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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. The impact of supraventricular arrhythmias on the outcomes of guideline-compliant implantable cardioverter defibrillator programming. J Cardiovasc Electrophysiol 2024; 35:794-801. [PMID: 38384108 DOI: 10.1111/jce.16216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/03/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients who underwent ICD insertion for primary prevention were classified into four groups based on SVA status and ICD programming: (1) guideline-concordant group (GC) with SVA, (2) GC without SVA, (3) nonguideline concordant group (NGC) with SVA, and (4) NGC without SVA. Cox proportional hazard models were analyzed for freedom from ICD therapies, shock, and mortality. RESULTS Seven hundred and seventy-two patients (median age, 64 years) were enrolled. ICD therapies were the most frequent in NGC with SVA (24.0%), followed by NGC without SVA (19.9%), GC without SVA (11.6%), and GC with SVA (8.1%). Guideline concordant programming was associated with 68% ICD therapy reduction (HR 0.32, p = .007) and 67% ICD shock reduction (HR 0.33, p = .030) in SVA patients and 44% ICD therapy reduction in those without SVA (HR 0.56, p = .030). CONCLUSION Programming ICDs in primary prevention patients based on current guidelines reduces therapy burden without increasing mortality in both SVA and non-SVA patients. A greater magnitude of reduced ICD therapy was found in those with supraventricular arrhythmias.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Teetouch Ananwattanasuk
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Muazzum Shah
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | - Waseem Barham
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Hakan Oral
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ranjan K Thakur
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Krit Jongnarangsin
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Kim AG, Park C, Tokavanich N, Sabanci R, Freel R, Hayes V, Thakur RK. Meteorological Influence on Atrial Fibrillation and Flutter: A Nationwide Observational Study in South Korea (2010-2022). Cureus 2023; 15:e46867. [PMID: 37954814 PMCID: PMC10638101 DOI: 10.7759/cureus.46867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality.
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Affiliation(s)
- Andrew G Kim
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Chanjoo Park
- General Practice, Catholic Kwandong University, Gangneung, KOR
| | - Nithi Tokavanich
- Cardiac Electrophysiology, University of Michigan, Ann Arbor, USA
| | - Rand Sabanci
- Internal Medicine, Michigan State University, East Lansing, USA
| | - Rebeccah Freel
- Cardiac Electrophysiology, Sparrow Hospital, Lansing, USA
| | - Victoria Hayes
- Cardiac Electrophysiology, Sparrow Hospital, Lansing, USA
| | - Ranjan K Thakur
- Cardiac Electrophysiology, Michigan State University, East Lansing, USA
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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines. J Interv Card Electrophysiol 2023; 66:1359-1366. [PMID: 36422768 DOI: 10.1007/s10840-022-01431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality. RESULTS A total of 488 patients were included (mean age, 66 ± 13 years). During a mean follow-up of 1.9 ± 0.9 years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42-0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34-1.52) or mortality (aHR 1.19, 95% CI, 0.47-3.05). CONCLUSIONS Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ronpichai Chokesuwattanaskul
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Cardiac Center, Bangkok, Thailand
| | - Muazzum Shah
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Waseem Barham
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjan K Thakur
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, 1800 N Capitol Ave, Room E300B, Indianapolis, IN, 46202, USA.
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Thakur RK, Natale A. Advances in Physiologic Pacing. Card Electrophysiol Clin 2022; 14:xiii-xiv. [PMID: 35715091 DOI: 10.1016/j.ccep.2022.04.001] [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: 10/18/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Cardiac Conduction System Disorders. Card Electrophysiol Clin 2021; 13:xiii. [PMID: 34689902 DOI: 10.1016/j.ccep.2021.07.007] [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: 10/20/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Device-Based Arrhythmia Monitoring. Card Electrophysiol Clin 2021; 13:xiii. [PMID: 34330382 DOI: 10.1016/j.ccep.2021.06.002] [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: 11/28/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Intracardiac Echocardiography. Card Electrophysiol Clin 2021; 13:xiii. [PMID: 33990281 DOI: 10.1016/j.ccep.2021.04.001] [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: 11/28/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Preexcitation Syndrome. Card Electrophysiol Clin 2020; 12:xiii. [PMID: 33162006 DOI: 10.1016/j.ccep.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Epicardial Interventions in Electrophysiology. Card Electrophysiol Clin 2020; 12:xiii. [PMID: 32771196 DOI: 10.1016/j.ccep.2020.06.002] [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: 10/24/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Ananwattanasuk T, Tanawuttiwat T, Chokesuwattanaskul R, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K. Programming implantable cardioverter–defibrillator in primary prevention: Guideline concordance and outcomes. Heart Rhythm 2020; 17:1101-1106. [DOI: 10.1016/j.hrthm.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/01/2020] [Indexed: 01/19/2023]
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12
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Thakur RK. Advances in Atrial Fibrillation Ablation. Card Electrophysiol Clin 2020; 12:xiii. [PMID: 32451110 DOI: 10.1016/j.ccep.2020.04.001] [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: 10/24/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue; Suite 400, Lansing, MI 48912, USA.
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13
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Thakur RK, Natale A. Left Atrial Appendage Occlusion. Card Electrophysiol Clin 2020; 12:xiii. [PMID: 32067653 DOI: 10.1016/j.ccep.2019.12.002] [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: 11/25/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Kushwaha RK, Srivastava S, Thakur RK, Anand R. Early Versus Delayed Initiation of Renal Replacement Therapy in Septic Shock Patients with Acute Kidney Injury. J Assoc Physicians India 2020; 68:87. [PMID: 31979824] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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15
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Modak R, Srivastava SL, Thakur RK, Anand R. Association of serum bicarbonate level in predicting short term mortality in patients presenting with shock. J Assoc Physicians India 2020; 68:87. [PMID: 31979828] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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16
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Bhuyan SK, Srivastava S, Thakur RK, Anand R, Krishna V. Prevalence of Iron Deficiency in Heart Failure Patients with Reduced Ejection Fraction. J Assoc Physicians India 2020; 68:57. [PMID: 31979617] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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17
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Thakur RK, Natale A. Mapping the Heart. Card Electrophysiol Clin 2019; 11:xiii. [PMID: 31706481 DOI: 10.1016/j.ccep.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Mapping the Heart. Card Electrophysiol Clin 2019; 11:xv. [PMID: 31400879 DOI: 10.1016/j.ccep.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Electrocardiographic Trilogy. Card Electrophysiol Clin 2019; 11:xiii. [PMID: 31084859 DOI: 10.1016/j.ccep.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Cardiac Resynchronization Therapy. Card Electrophysiol Clin 2019; 11:xiii. [PMID: 30717858 DOI: 10.1016/j.ccep.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. His Bundle Pacing: A 100-Year Journey. Card Electrophysiol Clin 2018; 10:xiii-xiv. [PMID: 30172293 DOI: 10.1016/j.ccep.2018.07.003] [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: 06/08/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Remembering Luigi Padeletti. Card Electrophysiol Clin 2018; 10:xiii. [PMID: 29784493 DOI: 10.1016/j.ccep.2018.03.002] [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: 06/08/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1440 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Barham W, Zeayter SA, Safadi A, Thakur RK. Amiodarone-induced Hyponatremia: A Case Report and a Review of the Literature. J Innov Card Rhythm Manag 2018; 9:3071-3076. [PMID: 32477802 PMCID: PMC7252766 DOI: 10.19102/icrm.2018.090303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022] Open
Abstract
Amiodarone is a widely used medication for controlling various types of cardiac arrhythmias. Nonetheless, it carries several known adverse effects that may preclude its use or necessitate discontinuation. Hyponatremia resulting from amiodarone is rarely reported, and its incidence is unknown. We present a case of severe hyponatremia secondary to amiodarone therapy and a review of the literature.
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Affiliation(s)
- Waseem Barham
- Department of Cardiology, Michigan State University, Lansing, MI, USA
| | - Samer A Zeayter
- Department of Nephrology, Michigan State University, Lansing, MI, USA
| | | | - Ranjan K Thakur
- Department of Cardiology, Michigan State University, Lansing, MI, USA
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Thakur RK, Natale A. Cardiac Implantable Electronic Devices. Card Electrophysiol Clin 2018; 10:xiii. [PMID: 29428147 DOI: 10.1016/j.ccep.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, 1400 East Michigan Avenue, Suite 400, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Sudden Cardiac Death: Back to the Future. Card Electrophysiol Clin 2017; 9:xv. [PMID: 29173419 DOI: 10.1016/j.ccep.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. On the Shoulder of Giants. Card Electrophysiol Clin 2017; 9:ix. [PMID: 28838553 DOI: 10.1016/j.ccep.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at, St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Foreword. Card Electrophysiol Clin 2017; 9:xiii. [PMID: 28457247 DOI: 10.1016/j.ccep.2017.04.002] [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: 10/19/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Abstract
Heart failure (HF) consumes a large proportion of the total national health care budget. Incidence and prevalence of HF are increasing and may give rise to an unsustainable increase in health care spending. Hospitalizations account for the vast majority of HF-related expenses, and 20% to 25% of patients discharged with a diagnosis of HF are readmitted within 60 days. Thus, efforts to reduce HF readmissions are a reasonable target for reducing overall expenses. It is to be seen if targeting readmission rates will lead to significant cost savings, and more importantly, to improved patient outcomes.
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Affiliation(s)
| | - Vini Singh
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA
| | - Vaibhav Satija
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA
| | - Ranjan K Thakur
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA.
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Thakur RK, Natale A. Ventricular Tachycardia Ablation. Card Electrophysiol Clin 2017; 9:xiii. [PMID: 28167091 DOI: 10.1016/j.ccep.2016.12.002] [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: 10/20/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at, St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, at St. David's Medical Center, 3000 North I-35, Suite 720, Austin, TX 78705, USA.
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Thakur RK, Natale A. A Matter of Definition. Card Electrophysiol Clin 2016; 8:xiii. [PMID: 27521097 DOI: 10.1016/j.ccep.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. The K(+) Channel: One Channel, Many Arrhythmias! Card Electrophysiol Clin 2016; 8:xiii. [PMID: 27261838 DOI: 10.1016/j.ccep.2016.03.002] [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: 10/21/2022]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at, St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Abstract
Heart failure (HF) consumes a large proportion of the total national health care budget. Incidence and prevalence of HF are increasing and may give rise to an unsustainable increase in health care spending. Hospitalizations account for the vast majority of HF-related expenses, and 20% to 25% of patients discharged with a diagnosis of HF are readmitted within 60 days. Thus, efforts to reduce HF readmissions are a reasonable target for reducing overall expenses. It is to be seen if targeting readmission rates will lead to significant cost savings, and more importantly, to improved patient outcomes.
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Affiliation(s)
| | - Vini Singh
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA
| | - Vaibhav Satija
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA
| | - Ranjan K Thakur
- Thoracic and Cardiovascular Institute, Michigan State University, Lansing, MI, USA.
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34
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Thakur RK, Natale A. Cardiac Resysnchronization Therapy: State of the Art. Card Electrophysiol Clin 2015; 7:xv-xvi. [PMID: 26596823 DOI: 10.1016/j.ccep.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 585, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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35
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Thakur RK, Natale A. Controversies in electrophysiology. Card Electrophysiol Clin 2015; 7:xiii. [PMID: 26304535 DOI: 10.1016/j.ccep.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Thakur RK, Natale A. Arrhythmias in cardiomyopathies. Foreword. Card Electrophysiol Clin 2015; 7:xiii. [PMID: 26002400 DOI: 10.1016/j.ccep.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Opreanu M, Wan C, Singh V, Salehi N, Ahmad J, Szymkiewicz SJ, Thakur RK. Wearable cardioverter-defibrillator as a bridge to cardiac transplantation: A national database analysis. J Heart Lung Transplant 2015; 34:1305-9. [PMID: 26094085 DOI: 10.1016/j.healun.2015.04.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 02/27/2015] [Accepted: 04/11/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD) are common in patients awaiting heart transplantation (HT), and the implantable cardioverter-defibrillator (ICD) is often used for primary prevention in this setting. Use of ICDs in these patients is not without risks and is sometimes contraindicated. The wearable cardioverter-defibrillator (WCD) may be a reasonable alternative to bridge the period of risk leading up to HT. METHODS We obtained a convenience sample of patients prescribed an WCD as a bridge therapy to HT. The available data consisted of demographics, cardiac transplantation status, associated comorbidities, device use, device-stored electrocardiogram (ECG) and reason for discontinuing the WCD. Statistical analyses were performed using SPSS version 17 and GraphPad PRISM 5. RESULTS The registry included 121 patients consisting of 83 (69%) men and 38 (31%) women. The mean age was 44 ± 18 years. Mean ejection fraction was 25 ± 15%. Non-ischemic cardiomyopathy (CMP) was the underlying diagnosis in 67 (55%) patients, whereas 21 (17%) patients had ischemic CMP and 33 (27%) had a mixed or uncharacterized CMP. New York Heart Association Class III heart failure was present in 32% and 34% were in Class IV. Eighty-eight patients (73%) were being evaluated for HT or were on an HT waiting list, and 33 patients (27%) had had a prior HT, experienced rejection, and were awaiting re-transplantation. The patients wore the WCD for an average of 127 ± 392 days (median 39 days) with average daily use of 17 ± 7 hours (median 20 hours). Seven patients (6%) received appropriate WCD shocks. Fifty-one patients (42%) ended use after ICD implantation and 13 patients (11%) after HT. There were 11 deaths (9%). CONCLUSIONS A significant proportion of patients on the HT waiting list will have VA. WCD use in our study showed high compliance and efficacy and a low complication rate, suggesting that the WCD is a reasonable bridge therapy for preventing SCD in patients awaiting HT.
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Affiliation(s)
- Madalina Opreanu
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | | | - Vini Singh
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | - Negar Salehi
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | - Jaffri Ahmad
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan
| | | | - Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan.
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Asirvatham SJ, Thakur RK, Natale A. Stroke in Atrial Fibrillation. Card Electrophysiol Clin 2014; 6:xiii-xiv. [PMID: 27063836 DOI: 10.1016/j.ccep.2013.12.001] [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: 06/05/2023]
Affiliation(s)
- Samuel J Asirvatham
- Department of Internal Medicine and Pediatric Cardiology, St. Mary's Hospital, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Ranjan K Thakur
- Thoracic and Cardiovascular Institute, Sparrow Health System, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA.
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation, St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
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Sharma AB, Lule EB, Razak A, Hussain SI, Sharma S, Deeprasertkul P, Thakur RK. Neurointerventional Therapies for Stroke in Atrial Fibrillation: Illustrated Cases. Card Electrophysiol Clin 2014; 6:169-180. [PMID: 27063831 DOI: 10.1016/j.ccep.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Approximately 800,000 strokes occur in the United States every year, resulting in 200,000 deaths. Strokes may be ischemic (80%) or hemorrhagic (20%). Strokes caused by atrial fibrillation (AF) are thromboembolic, and AF is the leading cause of ischemic stroke. Rapid distinction between these forms of strokes is critical because approaches to treatment are different. The goal for acute ischemic stroke is reperfusion of ischemic brain tissue, whereas the treatment of hemorrhagic stroke is supportive therapy and correction of the underlying conditions. The treatment of acute ischemic strokes is similar to treatment of acute myocardial infarction, which requires timely reperfusion for optimal results.
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Affiliation(s)
- Amit B Sharma
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Enoch B Lule
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Anmar Razak
- Department of Neurology and Ophthalmology, Michigan State University, Lansing, MI, USA
| | - Syed I Hussain
- Department of Neurology and Ophthalmology, Michigan State University, Lansing, MI, USA
| | - Shalini Sharma
- Department of Radiology, Michigan State University, Lansing, MI, USA
| | - Peerawut Deeprasertkul
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA
| | - Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Lansing, MI 48912, USA.
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Thakur RK, Jindal R, Singh UB, Ahluwalia AS. Plankton diversity and water quality assessment of three freshwater lakes of Mandi (Himachal Pradesh, India) with special reference to planktonic indicators. Environ Monit Assess 2013; 185:8355-8373. [PMID: 23649473 DOI: 10.1007/s10661-013-3178-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 03/26/2013] [Indexed: 06/02/2023]
Abstract
The present study deals with the limnobiotic status of three selected lakes of Himachal Pradesh using physicochemical and biological parameters (especially phytoplankton and zooplankton) over a period of 2 years. One hundred forty-eight species belonging to nine groups of phytoplankton and 79 species belonging to five groups of zooplankton were identified from the lakes. Trophic level and the pollution status of the lakes were assessed upon the basis of Shannon diversity index (H'), species richness index (S), and physicochemical parameters. Plankton population size was correlated with biotic and abiotic parameters (pH, alkalinity, temperature, dissolved oxygen, transparency, phosphate, chloride, and nitrate). The present investigation revealed that the distribution of plankton species depended upon the physicochemical parameters of the environment. Based on water quality standards given by the Central Pollution Control Board, the water quality was between "A-B" at Prashar wetland, "C-D" at Kuntbhyog Lake, and "D-E" at Rewalsar Lake. The results from the present study indicated that the potential of planktons as bioindicators of trophic status is very high.
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Affiliation(s)
- R K Thakur
- Department of Zoology, Panjab University, Chandigarh, 160014, India.
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Thakur RK, Natale A. "On the Front Lines" Contemporary Debates and Controversies-II. Card Electrophysiol Clin 2012; 4:xiii-xiv. [PMID: 26939966 DOI: 10.1016/j.ccep.2012.06.010] [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: 06/05/2023]
Affiliation(s)
- Ranjan K Thakur
- Sparrow Thoracic and Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
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Thakur RK, Natale A. Beyond the Shore of Ignorance. Card Electrophysiol Clin 2012; 4:xiii-xiv. [PMID: 26939824 DOI: 10.1016/j.ccep.2012.03.003] [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: 06/05/2023]
Affiliation(s)
- Ranjan K Thakur
- Arrhythmia Service, E.W. Sparrow Thoracic and, Cardiovascular Institute, Michigan State University, 1200 East Michigan Avenue, Suite 580, Lansing, MI 48912, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St. David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
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Abstract
Sinus arrest rarely occurs during acute myocardial infarction involving the right coronary artery (RCA) and sinus node (SN) artery. We report a rare case of sinus arrest caused by SN artery occlusion following RCA stenting. A 56-year-old woman with a significant history of RCA stenosis with prior bare metal stenting, presented to the emergency department with anginal chest pain. Initial work up showed significant elevation of cardiac troponin T with T-wave inversion in the inferior leads on electrocardiogram (ECG). Coronary angiography revealed a 90% stenosis of midportion of the RCA, mild occlusion in the left anterior descending coronary and left circumflex coronary arteries. Stenting was performed on the RCA lesion. Immediately after undergoing those interventions, thrombosis developed and occluded SN artery. Electrocardiogram showed junctional escape rhythm without P waves at a heart rate of 30 beats per minute, suggesting sinus arrest. The clot in the SN artery was identified and thrombectomy was performed. Neither symptoms nor hypotension were identified during this arrhythmia. Six days later, normal sinus rhythm began to appear on EKG with improving heart rate, and patient still remained completely hemodynamically stable. Pre-discharge exercise stress test had shown 50% predicted heart rate without ST segment change. Sinus node dysfunction is commonly related to degenerative processes, and rarely caused by thrombosis in the SN artery. In our case, we emphasize the potential complication of sinus arrest after RCA stent implantation.
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Prasertwitayakij N, Vodnala D, Pridjian AK, Thakur RK. Esophageal injury after atrial fibrillation ablation with an epicardial high-intensity focused ultrasound device. J Interv Card Electrophysiol 2011; 31:243-5. [DOI: 10.1007/s10840-011-9572-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
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Thakur RK, Natale A. Foreword From Genes to the Bedside. Card Electrophysiol Clin 2010; 2:xiii. [PMID: 28770725 DOI: 10.1016/j.ccep.2010.10.002] [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: 06/07/2023]
Affiliation(s)
- Ranjan K Thakur
- Thoracic and Cardiovascular Institute, 405 West Greenlawn, Suite 400, Lansing, MI 48910, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
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Thakur RK, Natale A. Foreword Contemporary Issues in Antiarrhythmic Drug Therapy. Card Electrophysiol Clin 2010; 2:xi. [PMID: 28770806 DOI: 10.1016/j.ccep.2010.08.001] [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: 06/07/2023]
Affiliation(s)
- Ranjan K Thakur
- Thoracic and Cardiovascular Institute, Sparrow Health System, Michigan State University, 405 West Greenlawn, Suite 400, Lansing, MI 48910, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
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Hiremath S, Punnam SR, Brar SS, Goyal SK, Gardiner JC, Shah AJ, Thakur RK. Implantable defibrillators improve survival in end-stage renal disease: results from a multi-center registry. Am J Nephrol 2010; 32:305-10. [PMID: 20714135 DOI: 10.1159/000319461] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 07/17/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small retrospective analyses suggest that end-stage renal disease (ESRD) patients do not obtain as much of a survival benefit from an implantable cardioverter-defibrillator (ICD) as non-ESRD patients do. We aimed to assess the survival effect of an ICD in ESRD patients with left ventricular dysfunction. METHODS Data from two registries identified ESRD patients with an ICD and ESRD patients with left ventricular dysfunction (defined as ejection fraction <0.35). Cox proportional hazards regression was performed, including certain predefined covariates to assess the effect of an ICD on survival. RESULTS Overall survival in the full cohort was a median of 4.7 years with 20 deaths in the ICD group and 29 deaths in the no-ICD group. The median survival in the ICD group was 8.0 years and 3.1 years in the no-ICD group. Crude analysis showed a better survival in the ICD group as compared to the no-ICD group (p = 0.016). The multivariable analysis confirmed that the ICD group had significantly less all-cause mortality compared to the no-ICD group (HR: 0.40; 95% CI: 0.19, 0.82; p = 0.013). CONCLUSION An ICD is associated with a higher survival in ESRD patients with left ventricular dysfunction. This result merits further study in a larger cohort of patients.
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Affiliation(s)
- Swapnil Hiremath
- Kidney Research Centre, Ottawa Hospital Research Institute, Ont., Canada.
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48
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Peddi P, Vodnala D, Kalavakunta JK, Thakur RK. Acute chest pain: Acute coronary syndrome versus lead perforation: A case report. Int Arch Med 2010; 3:13. [PMID: 20602800 PMCID: PMC2917397 DOI: 10.1186/1755-7682-3-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 07/06/2010] [Indexed: 11/21/2022] Open
Abstract
Background Diagnosing pacemaker lead perforation in the setting of chest pain and EKG changes is difficult and usually not considered unless we have awareness and high index of suspicion. This kind of clinical scenario represents one of the diagnostic challenges. Case presentation A 77 year-old Caucasian female came to emergency room with left sided non-exertional chest pain radiating to her back for the past two days. A week prior to this presentation, she had a stent supported angioplasty for in-stent re-stenosis and subsequently dual chamber pacemaker implantation for sick sinus syndrome. On physical exam she is very obese, had normal vital signs, peripheral pulses and cardio-respiratory exam. Electrocardiogram revealed new T- wave inversions in inferior and anterior leads. Initial chest X-ray, 2D-Echocardiogram and cardiac enzymes were normal. Acute coronary syndrome was considered as an initial probable diagnosis. She was anticoagulated with heparin and eptifibatide. Patient continued to have chest pain with negative cardiac biomarkers. She developed hypotension, oliguria, elevated white count, pyuria and renal failure. Because of a normal 2D-echocardiogram, cardiac etiology for shock was not suspected. After initial fluid challenge, empiric treatment for septic shock was initiated with antibiotics and vasopressors. Work up for pulmonary embolism and intra-abdominal hemorrhage was negative. Because of persistent chest pain, shock with cold & clammy extremities and elevated central venous pressure cardiogenic shock was considered and a repeat 2D-echocardiogram was done on third day of hospitalization which revealed pericardial effusion. Non-contrast CT-scan chest done to look for lead position confirmed that she had hemorrhagic pericardial effusion along with lead perforation. Patient underwent pericardial window placement along with over-sewing of atrial wall to seal the leakage point. The patient improved and was then discharged from the hospital. Conclusion Lead perforation presenting with chest pain and EKG changes is often not appreciated resulting in significant delay in diagnosis and inappropriate treatment.
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Affiliation(s)
- Prashanth Peddi
- Michigan State University/Sparrow Health System, Lansing, Michigan, 48912, USA.
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49
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Punnam SR, Goyal SK, Kotaru VPK, Pachika AR, Abela GS, Thakur RK. Amiodarone - a 'broad spectrum' antiarrhythmic drug. Cardiovasc Hematol Disord Drug Targets 2010; 10:73-81. [PMID: 20041841 DOI: 10.2174/187152910790780032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/30/2009] [Indexed: 11/22/2022]
Abstract
Amiodarone, an iodinated benzofuran derivative, introduced in 1960's as an anti-anginal agent, emerged as a potent anti-arrhythmic agent by 1970's and is currently one of the most commonly prescribed drugs in US for ventricular and atrial arrhythmias. Although amiodarone is considered a class III anti-arrhythmic agent, it also has class I, II, IV actions, making it a unique and effective anti-arrhythmic agent. Because of its minimal negative inotropic activity and very low rate of pro-arrhythmia, it is considered safe in treating arrhythmias in patients with Coronary Artery Disease and Left ventricular systolic dysfunction. Despite these advantages, long term oral therapy with amiodarone is limited by side effect profile involving various organs like thyroid, lung, heart, liver, skin etc. Though the side effects can be decreased significantly by keeping the maintenance dose at 200 to 300 mg/day, patients on amiodarone should be followed closely. Amiodarone interacts with medications such as Warfarin, Digoxin, Macrolides, Floroquinolones etc., which share Cytochrome P450 metabolic pathway. Hence reducing their doses prior to starting amiodarone is recommended. Amiodarone, a category D drug, is contraindicated in pregnant and breast feeding women. This review discusses the pharmacokinetics of amiodarone, its evolving clinical indications, management of toxicity and drug interactions.
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Affiliation(s)
- Sujeeth R Punnam
- Sparrow Health System, Division of Cardiology, Michigan State University, East Lansing, MI, USA
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Thakur RK, Natale A. Foreword. Card Electrophysiol Clin 2010; 2:xiii. [PMID: 28770741 DOI: 10.1016/j.ccep.2009.11.015] [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: 06/07/2023]
Affiliation(s)
- Ranjan K Thakur
- Thoracic and Cardiovascular Institute, 405 West Greenlawn, Suite 400, Michigan State University, Lansing, MI 48910, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Center for Atrial Fibrillation at St David's Medical Center, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA
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