1
|
Tchou P, Nemer D, Saliba W, Varma N, Aziz P, Patel A, Nakagawa H, Kanj M, Hussein A, Bhargava M, Wazni O. Junctional Tachycardia. JACC Clin Electrophysiol 2023; 9:425-441. [PMID: 36990601 DOI: 10.1016/j.jacep.2022.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 02/24/2023]
Abstract
Junctional tachycardia (JT) is typically considered to have an automatic mechanism originating from the distal atrioventricular node. When there is 1:1 retrograde conduction via the fast pathway, JT would resemble the typical form of atrioventricular nodal re-entrant tachycardia (AVNRT). Atrial pacing maneuvers have been proposed to exclude AVNRT and suggest a diagnosis of JT. However, after excluding AVNRT, one should consider the possibility of an infra-atrial narrow QRS re-entrant tachycardia, which can exhibit features that resemble AVNRT as well as JT. Pacing maneuvers and mapping techniques should be performed to assess for infra-atrial re-entrant tachycardia before concluding that JT is the mechanism of a narrow QRS tachycardia. Distinguishing JT from typical AVNRT or infra-atrial re-entrant tachycardia has notable implications regarding the approach to ablation of the tachycardia. Ultimately, a contemporary review of the evidence on JT raises some questions as to the mechanism and source of what has traditionally been considered JT.
Collapse
|
2
|
Gupta S, Karamlou T, Salim Hammoud M, Ghobrial J, Aziz P, Najm HK. Concomitant Mitral Valve Re-Repair for Mixed Congenital and Degenerative Mitral Disease, Tricuspid Repair, and Cox-Maze Procedure in a College Athlete. World J Pediatr Congenit Heart Surg 2023; 14:77-80. [PMID: 35770311 DOI: 10.1177/21501351221102891] [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: 11/17/2022]
Abstract
A significant proportion of patients undergoing repair of congenital mitral valve disease will require a subsequent reoperation. During somatic growth, mitral valve repair is preferable to replacement as it allows for annular growth, preservation of ventricular function, and avoidance of lifelong anticoagulation. Techniques to facilitate successful re-repairs for congenital and non-rheumatic mixed degenerative mitral valve disease are not well-described in the literature. Description of the encountered pathology and surgical maneuvers utilized in this case provides real-world tools to help surgeons deal with limited orifice availability, fibrosis, and multilevel lesions. We describe a mitral valve re-repair in a young athlete for a rare cleft posterior mitral leaflet, with a simultaneous tricuspid valve repair and Cox-Maze procedure. We focus on technical pearls that address specific anatomic challenges within our surgical approach.
Collapse
Affiliation(s)
- Sohini Gupta
- 2546Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Tara Karamlou
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Miza Salim Hammoud
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanna Ghobrial
- Department of Pediatric Cardiology, 2569Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Peter Aziz
- Department of Pediatric Cardiology, 2569Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hani K Najm
- Department of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
3
|
Aziz P, Scheib S, Tarsi E. Teaching the pelvic organ prolapse quantification (POPQ) exam for resident education utilizing a low fidelity popq model. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
4
|
Lynch A, Ahuja S, Miron A, Nakano S, Howard T, Villa C, Armstrong K, Kaufman B, Gardin L, Whitehill R, Parent J, Godown J, Henderson H, Aziz P, Colan S, Seshadri B, Kantor P, Russell M, Lal A, Butts R, Richmond M, Conway J, Weintraub R, Rossano J, Mital S. Sudden Cardiac Death and ICD Use in Rasopathy-Associated Hypertrophic Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1821] [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: 11/30/2022] Open
|
5
|
Alashi A, Svensson L, Klein J, Zahka K, Smedira NG, Najm H, Lever HM, Aziz P, Desai MY. Characteristics and Longer-Term Outcomes of Contemporary Patients <18 Years of Age With Hypertrophic Cardiomyopathy. Am J Cardiol 2021; 140:110-117. [PMID: 33159906 DOI: 10.1016/j.amjcard.2020.10.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
We describe characteristics and outcomes of contemporary pediatric hypertrophic cardiomyopathy (PHC) patients. We studied 398 consecutive pediatric HC patients (<18 years, median 14 years, 65% boys) seen at our center between 2002 and 2018. Baseline clinical and pediatric echocardiographic data was collected. Left ventricular outflow tract gradient (LVOTG), LV fractional shortening and Z-score for left ventricular (LV) wall thickness were calculated. Sudden cardiac death (SCD), appropriate internal defibrillator discharge (ICD), myectomy, and orthotopic heart transplant (OHT) were composite primary endpoint. A total of 133 (33%) had symptoms (71 [18%] dyspnea, 77 [19%] angina, and 19 [5%] syncope), 109 (27%) were on beta-blockers; 179 (45%) had family history of HC. A total of 146 (37%) underwent genetic testing (of which 91 (62%) were HC-gene positive). Basal septal LV thickness, septal LV z-score and fractional shortening were 1.2 ± 0.6 cm, 4.8 ± 5.6, and 42% ± 8, whereas 23% had extreme LV hypertrophy (z-score > 6) and 8% had LVOTG >30 mm Hg (range 0 to 139 mm Hg). At a median of 5.9 years (interquartile range 2.4, 9), there were 23 (6%) ICD's placed, and 47 (12%) primary composite events (9 [2%] deaths, 3 [1%] appropriate ICD discharge, 29 [7%] myectomy, and 8 [2%] OHT). There were no in hospital deaths following myectomy/OHT. Presence of symptoms (Hazard ratio or HR 2.45), ventricular tachycardia (HR 1.52), and higher basal septal LV z-score (HR 1.10) were independently associated with primary composite outcomes. LV septal z-score >4 was independently associated with events on spline analysis. Rate of SCD/appropriate ICD discharge was 0.5%/year. In conclusion, contemporary PHC patients seen at an experienced center have excellent outcomes with presence of symptoms and higher LV septal thickness associated with primary composite events.
Collapse
|
6
|
Klein J, Alashi A, Svensson LM, Komarlu R, Saarel E, Aziz P, Najm H, Lever H, Zahka K, Desai MY. CLINICAL AND ECHOCARDIOGRAPHIC PARAMETERS IN PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: RELATIONSHIP TO LV GLOBAL LONGITUDINAL STRAIN. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
7
|
Hu P, Aziz P. A DEADLY CASE OF THE JITTERS: CATECHOLAMINERGIC POLYMORPHIC VENTRICULAR TACHYCARDIA AND THE ROLE OF LEFT CARDIAC SYMPATHETIC DENERVATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33411-4] [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: 11/16/2022]
|
8
|
Alashi A, Svensson L, Klein J, Zahka K, Smedira N, Najm H, Stewart R, Lever H, Aziz P, Saarel E, Desai M. CHARACTERISTICS AND LONGER-TERM OUTCOMES OF PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A TERTIARY CARE CENTER EXPERIENCE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
9
|
Lambert C, Anjewierden S, Majdalany D, Saarel E, Aziz P. CARDIAC RESYNCHRONIZATION THERAPY VIA A TRANSVENOUS APPROACH IN ADULT CONGENITAL HEART DISEASE PATIENTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30998-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
10
|
Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El-Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm 2017; 14:e55-e96. [DOI: 10.1016/j.hrthm.2017.03.038] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 12/18/2022]
|
11
|
Steinberg JS, Varma N, Cygankiewicz I, Aziz P, Balsam P, Baranchuk A, Cantillon DJ, Dilaveris P, Dubner SJ, El‐Sherif N, Krol J, Kurpesa M, La Rovere MT, Lobodzinski SS, Locati ET, Mittal S, Olshansky B, Piotrowicz E, Saxon L, Stone PH, Tereshchenko L, Turitto G, Wimmer NJ, Verrier RL, Zareba W, Piotrowicz R. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Ann Noninvasive Electrocardiol 2017; 22:e12447. [PMID: 28480632 PMCID: PMC6931745 DOI: 10.1111/anec.12447] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023] Open
Abstract
Ambulatory ECG (AECG) is very commonly employed in a variety of clinical contexts to detect cardiac arrhythmias and/or arrhythmia patterns which are not readily obtained from the standard ECG. Accurate and timely characterization of arrhythmias is crucial to direct therapies that can have an important impact on diagnosis, prognosis or patient symptom status. The rhythm information derived from the large variety of AECG recording systems can often lead to appropriate and patient-specific medical and interventional management. The details in this document provide background and framework from which to apply AECG techniques in clinical practice, as well as clinical research.
Collapse
Affiliation(s)
- Jonathan S. Steinberg
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
- The Summit Medical GroupShort HillsNJUSA
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | | | - Peter Aziz
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Paweł Balsam
- 1st Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Daniel J. Cantillon
- Cardiac Pacing & ElectrophysiologyDepartment of Cardiovascular MedicineCleveland ClinicClevelandOHUSA
| | - Polychronis Dilaveris
- 1st Department of CardiologyUniversity of Athens Medical SchoolHippokration HospitalAthensGreece
| | - Sergio J. Dubner
- Arrhythmias and Electrophysiology ServiceClinic and Maternity Suizo Argentina and De Los Arcos Private HospitalBuenos AiresArgentina
| | | | - Jaroslaw Krol
- Department of Cardiology, Hypertension and Internal Medicine2nd Medical Faculty Medical University of WarsawWarsawPoland
| | - Malgorzata Kurpesa
- Department of CardiologyMedical University of LodzBieganski HospitalLodzPoland
| | | | | | - Emanuela T. Locati
- Cardiovascular DepartmentCardiology, ElectrophysiologyOspedale NiguardaMilanoItaly
| | | | | | - Ewa Piotrowicz
- Telecardiology CenterInstitute of CardiologyWarsawPoland
| | - Leslie Saxon
- University of Southern CaliforniaLos AngelesCAUSA
| | - Peter H. Stone
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Larisa Tereshchenko
- Knight Cardiovascular InstituteOregon Health & Science UniversityPortlandORUSA
- Cardiovascular DivisionJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Gioia Turitto
- Weill Cornell Medical CollegeElectrophysiology ServicesNew York Methodist HospitalBrooklynNYUSA
| | - Neil J. Wimmer
- Vascular Profiling Research GroupCardiovascular DivisionHarvard Medical SchoolBrigham & Women's HospitalBostonMAUSA
| | - Richard L. Verrier
- Division of Cardiovascular MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard‐Thorndike Electrophysiology InstituteBostonMAUSA
| | - Wojciech Zareba
- Heart Research Follow‐up ProgramUniversity of Rochester School of Medicine & DentistryRochesterNYUSA
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive ElectrocardiologyNational Institute of CardiologyWarsawPoland
| |
Collapse
|
12
|
D'Souza R, Thomas E, Macicek S, Aziz P, Shivapour JK, Snyder C. P- and R-wave Amplitude Sensed by Reveal LINQ™ Loop Recorder in Pediatric Patients. J Innov Card Rhythm Manag 2017; 8:2584-2588. [PMID: 32477753 PMCID: PMC7252757 DOI: 10.19102/icrm.2017.080102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/30/2017] [Indexed: 11/29/2022] Open
Abstract
Implantable loop recorders are commonly used to sense arrhythmias. The purpose of this study is to assess the P- and R-wave amplitudes at implantation (I) and follow-up (F) following insertion of the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) in an institutional review board-approved, multicenter study performed on pediatric patients younger than 18 years old. Collected data included demographics, presence of congenital heart disease (CHD), P- and R-wave-sensed amplitude at I and F, and the method of implant (i.e. mapping or standard.) P waves were manually measured and R-wave sensing was recorded by the device. A total of 87 patients had a Reveal LINQ™ (Medtronic, Minneapolis, MN) device implanted; the mean patient age was 11.8 years (0.5 years to 18 years) with 48% of patients being female and 19% of patients having CHD; mapping was used in 43% of patients. The Reveal LINQ™ (Medtronic, Minneapolis, MN) experienced no change in average sensed R-wave amplitude at either I or F (1.28 mV vs 1.26 mV, p = NS). There was no difference in sensed R-wave amplitude noted with or without mapping used at I (1.29 mV vs 1.26 mV, p = NS) or F (1.48 mV vs 1.18 mV, p = NS). Additionally, no difference could be found in R-wave sensing of patients with CHD or without CHD at I (1.26 mV vs 1.4 mV, p = NS) or F (1.32 mV vs 1.32 mV, p = NS). R-wave sensing trended towards being inversely proportional to patient body surface area (BSA) (p = NS). P waves were detected on 48% of tracings in all patients at I and/or F, irrespective of whether the Reveal LINQ™ (Medtronic, Minneapolis, MN) device was placed with mapping. The R wave was (0.37–3.5 mV) at I and (0.3–3 mV) (p = NS) at F when P waves were detected. From these results, it can be said that the Reveal LINQ™ Insertable Cardiac Monitor (Medtronic, Minneapolis, MN) has an excellent ability to sense R-wave amplitude in pediatric patients. No significant difference in the sensing ability of the device could be identified with respect to the presence of CHD, use of mapping or BSA. P waves tended to be identified when there was a higher baseline R-wave amplitude.
Collapse
Affiliation(s)
- Roshan D'Souza
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Peter Aziz
- Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Jill K Shivapour
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher Snyder
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| |
Collapse
|
13
|
Affiliation(s)
- Philip Aagaard
- From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH
| | - Bryan Baranowski
- From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH
| | - Peter Aziz
- From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH
| | - Dermot Phelan
- From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH
| |
Collapse
|
14
|
Key Words
- AV, atrioventricular
- AVNERP, atrioventricular node effective refractory period
- Ablation
- CHD, congenital heart disease
- CL, cycle length
- Congenital heart disease
- ECG, electrocardiogram
- EPS, electrophysiology study
- ERP, effective refractory period
- FV, fasciculoventricular
- FV-ERP, fasciculoventricular effective refractory period
- Pediatrics
- Preexcitation
- RV, right ventricular
- SVT, supraventricular tachycardia
- VA, ventriculoatrial
- VSD, ventricular septal defect
- WPW, Wolff-Parkinson-White syndrome
Collapse
Affiliation(s)
- Philip M Chang
- Keck School of Medicine of University of Southern California (USC), Keck Medical Center of USC, Los Angeles, California
| | - Akash R Patel
- University of California San Francisco (UCSF) School of Medicine, UCSF Benioff Children's Hospital, San Francisco, California
| | - Peter Aziz
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Children's Center for Pediatric and Adult Congenital Heart Disease, Cleveland, Ohio
| | - Maully J Shah
- University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
15
|
El-Assaad I, Al-Kindi S, Oliveira G, Wilkoff B, Boyle G, Aziz P. PACEMAKER IMPLANTATION IN PEDIATRIC HEART TRANSPLANT RECIPIENTS IS PREDICTED BY BIATRIAL ANASTOMOSIS AND DONOR AGE BUT DOES NOT AFFECT SURVIVAL. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|