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Monkhouse C, Fazil S, Binoy J, Harvie H, Granville H, Proctor W, Maclean E, Schilling R, Chow A, Finlay M, Honarbakhsh S, Hunter R, Lambiase PD, Providencia R, Ahsan S, Earley M. A Non-Physician, Outpatient Implantable Loop Recorder Explant Service Is Safe And Cost Effective. The OLÉ Audit. Heart Rhythm 2024:S1547-5271(24)02530-X. [PMID: 38704078 DOI: 10.1016/j.hrthm.2024.04.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ross Hunter
- Barts Heart Centre, West Smithfield, London, UK
| | - Pier D Lambiase
- Barts Heart Centre, West Smithfield, London, UK; Institute of Cardiovascular Science, University College London (UCL), London, UK
| | - Rui Providencia
- Barts Heart Centre, West Smithfield, London, UK; Institute of Cardiovascular Science, University College London (UCL), London, UK
| | - Syed Ahsan
- Barts Heart Centre, West Smithfield, London, UK
| | - Mark Earley
- Barts Heart Centre, West Smithfield, London, UK
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Maclean E, Mahtani K, Honarbakhsh S, Butcher C, Ahluwalia N, Dennis AS, Creta A, Finlay M, Elliott M, Mehta V, Wijesuriya N, Shaikh O, Zaw Y, Ogbedeh C, Gautam V, Lambiase PD, Schilling RJ, Earley MJ, Moore P, Muthumala A, Sporton SC, Hunter RJ, Rinaldi CA, Behar J, Martin C, Monkhouse C, Chow A. The BLISTER Score: A Novel, Externally Validated Tool for Predicting Cardiac Implantable Electronic Device Infections, and Its Cost-Utility Implications for Antimicrobial Envelope Use. Circ Arrhythm Electrophysiol 2024; 17:e012446. [PMID: 38258308 PMCID: PMC10949977 DOI: 10.1161/circep.123.012446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Antimicrobial envelopes reduce the incidence of cardiac implantable electronic device infections, but their cost restricts routine use in the United Kingdom. Risk scoring could help to identify which patients would most benefit from this technology. METHODS A novel risk score (BLISTER [Blood results, Long procedure time, Immunosuppressed, Sixty years old (or younger), Type of procedure, Early re-intervention, Repeat procedure]) was derived from multivariate analysis of factors associated with cardiac implantable electronic device infection. Diagnostic utility was assessed against the existing PADIT score (Prior procedure, Age, Depressed renal function, Immunocompromised, Type of procedure) in both standard and high-risk external validation cohorts, and cost-utility models examined different BLISTER and PADIT score thresholds for TYRX (Medtronic; Minneapolis, MN) antimicrobial envelope allocation. RESULTS In a derivation cohort (n=7383), cardiac implantable electronic device infection occurred in 59 individuals within 12 months of a procedure (event rate, 0.8%). In addition to the PADIT score constituents, lead extraction (hazard ratio, 3.3 [95% CI, 1.9-6.1]; P<0.0001), C-reactive protein >50 mg/L (hazard ratio, 3.0 [95% CI, 1.4-6.4]; P=0.005), reintervention within 2 years (hazard ratio, 10.1 [95% CI, 5.6-17.9]; P<0.0001), and top-quartile procedure duration (hazard ratio, 2.6 [95% CI, 1.6-4.1]; P=0.001) were independent predictors of infection. The BLISTER score demonstrated superior discriminative performance versus PADIT in the standard risk (n=2854, event rate: 0.8%, area under the curve, 0.82 versus 0.71; P=0.001) and high-risk validation cohorts (n=1961, event rate: 2.0%, area under the curve, 0.77 versus 0.69; P=0.001), and in all patients (n=12 198, event rate: 1%, area under the curve, 0.8 versus 0.75, P=0.002). In decision-analytic modeling, the optimum scenario assigned antimicrobial envelopes to patients with BLISTER scores ≥6 (10.8%), delivering a significant reduction in infections (relative risk reduction, 30%; P=0.036) within the National Institute for Health and Care Excellence cost-utility thresholds (incremental cost-effectiveness ratio, £18 446). CONCLUSIONS The BLISTER score (https://qxmd.com/calculate/calculator_876/the-blister-score-for-cied-infection) was a valid predictor of cardiac implantable electronic device infection, and could facilitate cost-effective antimicrobial envelope allocation to high-risk patients.
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Affiliation(s)
- Edd Maclean
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Karishma Mahtani
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Shohreh Honarbakhsh
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Charles Butcher
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Nikhil Ahluwalia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Adam S.C. Dennis
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Antonio Creta
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Malcolm Finlay
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Mark Elliott
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Vishal Mehta
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Nadeev Wijesuriya
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Omar Shaikh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Yom Zaw
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Chizute Ogbedeh
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Vasu Gautam
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Pier D. Lambiase
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Richard J. Schilling
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Mark J. Earley
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Philip Moore
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Amal Muthumala
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Simon C.E. Sporton
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Ross J. Hunter
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
| | - Christopher A. Rinaldi
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Jonathan Behar
- Department of Cardiac Electrophysiology, St. Thomas’ Hospital, London, United Kingdom (M.E., V.M., N.W., C.A.R., J.B.)
| | - Claire Martin
- Department of Cardiac Electrophysiology, Royal Papworth Hospital, Cambridge, United Kingdom (O.S., Y.Z., C.O., V.G., C. Martin)
| | - Christopher Monkhouse
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
| | - Anthony Chow
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew’s Hospital, London, United Kingdom (E.M., K.M., S.H., C.B., N.A., A.S.C.D., A.C., M.F., P.D.L., R.J.S., M.J.E., P.M., A.M., S.C.E.S., R.J.H., C. Monkhouse, A.C.)
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (E.M., S.H., N.A., R.J.S., R.J.H., A. Chow)
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Kanthasamy V, Schilling R, Zongo O, Khan K, Earley M, Monk V, Hunter R, Mangiafico V, Ang R, Creta A, Aluwhalia N, Honarbakhsh S, Dhinoja M, Gupta D, Finlay M. Feasibility of double-blinded, placebo-controlled interventional study for assessing catheter ablation efficacy in persistent atrial fibrillation: Insights from the ORBITA AF feasibility study. Am Heart J 2024; 269:56-71. [PMID: 38109985 DOI: 10.1016/j.ahj.2023.12.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND To date, there are no randomized, double-blinded clinical trials comparing catheter ablation to DC cardioversion (DCCV) with medical therapy in patients with persistent atrial fibrillation (PersAF). Conducting a large-scale trial to address this question presents considerable challenges, including recruitment, blinding, and implementation. We conducted a pilot study to evaluate the feasibility of conducting a definitive placebo-controlled trial. METHODS This prospective trial was carried out at Barts Heart Centre, United Kingdom, employing a randomized, double-blinded, placebo-controlled design. Twenty patients with PersAF (duration <2 years) were recruited, representing 10% of the proposed larger trial as determined by a power calculation. The patients were randomized in a 1:1 ratio to receive either PVI ± DCCV (PVI group) or DCCV + Placebo (DCCV group). The primary endpoint of this feasibility study was to evaluate patient blinding. Patients remained unaware of their treatment allocation until end of study. RESULTS During the study, 35% of patients experienced recurrence of PersAF prior to completion of 12 months follow-up. Blinding was successfully maintained amongst both patients and medical staff. The DCCV group had a trend to higher recurrence and repeat procedure rate compared to the PVI group (recurrence of PersAF 60% vs 30%; p = .07 and repeat procedure 70% vs 40%; p = .4). The quality of life experienced by individuals in the PVI group showed improvement, as evidenced by enhanced scores on the AF specific questionnaire (AF PROMS) (3 [±4] vs 21 [±8]) and SF-12 mental-component raw score (51.4 [±7] vs 43.24 [±15]) in patients who maintained sinus rhythm at 12 months. CONCLUSION This feasibility study establishes the potential for conducting a blinded, placebo-controlled trial to evaluate the efficacy of PVI versus DCCV in patients with PersAF.
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Affiliation(s)
- Vijayabharathy Kanthasamy
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Richard Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Olivier Zongo
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Kamran Khan
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mark Earley
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Vivienne Monk
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Ross Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Valentina Mangiafico
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard Ang
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Antonio Creta
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Nikhil Aluwhalia
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
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4
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Creta A, Ventrella N, Earley MJ, Finlay M, Sporton S, Maclean E, Kanthasamy V, Lemos Silva Di Nubila BC, Ricciardi D, Calabrese V, Picarelli F, Hunter RJ, Lambiase PD, Schilling RJ, Grigioni F, Monkhouse C, Muthumala A, Moore P, Providencia R, Chow A. DOACs vs Vitamin K Antagonists During Cardiac Rhythm Device Surgery: A Multicenter Propensity-Matched Study. JACC Clin Electrophysiol 2024; 10:121-132. [PMID: 37897463 DOI: 10.1016/j.jacep.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND There is a paucity of data comparing vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) at the time of cardiac implantable electronic device (CIED) surgery. Furthermore, the best management of DOACs (interruption vs continuation) is yet to be determined. OBJECTIVES This study aimed to compare the incidence of device-related bleeds and thrombotic events based on anticoagulant type (DOAC vs VKA) and regimen (interrupted vs uninterrupted). METHODS This was an observational multicenter study. We included patients on chronic oral anticoagulation undergoing CIED surgery. Patients were matched using propensity scoring. RESULTS We included 1,975 patients (age 73.8 ± 12.4 years). Among 1,326 patients on DOAC, this was interrupted presurgery in 78.2% (n = 1,039) and continued in 21.8% (n = 287). There were 649 patients on continued VKA. The matched population included 861 patients. The rate of any major bleeding was higher with continued DOAC (5.2%) compared to interrupted DOAC (1.7%) and continued VKA (2.1%) (P = 0.03). The rate of perioperative thromboembolism was 1.4% with interrupted DOAC, whereas no thromboembolic events occurred with DOAC or VKA continuation (P = 0.04). The use of dual antiplatelet therapy, DOAC continuation, and male sex were independent predictors of major bleeding on a multivariable analysis. CONCLUSIONS In this large real-world cohort, a continued DOAC strategy was associated with a higher bleeding risk compared to DOAC interruption or VKA continuation in patients undergoing CIED surgery. However, DOAC interruption was associated with increased thromboembolic risk. Concomitant dual antiplatelet therapy should be avoided whenever clinically possible. A bespoke approach is necessary, with a strategy of minimal DOAC interruption likely to represent the best compromise.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | | | - Mark J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Edward Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | | | - Danilo Ricciardi
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vito Calabrese
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | | | | | - Amal Muthumala
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Philip Moore
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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Dhillon G, Honarbakhsh S, Abbas H, Waddingham P, Dennis AS, Ahluwalia N, Finlay M, Sohaib A, Welch S, Daw H, Sporton S, Chow A, Earley MJ, Lambiase PD, Hunter RJ. ECGI targeted ablation for persistent AF not responding to pulmonary vein isolation: Results of a two-staged strategy (TARGET AF2). Heart Rhythm O2 2023; 4:609-617. [PMID: 37936670 PMCID: PMC10626178 DOI: 10.1016/j.hroo.2023.08.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Mechanisms sustaining persistent atrial fibrillation (AF) remain unclear. Objectives The study sought to evaluate both the clinical outcomes and response to ablation of potential drivers in patients with recurrent persistent AF recurrence following pulmonary vein isolation (PVI). Methods A total of 100 patients with persistent AF of <2 years' duration underwent cryoballoon PVI (ECGI phenotyping of persistent AF based on driver burden and distribution to predict response to pulmonary vein isolation). Patients with documented recurrence of atrial arrhythmia within 12 months were recruited and underwent repeat PVI (if needed) followed by ablation of potential drivers (PDs) identified by electrocardiographic imaging (ECGI). PDs were defined as rotational activity >1.5 revolutions or focal activations. Cycle lengths were measured pre- and postablation. The primary outcome was freedom from atrial arrhythmia off antiarrhythmic drugs at 1 year as per guidelines. Results Of 37 patients recruited, 26 had recurrent AF and underwent ECGI-guided ablation of PDs. An average of 6.4 ± 2.7 PDs were targeted per patient. The mean ablation time targeting PDs was 15.5 ± 6.9 minutes. An ablation response occurred in 20 patients (AF termination in 6, cycle length prolongation ≥10% in 14). At 1 year, 14 (54%) of 26 patients were free from arrhythmia, and 12 (46%) of 26 were off antiarrhythmic drugs. Considering the 96 patients who completed follow-up out of the original cohort of 100 patients undergoing cryoablation in this staged strategy, freedom from arrhythmia at 1 year following the last procedure was 72 (75%) of 96, or 70 (73%) of 96 off antiarrhythmic drugs. Conclusions In patients with recurrent AF despite PVI, ECGI-guided ablation caused an acute response in a majority with reasonable long-term outcomes.
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Affiliation(s)
| | | | - Hakam Abbas
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Peter Waddingham
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Adam S. Dennis
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nikhil Ahluwalia
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Afzal Sohaib
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sophie Welch
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Holly Daw
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mark J. Earley
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ross J. Hunter
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
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Kanthasamy V, Breitenstein A, Schilling R, Hofer D, Tiongco B, Ang R, Hunter R, Earley M, Ahsan S, Mangiafico V, Honarbakhsh S, Ahluwalia N, Maclean E, Creta A, Finlay M. Catheter ablation of atrial fibrillation with a multi-electrode radiofrequency balloon; first and early two centre experience in Europe. J Cardiovasc Electrophysiol 2023; 34:1350-1359. [PMID: 36598422 DOI: 10.1111/jce.15799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The Heliostar™ ablation system is a novel RF balloon ablation technology with an integrated three-dimensional mapping system. Here, we describe our early experience and procedural outcomes using this technology for atrial fibrillation catheter ablation. METHODS We sought to comprehensively assess the first 60 consecutive patients undergoing pulmonary vein isolation using the novel HELISOTAR™ RF balloon technology including procedural outcomes. A comparison of the workflow between two different anaesthetic modalities (conscious sedation [CS] vs. general anaesthesia [GA]) was made. Procedural data were collected prospectively from two high-volume centers (Barts Heart Centre, UK and University Hospital of Zurich, Zurich). A standardized approach for catheter ablation was employed. RESULTS A total of 35 patients had the procedure under CS and the remaining under GA. Mean procedural and fluoroscopy times were 84 ± 33 min and 1.1 min. The median duration of RF energy application was 7 (5-9.8) mins per patient. All veins were successfully isolated, and the median isolation time was 10 (7-15) seconds. Our cohort's rate of procedural complications was low, with no mortality within 30 days postprocedure. CONCLUSION Our early experience shows that catheter ablation using the Heliostar™ technology can be performed efficiently and safely; however, long-term data is yet to be established. Low fluoroscopy requirements, short learning curves and use of this technology with CS is possible, including the use of an oesophageal temperature probe.
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Affiliation(s)
- Vijayabharathy Kanthasamy
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Richard Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Daniel Hofer
- Klinik für Kardiologie Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland
| | - Benny Tiongco
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Richard Ang
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Ross Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Mark Earley
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Syed Ahsan
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Valentina Mangiafico
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Nikhil Ahluwalia
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Edd Maclean
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Antonio Creta
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
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7
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Creta A, Venier S, Tampakis K, Providencia R, Sunny J, Defaye P, Earley MJ, Finlay M, Hunter RJ, Lambiase PD, Papageorgiou N, Schilling RJ, Sporton S, Andrikopoulos G, Deschamps E, Albenque JP, Cardin C, Combes N, Combes S, Vinolas X, Moreno-Weidmann Z, Huang T, Eichenlaub M, Müller-Edenborn B, Arentz T, Jadidi AS, Boveda S. Amplified sinus-P-wave analysis predicts outcomes of cryoballoon ablation in patients with persistent and long-standing persistent atrial fibrillation: A multicentre study. Front Cardiovasc Med 2023; 10:1110165. [PMID: 37051067 PMCID: PMC10083273 DOI: 10.3389/fcvm.2023.1110165] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023] Open
Abstract
Introduction Outcomes of catheter ablation for non-paroxysmal atrial fibrillation (AF) remain suboptimal. Non-invasive stratification of patients based on the presence of atrial cardiomyopathy (ACM) could allow to identify the best responders to pulmonary vein isolation (PVI). Methods Observational multicentre retrospective study in patients undergoing cryoballoon-PVI for non-paroxysmal AF. The duration of amplified P-wave (APW) was measured from a digitally recorded 12-lead electrocardiogram during the procedure. If patients were in AF, direct-current cardioversion was performed to allow APW measurement in sinus rhythm. An APW cut-off of 150 ms was used to identify patients with significant ACM. We assessed freedom from arrhythmia recurrence at long-term follow-up in patients with APW ≥ 150 ms vs. APW < 150 ms. Results We included 295 patients (mean age 62.3 ± 10.6), of whom 193 (65.4%) suffered from persistent AF and the remaining 102 (34.6%) from long-standing persistent AF. One-hundred-forty-two patients (50.2%) experienced arrhythmia recurrence during a mean follow-up of 793 ± 604 days. Patients with APW ≥ 150 ms had a significantly higher recurrence rate post ablation compared to those with APW < 150 ms (57.0% vs. 41.6%; log-rank p < 0.001). On a multivariable Cox-regression analysis, APW≥150 ms was the only independent predictor of arrhythmia recurrence post ablation (HR 2.03 CI95% 1.28-3.21; p = 0.002). Conclusion APW duration predicts arrhythmia recurrence post cryoballoon-PVI in persistent and long-standing persistent AF. An APW cut-off of 150 ms allows to identify patients with significant ACM who have worse outcomes post PVI. Analysis of APW represents an easy, non-invasive and highly reproducible diagnostic tool which allows to identify patients who are the most likely to benefit from PVI-only approach.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Sandrine Venier
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Konstantinos Tampakis
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Juno Sunny
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | - Mark J. Earley
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Ross J. Hunter
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | - Simon Sporton
- Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - George Andrikopoulos
- Electrophysiology & Pacing Department, Henry Dunant Hospital Center, Athens, Greece
| | - Elodie Deschamps
- Department of Cardiology, Grenoble University Hospital and Grenoble Alpes University, Grenoble, France
| | | | | | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, Toulose, France
| | - Xavier Vinolas
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Arrhythmia Unit, Department of Cardiology, Hospital Universitario Sant Pau, Barcelona, Spain
| | - Taiyuan Huang
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Björn Müller-Edenborn
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Amir S. Jadidi
- Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulose, France
- Correspondence: Serge Boveda
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Satterfield B, Finlay M, Skeiky L, Lawrence-Sidebottom D, Schmidt M, Wisor J, Van Dongen H. ARC Genotype Modulates Slow Wave Sleep and EEG Spectral Power Following Total Sleep Deprivation. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Mahtani K, Maclean E, Honarbakhsh S, Bhuva A, Finlay M, Creta A, Earley MJ, Zemrak F, Moore P, Muthumala A, Sporton S, Schilling RJ, Hunter RJ, Monkhouse C, Chow A. Cardiac implantable electronic device infections: prognostic value of the PADIT score and its cost-utility implications for antimicrobial envelope use in the United Kingdom. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence of cardiac implantable electronic device (CIED) infections is rising.
Purpose
We examined the factors associated with CIED infection, assessed the prognostic power of the PADIT risk score, and modelled the cost-utility of selective TYRX antimicrobial envelope use for preventing CIED infections.
Methods
Data were extracted from 2016 to 2019, and included all de novo implants, generator changes and lead interventions for transvenous CIEDs at a high-volume UK centre. CIED infection was defined as hospitalisation for device infection within 12 months of a procedure. Cost-utility analysis was informed by standardised tariffs, and quality adjusted life year (QALY) and efficacy data was extrapolated from analysis of the WRAP-IT trial.
Results
6,035 patients underwent 7,383 procedures; CIED infection occurred in 59 individuals (0.8%). In addition to the constituents of the PADIT score, lead extraction (HR 3.3 (1.9–6.1), p<0.0001), C-reactive protein >50mg/l (HR 3.0 (1.4–6.4), p=0.005), re-intervention within two years (HR 10.1 (5.6–17.9), p<0.0001), and procedure duration over two hours (HR 2.6 (1.6–4.1), p=0.001) were independent predictors of infection. Increased PADIT score was strongly associated with infection (AUC: 0.82, HR per point increase: 1.36 (1.27–1.47), p<0.0001). A cost-utility model assigning TYRX envelopes to patients with PADIT scores ≥6 predicted a reduction in infections (number needed to treat: 72) and a cost per QALY gained within the UK's (NICE) cost-effectiveness threshold (£25,107).
Conclusions
The PADIT score was a powerful predictor of CIED infections in a heterogeneous population,and may facilitate cost-effective TYRX envelope allocation in selected high-risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahtani
- St Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- St Bartholomew's Hospital , London , United Kingdom
| | | | - A Bhuva
- St Bartholomew's Hospital , London , United Kingdom
| | - M Finlay
- St Bartholomew's Hospital , London , United Kingdom
| | - A Creta
- St Bartholomew's Hospital , London , United Kingdom
| | - M J Earley
- St Bartholomew's Hospital , London , United Kingdom
| | - F Zemrak
- St Bartholomew's Hospital , London , United Kingdom
| | - P Moore
- St Bartholomew's Hospital , London , United Kingdom
| | - A Muthumala
- St Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- St Bartholomew's Hospital , London , United Kingdom
| | | | - R J Hunter
- St Bartholomew's Hospital , London , United Kingdom
| | - C Monkhouse
- St Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- St Bartholomew's Hospital , London , United Kingdom
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10
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Roelas M, Vyas R, Maclean E, Mahtani K, Butcher C, Ahluwalia N, Honarbakhsh S, Finlay M, Chow A, Earley MJ, Sporton S, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP).
Purpose
We examined the associations of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016–2020.
Methods
Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT.
Results
3,239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP-related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above-median age (OR 2.4 (1.19–4.2), p=0.006) and those undergoing re-do procedures (OR 1.95 (1.29–3.43, p=0.042) were at higher risk of TRCT. Of the operator-dependent variables, choice of transseptal needle (Endrys vs Brockenbrough, p>0.1) or puncture sheath (Swartz vs Mullins vs Agilis vs Vizigo vs Cryosheath, all p>0.1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk (OR 4.42 (2.45–8.2), p=0.001), whilst top quartile operator experience (OR 0.4 (0.17–0.85, p=0.002), transoesophageal echocardiogram (TOE prevalence: 26%, OR 0.51 (0.11–0.94), p=0.023), and use of the SafeSept guidewire (OR 0.22 (0.08–0.62), p=0.001) reduced TRCT risk. An increase in SafeSept wire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2=0.72, p<0.001) and was associated with a relative risk reduction of 70%.
Conclusions
During left atrial ablation, the independent predictors of TRCT were patient age, re-do procedure, operator experience, unsuccessful first pass, TOE-guidance, and use of the SafeSept wire. A novel classification system for the causes of cardiac tamponade is proposed (table 1); this may be of interest to clinical trialists or auditors evaluating patient safety.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
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11
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Coronary sinus electrogram characteristics predict termination of AF with ablation and long-term clinical outcome. J Cardiovasc Electrophysiol 2022; 33:2139-2151. [PMID: 35775822 PMCID: PMC9796101 DOI: 10.1111/jce.15618] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Markers predicting atrial fibrillation (AF) termination and freedom from AF/atrial tachycardia (AT) has been proposed. This study aimed to evaluate the role of novel coronary sinus (CS) electrogram characteristics in predicting the acute ablation response and freedom from AF/AT during follow-up. METHODS Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals mapping study were included. Novel CS electrogram characteristics including CS cycle length variability (CLV) and CS activation pattern stability (APS) and proportion of low voltage zones (LVZs) were reviewed as potential predictors for AF termination on ablation and freedom from AF/AT during follow-up. The relationship between localized driver characteristics and CS electrogram characteristics was also assessed. RESULTS Sixty-five patients were included. AF termination was achieved in 51 patients and 80% of patients were free from AF/AT during a follow-up of 29.5 ± 3.7 months. CS CLV of <30 ms, CS APS of ≥30% and proportion of LVZ < 30% showed high diagnostic accuracy in predicting AF termination on ablation and freedom from AF/AT during follow-up (CS CLV odds ratio [OR] 25.6, area under the curve [AUC] 0.91; CS APS OR 15.9, AUC 0.94; proportion of LVZs OR 21.4, AUC 0.88). These markers were independent predictors of AF termination on ablation and AF/AT recurrence during follow-up. Ablation of a smaller number of drivers that demonstrate greater dominance strongly correlate with greater CS organization. CONCLUSION Novel CS electrogram characteristics were independent predictors of AF termination and AF/AT recurrence during follow-up. These markers can potentially aid in predicting outcomes and guide ablation and follow-up strategies.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Richard J. Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Emily Keating
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Malcolm Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Ross J. Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS TrustLondonUK
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12
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Doykov I, Baldwin T, Spiewak J, Gilmour KC, Gibbons JM, Pade C, Reynolds CJ, Áine McKnight, Noursadeghi M, Maini MK, Manisty C, Treibel T, Captur G, Fontana M, Boyton RJ, Altmann DM, Brooks T, Semper A, Moon JC, Kevin Mills, Heywood WE, Abiodun A, Alfarih M, Alldis Z, Altmann DM, Amin OE, Andiapen M, Artico J, Augusto JB, Baca GL, Bailey SN, Bhuva AN, Boulter A, Bowles R, Boyton RJ, Bracken OV, O’Brien B, Brooks T, Bullock N, Butler DK, Captur G, Carr O, Champion N, Chan C, Chandran A, Coleman T, Couto de Sousa J, Couto-Parada X, Cross E, Cutino-Moguel T, D’Arcangelo S, Davies RH, Douglas B, Di Genova C, Dieobi-Anene K, Diniz MO, Ellis A, Feehan K, Finlay M, Fontana M, Forooghi N, Francis S, Gibbons JM, Gillespie D, Gilroy D, Hamblin M, Harker G, Hemingway G, Hewson J, Heywood W, Hickling LM, Hicks B, Hingorani AD, Howes L, Itua I, Jardim V, Lee WYJ, Jensen M, Jones J, Jones M, Joy G, Kapil V, Kelly C, Kurdi H, Lambourne J, Lin KM, Liu S, Lloyd A, Louth S, Maini MK, Mandadapu V, Manisty C, McKnight Á, Menacho K, Mfuko C, Mills K, Millward S, Mitchelmore O, Moon C, Moon J, Sandoval DM, Murray SM, Noursadeghi M, Otter A, Pade C, Palma S, Parker R, Patel K, Pawarova M, Petersen SE, Piniera B, Pieper FP, Rannigan L, Rapala A, Reynolds CJ, Richards A, Robathan M, Rosenheim J, Rowe C, Royds M, West JS, Sambile G, Schmidt NM, Selman H, Semper A, Seraphim A, Simion M, Smit A, Sugimoto M, Swadling L, Taylor S, Temperton N, Thomas S, Thornton GD, Treibel TA, Tucker A, Varghese A, Veerapen J, Vijayakumar M, Warner T, Welch S, White H, Wodehouse T, Wynne L, Zahedi D. Quantitative, multiplexed, targeted proteomics for ascertaining variant specific SARS-CoV-2 antibody response. Cell Rep Methods 2022; 2:100279. [PMID: 35975199 PMCID: PMC9372021 DOI: 10.1016/j.crmeth.2022.100279] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 02/09/2023]
Abstract
Determining the protection an individual has to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VoCs) is crucial for future immune surveillance, vaccine development, and understanding of the changing immune response. We devised an informative assay to current ELISA-based serology using multiplexed, baited, targeted proteomics for direct detection of multiple proteins in the SARS-CoV-2 anti-spike antibody immunocomplex. Serum from individuals collected after infection or first- and second-dose vaccination demonstrates this approach and shows concordance with existing serology and neutralization. Our assays show altered responses of both immunoglobulins and complement to the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.1) VoCs and a reduced response to Omicron (B1.1.1529). We were able to identify individuals who had prior infection, and observed that C1q is closely associated with IgG1 (r > 0.82) and may better reflect neutralization to VoCs. Analyzing additional immunoproteins beyond immunoglobulin (Ig) G, provides important information about our understanding of the response to infection and vaccination.
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Affiliation(s)
- Ivan Doykov
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
| | - Tomas Baldwin
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK
| | - Justyna Spiewak
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK
| | - Kimberly C Gilmour
- Great Ormond Street Children's Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Mala K Maini
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas Treibel
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK.,Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK.,Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.,Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | | | | | - James C Moon
- St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Kevin Mills
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
| | - Wendy E Heywood
- Translational Mass Spectrometry Research Group, Genetics & Genomic Medicine Department, UCL Institute of Child Health, London, UK.,Great Ormond Street Biomedical Research Centre, UCL Institute of Child Health London
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Reynolds CJ, Pade C, Gibbons JM, Otter AD, Lin KM, Muñoz Sandoval D, Pieper FP, Butler DK, Liu S, Joy G, Forooghi N, Treibel TA, Manisty C, Moon JC, Semper A, Brooks T, McKnight Á, Altmann DM, Boyton RJ, Abbass H, Abiodun A, Alfarih M, Alldis Z, Altmann DM, Amin OE, Andiapen M, Artico J, Augusto JB, Baca GL, Bailey SNL, Bhuva AN, Boulter A, Bowles R, Boyton RJ, Bracken OV, O'Brien B, Brooks T, Bullock N, Butler DK, Captur G, Carr O, Champion N, Chan C, Chandran A, Coleman T, Couto de Sousa J, Couto-Parada X, Cross E, Cutino-Moguel T, D'Arcangelo S, Davies RH, Douglas B, Di Genova C, Dieobi-Anene K, Diniz MO, Ellis A, Feehan K, Finlay M, Fontana M, Forooghi N, Francis S, Gibbons JM, Gillespie D, Gilroy D, Hamblin M, Harker G, Hemingway G, Hewson J, Heywood W, Hickling LM, Hicks B, Hingorani AD, Howes L, Itua I, Jardim V, Lee WYJ, Jensen M, Jones J, Jones M, Joy G, Kapil V, Kelly C, Kurdi H, Lambourne J, Lin KM, Liu S, Lloyd A, Louth S, Maini MK, Mandadapu V, Manisty C, McKnight Á, Menacho K, Mfuko C, Mills K, Millward S, Mitchelmore O, Moon C, Moon J, Muñoz Sandoval D, Murray SM, Noursadeghi M, Otter A, Pade C, Palma S, Parker R, Patel K, Pawarova M, Petersen SE, Piniera B, Pieper FP, Rannigan L, Rapala A, Reynolds CJ, Richards A, Robathan M, Rosenheim J, Rowe C, Royds M, Sackville West J, Sambile G, Schmidt NM, Selman H, Semper A, Seraphim A, Simion M, Smit A, Sugimoto M, Swadling L, Taylor S, Temperton N, Thomas S, Thornton GD, Treibel TA, Tucker A, Varghese A, Veerapen J, Vijayakumar M, Warner T, Welch S, White H, Wodehouse T, Wynne L, Zahedi D, Chain B, Moon JC. Immune boosting by B.1.1.529 (Omicron) depends on previous SARS-CoV-2 exposure. Science 2022; 377:eabq1841. [PMID: 35699621 PMCID: PMC9210451 DOI: 10.1126/science.abq1841] [Citation(s) in RCA: 187] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022]
Abstract
The Omicron, or Pango lineage B.1.1.529, variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carries multiple spike mutations with high transmissibility and partial neutralizing antibody (nAb) escape. Vaccinated individuals show protection against severe disease, often attributed to primed cellular immunity. We investigated T and B cell immunity against B.1.1.529 in triple BioNTech BNT162b2 messenger RNA-vaccinated health care workers (HCWs) with different SARS-CoV-2 infection histories. B and T cell immunity against previous variants of concern was enhanced in triple-vaccinated individuals, but the magnitude of T and B cell responses against B.1.1.529 spike protein was reduced. Immune imprinting by infection with the earlier B.1.1.7 (Alpha) variant resulted in less durable binding antibody against B.1.1.529. Previously infection-naïve HCWs who became infected during the B.1.1.529 wave showed enhanced immunity against earlier variants but reduced nAb potency and T cell responses against B.1.1.529 itself. Previous Wuhan Hu-1 infection abrogated T cell recognition and any enhanced cross-reactive neutralizing immunity on infection with B.1.1.529.
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Affiliation(s)
| | - Corinna Pade
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joseph M Gibbons
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Kai-Min Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - David K Butler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Siyi Liu
- Department of Infectious Disease, Imperial College London, London, UK
| | - George Joy
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Nasim Forooghi
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Thomas A Treibel
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Charlotte Manisty
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | | | | | | | - Tim Brooks
- UK Health Security Agency, Porton Down, UK
| | - Áine McKnight
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Daniel M Altmann
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rosemary J Boyton
- Department of Infectious Disease, Imperial College London, London, UK.,Lung Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Ahluwalia N, Graham A, Honarbakhsh S, Tarkas T, Martin S, Monkhouse C, Finlay M, Earley MJ, Icart R, Spooner O, Chandratheva A, Schilling RJ. Contemporary Practice and Optimising Referral Pathways for Implantable Cardiac Monitoring for Atrial Fibrillation after Cryptogenic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106474. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106474] [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] [Received: 10/11/2021] [Revised: 02/13/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022] Open
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Maclean E, Mahtani K, Roelas M, Vyas R, Butcher C, Ahluwalia N, Honarbakhsh S, Creta A, Finlay M, Chow A, Earley MJ, Sporton S, Lowe MD, Sawhney V, Ezzat V, Ahsan S, Khan F, Dhinoja M, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. J Cardiovasc Electrophysiol 2022; 33:1747-1755. [PMID: 35671359 PMCID: PMC9543389 DOI: 10.1111/jce.15590] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Aims Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP‐related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP‐related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above‐median age [odds ratio (OR): 2.4 (1.19–4.2), p = .006] and those undergoing re‐do procedures [OR: 1.95 (1.29–3.43, p = .042] were at higher risk of TRCT. Of the operator‐dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p > .1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p > .1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p = .001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p = .002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p = .023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p = .001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p < .001) and was associated with a relative risk reduction of 70%. Conclusions During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE‐guidance, and use of a transseptal guidewire, and was increased by patient age, re‐do procedures, and failure to cross the septum first pass.
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Affiliation(s)
- E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Creta
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M D Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Sawhney
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Ezzat
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Ahsan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - F Khan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
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Breitenstein A, Kanthasamy V, Hofer D, Hunter R, Butcher CH, Ahluwalia N, Schilling RJ, Finlay M. Early results of the novel radiofrequency balloon ablation catheter for pulmonary vein isolation. Europace 2022. [DOI: 10.1093/europace/euac053.263] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Pulmonary vein isolation (PVI) remains the cornerstone for treating of symptomatic atrial fibrillation (AF). Single-shot PVI technologies have evolved as a standard for first-time PVI. A novel radiofrequency balloon ablation catheter is now available to offer single-shot RF pulmonary vein isolation.
Purpose
To summarize the early experience using the novel RF balloon ablation catheter for patients undergoing PVI in two tertiary centres in Europe.
Methods
We prospectively assessed the first 38 consecutive patients undergoing PVI using RF balloon ablation catheter for paroxysmal or persistent AF in two high volume centres. Both centres used a standardised approach including ultrasound-guided vascular access, uninterrupted anticoagulation, transeptal puncture via the RF balloon sheath and a limited 3D mapping software-guided LA geometry created with a circular mapping catheter. Radiofrequency application for 60s to the anterior segments and 20s posteriorly was performed in all cases, phrenic pacing was employed for ablation of right PVs. BHS performed all procedures (except 2 cases due to high BMI and severe sleep apnea) under sedation, while all patients from UHZ underwent PVI procedures with general anaesthesia as per institutional protocol. All patients had an oesophageal temperature probe to assess oesophageal temperature during ablation (passed orally under sedation) and had uninterrupted oral anticoagulation throughout the periprocedural period.
Results
Overall, mean age was 64±8 years, 23 (61%) were male, 24 (63%) of patients had paroxysmal AF. The majority were de novo interventions (92%). There was no significant difference between the patients demographics in the two hospitals. All veins were isolated in both groups with a total of 144 applications (n = 73 in the sedation group, n = 71 in the GA population). Median fluoroscopy time was comparable (sedation group 1.1 minutes vs GA group 1.2 minutes; P = 0.58), but median procedure time was shorter in the sedation group (65 minute vs 106 minutes; P < 0.001). The median number of RF ablation per patient (sedation group 7 vs GA group 9; P = 0.32) and time to isolation of each vein (sedation group 11 seconds vs GA group 10 seconds; P = 0.9) were similar. Number of acute reconnections requiring further ablations were not significantly different between groups (sedation group 11 [15%] vs GA group 14 [20%]; P = 0.96). One patient sustained transient phrenic nerve injury in the sedation group.
Conclusion
Our early experience shows the novel HS balloon ablation can be performed effectively, efficiently and safely under either GA or conscious sedition. The RF balloon ablation catheter paradigm lends itself to refined workflows, with low fluoroscopy requirements and a short learning curve even in initial cohorts.
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Affiliation(s)
| | - V Kanthasamy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Hofer
- University Heart Center, Zurich, Switzerland
| | - R Hunter
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - CH Butcher
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - N Ahluwalia
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - RJ Schilling
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - M Finlay
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Prabhu S, Ahluwalia N, Tyebally SM, Dennis ASC, Malomo SO, Abiodun AT, Tyrlis A, Dhillon G, Segan L, Graham A, Honarbakhsh S, Sawhney V, Sporton S, Lowe M, Finlay M, Earley MJ, Lambiase P, Schilling RJ, Hunter RJ. ERRATUM. J Cardiovasc Electrophysiol 2022; 33:567. [PMID: 35166413 DOI: 10.1111/jce.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Kanthasamy V, Papageorgiou N, Bajomo T, Monkhouse C, Creta A, Finlay M, Lambiase PD, Moore P, Sporton S, Earley MJ, Schilling RJ, Hayward C, Providência R, Hunter RJ, Chow AA, Muthumala A. Risk factors for developing pacing induced LV dysfunction: Experience from a tertiary centre in the UK. Pacing Clin Electrophysiol 2022; 45:365-373. [PMID: 35023176 DOI: 10.1111/pace.14442] [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: 10/03/2021] [Revised: 12/04/2021] [Accepted: 01/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The risk factors for developing pacing induced Left Ventricular dysfunction (LVD) in patients with high burden of right ventricular pacing (RVP) is poorly understood. Therefore, in the present study, we aimed to assess the determinants of pacing induced LVD. METHODS Our data were retrospectively collected from 146 patients with RVP > 40% who underwent generator change (GC) or cardiac resynchronisation therapy (CRT) upgrade between 2016-2019 who had left ventricular ejection fraction (EF) ≥50% at initial implant. RESULTS 75 patients had CRT upgrade due to pacing induced LVD (EF<50%) and 71 patients with preserved LV function (EF ≥50%) had a GC. Primary indication for pacing in both groups was complete heart block. Male predominance (p = 0.008), prior myocardial infarction (MI) (p = 0.001), atrial fibrillation (AF) (p = 0.009), chronic kidney disease (CKD) (p = 0.005), and borderline low systolic function (BLSF) (EF 50-55%) (p = 0.04) were more prevalent in the CRT upgrade group. Presence of AF (OR = 3.05, 95% CI 1.42-6.58; p = 0.004), BLSF (OR = 3.8, 95% CI 1.22-11.8; p = 0.02) and male gender (OR = 2.41, 95% CI 1.14-5.08; p = 0.02) were independent predictors for RVP induced LVD. Age (OR = 1.08, 95% CI 1.02-1.14; p = 0.005) and BLSF (OR = 5.33, 95% CI 1.26-22.5; p = 0.023) were independent predictors of earlier development of LVD after implant. CONCLUSIONS Our results suggested that AF, BLSF and male gender are predictors for development of pacing induced LVD in patients with high RVP burden. LVD can occur at any time after pacemaker implant with BLSF and increasing age associated with earlier development of LVD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Nikolaos Papageorgiou
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,Institute of Cardiovascular Science, University College London, UK
| | - Tomi Bajomo
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | | | - Antonio Creta
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,Institute of Cardiovascular Science, University College London, UK
| | - Phil Moore
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Carl Hayward
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Rui Providência
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Anthony Aw Chow
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Amal Muthumala
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
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Creta A, Earley MJ, Schilling RJ, Finlay M, Sporton S, Dhinoja M, Hunter RJ, Papageorgiou N, Ang R, Chow A, Lowe M, Segal OR, Lambiase PD, Providência R. Ethanol Ablation for Ventricular Arrhythmias: A Systematic Review and Meta-analysis. J Cardiovasc Electrophysiol 2021; 33:510-526. [PMID: 34921464 DOI: 10.1111/jce.15336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/11/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ethanol ablation (EA) is as an alternative option for subjects with ventricular arrhythmias (VAs) refractory to conventional medical and ablative treatment. However, data on efficacy and safety of EA remain sparse. METHODS A systematic literature search was conducted. The primary outcomes were 1) freedom from the targeted VA and 2) freedom from any VAs post EA. Additional safety outcomes were also analysed. RESULTS Ten studies were selected accounting for a population of 174 patients (62.3±12.5 years, 94% male) undergoing 185 procedures. The overall acute success rate of EA was 72.4% (CI95% 65.6-78.4). After a mean follow-up of 11.3±5.5 months, the incidence of relapse of the targeted VA was 24.4% (CI95% 17.1-32.8), while any VAs post EA occurred in 41.3% (CI95% 33.7-49.1). The overall incidence of procedural complications was 14.1% (CI95% 9.8-19.8), with pericardial complications and complete atrioventricular block being the most frequent. An anterograde transarterial approach was associated with a higher rate of VA recurrences and complications compared to a retrograde transvenous route; however, differences in the baseline population characteristics and in the targeted ventricular areas should be accounted. CONCLUSION EA is a valuable therapeutic option for VAs refractory to conventional treatment and can result in 1-year freedom from VA recurrence in 60 to 75% of the patients. However, anatomical or technical challenges preclude acute success in almost 30% of the candidates and the rate of complication is not insignificant, highlighting the importance of well-informed patient selection. The certainty of the evidence is low, and further research is necessary. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Antonio Creta
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | | | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Science, University College of London, London, UK
| | - Rui Providência
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Health Informatics Research, University College of London, London, UK
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20
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Sanghvi MM, Jones DM, Kalindjian J, Monkhouse C, Providencia R, Schilling RJ, Ahluwalia N, Earley MJ, Finlay M. The utility of implantable loop recorders (ILR) in patient management: an age and indication stratified study in the outpatient-implant era. Eur Heart J Qual Care Clin Outcomes 2021; 8:770-777. [PMID: 34601557 DOI: 10.1093/ehjqcco/qcab071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Implantable loop recorders (ILR) are now routinely implanted for long-term cardiac monitoring in the clinic setting. This study examined the real-world performance of these devices, focusing on the management decision changes made in response to ILR-recorded data. METHODS AND RESULTS This was a single centre, prospective observational study of consecutive patients undergoing ILR implantation. All patients who underwent implantation of a Medtronic Reveal LINQ device from September 2017 to June 2019 at Barts Heart Centre were included.501 patients were included. 302 (60%) patients underwent ILR implantation for an indication of pre-syncope/syncope, 96 (19%) for palpitations, 72 (14%) for atrial fibrillation (AF) detection with a history of cryptogenic stroke and 31 (6%) for patients deemed to be high risk of serious cardiac arrhythmia.The primary outcome of this study was that an ILR-derived diagnosis altered management in 110 (22%) of patients. Secondary outcomes concerned sub-group analyses by indication: in patients who presented with syncope/presyncope, a change in management resulting from ILR data was positively associated with age (HR: 1.04 [95%CI 1.02-1.06]; p < 0.001) and negatively associated with a normal ECG at baseline (HR 0.54 [0.31-0.93]; p = 0.03). Few patients (1/57, 2%) aged < 40 years in this group underwent device implantation, compared to 19/62 patients (31%) aged 75 years and over (p = 0.0024). 22/183 (12%) of patients in the 40-74 age range had a device implanted.In patients who underwent ILR insertion following cryptogenic stroke, 13/72 patients (18%) had AF detected leading to a decision to commence anticoagulation. CONCLUSION These results inform the utility of ILR in the clinical setting. Diagnoses provided by ILR that lead to changes in management are rare in patients under age 40, particularly following syncope, presyncope or palpitations. In older patients new diagnoses are frequently made and trigger important changes in treatment.
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Affiliation(s)
- Mihir M Sanghvi
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,William Harvey Heart Centre, Queen Mary University of London, Charterhouse Square, London, EC1A 6BQ
| | - Daniel M Jones
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Jeremy Kalindjian
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | | | - Rui Providencia
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Nikhil Ahluwalia
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE.,William Harvey Heart Centre, Queen Mary University of London, Charterhouse Square, London, EC1A 6BQ
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21
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Kanthasamy V, Finlay M. Left atrial appendage occlusion: a niche procedure for a niche cohort? Eur Heart J Qual Care Clin Outcomes 2021; 7:429-430. [PMID: 34313730 DOI: 10.1093/ehjqcco/qcab049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,William Harvey Heart Centre, Queen Mary University of London, Charterhouse Square, London EC1A 6BQ, UK
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22
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Wong G, Ahmed D, Creta A, Honarbakhsh S, Kanthasamy V, Maclean E, Sawhney V, Earley M, Hunter R, Schilling RJ, Finlay M. ProGlide venous closure device facilitates early ambulation following cryoablation of atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.221] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Heart Foundation
Background
Same-day discharge following atrial fibrillation (AF) ablation is increasingly common. ProGlide device suture-mediated vascular closure (PD) offers a technique that may expedite mobilisation following large-bore (>12F) venous access. The utility of PD closure following cryoablation of AF has not been reported.
Purpose
We sought to evaluate haemostasis and early ambulation outcomes in patients receiving the ProGlide compared with conventional techniques.
Methods
104 consecutive patients undergoing cryoballoon pulmonary vein isolation (PVI) for paroxysmal or persistent at a single high-volume institution were included. PVI was performed via a standardised approach including sedation, ultrasound-guided vascular access for 14F Cryosheath and second 7F sheath, anticoagulation protocol, transeptal puncture, 28mm cryoballoon and nurse-led same-day discharge protocol. Haemostasis was achieved using the Perclose Proglide device (PD) in the 14F access point ("pre-closure" technique) plus 5 minutes manual pressure at the 7F sheath site. Alternatively, a figure-of-eight/Z-suture (ZS) was employed for closure according to operator preference. Protamine was used for heparin reversal in all patients. Safety outcomes of major bleeding, haematoma and minor bleeding were assessed. Time to ambulation (TTA), time to discharge (TTD), same-day discharge and complications at initial follow-up were measured.
Results
Overall, mean age was 64 ± 11 years, 65 (64%) were male and 52 (50%) of patients had paroxysmal AF, there were no significant differences between group demographics, with 31 patients (30%) in the PD group and 73 (70%) in the ZS group. All patients had uninterrupted oral anticoagulation throughout the periprocedural period. No major femoral bleeding complications requiring intervention occurred in either group. Haematomas occurred in none of the PD group compared with 2 (2.8%) in the ZS group. Incidence of minor bleeding was not significantly different between groups (PD: 3 [9.7%] vs ZS: 2 [2.7%], p = 0.155). Mean TTA was significantly shorter in the PD group (3.3 ± 1.1 vs 4.1 ± 1.7 hrs, p = 0.025). However, there was no significant difference in same-day discharge (PD: 25 [81%] vs ZS: 53 [73%], p = 0.386) and TTD (5.0 ± 3.6 vs 6.1 ± 4.2 hrs, p = 0.275) between groups. 1 patient complained of groin pain which delayed discharge in the ZS group not seen in the PD group. After a mean follow-up of 2.2 ± 1.4 months, there were no differences in major or minor complications.
Conclusion
Use of the Proglide closure device was associated with significant reductions in time to ambulation compared with Z-suture haemostasis following cryoablation of AF, and groin access complications were uncommon across groups. PD closure may contribute to further streamlining patient pathways in day-case AF ablation.
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Affiliation(s)
- G Wong
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - D Ahmed
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Creta
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - S Honarbakhsh
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - V Kanthasamy
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - E Maclean
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - V Sawhney
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Earley
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - R Hunter
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - RJ Schilling
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
| | - M Finlay
- St Bartholomew"s Hospital, Department of Cardiac Electrophysiology, London, United Kingdom of Great Britain & Northern Ireland
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23
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Creta A, Elliott P, Earley MJ, Dhinoja M, Finlay M, Sporton S, Chow A, Hunter RJ, Papageorgiou N, Lowe M, Mohiddin SA, Boveda S, Adragao P, Jebberi Z, Matos D, Schilling RJ, Lambiase PD, Providência R. Catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a European observational multicentre study. Europace 2021; 23:1409-1417. [PMID: 33930121 DOI: 10.1093/europace/euab022] [Citation(s) in RCA: 3] [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: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). Data on the efficacy of catheter ablation of AF in HCM patients are sparse. METHODS AND RESULTS Observational multicentre study in 137 HCM patients (mean age 55.0 ± 13.4, 29.1% female; 225 ablation procedures). We investigated (i) the efficacy of catheter ablation for AF beyond the initial 12 months; (ii) the available risk scores, stratification schemes and genotype as potential predictors of arrhythmia relapse, and (iii) the impact of cryoballoon vs. radiofrequency in procedural outcomes. Mean follow-up was 43.8 ± 37.0 months. Recurrences after the initial 12-month period post-ablation were frequent, and 24 months after the index procedure, nearly all patients with persistent AF had relapsed, and only 40% of those with paroxysmal AF remained free from arrhythmia recurrence. The APPLE score demonstrated a modest discriminative capacity for AF relapse post-ablation (c-statistic 0.63, 95% CI 0.52-0.75; P = 0.022), while the risk stratification schemes for sudden death did not. On multivariable analysis, left atrium diameter and LV apical aneurysm were independent predictors of recurrence. Fifty-eight patients were genotyped; arrhythmia-free survival was similar among subjects with different gene mutations. Rate of procedural complications was high (9.3%), although reducing over time. Outcome for cryoballoon and radiofrequency ablation was comparable. CONCLUSION Very late AF relapses post-ablation is common in HCM patients, especially in those with persistent AF. Left atrium size, LV apical aneurysm, and the APPLE score might contribute to identify subjects at higher risk of arrhythmia recurrence. First-time cryoballoon is comparable with radiofrequency ablation.
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Affiliation(s)
- Antonio Creta
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Research Doctorate Programme, Campus Bio-Medico University of Rome, Rome, Italy
| | - Perry Elliott
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute for Cardiovascular Sciences, University College London, London, UK
| | - Mark J Earley
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Mehul Dhinoja
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Malcolm Finlay
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Simon Sporton
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Anthony Chow
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Ross J Hunter
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Nikolaos Papageorgiou
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Martin Lowe
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Saidi A Mohiddin
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Pedro Adragao
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Zeynab Jebberi
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Daniel Matos
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Richard J Schilling
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Pier D Lambiase
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Rui Providência
- Cardiac Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.,Institute of Health Informatics Research, University College of London, London, UK
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24
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Shurlock J, Rudd J, Jeanes A, Iacovidou A, Creta A, Kanthasamy V, Schilling R, Sullivan E, Cooke J, Laws-Chapman C, Baxter D, Finlay M. Communication in the intensive care unit during COVID-19: early experience with the Nightingale Communication Method. Int J Qual Health Care 2021; 33:6018447. [PMID: 33270866 PMCID: PMC7799099 DOI: 10.1093/intqhc/mzaa162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the utility and frequency of use of the Nightingale Communication Method, during the early operational phase of the Nightingale Hospital London (NHL) 4000-bed field hospital’s intensive care unit. Design Survey-based cross-sectional assessment. Setting The intensive care unit at the Nightingale London hospital. Participants Staff working in the clinical area and therefore requiring full personal protective equipment (PPE). Intervention Survey of all staff members sampled from a single shift at the Nightingale Hospital. This investigated perceived utility and actual use of identification methods (name and role labels on visors and gowns, coloured role identification tapes) and formal hand signals as an adjunctive communication method. Main Outcome Measure Self-reported frequency of use and perceived utility of each communication and personnel identification adjunct. Results Fifty valid responses were received (72% response rate), covering all clinical professional groups. Prominent name/role identifications and coloured role identification tapes were very frequently used and were perceived as being highly useful. Formal hand signals were infrequently used and not perceived as being beneficial, with respondents citing use of individual hand signals only in specific circumstances. Conclusion PPE is highly depersonalizing, and interpersonal identification aids are very useful. Despite being difficult, verbal communication is not completely prohibited, which could explain the low utility of formal hand signals. The methods developed at the Nightingale hospital have enhanced communication in the critical care, field hospital setting. There is potential for wider application to a variety of healthcare settings, in both the current situation and future pandemic scenarios.
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Affiliation(s)
- Jonathan Shurlock
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - James Rudd
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Annette Jeanes
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Aphrodite Iacovidou
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Antonio Creta
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | | | - Richard Schilling
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Eamonn Sullivan
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Joanne Cooke
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Colette Laws-Chapman
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - David Baxter
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
| | - Malcolm Finlay
- Intensive Care Unit, NHS Nightingale Hospital London, Royal Docks, London, E16 1SL, UK
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25
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Prabhu S, Ahluwalia N, Tyebally SM, Dennis ASC, Malomo SO, Abiodun AT, Tyrlis A, Dhillon G, Segan L, Graham A, Honarbakhsh S, Sawhney V, Sporton S, Lowe M, Finlay M, Earley MJ, Lambiase P, Schilling RJ, Hunter RJ. Long-term outcomes of index cryoballoon ablation or point-by-point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure. J Cardiovasc Electrophysiol 2021; 32:941-948. [PMID: 33527562 DOI: 10.1111/jce.14923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.
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Affiliation(s)
- S Prabhu
- Department of Cardiology, St Bartholomew's Hospital, London, UK.,Baker Heart and Diabetes Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - N Ahluwalia
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S M Tyebally
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A S C Dennis
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S O Malomo
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A T Abiodun
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - A Tyrlis
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - G Dhillon
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - L Segan
- Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - A Graham
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Honarbakhsh
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - V Sawhney
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - S Sporton
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Lowe
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M Finlay
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - M J Earley
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - P Lambiase
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Schilling
- Department of Cardiology, St Bartholomew's Hospital, London, UK
| | - R J Hunter
- Department of Cardiology, St Bartholomew's Hospital, London, UK
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26
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Honarbakhsh S, Schilling RJ, Providencia R, Dhillon G, Bajomo O, Keating E, Finlay M, Hunter RJ. Ablation guided by STAR-mapping in addition to pulmonary vein isolation is superior to pulmonary vein isolation alone or in combination with CFAE/linear ablation for persistent AF. J Cardiovasc Electrophysiol 2021; 32:200-209. [PMID: 33368766 PMCID: PMC8607469 DOI: 10.1111/jce.14856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 11/18/2022]
Abstract
Introduction The optimal ablation approach for persistent atrial fibrillation (AF) remains unclear. Methods and Results Objective was to compare the long‐term rates of freedom from AF/AT in patients that underwent STAR mapping guided ablation against outcomes of patients undergoing conventional ablation procedures. Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals (STAR) mapping study were included. Outcomes following 'pulmonary vein isolation (PVI) plus STAR mapping guided ablation (STAR mapping cohort) were compared to patients undergoing PVI alone ablation during the same time period and also a propensity‐matched cohort undergoing PVI plus the addition of complex fractionated electrogram (CFAE) and/or linear ablation (“conventional ablation”). Rates of procedural AF termination and freedom from AF/AT during follow‐up were compared. Sixty‐five patients were included in both the STAR cohort and propensity matched conventional ablation cohort. AF termination rates were significantly higher in the STAR cohort (51/65, 78.5%) than conventional ablation cohort (10/65, 15.4%) and PVI alone ablation cohort (13/50, 26.0%; STAR cohort vs. other 2 cohorts both p < .001). There was no significant difference in procedure time between the three cohorts. During ≥20 months follow‐up a lower proportion of patients had AF/AT recurrence in the STAR cohort (20.0%) compared with the conventional ablation cohort (50.8%) or the PVI alone ablation cohort (50.0%; both p < .05 compared to STAR cohort). Conclusions Outcomes of PVI plus STAR mapping guided ablation was superior to PVI alone or in combination with linear/CFAE ablation. A multicenter randomized controlled trial is planned to confirm these findings.
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Affiliation(s)
| | | | | | | | | | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, UK.,Queen Mary University of London
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27
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Creta A, Ventrella N, Providência R, Earley MJ, Sporton S, Dhillon G, Papageorgiou N, Chow A, Lambiase PD, Lowe M, Schilling RJ, Finlay M, Hunter RJ. Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach. J Cardiovasc Electrophysiol 2020; 31:3097-3103. [DOI: 10.1111/jce.14789] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 06/17/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Antonio Creta
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nicoletta Ventrella
- Faculty of Medicine and Surgery Campus Bio‐Medico University of Rome Rome Italy
| | - Rui Providência
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Mark J. Earley
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Simon Sporton
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Gurpreet Dhillon
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Nikolaos Papageorgiou
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Anthony Chow
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Pier D. Lambiase
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Martin Lowe
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Richard J. Schilling
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Malcolm Finlay
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
| | - Ross J. Hunter
- Department of Electrophysiology, Barts Heart Center St. Bartholomew's Hospital London UK
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28
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Augusto JB, Menacho K, Andiapen M, Bowles R, Burton M, Welch S, Bhuva AN, Seraphim A, Pade C, Joy G, Jensen M, Davies RH, Captur G, Fontana M, Montgomery H, O’Brien B, Hingorani AD, Cutino-Moguel T, McKnight Á, Abbass H, Alfarih M, Alldis Z, Baca GL, Boulter A, Bracken OV, Bullock N, Champion N, Chan C, Couto-Parada X, Dieobi-Anene K, Feehan K, Figtree G, Figtree MC, Finlay M, Forooghi N, Gibbons JM, Griffiths P, Hamblin M, Howes L, Itua I, Jones M, Jardim V, Kapil V, Jason Lee WY, Mandadapu V, Mfuko C, Mitchelmore O, Palma S, Patel K, Petersen SE, Piniera B, Raine R, Rapala A, Richards A, Sambile G, Couto de Sousa J, Sugimoto M, Thornton GD, Artico J, Zahedi D, Parker R, Robathan M, Hickling LM, Ntusi N, Semper A, Brooks T, Jones J, Tucker A, Veerapen J, Vijayakumar M, Wodehouse T, Wynne L, Treibel TA, Noursadeghi M, Manisty C, Moon JC. Healthcare Workers Bioresource: Study outline and baseline characteristics of a prospective healthcare worker cohort to study immune protection and pathogenesis in COVID-19. Wellcome Open Res 2020; 5:179. [PMID: 33537459 PMCID: PMC7836029 DOI: 10.12688/wellcomeopenres.16051.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Most biomedical research has focused on sampling COVID-19 patients presenting to hospital with advanced disease, with less focus on the asymptomatic or paucisymptomatic. We established a bioresource with serial sampling of health care workers (HCWs) designed to obtain samples before and during mainly mild disease, with follow-up sampling to evaluate the quality and duration of immune memory. Methods: We conducted a prospective study on HCWs from three hospital sites in London, initially at a single centre (recruited just prior to first peak community transmission in London), but then extended to multiple sites 3 weeks later (recruitment still ongoing, target n=1,000). Asymptomatic participants attending work complete a health questionnaire, and provide a nasal swab (for SARS-CoV-2 RNA by RT-PCR tests) and blood samples (mononuclear cells, serum, plasma, RNA and DNA are biobanked) at 16 weekly study visits, and at 6 and 12 months. Results: Preliminary baseline results for the first 731 HCWs (400 single-centre, 331 multicentre extension) are presented. Mean age was 38±11 years; 67% are female, 31% nurses, 20% doctors, and 19% work in intensive care units. COVID-19-associated risk factors were: 37% black, Asian or minority ethnicities; 18% smokers; 13% obesity; 11% asthma; 7% hypertension and 2% diabetes mellitus. At baseline, 41% reported symptoms in the preceding 2 weeks. Preliminary test results from the initial cohort (n=400) are available: PCR at baseline for SARS-CoV-2 was positive in 28 of 396 (7.1%, 95% CI 4.9-10.0%) and 15 of 385 (3.9%, 2.4-6.3%) had circulating IgG antibodies. Conclusions: This COVID-19 bioresource established just before the peak of infections in the UK will provide longitudinal assessments of incident infection and immune responses in HCWs through the natural time course of disease and convalescence. The samples and data from this bioresource are available to academic collaborators by application https://covid-consortium.com/application-for-samples/.
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Affiliation(s)
- João B Augusto
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mervyn Andiapen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ruth Bowles
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maudrian Burton
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sophie Welch
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Corinna Pade
- William Harvey Research Institute, Queen Mary University of London, London, UK
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - George Joy
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Melanie Jensen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
| | - Ben O’Brien
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Áine McKnight
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Hakam Abbass
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mashael Alfarih
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Zoe Alldis
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Georgina L Baca
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Alex Boulter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - Natalie Bullock
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Nicola Champion
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Carmen Chan
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - Keenan Dieobi-Anene
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Karen Feehan
- Division of Medicine, University College London, London, UK
| | - Gemma Figtree
- Royal North Shore Hospital; The University of Sydney, Sydney, Australia
| | - Melanie C Figtree
- Royal North Shore Hospital; The University of Sydney, Sydney, Australia
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Nasim Forooghi
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Joseph M Gibbons
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton & NIHR Applied Research Collaboration (ARC), Wessex, UK
| | - Matt Hamblin
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Lee Howes
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ivie Itua
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Meleri Jones
- Wolfson Institute of Preventative Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Victor Jardim
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Vikas Kapil
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Wing-Yiu Jason Lee
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Vineela Mandadapu
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Celina Mfuko
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Oliver Mitchelmore
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Susana Palma
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Kush Patel
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Brian Piniera
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Alicja Rapala
- Institute of Cardiovascular Science, University College London, London, UK
| | - Amy Richards
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Genine Sambile
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Jorge Couto de Sousa
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - George D Thornton
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Jessica Artico
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Dan Zahedi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Parker
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Mathew Robathan
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Lauren M Hickling
- East London NHS Foundation Trust Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, UK
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | | | - Art Tucker
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jessry Veerapen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mohit Vijayakumar
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Theresa Wodehouse
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Lucinda Wynne
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
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Honarbakhsh S, Schilling RJ, Finlay M, Keating E, Hunter RJ. Prospective STAR-Guided Ablation in Persistent Atrial Fibrillation Using Sequential Mapping With Multipolar Catheters. Circ Arrhythm Electrophysiol 2020; 13:e008824. [PMID: 32903033 PMCID: PMC7566307 DOI: 10.1161/circep.120.008824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND A novel stochastic trajectory analysis of ranked signals (STAR) mapping approach to guide atrial fibrillation (AF) ablation using basket catheters recently showed high rates of AF termination and subsequent freedom from AF. METHODS This study aimed to determine whether STAR mapping using sequential recordings from conventional pulmonary vein mapping catheters could achieve similar results. Patients with persistent AF<2 years were included. Following pulmonary vein isolation AF drivers (AFDs) were identified on sequential STAR maps created with PentaRay, IntellaMap Orion, or Advisor HD Grid catheters. Patients had a minimum of 10 multipolar recordings of 30 seconds each. These were processed in real-time and AFDs were targeted with ablation. An ablation response was defined as AF termination or cycle length slowing ≥30 ms. RESULTS Thirty patients were included (62.4±7.8 years old, AF duration 14.1±4.3 months) of which 3 had AF terminated on pulmonary vein isolation, leaving 27 patients that underwent STAR-guided AFD ablation. Eighty-three potential AFDs were identified (3.1±1.1 per patient) of which 70 were targeted with ablation (2.6±1.2 per patient). An ablation response was seen at 54 AFDs (77.1% of AFDs; 21 AF termination and 33 cycle length slowing) and occurred in all 27 patients. No complications occurred. At 17.3±10.1 months, 22 out of 27 (81.5%) patients undergoing STAR-guided ablation were free from AF/atrial tachycardia off antiarrhythmic drugs. CONCLUSIONS STAR-guided AFD ablation through sequential mapping with a multipolar catheter effectively achieved an ablation response in all patients. AF terminated in a majority of patients, with a high freedom from AF/atrial tachycardia off antiarrhythmic drugs at long-term follow-up. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02950844.
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Affiliation(s)
| | | | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
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30
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Augusto JB, Menacho K, Andiapen M, Bowles R, Burton M, Welch S, Bhuva AN, Seraphim A, Pade C, Joy G, Jensen M, Davies RH, Captur G, Fontana M, Montgomery H, O’Brien B, Hingorani AD, Cutino-Moguel T, McKnight Á, Abbass H, Alfarih M, Alldis Z, Baca GL, Boulter A, Bracken OV, Bullock N, Champion N, Chan C, Couto-Parada X, Dieobi-Anene K, Feehan K, Figtree G, Figtree MC, Finlay M, Forooghi N, Gibbons JM, Griffiths P, Hamblin M, Howes L, Itua I, Jones M, Jardim V, Kapil V, Jason Lee WY, Mandadapu V, Mfuko C, Mitchelmore O, Palma S, Patel K, Petersen SE, Piniera B, Raine R, Rapala A, Richards A, Sambile G, Couto de Sousa J, Sugimoto M, Thornton GD, Artico J, Zahedi D, Parker R, Robathan M, Hickling LM, Ntusi N, Semper A, Brooks T, Jones J, Tucker A, Veerapen J, Vijayakumar M, Wodehouse T, Wynne L, Treibel TA, Noursadeghi M, Manisty C, Moon JC. Healthcare Workers Bioresource: Study outline and baseline characteristics of a prospective healthcare worker cohort to study immune protection and pathogenesis in COVID-19. Wellcome Open Res 2020; 5:179. [PMID: 33537459 PMCID: PMC7836029 DOI: 10.12688/wellcomeopenres.16051.1] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 01/20/2024] Open
Abstract
Background: Most biomedical research has focused on sampling COVID-19 patients presenting to hospital with advanced disease, with less focus on the asymptomatic or paucisymptomatic. We established a bioresource with serial sampling of health care workers (HCWs) designed to obtain samples before and during mainly mild disease, with follow-up sampling to evaluate the quality and duration of immune memory. Methods: We conducted a prospective observational study on HCWs from three hospital sites in London, initially at a single centre (recruited just prior to first peak community transmission in London), but then extended to multiple sites 3 weeks later (recruitment still ongoing, target n=1,000). Asymptomatic participants attending work complete a health questionnaire, and provide a nasal swab (for SARS-CoV-2 RNA by RT-PCR tests) and blood samples (mononuclear cells, serum, plasma, RNA and DNA are biobanked) at 16 weekly study visits, and at 6 and 12 months. Results: Preliminary baseline results for the first 731 HCWs (400 single-centre, 331 multicentre extension) are presented. Mean age was 38±11 years; 67% are female, 31% nurses, 20% doctors, and 19% work in intensive care units. COVID-19-associated risk factors were: 37% black, Asian or minority ethnicities; 18% smokers; 13% obesity; 11% asthma; 7% hypertension and 2% diabetes mellitus. At baseline, 41% reported symptoms in the preceding 2 weeks. Preliminary test results from the initial cohort (n=400) are available: PCR at baseline for SARS-CoV-2 was positive in 28 of 396 (7.1%, 95% CI 4.9-10.0%) and 15 of 385 (3.9%, 2.4-6.3%) had circulating IgG antibodies. Conclusions: This COVID-19 bioresource established just before the peak of infections in the UK will provide longitudinal assessments of incident infection and immune responses in HCWs through the natural time course of disease and convalescence. The samples and data from this bioresource are available to academic collaborators by application https://covid-consortium.com/application-for-samples/.
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Affiliation(s)
- João B Augusto
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mervyn Andiapen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ruth Bowles
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maudrian Burton
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sophie Welch
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Andreas Seraphim
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Corinna Pade
- William Harvey Research Institute, Queen Mary University of London, London, UK
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - George Joy
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Melanie Jensen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Rhodri H Davies
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
| | - Ben O’Brien
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Áine McKnight
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Hakam Abbass
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mashael Alfarih
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Zoe Alldis
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Georgina L Baca
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Alex Boulter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - Natalie Bullock
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Nicola Champion
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Carmen Chan
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - Keenan Dieobi-Anene
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Karen Feehan
- Division of Medicine, University College London, London, UK
| | - Gemma Figtree
- Royal North Shore Hospital; The University of Sydney, Sydney, Australia
| | - Melanie C Figtree
- Royal North Shore Hospital; The University of Sydney, Sydney, Australia
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Nasim Forooghi
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Joseph M Gibbons
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton & NIHR Applied Research Collaboration (ARC), Wessex, UK
| | - Matt Hamblin
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Lee Howes
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ivie Itua
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Meleri Jones
- Wolfson Institute of Preventative Medicine, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - Victor Jardim
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Vikas Kapil
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Wing-Yiu Jason Lee
- The Blizard Institute, Queen Mary University of London School of Medicine and Dentistry, London, UK
| | - Vineela Mandadapu
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Celina Mfuko
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Oliver Mitchelmore
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Susana Palma
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Kush Patel
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- NIHR Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Brian Piniera
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Alicja Rapala
- Institute of Cardiovascular Science, University College London, London, UK
| | - Amy Richards
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Genine Sambile
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Jorge Couto de Sousa
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | | | - George D Thornton
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Jessica Artico
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Dan Zahedi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ruth Parker
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Mathew Robathan
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Lauren M Hickling
- East London NHS Foundation Trust Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, UK
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | | | - Art Tucker
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jessry Veerapen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mohit Vijayakumar
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Theresa Wodehouse
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Lucinda Wynne
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK, London, UK
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31
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Creta A, Hunter RJ, Earley MJ, Finlay M, Dhinoja M, Sporton S, Chow A, Mohiddin SA, Boveda S, Adragao P, Jebberi Z, Matos D, Schilling RJ, Lambiase PD, Providência R. Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2626-2631. [DOI: 10.1111/jce.14659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/14/2020] [Accepted: 06/30/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Antonio Creta
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
- Research Doctorate Programme Campus Bio‐Medico University of Rome Rome Italy
| | - Ross J. Hunter
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Mark J. Earley
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Malcolm Finlay
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Mehul Dhinoja
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Simon Sporton
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Anthony Chow
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Saidi A. Mohiddin
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Serge Boveda
- Department of Cardiology Clinic Pasteur of Toulouse Toulouse France
| | - Pedro Adragao
- Department of Cardiology Hospital de Santa Cruz Lisbon Portugal
| | - Zeynab Jebberi
- Department of Cardiology Clinic Pasteur of Toulouse Toulouse France
| | - Daniel Matos
- Department of Cardiology Hospital de Santa Cruz Lisbon Portugal
| | - Richard J. Schilling
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Pier D. Lambiase
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
| | - Rui Providência
- Department of Cardiac Electrophysiology Barts Heart Centre, St. Bartholomew's Hospital London UK
- Institute of Health Informatics Research University College of London London UK
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32
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Finlay M, Wilson M, Erwin JA, Hansen DA, Layton ME, Quock RM, Van Dongen H. 0730 Individuals Receiving Methadone For Medication-Assisted Treatment Of Opioid Use Disorder Show Evidence Of Respiratory Depression. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Abstract
Introduction
A well-established consequence of opiate use is respiratory depression during sleep, with a high prevalence of central sleep apneas. Medication-assisted treatment (MAT) is a widely used therapy for opioid use disorder (OUD) designed to reduce withdrawal symptoms and drug cravings. We investigated the presence of respiratory depression during sleep in patients receiving methadone-based opioid replacement treatment as part of a MAT program for OUD.
Methods
N=6 individuals (5 females, ages 43.8±12.8y, BMI 27.2±4.1kg/m2), who were within 90 days of methadone initiation, underwent in-laboratory overnight polysomnography (8h TIB, 22:00-06:00). Apneaic and hypopneic events were determined using AASM criteria.
Results
The average Apnea-Hypopnea Index (AHI) was 16.5±9.0 events/h, with 2 individuals exceeding the threshold of moderate sleep apnea (>15 events/h). 89.5% of the observed apnea-hypopnea events occurred during NREM sleep. Of all events, 57.1±16.3% were central apneas; and of all obstructive, central, and mixed apnea events, 93.0±14.3% were central apneas.
Conclusion
Individuals with OUD receiving methadone-based MAT may be at risk of respiratory depression during sleep, as evidenced by the frequent occurrence of central sleep apneas. Such risk could be a contributing factor in opioid overdose deaths. Currently, performing respiratory assessments during sleep is not considered standard of care in MAT programs. Our preliminary data suggest that monitoring and treatment of respiratory depression during sleep may be indicated in OUD patients on methadone-based MAT.
Support
Supported in part by a seed grant from the Washington State University Office of Research Advancement and Partnerships.
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Affiliation(s)
- M Finlay
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - M Wilson
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- College of Nursing, Washington State University, Spokane, WA
| | - J A Erwin
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - D A Hansen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - M E Layton
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - R M Quock
- Department of Psychology, Washington State University, Pullman, WA
| | - H Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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Erwin JA, Wilson M, Finlay M, Hansen DA, Little-Gott A, Reynolds D, Quock RM, Layton ME, Van Dongen H. 1038 Sleep Architecture In Individuals Receiving Methadone For Medication-Assisted Treatment Of Opioid Use Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1034] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
It has been established that the use of opioids suppresses stage N3 sleep. For individuals with opioid use disorder (OUD), medication-assisted treatment (MAT) is a widely employed opioid replacement therapy used to mitigate withdrawal effects and drug cravings. We investigated sleep architecture in individuals receiving methadone-based MAT.
Methods
N=6 individuals (aged 43.8±12.8y; 5 females), who were within 90 days of methadone initiation, underwent in-laboratory overnight polysomnography (8h TIB; 22:00-06:00). Prior to bedtime, pain intensity and opioid withdrawal symptoms were assessed using the Numeric Pain Rating Scale (0-10) and the Clinical Opiate Withdrawal Scale (0-48). Sleep recordings were scored visually according to AASM guidelines.
Results
In this sample, subjects exhibited 87.4-93.0% (M: 92.2%) sleep efficiency (SE), 8.0-16.2min (M: 12.1min) sleep latency (SL), 5.5-7.5% (M: 6.5%) N1, 46.4-52.7% (M: 49.6%) N2, 20.7-30.6% (M: 25.6%) N3, 17.5-19.1% (M: 18.3%) REM, 28.0-38.5min (M: 33.3min) N3 latency, and 84.1-125.9min (M: 105.0min) REM latency. Subjects reported moderate pain intensity scores of 5-6 (M: 5.3) and mild to moderate withdrawal symptoms of 1-15 (M: 7.8).
Conclusion
Relative to published healthy sleeper norms, subjects showed more N1 and N3 and less REM sleep. The increased N3 was unexpected given that opioids (such as methadone) typically suppress N3; it may reflect subjects carrying a substantial sleep debt. Pain and withdrawal symptoms may be a factor increasing N1 and reducing REM sleep. Such potential sleep deficiencies may interfere with subjects achieving OUD recovery goals and are worthy of further investigation.
Support
Supported in part by a seed grant from the Washington State University Office of Research Advancement and Partnerships.
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Affiliation(s)
- J A Erwin
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - M Wilson
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- College of Nursing, Washington State University, Spokane, WA
| | - M Finlay
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - D A Hansen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - A Little-Gott
- College of Nursing, Washington State University, Spokane, WA
| | - D Reynolds
- College of Nursing, Washington State University, Spokane, WA
| | - R M Quock
- Department of Psychology, Washington State University, Pullman, WA
| | - M E Layton
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - H Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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Honarbakhsh S, Schilling RJ, Keating E, Finlay M, Hunter RJ. Drivers in AF colocate to sites of electrogram organization and rapidity: Potential synergy between spectral analysis and STAR mapping approaches in prioritizing drivers for ablation. J Cardiovasc Electrophysiol 2020; 31:1340-1349. [PMID: 32219906 DOI: 10.1111/jce.14456] [Citation(s) in RCA: 5] [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: 12/17/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stochastic trajectory analysis of ranked signals (STAR) mapping has recently been used to ablate persistent atrial fibrillation (AF) with high rates of AF termination and long-term freedom from AF in small, single-arm studies. We hypothesized that rapidity and organization markers would correlate with early sites of activation (ESA). METHODS Patients undergoing persistent AF ablation as part of the STAR mapping study were included. Five-minute unipolar basket recordings used to create STAR maps were used to determine the minimum-cycle length (Min-CL) and CL variability (CLV) at each electrode to identify the site of the fastest Min-CL and lowest CLV across the left atrium (LA). The location of ESA targeted with ablation was compared with these sites. Dominant frequency was assessed at ESA and compared with that of neighboring electrodes to assess for regional gradients. RESULTS Thirty-two patients were included with 83 ESA ablated, with an ablation response at 73 sites (24 AF termination and 49 CL slowing ≥30 ms). Out of these, 54 (74.0%) and 56 (76.7%) colocated to sites of fastest Min-CL and lowest CLV, respectively. Regional CL and frequency gradients were demonstrable at majority of ESA. ESA colocating to sites of fastest Min-CL and lowest CLV were more likely to terminate AF with ablation (odds ratio, 34 and 29, respectively, P = .02). These showed a moderate sensitivity (74.0% Min-CL and 75.3% CLV) and specificity (66.7% Min-CL and 76.9% CLV) in predicting ESA with an ablation response. CONCLUSIONS ESA correlate with rapidity and organization markers. Further work is needed to clarify any role for spectral analysis in prioritizing driver ablation.
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Affiliation(s)
| | | | - Emily Keating
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.,QUML
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Creta A, Providência R, Adragão P, de Asmundis C, Chun J, Chierchia G, Defaye P, Schmidt B, Anselme F, Finlay M, Hunter RJ, Papageorgiou N, Lambiase PD, Schilling RJ, Combes S, Combes N, Albenque JP, Pozzilli P, Boveda S. Impact of Type-2 Diabetes Mellitus on the Outcomes of Catheter Ablation of Atrial Fibrillation (European Observational Multicentre Study). Am J Cardiol 2020; 125:901-906. [PMID: 31973808 DOI: 10.1016/j.amjcard.2019.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022]
Abstract
Type-2 diabetes mellitus (DM) is associated with an increased risk of atrial fibrillation (AF). It is unclear whether DM is a risk factor for arrhythmia recurrence following catheter ablation of AF. We performed a nonrandomised, observational study in 7 high-volume European centres. A total of 2,504 patients who underwent catheter ablation of AF were included, and procedural outcomes were compared among patients with or without DM. Patients with DM (234) accounted for 9.3% of the sample, and were significantly older, had a higher BMI and suffered more frequently from persistent AF. Arrhythmia relapses at 12 months after AF ablation occurred more frequently in the DM group (32.0% vs 25.3%, p = 0.031). After adjusting for type of AF (i.e., paroxysmal vs persistent), during a median follow-up of 17 ± 16 months, atrial arrhythmia free-survival was lower in the diabetics with persistent AF (log-rank p = 0.003), and comparable for paroxysmal AF (log-rank p = 0.554). These results were confirmed in a propensity-matched analysis, and DM was also an independent predictor of AF recurrence on the multivariate analysis (hazard ratio 1.39; 95% confidence interval 95%1.07 to 1.88; p = 0.016). There was no significant difference in the rate of periprocedural complications among DM and non-DM patients (3.8% vs 6.3%, p = 0.128). Efficacy and safety of cryoballoon ablation were comparable to radiofrequency ablation in both DM and no-DM groups. In conclusion, catheter ablation of AF appears to be safe in patients with DM. However, DM is associated with higher rate of atrial arrhythmia relapse, particularly for patients with persistent AF.
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Affiliation(s)
- Antonio Creta
- Campus Bio-Medico University of Rome, Rome, Italy; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
| | - Rui Providência
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Clinic Pasteur of Toulouse, Toulouse, France; Institute of Health Informatics Research, University College of London, London, United Kingdom
| | - Pedro Adragão
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universiteit Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Julian Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Gianbattista Chierchia
- Heart Rhythm Management Centre, Universiteit Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | | | - Malcolm Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross Jacob Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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Dhillon GS, Schilling RJ, Honarbakhsh S, Graham A, Abbass H, Waddingham P, Sawhney V, Creta A, Sporton S, Finlay M, Providencia R, Chow A, Earley MJ, Lowe M, Lambiase PD, Hunter RJ. Impact of pulmonary vein isolation on mechanisms sustaining persistent atrial fibrillation: Predicting the acute response. J Cardiovasc Electrophysiol 2020; 31:903-912. [PMID: 32048786 DOI: 10.1111/jce.14392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Noninvasive mapping identifies potential drivers (PDs) in atrial fibrillation (AF). We analyzed the impact of pulmonary vein isolation (PVI) on PDs and whether baseline PD pattern predicted termination of AF. METHODS Patients with persistent AF less than 2 years underwent electrocardiographic imaging mapping before and after cryoballoon PVI. We recorded the number of PD occurrences, characteristics (rotational wavefronts ≥ 1.5 revolutions or focal activations), and distribution using an 18-segment atrial model. RESULTS Of 100 patients recruited, PVI terminated AF in 15 patients; 21.3% ± 9.1% (8.7 ± 4.8) of PDs occurred at the pulmonary veins (PVs) and posterior wall. PVI had no impact on PD occurrences outside the PVs and posterior wall (33.2 ± 12.9 vs 31.6 ± 12.5; P = .164), distribution over the remaining 13 segments (9 [8-11] vs 9 [8-10]; P = .634), the proportion of PDs that was rotational (82.9% ± 9.7% vs 83.6% ± 10.1%; P = .496), or temporal stability (2.4 ± 0.4 vs 2.4 ± 0.5 rotations; P = .541). Fewer focal PDs (area under the curve, 0.683; 95% CI, 0.528-0.839; P = .024) but not rotational PDs (P = .626) predicted AF termination with PVI. CONCLUSIONS PVI did not have a global impact on PDs outside the PVs and posterior wall. Although fewer focal PDs predicted termination of AF with PVI, the burden of rotational PDs did not. It is accepted though not all PDs are necessarily real or important. Outcome data are needed to confirm whether noninvasive mapping can predict patients likely to respond to PVI.
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Affiliation(s)
- Gurpreet S Dhillon
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Richard J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Adam Graham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Hakam Abbass
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Peter Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Vinit Sawhney
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Antonio Creta
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Simon Sporton
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Malcolm Finlay
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anthony Chow
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Mark J Earley
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Martin Lowe
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Graham AJ, Orini M, Zacur E, Dhillon G, Daw H, Srinivasan NT, Martin C, Lane J, Mansell JS, Cambridge A, Garcia J, Pugliese F, Segal O, Ahsan S, Lowe M, Finlay M, Earley MJ, Chow A, Sporton S, Dhinoja M, Hunter RJ, Schilling RJ, Lambiase PD. Evaluation of ECG Imaging to Map Hemodynamically Stable and Unstable Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2020; 13:e007377. [PMID: 31934784 DOI: 10.1161/circep.119.007377] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND ECG imaging (ECGI) has been used to guide treatment of ventricular ectopy and arrhythmias. However, the accuracy of ECGI in localizing the origin of arrhythmias during catheter ablation of ventricular tachycardia (VT) in structurally abnormal hearts remains to be fully validated. METHODS During catheter ablation of VT, simultaneous mapping was performed using electroanatomical mapping (CARTO, Biosense-Webster) and ECGI (CardioInsight, Medtronic) in 18 patients. Sites of entrainment, pace-mapping, and termination during ablation were used to define the VT site of origin (SoO). Distance between SoO and the site of earliest activation on ECGI were measured using co-registered geometries from both systems. The accuracy of ECGI versus a 12-lead surface ECG algorithm was compared. RESULTS A total of 29 VTs were available for comparison. Distance between SoO and sites of earliest activation in ECGI was 22.6, 13.9 to 36.2 mm (median, first to third quartile). ECGI mapped VT sites of origin onto the correct AHA segment with higher accuracy than a validated 12-lead ECG algorithm (83.3% versus 38.9%; P=0.015). CONCLUSIONS This simultaneous assessment demonstrates that CardioInsight localizes VT circuits with sufficient accuracy to provide a region of interest for targeting mapping for ablation. Resolution is not sufficient to guide discrete radiofrequency lesion delivery via catheter ablation without concomitant use of an electroanatomical mapping system but may be sufficient for segmental ablation with radiotherapy.
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Affiliation(s)
- Adam J Graham
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.).,Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.D.L.)
| | - Ernesto Zacur
- Institute of Biomedical Engineering, University of Oxford, United Kingdom (E.Z.)
| | - Gurpreet Dhillon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Holly Daw
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Neil T Srinivasan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Claire Martin
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Jem Lane
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Josephine S Mansell
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Alex Cambridge
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Jason Garcia
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Francesca Pugliese
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Oliver Segal
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Syed Ahsan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Mark J Earley
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Anthony Chow
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Ross J Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Richard J Schilling
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.)
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., C.M., J.L., J.S.M., A.C., J.G., F.P., O.S., S.A., M.L., M.F., M.J.E., A.C., S.S., M.D., R.J.H., R.J.S., P.D.L.).,Institute of Cardiovascular Science, University College London, United Kingdom (M.O., P.D.L.)
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Sawhney V, Schilling RJ, Providencia R, Cadd M, Perera D, Chatha S, Mercer B, Finlay M, Halimi F, Pavin D, Anselme F, Cebron JP, Chun J, Schmidt B, Defaye P, Dhillon G, Boveda S, Albenque JP, Tayebjee M, de Asmundis C, Chierchia G, Hunter RJ. Cryoablation for persistent and longstanding persistent atrial fibrillation: results from a multicentre European registry. Europace 2019; 22:375-381. [PMID: 31808520 DOI: 10.1093/europace/euz313] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/14/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractAimsAlthough cryoballoon pulmonary vein isolation is a well-established treatment for paroxysmal atrial fibrillation (AF), it’s role in persistent AF is unclear. We examined procedural success and long-term outcomes of cryoablation in persistent and longstanding persistent AF.Methods and resultsInternational multicentre registry from three UK and eight European centres. Consecutive patients undergoing cryoablation for persistent AF included. Procedural data, complications, and follow-up were prospectively recorded. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram with open access to arrhythmia nurses thereafter. Ambulatory monitoring was dictated by symptoms. Success was defined as freedom from AF or atrial tachycardia lasting >30 s off antiarrhythmic drugs (AADs). Six hundred and nine consecutive cryoablation procedures. Mean procedure and fluoroscopy times were 95 ± 65 and 13 ± 10 min. Single procedure success rates were 368/602 (61%) off AADs over a median of 2.4 (1.0–4.0) years. Arrhythmia-free survival off AADs was 64% and 57% for persistent and longstanding persistent AF at 24 months of follow-up (P = 0.02). Rate of repeat ablations was 20% in persistent and 32% in longstanding persistent AF (P = 0.006). Cox regression analyses showed a significant association between duration of AF and left atrial diameter and arrhythmia recurrence [hazard ratio (HR) 1.05, P-value 0.01 and HR 1.02, P-value 0.004].ConclusionCryoablation for persistent AF is safe, fast and has good outcomes at long-term follow-up. Cryoablation is reasonable as a first line option for these patients. Short procedure times may help increase capacity of cardiac units to meet the rising demand for AF ablation. Randomised control trials are needed to compare outcomes with different techniques.
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Affiliation(s)
- Vinit Sawhney
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Richard J Schilling
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Rui Providencia
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Matthew Cadd
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Dhanuka Perera
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Salman Chatha
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Ben Mercer
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Malcolm Finlay
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Franck Halimi
- Department of Cardiology, Hospital Prive Parly 2, Le Chesnay, Paris, France
| | - Dominique Pavin
- Department of Cardiology, Hospital Pontchaillou of Rennes, Rennes, France
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | | | - Jongi Chun
- Department of Cardiology, Medizinische Klinik 3, Markuskrankenhaus, Frankfurt, Germany
| | - Boris Schmidt
- Department of Cardiology, Medizinische Klinik 3, Markuskrankenhaus, Frankfurt, Germany
| | - Pascal Defaye
- Department of Cardiology, University Hospital of Grenoble, Grenoble, France
| | - Gurpreet Dhillon
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Muzahir Tayebjee
- West Yorkshire Arrhythmia Service, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Carlo de Asmundis
- Department of Cardiology, Heart Rhythm Management Centre, Brussels, Belgium
| | | | - Ross J Hunter
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew’s Hospital, London, UK
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Lim WY, Papageorgiou N, Sukumar SM, Alexiou S, Srinivasan NT, Monkhouse C, Daw H, Caldeira H, Harvie H, Kuriakose J, Baca M, Ahsan SY, Chow AW, Hunter RJ, Finlay M, Lambiase PD, Schilling RJ, Earley MJ, Providencia R. A nurse-led implantable loop recorder service is safe and cost effective. J Cardiovasc Electrophysiol 2019; 30:2900-2906. [PMID: 31578806 DOI: 10.1111/jce.14206] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures. METHODS Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed. RESULTS A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures. CONCLUSION ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings.
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Affiliation(s)
- Wei Yao Lim
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Nikolaos Papageorgiou
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Shivasankar M Sukumar
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sophia Alexiou
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Neil T Srinivasan
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Christopher Monkhouse
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Holly Daw
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helder Caldeira
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Helen Harvie
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Jincymol Kuriakose
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Marco Baca
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Syed Y Ahsan
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anthony W Chow
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.,Institute of Cardiovascular Science, University College of London, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rui Providencia
- Barts Heart Centre - Electrophysiology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.,Institute of Health Informatics, University College of London, London, United Kingdom
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Honarbakhsh S, Schilling RJ, Finlay M, Keating E, Ullah W, Hunter RJ. STAR mapping method to identify driving sites in persistent atrial fibrillation: Application through sequential mapping. J Cardiovasc Electrophysiol 2019; 30:2694-2703. [PMID: 31552697 PMCID: PMC6916564 DOI: 10.1111/jce.14201] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/05/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The optimal way to map localized drivers in persistent atrial fibrillation (AF) remains unclear. The objective of the study was to apply a novel vector mapping approach called Stochastic Trajectory Analysis of Ranked signals (STAR) in AF. METHODS AND RESULTS Patients having persistent AF ablation were included. Early sites of activation (ESA) identified on global STAR maps created with basket catheters were used to guide AF ablation post-pulmonary vein isolation (PVI). All patients also had sequential STAR maps created with ≥10 PentaRay recordings of 30 seconds. These were validated offline in their ability to identify the ESA targeted with a study-defined ablation response (AF termination or cycle length [CL] slowing of ≥30 ms). Thirty-two patients were included in whom 92 ESA were identified on the global STAR maps, with 73 of 83 targeted sites demonstrating an ablation response (24 AF termination and 49 CL slowing). Sixty-one out of 73 (83.6%) ESA were also identified on the sequential STAR maps. These showed greater consistency (P < .001), were seen pre- and post-PVI (P < .001) and were more likely to be associated with AF termination on ablation (P = .007). The sensitivity and specificity of sequential mapping for the detection of ESA with an ablation response was 84.9% (95% confidence interval [CI] = 74.6-92.2) and 90.0% (95% CI = 55.5-99.8), respectively. During a follow-up of 19.4 ± 3.7 months, 28 (80%) patients were free from AF/atrial tachycardia. CONCLUSIONS STAR mapping consistently identified ESA in all patients and the ablation response was compatible with ESA being driver sites. Mechanistically important ESA were successfully identified using sequential recordings.
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Affiliation(s)
- Shohreh Honarbakhsh
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Richard J Schilling
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Malcolm Finlay
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Emily Keating
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Waqas Ullah
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
| | - Ross J Hunter
- Electrophysiology department, The Barts Heart Centre, London, United Kingdom
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Creta A, Providência R, Finlay M. Fluoroscopy guided axillary vein access versus cephalic vein access in pacemaker and defibrillator implantation: Randomized clinical trial of efficacy and safety. J Cardiovasc Electrophysiol 2019; 30:2183. [DOI: 10.1111/jce.14115] [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] [Received: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Creta
- Barts Heart CentreSt. Bartholomew's HospitalLondon United Kingdom
- Campus Bio‐Medico University of RomeRome Italy
| | - Rui Providência
- Barts Heart CentreSt. Bartholomew's HospitalLondon United Kingdom
| | - Malcolm Finlay
- Barts Heart CentreSt. Bartholomew's HospitalLondon United Kingdom
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Papageorgiou N, Falconer D, Ioannou A, Wongwarawipat T, Barra S, Tousoulis D, Lim WY, Khan FZ, Ahsan S, Muthumala A, Hunter RJ, Finlay M, Creta A, Rowland E, Lowe M, Segal OR, Schilling RJ, Lambiase PD, Chow AW, Providência R. Full blood count as potential predictor of outcomes in patients undergoing cardiac resynchronization therapy. Sci Rep 2019; 9:13016. [PMID: 31506584 PMCID: PMC6736835 DOI: 10.1038/s41598-019-49659-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/18/2019] [Indexed: 01/05/2023] Open
Abstract
Almost a third of patients fulfilling current guidelines criteria have suboptimal responses following cardiac resynchronization therapy (CRT). Circulating biomarkers may help identify these patients. We aimed to assess the predictive role of full blood count (FBC) parameters in prognosis of heart failure (HF) patients undergoing CRT device implantation. We enrolled 612 consecutive CRT patients and FBC was measured within 24 hours prior to implantation. The follow-up period was a median of 1652 days (IQR: 837–2612). The study endpoints were i) composite of all-cause mortality or transplant, and ii) reverse left ventricular (LV) remodeling. On multivariate analysis [hazard ratio (HR), 95% confidence interval (CI)] only red cell count (RCC) (p = 0.004), red cell distribution width (RDW) (p < 0.001), percentage of lymphocytes (p = 0.03) and platelet count (p < 0.001) predicted all-cause mortality. Interestingly, RDW (p = 0.004) and platelet count (p = 0.008) were independent predictors of reverse LV remodeling. This is the first powered single-centre study to demonstrate that RDW and platelet count are independent predictors of long-term all-cause mortality and/or heart transplant in CRT patients. Further studies, on the role of these parameters in enhancing patient selection for CRT implantation should be conducted to confirm our findings.
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Affiliation(s)
- Nikolaos Papageorgiou
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom. .,Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Debbie Falconer
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adam Ioannou
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Tanakal Wongwarawipat
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sergio Barra
- Cardiology Department, Papworth Hospital, Cambridge, United Kingdom
| | | | - Wei Yao Lim
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Fakhar Z Khan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Syed Ahsan
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Amal Muthumala
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Malcolm Finlay
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Antonio Creta
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Edward Rowland
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Richard J Schilling
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Anthony W Chow
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Rui Providência
- Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Science, University College London, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
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Bhar-Amato J, Finlay M, Santos D, Orini M, Chaubey S, Vyas V, Taggart P, Grace AA, Huang CLH, Ben Simon R, Tinker A, Lambiase PD. Pharmacological Modulation of Right Ventricular Endocardial-Epicardial Gradients in Brugada Syndrome. Circ Arrhythm Electrophysiol 2019; 11:e006330. [PMID: 30354290 DOI: 10.1161/circep.118.006330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We explored the hypothesis that increased cholinergic tone exerts its proarrhythmic effects in Brugada syndrome (BrS) through increasing dispersion of transmural repolarization in patients with spontaneous and drug-induced BrS. Methods BrS and supraventricular tachycardia patients were studied after deploying an Ensite Array in the right ventricular outflow tract and a Cardima catheter in the great cardiac vein to record endo and epicardial signals, respectively. S1-S2 restitution curves from the right ventricular apex were conducted at baseline and after edrophonium challenge to promote increased cholinergic tone. The local unipolar electrograms were then analyzed to study transmural conduction and repolarization dynamics. Results The study included 8 BrS patients (5 men:3 women; mean age, 56 years) and 8 controls patients with supraventricular tachycardia (5 men:3 women; mean age, 48 years). Electrophysiological studies in controls demonstrated shorter endocardial than epicardial right ventricular activation times (mean difference: 26 ms; P<0.001). In contrast, patients with BrS showed longer endocardial than epicardial activation time (mean difference: -15 ms; P=0.001). BrS hearts, compared with controls, showed significantly larger transmural gradients in their activation recovery intervals (mean intervals, 20.5 versus 3.5 ms; P<0.01), with longer endocardial than epicardial activation recovery intervals. Edrophonium challenge increased such gradients in both controls (to a mean of 16 ms [ P<0.001]) and BrS (to 29.7 ms; P<0.001). However, these were attributable to epicardial and endocardial activation recovery interval prolongations in control and BrS hearts, respectively. Dynamic changes in repolarization gradients were also observed across the BrS right ventricular wall in BrS. Conclusions Differential contributions of conduction and repolarization were identified in BrS which critically modulated transmural dispersion of repolarization with significant cholinergic effects only identified in the patients with BrS. This has important implications for explaining the proarrhythmic effects of increased vagal tone in BrS, as well as evaluating autonomic modulation and epicardial ablation as therapeutic strategies.
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Affiliation(s)
- Justine Bhar-Amato
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.)
| | - Malcolm Finlay
- Barts Heart Centre, London, United Kingdom (M.F., V.V., R.B.S., P.D.L.).,Queen Mary's College London, United Kingdom (M.F., A.T.)
| | - Diogo Santos
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.)
| | - Michele Orini
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.)
| | | | - Vishal Vyas
- Barts Heart Centre, London, United Kingdom (M.F., V.V., R.B.S., P.D.L.)
| | - Peter Taggart
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.)
| | - Andrew A Grace
- Cambridge University, United Kingdom (A.A.G., C.L.-H.H.)
| | | | - Ron Ben Simon
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.).,Barts Heart Centre, London, United Kingdom (M.F., V.V., R.B.S., P.D.L.)
| | - Andrew Tinker
- Queen Mary's College London, United Kingdom (M.F., A.T.)
| | - Pier D Lambiase
- University College London, United Kingdom (J.B.-A., D.S., M.O., P.T., P.D.L.).,Barts Heart Centre, London, United Kingdom (M.F., V.V., R.B.S., P.D.L.)
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Thomas AM, Cabrera CP, Finlay M, Lall K, Nobles M, Schilling RJ, Wood K, Mein CA, Barnes MR, Munroe PB, Tinker A. Differentially expressed genes for atrial fibrillation identified by RNA sequencing from paired human left and right atrial appendages. Physiol Genomics 2019; 51:323-332. [PMID: 31172864 PMCID: PMC6732415 DOI: 10.1152/physiolgenomics.00012.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 03/13/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation is a significant worldwide contributor to cardiovascular morbidity and mortality. Few studies have investigated the differences in gene expression between the left and right atrial appendages, leaving their characterization largely unexplored. In this study, differential gene expression was investigated in atrial fibrillation and sinus rhythm using left and right atrial appendages from the same patients. RNA sequencing was performed on the left and right atrial appendages from five sinus rhythm (SR) control patients and five permanent AF case patients. Differential gene expression in both the left and right atrial appendages was analyzed using the Bioconductor package edgeR. A selection of differentially expressed genes, with relevance to atrial fibrillation, were further validated using quantitative RT-PCR. The distribution of the samples assessed through principal component analysis showed distinct grouping between left and right atrial appendages and between SR controls and AF cases. Overall 157 differentially expressed genes were identified to be downregulated and 90 genes upregulated in AF. Pathway enrichment analysis indicated a greater involvement of left atrial genes in the Wnt signaling pathway whereas right atrial genes were involved in clathrin-coated vesicle and collagen formation. The differing expression of genes in both left and right atrial appendages indicate that there are different mechanisms for development, support and remodeling of AF within the left and right atria.
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Affiliation(s)
- Alison M Thomas
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Claudia P Cabrera
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Malcolm Finlay
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Kulvinder Lall
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Muriel Nobles
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Kristie Wood
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, London, United Kingdom
| | - Charles A Mein
- Barts and London Genome Centre, School of Medicine and Dentistry, Blizard Institute, London, United Kingdom
| | - Michael R Barnes
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Centre for Translational Bioinformatics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew Tinker
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Finlay M, Bhar-Amato J, Ng KE, Santos D, Orini M, Vyas V, Taggart P, Grace AA, Huang CLH, Lambiase PD, Tinker A. Autonomic modulation of the electrical substrate in mice haploinsufficient for cardiac sodium channels: a model of the Brugada syndrome. Am J Physiol Cell Physiol 2019; 317:C576-C583. [PMID: 31291141 DOI: 10.1152/ajpcell.00028.2019] [Citation(s) in RCA: 5] [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] [Indexed: 12/19/2022]
Abstract
A murine line haploinsufficient in the cardiac sodium channel has been used to model human Brugada syndrome: a disease causing sudden cardiac death due to lethal ventricular arrhythmias. We explored the effects of cholinergic tone on electrophysiological parameters in wild-type and genetically modified, heterozygous, Scn5a+/- knockout mice. Scn5a+/- ventricular slices showed longer refractory periods than wild-type both at baseline and during isoprenaline challenge. Scn5a+/- hearts also showed lower conduction velocities and increased mean increase in delay than did littermate controls at baseline and blunted responses to isoprenaline challenge. Carbachol exerted limited effects but reversed the effects of isoprenaline with coapplication. Scn5a+/- mice showed a reduction in conduction reserve in that isoprenaline no longer increased conduction velocity, and this was not antagonized by muscarinic agonists.
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Affiliation(s)
- Malcolm Finlay
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Justine Bhar-Amato
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Keat-Eng Ng
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Diogo Santos
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Vishal Vyas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andrew A Grace
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Christopher L-H Huang
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andrew Tinker
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Manimaran M, Das D, Martinez P, Schwartz R, Schilling R, Finlay M. The impact of virtual arrhythmia clinics following catheter ablation for atrial fibrillation. Eur Heart J Qual Care Clin Outcomes 2019; 5:272-273. [PMID: 30847488 DOI: 10.1093/ehjqcco/qcz011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maniragav Manimaran
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.,University College London, Gower Street, London, UK
| | - Debashish Das
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Paula Martinez
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rhona Schwartz
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Richard Schilling
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Malcolm Finlay
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
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Honarbakhsh S, Hunter RJ, Ullah W, Keating E, Finlay M, Schilling RJ. Ablation in Persistent Atrial Fibrillation Using Stochastic Trajectory Analysis of Ranked Signals (STAR) Mapping Method. JACC Clin Electrophysiol 2019; 5:817-829. [PMID: 31320010 DOI: 10.1016/j.jacep.2019.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 02/28/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate that a stochastic vector-based mapping approach could guide ablation of atrial fibrillation (AF) drivers as evidenced by ablation response and long-term follow-up outcomes. BACKGROUND The optimal method for mapping and ablation of AF drivers is yet to be defined. METHODS Patients undergoing persistent AF ablation were recruited. Patients underwent pulmonary vein isolation (PVI) with further ablation guided by the stochastic trajectory analysis of ranked signals (STAR) mapping method. The proportion of the time an electrode's activation was seen to precede its neighboring electrodes activation was used to determine early sites of activation (ESA). A positive ablation response at ESA was defined as AF termination or cycle length slowing of ≥30 ms. Clinical outcome was defined as recurrence of AF/atrial tachycardia (AT) during a follow-up of 12 months. RESULTS Thirty-five patients were included (AF duration of 14.4 ± 5.3 months). After PVI, an average of 2.6 ± 0.8 ESA were ablated per patient with study-defined ablation response achieved in all patients. Of the 86 STAR maps created post-PVI, the same ESA was identified on 73.8 ± 26.1% of maps. ESA that resulted in AF termination were more likely to be identified on both pre- and post-PVI maps than those associated with cycle length slowing (23 of 24 vs. 16 of 49; p < 0.001). During a follow-up of 18.5 ± 3.7 months, 28 (80%) patients were free from AF/AT. CONCLUSIONS The ablation response at ESA suggests they may be drivers of AF. Ablation guided by STAR mapping produced a favorable clinical outcome and warrants testing through a randomized controlled trial. (Identification, Electro-mechanical Characterisation and Ablation of Driver Regions in Persistent Atrial Fibrillation [STAR MAPPING]; NCT02950844).
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Affiliation(s)
- Shohreh Honarbakhsh
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Waqas Ullah
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Emily Keating
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom.
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Graham AJ, Orini M, Zacur E, Dhillon G, Daw H, Srinivasan NT, Lane JD, Cambridge A, Garcia J, O’Reilly NJ, Whittaker-Axon S, Taggart P, Lowe M, Finlay M, Earley MJ, Chow A, Sporton S, Dhinoja M, Schilling RJ, Hunter RJ, Lambiase PD. Simultaneous Comparison of Electrocardiographic Imaging and Epicardial Contact Mapping in Structural Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007120. [DOI: 10.1161/circep.118.007120] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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)
- Adam J. Graham
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
- Department of Mechanical Engineering (M.O.), University College London, United Kingdom
| | - Ernesto Zacur
- Institute of Biomedical Engineering, University of Oxford, United Kingdom (E.Z.)
| | - Gurpreet Dhillon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Holly Daw
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Niel T. Srinivasan
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Jem D. Lane
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Alex Cambridge
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Jason Garcia
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Nanci J. O’Reilly
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Sarah Whittaker-Axon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Peter Taggart
- Institute of Cardiovascular Science (P.T., P.D.L.), University College London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Malcolm Finlay
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Mark J. Earley
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Antony Chow
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Simon Sporton
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Richard J. Schilling
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Ross J. Hunter
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
| | - Pier D. Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (A.J.G., M.O., G.D., H.D., N.T.S., J.D.L., A. Cambridge, J.G., N.J.O., S.W.-A., M.L., M.F., M.J.E., A. Chow, S.S., M.D., R.J.S., R.J.H., P.D.L.)
- Institute of Cardiovascular Science (P.T., P.D.L.), University College London, United Kingdom
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Honarbakhsh S, Hunter RJ, Finlay M, Ullah W, Keating E, Tinker A, Schilling RJ. Development, in vitro validation and human application of a novel method to identify arrhythmia mechanisms: The stochastic trajectory analysis of ranked signals mapping method. J Cardiovasc Electrophysiol 2019; 30:691-701. [PMID: 30801836 PMCID: PMC8609431 DOI: 10.1111/jce.13882] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Abstract
Introduction Methods and Results Conclusions
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Affiliation(s)
- Shohreh Honarbakhsh
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
| | - Ross J. Hunter
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
| | - Malcolm Finlay
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
| | - Waqas Ullah
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
| | - Emily Keating
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
| | | | - Richard J. Schilling
- Electrophysiology DepartmentThe Barts Heart Centre, Barts Health NHS trust London United Kingdom
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Creta A, Chow AW, Sporton S, Finlay M, Papageorgiou N, Honarbakhsh S, Dhillon G, Graham A, Patel KH, Dhinoja M, Earley MJ, Hunter RJ, Lowe M, Rowland E, Segal OR, Calabrese V, Ricciardi D, Lambiase PD, Schilling RJ, Providência R. Catheter ablation for fascicular ventricular tachycardia: A systematic review. Int J Cardiol 2019; 276:136-148. [DOI: 10.1016/j.ijcard.2018.10.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
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