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Akhtar Z, Sohal M, Kontogiannis C, Leung LWM, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in coronary venous drainage: challenges and solutions in delivering cardiac resynchronisation therapy. Europace 2022. [DOI: 10.1093/europace/euac053.490] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac resynchronisation therapy (CRT) is the cornerstone of heart failure management. Delivery of a left ventricular lead can occur in a small proportion of patients undermining the benefits of this treatment. Abnormal coronary venous anatomy is a contributing factor to this failure. Although epicardial lead placement is available, this patient cohort requiring CRT is subject to higher peri-operative morbidity and mortality than the general population; a transvenous approach is preferable.
Purpose
To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties.
Methods
From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted ‘normal’ anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected.
Results
From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an ‘unroofed’ coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant.
Conclusion
CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required.
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Affiliation(s)
- Z Akhtar
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - C Kontogiannis
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Harding
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Pearse
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Beeton
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Akhtar Z, Zuberi Z, Leung LWM, Kontogiannis C, Waleed K, Elbatran AI, Sohal M, Gallagher MM. Transvenous lead extraction: the Tandem approach. Europace 2022. [DOI: 10.1093/europace/euac053.535] [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
Transvenous lead extraction (TLE) has become an important strategy in the management of patients with cardiac implantable electronic devices (CIEDs). A rising population of patients with CIEDs coupled with an expanding indication for TLE, has fuelled demand. There are notable procedural risks however development of techniques and tools have contributed to an improvement in the safety and efficacy of TLE. The mechanical rotational dissecting sheath is safe and efficacious whilst the Needle’s Eye Snare (NES) is an additional ‘bail-out’ strategy contributing to procedural success.
Purpose
We sought to evaluate the outcomes of TLE performed from the superior access in conjunction with counter-traction provided by snaring of the targeted lead via the femoral access.
Method
The ‘Tandem’ procedure consisted of the rotational powered sheath performing dissection of the adhesions encapsulating the leads (at the superior access), in ‘Tandem’ with the Needle’s Eye Snare providing countertraction via the femoral vein. In brief: after deployment of the locking stylet in the lead lumen, the NES was used to grasp the lead in the right atrium and hold it tort while a rotational sheath was used to dissect through the veins. Once the sheath reached the right atrium, the lead was released from the snare and the sheath was used to continue dissection toward the lead tip. Data for all consecutive ‘Tandem’ procedures performed between 1/1/2021 – 1/1/2022 in our high-volume TLE institute were collected and evaluated for safety and efficacy.
Results
Forty patients aged 69.2±16.3 (70% male), underwent TLE of 75 leads (45 right ventricle, 25, right atrium, 5 left ventricle) with dwell time of 150.1±80.3 months for a non-infectious indication (65%). Of the 40 cases, 27 were hypertensives, 14 had ischaemic heart disease whilst 5 suffered diabetes with a left ventricle ejection fraction of 46.8±10.2%; 12 (30%) were pacing dependent. Procedures were performed by cardiologists in the cardiac catheterisation suite under general anaesthesia (95%) using a locking stylet (100%) with an Evolution RL (11-french 58.7%); a NES 13 millimetres curve (88%) was used to successfully snare 91% of the targeted leads. Complete procedural success was achieved in 92% of leads with 98.7% clinical success. Minor complications occurred in 2 cases (pneumothorax, pocket haematoma requiring intervention), in the absence of any major complications or peri-procedural mortality; there was no 30-day mortality.
Conclusion
The ‘Tandem’ procedure provides an additional strategy to improve the safety and efficacy of TLE, especially in leads of a long dwell time.
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Affiliation(s)
- Z Akhtar
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - C Kontogiannis
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - K Waleed
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - AI Elbatran
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Leung L, Akhtar Z, Bajpai A, Li A, Sohal M, Norman M, Kaba R, Al-Subaie N, Louis-Auguste J, Hayat J, Zuberi Z, Gallagher M. Oesophageal protection during AF ablation: real world registry data and mechanisms behind the therapeutic effect of tissue cooling. Europace 2022. [DOI: 10.1093/europace/euac053.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Oesophageal protection using a dedicated device to provide controlled active thermal protection of the oesophagus during atrial fibrillation ablation has been shown to be effective at reducing endoscopically detected oesophageal lesions. Real world registry data of this device and established evidence on the effect of cooling on localized tissue after thermal injury have been under review.
Purpose
To determine the safety of an oesophageal temperature control device by a review of real-world registry data on its clinical use during catheter ablation procedures and to clarify basic mechanisms of its therapeutic action by a literature review of scientific studies on cooling in the context of thermal injury.
Methods
The United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE), FDA Medical and Radiation Emitting Device Recalls, the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Alerts and SwissMedic records of Field Safety Corrective Actions (FSCA) databases were reviewed for any device-related adverse events. A systematic literature review was conducted to clarify the findings from studies investigating the physiological processes behind the therapeutic effect of cooling after tissue thermal injury.
Results
Of over 20,000 oesophageal temperature control devices clinically used, 7976 were recorded as having been used for the purpose of oesophageal protection during left atrial catheter ablations. No adverse events occurred related to its use during left atrial catheter ablations. No case of clinically significant oesophageal injury was reported in a patient who had been protected by the oesophageal temperature control device. 208 research articles retrieved from PubMed and MEDLINE that met the search criteria were reviewed. The common finding in all the studies was that cooling had an anti-inflammatory and restorative effect via modulation of several immune-mediated pathways, local cellular function and genetic expression.
Conclusions
There have been no adverse events reported to date in real world clinical use of an oesophageal temperature control device during left atrial catheter ablations, for the purpose of active thermal protection. Literature review data suggests that there are complex biophysical and cellular effects from cooling that leads to its therapeutic effect but further work is required to define the mechanisms of action of thermal protection in this specific context.
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Affiliation(s)
- L Leung
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - R Kaba
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - N Al-Subaie
- Ahmadi hospital, Anaesthetics, Kuwait, Kuwait
| | - J Louis-Auguste
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - J Hayat
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Gallagher
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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Gallagher M, Akhtar Z, Gang Y, Gonna H, Li A, Bajpai A, Zuberi Z, Norman M, Sohal M, Leung LWM. Randomised comparison of achieve and traditional circular mapping catheters in cryoballoon ablation: results at up to a decade. Europace 2022. [DOI: 10.1093/europace/euac053.082] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A single-centre trial randomised patients to the use of the Achieve mapping catheter or a traditional circular mapping catheter during cryoballoon procedures for paroxysmal atrial fibrillation (AF) in 2011-2014. Long-term outcomes from the cohort were determined in 2021.
Purpose
To evaluate the determinants of long-term outcome of ablation for paroxysmal AF.
Methods
Patient and study procedure characteristics and clinical outcomes were determined, including mapping catheter assignment, model of cryoballoon used, AF recurrence, repeat ablations required, findings at repeat ablation long term survival of the patient.
Results
Of 102 patients in the original study, 98 had long-term (4.11+/-2.82 years) follow up data available. 35 patients (35.7%) had AF recurrence, giving a long-term success rate at 64.3% after 1 ablation, increasing to 81.6% after repeat ablation. Of the study cohort n=8 (8.16%) died at a median of 4.9 years after ablation (IQR:1.7-5.7). 25/98 (25.5%) patients had a second ablation and 7 (7.1%) had a third or more ablations. Those who had AF recurrence were older, with a higher prevalence of prior ischaemic heart disease and cardiac device implantation (p=0.02-0.03). After multi-variate analysis, a prior implanted cardiac device was the only significant predictor of recurrence (p=0.03).
Conclusion
Long-term outcomes after a 1st time PAF cryoablation were similar regardless of the type of mapping catheter used, the generation of cryoballoon, and traditional procedure endpoints. AF recurrences were more often detected in older patients with a history of ischaemic heart disease and implanted cardiac devices.
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Affiliation(s)
- M Gallagher
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Y Gang
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - H Gonna
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- Epsom and St Helier University Hospitals NHS Trust, Cardiology, Epsom, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- Royal Surrey County Hospital, Cardiology, Guildford, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- Frimley Park Hospital, Cardiology, Frimley, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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5
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Akhtar Z, Gallagher MM, Leung LWM, Kontogiannis C, Elbatran AI, Zuberi Z, Sohal M. Tunnelled dialysis catheter extraction: a cardiology experience. Europace 2022. [DOI: 10.1093/europace/euac053.536] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Tunnelled dialysis catheters are integral to the management of patients with chronic kidney disease (CKD), providing a means to dialysis. They are prone to blockages necessitating removal. Most catheters are removed with manual traction without any sequalae by renal physicians whilst a small proportion require further intervention which may include interventional radiology or an ‘open’ surgical removal which carries additional risk. Cardiologists versed in transvenous lead extraction (TLE) provide an additional strategy.
Purpose
To evaluate the outcomes of tunnelled dialysis catheter ‘extractions’ performed by cardiologists at a high-volume TLE institute.
Method
All consecutive patients referred to cardiologists (1/10/2016 – 1/10/21) for extraction of tunnelled dialysis catheters following an unsuccessful attempt by the renal physicians and interventional radiology, were included in this series. Data of procedural outcomes was evaluated for safety and efficacy.
Results
Twelve patients (7 male) aged 64.15±15.04 years with a body mass index of 28.3 kg/m2 were referred for tunnelled catheter extraction for non-functioning lines (75%). Of these 12 CKD patients, the aetiology included focal segmental glomerulosclerosis (n=2), hypertension (n=2), diabetes (n=1) and sickle cell disease (n=1). In total, 12 tunnelled catheters (75%; n=9 right side) were completely removed (100%) using local anaesthesia (83.3%) in a procedure lasting 54.7±29.8 minutes and requiring 0.79±1.32 minutes of fluoroscopy. Eleven patients (91.7%) had their catheters successfully extracted with manual traction alone; 3 necessitated the use of a 0.035 stiff J-tip wire whilst one required the use of a rotational dissecting sheath Evolution (Cook Medical, USA). Of the 12 cases, 11 had a failed previous attempt including 1 patient who suffered a ventricular fibrillation cardiac arrest during the procedure and 1 was referred directly without an attempt as there was a concurrent pacemaker situated from the contralateral side; 4 patients had new lines placed and no significant complications occurred. There were no complications or procedural mortality.
Conclusion
Extraction of tunnelled dialysis catheter lines performed by cardiologists is safe and efficacious; experience in TLE is vital. This may provide an additional strategy for removal of these catheters when other percutaneous attempts fail.
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Affiliation(s)
- Z Akhtar
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - C Kontogiannis
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - AI Elbatran
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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6
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Stoddard K, Sohal M, Bedson R. Anaesthetic management of patients with sickle cell disease in obstetrics. BJA Educ 2022; 22:87-93. [PMID: 35211325 PMCID: PMC8847837 DOI: 10.1016/j.bjae.2021.11.005] [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] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- K. Stoddard
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M. Sohal
- Imperial College Healthcare NHS Trust, London, UK
| | - R. Bedson
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author.
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Akhtar Z, Gallagher MM, Elbatran A, Starck CT, Leung LWM, Sohal M. PROMET: The effect of operator profession on non-laser transvenous lead extraction. Europace 2021. [DOI: 10.1093/europace/euab116.493] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
PROMET group
Background
As implantation of cardiac implantable devices (CIED) rises globally, there is a paralleled need for extraction of these devices. Indications for transvenous lead extraction (TLE) is expanding, fuelling demand. This lifesaving procedure is performed by cardiologists and cardiac surgeons (CS). Cardiologists are familiar with transvenous methods whilst cardiac surgeons possess the skillset to address the significant complications associated with this procedure.
We compared non-laser TLE outcomes performed by cardiologists and cardiac surgeons from six high-volume extraction centres across Europe.
Methods
Data was collected retrospectively from six major European TLE centres of 2205 patients and 3849 leads (PROMET). Propensity 1:1 score matching (PSM) was performed to account for confounding variables. PSM model with variables: lead dwell time, infection indication, biventricular system and defibrillator device, was best matched. This dataset was analysed to compare outcomes of TLE performed by the cardiologists and CS. Predictors of 30-day mortality and complications were identified using a multivariate regression analysis.
Results
Patients treated by CS and cardiologists were similar in age (64.7 vs 66.7 years, p = NS) and equally male (70.3% vs 72.3%, p = 0.39) with a parallel infectious indication (51.7% vs 47.6%, p = 0.1). Surgeons achieved a significantly higher proportion of clinical success than cardiologists (98.9% vs 96.4%, p = 0.001) and complete lead extraction (98% vs 95.9%, p < 0.01) with a higher rate of minor complications (4.1% vs 2.2%, p = 0.024); major complications were similar (0.9% vs 1.2%, respectively, p = 0.46) as was 30-day mortality (3.2% vs 2%, respectively, p = 0.28). Multivariate regression analysis revealed systemic infection (p < 0.001, OR 7.2 [CI 2.3-20.1]) and defibrillator system extraction (p = 0.025, OR 3.4 [CI 1.2-10.2]) increased the odds of 30-day mortality, whilst Evolution™ sheath use reduced the odds (p = 0.025, OR 0.34 [CI 0.13-0.88]); lead dwell time (p = 0.02, OR 1.005 [1-1.009] and Evolution™ sheath use (p = 0.023, OR 2.15[1.1-4.15]) increased the odds of complications.
Conclusion
Cardiac surgeons and cardiologists achieved a high rate of TLE procedural success and with a similar safety profile, replicating standards seen across Europe.
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Affiliation(s)
- Z Akhtar
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Elbatran
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - CT Starck
- German Heart Center Berlin, Berlin, Germany
| | - L WM Leung
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Akhtar Z, Elbatran A, Starck CT, Leung LWM, Sohal M, Gallagher MM. PROMET: the effect of age on patient outcomes in non-laser transvenous lead extraction. Europace 2021. [DOI: 10.1093/europace/euab116.492] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
PROMET group
Background
Cardiac implantable electronic devices (CIEDs) improve morbidity and mortality. This has fuelled an upsurge in implantation of these devices across all patient cohorts, simultaneously increasing the need for transvenous lead extractions (TLE). As the global population expands and life-expectancy extends, TLE will play a significant role in CIED management. Advancing patient age is a recognised risk factor for poor outcomes however the association between patient age and TLE outcomes remains unclear.
We sought to evaluate the relationship between patient age and non-laser TLE outcomes.
Method
Data of 2205 patients (3849 leads) was collected retrospectively from six high-volume TLE institutes across Europe (PROMET) between January 2005-December 2018. Propensity 1:1 score matching was performed to limit the effects of confounding variables, pairing 353 patients in the >80 years of age category with 353 patients in <80 years of age group. Procedural outcomes were compared between the two age groups and multivariate regression analysis was used for predictors of 30-day mortality.
Results
In the <80 and >80 years-of-age cohorts, there was a similar proportion of male patients (65.3% vs 67.9%, p = 0.47) treated under general anaesthesia (96.5% vs 93.4%, p = 0.078) for a pre-dominant infectious indication (56.7% vs 60.3%, p = 0.52) but with a higher requirement of the EvolutionTM sheath in the octogenarians (39.4% vs 48.4%, p = 0.015). A similar clinical success per lead was achieved between the two age groups (96.6% vs 98%, <80 vs >80 years, p = 0.245) as was complete lead extraction (95.5% vs 96.6%, <80 vs >80 years, p = 0.44) with a comparable minor complication rate (2.3% vs 3.1%, <80 vs >80 years, p = 0.29) and major complications (1.1% vs 1.4%, <80 vs >80 years, p = 0.74). Thirty-day mortality was higher in the octogenarian cohort than the <80-year-olds without reaching statistical significance (5.4% vs 2.6%, p = 0.08); peri-procedural mortality was similar in both age groups (0.3% vs 0.6%, respectively, p = 0.56). Multivariate regression analysis revealed age (p = 0.013, OR 1.06 [1.01-1.12]), systemic infection (p = 0.026, OR 3.4 [1.16-10.35]) and lead dwell time (p = 0.007, OR 1.01 [1.003-1.017]) increased the odds of 30-day mortality.
Conclusion
Transvenous lead extraction is similar in efficacy and safety across all age groups. Thirty-day mortality is higher in the advanced age group, signifying the importance of post-procedural management in this cohort.
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Affiliation(s)
- Z Akhtar
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Elbatran
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - CT Starck
- German Heart Center Berlin, Berlin, Germany
| | - L WM Leung
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Elbatran A, Akhtar Z, Bajpai A, Leung LWM, Li A, Pearse S, Zuberi Z, Kaba R, Saba M, Norman M, Grimster A, Gallagher MM, Sohal M. Transvenous lead revision for cardiac perforation: a single centre experience. Europace 2021. [DOI: 10.1093/europace/euab116.491] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac perforation is an uncommon but life-threatening complication of cardiac implantable electronic device (CIED) implantation. Management strategy commonly relies on diagnostic Computed Tomography (CT) imaging and cardiac surgery. Emerging evidence has indicated a diversion from this approach. Transvenous culprit lead revision has been shown to be safe and efficacious in limited series.
We sought to evaluate the outcomes of transvenous lead revision in patients with cardiac perforation.
Method
Data was collected retrospectively of patients admitted to a single tertiary centre with CIED-related cardiac perforation between December 2013 – October 2019. Transvenous lead revision was performed as standard with cardiac surgery on standby. Patient demographics, use of CT imaging, method of removal and 30-day outcomes were recorded.
Results
Of the 46 recorded CIED-related cardiac perforations, the majority occurred in female patients (63%) and hypertensives (61%), whilst a proportion had cancer (20%) and ischaemic heart disease (30%). The culprit in most cases was a standard pacing lead (92%) of an active fixation (98%) in the right ventricle (80%) positioned at the ventricular apex (65%). The median time to presentation from implant was 14 days [IQR 4-50 days] with chest pain (44%); abnormal pacing indices was highly prevalent (95%) whilst a pericardial effusion was noted in the majority of cases (57%). CT scanning was performed in 19 cases (41%) for various indications but deemed essential in only 4, all of which had non-diagnostic pacing indices and imaging. Chest X-ray (CXR) found clear perforation, lead displacement or pleural effusion in 74% of cases, whilst an echocardiogram found these in 64% of cases. The culprit lead was replaced in the majority of cases (87%) under local anaesthesia (76%) with surgical backup. The median hospital stay was 7 days [IQR 3-10 days] with zero procedural and 30-day mortality.
Conclusion
Transvenous lead revision for CIED-related cardiac perforation is safe and efficacious. CT modality for diagnostic purposes is useful in providing incremental value in a minority of cases; patients with non-diagnostic pacing parameters and non-CT imaging benefit most from this.
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Affiliation(s)
- A Elbatran
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - L WM Leung
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Pearse
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kaba
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Saba
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Grimster
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Leung L, Bajpai A, Zuberi Z, Li A, Norman M, Kaba RA, Sohal M, Akhtar Z, Evranos B, Gonna H, Harding I, Al Subaie N, Louis-Auguste J, Hayat J, Gallagher MM. A registry review of 2532 catheter ablations for atrial fibrillation using active thermal protection. Europace 2021. [DOI: 10.1093/europace/euab116.250] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Dr Leung has received research support from Attune Medical (Chicago, IL). Dr Gallagher has received research funding from Attune Medical (Chicago, IL).
Background
Thermal injury to the oesophagus causes a spectrum of adverse effects after ablation for atrial fibrillation (AF); at the most severe end, atrio-oesophageal fistula carries a high mortality rate. Controlled active thermal protection in the oesophagus during ablation is the most promising method of oesophageal protection. Randomized evidence from the IMPACT trial (NCT03819946) showed an 83.4% reduction in endoscopically detected oesophageal lesions compared to standard care when an oesophageal temperature control device was used to control the local temperature. The IMPACT patients who were randomized to the use of the device had no adverse event related to its use. Real world registry data on applications of this device have not previously been available.
Purpose
To determine the safety of an oesophageal temperature control device by review of real-world registry data on its clinical use and any reported device-related adverse events.
Methods
We reviewed the following databases for any reported oesophageal temperature control device-related complications: The United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE), FDA Medical and Radiation Emitting Device Recalls, the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Alerts and SwissMedic records of Field Safety Corrective Actions (FSCA). An internal registry (post-marketing follow up) database maintained by the manufacturer of the device was used to quantify the number used for each indication. Reported events were reviewed and catalogued for description and identification of any events related to its use in the cardiac electrophysiology lab. The IMPACT study patients were reviewed for any device-related events.
Results
Of the 13, 284 oesophageal temperature control devices used, 2532 were recorded as having been used for the purpose of oesophageal protection during catheter ablation for AF. A total of 5 events associated with the device were identified, all from the MAUDE database. Three were from 2017, one from 2018, and one from 2019. All involved its use in critical care or trauma patients and were related to user error or contraindicated patient selection; none resulted in serious harm to the patient. No adverse events occurred related to its use in the cardiac electrophysiology lab. No case of clinically significant oesophageal injury was reported in a patient who had been protected by the oesophageal temperature control device.
Conclusions
Real world registry data has shown no adverse events reported to date in over 2500 uses of an oesophageal temperature control device in the cardiac electrophysiology lab, for the purpose of active thermal protection. This data supports the randomized trial evidence of its clinical effectiveness. Abstract Figure. Oesophageal active thermal protection
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Affiliation(s)
- L Leung
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - RA Kaba
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - B Evranos
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - H Gonna
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - I Harding
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - N Al Subaie
- Ahmadi hospital, Anaesthetics , Kuwait, Kuwait
| | - J Louis-Auguste
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - J Hayat
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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11
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Leung L, Bajpai A, Zuberi Z, Li A, Norman M, Kaba R, Akhtar Z, Evranos B, Gonna H, Harding I, Sohal M, Al-Subaie N, Louis-Auguste J, Hayat J, Gallagher M. Patient outcomes after AF ablation using Ablation Index technology with oesophageal protection: insight from the IMPACT study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0619] [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: 11/12/2022] Open
Abstract
Abstract
Background
Atrio-oesophageal fistula formation accounts for the majority of AF ablation-related morbidity and mortality. Thermal injury to the oesophagus can be significantly reduced by application of oesophageal cooling for protection during AF ablation. The effect of this method of oesophageal protection in patients receiving radiofrequency (RF) ablation guided by Ablation Index technology is currently unknown.
Objective
To investigate the ability of a temperature control device to protect the oesophagus from ablation-related thermal injury in patients receiving AF ablation guided by Ablation Index technology.
Methods
The IMPACT study is a single-centre, prospective, double-blind randomized controlled trial, which investigated the ability of a controlled method of oesophageal cooling to protect the oesophagus from ablation-related thermal injury. The EnsoETM device was used to deliver oesophageal cooling. This method was compared in a 1:1 randomization to a control group of standard practice utilizing a single-sensor temperature probe. In the study group, the device was used to keep the luminal temperature at 4°C during RF ablation. All participants received AF ablation using Ablation Index technology at posterior and anterior settings (30W at 350–400 and 40W at 450–500, respectively). Endoscopic examination was performed within 7 days post-ablation and oesophageal injury was graded. The patient and the endoscopist were blinded to the randomization. Structured clinical follow up occurred after 3 months post-ablation; both patient and follow up clinician were blinded.
Results
We recruited 188 patients, of whom 120 underwent endoscopic evaluation. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 versus 2/60; P=0.008). There was no difference between groups in RF time, lesion duration, force, power and combined ablation index (P value range= 0.2–0.9). Procedure and fluoroscopy duration were similar (P=0.97, P=0.91 respectively). The majority of those who passed through the 1st follow up evaluation (n=136) did not have gastrointestinal or chest pain symptoms post ablation and there was no difference between the randomized groups. Only 4.4% overall had severe symptoms and they were poorly correlated against those who sustained mucosal lesions. AF recurrence was similar in both groups (8% vs 8.8%). There were 2 cases of vascular trauma needing intervention in the control group and 1 case of conservatively managed pericardial effusion in the protected group only. Clinical and endoscopy findings did not report any EnsoETM device-related trauma.
Conclusion
Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared to standard care when ablation is performed using radiofrequency with Ablation Index technology. This method of oesophageal protection is safe and does not compromise the efficacy of the ablation procedure.
Endoscopy findings and patient symptoms.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): 1. Public hospital: St. George's NHS Foundation Trust; 2. Private company: Attune Medical (Chicago, IL)
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Affiliation(s)
- L Leung
- St. George's Hospital, London, United Kingdom
| | - A Bajpai
- St. George's Hospital, London, United Kingdom
| | - Z Zuberi
- St. George's Hospital, London, United Kingdom
| | - A Li
- St. George's Hospital, London, United Kingdom
| | - M Norman
- St. George's Hospital, London, United Kingdom
| | - R Kaba
- St. George's Hospital, London, United Kingdom
| | - Z Akhtar
- St. George's Hospital, London, United Kingdom
| | - B Evranos
- St. George's Hospital, London, United Kingdom
| | - H Gonna
- St. George's Hospital, London, United Kingdom
| | - I Harding
- St. George's Hospital, London, United Kingdom
| | - M Sohal
- St. George's Hospital, London, United Kingdom
| | - N Al-Subaie
- St. George's Hospital, London, United Kingdom
| | | | - J Hayat
- St. George's Hospital, London, United Kingdom
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Kaba R, Ashry A, Elbadri A, Gukop P, Li A, Sohal M, Bajpay A, Saba M, Sharma R, Gallagher M, Chandrasekaran V, Momin A. 16-month outcomes following hybrid ablation for long-standing persistent atrial fibrillation in patients with dilated atria. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0629] [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
Introduction
Although catheter ablation therapy is a well-established treatment for cardiac dysrhythmias, the success rates for longstanding, persistent AF with dilated atria remain unsatisfactory. The minimally invasive hybrid technology is a novel form of therapy.
Methods
A prospective, single-center UK study to evaluate the hybrid ablation technique for patients with longstanding (>1 year) persistent AF and dilated atria. Stage 1 was a minimally invasive epicardial approach for ablation of the posterior wall of left atrium (LA) and pulmonary veins (PVs). Stage 2 was a transcatheter approach via the femoral veins to isolate the endocardial aspect of the PVs +/− posterior wall. Occasionally, the sequence of the stages was reversed.
Results
Forty-one patients were enrolled for the study with a mean follow-up for 16±9 months. Mean age was 65±9 years and the mean BMI was 32±7. Males constituted 75% of the study cohort. Mean LA size was 48±7 mm and mean left ventricular ejection fraction (LVEF) was 51.9%, although 51.6% of patients had impaired LVSF (LVEF below 55%). 87.8% CI (0.7–0.9) of patients remained in sinus rhythm (SR) without repeat ablation, whereas only 12.2% CI (0.04–0.02) had redeveloped persistent AF. Although numerically different, there was no statistically significant difference in maintaining SR between patients with severely dilated LA (>50 mm) and those without (70% vs. 90%, respectively; z=−1.39, p=0.165). Major perioperative complications during stage 1 ablation were low, with IVC injury in 1 patient and a mild stroke in 1 patient. Median LOS was 1 day (1–4 days) and there was no 30-day mortality after stage 1.
Conclusions
The hybrid ablation therapy has a conversion rate from longstanding persistent AF to SR of 87.8% at a mean follow-up of 16±9 months, without repeat ablation. LOS was short, with very few complications and no peri-operative mortality. The hybrid approach appears to be very encouraging for a condition with otherwise low success rates by conventional endocardial techniques alone.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R.A Kaba
- St George's Hospital (London), London, United Kingdom
| | - A Ashry
- St George's Hospital (London), London, United Kingdom
| | - A Elbadri
- St George's Hospital (London), London, United Kingdom
| | - P Gukop
- St George's Hospital (London), London, United Kingdom
| | - A Li
- St George's Hospital (London), London, United Kingdom
| | - M Sohal
- St George's Hospital (London), London, United Kingdom
| | - A Bajpay
- St George's Hospital (London), London, United Kingdom
| | - M Saba
- St George's Hospital (London), London, United Kingdom
| | - R.A Sharma
- St George's Hospital (London), London, United Kingdom
| | - M Gallagher
- St George's Hospital (London), London, United Kingdom
| | | | - A Momin
- St George's Hospital (London), London, United Kingdom
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Sohal M, McLarty S, Friend KE, Johnson KD, Johlie M, Sawicki C, Johnson KA. Using digital engagement to proactively manage symptoms in patients on capecitabine. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12079] [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: 11/20/2022] Open
Abstract
12079 Background: Adherence to oral chemotherapy is a challenge due to the toxic adverse events (AEs) patients’ experience. Capecitabine (CAP) may cause patients to experience AEs such as diarrhea and hand and foot syndrome (HFS), leading to therapy non-adherence. Digital patient engagement has successfully improved patient adherence and has been used to monitor AEs in a variety of cancer types. We used proprietary secure messaging to engage specialty patients receiving CAP and to message them at the expected onset of diarrhea and HFS; nurse care management was deployed for patients reporting an AE. The objective of this study was to determine whether nurse engagement using digital tools to manage oncology AEs resulted in improved medication adherence. Methods: CAP patients were sent outgoing SMS branching logic messages during November 2019, and respondents reporting AEs were engaged by nurses using a proprietary secure messaging platform. Nurses made clinical interventions in these patients by either making a pharmacologic or non-pharmacologic recommendation or referring the patient to an oncologist. The number of patients responding to outgoing SMS and secure messaging, nurse interventions, and medication fill history were measured. We compared 30-day post-intervention proportion of days covered (PDC) in the intervention group (those that engaged with nurses and received digital adherence and clinical messages) to standard of care (those who received digital adherence and clinical messages but did not engage) using the Student’s t-test. Results: 1,421 outgoing messages were sent to utilizers of CAP; 95 patients replied indicating the occurrence of either diarrhea or HFS. Nurse care managers reached 49 (52%) unique patients resulting in 54 interventions where care coordination was provided. The majority of engaged patients reached (74%) had symptom resolution as a result of nurse intervention. PDC was 79.3% in the intervention group and 68.8% (p = 0.038) in the standard of care group. Conclusions: SMS and secure messaging patients with AEs on CAP resulted in clinical interventions by nurse care managers. Nurse intervention resulted in the majority of patients having symptomatic resolution and therapy continuation. PDC indicated greater medication adherence in the engaged group. These results for one drug suggest that nurse digital engagement can be effective in increasing adherence for patients treated with oral oncolytics suffering from AEs. Proactive symptom tracking supports the early identification of potential AEs and effective nurse care coordination.
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Fedida J, Strisciuglio T, Sohal M, Wolf M, Vanbeeumen K, Neyrinck A, Taghji P, Lepiece C, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Efficacy of advanced pace mapping technology for idiopathic premature ventricular complexes ablation: Usefulness of pace mapping. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Sieniewicz B, Behar J, Sohal M, Claridge S, Porter B, Niederer S, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke FA, Rinaldi CA. 533Does targeting the site of maximal electrical delay result in the optimal haemodynamic improvement; results from an international multi-centre registry. Europace 2018. [DOI: 10.1093/europace/euy015.300] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - M Sohal
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Niederer
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gamble
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - P Jais
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - N Derval
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - D Spragg
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - P Steendijk
- Leiden University Medical Center, Leiden, Netherlands
| | | | - F A Bracke
- Catharina Hospital, Eindhoven, Netherlands
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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Sieniewicz B, Behar J, Sohal M, Porter B, Claridge S, Niederer S, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder BERRY, Bracke FA, Rinaldi CA. 687Cardiomyoapthic aetiology affects the distribution of endocardial electrical latency; results from a multi-centre registry. Europace 2018. [DOI: 10.1093/europace/euy015.332] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Sieniewicz
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Behar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - M Sohal
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - B Porter
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Claridge
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - S Niederer
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Gamble
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - T R Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - P Jais
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - N Derval
- Hospital Haut Leveque, Bordeaux-Pessac, France
| | - D Spragg
- Johns Hopkins University of Baltimore, Baltimore, United States of America
| | - P Steendijk
- Leiden University Medical Center, Leiden, Netherlands
| | | | - F A Bracke
- Catharina Hospital, Eindhoven, Netherlands
| | - C A Rinaldi
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
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Fedida J, Strisciuglio T, Sohal M, Wolf M, Van Beeumen K, Neyrinck A, Taghji P, Lepiece C, Almorad A, Vandekerckhove Y, Tavernier R, Duytschaever M, Knecht S. Efficacy of advanced pace-mapping technology for idiopathic premature ventricular complexes ablation. J Interv Card Electrophysiol 2018; 51:271-277. [DOI: 10.1007/s10840-018-0320-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke F, Rinaldi A. 807Identifying the optimal location for LV endocardial pacing: results from a multicentre international registry. Europace 2017. [DOI: 10.1093/ehjci/eux149.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fedida J, Sohal M, Wolf M, Van Beeumen K, Neyrinck A, Taghji P, Choudhury R, Louw R, Vandekerkchove Y, Tavernier R, Duytschaever M, Knecht S. P925Efficacy of advanced pace mapping technology for idiopathic pvc ablation. Europace 2017. [DOI: 10.1093/ehjci/eux151.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gleder B, Bracke F, Rinaldi CA. P260Electrical latency (Q-LV) predicts the optimal LV endocardial pacing site; results from a multi-centre registry. Europace 2017. [DOI: 10.1093/ehjci/eux171.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sieniewicz B, Behar J, Sohal M, Gamble J, Betts TR, Jais P, Derval N, Spragg D, Steendijk P, Van Gelder B, Bracke F, Rinaldi CA. P998Paced QRS duration predicts the optimal LV endocardial pacing site; results from a multi-centre registry. Europace 2017. [DOI: 10.1093/ehjci/eux151.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Whitaker J, Fish J, Chubb H, Harrison J, Williams S, Sohal M, Van Zaen J, Gibbs J, Rittey D, Thorsten J, Donskoy E, Mukherjee R, O'neill L, Wright M, O'neill M. P877Lesion Index facilitates continuous transmural radiofrequency ablation lesions in a porcine recovery model. Europace 2017. [DOI: 10.1093/ehjci/eux151.059] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Domenichini G, Gonna H, Harding I, Arthur M, Khan P, Jones S, Sohal M, Gallagher MM. P992Transvenous lead extraction in octogenarian and nonagenarian patients. Europace 2017. [DOI: 10.1093/ehjci/eux151.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Evans J, Silberbauer J, Glover B, Kontogeorgis A, McLellan A, Panikker S, Sieniewicz B, Martin C, Burg M, Providencia R, Behar J, Burke M, Withers K, White J, Lencioni M, Carolan-Rees G, Wood K, Patrick H, Griffith M, Gomes J, Kirubakaran S, O'Nunain S, Bencat M, McCready J, Michael K, Hashemi J, Gupta D, Akl S, Redfearn D, Lim E, Panikker S, Butcher C, Khan H, Mantziari L, Jarman J, Hussain W, Jones D, Clague J, Ernst S, Markides V, Wong T, Ezzat V, Schilling R, Lowe M, Whitaker J, Virmani R, Kutys R, Jarman J, Fastl T, Haldar S, Butcher C, Khan H, Mantziari L, O'Neill M, Corado C, Nicol E, Foran J, Markides V, Niederer S, Wong T, Behar J, Sohal M, Jais P, Derval N, Spragg D, Van Gelder B, Bracke F, Steendijk P, Rinaldi C, Chooneea B, Gajendragadkar P, Ahsan S, Begley D, Dhinoja M, Earley M, Ezzat V, Finlay M, Grace A, Heck P, Hunter R, Lambiase P, Lowe M, Rowland E, Schilling R, Segal O, Sporton S, Virdee M, Chow A, Apap Bologna R, Camilleri W, Sammut M, Aquilina O, Barra S, Papageorgiou N, Falconer D, Duehmke R, Rehal O, Ahsan S, Ezzat V, Dhinoja M, Ioannou A, Segal O, Sporton S, Rowland E, Lowe M, Lambiase P, Agarwal S, Chow A, Toth D, Mountney P, Reiml S, Panayioutu M, Brost A, Fahn B, Sohal M, Patel N, Claridge S, Jackson T, Adhya S, Sieniwicz B, O'Neill M, Razavi R, Rhode K, Rinaldi C, Tjong F, Brouwer T, Koop B, Soltis B, Shuros A, Knops R. ORAL ABSTRACTS (2)EP & Ablation19CARDIAC ABLATION PATIENT REPORTED OUTCOMES MEASURES (PROMS): ANALYSIS OF POST-ABLATION AND 1 YEAR FOLLOW-UP DATA20INTENTIONAL CORONARY VEIN EXIT AND CARBON DIOXIDE INSUFFLATION TO ALLOW SAFE SUBXIPHOID EPICARDIAL ACCESS FOR VENTRICULAR MAPPING AND ABLATION - FIRST EXPERIENCE21PACED FRACTIONATION DETECTION AS A TOOL FOR MAPPING SCARS IN VT22DOES USE OF CONTACT-FORCE SENSING CATHETERS IMPROVE THE OUTCOME OF ABLATION OF VENTRICULAR TACHYCARDIA?23RETROGRADE AORTIC ACCESS OF THE PULMONARY VENOUS ATRIUM PROVIDES EQUIVALENT OUTCOMES TO RIGHT ATRIAL OR TRANSEPTAL ACCESS OF THE LEFT ATRIUM IN PATIENTS WITH CONGENITAL HEART DISEASE24COMPUTATIONAL THREE-DIMENSION LEFT ATRIAL APPENDAGE WALL THICKNESS MAPS AND HISTOLOGICAL ANALYSIS TO GUIDE LEFT ATRIAL APPENDAGE ELECTRICAL ISOLATIONPacing & Devices25IDENTIFYING THE OPTIMAL LOCATION FOR LV ENDOCARIDAL PACING:RESULTS FROM A MULTICENTRE INTERNATIONAL REGISTRY OF LV ENDOCARDIAL PACING26UK MULTI-CENTRE REGISTRY OF TRANSVENOUS LEAD EXTRACTION: CLINICAL OUTCOME USING TRACTION, CUTTING SHEATHS AND LASER TECHNIQUES27SKIN FISTULA FORMATION - A NEW EXPERIENCE WITH THE NEW TYRX ABSORBABLE ANTIMICROVIAL ENVELOPE28BIFOCAL RIGHT VENTRICULAR PACING IN PATIENTS WITH FAILED CORONARY-SINUS LEAD IMPLANTS: LONG-TERM RESULTS FROM MULTICENTRE REGISTRY29REAL TIME X-MRI GUIDED LEFT VENTRICULAR LEAD IMPLANTATION FOR TARGETED DELIVERY OF CARDIAC RESYNCHRONIZATION THERAPY30ACUTE AND CHRONIC PERFORMANCE OF COMMUNICATING LEADLESS ANTI-TACHYCARDIA PACEMAKER AND SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR. Europace 2016. [DOI: 10.1093/europace/euw271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Behar J, Behar J, Providência R, Cronbach P, Siddiqui S, Brough C, Ara F, Newham W, Ng F, Ayala-Paredes F, Withers K, Hayward C, Chin H, Fearn S, Omerod J, Gamble J, Foley P, Bostock J, Claridge S, Jackson T, Sohal M, Razavi R, Betts T, Herring N, Rinaldi C, Pourmorteza A, McVeigh E, Niederer S, Claridge S, Jackson T, Sohal M, Preston R, Carr-White G, Razavi R, Rajani R, Rinaldi C, Boveda S, Defaye P, Barra S, Babu G, Ang R, Algalarrondo V, Bouzeman A, Ahsan S, Deharo JC, Sporton S, Segal O, Klug D, Lambiase P, Sadoul N, Agarwal S, Piot O, Chow A, Périer M, Fauchier L, Babuty D, Lowe M, Leclercq C, Bordachar P, Marijon E, Wilson D, Panfilo D, Greenhut S, Stegemann B, Morgan J, Nicolson W, Li A, Behr E, Ng G, Raman G, Belchambers S, Rao A, Wright D, John I, Crockford C, Kaba R, Begg G, Tayebjee M, Leong K, Hu M, Kanapeckaite L, Roney C, Lim P, Harding S, Peters N, Varnava A, Kanagaratnam P, Roux JF, Badra M, White J, Lencioni M, Carolan-Rees G, Patrick H, Griffith M, Patel H, Spiesshoefer J, Morley-Smith A, Patel K, Rosen S, DiMario C, Lyon A, Cowie M. Devices & Sudden death. Europace 2015; 17:v10-v13. [PMCID: PMC4892105 DOI: 10.1093/europace/euv331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
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Jackson TA, Sohal M, Child N, Chen Z, Sammut E, Behar J, Claridge S, Carr-White G, Razavi R, Rinaldi CA. 60 * Greater mechanical dyssynchrony is demonstrated by cardiac magnetic resonance cine imaging amongst heart failure patients awaiting cardiac resynchronisation therapy with strict left bundle branch block. Europace 2014. [DOI: 10.1093/europace/euu242.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Phan TT, Khan S, Dewhurst M, Lee D, James S, de Belder M, Linker NJ, Thornley A, Turley AJ, Ahmed FZ, Arumugam P, Allen S, Daniels K, Clarke B, Mamas M, James J, Zaidi AM, Ullah W, Hunter R, Lovell M, Dhinoja M, Earley M, Sporton S, Schilling R, Raju H, Hedley P, Arno G, Ware J, Jeffery S, Cook S, Christiansen M, Behr ER, Sohal M, Chen Z, Sammut E, Jackson T, Child N, Wright M, O'Neill M, Cooklin M, Gill J, Carr-White G, Razavi R, Rinaldi CA, Nunn LM, Lopes L, Syrris P, Plagnol V, Firman E, Dalageorgou C, Domingo D, Zorio E, Murday V, Findlay I, Duncan A, Fynn S, White A, Goddard M, Carr-White G, Robert L, Bueser T, Langman C, Bundgaard H, Ferrero-Miliani L, Wheeldon N, O'Beirne A, Suvarna SK, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. YOUNG INVESTIGATORS COMPETITION, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ang R, Birnbaumer L, Gourine AV, Tinker A, Hamilton RM, Strandberg L, Cui X, Rath A, Liu J, Sirigam V, Ackerley C, Jaeggi E, Backx P, Silverman ED, Debney MT, Ng FS, Lyon AR, Peters NS, Opel A, Nobles M, Tinker A, Winter J, Chin SH, Brack KE, Ng GA, Finlay MC, Xu L, Nobles M, Lane J, Lowe M, Ben-Simon R, Bhar-Amato J, Hussain Q, Sebastian S, Taggart P, Tinker A, Lambiase PD, Almeida TP, Salinet J, Chu GS, Schlindwein FS, Ng GA, Williams SE, Linton NWF, Harrison J, Wright M, Plank G, O'Neill MD, Niederer S, Raine DT, Langley P, Shepherd E, Lord S, Murray S, Bourke JP, Chen Z, Hanson B, Sohal M, Child N, Sammut E, Jackson T, Shetty A, Bostock J, Gill J, Carr-White G, Rinaldi CA, Taggart P, Williams SE, Linton NW, Harrison J, Wright M, Rhode K, O'Neill MD, Barrows S, Jones K, Porter N. POSTER SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dewey S, Lai X, Witzmann FA, Sohal M, Gomes AV. Proteomic Analysis of Hearts from Akita Mice Suggests That Increases in Soluble Epoxide Hydrolase and Antioxidative Programming Are Key Changes in Early Stages of Diabetic Cardiomyopathy. J Proteome Res 2013; 12:3920-33. [DOI: 10.1021/pr4004739] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Xianyin Lai
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - Frank A. Witzmann
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
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Chen Z, Kotecha T, Crichton S, Shetty A, Sohal M, Arujuna A, Kirubakaran S, Bostock J, Cooklin M, O'Neill M, Wright M, Gill JS, Rinaldi CA. Lower incidence of inappropriate shock therapy in patients with combined cardiac resynchronisation therapy defibrillators (CRT-D) compared with patients with non-CRT defibrillators (ICDs). Int J Clin Pract 2013; 67:733-9. [PMID: 23869676 DOI: 10.1111/ijcp.12033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A significant number of patients experience inappropriate shock therapy (IST) from implantable cardioverter-defibrillators (ICD). An increasing number of patients with advanced heart failure receive combined ICD and cardiac resynchronisation therapy devices (CRT-D). The incidence of IST in this group is less well described. We aimed to assess the incidence and predictors of IST in CRT-D patients. METHODS A retrospective cohort study of prospectively collected data on patients who received an ICD and CRT-D between October 2007 and January 2009 at our institution were studied. The primary outcome measures were the IST event rate and all-cause mortality. RESULTS A total of 185 patients with ICD/CRT-D (100/85) were included in the analysis. Eighteen patients experienced 35 episodes of IST during the follow-up (21 ± 13 months). There was a significantly lower IST cumulative event rate in the CRT-D vs. ICD group, 5% (CI: 1-13%) vs. 19% (95% CI: 11-30%) by 24 months, (p = 0.017). The majority of the IST was caused by atrial arrhythmias with atrial fibrillation accounting for 28 episodes of IST in nine patients. Multivariate analysis using Cox hazard model including baseline characteristics and coexisting appropriate shock therapy showed that a history of atrial fibrillation/flutter was the strongest independent predictor of IST with a hazard ratio of 3.53 (p = 0.019). CONCLUSION Patients with CRT-D had a significantly lower incidence of IST compared with patients receiving an ICD. Given that atrial arrhythmia remained the commonest trigger for IST, our finding lends support to the hypothesis that CRT may reduce atrial fibrillation burden in patients receiving CRT-D.
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Affiliation(s)
- Z Chen
- Kings College London, London, UK.
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Dewey S, Sohal M, Gomes AV. Proteomic Analysis of Akita Mice Reveals 9 Proteins Altered during Early Stages of Diabetic Cardiomyopathy. Biophys J 2013. [DOI: 10.1016/j.bpj.2012.11.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sohal M, Williams SE, Chen Z, Bostock J, Hamid S, Patel N, Bucknall C, Gill JS, Rinaldi CA. 060 The practice and perception of transvenous lead extraction in the UK: lessons from a nationwide survey. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shetty AK, Mehta PA, Squirrel M, Bostock J, Rinaldi CA, Wright GA, Lines I, Tomlinson DR, Haywood GA, Shetty AK, Neiderer S, Bostock J, Ginks M, Duckett SG, Ma Y, Chen Z, Sohal M, Mehta P, Kapetanakis S, Carr-White G, Rinaldi CA, Kyriacou A, Pabari P, Lefroy D, Davies DW, Peters N, Kanagaratnam P, Mayet J, Hughes A, Francis DP, Whinnett ZI, Khoo CW, Krishnamoorthy S, Dwivedi G, Lip GYH, Lim HS, Khoo CW, Krishnamoorthy S, Dwivedi G, Lip GYH, Lim HS, Nallur Shivu G, Brooks V, Johns MJ, Bleasdale RA, Yung LTM, Wilson S, Slade AKB, Johnston RT, Chernyshev AA, Kovalev IA, Zavadovsky KV, Popov SV, Garg P, Khan I, Douglas H. POSTER SESSION 2, HRC 2011. Europace 2011. [DOI: 10.1093/europace/eur292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shetty AK, Mehta P, Duckett S, Bostock J, Ginks M, Hamid S, Sohal M, Razavi R, Ma Y, Rhode K, Arujuna A, Rinaldi CA. 153 Ventricular pacing along individual branches of the coronary sinus using a quadripolar LV pacing lead. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shetty A, Duckett S, Ginks M, Ma Y, Sohal M, Mehta P, Hamid S, Bostock J, Carr-White G, Rhode K, Razavi R, Rinaldi CA. 152 Real-time cardiac MR anatomy and dyssynchrony overlay to guide left ventricular lead placement in CRT. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chase AR, Sohal M, Howard J, Laher R, McCarthy A, Layton DM, Oteng-Ntim E. Pregnancy outcomes in sickle cell disease: a retrospective cohort study from two tertiary centres in the UK. Obstet Med 2010; 3:110-2. [PMID: 27579072 DOI: 10.1258/om.2010.100026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 08/16/2010] [Indexed: 11/18/2022] Open
Abstract
The objective of this retrospective cohort study from two tertiary centres in the UK was to describe the pregnancy outcomes of women with sickle cell disease (SCD) who booked at these centres between 2004 and 2008, and to compare this with historical data. The study population comprised 122 singleton pregnancies in women with SCD: homozygous sickle cell disease 64, sickle cell haemoglobin C disease 45, sickle b plus thalassaemia 11, sickle cell haemoglobin E disease 1 and sickle cell delta disease 1 from 2004 to 2008 managed in the joint haematology/obstetric antenatal clinics in two tertiary teaching hospitals. The main outcome measures were the frequency of sickle cell crises and obstetric complications. Age and gestation at booking were 18-43 years (mean 29.7) and 9-36 weeks gestation (mean 17.3), respectively. Complications of SCD occurred in 25% of pregnancies. Fifty-four percent of women had induction of labour and 39% were delivered by emergency caesarean section. Thirty-three percent had a postpartum haemorrhage. Nineteen percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 20% of singleton pregnancies. Three neonates developed transient complications related to maternal opiate exposure postnatally. Three intrauterine deaths occurred at 24, 29 and 34 weeks. Two of these had congenital defects, and the other severe intrauterine growth restriction. No maternal deaths occurred. Successful pregnancy outcomes can be achieved in SCD. There has been an improvement in fetal and maternal morbidity and mortality compared with historical data. Pregnancy in women with SCD remains high risk. Early access to antenatal care and to expertise in SCD is essential. A matched control population from the same time period and prospective data collection is needed to address confounders such as ethnicity and deprivation.
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Affiliation(s)
- A R Chase
- Women's Health Department, Guy's and St Thomas' Hospital NHS Foundation Trust
| | - M Sohal
- Department of Haematology, Imperial College Healthcare NHS Trust
| | - J Howard
- Department of Haematology, Guy's and St Thomas' Hospital NHS Foundation Trust (GSTFT)
| | - R Laher
- King's College London School of Medicine
| | - A McCarthy
- Department of Obstetrics, Queen Charlotte's and Chelsea Hospital (QCCH) , London , UK
| | - D M Layton
- Department of Haematology, Imperial College Healthcare NHS Trust
| | - E Oteng-Ntim
- Women's Health Department, Guy's and St Thomas' Hospital NHS Foundation Trust
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Sohal M, Strike PC. Multiple complications of aortic valve endocarditis diagnosed from the ECG. Heart 2006; 92:678. [PMID: 16614282 PMCID: PMC1860914 DOI: 10.1136/hrt.2005.073916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Murphy DA, Roy DL, Sohal M, Chandler BM. Anomalous origin of left main cononary artery from anterior sinus of Valsalva with myocardial infarction. J Thorac Cardiovasc Surg 1978; 75:282-5. [PMID: 625134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The origin of the left main coronary artery, or its branches, from the right or anterior sinus of Valsalva is a recognized congenital anomaly. The origin of the entire left main coronary artery from a separate ostium in the right sinus of Valsalva and its course to the right and behind the ascending aorta, in a living patient without associated congenital heart disease, has not been described. This anomaly was recognized as the cause of an anterior myocardial infarction in a 12-year-old girl, and it is the subject of this case report.
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Murphy D, Roy D, Sohal M, Chandler B. Anomalous origin of left main coronary artery from anterior sinus of Valsalva with myocardial infarction. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41300-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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