076466 PMCID: PMC3063854 DOI: 10.1038/onc.2010.521] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The transcription factor nuclear factor kappa B (NF-κB) is activated in human breast cancer tissues and cell lines. However, it is unclear whether NF-κB activation is a consequence of tumor formation or a contributor to tumor development. We developed a doxycycline-inducible mouse model, termed DNMP, to inhibit NF-κB activity specifically within the mammary epithelium during tumor development in the polyoma middle T oncogene (PyVT) mouse mammary tumor model. DNMP females and PyVT littermate controls were treated with doxycycline from 4 to 12 weeks of age. We observed an increase in tumor latency and a decrease in final tumor burden in DNMP mice compared to PyVT controls. A similar effect with treatment from 8 to 12 weeks indicates that outcome is independent of effects on postnatal virgin ductal development. In both cases, DNMP mice were less likely to develop lung metastases than controls. Treatment from 8 to 9 weeks was sufficient to impact primary tumor formation. Inhibition of NF-κB increases apoptosis in hyperplastic stages of tumor development and decreases proliferation at least in part by reducing CyclinD1 expression. To test the therapeutic potential of NF-κB inhibition, we generated palpable tumors by orthotopic injection of PyVT cells and then treated systemically with the NF-κB inhibitor thymoquinone (TQ). TQ treatment resulted in a reduction in tumor volume and weight as compared to vehicle-treated control. This data indicates that epithelial NF-κB is an active contributor to tumor progression and demonstrates that inhibition of NF-κB could have a significant therapeutic impact even at later stages of mammary tumor progression.
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Affiliation(s)
- L Connelly
- Department of Cancer Biology, Vanderbilt University, Nashville, TN 37232-6838, USA
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