1
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Brouner M, Hammock J, Doppalapudi H. Reciprocal Changes and Emergent Trips to the Catheterization Laboratory. JAMA Intern Med 2023:2804302. [PMID: 37093579 DOI: 10.1001/jamainternmed.2023.1045] [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: 04/25/2023]
Affiliation(s)
- Michael Brouner
- Tinsley Harrison Internal Medicine Residency Program, UAB Department of Medicine, The University of Alabama, Birmingham
| | - Jamey Hammock
- Cardiology Fellowship Program, UAB Department of Medicine, The University of Alabama, Birmingham
| | - Harish Doppalapudi
- Cardiovascular Disease, UAB Department of Medicine, The University of Alabama, Birmingham
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2
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Ives C, Doppalapudi H. HIGH-GRADE ATRIOVENTRICULAR BLOCK IN A MAN WITH RESISTANT HYPERTENSION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03221-7] [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: 03/06/2023]
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3
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Brouner M, Hammock J, Doppalapudi H. Does ST Elevation in Lead aVR Require an Emergent Trip to the Catheterization Laboratory? JAMA Intern Med 2023; 183:261-262. [PMID: 36622682 DOI: 10.1001/jamainternmed.2022.5901] [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: 01/10/2023]
Abstract
This case report describes a patient in their 50s with hypertension, chronic obstructive pulmonary disease, heavy alcohol use, and tobacco use who presented to the emergency department with a 2-month history of nausea and vomiting.
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Affiliation(s)
- Michael Brouner
- Tinsley Harrison Internal Medicine Residency Program, University of Alabama-Birmingham Department of Medicine
| | - Jamey Hammock
- Cardiology Fellowship Program, University of Alabama-Birmingham Department of Medicine
| | - Harish Doppalapudi
- Cardiovascular Disease, University of Alabama-Birmingham Department of Medicine
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4
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Centor RM, Doppalapudi H. Web Exclusive. Annals On Call - Atrial Fibrillation: Control Rate or Rhythm? Ann Intern Med 2023; 176:eA220001. [PMID: 36592469 DOI: 10.7326/a22-0001] [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: 01/04/2023] Open
Affiliation(s)
- Robert M Centor
- Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)
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5
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Han J, Husband G, Doppalapudi H. Tachycardia Associated With Pacing. Circulation 2022; 146:1475-1477. [PMID: 36343099 DOI: 10.1161/circulationaha.122.061710] [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: 11/09/2022]
Affiliation(s)
- Jingnan Han
- Department of Cardiology (J.H., H.D.), University of Alabama at Birmingham, School of Medicine
| | - Graham Husband
- Department of Internal Medicine (G.H.), University of Alabama at Birmingham, School of Medicine
| | - Harish Doppalapudi
- Department of Cardiology (J.H., H.D.), University of Alabama at Birmingham, School of Medicine
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6
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Santana JC, Doppalapudi H, Ives CW, Farag AA, Rizk DV, Kumar V, Iskandrian AE, Hage FG. Prognostic value of silent myocardial infarction in patients with chronic kidney disease after kidney transplantation. Am J Transplant 2022; 22:1115-1122. [PMID: 34967107 DOI: 10.1111/ajt.16938] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/25/2023]
Abstract
We have shown that silent myocardial infarction (SMI) on 12-lead ECG is associated with increased cardiovascular disease (CVD) risk in patients awaiting renal transplantation (RT). In this study, we evaluated the prevalence of SMI in patients undergoing RT and their prognostic value after RT. MI was determined by automated analysis of ECG. SMI was defined as ECG evidence of MI without a history of clinical MI (CMI). The primary outcome was a composite of CVD death, non-fatal MI and coronary revascularization after RT. Of the 1189 patients who underwent RT, a 12-lead ECG was available in >99%. Of the entire cohort 6% had a history of CMI while 7% had SMI by ECG. During a median follow-up of 4.6 years, 147 (12%) experienced the primary outcome (8% CVD death, 4% MI, 4% coronary revascularization) and 12% died. Both SMI and CMI were associated with an increased risk of CVD events and all-cause deaths. In a multivariable adjusted Cox-regression model, both SMI (adjusted hazard ratio 2.03 [1.25-3.30], p = .004) and CMI (2.15 [1.24-3.74], p = .007) were independently associated with the primary outcome. SMI detected by ECG prior to RT is associated with increased risk of CVD events after RT.
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Affiliation(s)
- Julio C Santana
- Internal Medicine Department, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Christopher W Ives
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ayman A Farag
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dana V Rizk
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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7
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Morgan W, Baniahmad O, Doppalapudi H. PAROXYSMAL AV BLOCK AND PRESYNCOPE IN A YOUNG WOMAN. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03548-3] [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: 10/18/2022]
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8
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Derenbecker R, Colon C, Barrios J, Arora P, Parcha V, Krothapalli S, Shah R, Plumb VJ, Doppalapudi H, McElderry HT, Maddox WR. RISK FACTORS ASSOCIATED WITH 60-DAY MORTALITY FOLLOWING CARDIAC LEAD EXTRACTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01160-3] [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: 11/17/2022]
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9
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Patel H, Doppalapudi H, Hage FG. Myocardial infarction assessment by surface electrocardiography. J Nucl Cardiol 2021; 28:1374-1377. [PMID: 31646471 DOI: 10.1007/s12350-019-01903-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Haren Patel
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, LHRB 326, 701 19th Street South, Birmingham, AL, 35294, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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10
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Prejean SP, Camacho R, Wang B, Watts TE, Daya HA, Ahmed MI, Hage FG, Bajaj NS, Doppalapudi H, Iskandrian AE. Review of Published Cases of Syncope and Sudden Death in Patients With Severe Aortic Stenosis Documented by Electrocardiography. Am J Cardiol 2021; 148:124-129. [PMID: 33667448 DOI: 10.1016/j.amjcard.2021.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
The ECG findings during sudden collapse (syncope or sudden death) in severe aortic stenosis (AS) are not well defined. We conducted a comprehensive review of the literature for ECG data during sudden collapse in patients with AS and provided a case report of our own. There were 37 published cases of syncope or sudden death in patients with severe AS which were documented by ECG. Brady- or ventricular arrhythmias were documented in 34 cases (92%). Bradyarrhythmia (n = 24; 71%) was more common at the time of collapse than ventricular tachyarrhythmia (n = 10; 29%). There was slowing of the sinus rate before bradyarrhythmia in the vast majority of patients with bradyarrhythmia but not in those presenting with ventricular tachyarrhythmia (75% vs 0%; p <0.001). ECG evidence of ischemia (ST-segment depression or elevation) was present in most patients with bradyarrhythmia but not in those with ventricular tachyarrhythmia (75% vs 0%; p = 0.011). In conclusion, our findings suggest that left ventricular baroreceptor activation plays a dominant role in the pathophysiology of sudden collapse in patients with severe AS and suggest that ischemia may play a role as well.
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11
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Wang B, Prejean S, Camacho R, Watts T, Daya HA, Ahmed M, Hage F, Bajaj N, Doppalapudi H, Iskandrian A. SYNCOPE AND SUDDEN DEATH IN A PATIENT WITH SEVERE AORTIC STENOSIS DOCUMENTED BY ELECTROCARDIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03284-8] [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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12
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Hasnie UA, Patel H, Doppalapudi H. An Unusual Case of Chest Pain With Wide Complex Arrhythmia-No Stents Needed. JAMA Intern Med 2021; 181:546-547. [PMID: 33616616 DOI: 10.1001/jamainternmed.2020.8999] [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: 11/14/2022]
Affiliation(s)
- Usman A Hasnie
- Department of Medicine, University of Alabama at Birmingham
| | - Haren Patel
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham.,Section of Cardiology, Birmingham VA Medical Center, Birmingham, Alabama
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13
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Thomas G, Choi DY, Doppalapudi H, Richards M, Iwai S, Daoud EG, Houmsse M, Kanagasundram AN, Mainigi SK, Lubitz SA, Cheung JW. Subclinical atrial fibrillation detection with a floating atrial sensing dipole in single lead implantable cardioverter-defibrillator systems: Results of the SENSE trial. J Cardiovasc Electrophysiol 2019; 30:1994-2001. [PMID: 31328298 PMCID: PMC6852241 DOI: 10.1111/jce.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Subclinical atrial fibrillation (AF), in the form of cardiac implantable device-detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter-defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort-controlled trial. METHODS AND RESULTS One hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age-, sex-, and left ventricular ejection fraction-matched single- and dual-chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow-up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single-chamber, and 19 (13%) in the dual-chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single-chamber cohort (P = .026), but not significantly different compared to the dual-chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV. CONCLUSION Use of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single-chamber ICD system.
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Affiliation(s)
- George Thomas
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y Choi
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Harish Doppalapudi
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sei Iwai
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
| | - Emile G Daoud
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Sumeet K Mainigi
- Department of Cardiology and Electrophysiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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14
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Yamada T, Kumar V, Yoshida N, Doppalapudi H. Eccentric Activation Patterns in the Left Ventricular Outflow Tract during Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit. Circ Arrhythm Electrophysiol 2019; 12:e007419. [DOI: 10.1161/circep.119.007419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
Background:
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) can be ablated from the great cardiac vein and remote endocardial sites. The ablation sites are determined by mapping in the great cardiac vein and left ventricular outflow tract. This study investigated whether that mapping could accurately predict the sites of LVS-VA origins.
Methods:
We studied 26 consecutive patients with idiopathic LVS-VA origins that were identified in the basal and apical LVS in 15 and 11 patients, respectively.
Results:
Radiofrequency catheter ablation of the apical LVS-VAs was successful in the great cardiac vein in 9 patients and in the apical LV outflow tract in 2. That of the basal LVS-VAs was successful in the aortomitral continuity in 9 patients, at the junction of the left and right coronary cusps in 4, and in the left coronary cusp in 2. Three apical LVS-VAs exhibited an eccentric endocardial activation pattern that was from the basal to apical LV outflow tract. In 11 basal LVS-VAs, the activation pattern was eccentric because the ventricular activation within the great cardiac vein in the apical LVS was earlier than that in the basal LV outflow tract. In 2 basal LVS-VAs, the activation pattern was eccentric because a relatively early ventricular activation was recorded at multiple sites away from the successful ablation site.
Conclusions:
Eccentric activation patterns often occurred during idiopathic LVS-VAs, which could mislead the catheter ablation of those VAs. Understanding such eccentric activation patterns was suggested to be able to improve the outcomes of the catheter ablation of those VAs by the anatomic approach.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Vineet Kumar
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Naoki Yoshida
- Division of Cardiovascular Disease, University of Alabama at Birmingham
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15
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Andrikopoulou E, Morgan CJ, Brice L, Bajaj NS, Doppalapudi H, Iskandrian AE, Hage FG. Incidence of atrioventricular block with vasodilator stress SPECT: A meta-analysis. J Nucl Cardiol 2019; 26:616-628. [PMID: 29043556 PMCID: PMC5904011 DOI: 10.1007/s12350-017-1081-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/16/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adenosine or regadenoson are often used with pharmacologic stress testing. Adenosine may trigger atrioventricular block (AVB). Despite its higher selectivity, regadenoson has also been associated with AVB. We studied the incidence of de novo AVB with these agents. METHODS A comprehensive search of SCOPUS was performed from inception to March 2016. Studies of at least 10 patients, using adenosine and/or regadenoson with SPECT-MPI, reporting rates of AVB were selected for further review. RESULTS Thirty four studies were pooled including 22,957 patients. Adenosine was used in 21 studies and regadenoson in 15. Both were administered in two studies. The estimated incidence of overall and high-grade AVB was 3.81% (95% CI 1.99%-6.19%) and 1.93% (95% CI 0.77%-3.59%), respectively. The incidence of AVB (8.58%; 95% CI 5.55%-12.21% vs 0.30%; 95% CI 0.04%-0.82%, respectively, P < .001) and high-grade AVB (5.21%; 95% CI 2.81%-8.30% vs 0.05%; 95% CI < .001%-0.19% respectively, P < .001) were higher with adenosine compared to regadenoson. CONCLUSION AVB is seen in about 4% of patients undergoing vasodilator stress test. Both overall and high-grade AVB are more frequent with adenosine compared to regadenoson.
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Affiliation(s)
- Efstathia Andrikopoulou
- University of Alabama at Birmingham, Birmingham, AL, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | | | - Lizbeth Brice
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Navkaranbir S Bajaj
- University of Alabama at Birmingham, Birmingham, AL, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | - Harish Doppalapudi
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Fadi G Hage
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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16
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Velasco A, Doppalapudi H. Noninvasive myocardial blood flow assessment: Another marker of arrhythmic risk? J Nucl Cardiol 2019; 26:428-430. [PMID: 28699070 DOI: 10.1007/s12350-017-0989-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Alejandro Velasco
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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17
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Abstract
BACKGROUND Recent studies of patients with pacemakers and implantable cardioverter/defibrillators have shown that subclinical atrial fibrillation (AF) is common and is associated with thromboembolic risk. We sought to evaluate the frequency, characteristics, and impact of new AF diagnosed by ambulatory 30-day rhythm monitoring. METHODS The 30-day rhythm monitoring data from January 2010 to August 2015 at our institution were reviewed. Medical record review was performed on patients that had a new or preexisting diagnosis of AF. RESULTS Of 2,326 patients without a previous diagnosis of AF, 78 had a new diagnosis of AF (3.4%) during 30-day monitoring. Patients with a new diagnosis of AF (mean age of 68.5 years, 56% female) had a mean CHA2DS2-VASc score of 3.2 (±1.8). The median time to diagnosis was 6 days, and 86% were diagnosed within 14 days. In 31 patients (40%), AF was exclusively detected automatically by the monitor. Of 46 patients that had manually activated the monitor, 34 also had automatically detected AF. Each patient had a median of 7 episodes, with the median duration of the longest episode being approximately 2 hours. Following the diagnosis of AF, 37 (47%) were started on anticoagulation and 9 (12%) were prescribed aspirin. CONCLUSIONS A total of 3.4% of patients who underwent 30-day rhythm monitoring for any indication were found to have a new diagnosis of AF (402 per 1000 patient-years). Most of these episodes were detected automatically, corresponding to device-detected subclinical AF. The most common intervention following diagnosis of AF was initiation of oral anticoagulation.
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Affiliation(s)
- Gary Ross Farris
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Blake G Smith
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ethan T Oates
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Chad Colon
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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18
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Yamada T, Yoshida N, Litovsky SH, Itoh T, Doppalapudi H, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Infundibular Muscles. Circ Arrhythm Electrophysiol 2018; 11:e005749. [DOI: 10.1161/circep.117.005749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/03/2017] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Taihei Itoh
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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19
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Farag AA, AlJaroudi W, Neill J, Doppalapudi H, Kumar V, Rizk D, Iskandrian AE, Hage FG. Prognostic value of silent myocardial infarction in patients with chronic kidney disease being evaluated for kidney transplantation. Int J Cardiol 2017; 249:377-382. [PMID: 28958755 DOI: 10.1016/j.ijcard.2017.09.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 08/20/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with advanced chronic kidney disease (CKD) have increased risk of myocardial infarction (MI). Silent MIs (SMIs) are common in CKD patients and carry increased mortality risk. The prevalence and prognostic value of SMI in advanced CKD has not been evaluated. METHODS We identified consecutive patients with advanced CKD who were evaluated for renal transplantation at the University of Alabama at Birmingham between June 2004 and January 2006. Clinical MI (CMI) was determined by review of medical records. SMI was defined as ECG evidence of MI without clinical history of MI. The primary end-point was a composite of death, MI, or coronary revascularization censored at time of renal transplantation. RESULTS The cohort included 1007 patients with advanced CKD aged 48±12years (58% men, 43% diabetes, 75% on dialysis). The prevalence of SMI and CMI was 10.7% and 6.7%, respectively. The only independent predictor of SMI was older age (odds ratio for age ≥50yrs. 2.32, p<0.001). During a median follow-up of 28months, 376 (37%) patients experienced the primary outcome (33% death, 2% MI, 5% coronary revascularization). In a multivariable adjusted Cox-regression model, both SMI (adjusted HR 1.58, [1.13-2.20], p=0.007) and CMI (adjusted HR 1.67 [1.15-2.43], p=0.007) were independently associated with the primary outcome. Further, both SMI (HR 2.37 [1.15-4.88], p=0.02) and CMI (HR 4.02 [1.80-8.98], p=0.001) were associated with increased risk after renal transplantation. CONCLUSIONS SMI is more common than CMI in patients with advanced CKD. Both SMI and CMI are associated with increased risk of future cardiovascular events.
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Affiliation(s)
- Ayman A Farag
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - John Neill
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vineeta Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dana Rizk
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, United States.
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20
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Shah RR, Pillai A, Schafer P, Meggo D, McElderry T, Plumb V, Yamada T, Kumar V, Doppalapudi H, Gunter A, Pentecost E, Maddox WR. Safety and Efficacy of Uninterrupted Apixaban Therapy Versus Warfarin During Atrial Fibrillation Ablation. Am J Cardiol 2017; 120:404-407. [PMID: 28595862 DOI: 10.1016/j.amjcard.2017.04.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Thromboembolic cerebrovascular accident remains a rare but potentially devastating complication of catheter-based atrial fibrillation (AF) ablation. Uninterrupted oral anticoagulant therapy with warfarin has become the standard of care when performing catheter-based AF ablation. Compared with warfarin, apixaban, a factor Xa inhibitor, has been shown to reduce the risk of stroke and major bleeding in nonvalvular AF. With an increase in apixaban use for stroke prophylaxis in patients with AF, there is an increased interest in the safety and efficacy of uninterrupted apixaban therapy during AF ablation. We compared the safety and efficacy of uninterrupted OA therapy with either warfarin or apixaban in all patients who underwent catheter-based AF ablation at the University of Alabama at Birmingham and at Augusta University Medical Center from January 7, 2013, to February 25, 2016. All patients underwent a transesophageal echocardiogram on the day of their ablation to assess for the presence of intracardiac thrombi. All complications were identified and classified as bleeding, thromboembolic events, or other. A total of 627 patients were analyzed as described earlier. There were 310 patients in the warfarin group and 317 patients in the apixaban group. There were 8 complications in the warfarin group and 5 complications in the apixaban group (p = 0.38). There were no thromboembolic complications in either group. In conclusion, the use of apixaban is as safe and effective as warfarin for uninterrupted OA therapy during catheter-based ablation of AF.
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21
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Yamada T, Yoshida N, Itoh T, Litovsky SH, Doppalapudi H, McElderry HT, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Parietal Band. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005099. [DOI: 10.1161/circep.117.005099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/28/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
Backgrounds—
The parietal band is one of the muscle bands in the right ventricle. This study investigated the electrocardiographic and electrophysiological characteristics and ablation outcome of idiopathic ventricular arrhythmias (VAs) originating from the parietal band.
Methods and Results—
We studied 14 patients with idiopathic VA origins in the parietal band among 294 consecutive patients with VA origins in the right ventricle. The QRS morphologies of the parietal band VAs were characterized by a left bundle branch block and left inferior (n=12) or superior (n=2) axis pattern with the presence of a notch in the middle of the QRS in all cases, precordial transition at ≤lead V3 in 7 patients, and a slow QRS onset in 4 patients. During parietal band VAs, a far-field ventricular electrogram with an early activation was always recorded in the His bundle region, regardless of the location of the VA origins. During the catheter ablation, a mean number of 10.4±7.4 radiofrequency applications with a duration of 1099±1034 seconds were delivered. Catheter ablation was successful in 10 patients, and VAs recurred in 4 during a mean follow-up period of 41±24 months. A change in the QRS morphology was observed spontaneously in 4 patients, immediately after the ablation in 4, and at the time of a VA recurrence in 2.
Conclusions—
Idiopathic VAs rarely originated from the parietal band. The catheter ablation of the parietal band VAs was always challenging, requiring a large amount of the radiofrequency energy delivery for a successful ablation with a relatively high recurrence rate.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Taihei Itoh
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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22
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Itoh T, Doppalapudi H, Yamada T. Epicardial ventricular tachycardia successfully ablated from the left atrium in a case with a prior mitral valve repair. Europace 2017; 19:1356. [PMID: 28379557 DOI: 10.1093/europace/eux049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Taihei Itoh
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294, USA
| | - Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294, USA
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23
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Yamada T, Yoshida N, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Efficacy of an Anatomical Approach in Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2017; 10:e004959. [DOI: 10.1161/circep.116.004959] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/18/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
Background—
When anatomic obstacles preclude radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT), an alternative approach from the anatomically opposite side (endocardial versus epicardial or above versus below the aortic valve) may be considered (anatomic ablation). The purpose of this study was to investigate the efficacy of an anatomic ablation in idiopathic LVOT VAs.
Methods and Results—
We studied 229 consecutive patients with idiopathic LVOT VAs. Radiofrequency ablation from the first suitable site was successful in 190 patients, and in the remaining 39 patients, it was unsuccessful or had to be abandoned because of anatomic obstacles. In 22 of these 39 patients, an anatomic ablation was successful, and the VA origins were located in the intramural LVOT in 17 patients, basal left ventricular summit in 4, and LVOT septum near the His bundle in 1. The anatomic ablation was highly successful for idiopathic VAs originating from the intramural LVOT (>75%) and lateral LVOT, whereas it was unlikely to be successful for idiopathic VAs originating from the basal left ventricular summit (25%) and sepal LVOT.
Conclusions—
When a standard catheter ablation targeting the best electrophysiological measure of idiopathic LVOT VAs was unsuccessful or had to be abandoned because of anatomic obstacles, an anatomic ablation was moderately successful. These idiopathic LVOT VAs with a successful anatomic ablation commonly arose from the intramural LVOT among the left coronary cusp, aortomitral continuity, and epicardium, occasionally the basal left ventricular summit, and rarely the LVOT septum near the His bundle.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
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24
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Doppalapudi H, Barrios J, Cuellar J, Gannon M, Yamada T, Kumar V, Maddox WR, Plumb VJ, Brown TM, McElderry HT. Significant Discrepancy Between Estimated and Actual Longevity in St. Jude Medical Implantable Cardioverter-Defibrillators. J Cardiovasc Electrophysiol 2017; 28:552-558. [PMID: 28181727 DOI: 10.1111/jce.13178] [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: 12/13/2016] [Revised: 01/15/2017] [Accepted: 01/31/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Real-time estimated longevity has been reported in pacemakers for several years, and was recently introduced in implantable cardioverter-defibrillators (ICDs). OBJECTIVE We sought to evaluate the accuracy of this longevity estimate in St. Jude Medical (SJM) ICDs, especially as the device battery approaches depletion. METHODS Among patients with SJM ICDs who underwent generator replacements due to reaching elective replacement indicator (ERI) at our institution, we identified those with devices that provided longevity estimates and reviewed their device interrogations in the 18 months prior to ERI. Significant discrepancy was defined as a difference of more than 12 months between estimated and actual longevity at any point during this period. RESULTS Forty-six patients with Current/Promote devices formed the study group (40 cardiac resynchronization therapy [CRT] and 6 single/dual chamber). Of these, 34 (74%) had significant discrepancy between estimated and actual longevity (28 CRT and all single/dual). Longevity was significantly overestimated by the device algorithm (mean maximum discrepancy of 18.8 months), more in single/dual than CRT devices (30.5 vs. 17.1 months). Marked discrepancy was seen at voltages ≥2.57 volts, with maximum discrepancy at 2.57 volts (23 months). The overall longevity was higher in the discrepant group of CRT devices than in the nondiscrepant group (67 vs. 61 months, log-rank P = 0.03). CONCLUSIONS There was significant overestimation of longevity in nearly three-fourths of Current/Promote SJM ICDs in the last 18 months prior to ERI. Longevity estimates of SJM ICDs may not be reliable for making clinical decisions on frequency of follow-up, as the battery approaches depletion.
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Affiliation(s)
- Harish Doppalapudi
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James Barrios
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Melanie Gannon
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Takumi Yamada
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vineet Kumar
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Maddox
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vance J Plumb
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Todd M Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - H Tom McElderry
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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25
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Reddy VY, Miller MA, Knops RE, Neuzil P, Defaye P, Jung W, Doshi R, Castellani M, Strickberger A, Mead RH, Doppalapudi H, Lakkireddy D, Bennett M, Sperzel J. Retrieval of the Leadless Cardiac Pacemaker. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004626. [DOI: 10.1161/circep.116.004626] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 07/24/2016] [Accepted: 10/26/2016] [Indexed: 11/16/2022]
Abstract
Background—
Leadless cardiac pacemakers have emerged as a safe and effective alternative to conventional transvenous single-chamber ventricular pacemakers. Herein, we report a multicenter experience on the feasibility and safety of acute retrieval (<6 weeks) and chronic retrieval (>6 weeks) of the leadless cardiac pacemaker in humans.
Methods and Results—
This study included patients enrolled in 3 multicenter trials, who received a leadless cardiac pacemaker implant and who subsequently underwent a device removal attempt. The overall leadless pacemaker retrieval success rate was 94%: for patients whose leadless cardiac pacemaker had been implanted for <6 weeks (acute retrieval cohort), complete retrieval was achieved in 100% (n=5/5); for those implanted for ≥ 6 weeks (chronic retrieval cohort), retrieval was achieved in 91% (n=10/11) of patients. The mean duration of time from implant to retrieval attempt was 346 days (range, 88–1188 days) in the chronic retrieval cohort, and nearly two thirds (n=7; 63%) had been implanted for >6 months before the retrieval attempt. There were no procedure-related adverse events at 30 days post retrieval procedure.
Conclusions—
This multicenter experience demonstrated the feasibility and safety of retrieving a chronically implanted single-chamber (right ventricle) active fixation leadless pacemaker.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT02051972, NCT02030418, and NCT01700244.
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Affiliation(s)
- Vivek Y. Reddy
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Marc A. Miller
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Reinoud E. Knops
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Petr Neuzil
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Pascal Defaye
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Werner Jung
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Rahul Doshi
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Mark Castellani
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Adam Strickberger
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - R. Hardwin Mead
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Harish Doppalapudi
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Dhanunjaya Lakkireddy
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Matthew Bennett
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
| | - Johannes Sperzel
- From the Helmsley Center for Electrophysiology, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., M.A.M.); Department of Cardiology, Amsterdam Medical Center, The Netherlands (R.E.K.); Department of Cardiology, Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.); Department of Cardiology, CHU, Grenoble, France (P.D.); Department of Cardiology, Schwarzwald Baar Klinikum, Villingen-Schwenningen, Germany (W.J.); Division of Cardiovascular Diseases, USC University Hospital, Los Angeles,
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Abstract
Sudden cardiac death (SCD) continues to be a major public health problem and is thought to account for almost half of all cardiac deaths. Cardiac arrest and SCD are most commonly due to ventricular arrhythmias. Most patients who suffer cardiac arrest have underlying structural heart disease, with coronary artery disease (CAD) being the most common. In the setting of CAD, ventricular arrhythmias can result due to acute ischemia in the absence of preexisting myocardial scarring or in the presence of established scar from prior infarction without clinically significant ischemia. LV systolic dysfunction is an important predictor of risk for SCD in ischemic heart disease and in most nonischemic disorders, although other factors such as ventricular hypertrophy also play a role. Cardiac arrest and SCD can also occur due to primary electrical disorders in the absence of major structural abnormalities.
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Affiliation(s)
- Samuel K McElwee
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alejandro Velasco
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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27
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Yamada T, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004202. [DOI: 10.1161/circep.116.004202] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs.
Methods and Results—
Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied. RFCA was successful within the main trunk of the GCV in 16 patients and within a branch of the GCV traversing the basal LV (B-LV) summit in 7. Transpericardial RFCA was successful on the epicardial surface in the A-LV summit in 6 patients and was abandoned in 14 with the B-LV summit VAs because of the close proximity to the coronary arteries and thick fat pads. RFCA was successful at the aortomitral continuity in 3 patients (2 with a failed transpericardial RFCA), and left coronary cusp in 1. The RFCA success rate of the A-LV summit VAs including the GCV VAs was 100% (22/22), whereas that of the B-LV summit VAs was 48% (11/23). The B-LV summit VAs could be differentiated from the A-LV summit VAs by left bundle branch block pattern, QRS duration ≤175 ms, precordial transition ≥V1, and maximum deflection index of ≥0.55.
Conclusions—
This study revealed that ≈50% of the B-LV summit VAs could be eliminated by a direct approach through a GCV branch running below the proximal left coronary arteries and a remote approach from the adjacent endocardial sites.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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28
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Yamada T, Doppalapudi H, Maddox WR, McElderry HT, Plumb VJ, Kay GN. Prevalence and Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004079. [DOI: 10.1161/circep.116.004079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 01/26/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from both the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the prevalence and electrocardiographic and electrophysiological characteristics of these idiopathic intramural LVOT VAs when compared with the idiopathic endocardial and epicardial LVOT VAs.
Methods and Results—
We studied 82 consecutive VAs with origins in the aortomitral continuity (n=30), LV summit (n=34), and intramural site (n=18). The maximum deflection index (the time to the maximum deflection in the precordial leads/QRS duration) was the largest in LV summit VAs (0.52±0.07), smallest in aortomitral continuity VAs (0.45±0.06), and midrange in intramural VAs (0.49±0.05). The electrocardiographic and electrophysiological characteristics of the intramural LVOT VAs were similar to those of the aortomitral continuity VAs. The intramural LVOT VAs exhibited a significantly smaller R-wave amplitude ratio in leads III to II, and ratio of the Q-wave amplitude in leads aVL to aVR, and a significantly earlier and later local ventricular activation time relative to the QRS onset at the His bundle and successful ablation sites than the LV summit VAs, respectively.
Conclusions—
Intramural sites account for a significant proportion of LVOT VAs. The electrocardiographic and electrophysiological characteristics of the idiopathic intramural LVOT VAs were midrange between those of the idiopathic endocardial and epicardial LVOT VAs, and more similar to those of the idiopathic endocardial LVOT VAs than those of the idiopathic epicardial LVOT VAs.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
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Knops R, Reddy VY, Defaye P, Jung W, Doshi R, Castellani M, Strickberger A, Mead RH, Doppalapudi H, Sperzel J. 9-04: Worldwide Clinical Experience of the Retrieval of Leadless Cardiac Pacemakers. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i24] [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: 11/14/2022] Open
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Yamada T, Doppalapudi H, Kay GN. Ventricular tachycardia originating from the right ventricular outflow tract in a patient with dextrocardia. Europace 2015; 17:1579. [PMID: 26498717 DOI: 10.1093/europace/euv213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA
| | - Harish Doppalapudi
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA
| | - G Neal Kay
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA
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Abstract
Fabry disease is an X-linked multisystem disorder caused by deficiency of the α-galactosidase A enzyme. Cardiovascular manifestations include hypertension, coronary disease, arrhythmias, valvular abnormalities, heart failure, and sudden death. Bradycardia and conduction system abnormalities are related initially to abnormal accumulation of glycolipids in the lysosomes of conduction tissues. Hypertrophy and eventual fibrosis provides a substrate for persistent conduction abnormalities and ventricular arrhythmias. Sudden cardiac death can be related to bradyarrhythmias or tachycardias. Enzyme replacement therapy can improve cardiac function and clinical outcomes. Pacemakers or defibrillators are important in the treatment of patients with Fabry disease who are at risk for arrhythmias.
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Affiliation(s)
- Deepak Acharya
- Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1900 University Boulevard, THT 321, Birmingham, AL 35294, USA.
| | - Harish Doppalapudi
- Section of Electrophysiology, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Faculty Office Tower, Room 930, 1530 3rd Avenue South, Birmingham, AL 35294-3400, USA
| | - José A Tallaj
- Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1900 University Boulevard, THT 321, Birmingham, AL 35294, USA
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Yamada T, Maddox WR, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2015; 8:344-52. [PMID: 25637597 DOI: 10.1161/circep.114.002259] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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] [Received: 08/27/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the efficacy of sequential and simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides in treating intramural LVOT VAs.
Methods and Results—
Fourteen consecutive LVOT VAs, which required sequential or simultaneous irrigated unipolar radiofrequency ablation from the endocardial and epicardial sides for their elimination, were studied. The first ablation was performed at the site with the earliest local ventricular activation and best pace map on the endocardial or epicardial side. When the first ablation was unsuccessful, the second ablation was delivered on the other surface. If this sequential unipolar ablation failed, simultaneous unipolar ablation from both sides was performed. The first ablation was performed on the epicardial side in 9 VAs and endocardial side in 5 VAs. The intramural LVOT VAs were successfully eliminated by the sequential (n=9) or simultaneous (n=5) unipolar catheter ablation. Simultaneous ablation was most likely to be required for the elimination of the VAs when the distance between the endocardial and epicardial ablation sites was >8 mm and the earliest local ventricular activation time relative to the QRS onset during the VAs of <–30 ms was recorded at those ablation sites.
Conclusions—
LVOT VAs originating from intramural foci could usually be eliminated by sequential unipolar radiofrequency ablation and sometimes required simultaneous ablation from both the endocardial and epicardial sides.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
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Yamada T, Lau YR, Litovsky SH, Thomas McElderry H, Doppalapudi H, Osorio J, Plumb VJ, Neal Kay G. Prevalence and clinical, electrocardiographic, and electrophysiologic characteristics of ventricular arrhythmias originating from the noncoronary sinus of Valsalva. Heart Rhythm 2013; 10:1605-12. [DOI: 10.1016/j.hrthm.2013.08.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Indexed: 11/26/2022]
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Jennings JM, Robichaux R, McElderry HT, Plumb VJ, Gunter A, Doppalapudi H, Osorio J, Yamada T, Kay GN. Cardiovascular implantable electronic device implantation with uninterrupted dabigatran: comparison to uninterrupted warfarin. J Cardiovasc Electrophysiol 2013; 24:1125-9. [PMID: 23889767 DOI: 10.1111/jce.12214] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 03/11/2013] [Revised: 05/04/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND While continuation of oral anticoagulation (OAC) with warfarin may be preferable to interruption and bridging with heparin for patients undergoing cardiovascular implantable electronic device (CIED) implantation, it is uncertain whether the same strategy can be safely used with dabigatran. OBJECTIVE AND METHODS To determine the risk of bleeding and thromboembolic complications associated with uninterrupted OAC during CIED implantation, replacement, or revision, the outcomes of patients receiving uninterrupted dabigatran (D) were compared to those receiving warfarin (W). RESULTS D was administered the day of CIED implant in 48 patients (age 66 ± 12.4 years, 13 F and 35 M, 21 ICDs and 27 PMs), including new implant in 25 patients, replacement in 14 patients, and replacement plus lead revision in 9 patients. D was held the morning of the procedure in 14 patients (age 70 ± 11 years, 4 F and 10 M, 5 ICDs and 9 PMs). W was continued in 195 patients (age 60 ± 14.4 years, 54 F, and 141 M), including new implant in 122 patients, replacement in 33 patients, and replacement plus lead revision or upgrade in 40 patients. Bleeding complications occurred in 1 of 48 patients (2.1%) with uninterrupted dabigatran (a late pericardial effusion), 0 of 14 with interrupted D, and 9 of 195 patients (4.6%) on W (9 pocket hematomas), P = 0.69. Fifty percent of bleeding complications were associated with concomitant antiplatelet medications. CONCLUSIONS The incidence of bleeding complications is similar during CIED implantation with uninterrupted D or W. The risks are higher when OAC is combined with antiplatelet drugs.
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Affiliation(s)
- John M Jennings
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Yamada T, Robertson PG, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. Successful reduction of a high defibrillation threshold by a combined implantation of a subcutaneous array and azygos vein lead. Pacing Clin Electrophysiol 2012; 35:e173-6. [PMID: 22360586 DOI: 10.1111/j.1540-8159.2012.03332.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 72-year-old man with nonischemic cardiomyopathy was referred because his implantable cardioverter defibrillator had failed to terminate spontaneous ventricular fibrillation (VF). Defibrillation threshold (DFT) testing confirmed that 830-V shocks failed to defibrillate VF despite optimization of the biphasic waveform and reversal of shock polarity. The placement of a new right ventricular lead and the addition of a subcutaneous array failed to defibrillate VF at 830 V. The combination of a subcutaneous array and azygos vein coil successfully defibrillated VF. The mechanism for successful DFT reduction was likely greater current supplied to the posterior basal left ventricle by the azygos vein lead.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Great cardiac venography by contrast injection through an external irrigation catheter. Heart Rhythm 2012; 9:156-7. [DOI: 10.1016/j.hrthm.2010.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Indexed: 11/29/2022]
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Atrial tachycardia originating from the junction of the right atrium and a diverticulum of the inferior vena cava. Circ Arrhythm Electrophysiol 2011; 4:e44-6. [PMID: 21846882 DOI: 10.1161/circep.111.964015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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Yamada T, Plumb VJ, Allred JD, McElderry HT, Doppalapudi H, Kay GN. Idiopathic ventricular tachycardia originating from the left ventricle near the His bundle. Pacing Clin Electrophysiol 2011; 33:e114-8. [PMID: 20345625 DOI: 10.1111/j.1540-8159.2010.02734.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man with idiopathic ventricular tachycardia (VT) exhibiting left bundle branch block and left inferior axis QRS morphology with a Qr in lead III underwent electrophysiological testing. Successful ablation was achieved in the left ventricle (LV) at a site with an excellent pace map, adjacent to the His bundle electrogram recording site. At that site, the sequence of the ventricular electrogram and late potential recorded during sinus rhythm reversed during spontaneous premature ventricular contractions with the same QRS morphology as the VT. This case shows that VT can arise from the LV ostium adjacent to the membranous septum.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. A couplet of PVCs with different QRS morphologies arising from a single origin in the left ventricular outflow tract. Pacing Clin Electrophysiol 2011; 33:e88-92. [PMID: 20230472 DOI: 10.1111/j.1540-8159.2010.02716.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 59-year-old man with two different premature ventricular contractions (PVCs) forming a couplet underwent electrophysiological testing. Although pacing from the aorto-mitral continuity (AMC) produced an excellent pace map of one type of PVCs, a radiofrequency application within the right coronary cusp (RCC) eliminated all the PVCs. This case demonstrates that a single origin with two breakout sites in the left ventricular ostium (LVos) may result in a couplet consisting of different PVCs and preferential conduction from the RCC to AMC may also occur. These possibilities should be kept in our mind when predicting sites of origin of LVos ventricular arrhythmias.
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Yamada T, Robertson PJ, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. An atrial tachycardia with altered atrial activation sequences within the coronary sinus: what is the mechanism? J Cardiovasc Electrophysiol 2011; 22:220-1. [PMID: 21314747 DOI: 10.1111/j.1540-8167.2010.01902.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: 12/01/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Yamada T, Doppalapudi H, McElderry HT, Plumb VJ, Kay GN. Successful epicardial catheter ablation of a septal ventricular tachycardia after myocardial infarction. Pacing Clin Electrophysiol 2011; 35:e116-9. [PMID: 21208235 DOI: 10.1111/j.1540-8159.2010.02996.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 55-year-old man underwent catheter ablation of ventricular tachycardia (VT) after anterior myocardial infarction. Although electrophysiological study suggested that the VT originated from the septum, biventricular endocardial irrigated radiofrequency ablation failed to interrupt the VT. Epicardial ablation at the site located halfway between the lesions in the right and left ventricles via a pericardial approach eliminated the VT, suggesting that the VT likely originated from the top of the septum. When VTs originating from the upper septum are refractory to endocardial ablation, epicardial mapping and ablation may be considered because only that site may be accessible with an epicardial approach.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Okada T, Murakami Y, Yoshida Y, Yoshida N, Inden Y, Murohara T, Plumb VJ, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit. Circ Arrhythm Electrophysiol 2010; 3:616-23. [DOI: 10.1161/circep.110.939744] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [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)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Okada
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshimasa Murakami
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiko Yoshida
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yamada T, Tabereaux PB, McElderry HT, Doppalapudi H, Kay GN. Idiopathic premature ventricular contractions arising from the intraventricular septum adjacent to the his bundle. Pacing Clin Electrophysiol 2010; 35:e108-11. [PMID: 21091731 DOI: 10.1111/j.1540-8159.2010.02959.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/29/2022]
Abstract
A 57-year-old woman with idiopathic premature ventricular contractions (PVCs) exhibiting a left bundle branch block and left inferior axis QRS morphology underwent electrophysiological testing. Mapping revealed that the earliest ventricular activation times during the PVCs recorded on either side of the interventricular septum were the same and no excellent pace maps were reproduced at these sites. Successful radiofrequency catheter ablation was achieved in the right ventricular septum adjacent to the recording site of the His bundle electrogram. These findings suggested that the origin of this PVC was located in the intraventricular septum rather than the endocardial surface.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Bowman K, Popple R, Doppalapudi H, Fiveash J, Meredith R, Brezovich I, Bonner J, Spencer S. Monitoring Cardiovascular Implantable Electronic Devices (CIEDs) for Patients Receiving Radiotherapy (RT). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1395] [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: 11/26/2022]
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Idiopathic premature ventricular contractions successfully ablated from the epicardial right ventricular outflow tract. Europace 2010; 13:595-7. [PMID: 20974761 DOI: 10.1093/europace/euq395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A case of idiopathic premature ventricular contractions successfully ablated from the epicardial right ventricular outflow tract (RVOT) via the subxiphoid pericardial approach was described. The sites with earliest endocardial and epicardial ventricular activation were located adjacent to each other in the RVOT and at both sites, double potentials were recorded. Coronary angiography was helpful for identifying the ablation site.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA.
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Kim EM, Desai RV, Doppalapudi H, Lloyd SG. Boomerang-shaped heart in isolated dextroversion. Eur Heart J 2010; 32:247. [PMID: 20861139 DOI: 10.1093/eurheartj/ehq363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eddie M Kim
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Cardiovascular MRI, 1808 7th Avenue South, Birmingham, AL 35294, USA
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Yamada T, Doppalapudi H, McElderry HT, Plumb VJ, Kay GN. Demonstration of a right ventricular substrate of ventricular tachycardia after myocardial infarction. Europace 2010; 13:133-5. [PMID: 20858693 DOI: 10.1093/europace/euq345] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 57-year-old man with prior anteroseptal myocardial infarction underwent catheter ablation of ventricular tachycardia (VT) exhibiting a left bundle branch block QRS morphology. After failed left ventricular ablation, catheter ablation from the right ventricle (RV) eliminated the VT. An RV voltage map demonstrated an area of low voltage around the successful ablation site that likely allowed for a VT substrate.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA.
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Yamada T, Plumb VJ, McElderry HT, Doppalapudi H, Epstein AE, Kay GN. Focal ventricular arrhythmias originating from the left ventricle adjacent to the membranous septum. Europace 2010; 12:1467-74. [DOI: 10.1093/europace/euq259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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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Yamada T, Doppalapudi H, McElderry HT, Okada T, Murakami Y, Inden Y, Yoshida Y, Yoshida N, Murohara T, Epstein AE, Plumb VJ, Litovsky SH, Kay GN. Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: relevance for catheter ablation. Circ Arrhythm Electrophysiol 2010; 3:324-31. [PMID: 20558848 DOI: 10.1161/circep.109.922310] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular papillary muscles (PAMs). This study investigated the electrophysiological characteristics of these VAs and their relevance for the results of catheter ablation. METHODS AND RESULTS We studied 19 patients who underwent successful catheter ablation of idiopathic VAs originating from the anterior (n=7) and posterior PAMs (n=12). Although an excellent pace map was obtained at the first ablation site in 17 patients, radiofrequency ablation at that site failed to eliminate the VAs, and radiofrequency lesions in a relatively wide area around that site were required to completely eliminate the VAs in all patients. Radiofrequency current with an irrigated or nonirrigated 8-mm-tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins. During 42% of the PAM VAs, a sharp ventricular prepotential was recorded at the successful ablation site. In 9 (47%) patients, PAM VAs exhibited multiple QRS morphologies, with subtle, but distinguishable differences occurring spontaneously and after the ablation. In 7 (78%) of those patients, radiofrequency lesions on both sides of the PAMs where pacing could reproduce an excellent match to the 2 different QRS morphologies of the VAs were required to completely eliminate the VAs. CONCLUSIONS Radiofrequency catheter ablation of idiopathic PAM VAs is challenging probably because the VA origin is located relatively deep beneath the endocardium of the PAMs. PAM VAs often exhibit multiple QRS morphologies, which may be caused by a single origin with preferential conduction resulting from the complex structure of the PAMs.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease and Department of Pathology, University of Alabama at Birmingham, 1670 University Blvd., 1530 3rd Ave. S., Birmingham, AL 35294-0019, USA.
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Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, Iskandrian AE. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010; 17:398-404. [PMID: 20300907 DOI: 10.1007/s12350-009-9169-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [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: 09/24/2009] [Accepted: 11/05/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Left-ventricular (LV) dyssynchrony could be measured by gated SPECT myocardial perfusion imaging (MPI). This study examined the relation between the degree of dyssynchrony and outcome in patients with implantable cardiac defibrillators (ICDs). METHODS AND RESULTS We studied 70 patients with ICD and LV ejection fraction (EF) <.40 by gated MPI (performed within 6 weeks of the device implantation). The images were re-processed using phase analysis to derive phase standard deviation (SD) and histogram bandwidth. All-cause mortality and appropriate ICD shocks were identified as the primary endpoint. There were 87% men, aged 62 +/- 11 years. The EF was 26 +/- 8% (range 12%-39%). The phase SD was 51 degrees +/- 20 degrees (range 12 degrees -99 degrees ) and the histogram bandwidth was 157 degrees +/- 72 degrees (range 21 degrees -327 degrees ). The SD and bandwidth were significantly greater than corresponding values in patients with normal EF (15.8 +/- 11.8 degrees and 42.0 +/- 28.4 degrees , respectively, P < .0001, each). At 1 year, 8 patients (11%) died or had shocks. The patients with events had higher phase SD than those without events (60 +/- 5 degrees vs 50 +/- 21 degrees , P = .002). The histogram bandwidth was also higher in those with events (185 +/- 37 vs 154 +/- 75, P = .07). All patients with event had a phase SD >or= 50 degrees , while none of the patients with a phase SD < 50 degrees (N = 26) had an event (P = .02). CONCLUSIONS The severity of LV dyssynchrony by phase analysis in patients with LV dysfunction, and ICD is associated with increased risk of death and appropriate ICD shock; a phase SD < 50 degrees was associated with no events at 1 year.
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Affiliation(s)
- Wael A Aljaroudi
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 318 LHRB, 1900 University BLVD, Birmingham, AL 35294-0006, USA.
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