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Saunderson CED, Hogarth AJ, Papaspyros S, Tingerides C, Tayebjee MH. An unusual cause of a haemothorax following pacemaker implantation: A case report. Eur Heart J Case Rep 2022; 6:ytac185. [PMID: 35592745 PMCID: PMC9113347 DOI: 10.1093/ehjcr/ytac185] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/18/2022] [Accepted: 04/28/2022] [Indexed: 11/20/2022]
Abstract
Background Haemothoraces are a reported but extremely rare complication of pacemaker implantation. Haemothoraces can be a consequence of lead perforation through the right ventricle (RV) and pericardium into the pleural space, direct lung or vascular injury during access. Case summary A 72-year-old woman presented 24 h after a pacemaker implantation with chest pain and shortness of breath. Computed tomography of the chest confirmed perforation of the RV lead into the left pleural cavity with a large left sided haemothorax. Following percutaneous drainage of the left sided haemothorax, the patient became haemodynamically unstable necessitating emergent sternotomy. During surgery, the extra-cardiac portion of the pacing lead was cut, the RV repaired and a large haematoma evacuated from the left pleural space. Despite this, the patient remained hypotensive, and further exploration showed a bleeding intercostal artery that had been lacerated by the pacing lead. This was treated by electrocautery, and the patient’s haemodynamic status improved. The RV lead remnant was removed transvenously via the subclavian vein, and the patient was left with a single chamber atrial pacemaker. Discussion Prompt recognition of RV lead perforation and its associated sequalae, often utilising multi-modality imaging, is vital to enable transfer to a centre with cardiac surgical expertise. In this case, the perforating RV lead lacerated an intercostal artery, and this was only identified at the time of surgery. In order to minimize the risk of perforation, multiple fluoroscopic views should be used, and care should be taken during helix deployment.
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Affiliation(s)
- Christopher E. D. Saunderson
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J. Hogarth
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sotiris Papaspyros
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Costa Tingerides
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Muzahir H. Tayebjee
- Department of Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Cardiology, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Begg GA, O’Neill J, Sohaib A, McLean A, Pepper CB, Graham LN, Hogarth AJ, Page SP, Gillott RG, Hill N, Walshaw J, Schilling RJ, Kanagaratnam P, Tayebjee MH. Multicentre randomised trial comparing contact force with electrical coupling index in atrial flutter ablation (VERISMART trial). PLoS One 2019; 14:e0212903. [PMID: 30943196 PMCID: PMC6447159 DOI: 10.1371/journal.pone.0212903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Electrical coupling index (ECI) and contact force (CF) have been developed to aid lesion formation during catheter ablation. ECI measures tissue impedance and capacitance whilst CF measures direct contact. The aim was to determine whether the presence of catheter / tissue interaction information, such as ECI and CF, reduce time to achieve bidirectional cavotricuspid isthmus block during atrial flutter (AFL) ablation. Methods Patients with paroxysmal or persistent AFL were randomised to CF visible (range 5-40g), CF not visible, ECI visible (change of 12%) or ECI not visible. Follow-up occurred at 3 and 6 months and included a 7 day ECG recording. The primary endpoint was time to bidirectional cavotricuspid isthmus block. Results 114 patients were randomised, 16 were excluded. Time to bidirectional block was significantly shorter when ECI was visible (median 30.0 mins (IQR 31) to median 10.5mins (IQR 12) p 0.023) versus ECI not visible. There was a trend towards a shorter time to bidirectional block when CF was visible. Higher force was applied when CF was visible (median 9.03g (IQR 7.4) vs. 11.3g (5.5) p 0.017). There was no difference in the acute recurrence of conduction between groups. The complication rate was 2%, AFL recurrence was 1.1% and at 6 month follow-up, 12% had atrial fibrillation. Conclusion The use of tissue contact information during AFL ablation was associated with reduced time taken to achieve bidirectional block when ECI was visible. Contact force data improved contact when visible with a trend towards a reduction in the procedural endpoint. ClinicalTrials.gov trial identifier: NCT02490033.
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Affiliation(s)
- Gordon A. Begg
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - James O’Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Afzal Sohaib
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Ailsa McLean
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Chris B. Pepper
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Lee N. Graham
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Andrew J. Hogarth
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Stephen P. Page
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard G. Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Nicola Hill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Jacqueline Walshaw
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard J. Schilling
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
- * E-mail:
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Left atrial voltage, circulating biomarkers of fibrosis, and atrial fibrillation ablation. A prospective cohort study. PLoS One 2018; 13:e0189936. [PMID: 29293545 PMCID: PMC5749720 DOI: 10.1371/journal.pone.0189936] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Received: 07/02/2017] [Accepted: 12/05/2017] [Indexed: 12/30/2022] Open
Abstract
Aims To test the ability of four circulating biomarkers of fibrosis, and of low left atrial voltage, to predict recurrence of atrial fibrillation after catheter ablation. Background Circulating biomarkers potentially may be used to improve patient selection for atrial fibrillation ablation. Low voltage areas in the left atrium predict arrhythmia recurrence when mapped in sinus rhythm. This study tested type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the left atrium predicted atrial fibrillation recurrence, irrespective of the rhythm during mapping. Methods 92 atrial fibrillation ablation patients were studied. Biomarker levels in peripheral and intra-cardiac blood were measured with enzyme-linked immunosorbent assay. Low voltage (<0.5mV) was expressed as a proportion of the mapped left atrial surface area. Follow-up was one year. The primary endpoint was recurrence of arrhythmia. The secondary endpoint was a composite of recurrence despite two procedures, or after one procedure if no second procedure was undertaken. Results The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis, high proportion of low voltage area in the left atrium was found to predict the primary endpoint in sinus rhythm mapping (hazard ratio 4.323, 95% confidence interval 1.337–13.982, p = 0.014) and atrial fibrillation mapping (hazard ratio 5.195, 95% confidence interval 1.032–26.141, p = 0.046). This effect was also apparent for the secondary endpoint. Conclusion The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. Left atrial voltage is an independent predictor of recurrence, whether the left atrium is mapped in atrial fibrillation or sinus rhythm.
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Affiliation(s)
- Gordon A Begg
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Rashed Karim
- Department of Biomedical Engineering, King's College, London, United Kingdom
| | - Tobias Oesterlein
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lee N Graham
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Andrew J Hogarth
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Stephen P Page
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | | | - Kawal Rhode
- Department of Biomedical Engineering, King's College, London, United Kingdom
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Arun V Holden
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
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O'Neill J, Hogarth AJ, Pearson I, Law H, Bowes R, Kidambi A, Wheatcroft S, Sivananthan UM, Tayebjee MH. Transcoronary pacing to assess myocardial viability prior to percutaneous coronary intervention: Pilot study to assess feasibility. Catheter Cardiovasc Interv 2017; 92:269-273. [DOI: 10.1002/ccd.27349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/31/2017] [Indexed: 11/09/2022]
Affiliation(s)
- James O'Neill
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Andrew J. Hogarth
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Ian Pearson
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Hannah Law
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Robert Bowes
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Ananth Kidambi
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Stephen Wheatcroft
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - U. Mohanaraj Sivananthan
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology; Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street; Leeds LS1 3EX United Kingdom
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O'Neill J, Hogarth AJ, Pearson I, Kidambi A, Sivananthan UM, Tayebjee MH. 91Trans-coronary pacing to assess myocardial viability prior to percutaneous coronary intervention. Europace 2017. [DOI: 10.1093/europace/eux283.086] [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: 11/15/2022] Open
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Begg GA, Karim R, Oesterlein T, Graham L, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. 28Left atrial voltage predicts AF recurrence after ablation, irrespective of the rhythm during mapping, while circulating biomarkers of fibrosis do not. Europace 2017. [DOI: 10.1093/europace/eux283.037] [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: 11/13/2022] Open
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Battipaglia I, O’Neill J, Hogarth AJ, Tayebjee MH. Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature. World J Cardiol 2017; 9:422-428. [PMID: 28603589 PMCID: PMC5442410 DOI: 10.4330/wjc.v9.i5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/25/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation (AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a cost-effective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.
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Begg GA, Karim R, Oesterlein T, Graham LN, Hogarth AJ, Page SP, Pepper CB, Rhode K, Lip GYH, Holden AV, Plein S, Tayebjee MH. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation. Europace 2017; 19:1944-1950. [DOI: 10.1093/europace/euw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/10/2016] [Indexed: 12/13/2022] Open
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Battipaglia I, Gilbert K, Hogarth AJ, Tayebjee MH. Screening For Atrial Fibrillation In The Community Using A Novel ECG Recorder. J Atr Fibrillation 2016; 9:1433. [PMID: 27909536 DOI: 10.4022/jafib.1433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 12/24/2022]
Abstract
Aims: MyDiagnostick (MDK) is a novel portable ECG recorder. We conducted this study to evaluate its role in screening for atrial fibrillation (AF). Methods: The device is a cylindrical rod with metallic electrodes at both ends recording electrocardiogram (ECG) when both electrodes are held. Individuals were requested to hold the device for approximately 15 s, the device was then connected to a laptop (with proprietary software downloaded) and analysed. Anonymised ECGs were stored for further analysis. A total of 855 ECGs were recorded and analysed offline by two arrhythmia specialists assessing ECG quality, in particular the level of noise. A noise score (NS) was devised regarding ECG quality. Results: Seven individuals were found with unknown AF (0,8%). In general ECG quality was good and rhythm diagnosis was certain with total interobserver agreement. Conclusion: The MDK provided a rapid and accurate rhythm analysis and has potential implications in preventing ischaemic cardio-embolic stroke.
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Affiliation(s)
- Irma Battipaglia
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Katrina Gilbert
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Andrew J Hogarth
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
| | - Muzahir H Tayebjee
- The West Yorkshire Arrhythmia Service, Leeds Teaching Hospitals NHS, Leeds, West Yorkshire, UK
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Abstract
BACKGROUND Normal heart ventricular arrhythmia occurring during pregnancy has been previously described. Whilst there are established reports of catheter ablation to treat supraventricular arrhythmia during pregnancy, there are no reports of ablation to treat ventricular tachycardia. CASE We present the case of a 36 year old women, 31 weeks into an otherwise uncomplicated pregnancy, experiencing significant, troublesome and drug refractory tachycardia emanating from the right ventricular outflow tract. CONCLUSION We describe a successful radio frequency ablation in the third trimester of pregnancy.
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Affiliation(s)
- Andrew J Hogarth
- Department of Cardiac Electrophysiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - Lee N Graham
- Department of Cardiac Electrophysiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
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Hogarth AJ, Dobson LE, Tayebjee MH. During ablation for atrial fibrillation, is simultaneous renal artery ablation appropriate? J Hum Hypertens 2013; 27:707-14. [PMID: 23945464 DOI: 10.1038/jhh.2013.75] [Citation(s) in RCA: 5] [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: 03/19/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 01/12/2023]
Abstract
Over the past few decades, the mainstay of hypertension management has been pharmacological therapy; however, there is now a growing body of evidence that drug-resistant hypertension can be managed effectively by renal artery ablation. Several studies have documented the feasibility and safety of this treatment, although data regarding long-term outcomes are still emerging. Atrial fibrillation (AF) and hypertension commonly coexist, and recent work has demonstrated improved outcomes from catheter ablation of AF with concomitant renal artery denervation at little extra cost in terms of time and resource. The aim of this review is to explore the link between hypertension and AF, the synergistic effect of renal artery ablation on AF ablation, explain how this may work and address unanswered questions.
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Affiliation(s)
- A J Hogarth
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
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Simms AD, Hogarth AJ, Hudson EA, Worsnop VL, Blackman DJ, O'Regan DJ, Tayebjee MH. Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement. Interact Cardiovasc Thorac Surg 2013; 17:328-33. [PMID: 23620339 DOI: 10.1093/icvts/ivt175] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an established intervention for aortic stenosis. While it is known that the requirement for permanent pacing is higher following CoreValve (Medtronic, Inc., Minneapolis, MN, USA) TAVI than after surgical aortic valve replacement (SAVR), it remains uncertain whether pacing is required in the medium-to-long term. We hypothesized that complete heart block following TAVI is more likely to resolve than that following SAVR. METHODS A retrospective analysis of prospectively collated data on 528 patients undergoing TAVI or SAVR from May 2008 to December 2010 at a cardiac tertiary referral hospital. Demographic data, timing and indication for pacing post-procedure plus follow-up were recorded. Paced patients were compared and analysed by existing initial indication for pacing. RESULTS In total, 31 (5.9%) patients received a pacemaker, and there were limited differences between not paced and paced patient characteristics by procedure type. Of these, a greater proportion were implanted post-TAVI compared with SAVR (17 vs 3.2%, P<0.001). The mean time to pacemaker follow-up for TAVI and SAVR was 234 and 188 days, P=0.32, respectively. Fewer patients compared with pacing indication remained in complete heart block at latest follow-up for TAVI (76.5 vs 33.3%, P=0.02) and SAVR (92.9 vs 58.3%, P=0.04). Although, there was a trend towards a greater magnitude of TAVI patients regaining atrioventricular nodal conduction, this did not differ significantly from that seen in SAVR patients. CONCLUSIONS In keeping with previous reports, this single-centre experience demonstrates that patients undergoing TAVI have higher rates of pacemaker implantation than those following SAVR. However, pacing indication in the short-to-medium term may not persist for all paced patients post-TAVI and -SAVR with the suggestion that a significant proportion recover atrioventricular conduction, which tended to be greatest in TAVI paced patients.
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Mahida S, Hogarth AJ, Cowan C, Tayebjee MH, Graham LN, Pepper CB. Genetics of congenital and drug-induced long QT syndromes: current evidence and future research perspectives. J Interv Card Electrophysiol 2013; 37:9-19. [PMID: 23515882 DOI: 10.1007/s10840-013-9779-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 11/06/2012] [Accepted: 01/07/2013] [Indexed: 12/17/2022]
Abstract
The long QT syndrome (LQTS) is a condition characterized by abnormal prolongation of the QT interval with an associated risk of ventricular arrhythmias and sudden cardiac death. Congenital forms of LQTS arise due to rare and highly penetrant mutations that segregate in a Mendelian fashion. Over the years, multiple mutations in genes encoding ion channels and ion channel binding proteins have been reported to underlie congenital LQTS. Drugs are by far the most common cause of acquired forms of LQTS. Emerging evidence suggests that drug-induced LQTS also has a significant heritable component. However, the genetic substrate underlying drug-induced LQTS is presently largely unknown. In recent years, advances in next-generation sequencing technology and molecular biology techniques have significantly enhanced our ability to identify genetic variants underlying both monogenic diseases and more complex traits. In this review, we discuss the genetic basis of congenital and drug-induced LQTS and focus on future avenues of research in the field. Ultimately, a detailed characterization of the genetic substrate underlying congenital and drug-induced LQTS will enhance risk stratification and potentially result in the development of tailored genotype-based therapies.
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Affiliation(s)
- Saagar Mahida
- Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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Hogarth AJ, Bebb OJ, Graham LN. A case of malignant arrhythmia. Heart 2012; 98:1539. [PMID: 22760873 DOI: 10.1136/heartjnl-2012-301955] [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: 11/04/2022] Open
Affiliation(s)
- Andrew J Hogarth
- Department of Cardiac Electrophysiology, The Yorkshire Heart Centre, G Floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Hogarth AJ, Artis NJ, Sivananthan UM, Pepper CB. Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker. Heart Int 2011; 6:e19. [PMID: 22355486 PMCID: PMC3282436 DOI: 10.4081/hi.2011.e19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/22/2011] [Accepted: 09/19/2011] [Indexed: 01/09/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is increasingly used as the optimum modality for cardiac imaging. An aging population and rising numbers of patients with permanent pacemakers means many such individuals may require cardiac MRI scanning in the future. Whilst the presence of a permanent pacemaker is historically regarded as a contra-indication to MRI scanning, pacemaker systems have been developed to limit any associated risks. No reports have been published regarding the use of such devices with cardiac MRI in a clinical setting. We present the safe, successful cardiac MRI scan of a patient with an MRI-conditional permanent pacing system.
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Hogarth AJ, Hares DL, Hill NJ, Graham LN. Repetitive irregular narrow and wide-complex tachycardia: what is the mechanism? Pacing Clin Electrophysiol 2011; 35:492-5. [PMID: 21954909 DOI: 10.1111/j.1540-8159.2011.03216.x] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Andrew J Hogarth
- Department of Cardiac Electrophysiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom.
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Abstract
AIMS To determine whether the magnitude of post-acute myocardial infarction (AMI) sympathetic activation is greater in women (F-AMI) than men (M-AMI). METHODS AND RESULTS Both sympatho-humoral activation and female gender are associated with worse outcome in the early phase following AMI. However, women have lower sympathetic output than men. We therefore examined matched groups of F-AMI (18) and M-AMI (18) patients 2-4 days following uncomplicated AMI, then 3 monthly to 9 months; matched normal control (NC) groups comprised M-NC (18) and F-NC (18). Muscle sympathetic nerve activity (MSNA) was measured by microneurography. Muscle sympathetic nerve activity was lower in the F-NC than M-NC (at least P < 0.05) and greater in the two AMI groups than their corresponding NC groups (at least P < 0.001). Muscle sympathetic nerve activity was similar in the F-AMI and M-AMI groups indicating a post-AMI increase in women of about twice that in men (P < 0.0001). Both AMI groups returned to corresponding NC (lower in women) levels by 9 months. CONCLUSION Following uncomplicated AMI, women developed a relatively greater magnitude of sympathetic activation lasting until its resolution at 9 months. This is consistent with reports of their worse prognosis observed during this time period, with important potential clinical implications.
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Affiliation(s)
- Andrew J Hogarth
- Department of Cardiology, Leeds Teaching Hospital NHS Trust, G floor, Jubilee wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Hogarth AJ, Burns J, Mackintosh AF, Mary DASG. Sympathetic nerve hyperactivity of essential hypertension is lower in postmenopausal women than men. J Hum Hypertens 2008; 22:544-9. [DOI: 10.1038/jhh.2008.31] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The risk of cardiovascular disease has been linked to sympathetic activation and its incidence is known to be lower in women than in men. However, the effect of gender on the sympathetic vasoconstrictor drive has not yet been established. In the present study, we investigated whether there is a gender difference in MSNA (muscle sympathetic nerve activity) and blood flow, and to determine the mechanisms involved. We examined 68 normal subjects, 34 women and 34 men, matched for age, BMI (body mass index) and waist circumference. MSNA was measured as the mean frequency of single units (s-MSNA) and as multi-unit bursts (m-MSNA) from the peroneal nerve simultaneously with its supplied muscle CBF (calf blood flow). Women had lower (P=0.0007) s-MSNA (24+/-2.0 impulses/100 cardiac beats) than men (34+/-2.3 impulses/100 cardiac beats), and a greater baroreceptor reflex sensitivity controlling efferent sympathetic nerve activity than men. The sympathetic activity was inversely and directly correlated respectively, with CBF (P=0.03) and CVR (calf vascular resistance; P=0.01) in men only. The responses of an increase in CVR to cold pressor and isometric handgrip tests were significantly smaller in women (P=0.002) than in men, despite similar increases in efferent sympathetic nerve activity. Women had a lower central sympathetic neural output to the periphery, the mechanism of which involved differences in central and reflex control, as well as a lower vasoconstrictor response to this neural output. It is suggested that this may partly explain the observed lower incidence of cardiovascular events in women compared with men.
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Affiliation(s)
- Andrew J Hogarth
- The Department of Cardiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Abstract
We planned to determine whether or not there is a difference in the level of muscle sympathetic nerve activity (MSNA) between hypertensive women and hypertensive men. Sympathetic activation of essential hypertension (EHT) has been associated with increased cardiovascular events, which are known to be less likely to occur in women than in men. Normal women have been reported to have less sympathetic nerve activity than men, but no reported data are available regarding gender differences in sympathetic activity in hypertensive subjects. We examined 36 patients with untreated and uncomplicated EHT comprising 18 women and 18 men, and 36 normal controls comprising 18 women and 18 men. MSNA was quantified as the mean frequency of single units and as multiunit bursts using the technique of microneurography. The hypertensive groups had greater sympathetic nerve activity than the control groups. Female hypertensives had lower (P<0.001) single unit hyperactivity (56+/-1.7 impulses/100 cardiac beats) than male hypertensives (72+/-1.7 impulses/100 cardiac beats). Normotensive females had lower (P<0.01) single unit activity (42+/-3.6 impulses/100 cardiac beats) than normotensive males (56+/-4.6 impulses/100 cardiac beats). Similar results were obtained for the frequency of multiunit burst activity. Hypertension in women is associated with a lower level of central sympathetic hyperactivity than in men. It is suggested that this may at least partly explain the observed lower hypertension-related cardiovascular events in women than in men. In addition, the findings may have implications for gender-specific management of hypertension.
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Affiliation(s)
- A J Hogarth
- The Department of Cardiology, St James's University Hospital, Leeds, UK.
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21
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Huggett RJ, Hogarth AJ, Mackintosh AF, Mary DASG. Sympathetic nerve hyperactivity in non-diabetic offspring of patients with type 2 diabetes mellitus. Diabetologia 2006; 49:2741-4. [PMID: 16969648 DOI: 10.1007/s00125-006-0399-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [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: 04/25/2006] [Accepted: 07/06/2006] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes mellitus with hyperinsulinaemia is a state of sympathetic nerve hyperactivity, which can develop subsequently in non-diabetic first-degree offspring of patients with type 2 diabetes. Although both type 2 diabetes and sympathetic activation are major cardiovascular risk factors, the level of sympathetic nerve activity is as yet unknown in offspring of type 2 diabetic patients who are ostensibly normal. We therefore sought to quantify sympathetic nerve activity and its relationship to plasma insulin levels in ostensibly normal offspring of patients with type 2 diabetes, relative to a matched normal control group with no family history of type 2 diabetes. SUBJECTS AND METHODS In two closely matched groups comprising 23 non-diabetic offspring of type 2 diabetic patients and 23 normal control individuals we measured resting muscle sympathetic nerve activity (MSNA) as the mean frequency of multi-unit bursts of MSNA and single units of MSNA (s-MSNA) with defined vasoconstrictor properties. RESULTS In offspring of type 2 diabetic patients, the fasting plasma levels of insulin (7.4+/-0.80 microU/ml) and s-MSNA (45+/-3.2 impulses/100 beats) were greater (p<0.009 and p<0.003) than those in control persons (4.6+/-0.76 microU/ml and 32+/-3.1 impulses/100 beats, respectively). MSNA bursts and derived insulin resistance followed similar trends. Sympathetic nerve activity was significantly correlated to insulin levels (p<0.0002) and resistance (p<0.0001) in offspring of type 2 diabetic patients, but not in control subjects. CONCLUSIONS/INTERPRETATION Sympathetic activation occurred in normal non-diabetic offspring of patients with type 2 diabetes in proportion to their plasma insulin levels. Our data indicate the presence of a mechanistic link between hyperinsulinaemia and sympathetic activation, both of which could play a role in the subsequent development of cardiovascular risk factors.
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Affiliation(s)
- R J Huggett
- Department of Cardiology, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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22
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Hogarth AJ, Mackintosh AF, Mary DASG. The sympathetic drive after acute myocardial infarction in hypertensive patients. Am J Hypertens 2006; 19:1070-6. [PMID: 17027830 DOI: 10.1016/j.amjhyper.2006.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 03/22/2006] [Accepted: 03/23/2006] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Sympathetic activation occurs in hypertension (HT) and after acute myocardial infarction (AMI) and is related to greater cardiovascular risk. Also, AMI in patients with HT (AMI-HT) carries greater risk than that in normal subjects (AMI-NT). We therefore planned to determine whether the sympathetic activation and its duration after AMI are greater in patients with antecedent HT than in patients with normal arterial pressure (NT). METHODS In 68 matched subjects with uncomplicated AMI-HT (n = 17), AMI-NT (n = 17), HT (n = 17), and NT (n = 17), we measured resting muscle sympathetic nerve activity (MSNA) as the mean frequency of multiunit bursts (m-MSNA) and single units (s-MSNA). In AMI groups data were obtained 2 to 4 days after AMI and then at 3-month intervals until MSNA returned to levels found in HT and NT. RESULTS The AMI-HT had greater (at least P < 0.05; ANOVA) s-MSNA (99 +/- 3.5 impulses/100 cardiac beats) than AMI-NT (84 +/- 2.8 impulses/100 cardiac beats). During follow up, s-MSNA hyperactivity in AMI-HT was always greater than in AMI-NT, and returned to values found in HT and NT (84 +/- 3.5 impulses/100 cardiac beats and 62 +/- 4.4 impulses/100 cardiac beats, respectively) 9 months after AMI. Similar results were obtained for m-MSNA. CONCLUSIONS AMI in hypertensives resulted in greater MSNA levels lasting at least 6 months longer than AMI in normotensives. This indicates that AMI further augmented the MSNA hyperactivity of HT and that this could be one mechanism involved in the reported worse prognosis in AMI-HT.
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Affiliation(s)
- Andrew J Hogarth
- The Department of Cardiology, St James's University Hospital, Leeds, UK.
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Hogarth AJ, Perkins R. The APLS guidelines for paediatric endotracheal tube selection - how accurate are they and do they need updating? Paediatr Anaesth 2000; 10:694. [PMID: 11119223 DOI: 10.1111/j.1460-9592.2000.ab01l.x] [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: 11/26/2022]
Affiliation(s)
- AJ Hogarth
- Department of Anaesthesia, Booth Hall Children's Hospital, Blackley, Manchester, UK
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Hogarth AJ, Hunter DE, Jacobs WA, Garleb KA, Wolf BW. Ion chromatographic determination of three fructooligosaccharide oligomers in prepared and preserved foods. J Agric Food Chem 2000; 48:5326-5330. [PMID: 11087481 DOI: 10.1021/jf000111h] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Fructooligosaccharides (FOS) are short-chain sugars that occur naturally and have dietary benefits for humans. They are widely distributed in nature and are a natural part of the human diet. The objective of this study was to determine the concentrations of 1-kestose (GF(2)), nystose (GF(3)), and 1(F)-beta-fructofuranosylnystose (GF(4)) in a variety of common processed and prepared foods. An ion chromatographic method was developed for this purpose in which the sugar concentrations were measured using integrated amperometry. The samples were simply prepared by blending with water and filtering the suspensions through a 10000 Da cutoff centrifugal filter. These samples were then injected into the ion chromatograph, which had been programmed for gradient elution, and the areas of the sugar peaks obtained compared to those of standard sugars on a calibration curve. Selected samples were prepared both with and without standard spikes in order to assess the efficiency of the determination. Of the vegetables investigated, artichokes contained by far the most FOS, followed by onions; bananas contained more FOS than other fruits investigated. The method was shown to be simple, convenient, and relatively fast for the quantitation of FOS in processed and prepared food products.
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Affiliation(s)
- A J Hogarth
- Ross Products Division, Abbott Laboratories, Columbus, Ohio 43215, USA
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Hussein HS, Campbell JM, Bauer LL, Fahey GC, Hogarth AJ, Wolf BW, Hunter DE. Selected fructooligosaccharide composition of pet-food ingredients. J Nutr 1998; 128:2803S-2805S. [PMID: 9868272 DOI: 10.1093/jn/128.12.2803s] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H S Hussein
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801 USA
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